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Publications

Journal Article Ahead of print

PubMed: 40548915 DOI: 10.1016/j.eprac.2025.03.006

Moving the Goalposts: Do Adults With Type 1 Diabetes Want Time in Tight Range?

Endocr Pract

Authors: Molly L Tanenbaum, Mabelle B Pasmooij, Rachel Tam, Marina Basina, Michael S Hughes, Franziska K Bishop, David M Maahs

Affiliations

  • Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Stanford University School of Medicine, Stanford Diabetes Research Center, Stanford, California.
  • Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California.
  • Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.
  • Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Stanford University School of Medicine, Stanford Diabetes Research Center, Stanford, California.

Abstract

OBJECTIVES

Our objective was to understand attitudes toward time in tight range (TITR: 70-140 mg/dL) among adults with type 1 diabetes. The perspectives of people with type 1 diabetes on TITR can inform educational approaches to introducing potential new continuous glucose monitoring (CGM) metrics in a way that optimizes glycemic and quality of life outcomes for people with type 1 diabetes.

METHODS

Focus groups with adult CGM users with type 1 diabetes elicited feedback on a potential shift to TITR. Groups were audio-recorded, transcribed, and analyzed using content analysis.

RESULTS

Participants were 33 adults (age 42.7 ± 16.7 years, 55% female, 91% non-Hispanic White, 23 ± 16 years living with diabetes, HbA1c 6.5 ± 0.6% (48 ± 6 mmol/mol)). Most (88%) used automated insulin delivery. Some approved of TITR for the potential to improve their long-term health. Concerns about TITR included increased management burden; risk of anxiety, hypoglycemia, disordered eating; and feelings of failure. Participants advocated for flexible, personalized clinical targets and better technologies, insulins, and access, to make TITR achievable for more people with type 1 diabetes.

CONCLUSIONS

Results indicate that TITR may be a welcome shift for some who are already using the tighter metric but may add risks and psychosocial and self-management burden even in a group of adults predominantly using automated insulin delivery and achieving current HbA1c goals. Including the perspectives of people with type 1 diabetes in decision-making around CGM metrics will be important for the implementation of new clinical targets to improve patient care.

MeSH

Diabetes Mellitus, Insulin, Diabetes Mellitus, Type 1, Endocrine System Diseases, Continuous Glucose Monitoring