Association of time in range, as assessed by continuous glucose monitoring, with painful diabetic polyneuropathy

Abstract

Aims/Introduction: This study aimed to evaluate the association between time in range (TIR) obtained from continuous glucose monitoring and the prevalence and degree of painful diabetic neuropathy. Materials and Methods: A total of 364 individuals with diabetic peripheral neuropathy were enrolled in this study. Sensor-based flash glucose monitoring systems were used to monitor the participants' glucose levels, and the glycemic variability metrics were calculated, including the TIR, glucose coefficient of variation, standard deviation and the mean amplitude of glycemic excursions. The participants were asked to record any form of pain during the 2 weeks of monitoring, and score the pain every day on a numerical rating scale. Based on the numerical rating scale, the patients were divided into the pain-free group, mild pain group and moderate/severe pain group. Results: Overall, 51.92% (189/364) of the participants were diagnosed with painful diabetic neuropathy. Compared with the pain-free group, the level of TIR decreased significantly in the mild pain and moderate/severe pain groups (P < 0.05). The prevalence of mild pain and moderate/severe pain decreased with increasing TIR quartiles (all P < 0.05). Multiple linear regression analysis showed that TIR was significantly negatively correlated with the numerical rating scale score after adjustment for glycated hemoglobin, glycemic variability indicators and other risk factors (P < 0.05). Logistic regression analysis showed that a decreasing level of TIR was significantly associated with an increasing risk of any pain and moderate/severe pain (P < 0.05). Conclusions: TIR is correlated with painful diabetic neuropathy and is underscored as a valuable clinical evaluation measure.

Time in Range from Continuous Glucose Monitoring: A Novel Metric for Glycemic Control

“…HbA1c has been the only prospectively evaluated tool for assessing the risk for diabetes complications. However, as TIR emerges as a new metric for assessing glycemic control in addition to HbA1c, numerous studies have reported TIR as a metric for correlation with diabetes complications (Table 2) [28][29][30][31][32][33]. At first, a TIR of target glucose and TAR computed from 7-point SMBG but not CGM were retrospectively investigated for retinopathy and microalbuminuria outcomes using DCCT data and the associations have been reported [34].…”

“…Ranjan et al [ 31 ] proved the relationship between the two in the longitudinal study in T1DM. Also, TIR was reported to be associated with painful diabetic polyneuropathy [ 32 ]. However, the TIR cuff-offs for reducing diabetes complications are lacking.…”

Comprehensive elaboration of glycemic variability in diabetic macrovascular and microvascular complications

“…Short-term GV was estimated by MAGE in CGM and was found to be independently associated with a higher risk of DPN with type 1 or 2 diabetes [70], but the study had a small sample size, which might not be able to evaluate patients with severe diabetes complications. Yang et al found that a decreasing level of TIR was significantly associated with an increasing risk of painful diabetic neuropathy, which might be underscored as a valuable clinical evaluation measure [71]. Investigators of a retrospective study reported that long-term variability as evaluated by FPG-CV was associated to the risk of painful DPN in patients with T2DM [72].…”

Use of Continuous Glucose Monitoring (CGM) Technology in the Management of Type 2 Diabetes Mellitus in the Primary Care Setting: A Case Report

“…5 As such, there should be more awareness in the use of CGM to help identify patients whose HbA1c may be ideal but fall short in the TiR target. This might have a positive impact on our diabetic care management because there are an increasing number of studies linking better TiR with lower rates of complications such as diabetic retinopathy 6,7 , peripheral neuropathy 8,9 and carotid intima thickness. 10 Technological advances in CGM opened up more windows of opportunity for coordination of care between physicians and patients in the primary care setting.…”