title: Associations between features of glucose exposure and A1C: the A1C-Derived Average Glucose (ADAG) study.
abstract: OBJECTIVE
  Various methods are used to quantify postprandial glycemia or glucose variability, but few have been compared and none are standardized. Our objective was to examine the relationship among common indexes of postprandial glycemia, overall hyperglycemia, glucose variability, and A1C using detailed glucose measures obtained during everyday life and to study which blood glucose values of the day provide the strongest prediction of A1C.
  
  
  METHODS
  In the A1C-Derived Average Glucose (ADAG) study, glucose levels were monitored in 507 participants (268 type 1 diabetic, 159 type 2 diabetic, and 80 nondiabetic subjects) with continuous glucose monitoring (CGM) and frequent self-monitoring of blood glucose (SMBG) during 16 weeks. We calculated several indexes of glycemia and analyzed their intercorrelations. The association between glucose measurements at different times of the day (pre- and postprandial) and A1C was examined using multiple linear regression.
  
  
  RESULTS
  Indexes of glucose variability showed strong intercorrelation. Among postprandial indexes, the area under the glucose curve calculated from CGM 2 h after a meal correlated well with the 90-min SMBG postprandial measurements. Fasting blood glucose (FBG) levels were only moderately correlated with indexes of hyperglycemia and average or postprandial glucose levels. Indexes derived with SMBG strongly correlated with those from CGM. Some SMBG time points had a stronger association with A1C than others. Overall, preprandial glucose values had a stronger association with A1C than postprandial values for both diabetes types, particularly for type 2 diabetes.
  
  
  CONCLUSIONS
  Indexes of glucose variability and average and postprandial glycemia intercorrelate strongly within each category. Variability indexes are weakly correlated with the other categories, indicating that these measures convey different information. FBG is not a clear indicator of general glycemia. Preprandial glucose values have a larger impact on A1C levels than postprandial values.
authors.affiliation: Steno Diabetes Center, Copenhagen, Denmark. rbrg@steno.dk
authors.forename: Rikke
authors.initials: R
authors.lastname: Borg
authors.forename: Judith C
authors.initials: JC
authors.lastname: Kuenen
authors.forename: Bendix
authors.initials: B
authors.lastname: Carstensen
authors.forename: Hui
authors.initials: H
authors.lastname: Zheng
authors.forename: David M
authors.initials: DM
authors.lastname: Nathan
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Heine
authors.forename: Jorn
authors.initials: J
authors.lastname: Nerup
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Witte
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000097:blood*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood; D008297:Male; D008875:Middle Aged; D018670:Monitoring, Ambulatory; D019518:Postprandial Period / Q000502:physiology*; D012044:Regression Analysis
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin