Time in Range

[Tom1982]

Hello again everyone.
What’s a decent time in range percentage to aim for with kids at school age?
Cheers
Tom

 

[pawprint91]

I know generally it is 80%+ but I want to say I’ve heard for children somewhere it can be 70%+ - I have diabetes, but have also been on courses linked to my work to support and manage children with diabetes at school, and actually seeing how those kids manage their levels makes me think 80% could be slightly harder than it is for adults - and it’s hard for adults at times for various reasons - (particularly if they’re heading towards puberty), which makes me more confident to say 70%. But there’s probably others on here who can give a clearer insight!

 

[Inka]

It’s 70% for adults @Tom1982 but I’ve not seen a figure for children. I guess it depends on their age. @Bruce Stephens might know.

 

[pawprint91]

It’s 70% for adults @Tom1982 but I’ve not seen a figure for children. I guess it depends on their age. @Bruce Stephens might know.

@Inka my DSN told me 80% (and I’m sure I’ve seen something on here saying 80%!) - has it changed recently?

 

[Robin]

@Inka my DSN told me 80% (and I’m sure I’ve seen something on here saying 80%!) - has it changed recently?

All the data sheets and graphs on Libreview give 70% as the target, and have done since I started using it five years ago. And that’s what my hospital clinic goes by.

 

[helli]

The number I have seen quoted is definitely 70% for adults.
There was a thread this week where someone said their DSN has said there is little advantage of anything over 70%.
As many people are probably bored of reading, I also think it is important to live a balanced life rather than survive a live focused on diabetes control.
Just like working your **** off to earn lots of money but having no time or energy to spend it.

 

[Robin]

This is a screenshot from the Libre view data sheets.

 

[Inka]

@Inka my DSN told me 80% (and I’m sure I’ve seen something on here saying 80%!) - has it changed recently?

I don’t know. I just know that 70% or above is considered very good control. If it’s changed, I wasn’t aware of it. The Freestyle site says 70% too because I just looked to see if there was a child target.

 

[Tom1982]

since we’ve sorted the basal dose out Jo is between 80 to 90% in range

The number I have seen quoted is definitely 70% for adults.
There was a thread this week where someone said their DSN has said there is little advantage of anything over 70%.
As many people are probably bored of reading, I also think it is important to live a balanced life rather than survive a live focused on diabetes control.
Just like working your **** off to earn lots of money but having no time or energy to spend it.

Glad to read this. Since we’ve sorted out Jo’s background dose she is 80 to 90% in range. If we really pushed it (cut out the pizza, chocolate and ice cream and so on) we could probably get that up into the late 90s but to what end? She’d be miserable! So anything over 70 odd your doing okay?

 

[pawprint91]

Don’t know why my DSN has decided to add an extra 10% on for me then I’ve definitely seen it somewhere on here too (will never find the thread now) but I’ll use 70+ from now on! Sorry for the confusion and thanks for the clarification everyone!

 

[pawprint91]

https://forum.diabetes.org.uk/boards/threads/10-months-in-still-got-some-queries.105767/#post-1252943

It was the screenshot Bruce Stephens added to post 4 in the above thread - and to be honest, it doesn’t actually say 80%; it just includes it in the post - Bruce himself in the post says 70. Happy I found this though! Still puzzled why my hospital are giving me 80%, it’s been said on multiple occasions but hey ho!

 

[Leadinglights]

The Masterchef program last night with the chap whose daughter is Type 1 was still pushing the ideas that she couldn't have sugar, and sweet things and this and that. I feel quite sorry for her. Somebody commented about it in a post the other day as well.
Though the food he made did look very good.

 

[Bruce Stephens]

It’s 70% for adults @Tom1982 but I’ve not seen a figure for children. I guess it depends on their age. @Bruce Stephens might know.

I think it's complex and really (just like HbA1c) TIR targets should be a conversation between the healthcare team and the patient. There's a table in the paper (in Clinical Validity of Measures) giving correlations between TIR and HbA1c, with 70% mapping to 53 and 80% mapping to 48. So if you want to aim for 48 then 80% would make sense.

Elsewhere in the paper it talks about for a child, perhaps a target of 58 or so might be more appropriate and that would be a TIR of 60%. I suspect it depends lots on individuals.

Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range

Improvements in sensor accuracy, greater convenience and ease of use, and expanding reimbursement have led to growing adoption of continuous glucose monito

diabetesjournals.org

 

[nonethewiser]

Don’t know why my DSN has decided to add an extra 10% on for me then I’ve definitely seen it somewhere on here too (will never find the thread now) but I’ll use 70+ from now on! Sorry for the confusion and thanks for the clarification everyone!

She sees potential in you.

Agree with others, with so many factors at play anything over 70% is great achievement.

 

[SB2015]

I have always been glad of the expectation of 70% or above is very good control.

I was advised once I was looping to expect 80% +.
Perhaps that is where the other figure comes from @pawprint91 .
I loop and generally hit the 90s or upper 80s but still have days in the 70s and still I think that is fine. I know why it has happened and I am happy with the actions that I took (no opportunity to pre-bolus, no opportunity to go for a walk after the meal, ….) . As you said @Tom1982 if we try to drive our TIR up we need to see the cost of this. It is all a question of balance, and just do The Best That I Can.

 

[Proud to be erratic]

Hello again everyone.
What’s a decent time in range percentage to aim for with kids at school age?
Cheers
Tom

The International Consensus from 8 June 2019 agreed 70%. I gleaned this from a post by @everyydayupsanddowns, some months ago. But the Consensus also defined a relatively small lower limit of <4% for below 3.9 and a more relaxed upper limit of 25% for >10. Their tables DID NOT include a category for children. The link to this report published by the American Diabetes Association (ADA) is:
https://diabetesjournals.org/care/a...cal-Targets-for-Continuous-Glucose-Monitoring
and the pertinent table (figure 1) is:

https://diabetesjournals.org/view-large/figure/3249168/dci190028f1.jpeg.

I think the more consequential question is: which of time above 10 or below 3.9 is potentially more harmful or damaging, in the long term, for youngsters - along with the more obvious question of whether that 70% TIR is even necessary or appropriate for children. Does child growth overtake (replace) possible damage from less satisfactory BG management? There doesn't seem to be much consideration of that age group in the consensus report. Of course since TIR is a relatively new criterion there may not be sufficient knowledge from former youngsters to know the long term effects and relate that back to TIR. As a 73yr old I'm personally more concerned about potential mental decline and keeping my time below 3.9 well below 4% - but perhaps that scenario of mental decline is already predetermined (?)!

 

[Sally71]

70% rings a bell with me, but I know my daughter has been as low as 39% before and more commonly around the 60% range, and we’ve never got told off about it. As long as the medics can see that you are doing everything you can and not just sitting back on your laurels and not caring, then it’s ok. My daughter’s HbA1s have mostly been around the 50-53 mark which they are also pleased with.

I don’t think we’ve ever got anywhere near 90% so don’t be pushing too hard for that! Type 1 is IMPOSSIBLE to control perfectly, no matter how hard you try. You’re doing really well 🙂

We switched over to Control-IQ on my daughter’s pump just before Christmas, so it’s looping with sensors and automatically adjusting basal throughout the day. We have only had one set of results since then, HbA1c had dropped 9 points to 43 and TIR had gone up to 78% which is pretty exceptional for us (will be interesting to see if it has gone up any more next time). If you’re doing it all yourself then keep up the good work, our pump now officially knows what it’s doing better than we do !

 

[Sally71]

The Masterchef program last night with the chap whose daughter is Type 1 was still pushing the ideas that she couldn't have sugar, and sweet things and this and that. I feel quite sorry for her. Somebody commented about it in a post the other day as well.
Though the food he made did look very good.

I thought that too, and wondered if I was missing something! They keep banging on about it, but we’ve always been taught that daughter can basically eat what she likes as long as she gets the insulin dose correct. Including junk like doughnuts and stuff. It is true that blood sugars will be more stable if you try to avoid sugar, and we’ve always had pumps so perhaps if the kid is on injections that makes it a bit more tricky, but plenty of T1s on here are not on pumps and make it work. The chap did once mention that less carbs means less insulin, so he obviously understands a bit about carb counting, but I wonder who told him that sugar is out completely? He made his daughter’s favourite curry, complete with a load of rice and breads and sugar-free chutney… if she can eat the rice and breads then a bit of sugar in her chutney is going to make hardly any difference! I have been practically yelling at the TV!
He does look like he can make a mean pudding though, sugar free or not…

 

[everydayupsanddowns]

@Inka my DSN told me 80% (and I’m sure I’ve seen something on here saying 80%!) - has it changed recently?

Try this @pawprint91

International consensus recommendations for Time in Range for adults using sensors.

I’m not sure if there is paediatric TIR suggestions in the NICE guidelines for children and young people?