Top Pediatric Endocrinologist Discusses Time in Range With Patients
Leading endocrinologist Prof. Thomas Danne spoke with diaTribe about how he uses time in range in his practice and shared his best tips for people living with diabetes.
As time in range increasingly becomes an essential part of clinical trials and diabetes management, healthcare providers around the world are using the metric in their clinics to help people with diabetes reach their glucose goals. For Professor Thomas Danne, director of the Department of General Pediatrics Endocrinology/Diabetology at the Auf der Bult Hospital for Children and Adolescents in Hannover, Germany, the metric provides an opportunity to understand where certain improvements in glucose management can be made.
Maintaining a 70% time in range (the percentage of time a person’s blood glucose is between the recommended range of 70-180 mg/dL) is not an easy task; it can be especially challenging for children. Here is how Prof. Danne discusses time in range with the children in his clinic.
Color-coding time in range
When families bring their children into the office, Danne always speaks to the children first to learn about their concerns and questions. Although numbers, percentages, and decimals might be challenging for some young children to understand, representing glucose ranges as colors can simplify glucose management: orange is hyperglycemia (>180 mg/dL), green is in range (70-180 mg/dL), and red is hypoglycemia (<70 mg/dL). There are two shades of orange and red to denote levels.
“The colors make a big difference; they’re easier. Children [understand] that green is something good,” said Danne. “We want to do everything we can so that there’s more green and no red. We make sure that children understand that red is a low [glucose] value, and they feel uncomfortable when they’re low.”
If you are a parent of a child with diabetes, you can focus on the colors, too, rather than numbers, when discussing their time in range. Ask them how they feel when their levels are in the orange, green, or red areas.
Watching for and managing hypoglycemia
Danne recommends that everyone focus on reducing hypoglycemia. “We try to find out what times hypoglycemia is happening, and try to see if there is anything they consider as potential causes of hypoglycemia,” said Danne.
Hypoglycemia is a common source of anxiety for parents, especially when their kids are at school, on a playdate, or anywhere else away from home and a caretaker.
Prepare for potential incidents of hypoglycemia by setting up an emergency plan to treat a severe low at school. School staff should have all the supplies needed and know exactly what to do in case of an emergency, such as knowing how to use a glucagon device. Make sure to send children to school with a nutritious lunch and plenty of snacks, especially if they are exercising that day.
Making sense of the ambulatory glucose profile report
After answering any questions a child might have and discussing time in range using colors, Danne reviews the ambulatory glucose profile (AGP) report with the family to try to “figure out if there’s a time when [glucose levels] are highest and discuss what to do.”
According to Danne, from the start of diagnosis, “it’s always very important to have targets. If the team is not clear about the targets, [glucose management] is not as good. We [need] clear targets that everyone understands.”
Overall, the time in range provides “very actionable things for the family to work with,” said Danne. “Now that we have time in range and the AGP, you can really make sense of all these different values and see where you’re going. It’s easier to set priorities for what the individual target is going to be for the next visit.”
Make sure to review the targets with your child and focus on how these targets are associated with the colors on an AGP report.
Setting realistic time-in-range goals
Danne reminds his patients and caregivers to set realistic time-in-range goals, and not to expect perfection every single day.
“Nobody, in whatever area of life, is perfectly 100% time in range. Even people who do not have diabetes, they don’t have 100% time in range,” said Danne. “This is something that’s a long-term [goal], so nobody has to be afraid [of] a bad week or a bad day [having] long-term consequences.”
Living with diabetes can be especially difficult for children, who at a young age must learn to live with a challenging condition. Luckily, having open and honest communication with your child about their time in range can make the experience easier to set and achieve goals.
Read these articles for more information on raising a child with diabetes.