medwireNews: People with diabetes who spend longer with their blood glucose levels within target range have better glycated hemoglobin (HbA1c) levels, reduced diabetes-related distress, better hypoglycemia awareness, and fewer hypoglycemia-related hospital admissions than individuals with diabetes that is less well controlled.
The observational study, presented by Harshal Deshmukh (University of Hull, UK) at the 82nd ADA Scientific Sessions in New Orleans, Louisiana, was based on data collected from a nationwide UK audit of people with diabetes (96% type 1 diabetes) using the FreeStyle Libre flash glucose monitor from November 2017 until August 2021.
Time in range (TIR) data were available for 3250 of 16,427 individuals using the monitor. Of these, 1241 (38%) used TIR measures in line with the international consensus of 3.9–10.0 mmol/L (70–180 mg/dL) and 2009 had personalized measures for TIR.
Focusing on the group using the international consensus measure, Deshmukh and colleagues found 594 individuals in the group had TIR less than 50% of the time, 439 individuals 50–70% of the time, and 208 more than 70% of the time. The average follow-up time in the group was 7.6 months.
Following adjustment for age, sex, related baseline values, and duration of diabetes, those in the 50–70% TIR group had a significant 0.8% (8.7 mmol/mol) reduction in HbA1c, a significant 0.18-point reduction in the Gold Score (high scores indicate low hypoglycemia awareness), and a significant 0.29-point reduction in the diabetes distress score at follow-up.
Significant reductions were also seen for participants meeting the 70% or longer TIR guidelines, at 1.3% (14.0 mmol/mol) for HbA1c, 0.33 points for Gold Score, and 0.39 points for diabetes distress.
“The TIR could be the new HbA1c, but I think we need much more data for this,” commented Deshmukh.
“The clinician use of international consensus time in range was very low in the United Kingdom, highlighting the need to increase the awareness and encourage wider adoption of [it],” he added.
Overall, use of healthcare resources was also improved in individuals with diabetes using the FreeStyle Libre. There was a 67% reduction in hospital admissions for hypoglycemia (no admissions in those with a TIR above 50%). Independent of TIR, there was also a 63% reduction in hospital admissions related to hyperglycemia or diabetic ketoacidosis and an 85% reduction in paramedic callouts in those using the monitor.
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