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Medical Information | Non-US Health Care Professionals
Time in Range (TIR)
Time in Range (TIR)
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CLINICAL GUIDANCE AND TARGETS FOR TIME IN RANGE (TIR)

The American Diabetes Association Standards of Care and the International Consensus Report on TIR recommends that many nonpregnant adults with diabetes spend at least 70% of the day (around 17 hours) in the target glycemic range of 70 to 180 mg/dL, which corresponds to the recommended hemoglobin A1c (HbA1c) target of approximately 7%.1,2

TIR HCP Educational Content: Time in Range KOL Video of Dr. Cheng
(10:46)

Dr Alice Cheng, University of Toronto, explains how the TIR targets from the International Consensus Report may be applied in clinical practice.

Healthcare professional has received a fee from Novo Nordisk Inc. for her participation.

A deeper dive into the International Consensus Report and guidance recommendations

The International Consensus Report was endorsed by 8 international professional associationsa in 2019 following the Advanced Technologies & Treatments for Diabetes (ATTD) Congress.1 It presents guidance to support healthcare professionals and people with diabetes in using continuous glucose monitoring (CGM) data to identify metrics of glucose control, including TIR.1

aThe International Consensus Report was endorsed following the 2019 ATTD congress by: American Diabetes Association (ADA), American Association of Clinical Endocrinologists (AACE), American Association of Diabetes Educators (AADE), European Association for the Study of Diabetes (EASD), Foundation of European Nurses in Diabetes (FEND), International Society for Pediatric and Adolescent Diabetes (ISPAD), Juvenile Diabetes Research Foundation (JDRF), and Pediatric Endocrine Society (PES).1

Following the publication of the consensus paper, the American Diabetes Association (ADA) Standards of Care included TIR as a useful metric for people to assess glucose levels using CGM.1,2

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Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range

Find the Advanced Technologies & Treatments for Diabetes (ATTD) consensus recommendations for the application of CGM metrics in clinical practice and their use in various diabetes populations.(1)

(1) Battelino T, Danne T, Bergenstal RM, et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the international consensus on time in range. Diabetes Care. 2019;42(8):1593-1603. doi:10.2337/dci19-0028.

While HbA1c is an important metric, there is now a growing body of evidence supporting TIR as an additional valuable end point in clinical trials.2-5 For the latest updates to CGM metrics for clinical trials, view the 2023 International Consensus Statement. The following is an overview of the 2019 consensus report related to TIR1,2:

different diabetes populations with time in range targets chart
different diabetes populations with Time in Range targets chart vertical
  • The recommended glucose range for most people with diabetes is 70 to 180 mg/dL1,2
  • Most people with type 1 and type 2 diabetes should spend at least 70% (approximately 17 hours) of the day within this glucose range. This corresponds to an HbA1c target of approximately 7%1,2
  • Some people with diabetes may require ongoing support from their healthcare team in order to achieve target TIR1
  • In addition to TIR, other CGM metrics can help guide glycemic control, such as Time Below Range (TBR), Time Above Range (TAR), mean glucose levels, and glycemic variability2
    • TBR is the percentage of time spent below 70 mg/dL (including percentage of values <54 mg/dL)1,2
    • TAR is the percentage of time spent above 180 mg/dL (including percentage of values >250 mg/dL)1,2
    • Most people with diabetes are advised to spend less than 4% of their day below range (1 hour) and less than 25% of their day above range (6 hours)1,2
      • <1% of time (15 minutes) should be spent in the “very low” TBR of <54 mg/dL.1,2 This also applies to pregnant women with type 1 diabetes
      • <5% of time (~1 hour, 12 minutes) should be spent in the “very high” TAR of >250 mg/dL1,2

These clinical guidance recommendations and targets were put in place to help healthcare professionals interpret, report, and apply CGM data. This allows them to build individualized action plans to help improve glycemic control and increase TIR for people with diabetes.1,2

  1. Battelino T, Danne T, Bergenstal RM, et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care. 2019;42(8):1593-1603.
  2. American Diabetes Association. Standards of Care in Diabetes—2023. Diabetes Care. 2023;46(suppl 1):S1-S291.
  3. Advani A. Positioning time in range in diabetes management. Diabetologia. 2020;63(2):242-252.
  4. Battelino T, Bosnyak Z, Danne T, et al. InRange: Comparison of the Second-Generation Basal Insulin Analogues Glargine 300 U/mL and Degludec 100 U/mL in Persons with Type 1 Diabetes Using Continuous Glucose Monitoring-Study Design. Diabetes Ther. 2020;11(4):1017-1027.
  5. Bajaj HS, Bergenstal RM, Christoffersen A, et al. Switching to Once-Weekly Insulin Icodec Versus Once-Daily Insulin Glargine U100 in Type 2 Diabetes Inadequately Controlled on Daily Basal Insulin: A Phase 2 Randomized Controlled Trial. Diabetes Care. 2021. Epub ahead of print. doi: 10.2337/dc20-2877.