Choosing the duration of continuous glucose monitoring for reliable assessment of time in range: A new analytical approach to overcome the limitations of correlation‐based methods

Camerlingo, Nunzio; Vettoretti, Martina; Sparacino, Giovanni; Facchinetti, Andrea; Mader, Julia K.; Choudhary, Pratik; Favero, Simone Del

doi:10.1111/dme.14758

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…This is justified since blood sampling are not taken at every visit in the clinic in practice, and the intention of our study was to reflect the relationships between the outcome variables in regular routine work at specialist clinics. It is also possible that a longer time interval for the acquisition of CGM data should be standard, as discussed recently [ 20 , 21 ]. Pregnant women are usually checked at specialized maternity care centers that do not report to the NDR.…”

Section: Discussionmentioning

confidence: 99%

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

Eliasson,

Allansson Kjölhede,

Salö

et al. 2024

Diabetes Ther

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Introduction Continuous glucose monitoring (CGM) introduces novel indicators of glycemic control. Methods This cross-sectional study, based on the Swedish National Diabetes Register, examines 27,980 adults with type 1 diabetes. It explores the relationships between HbA1c (glycated hemoglobin) and various CGM-derived metrics, including TIR (time in range, representing the percentage of time within the range of 4–10 mmol/l for 2 weeks), TAR (time above range), TBR (time below range), mean glucose, standard deviation (SD), and coefficient of variation (CV). Pearson correlation coefficients and linear regression models were utilized for estimation. Results The analysis included 46% women, 30% on insulin pump, 7% with previous coronary heart disease and 64% with retinopathy. Mean ± SD values were age 48 ± 18 years, diabetes duration 25 ± 16 years, HbA1c 58.8 ± 12.8 mmol/mol, TIR 58.8 ± 19.0%, TAR 36.3 ± 20.0%, TBR 4.7 ± 5.4%, mean sensor glucose 9.2 ± 2.0 mmol/l, SD 3.3 ± 1.0 mmol/l, and CV 36 ± 7%. The overall association between HbA1c and TIR was − 0.71 (Pearson’s r ), with R 2 0.51 in crude linear regression and 0.57 in an adjusted model. R 2 values between HbA1c and CGM mean glucose were 0.605 (unadjusted) 0.619 (adjusted) and TAR (unadjusted 0.554 and fully adjusted 0.568, respectively), while fully adjusted R 2 values were 0.458, 0.175 and 0.101 between HbA1c and CGM SD, CGM CV and TBR, respectively. Conclusions This descriptive study demonstrates that the degree of association between HbA1c and new and readily available CGM-derived metrics, i.e., time in range (TIR), time above range (TAR), and CGM mean glucose, is robust in assessing the management of individuals with type 1 diabetes in clinical settings. Metrics from CGM that pertain to variability and hypoglycemia exhibit only weak correlations with HbA1c. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-024-01572-z.

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Section: Discussionmentioning

confidence: 99%

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

Eliasson,

Allansson Kjölhede,

Salö

et al. 2024

Diabetes Ther

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show abstract

“…Longer periods of CGM monitoring before the clamp study would achieve a more robust impression of the average glucose profile of the participants and limit the effect of potential behavioural changes and measurement insecurities in the first days of wearing a CGM sensor. 30…”

Section: Discussionmentioning

confidence: 99%

“…It is possible that the CGM‐detected hypoglycaemia over the 7‐day period may be a biomarker of those individuals who have experienced recurrent hypoglycaemia over much longer periods of time or people with short‐term behavioural changes in the recording period. Longer periods of CGM monitoring before the clamp study would achieve a more robust impression of the average glucose profile of the participants and limit the effect of potential behavioural changes and measurement insecurities in the first days of wearing a CGM sensor 30 …”

Section: Discussionmentioning

confidence: 99%

Association between recent exposure to continuous glucose monitoring‐recorded hypoglycaemia and counterregulatory and symptom responses to subsequent controlled hypoglycaemia in people with type 1 diabetes

Svensson,

Fabricius,

Verhulst

et al. 2024

Diabetes Obesity Metabolism

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AimExperimental hypoglycaemia blunts the counterregulatory hormone and symptom responses to a subsequent episode of hypoglycaemia. In this study, we aimed to assess the associations between antecedent exposure and continuous glucose monitoring (CGM)‐recorded hypoglycaemia during a 1‐week period and the counterregulatory responses to subsequent experimental hypoglycaemia in people with type 1 diabetes.Materials and MethodsForty‐two people with type 1 diabetes (20 females, mean ± SD glycated haemoglobin 7.8% ± 1.0%, diabetes duration median (interquartile range) 22.0 (10.5‐34.9) years, 29 CGM users, and 19 with impaired awareness of hypoglycaemia) wore an open intermittently scanned CGM for 1 week to detect hypoglycaemic exposure before a standardized hyperinsulinaemic‐hypoglycaemic [2.8 ± 0.1 mmol/L (50.2 ± 2.3 mg/dl)] glucose clamp. Symptom responses and counterregulatory hormones were measured during the clamp. The study is part of the HypoRESOLVE project.ResultsCGM‐recorded hypoglycaemia in the week before the clamp was negatively associated with adrenaline response [β −0.09, 95% CI (−0.16, −0.02) nmol/L, p = .014], after adjusting for CGM use, awareness of hypoglycaemia, glycated haemoglobin and total daily insulin dose. This was driven by level 2 hypoglycaemia [<3.0 mmol/L (54 mg/dl)] [β −0.21, 95% CI (−0.41, −0.01) nmol/L, p = .034]. CGM‐recorded hypoglycaemia was negatively associated with total, autonomic, and neuroglycopenic symptom responses, but these associations were lost after adjusting for potential confounders.ConclusionsRecent exposure to CGM‐detected hypoglycaemia was independently associated with an attenuated adrenaline response to experimental hypoglycaemia in people with type 1 diabetes.

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Assessment of the Glucose Management Indicator Using Different Sampling Durations

Bailey

Calhoun

Bergenstal

et al. 2023

Diabetes Technology & Therapeutics

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Choosing the duration of continuous glucose monitoring for reliable assessment of time in range: A new analytical approach to overcome the limitations of correlation‐based methods

Abstract: This is an open access article under the terms of the Creat ive Commo ns Attri bution-NonCo mmercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 4 publications

References 22 publications

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

Associations Between HbA1c and Glucose Time in Range Using Continuous Glucose Monitoring in Type 1 Diabetes: Cross-Sectional Population-Based Study

Association between recent exposure to continuous glucose monitoring‐recorded hypoglycaemia and counterregulatory and symptom responses to subsequent controlled hypoglycaemia in people with type 1 diabetes

Assessment of the Glucose Management Indicator Using Different Sampling Durations

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