Significance of the CGM metric of time in range in children and adolescents with type 1 diabetes
Open accessAbstract
Continuous glucose monitoring (CGM) has been widely used in children and adolescents as well as adults with type 1 diabetes. CGM metrics include three key measurements of target glucose: time in range (TIR: 70-180 mg/dL), time below range (TBR: <70 mg/dL), and time above range (TAR: >180 mg/dL). The primary goal of optimal glycemic control is to increase TIR to more than 70%, while simultaneously reducing TBR to less than 4%, while minimizing severe hypoglycemia to less than 1%, as proposed by the Advanced Technologies and Treatments for Diabetes (ATTD) panel. However, several studies have indicated that the TIR goal is quite difficult to achieve in pediatric patients who have remarkable interindividual and day-to-day glycemic variation due to their irregular lifestyles. Previous studies have demonstrated that patients without an automated insulin delivery system are unlikely to attain the recommended glycemic goals. On the other hand, reduction of hypoglycemia, particularly minimizing severe hypoglycemia, is a critical issue in the effective management of children with type 1 diabetes. Frequent episodes of severe hypoglycemia and hypoglycemia can cause lasting neurological damage. Accordingly, we propose reducing the TBR to less than 5%, rather than just targeting the TIR to more than 70%. In CGM metrics this should be the cardinal glycemic goal for pediatric patients who are either being treated with multiple daily injections of insulin or a conventional insulin pump, but who are not using an automated insulin delivery system.
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Greater engagement with data provided by continuous glucose monitoring correlates with improved glycaemic metrics.
“Greater engagement with data provided by continuous glucose monitoring correlates with improved glycaemic metrics.20-22”
From Blood glucose monitoring devices: current considerations (2023) · cites this paper as [20]
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Battelino, T., Danne, T., Bergenstal, R. M., Amiel, S. A., Beck, R., Biester, T., Bosi, E., Buckingham, B. A., Cefalu, W. T., Close, K. L., et al. (2019) · Diabetes Care · doi:10.2337/dci19-0028 · Cited by 4,032 · see citing works
Self-citationState of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018
Foster, N. C., Beck, R. W., Miller, K. M., Clements, M. A., Rickels, M. R., DiMeglio, L. A., Maahs, D. M., Tamborlane, W. V., Bergenstal, R., Smith, E., et al. (2019) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0384 · Cited by 1,907 · see citing works
Beck, R. W., Riddlesworth, T., Ruedy, K., Ahmann, A., Bergenstal, R., Haller, S., Kollman, C., Kruger, D., McGill, J. B., Polonsky, W., et al. (2017) · JAMA · doi:10.1001/jama.2016.19975 · Cited by 1,185 · see citing works
Bolinder, J., Antuna, R., Geelhoed-Duijvestijn, P., Kröger, J., & Weitgasser, R. (2016) · The Lancet · doi:10.1016/s0140-6736(16)31535-5 · Cited by 893 · see citing works
Gold, A. E., Macleod, K. M., & Frier, B. M. (1994) · Diabetes Care · doi:10.2337/diacare.17.7.697 · Cited by 810 · see citing works
Lind, M., Polonsky, W., Hirsch, I. B., Heise, T., Bolinder, J., Dahlqvist, S., Schwarz, E., Ólafsdóttir, A. F., Frid, A., Wedel, H., et al. (2017) · JAMA · doi:10.1001/jama.2016.19976 · Cited by 705 · see citing works
Glucose management indicator (GMI): a new term for estimating A1C from continuous glucose monitoring
Bergenstal, R. M., Beck, R. W., Close, K. L., Grunberger, G., Sacks, D. B., Kowalski, A., Brown, A. S., Heinemann, L., Aleppo, G., Ryan, D. B., et al. (2018) · Diabetes Care · doi:10.2337/dc18-1581 · Cited by 684 · see citing works
Safety of a hybrid closed-loop insulin delivery system in patients with type 1 diabetes
Bergenstal, R. M., Garg, S., Weinzimer, S. A., Buckingham, B. A., Bode, B. W., Tamborlane, W. V., & Kaufman, F. R. (2016) · JAMA · doi:10.1001/jama.2016.11708 · Cited by 644 · see citing works
Haak, T., Hanaire, H., Ajjan, R., Hermanns, N., Riveline, J.-P., & Rayman, G. (2017) · Diabetes Therapy · doi:10.1007/s13300-016-0223-6 · Cited by 623 · see citing works
DiMeglio, L. A., Acerini, C. L., Codner, E., Craig, M. E., Hofer, S. E., Pillay, K., & Maahs, D. M. (2018) · Pediatric Diabetes · doi:10.1111/pedi.12737 · Cited by 604 · see citing works
Miller, K. M., Beck, R. W., Bergenstal, R. M., Goland, R. S., Haller, M. J., McGill, J. B., Rodriguez, H., Simmons, J. H., Hirsch, I. B., & for the T1D Exchange Clinic Network (2013) · Diabetes Care · doi:10.2337/dc12-1770 · Cited by 505 · see citing works
The relationships between time in range, hyperglycemia metrics, and HbA1c
Beck, R. W., Bergenstal, R. M., Cheng, P., Kollman, C., Carlson, A. L., Johnson, M. L., & Rodbard, D. (2019) · Journal of Diabetes Science and Technology · doi:10.1177/1932296818822496 · Cited by 479 · see citing works
Dagogo-Jack, S. E., Craft, S., & Cryer, P. E. (1993) · Journal of Clinical Investigation · doi:10.1172/jci116302 · Cited by 471 · see citing works
The relationship of hemoglobin A1C to time-in-range in patients with diabetes
Vigersky, R. A., & McMahon, C. (2019) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0310 · Cited by 464 · see citing works
Agiostratidou, G., Anhalt, H., Ball, D., Blonde, L., Gourgari, E., Harriman, K. N., Kowalski, A. J., Madden, P., McAuliffe-Fogarty, A. H., McElwee-Malloy, M., et al. (2017) · Diabetes Care · doi:10.2337/dc17-1624 · Cited by 397 · see citing works
van Beers, C. A. J., DeVries, J. H., Kleijer, S. J., Smits, M. M., Geelhoed-Duijvestijn, P. H., Kramer, M. H. H., Diamant, M., Snoek, F. J., & Serné, E. H. (2016) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(16)30193-0 · Cited by 386 · see citing works
Maiorino, M. I., Signoriello, S., Maio, A., Chiodini, P., Bellastella, G., Scappaticcio, L., Longo, M., Giugliano, D., & Esposito, K. (2020) · Diabetes Care · doi:10.2337/dc19-1459 · Cited by 364 · see citing works
Cognitive Function in Children With Type 1 Diabetes
Gaudieri, P. A., Chen, R., Greer, T. F., & Holmes, C. S. (2008) · Diabetes Care · doi:10.2337/dc07-2132 · Cited by 353 · see citing works
Reddy, M., Jugnee, N., El Laboudi, A., Spanudakis, E., Anantharaja, S., & Oliver, N. (2018) · Diabetic Medicine · doi:10.1111/dme.13561 · Cited by 245 · see citing works
Dunn, T. C., Xu, Y., Hayter, G., & Ajjan, R. A. (2018) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2017.12.015 · Cited by 239 · see citing works
Abraham, M. B., Jones, T. W., Naranjo, D. M., Karges, B., Oduwole, A. O., Tauschmann, M., & Maahs, D. M. (2018) · Pediatric Diabetes · doi:10.1111/pedi.12698 · Cited by 228 · see citing works
Schütt, M., Kern, Krause, U., Busch, Dapp, A., Grziwotz, Mayer, I., Rosenbauer, Wagner, C., Zimmermann, et al. (2006) · Experimental and Clinical Endocrinology & Diabetes · doi:10.1055/s-2006-924152 · Cited by 218 · see citing works
Neuro-cognitive Performance in Children with Type 1 Diabetes—A Meta-analysis
Naguib, J. M., Kulinskaya, E., Lomax, C. L., & Garralda, M. E. (2008) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsn074 · Cited by 186 · see citing works
Visser, M. M., Charleer, S., Fieuws, S., De Block, C., Hilbrands, R., Van Huffel, L., Maes, T., Vanhaverbeke, G., Dirinck, E., Myngheer, N., et al. (2021) · The Lancet · doi:10.1016/s0140-6736(21)00789-3 · Cited by 165 · see citing works
Oskarsson, P., Antuna, R., Geelhoed-Duijvestijn, P. H. L. M., Kröger, J., Weitgasser, R., & Bolinder, J. (2017) · Diabetologia · doi:10.1007/s00125-017-4527-5 · Cited by 162 · see citing works
An alternative sensor-based method for glucose monitoring in children and young people with diabetes
Edge, J., Acerini, C. L., Campbell, F., Hamilton-Shield, J. P., Moudiotis, C., Rahman, S., Randell, T. L., Smith, A., & Trevelyan, N. (2017) · Archives of Disease in Childhood · doi:10.1136/archdischild-2016-311530 · Cited by 155 · see citing works
Bally, L., Thabit, H., Kojzar, H., Mader, J. K., Qerimi-Hyseni, J., Hartnell, S., Tauschmann, M., Allen, J. M., Wilinska, M. E., Pieber, T. R., et al. (2017) · The Lancet Diabetes & Endocrinology · doi:10.1016/s2213-8587(17)30001-3 · Cited by 149 · see citing works
Hásková, A., Radovnická, L., Petruželková, L., Parkin, C. G., Grunberger, G., Horová, E., Navrátilová, V., Kádě, O., Matoulek, M., Prázný, M., et al. (2020) · Diabetes Care · doi:10.2337/dc20-0112 · Cited by 146 · see citing works
Porter, P., Keating, B., Byrne, G. C., & Jones, T. W. (1997) · The Journal of Pediatrics · doi:10.1016/s0022-3476(97)70197-5 · Cited by 111 · see citing works
Reddy, M., Jugnee, N., Anantharaja, S., & Oliver, N. S. (2018) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2018.0252 · Cited by 92 · see citing works
Aye, T., Reiss, A. L., Kesler, S. R., Hoang, S., Drobny, J., Park, Y., Schleifer, K., Baumgartner, H. A., Wilson, D. M., & Buckingham, B. A. (2011) · Diabetes Care · doi:10.2337/dc10-2164 · Cited by 86 · see citing works
Jiao, X., Shen, Y., & Chen, Y. (2022) · BMJ Open Diabetes Research & Care · doi:10.1136/bmjdrc-2021-002633 · Cited by 76 · see citing works
Cherubini, V., Bonfanti, R., Casertano, A., Nitto, E. D., Iannilli, A., Lombardo, F., Maltoni, G., Marigliano, M., Bassi, M., Minuto, N., et al. (2020) · Diabetes Technology & Therapeutics · doi:10.1089/dia.2020.0031 · Cited by 53 · see citing works
Age-Related Loss of Brain Volume and T2 Relaxation Time in Youth With Type 1 Diabetes
Pell, G. S., Lin, A. P., Wellard, R. M., Werther, G. A., Cameron, F. J., Finch, S. J., Papoutsis, J., & NORTHAM, E. A. (2012) · Diabetes Care · doi:10.2337/dc11-1290 · Cited by 31 · see citing works
Urakami, T., Yoshida, K., Kuwabara, R., Mine, Y., Aoki, M., Suzuki, J., & Morioka, I. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13618 · Cited by 26 · see citing works
Self-citationSuzuki, J., Urakami, T., Yoshida, K., Kuwabara, R., Mine, Y., Aoki, M., & Morioka, I. (2020) · Pediatrics International · doi:10.1111/ped.14412 · Cited by 22 · see citing works
Self-citationUrakami, T., Yoshida, K., Kuwabara, R., Mine, Y., Aoki, M., Suzuki, J., & Morioka, I. (2020) · Endocrine Journal · doi:10.1507/endocrj.ej20-0193 · Cited by 21 · see citing works
Self-citationPréau, Y., Galie, S., Schaepelynck, P., Armand, M., & Raccah, D. (2021) · Sensors · doi:10.3390/s21186131 · Cited by 16 · see citing works
Urakami, T., Yoshida, K., Kuwabara, R., Mine, Y., Aoki, M., Suzuki, J., & Morioka, I. (2020) · Hormone Research in Paediatrics · doi:10.1159/000510454 · Cited by 14 · see citing works
Self-citationUrakami, T., Terada, H., Yoshida, K., Kuwabara, R., Mine, Y., Aoki, M., Shoji, Y., Suzuki, J., & Morioka, I. (2022) · Journal of Diabetes Investigation · doi:10.1111/jdi.13830 · Cited by 13 · see citing works
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Martins, A. J. L., Velásquez, R., Gaillac, D. B., dos Santos, V. N., Tami, D., Souza, R. N. P., Osorio, F. C., Fogli, G. A., Soares, B. S., do Rego, C. G., et al. (2024) · Biosensors and Bioelectronics · doi:10.1016/j.bios.2024.117081 · Cited by 37 · see citing works
Urakami, T., Terada, H., Tanabe, S., Mine, Y., Aoki, M., Aoki, R., Suzuki, J., & Morioka, I. (2024) · Journal of Diabetes Investigation · doi:10.1111/jdi.14303 · Cited by 19 · see citing works
Self-citationSebastián‐Valles, F., Alfonso, J. M., Martín, J. A. A., Jiménez‐Díaz, J., Alday, I. H., Navas-Moreno, V., Joya, T. A., García, M. D. M. F., Gómez, G. L. R., Lobariñas, L. E. L., et al. (2023) · Acta Diabetologica · doi:10.1007/s00592-023-02204-x · Cited by 18 · see citing works
Blood glucose monitoring devices: current considerations
Sly, B., & Taylor, J. (2023) · Australian Prescriber · doi:10.18773/austprescr.2023.013 · Cited by 11 · see citing works
Been, R. A., van Helsdingen, M. R. X., Zammit, D., Grzegorczyk, M. A., Krijnen, W. P., Tamási, K., Gans, R. O. B., van Beek, A. P., & van Dijk, P. R. (2025) · Diabetes Obesity and Metabolism · doi:10.1111/dom.16417 · Cited by 4 · see citing works
Giardinelli, S., Lambertini, A., Lumaca, A., Boschiero, D., Cavallin, F., Zucchini, S., Malaventura, C., & Suppiej, A. (2025) · European Journal of Pediatrics · doi:10.1007/s00431-025-06401-4 · Cited by 3 · see citing works
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Gea, I. L., Jabato, F. M., Jiménez, A. B. A., Jurado, A. L., Gómez‐Perea, A., Romero-Pérez, M. D. M., García, E. G., Mata, M. Á. S., Martínez-Moya, G., Momblán, J. J., et al. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14176243 · Cited by 1 · see citing works
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- Authors
- Urakami, T.
- Affiliations
- Nihon University (JP)
- Corresponding author
- Urakami, Tatsuhiko
- ORCID
- Urakami, Tatsuhiko
- Venue
- Endocrine Journal
- Publisher
- Japan Endocrine Society
- Published
- 2022
- Volume
- 69
- Issue
- 9
- Pages
- 1035-1042
- ISSN
- 0918-8959 (ISSN-L)
- 1348-4540
- OpenAlex
- W4293105420
- Cited by
- 11
- References
- 40
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 4
- FWCI
- 1.86
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Endocrine Journal (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- type 1 diabetes, continuous glucose monitoring, time in range, time below range, time above range, glycemic control, severe hypoglycemia, pediatric patients, adolescents, insulin pump therapy, multiple daily insulin injections, hypoglycemia prevention
- MeSH terms
- Adolescent, Adult, Blood Glucose, Child, Diabetes Mellitus, Type 1, Glycated Hemoglobin, Humans, Hypoglycemia, Hypoglycemic Agents, Insulin, Blood Glucose Self-Monitoring
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