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New Recommendations for Time In Range Goals Using A CGM — ADA 2019

Jun 18, 2019
 
Editor: Steve Freed, R.PH., CDE

Author: Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate

As the use of continuous glucose monitoring expands into clinical practice, new consensus recommendations for time in range goals featured at ADA.

Due to better improvements in sensor accuracy, greater convenience, and expanding reimbursement, the use of continuous glucose monitoring (CGM) has been rapidly growing. Yet, the routine use of CGM in clinical practice remains low due to the unclear parameters for blood glucose target goals in CGM metrics. Diabetes experts around the world have come together to establish clear targets for CGM metrics that clinicians and people with diabetes can work together to achieve. These new recommendations were presented at the 79th Scientific Sessions of the American Diabetes Association (ADA) in San Francisco.

CGM provides people with diabetes readings of their glucose levels throughout the day and night, by a sensor that is inserted under the skin. The sensor is combined with software that codes the glucose level for users to read. This information informs people with diabetes on proper decisions to make about dietary consumptions, mealtime, and correct insulin dosing. CGM also has the ability to compute the time below, within, and above the set glycemic targets.  CGM is also helpful in preventing glycemic events from occurring by users being able to respond immediately. CGM has progressed in advancement and convenience for people with diabetes but the use of CGM in clinical or research settings is limited. The lack of application of CGM can have stemmed from consistent glycemic target goals not being established, that both clinicians and people with diabetes can work towards.

In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress organized an international panel of diabetes experts with experience in CGM technologies to create clinical CGM targets to supplement the current metrics for CGM derived time in range goals for routine clinical care and research. All geographic regions were represented on the consensus panel, with individuals living with diabetes a part of the panel as well. The panel was split into various subgroups to provide recommendations relevant to CGM data utilization and review literature among various diabetes populations, relating to relationships between time in range and HbA1c and glycemic events. It is evident that glycemic target goals should be personalized to meet the needs of each individual with diabetes; thus the consensus on glycemic recommendations were based from large pre-CGM clinical trials, CGM randomized control trials, and expert opinion. The international consensus report was approved by the ADA, American Association of Clinical Endocrinologists, American Association of Diabetes Educators, European Association for the Study of Diabetes, Foundation of European Nurses in Diabetes, International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation, and Pediatric Endocrine Society.

In the international consensus on time in range goals for individuals with type 1 and type 2 diabetes, the recommended glycemic target range was 70-180 mg/dL. For pregnancy, the recommended target range was 63-140 mg/dL, along with a set of targets for the time per day (percentage of CGM readings or minutes per hours). The recommendation for CGM targets for individuals with diabetes who are older and/or considered high-risk, who want to reduce the percentage of time spent and preventing excessive hyperglycemia, is <70 mg/dL. The consensus panel emphasize an important way of implementing the CGM target goals in clinical setting would be to use a standard continuous glucose monitoring report such as the ambulatory glucose profile.

During the presentation at the Scientific Session, Tadej Battelino, MD, PhD, of Ljubljana University Medical Centre, Slovenia, stated that diabetes care may be transformed with continuous glucose monitoring. Battelino believes that the international consensus report provides clear, easy-to-understand glycemic targets for time-in-range levels that will lead to positive outcomes in individuals with diabetes. An agreed-upon standard core has been established for CGM metrics, which is critical for clinical care, stated Battelino.

Practice Pearls:

  • The consensus panel has recommended a target range of 70 to 180 mg/dL (3.9-10.0 mmoL/L) for patients with type 1 diabetes and type 2 diabetes, and 63 to 140 mg/dL (3.5-7.8 mmoL/L) during pregnancy, along with a set of targets for the time per day (percentage of continuous glucose monitored readings or minutes per hour).
  • Conservative continuous glucose monitoring targets are to be set for patients with diabetes who are older and/or considered at high risk, with a strong focus on reducing the percentage of time spent <70 mg/dL (<3.9 mmoL/L) and preventing excessive hyperglycemia.
  • The international consensus report set target glycemic ranges for individuals with type 1 and type 2 diabetes, and women with diabetes during pregnancy to achieve.
  • These recommendations are appropriate and useful as clinical targets and outcome measurements for HbA1c for a wide range of people with diabetes for day-to-day treatment decision making.

References:

  1. “ADA 2019: Recommendations for Time-in-Range Targets During Continuous Glucose Monitoring Have Been Updated.” PracticeUpdate, www.practiceupdate.com/content/adanbsp2019-recommendations-for-time-in-range-targets-during-continuous-glucose-monitoring-have-been-updated/85191.
  2. Battelino, Tadej, et al. “Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range.” Diabetes Care, American Diabetes Association, 7 June 2019, care.diabetesjournals.org/content/early/2019/06/07/dci19-0028
  3. Battelino, Tadej. New Recommendations for Time-in-Range Targets During Continuous Glucose Monitoring

 

Reported at the American Diabetes Association 79th Scientific Sessions June, 2019

Maya Rudolph, Florida A&M University, College of Pharmacy & Pharmaceutical Sciences, PharmD Candidate