The argument for Time in Range importance over A1C

I was doing some analysis this morning and think this is the perfect illustration of why Time in Range is far more important than A1C. This is glucose distribution from 1 year ago and this week. The time in target range (70-150) is 10% better. Time hypo is 1.8% better and time hyper is 8.3% better. My standard deviation went from 37.3 to 26.5%. But when you look at the estimated A1C, all this improvement adds up to 0.1%. Looping with Omnipod and Dexcom G6 using the automatic bolus branch has helped dramatically reduce the day to day burden of my blood sugar management. This technology has given me my life back.

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One just popped up, @zatff. zatff has been looking for other loopers to talk to. He is relatively new Looper with some ?'s.
We have a Loop section (that you may or may not want to use). If you do, it is here: https://forum.tudiabetes.org/c/diabetes-technology/diy-closed-loop-systems/53

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Those are some very impressive readings. How do you go about tweaking your settings to get better control with more time in range? What changes did you make that you found most effective?

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Hi Zatff
I have been using Autotune to get suggestions for tweaks. Most recently I changed ISF from 45 to 50 because I was going low too often. And I changed I:C from 1-7.5 to 1-8. I don’t do too much with basal rates because the auto bolus keeps me in line.
Clare

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Very impressive!! I agree, I’m on auto bolus, too, and pretty much use just one basal profile, except for overrides during exercise.

It definitely keeps me from straying too far from my target. Sure it takes a bit of diligence but it is much easier than doing all the math myself.

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Can you use autotune with an iPhone and OmniPod with the looping program?

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You need a Nightscout account and URL to run Autotune. https://autotuneweb.azurewebsites.net/ The program pulls your data from Nightscout and then sends an email with settings your data suggest. So yes you can manage and run autotune on your iPhone and get the results sent to email and read them on your phone you just need Nightscout.
Clare

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I have a Night Scout account so I will try the autotune program to see what it recommends. Lately my looping program has been very erratic in terms of controlling my blood glucose levels. For the first two weeks it kept me from having any night time lows but the other night I had a very serious low and my settings are all about the same.

Hope it helps you dial into the problem if there is one. D can be very erratic on its own. I have found Loop smooths out the peaks and valleys and nights have been without hypo events.

I think this important point is starting to sink in with both patients and their doctors. Glucose variability as measured by standard deviation is obscured with A1c. Unfortunately that number has dominated clinical thinking for so long that it will take some time for A1c to be replaced by TIR as the single best number to indicate glycemic control quality.

One nit-pick I have with TIR comparisons is that the doctors chose 70-180 (3.9-10) as the standard for clinical analysis. I appreciate that this range is a reasonable one for a population with diabetes but it personally underwhelms me. I don’t see the 140-180 (7.8-10) range as healthy for glucose metabolism.

Sure, even gluco-normals traverse this range at times, but unfortunately those of us who live with diabetes often spend much longer periods of time there. It would be nice if the clinicians and their professional organizations would adopt a second more ambitious range for those of us who pay closer attention to such things.

In the end, it’s just a number. More important to us is spending as much time as possible in a healthy glucose range as possible.

Little comfort is taken from a study that only found 12% of the US population with a healthy metabolism. It saddens me that so many people could restore their failing metabolisms with some lifestyle changes yet choose not to. These same lifestyle changes still allow me better health but I will never be able to place my T1D into remission. :frowning_face:

Congrats on the stellar performance, @Clare_T_Fishman! I’ve never tried the auto-bolus branch of Loop but I’m satisfied with the results I’m getting with the main branch. I wonder if it could ease some of the cognitive burden that even Loop management entails.

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Terry,
Thank you ! The whole reason I decided to try the auto-bolus branch was to ease the mental burden. Not having to constantly be in charge and making little decisions to stay in range (and I agree wholeheartedly the 70-180 range is pretty broad) but it gives them a basis for comparison of large populations of PWD. You know we don’t reside in the average population of people with D. I found basal adjustments only were too slow so decided to try the auto bolus branch. Until we have much faster - more physiologic insulin and real time CGM we just have to work the most efficiently with the tools we do have.
Clare

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My view of TIR vs A1C. Let’s pretend the goal A1C is 5. If your bg’s run 5, 5, and 5, Great! Your A1C is 5 and youur TIR is 100%. But…if your bg’s run 0, 5 and 10, your A1C is still 5 and your TIR is??? maybe 45%? I don’t like the high range for TIR, but since I set my own goals in terms of high and low alerts, my tighter mgt results in good results per the standard and needs for improvement for my standard. My range of choice is 60-120

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