The 2024 American Diabetes Association Standards of Care are here—and they’ve made it clear that time in range use and CGM access are important for daily diabetes management.
The ADA Standards of Care for Diabetes are updated annually and include expert consensus on recommendations for treatment and management of all kinds of diabetes. The Standards of Care recognizes time in range (TIR) as a valid glycemic assessment in people with diabetes associated with the risk of microvascular complications and acknowledges time below range and time above range as useful parameters for evaluating treatment. It also recognizes the limitations of A1C—and highlights that A1C does not provide a measure of glycemic variability or hypoglycemia. You can find summaries on past Standards of Care and their parameters around time in range by clicking here.
This year, the Standards of Care include some major updates that encourage the use of time in range!
People with diabetes should be offered any type of diabetes device: This year’s Standards of Care include that people with diabetes should be offered any kind of diabetes device, including continuous glucose monitoring (CGM). This means that whether you are treating someone with Type 1, Type 2, LADA, gestational, or any kind of diabetes—a CGM can be useful to daily diabetes management. Time in range is most easily found through CGM, and expanding access to CGM will expand access to time in range—which is shown to lower A1C, improve quality of life, and so much more!
Guidelines around CGM and time in range use in pregnant individuals with type 2 diabetes or GDM has been updated and clarified. The decision of whether to use CGM in pregnant individuals with type 2 diabetes or GDM should be individualized based on treatment regimen, circumstances, preferences, and needs, though data from one study suggests that the use of the CGM-reported mean glucose is superior to the use of estimated A1C, glucose management indicator, and other calculations to estimate A1C, given the changes to A1C that occur in pregnancy! Additionally, the international consensus on TIR endorsed the following glucose target ranges for individuals with type 2 diabetes in pregnancy and GDM.
Target sensor glucose range 63–140 mg/dL (3.5–7.8 mmol/L): TIR, goal >70%
Time below range (<63 mg/dL [<3.5 mmol/L]): level 1 TBR, goal <4%
Time below range (<54 mg/dL [<3.0 mmol/L]): level 2 TBR, goal <1%
Time above range (>140 mg/dL [>7.8 mmol/L]): TAR, goal <25%
Healthcare teams need sufficient knowledge, through training and education, on diabetes tech. In recent studies, only 56% of U.S. PCPs were knowledgeable about TIR. The Standards of Care emphasizes the need for assessment of competencies in diabetes technology for anyone involved in the care of people with diabetes. When more healthcare professionals are knowledgeable about CGM and TIR, more people with diabetes can be empowered in their own diabetes management and live happier, healthier lives. You can learn more about CGM and TIR training and implementation resources on our Get Started page.
The inclusion of time in range and CGM access in the ADA Standards of Care is vital for the expanded use of time in range in daily diabetes management for everyone with diabetes. Healthcare professionals all over the U.S. use these recommendations as guidelines for their care. And when healthcare teams are excited about time in range, those in their care follow.
Looking for even more information on this year’s Standards of Care?
