Time in Tight Range Versus Time in Range for Predicting Diabetic Retinopathy in Adults with Type 1 Diabetes Using...

Area of Science:

• Endocrinology
• Ophthalmology
• Metabolic Diseases

Background:

• Time in tight range (TITR) is a stricter glycemic metric than time in range (TIR).
• The prognostic value of TITR for diabetic retinopathy (DR) in type 1 diabetes (T1D) is not well-established.
• Continuous glucose monitoring (CGM) offers granular glycemic data for assessing diabetes complications.

Purpose of the Study:

• To evaluate whether TITR offers additional prognostic value for DR in adults with T1D compared to TIR.
• To assess the association between CGM-derived glycemic metrics and the incidence and progression of DR.
• To determine the predictive performance of TITR versus TIR for DR outcomes.

Main Methods:

• Retrospective cohort study of 309 adults with T1D using CGM.
• Ophthalmological assessments for DR at baseline and 12-month follow-up.
• Multivariable logistic regression analysis adjusted for key clinical factors.

Main Results:

• Higher TITR was independently associated with a lower risk of incident DR, while TIR was not.
• TITR demonstrated superior discrimination for incident DR prediction compared to TIR (AUC 0.580 vs. 0.430).
• Both TITR and TIR showed similar performance in predicting DR progression.

Conclusions:

• TITR offers modestly superior predictive value over TIR for incident DR, especially in individuals with near-target HbA1c.
• CGM-derived metrics like TITR and TIR should be interpreted alongside overall glycemic control and clinical risk factors.
• Further research is needed to fully elucidate the role of TITR in managing diabetes complications.