Instituto Universitario de Automática e Informática Industrial, Universitat Politècnica de València, València, Spain.
Department of Electrical and Electronic Engineering, Imperial College London, London, United Kingdom.
Diabetes Technol Ther. 2020 Oct;22(10):719-726. doi: 10.1089/dia.2019.0415.
Increasing use of continuous glucose monitoring (CGM) data has created an array of glucose metrics for glucose variability, temporal patterns, and times in ranges. However, a gold standard metric has not been defined. We assess the performance of multiple glucose metrics to determine their ability to detect intra- and interperson variability to determine a set of recommended metrics. The Juvenile Diabetes Research Foundation data set, a randomized controlled study of CGM and self-monitored blood glucose conducted in children and adults with type 1 diabetes (T1D), was used. To determine the ability of the evaluated glycemic metrics to discriminate between different subjects and attenuate the effect of within-subject variation, the discriminant ratio was calculated and compared for each metric. Then, the findings were confirmed using data from two other recent randomized clinical trials. Mean absolute glucose (MAG) has the highest discriminant ratio value (2.98 [95% confidence interval {CI} 1.64-3.67]). In addition, low blood glucose index and index of glycemic control performed well (1.93 [95% CI 1.15-3.44] and 1.92 [95% CI 1.27-2.93], respectively). For percentage times in glucose target ranges, the optimal discriminator was percentage time in glucose target 70-180 mg/dL. MAG is the optimal index to differentiate glucose variability in people with T1D, and may be a complementary therapeutic monitoring tool in addition to glycated hemoglobin and a measure of hypoglycemia. Percentage time in glucose target 70-180 mg/dL is the optimal percentage time in range to report.
连续血糖监测（CGM）数据的应用日益广泛，为血糖变异性、时间模式和血糖范围时间提供了一系列血糖指标。然而，尚未定义金标准指标。我们评估了多种血糖指标的性能，以确定它们检测个体内和个体间变异性的能力，从而确定一组推荐的指标。
该研究使用了青少年糖尿病研究基金会（Juvenile Diabetes Research Foundation，JDRF）数据集，这是一项针对 CGM 和自我监测血糖的随机对照研究，参与者为 1 型糖尿病（type 1 diabetes，T1D）患儿和成人。为了确定评估的血糖指标区分不同个体的能力，并减弱个体内变异的影响，计算并比较了每个指标的判别比。然后，使用另外两项最近的随机临床试验的数据对研究结果进行了验证。
平均绝对血糖（mean absolute glucose，MAG）的判别比最高（2.98[95%置信区间1.64-3.67]）。此外，低血糖指数和血糖控制指数表现良好（1.93[95%置信区间1.15-3.44]和 1.92[95%置信区间1.27-2.93]）。对于血糖目标范围内的时间百分比，最佳判别指标是血糖目标 70-180mg/dL 范围内的时间百分比。
MAG 是区分 T1D 患者血糖变异性的最佳指标，除了糖化血红蛋白和低血糖测量之外，它可能成为一种补充治疗监测工具。报告血糖目标 70-180mg/dL 范围内的时间百分比是最佳的时间百分比。
