Yuri D Foreman1,2, Martijn C G J Brouwers2,3, Carla J H van der Kallen1,2, Demi M E Pagen1,2, Marleen M J van Greevenbroek1,2, Ronald M A Henry1,2,4, Annemarie Koster5,6, Anke Wesselius7, Nicolaas C Schaper2,3,5, Coen D A Stehouwer1,2. 1. Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands. 2. CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands. 3. Division of Endocrinology and Metabolic Disease, Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands. 4. Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, the Netherlands. 5. CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. 6. Department of Social Medicine, Maastricht University, Maastricht, the Netherlands. 7. NUTRIM School for Nutrition and Translational Research in Metabolism, Department of Complex Genetics and Epidemiology, Maastricht University, Maastricht, the Netherlands.
Abstract
Background: Glucose variability (GV) measured by continuous glucose monitoring (CGM) has become an accepted marker of glycemic control. Nevertheless, several methodological aspects of GV assessment require further study. We, therefore, investigated the minimum number of days needed to reliably measure GV, assessed GV reference values, and studied the correlation of GV with established glycemic indices (i.e., HbA1c, seven-point oral glucose tolerance test [OGTT]-derived indices). Methods: We used cross-sectional data from The Maastricht Study, an observational population-based cohort enriched with type 2 diabetes. Participants with more than 48 h of CGM (iPro2; Medtronic) were included for analysis (n = 851; age: 60 ± 9years; 49% women; 23% type 2 diabetes). We used mean sensor glucose (MSG), standard deviation (SD), and coefficient of variation (CV) as CGM-derived indices (the latter two for GV quantification). We calculated reliability using the Spearman-Brown prophecy formula, established reference values by calculating 2.5th-97.5th percentiles, and studied correlations using Spearman's rho. Results: Sufficient reliability (R > 0.80) was achieved with two (MSG and SD), or three monitoring days (CV). The reference ranges, assessed in individuals with normal glucose metabolism (n = 470), were 90.5-120.6 mg/dL (MSG), 7.9-24.8 mg/dL (SD), and 7.74%-22.45% (CV). For MSG, the strongest correlation was found with fasting plasma glucose (rho = 0.65 [0.61; 0.69]); for SD, with the 1-h OGTT value (rho = 0.61 [0.56; 0.65]); and for CV, with both the incremental glucose peak (IGP) during the OGTT (rho = 0.50 [0.45; 0.55]) and the 1-h OGTT value (rho = 0.50 [0.45; 0.55]). Conclusions: The reliability findings and reference values are relevant for studies that aim to investigate CGM-measured GV. One-hour OGTT and IGP values can be used as GV indices when CGM is unavailable.
Background: Glucose variability (GV) measured by continuous glucose monitoring (CGM) has become an accepted marker of glycemic control. Nevertheless, several methodological aspects of GV assessment require further study. We, therefore, investigated the minimum number of days needed to reliably measure GV, assessed GV reference values, and studied the correlation of GV with established glycemic indices (i.e., HbA1c, seven-point oral glucose tolerance test [OGTT]-derived indices). Methods: We used cross-sectional data from The Maastricht Study, an observational population-based cohort enriched with type 2 diabetes. Participants with more than 48 h of CGM (iPro2; Medtronic) were included for analysis (n = 851; age: 60 ± 9years; 49% women; 23% type 2 diabetes). We used mean sensor glucose (MSG), standard deviation (SD), and coefficient of variation (CV) as CGM-derived indices (the latter two for GV quantification). We calculated reliability using the Spearman-Brown prophecy formula, established reference values by calculating 2.5th-97.5th percentiles, and studied correlations using Spearman's rho. Results: Sufficient reliability (R > 0.80) was achieved with two (MSG and SD), or three monitoring days (CV). The reference ranges, assessed in individuals with normal glucose metabolism (n = 470), were 90.5-120.6 mg/dL (MSG), 7.9-24.8 mg/dL (SD), and 7.74%-22.45% (CV). For MSG, the strongest correlation was found with fasting plasma glucose (rho = 0.65 [0.61; 0.69]); for SD, with the 1-h OGTT value (rho = 0.61 [0.56; 0.65]); and for CV, with both the incremental glucose peak (IGP) during the OGTT (rho = 0.50 [0.45; 0.55]) and the 1-h OGTT value (rho = 0.50 [0.45; 0.55]). Conclusions: The reliability findings and reference values are relevant for studies that aim to investigate CGM-measured GV. One-hour OGTT and IGP values can be used as GV indices when CGM is unavailable.
Authors: Frank C T van der Heide; Yuri D Foreman; Iris W M Franken; Ronald M A Henry; Abraham A Kroon; Pieter C Dagnelie; Simone J P M Eussen; Tos T J M Berendschot; Jan S A G Schouten; Carroll A B Webers; Miranda T Schram; Carla J H van der Kallen; Marleen M J van Greevenbroek; Anke Wesselius; Casper G Schalkwijk; Nicolaas C Schaper; Martijn C G J Brouwers; Coen D A Stehouwer Journal: Sci Rep Date: 2022-10-22 Impact factor: 4.996
Authors: Adam Hulman; Yuri D Foreman; Martijn C G J Brouwers; Abraham A Kroon; Koen D Reesink; Pieter C Dagnelie; Carla J H van der Kallen; Marleen M J van Greevenbroek; Kristine Færch; Dorte Vistisen; Marit E Jørgensen; Coen D A Stehouwer; Daniel R Witte Journal: PLoS Biol Date: 2021-03-11 Impact factor: 8.029
Authors: Michael Yapanis; Steven James; Maria E Craig; David O'Neal; Elif I Ekinci Journal: J Clin Endocrinol Metab Date: 2022-05-17 Impact factor: 6.134
Authors: Yuri D Foreman; William P T M van Doorn; Nicolaas C Schaper; Marleen M J van Greevenbroek; Carla J H van der Kallen; Ronald M A Henry; Annemarie Koster; Simone J P M Eussen; Anke Wesselius; Koen D Reesink; Miranda T Schram; Pieter C Dagnelie; Abraham A Kroon; Martijn C G J Brouwers; Coen D A Stehouwer Journal: Diabetologia Date: 2021-05-15 Impact factor: 10.122