Time in range predicts microvascular complication risk in type 1 diabetes
medwireNews: Among people with type 1 diabetes using continuous glucose monitoring (CGM), shorter time in range (TIR) is associated with an increased risk for microvascular complications, suggests an analysis of data from the RESCUE trial.
Presenting the findings at the virtual 56th EASD Annual Meeting, Anass El Malahi (University Hospital Antwerp, Belgium) said that the use of CGM since 2016 has provided “a more comprehensive view” on glycemic variability and TIR than was previously available with self-monitored blood glucose levels.
The study involved 515 adults with type 1 diabetes who entered the Belgian reimbursement system for real-time CGM between 2014 and 2017. All participants were using an insulin pump.
Overall, increasing time spent with glucose levels in the target range of 70–180 mg/dL (3.9–9.9 mmol/L) was associated with decreasing risk for microvascular complications. For instance, 50.0% of the 10 individuals in the lowest category for TIR (<40%) had at least one microvascular complication, compared with just 27.3% of the 99 people in the highest category for TIR (≥70%).
Moreover, El Malahi said that the 180 people with microvascular complications had significantly lower average TIR than the 324 individuals without, at 60.4% versus 63.9%.
In a logistic regression analysis, longer TIR was independently associated with a reduced microvascular complication risk (odds ratio [OR]=0.97), whereas longer duration of diabetes was associated with an increased risk (OR=1.12). When individual complications were assessed separately, longer TIR was significantly associated with a reduced risk for retinopathy (OR=0.96), but not nephropathy, whereas longer diabetes duration was significantly associated with an increased risk for both complications.
El Malahi and team also found that TIR predicted acute complication risk. Average TIR was significantly lower for patients who had been hospitalized due to hypoglycemia or ketoacidosis in the previous year than those who had not, at 58.9% versus 63.6%, and longer TIR was independently associated with a reduced risk for these events on logistic regression analysis, with an OR of 0.97.
In contrast to these findings, however, TIR was not significantly associated with the risk for macrovascular complications. Average TIR was comparable among patients with (n=25) and without (n=477) macrovascular complications, while age and glycated hemoglobin levels were identified as significant predictors of these events.
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