Poincaré plot quantification for assessing glucose variability from continuous glucose monitoring systems and a new risk marker for hypoglycemia: application to type 1 diabetes patients switching to continuous subcutaneous insulin infusion.
BACKGROUND
The Poincaré plot (PCP) is a valuable tool for describing glucose variability (GV) from continuous glucose monitoring (CGM) but remains only visual and qualitative. The aim of this work was to validate metrics for the geometry of the PCP in type 1 diabetes and to apply them to the study of a series of patients switching to continuous subcutaneous insulin infusion (CSII).


METHODS
We reviewed the CGM profiles of 44 patients with type 1 diabetes. A subgroup (n=13) used CGM before and after 6 months on CSII. Additionally, we prospectively collected seven recordings from healthy controls. The new PCP metrics were correlated with hypoglycemia and classical GV indices and were compared between groups.


RESULTS
SDs related to the PCP fitting ellipse (SD1, SD2) and area and shape of the fitting ellipse (SFE) were all higher in diabetes patients than in the controls and decreased significantly on CSII. SD1 represented short-term GV and was equivalent to continuous overlapping net glycemic action (CONGA). SD2 represented long-term GV and correlated with the SD of glucose levels (r ≥ 0.98), mean of daily differences (r ≥ 0.91), and mean amplitude of glycemic excursions (r ≥ 0.88). SFE correlated positively with CONGA at 1 h but not with the other indices and was inversely correlated with hypoglycemic episodes (Spearman's ρ=-0.42), independently of the coefficient of variation and the Low Blood Glucose Index in a multivariate analysis (partial r=-0.34).


CONCLUSIONS
PCP metrics are correlated with known GV indices and may be used for the study of CGM recording series in type 1 diabetes. SFE is a new risk marker for hypoglycemia.
Department of Endocrinology, Free University of Brussels-Erasme Hospital , Brussels, Belgium .
Laurent
L
Crenier
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy; D007003:Hypoglycemia / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D018570:Risk Assessment; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; C517652:hemoglobin A1c protein, human