Robust Determination of the Optimal Continuous Glucose Monitoring Length of Intervention to Evaluate Long-Term Glycemic Control
Robust Determination of the Optimal Continuous Glucose Monitoring Length of Intervention to Evaluate Long-Term Glycemic Control
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DOI：
10.1089/dia.2020.0387
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发表时间：
2021-04-01
影响因子：
5.4
通讯作者：
Oliver, Nick
中科院分区：
文献类型：
--
作者：
Herrero, Pau;Alalitei, Antonia;Oliver, Nick
目的：共识连续葡萄糖监测（CGM）指南包括一项建议，即至少使用14天的CGM数据来报告范围内的时间。以前采用的方法来确定CGM数据的最佳持续时间有局限性。在这项研究中，我们提出了一个强大的方法来定义CGM数据的最小持续时间报告的时间范围，以及其他glycemic metrics.Methods：该方法是基于中位数的绝对百分比误差，并采用滑动时间窗口，以减少时间间隔变异的影响，因此允许使用较小的数据集。采用10%和5%阈值来评估CGM数据的最佳持续时间，用于评估血糖控制质量和血糖变异性的一组常用指标。为了评估数据集大小和干预类型的影响，使用了两项随机对照试验的数据，这些试验涉及1型糖尿病患者（n = 236和n = 25）。结果表明，平均葡萄糖在2周内达到平均绝对百分比误差的5%阈值，而目标70-180 mg/dL的百分比时间、平均绝对葡萄糖、标准差，和变异系数在4周内在两个数据集中达到相同的阈值，表明这些指标可以从4周的CGM数据中稳健地评估，而其他一些指标需要更长的窗口长度，特别是那些评估低血糖的指标。结论：我们的数据表明，CGM数据不存在稳健评估所有结局的最佳持续时间，稳健结局所需的持续时间取决于所研究的人群、抽样频率和所选择的主要结果。
Objective: Consensus continuous glucose monitoring (CGM) guidance includes a recommendation that a minimum of 14 days of CGM data are used to report times in ranges. The previously employed approaches to determine the optimal duration for CGM data have limitations. In this study, we present a robust approach to define the minimum duration of CGM data to report times in ranges, as well as other glycemic metrics.Methods: The approach is based on the median absolute percentage error and employs a sliding time window to reduce the impact of inter-time interval variability, hence allowing smaller data sets to be used. A 10% and 5% threshold were employed to assess the optimal duration of CGM data for a set of commonly employed metrics to assess quality of glycemic control and glycemic variability. To evaluate the impact of the data set size and type of intervention, data from two randomized controlled trials involving participants with type 1 diabetes were used (n = 236 and n = 25).Results: Results suggest that mean glucose reaches the 5% threshold for mean absolute percentage error within 2 weeks, whereas percentage time in target 70-180 mg/dL, mean absolute glucose, standard deviation, and coefficient of variation reach the same threshold within 4 weeks in both data sets, suggesting that these metrics can be robustly assessed from CGM data for a 4-week period, whereas some other metrics require much longer window lengths, especially those evaluating hypoglycemia.Conclusions: Our data suggest that there is no optimal duration for CGM data to robustly assess all outcomes and that the duration required for a robust outcome depends on the population being studied, the sampling frequency, and the primary outcomes selected.