ATTD consensus group releases time in range recommendations
medwireNews: A statement from an ATTD consensus group has streamlined previously agreed continuous glucose monitoring (CGM) metrics and set out time in range (TIR) targets.
The group has reduced the 14 metrics for clinical care agreed in 2017 to 10 measures, including five based on time in, above, and below the recommended blood glucose range.
The primary goal of the group was to develop targets based on the agreed metrics; they speculate that the persistent “relatively low” adoption of CGM in routine practice “may be due in part to the lack of clear and agreed-upon glycemic targets toward which both diabetes teams and people with diabetes can work toward.”
Tadej Battelino (University of Ljubljana, Slovenia) and fellow consensus group members stress that these CGM metrics are complementary to glycated hemoglobin, saying that, despite its limitations, glycated hemoglobin “is the only prospectively evaluated tool for assessing the risk for diabetes complications, and its importance in clinical decision making should not be undervalued.”
For most people with type 1 or type 2 diabetes, the group advises the following targets:
- Greater than 70% of time within the blood glucose range of 70–180 mg/dL (3.9–10.0 mmol/L).
- Less than 25% of time above 180 mg/dL (10.0 mmol/L).
- Less than 5% of time above 250 mg/dL (13.9 mmol/L).
- Less than 4% of time below 70 mg/dL (3.9 mmol/L).
- Less than 1% of time below 54 mg/dL (3.0 mmol/L).
The statement authors stress that the “first priority” is to reduce time below range, with TIR and hyperglycemia to be addressed afterwards.
The targets that they recommend can be individualized, and indeed, they suggest variations on the standard targets for different subgroups of people with diabetes, such as older people and pregnant women.
“Importantly, in order to make the recommendations generalizable and comprehensive, the consensus panel included individuals living with diabetes and had international representation from physicians and researchers from all geographic regions,” the team writes in Diabetes Care.
For older or high-risk people, the target for time below 70 mg/dL (3.9 mmol/L) is very strict, at less than 1%, with a corresponding relaxing of the targets for TIR and time above range. Conversely, pregnant women have stricter targets for time above range, with a lower target range than for other people, of 63–140 mg/dL (3.5–7.8 mmol/L).
The authors concede that the recommended targets may be “aspirational in some situations” and stress that “even small, incremental improvements yield significant glycemic benefits.”
They say: “Therefore, when advising individuals with diabetes (particularly children, adolescents, and high-risk individuals) about their glycemic goals, it is important to take a stepwise approach, emphasizing that what may appear to be small, incremental successes (e.g., 5% increase in TIR) are, in fact, clinically significant in improving their glycemia.”
But they caution that “when counseling women planning pregnancy and pregnant women, greater emphasis should be placed on getting to goal as soon as possible.”
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