I really love continuous glucose monitoring (CGM). I love all of the information it provides — how it connects the dots and lets us know what’s happening to people overnight and in between glucose checks. What I especially love about CGM is that it doesn’t have to be perfect. With the A1C test, it seems like a grade: Under 7%, you passed; Over 7%, and you failed this test. Of course this is not true, but it can feel that way for both the person with diabetes (PWD) and the diabetes educator who is supposed to help the PWD achieve that goal.
But CGM is different. Because there is a wider target range of 70-180mg/dL and the glucose variability becomes more important. Recently there was an International Consensus on Time in Range from a large panel of distinguished clinicians. They provided standardized CGM metrics and one part that especially stood out for me was the goal of 70% time in range for most people with type 1 or type 2 diabetes and 50% time in range for higher risk or older adults. The goal for pre-existing type 1 diabetes in pregnancy is also 70% although with a target of 63-140mg/dL. This means that you don’t have to be perfect! How refreshing to know that it doesn’t have to be perfect to be better. Pregnancy can especially be such a high anxiety time. People with diabetes may feel guilt about not always staying under that 140mg/dL after meals. And even I have felt guilt in the past about not succeeding in helping my patients achieve those goals all of the time. How reassuring to know that A: it’s incredibly difficult to achieve 100% time in target; and B: it doesn’t have to be there 100% of the time to have healthy outcomes.
I think this is important because it’s easy to fall into the trap of feeling like a failure or harboring a sense of guilt if you don’t meet a certain mark. But we don’t need to be perfect. As leaders, there may be times when we can really inspire change and growth, where our teams work so well together and move mountains. At other times, it’s just an accomplishment to get the work done, period. That’s okay; just as we don’t expect a PWD to be 100% time in range, our leadership, our teams, our colleagues, and our work can’t possibly be 100% all of the time. My hope is that if my fellow leaders can remember this wisdom, we can avoid burnout and find the motivation to keep going even on those harder days. Let’s not fall into the trap of perfection. After all, done is usually better than perfect.
Battelino R, Danne T, Bergental RM et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care 2019 Jun; dci190028.