New Recommendations for Time-in-Range Targets During Continuous Glucose Monitoring Presented Today at the ADA’s Scientific Sessions
San Francisco, California
June 8, 2019
Evidence-based guidelines for Continuous Glucose Monitoring (CGM) have been determined by an international panel of diabetes experts striving for consistent parameters for CGM blood glucose level goals in both research and clinical settings, according to a presentation today of the abstract titled “CGM-Based Clinical Targets: Recommendations from the International Consensus on Time-in-Range (TIR)” at the American Diabetes Association’s® (ADA’s) 79th Scientific Sessions® at Moscone Convention Center in San Francisco. The group’s recommendations are also published online today as a manuscript titled, “Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time-in-Range” in Diabetes Care.
Continuous Glucose Monitoring (CGM) provides people living with diabetes real-time readings of their blood glucose levels via a sensor that is inserted under the skin. The technology offers measurement of current glucose levels and insight on the direction and rate of change in glucose levels. This information allows people with diabetes to optimize dietary intake and exercise and make informed care decisions regarding mealtime and correct insulin dosing. CGM also enables people with diabetes to respond immediately and appropriately to decrease or prevent acute glycemic events. As research surrounding CGM has demonstrated increased accuracy and improved convenience, the use of CGM in clinical settings remains relatively low. One potential reason is a lack of clear and agreed upon glycemic targets that diabetes care teams and people with diabetes can work towards.
The Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of 43 physicians, researchers, and individuals with diabetes who are experts in CGM technologies and diabetes research and care to create guidelines for CGM Time-in-Range goals. The group’s objective was to develop evidence-based, clinical CGM targets to supplement the currently agreed-upon metrics for CGM derived times in glucose ranges (within target range, below target range, above target range) in order to provide guidance for clinicians, researchers, and individuals with diabetes to utilize, interpret and report CGM data in routine clinical care and research. To ensure the recommendations are generalizable and comprehensive, the consensus panel included individuals living with diabetes and had international representation from physicians and researchers from all geographic regions. This international consensus report has been endorsed by the American Diabetes Association, 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, JDRF, and Pediatric Endocrine Society.
“Although unified recommendations for the use of key CGM metrics have been established, formal adoption by diabetes professional organizations, and guidance in the practical application of these metrics in routine clinical practice has been lacking,” said presenting author Tadej Battelino, MD, PhD, head of the department of pediatric and adolescent endocrinology at Ljubljana University Medical Centre in Slovenia, and chair and professor of pediatrics at the University of Ljubljana. “CGM has the potential to transform diabetes care and our group believes that clear, easy-to-understand and broadly agreed-upon glycemic targets for time-in-range levels will positively impact short- and long-term diabetes outcomes, particularly if understood and adopted by people with diabetes. It is critical for clinical care, regulatory oversight and research efforts related to CGM to all agree on standard core CGM metrics.”
While the panel maintains that CGM-based glycemic targets must be personalized to meet the needs of each individual with diabetes, the group reached a general consensus on glycemic recommendations based on data from large pre-CGM clinical trials, CGM randomized controlled trials and expert opinion. In their recommendations, the International Consensus on TIR targets, the panel outlines recommended cut points that individuals with type 1 diabetes, type 2 diabetes and women with diabetes during pregnancy should strive to achieve. The group recommends a target range of 70-180 mg/dL [3.9-10.0 mmol/L] for individuals with type 1 diabetes and type 2 diabetes, and 63-140 mg/dL [3.5-7.8 mmol/L] during pregnancy, along with a set of targets for the time per day [% of CGM readings or minutes/hrs]). The recommendations also outline setting conservative CGM targets for people with diabetes who are older and/or considered 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 consensus group also emphasized that one important way to translate these new CGM targets into clinical practice is to implement a standard CGM report like the ambulatory glucose profile (AGP Report).
“These standardized CGM metrics and targets will be instrumental in improving care for people with diabetes,” added Dr. Battelino. “In a clinical practice setting, time in ranges are both appropriate and instrumental outcome measurements that, like A1C levels, are an integral component of treatment decisions.”
To speak with Dr. Battelino, please contact the ADA Press Office on-site at San Francisco’s Moscone Convention Center on June 7-11, by phone at 415-978-3606 or by email at SciSessionsPress@diabetes.org.
The American Diabetes Association’s 79th Scientific Sessions, the world’s largest scientific meeting focused on diabetes research, prevention and care, is being held June 7-11, 2019, at the Moscone Center in San Francisco, California. Nearly 15,000 leading physicians, scientists, health care professionals and industry representatives from around the world are convened at the Scientific Sessions to unveil cutting-edge research, treatment recommendations and advances toward a cure for diabetes. During the five-day meeting, attendees receive exclusive access to more than 850 presentations and 2,000 original research presentations, participate in provocative and engaging exchanges with leading diabetes experts, and can earn Continuing Medical Education (CME) or Continuing Education (CE) credits for educational sessions. The program is grouped into eight thematic areas: Acute and Chronic Complications; Behavioral Medicine, Clinical Nutrition, Education and Exercise; Clinical Diabetes/Therapeutics; Epidemiology/Genetics; Immunology/Transplantation; Insulin Action/Molecular Metabolism; Integrated Physiology/Obesity; and Islet Biology/Insulin Secretion. Gretchen Youssef, MS, RDN, CDE, President of Health Care and Education, will deliver her address, “It’s All About Access!,” on Saturday, June 8, and Louis H. Philipson, MD, PhD, FACP, President of Medicine and Science, will deliver his lecture, “Precision Medicine—Addressing the Many Faces of Diabetes,” on Sunday, June 9. Join the Scientific Sessions conversation on social media using #ADA2019.
About the American Diabetes Association
Every day more than 4,000 people are newly diagnosed with diabetes in America. Nearly 115 million Americans have diabetes or prediabetes and are striving to manage their lives while living with the disease. The American Diabetes Association (ADA) is the nation’s leading voluntary health organization fighting to bend the curve on the diabetes epidemic and help people living with diabetes thrive. For nearly 80 years the ADA has been driving discovery and research to treat, manage and prevent diabetes, while working relentlessly for a cure. We help people with diabetes thrive by fighting for their rights and developing programs, advocacy and education designed to improve their quality of life. Diabetes has brought us together. What we do next will make us Connected for Life. To learn more or to get involved, visit us at diabetes.org or call 1-800-DIABETES (1-800-342-2383). Information is available in English and Spanish. Join the fight with us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).
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