Association Between Continuous Glucose Monitoring-Derived Time in Range, Other Core Metrics, and Albuminuria in Type 2 Diabetes

Yoo, Jee Hee; Choi, Min Sun; Js, Ahn; Park, Sung Woon; Kim, Yejin; Hur, Kyu Yeon; Jin, Sang‐Man; Kim, Jae Hyun

doi:10.1089/dia.2019.0499

Cited by 72 publications

(76 citation statements)

References 32 publications

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“…However, in the present study, as we retrospectively con rmed blood glucose levels using blind CGM and the actual life pattern of the patients could be re ected in the outpatient setting, there was a reduced discrepancy between the value of HbA1c at baseline and TIR. In this manner, probably due to the strong association between HbA1c at baseline and TIR, our study did not show a signi cant association between TIR and CAN after further adjusting for HbA1c (data not shown), which was similar to in our previous study concerning the relationship between TIR and albuminuria in the outpatient setting [13].…”

Section: Discussionsupporting

confidence: 90%

“…In addition, in the relationship between TIR and carotid intima-media thickness, which is a surrogate marker for cardiovascular disease, when TIR was increased by 10% the risk of abnormal carotid intima-media thickness decreased by 6.4% [12]. We previously reported that albuminuria, a microvascular complication of diabetes, was found to be associated with TIR and hyperglycemic metrics and, as in other studies, it was inversely correlated even after adjusting the glycemic variability metrics [13]. The results of these previous studies strengthen the potential of TIR as a tool to predict the risk of complications of diabetes.…”

Section: Discussionmentioning

confidence: 62%

“…Several studies have shown to date that TIR and other key parameters are correlated with the clinical outcomes of type 2 diabetes. According to the results of previous studies in patients with type 2 diabetes, TIR has been signi cantly linked to a lower presence of more advanced diabetic retinopathy and each 10% increase in the TIR of 70 to 180 mg/dL was associated with a reduced risk of abnormal carotid intimamedia thickness and albuminuria by 6.4% and 6.0%, respectively [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

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The Association Between Continuous Glucose Monitoring-derived Metrics, Including Time in Range, and Cardiovascular Autonomic Neuropathy in Outpatients With Type 2 Diabetes

et al. 2020

Preprint

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BackgroundContinuous glucose monitoring (CGM)-derived metrics including time in range (TIR) are attracting attention as new indicators of glycemic control and diabetes complications beyond hemoglobin A1c. This study investigated the association between CGM-derived TIR, hyperglycemia, hypoglycemia metrics, and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes.MethodsA total of 284 patients with type 2 diabetes who underwent CGM for three days and autonomic function tests within three months based on outpatient data were recruited. The definition of CGM-derived metrics was subject to the most recent international consensus. CAN was defined as an abnormal case in two or more parasympathetic and the severity of CAN was estimated as the sum of the scores of the five cardiovascular autonomic function tests.ResultsMultiple logistic regression analysis revealed that the odds ratio of definite CAN was 0.876 [95% confidence interval (CI): 0.79–0.98] per 10% increase in the TIR of 70 to 180 mg/dL, after adjusting for age, sex, diabetes duration, any medications, and glycemic variability. A 10% increase in TIR was significantly inversely associated with the presence of advanced CAN (OR: 0.89, 95% CI: 0.81–0.98). In addition, there was a strong inverse association between a 10% increase in the TIR and the total CAN score (p for trend = 0.001). Among the metrics of hyperglycemia, a time above range (TAR) of greater than 180 mg/dL was also independently correlated with the presence of definite CAN (OR: 1.013, 95% CI: 1.00–1.02) and advanced CAN (OR: 1.01, 95% CI: 1.00–1.02).ConclusionsA TIR value of 70 to 180 mg/dL and a TAR value of greater than 180 mg/dL were significantly associated with cardiovascular autonomic neuropathy in outpatients with type 2 diabetes.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 62%

Section: Introductionmentioning

confidence: 99%

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The Association Between Continuous Glucose Monitoring-derived Metrics, Including Time in Range, and Cardiovascular Autonomic Neuropathy in Outpatients With Type 2 Diabetes

et al. 2020

Preprint

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“…However, there is limited data about the clinical impact of intra-day and inter-day glucose variability on the presence or progression of albuminuria in patients with type 2 diabetes. Two previous studies conducted by the same group did not show a signi cant association between CGM-derived metrics of intra-day and inter-day glucose variability and the presence of albuminuria independent of HbA1c levels in patients with type 2 diabetes with HbA1c levels of more than 8% [32,33]. In contrast, our study clearly showed close relationships between FLP-CGM-derived metrics related to intra-day and inter-day glucose variability and the severity of albuminuria, even after adjusting for various possible risk factors including HbA1c, in patients with type 2 diabetes.…”

Section: Discussionmentioning

confidence: 74%

Associations Between Continuous Glucose Monitoring-derived Metrics and Diabetic Retinopathy and Albuminuria in Patients With Type 2 Diabetes

Wakasugi

Mita

Katakami³

et al. 2020

Preprint

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BackgroundPreventing the development and progression of diabetic microvascular complications through optimal blood glucose control remains an important challenge. Whether metrics based on continuous glucose monitoring are useful for the management of diabetic microvascular complications is not entirely clear.MethodsThis is an exploratory analysis of an ongoing prospective, multicenter, 5-year follow-up observational study. Study participants included 999 outpatients with type 2 diabetes who underwent continuous glucose monitoring at baseline. Associations between continuous glucose monitoring-derived metrics and the severity of diabetic retinopathy or albuminuria were investigated using multivariable proportional odds models.ResultsThe overall prevalence of diabetic retinopathy was 22.2%. Multivariate analysis with proportional odds models demonstrated that continuous glucose monitoring-derived metrics related to intra-day and inter-day glucose variability are significantly associated with the severity of diabetic retinopathy, even after adjusting for various possible risk factors. However, significant relationships were not observed after adjusting for HbA1c levels. The prevalence of microalbuminuria and macroalbuminuria were 20.3% and 6.7%, respectively. Similarly, multivariate analysis demonstrated that those metrics are significantly associated with the severity of albuminuria. These relationships remained significant even after further adjusting for HbA1c levels. ConclusionsContinuous glucose monitoring-derived metrics related to intra-day and inter-day glucose variability are significantly associated with the severity of diabetic retinopathy or albuminuria in patients with type 2 diabetes. Thus, evaluating these metrics might possibly be useful for risk assessment of diabetic microvascular complications.

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“…However, unlike HbA1c, CGM-measured outcomes can assess both shortterm and long-term complications. Many researchers have emphasized the importance of time in range (TIR) and hypoglycemia as these represent daily goals for participants with T1D and type 2 diabetes (T2D) and are associated with micro-and macrovascular complications [6][7][8] and severe hypoglycemia. 9 This article extends this analysis by assessing CGM outcomes according to baseline TIR and focusing on individual participant responder outcomes.…”

Section: Introductionmentioning

confidence: 99%

Glycemic Improvement Using Continuous Glucose Monitoring by Baseline Time in Range: Subgroup Analyses from the DIAMOND Type 1 Diabetes Study

Calhoun

Price

Beck

2021

Diabetes Technology & Therapeutics

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The DIAMOND study demonstrated that real-time continuous glucose monitors (rtCGMs) improve glycemia for adults with type 1 diabetes using multiple daily injections. This analysis explores the relationship between baseline time in range (TIR) and improvement in TIR using rtCGMs or self-monitoring of blood glucose (SMBG). Baseline TIR was divided into three categories: <40% (9.6 h per day), <50% (12 h per day), and <60% (14.4 h per day). Compared with SMBG, use of rtCGMs increased mean TIR by an additional 16 min per day for participants with a baseline TIR <40%, 77 min per day for baseline TIR <50%, and 88 min per day for baseline TIR <60%. A greater percentage of participants increased TIR by >4 h per day using rtCGMs within the three baseline TIR groups. For participants with a baseline TIR <50%, 29% of rtCGM users improved their TIR by >4 h per day compared with no SMBG users (P < 0.001). Similar trends were found for improvement in mean glucose and time spent in hyper-and hypoglycemic ranges.

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Association Between Continuous Glucose Monitoring-Derived Time in Range, Other Core Metrics, and Albuminuria in Type 2 Diabetes

Cited by 72 publications

References 32 publications

The Association Between Continuous Glucose Monitoring-derived Metrics, Including Time in Range, and Cardiovascular Autonomic Neuropathy in Outpatients With Type 2 Diabetes

The Association Between Continuous Glucose Monitoring-derived Metrics, Including Time in Range, and Cardiovascular Autonomic Neuropathy in Outpatients With Type 2 Diabetes

Associations Between Continuous Glucose Monitoring-derived Metrics and Diabetic Retinopathy and Albuminuria in Patients With Type 2 Diabetes

Glycemic Improvement Using Continuous Glucose Monitoring by Baseline Time in Range: Subgroup Analyses from the DIAMOND Type 1 Diabetes Study

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