Abstract Body

The Time in Range (TIR) metrics are now accepted internationally and in India as a means of assessing the entire glycemic movement and glycemic variability. The TIR is measured using predominantly CGM devices and also SMBG (although SMBG does have limitations). Professional CGM systems have been available in India for over a decade with the Libre Pro Flash Glucose monitoring being introduced in India for the first time in 2015.

Despite the availability of the libre freestyle and other real time CGM devices like Guardian Rt in India, their use is limited in comparison with the retrospective, professional cgms due to cost and poor awareness. Though the Indian CGM guidelines recommend routine use of cgm for patients with type 1 DM and those with type 2 DM with potential for hypoglycemia the uptake is still slow. TIR as supplementary to HBA1C is slowly gaining relevance amongst Indian physicians and as the use of this technology is predominantly intermittent where used the assessment of TIR through professional blinded CGM (does not get influenced by change in lifestyle and drug dose like in case of real time CGM use) seems most appropriate in the Indian population context.

An important component of the TIR metrics besides the Time in Target and Time above Target percentage is the Time below Target Range as unrecognized hypoglycemia is one of the biggest drawback and limitation of the current approach towards diabetes management. We have identified significant time spent by patients below range inspite of being in higher hba1c bracket and that is an important indicator for routine assessment of TIR in Indian patients through intermittent professional CGM.