The Optimal “Time in Range” and “Time below Range” are Difficult to Coordinate in Patients with Type 1 Diabetes

The Optimal “Time in Range” and “Time below Range” are Difficult to Coordinate in Patients with Type 1 Diabetes

Sho Sekiguchi,¹ Eijiro Yamada,¹ Yasuyo Nakajima,¹ Shunichi Matsumoto,¹ Satoshi Yoshino,¹ Kazuhiko Horiguchi,¹ Emi Ishida,¹ Ryota Uehara,¹ Shuichi Okada¹ and Masanobu Yamada¹

¹Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan

Achieving the optimal glucose level time in range (TIR), as recently proposed by the “International Consensus on Time in Range,” is challenging. We retrospectively analyzed data from 192 patients, including 58 with type 1 diabetes, using the FreeStyle Libre Pro system. This device was used by physicians for continuous glucose monitoring (CGM) and for making therapeutic decisions based on unbiased data, as the patients were blinded to their blood glucose levels during monitoring. The desired 70% TIR among patients with type 2 diabetes corresponded to an HbA1c of 7.7%. Importantly, however, a 70% TIR for patients with type 1 diabetes corresponded to an HbA1c of 6.9%, which diverged markedly from the HbA1c of 7.9% that corresponded to the desired 4% time below range (TBR). Moreover, these dissociations were observed more in patients with type 1 diabetes with a higher % coefficient of variation (¥> 36%). Hence, while the TIR is strongly correlated with HbA1c, it is difficult to coordinate with the TBR in Japanese patients with type 1 diabetes. As these metrics (which are critical indicators in clinical practice) are rapidly gaining popularity globally, including in Japan, our data strongly support the cautious use of new CGM metrics such as TIR and TBR/time above range, and emphasize the importance of individualized treatment in achieving the optimal TIR and TBR, especially in patients with type 1 diabetes.

Keywords —— continuous glucose monitoring; diabetes mellitus; time above range; time below range; time in range

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Tohoku J. Exp. Med 2021, 255, 221-227.

Correspondence: Eijiro Yamada, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan.

e-mail: eijiro.yamada@gunma-u.ac.jp