Relationships between time in range, glycemic variability including hypoglycemia and types of diabetes therapy in Japanese patients with type 2 diabetes mellitus: Hyogo Diabetes Hypoglycemia Cognition Complications study

Abstract

Aims/Introduction Continuous glucose monitoring (CGM) metrics, such as times in range (TIR) and time below range, have been shown to be useful as clinical targets that complement glycated hemoglobin (HbA1c) for patients with type 2 diabetes mellitus. We investigated the relationships between TIR, glycemic variability and patient characteristics in patients with type 2 diabetes mellitus. Materials and Methods We carried out continuous glucose monitoring in 281 outpatients with type 2 diabetes mellitus who participated in a multicenter cohort (Hyogo Diabetes Hypoglycemia Cognition Complications) study. Results The results are shown as the median (interquartile range). The age, disease duration and HbA1c were 68 years (62–71 years), 13 years (7–23 years) and 6.9% (6.5–7.5%), respectively. TIR and standard deviation obtained by continuous glucose monitoring worsened significantly with increasing disease duration. Multiple regression analyses showed that disease duration (standard partial regression coefficient, β = −0.160, P = 0.003), diabetic peripheral neuropathy (β = −0.106, P = 0.033) and urinary albumin excretion (β = −0.100, P = 0.043) were useful explanatory factors for TIR. In contrast, HbA1c (β = −0.398, P < 0.001) and the use of antidiabetic drugs potentially associated with severe hypoglycemia (β = 0.180, P = 0.028), such as sulfonylureas, glinides and insulin, were useful explanatory factors for time below range in the elderly patients with type 2 diabetes mellitus. Conclusions The results of this study suggest that disease duration and diabetic complications are associated with TIR deterioration. In addition, low HbA1c levels and the use of antidiabetic drugs potentially associated with severe hypoglycemia might worsen the time below range in the elderly.

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

“…Previous reports have shown that diabetic microvascular complications and vascular endothelial dysfunction are associated with TIR 70–180 deterioration 23–26 . The Advanced Technologies & Treatments for Diabetes stated that TIR is an appropriate and useful clinical target and outcome measurement that complements HbA1c for a wide range of patients with diabetes 21 .…”

“…Beck et al 26 . reported that an HbA1c level of 7.0% corresponded to a TIR 70–180 of 64% in patients with type 1 diabetes mellitus.…”

“…For these reasons, there seemed to be a difference in the regression equation using 1,5-AG as an objective variable between type 1 diabetes mellitus and type 2 diabetes mellitus patients. Beck et al 26 reported that an HbA1c level of 7.0% corresponded to a TIR of 64% in patients with type 1 diabetes mellitus. The present study found that an HbA1c level of 7.0% The least squares method was used to predict from time in range (TIR) and time above range (TAR) from hemoglobin A1c (HbA1c), glycated albumin (GA), and 1,5-anhydro-D-glucitol (1,5-AG).…”

Time In Range, as measured by continuous glucose monitor, as a predictor of microvascular complications in type 2 diabetes– A systemic review

“…15 eligible publications were retrieved in the full text, of which 4 did not meet inclusion criteria. Ultimately, we included 11 articles in our systematic review (Figure 1) (11-21). There was complete agreement between authors regarding article inclusion, risk-of-bias assessment, and data extraction.…”

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

“…Taken together, the ndings suggest that the predictive markers for hypoglycemia in patients with diabetes differ between elderly patients and adult patients of all ages. Recently, an observation study involving CGM for 281 adult type 2 diabetes outpatients aged 40-75 years, including 181 patients aged 65-70 years, revealed that low HbA1c level and use of hypoglycemic agents related to hypoglycemia including sulfonylureas, glinides and insulin were associated with high TBR [15]. Although the subjects in that study were aged < 75 years, our study enrolled older patients (> 75 years) to provide more re ective data for real-world clinical practice.…”