As the number of people affected by diabetes continues to grow and the disease remains one of the leading causes of death worldwide,1,2 it’s clear that the management of diabetes needs to advance to improve outcomes.
Time In Range (TIR) is emerging as a valuable metric that could revolutionise diabetes management by providing a more complete picture of glucose levels and variability over much shorter periods of time than HbA1c. 3-5 It is a practical tool that can empower people living with diabetes and their healthcare professionals (HCPs) to make informed decisions about diabetes treatment and management that can support better control and help patients feel more engaged with their diabetes.5,6
As continuous glucose monitoring use is increasingly recommended and reimbursed, the case for wider adoption of Time in Range (TIR) grows stronger.3,7,8 Yet there are some barriers – including concerns that it could be a daunting and time-consuming task to analyse TIR data to gain the insights needed for clinical management.4,5,9 These concerns highlight a need for education about Time in Range (TIR) and familiarisation with the Ambulatory Glucose Profile (AGP) report, which presents assimilated continuous glucose monitor (CGM) data which reveal TIR and glucose variability over a 14-day period.3,4
Quantitative research findings
HCPs agree: Time in Range (TIR) could become the standard of diabetes management in the future4
A large global survey of more than 1,700 HCPs was independently conducted to explore knowledge, use of and attitudes towards Time in Range.4 There was overwhelming agreement that TIR is likely to become the standard of diabetes management, and HCPs consider it effective in providing accurate information on hypoglycaemia and optimising insulin regimens as well as non-insulin regimens for patients with type 2 diabetes.4
These benefits have the potential to empower both HCPs and patients by supporting patients in accepting and following HCP advice. Increased compliance can support better self-management through lifestyle changes for diabetes, and TIR has also been associated with psychosocial and emotional benefits including reduced stress, improved wellbeing, and an improved perception of treatment success.4,5,10,11 You can read more about how to encourage patients to increase their TIR here – you’ll also find patient-friendly ‘top tips’ to share to support their diabetes self management.
Many HCPs agree Time in Range is time saving – for both themselves and their patients4,9
The majority of HCPs in the survey identified the metric’s ability to save time for both HCPs and patients as one of the main benefits of TIR.4,5 TIR can enable more timely intervention, encourage patient adherence and diabetes self management and add speed and efficiency to patient consults.4,5,9 Using TIR in practice is supported by modern CGM devices with built-in software for downloading data, digital health tools and telemedicine for remote monitoring and patient consultations.12,13
Saving time is one of the perceived benefits of TIR4
Adapted from Cheng et al, 2022.4
Data shown are for % rating as very effective/effective.
*e.g. decisions can be made faster and more efficiently, fewer emergency visits, no need to wait 3 months for HbA1c results. Specialists (n=741) had primary specialty in endocrinology/diabetology. Generalists (n=671) had primary specialty in family practice, general practice, primary care, internal medicine, cardiology (Brazil, Sweden), geriatrics (Brazil, Sweden). Allied HCPS (n=307) were diabetes nurse specialists, diabetes educators, general nurses, nurse practitioners and physician assistants. HCP subgroups were compared with an exploratory analysis (standard crosstabs) and statistical differences between subgroups analysed. Subgroup differences were tested at 95% level of confidence. T-test of means and Z-test of proportions were used. No multiple comparison adjustments were made.
Together, continuous glucose monitoring and TIR can optimise time by leveraging the growing use of digital health tools and techniques9,12 CGM data and the 14-day AGP report can be downloaded and viewed remotely to enable digital patient monitoring, and telemedicine gives remote patients access to HCP consults from any location. Together, these can reduce HCP and health care team burden and save patients time, and overall healthcare expense.9,12,13
Saving time through connected interaction
The above is an excerpt from an infographic which provides a visual overview of how glucose monitor data, HCPs and patients can interact via digital health: DOWNLOAD CGM & DIGITAL HEALTH INFOGRAPHIC
And the following guide for patients explains how using a continuous glucose monitor, and taking the opportunities digital health provides, can optimise diabetes management and facilitate connections with clinicians. This can be downloaded to support conversations with with patients about digital health and the AGP in diabetes. It can also be printed out to share. DOWNLOAD CGM & DIGITAL HEALTH PATIENT GUIDE
The AGP has been incorporated into the data management software of all CGM devices and, whilst each brand has specific features, they all conform to the international consensus recommendations for Time in Range.9 Thus, CGM data and recurring AGP reports (usually produced roughly every 14 days) can be transmitted to healthcare professionals via web-based cloud-access sites or dedicated download software programmes.13,14
Connecting patients with HCPs, CGM data and digital health tools (as shown in the infographic above) can make using the AGP in diabetes management more efficient and less time-consuming.9,12,13 Numerous studies have shown that virtual patient consults via telehealth in conjunction with remotely monitoring glucose can improve glycaemic control, reduce diabetes-related distress, enhance adherence to therapy and improve cost-effectiveness.13
How CGM Time in Range can save you time
Professor Christophe De Block and Associate Professor Julia Mader discuss how HCPs can use their time effectively to analyse the AGP report and decide on actions
Barriers and challenges
The global HCP survey referred to above highlighted lack of education and training as one of the top barriers to the adoption of Time in Range.4 The survey also revealed limited use and knowledge of TIR as well as limited use of the AGP report.4,5 So, although HCPs agree on the importance and future of TIR, focused education is key to driving wider adoption.
Data analysis in just 10 minutes
"If [HCPs] have such a support, they can analyse these data within ten minutes"
The downloadable infographic below describes a stepwise process for analysing the AGP in diabetes. Analysis can be made easier by taking a systematic approach, breaking down the report into three intuitive sections to examine sequentially.14
DOWNLOAD AGP INFOGRAPHIC
You can read more about unlocking insights from the AGP report here.
AGP report section 1 at a glance – key statistics and Time Above, In and Below Range3
- Key statistics include GMI; a surrogate for HbA1c
- A simple coloured histogram shows time in ranges (targets are added)
Adapted from Battelino et al. 20193.
The glucose ranges and Time in Range goals are the recommendations for most people and differ across patient groups.3
"At first it looks like it might take a lot of time, but when you look at the Time in Range report it actually takes less time because you gain much more information in a short period of time, as compared to what you’ve been seeing with the SMBG profiles. You lack a lot of information, for instance about the postprandial glucose levels, but also nocturnal glucose levels. And in fact, it takes only a few minutes."
The AGP in diabetes reduces the burden on diabetes care teams by making CGM data easily comparable across all devices.9 And data from the AGP report can be supported by a wider care team involving office staff, nurses, nurse practitioners and pharmacists as appropriate, with modification of workflow to include the printing of AGP reports before patient consultations. This has been shown to reduce visit time and has the potential to encourage holistic care.9
Practical step-by-step guides to support quick analysis of the AGP in diabetes
For clinicians who are unfamiliar with using continuous glucose monitoring and integrating this technology into clinical practice might appear daunting.13 To help address the education gap a number of resources now exist that interested clinicians can utilise to help smooth the transition, including guides produced by CGM device manufacturers.13 Simple, stepped approaches to interpreting the AGP have also been published in peer-reviewed journals, informed by literature and professional guidelines, and authors’ clinical experience.15,16 Independent qualitative research with patients indicates that the process can be facilitated as they learn to interpret CGM and AGP data in between HCP consults.6
HQ22DI00278 June 2023