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    • 1 hour, 56 minutes ago
      Kathleen Juzenas likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I find a using the T-Connect app I have the main features needed, CMG, bolus, battery level and remaining insulin.
    • 2 hours, 48 minutes ago
      Kathy Hanavan likes your comment at
      When you change your insulin pump site, do you tend to notice a spike in your blood glucose levels afterward?
      There are certain areas on my body where the insulin is more effective than others.
    • 5 hours, 49 minutes ago
      TEH likes your comment at
      When you change your insulin pump site, do you tend to notice a spike in your blood glucose levels afterward?
      There are certain areas on my body where the insulin is more effective than others.
    • 5 hours, 50 minutes ago
      TEH likes your comment at
      When you change your insulin pump site, do you tend to notice a spike in your blood glucose levels afterward?
      Sometimes, which makes sense to me. It seems like it takes a while til the new insulin is absorbed.
    • 5 hours, 58 minutes ago
      atr likes your comment at
      When you change your insulin pump site, do you tend to notice a spike in your blood glucose levels afterward?
      There are certain areas on my body where the insulin is more effective than others.
    • 6 hours ago
      atr likes your comment at
      When you change your insulin pump site, do you tend to notice a spike in your blood glucose levels afterward?
      Usually the opposite. Fresh insulin sometimes sends me low.
    • 6 hours, 12 minutes ago
      Lawrence S. likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      Mostly pump because I want to quickly see insulin on board. Tandem on IPhone when holding my great-niece while she sleeps since getting my pump out of my pocket always wakes her ☺️. Dexcom app if not in need of insulin.
    • 6 hours, 12 minutes ago
      Lawrence S. likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      usually the pump; sometimes my phone.
    • 6 hours, 12 minutes ago
      Lawrence S. likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      My pump (Tandem X2). Since I have to carry a work phone close to 247, I don't want to deal with two phones (device overload!). As I go about my day, looking at my pump meets my needs, I can decide to bolus etc - and edit the bolus. For more in depth data review and analysis, I use the TConnect.
    • 6 hours, 13 minutes ago
      Lawrence S. likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I read it from my pump.
    • 6 hours, 13 minutes ago
      Lawrence S. likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      On my insulin pump
    • 6 hours, 13 minutes ago
      Lawrence S. likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      My pump. Keep it simple.
    • 6 hours, 15 minutes ago
      Lawrence S. likes your comment at
      How well do you understand the details of your health insurance coverage?
      Do you realize what you have just said: "Obscurantism, gobbledegook, and pointillism used not as an art form but as a 'Gotcha!' of legal/financial determinism?"
    • 6 hours, 17 minutes ago
      Lawrence S. likes your comment at
      How well do you understand the details of your health insurance coverage?
      How much of this is intentionally misleading? My mail order prescription service says that can’t possibly know the cost of a medication until after it’s been shipped, which is too late to cancel or return, of course, and makes it impossible to comparison shop.
    • 6 hours, 18 minutes ago
      Lawrence S. likes your comment at
      How well do you understand the details of your health insurance coverage?
      I have an MA in writing and lit, but gobbledegook is gobbledegook. The fancy term is obscurantism.
    • 6 hours, 19 minutes ago
      Lawrence S. likes your comment at
      How well do you understand the details of your health insurance coverage?
      They change all the time. Generally not in a direction to improve my health, but to increase the money in their wallet.
    • 6 hours, 34 minutes ago
      Lawrence S. likes your comment at
      When you change your insulin pump site, do you tend to notice a spike in your blood glucose levels afterward?
      Usually the opposite. Fresh insulin sometimes sends me low.
    • 1 day, 3 hours ago
      Sarah Berry likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      My pump
    • 1 day, 4 hours ago
      Marty likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      One nice thing about a watch for readings is that, while it is normally redundant, you can be separated from your phone. For example, when you are in water.
    • 1 day, 4 hours ago
      Marty likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I use both as you can’t do everything you want in one or the other
    • 1 day, 5 hours ago
      Kathy Hanavan likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I selected “other” because my preference (smart watch, mobile phone, or pump screen) depends on circumstances. Watch for a quick and discrete view; pump if I’m preparing for a profile or activity adjustment or bolus, mobile phone if just a food bolus.
    • 1 day, 5 hours ago
      John Barbuto likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I use both as you can’t do everything you want in one or the other
    • 1 day, 6 hours ago
      Gerald Oefelein likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I use both as you can’t do everything you want in one or the other
    • 1 day, 6 hours ago
      Laurie B likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I’m curious about the reasoning behind using a dedicated reader. Could someone please enlighten me?
    • 1 day, 6 hours ago
      Laurie B likes your comment at
      If you use a continuous glucose monitor (CGM), where do you prefer to view your CGM readings?
      I selected “other” because my preference (smart watch, mobile phone, or pump screen) depends on circumstances. Watch for a quick and discrete view; pump if I’m preparing for a profile or activity adjustment or bolus, mobile phone if just a food bolus.
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    When evaluating your T1D, is your A1c or your time in range more important to you?

    Home > LC Polls > When evaluating your T1D, is your A1c or your time in range more important to you?
    Previous

    Do you have a carb counting app on your smartphone device?

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    How important is the A1c measurement to you?

    Samantha Walsh

    Samantha Walsh has lived with type 1 diabetes for over five years since 2017. After her T1D diagnosis, she was eager to give back to the diabetes community. She is the Community and Partner Manager for T1D Exchange and helps to manage the Online Community and recruit for the T1D Exchange Registry. Prior to T1D Exchange, Samantha fundraised at Joslin Diabetes Center. She graduated from the University of Massachusetts with a Bachelors degree in sociology and early childhood education.

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Their collective expertise is central to our mission of improving outcomes for all people living with T1D.  “We’re excited to be working with our advisors given their deep expertise across a broad range of areas in T1D,” said Dave Walton, CEO of T1D Exchange. “Their involvement magnifies our reach, knowledge, and impact. These advisors are shaping the future of diabetes care — driving innovation across research, clinical practice, and quality improvement.”    Meet the Medical & Research Advisory Team  The T1D Exchange Medical and Research Advisory Team brings together four leading endocrinologists, each offering a unique perspective and shared commitment to advancing T1D care:    Jenise Wong, MD, PhD Pediatric endocrinologist at UCSF Benioff Children’s Hospital and Professor of Pediatrics in the Division of Endocrinology at the University of California, San Francisco Focus areas: Diabetes technology adoption and usability; health equity and access to care and technology; community-based and peer-support interventions; culturally responsive care          Jennifer Sherr, MD, PhD Pediatric endocrinologist at Yale Medicine and Professor of Pediatrics in the Division of Endocrinology at Yale School of Medicine in New Haven, Connecticut Focus areas: Clinical trials in diabetes technology (CGM and AID systems), disease-modifying treatments and immunotherapies, and emerging technologies and medications, including continuous ketone monitoring and nasal glucagon     Viral Shah, MD Adult endocrinologist at Indiana University Health and Professor of Medicine in the Division of Endocrinology and Metabolism at Indiana University School of Medicine in Indianapolis, Indiana Focus areas: Diabetes technology and adjunctive therapy trials; translational and data-driven research; T1D complications and bone health         Nestoras Mathioudakis, MD, MHS Adult endocrinologist at Johns Hopkins Medicine and Associate Professor of Medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland Focus areas: AI-driven clinical support tools; EMR-based data analytics for clinical decision making; data-driven quality improvement; health equity in T1D care        This accomplished team’s expertise spans adult and pediatric endocrinology, research, and quality improvement affiliated with leading institutions nationwide. Collectively, they have authored over 500 diabetes publications and secured research funding from organizations such as the National Institutes of Health, Helmsley Charitable Trust, the American Diabetes Association, and Breakthrough T1D — while remaining actively engaged in both clinical care and research.  “These individuals represent an impressive body of work while remaining deeply involved in the day-to-day realities of diabetes care,” said Walton. Their expertise covers the full spectrum of T1D care — from AI and predictive analytics to complication prevention, automated insulin delivery, continuous glucose and ketone monitoring, GLP-1 treatments, health equity, mental health, autoantibody screening, and disease prevention.    Turning insight into impact  The team’s work goes beyond research, focusing on translating insights into real-world practice. By leveraging data to scale best practices, the goal is to drive meaningful, measurable change across clinics and communities.  “Our advisors will help to extend our impact — whether through QI strategy, research innovation, funding opportunities, or new data-driven solutions,” said Walton. “We want to take what’s working at individual centers and spread that as broadly as possible.”   He added, “As a Collaborative, we’re also focused on advanced population health strategies such as exploring predictive data models to identify risks earlier and intervene before complications even begin to happen.”    The power of the T1D Exchange Quality Improvement Collaborative  Central to this work is the T1D Exchange Quality Improvement Collaborative (T1DX-QI) — a nationwide network of clinics working together to improve care through shared data, benchmarking, and evidence-based practices.  “I’m thrilled to serve as a Medical Advisor for T1D Exchange, because I’ve seen firsthand the impact this network can have on patient care,” said Dr. Nestoras Mathioudakis. “T1D Exchange is the premier organization for quality improvement in type 1 diabetes, with unparalleled assets like a large EHR database and robust patient registry.”  He added that he is excited to apply his expertise in EHR research and big data analytics to generate real-world evidence across diagnosis, management, and outcomes.  Dr. Viral Shah echoed that perspective, reflecting on T1DX-QI's evolution: “I have been involved with T1D Exchange since its early days and have had the privilege of witnessing how it has transformed the quality of diabetes care across the United States. I’m delighted to return as a Medical Advisor.”  He emphasized the importance of accelerating impact. “I look forward to working closely with the team to accelerate the evidence generation and to help translate these insights to improve patient care.”   Dr. Jenise Wong highlighted the visible impact of T1DX-QI on the delivery of care. "I’m truly honored and grateful to be working with T1D Exchange as a Medical Advisor. 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    25 Comments

    1. Jane Cerullo

      A1c is what it is. TIR can be manipulated by changing the parameters.

      3
      2 years ago Log in to Reply
      1. wyndare3

        While it wasn’t stated, I felt it was implied 70-180 was considered the range.

        1
        2 years ago Log in to Reply
    2. Jim Andrews

      If my time in range is good, I know my A1C will be good as well. The fallacy in relying solely on your A1C is that you can be swinging high and low wildly and still have a decent A1C.

      5
      2 years ago Log in to Reply
    3. Nevin Bowman

      This is a loaded question – Ideally, I would have a low A1C and 100% time in range. But, if the time in range is very wide such as 70-200 it becomes pointless. Also, a low A1C with little time in range could indicate a lack of control.

      4
      2 years ago Log in to Reply
    4. Ernie Richmann

      So if I am usually in range, I probably have an acceptable A1c. If not my range needs an edit. I guess I could be at the high end of my range and have an A1c above 7or higher.

      2
      2 years ago Log in to Reply
    5. george lovelace

      I answered Both however A1c can be spot on but TIR really is more determinative to Control

      1
      2 years ago Log in to Reply
    6. wyndare3

      Time in range doesn’t tell the entire story on management, especially without average glucose. You could be at 179 level and have a high A1C or be at 71 the entire time and be borderline low all the time and still be in range 100% of the time. A1C while weighted for the last 30 days of the 90 period measured gives at better look at management control in general. I think it is important to use all the tools to manage the best(and safest) control.

      3
      2 years ago Log in to Reply
      1. cynthia jaworski

        Those same extremes could also result in an admirable a1c……since it is an average.

        2 years ago Log in to Reply
    7. Lawrence S.

      I view them both as important. The goal is to keep my A1c below 6, and my time in range above 85%, preferably in the 90’s%. They must both remain good numbers, depending upon our goals.

      1
      2 years ago Log in to Reply
    8. Eva

      Here is how I evaluated the question. If I am judging how much sugar is attached to my red blood cells on average, then A1C is the measure that is important. Why? Because, as we all know, too much sugar in your blood cells hardens arteries, and too much potassium and other minerals floating around in your blood (rather than in your cells) wreaks havoc too.
      So, I don’t even consider my TIR because my most important metric is my blood sugar at this moment. If high, I need to consider how to bring it down to 80. If low (below 65), I need treat to 80. If I focus on the here and now, I can better manage what the future is going to look like and my TIR is spot on.

      2 years ago Log in to Reply
    9. Derek West

      I monitor my control daily, TIR on a weekly basis and use the A1c as a confirmation that I have been doing ok for the last 90 days.

      2
      2 years ago Log in to Reply
    10. Henry McNett

      The problem with TIR as defined by the ADA is that up to 180 gm/dl is not a physiologic number, it is indeed pathologic which we should not be normalizing. Most normal people will not go above 140 after a carb heavy meal, and will stay there only temporarily.

      1
      2 years ago Log in to Reply
    11. Susan Wood

      They are equally important.

      0
      2 years ago Log in to Reply
    12. William Bennett

      A1C used to be all we had, pretty much, but as an **average** it conceals as much as it reveals. You can get a pretty low A1C as a result of having a lot of severe hypos, which is why Endo’s used to yell at us for getting that number too LOW. But since the advent of CGM we can look at the whole graph over the same time period and see whether hypos are a factor or not. Back in the day TIR didn’t even exist, but now that it does it gives us a much more complete picture of how we’re doing. A1C is only secondary in terms of how much information it’s really adding to that picture.

      4
      2 years ago Log in to Reply
    13. Steven Gill

      I think a lower a1C with very few episodes of hypoglycemia would prevent a lot of diabetic complications. And admittedly a large number of lows would skew that number (while indicating the glucose removal from the blood, but not consider if any damage from short-term highs), so a “time in range” is important. My alarms are set 70-130, I’m there almost 70% of the time with 3% lows (Medtronic), while at that generic 70-180 I’m there in the 90 percentile. These all influence the a1C, influencing the risk to our body.

      If I could be guaranteed an a1C 9.7 I’d die happy and healthy I wouldn’t worry, but that’s not the case. And regardless I personally feel to work so hard for a good a1C and still smoke, eat extremely unhealthily not be active almost seems hypocritical because damage from any reason is still damage. Neuropathy, cardiovascular problems, eye damage are present in both diabetic and non-diabetic members in my family. To me means there’s a probable tendency towards that: so my goal is to cause as much trouble and prevent health problems that at the same time.

      2 years ago Log in to Reply
    14. Chris Albright

      The A1C is a measurable metric. If you have a low A1C (5’s, 6’s, 7’s) you ‘most likely’ have good time in range. Since an A1C is a more ‘measurable metric, it provides you the data to work towards improvement. (IMO)

      2 years ago Log in to Reply
    15. lis be

      If my A1c is reasonable, then time in range is more important to me. If my A1c shows as high, then that becomes more important to me.

      1
      2 years ago Log in to Reply
    16. David Hedeen

      Selected A1c only because TIR has always exceeded physician’s target

      2 years ago Log in to Reply
    17. Ceolmhor

      I manage, hour-to-hour and day-to-day, using time in range. I evaluate the long-term effect using A1c.

      2 years ago Log in to Reply
    18. Sandy Norman

      I think both are important tools, I think if you have an A1c in the mid 6’s and a TIR in 90% that would be fantastic, granted maybe hard, but I try for that and look at both daily.

      1
      2 years ago Log in to Reply
    19. Anita Stokar

      I put time-in-range, however the A1c is a close second. I certainly don’t want to average around 140 even though my time in range is 100%.

      1
      2 years ago Log in to Reply
    20. Jeff Balbirnie

      The basic question incorrectly pre-supposes significant emotional import. I reject the premise entirely.

      2 years ago Log in to Reply
    21. T1D4LongTime

      There are 3 measurements that are needed to monitor T1D control. They are all important for good control. Time in Range is the primary measure. A1C and Standard Deviation can be good, but good TIR prevents complications and dangerous medical events. A1C is equally important because it is NOT dependent on any technology. However, horrible control with lots of lows can result in a deceiving low/good A1C. Standard Deviation(SD) is important because it shows how much your BG swings up and down from the average. Continuous SD and TIR are only available with CGMs, so are dependent on accuracy and how often worn. All 3 measures give a more accurate picture

      2 years ago Log in to Reply
    22. Nicholas Argento

      I look at men BG on CGM for 1 month and time in range, I set a goal of > 90%. A1c does not mean much to me, I put more weight on GMI (A1c from CGM) because it is more accurate for the individual

      2 years ago Log in to Reply
    23. ChrisW

      A1C is the hammer of diabetes tools. It has been around for a long time and has been surpassed by many better options.

      2 years ago Log in to Reply

    When evaluating your T1D, is your A1c or your time in range more important to you? Cancel reply

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