Sarah Howard
Sarah Howard (nee Tackett) has dedicated her career to supporting the T1D community ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Manager of Marketing at T1D Exchange.
Sarah and her husband live in NYC with their cat Gracie. In her spare time, she enjoys doing comedy, taking dance classes, visiting art museums, and exploring different neighborhoods in NYC.
Time in range is much more important to me. A1C is not complete indicator of blood sugar management
I marked important. Also important is time in range.
With tge fact that A1c is an antiquated, subject , and unreliable lab test, with a CGM the data I have access to not make the A1c test irrelevant when assessing daily management.
I was wavering between important and very important, but then thought that I have never had an A1C above the 7 something. That would be very impacting and tell me something was very wrong.
Television destroys nuance. You see so many ads for CGM’s touting “good A1c’s, good A1c’s” when in fact the CGM benefits of time in range and standard deviation make for very poor marketing phrases. Pity! The latter two push A1c down to “somewhat important” on my list. ( ͡❛ ‿‿ ͡❛)
My endo is more concerned with my Time in Range.
Important, but time in range and standard deviation are more important. That being said, if it came back over 6, I would make changes based on the other 2 criteria.
It is not as important as time in range to me or my endo. A1C can be manipulated by donating blood. Time in range cannot.
Have always had A1c below 6 but now more interested in TIR. I have it set between 70-150 and mostly stay in the 90 -100 percentile. It is a struggle. The older I get the more complications I get. Not sure if all diabetes related. But life goes on.
Used to be very important. Now somewhat. A good a1c keeps my endo happy but I’m relying more on TIR and std dev now.
Time in range means much more than A1C but I use a CGM so I know what my true time in range is. Checking your glucose once a day is not time in range. I run numbers weekly also so I pay attention to all the detail.
I am currently struggling with very high blood sugar levels after meals. I just got done with my Endo visit. She wants me to add proteins to my meals, and make some adjustments to carb ratios, correction factors, and basal rates. When I saw that my A1c is currently 5.9, I find it hard to believe, given all of my high BG’s. But, I still consider the A1c to be “very important”. But, it doesn’t tell the whole story. I don’t believe my control is as good as it should be right now.
My CGM data is far more informative about my glucose control because measurements actual blood glucose values every 5 min. Also, I have a blood condition that makes my red blood cells “younger” than average so they don’t accumulate glycosylation normally, which makes my A1c lower than it should be.
I follow all of the numbers because it is not a competition. I think all of the testing is important and it all helps patients and Drs understand what is happening which continually changes moment by moment. Happy 100th Birthday to Insulin!!!!! That’s the most important research that became a gift to all T1Ds.
As others have said CGI and TIR are more important than A1C. All A1C gives you is a long term average, a macro view. It cant tell you where the trouble areas are. As other have indicated, CGI show you each response to each meal, a micro view. From that Carb ratios can be fine tuned. TIR tells you how well you stayed “in-bounds”. From that you can review what other outside influences are affecting you BG levels. I have good days and bad days I can see that with TIR.
Tell that to you GP next time they don’t understand CGI and TIR.
Time in range has become most important to me since getting a cam.
CGM
My endocrinologist would like to see it ar 7 or lower do that is my goal as I’m now ranging between 7.2-7.5….getting there🙏
TIR which I found is dependent on SD
Pretty useful and, in my experience, correlates strongly with time in range.
I put “somewhat” because I put equal, if not more, value in GMI and TIR. All three together serve as a verification check and balance to ensure an accurate perspective.
I use a CGM. Anyone who wishes to know what my blood sugar has been for the past 3 months can look at each of the thousands of readings taken every 5 minutes during that time.
If I’m showing ~80% TIR and less than 2%… I’m not worried about A1c… it will be under 6.5%.
If I keep my A1c between 5 and 6, I am good. The actual number beyond that is not important. My variability is very important to me. A1c would be very important to me if it went above 6 as I would know that my management was starting to falter a bit. Ha, I think I should have checked important. I have just had it between 5 and 6 for so long that I am working more on variability to make my days go better.
What I’ve learned from experience is that I need to keep a higher than recommended BS level if I exercise, to prevent. going hypo.
Of course, I could choose to be a couch potato with a great A1C.
Totally unimportant. The new standard is Time in Range!
I think time range is equally if not slightly more important
A1c is important, but definitely not as important as TIR and Standard Deviation. Of utmost importance is QoL, quality of life.
I agree with you and say Amen to that!!!
Janis and Connie –
I agree wholeheartedly and unreservedly!! 🙂
A1C is important but a measurement that is losing it’s purpose with the ability to monitor Time In Range(TIR). I did not choose Very Important. Very Important is Time in Range. A1C is more or less and average, so if I am wildly swinging between lows and highs with more lows, my A1C would look very good <6.5. But you can have a very good Time in Range, but always run on the high side of normal range so A1C would be higher indicating a great TIR is not reflecting the optimal BG levels.
Not as important as it once was since TIR became the cutting edge and preferred method for assessing BG control. I still pay attention to A1c since most HCPs, insurance companies, and many PWDs still use it as their standard measure of understanding overall BG control. However, you don’t really get a picture of day to day TIR if you are not using a CGM.
Diabetes science and technology has grown and changed by leaps and bounds since the discovery of how to use insulin as a hormone replacement for people with beta cell destruction and resultant insulin deficiency. However, not everyone uses a CGM to track BGs and TIR, so for the time being the two measurements of A1c and TIR can work alone and apart, as well as in tandem with each other.
I only put “important” because the A1c is still being used as the gold standard and demarcation line for certain other medical services… despite the A1c needing to be customized to the patient and its known reliability problems.
Very important… as one indicator.
I put somewhat important. I think TIR is a better indication. My A1c has been in the same range for years but in the past I had so many serious lows and highs. Now I often have daily TIR of 100% or close to it and still have the same A1c as before.
I put important. I follow time-in-range all the time, but lets face it, if the time-in-range is always hovering around 165, the A1c isn’t going to be below 7. My A1cs typically are around 5.6-5.7, and if my time-in-ranges are typically around 92-95%, then I feel like I am handling my diabetes pretty well.
It helps me to keep track of how I’m doing. If it’s 7.5 or lower I’m happy. Right now it is 8.1, so I have to get back on track.
It took learning my TIR before I could get my A1C below 7.5. Im now at 6.9. Keep going. You can make it there!
I have my a1c checked at every endo appointment. However, my endo wants me to focus more on my time in range and what is going on in my life rather than my a1c because you can have a perfect a1c but low blood sugars all the time. Time in range is a better tool.
Started with 4 day surgeries on my hands. Managed my pump and made sure anesthesiologist knew to keep eye on my numbers. Then had hip replaced. Stayed overnight and no problems managing my own blood sugars. I make sure to let everybody know just in case I have a problem.