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. 2025 Apr 18:S1530-891X(25)00074-6.
doi: 10.1016/j.eprac.2025.03.006. Online ahead of print.

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

Molly L Tanenbaum  1 , Mabelle B Pasmooij  2 , Rachel Tam  3 , Marina Basina  2 , Michael S Hughes  2 , Franziska K Bishop  3 , David M Maahs  4
Affiliations

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

Molly L Tanenbaum et al. Endocr Pract. .

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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Conflict of interest statement

Disclosure M.L.T.: None. M.B.P.: None. R.T.: None. M.B.: None. M.S.H.: Served as a consultant for Dexcom and has received research support through his institution from Dexcom, Insulet, Medtronic, Sinocare, and Tandem. F.K.B.: None. D.M.M: Research support from the NIH, JDRF, NSF and the Leona M. and Harry B. Helmsley Charitable Trust and his institution has had research support from Medtronic, Dexcom, Insulet, Bigfoot Biomedical, Tandem, and Roche; and has consulted for Abbott, Aditxt, the Leona M. and Harry B. Helmsley Charitable Trust, Lifescan, Mannkind, Sanofi, Novo Nordisk, Eli Lilly, Medtronic, Insulet, Dompe, and Biospex.

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