15. Diabetes Advocacy: Standards of Medical Care in Diabetes—2018
Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Relationships between time in target range and A1C have been observed.
“Relationships between time in target range and A1C (25; 26) and number of severe and non-severe hypoglycemic events (27-31) have also been observed.”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
Each incremental 5% increase in TIR is associated with clinically significant benefits for people with type 1 or type 2 diabetes.
“Importantly, as demonstrated by Beck et al. (25), Vigersky et al. (26) and Feig et al. (47), even small, incremental improvements yield significant glycemic benefits.”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
There is suggestive evidence from recent studies that time in target range (70-180 mg/dL) correlates with diabetes complications.
“there is suggestive evidence from a number of recent studies, one a cross-sectional study correlating current retrospective 3-day TIR with varying degrees of diabetes retinopathy (25) and an analysis of the 7-point SMBG data from the DCCT (26) have shown correlations of time in target range (70-180 mg/dL [3.9-10.0 mmol/L]) with diabetes complication.”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
An increase in TIR of 10% (2.4 hours per day) corresponds to a decrease in A1C of approximately 0.5% (5.0 mmol/mol).
“An increase in TIR of 10% (2.4 hours per day) corresponded to a decrease in A1C of approximately 0.5% (5.0 mmol/mol); similar associations were seen in an analysis of 18 RCTs by Vigersky et al. that included over 2,500 individuals with type 1 diabetes and type 2 diabetes over a wide range of ages and A1C levels (26).”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
In adults with type 1 diabetes, TIR of 50% corresponds to an A1C of approximately 8%.
“TIR (70180 mg/dL [3.9-10.0 mmol/L]) of 70% and 50% strongly corresponded with an A1C of approximately 7% (53 mmol/mol) and 8% (64 mmol/mol), respectively.”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
TIR has a relationship with A1C.
“as well as a relationship between TIR and A1C (25; 26).”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
In adults with type 1 diabetes, TIR of 70% corresponds to an A1C of approximately 7%.
“TIR (70180 mg/dL [3.9-10.0 mmol/L]) of 70% and 50% strongly corresponded with an A1C of approximately 7% (53 mmol/mol) and 8% (64 mmol/mol), respectively.”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
A 5% increase in TIR is clinically significant in improving glycemic control.
“emphasizing that what may appear to be small, incremental successes (e.g. 5% increase in TIR) are, in fact, clinically significant in improving their glycemic control (25; 26; 47).”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
Even small, incremental improvements yield significant glycemic benefits.
“Importantly, as demonstrated by Beck et al. (25), Vigersky et al. (26) and Feig et al. (47), even small, incremental improvements yield significant glycemic benefits.”
From Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range (2019) · cites this paper as [25]
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- Authors
- American Diabetes Association
- Corresponding author
- American Diabetes Association
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2017-11-24
- Volume
- 41
- Issue
- Supplement_1
- Pages
- S152-S153
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W4237834786
- Cited by
- 97
- References
- 5
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 12 · 2020: 17 · 2019: 26 · 2018: 21
- FWCI
- 13.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- diabetes advocacy, clinical guidelines, quality of care, level of evidence, diabetes management guidelines
- MeSH terms
- Diabetes Mellitus, Humans, Patient Advocacy, Patient Rights
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