title: Evaluating quality of glycemic control: graphical displays of hypo- and hyperglycemia, time in target range, and mean glucose.
abstract: There is need for readily understandable graphical displays of glucose data to facilitate interpretation by clinicians and researchers. (1) Display of the percentage of glucose values above a specified threshold for hyperglycemia (%High) versus percentage of glucose values below a specified threshold for hypoglycemia (%Low). If all glucose values fell within the target range, then all data points would fall at the origin. (2) After an intervention, one can plot the change in percentage of glucose values above a specified threshold for hyperglycemia versus the change in percentage of glucose values below a specified threshold defining hypoglycemia: The quadrants of this graph correspond to (a) increased risk of both hyper- and hypoglycemia, (b) decreased hyperglycemia but increased risk of hypoglycemia, (c) decreases in both hypo- and hyperglycemia, and (d) decreased hypoglycemia but increased hyperglycemia. (3) A 2-dimensional triangular graph can be used for simultaneous display of %High, %Low, and percentage in target range. (4) Display of risk of hyper- versus risk of hypoglycemia based on both frequency and severity of departures from the target range can be used. (5) Graphs (1) and (4) can also be presented using percentile scores relative to a reference population. (6) It is also useful to analyze %Hypoglycemia or risk of hypoglycemia versus mean glucose. These methods are illustrated with examples from representative cases and shown to be feasible, practical, and informative. These new types of graphical displays can facilitate rapid analysis of risks of hypo- and hypoglycemia simultaneously and responses to therapeutic interventions for individuals or in clinical trials.
authors.affiliation: Biomedical Informatics Consultants LLC, Potomac, MD, USA drodbard@comcast.net.
authors.forename: David
authors.initials: D
authors.lastname: Rodbard
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D015190:Blood Glucose Self-Monitoring / Q000592:standards / Q000706:statistics & numerical data; D003196:Computer Graphics / Q000592:standards* / Q000706:statistics & numerical data; D000068598:Data Accuracy; D003626:Data Display / Q000592:standards* / Q000706:statistics & numerical data; D003627:Data Interpretation, Statistical; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D007003:Hypoglycemia / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011786:Quality Control; D013997:Time Factors
chemical_list: D001786:Blood Glucose
keywords: continuous glucose monitoring; diabetes mellitus; glycemic control; hyperglycemia; hypoglycemia; self-monitoring of blood glucose