Related Experiment Videos

Association Between Time in Range and Advanced Cardiovascular-Kidney-Metabolic Syndrome in Older Adults With Type 2

Hang Su1,2, Jiaying Ni2, Jinghao Cai2

  • 1Department of Gerontology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Diabetes, Obesity & Metabolism
|July 22, 2026
PubMed

Insights

Lower time in range (TIR) in continuous glucose monitoring (CGM) is linked to advanced cardiovascular-kidney-metabolic (CKM) syndrome in older adults with type 2 diabetes. This suggests TIR can help assess multisystem CKM burden.

Area of Science:

  • Endocrinology and Metabolism
  • Cardiology
  • Nephrology
  • Diabetes Management

Background:

  • Cardiovascular, kidney, and metabolic diseases are interconnected, forming the cardiovascular-kidney-metabolic (CKM) syndrome.
  • Continuous glucose monitoring (CGM) provides valuable insights into glycemic control, with time in range (TIR) being a key metric.
  • Limited evidence exists on the association between CGM-derived TIR and advanced CKM syndrome.

Purpose of the Study:

  • To investigate the relationship between time in range (TIR), a primary metric from continuous glucose monitoring (CGM).
  • To examine the association between TIR and the presence of advanced cardiovascular-kidney-metabolic (CKM) syndrome.
  • To evaluate the utility of CGM-derived TIR in assessing multisystem CKM burden in older adults with type 2 diabetes.

Main Methods:

  • A cohort of 2497 adults aged 60 years and older with type 2 diabetes was analyzed.
  • Cardiovascular-kidney-metabolic (CKM) syndrome was defined based on the American Heart Association Presidential Advisory.
  • Advanced CKM syndrome was classified as stages 3-4, and its association with TIR was assessed using multivariable regression and restricted cubic spline analyses.

Main Results:

  • Participants with advanced CKM syndrome had significantly lower TIR levels compared to those without (p < 0.001).
  • Each 1-standard deviation decrease in TIR was independently associated with increased odds of advanced CKM syndrome (OR 1.28).
  • A progressive increase in advanced CKM syndrome prevalence was observed across decreasing TIR categories (p for trend < 0.001), with no increased hypoglycemia risk.

Conclusions:

  • Lower time in range (TIR) is significantly associated with advanced cardiovascular-kidney-metabolic (CKM) syndrome in older adults with type 2 diabetes.
  • CGM-derived TIR may serve as a valuable metric for evaluating the multisystem CKM burden in this population.
  • These findings support the integration of TIR monitoring into the comprehensive management of type 2 diabetes, considering its impact on CKM syndrome.
Abstract

Keywords:
cardiovascular‐kidney‐metabolic syndromecomorbiditycontinuous glucose monitoringolder adultstime in rangetype 2 diabetes

Related Concept Videos

Diabetic Nephropathy01:28

Diabetic Nephropathy

Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration occur due to afferent arteriolar...
Chronic Kidney Disease I: Introduction01:25

Chronic Kidney Disease I: Introduction

Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
Chronic Kidney Disease II: Clinical Manifestations01:24

Chronic Kidney Disease II: Clinical Manifestations

Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
Chronic Kidney Disease III: Interprofessional Care01:28

Chronic Kidney Disease III: Interprofessional Care

Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion01:18

Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion

In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
Chronic Kidney Disease IV: Nursing Management01:18

Chronic Kidney Disease IV: Nursing Management

Nursing management is essential for preventing complications, maintaining stability, and improving patients' quality of life in chronic kidney disease (CKD). By using a structured approach, nurses help slow CKD progression and support effective patient care​.1. Comprehensive patient assessmentEffective management begins with nurses reviewing the patient’s medical history, and identifying key risk factors like diabetes, hypertension, and nephrotoxic drug use. Nurses assess signs of fluid...