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Published Online: 27 February 2011

Calculating the Mean Amplitude of Glycemic Excursion from Continuous Glucose Monitoring Data: An Automated Algorithm

Publication: Diabetes Technology & Therapeutics
Volume 13, Issue Number 3

Abstract

Background: Glycemic variability is currently under scrutiny as a possible predictor of the complications of diabetes. The manual process for estimating a now classical measure of glycemic variability, the mean amplitude of glycemic excursion (MAGE), is both tedious and prone to error, and there is a special need for an automated method to calculate the MAGE from continuous glucose monitoring (CGM) data.
Methods: An automated algorithm for identifying the peaks and nadirs corresponding to the glycemic excursions required for the MAGE calculation has been developed. The algorithm takes a column of timed glucose measurements and generates a plot joining the peaks and nadirs required for estimating the MAGE. It returns estimates of the MAGE for both upward and downward excursions, together with several other indices of glycemic variability.
Results: Details of the application of the algorithm to CGM data collected over a 48-h period are provided, together with graphical illustrations of the intermediate stages in identifying the peaks and nadirs required for the MAGE. Application of the algorithm to 104 CGM datasets (92 from children with diabetes and 12 from controls) generated plots that, on visual inspection, were all found to have identified the peaks, nadirs, and excursions correctly.
Conclusions: The proposed algorithm eliminates the tedium and/or errors of manually identifying and measuring countable excursions in CGM data in order to estimate the MAGE. It can also be used to calculate the MAGE from “sparse” blood glucose measurements, such as those collected in home blood glucose monitoring.

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References

1.
Monnier LMas EGinet CMichel FVillon LCristol JPColette C. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetesJAMA20062951681-1687. 1. Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, Colette C: Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA 2006;295:1681–1687.
2.
The relationship of a glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications TrialDiabetes199544968-983. 2. The relationship of a glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. Diabetes 1995;44:968–983.
3.
Kilpatrick ESRigby ASAtkin SL. Effect of glucose variability on the long-term risk of microvascular complications in type 1 diabetesDiabetes Care2009321901-1903. 3. Kilpatrick ES, Rigby AS, Atkin SL: Effect of glucose variability on the long-term risk of microvascular complications in type 1 diabetes. Diabetes Care 2009;32:1901–1903.
4.
Cameron FJDonath SMBaghurst PA. Measuring glycaemic variationCurr Diabetes Rev2010617-26. 4. Cameron FJ, Donath SM, Baghurst PA: Measuring glycaemic variation. Curr Diabetes Rev 2010;6:17–26.
5.
Rodbard D. Interpretation of continuous glucose monitoring data: glycemic variability and quality of glycemic controlDiabetes Technol Ther200911Suppl 1S-65-S-67. 5. Rodbard D: Interpretation of continuous glucose monitoring data: glycemic variability and quality of glycemic control. Diabetes Technol Ther 2009;11(Suppl 1):S-65–S-67.
6.
Rodbard D. New and improved methods to characterize glycemic variability using continuous glucose monitoringDiabetes Technol Ther200911551-565. 6. Rodbard D: New and improved methods to characterize glycemic variability using continuous glucose monitoring. Diabetes Technol Ther 2009;11:551–565.
7.
Rodbard DBailey TJovanovic LZisser HKaplan RGarg SK. Glycemic variability with use of continuous glucose monitoringDiabetes Technol Ther200911717-723. 7. Rodbard D, Bailey T, Jovanovic L, Zisser H, Kaplan R, Garg SK: Glycemic variability with use of continuous glucose monitoring. Diabetes Technol Ther 2009;11:717–723.
8.
Service FJMolnar GDRosevear JWAckerman EGatewood LCTaylor WF. Mean amplitude of glycemic excursions, a measure of diabetic instabilityDiabetes197019644-655. 8. Service FJ, Molnar GD, Rosevear JW, Ackerman E, Gatewood LC, Taylor WF: Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes 1970;19:644–655.
9.
Service FJNelson RL. Characteristics of glycemic stabilityDiabetes Care1980358-62. 9. Service FJ, Nelson RL: Characteristics of glycemic stability. Diabetes Care 1980;3:58–62.
10.
Service FJO'Brien PCRizza RA. Measurements of glucose controlDiabetes Care198710225-237. 10. Service FJ, O'Brien PC, Rizza RA: Measurements of glucose control. Diabetes Care 1987;10:225–237.

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Published In

cover image Diabetes Technology & Therapeutics
Diabetes Technology & Therapeutics
Volume 13Issue Number 3March 2011
Pages: 296 - 302
PubMed: 21291334

History

Published in print: March 2011
Published online: 27 February 2011
Published ahead of print: 3 February 2011

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Public Health Research Unit, Women's and Children's Hospital, Children Youth and Women's Health Service, North Adelaide, South Australia, Australia.
The Disciplines of Paediatrics and Public Health, Faculty of Health Sciences, University of Adelaide, Adelaide, South Australia, Australia.

Notes

Address correspondence to:Associate Professor Peter A. Baghurst, Ph.D.Public Health Research UnitChildren Youth and Women's Health Service72 King William RoadNorth Adelaide, SA 5006, Australia
E-mail: [email protected]

Author Disclosure Statement

No competing financial interests exist.

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