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Positioning time in range in diabetes management – published online 07/11/2019

Fig from Advani paper

Andrew Advani

The time in range (TIR) metric has emerged as being a key indicator of the quality of glucose control in diabetes. In this issue, Andrew Advani (https://doi.org/10.1007/s00125-019-05027-0) summarises recent TIR research with the aim of assisting healthcare professionals and individuals living with diabetes in interpreting TIR data and setting TIR goals. Evidence is beginning to emerge linking reduced TIR with increased risk of long-term diabetes complications and adverse pregnancy outcomes. This association may be expected given the inverse correlation between TIR and HbA1c levels. The author explains that, because of the skewed distribution of glucose levels outside the target range, TIR (on its own) is a poor indicator of the frequency and severity of hypoglycaemia. Thus, all TIR discussions should separately consider time below range and, by inference, time above range. In this review, the recent consensus recommendations for time in ranges goals are summarised, although, as is always the case, glycaemic targets should be individualised. The figures from this review are available as a downloadable slideset.

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