New gold standard for diabetes control

Before 1980, we measured blood sugar levels by how much sugar was present in our urine. If the test showed a negative result for our urine sugar, all that meant was our actual blood sugar was under 200 mg/dl. At the time, that was the best way to measure our diabetes control.
The 1980s brought a new standard of care, introducing the A1C and the glucometer. What does the A1C tell us? If you have an A1C of 7.0, that means you’ve had an average blood sugar of 150 mg/dl for the prior 90 days. It was considered state-of-the-art. But … does this method of testing really show us how well we’re controlling our diabetes?

 Your blood sugar for the first 45 of that 90 days could be running constantly at 100 mg/dl. Then, during the second 45 days, your blood sugar could be running steady at 300 mg/dl. These disparate levels combine to result in an A1C of 7.0. Let’s say, for another example, that your blood sugar level was alternating, daily, between 100 mg/dl and 300 mg/dl. Every other day, your blood sugar rose to 300. After 90 days, your resulting A1C would be 7.0. While the A1C is an important test, it does not accurately report our level of control.
The American Diabetes Association in 2019 made important updates to the standard of care that included Time in Range.

Time in Range evolved from the introduction of the continuous glucose monitor (CGM). A CGM measures our blood sugar every 5 minutes and sends the results to our phone or insulin pump. Every 24 hours, the CGM provides 256 blood sugar readings. Every 90 days, the CGM records 23,000 glucose results. My personal target range programmed on my CGM is between 100 mg/dl – 180 mg/dl. Each individual diabetic may have a different target range. If you don’t know your range, ask your doctor. The goal is to be 70% of the time or higher of whatever your range turns out to be. So, for example, if your range is 100 mg/dl – 180 mg/dl and your percent is 80% of the time, you’re doing even better than the standard.
As for me, I’m a type 1 diabetic. I try not to go too low to prevent severe hypoglycemic occurrences. A type 2 diabetic may want to have a lower range set on their CGM. It depends on their use of insulin. My goal is to have at least 70% of the time my CGM results fall between 100 mg/dl to 180 mg/dl. The ADA standards of care is 70% of the time between 70 mg/dl -180 mg/dl. This is a benchmark, but your target range may vary, depending on your doctor’s recommendation.

The only way to measure time in range is with a CGM. Years ago, CGM was considered a luxury for diabetics, but now it’s the standard of care and covered by most health insurances, including Medicare. Most diabetics today don’t know what time in range is. Clinical studies have shown the higher percentage of time in range, the lower the complications from diabetes such as, kidney failure, lower limb amputation and diabetic blindness. To learn more about time in range visit: