Unfortunately, healthcare professionals can sometimes contribute to diabetes stigma. However, discussing Time in Range may help empower people with diabetes and reduce some of that stigma by encouraging collaboration.
Everyone with diabetes deserves to have access to continuous glucose monitors (CGM) and the wealth of data they provide to help them better manage their diabetes. While we know that CGMs can help people improve their glucose levels and A1C and prevent complications associated with diabetes, CGMs and Time in Range (TIR) metrics can potentially help reduce diabetes stigma and empower people as well.
What are the different TIR metrics?
Because CGMs measure your glucose level as often as once every five minutes, they provide data and trends that you can use to help manage your diabetes – including your TIR.
TIR is the percentage of time you spend with your blood glucose levels in a target range. The range varies depending on the person, but general guidelines suggest a range of 70 to 180 mg/dl. In addition, other metrics like Time Above Range (the percentage of time spent above 180 mg/dL) and Time Below Range (the percentage of time spent below 70 mg/dL) are helpful tools for understanding your glucose levels.
Why is TIR important?
Time in Range captures the highs, lows, and in-range values that characterize daily life with diabetes.
TIR gives you and your healthcare team the chance to look at your diabetes in terms of the cause-and-effect relationships that make up each day. For instance, you can see how specific foods or exercises affect your TIR, or identify a time of day when you frequently experience highs or lows.
How can TIR help reduce diabetes stigma and empower you?
Diabetes stigma is the exclusion, rejection, prejudice, and blame that people unfairly experience as a result of having diabetes.
It stems from the incorrect notion that poor choices and unhealthy behaviors cause diabetes. This belief oversimplifies the complexity of diabetes and overlooks key factors such as genetics or a person’s environment and socioeconomic status.
Unfortunately, many people experience diabetes stigma when they meet with their healthcare providers. Even when this happens unintentionally or subconsciously, it can still have a negative impact. These instances of stigma can include being shamed for your weight, A1C, behaviors, feeling like you’re not being heard by your healthcare provider, and being blamed for things outside of your control.
However, TIR may be a tool that you and your healthcare team can use to level the playing field and open up a discussion that fosters cooperation and support – instead of fear, shame, or blame.
For example, discussing your A1C can sometimes feel like you’re being graded on how well you managed your diabetes. And because A1C looks at your glucose levels over the last three months, you cannot see how any of your behaviors impacted your A1C throughout that three month period.
TIR allows you and your healthcare provider to think about your diabetes in terms of simple and actionable relationships. You can see exactly how certain food, or getting sick, or going for a walk affects your glucose levels. Then, you can discuss these changes with your healthcare provider.
Suddenly, instead of being blamed for a poor A1C and receiving a list of instructions from your healthcare provider telling you what you should or shouldn’t do, the discussion becomes collaborative. You can discuss the data, ask questions, and identify certain trends with your healthcare team, and celebrate all of the times when your glucose levels were in range.
But it’s important not to view your TIR as “good” or “bad.” Instead, when talking with your healthcare team about your TIR, focus on seeing your values and trends as a guide for your diabetes management. What behaviors help keep you in range, and what are areas for improvement?
Each person is different, and in fact, research shows even people without diabetes on average do not have 100% TIR. Instead of aiming for perfection, talk with your healthcare provider about what goals are realistic for you, and do your best to reach them as often as possible.
One of the most common myths about living with diabetes is that it is entirely your fault and that laziness is what leads to poor glucose levels and complications. A1C alone may not be able to do much to counter those assumptions because it is a single number that attempts to “grade” your diabetes management over a period of three months. However, TIR can because it provides so much more data for you to understand your daily glucose levels.
TIR highlights the fact that every person with diabetes is actively making choices each day that affect their glucose levels. The data provides additional context so you can understand what impact your choices may have on your glucose, and what factors, like hormone levels or stress, lie outside of your control. There is so much about managing a chronic condition that is hard to account for – and that’s okay!
The bottom line
CGM and TIR may be able to empower you as you manage your diabetes and in your healthcare appointments.
While you can’t account for every factor that surrounds your diabetes, it helps when you and your healthcare team collaborate and look at your diabetes management holistically. It’s a lot easier to have productive conversations about maintaining the things that keep your glucose levels in range, and identifying those times where you might be able to make tweaks to improve them.