Clinical Recommendations for the Use of the Ambulatory Glucose Profile in Diabetes Care

Abstract

Background: The ambulatory glucose profile (AGP) uses the wealth of data that are generated by continuous glucose monitoring, including flash glucose monitoring technologies, to provide a visual representation of glucose levels over a typical standard day of usually the most recent two weeks for a person with diabetes and helps to identify patterns and trends in glucose control. The AGP allows certain patterns of glucose levels to be identified and analyzed, such that treatment adjustments can be made, and new individual treatment goals can be defined. This helps to ensure increased treatment satisfaction and adherence, quality of life, and an improvement in metabolic management for people with diabetes.

Objective: To date, a range of approaches exists for interpreting the information contained in an AGP, with different priorities given to identifying and targeting patterns of hypoglycemia and the degree of variability and stability underlying the glucose levels. The objective of the present recommendation is to describe the steps for assessing an AGP in detail and to illustrate these steps using visual examples.

Conclusion: This paper describes the consensus recommendations from a group of German expert diabetologists on the necessary steps for assessing an AGP in a structured and detailed way and to explain these steps using practical clinical examples.

Keywords: AGP; CGM; ambulatory glucose profile; continuous glucose monitoring; diabetes self-management; diabetes therapy; flash glucose monitoring; glycemic control; glycemic stability; glycemic variability; hypoglycemia; isCGM; rtCGM.

Figure 1.

Examples are shown of hypoglycemic events from individual ambulatory glucose profiles that have been evaluated by the expert group in terms of frequency, duration, depth, and periodic occurrence, with corresponding recommendations for action. Green: no therapeutic intervention required (the darker the green color, the less critical the situation). Orange: therapeutic intervention required (the darker the orange color, the more critical the situation). Red: immediate therapeutic intervention required. *Period is defined as ≥5 hypoglycemic events (glucose level <54 mg/dL <3.0 mmol/L) in an interval of 6 hours over a period of 14 days.

Figure 2.

The median value, the interquartile range, and the interdecile range for the glucose levels measured in a person with diabetes are displayed. For illustrative purposes only, not real patient data. The glucose levels are quantified in mg/dL (left-hand side) or mmol/L (right-hand side) over a standardized day. The interquartile range is shown by the darker blue band and represents 50% of the glucose values closest to the median value. The interdecile range is shown by the lighter-blue band and represents 80% of the glucose values around the median.

Figure 3.

Example of the interquartile range and interdecile range representations of glucose variability, along with possible causes for these fluctuations in glucose levels. For illustrative purposes only, not real patient data. BE, bread exchange unit; CEU, carbohydrate exchange unit; IMI, injection-meal interval. *The assessment of the ambulatory glucose profile is limited due to an “irregular” daily routine.

Figure 4.

Example of an ambulatory glucose profile from a metabolically healthy individual. For illustrative purposes only, not real patient data.

Figure 5.

Illustration of glucose stability is using the positive and negative gradients of the median curve. For illustrative purposes only, not real patient data. The glucose levels are quantified in mg/dL (left-hand side) or mmol/L (right-hand side) over a standardized day.