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BMC Endocrine Disorders
Published in: BMC Endocrine Disorders 1/2021

Open Access 01-12-2021 | Hyperglycemia | Research article

Glycemic deviation index: a novel method of integrating glycemic numerical value and variability

Authors: Yizhou Zou, Wanli Wang, Dongmei Zheng, Xu Hou

Published in: BMC Endocrine Disorders | Issue 1/2021

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Abstract

Background

There are many continuous blood glucose monitoring (CGM) data-based indicators, and most of these focus on a single characteristic of abnormal blood glucose. An ideal index that integrates and evaluates multiple characteristics of blood glucose has not yet been established.

Methods

In this study, we proposed the glycemic deviation index (GDI) as a novel integrating characteristic, which mainly incorporates the assessment of the glycemic numerical value and variability. To verify its effectiveness, GDI was applied to the simulated 24 h glycemic profiles and the CGM data of type 2 diabetes (T2D) patients (n = 30).

Results

Evaluation of the GDI of the 24 h simulated glycemic profiles showed that the occurrence of hypoglycemia was numerically the same as hyperglycemia in increasing GDI. Meanwhile, glycemic variability was added as an independent factor. One-way ANOVA results showed that the application of GDI showed statistically significant differences in clinical glycemic parameters, average glycemic parameters, and glycemic variability parameters among the T2D groups with different glycemic levels.

Conclusions

In conclusion, GDI integrates the characteristics of the numerical value and the variability in blood glucose levels and may be beneficial for the glycemic management of diabetic patients undergoing CGM treatment.
Literature
1.
El-Osta A, Brasacchio D, Yao D, Pocai A, Jones PL, Roeder RG, Cooper ME, Brownlee M. Transient high glucose causes persistent epigenetic changes and altered gene expression during subsequent normoglycemia. J Exp Med. 2008;205(10):2409–17.PubMedPubMedCentralCrossRef
2.
Gorst C, Kwok CS, Aslam S, Buchan I, Kontopantelis E, Myint PK, Heatlie G, Loke Y, Rutter MK, Mamas MA. Long-term glycemic variability and risk of adverse outcomes: a systematic review and meta-analysis. Diabetes Care. 2015;38(12):2354–69.PubMedCrossRef
3.
Skrha J, Soupal J, Skrha J Jr, Prazny M. Glucose variability, HbA1c and microvascular complications. Rev Endocr Metab Disord. 2016;17(1):103–10.PubMedCrossRef
4.
Frontoni S, Di Bartolo P, Avogaro A, Bosi E, Paolisso G, Ceriello A. Glucose variability: an emerging target for the treatment of diabetes mellitus. Diabetes Res Clin Pract. 2013;102(2):86–95.PubMedCrossRef
5.
6.
Sacks DB, Arnold M, Bakris GL, Bruns DE, Horvath AR, Kirkman MS, Lernmark A, Metzger BE, Nathan DM. Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Diabetes Care. 2011;34(6):e61–99.PubMedPubMedCentralCrossRef
7.
English E, Lenters-Westra E. HbA1c method performance: the great success story of global standardization. Crit Rev Clin Lab Sci. 2018;55(6):408–19.PubMedCrossRef
8.
Kovatchev BP. Metrics for glycaemic control - from HbA1c to continuous glucose monitoring. Nat Rev Endocrinol. 2017;13(7):425–36.PubMedCrossRef
9.
10.
Fokkert MJ, van Dijk PR, Edens MA, Abbes S, de Jong D, Slingerland RJ, Bilo HJ. Performance of the FreeStyle libre flash glucose monitoring system in patients with type 1 and 2 diabetes mellitus. BMJ Open Diabetes Res Care. 2017;5(1):e000320.PubMedPubMedCentralCrossRef
11.
Wadwa RP, Laffel LM, Shah VN, Garg SK. Accuracy of a factory-calibrated, real-time continuous glucose monitoring system during 10 days of use in youth and adults with diabetes. Diabetes Technol Ther. 2018;20(6):395–402.PubMedPubMedCentralCrossRef
12.
13.
Fleischer J, Laugesen E, Cichosz SL, Hoeyem P, Dejgaard TF, Poulsen PL, Tarnow L, Hansen TK. Continuous glucose monitoring adds information beyond HbA1c in well-controlled diabetes patients with early cardiovascular autonomic neuropathy. J Diabetes Complicat. 2017;31(9):1389–93.CrossRef
14.
McDonnell CM, Donath SM, Vidmar SI, Werther GA, Cameron FJ. A novel approach to continuous glucose analysis utilizing glycemic variation. Diabetes Technol Ther. 2005;7(2):253–63.PubMedCrossRef
15.
Moberg E, Kollind M, Lins PE, Adamson U. Estimation of blood-glucose variability in patients with insulin-dependent diabetes mellitus. Scand J Clin Lab Invest. 1993;53(5):507–14.PubMedCrossRef
16.
Service FJ, Molnar GD, Rosevear JW, Ackerman E, Gatewood LC, Taylor WF. Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes. 1970;19(9):644–55.PubMedCrossRef
17.
Guerci B, Monnier L, Serusclat P, Petit C, Valensi P, Huet D, Raccah D, Colette C, Quere S, Dejager S. Continuous glucose profiles with vildagliptin versus sitagliptin in add-on to metformin: results from the randomized optima study. Diabetes Metab. 2012;38(4):359–66.PubMedCrossRef
18.
Agiostratidou G, Anhalt H, Ball D, Blonde L, Gourgari E, Harriman KN, Kowalski AJ, Madden P, McAuliffe-Fogarty AH, McElwee-Malloy M, et al. Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care. 2017;40(12):1622–30.PubMedPubMedCentralCrossRef
19.
Wojcicki JM. Mathematical descriptions of the glucose control in diabetes therapy. Analysis of the Schlichtkrull "M"-value. Horm Metab Res. 1995;27(1):1–5.PubMedCrossRef
20.
Clarke W, Kovatchev B. Statistical tools to analyze continuous glucose monitor data. Diabetes Technol Ther. 2009;11(Suppl 1):S45–54.PubMedCrossRef
21.
Rodbard D. Interpretation of continuous glucose monitoring data: glycemic variability and quality of glycemic control. Diabetes Technol Ther. 2009;11(Suppl 1):S55–67.PubMedCrossRef
22.
Hill NR, Hindmarsh PC, Stevens RJ, Stratton IM, Levy JC, Matthews DR. A method for assessing quality of control from glucose profiles. Diabetic Med. 2007;24(7):753–8.PubMedCrossRef
23.
Leelarathna L, Thabit H, Wilinska ME, Bally L, Mader JK, Pieber TR, Benesch C. Evaluating Glucose Control With a Novel Composite Continuous Glucose Monitoring Index. J Diabetes Sci Technol. 2020;14(2):277–83.PubMedCrossRef
24.
Augstein P, Heinke P, Vogt L, Vogt R, Rackow C, Kohnert KD, Salzsieder E. Q-score: development of a new metric for continuous glucose monitoring that enables stratification of antihyperglycaemic therapies. BMC Endocr Disord. 2015;15:22.PubMedPubMedCentralCrossRef
25.
Vigersky RA, Shin J, Jiang B, Siegmund T, McMahon C, Thomas A. The comprehensive glucose pentagon: a glucose-centric composite metric for assessing glycemic control in persons with diabetes. J Diabetes Sci Technol. 2018;12(1):114–23.PubMedCrossRef
26.
Nguyen M, Han J, Spanakis EK, Kovatchev BP, Klonoff DC. A review of continuous glucose monitoring-based composite metrics for glycemic control. Diabetes Technol Ther. 2020;22(8):613–22.PubMedCrossRef
27.
Hirsch IB, Balo AK, Sayer K, Garcia A, Buckingham BA, Peyser TA. A simple composite metric for the assessment of glycemic status from continuous glucose monitoring data: implications for clinical practice and the artificial pancreas. Diabetes Technol Ther. 2017;19(S3):S38–s48.PubMedCrossRef
28.
Kovatchev BP, Cox DJ, Gonder-Frederick LA, Clarke W. Symmetrization of the blood glucose measurement scale and its applications. Diabetes Care. 1997;20(11):1655–8.PubMedCrossRef
29.
Welsh JB, Kaufman FR, Lee SW. Accuracy of the Sof-sensor glucose sensor with the iPro calibration algorithm. J Diabetes Sci Technol. 2012;6(2):475–6.PubMedPubMedCentralCrossRef
30.
Wang C, Lv L, Yang Y, Chen D, Liu G, Chen L, Song Y, He L, Li X, Tian H, et al. Glucose fluctuations in subjects with normal glucose tolerance, impaired glucose regulation and newly diagnosed type 2 diabetes mellitus. Clin Endocrinol. 2012;76(6):810–5.CrossRef
31.
Brouns F, Bjorck I, Frayn KN, Gibbs AL, Lang V, Slama G, Wolever TM. Glycaemic index methodology. Nutr Res Rev. 2005;18(1):145–71.PubMedCrossRef
32.
Beck RW, Connor CG, Mullen DM, Wesley DM, Bergenstal RM. The fallacy of average: how using HbA1c alone to assess glycemic control can be misleading. Diabetes Care. 2017;40(8):994–9.PubMedPubMedCentralCrossRef
33.
34.
35.
Umpierrez G, Korytkowski M. Diabetic emergencies - ketoacidosis, hyperglycaemic hyperosmolar state and hypoglycaemia. Nat Rev Endocrinol. 2016;12(4):222–32.PubMedCrossRef
36.
Zhou J, Li H, Ran X, Yang W, Li Q, Peng Y, Li Y, Gao X, Luan X, Wang W, et al. Establishment of normal reference ranges for glycemic variability in Chinese subjects using continuous glucose monitoring. Med Sci Monitor. 2011;17(1):Cr9–13.CrossRef
37.
Lantz B. The impact of sample non-normality on ANOVA and alternative methods. Br J Math Stat Psychol. 2013;66(2):224–44.PubMedCrossRef
38.
van Dijk JW, Manders RJ, Hartgens F, Stehouwer CD, Praet SF, van Loon LJ. Postprandial hyperglycemia is highly prevalent throughout the day in type 2 diabetes patients. Diabetes Res Clin Pract. 2011;93(1):31–7.PubMedCrossRef
39.
Gerich JE. Postprandial hyperglycemia and cardiovascular disease. Endocr Pract. 2006;12(Suppl 1):47–51.PubMedCrossRef
40.
Klimontov VV, Myakina NE. Glucose variability indices predict the episodes of nocturnal hypoglycemia in elderly type 2 diabetic patients treated with insulin. Diabetes Metab Syndr. 2017;11(2):119–24.PubMedCrossRef
41.
Su JB, Chen T, Xu F, Wang XQ, Chen JF, Wu G, Jin Y, Wang XH. Glycemic variability in normal glucose regulation subjects with elevated 1-h postload plasma glucose levels. Endocrine. 2014;46(2):241–8.PubMedCrossRef
42.
Jung HS. Clinical Implications of Glucose Variability: Chronic Complications of Diabetes. Endocrinol Metab (Seoul, Korea). 2015;30(2):167–74.CrossRef
43.
Gu W, Liu Y, Liu H, Yang G, Guo Q, Du J, Jin N, Zang L, Lv Z, Ba J, et al. Characteristics of glucose metabolism indexes and continuous glucose monitoring system (CGMS) in patients with insulinoma. Diabetol Metab Syndr. 2017;9:17.PubMedPubMedCentralCrossRef
44.
Freitas PAC, Ehlert LR, Camargo JL. Glycated albumin: a potential biomarker in diabetes. Arch Endocrinol Metabol. 2017;61(3):296–304.CrossRef
45.
Jones IR, Owens DR, Williams S, Ryder RE, Birtwell AJ, Jones MK, Gicheru K, Hayes TM. Glycosylated serum albumin: an intermediate index of diabetic control. Diabetes Care. 1983;6(5):501–3.PubMedCrossRef
46.
Siu AL. Screening for abnormal blood glucose and type 2 diabetes mellitus: U.S. preventive services task force recommendation statement. Ann Intern Med. 2015;163(11):861–8.PubMedCrossRef
47.
Beck RW, Bergenstal RM. Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials. Diabetes Care. 2019;42(3):400–5.PubMedCrossRef
48.
Wojcicki JM. “J”-index. A new proposition of the assessment of current glucose control in diabetic patients. Horm Metab Res. 1995;27(1):41–2.PubMedCrossRef
Metadata
Title
Glycemic deviation index: a novel method of integrating glycemic numerical value and variability
Authors
Yizhou Zou
Wanli Wang
Dongmei Zheng
Xu Hou
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Endocrine Disorders / Issue 1/2021
Electronic ISSN: 1472-6823
DOI
https://doi.org/10.1186/s12902-021-00691-z

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