Getting started with Time in Range

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
• Review the Diabetes Canada Clinical Practice Guidelines on Time in Range.²
• Identify who could benefit from CGM, as outlined by Dr. Alice Cheng, University of Toronto in the video below.

The International Consensus Report on Time in Range has recommended that healthcare professionals take the following steps as they start adopting TIR for 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.  Both Diabetes Canada and the International Consensus on Time in Range recommend using these criteria for most adults with Type 1 and Type 2 Diabetes.^1,4

Continuous Glucose Monitoring Metrics^1,2

1. Emphasize the importance of reducing the time spent below range, with glucose levels below 3.9 mmol/L to “less than one hour per day” and time spent below 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 10.0 mmol/L as “less than six hours per day” and time spent above 13.9 mmol/L to “less than one hour 12 minutes per day.”
3. Review the AGP to identify the timings and magnitudes of glycemic 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.