Association Between Time in Range and Advanced Cardiovascular‐Kidney‐Metabolic Syndrome in Older Adults With Type 2 Diabetes

AIMS: Cardiovascular, kidney and metabolic diseases are pathophysiologically interrelated and are conceptualised within the cardiovascular-kidney-metabolic (CKM) syndrome framework. However, evidence linking continuous glucose monitoring (CGM) to CKM syndrome remains limited. This study examined the association between time in range (TIR), the core CGM metric, and advanced CKM syndrome. MATERIALS AND METHODS: A total of 2497 adults aged ≥ 60 years with type 2 diabetes were included. CKM syndrome was defined according to the American Heart Association Presidential Advisory, with stages 3-4 classified as advanced CKM syndrome. RESULTS: Participants with advanced CKM syndrome exhibited significantly lower TIR levels than those with non-advanced CKM syndrome (p < 0.001). After multivariable adjustment, each 1-standard deviation decrease in TIR was independently associated with higher odds of advanced CKM syndrome (OR 1.28, 95% CI 1.16-1.42). Restricted cubic spline analyses demonstrated a linear inverse association between TIR and advanced CKM syndrome, with the estimated OR approaching unity at approximately 70%. The prevalence of advanced CKM syndrome increased progressively across TIR categories of > 70%, 50%-70% and ≤ 50% (p for trend < 0.001). Although TIR levels of 50%-70% exceed the currently recommended target of > 50% for older adults, this range remained associated with higher odds of advanced CKM syndrome compared with TIR > 70% (OR 1.40, 95% CI 1.12-1.75). Higher TIR was not associated with increased hypoglycemia exposure. CONCLUSIONS: Lower TIR was associated with advanced CKM syndrome, supporting the potential value of CGM-derived TIR in evaluating multisystem cardiovascular-kidney-metabolic burden in older adults with type 2 diabetes.