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Respective Contributions of Glycemic Variability and Mean Daily Glucose as Predictors of Hypoglycemia in Type 1 Diabetes: Are They Equivalent?
Diabetes Care ( IF 16.2 ) Pub Date : 2020-01-27 , DOI: 10.2337/dc19-1549
Louis Monnier 1 , Anne Wojtusciszyn 2 , Nicolas Molinari 3 , Claude Colette 4 , Eric Renard 5 , David Owens 6
Affiliation  

OBJECTIVE To evaluate the respective contributions of short-term glycemic variability and mean daily glucose (MDG) concentration to the risk of hypoglycemia in type 1 diabetes. RESEARCH DESIGN AND METHODS People with type 1 diabetes (n = 100) investigated at the University Hospital of Montpellier (France) underwent continuous glucose monitoring (CGM) on two consecutive days, providing a total of 200 24-h glycemic profiles. The following parameters were computed: MDG concentration, within-day glycemic variability (coefficient of variation for glucose [%CV]), and risk of hypoglycemia (presented as the percentage of time spent below three glycemic thresholds: 3.9, 3.45, and 3.0 mmol/L). RESULTS MDG was significantly higher, and %CV significantly lower (both P < 0.001), when comparing the 24-h glycemic profiles according to whether no time or a certain duration of time was spent below the thresholds. Univariate regression analyses showed that MDG and %CV were the two explanatory variables that entered the model with the outcome variable (time spent below the thresholds). The classification and regression tree procedure indicated that the predominant predictor for hypoglycemia was %CV when the threshold was 3.0 mmol/L. In people with mean glucose ≤7.8 mmol/L, the time spent below 3.0 mmol/L was shortest (P < 0.001) when %CV was below 34%. CONCLUSIONS In type 1 diabetes, short-term glycemic variability relative to mean glucose (i.e., %CV) explains more hypoglycemia than does mean glucose alone when the glucose threshold is 3.0 mmol/L. Minimizing the risk of hypoglycemia requires a %CV below 34%.

中文翻译:

血糖变异性和平均每日血糖分别作为1型糖尿病低血糖症的预测因素:它们等效吗?

目的评估短期血糖变异性和平均每日葡萄糖(MDG)浓度对1型糖尿病低血糖风险的各自贡献。研究设计与方法在蒙彼利埃大学医院(法国)接受调查的1型糖尿病(n = 100)患者连续两天接受连续血糖监测(CGM),总共提供200种24小时血糖记录。计算了以下参数:MDG浓度,日内血糖变异性(葡萄糖变异系数[%CV])和低血糖风险(表示为花费在三个血糖阈值以下的时间百分比:3.9、3.45和3.0 mmol / L)。结果MDG显着升高,%CV显着降低(均P <0.001),根据是否在阈值以下花费了没有时间或一定时间来比较24小时血糖曲线。单变量回归分析表明,MDG和%CV是进入结果模型的两个解释变量(花费的时间低于阈值)。分类和回归树程序表明,当阈值为3.0 mmol / L时,低血糖的主要预测因子为%CV。在平均葡萄糖≤7.8mmol / L的人群中,当%CV低于34%时,花费低于3.0 mmol / L的时间最短(P <0.001)。结论在1型糖尿病中,当血糖阈值为3.0 mmol / L时,相对于平均葡萄糖(即%CV)的短期血糖变异性说明的低血糖症比单独平均血糖的原因多。要将低血糖症的风险降至最低,要求%CV低于34%。
更新日期:2020-03-21
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