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

Molly L Tanenbaum¹, Mabelle B Pasmooij², Rachel Tam³

¹Division 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.

Endocrine Practice : Official Journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists

|June 23, 2025

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.

Keywords:

automated insulin delivery clinical guidelines continuous glucose monitoring glycemic target psychosocial aspects type 1 diabetes

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