A Comparison of Average Daily Risk Range Scores for Young Children with Type 1 Diabetes Mellitus Using Continuous Glucose Monitoring and Self-Monitoring Data

Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
Diabetes Technology &amp Therapeutics (Impact Factor: 2.11). 11/2011; 14(3):239-43. DOI: 10.1089/dia.2011.0169
Source: PubMed


Young children with type 1 diabetes are vulnerable to glycemic excursion. Continuous glucose monitoring (CGM), combined with variability statistics, can offer a richer and more complete picture of glycemic variability in young children. In particular, we present data for the Average Daily Risk Range (ADRR) and compare ADRR scores calculated using CGM versus self-monitoring of blood glucose (SMBG) data for young children.
CGM and SMBG data from 48 young children with type 1 diabetes (mean age, 5.1 years) were used to calculate two separate ADRR scores, using SMBG data (ADRRs) and CGM data (ADRRc), for each child. Additionally, we calculated mean amplitude of glycemic excursion (MAGE) scores for children to examine the concurrent validity of the ADRRs and ADRRc.
Young children's mean ADRRc score was significantly greater than their ADRRs score (55±12 and 46±11, respectively; P<0.001). In addition, 74% of the time the children's ADRRc score reflected greater variability risk than their ADRRs score. Examining the concurrent validity, children's ADRRc scores correlated positively with MAGE scores calculated using their CGM and SMBG data, whereas their ADRRs scores only correlated with MAGE scores calculated using SMBG.
ADRR scores generated for young children with type 1 diabetes demonstrate a high risk for glucose variability, but ADRR scores generated from CGM data may provide a more sensitive measure of variability than ADRR scores generated from SMBG. In young children with type 1 diabetes, ADRR scores calculated from CGM data may be superior to scores calculated from SMBG for measuring risk of excursion.

Full-text preview

Available from:
  • [Show abstract] [Hide abstract]
    ABSTRACT: Compared with multiple daily injections (MDI), sensor-augmented pump (SAP) insulin therapy may reduce glycemic variability and oxidative stress in type 1 diabetes in a glycosylated hemoglobin (A1C)-independent manner. The STAR 3 study compared SAP with MDI therapy for 1 year. Week-long continuous glucose monitoring studies were conducted at baseline and 1 year for assessment of glycemic variability in both groups. Soluble CD40 ligand (CD40L), a biomarker of inflammation and thrombocyte function, was measured at baseline and 1 year. Subjects were classified according to treatment group and 1-year A1C levels (<6.5%, 6.5-6.9%, 7-7.9%, ≥8%). Glycemic parameters were compared between SAP and MDI subjects in each A1C cohort. At 1 year, sensor glucose values at A1C levels ≥6.5% were similar in the SAP and MDI groups. However, sensor glucose SD and coefficient of variation (CV) values were lower at A1C levels <8% among SAP than among MDI subjects; the overall between-group difference was significant for both SD (P<0.01) and CV (P=0.01). The overall mean amplitude of glycemic excursion was similar in MDI and SAP groups (P=0.23). CD40L levels fell over the course of the study in both groups, but the between-group difference was not significant (P=0.18). CD40L concentrations were unrelated to A1C, change in A1C from baseline, or glycemic variability. At comparable A1C levels of <8%, SAP reduced glycemic variability as measured by SD and CV compared with MDI. SAP may provide beneficial reductions in the number and severity of glycemic excursions.
    Diabetes Technology &amp Therapeutics 04/2012; 14(7):644-7. DOI:10.1089/dia.2011.0294 · 2.11 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A new borate polymer PAA-ran-PAAPBA that can specifically adsorb glucose was introduced in the glucose measurement based on surface plasmon resonance, and the high-precision specific detection of glucose concentration was realized. Six layers and twelve layers of borate polymer were respectively bound onto the SPR sensors through the layer-by-layer self-assembly binding method, and the effect of different layers of borate polymer on the glucose surface plasmon resonance measurement was studied. The experiment was conducted in the concentration range of 1-10 mg x dL(-1) (interval delta = 1 mg x dL(-1)), 10-100 mg x dL(-1) (interval delta = 10 mg x dL(-1)), and 100-1 000 mg x dL(-1) (interval delta = 100 mg x dL(-1)), experiment data was fitted by quadric curve and the fitting degree of refractive index difference deltaRU and glucose concentration was obtained. Results showed that the 12-layer-polymer sensor was better than the 6-layer-polymer sensor in the first two smaller ranges, and the measuring result was not significantly affected by layers in the third range, indicating that for the small concentrations increasing polymer layer can dramatically improve the measurement.
    Guang pu xue yu guang pu fen xi = Guang pu 04/2013; 33(1):142-6. DOI:10.3964/j.issn.1000-0593(2013)01-0142-05 · 0.29 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To assess glycemic variability, oxidative stress and their relationship in children and adolescents with type 1 diabetes (T1DM) attending a summer camp. Patients and method Cross-sectional study that included 54 children and adolescents with T1DM aged 7-16, attending a 7 day summer camp. Sociodemographic information, clinical data, and blood glucose values measured using an Accu-Chek Nano® glucose meter were recorded. Glucose variability markers (standard deviation [SD], low blood glucose index [LBGI], high blood glucose index [HBGI], mean amplitude of glycemic excursions [MAGE] and mean of daily differences [MODD]) were calculated. Oxidative stress was assessed by the measurement of 8-iso-prostaglandin F2 alpha (PGF2α) in a 24-hour urine sample collected at the end of the camp in 14 children. Results The Median SD, MAGE and MODD indexes were in the high range (61, 131 and 58 mg/dl, respectively), LBGI in the moderate range (3.3), and HBGI in the low range (4.5). The mean HbA1c was 7.6% and the median urinary excretion rate of 8-iso-PGF2α was 864.39 pg/mg creatinine. The Spearman correlation coefficients between markers of glycemic variability (SD, HBGI, MAGE, MODD) were significant. Non-significant correlations were found between markers of glycemic variability and urinary 8-iso-PGF2α. Conclusions High glycemic variability was observed in children and adolescents attending a summer camp. However, no correlations were found between markers of glycemic variability and oxidative stress measured by urinary 8-iso-PGF2α. Further studies are needed to address the relationship between oxidative stress and glycemic variability in children with T1DM.
    Anales de Pediatría 01/2013; 81(3). DOI:10.1016/j.anpedi.2013.09.007 · 0.83 Impact Factor
Show more