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Volume 13 Issue 6 (June) 2024

Original Articles

Correlation Between Hba1c and Time in Range in Type 2 Diabetes Patients with Normal Hba1c, Attending A Tertiary Care Medical College Hospital in South India
Dr Daniel Tony Kannampuzha, Dr Mohammed Ramees, Dr Diana David, Dr Antony Paul, Dr Ambu Cyril, Dr Rijas Keethadath, Dr Judith Susan John, Dr Edwin J George, Dr Thomas Joseph

Background: Diabetes mellitus is a non-communicable disease that has a high prevalence in our country and is known for causing both microvascular and macrovascular complications, especially in patients with uncontrolled HbA1C. Since the beginning of clinical use in the 1970s, hemoglobin A1c (A1c) has become the standard tool for monitoring glycemic control in patients with diabetes. The role of the A1c test was broadened in 2010 when the American Diabetes Association added A1c as a diagnostic criterion for diabetes. Because of hemoglobin A1c’s integral role in diagnosis and treatment, it is important to recognize clinical scenarios and interfering factors that yield false results1. HbA1C has been traditionally done in patients with diabetes to assess the previous three months' average glycemic control. But it has got its pitfalls. A patient with hyperglycemic and hypoglycemic episodes can have a normal HbA1C because HbA1c shows just an average value. A normal HbA1c doesn’t mean that the patient was in euglycemic state for the past three months. Both intra-day and inter-day variability in blood glucose levels can contribute significantly to HbA1C levels. To address this area, something new has come up with the name “TIME IN RANGE”. Time in range is the amount of time you spend in the target blood sugar (blood glucose) range—between 70 and 180 mg/dL for most people. Most people with type 1 and type 2 diabetes should aim for a time in range of at least 70 percent which means patients must aim for roughly 17 out of 24 hours each day to be in range (not high or low).). Some may have different targets. This is usually assessed by using a continuous glucose monitoring device and monitoring the glycemic crests and troughs. From the graphs and other data generated by the CGMS device, it's easy to calculate the time the patient spent “out of the range”, both high and low. With more and more insights into this area, HbA1C is being gradually replaced by TIME IN RANGE (TIR). Objective: The objective of the study is to find the correlation between HbA1c and “TIME IN RANGE” in patients with normal HbA1C levels. Methods: A total of 99 patients between 18-60 years under both OP and IP care were examined after excluding patients with known conditions that can falsely elevate or bring down the HbA1C levels like anemia, uremia, severe hypertriglyceridemia, severe hyperbilirubinemia, pregnancy, hemolytic anemia, splenomegaly, and chronic alcoholics. The detailed history of the patient was taken including the treatment history to know the duration of the disease and proper drug compliance. All the patients enrolled in our study were monitored for two weeks by attaching Abbott Free style Libre Pro CGMS device onto the patient’s left arm posterior aspect. After the completion of two weeks with CGMS, the sensor was removed from the patient's body and subjected to assessment and processing of AGP (Ambulatory glucose profile). An AGP report is a standardized, single-page report that includes glucose statistics like TIR, a summary glucose profile, and daily glucose graphs. It converts blood glucose readings from a CGM device into a detailed picture, allowing you to quickly visualize the time you spend above and below your target range. The report is based on 14 days of CGM data.

 
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