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New recommendations for CGM time-in-range targets

By Editor
12th June 2019
Continuous glucose monitoring, Research Technology

Evidence-based guidelines for continuous glucose monitoring (CGM) have been published by an international panel of diabetes experts.

They presented a set of consistent parameters for CGM blood glucose level goals in both research and clinical settings at the American Diabetes Association’s (ADA’s) 79th Scientific Sessions in San Francisco.

The group’s recommendations have been online as a manuscript titled, Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time-in-Range Diabetes Care.

Group Recommendation
Peoplewith type 1 and 2 diabetes 70-180 mg/dL [3.9-10.0 mmol/L]
Peoplewith type 1 and 2 diabetes during pregnancy 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])
Older and/or considered high-risk people with type 1 and 2 diabetes The panel recommends setting conservative CGM targets, with a strong focus on reducing the percentage of time spent <70 mg/dL (<3.9 mmol/L) and preventing excessive hyperglycaemia.

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).

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 utilising, interpreting and reporting CGM data in routine clinical care and research.

Presenting author Professor Tadej Battelino

Presenting author, Professor Tadej Battelinois the 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.

He said: “Although unified recommendations for the use of key CGM metrics have been established, formal adoption by diabetes professional organisations, and guidance in the practical application of these metrics in routine clinical practice has been lacking.

“CGM has the potential to transform diabetes care and our group believes that clear, easy-to-understand and broadly agreed-upon glycaemic 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 glycaemic targets must be personalised to meet the needs of each individual with diabetes, the group reached a general consensus on glycaemic recommendations based on data from large pre-CGM clinical trials, CGM randomised 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.

Professor Battelino added: “These standardised CGM metrics and targets will be instrumental in improving care for people with diabetes. 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 ensure the recommendations are generalisable 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.

To access the article, click here.

Picture credits: © ADA/Todd Buchanan 2019

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