What Do Endocrinologists Think About Time in Range?

A survey jointly conducted by diabetes research company dQ&A and The diaTribe Foundation assessed how well endocrinologists understood Time in Range and which diabetes metrics they consider most important for setting treatment goals.

Continuous glucose monitoring (CGM) has significantly changed the way that people manage their diabetes and how healthcare professionals deliver care. CGM users have access to an extensive amount of information – up to 288 glucose readings a day – giving them insight into how their glucose levels respond to certain treatments and behaviors.

Time in Range (TIR) conveniently summarizes all this user data into three percentages: their TIR, Time Above Range (TAR), and Time Below Range (TBR). These percentages can help healthcare professionals and people with diabetes understand the day-to-day fluctuations in diabetes management.

Members of the diabetes community have told us how TIR provides them with a sense of comfort and meaningful information to supplement their A1C. Accomplished researchers and leaders in diabetes care have been advocating for the adoption of TIR in clinical care for several years. You can read and hear from three healthcare providers about the importance of this metric in our “Understanding Your AGP Report” series:

• Shedding Light on the AGP Report with Dr. Rich Bergenstal

• Shedding Light on the AGP Report with Dr. Rich Bergenstal – Part 2

• Use Your AGP Report to Increase Your Time in Range: Three Examples and Success Stories from People and their Care Teams with Dr. Anders Carlson

• Real Stories, Real Data, Real Results – Using Your CGM to Improve Time in Range

diaTribe collaborated with market research company dQ&A to survey 243 endocrinologists about the metrics they use to guide decision-making and to come up with treatment goals for their patients with diabetes. Most responses came from endocrinologists working in private offices (63%) and teaching/research hospitals (32%). Every endocrinologist had experience with insulin pumps and CGM.

For the survey, respondents were given 13 different metrics to choose from to answer the questions, including A1C, TIR, hypoglycemia, hyperglycemia, lipid levels, diet, fasting blood glucose, behavior change, exercise, blood pressure, weight, number of medications taken, and “other.” The results were presented at the 14th International Conference on Advanced Technologies & Treatments for Diabetes (ATTD 2021).

The following questions were posed to participants:

• For each patient group [type 1, type 2 on basal-bolus insulin, type 2 on basal insulin only, type 2 not on insulin], please indicate whether your treatment goals incorporate any of the following. Please select all that apply.

• Which of the following is most important when it comes to your goals for each patient group?

• How familiar are you with the concept of TIR as it relates to the management of diabetes?

• In your opinion, how important is TIR for each patient group when it comes to diabetes management?

• Do you ever discuss TIR with patients not using CGM?

• To what degree do you agree or disagree with the following statement: “TIR is only a useful metric for patients using CGM?”

Important survey results included:

• Endocrinologists centered people with diabetes’ treatment goals around TIR, A1C, and weight, though this varied among different population groups.

• 50% of endocrinologists rated TIR as the top metric they use for type 1 diabetes, compared to 25% of who preferred A1C.

• For people with type 2 on basal-bolus insulin therapy, 40% of the endocrinologists ranked A1C as the most important metric and 34% ranked TIR as the most important.

• A1C was the top-ranked metric for people with type 2 on basal insulin (47%) and type 2s not on insulin (40%).

• Almost all endocrinologists surveyed (98%) have heard of TIR and know what it is to some degree.

• Of the endocrinologists who were the most familiar with TIR, 75% rated it as the most important metric for people with type 1 and 66% rated it as the most important metric for people with type 2 on basal-bolus insulin therapy.

• A third of the endocrinologists thought that TIR was useful for non-CGM users with half reporting that they do discuss TIR with this group as well.

This data is insightful for a number of reasons. Given the usefulness of the metric, people with diabetes who do not use a personal CGM and their healthcare teams should consider ways that they can learn more about their TIR, such as through self-monitoring of blood glucose (SMBG) or professional CGM. In addition, even though TIR awareness is high among endocrinologists, there needs to be more education around its benefits for other healthcare professionals who work with people with diabetes, such as primary care providers and nurse practitioners. Finally, A1C remains a critical metric in diabetes care, especially for people with type 2, but TIR can be a powerful supplement to it that gives people with diabetes even more insight into their diabetes management.

This article is part of a series on Time in Range. 

The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand time in range to maximize patients' health. Learn more about the Time in Range Coalition here.