Critical Reappraisal of the Time-in-Range: Alternative or Useful Addition to Glycated Hemoglobin?

Heinemann, Lutz; Freckmann, Guido; Müller‐Wieland, Dirk; Kellerer, Monika

doi:10.1177/1932296819883885

Cited by 18 publications

(9 citation statements)

References 25 publications

(29 reference statements)

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“…A recent cross-sectional study conducting similar research in T1D neither found significant associations between TIR and carotid artery wall thickness or endothelial function [ 35 ]. Hence, our current findings are in favour of keeping HbA1c in the risk assessment for diabetic complications in T1D, complemented with instead of replaced by TIR, therefore we advocate for a multifactorial approach [ 36 ]. Indeed, it is expected that the landscape of glycemia management based on HbA1c is likely to change in favour of a more holistic approach considering all different aspects of dysglycemia [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Time-varying parameters of glycemic control and glycation in relation to arterial stiffness in patients with type 1 diabetes

Helleputte

Rodenbach

Marlier

et al. 2022

Cardiovasc Diabetol

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Background A substantial proportion of type 1 diabetes (T1D) patients free from known cardiovascular disease (CVD) show premature arterial stiffening, with age, blood pressure, and HbA1c—as gold standard of glycemic control—as main predictors. However, the relationship of arterial stiffness with other time-varying parameters of glycemic control and glycation has been far less explored. This study investigated the relationship of arterial stiffness with several short- and long-term parameters of glycemic control and glycation in patients with T1D, such as advanced glycation end-products (AGEs) and continuous glucose monitoring (CGM)-derived parameters. Methods Cross-sectional study at a tertiary care centre including 54 patients with T1D free from known CVD. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (cf-PWV). Current level and 10-year history of HbA1c were evaluated, and skin AGEs, urinary AGEs, and serum soluble AGE-receptor (sRAGE) concentrations. CGM for 7 days was used to determine time in range, time in hyper- and hypoglycemia, and glycemic variability. Results Cf-PWV was associated with current HbA1c (rs = + 0.28), mean 10-years HbA1c (rs = + 0.36), skin AGEs (rs = + 0.40) and the skin AGEs-to-sRAGE ratio (rs = + 0.40), but not with urinary AGE or serum sRAGE concentrations; and not with any of the CGM-parameters. Multiple linear regression for cf-PWV showed that the model with the best fit included age, T1D duration, 24-h mean arterial pressure and mean 10-years HbA1c (adjusted R2 = 0.645, p < 0.001). Conclusions Longer-term glycemic exposure as reflected by current and mean 10-years HbA1c is a key predictor of arterial stiffness in patients with T1D, while no relationship was found with any of the short-term CGM parameters. Our findings stress the importance of early and sustained good glycemic control to prevent premature CVD in patients with T1D and suggest that HbA1c should continue to be used in the risk assessment for diabetic complications. The role of skin glycation, as a biomarker for vascular aging, in the risk assessment for CVD is an interesting avenue for further research.

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Section: Discussionmentioning

confidence: 99%

Time-varying parameters of glycemic control and glycation in relation to arterial stiffness in patients with type 1 diabetes

Helleputte

Rodenbach

Marlier

et al. 2022

Cardiovasc Diabetol

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“…While CGM-derived metrics (eg, TiR and TaR) are becoming more and more popular in diabetes care, HbA1c is still the gold standard and most healthcare professionals are accustomed to its use as a reference parameter. Thus, the estimation of HbA1c from CGM plays the important role of enabling a smooth and increasing coaching of CGM in diabetes care, 33 by effectively relating its metrics to the well-consolidated use of HbA1c.…”

Section: Discussionmentioning

confidence: 99%

Predicting Glycated Hemoglobin Through Continuous Glucose Monitoring in Real-Life Conditions: Improved Estimation Methods

Valenzano

Bertolotti

Grassi

et al. 2022

J Diabetes Sci Technol

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Background: The adoption of continuous glucose monitoring (CGM) already helps to improve glycemic control in diabetes. When coupled with appropriate data analysis techniques, CGM also provides dependable estimates for significant metrics, like glycated hemoglobin (HbA1c). Findings from the REALISM-T1D study can boost HbA1c estimation methods in diabetes care and stimulate their use in clinical practice. Methods: Continuous glucose monitoring data of 27 adults affected by type-1 diabetes were acquired by means of G6 (Dexcom, San Diego, CA) sensors for a time span of 120 days. Glycated hemoglobin laboratory assays were performed during the concluding follow-up visits. Data were then analyzed to derive estimates of assay results, taken as the gold standard. Results: Bland-Altman (BA) plots show that smart interpolation to patch missing data and a wise choice of interstitial glucose (IG) weighting function, besides a proper mean interstitial glucose (MIG) to HbA1c regression equation, improve HbA1c estimation quality with respect to methods relying on MIG alone. A decrease in the BA plot-related variance of differences with respect to the gold standard confirms the improvement. Wilcoxon signed-rank tests on the bias-compensated mean squared error (MSE) with respect to conventional MIG-based methods show that the improvement is statistically significant with a confidence level better than 95% ( P = .0179). Conclusions: Improved HbA1c estimation methods result in better HbA1c prediction quality with respect to those based on MIG alone, thus providing quick, but still relatively accurate feedback to diabetologists. They alleviate the discordances reported in literature and, with further improvements, may become a viable complement/alternative to HbA1c assays.

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“…Other parameters complementary to TIR are time spent with glucose values below 70 mg/dl, time below range (TBR), and time spent above 180 mg/dl, time above range (TAR). These parameters have some limits, related to the lack of an established standard for glucose measurement with CGM: as suggested by several authors, TIR should be regarded as a complement to HbA1c [77]. Indeed HbA1c values have been considered over the last decades the parameter that better correlates with clinical outcomes, even though additional evidence of a correlation between TIR and diabetes complications are emerging, both for micro and macrovascular complications [78][79][80].…”

Section: Continuous Glucose Monitoring (Cgm)mentioning

confidence: 99%

Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives

Boscari

Avogaro

2021

Rev Endocr Metab Disord

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Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.

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Critical Reappraisal of the Time-in-Range: Alternative or Useful Addition to Glycated Hemoglobin?

Cited by 18 publications

References 25 publications

Time-varying parameters of glycemic control and glycation in relation to arterial stiffness in patients with type 1 diabetes

Time-varying parameters of glycemic control and glycation in relation to arterial stiffness in patients with type 1 diabetes

Predicting Glycated Hemoglobin Through Continuous Glucose Monitoring in Real-Life Conditions: Improved Estimation Methods

Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives

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