Different indexes of glycemic variability as identifiers of patients with risk of hypoglycemia in type 2 diabetes mellitus
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Date
2018-02-16Authors
Gómez, Ana M.Muñoz, Oscar M.
Marin, Alejandro
Fonseca, Maria Camila
Rondón, Martín
Robledo Gómez, María Alejandra
Sanko, Andrei
Lujan, Dilcia
García-Jaramillo, Maira
León Vargas, Fabian Mauricio
Corporate Author(s)
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Epidemiología Clínica y Bioestadística
Pontificia Universidad Javeriana. Facultad de Medicina. Departamento de Medicina Interna. Enfermedades Crónicas del Adulto
Type
Artículo de revista
ISSN
1932-2968 / 1932-2968 (Electrónico)
Pages
1007-1015
Item type
Artículo original
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Abstract
Introduction:
Recent publications frequently introduce new indexes to measure glycemic variability (GV), quality of glycemic control, or glycemic risk; however, there is a lack of evidence supporting the use of one particular parameter, especially in clinical practice.
Methods:
A cohort of type 2 diabetes mellitus (T2DM) patients in ambulatory care were followed using continuous glucose monitoring sensors (CGM). Mean glucose (MG), standard deviation, coefficient of variation (CV), interquartile range, CONGA1, 2, and 4, MAGE, M value, J index, high blood glucose index, and low blood glucose index (LBGI) were estimated. Hypoglycemia incidence (<54 mg/dl) was calculated. Area under the curve (AUC) was determined for different indexes as identifiers of patients with risk of hypoglycemia (IRH). Optimal cutoff thresholds were determined from analysis of the receiver operating characteristic curves.
Results:
CGM data for 657 days from 140 T2DM patients (4.69 average days per patient) were analyzed. Hypoglycemia was present in 50 patients with 144 hypoglycemic events in total (incidence rate of 0.22 events per patient/day). In the multivariate analysis, both CV (OR 1.20, 95% CI 1.12-1.28, P < .001) and LBGI (OR 4.83, 95% CI 2.41-9.71, P < .001) were shown to have a statistically significant association with hypoglycemia. The highest AUC were for CV (0.84; 95% CI 0.77-0.91) and LBGI (0.95; 95% CI 0.92-0.98). The optimal cutoff threshold for CV as IRH was 34%, and 3.4 for LBGI.
Conclusion:
This analysis shows that CV can be recommended as the preferred parameter of GV to be used in clinical practice for T2DM patients. LBGI is the preferred IRH between glycemic risk indexes.
Link to the resource
https://journals.sagepub.com/doi/full/10.1177/1932296818758105Source
Journal of Diabetes Science and Technology; Vol. 12 Núm. 5 (2018)
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