Thread by @JamesRi81958925

1/14
Time for another #thursdaythread in collaboration with @diabeteschat.

This one is about 'time in range' (TIR)⏰

It was requested during this week's #diabeteschat session.

This thread aims to define TIR and identify recommendations for TIR.

2/14
What is 'time in range'?

It is a measurement of CGM sensor data highlighting how much time glucose levels are within a specific glucose range for a 24 hours period:
· 3.9 – 10.0mmol/L (70 – 180 mg/dL) for adults.
· 3.5 – 7.8mmol/L (63 – 140 mg/dL) during pregnancy🤰

3/14
Where did TIR come from?

In 2019, the @ATTDconf congress brought together a panel of individuals: #pwd, healthcare professionals and researchers with expertise in CGM.

They developed CGM target percentages of time within, below and above the glucose range⏰

4/14
The International Consensus on Time in Range was then created🌟

Please click on the link below for info:
diabetesjournals.org/care/article/4…

5/14
So what is the recommended amounts of time in range?

The measurement of time in range is presented as a percentage (%) and as hours and minutes⏰

The image below shows the recommended amounts of time within, below and above target range.

6/14
Let's break it down a little more.

For independent adults with #T1D or #T2D it recommends:
<25% (under 6 hours) above range (10.0mmol/L)
<4% (under 1 hour) below range (3.9mmol/L)
>70% (16 hours, 48 minutes) within range (3.9-10.0mmol/L)

7/14
For older/high risk individuals with #T1D or #T2D it recommends:
<50% (under 12 hours) above range (10.0mmol/L)
<1% (under 15 minutes) below range (3.9mmol/L)
>50% (over 12 hours) within range (3.9-10.0mmol/L)

8/14
For a person with #T1D who is pregnant, it recommends:
<25% (under 6 hours) above range (7.8mmol/L)
<4% (under 1 hour) below range (3.5mmol/L)
>70% (16 hours, 48 minutes) within range (3.5-7.8mmol/L)

9/14
You may be wondering why a tighter glucose target range during pregnancy.

Tighter targets during pregnancy and the use of CGM helps to improve neonatal outcomes, as highlighted in the CONCEPT trial.

Click the link for info:
thelancet.com/journals/lance…

10/14
Can any other health benefits come from improving time in range?

Each 10% (2.4 hours) increase of time in range reduces:
- HbA1c by approximately 0.5% (5.0mmol/mol)🩸
- Risk of diabetes-related eye problems by 64%👁️
- Risk of kidney problems (microalbuminuria) by 40%.
👍

11/14
Just remember that these are the gold standard recommendations and achieving them is very hard.

Some days you will have more or less time in range than the day before.

The main thing is to keep going and do the best you can🙂

12/14
You might occasionally see people tweeting out 'unicorn' moments 🦄

These are when a person has spent 100% of time in range for the past 24 hours.

Such moments are great but very rare for many.

Celebrate any moment of improvement, whether that is just a few % more🙂

13/14
I could write about time in range until the cows come home, but I'll leave this thread here.

One thing I would advise is to educate where possible.

@DTN_UK have some fab resources for both #pwd and #hcps

@EDEN_Leicester have a brill glucose sensing programme for #hcps

14/14
Before we finish why not complete this quick poll which asks you how useful this time in range thread was:

I have just seen that I put the wrong diabetes chat tag on the thread. It should have been @diabetes_chat🙈