«TIME IN RANGE» INDICATOR DEPENDING ON THE DEGREE OF VIOLATIONS OF THE GLUCOSE CONTROL SYSTEM

Mustafaeva S. A.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Goal. Determine the frequency of occurrence of Time in range indicators in people with different degrees of degradation of the glucose control system. Methods. 125 people were examined. The research material was collected during the survey by DMG devices – MiniMed (Medtronic, USA), FreeStyle Libre (Abbott, USA), Dexcom 4G (Dexcom, USA). Data were evaluated based on the number of glucose determinations and the frequency of normal glucose values in 4 groups: group 1 (n = 8) – persons without diabetes (persons without carbohydrate metabolism disorders (n = 4) and persons with prediabetes (n = 4); group 2 (n = 25) – patients with type 2 diabetes on insulin-free therapy; group 3 (n = 45) – patients with type 2 diabetes mellitus on insulin therapy (combined therapy of hypoglycemic peroral drugs with extended-acting insulin (n = 9) and intensive insulin therapy (n =36); group 4 (n = 47) – patients with type 1 diabetes. Passport data was registered for all the examined patients, information was collected about the current treatment, the presence of hypoglycemic therapy, and whether the treatment was performed with insulin or non-insulin hypoglycemic drugs. Diagnosis of diabetes and detection of prediabetes and ascertaining the normal state of carbohydrate metabolism were carried out in accordance with the recommendations of the Azerbaijan Association of Endocrinology, Diabetology and Therapeutic Training and the American Diabetes Association. Results. The total number of glucose studies was 11085 in the group without diabetes mellitus, 38727 in the group with type 2 diabetes mellitus without insulin therapy, 77616 in the group with type 2 diabetes mellitus on insulin therapy, and 82292 in the group with type 1 diabetes mellitus. The relative «risk» of determining glycemic parameters outside the target range (>180 mg/DL or >10.0 mmol/l) was minimal in individuals without DM and was 0.312; 0.208; 0.150 compared to the SD2 BIT, SD2 it and SD1 groups, respectively. The relative «risk» of determining glycemic parameters outside the target range was highest in the SD1 group. Conclusions. The frequency of occurrence of glucose values in the target range corresponded to 92.1% in the group of people without DM; 74.7% in the group of PEOPLE with SD2 bit; 62.2% in the group with SD2 it; 47.5% in the group with SD1 (differences between the groups in all cases were statistically significant (p < 0.0001)). The data obtained indicate that the frequency of occurrence of the Time in range indicator decreases with the degradation of the glucose control system.

long-term glucose monitoring, glycohemoglobin, «Time in range» indicator, diabetes mellitus.

1. Lind M, Polonsky W, Hirsch IB, Heise T, Bolinder J, Dahlqvist S, et al. Continuous Glucose Monitoring vs Conventional Therapy for Glycemic Control in Adults With Type 1 Diabetes Treated With Multiple Daily Insulin Injections: The GOLD Randomized Clinical Trial. JAMA. 2017;317(4):379-87.
2. Beck RW, Riddlesworth T, Ruedy K, Riddlesworth T, Ruedy K, Ahmann A, et al. DIAMOND Study Group. Effect of continuous glucose monitoring on glycemic control in adults with type 1 diabetes using insulin injections: The DIAMOND randomized clinical trial. JAMA. 2017;317:371-8.
3. Qu Y, Jacober SJ, Zhang Q, Wolka LL, DeVries JH. Rate of hypoglycemia in insulin-treated patients with type 2 diabetes can be predicted from glycemic variability data. Diabetes Technol Ther. 2012;14:1008-12.
4. Bry L, Chen PC, Sacks DB. Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin. Clin Chem. 2001;47:153-63.
5. National Institute of Diabetes and Digestive and Kidney Diseases Health Information Center. Sickle cell trait & other hemoglobinopathies & diabetes (for providers) [Internet]. Available from: https://www.niddk.nih.gov/health-information/diagnostic-tests/sickle-cell-traithemoglobinopathies-diabetes
6. Ford ES, Cowie CC, Li C, Handelsman Y, Bloomgarden ZT. Iron-deficiency anemia, non-iron-deficiency anemia and HbA1c among adults in the US. J Diabetes. 2011;3:67-73.
7. Nielsen LR, Ekbom P, Damm P, Glumer C, Frandsen MM, Jensen DM, Mathiesen ER. HbA1c levels are significantly lower in early and late pregnancy. Diabetes Care. 2004;27:1200-1.
8. Beck RW, Bergenstal RM, Riddlesworth TD, Kollman C, Li Z, Brown AS, Close KL. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care. 2019;42:400-5.
9. Aleppo G, Ruedy KJ, Riddlesworth TD, Kruger DF, Peters AL, Hirsch I, et al. REPLACE-BG Study Group. REPLACE-BG: A randomized trial comparing continuous glucose monitoring with and without routine blood glucose monitoring in adults with well-controlled type 1 diabetes. Diabetes Care. 2017;40:538-45.
10. Petrie JR, Peters AL, Bergenstal RM, Holl RW, Fleming GA, Heinemann L. Improving the clinical value and utility of CGM Systems: issues and recommendations: a joint statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care. 2017;40:1614-21.
11. Sherr JL, Tauschmann M, Battelino T, de Bock M, Forlenza G, Roman R, et al. ISPAD Clinical Practice Consensus Guidelines 2018: diabetes technologies. Pediatr Diabetes. 2018;19(27):302-25.
12. New Recommendations for Time-in-rangee Targets During Continuous Glucose Monitoring, Press Release American Diabetes Association, 08 June 2019.
13. Vigersky RA, McMahon C. The relationship of hemoglobin A1C to time-in-range in patients with diabetes. Diabetes Technol Ther. 2019;21:81-5.
14. Azərbaycan Respublikası Endokrinologiya, Diabetologiya və Terapevnik Təlimat assosiasiyası. Şəkərli diabetin diaqnostikası, profilaktikası və tibbi yardım üzrə standartları. Bakı, 2017, “Azərdiab” nəşriyatı, 134 s.
15. American Diabetes Association. Standards of Medical Care in Diabetes – 2020. Diabetes Care. 2020;43:1-212.
16.  Easy Fisher Exac Test Calculator. Available from: https://www.socscistatistics.com/tests/fisher/default2.aspx
17. Lakin GF. Biometriya. Moskva: Vysshaya shkola; 1980. 293 s. [in Russiаn].

«Bulletin of problems biology and medicine» Issue 1 (155), 2020 year, 167-170 pages, index UDK 612.015.32:616.379-008.64

10.29254/2077-4214-2020-1-155-167-170