Kovatchev Boris P, Otto Erik, Cox Daniel, Gonder-Frederick Linda, Clarke William
University of Virginia Health System, Box 800137, Charlottesville, VA 22908, USA.
Diabetes Care. 2006 Nov;29(11):2433-8. doi: 10.2337/dc06-1085.
Recent studies show the importance of controlling blood glucose variability in relationship to both reducing hypoglycemia and attenuating the risk for cardiovascular and behavioral complications due to hyperglycemia. It is therefore important to design variability measures that are equally predictive of low and high blood glucose excursions.
We introduce the average daily risk range (ADRR), a variability measure computed from routine self-monitored blood glucose (SMBG) data. The ADRR was constructed using a development dataset for 39 and 31 adults with type 1 and type 2 diabetes, respectively. The formula was then fixed, and the ADRR was compared against other variability measures using an independent validation dataset containing approximately 4 months of SMBG for 254 and 81 adults with type 1 and type 2 diabetes.
From the 1st month of validation SMBG data, we computed the ADRR, blood glucose SD and coefficient of variation, daily blood glucose range and interquartile range, mean amplitude of glycemic excursion, M-value, and lability index. Then all measures were tested as predictors of low blood glucose (<2.2 mmol/l; <3.9 mmol/l) and high (>10 mmol/l; >22.2 mmol/l) events in the subsequent 3 months. The ADRR was the best predictor of both hypoglycemia and hyperglycemia, with a 6-fold increase in the likelihood of hypoglycemia and 3.5-fold increase in the likelihood of hyperglycemia across its risk categories.
In a large SMBG database, the ADRR showed strong association with subsequent out-of-control glucose readings. Compared with other variability measures, the ADRR demonstrated a superior balance of sensitivity to predicting both hypoglycemia and hyperglycemia. This prediction was independent from type of diabetes.
近期研究表明，控制血糖变异性对于降低低血糖风险以及减轻高血糖所致心血管和行为并发症风险均具有重要意义。因此，设计出能够同样有效预测低血糖和高血糖波动的变异性测量指标至关重要。
我们引入了平均每日风险范围（ADRR），这是一种根据常规自我监测血糖（SMBG）数据计算得出的变异性测量指标。ADRR是利用分别包含39名1型糖尿病成人和31名2型糖尿病成人的一个开发数据集构建而成的。随后固定该公式，并使用一个独立验证数据集将ADRR与其他变异性测量指标进行比较，该验证数据集包含254名1型糖尿病成人和81名2型糖尿病成人约4个月的SMBG数据。
从验证SMBG数据的第1个月起，我们计算了ADRR、血糖标准差和变异系数、每日血糖范围和四分位间距、血糖波动平均幅度、M值以及不稳定指数。然后将所有测量指标作为随后3个月内低血糖（<2.2 mmol/l；<3.9 mmol/l）和高血糖（>10 mmol/l；>22.2 mmol/l）事件的预测指标进行测试。ADRR是低血糖和高血糖的最佳预测指标，在其各个风险类别中，低血糖发生可能性增加了6倍，高血糖发生可能性增加了3.5倍。
在一个大型SMBG数据库中，ADRR与随后的血糖失控读数显示出强烈关联。与其他变异性测量指标相比，ADRR在预测低血糖和高血糖方面表现出更优的敏感性平衡。这种预测与糖尿病类型无关。
