Time in range: A best practice guide for UK diabetes healthcare professionals in the context of the COVID‐19 global pandemic

Abstract

The emergence of continuous glucose monitoring has driven improvements in glycaemic control and quality of life for people with diabetes. Recent changes in access to continuous glucose monitoring systems within UK health services have increased the number of people able to benefit from these technologies. The COVID-19 pandemic has created an opportunity for diabetes healthcare professionals to use continuous glucose monitoring technology to remotely deliver diabetes services to support people with diabetes. This opportunity can be maximized with improved application and interpretation of continuous glucose monitoring-generated data. Amongst the diverse measures of glycaemic control, time in range is considered to be of high value in routine clinical care because it is actionable and is visibly responsive to changes in diabetes management. Importantly, it is also been linked to the risk of developing complications associated with diabetes and can be understood by people with diabetes and healthcare professionals alike. The 2019 International Consensus on Time in Range has established a series of target glucose ranges and recommendations for time spent within these ranges that is consistent with optimal glycaemic control. The recommendations cover people with type 1 or type 2 diabetes, with separate targets indicated for elderly people or those at higher risk from hypoglycaemia, as well as Note: Each of these measures of glycaemia can be derived and reported by isCGM or rtCGM systems. They are all endorsed by international consensus guidance on use of CGM systems in the management of diabetes. 11,14,15 Abbreviations: CGM, continuous glucose monitoring; CV, coefficient of variation; eA 1c , estimated HbA 1c ; GMI, glucose management indicator; isCGM, intermittently scanned CGM (flash glucose monitoring); rtCGM, real-time CGM; TAR, time above range; TBR, time below range; TIR, time in range.

Glucose control in diabetes during home confinement for the first pandemic wave of COVID-19: a meta-analysis of observational studies

“…The principal endpoints were variations from baseline in glycated haemoglobin (HbA1c) and Time in Range [ 19 ] (TIR, time during which glycaemia is maintained between 70 and 180 mg/dl) during and after lockdown. Additional outcomes were Time Above Range (TAR, time during which glycaemia is above 180 mg/dl), Time Below Range (TBR, time during which glycaemia is below 70 mg/dl), mean glucose, glucose variability (coefficient of variation), frequency of glucose monitoring, variations in eating habits and physical activity, perceived stress.…”

2020 NICE guideline update: Good news for pregnant women with type 1 diabetes and past or current gestational diabetes

“…The Diabetes Technology Network (DTN) has also produced Top Tips for CGM users and Best Practice Guidelines for health care professionals (https://abcd.care/dtn/CGM). NICE did not provide clear guidance for time‐in‐range pregnancy glucose targets, which are more than 70% CGM time‐in‐range (TIR 3.5–7.8 mmol/L), less than 25% time‐above‐range (TAR > 7.8 mmol/L) and less than 4% time‐below‐range (TBR < 3.5 mmol/L) in type 1 diabetes pregnancy 4 …”

Optimizing the use of technology to support people with diabetes: research recommendations from Diabetes UK’s 2019 diabetes and technology workshop

“…The need to improve the awareness and understanding of many healthcare professionals of TIR as a measurement and how to use it to inform care was also highlighted. 19…”