Resistance to Data Loss of Glycemic Variability Measurements in Long-Term Continuous Glucose Monitoring.

BACKGROUND Continuous glucose monitoring (CGM) is a method of estimating blood glucose values from those recorded in the interstitial fluid. Because increasingly longer CGM measurements are possible, errors and data loss become more and more likely and potentially more damaging to accurate calculations of glycemic variability (GV) indices. Our research investigates the resistance of the CGM recording to data loss. METHODS We collected 71 CGM recordings (duration of min: 2, max: 265, median: 42 days) from patients with type 1 diabetes and used three algorithms to introduce missing data. We calculated mean and standard deviation (SD) of absolute percentage error of 12 variability indices and correlated those with the percentage of missing data and duration of the measurements. RESULTS Mean absolute percentage error of variability indices increased linearly with the percentage of missing data along with SD of absolute percentage error. Except for mean amplitude of glycemic excursions and time spent in hypoglycemia, all absolute errors never exceeded 25%, while mean absolute errors stayed below 5%. The gradient removal algorithm introduced errors larger than the single datapoint and block removal algorithms. The absolute percentage error of variability indices correlated negatively with the duration of the CGM measurements. CONCLUSIONS Standard GV measurements in long-term glucose monitoring are robustly resistant to data loss.

[1]  R. Vigersky,et al.  The Benefits, Limitations, and Cost-Effectiveness of Advanced Technologies in the Management of Patients With Diabetes Mellitus , 2015, Journal of diabetes science and technology.

[2]  Stephanie J. Fonda,et al.  Minding the Gaps in Continuous Glucose Monitoring: A Method to Repair Gaps to Achieve More Accurate Glucometrics , 2013, Journal of diabetes science and technology.

[3]  Santhisagar Vaddiraju,et al.  Technologies for Continuous Glucose Monitoring: Current Problems and Future Promises , 2010, Journal of diabetes science and technology.

[4]  F. Cavalot Do data in the literature indicate that glycaemic variability is a clinical problem? Glycaemic variability and vascular complications of diabetes , 2013, Diabetes, obesity & metabolism.

[5]  D. Rodbard,et al.  The Minimum Frequency of Glucose Measurements from Which Glycemic Variation Can Be Consistently Assessed , 2010, Journal of diabetes science and technology.

[6]  D. Rubin INFERENCE AND MISSING DATA , 1975 .

[7]  Peter A Baghurst,et al.  The Minimum Duration of Sensor Data From Which Glycemic Variability Can Be Consistently Assessed , 2014, Journal of diabetes science and technology.

[8]  J. Hans DeVries,et al.  Accuracy and reliability of continuous glucose monitoring systems: a head-to-head comparison. , 2013, Diabetes technology & therapeutics.

[9]  K. Short,et al.  Glycemic Variability Is Associated with Markers of Vascular Stress in Adolescents. , 2016, Jornal de Pediatria.

[10]  Roderick J. A. Little,et al.  Statistical Analysis with Missing Data: Little/Statistical Analysis with Missing Data , 2002 .

[11]  Steven J. Russell,et al.  A Comparative Effectiveness Analysis of Three Continuous Glucose Monitors , 2014, Journal of diabetes science and technology.

[12]  David Rodbard,et al.  Clinical Interpretation of Indices of Quality of Glycemic Control and Glycemic Variability , 2011, Postgraduate medicine.

[13]  J. DeVries,et al.  Glucose fluctuations and activation of oxidative stress in patients with type 1 diabetes , 2007, Diabetologia.

[14]  Peter A Baghurst,et al.  Calculating the mean amplitude of glycemic excursion from continuous glucose monitoring data: an automated algorithm. , 2011, Diabetes technology & therapeutics.

[15]  Pantelis Georgiou,et al.  Glycemic Variability and Its Impact on Quality of Life in Adults With Type 1 Diabetes , 2015, Journal of diabetes science and technology.

[16]  Lutz Heinemann,et al.  Finger Pricking and Pain: A Never Ending Story , 2008, Journal of diabetes science and technology.