Ambulatory glucose profile (AGP): utility in UK clinical practice

Abstract

Glycaemic variability may contribute to the pathophysiology of diabetes complications independently of the average level of blood glucose and increases the barriers to achieving such mean goals as well as the risk of hypoglycaemia. Continuous glucose monitoring (CGM) has the potential to identify and address glycaemic variability. Achieving effective use of the extensive data generated by CGM within a routine diabetes consultation is challenging, particularly where glycaemic variability is high. Expert groups have called for more standardisation of the analysis and reporting of glycaemic data. The Ambulatory Glucose Profile (AGP) is an internationally recognised, consensus-approved visual representation which simply summarises glycaemic data and its descriptive statistics in a clinically meaningful format, thus providing a solution to this unmet need. The AGP collates and presents several days of glucose records in a single projection, presenting a visual trace for the median glucose level, with its 25-75th and 10-90th percentiles, according to a 'modal' day. In this way, the AGP provides a straightforward and visual means of identifying times of increased risk of hypoglycaemia or hyperglycaemia that, in turn, provides a robust platform for the diabetes healthcare professional and the person with diabetes to explore, discuss and resolve the underlying reasons for suboptimal diabetes control. Br J Diabetes 2017;17:26-33

The use of real time continuous glucose monitoring or flash glucose monitoring in the management of diabetes: A consensus view of Italian diabetes experts using the Delphi method

“…This is most emphasized when glycemic profiles highlight wide glycemic variability, which makes it hard to identify specific patterns and potential causes (Table 4b, section 13.3). This reflects the growing international consensus on the place of global profiling tools such as AGP in clinical practice [42,48,49].…”

Clinical Use of Continuous Glucose Monitoring in Adults with Type 2 Diabetes

“…[38][39][40][41] The ambulatory glucose profile (AGP) has been suggested as a non-industry, standard glucose report and is gaining international attention. 39,[42][43][44][45][46][47] The AGP report includes three sections: glucose statistics, the AGP graph, and a third section (daily glucose graphs in a calendar view or insulin graphs) that is variable based on the data available and the clinical/ treatment needs of the individual patient (Fig. 1).…”

National Consensus in the use of the Flash Glucose Monitoring System in Portugal

“…The median line shows the usual exposure to glucose, while the amplitude of areas determined by the percentile curves indicates glucose variability: the width of the 25 th -75 th percentile band around the median line indicates the "usual" variability, while the width of the 10 th -90 th percentile band indicates "occasional" variability. 25 Periods where the risk of hypoglycaemia is high or worse than usual correspond to the times when the 10 th percentile line approaches or surpasses the minimum glucose concentration limit considered to define these episodes (usually 70 mg/dL).…”

“…These recommendations usually take the form of an algorithm, which focuses essentially on three key steps: 1) analysing the quality of the collected data; 2) analysing the probability of hypoglycaemic periods; and 3) dividing the day into four parts for detailed analysis and discussion of each of them with the patient. 6,[25][26][27]…”