Assessing the value of the Ambulatory Glucose Profile in clinical practice
AbstractGlycated haemoglobin (HbA1c) is a measure of mean blood glucose levels over time. It is not a good indicator of day-to-day diabetes control and may not reveal variability in blood glucose. Continuous glucose monitoring (CGM) enables the real-time monitoring of glycaemic variability, potentially addressing issues such as episodic hypoglycaemia, hyperglycaemia, and the risk of complications associated with significant glycaemic excursions. Given the quantity of data produced by CGM, there is a need for standardised analysis to enable patterns of blood glucose variation to be revealed. This need has been addressed by the development of specific software – the Ambulatory Glucose Profile (AGP) – which combines inputs from multiple days of CGM data and collates them into a single 24-hour period, making glycaemic patterns more recognisable. In this study, European diabetologists were asked to evaluate the AGP software and report their findings by means of a questionnaire. The results support the use of AGP for analysis of patient glucose data and informing subsequent treatment decisions. When shared with the patient, the AGP results were found to be an effective basis for education, helping achieve better understanding of glycaemic variability and increasing involvement in diabetes self-management.
Kowalski AJ, Dutta S. It’s time to move from A1c to better metrics for diabetes control. Diabetes Technol Ther 2013;15:194-6. http://dx.doi.org/10.1089/dia.2013.0060
DCCT/EDIC Research Group. Modern-day clinical course of type 1 diabetes mellitus after 30 years’ duration: the Diabetes Control Intervention and Complications and Pittsburgh Epidemiology of Diabetes Complications experience (1983–2005). Arch Intern Med 2009;169:1307-16. http://dx.doi.org/10.1001/archinternmed.2009.193
DCCT Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329:977-86. http://dx.doi.org/10.1056/NEJM199309303291401
UKPDS Group. Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS34). Lancet 1998;352:854-65. http://dx.doi.org/10.1016/S0140-6736(98)07037-8
DCCT/EDIC Research Group. Intensive diabetes therapy and glomerular filtration rate in type 1 diabetes. N Engl J Med 2011;365:2366-76. http://dx.doi.org/10.1056/NEJMoa1111732
Writing team for the DCCT/EDIC Research Group. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Intervention and Complications (EDIC) Study. JAMA 2003;290:2159-67. http://dx.doi.org/10.1001/jama.290.16.2159
Cryer PE. Hypoglcaemia: the limiting factor in the glycaemic management of type I and II diabetes. Diabetologia 2002;45:937-48. http://dx.doi.org/10.1007/s00125-002-0822-9
Cryer PE. Severe hypoglycemia predicts mortality in diabetes. Diabetes Care 2012;35:1814-16. http://dx.doi.org/10.2337/dc12-0749
Hirsch IB, Brownlee M. Should minimal blood glucose variability become the gold standard of glycemic control? J Diabetes Complications 2005;19:178-81. http://dx.doi.org/10.1016/j.jdiacomp.2004.10.001
DCCT Research Group. The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. Diabetes 1995;44:968-83. http://dx.doi.org/10.2337/diab.44.8.968
Mazze R. Making sense of glucose monitoring technologies: from SMBG to CGM. Diabetes Technol Ther 2005;7:784-7. http://dx.doi.org/10.1089/dia.2005.7.784
Mazze R, Lucido D, Langer O, et al. Ambulatory Glucose Profile: representation of verified self-monitored blood glucose data. Diabetes Care 1987;10:111-17. http://dx.doi.org/10.2337/diacare.10.1.111
Bergenstal RM, Ahmann AJ, Bailey T, et al. Recommendations for standardizing glucose reporting and analysis to optimize clinical decision making in diabetes: the Ambulatory Glucose Profile (AGP). Diabetes Technol Ther 2013;15:198-211. http://dx.doi.org/10.1089/dia.2013.0051
Serrano K. FDA supports standardized reporting and analysis on CGM devices. Diabetes Technol Ther 2013;15:348-9. http://dx.doi.org/10.1089/dia.2013.8313
Abbott Diabetes Care. System Components [Internet]. 2013 Available from: https://www.abbottdiabetescare.co.uk/your-products/freestyle-navigator/system-components. (Accessed August 2014)
Dunn TC, Crouther N. Assessment of the variance of the ambulatory glucose profile over 3 to 20 days of continuous glucose monitoring. Abstract 1054, presented at EASD 2010.
Hoss U, Budiman ES, Liu H, Christiansen MP. Continuous glucose monitoring in the subcutaneous tissue over a 14-day sensor wear period. J Diabetes Sci Technol 2013;7:1210-19.
Mazze R, Akkerman B, Mettner J. An overview of continuous glucose monitoring and the ambulatory glucose profile. Minnesota Medicine [Internet]. 2011. Available from: www.minnesotamedicine.com/PastIssues/PastIssues2011/August2011/ContinuousGlucoseMonitoringandtheAmbulatory.aspx (Accessed August 2014).
Cranston IC, Nicholson E. Glucose data and the individualised diabetes consultation. How should we use it? What is enough? Can we ever have too much? Practical Diabetes 2014;31:143-8. http://dx.doi.org/10.1002/pdi.1850
Publish & Transfer of Copyright Agreement
For the mutual benefit and protection of the Author and the Journal Owner/Publisher it is necessary that the Author provides formal written Consent to Publish and Transfer of Copyright before publication of the Work.