Association of time in range with hemoglobin A1c, glycated albumin and 1,5‐anhydro‐d‐glucitol

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Abstract

Aims/Introduction

Hemoglobin A1c (HbA1c), glycated albumin (GA) and 1,5‐anhydro‐ d‐glucitol (1,5‐AG) are used as indicators of glycemic control, whereas continuous glucose monitoring (CGM) is used to assess daily glucose profiles. The aim of this study was to investigate the relationships between CGM metrics, such as time in range (TIR), and glycemic control indicators.

Materials and Methods

We carried out retrospective CGM and blood tests on 189 outpatients with impaired glucose tolerance ( n = 22), type 1 diabetes mellitus ( n = 67) or type 2 diabetes mellitus ( n = 100).

Results

In type 1 diabetes mellitus and type 2 diabetes mellitus patients, HbA1c and GA were negatively correlated with TIR, whereas 1,5‐AG was positively correlated with TIR. In type 1 diabetes mellitus patients, a TIR of 70% corresponded to HbA1c, GA and 1,5‐AG of 6.9% (95% confidence interval [CI] 6.5–7.2%), 20.3% (95% CI 19.0–21.7%) and 6.0 µg/mL (95% CI 5.1–6.9 µg/mL), respectively. In type 2 diabetes mellitus patients, a TIR of 70% corresponded to HbA1c, GA and 1,5‐AG of 7.1% (95% CI 7.0–7.3%), 19.3% (95% CI 18.7–19.9%) and 10.0 µg/mL (95% CI 9.0–11.0 µg/mL), respectively. TIR values corresponding to HbA1c levels of 7.0% were 56.1% (95% CI 52.3–59.8%) and 74.2% (95% CI 71.3–77.2%) in type 1 diabetes mellitus and type 2 diabetes mellitus patients, respectively.

Conclusions

The results of this study showed that the estimated HbA1c corresponding to a TIR of 70% was approximately 7.0% for both type 1 diabetes mellitus and type 2 diabetes mellitus patients, and that the estimated 1,5‐AG calculated from the TIR of 70% might be different between type 1 diabetes mellitus and type 2 diabetes mellitus patients.

Abstract

Hemoglobin A1c was the most useful explanatory factor for mean sensor glucose levels. Glycated albumin was the most useful explanatory factor for glycemic variability and time in range.

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Most cited references 36

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The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

S Genuth, C. Siebert, D. M. Nathan … (1993)

Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications. A total of 1441 patients with IDDM--726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly. In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of > or = 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of > or = 300 mg per 24 hours) by 54 percent (95 percent confidence interval 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia. Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.

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Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Tadej Battelino, Thomas Danne, Richard M. Bergenstal … (2019)

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.

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Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

(1998)

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Author and article information

Contributors

Yoshiki Kusunoki:

ORCID: https://orcid.org/0000-0002-9361-9317

ykusu@hyo-med.ac.jp

Journal

Journal ID (nlm-ta): J Diabetes Investig

Journal ID (iso-abbrev): J Diabetes Investig

Journal ID (doi): 10.1111/(ISSN)2040-1124

Journal ID (publisher-id): JDI

Title: Journal of Diabetes Investigation

Publisher: John Wiley and Sons Inc. (Hoboken )

ISSN (Print): 2040-1116

ISSN (Electronic): 2040-1124

Publication date (Electronic): 15 November 2020

Publication date (Print): June 2021

Volume: 12

Issue: 6 ( doiID: 10.1111/jdi.v12.6 )

Pages: 940-949

Affiliations

[ ¹ ] Department of Diabetes, Endocrinology and Clinical Immunology Hyogo College of Medicine Nishinomiya Hyogo Japan

[ ² ] Department of Occupational Therapy School of Rehabilitation Hyogo University of Health Sciences Kobe Hyogo Japan

[ ³ ] Department of Diabetes Mellitus Takarazuka City Hospital Takarazuka Hyogo Japan

Author notes

[*] [* ] Correspondence

Yoshiki Kusunoki

Tel.: +81‐798‐45‐6592

Fax: +81‐798‐45‐6443

E‐mail address: ykusu@ 123456hyo-med.ac.jp

Author information

Mana Ohigashi https://orcid.org/0000-0002-1420-9337

Yoshiki Kusunoki https://orcid.org/0000-0002-9361-9317

Article

Publisher ID: JDI13437

DOI: 10.1111/jdi.13437

PMC ID: 8169363

PubMed ID: 33058513

SO-VID: 145bd7d5-cbc1-4959-9163-2ef3cc699d6e

License:

This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

History

Date revision received : 03 October 2020

Date received : 16 May 2020

Date accepted : 07 October 2020

Page count

Figures: 3, Tables: 6, Pages: 10, Words: 7677

Funding

Funded by: Hyogo College of Medicine , open-funder-registry 10.13039/501100005845;

Award ID: 210790

Custom metadata

source-schema-version-number 2.0

cover-date June 2021

details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:01.06.2021

Association of time in range with hemoglobin A1c, glycated albumin and 1,5‐anhydro‐d‐glucitol

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Most cited references 36

The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus

Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)

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