Since the beginning of time, healthcare professionals, like myself, and our patients with diabetes have relied on A1C as the gold standard indicating “good” or “bad” glucose control. People living with diabetes, also like myself, have been vigilant in watching our A1C values, but with the advent of real-time continuous glucose monitoring (CGM) systems, time in range has emerged, with tremendous benefits for both people with diabetes and healthcare professionals.
Time in range is an important indicator of how a person with diabetes is doing every minute of every day and night, whereas A1C can only give an estimate of the average glucose over the past two to three months. While A1C allows for long-term prognostic values when it comes to complications, it gives no information on the day-to-day glucose fluctuations that are so commonly experienced.
The best tool for measuring time in range is a CGM, as CGM technology allows users to see in real time whether they are in or out of their target range, displaying trend arrows to show the speed and direction in which glucose levels are heading. It also allows people to set their own high and low alerts levels to be warned well ahead of time before they become dangerously out of range. These insights and data allow people with diabetes to make meaningful diabetes management decisions more easily.
Time in range and other metrics that one can get from a CGM report can give important information to both people with diabetes and healthcare providers on what adjustments need to be made with medication dosage and timing, dietary habits, exercise routines, and more in order to improve time in range. For many of my patients, it gives them a daily goal and encourages them to celebrate small wins throughout their diabetes journey by allowing them to figure out what is causing glucose highs or lows so they can make changes to address these risks. Managing time in range has real-life benefits as well—my patients share with me that when they are in range, they feel healthier, more energetic, and experience less diabetes distress. For healthcare professionals who are knowledgeable about time in range, it helps to make the time with their patients more efficient, as one can pinpoint potential issues and develop a plan together as a team to safely improve a patient’s treatment regimen. Even a 5% increase in time in range is considered clinically meaningful and can make a big difference in a patient’s life, both short and long term.
I was surprised when I saw a recent survey that found that nearly one-half (47%) of people with insulin-treated diabetes said they were unaware of what time in range is and its advantages as a metric to gauge treatment success. Also, 53% said they have never discussed time in range with their healthcare professional. Despite the effectiveness of time in range in guiding treatment plans and improving health of people with diabetes, not enough professionals or patients know about it.
Diabetes experts have released an International Consensus on Time in Range that aims to align the industry on time in range as a critical measure of glucose control, and researchers are now routinely including time in range improvement as a standard validation of success in clinical studies.
Time in range is truly a unique metric in that it is important for both people with diabetes and healthcare professionals–it brings us all together in an effort to make living with diabetes more manageable. It’s up to us–healthcare professionals caring for patients with diabetes each and every day–to understand time in range and adopt it as an important standard and essential metric of glucose control.
Learn more about the technologies and tools that can improve the health and outcomes of your patient population. Recently launched, The Global Movement for Time in Range and its supporting nonprofits–including the organization I founded, Taking Control of Your Diabetes–has resources available to educate your patients while providing you with more information about time in range to help you explore treatment options and provide the best possible care to all patients with diabetes.