Evaluating the role of time in range as a glycemic target during short‐term intensive insulin therapy in patients with newly diagnosed type 2 diabetes

Abstract

Abstract Background Tight glycemic control during short‐term intensive insulin therapy (SIIT) is critical for inducing diabetes remission in patients with newly diagnosed type 2 diabetes (T2D). This work aimed to investigate the role of time in range (TIR) during SIIT as a novel glycemic target by predicting clinical outcomes. Methods SIIT was given to 116 patients with newly diagnosed T2D, with daily eight‐point capillary glucose monitored. Glycemic targets (fasting/premeal glucose, 3.9–6.0 mmol/L; 2 h postprandial blood glucose, 3.9–7.8 mmol/L) were achieved and maintained for 2 weeks. TIR PIR was calculated as the percentage of glucose points within these glycemic targets during the maintenance period and was compared to TIR 3.9–7.8mmol/L and TIR 3.9–10.0mmol/L . Acute insulin response (AIR), HOMA‐IR, HOMA‐B, and disposition index (DI) were measured. Patients were followed up for 1 year to observe clinical outcomes. Results TIR PIR , TIR 3.9–7.8mmol/L , and TIR 3.9–10.0mmol/L were 67.2 ± 11.2%, 80.8 ± 9.2%, and 90.1 ± 6.2%, respectively. After SIIT, β‐cell function and insulin sensitivity improved remarkably, and the 1‐year remission rate was 55.2%. △AIR and △DI were positively correlated with all the TIR values, whereas only TIR PIR was correlated with △HOMA‐IR (r = −0.22, p = 0.03). Higher TIR PIR but not TIR 3.9–7.8mmol/L or TIR 3.9–10.0mmol/L was robustly associated with diabetes remission; patients in the lower TIR PIR tertile had an elevated risk of hyperglycemia relapse (hazard ratio 3.4, 95% confidence interval 1.6–7.2， p = .001). Only those with TIR PIR ≥ 65% had a one‐year remission rate of over 60%. Conclusions These findings advocate TIR PIR ≥ 65% as a novel glycemic target during SIIT for clinical decision‐making.

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