The Implication of Time-in-Range for the Management of Diabetes in India: A Narrative Review

Abstract

Introduction: In recent times, traditional self-monitoring of blood glucose (SMBG) using fingerstick capillary samples is moving to continuous glucose monitoring (CGM) due to inherent limitations of the traditional methods. CGM displays current glucose level, trends, rate of change, time-in-range (TIR), and glucose variability (GV) over a period of several days. It detects episodes of hyperglycemia and hypoglycemia, which allows immediate response to prevent these episodes. It also allows physicians to provide a personalized glycemic response to the patients. Materials and methods: Though CGM systems have been available for more than 20 years, their use is quite low. It is challenging for clinicians to invest time in learning and understanding the diverse reports of the various CGM devices. Moreover, there is a lack of consensus on the frequency of TIR measurement. Hence. a review of the literature was performed and existing guidelines from India and abroad were reviewed for a need for CGM and its frequency of measurements in DM patients. Results: TIR is inversely correlated to the risk of microvascular and macrovascular complications. CGM is recommended by expert clinician consensus and national and international medical organizations. For the patients use of CGMs involves cost. Besides, there is the discomfort and inconvenience of wearing the device. Hence, defining the implications of using CGM in practice is important. According to the 2020 recommendations by the Research Society for the Study of Diabetes in India (RSSDI) — Endocrine Society of India (ESI) and the 2019 recommendations by an expert group of endocrinologists and diabetologists, in the Indian context, CGM could be suggested for patients with Type 2 Diabetes who encounter severe hyperglycemia or hypoglycemia, repeated hypoglycemia, asymptomatic hypoglycemia, nocturnal hypoglycemia, refractory hyperglycemia, or large blood glucose excursions. Conclusions: The role of CGM to achieve better glycemic control and prevention of complications in T1D and T2D is well established. Significant education and awareness on CGM needs to be provided to physicians as well as patients with high GV and those on insulin therapy.