Clinical Interpretation of Indices of Quality of Glycemic Control and Glycemic Variability

Abstract

The practicing physician is faced with the task of interpreting > 2 dozen indices of quality of glycemic control and glycemic variability. It would be desirable to have reference data from relevant patient populations (eg, patients with the same type of diabetes, duration of diabetes, therapeutic regimen, or glycated hemoglobin [HbA_1c] levels). The physician can then select the appropriate reference set for interpretation of results for each patient. Institutions and clinics may wish to develop their own reference data. Results can be interpreted as excellent, good, fair, or poor, corresponding with quartiles of their distributions. Each index of glycemic control and variability can be given a numerical score in terms of its percentile within the selected reference population. One can then compute the mean and standard deviation of the percentile scores to obtain an integrated measure of the quality of glycemic control or variability. We calculated quartiles for measures of quality of glycemic control and variability. One can use the percent coefficient of variation (%CV) with criteria that apply irrespective of the HbA_1c level as a general rule for interpretation of glycemic variability. For example, a %CV < 33.5% can be regarded as excellent, a %CV between 33.5% to 36.8% as good, a %CV between 36.8% to 40.6% as fair, and a %CV > 40.6% as poor. A graphical display can be used to make more accurate assessments for narrow HbA_1c ranges, as the percentiles of the %CV can change systematically with HbA_1c level or with mean glucose level.

Keywords:

• diabetes mellitus
• glycemic control
• glycemic variability
• continuous glucose monitoring
• self-monitoring of blood glucose