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ADA Issues Time-in-Range Targets for CGM Use

Mary Caffrey
The consensus report was presented at the 79th Scientific Sessions of the American Diabetes Association in San Francisco, California. 
Battelino briefed members of the media on the group’s consensus recommendations, and encouraged wide dissemination “to improve outcomes and reduce the burden of diabetes.” Guidelines are as follows:

Type 1/Type 2 Users
  • The target of 70 mg/dL to 180 mg/dL should be maintained at least 70% of the time.
  • CGM users should allow low blood glucose levels of at least 70 mg/dL for less than 4% of the day, or about 1 hour, and very low levels of less than 54 mg/dL for no more than 1% of the day, or 15 minutes.
  • Users should allow blood glucose of more than 180 mg/dL for less than 25% of the time, and very high levels of more than 250 mg/dL for less than 5% of the time.
Older/High-Risk Users, Both Type 1 and Type 2
  • The target of 70 mg/dL to 180 mg/dL should be maintained more than 50% of the time.
  • Avoiding hypoglycemia is a priority in this population, so CGM users should allow low blood glucose levels of less than 70 mg/dL for less than 1% of the day, or 15 minutes.
  • Users should allow blood glucose of more than 180 mg/dL for less than 50% of the time, and very high levels of more than 250 mg/dL for less than 10% of the time.
Pregnant Users With T1D
  • A target of 63 mg/dL to 140 mg/dL should be maintained more than 70% of the time.
  • Pregnant CGM users with T1D should allow low blood glucose levels of less than 63 mg/dL for less than 4% of the day (1 hour) and very low levels of less than 54 mg/dL for less than 1% of the day (15 minutes). 
  • Users can keep blood glucose of more than 140 mg/dL to less than 25% of the time, or 6 hours.
Pregnant Users With Type 2 Diabetes (T2D) or Gestational Diabetes
  • A target of 63 mg/dL to 140 mg/dL should be maintained.
  • Because of the lack of evidence on CGM targets for women with gestational diabetes or T2D in pregnancy, percentages of time spent in range, below range and above range were not provided.
How can the guidelines be implemented into clinical practice? The consensus group called for translating the new CGM targets in a standard report, such an ambulatory glucose profile, or AGP Report.

“These standardized CGM metrics and targets will be instrumental in improving care for people with diabetes,” Battelino said in a statement. “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.”

Besides the ADA, groups endorsing the report are the 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.

Reference
Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time-in-range [published online June 8, 2019]. Diabetes Care. 2019; doi.org/10.2337/dci19-0028.

 
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