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Introducing Time in Range (TiR) – a new approach to diabetes

What if there was a way to find out how your diabetes control is going, without waiting for your next HbA1c test? Time in Range (TiR) is an up-and-coming diabetes measure that lets you do just that. With Time in Range, you get regular access to detailed summaries of your blood glucose levels. Time in Range lets you see all the peaks and dips during each day and night, and it shows you exactly what your medication, food and exercise do to your blood sugar levels.1

If you use a continuous glucose monitor (CGM), you will know that it allows you to measure your ‘interstitial’ glucose throughout the day and night.1 Interstitial glucose sounds complicated but all it means is that the monitor measures the sugar level in the fluid under your skin rather than directly from your blood.2 You may also have heard of Time in Range, a term often used by the medical profession. Time in Range is an up-and-coming diabetes measure that could help you manage your blood sugar and talk to your healthcare professional about your diabetes management, using the numbers from your CGM.1

Read on and find out more about Time in Range and how this measurement can help you and your healthcare professional improve your diabetes management.1

This free CGM Cheat Sheet gives you the basics about starting with a CGM and TiR

What is Time in Range?

The Time in Range diabetes measure shows how much time you spend in your target blood sugar range, using the numbers from your CGM.1 You can use other CGM measures alongside TiR as a guide to managing your diabetes, such as how long you spend above (Time Above Range) or below (Time Below Range) your range. Together they show you how much your blood sugars vary during the day and night.3,4

For most people, blood sugar is ‘in range’ when it is between 70 and 180 mg/dl (3.9–10 mmol/l). Experts recommend that if you have type 1 or type 2 diabetes, most people should spend at least 17 hours (70%) of their day within this target range.1 Check with your doctor what your personal target range is.


What are the recommended targets for Time in Range, Time Above Range, and Time Below Range?

Time in Range + HbA1c = a more complete picture of your diabetes blood sugar management

You will be familiar with using HbA1c to manage your diabetes. Time in Range does not replace HbA1c but can provide extra information and greater insight, because it shows you the peaks and dips in your blood sugar levels each day and night.1,3

HbA1c is a helpful way to look at your average blood sugar levels for the previous three months and it helps to predict your risk of diabetes complications.1 But it cannot show you the daily patterns in your sugar levels so you cannot see any highs and lows you might be having.1 In fact, people with the same HbA1c values could have very different blood sugar patterns.5 A quick look at this article will help explain the differences between TiR and HbA1c.

Two people with the same HbA1c levels can have different blood sugar patterns.


24-hour blood sugars of a person with type 1 diabetes
HbA1c result = 7.0%

High blood sugar variability – an episode of hypoglycaemia and a couple of episodes of hyperglycaemia


24-hour blood sugars of a different person with type 1 diabetes
HbA1c result = 7.0%

Low blood sugar variability and no hypo- or hyperglycaemia

By adding Time in Range to your diabetes management, you can get a more complete picture of your blood sugar levels. It can also help you spot any patterns in low blood sugar (hypoglycaemia) and high blood sugar (hyperglycaemia) during the day and night, and between different days. By using Time in Range with HbA1c, you get a personalised story about your blood sugar levels, helping you understand how they fluctuate daily and what might be causing the peaks and dips.1

“Time in Range makes it possible to plan ahead. If I’m going out, if I’m doing something that’s active, if I’m making a food choice, if I’m taking my medicine, I have that real-time data that helps me plan accordingly.”

-Mary Van Doom, living with type 2 diabetes

A video snapshot of Time in Range

A diabetes expert explains how Time in Range is helping people with diabetes

Time in Range can help you reduce the risk of health problems

Living with diabetes means an increased risk of certain health complications, but the good news is that increasing time spent in your target blood sugar range may help to reduce this risk.6,7

The more you know about your health, the greater your chance of regulating and promoting it. Time in Range can help you to better understand the daily patterns in your blood sugar levels, your blood sugar management and your blood sugar targets.1 A survey of people with diabetes found that Time in Range came second only to food as the most important factor affecting their daily lives.8

Getting the most out of your blood sugar monitor

Continuous glucose monitoring and Time in Range can also help you have more detailed discussions with your healthcare professional about your diabetes, and better understand the advice you are given. Together you can discuss your eating habits and physical activity as well as your treatment choices, insulin dosage and the timing of your doses to improve your diabetes management.1,8

By using Time in Range alongside HbA1c, you can work with your diabetes care team to make a realistic and effective plan for how to manage your diabetes by spending more time within your target blood sugar range.1

This free CGM Cheat Sheet gives you the basics about starting with a CGM and TiR


 

References
  1. Battelino T, Danne T, Bergenstal RM, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations from the International Consensus on Time in Range. Diabetes Care 2019;42(8):1593–1603.
  2. American Diabetes Association. Choosing a CGM. Available at : https://diabetes.org/tools-support/devices-technology/choosing-cgm. Accessed October 2022.
  3. Danne T, Nimri R, Battelino T, et al. International Consensus on Use of Continuous Glucose Monitoring. Diabetes Care 2017;40(12):1631-1640.
  4. American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes 2022. Diabetes Care 2022;45(Supplement 1):S1-S264.
  5. Dunn TC, Hayter GA, Doniger KJ, et al. Development of the Likelihood of Low Glucose (LLG) algorithm for evaluating risk of hypoglycemia: a new approach for using continuous glucose data to guide therapeutic decision making. J Diabetes Sci Technol 2014; 8(4):720–730.
  6. Lu J, Ma X, Zhou J, et al. Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes. Diabetes Care 2018; 41(11):2370-2376.
  7. Mayeda L, Katz R, Ahmad I, et al. Glucose Time in Range and peripheral neuropathy in type 2 diabetes mellitus and chronic kidney disease. BMJ Open Diabetes Research and Care 2020; 8(1):e000991.
  8. Runge AS, Kennedy L, Brown AS, et al. Does Time-in-Range Matter? Perspectives From People With Diabetes on the Success of Current Therapies and the Drivers of Improved Outcomes. Clin Diabetes 2018; 36(2):112-119.

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