Time in range: The new metric that can help diabetics prevent long-term complications


Written by Jayashree Narayanan
| Pune |

Updated: March 4, 2020 11:08:52 am


TIR, glycated haemoglobin, diabetes care, blood glucose levels, new ways to track blood sugar, indianexpress.com, indianexpress,HbA1c, what is Time in Range, Time in Range diabetes, Continuous Glucose Monitoring (CGM) helps generate blood sugar readings every few minutes and is available on a smartphone or tablet. (Photo: Wikimedia Commons)

Of the several new advances in diabetes care and management, glucose monitoring with Time In Range (TIR) is now being considered to be an effective gamechanger. While finger-stick testing only offers a limited level of analysis of an individual’s blood sugar over the course of a day, Continuous Glucose Monitoring (CGM) helps generate blood sugar readings every few minutes and available on a smartphone or tablet.

Endorsed by the American Diabetes Association (ADA), the Time In Range metric is said to explain the duration of time patients with diabetes spent within the prescribed range of 70-180mg/dL in a day to prevent any complications. From 2020, it is recommended internationally that an AGP or Ambulatory Glucose Profile (AGP) report which consists of TIR data “should be provided to motivate patients to adopt simple, measurable, realistic and time-bound measures to reach glycemic goals”.

The Indian findings on AGP/TIR and its correlation with the time-tested HbA1c or glycated haemoglobin which tells the average blood sugar levels over three months — a method in use for more than two decades — was presented recently by a team of researchers led by Dr Jothydev Kesavadev from Thiruvananthapuram at the 13th ATTD Global Conference in Madrid, Spain.

TIR, glycated haemoglobin, diabetes care, blood glucose levels, new ways to track blood sugar, indianexpress.com, indianexpress,HbA1c, what is Time in Range, Time in Range diabetes, Dr Jothydev Kesavadev from Thiruvananthapuram at the 13th ATTD Global Conference in Madrid, Spain.

What do the findings suggest?

According to the findings, the data based on researches on TIR, underlines the fact that subjects with diabetes must put a conscious effort to maintain their blood glucose level within the prescribed range of 70-180mg/dL as much as possible. Ideally, the time spent below 70mg the range should never be above 75 minutes a day. For the elderly as well as patients with serious kidney disorders and heart diseases, this should not exceed 15 minutes “to avoid any serious outcomes”.

The new reporting system will certainly help prevent the serious complications and death in a greater number of subjects with diabetes, said Dr Kesavadev. He explained that the data was extracted from 485 Continuous Glucose Monitoring (CGM) of type 2 diabetes patients who visited his centre in Thiruvananthapuram from 2015-2019.

“Out of this, 200 patients who matched the inclusion and exclusion criteria were identified and data was analysed using statistical software. Their therapeutic regimen and other relevant parameters were also studied. The systematic data analysis was performed over a period of three months,” Dr Kesavadev told indianexpress.com.

Dr Kesavadev said the correlation between A1c and TIR was “originally done in Caucasian population”. “This is the Indian data. We found strong correlation between the two when A1c is low and it becomes weaker when it goes up. Hence, overall our study matched international recommendations,” he said.

Conducted at Jothydev’s Diabetes Research Centre, the data pinpopinted and was claimed to be the first-ever research from India on TIR and its correlation with HbA1c.

Why is TIR needed?

Since HbA1c does not give any idea on the direction of change of glucose or the duration which is spent in normal, high or low glucose levels, it was felt that a system was needed to track continuous data for preventing serious diabetes complications including death. “Like A1c, TIR is also customised based on the overall health of the individual. Higher the time spent in normal range, better will be the outcome, provided therapies and technologies are in aid to prevent fatality due to low sugar,” as per the study.

How does continuous monitoring help streamline diabetes care?

As per Lorena Alarcon-Casas Wright, M D, a physician at the University of Washington Diabetes Institute in Seattle, CGMs “offer a nuanced look at blood sugar levels around the clock”. “Users can see how various foods and exercise affect their blood sugar. They can correct a high reading with a calibrated dose of insulin or a low one with a handful of raisins or drink of juice,” she wrote in statnews.com.

In simple words, a stable glucose level monitored through blood sugar measurements throughout a day over a longer period of time helps avoid complications like vision loss and kidney problems among others. Combined data from over a period of time helps identify the pain points which helps make diagnosis much more timely.

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