Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Author:

Battelino Tadej1ORCID,Danne Thomas2ORCID,Bergenstal Richard M.3ORCID,Amiel Stephanie A.4ORCID,Beck Roy5ORCID,Biester Torben2,Bosi Emanuele6,Buckingham Bruce A.7,Cefalu William T.8,Close Kelly L.9,Cobelli Claudio10ORCID,Dassau Eyal11ORCID,DeVries J. Hans1213ORCID,Donaghue Kim C.14,Dovc Klemen1,Doyle Francis J.11ORCID,Garg Satish15,Grunberger George16ORCID,Heller Simon17ORCID,Heinemann Lutz18,Hirsch Irl B.19ORCID,Hovorka Roman20ORCID,Jia Weiping21ORCID,Kordonouri Olga2,Kovatchev Boris22ORCID,Kowalski Aaron23ORCID,Laffel Lori24ORCID,Levine Brian9,Mayorov Alexander25,Mathieu Chantal26ORCID,Murphy Helen R.27ORCID,Nimri Revital28ORCID,Nørgaard Kirsten29ORCID,Parkin Christopher G.30ORCID,Renard Eric31ORCID,Rodbard David32,Saboo Banshi33,Schatz Desmond34ORCID,Stoner Keaton35,Urakami Tatsuiko36ORCID,Weinzimer Stuart A.37,Phillip Moshe2838ORCID

Affiliation:

1. Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children’s Hospital, University Medical Centre Ljubljana, and Faculty of Medicine, University of Ljubljana, Slovenia

2. Diabetes Centre for Children and Adolescents, Kinder- und Jugendkrankenhaus Auf der Bult, Hannover, Germany

3. International Diabetes Center at Park Nicollet, Minneapolis, MN

4. Diabetes Research Group, King's College London, London, U.K.

5. Jaeb Center for Health Research, Tampa, FL

6. Diabetes Research Institute, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy

7. Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford Medical Center, Stanford, CA

8. American Diabetes Association, Alexandria, VA

9. Close Concerns and The diaTribe Foundation, San Francisco, CA

10. Department of Information Engineering, University of Padova, Padua, Italy

11. Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA

12. Profil, Neuss, Germany

13. Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

14. Children's Hospital at Westmead, University of Sydney, Sydney, Australia

15. University of Colorado Denver and Barbara Davis Center for Diabetes, Aurora, CO

16. Grunberger Diabetes Institute, Bloomfield Hills, MI

17. Academic Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, U.K.

18. Science Consulting in Diabetes, Neuss, Germany

19. Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, WA

20. Wellcome Trust-MRC Institute of Metabolic Science, and Department of Paediatrics, University of Cambridge, Cambridge, U.K.

21. Department of Endocrinology & Metabolism, Shanghai Clinical Center of Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China

22. Center for Diabetes Technology, University of Virginia, Charlottesville, VA

23. JDRF, New York, NY

24. Pediatric, Adolescent and Young Adult Section and Section on Clinical, Behavioral and Outcomes Research, Joslin Diabetes Center, Harvard Medical School, Boston, MA

25. Endocrinology Research Centre, Moscow, Russia

26. Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium

27. Norwich Medical School, University of East Anglia, Norwich, U.K.

28. Jesse Z and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

29. Steno Diabetes Center Copenhagen, Gentofte, Denmark

30. CGParkin Communications, Inc., Henderson, NV

31. Department of Endocrinology, Diabetes, and Nutrition, Montpellier University Hospital; Institute of Functional Genomics, University of Montpellier; and INSERM Clinical Investigation Centre, Montpellier, France

32. Biomedical Informatics Consultants LLC, Potomac, MD

33. DiaCare, Ahmedabad, Gujarat, India

34. Pediatric Endocrinology, University of Florida, Gainesville, FL

35. dQ&A Market Research, Inc., San Francisco, CA

36. Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan

37. Department of Pediatrics, Yale University School of Medicine, New Haven, CT

38. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

Abstract

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monitoring (CGM). However, successful utilization of CGM technology in routine clinical practice remains relatively low. This may be due in part to the lack of clear and agreed-upon glycemic targets that both diabetes teams and people with diabetes can work toward. Although unified recommendations for use of key CGM metrics have been established in three separate peer-reviewed articles, formal adoption by diabetes professional organizations and guidance in the practical application of these metrics in clinical practice have been lacking. In February 2019, the Advanced Technologies & Treatments for Diabetes (ATTD) Congress convened an international panel of physicians, researchers, and individuals with diabetes who are expert in CGM technologies to address this issue. This article summarizes the ATTD consensus recommendations for relevant aspects of CGM data utilization and reporting among the various diabetes populations.

Publisher

American Diabetes Association

Subject

Advanced and Specialized Nursing,Endocrinology, Diabetes and Metabolism,Internal Medicine

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