Individualization of recommendations from the international consensus on continuous glucose monitoring-derived metrics in Japanese children and adolescents with type 1 diabetes

Abstract

We assessed the significance of recommendations from the international consensus on continuous glucose monitoring (CGM)-derived metrics in Japanese children and adolescents with type 1 diabetes. Eighty-five patients (age, 13.5 ± 4.7 years) who wore the FreeStyle ® Libre for a 28-day period were enrolled in this study. Seventy-three patients were treated with multiple daily injections of insulin and 12 with insulin pump therapy without using a sensor-augmented pump or a predictive low-glucose suspend-function pump. We evaluated the relationship between CGM-derived metrics: time in range (TIR: 70-180 mg/dL), time below range (TBR: <70 mg/dL), and time above range (TAR: >180 mg/dL), and laboratorymeasured HbA1c and estimated HbA1c (eA1c) levels calculated from the mean glucose values. The TIR was 50.7 ± 12.2% (23-75%), TBR was 11.8 ± 5.8% (2-27%), and TAR was 37.5 ± 13.5% (9-69%). The TIR was highly correlated with HbA1c level, eA1c level, and TAR, but not with TBR. An HbA1c level of 7.0% corresponded to a TIR of 55.1% (95% CI: 53.7-56.5%), whereas a TIR of 70% corresponded to an HbA1c level of 6.1% (95% CI: 5.9-6.3%). The results of eA1c levels were similar to those observed for HbA1c levels. From these findings, we conclude that low rates of a recommended TIR of 70% may be due to less use of advanced technology and insufficient comprehensive diabetes care. Ethnic characteristics including lifestyle and eating customs may have contributed to the result. CGM-derived targets must be individualized based on ethnic characteristics, insulin treatment and diabetes care, and needs of individuals with diabetes.

Association of time in range with hemoglobin A1c, glycated albumin and 1,5‐anhydro‐d‐glucitol

“…corresponded to a TIR 70-180 of 56.1% in patients with type 1 diabetes mellitus. Furthermore, Urakami et al 34 reported that an HbA1c level of 7.0% corresponded to a TIR 70-180 of 55.1% in Japanese children and adolescents with type 1 diabetes mellitus, a finding similar to that presented in the present study. In contrast, we found that an HbA1c level of 7.0% corresponded to a TIR 70-180 of 74.2% in patients with type 2 diabetes mellitus, which differed from the values of those with type 1 diabetes mellitus.…”

“…The present study found that an HbA1c level of 7.0% corresponded to a TIR 70–180 of 56.1% in patients with type 1 diabetes mellitus. Furthermore, Urakami et al 34 . reported that an HbA1c level of 7.0% corresponded to a TIR 70–180 of 55.1% in Japanese children and adolescents with type 1 diabetes mellitus, a finding similar to that presented in the present study.…”

The association between hypoglycemia and glycemic variability in elderly patients with type 2 diabetes: cross-sectional study

“…Our study showed that low TAR had a signi cant association with TBR ≥ 1%. While few studies have investigated the relationship between TAR and TBR in patients with type 2 diabetes, one study conducted CGM in 85 children and adolescents with type 1 diabetes and showed a weak inverse correlation between TAR and TBR [22]. This nding is compatible with our results.…”

Continuous and Intermittent Glucose Monitoring in 2020

“…What else do we need to improve? Certainly a more general access to the CGM technology for all individuals with T1D, in the less affluent environments; wider availability of CGM for individuals with T2D; more individualized approaches in CGM implementation for every person with diabetes (43); and firm establishment of CGM-derived metrics like TIR/TBR as primary outcomes in clinical trials. Engaging the regulatory bodies would certainly help.…”