Proportion of daily capillary blood glucose readings required in the target range for target glycaemic control: shift of focus from target range to proportion in range. Issue 10 (15th August 2017)

• Record Type: Journal Article
• Authors: Sivasubramaniyam, S.; Amiel, S. A.; Choudhary, P.
• Is Part Of: Diabetic medicine. Volume 34:Issue 10(2017)
• Page Start: 1456
• Page End: 1460
• Publication Date: 2017-08-15
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13438
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aim: Most guidelines provide people with Type 1 diabetes with pre‐ and post‐meal capillary blood glucose (CBG) targets to achieve optimal glycaemic control. We evaluated the proportion of daily CBG readings between 4 and 10 mmol/l in people achieving different HbA1c levels. Method: We analysed CBG data from routine pump/meter downloads from 201 adults treated with continuous subcutaneous insulin infusion (CSII) at a single hospital clinic. Exclusion criteria were CSII < 6 months, < 3 CBG/day, pregnancy, haemoglobinopathy and continuous sensor use. People were categorized into three groups based on HbA1c : < 58 mmol/mol, < 7.5% ( n = 58); 58–74 mmol/mol, 7.5–8.9% ( n = 107); and ≥ 75 mmol/mol, ≥ 9.0% ( n = 36). Results: Participants had a mean age of 43 ± 13 years and mean HBA1c of 64 mmol/mol (8.0 ± 1.1%). 47% of people started CSII for raised HbA1c, 25% due to hypoglycaemia and the rest during pregnancy. Downloads contained a mean of 22 ± 6.8 days of data per participant. CBG frequency was similar between the three groups (5.6 ± 2.0, 5.6 ± 1.9 and 5.4 ± 1.2 CBG/day; P = 0.468). The proportion of CBG readings between 4 and 10 mmol/l (72–180 mg/dl) was 57.3 ± 25.4%, 50.6 ± 11.1% and 39.9 ± 16.5% ( P < 0.0001); < 4 mmol was 13.8%, 8.8% and 4.4% ( P < 0.0001) and > 10 mmol/l was 28.9 ± 16.5%, 40.6 ± 12.1% and 55.6 ± 17.9% ( P < 0.0001) in the three groups respectively. Conclusions: Participants achieving HBA1c < 58 mmol/mol (< 7.5%) had ~ 60% of CBG readings in range (4–10 mmol/l), with up to 30% of readings > 10 mmol/l. This target of achieving 60% or more readings within target, and being permissive with up to 30% readings > 10 mmol/l may be a novel target for people with diabetes, and may reduce anxiety associated with readings out of range. What's new?: These 'real‐world' data suggest that those achieving HbA1c < 58 mmol/mol (< 7.5%) have ˜ 60% of readings in range (4–10 mmol/l) and up to 30% readings > 10 mmol/l. These 'time‐in‐range' values from capillary blood glucose testing seem to be similar to time‐in‐range data from people with similar HAb1c using continuous glucose monitoring data and suggest these may be appropriate targets. The observation that 30% of readings being above the target range is compatible with achieving target HbA1c may help diminish anxiety around capillary blood glucose testing by allowing for 'realistic and easily recognizable target setting'.