22 Comments
How important is the time-in-range measurement to you when assessing your T1D management?
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CGM has made time in range 95+% achievable, but not east. It has enabled me to move focus to variability of blood glucose level. I’m not sure what to aim for in this area! Any practical tips?
It is the only thing I really care about. A1C is a myth because you can have a very wide range of glucose readings from way too high to way too low and still show a good A1C.
I have long-term gastroparesis treated with propulsid I get through a compassionate need/IND program and dietary restrictions. I frequently go in and out of Auto Mode to use the split/square wave boluses. The only way I can be in range all the time is by eating the same things ate the same times everyday. That’s not a fun or healthy way to live, so I try not to get hung up too much on numbers.
My endo apts. always include an A1C either in the lab orders or on the office machine. I understand it is an average but perhaps both TIR and A1C are both informative to the patient and Dr. I feel better without the swings, but that is the nature of this T1D.
I answered “Other” because I don’t know where the Time In Range number is to be found. I tried to figure mine out by going onto my TConnect program and crunching the numbers. Between 70 and 180 I am at approximately 85%. Seems that it would be a useful measurement, if I knew how to quickly find it. My numbers go high frequently because I purposely raise my blood sugars so I can run and workout. Also, my gastroparesis doesn’t help my numbers much either.
If you are using Dexccom together with your t:Slim, then download the Dexcom Clarity app and it shows Time in Range right on the home page.
T:connect includes the TIR if you’re using the current software. Check https://support.tandemdiabetes.com/hc/en-us/articles/1500004088582-How-do-I-get-the-time-in-range-feature-on-the-t-connect-mobile-app-
In my t:connect app, the Time In Range shows up in large numbers on the bottom of the opening screen – just under the graphs.
Thank you all for your responses. I’ll check these out.
It does not take much ( 1 or 2 highs or lows) to drop the percentage of time in range.
Good, but not perfect metric. IMO, more discussion vis a vis patient/provider needed relative to agreement on a realistic and therapeutic “range “ planning. Excellent comparative variant but not a substitute for A1C.
I consider A1c, GMI, and TIR the three legs of the T1D stool. While A1c has the tag of “gold standard,” I don’t believe it’s deserved, as most T1s only get a test every 3-6 months. A1c is backwards focused, so while useful in determining corrective action is needed, its doesn’t provide a what, when, or how factor to consider. Additionally, it can be misleading; you can have a great A1c, but a chart of daily/more often BGs may show constant hypo/hyper swings which may hurt you in the long run. For those with CGMs, GMI and TIR are continuous and relatively current, so of more practical use in treatment decisions. GMI is the replacement name for eA1c and is based on CGM data in an updated algorithm attributed to eA1c (see https://diabetesjournals.org/care/article/41/11/2275/36593/Glucose-Management-Indicator-GMI-A-New-Term-for). It can be based on a different # of days readings to get a feel for improvement or detriment. TIR, takes it step further and reduces or eliminates the negative factors mentioned above by letting you know TIR, TAR, and TBR. Reviewing a chart of these along with a reasonable food/insulin intake chart, you can determine when your TARs/TBRs occur, probable causes (food types, insulin prebolus timing, etc.), and take action to correct them.
If I had only one of three as choices, I’d choose TIR because it subsumes most of the good features of the others plus some; but I’d prefer being able to set my own range. Vice the often touted 70-180. I’d up the 70 to 80 (when I’m that low, I tend to continue the drop) and drop the 180 to 160 (if not a bit lower), to improve my potential control, while negating significant hypos and hyper.
Time in range is significantly more important than the A1c reading since an “ideal” A1c reading can be reached even with a mix of way too high and way too low BG readings intermixed within the time period the A1c test supposedly shows for.
I agree !!
I watch in on clarity every day which gives me the summary of the previous 2 days. It keeps me informed of any significant changes and I can easily remember what might have caused those changes. Do I need to adjust insulin, behaviors, food, exercise, stress management, sleep…?
A higher TIR = a more consistent Quality Of Life for me, so I find it very important.
Weather you know it or not, A1C is not that accurate for people that have been on Insulin for some period of time (Great for people just diagnosed.). An A1C is only an average that supposed to take the last three (3) months of glucose flowing through your body, however, it uses heavily on the last month and as we all learned in school you could have an average blood glucose number in the two hundreds, just slip a couple of lows in the mix and it makes you look great. In range is far more accurate in predicting your Diabetes Management. The Tandem X2 pump, Control IQ program range spread is quite broad, 70-180mg/dl.
Interestingly TIR if very important to me when I am assessing whether my management is good or not–but– not very important at all to my endocrinologist. He has told me not to worry much about it because I have Control IQ on my pump. Doesn’t make sense to me to give myself an excuse to not TRY to stay in range. But…
The reason I said “Important” and not “very important” is that TIR can be different. So I have alarms set at 70-130 but, for me, being 100% in range of 70-180 wouldn’t let me know if I’m doing a good job (for me). I want tight range and if I can be a higher percentage with a lower threshold then that’s a fantastic measurement but a higher percentage of a higher range wouldn’t be relevant/important to me. Hoping that makes sense.
time in range is even more important to me then my A1C. Ive been diabetic for 40 years and was only told this year (for the irst time) that time in range is the best way to protect the eyes.
I care far more about TIR than A1c. I had amazing A1cs preCGM while battling multiple extreme hypoglycemic events. Not healthy. Not “good” control.
Now if only I can find an endo who isn’t stuck in the 1980s…
T1D for 55 years. Time in Range (TIR) is the most important measurement. Standard Deviation is the other measurement I use to determine how much my highs and lows vary. I’ve always had A1Cs below 6.5, however I previously had rapidly changing BGs that swung very low to very high. It makes the A1C look great, but TIR is terrible. I still have widely swinging BGs, but TIR is 85-95% with a 30-40 SD. I would like to get to 95-100 TIR and no more than 20 SD