Taking the Reins on Time in Range
After joining The diaTribe Foundation earlier this year, Julie Heverly recently assumed the role of senior director of the Time in Range Coalition. Read how Julie, along with the members of the Coalition, plans to work on increasing awareness and adoption of Time in Range among people with diabetes, healthcare providers, and regulatory agencies.
Sometime in 2019, a colleague asked me if I was using Time in Range (TIR) to manage my diabetes. I was working at the American Diabetes Association at the time, wearing an insulin pump and continuous glucose monitor (CGM) for more than a decade, and I had no clue what she was talking about.
TIR had not been discussed with me at my endocrinologist appointments or in conversations with my diabetes educator. The topic had never been included by my local board president during his diabetes update presentations. And at that point, I had not seen information about this metric in publications like Diabetes Forecast or elsewhere online.
Thanks to a networking group of people living with diabetes, the aforementioned colleague shared more with me about TIR. My interest was sparked and my journey to learn more began.
TIR is simply the percentage of time that a person with diabetes spends with their glucose levels in a target range, typically between 70 to 180 mg/dl. TIR is generally for people who use a CGM, however there are ways to get TIR estimates even if you use a blood glucose meter. For people living with diabetes, these goals have been ingrained into our consciousness, so there had to be more.
You see, TIR also captures glucose variability – the highs, lows, and in-range values – that characterize life with diabetes. People experience different energy levels, moods, and overall quality of life when they are “in-range” vs. “out-of-range.” And thanks to the apps offered by CGM companies, we can view these measurements at home on a daily or weekly basis – and we can see even greater trends when we look at it monthly or every three months. This allows us to understand what behaviors and choices lead to more TIR, what drives glucose out of range, and where changes can be made.
This information provides people with diabetes a huge advantage over those who only know their A1C. Since A1C measures the average blood sugar over a two-to-three-month period, it cannot capture time spent in various glucose ranges and cannot tell you your glucose variability. Plus your A1C can be affected by a number of other factors, which could affect its accuracy.
Eventually, I heard that The diaTribe Foundation was building a coalition of patient advocacy groups, corporations, and medical organizations with a goal of ensuring that TIR becomes the primary glucose metric for daily management, complemented by A1C, in diabetes care globally. To accomplish this, the Coalition focuses on the following priority areas:
- People with Diabetes – Increase the adoption and use of TIR for daily disease management among people with diabetes.
- Healthcare Providers – Increase the adoption and use of TIR for daily disease management among healthcare providers.
- Regulatory & Policy – Advocate for TIR to be used in diabetes research and regulatory decision-making.
The Coalition includes groups that I have immense respect for, like the American Diabetes Association, JDRF, Helmsley Charitable Trust, Beyond Type 1 and the College Diabetes Network. All of them are committed to this shift in diabetes care. Corporations like Novo Nordisk, Lilly, and Sanofi were also making TIR a priority because they believed, alongside Abbott, Insulet, Medtronic and DexCom, that this could substantially impact and improve diabetes management.
In 2021, I joined the diaTribe Foundation to support these efforts in a more meaningful way, and in October, I was named the Senior Director of the Time in Range Coalition.
Since the Coalition formed in 2019, we have had several notable achievements that have brought us closer to our objectives. We have published over 100 articles about TIR in diaTribe Learn and diaTribe Change that have been read by over 700,000 people with diabetes, caregivers, and healthcare providers.
To inform how we can best raise awareness for TIR for people with diabetes and for healthcare providers, the Coalition has completed four comprehensive market research projects with dQ&A to understand the current perceptions and awareness on the topic. The Coalition has also met with the FDA to discuss the clinical evidence supporting the use of TIR in diabetes management. These achievements, among others, are helping to increase the adoption of TIR among people with diabetes, healthcare providers, and regulatory bodies.
Bringing together so many groups in the diabetes ecosystem to help drive this work forward is no easy task. However, the progress the coalition has made since 2019 is already advancing the adoption of TIR by more and more people, helping to improve the lives of those with diabetes, and I am thrilled to have the opportunity to contribute to this work.
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 patient’s health. Learn more about the Time in Range Coalition here.