The relationships between time in range, hyperglycemia metrics, and HbA1c
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BACKGROUND: As the use of continuous glucose monitoring (CGM) increases, there is a need to better understand key metrics of time in range 70-180 mg/dL (TIR(70-180)) and hyperglycemia and how they relate to hemoglobin A1c (A1C). METHODS: Analyses were conducted utilizing datasets from four randomized trials encompassing 545 adults with type 1 diabetes (T1D) who had central-laboratory measurements of A1C. CGM metrics were calculated and compared with each other and A1C cross-sectionally and longitudinally. RESULTS: Correlations among CGM metrics (TIR(70-180), time >180 mg/dL, time >250 mg/dL, mean glucose, area under the curve above 180 mg/dL, high blood glucose index, and time in range 70-140 mg/dL) were typically 0.90 or greater. Correlations of each metric with A1C were lower (absolute values 0.66-0.71 at baseline and 0.73-0.78 at month 6). For a given TIR(70-180) percentage, there was a wide range of possible A1C levels that could be associated with that TIR(70-180) level. On average, a TIR(70-180) of 70% and 50% corresponded with an A1C of approximately 7% and 8%, respectively. There also was considerable spread of change in A1C for a given change in TIR(70-180), and vice versa. An increase in TIR(70-180) of 10% (2.4 hours per day) corresponded to a decrease in A1C of 0.6%, on average. CONCLUSIONS: In T1D, CGM measures reflecting hyperglycemia (including TIR and mean glucose) are highly correlated with each other but only moderately correlated with A1C. For a given TIR or change in TIR there is a wide range of possible corresponding A1C values.
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