Essential Continuous Glucose Monitoring Metrics: The Principal Dimensions of Glycemic Control in Diabetes

Abstract

Background:

With the proliferation of continuous glucose monitoring (CGM), a number of metrics were developed to assess quality of glycemic control. Many of them are highly correlated. Thus, we aim to identify the principal dimensions of glycemic control—a minimal set of metrics, necessary and sufficient for comprehensive assessment of diabetes management.

Methods:

Seventy-five thousand five hundred sixty-three 2-week CGM profiles recorded in six studies by 790 individuals with type 1 or type 2 diabetes were used to compute mean glucose (MG), percentage time >180 mg/dL (TAR), >250 mg/dL (TAR2), <70 mg/dL (TBR), <54 mg/dL (TBR2), and coefficient of variation (CV). The true dimensionality of the glycemic-metric space was identified in a training set (53,380 profiles) and validated in an independent test set (22,183 profiles).

Results:

Correlation analysis identified two blocks of metrics—(MG, TAR, TAR2) and (TBR, TBR2, CV)—each with high internal correlation, but insignificant between-block correlation, suggesting that the true dimensionality of the glycemic-metric space is 2. Principal component analysis confirmed two essential metrics quantifying exposure to hyperglycemia (i.e., treatment efficacy) and risk for hypoglycemia (i.e., treatment safety), and explaining ∼90% of the variance in the training and test data.

Conclusion:

Two essential metrics, treatment efficacy and treatment safety, are necessary and sufficient to characterize glycemic control in diabetes. Thus, quantitatively, diabetes treatment optimization is reduced to a two-dimensional problem, meaning that minimizing both exposure to hyperglycemia and risk for hypoglycemia will lead to improvement in any other metric of glycemic control.