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Glucose Biosensing: Adding Time in Range to Your Toolbox
Provided by AAFP partner
A1C has been recognized as a metric to gauge the long-term complication risk for those living with type 1 diabetes (T1D) and type 2 diabetes (T2D). Expressing the average glucose level over the previous 2-3 months, A1C has limitations that include the absence of information concerning glycemic variability, short-term complications of hyper- and hypoglycemia, and glycemic excursions. Additionally, A1C values can be invalidated by certain states of health, such as iron deficiency, anemia, pregnancy and hemoglobinopathies, and even by race or ethnicity.1
Unlike A1C testing, continuous glucose monitoring (CGM) provides data concerning daily glucose profiles, glucose variability and glycemic excursions.1 This data can guide short-term and long-term decision-making.
What is time in range?
Time in range (TIR) is a high-powered metric and companion to A1C. Individuals living with diabetes can use TIR to have a more comprehensive picture of their glucose that can only be measured using CGM. TIR identifies the percentage of time glucose levels are within a target range. For most individuals living with diabetes, the target range is between 70 and 180 mg/dL.1 The daily goal for most people living with T1D and T2D is >70% TIR (approximately 16 hours, 48 minutes).1 To learn more about TIR, read “Beyond A1C: the importance of time in range” on SIGMA’s CGM Resource Guide.
How can TIR be applied in practice?
Use of standardized TIR metrics can foster shared decision-making and progress towards common goals for those living with diabetes and their family physician. The goal is to optimize TIR without increasing hypoglycemia. Each 5% increase in TIR is considered clinically significant,1 and for every 10% increase in TIR, there is approximately a 0.8% reduction in A1C.2
A1C values can look similar from one patient to the next, but their individualized CGM patterns will drive very different discussions and treatment plans. These discussions can be strength focused and engage the individual by using CGM to make positive changes for health.
To learn more about how to use CGM data and TIR with your patients, read this tool from the International Diabetes Center/HealthPartners: “CGM-Guided Glucose Management: Partnering for Personalized Diabetes Care.”
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REFERENCES
- Battelino T, et al. Diabetes Care. 2019;42(8):1593–1603.
- Vigersky RA, et al. Diabetes Technol Ther. 2019;21(2):81-85.
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