AGP in daily clinical practice: a guide for use with the FreeStyle Libre flash glucose monitoring system
Keywords:ambulatory glucose profile, AGP, continuous glucose monitoring, flash glucose monitoring, CGM, glycaemic control, glycaemic variability, glycaemic stability, hypoglycaemia, hyperglycaemia
As real-time continuous glucose monitoring and flash glucose monitoring systems become more widely prescribed in the daily management of diabetes, it is important that the ambulatory glucose profile (AGP) methodology for reviewing and interpreting trends in glucose control is effectively applied. In this article we look at the essential features of the AGP and provide systematic and practical guidance on how the AGP can be interpreted in daily diabetes care with confidence. Using examples taken from glucose data captured by the FreeStyle Libre flash glucose monitoring system, we show how each aspect of the AGP can be used to understand daily patterns in glucose control for a person with diabetes, including the importance of time in range and adjunct use of individual daily logs. Using these elements collectively, we show how and why treatment adjustments can be made, with the goal of improving glycaemic control and diabetes outcomes.
Mazze RS, Lucido D, Langer O, Hartmann K, Rodbard D. Ambulatory Glucose Profile: Representation of Verified Self-Monitored Blood Glucose Data. Diabetes Care. 1987; 10:111–117. https://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. Diabetes Technol Ther. 2013; 15: 198-211. https://dx.doi.org/10.1089/dia.2013.0051
Mazze RS, Strock E, Wesley D, et al. Characterizing glucose exposure for individuals with normal glucose tolerance using continuous glucose monitoring and ambulatory glucose profile analysis. Diabetes Technol Ther. 2008; 10:149–159. https://dx.doi.org/10.1089/dia.2007.0293
Matthaei S, DeAlaiz R, Bosi E, Evans M, Geelhoed-Duijvestijn N, Joubert M. Consensus recommendations for the use of Ambulatory Glucose Profile in clinical practice. Br J Diabetes. 2014; 14:153–157. https://dx.doi.org/10.15277/bjdvd.2014.046
Evans M, Cranston I, Bailey CJ. Ambulatory glucose profile (AGP): utility in UK clinical practice. Br J Diabetes. 2017; 17:26–33. https://dx.doi.org/10.15277/bjd.2017.121
Riddlesworth TD, Beck RW, Gal RL, et al. Optimal Sampling Duration for Continuous Glucose Monitoring to Determine Long-Term Glycemic Control. Diabetes Technol Ther. 2018; 4:314-316. https://dx.doi.org/10.1089/dia.2017.0455
Johnson ML, Martens TW, Criego AB, Carlson AE, Simonson GD, Bergenstal RM. Utilizing the Ambulatory Glucose Profile to Standardize and Implement Continuous Glucose Monitoring in Clinical Practice. Diabetes Technol Ther. 2019; 21(Suppl 2): S217-S225. https://dx.doi.org/10.1089/dia.2019.0034
Dunn TC, Crouther N. Assessment of the variance of the ambulatory glucose profile over 3 to 20 days of continuous glucose monitoring. 46th EASD Conference, Stockholm. Poster 1054.
Beck RW, Bergenstal RM, Cheng P, et al. The Relationships Between Time in Range, Hyperglycemia Metrics, and HbA1c. J Diabetes Sci Technology. 2019; 13: 614-626. https://dx.doi.org/10.1177/1932296818822496
Lu J, Ma X, Zhou J, et al. Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes. Diabetes Care. 2018; 41: 2370-2376. https://dx.doi.org/10.2337/dc18-1131
Danne T, Nimri R, Battelino T, et al. International Consensus on Use of Continuous Glucose Monitoring. Diabetes Care. 2017; 40: 1631–1640. https://dx.doi.org/10.2337/dc17-1600
Petrie JR, Peters AL, Bergenstal RM, et al. Improving the Clinical Value and Utility of CGM Systems: Issues and Recommendations: A Joint Statement of the European Association for the Study of Diabetes and the American Diabetes Association Diabetes Technology Working Group. Diabetes Care. 2017; 40: 1614-1621. https://dx.doi.org/10.2337/dci17-0043
Agiostratidou G, Anhalt H, Ball D, et al. Standardizing Clinically Meaningful Outcome Measures Beyond HbA1c for Type 1 Diabetes: A Consensus Report of the American Association of Clinical Endocrinologists, the American Association of Diabetes Educators, the American Diabetes Association, the Endocrine Society, JDRF International, The Leona M. and Harry B. Helmsley Charitable Trust, the Pediatric Endocrine Society, and the T1D Exchange. Diabetes Care. 2017; 40: 1622–1630. https://dx.doi.org/10.2337/dc17-1624
Battellino T, Danne T, Amiel SA et al. Clinical targets for continuous glucose monitoring data interpretation: recommendations from the International Consensus on Time in Range. Diabetes Care 2019; 42: 1593-1603. https://dx.doi.org/10.2337/dci19-0028
American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes—2019. Diabetes Care. 2019; 42:S61–70. https://dx.doi.org/10.2337/dc19-S006
Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, Lachin J, et al. The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus. New Engl J Medicine. 1993; 329:977–986. http://dx.doi.org/10.1056/NEJM199309303291401
Stratton IM, Adler AI, Neil AH, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ. 2000; 321:405-412. https://dx.doi.org/10.1136/bmj.321.7258.405
Holman RR, Paul SK, Bethel AM, Matthews DR, Neil AW. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes. New Engl J Medicine. 2008; 359:1577–1589. https://dx.doi.org/10.1056/NEJMoa0806470
Ceriello A, Monnier L, Owens D. Glycaemic variability in diabetes: clinical and therapeutic implications. Lancet Diabetes Endocrinol. 2018; 7:221-230. https://dx.doi.org/10.1016/S2213-8587(18)30136-0
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.