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Review
. 2023 Sep;17(5):1326-1336.
doi: 10.1177/19322968221088601. Epub 2022 Apr 26.

Expert Recommendations for Using Time-in-Range and Other Continuous Glucose Monitoring Metrics to Achieve Patient-Centered Glycemic Control in People With Diabetes

Virginia Bellido  1 , Eva Aguilera  2 , Roque Cardona-Hernandez  3 , Gonzalo Diaz-Soto  4   5 , Noemi González Pérez de Villar  6 , María J Picón-César  7   8   9 , Francisco Javier Ampudia-Blasco  10   11   12   13
Affiliations
Review

Expert Recommendations for Using Time-in-Range and Other Continuous Glucose Monitoring Metrics to Achieve Patient-Centered Glycemic Control in People With Diabetes

Virginia Bellido et al. J Diabetes Sci Technol. 2023 Sep.

Abstract

New metrics for assessing glycemic control beyond HbA1c have recently emerged due to the increasing use of continuous glucose monitoring (CGM) in diabetes clinical practice. Among them, time in range (TIR) has appeared as a simple and intuitive metric that correlates inversely with HbA1c and has also been newly linked to the risk of long-term diabetes complications. The International Consensus on Time in Range established a series of target glucose ranges (TIR, time below range and time above range) and recommendations for time spent within these ranges for different diabetes populations. These parameters should be evaluated together with the ambulatory glucose profile (AGP). Using standardized visual reporting may help people with diabetes and healthcare professionals in the evaluation of glucose control in frequent clinical situations. The objective of the present review is to provide practical insights to quick interpretation of patient-centered metrics based on flash glucose monitoring data, as well as showing some visual examples of common clinical situations and giving practical recommendations for their management.

Keywords: ambulatory glucose profile; continuous glucose monitoring; flash glucose monitoring; glycemic variability; hypoglycemia; time in range.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: VB has received speaker/advisory honoraria from Abbott, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Esteve, Janssen, Merck, Mundi- pharma, Novartis, Novo Nordisk, Roche, Sanofi. EAH has received honoraria from Abbott, Novo Nordisk, Sanofi, Lilly and Roche Diabetes Care. RCH has received speaker honoraria from Abbott, Lilly, Medtronic, Novo-Nordisk and Sanofi-Aventis and has consulted for Abbott, Lilly, Novo-Nordisk and Sanofi. GDS has received advisory honoraria/research support from NovoNordisk, Lilly, Medtronic and Abbott. NGPV has received speaker honorary from Sanofi, Novo Nordisk, Boehringer Ingelheim, Lilly Astra Zeneca, Abbott, and MSD. MJPC have received fees for collaborations from Abbott Diabetes Care, Ascensia Diabetes Care, Novo Nordisk and Sanofi. FJAB has received consultant/advisor honoraria from Abbott Diabetes Care, AstraZeneca, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, LifeScan, MannKind Co., Medtronic, Menarini, Merck, Novartis, Novo Nordisk, Sanofi; Speaker honoraria from Abbott Diabetes Care, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, LifeScan, Eli Lilly, Madaus, Medtronic, Menarini, Merck, Novartis, Novo Nordisk, Sanofi; Grant support from Novo Nordisk, Sanofi.

Figures

Figure 1.
Figure 1.
Glycemic control objectives in T1D and T2D according to patient profiles. Consensus recommendations for time in range (TIR), time below range (TBR) and time above range (TAR) for: (a) adults with T1D or T2D: (b) older adults or people at high-risk of hypoglycemia because of age, duration of diabetes, duration of insulin therapy or impaired awareness of hypoglycemia (IAH); (c) children/adolescents; (d) TIR in pregnancy. Recommendations are based on limited evidence. (e) No consensus recommendations for TIR in pregnancy in T2D or in gestational diabetes are available.
Figure 2.
Figure 2.
Variable insulin needs throughout the day according to age range in pediatric population. The graph shows the daily insulin sensitivity profiles for children and adolescents of different age groups, as well as for adult subjects. Data are represented as % of total daily basal-rate insulin requirements per hour, across a 24-hour period.
Figure 3.
Figure 3.
Identifying some scanning patterns with CGM. The figure shows two examples of scanning behavior that can be discussed with a patient. (a) A loss of data because of insufficient scanning, failing to capture data at least every 8 hours: (b) indicates a period of compulsive scanning (for example, after correction of hypoglycemia). Abbreviation: CGM, continuous glucose monitoring.
See this image and copyright information in PMC

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