Time in Tight Range: A New Diabetes Goal?
Key takeaways:
- Guidelines generally define time in range between 70 to 180 mg/dL. Time in tight range (70 to 140 mg/dL) is another way of stating the normal glucose range experienced by people without diabetes.
- Time in tight range may be a helpful metric for certain populations, including young children and pregnant people with type 1 diabetes, though more research is needed.
- Concerns around time in tight range for people with diabetes include increased burnout, more stress, and not having access to the proper tools or care team. However, given new technologies and therapies, more people with diabetes may be able to achieve such levels.
You’ve probably heard of time in range, but time in tight range (70 to 140 mg/dL) has emerged as a potential new metric for diabetes management over the last few years. There’s been a lot of back and forth on the topic, most recently, at the Advanced Technologies & Treatments for Diabetes (ATTD) 2025 conference in Amsterdam.
While some experts argue that lowering the upper threshold from 180 mg/dL to 140 mg/dL could be beneficial for certain people with type 1 diabetes (children, for example) and is possible for people with type 2 diabetes with weight loss on newer medications, the narrower range may not be realistic for many – and could even make diabetes management harder. Here’s what experts and people living with diabetes have to say about time in tight range.
What does time in tight range offer?
It’s generally recommended to minimize time above 180 mg/dL (10.0 mmol/L) as much as possible to avoid the risk of diabetes-related complications, which is why that’s the upper limit for the standard time in range. However, it’s possible that some individuals may see greater benefits with 140 mg/dL (7.8 mmol/L).
“As we move to this idea of diagnosing dysglycemia earlier or if we’re trying to identify individuals who would benefit from an earlier intervention, we could use time in tight range to distinguish those,” said Dr. Anders Carlson, an endocrinologist and associate director of the International Diabetes Center in Minnesota. He explained that pregnant people and children with type 1 diabetes, as well as people with new-onset diabetes, may benefit from aiming for a tighter target.
For example, studies have found spending greater time above 140 mg/dL (7.8 mmol/L) predicts the progression of diabetes in children with type 1 autoantibodies. Since children with diabetes are at a higher risk of early complications, optimizing their blood sugar is key. Because of the possible benefits that early and aggressive treatment can bring, researchers suggest a target of 50-55% time in tight range for preschoolers with diabetes.
Despite the potential benefits for some people with diabetes, that doesn’t mean time in tight range is for everyone.
“More work needs to be done on which population it should be applied to,” Carlson said. “We still have quite a bit of research to do on the possible impacts – both good and bad – that setting these tighter targets can have on people with diabetes, their caregivers, and all of us in the healthcare community.”
Time in tight range: is it realistic?
“The thinking is if time in tight range can be better for long-term health, why not advocate for its use?” said Dr. Molly Tanenbaum, a clinical psychologist and diabetes researcher at Stanford Medicine.
In a recent survey of people with type 1 diabetes on time in tight range, Tanenbaum said about a third of respondents were receptive to the idea but a much bigger proportion (over 60%) expressed concerns. First, not everyone has the care and support needed from their healthcare team to reach a narrower glycemic goal. In addition, not everyone has access to the diabetes technology needed to achieve time in a normal glucose range. Even with the help of automated insulin delivery (AID) systems, Tanenbaum cited research showing that only 45% of AID users reached tighter glycemic goals (current recommendations are spending around 50% time in tight range and 70% time in range).
“A normal glucose range, that’s what we’re really talking about when we talk about time in tight range,” said Julie Heverly, senior director of the Time in Range Coalition and person living with type 1 diabetes. To make that more clear (plus, the term "tight" may convey a sense of pressure or judgment), some people have started using the alternative term "time in normal glucose," aka TING.
“If you are wondering why, as I was, that’s never been the goal, I think the answer is as simple as we’ve never been able to figure out how to make that happen.”
“Do I want to have normal glucose ranges? Yes, I very much want that. The desire is there, but there’s a lot of concern and frustration and I'm not alone in that thinking either,” she added.
Heverly described her own personal experience with time in tight range (though at the time, the term didn’t exist) when she was pregnant. Before she conceived and during her pregnancy, Heverly put in huge efforts to make sure her levels were in the tightest range possible. But Heverly didn’t get there on her own. Every Friday, her provider called her to review 20 pages of CGM data to make sure her levels were where they needed to be.
“I remember how important tight control was. I remember my doctor telling me it was potentially dangerous for both my baby and me if my control wasn't intact,” Heverly said. “My diabetes management during my pregnancy was a full-time job – time in tight range was a full-time job. But it was worth it because I wanted this healthy baby so much.”
Tanenbaum noted similar feedback from pregnant people her team surveyed, finding that they worked diligently to achieve a normal glucose range during pregnancy, but stopped after because they didn’t feel it was sustainable.
Other concerns raised by people with type 1 diabetes about time in tight range included:
- Risk of hypoglycemia
- Increased stress and burden
- More diabetes burnout
- Restricted or disordered eating
- Feeling like a “failure” or being “bad” at managing diabetes
- More judgment from healthcare teams
Time in normal glucose range may also not be a realistic goal for people who menstruate since current AID systems aren't set up to keep them in range during those times. Tanenbaum added that there are even fewer resources for people going through menopause.
Some of the people Tanenbaum surveyed said they were already working to achieve a range between 70-140 mg/dL, and it was worth the burden and risk of burnout to achieve optimal glucose control. But, with the numerous challenges the metric presents, Tanenbaum added: “If everyone isn't for time in tight range, is time in tight range for everyone? Would it mean losing sight of ‘time in happiness?’”
“People with type 1 diabetes already struggle with the need to be ‘perfect’ using wider ranges, so a tighter range could cause more stress, stigma, and undue pressure from doctors,” Tanenbaum said.
One possible suggestion offered by people with diabetes to reduce the pressure of a narrower metric is having time in tight range be an optional goal they set for themselves – not an external goal given by their healthcare team.
“The patient experience using time in tight range is paramount. There are scenarios where a tighter glucose target might be appropriate, but we don’t want to add burden and we don’t want to stress patients out,” Carlson added.
Looking forward
Though time in range and time in tight range are similar, achieving time between 70-140 mg/dL is not an easy feat. For many people with diabetes, it may not be a fair or realistic goal.
However, in situations where tighter glycemic management is necessary – like during pregnancy and for young children or people with new-onset diabetes – the metric may be useful. That said, the proper care team, education, and tools like AID and CGM are paramount to making it possible. And, as Tanenbaum pointed out, time in tight range should not come at the expense of “time in happiness.”
“How much am I willing to sacrifice for that goal? I’m not interested in 55%, I want 90% with normal glucose levels. That’s what I want,” Heverly said. “But I don’t want it if I'm consistently low or if I can't have a glass of wine. I definitely want to have normal glycemia, but I want to be able to live my life.”
"The burden cannot be placed on the shoulders of the people with diabetes alone," she added. "Without the right tools to make our bodies work correctly, it cannot happen. Getting all people living with diabetes to normal glucose levels should be the goal. But it's one that must be shared by people with diabetes, healthcare professionals, industry, researchers, developers, and everyone in this space.”
Learn more about time in range here: