Time Below Range and Its Influence on Hypoglycemia Awareness and Severe Hypoglycemia: Insights From the Association of British Clinical Diabetologists Study
Authors' conclusion
Our findings support the international consensus recommending a TBR of <4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.
Study context
- Population
- Individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit5,029 with follow-up time below range (TBR) and severe hypoglycemia (SH) data
- Participants
- 15,777 individuals
- Outcome
- Association between TBR (<70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score (≥4 denoting IAH) and SH incidence
- Follow-up
- First
Main finding
As reported in the abstract
- TBR significantly associated with SH, adjusted for age, sex and BMI
- P < 0.001
- TBR significantly associated with impaired awareness of hypoglycemia (IAH), adjusted for age, sex and BMI
- P = 0.005
Observational data: associations, not effects.
Further findings
TBR distribution
- Median TBR (IQR 2-6.6%)
- 4%
- Meeting recommended TBR of ≤4%
- 42%
Optimal TBR cutoffs (Youden J index)
- Optimal TBR cutoff for IAH
- 3.35%
- NPV for IAH
- 85%
- Optimal TBR cutoff for SH
- 3.95%
- NPV for SH
- 97%
Original publication
Time Below Range and Its Influence on Hypoglycemia Awareness and Severe Hypoglycemia: Insights From the Association of British Clinical Diabetologists Study. Diabetes Care. Published 2 January 2025. doi:10.
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