This content originally appeared on diaTribe. Republished with permission.

By Natalie Sainz

You’ve got probably heard of time in range (TIR), but time in tight range (TITR) has slowly turn out to be popular amongst some diabetes experts. Whereas guidelines generally define time in range as a spread of between 70 to 180 mg/dl, time in tight range is defined as between 70 to 140 mg/dl.

Identical to standard TIR, TITR needs to be measured using a continuous glucose monitor (CGM).

“Time in tight range describes the time a person spends in normoglycemia [normal levels of blood glucose],” said Dr. Thomas Danne, director of the Department of General Pediatrics Endocrinology/Diabetology & Clinical Research at Children’s Hospital Auf der Bult in Hanover, Germany. He spoke as a part of a panel on the brand new metric on the Advanced Technologies and Treatments for Diabetes (ATTD) conference in Berlin, Germany.

The metric essentially lowers the upper threshold for higher glucose levels. “Elevated glucose is harmful, which is why we’d like a good range,” said Dr. Tadej Battelino of the University of Ljubljana on the session.

Spending 18% or greater time above 140 mg/dL predicts the progression of diabetes in children with autoantibodies (who’re at higher risk for type 1 diabetes), explained Danne, citing a 2019 study. Moreover, a Swedish study concluded that having type 1 diabetes and an A1C of slightly below 7% which is assumed to translate to a time in range of about 70% still significantly increases one’s risk for heart problems.

It is usually really useful to attenuate time above 180 mg/dL as much as possible, which is why that’s the upper limit for the usual time in range, but it surely is feasible that some individuals might even see greater advantages with 140 mg/dl. Based on Danne, time in tight range could potentially result in an extended life expectancy because it reduces the danger of complications.

Time in tight range may be used for timely therapy intensification and optimization, explained Battelino. “The upper the A1C, the upper the risk of dementia for individuals with type 2 diabetes,” which is why he proposes a concentrate on time in tight range.

Due to possible advantages that early and aggressive treatment can bring, some experts have proposed a concentrate on time in tight range for preschoolers with diabetes.

One other panelist, Peter Adolfsson explained that CGM is the really useful tool for glucose monitoring for this population and when using a CGM, an affordable treatment goal is 50% time in tight range (3.9-7.8 mmol/l, or 70-140 mg/dl).

Time in tight range is a more difficult goal to realize than time in range, but diabetes technology like CGM, and automatic insulin delivery (AID) may also help make it possible.

“There’s a quick and ongoing evolution of technology that allows a greater proportion of people to achieve high goals,” said Adolfsson. “High goals may be achieved without increased acute complications.”