How Should We Assess Glycemic Variability in Type 1 Diabetes? Contribution of Principal Component Analysis for Interstitial Glucose Indices in 142 Children

Diabetes Technol Ther. 2018 Jun;20(6):440-447. doi: 10.1089/dia.2017.0404.

Abstract

Background: Glycemic variability (GV) can be used to assess glycemic control in diabetes, but there is no clear consensus concerning the methods to use for its assessment. Methodological differences have resulted in differences in the outcome of GV metrics used in research studies, controversies over clinical impact, and an absence of integration into routine care.

Aim: To identify the indicators of GV most meaningful for clinicians, patients, and clinical researchers.

Materials and methods: Continuous glucose monitoring data were collected during the first 3 months of a pediatric diabetes clinical trial (Start-In!; n = 142). We used principal component analysis (PCA) to analyze weekly averages for 22 parameters relating to GV.

Results: PCA identified five groups of parameters and three components explaining 85.7% of the variance. These components represented the amplitude, direction (hypoglycemia vs. hyperglycemia), and timing (within-day vs. between-days) of glucose excursions.

Conclusions: This study provides elements that could make GV parameters more useful in clinical practice and research. No single parameter was sufficient to represent the complexity of GV, but it was possible to restrict the number of indicators required. The five groups of parameters identified by PCA could facilitate the choice of the most relevant outcomes for GV analysis in pediatric diabetes according to the purpose of the analysis (e.g., exploration of GV associated with hypo- or hyperglycemia, with short- or long-term periodicity, or GV in its entirety).

Keywords: Adolescent; Children; Continuous glucose monitoring; Glycemic variability; Principal component analysis; Type 1 diabetes.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Blood Glucose / analysis*
  • Blood Glucose Self-Monitoring*
  • Child
  • Diabetes Mellitus, Type 1 / blood*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Male
  • Principal Component Analysis

Substances

  • Blood Glucose
  • Glycated Hemoglobin A