Individualizing Time-in-Range Goals in Management of Diabetes Mellitus and Role of Insulin: Clinical Insights From a Multinational Panel

Abstract

Diabetes mellitus is a global health concern associated with significant morbidity and mortality. Inadequate control of diabetes leads to chronic complications and higher mortality rates, which emphasizes the importance of achieving glycemic targets. Although glycated hemoglobin (HbA 1c ) is the gold standard for measuring glycemic control, it has several limitations. Therefore, in recent years, along with the emergence of continuous glucose monitoring (CGM) technology, glycemic control modalities have moved beyond HbA 1c . They encompass modern glucometrics, such as glycemic variability (GV) and time-in-range (TIR). The key advantage of these newer metrics over HbA 1c is that they allow personalized diabetes management with person-centric glycemic control. Basal insulin analogues, especially second-generation basal insulins with properties such as longer duration of action and low risk of hypoglycemia, have demonstrated clinical benefits by reducing GV and improving TIR. Therefore, for more effective and accurate diabetes management, the development of an integrated approach with second-generation basal insulin and glucometrics involving GV and TIR is the need of the hour. With this objective, a multinational group of endocrinologists and diabetologists reviewed the existing recommendations on TIR, provided their clinical insights into the individualization of TIR targets, and elucidated on the role of the second-generation basal insulin analogues in addressing TIR.

Multidisciplinaridade em saúde: a necessidade da integração

“…Doenças como diabetes e doença periodontal trazem um grande risco à saúde, é essencial um diagnóstico correto para as mesmas. Portanto, no caso da diabete, que é uma doença que afeta, em média, 6 a cada 100 pessoas por ano 34 , o diagnóstico é realizado por meio de uma medição do nível de glicose sanguínea 35 , sendo o padrão ouro para a medição da glicemia, a realização do exame de hemoglobina glicada, que fornece com exatidão os níveis de glicose sanguínea 36 .…”

Approach to a Newly Diagnosed Adult with Type 2 Diabetes in the Indian Context: Recommendations by Association of Clinical Endocrinologists Consensus Group

“…According to the most recent advanced technologies and treatments for diabetes (ATTD) international time in range (TIR) consensus (2019), most people with T2DM should aim to spend > 70% of their time per day (approx. > 17 h) in TIR (70-180 mg/dL), with time below range (TBR) < 70 mg/dL < 4% and time above range (TAR) > 180 mg/dL being less than 25% of time per day [45]. Less stringent targets are recommended for older or highrisk people, as well as for adults under the age of 25.…”

Current and future therapies to treat impaired awareness of hypoglycemia

“…Recent data has shown that CGM users (N = 5,506/11,469) had better glycemic control (lower median HbA1C, 7.7%) and lower rates of severe hypoglycemia compared to non-CGM users ( DeSalvo et al, 2023 ). While HbA1c has been the gold standard for assessing long-term glycemic control, the data available from CGMs are making these devices the new standard of care ( Battelino et al, 2019 ; Advani, 2020 ; Battelino and Bergenstal, 2020 ; Kalra et al, 2021 ; Dovc et al, 2023 ). CGMs indicate the amount of time subjects experience hypoglycemia and how often these episodes go unnoticed.…”