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Dr. Rich Bergenstal expertly advocated for diabetes care to focus on outcomes beyond A1C,
particularly by using CGM data to measure time-in-range

EASD 2019 has been packed with discussions on time-in-range and CGM use, coming up in some form in almost every session.

This increased focus follows a global consensus on targets for time-in-range and an update to ADA’s Standards of Caret hat included the agreed upon targets and CGM metrics. 

HbA1C has long been the “gold standard” for diabetes care in clinical and regulatory settings due to its correlation with long-term complications, but Dr. Bergenstal is pushing to validate time-in-range as the next “gold standard.”

In 2018, Dr. Bergenstal and others published a paper in Diabetes Care
that linked time-in-range with complications, including retinopathy and microalbuminuria. In his presentation, Dr. Bergenstal highlighted that A1C has significant limitations, especially because it does not identify hypoglycemia or glucose variability. Read more on why A1C alone is not enough here

Looking to the future, Dr. Bergenstal called for research on the correlation between time-in-range and long-term outcomes using CGM data, saying “CGM will never win the day if you are not convinced that it is related to long-term complications.”

In the August 2019 Stand of Care updates, ADA also recommended use of the one-page AGP (ambulatory glucose profile), which Dr. Bergenstal called “the EKG for glucose management” due to the comprehensive and concise nature of both reports. AGPs (as well as EKGs) provide answers to the two main questions in glucose management with the output of metrics and a profile: “Is there a problem?” and “Where is the problem?”

In conclusion, Dr. Bergenstal shared two acronyms that he uses to help people understand their AGP (or CGM) profile: MGLR (more green, less red) and FNIR (flat, narrow, and in range).

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