Diabetes Dialogue: Establishing Time in Range as a Primary Glucose Metric

Few fields have embraced the idea of patient voice as the diabetes community, which uses a patient-first approach to developing guidelines and education. This push to incorporate patient voice and an emphasis on quality of life is part of what has contributed to the growing popularity of time in range as opposed to HbA1c.

Since the American Diabetes Association (ADA) released its first official recommendations on time in range in 2019, the use of it as a metric for quantifying glycemic variability has grown with each passing year.¹ A portion of this growth is due, in part, to the work of organizations involved in patient education, such as Diatribe Learn and their Time in Range Coalition.²

Formed in 2019, the Time in Range Coalition is described as a multistakeholder group of companies, foundations, non-profit organizations, researchers, and clinicians with the aim of establishing time in range as an essential part of diabetes management and ensuring it becomes the primary glucose metric for daily management in diabetes care. With this in mind, the partnership focuses its efforts in reforming patient and provider education as well as informing forthcoming regulatory and policy changes.²

The increase in popularity of time in range as a glucose metrics on full display at the 83rd Scientific Sessions of the ADA (ADA 2023), with dozens of abstracts and presentations examining the effects of time in range, time below range, and time above range in management of diabetes. During their time on-site at ADA 2023 hosts of Diabetes Dialogue: Technology, Therapeutics, & Real-World Perspectives Diana Isaacs, PharmD, an endocrine clinical pharmacist, director of Education and Training in Diabetes Technology, and codirector of Endocrine Disorders in Pregnancy at the Cleveland Clinic, and Natalie Bellini, DNP, program director of Diabetes Technology at University Hospitals Diabetes and Metabolic Care Center, sat down with Julie Heverly, senior director of the Time In Range Coalition, to learn more about the group’s efforts to reform care. During the episode, Heverly also offers a history lesson on the development of time in range as a metric and discusses patient resources for education on the benefits of and access to time in range.

Relevant disclosures for Dr. Isaacs include Eli Lilly and Company, Novo Nordisk, Sanofi, Abbott Diabetes Care, Dexcom, Medtronic, and others. Relevant disclosures for Dr. Bellini include Abbott Diabetes Care, MannKind, Provention Bio, and others. Heverly reports no relevant disclosures.

References:

1. Battelino T, Danne T, Bergenstal RM, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-1603. doi:10.2337/dci19-0028
2. Kenney J. Introducing the time in range coalition. diaTribe Change. August 20, 2021. Accessed July 6, 2023. https://diatribechange.org/news/introducing-time-range-coalition.