'Better Glycemic Control Than I've Ever Seen'

This transcript has been edited for clarity.

Recently, I noticed something strange happening in my clinic. Most of my patients with type 1 diabetes are coming in with A1c levels below 7%—not slightly below 7%, but 5.7% to 6.5%. Many of these patients had had higher A1c levels for years and really struggled to bring them down.

When I think about it, there are two fundamental changes in the management of my patients with type 1 diabetes. Part of this is driven first by new concepts, specifically that of the ambulatory glucose profile, and second by new technology.

Time in Range

First, I'm going to talk about the concept that comes from patients wearing continuous glucose monitors, and that's the notion of time in range. An A1c result is a 3-month average, and it's kind of abstract. You can't tell based on an A1c of 7.5% whether a patient is high overnight and low in the afternoon. You only know what the average is.

The time in range tells you how much of the time a patient is in the range between 70 and 180 mg/dLYou know that a patient can have a good A1c of 6.5%, but be up and down and up and down. That's someone who may not feel like their diabetes is well controlled, and they may be suffering from frequent episodes of high and low blood sugars.