Associations between continuous glucose monitoring-derived metrics and HbA1c in patients with type 2 diabetes mellitus

Comparison between a tubeless, on-body automated insulin delivery system and a tubeless, on-body sensor-augmented pump in type 1 diabetes: a multicentre randomised controlled trial

AIMS/HYPOTHESIS

This study compares the efficacy and safety of a tubeless, on-body automated insulin delivery (AID) system with that of a tubeless, on-body sensor-augmented pump (SAP).

METHODS

This multicentre, parallel-group, RCT was conducted at 13 tertiary medical centres in South Korea. Adults aged 19-69 years with type 1 diabetes who had HbA1c levels of <85.8 mmol/mol (<10.0%) were eligible. The participants were assigned at a 1:1 ratio to receive a tubeless, on-body AID system (intervention group) or a tubeless, on-body SAP (control group) for 12 weeks. Stratified block randomisation was conducted by an independent statistician. Blinding was not possible due to the nature of the intervention. The primary outcome was the percentage of time in range (TIR), blood glucose between 3.9 and 10.0 mmol/l, as measured by continuous glucose monitoring. ANCOVAs were conducted with baseline values and study centres as covariates.

RESULTS

A total of 104 participants underwent randomisation, with 53 in the intervention group and 51 in the control group. The mean (±SD) age of the participants was 40±11 years. The mean (±SD) TIR increased from 62.1±17.1% at baseline to 71.5±10.7% over the 12 week trial period in the intervention group and from 64.7±17.0% to 66.9±15.0% in the control group (difference between the adjusted means: 6.5% [95% CI 3.6%, 9.4%], p<0.001). Time below range, time above range, CV and mean glucose levels were also significantly better in the intervention group compared with the control group. HbA1c decreased from 50.9±9.9 mmol/mol (6.8±0.9%) at baseline to 45.9±7.4 mmol/mol (6.4±0.7%) after 12 weeks in the intervention group and from 48.7±9.1 mmol/mol (6.6±0.8%) to 45.7±7.5 mmol/mol (6.3±0.7%) in the control group (difference between the adjusted means: -0.7 mmol/mol [95% CI -2.0, 0.8 mmol/mol] (-0.1% [95% CI -0.2%, 0.1%]), p=0.366). No diabetic ketoacidosis or severe hypoglycaemia events occurred in either group.

CONCLUSIONS/INTERPRETATION

The use of a tubeless, on-body AID system was safe and associated with superior glycaemic profiles, including TIR, time below range, time above range and CV, than the use of a tubeless, on-body SAP.

TRIAL REGISTRATION

Clinical Research Information Service (CRIS) KCT0008398 FUNDING: The study was funded by a grant from the Korea Medical Device Development Fund supported by the Ministry of Science and ICT; the Ministry of Trade, Industry and Energy; the Ministry of Health and Welfare; and the Ministry of Food and Drug Safety (grant number: RS-2020-KD000056).

Glycemic variability through the perspective of the glycemia risk index and time in range and their association with glycated hemoglobin A1c in pediatric patients on sensor-augmented pump therapy

Introduction

From the introduction of continuous glucose monitoring (CGM) in treatments of type 1 diabetes, particularly its integration with insulin pumps, there has been a quest for new parameters that describe optimal glycemic control. As of the consensus reached in 2019, the ambulatory glucose profile (AGP) has become the standard, with time in range (TIR) emerging as a fundamental parameter for metabolic control assessment. However, with technological advancements, new parameters, such as the glycemia risk index (GRI), have been introduced and clinically utilized. Therefore, exploring the relationships between traditional and novel parameters to understand metabolic control comprehensively is imperative.

Materials and methods

This study was conducted at the Pediatric Clinic of the University Hospital of the Republic of Srpska Banja Luka between January and July 2023. The participants were randomly selected, with the inclusion criteria specifying an age greater than eight years and a diabetes type 1 duration exceeding two years. All participants were required to use a sensor-augmented insulin pump for the next three months (90 days), irrespective of prior use, with the suspend-before-low option activated.

Results

Of the 35 participants, 30 completed the study, 14 (46.7%) of whom were male. The mean age of the subjects was 14.90 ± 2.88 years, and the mean duration of diabetes was 7.83 ± 4.76 years. Over the 90-day period, HbA1c increased to an average of 7.31%. The analysis revealed significant effects of TIR (β=-0.771) and GRI (β=0.651) on HbA1c. Furthermore, GRI and TIR strongly correlated (β=-0.953).

Discussion and conclusion

New parameters generated from the ambulatory glucose profile (AGP) can help clinicians create a complete picture of a patient's metabolic control in relation to HbA1c levels. Additionally, the GRI is a mathematically tailored parameter that incorporates all components of the ambulatory glucose profile and demonstrates strong correlations with laboratory-measured HbA1c and TIR. The GRI potentially can become a valuable statistical parameter for evaluating and managing patients in routine clinical practice.

Correlation between time on target and glycated hemoglobin in people with diabetes mellitus: systematic review

to analyze the correlation between time on target and glycated hemoglobin in people living with diabetes mellitus and carrying out continuous blood glucose monitoring or self-monitoring of capillary blood glucose.

systematic review of etiology and risk based on JBI guidelines and reported according to Preferred Reporting Items for Systematic Reviews and Meta- Analyses, covering six databases and grey literature. The sample included 16 studies and methodological quality was assessed using JBI tools. Protocol registered in the Open Science Framework, available at https://doi.org/10.17605/OSF.IO/NKMZB.

time on target (70-180 mg/dl) showed a negative correlation with glycated hemoglobin, while time above target (>180 mg/dl) showed a positive correlation. Correlation coefficients ranged between -0.310 and -0.869 for time on target, and between 0.66 and 0.934 for time above target. A study was carried out on a population that performed self-monitoring.

there is a statistically significant correlation between time on target and time above target with glycated hemoglobin. The higher the proportion in the adequate glycemic range, the closer to or less than 7% the glycated hemoglobin will be. More studies are needed to evaluate this metric with data from self-monitoring of blood glucose.

Association Between Time in Range and Postprandial Glucose Contribution Rate in Non-Insulin-Treated Type 2 Diabetes Patients: Inverse Correlation of Time in Range with Postprandial Glucose Contribution Rate

Background: Whether time in range (TIR), a parameter derived from continuous glucose monitoring (CGM), is a marker of postprandial hyperglycemia remains to be determined. In this study, we examined the association between TIR and postprandial glucose in non-insulin-treated type 2 diabetic patients. Methods: Our cross-sectional study included 729 non-insulin-treated patients with type 2 diabetes who underwent CGM without any changes in drug therapy on admission. The 24-h CGM record was analyzed for average glucose, standard deviation, percentage coefficient of variation, time above range, TIR, time below range, area under the curve (AUC) of basal glucose, AUC of postprandial glucose, and postprandial glucose contribution rate (%). The primary endpoint was the association between TIR and the postprandial glucose contribution rate. Results: We made TIR groups divided into 10% increments for a 7-group and compared with <40% to >90%. The basal and postprandial glucose AUCs correlated negatively with TIR. The postprandial glucose contribution rate correlated with TIR. The cutoff value for TIR, where postprandial glucose contribution rate was lower than the basal glucose contribution rate, was 66.3%. Conclusions: In non-insulin-treated type 2 diabetic patients, postprandial glucose AUC was higher in the high TIR group, whereas the basal glucose AUC was higher in the low TIR group. Good glycemic control can be achieved with therapeutic interventions that target postprandial glucose and basal glucose in patients with TIR ≥66.3% and <66.3%, respectively. University Medical Information Network [UMIN] ID: UMIN0000254333.