Time in Range Estimation in Patients with Type 2 Diabetes is Improved by Incorporating Fasting and Postprandial Glucose Levels

Abstract

Introduction Time in range (TIR) as assessed by continuous glucose monitoring (CGM) measures an individual’s glucose fluctuations within set limits in a time period and is increasingly used together with HbA1c in patients with diabetes. HbA1c indicates the average glucose concentration but provides no information on glucose fluctuation. However, before CGM becomes available for patients with type 2 diabetes (T2D) worldwide, especially in developing nations, fasting plasma glucose (FPG) and postprandial plasma glucose (PPG) are still the common biomarkers used for monitoring diabetes conditions. We investigated the importance of FPG and PPG to glucose fluctuation in patients with T2D. We used machine learning to provide a new estimate of TIR based on the HbA1c, together with FPG and PPG. Methods This study included 399 patients with T2D. (1) Univariate and (2) multivariate linear regression models and (3) random forest regression models were developed to predict the TIR. Subgroup analysis was performed in the newly diagnosed T2D population to explore and optimize the prediction model for patients with different disease history. Results Regression analysis suggests that FPG was strongly linked to minimum glucose, while PPG was strongly correlated with maximum glucose. After FPG and PPG were incorporated into the multivariate linear regression model, the prediction performance of TIR was improved compared with the univariate correlation between HbA1c and TIR, and the correlation coefficient (95% CI) increased from 0.62 (0.59, 0.65) to 0.73 (0.72, 0.75) ( p < 0.001). The random forest model significantly outperformed the linear model ( p < 0.001) in predicting TIR through FPG, PPG and HbA1c, with a stronger correlation coefficient 0.79 (0.79, 0.80). Conclusions The results offered a comprehensive understanding of glucose fluctuations through FPG and PPG compared to HbA1c alone. Our novel TIR prediction model based on random forest regression with FPG, PPG, and HbA1c provides a better prediction performance than the univariate model with solely HbA1c. The results indicate a nonlinear relationship between TIR and glycaemic parameters. Our results suggest that machine learning may have the potential to be used in developing better models for understanding patients’ disease status and providing necessary interventions for glycaemic control. Supplementary Information The online version contains supplementary material available at 10.1007/s13300-023-01432-2.

Time in range prediction using the experimental mobile application in type 1 diabetes

“…Одной из главных нерешенных проблем в этой области остается вопрос интерпретации и практического применения показателя dTIR, рассчитанного на основании данных СМГК. Альтернативой dTIR является применение технологий предсказания TIR(НМГ) с использованием параметра прогнозируемого TIR (estimated time in range, eTIR) [6]. При анализе актуальной литературы нами не найдено информации о сравнительных исследованиях параметров dTIR и eTIR и сопоставления их с референсным методом -TIR(НМГ).…”

“…Sun и соавт. предлагают прогнозировать TIR с помощью алго-ритмов машинного обучения (МО) на основании данных HbA 1c , пре-и постпрандиальной ГК [6]. Другим подходом в прогнозировании TIR может быть использование данных о самоконтроле, полученных с помощью специализированного МП (показатели средней ГК, времени нахождения в различных диапазонах ГК, параметры вариабельности гликемии), однако данные актуальной литературы не содержат информации о подобных работах, что подчеркивает актуальность и новизну настоящего исследования.…”

“…В ретроспективном исследовании Sun R. и соавт. описывается разработка прогностических моделей eTIR на основании ПЛР (предиктор -HbA 1c ), МЛР (предикторы: HbA 1c , пре-и постпрандиальная ГК), модели МО «случайный лес» (предикторы: HbA 1c , пре-и постпрандиальная ГК) [6]. RMSE при СД2 для указанных моделей составила 21,79, 19,18, 18,48 соответственно, что указывало на потенциальное преимущество модели «случайный лес».…”

Letter to the Editor Regarding “Time in Range Estimation in Patients with Type 2 Diabetes is Improved by Incorporating Fasting and Postprandial Glucose Levels”

“…The article published by Sun et al [ 3 ] provides a well-organized and systematic approach to comparing FPG and PPG with HbA1c in terms of glycemic control, highlighting the nonlinear relationship between TIR and glycemic parameters. The study mentions that previous research has shown severe cardiovascular symptoms even in individuals with normal HbA1c levels, yet the underlying cause of this effect remains unresolved.…”

“…I highly appreciate that the authors provided substantial data and graphs, including univariate ( R 2 = 0.26, p < 0.001) and multivariate regression analysis ( R 2 = 0.36, p < 0.001) [ 3 ]. However, future studies and meta-analyses are required to gain further clarity on these intriguing results.…”