For healthcare professionals who may not be familiar with continuous glucose monitoring (CGM) or Time in Range (TIR) but are interested in learning more about how to integrate them into clinical practice:

  • Review the International Consensus Report on Clinical Targets for CGM Data Interpretation, which provides information about specific glucose targets and treatment goals.1
  • Identify who could benefit from CGM, as outlined by Dr. Alice Cheng, University of Toronto in the video below.

The ideal candidate for CGM: Dr. Alice Cheng describes who she would recommend for CGM.

According to the Association of Diabetes Care & Education Specialists (ADCES), any of these factors could indicate that a person with diabetes may benefit from CGM:2,3

  • Taking multiple daily injections of insulin
  • Using an insulin pump
  • Frequent hypoglycaemia
  • Hypoglycaemia unawareness
  • Newly diagnosed with type 2 diabetes, to use as an educational tool
  • High degree of glycaemic variability
  • Not achieving glucose targets
  • People with type 2 diabetes not on intensive insulin regimens and exhibiting good glucose control, but may benefit from CGM as an alternative to self-monitoring of blood glucose (SMBG)

    Steps for getting started with TIR

    It is recommended that healthcare professionals take the following steps as they start adopting TIR with people with diabetes:1,3,4

    1. Check that adequate glucose data are available for evaluation, considering the CGM metrics listed in the table below.
    Continuous glucose monitoring metrics for clinical care
    1. Emphasise the importance of reducing the time spent below range, with glucose levels below 70 mg/dL (3.9 mmol/L) to “less than one hour per day” and time spent below 54 mg/dL (3.0 mmol/L) to “less than 15 minutes per day.” This way, people do not have to determine the time corresponding to these percentages (4% and 1%, respectively) on their own.
    2. Ensure understanding of reducing time spent above range, with glucose levels above 180 mg/dL (10.0 mmol/L) as “less than six hours per day” and time spent above 250 mg/dL (13.9 mmol/L) to “less than one hour 12 minutes per day.”
    3. Review the AGP to identify the timings and magnitudes of glycaemic variability.
    4. Consider all the variables, such as food choices, physical activity and medications, that affect a person’s glucose profile before making treatment recommendations.
    5. Ensure each person with diabetes understands their glucose targets and is comfortable using CGM.

    In her video (below), Dr. Alice Cheng suggests that it may help to tell people with diabetes who are starting on CGM that they will receive a higher volume of data than they might be used to and not to be alarmed by this information in the first couple of days. Their next follow-up visit can often be an opportunity for them to ask questions and review different metrics, such as TIR, within their app or device. This will help them to understand the potential drivers between in range and out of range readings, and to make any necessary lifestyle or behavioural adjustments to increase TIR.

    Dr. Alice Cheng shares her key considerations when getting a person started with CGM and empowering them to manage their glucose levels.