Expert Consensus Recommendations on Time in Range for Monitoring Glucose Levels in People with Diabetes: An Indian Perspective

Abstract

Keeping up with the global scenario, diabetes prevalence is on rise in India. Inadequate glycemic control is a major cause of diabetes-related morbidity and mortality. The conventional standards of care (SOC) in diabetes, including self-monitoring of blood glucose and measurement of glycated hemoglobin, have supported achievement of glycemic control, yet there are a few limitations. With the use of current technologies and metrics, such as continuous glucose monitoring (CGM) and standardized CGM data reporting, the continuous real-time glucose levels can be measured, and importantly, the percentage of time above, below, and within the target glucose range can be calculated, which facilitates patient-centric care, a current goal in diabetes management. International consensus recommendations endorse the incorporation of CGM and CGM data reporting in SOC for diabetes management. The guidelines provide time in range (TIR) thresholds for different patient populations and different types of diabetes. However, extrapolation of these global guidelines does not aptly cover the Indian population, which has diverse diet, culture, and religious practices. In this context, a consensus meeting was held in India in 2021 with experts in the field of diabetes care. The purpose of the meeting was to develop consensus recommendations for TIR thresholds for different patient profiles in India. Those expert recommendations, together with an evidence-based review, are reported here. The aim of this agreement is to aid clinicians across India to routinely use CGM and CGM data reports for optimizing individualized diabetes care, by implementing clinical targets for TIR.

Efficacy of Fixed-dose Combination of Dapagliflozin and Sitagliptin in Type 2 Diabetes Mellitus Using Continuous Glucose Monitoring: A Real-world Study in India

“…In addition to the improvement in ADG, in the present study the FDC treatment also led to significant changes in TIT, which increased from 40.73±28.62% to 54.77±34.24% (overall improvement of 34.47%, p<0.05). The study results compliments the goal set by the ADA, which includes the description of and the use of CGM report as part of its standard of care (SOC) since 2020 [20]. According to the ADA, a TIT of glucose level between 70 to 180 mg/dL should be greater than 70% [28] For patients below 25 years of age, the TIT should be >60 % and for older patients, >50% TIT is recommended.…”

“…For the Indian population, it has been demonstrated that a TIT of more than 70% correlates to an HbA1c level of less than 7.5%. [20]. The increase in the TIT while reducing the TBT is considered the primary glycaemic goal to achieve effective and safe glucose control [21].…”

Continuous glucose monitoring metrics in pregnancy with type 1 diabetes mellitus

“…Poor glycaemic control in pregnancy can have detrimental consequences not only for the mother but also for the developing foetus[ 16 ]. Therefore, CGM emerges as a protective tool for achieving favourable obstetric outcomes in pregnancies complicated by T1DM[ 17 ]. Studies have shown that pregnant women using CGM exhibit improved glycaemic control.…”

Metabolic health tracking using Ultrahuman M1 continuous glucose monitoring platform in non- and pre-diabetic Indians: a multi-armed observational study

“…In South Asia, especially India, CGMs are predominantly used for diabetes evaluation. 17 While wellness and lifestyle monitoring apps enjoy reasonable following, the data include user-uploaded, non-biomarker information such as food logs, step counts, sleep duration, etc., which provide a general overview of health but cannot be substantially correlated to clinical biomarkers. This gap in biomarker-based tracking is especially crucial for India which is increasingly being known as the "Diabetic capital of the world".…”