Evaluation of the Average Daily Risk Range as a Measure of Glycemic Variability in Youths with Type 1 Diabetes

Abstract

Objective: The Average Daily Risk Range (ADRR) is a measure of glycemic variability (GV) developed for adults with diabetes. Although the ADRR is increasingly being reported in pediatric diabetes research and may also be used in clinical management, it has never been examined for its sensitivity to predicting hyper-and hypoglycemia in youths or compared for its predictive ability with other measures of GV in youths. Thus, we present predictive validity data for the ADRR in youths with type 1 diabetes. Materials and Methods: Glucometer data for 436 youths (mean age, 11.8 -3.8 years) were collected from a clinical database. Using these data, we computed the ADRR, SD of blood glucose, coefficient of variation of blood glucose, Low Blood Glucose Index, High Blood Glucose Index, the percentage of glucose values ‡70 and £180 mg/dL, the percentage of high glucose values >180 mg/dL and >400 mg/dL, and the percentage of low glucose values <70 mg/dL and <40 mg/dL in Month 1. We then compared these with episodes of hypo-and hyperglycemia in Month 2. Results: The ADRR showed good concurrent validity with other measures of GV in youths experiencing hyperglycemic events but limited predictive validity in general and specifically with future hypoglycemic events. The percentages of current hyper-and hypoglycemic episodes appeared to be stronger predictors of future hyperand hypoglycemic episodes, respectively. Conclusions: In a large pediatric sample, the ADRR was not the strongest predictor of future glycemic excursion. The percentages of current hyper-and hypoglycemic episodes appear to be stronger predictors.

Measures of Risk and Glucose Variability in Adults Versus Youths

“…For children, these metrics continue to perform in the hyperglycemic range, 1,6 and the LBGI works as designed in the hypoglycemic range as well ( Table 1 in Patton et al 1 ). However, according to this latest report, the predictive value of the ADRR may be weaker in the pediatric population.…”

“…However, according to this latest report, the predictive value of the ADRR may be weaker in the pediatric population. 1 This may be due to artifacts in the study, such as the very low frequency of extreme low BG events (<40 mg/dL), which was 0.3% according to the text or 0.03% according to Table 2 in Patton et al 1 Statistically, it is natural to expect that low frequency of extreme hypoglycemia would result in nearzero correlation for metrics tuned to detect extreme hypoglycemia such as the ADRR; it is also normal that metrics taking into account all low BG values (e.g., the LBGI or the percentage of readings below a certain threshold) would perform better, as evidenced by Table 1 in Patton et al 1 Assuming, however, that the effect is real and is due to the specifics of the studied population, a correction of the ADRR may be in order for pediatric patients, and the metric may indeed require ''new guidelines.'' 6 Figure 1B presents a possible solution to this problem, derived from the basic definition of the BG scale transformation function.…”

“…The other GV metrics used for this prediction included SD and coefficient of variation of blood glucose (BG), Low Blood Glucose Index (LBGI), High Blood Glucose Index (HBGI), the percentage of glucose values >70 and <180 mg/dL, the percentage of high glucose values >180 mg/dL and >400 mg/dL, and the percentage of low glucose values <70 mg/dL and <40 mg/dL in Month 1. Patton et al 1 concluded that ''In a large pediatric sample, the ADRR was not the strongest predictor of future glycemic excursion. The percentages of current hyper-and hypoglycemic episodes appear to be stronger predictors.''…”

“…T he article by Patton et al 1 published in this issue of Diabetes Technology & Therapeutics reports an array of correlations between various metrics of glucose variability (GV), derived from 1 month of self-monitoring of blood glucose (SMBG) data, with the frequency of hypo-and hyperglycemic events in a subsequent month of SMBG records. The data were derived from the clinical patient records of 3,453 individuals, 436 of whom met the study inclusion criteria (e.g., ages between 0 and 18 years old and a minimum of 14 days of SMBG in each month with three or more SMBG values per day).…”

Glycemic Variability and Hypoglycemic Excursions With Continuous Glucose Monitoring Compared to Intermittently Scanned Continuous Glucose Monitoring in Adults With Highest Risk Type 1 Diabetes

“…2 A description of various measures, with formulae used for their calculations, and a critical review of their limitations have been previously reported. 1,4 Risk-based GV measures are associated with frequency and severity of hypoglycemia, 5 while in vitro and in vivo data suggest that GV is as an independent risk factor for total mortality and death due to cardiovascular disease in both type 1 and type 2 diabetes. [6][7][8] The burden of hypoglycemia in adults with T1DM is significant and is associated with mortality and morbidity.…”