Many patients are looking at their continuous glucose monitoring data 10, 20, or 30 times a day. Second, you can teach patients how to use real-time continuous glucose monitoring data to effectively manage their diabetes. Then you can agree on appropriate changes in lifestyle or medications to minimize this risk of hypoglycemia. If your patient has too much TBR, or hypoglycemia, you can review the retrospective continuous glucose monitoring data with your patient to see when during the day or night hypoglycemia most often occurs. For example, if the AGP shows that your patient isn’t reaching the target of 70 percent TIR, you can encourage your patient to steadily work to increase TIR by at least 5 percent before the next visit or phone call. You can review and discuss the AGP with patients during clinic visits or phone calls. The Ambulatory Glucose Profile (AGP) is a standard one-page report that includes the core continuous glucose monitoring metrics and targets, along with a visualization of the patient’s daily glucose profile. Q: How can health care professionals work with their patients who use CGMs?Ī: First, you can use continuous glucose monitoring data in shared decision-making with patients. For patients who are significantly below the target of 70 percent TIR and may feel discouraged, health care professionals can emphasize that every 5 percent increase in TIR will have clinical benefits. This research informed the 2019 international consensus report statement that every 5 percent increase in TIR is clinically important for all people with type 1 or type 2 diabetes. This research has led to more routine use of continuous glucose monitoring during pregnancy and showed that even small increases in TIR have clinical benefits. A JDRF-funded study, Continuous Glucose Monitoring in Women With Type 1 Diabetes in Pregnancy Trial (CONCEPTT), found the use of CGM led to an increase in TIR by 7 percent and this improved pregnancy outcomes. An A1C of 7 percent is a long-standing goal for reducing the risk of diabetes complications, if a person can achieve this goal safely.Ī couple of good studies have shown that using continuous glucose monitoring to help manage type 1 diabetes during pregnancy improves neonatal outcomes. For example, studies have shown that 70 percent TIR approximately correlates with an A1C of 7 percent. We based the targets on evidence in the literature to ensure that reaching these targets was possible and would reduce the risk of acute and long-term complications. Q: Why are data about time in ranges important? How can meeting these targets improve diabetes management?Ī: The clinical targets may be aspirational for some people with diabetes. The report also recommends time-in-range targets for older and/or high-risk individuals with type 1 or type 2 diabetes and for pregnant women with type 1 diabetes. TAR above 250 mg/dL: less than 5 percent.TAR above 180 mg/dL: less than 25 percent.TBR below 54 mg/dL: less than 1 percent.TBR below 70 mg/dL: less than 4 percent.We recommend the following clinical targets for CGM blood glucose readings for most people who have type 1 or type 2 diabetes The second step was to decide on clinical targets for these metrics, so health care professionals and patients would know what values to strive for.Īnother international consensus group convened, and the resulting report, Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time in Range, was published in Diabetes Care in 2019. The metrics include time in range (TIR)-time in the target blood glucose range of 70 to 180 mg/dL-as well as time below range (TBR) and time above range (TAR). These metrics are included in the American Diabetes Association (ADA) Standards of Medical Care in Diabetes-2020. It took until 2019 to develop the 10 standardized, clinically useful metrics for continuous glucose monitoring. The effort began with an international consensus meeting in 2012. Over the past decade, the Park Nicollet International Diabetes Center and many investigators, including myself, have been working on this issue. How did the group develop these targets?Ī: The first step was to develop standardized continuous glucose monitoring metrics. Q: You were part of an international group that recommended clinical targets for people who have diabetes and use CGMs. Meeting these clinical targets can help improve diabetes management and lower the risk for diabetes complications. An international group of experts on continuous glucose monitoring developed the targets, which were published in 2019 and focus on the amount of time a person’s blood glucose levels are within specific ranges. Bergenstal, MD, talks about the latest clinical targets for people with diabetes who use continuous glucose monitors (CGMs).
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