scholarly journals Analysis of time in range depending on the method of assessing the glucose level

2021 ◽  
pp. 46-55
Author(s):  
L. A. Suplotova ◽  
A. S. Sudnitsyna ◽  
N. V. Romanova ◽  
K. A. Sidorenko ◽  
L. U. Radionova ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Glucose Level ◽  
Glucose Monitoring ◽  
Diabetes Type ◽  
Diabetes Type 1 ◽  
Self Monitoring ◽  
Patients With Diabetes ◽  
Time In Range

Introduction. In recent years, there has been an increase in the prevalence and incidence diabetes type 1. The high-quality glycemic control is critical in reducing the risk of developing and progression of vascular complications and adverse outcomes of diabetes. Self-monitoring blood glucose (SMBG) and professional continuous glucose monitoring (PCGM) provide the data set which must be interpreted using multiple indicators of glycemic control. A number of researchers have demonstrated the relationship between the time in range (TIR) and the risk of developing both micro- and macrovascular complications of diabetes. Considering the insufficient amount of data on TIR differences depending on the glucose level assessment method and the significant potential of using this indicator for the stratification of the risk of both micro- and macrovascular complications of diabetes, the study of TIR differences based on the data of PCGM and SMBG is relevant at present.Aims. To estimate the time range according to professional continuous glucose monitoring and self-monitoring of blood glucose levels in the patients with diabetes type 1 among the adult population to improve the control of the disease course.Materials and methods. An interventional open-label multicenter study in the patients with diabetes type 1 was conducted. The patients with diabetes type 1 aged 18 and older, with the disease duration of more than 1 year receiving the therapy with analog insulin was enrolled into the study. The calculation of the indicators of the time spent in the ranges of glycemia was carried out on the basis of the data of PCGM and SMBG.Results and discussion. We examined 218 patients who met the inclusion criteria and did not have exclusion criteria. The presented differences in the indicators of time in ranges indicate the comparability of the SMBG and PCGM methods.Conclusions. When assessing the indicators of time in the ranges of glycemia obtained on the basis of the data of PCGM and SMBG, clear correlations and linear dependence were demonstrated, which indicates the comparability of these parameters regardless of the measurement method.

Continuous Glucose Monitoring for Glycemic Control in Children and Adolescents Diagnosed with Diabetes Type 1: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Elena Dorando ◽  
Thomas Haak ◽  
Dawid Pieper
Keyword(s):  
Systematic Review ◽  
Glycemic Control ◽  
Children And Adolescents ◽  
Meta Analysis ◽  
Glucose Monitoring ◽  
Diabetes Type ◽  
Diabetes Type 1 ◽  
Meta Analyses

Abstract Aim The aim of this meta-analysis was to evaluate the impact of continuous glucose monitoring (CGM) systems on short- and long-term glycemic control in children and adolescents diagnosed with diabetes type 1. Methods The review was registered in PROSPERO (CRD42019135152). We partly updated a formerly published systematic review and searched several databases (Ovid MEDLINE, Embase, CENTRAL, and Clinicaltrials.gov) in May 2019. Summary measures were estimated as relative risks (RR) and standardized mean differences (SMD). The primary endpoint of our analysis was frequency of hypoglycemic events. Quality of evidence was evaluated using the GRADE approach. Results Eleven studies with a total number of 818 patients were included in our review. Meta-analyses indicated a potential benefit of CGM systems regarding the relative risk of a severe hypoglycemic event (RR 0.78; 95% CI 0.29 to 2.04) and mean level of HbA1c at end of study (SMD -0.23; 95% CI -0.46 to 0.00). Certainty of evidence for effect estimates of these meta-analyses was low due to risk of selection bias and imprecision of the included studies. Qualitative analyses of the secondary outcomes of user satisfaction and long-term development of blood glucose supported these findings. Conclusion CGM systems may improve glycemic control in children and adolescents diagnosed with diabetes type 1, but the imprecision of effects is still a problem. Only a few studies examined and reported data for pediatric populations in sufficient detail. Further research is needed to clarify advantages and disadvantages of CGM systems in children and adolescents.

scholarly journals The Changing Landscape of Glycemic Targets: Focus on Continuous Glucose Monitoring

2020 ◽  
Author(s):  
Pamela R. Kushner ◽  
Davida F. Kruger
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Treatment Decisions ◽  
Diabetes Treatment ◽  
Good Glycemic Control ◽  
Patients With Diabetes ◽  
Time In Range ◽  
Glycemic Targets

Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range,” (typically 70–180 mg/dL) has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.

scholarly journals The Changing Landscape of Glycemic Targets: Focus on Continuous Glucose Monitoring

2020 ◽  
Author(s):  
Pamela R. Kushner ◽  
Davida F. Kruger
Keyword(s):  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Glucose Monitoring ◽  
Treatment Decisions ◽  
Diabetes Treatment ◽  
Good Glycemic Control ◽  
Patients With Diabetes ◽  
Time In Range ◽  
Glycemic Targets

Continuous glucose monitoring (CGM) provides comprehensive assessment of daily glucose measurements for patients with diabetes and can reveal high and low blood glucose values that may occur even when a patient’s A1C is adequately controlled. Among the measures captured by CGM, the percentage of time in the target glycemic range, or “time in range,” (typically 70–180 mg/dL) has emerged as one of the strongest indicators of good glycemic control. This review examines the shift to using CGM to assess glycemic control and guide diabetes treatment decisions, with a focus on time in range as the key metric of glycemic control.

scholarly journals MON-625 Utility of Continuous Glucose Monitoring in Children with Type 1 Diabetes: Is HbA1c Enough?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Lindsey L Owens ◽  
Sweta Chalise ◽  
Neha Vyas ◽  
Shilpa Gurnurkar
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Pediatric Patients ◽  
Glucose Monitoring ◽  
Self Monitoring ◽  
Average Change ◽  
Hba1c Levels

Abstract Introduction: Type 1 diabetes is an autoimmune condition resulting in insulin deficiency that requires daily insulin therapy and self-monitoring of blood glucose. Continuous glucose monitoring (CGM) systems allow for measurement of interstitial fluid glucose levels in a continuous fashion to identify variations and trends that are not feasible with conventional self-monitoring. Hemoglobin A1C (HbA1C) is the method used to assess adequate glycemic control and relates to future risk of developing complications. Current evidence has shown improvement in HbA1C with concomitant use of CGM in adults over 25 years of age with Type 1 diabetes, whereas studies in children and adolescents have failed to show this. However, it is important to note the limitations in HbA1C use as it is a marker of average blood glucose over 3 months but does not reflect glycemic variability. More recent data has suggested that factors such as time in range (TIR), which can be determined with CGM use, are also associated with decrease risk of diabetes complications. Methods: The goal of our study was to analyze the change in HbA1C levels after using a CGM (DEXCOM G4, G5, G6) over a 6-month period in pediatric patients with Type I diabetes. Two HBA1c levels 3 months apart from 92 patients were collected before using a CGM and two while using a CGM. Results were compared by using a dependent samples t-test. IBM SPSS 25.0 was used for data analysis. Results: Preliminary analysis indicates the average change in HBA1C among the patients (N=92) before (-0.08 ± 1.16) and while using the CGM (0.12 ± 1.00) was not significantly different (t (79) = -1.27, p = 0.21). The average change in HBA1C was also not significantly different (p>0.05) among the patients before and while using the CGM for gender (males and females), age groups (0-7 years, 8-14 years, and 15-24 years), and generations of DEXCOM used (G4, G5, and G6). Conclusion: As has been shown in other studies, we did not find a significant change in HbA1c after CGM use for 6 months in our patients. While HbA1C is a reflection of blood sugars over a 3-month period, it does not provide information about glycemic excursions. Metrics derived from CGM use, such as TIR, can provide actionable information which we did not address in our study. There have been reports of the association between TIR and long-term complications of diabetes. Most data comes from studies in adults and pediatric data is lacking. We propose that future studies must look into CGM metrics such as TIR to better define glycemic control in pediatric patients with diabetes mellitus.

scholarly journals Flash glucose monitoring helps achieve better glycemic control than conventional self-monitoring of blood glucose in non-insulin-treated type 2 diabetes: a randomized controlled trial

2020 ◽  
Vol 8 (1) ◽  
pp. e001115 ◽  
Author(s):  
Eri Wada ◽  
Takeshi Onoue ◽  
Tomoko Kobayashi ◽  
Tomoko Handa ◽  
Ayaka Hayase ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glucose Monitoring ◽  
Analysis Of Covariance ◽  
Self Monitoring ◽  
Flash Glucose Monitoring ◽  
Baseline Values ◽  
The Mean

IntroductionThe present study aimed to evaluate the effects of flash glucose monitoring (FGM) and conventional self-monitoring of blood glucose (SMBG) on glycemic control in patients with non-insulin-treated type 2 diabetes.Research design and methodsIn this 24-week, multicenter, open-label, randomized (1:1), parallel-group study, patients with non-insulin-treated type 2 diabetes at five hospitals in Japan were randomly assigned to the FGM (n=49) or SMBG (n=51) groups and were provided each device for 12 weeks. The primary outcome was change in glycated hemoglobin (HbA1c) level, and was compared using analysis of covariance model that included baseline values and group as covariates.ResultsForty-eight participants in the FGM group and 45 in the SMBG group completed the study. The mean HbA1c levels were 7.83% (62.1 mmol/mol) in the FGM group and 7.84% (62.2 mmol/mol) in the SMBG group at baseline, and the values were reduced in both FGM (−0.43% (−4.7 mmol/mol), p<0.001) and SMBG groups (−0.30% (−3.3 mmol/mol), p=0.001) at 12 weeks. On the other hand, HbA1c was significantly decreased from baseline values in the FGM group, but not in the SMBG group at 24 weeks (FGM: −0.46% (−5.0 mmol/mol), p<0.001; SMBG: −0.17% (−1.8 mmol/mol), p=0.124); a significant between-group difference was also observed (difference −0.29% (−3.2 mmol/mol), p=0.022). Diabetes Treatment Satisfaction Questionnaire score was significantly improved, and the mean glucose levels, SD of glucose, mean amplitude of glycemic excursions and time in hyperglycemia were significantly decreased in the FGM group compared with the SMBG group.ConclusionsGlycemic control was better with FGM than with SMBG after cessation of glucose monitoring in patients with non-insulin-treated type 2 diabetes.Trial registration numberUMIN000026452, jRCTs041180082.

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