Time in Range (TIR) is emerging as an important new diabetes metric for both clinicians and patients that is measured with continuous glucose monitoring (CGM). TIR reflects the amount of time a person with diabetes spends within a target glycaemic range (between 70 and 180 mg/dL or 3.9–10 mmol/L for most people).1 This range was recommended by a specially convened Advanced Technologies & Treatments for Diabetes (ATTD) expert panel in 2019 and confirmed by an International Time in Range Consensus Report. It is recommended that most people with type 1 or type 2 diabetes should aim to spend at least 70% of their day (around 17 out of 24 hours) within range.1
However, studies suggest some patients may feel they struggle to achieve their Time in Range goals, which may lead to stress and worry in their daily lives.2
"Patients may perceive more Time in Range as very rewarding and they feel more confident in what they’ve achieved so far by adapting their doses of their oral antidiabetic agents or their insulin doses, the timings of injections, the physical exercise they have commenced. It helps build positivity and decreases the negativity about having diabetes…they are self-managing their diabetes, and this is very reassuring for the patient."
Pursuing Time in Range goals has multiple benefits beyond clinical gain
There is accumulating real-world evidence that Time in Range could have multiple positive impacts on patients, healthcare professionals and healthcare systems. In addition to improving diabetes management and reducing the risk of short- and long-term complications of disease, TIR has the potential to tackle challenging psychological, social and economic issues associated with diabetes healthcare.1, 3-5
In a large global survey of over 1,700 HCPs, healthcare professionals have reported that Time in Range (TIR) can improve treatment adherence.3,6 Findings from global qualitative research among patients suggest that seeing daily glucose patterns helps them be more effective in their diabetes self management.6 TIR could also help combat the psychosocial costs of diabetes.5 Users of continuous glucose monitoring devices report significant improvements in quality of life, enhanced sense of well-being, less fear of hypoglycaemia and less worry.5 Notably, children and adolescents using continual glucose monitor report similar benefits and TIR can reduce barriers to treatment.5
From an economic perspective, it is considered that use of Time in Range (TIR) in both people with type 1 diabetes and type 2 diabetes could help optimise effectiveness and cost of diabetes healthcare. The timely adjustments of medication and reduction in short-term disease complications associated with use of TIR, together with the possibility of remote-monitoring, could contribute to these cost savings.5 This article describes the effective use of Time in Range (TIR) in everyday clinical practice.
"We have seen that using CGM reduces acute admissions to the hospital and enables healthcare professionals to do remote monitoring. So, for example, people who live further apart from a specialised centre, they can send over the data and review from a distance."
This downloadable infographic illustrates how remote monitoring, with interactions between patients, CGM data, digital health tools and their HCPs can support patients and clinicians.
Top Tips for your patients to support their Time in Range goals
There are several habits and lifestyle practices that encourage achievement of the ‘70% TIR’ goal, and we have gathered some top tips as a diabetes self management education tool. The ‘top tips’ are written for people with diabetes and are listed below for you to use during consultations. They can also be downloaded and printed for patients to take home.
Download Top Tips to help patients increase their Time in Target Range
Did you know, if you’re living with diabetes, increasing the time you spend in your target glucose range may help reduce your risk of diabetes-related health complications? 7-12 What’s more, it could also improve your mood and energy levels.13 So, the more time each day your glucose is in range, the better.1
To spend more Time in Range you can try the following helpful tips.
1. Get to know your Time in Range
Your Ambulatory Glucose Profile (AGP) report shows the data measured by your continuous glucose monitoring (CGM) device. To determine your Time in Range, you’ll need at least 14 days of this glucose data. When you have enough data to get a good picture of your Time in Range, it is recommended that most people with type 1 or type 2 diabetes should aim for:1,14
- At least 70% of the day (around 17 hours) with their glucose levels between 70–180 mg/dL (3.9 to 10 mmol/L)
- Less than 4% of the day (around 1 hour) with their glucose levels below 70 mg/dL (3.9 mmol/L)
- Less than 25% of the day (around 6 hours) with their glucose levels above 180 mg/dL (10 mmol/L)
2. Reduce post-meal spikes
To increase your Time in Range, it’s best to keep an eye on your glucose monitor data after meals. If you're taking insulin a pre-meal dose can be important and taking this 15-20 minutes before eating is one of the most effective ways to stay in range.15 To reduce post-meal spikes, try to replace foods that are high in processed starch and sugar, such as white bread, pasta and rice, with foods that are loaded with fibre and complex sugars, such as wholemeal bread, wholegrain rice and pasta.16
3. And if that spike isn’t coming back down…
If your glucose levels is stubbornly staying above your target range, aerobic exercise, such as jogging, cycling or swimming, could help. A brisk 20-minute walk around half an hour after a meal has been shown to be effective for lowering post-meal spikes.17
4. Take action when you go too low
It’s just as important to act when your glucose levels drops below 70 mg/dL (3.9 mmol/L).18 If this happens, try the '15-15 rule' and consume 15 grams of simple or fast carbs in a snack, or a glucose tablet, wait 15 minutes then check your CGM data. The 15/15 rule is a quick and balanced way to increase your blood glucose levels.17,19
5. Think before you reach for the carbs
When your glucose levels dip, it’s tempting to grab whatever food is at hand to avoid going into hypoglycaemia (below 70 mg/dL [3.9mmol/L]), but the type of carb you eat is important.16,18 Fruit, vegetables and wholegrain snacks will help get your glucose levels gently back in range.16 Fast-acting carbs are needed, however, if your glucose goes very low.18
6. Learn from your good days …
On the days you succeed in spending lots of time in your target range, ask yourself: ‘What did I eat?’ ‘How much exercise did I get?’ Remember to record this information and try to repeat the same routine in the following days to see if you get a similar result. This could help you to achieve your time in range goals.
7. … and learn from the bad days too
When you see less Time in Range (TIR) on your diabetes AGP report report, ask yourself: ‘What physical activity did I do and what did I eat on that day that caused me to spend more time out of range? Was I feeling stressed, or unwell?' Consider what you could do differently next time…it's good to learn to manage stress by building rest and relaxation into your routine, and techniques like breathing exercises can help.20,21 And take care of yourself when you're ill.20 Always be patient with yourself. You are trying your best.
8. Celebrate your successes!
Alongside diet, exercise and medication, your emotions and mood can affect Time in Range (TIR).20 While you’ll have good and bad days, try to keep motivated and stay positive by celebrating your successes.
HQ22DI00276 June 2023