683-P: TBR (Time Below Range) in Routine Clinical Practice: A Retrospective Analysis of Routine CGM in Outpatient Care

Abstract

Background: Patients with diabetes need monitoring to achieve good glucose control and avoid complications . Assessing the time in range (TIR) metrics is a novel way to identify glycaemic variability (GV) , Time above range (TAR) , Time in Range (TIR) and Time below range (TBR) . Aim: To identify TBR- hypoglycemia (< 70 mg/dl) in routine clinical practice through continuous glucose monitoring (CGM) Methodology: This was a single centre analysis of Flash Glucose Monitoring (FGM libre pro) used as a means of CGM in type 1 & 2 DM patients as part of routine care in a specialty clinic over last one year. 227 adult participants were categorized based on their Hba1c levels. Time In Range metrics in different groups was determined. Statistical analysis was done to calculate the significance by p value. Results: 17.6 % of participants had good glycemic control (HbA1c below 7 %) , 22.5 % had HbA1c levels of 7 to 8 %, 33.5 % had HbA1c within 8 to 9 %, and 26% had poor glycemic control with HbA1c above 9 %. Patients with HbA1c levels below 7% spent maximum time below range compared with those in other groups (p= 0.0016) . Those having HbA1c levels of 7 to 8 (p= 1.00) and 8 to 9 (p= 0.0008) spent nearly % of their time below range . No statistical differences in TBR was found between male and female participants and based on treatment regimen. 77.5 % of patients having A1C levels below 7 %, 54 % of patients with A1C levels between 7 to 8 %, 61.8 % patients with A1C levels between 8 to 9% and 40.6 % of patients with A1C levels above 9 %, spent more than 5 % of their time below range. Conclusion: Our study found that although individuals with HbA1c levels < 7 % were at maximum risk of hypoglycemia spending significantly more than 5 % of their time below range, patients with poor glycemic control also spent a large amount of time below range. Thus patients with DM are at an increased risk of hypoglycemia regardless of their levels of glycemic control and treatment regimen, and CGM and TIR evaluation should be used routinely. Disclosure P.M.Chawla: Speaker’s Bureau; Biocon, Boehringer Ingelheim International GmbH, Eris Lifesciences Ltd., Novo Nordisk, Sanofi. M.S.Chawla: Speaker’s Bureau; Biocon, Boehringer Ingelheim International GmbH, Janssen Pharmaceuticals, Inc., Novo Nordisk, Sanofi.