Evaluation of a new measure of blood glucose variability in diabetes.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Kovatchev
Boris P
BP
University of Virginia Health System, Box 800137, Charlottesville, VA 22908, USA. boris@virginia.edu
Otto
Erik
E
Cox
Daniel
D
Gonder-Frederick
Linda
L
Clarke
William
W
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000592:standards / Q000706:statistics & numerical data*; D016208:Databases, Factual; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D007003:Hypoglycemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
D001786:Blood Glucose