How important is the time-in-range measurement to you when assessing your T1D management?

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- 9 hours, 1 minute ago
  
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  Why aren't there more studies on heart disease risk with only T1Ds? I have read peer reviewed medical articles that confirm that T1Ds were not studied exclusively in statin research. We were advised to be treated with statins even if our cholesterol was excellent and there were no other risk factors. I suffered from elevated A1c, weight gain, insulin resistance, extremely low cholesterol which led to vitamin D deficiency which caused respiratory problems and inability to exercise or enjoy leisure activities due to breathlessness and muscle pain. Doctors believed that any symptoms reported by patients were due to the "Nocebo effect" despite my improvement when I didn't take statins for six months when I forgot to refill my prescription! I suffered these side effects from 2002-2016 when I finally found a doctor who took me seriously. We need to be treated as individuals with T1D, not treated based on studies on the majority of T2 studies.
- 10 hours, 8 minutes ago
  
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  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes, my dad had T1. My diagnosi made him and my mom so sad. I tried hard to make it no big deal so they wouldn’t worry.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
- 10 hours, 9 minutes ago
  
  Lenora Ventura has commented in the same post you commented in :
  At the time of your T1D diagnosis, did you already personally know anyone who had T1D?
  Yes. My dad also diagnosed when he was 9, his baby sister diagnosed w/ in 6 months of his diagnosis when she was 5, and his older brother who was diagnosed @ 33.
Clear All

How important is the time-in-range measurement to you when assessing your T1D management?

For this question, we're re-asking a recent question. Even if you answered before, please answer again. If you use both an insulin pump and CGM, do you currently use any of the following automated insulin delivery (also known as “predictive low glucose suspend” or “hybrid closed loop”) algorithms?

Sarah Howard

22 Comments

RegMunro

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?

11 months ago Log in to Reply
Larry Martin

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.

5

11 months ago Log in to Reply
Lisa Anderson

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.

1

11 months ago Log in to Reply
connie ker

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.

1

11 months ago Log in to Reply
Lawrence S.

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.

1

11 months ago Log in to Reply
1. Miriam Gordon
  
  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.
  
  1
  
  11 months ago Log in to Reply
2. TomH
  
  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-
  
  11 months ago Log in to Reply
3. Gerald Oefelein
  
  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.
  
  11 months ago Log in to Reply
4. Lawrence S.
  
  Thank you all for your responses. I’ll check these out.
  
  11 months ago Log in to Reply
Emily Meister

It does not take much ( 1 or 2 highs or lows) to drop the percentage of time in range.

1

11 months ago Log in to Reply
Edward Geary

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.

11 months ago Log in to Reply
TomH

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.

5

11 months ago Log in to Reply
Mark Schweim

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.

6

11 months ago Log in to Reply
1. n6jax@scinternet.net
  
  I agree !!
  
  11 months ago Log in to Reply
Carol Meares

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…?

11 months ago Log in to Reply
Janis Senungetuk

A higher TIR = a more consistent Quality Of Life for me, so I find it very important.

3

11 months ago Log in to Reply
mbulzomi@optonline.net

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.

2

11 months ago Log in to Reply
Marcie Dutton

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…

11 months ago Log in to Reply
Kelly Wilhelm

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.

2

11 months ago Log in to Reply
lis be

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.

11 months ago Log in to Reply
T1D5/1971

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…

10 months ago Log in to Reply
Cheryl Seibert

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

10 months ago Log in to Reply