A Glycemia Risk Index (GRI) of Hypoglycemia and Hyperglycemia for Continuous Glucose Monitoring Validated by Clinician Ratings

Author:

Klonoff David C.1ORCID,Wang Jing2ORCID,Rodbard David3ORCID,Kohn Michael A.4ORCID,Li Chengdong2ORCID,Liepmann Dorian5ORCID,Kerr David6ORCID,Ahn David7ORCID,Peters Anne L.8ORCID,Umpierrez Guillermo E.9ORCID,Seley Jane Jeffrie10ORCID,Xu Nicole Y.11ORCID,Nguyen Kevin T.11ORCID,Simonson Gregg12ORCID,Agus Michael S. D.13ORCID,Al-Sofiani Mohammed E.1415ORCID,Armaiz-Pena Gustavo16ORCID,Bailey Timothy S.17ORCID,Basu Ananda18ORCID,Battelino Tadej19ORCID,Bekele Sewagegn Yeshiwas20ORCID,Benhamou Pierre-Yves21ORCID,Bequette B. Wayne22ORCID,Blevins Thomas23ORCID,Breton Marc D.18ORCID,Castle Jessica R.24ORCID,Chase James Geoffrey25ORCID,Chen Kong Y.26ORCID,Choudhary Pratik27ORCID,Clements Mark A.28ORCID,Close Kelly L.29ORCID,Cook Curtiss B.30ORCID,Danne Thomas31,Doyle Francis J.32ORCID,Drincic Angela33ORCID,Dungan Kathleen M.34ORCID,Edelman Steven V.35ORCID,Ejskjaer Niels36ORCID,Espinoza Juan C.37ORCID,Fleming G. Alexander38ORCID,Forlenza Gregory P.39ORCID,Freckmann Guido40ORCID,Galindo Rodolfo J.9ORCID,Gomez Ana Maria41ORCID,Gutow Hanna A.29ORCID,Heinemann Lutz42ORCID,Hirsch Irl B.43ORCID,Hoang Thanh D.44ORCID,Hovorka Roman45ORCID,Jendle Johan H.46ORCID,Ji Linong47ORCID,Joshi Shashank R.48ORCID,Joubert Michael49ORCID,Koliwad Suneil K.4ORCID,Lal Rayhan A.50ORCID,Lansang M. Cecilia5152ORCID,Lee Wei-An (Andy)53ORCID,Leelarathna Lalantha54ORCID,Leiter Lawrence A.55ORCID,Lind Marcus56ORCID,Litchman Michelle L.57ORCID,Mader Julia K.58ORCID,Mahoney Katherine M.29ORCID,Mankovsky Boris59ORCID,Masharani Umesh4ORCID,Mathioudakis Nestoras N.15ORCID,Mayorov Alexander60ORCID,Messler Jordan61ORCID,Miller Joshua D.62ORCID,Mohan Viswanathan6364ORCID,Nichols James H.65ORCID,Nørgaard Kirsten66ORCID,O’Neal David N.67ORCID,Pasquel Francisco J.9ORCID,Philis-Tsimikas Athena68ORCID,Pieber Thomas58ORCID,Phillip Moshe69ORCID,Polonsky William H.70ORCID,Pop-Busui Rodica71ORCID,Rayman Gerry72ORCID,Rhee Eun-Jung73ORCID,Russell Steven J.74ORCID,Shah Viral N.39ORCID,Sherr Jennifer L.75ORCID,Sode Koji7677ORCID,Spanakis Elias K.78ORCID,Wake Deborah J.79ORCID,Waki Kayo80ORCID,Wallia Amisha81ORCID,Weinberg Melissa E.82ORCID,Wolpert Howard83ORCID,Wright Eugene E.84ORCID,Zilbermint Mihail1585ORCID,Kovatchev Boris18ORCID

Affiliation:

1. Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA

2. Florida State University College of Nursing, Tallahassee, FL, USA

3. Biomedical Informatics Consultants LLC, Potomac, MD, USA

4. University of California, San Francisco, San Francisco, CA, USA

5. University of California, Berkeley, Berkeley, CA, USA

6. Sansum Diabetes Research Institute, Santa Barbara, CA, USA

7. Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA

8. University of Southern California, Los Angeles, CA, USA

9. Emory University, Atlanta, GA, USA

10. Weill Cornell Medicine, New York, NY, USA

11. Diabetes Technology Society, Burlingame, CA, USA

12. International Diabetes Center, Minneapolis, MN, USA

13. Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

14. King Saud University, Riyadh, Saudi Arabia

15. Johns Hopkins University, Baltimore, MD, USA

16. UT Health San Antonio, San Antonio, TX, USA

17. AMCR Institute, Escondido, CA, USA

18. University of Virginia, Charlottesville, VA, USA

19. Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia

20. Addis Ababa University, Addis Ababa, Ethiopia

21. Centre Hospitalier Universitaire de Grenoble, Grenoble, France

22. Rensselaer Polytechnic Institute, Troy, NY, USA

23. Texas Diabetes and Endocrinology, Austin, TX, USA

24. Oregon Health & Science University, Portland, OR, USA

25. University of Canterbury, Christchurch, New Zealand

26. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA

27. University of Leicester, Leicester, UK

28. Children’s Mercy Hospital, Kansas City, MO, USA

29. Close Concerns, San Francisco, CA, USA

30. Mayo Clinic Arizona, Scottsdale, AZ, USA

31. Diabetes Center Auf der Bult, Hannover Medical School, Hannover, Germany

32. Harvard University, Cambridge, MA, USA

33. University of Nebraska, Omaha, NE, USA

34. The Ohio State University, Columbus, OH, USA

35. University of California, San Diego, San Diego, CA, USA

36. Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

37. Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA, USA

38. Kinexum, Harpers Ferry, WV, USA

39. Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO, USA

40. Institute for Diabetes-Technology GmbH, Ulm, Germany

41. Pontificia Universidad Javeriana, Bogotá, Colombia

42. Science Consulting in Diabetes GmbH, Kaarst, Germany

43. University of Washington, Seattle, WA, USA

44. Walter Reed National Military Medical Center, Bethesda, MD, USA

45. University of Cambridge, Cambridge, UK

46. Örebro University, Örebro, Sweden

47. Peking University People’s Hospital, Peking University Diabetes Center, Beijing, China

48. Joshi Clinic, Mumbai, India

49. Caen University Hospital, Caen, France

50. Stanford University, Stanford, CA, USA

51. Cleveland Clinic, Cleveland, OH, USA

52. Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA

53. LAC + USC Medical Center, Los Angeles County Department of Health Service, Los Angeles, CA, USA

54. Manchester University NHS Foundation Trust and The University of Manchester, Manchester, UK

55. Li Ka Shing Knowledge Institute, St. Michael’s Hospital and University of Toronto, Toronto, ON, Canada

56. University of Gothenburg, Gothenburg, Sweden

57. The University of Utah College of Nursing, Salt Lake City, UT, USA

58. Medical University of Graz, Graz, Austria

59. National Healthcare University of Ukraine, Kiev, Ukraine

60. Endocrinology Research Centre, Moscow, Russian Federation

61. Morton Plant Hospital, Clearwater, FL, USA

62. Stony Brook University, Stony Brook, NY, USA

63. Dr. Mohan’s Diabetes Specialities Centre, Chennai, India

64. Madras Diabetes Research Foundation, Chennai, India

65. Vanderbilt University Medical Center, Nashville, TN, USA

66. Steno Diabetes Center Copenhagen, Herlev, Denmark

67. University of Melbourne, Melbourne, VIC, Australia

68. Scripps Whittier Diabetes Institute, San Diego, CA, USA

69. Institute for Endocrinology and Diabetes, Schneider Children’s Medical Center of Israel and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

70. Behavioral Diabetes Institute, San Diego, CA, USA

71. University of Michigan, Ann Arbor, MI, USA

72. Ipswich Hospital, East Suffolk and North Essex Foundation Trust and University of East Anglia, Ipswich, UK

73. Kangbuk Samsung Hospital, Sungkyunkwan University, Seoul, Korea

74. Massachusetts General Hospital Diabetes Research Center, Boston, MA, USA

75. Yale University, New Haven, CT, USA

76. The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

77. North Carolina State University, Raleigh, NC, USA

78. University of Maryland, Baltimore, MD, USA

79. The University of Edinburgh, Edinburgh, UK

80. The University of Tokyo, Tokyo, Japan

81. Northwestern University, Chicago, IL, USA

82. California Pacific Medical Center, San Francisco, CA, USA

83. Boston Medical Center, Boston, MA, USA

84. Charlotte AHEC, Charlotte, NC, USA

85. Johns Hopkins Community Physicians, Bethesda, MD, USA

Abstract

Background: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data. Methods: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia. We used principal component analysis and multiple regressions to develop a model to predict the clinician ranking based on seven standard metrics in an Ambulatory Glucose Profile: very low–glucose and low-glucose hypoglycemia; very high–glucose and high-glucose hyperglycemia; time in range; mean glucose; and coefficient of variation. Results: The analysis showed that clinician rankings depend on two components, one related to hypoglycemia that gives more weight to very low-glucose than to low-glucose and the other related to hyperglycemia that likewise gives greater weight to very high-glucose than to high-glucose. These two components should be calculated and displayed separately, but they can also be combined into a single Glycemia Risk Index (GRI) that corresponds closely to the clinician rankings of the overall quality of glycemia (r = 0.95). The GRI can be displayed graphically on a GRI Grid with the hypoglycemia component on the horizontal axis and the hyperglycemia component on the vertical axis. Diagonal lines divide the graph into five zones (quintiles) corresponding to the best (0th to 20th percentile) to worst (81st to 100th percentile) overall quality of glycemia. The GRI Grid enables users to track sequential changes within an individual over time and compare groups of individuals. Conclusion: The GRI is a single-number summary of the quality of glycemia. Its hypoglycemia and hyperglycemia components provide actionable scores and a graphical display (the GRI Grid) that can be used by clinicians and researchers to determine the glycemic effects of prescribed and investigational treatments.

Publisher

SAGE Publications

Subject

Biomedical Engineering,Bioengineering,Endocrinology, Diabetes and Metabolism,Internal Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3