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Diabetes and Vascular Disease

SAT-642 - Time in Range Versus HbA1c: Which Better Predicts Cardiometabolic Risk in Type 2 Diabetes? A Systematic Review and Meta-Analysis

Saturday, June 13, 2026
9:30 AM - 4:30 PM CT
Type 2 diabetes mellitus (T2DM) is a leading cause of cardiovascular morbidity and mortality. Although glycated hemoglobin (HbA1c) is the standard for glycemic control, it fails to capture glycemic variability. Time in Range (TIR) evaluates the time spent within the target glucose range (70–180 mg/dL) and may provide a more accurate risk prediction. However, whether TIR is superior or complementary to HbA1c in this clinical context remains yet to be fully established. Therefore, this study aims to compare the performance of both metrics in predicting cardiovascular outcomes in patients with T2DM.
A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Electronic searches were performed in PubMed, Embase, and the Virtual Health Library (VHL), including English-language publications from the past 10 years. A total of 141 articles were identified, followed by independent, blinded screening by two reviewers using the Rayyan platform. Pediatric, experimental, narrative review, and editorial studies were excluded. Ultimately, five observational cohort studies evaluating the association between TIR and cardiometabolic outcomes in patients with T2DM were included. Methodological quality was assessed using the Newcastle–Ottawa Scale, and quantitative synthesis was performed using R software.
The analysis demonstrated that TIR is a robust predictor in T2DM, overcoming the limitations of HbA1c by capturing both glycemic variability and the duration of exposure to hyperglycemia. After adjustment for heterogeneity, each 10% increment in TIR was associated with an 11% reduction in cardiometabolic risk (HR: 0.89; 95% CI: 0.87–0.92; p < 0.0001; I² = 0%). While HbA1c reflects only average glycemic exposure, TIR emerged as a significant prognostic marker for reducing cardiovascular events due to its ability to integrate glycemic variability.
TIR demonstrated a consistent association with reduced cardiometabolic risk in patients with T2DM, outperforming glycated hemoglobin in predicting cardiovascular outcomes and markers of subclinical atherosclerosis. By incorporating glycemic variability and duration of exposure to hyperglycemia, TIR provides a more comprehensive assessment, capturing dimensions overlooked by HbA1c. In this context, TIR stands out as a potentially superior metric for risk stratification; however, its combined use with HbA1c may offer the most comprehensive evaluation of the patient’s metabolic profile.

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