Department of Diabetology and Endocrinology, Hôpital Lariboisière, APHP, Paris, France.
Unité INSERM U1138 Immunity and Metabolism in Diabetes, ImMeDiab Team, Centre de Recherches des Cordeliers, Paris, France.
Diabetes Obes Metab. 2022 Nov;24(11):2102-2107. doi: 10.1111/dom.14795. Epub 2022 Jul 7.
Flash glucose monitoring provides a range of glucose metrics. In the current study, we aim to identify those that indicate that glycaemic targets can be consistently met and contrast the total (t-CV) and within-day coefficient of variation (wd-CV) to guide the assessment of glucose variability and hypoglycaemia exposure.
De-identified data from Flash readers were collected. The readers were sorted into 10 equally sized groups of scan frequency followed by quartiles of estimated A1c (eA1c). A similar grouping was performed for the total coefficient of variation (t-CV) and within-day coefficient of variation (wd-CV). In addition, analysis of the association of time below 54 mg/dl and glucose variability measured by t-CV and wd-CV was performed.
The dataset included 1 002 946 readers. Readers sorted by 10 equal groups of scan rate and quartiles by eA1c, t-CV and wd-CV represented 25 074 readers per group. The association of lower eA1c with higher time in range and reduced time above range was clear. The correlation of eA1c quartiles and time below range was not consistent. An association between glucose variability and hypoglycaemia was found. Both wd-CV and t-CV were associated with time below range. For achieving the consensus target of <1% time below 54 mg/dl, the associated wd-CV and t-CV values were 33.5% and 39.5%, respectively.
The type of CV reported by the different continuous glucose monitoring systems should be acknowledged. CV <36% might not be adequate to ensure low hypoglycaemia exposure. To our knowledge, the majority of continuous glucose monitoring reports the t-CV. Appropriate thresholds should be used to identify patients that would probably meet time below range targets (t-CV <40% or wd-CV <34%).
瞬态血糖监测提供了一系列血糖指标。在本研究中，我们旨在确定那些表明可以持续达到血糖目标的指标，并对比总变异系数（t-CV）和日内变异系数（wd-CV），以指导血糖变异性和低血糖暴露的评估。
收集瞬态血糖监测仪的匿名数据。根据扫描频率将监测仪分为 10 个相等大小的组，然后根据估计的 A1c（eA1c）分为四分位数。总变异系数（t-CV）和日内变异系数（wd-CV）也进行了类似的分组。此外，还分析了时间低于 54mg/dl 与 t-CV 和 wd-CV 测量的血糖变异性之间的关系。
数据集包括 1002946 个监测仪。根据扫描速率和 eA1c 的四分位数将监测仪分为 10 个相等的组，每组有 25074 个监测仪。较低的 eA1c 与更高的血糖达标时间和减少的血糖高于目标时间呈明显相关。eA1c 四分位数与血糖低于目标时间的相关性并不一致。血糖变异性与低血糖之间存在关联。wd-CV 和 t-CV 均与血糖低于目标时间有关。为达到<1%时间血糖低于 54mg/dl 的共识目标，相应的 wd-CV 和 t-CV 值分别为 33.5%和 39.5%。
不同连续血糖监测系统报告的变异系数类型应得到认可。CV<36%可能不足以确保低血糖暴露低。据我们所知，大多数连续血糖监测报告 t-CV。应使用适当的阈值来识别可能达到血糖达标目标（t-CV<40%或 wd-CV<34%）的患者。
