Association of Time in Range with Glycemic Control Indicators in Indian Adults with Diabetes: A Retrospective Continuous Glucose Monitoring Study

Background:Continuous glucose monitoring (CGM) provides detailed insight into glycemic patterns beyond traditional markers like HbA1c. However, despite growing interest in CGM worldwide, adoption in India remains limited due to cost and lack of local calibration studies.Materials and Methods:This retrospective study included 499 Indian adults with type 2 (n = 487) and type 1 (n = 12) diabetes who used a CGM device (FreeStyle Libre Pro or Gluconova) for 5-14 days. Clinical data included age, sex, body mass index, diabetes duration, HbA1c, and postprandial blood sugar (PPBS). CGM metrics analyzed were time in range (TIR), time above range (TAR), and time below range (TBR). Multivariable linear regression was used to identify independent predictors of CGM outcomes. A separate subgroup analysis assessed the relationship between PPBS and TIR.Results:Mean TIR was 47.0% +/- 26.7%, TAR was 41.2% +/- 30.9%, and TBR was 11.8% +/- 16.6%. HbA1c was independently associated with all CGM metrics. In the PPBS subgroup (n = 259), each 1 mg/dL increase in PPBS was associated with a 0.06% reduction in TIR (P < 0.001). According to international consensus guidelines (TIR > 70%, TBR < 4%), 78% of patients had suboptimal TIR, and 51% had excessive TBR. Overall, 88% (n = 437) of patients failed to meet one or both targets.Conclusion:In this real-world Indian cohort, CGM revealed poor glycemic control in the majority of patients. HbA1c and PPBS were independently associated with CGM-derived outcomes, particularly TIR. These findings support the integration of CGM with standard glycemic markers to improve individualized diabetes care.