The Relationships Between Time in Range, Hyperglycemia Metrics, and HbA1c. (July 2019)

• Record Type: Journal Article
• Authors: Beck, Roy W.; Bergenstal, Richard M.; Cheng, Peiyao; Kollman, Craig; Carlson, Anders L.; Johnson, Mary L.; Rodbard, David
• Is Part Of: Journal of diabetes science and technology. Volume 13:Number 4(2019:Jul.)
• Page Start: 614
• Page End: 626
• Publication Date: 2019-07
• Subjects: type 1 diabetes -- continuous glucose monitoring -- glucose time in range; Diabetes -- Periodicals; Medical technology -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462005
• DOI: 10.1177/1932296818822496
• Languages: English
• ISSNs: 1932-2968

Abstract

Background: As the use of continuous glucose monitoring (CGM) increases, there is a need to better understand key metrics of time in range 70-180 mg/dL (TIR 70-180 ) and hyperglycemia and how they relate to hemoglobin A1c (A1C). Methods: Analyses were conducted utilizing datasets from four randomized trials encompassing 545 adults with type 1 diabetes (T1D) who had central-laboratory measurements of A1C. CGM metrics were calculated and compared with each other and A1C cross-sectionally and longitudinally. Results: Correlations among CGM metrics (TIR 70-180, time >180 mg/dL, time >250 mg/dL, mean glucose, area under the curve above 180 mg/dL, high blood glucose index, and time in range 70-140 mg/dL) were typically 0.90 or greater. Correlations of each metric with A1C were lower (absolute values 0.66-0.71 at baseline and 0.73-0.78 at month 6). For a given TIR 70-180 percentage, there was a wide range of possible A1C levels that could be associated with that TIR 70-180 level. On average, a TIR 70-180 of 70% and 50% corresponded with an A1C of approximately 7% and 8%, respectively. There also was considerable spread of change in A1C for a given change in TIR 70-180, and vice versa. An increase in TIR 70-180 of 10% (2.4 hours per day) corresponded to a decrease in A1C of 0.6%, on average. Conclusions: In T1D, CGM measures reflecting hyperglycemia (including TIR and mean glucose) are highly correlated with each other but only moderately correlated with A1C. For a given TIR or change in TIR there is a wide range of possible corresponding A1C values.