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Time in Range (TIR) is clinical metric that, together with Time Below Range (TBR) and Time Above Range (TAR), provides a more complete picture of a person’s glucose levels, enabling a more data-driven approach to diabetes management.¹

TIR: Time saver or time spender? Dr. Alice Cheng, University of Toronto, discusses how TIR takes the guesswork away in diabetes management.

Measured by continuous glucose monitoring (CGM), TIR is a complement to HbA_1c in clinical practice.¹ These two metrics in combination may be used by healthcare professionals to build personalised action plans to improve daily diabetes management.¹ This additional layer of insight offers the potential to drive meaningful conversations with people with diabetes around appropriate lifestyle adjustments, such as food choices and physical activity.¹ The data also support healthcare professionals to make informed decisions on treatment choice, insulin dosage and timing of doses.¹

Clinical guidance and targets for TIR, a new clinical metric and complement to HbA_1c in clinical practice.

TIR and HbA_1c – working together to provide actionable insights

TIR and HbA_1c provide actionable insights that empower people with diabetes and healthcare professionals to work together to improve glucose control and increase TIR.¹ The table below is one representation of how TIR corresponds to HbA_1c.²

The higher a person’s HbA_1c, the higher their risk of developing diabetes-related complications.^3-6 Increasing TIR corresponds to a decrease in HbA_1c, with studies showing that for every absolute 10% change in TIR, there is an approximate 0.8% (9 mmol/mol) change in HbA_1c.²

The International Consensus Report recommends that most people with diabetes* should spend at least 70% of the day, or around 17 hours, in the target glycaemic range of 70 to 180 mg/dL (3.9 to 10 mmol/L). This corresponds to the recommended HbA_1c target of approximately 7% (53 mmol/mol).¹

TBR, the percentage of time spent below 70 mg/dL, indicates hypoglycaemia. Most people with diabetes* should spend less than 4% of their day (one hour)** below range. TAR, the percentage of time spent above 180 mg/dL indicates hyperglycaemia. Most people with diabetes should spend less than 25% of their day (six hours)^† above range.¹

* For older and/or high-risk people with diabetes, the TIR target is lowered to >50% and TBR reduced to <1% at <70 mg/dL (<3.9 mmol/L).¹

*^**<1% of this time should be spent in the “very low” TBR of <54 mg/dL (3.0 mmol/L).*¹

^†<5% of this time should be spent in the “very high” TAR of >250 mg/dL (13.9 mmol/L).¹

Up next:

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How to use Time in Range in clinical practice

TIR and HbA1c – working together to provide actionable insights

* For older and/or high-risk people with diabetes, the TIR target is lowered to >50% and TBR reduced to <1% at <70 mg/dL (<3.9 mmol/L).1

** <1% of this time should be spent in the “very low” TBR of <54 mg/dL (3.0 mmol/L).1

† <5% of this time should be spent in the “very high” TAR of >250 mg/dL (13.9 mmol/L).1

TIR and HbA_1c – working together to provide actionable insights

* For older and/or high-risk people with diabetes, the TIR target is lowered to >50% and TBR reduced to <1% at <70 mg/dL (<3.9 mmol/L).¹

*^**<1% of this time should be spent in the “very low” TBR of <54 mg/dL (3.0 mmol/L).*¹

^†<5% of this time should be spent in the “very high” TAR of >250 mg/dL (13.9 mmol/L).¹