An Assessment of Clinical Continuous Glucose Monitoring Targets for Older and High-Risk People Living with Type 1 Diabetes

David N. O'Neal, Ohad Cohen, Sara Vogrin, Robert A. Vigersky, Alicia J. Jenkins

Research output: Contribution to journalArticlepeer-review

Abstract

Aim: To assess relationships between continuous glucose monitoring (CGM) time in range (TIR), 70-180 mg/dL, time below range (TBR), <70 mg/dL, time above range (TAR), >180 mg/dL, and glucose coefficient of variation (CV) in relation to currently recommended clinical CGM targets for older people, which recommend reduced TIR and TBR targets relative to the general type 1 diabetes population. Methods: We conducted a post hoc analysis using the JDRF Australia Adult Hybrid Closed Loop trial database examining correlations in 120 adults with type 1 diabetes of 3 weeks masked CGM (Guardian Sensor 3; Medtronic) metrics (n = 61 on multiple daily injections, 59 on non-CGM augmented pumps) using manual insulin dosing at baseline and at 26-weeks, with 50% randomized to automated insulin dosing (AID). Results: Correlations between baseline TIR and TAR were strong (r =-0.966; P < 0.0001), weak for TBR (r = 0.363; P < 0.0001), and glucose CV (r = 0.037; P = 0.687) while moderate between CV and TBR (r = 0.726; P < 0.0001). Associations were similar for participants aged >60 years (n = 15) versus younger subjects. Correlations of changes in (Δ) TIR with ΔTAR over 26 weeks were strong (r =-0.945; P < 0.001) and correlations for ΔTBR were weak (r = 0.025; P = 0.802). ΔCV did not significantly correlate with ΔTAR (r =-0.064; P = 0.526) but did with ΔTBR (r = 0.770; P = <0.001). Conclusions: Changes in TIR are not associated with changes in TBR. Thus, we recommend that for older AID users whilst TBR targets should be prioritized to reduce hypoglycemia-related risk, TBR should be addressed independently of TIR. Clinical Trial Registratrion number: (ACTRN12617000520336).

Original languageEnglish
Pages (from-to)108-115
Number of pages8
JournalDiabetes Technology and Therapeutics
Volume25
Issue number2
DOIs
StatePublished - 1 Feb 2023
Externally publishedYes

Funding

FundersFunder number
Australian Research Council
National Health and Medical Research CouncilAPP1099379
Juvenile Diabetes Research Foundation Australia3-SRA-2016-351-M-B

    Keywords

    • Continuous glucose monitoring
    • Elderly
    • Glucose target ranges
    • Hypoglycemia
    • Type 1 diabetes

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