ADA Conference: Thaddeus Battelino and Time In Range
A large and important consensus on diabetes regulation and continuous glucose measurement was presented at the American Diabetes Association (ADA) conference. The main “face” of this agreement is our man, Professor Tadej Battelino. Well, he’s not exactly “ours”, he is from Ljubljana. In fact, he is not from Ljubljana either, but is of Italian origin, but all that is unimportant far away, “across the big pond” in San Francisco. The man speaks Croatian fluently, has participated in our Technology Panel and has achieved WORLD SUCCESS – so, “he’s ours”.
What is the great success of Prof. Battelina and his team?
Let’s start from the end. The very fact that they were the first to do something and that it was accepted and confirmed by important world organizations means that it is a great success and a mining business.
Just look at who all supported / confirmed the story of prof. Battelina and his team and it will be clearer to you:
- American Diabetes Association (ADA),
- European Association for the Study of Diabetes (EASD),
- Juvenile Diabetes Research Foundation (JDRF),
- American Association of Clinical Endocrinologists (AACE),
- American Association of Diabetes Educators (AADE),
- Foundation of European Nurses in Diabetes,
- International Society for Pediatric and Adolescent Diabetes,
- Pediatric Endocrine Society.
“Big Pharma” also joined these recommendations, specifically:
- Abbott Diabetes Care,
- Novo Nordisk,
- Eli Lilly,
- Roche Diabetes Care,
So what did they do?!
All of you who visit this portal know very well what CGM is, i.e. painless continuous glucose measurement, but the question is what do you want to achieve with this continuous measurement? One of the most important goals is to spend as much time as possible within the desired glucose levels – TIR – Time In Range.
And here we come to two key and very specific questions:
1) What are these desirable glucose levels? From how many to how many mmol / L?
2) How much time is enough within these desirable limits, and how much is too little?
Reaching answers to these questions and consensus around them is much harder than it seems and it is a very thankless mining job because we are all different and have different opportunities. Not to mention the communication and consent of all the mentioned professional associations and societies. By the way, our Maja Vukovic wrote about TIR here a year ago.
What exactly are the agreed limits of the first and so far only consensus on TIR and how much time “there” should we spend per day (refers to the general population of type 1 and type 2):
Pregnant women with type 1 got their “goals”:
For pregnant women, TIR, Time In Range, in the free Croatian translation VUC 🙂, “Time In Target”, is defined as: 3.5 mmol / L – 7.8 mmol / L, etc. Recommended values of this, among other things, and because glucose levels in pregnancy also differ physiologically. With this in mind, Battelino and colleagues recommended that pregnant women with type 1 diabetes have a TIR as well as the first group, and the values for “pregnant blood” were transferred above.
Aren’t the limits for “classic” people with diabetes “too loose”?
This is a question that our Ines Jakopanec fired like a cannon at a press conference. Prof. Battelino replied that she asked a frequent and logical question. These guidelines are the first in history and cover an incredibly wide population in many countries around the world, with different approaches to medical care. In addition, it is a consensus of various associations, some of which are focused on children and the goal was to reach a universal recommendation, acceptable to the widest possible population for which they are intended. Another reason for such unification is the tendency for as many different medical professionals as possible to look at data in the same way, which is now easier to directly compare.
Of course, patients and their specialists are left free to define personal goals that will be stricter than these “universal” ones, according to their own abilities and motives. In addition, prof. Battelino left the possibility that the guidelines would be revised in the future, and thus perhaps narrowed. This will be especially possible by further introducing CGM into as wide a population as possible and increasing its accuracy.
In addition, with the further introduction of SAP (Sensor Augumented Pump Therapy), we will be able to take a break and let sensors, smart algorithms and pumps take care of TIR. We will do something smarter.