Using Time in Tight Glucose Range as a Health-Promoting Strategy in Preschoolers With Type 1 Diabetes

Abstract

Children who develop diabetes in their first years of life risk being exposed to many decades of hyperglycemia, hence having a high risk of early complications and premature death. An additional age-dependent risk is that dysglycemia, especially hyperglycemia, negatively affects the developing brain. In evaluating the outcome of insulin treatment at an individual and group level, cutoff thresholds for glucose values are needed. Time in tight range (TITR) was defined as a measurement of time spent in a state of normoglycemia. The International Society of Pediatric and Adolescent Diabetes recommended that for preschoolers with type 1 diabetes (T1D), either >70% of time with glucose in range 70-180 mg/dL (3.9-10 mmol/L) or >50% of time in a tighter range 70-140 mg/dL (TITR) can be used as continuous glucose monitoring targets. In Sweden, over the past two decades, pediatric diabetes teams set glycemic targets to 70-140 mg/dL (3.9-7.8 mmol/L). Swedish registry data show that >50% of children <7 years old have >50% TITR. The purpose of this review is to share and discuss international knowledge and experiences of working with TITR as a health-promoting strategy in preschoolers with T1D on a structural and individual level. We conclude that as insulin treatment improves, a reasonable goal is to strive for as much time in a state of normoglycemia as possible, and this can easily be explained to families of children with diabetes. For children with access to an experienced health care team and diabetes technologies a currently realistic target can be at least half of the time in normoglycemic range, i.e., TITR >50%.

Graphical abstract

Figure 1

Supporting a high sense of coherence in young children with T1D.

Figure 2

Proportion of children, ages 0–6 years, with T1D in Sweden with >50% TITR (70–140 mg/dL, 3.9–7.8 mmol/L), years 2019–2023. Data from Knappen, NDR (24).

Figure 3

Mean HbA_1c per year for one pediatric diabetes team, “Team V,” and in Sweden nationally. Team V changed their local target and focused on normoglycemia. Their experiences inspired other pediatric diabetes teams. In parallel, new technology was introduced and structured quality work was ongoing.

Figure 4

HbA_1c levels divided into subgroups each year since 2000 among children ages 0–6 years: ≤48 mmol/mol (≤6.5%), 49–51 mmol/mol (6.6%–6.8%), 52–56 mmol/mol (6.9%–7.3%), 57–64 mmol/mol (7.4%–8.0%), 65–70 mmol/mol (8.1%–8.6%), >70 mmol/mol (>8.6%). Children with <3 months’ diabetes duration are excluded.

Figure 5

Proportion of children aged 0–6 years with overweight or obesity (age- and sex-adjusted isoBMI ≥25 kg/m²) years 2019–2023. Data from Knappen, NDR (24).