Interpretation of Continuous Glucose Monitoring Data: Glycemic Variability and Quality of Glycemic Control
Interpretation of Continuous Glucose Monitoring Data: Glycemic Variability and Quality of Glycemic Control
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DOI：
10.1089/dia.2008.0132
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发表时间：
2009-04-01
影响因子：
5.4
通讯作者：
Rodbard, David
中科院分区：
文献类型：
--
作者：
Rodbard, David
有大量的血糖变异性测量方法，包括标准差(SD)、百分比变异系数(%CV)、四分位数范围(IQR)、平均血糖漂移幅度(MAGE)、每日差值平均值(Modd)和n小时内连续重叠的净升糖作用(COMA(N))。这些都与总体或“总”标准偏差、标准偏差(T)高度相关。SD(T)由对应于日内变化、日间变化(日平均值之间和日之间--在特定时间点内)以及这些变化来源的相互作用的几个组成部分组成。我们确定了SD的几个亚型；每个亚型都与SD(T)高度相关。可变性也可能取决于一天中的时间。已经提出了许多血糖控制质量的衡量标准，包括血糖控制质量加权平均值(M(R))(例如，M(100)是M在100 mg/dL时的加权平均值)、基于平均值和SD(J)的血糖控制质量衡量标准、血糖风险评估糖尿病方程(分级)、血糖控制指数(IGC)、高血糖指数(HBGI)、低血糖指数(LBGI)、平均每日风险极差(ADRR)以及指定范围内的血糖值百分比。这些方法通常但不总是提供一致的结果：它们在检测对治疗干预的反应的能力方面可能存在很大差异。在回顾这些方法的优点和局限性以及应用这些方法的广泛经验的基础上，我们概述了一种系统的方法来解释连续的血糖监测数据，供临床研究人员和临床医生使用来评估血糖控制的质量，血糖变异性包括日内和日间变异性，血糖模式的日常稳定性，以及对治疗的反应变化。
There are a large number of measures of glycemic variability, including standard deviation (SD), percentage coefficient of variation (%CV), interquartile range (IQR), mean amplitude of glucose excursion (MAGE), mean of daily differences (MODD), and continuous overlapping net glycemic action over an n-hour period (CONGA(n)). These are all highly correlated with the overall or "total'' SD, SD(T). SD(T) is composed of several components corresponding to within-day variability, between-day variability (between daily means and between days-within specified time points), and the interaction of these sources of variability. We identify several subtypes of SD; each is highly correlated with SD(T). Variability may also depend on time of day. Numerous measures of quality of glycemic control have been proposed, including a weighted average of glucose values (M(R)) (e. g., M(100) is M at 100mg/dL), a measure of quality of glycemic control based on mean and SD (J), the Glycemic Risk Assessment Diabetes Equation (GRADE), the Index of Glycemic Control (IGC), the High Blood Glucose Index (HBGI), the Low Blood Glucose Index (LBGI), the Average Daily Risk Range (ADRR), and percentage of glucose values within specified ranges. These methods usually but not always give consistent results: they can differ widely in terms of their ability to detect responses to therapeutic interventions. Based on review of the advantages and limitations of these measures and on extensive experience in the application of these methods, we outline a systematic approach to the interpretation of continuous glucose monitoring data for use by clinical researchers and clinicians to evaluate the quality of glycemic control, glucose variability including within-and between-day variability, the day-to-day stability of glycemic patterns, and changes in response to therapy.