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Is Time in Range the new Fashion Trend?

By Kathleen Brown posted 03-15-2019 15:15

  

A Recent Study looked at the association of Time in Range (TIR) with the development of retinopathy and microalbuminuria using the Diabetes Control and Complications (DCCT) data set to validate Time in Range as an acceptable end-point for clinical trials.

 

The conclusion proved a strong correlation between increased TIR & reduced risk of microvascular diseases.

 

So Why use HA1c?

It’s the only validated marker for the development of long-term diabetes complications (DCCT, UKPDS, etc…); and It is linked to pathways that drive long‐term complications.

 

Why Not HA1c?

It’s long‐term measurement of blood glucose is not reflective of day‐to‐day blood sugar values; and It Does Not reflect hypoglycemia or Blood glucose variability.

 

So Why use Time in Range?

It Provides both hyper and hypoglycemia transparency and a more physiologic target for improved glycemic control. It also provides the best representation of diabetes glycemic “health”

 

Why Not Time in Range?

We have not agreed on the ideal time in range or the goal.

It is CGM‐dependent (to a large degree).

 

So, the question remains ????

Is Time in Range a better indicator then HA1c?   Do we need to go beyond the HA1c and encompass diabetes outcomes that reach beyond HA1c to better reflect glycemic control and how patients feel, function and live?

 

I would love to hear your comments.

 

Kathleen. T Brown   RN, BSN, CPT, CDE, CCRN

Clinical Territory Manager

kathleen.t.brown@medtronic.com

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Comments

Jennifer Riley
03-22-2019 08:15

Time in range is more than a fashion trend

Using time in range is long over due vs. using A1c alone. Too often hypoglycemia has been inadequately addressed when A1c's  in the 8's. Despite no current definitions, we are making progress as noted at the ATTD International conference and a agreement on targets for specific populations. The writing committee's goal is to refine preliminary targets and publish by ADA.  Source: closeconcerns.com

They are also defining minimum days of CGM data to required for a representative profile and what constitutes a clinically meaningful change in TIR.

As CGM use grows and becomes the measurement norm, our landscape of terms will continue to evolve.

  • Coefficient of Variation: a measurement of the up and down movement of CGM data
  •  GMI: Glucose Management Indicator as a replacement term for eA1c for CGM.

Tidepool has already incorporated into their report metrics and others will certainly follow suit.

Diane Battaglia
03-19-2019 07:34

This is so very important!

Diabetes Educators have been saying this for a decade. Following A1c is only part of something bigger with prevalent hypoglycemia in the picture. Looking at TIR is more telling and also, now has the data to support it! I am very grateful to you in sharing this blog Kathleen!!