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Cited by 170Diabetes Management and ResearchDiabetes Management and EducationDiabetes Treatment and Management

Positioning time in range in diabetes management

Open access
Advani, Andrew·2020·Diabetologia
DOI 10.1007/s00125-019-05027-0
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Abstract

Recent upswings in the use of continuous glucose monitoring (CGM) technologies have given people with diabetes and healthcare professionals unprecedented access to a range of new indicators of glucose control. Some of these metrics are useful research tools and others have been welcomed by patient groups for providing insights into the quality of glucose control not captured by conventional laboratory testing. Among the latter, time in range (TIR) is an intuitive metric that denotes the proportion of time that a person’s glucose level is within a desired target range (usually 3.9–10.0 mmol/l [3.5–7.8 mmol/l in pregnancy]). For individuals choosing to use CGM technology, TIR is now often part of the expected conversation between patient and healthcare professional, and consensus recommendations have recently been produced to facilitate the adoption of standardised TIR targets. At a regulatory level, emerging evidence linking TIR to risk of complications may see TIR being more widely accepted as a valid endpoint in future clinical trials. However, given the skewed distribution of possible glucose values outside of the target range, TIR (on its own) is a poor indicator of the frequency or severity of hypoglycaemia. Here, the state-of-the-art linking TIR with complications risk in diabetes and the inverse association between TIR and HbA 1c are reviewed. Moreover, the importance of including the amount and severity of time below range (TBR) in any discussions around TIR and, by inference, time above range (TAR) is discussed. This review also summarises recent guidance in setting ‘time in ranges’ goals for individuals with diabetes who wish to make use of these metrics. For most people with type 1 or type 2 diabetes, a TIR >70%, a TBR <3.9 mmol/l of <4%, and a TBR <3.0 mmol/l of <1% are recommended targets, with less stringent targets for older or high-risk individuals and for those under 25 years of age. As always though, glycaemic targets should be individualised and rarely is that more applicable than in the personal use of CGM and the data it provides.

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  • TIR, and especially mean CGM glucose, correlates with A1C.

    “TIR, and especially mean CGM glucose, correlates with A1C (27)(28)(29)(30)(31).”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [27]

    In 'The relationship between TIR and hyperglycaemia' (page not available), the paper reports strong inverse correlations between TIR and HbA1c. 'Evidence underlying consensus recommendations on TIR targets' says HbA1c reflects mean glucose levels, but does not establish the claim that mean CGM glucose correlates with HbA1c more strongly than TIR does. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Standardized reports with visual summaries have been implemented and help individuals with diabetes and health care professionals interpret the data to guide treatment decisions.

    “To make these metrics actionable, standardized reports with visual summaries have been implemented (33) and help individuals with diabetes and health care professionals interpret the data to guide treatment decisions (27,30).”

    From 6. Glycemic Goals, Hypoglycemia, and Hyperglycemic Crises: Standards of Care in Diabetes-2026. (2026) · cites this paper as [27]

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Research works printed but not linked: 1

  1. [44]44. Bergenstal RM, Gal RL, Connor CG et al (2017) Racial differences in the relationship of glucose concentrations and hemoglobin A1c levels. Ann Intern Med 167(2):95-102. https://doi.org/10.7326/ M16-2596

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Authors
Advani, A.
Affiliations
St. Michael's Hospital (CA)
Corresponding author
Advani, Andrew
ORCID
Advani, Andrew
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
2019-11-07
Volume
63
Issue
2
Pages
242-252
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s00125-019-05027-0
OpenAlex
W2987603677
Cited by
170
References
63
Citations by year
2026: 12 · 2025: 24 · 2024: 24 · 2023: 37 · 2022: 28 · 2021: 30 · 2020: 14 · 2014: 1
FWCI
2.77
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetologia (publishedVersion, other-oa)
  • PubMed (publishedVersion)
Funders
  • Institute of Nutrition, Metabolism and Diabetes
  • Heart and Stroke Foundation of Canada
  • RDV Foundation
  • Diabetes Canada
  • Kidney Foundation of Canada
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
Keywords
time in range, continuous glucose monitoring, diabetes management, hypoglycemia, time below range, time above range, HbA1c, glycemic targets, diabetes complications, type 1 diabetes, type 2 diabetes
MeSH terms
Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Time Factors, Blood Glucose Self-Monitoring, Diabetes Complications

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