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:

The ideal candidate for CGM: Dr. Alice Cheng describes who she would recommend for CGM.

According to the Diabetes Canada Clinical Practice Guidelines Expert Working Group, clinicians should consider CGM for the following patients:2

  • Adults with type 1 diabetes who:
    • Use basal-bolus insulin therapy or continuous subcutaneous insulin infusion (CSII), or
    • Experience impaired hypoglycemia awareness, or
    • Experienced recent severe hypoglycemia, or
    • Are pregnant
  • Adults with type 2 diabetes on basal-bolus insulin therapy who have not achieved their A1C target

    Diabetes Canada has recently updated their guidelines on blood glucose monitoring to include Time in Range recommendations. Learn how these new recommendations might impact your practice.2

    Read more

    Steps for getting started with TIR

    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 Metrics1,2
    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.

    Dr. Alice Cheng shares her key considerations when getting a person started with CGM and empowering them to manage their glucose levels.