Methods for quantifying self-monitoring blood glucose profiles exemplified by an examination of blood glucose patterns in patients with type 1 and type 2 diabetes

Abstract

The maintenance of glycemic control in patients with type 1 or type 2 diabetes mellitus (T1DM and T2DM, respectively) is commonly assisted by devices for self-monitoring of blood glucose (SMBG) that store multiple BG determinations. However, besides average BG, no other SMBG characteristics are routinely computed. We describe several SMBG-based measures that quantify the extent and rate of patients' BG excursions into hypoglycemia and hyperglycemia and can be used as markers for patients' vulnerability to hypoglycemia and BG irregularity. These markers are applied to analyze data from patients with T1DM (n = 277) and T2DM (n = 323), all of whom used insulin. T1DM and T2DM patients were matched by HbA(1c), gender, and number of SMBG readings/day. On average, 230 SMBG readings and three HbA(1c) assays were collected for each subject over 3 months. Compared with T2DM, patients with T1DM diabetes had (1) more extreme low and high BGs, (2) greater risk for severe hypoglycemia as quantified by the Low BG Index, (3) faster descent into hypoglycemia as quantified by the risk rate of change/hour, and (4) greater BG irregularity as computed by BG rate of change/hour and BG SD (all p levels < 0.0001). SMBG data allow for computing and frequent updating of various idiosyncratic diabetes characteristics and risk factors. The use of such computations may assist in optimizing patients' glycemic control.