De Block Christophe, Cheng Alice Y Y, Christensen Trine Brandt, Patted Usha Rani H, Ginovker Anna
Laboratory of Experimental Medicine and Paediatrics, Member of the Infla-Med Center of Excellence, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium.
Department of Endocrinology, Diabetology and Metabolism, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
Diabetes Ther. 2023 Aug;14(8):1399-1413. doi: 10.1007/s13300-023-01429-x. Epub 2023 Jun 18.
Time in range (TIR) is a metric of glycaemic target management derived from continuous glucose monitoring (CGM) data. This study aimed to understand knowledge of and attitudes towards use of TIR among healthcare professionals (HCPs), and gain insights into benefits and barriers to its use in clinical practice.
An online survey was disseminated across seven countries. Participants were sampled from online HCP panels and were aware of TIR (defined as amount of time in, below, and above target range). Participants were HCPs classified as specialists (SP), generalists (GP), or allied HCPs (AP; diabetes nurse specialists, diabetes educators, general nurses, nurse practitioners/physician assistants).
Respondents included 741 SP, 671 GP and 307 AP. Most HCPs (approximately 90%) agreed TIR is likely/somewhat likely to become the standard of diabetes management. Perceived benefits of TIR included helping to optimise medication regimen (SP, 71%; GP, 73%; AP, 74%), giving HCPs the knowledge and insights to make informed clinical decisions (SP, 66%; GP, 61%; AP, 72%), and empowering people with diabetes with information to successfully manage their diabetes (SP, 69%; GP, 77%; AP, 78%). Barriers to wider adoption included limited CGM access (SP, 65%; GP, 74%; AP, 69%) and lack of HCP training/education (SP, 45%; GP, 59%; AP, 51%). Most participants considered integration of TIR into clinical guidelines, recognition of TIR by regulators as a primary clinical endpoint, and recognition of TIR by payers as a parameter for diabetes treatment evaluation as key factors for increased use.
Overall, HCPs agreed on the benefits of using TIR for diabetes management. Besides raising awareness among HCPs and people with diabetes, more training and healthcare system updates are needed to facilitate increased TIR use. In addition, integration into clinical guidelines and recognition by regulators and payers are needed.
血糖达标时间（TIR）是一种基于连续血糖监测（CGM）数据得出的血糖目标管理指标。本研究旨在了解医疗保健专业人员（HCP）对TIR的了解程度和使用态度，并深入了解其在临床实践中应用的益处和障碍。
在七个国家开展了一项在线调查。参与者从在线HCP小组中抽取，且知晓TIR（定义为处于目标范围内、低于目标范围和高于目标范围的时间量）。参与者为被归类为专科医生（SP）、全科医生（GP）或相关HCP（AP；糖尿病专科护士、糖尿病教育工作者、普通护士、执业护士/医师助理）的HCP。
受访者包括741名SP、671名GP和307名AP。大多数HCP（约90%）同意TIR很可能/ somewhat可能成为糖尿病管理的标准。TIR的感知益处包括有助于优化药物治疗方案（SP，71%；GP，73%；AP，74%），使HCP有知识和见解做出明智的临床决策（SP，66%；GP，61%；AP，72%），以及为糖尿病患者提供信息使其成功管理自身糖尿病（SP，69%；GP，77%；AP，78%）。更广泛采用的障碍包括CGM获取受限（SP，65%；GP，74%；AP，69%）和HCP培训/教育不足（SP，45%；GP，59%；AP，51%）。大多数参与者认为将TIR纳入临床指南、监管机构将TIR认可为主要临床终点以及支付方将TIR认可为糖尿病治疗评估参数是增加其使用的关键因素。
总体而言，HCP们认同使用TIR进行糖尿病管理的益处。除了提高HCP和糖尿病患者的认识外，还需要更多培训和医疗系统更新以促进TIR的更多使用。此外，需要将其纳入临床指南并获得监管机构和支付方的认可。
