Ongoing advances in the accuracy and affordability of continuous glucose monitoring (CGM) technologies have led to a growing emphasis on time-in-range as a primary metric in pediatric diabetes.
A panel of experts will review the growing evidence supporting time-in-range and discuss recommendations for incorporating the metric into clinical practice during the Joint ADA/International Society for Pediatric and Adolescent Diabetes (ISPAD) Symposium Hemoglobin A1C vs. Time-in-Range as the Primary Metric in Pediatric Diabetes? The two-hour virtual symposium begins at 1:45 p.m. CT on Saturday, June 13.
William E. Winter, MD, Endocrinology Unit Director at UF Health Pathology Laboratories at the University of Florida, will present “The Case for A1C as the Primary Metric,” and Thomas Danne, MD, will present “The Case for Time-in-Range as the Primary Metric.” Dr. Danne is Director of the Department of General Pediatrics and Endocrinology/Diabetology at the Children’s Hospital on the Bult, Hannover Medical School. He also heads the Diabetes Center for Children and Adolescents in Germany.
Daniel J. DeSalvo, MD, will conclude the symposium with a discussion of “Practical Strategies to Personalize and Target Time-in-Range in Pediatric Diabetes.” Dr. DeSalvo is Assistant Professor of Pediatrics, Director of Strategic Collaboration at Texas Children’s Diabetes and Endocrine Care Center, and Type 1 Diabetes Clinic Lead in the Section of Pediatric Diabetes and Endocrinology at Baylor College of Medicine/Texas Children’s Hospital.
“Most experts agree that we should strive for as much time-in-range as possible (70% or more values in 70-180mg/dL range) while keeping hypoglycemia at minimum (<4% of values below 70 mg/dL and <1% of values below 54 mg/dL),” Dr. DeSalvo said. “However, recent pediatric CGM studies—including SENCE in young children and CITY in teens and young adults—indicate that pediatric patients on average spend less than 50% at time-in-range (70-180 mg/dL).”
An increase in time-in-range by 10 percentage points, where hyperglycemia is reduced, he noted, could correspond to a reduction in A1C of 0.5% to 0.8% for most individuals with diabetes.
“I hope this serves as a call to action to double down in our efforts of developing innovative, holistic strategies for supporting youth with diabetes,” Dr. DeSalvo said. “We certainly have our work cut out for us, but there are already examples of children thriving with diabetes with optimal time-in-range. We have tools and technologies at our disposal that can enable children to live well and thrive with diabetes while maximizing their time-in-range.”
Dr. DeSalvo describes his personal mission in clinical practice as “Vision Zero,” which he says is a visionary target based on the ethical refusal to accept diabetes-related complications as a result of suboptimal glycemic control.
“While an ideal goal for time-in-range may be >70%, it should be individualized and adjusted over time,” he said. “When discussing glucose outcomes with patients, we must be cognizant of our language. CGM metrics are data points to learn from rather than a pass/fail test, and improvements and success should be celebrated.”