Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino¹, Thomas Danne², Richard M Bergenstal³, Stephanie A Amiel⁴, Roy Beck⁵, Torben Biester², Emanuele Bosi⁶, Bruce A Buckingham⁷, William T Cefalu⁸, Kelly L Close⁹, Claudio Cobelli¹⁰, Eyal Dassau¹¹, J Hans DeVries^{12

13}, Kim C Donaghue¹⁴, Klemen Dovc¹⁵, Francis J Doyle 3rd¹¹, Satish Garg¹⁶, George Grunberger¹⁷, Simon Heller¹⁸, Lutz Heinemann¹⁹, Irl B Hirsch²⁰, Roman Hovorka²¹, Weiping Jia²², Olga Kordonouri², Boris Kovatchev²³, Aaron Kowalski²⁴, Lori Laffel²⁵, Brian Levine⁹, Alexander Mayorov²⁶, Chantal Mathieu²⁷, Helen R Murphy²⁸, Revital Nimri²⁹, Kirsten Nørgaard³⁰, Christopher G Parkin³¹, Eric Renard³², David Rodbard³³, Banshi Saboo³⁴, Desmond Schatz³⁵, Keaton Stoner³⁶, Tatsuiko Urakami³⁷, Stuart A Weinzimer³⁸, Moshe Phillip^{29

39}

Affiliations

¹ Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia tadej.battelino@mf.uni-lj.si.
² Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany.
³ International Diabetes Center at Park Nicollet, Minneapolis, MN.
⁴ Diabetes Research Group, King's College London, London, U.K.
⁵ Jaeb Center for Health Research, Tampa, FL.
⁶ Diabetes Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
⁷ Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA.
⁸ American Diabetes Association, Alexandria, VA.
⁹ Close Concerns and The diaTribe Foundation, San Francisco, CA.
¹⁰ Department of Information Engineering, University of Padova, Padua, Italy.
¹¹ Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.
¹² Profil, Neuss, Germany.
¹³ Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
¹⁴ Children's Hospital at Westmead, University of Sydney, Sydney, Australia.
¹⁵ Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia.
¹⁶ University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO.
¹⁷ Grunberger Diabetes Institute, Bloomfield Hills, MI.
¹⁸ Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, U.K.
¹⁹ Science Consulting in Diabetes, Neuss, Germany.
²⁰ Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
²¹ Wellcome Trust-MRC Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, Cambridge, U.K.
²² Department of Endocrinology & Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
²³ Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
²⁴ JDRF, New York, NY.
²⁵ Pediatric, Adolescent and Young Adult Section and Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA.
²⁶ Endocrinology Research Centre, Moscow, Russia.
²⁷ Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.
²⁸ Norwich Medical School, University of East Anglia, Norwich, U.K.
²⁹ Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
³⁰ Steno Diabetes Center Copenhagen, Gentofte, Denmark.
³¹ CGParkin Communications, Inc., Henderson, NV.
³² Department of Endocrinology, Diabetes, and Nutrition, Montpellier University Hospital; Institute of Functional Genomics, University of Montpellier; and INSERM Clinical Investigation Centre, Montpellier, France.
³³ Biomedical Informatics Consultants LLC, Potomac, MD.
³⁴ DiaCare, Ahmedabad, Gujarat, India.
³⁵ Pediatric Endocrinology, University of Florida, Gainesville, FL.
³⁶ dQ&A Market Research, Inc., San Francisco, CA.
³⁷ Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan.
³⁸ Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
³⁹ Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 31177185
PMCID: PMC6973648
DOI: 10.2337/dci19-0028

Review

Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino et al. Diabetes Care. 2019 Aug.

. 2019 Aug;42(8):1593-1603.

doi: 10.2337/dci19-0028. Epub 2019 Jun 8.

Authors

Affiliations

¹ Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia tadej.battelino@mf.uni-lj.si.
² Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany.
³ International Diabetes Center at Park Nicollet, Minneapolis, MN.
⁴ Diabetes Research Group, King's College London, London, U.K.
⁵ Jaeb Center for Health Research, Tampa, FL.
⁶ Diabetes Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
⁷ Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA.
⁸ American Diabetes Association, Alexandria, VA.
⁹ Close Concerns and The diaTribe Foundation, San Francisco, CA.
¹⁰ Department of Information Engineering, University of Padova, Padua, Italy.
¹¹ Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA.
¹² Profil, Neuss, Germany.
¹³ Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
¹⁴ Children's Hospital at Westmead, University of Sydney, Sydney, Australia.
¹⁵ Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia.
¹⁶ University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO.
¹⁷ Grunberger Diabetes Institute, Bloomfield Hills, MI.
¹⁸ Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, U.K.
¹⁹ Science Consulting in Diabetes, Neuss, Germany.
²⁰ Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA.
²¹ Wellcome Trust-MRC Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, Cambridge, U.K.
²² Department of Endocrinology & Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.
²³ Center for Diabetes Technology, University of Virginia, Charlottesville, VA.
²⁴ JDRF, New York, NY.
²⁵ Pediatric, Adolescent and Young Adult Section and Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA.
²⁶ Endocrinology Research Centre, Moscow, Russia.
²⁷ Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.
²⁸ Norwich Medical School, University of East Anglia, Norwich, U.K.
²⁹ Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.
³⁰ Steno Diabetes Center Copenhagen, Gentofte, Denmark.
³¹ CGParkin Communications, Inc., Henderson, NV.
³² Department of Endocrinology, Diabetes, and Nutrition, Montpellier University Hospital; Institute of Functional Genomics, University of Montpellier; and INSERM Clinical Investigation Centre, Montpellier, France.
³³ Biomedical Informatics Consultants LLC, Potomac, MD.
³⁴ DiaCare, Ahmedabad, Gujarat, India.
³⁵ Pediatric Endocrinology, University of Florida, Gainesville, FL.
³⁶ dQ&A Market Research, Inc., San Francisco, CA.
³⁷ Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan.
³⁸ Department of Pediatrics, Yale University School of Medicine, New Haven, CT.
³⁹ Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

PMID: 31177185
PMCID: PMC6973648
DOI: 10.2337/dci19-0028

Abstract

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.

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Figures

**Figure 1**
CGM-based targets for different diabetes populations.

**Figure 2**
Ambulatory Glucose Profile.

See this image and copyright information in PMC

References

1. Lind M, Polonsky W, Hirsch IB, et al. . Continuous glucose monitoring vs conventional therapy for glycemic control in adults with type 1 diabetes treated with multiple daily insulin injections: the GOLD randomized clinical trial. JAMA 2017;317:379–387 - PubMed
1. Aleppo G, Ruedy KJ, Riddlesworth TD, et al. .; REPLACE-BG Study Group . REPLACE-BG: A randomized trial comparing continuous glucose monitoring with and without routine blood glucose monitoring in adults with well-controlled type 1 diabetes. Diabetes Care 2017;40:538–545 - PMC - PubMed
1. Beck RW, Riddlesworth T, Ruedy K, et al. .; DIAMOND Study Group . Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA 2017;317:371–378 - PubMed
1. Beck RW, Riddlesworth TD, Ruedy K, et al. .; DIAMOND Study Group . Continuous glucose monitoring versus usual care in patients with type 2 diabetes receiving multiple daily insulin injections: a randomized trial. Ann Intern Med 2017;167:365–374 - PubMed
1. Polonsky WH, Hessler D, Ruedy KJ, Beck RW; DIAMOND Study Group . The impact of continuous glucose monitoring on markers of quality of life in adults with type 1 diabetes: further findings from the DIAMOND randomized clinical trial. Diabetes Care 2017;40:736–741 - PubMed

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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

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