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Layne JE, Jepson LH, Carite AM, Parkin CG, Bergenstal RM. Long-Term Improvements in Glycemic Control with Dexcom CGM Use in Adults with Noninsulin-Treated Type 2 Diabetes. Diabetes Technol Ther 2024. [PMID: 38904213 DOI: 10.1089/dia.2024.0197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Aims: The objective of this real-world, observational study was to evaluate change in continuing glucose monitoring (CGM) metrics for 1 year after CGM initiation in adults with noninsulin-treated type 2 diabetes (T2D). Methods: Data were analyzed from Dexcom G6 and G7 users who self-reported: T2D, ≥18 years, gender, no insulin use, and had a baseline percent time in range (TIR) 70-180 mg/dL of ≤70%. Outcomes were change in CGM metrics from baseline to 6 and 12 months overall and for younger (<65 years) and older (≥65 years) cohorts. Additional analyses explored the relationship between use of the high alert feature and change in TIR and time in tight range (TITR) 70-140 mg/dL. Results: CGM users (n = 3,840) were mean (SD) 52.5 (11.2) years, 47.9% female, mean TIR was 41.7% (21.4%), and 12.4% of participants were ≥65 years. Significant improvement in all CGM metrics not meeting target values at baseline was observed at 6 months, with continued improvement at 12 months. Mean baseline TIR increased by 17.3% (32.1%) from 41.7% (21.4%) to 59.0% (28.9%), and mean glucose management indicator decreased by 0.5% (1.2%) from 8.1% (0.9%) to 7.6% (1.1%) (both P < 0.001). Participants who maintained or customized the high alert default setting of 250 mg/dL had a greater increase in TIR and TITR compared with participants who disabled the alert. Days of CGM use over 12 months were high in 84.7% (15.9%). Conclusion: In this large, real-world study of adults with suboptimally controlled T2D not using insulin, Dexcom CGM use was associated with meaningful improvements in glycemic control over 12 months. Use of the high alert system feature was positively associated with glycemic outcomes. High use of CGM over 12 months suggests benefits related to consistent CGM use in this population.
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Affiliation(s)
| | | | | | | | - Richard M Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
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Zhang L, Sun XX, Tian QS. Research progress on the association between glycemic variability index derived from CGM and cardiovascular disease complications. Acta Diabetol 2024; 61:679-692. [PMID: 38467807 DOI: 10.1007/s00592-024-02241-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 01/13/2024] [Indexed: 03/13/2024]
Abstract
Currently, glycated hemoglobin A1c (HbA1c) has been widely used to assess the glycemic control of patients with diabetes. However, HbA1c has certain limitations in describing both short-term and long-term glycemic control. To more accurately evaluate the glycemic control of diabetes patients, the continuous glucose monitoring (CGM) technology has emerged. CGM technology can provide robust data on short-term glycemic control and introduce new monitoring parameters such as time in range, time above range, and time below range as indicators of glycemic fluctuation. These indicators are used to describe the changes in glycemic control after interventions in clinical research or treatment modifications in diabetes patient care. Recent studies both domestically and internationally have shown that these indicators are not only associated with microvascular complications of diabetes mellitus but also closely related to cardiovascular disease complications and prognosis. Therefore, this article aims to comprehensively review the association between CGM-based glycemic parameters and cardiovascular disease complications by analyzing a large number of domestic and international literature. The purpose is to provide scientific evidence and guidance for the standardized application of these indicators in clinical practice, in order to better evaluate the glycemic control of diabetes patients and prevent the occurrence of cardiovascular disease complications. This research will contribute to improving the quality of life for diabetes patients and provide important references for clinical decision-making.
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Affiliation(s)
- Lei Zhang
- The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China
- Cardiovascular Medicine Department, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China
| | - Xiao-Xuan Sun
- School of Nursing, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China.
- Nursing Department, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China.
| | - Qing-Shan Tian
- Cardiovascular Medicine Department, The 1st Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China.
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Bahillo-Curieses P, Fernández Velasco P, Pérez-López P, Vidueira Martínez AM, Nieto de la Marca MDLO, Díaz-Soto G. Utility of time in tight range (TITR) in evaluating metabolic control in pediatric and adult patients with type 1 diabetes in treatment with advanced hybrid closed-loop systems. Endocrine 2024:10.1007/s12020-024-03881-6. [PMID: 38814372 DOI: 10.1007/s12020-024-03881-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/16/2024] [Indexed: 05/31/2024]
Abstract
PURPOSE To analyze the time in tight range (TITR), and its relationship with other glucometric parameters in patients with type 1 diabetes (T1D) treated with advanced hybrid closed-loop (AHCL) systems. METHODS A prospective observational study was conducted on pediatric and adult patients with T1D undergoing treatment with AHCL systems for at least 3 months. Clinical variables and glucometric parameters before and after AHCL initiation were collected. RESULTS A total of 117 patients were evaluated. Comparison of metabolic control after AHCL initiation showed significant improvements in HbA1c (6.9 ± 0.9 vs. 6.6 ± 0.5%, p < 0.001), time in range (TIR) (68.2 ± 11.5 vs. 82.5 ± 6.9%, p < 0.001), TITR (43.7 ± 10.8 vs. 57.3 ± 9.7%, p < 0.001), glucose management indicator (GMI) (6.9 ± 0.4 vs. 6.6 ± 0.3%, p < 0.001), time below range (TBR) 70-54 mg/dl (4.3 ± 4.5 vs. 2.0 ± 1.4%, p < 0.001), and time above range (TAR) > 180 mg/dl (36.0 ± 7.6 vs. 15.1 ± 6.4%, p < 0.001). Coefficient of variation (CV) also improved (36.3 ± 5.7 vs. 30.6 ± 3.7, p < 0.001), while time between 140-180 mg/dl remained unchanged. In total, 76.3% achieved TITR > 50% (100% pediatric). Correlation analysis between TITR and TIR and GRI showed a strong positive correlation, modified by glycemic variability. CONCLUSIONS AHCL systems achieve significant improvements in metabolic control (TIR > 70% in 93.9% patients). The increase in TIR was not related to an increase in TIR 140-180 mg/dl. Despite being closely related to TIR, TITR allows for a more adequate discrimination of the achieved control level, especially in a population with good initial metabolic control. The correlation between TIR and TITR is directly influenced by the degree of glycemic variability.
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Affiliation(s)
- Pilar Bahillo-Curieses
- Department of Pediatrics, Pediatric Endocrinology, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain.
| | - Pablo Fernández Velasco
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - Paloma Pérez-López
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - Ana María Vidueira Martínez
- Department of Pediatrics, Pediatric Endocrinology, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - María de la O Nieto de la Marca
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
| | - Gonzalo Díaz-Soto
- Department of Endocrinology and Nutrition, Hospital Clínico Universitario Valladolid, Ramón y Cajal Avenue, Number 3, 47005, Valladolid, Spain
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Akturk HK, Battelino T, Castañeda J, Arrieta A, van den Heuvel T, Cohen O. Future of Time-in-Range Goals in the Era of Advanced Hybrid Closed-Loop Automated Insulin Delivery Systems. Diabetes Technol Ther 2024; 26:102-106. [PMID: 38377325 PMCID: PMC10890947 DOI: 10.1089/dia.2023.0432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
The concept of maintaining blood glucose levels within the 70-180 mg/dL range, known as time-in-range, has raised questions regarding its representation of true physiological euglycemia. Some have speculated that focusing on the time spent within the 70-140 mg/dL range, introduced as time in tight range (TITR) through the International Consensus statement, could serve as a more precise metric for assessing normoglycemia in individuals with type 1 diabetes. This article delves into the current status of TITR as an emerging marker and explores how advanced hybrid closed-loop systems may offer a promising avenue for achieving this higher level of glycemic control.
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Affiliation(s)
- Halis K. Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado, USA
| | - Tadej Battelino
- University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Arcelia Arrieta
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
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Dovc K, Bode BW, Battelino T. Continuous and Intermittent Glucose Monitoring in 2023. Diabetes Technol Ther 2024; 26:S14-S31. [PMID: 38441451 DOI: 10.1089/dia.2024.2502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Klemen Dovc
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Bruce W Bode
- Atlanta Diabetes Associates and Emory University School of Medicine, Atlanta, GA, USA
| | - Tadej Battelino
- University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Beck RW. Is It Time to Replace Time-in-Range with Time-in-Tight-Range? Maybe Not. Diabetes Technol Ther 2024; 26:147-150. [PMID: 38156959 DOI: 10.1089/dia.2023.0602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Roy W Beck
- JAEB Center for Health Research, Tampa, Florida, USA
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Beck RW, Raghinaru D, Calhoun P, Bergenstal RM. A Comparison of Continuous Glucose Monitoring-Measured Time-in-Range 70-180 mg/dL Versus Time-in-Tight-Range 70-140 mg/dL. Diabetes Technol Ther 2024; 26:151-155. [PMID: 37870460 DOI: 10.1089/dia.2023.0380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Objective: To evaluate the relationship between continuous glucose monitoring (CGM)-measured time-in-range 70-180 mg/dL (TIR) and time-in-tight-range 70-140 mg/dL (TITR). Methods: TIR and TITR were calculated from CGM data collected using blinded or unblinded Dexcom sensors from 9 studies with 912 participants with type 1 diabetes (T1D) and 2 studies with 184 participants with type 2 diabetes (T2D). The TIR-TITR relationship was assessed overall and stratified by coefficient of variation (CV) and by time below range <70 mg/dL (TBR). Results: The correlation between TIR and TITR was 0.94. TITR was higher for a given TIR for T2D compared with T1D. However, after adjusting for the differences in CV or TBR, both of which were higher with T1D than T2D, the differences were minimized. The TIR-TITR relationship was nonlinear, with a higher ratio of TITR:TIR observed as TIR increased ranging from 0.42 when TIR was 20% to 0.66 when TIR was 80%. Similarly, as TITR increased, the ratio of TIR:TITR decreased, varying from 2.6 with TITR of 10% to 1.3 for TITR of 70%. The TIR-TITR relationship varied according to CV and TBR, such that the higher the CV or higher the amount of TBR the greater was TITR for a given TIR. Conclusions: TIR and TITR are highly correlated, although the relationship is nonlinear. With knowledge of TIR, TITR can be estimated with reasonable precision.
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Affiliation(s)
- Roy W Beck
- JAEB Center for Health Research, Tampa, Florida, USA
| | - Dan Raghinaru
- JAEB Center for Health Research, Tampa, Florida, USA
| | - Peter Calhoun
- JAEB Center for Health Research, Tampa, Florida, USA
| | - Richard M Bergenstal
- International Diabetes Center, HealthPartners Institute, Minneapolis, Minnesota, USA
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Sun C, Zhou JH, Huang YL, Ning YL, Xu XH. The optimal blood glucose is significantly associated with lower mortality in critically ill patients with cardiogenic shock: an analysis revealed with time series blood glucose records. Eur J Med Res 2024; 29:129. [PMID: 38368401 PMCID: PMC10874009 DOI: 10.1186/s40001-024-01724-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/10/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND The optimal blood glucose (BG) level for patients with cardiogenic shock in the intensive care unit (ICU) remains unclear. Studies have found that both excessively high and low BG levels contribute to adverse cardiovascular events. Our study aims to investigate the optimal BG level for critically ill patients with cardiogenic shock and evaluate the effects of optimal BG on the prognosis of patients. METHODS A total of 2013 patients with cardiogenic shock obtained from the Medical Information Mart for Intensive Care (MIMIC) IV database were included in the final cohort for our retrospective observational study for data analysis. The exposure was time-weighted average BG (TWA-BG), which was calculated by the time-series BG records and corresponding time stamps of patients with cardiogenic shock during their stay in the ICU. The cut-off value of TWA-BG was identified by the restricted cubic spline curve and included patients were categorized into three groups: low TWA-BG group (TWA-BG ≤ 104 mg/dl), optimal TWA-BG group (104 < TWA-BG ≤ 138 mg/dl), and high TWA-BG group (TWA-BG > 138 mg/dl). The primary outcome was 28-day mortality, and the secondary outcomes were ICU and in-hospital mortality. We performed the log-rank test to detect whether there is a difference in mortality among different groups in the original cohort. Multiple distinct models were employed to validate the robustness of the results. RESULTS Our study revealed that the optimal BG level for critically ill patients with cardiogenic shock is 104-138 mg/dl. Compared to the optimal TWA-BG group, the low TWA-BG group (hazard ratio (HR): 1.67, 95% confidence interval (CI): 1.19-2.33, p = 0.002) and high TWA-BG group (HR: 1.72, 95% CI: 1.46-2.03, p < 0.001) exhibited higher 28-day mortality. Similarly, the low TWA-BG group and high TWA-BG group demonstrated higher risks in terms of ICU mortality (low TWA-BG group: HR: 2.30, 95% CI: 1.40-3.79, p < 0.001; high TWA-BG group: HR: 1.77, 95% CI: 1.45-2.17, p < 0.001) and in-hospital mortality (low TWA-BG group: HR: 1.73, 95% CI: 1.19-2.51, p = 0.001; high TWA-BG group: HR: 1.64, 95% CI: 1.38-1.95, p < 0.001). Sensitivity analysis conducted through propensity score matching and the subgroup analysis further substantiated the robustness of the results. CONCLUSION The optimal BG level for patients with cardiogenic shock is 104-138 mg/dl. BG levels below 104 mg/dl and above 138 mg/dl were associated with a less favorable prognosis.
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Affiliation(s)
- Ce Sun
- Department of Critical Care Medicine, Meizhou Hospital of Guangzhou University of Chinese Medicine, Meizhou, China
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ji-Hong Zhou
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine (PCCM), Bao'an District Hospital of Chinese Medicine, Shenzhen, China
| | - Yan-Ling Huang
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Pulmonary and Critical Care Medicine (PCCM), Bao'an District Hospital of Chinese Medicine, Shenzhen, China
| | - Yi-Le Ning
- The First Clinical School, Guangzhou University of Chinese Medicine, Guangzhou, China.
| | - Xiang-Hui Xu
- Department of Critical Care Medicine, Bao'an District Hospital of Chinese Medicine, Shenzhen, China.
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Bergenstal RM. Roadmap to the Effective Use of Continuous Glucose Monitoring: Innovation, Investigation, and Implementation. Diabetes Spectr 2023; 36:327-336. [PMID: 37982061 PMCID: PMC10654130 DOI: 10.2337/dsi23-0005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
For 25 years, continuous glucose monitoring (CGM) has been evolving into what it is now: a key tool to both measure individuals' glycemic status and to help guide their day-to-day management of diabetes. Through a series of engineering innovations, clinical investigations, and efforts to optimize workflow implementation, the use of CGM is helping to transform diabetes care. This article presents a roadmap to the effective use of CGM that outlines past, present, and possible future advances in harnessing the potential of CGM to improve the lives of many people with diabetes, with an emphasis on ensuring that CGM technology is available to all who could benefit from its use.
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