Respective Contributions of Glycemic Variability and Mean Daily Glucose as Predictors of Hypoglycemia in Type 1 Diabetes: Are They Equivalent?
- 27 January 2020
- journal article
- research article
- Published by American Diabetes Association in Diabetes Care
- Vol. 43 (4), 821-827
- https://doi.org/10.2337/dc19-1549
Abstract
OBJECTIVE To evaluate the respective contributions of short-term glycemic variability and mean daily glucose (MDG) concentration to the risk of hypoglycemia in type 1 diabetes. RESEARCH DESIGN AND METHODS People with type 1 diabetes (n = 100) investigated at the University Hospital of Montpellier (France) underwent continuous glucose monitoring (CGM) on two consecutive days, providing a total of 200 24-h glycemic profiles. The following parameters were computed: MDG concentration, within-day glycemic variability (coefficient of variation for glucose [%CV]), and risk of hypoglycemia (presented as the percentage of time spent below three glycemic thresholds: 3.9, 3.45, and 3.0 mmol/L). RESULTS MDG was significantly higher, and %CV significantly lower (both P < 0.001), when comparing the 24-h glycemic profiles according to whether no time or a certain duration of time was spent below the thresholds. Univariate regression analyses showed that MDG and %CV were the two explanatory variables that entered the model with the outcome variable (time spent below the thresholds). The classification and regression tree procedure indicated that the predominant predictor for hypoglycemia was %CV when the threshold was 3.0 mmol/L. In people with mean glucose ≤7.8 mmol/L, the time spent below 3.0 mmol/L was shortest (P < 0.001) when %CV was below 34%. CONCLUSIONS In type 1 diabetes, short-term glycemic variability relative to mean glucose (i.e., %CV) explains more hypoglycemia than does mean glucose alone when the glucose threshold is 3.0 mmol/L. Minimizing the risk of hypoglycemia requires a %CV below 34%.Keywords
This publication has 40 references indexed in Scilit:
- Hypo- and Hyperglycemia in Relation to the Mean, Standard Deviation, Coefficient of Variation, and Nature of the Glucose DistributionDiabetes Technology & Therapeutics, 2012
- The Contribution of Glucose Variability to Asymptomatic Hypoglycemia in Persons with Type 2 DiabetesDiabetes Technology & Therapeutics, 2011
- Clinical Interpretation of Indices of Quality of Glycemic Control and Glycemic VariabilityPostgraduate Medicine, 2011
- Severe Hypoglycemia and Risks of Vascular Events and DeathThe New England Journal of Medicine, 2010
- Translating the A1C Assay Into Estimated Average Glucose ValuesDiabetes Care, 2008
- Long-Acting Insulin Analogs Versus Insulin Pump Therapy for the Treatment of Type 1 and Type 2 DiabetesDiabetes Care, 2008
- Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 DiabetesThe New England Journal of Medicine, 2005
- Defining and Reporting Hypoglycemia in DiabetesDiabetes Care, 2005
- Frequency of severe hypoglycemia in insulin-dependent diabetes mellitus can be predicted from self-monitoring blood glucose dataJournal of Clinical Endocrinology & Metabolism, 1994
- The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes MellitusThe New England Journal of Medicine, 1993