Q-Score

Development of a New Metric for Continuous Glucose Monitoring That Enables Stratification of Antihyperglycaemic Therapies

Petra Augstein; Peter Heinke; Lutz Vogt; Roberto Vogt; Christine Rackow; Klaus-Dieter Kohnert; Eckhard Salzsieder

BMC Endocr Disord. 2015;15(22)

Conclusions

We developed a metric for automated, objective evaluations of CGM profiles called the Q-Score. The Q-Score included the essential factors describing a glucose profile and therefore provides global information on glucose profiles, summarised in one value. The Q-Score can be categorised, and is suitable for screening profiles of individuals with insufficient metabolic control. In addition, it allows identification of factor(s) underlying the profiles that are mainly responsible for the quality of metabolic control in a given patient. Those parameters with improvement potential can be identified and addressed by therapeutic actions. Therefore, the Q-Score may efficiently contribute to designing strategies for patient-tailored diabetes care and management.

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Abbreviations
AUC_G: Area under the curve for glucose, BU: Bread units, CHO: Carbohydrate intake, CGM: Continuous glucose monitoring, Q-Score: Quality evaluation score, MBG: Mean blood glucose, MAGE: Mean amplitude of glycaemic excursions, CONGA: Continuous overall net glycaemic action, MODD: Mean of daily differences, LBGI: Low glucose index, HBGI: High glucose index, GRADE: Glycaemic risk assessment diabetes equation, OHA: Oral hypoglycaemic agent, t_G time: Outside glucose target range, T1DM: Type 1 diabetes mellitus, T2DM: Type 2 diabetes mellitus

Acknowledgments
Research and development of model-based decision-support systems, including KADIS®-based health care services was performed at the Institute of Diabetes 'Gerhardt Katsch' Karlsburg, supported by grants from the German Federal Ministry of Education and Research (BMBF; FKZ: 03i2700) and the Regional Ministry of Education, Science, and Culture Mecklenburg-Vorpommern (IDK 97 007 80/SOM, IDK 97 007 80/HSP III).

Table 1. Patient demographics and characteristics
		T2DM			T1DM
Parameter	Diet	OHA	OHA + Insulin	Insulin	Insulin
	(n = 120)	(n = 513)	(n = 439)	(n = 442)	(n = 48)
Age [years]	64.9 ± 8.2	65.7 ± 8.5	65.1 ± 8.1	68.1 ± 9.2	52.9 ± 10.4
Gender [f/m]	33/87	174/339	136/303	135/307	21/27
DM duration [years]	3 (2–6)	6 (3–11)	12 (8–17)	16 (9–23)	31 (21–36)
BMI [kg/m²]	29.3 ± 4.1	30.5 ± 5.2	32.6 ± 5.5	30.7 ± 5.2	26.0 ± 3.8
HbA1c [%]	6.3 ± 0.7	6.8 ± 0.8	7.2 ± 1.0	7.1 ± 1.0	7.6 ± 1.0

Data represent the mean ± SD or median (interquartile range) for each category.
OHA, oral hypoglycaemic agent; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.

Table 2. Parameters for four factors identified in the factor analysis ^a
Parameter	FACTORS
	1	2	3	4
	Central tendency and hyperglycaemia	Intra-day variability	Hypoglycaemia	Inter-day variability
Range	0.298	0.903	0.156	0.077
SD	0.320	0.920	0.186	0.078
IQR	0.344	0.863	0.174	0.073
MAGE	0.259	0.901	0.160	0.077
CONGA-6 h	0.302	0.916	0.171	0.025
MBG	0.922	0.260	−0.264	0.055
Median	0.931	0.176	−0.276	0.074
t_{G >8.9 mmol/l}	0.876	0.334	−0.139	0.101
AUC_{G >8.9 mmol/l}	0.906	0.320	−0.027	0.032
HBGI	0.931	0.321	−0.070	0.044
GRADE	0.929	0.348	0.027	0.068
t_{G <3.9 mmol/l}	−0.143	0.195	0.951	0.036
AUC_{G <3.9 mmol/l}	−0.083	0.201	0.954	0.020
LBGI	−0.230	0.189	0.942	0.018
MODD	0.354	0.657	0.139	0.649

^aData are from 1,562 continuous glucose monitoring profiles.
Parameter loadings >0.5 indicate that the given factor was important for interpretation of the factor (denoted in bold).
AUC_G, area under the curve for glucose; CONGA, continuous overall net glycaemic action; GRADE, glycaemic risk assessment for diabetes equation; HBGI, high blood glucose index; IQR, interquartile range; LBGI, low blood glucose index; MAGE, mean amplitude of glycaemic excursions; MBG, mean blood glucose; MODD, mean of daily differences; SD, standard deviation; t_G, time outside glucose target range.

Table 3. Q-Score in relation to diabetes therapy
		T2DM			T1DM
Parameter	Diet	OHA	OHA + Insulin	Insulin	Insulin
	(n = 120)	(n = 513)	(n = 439)	(n = 442)	(n = 48)
Q-Score	5.1 ± 2.6	6.8 ± 3.0	8.6 ± 3.3	9.2 ± 3.4	12.7 ± 3.2
MBG (mmol/l)	6.9 ± 1.3	7.5 ± 1.6	8.0 ± 1.8	8.0 ± 1.6	8.5 ± 1.6
Range (mmol/l)	5.1 ± 2.1	6.5 ± 2.4	7.9 ± 2.7	8.5 ± 2.9	11.1 ± 2.7
t_G>8.9mmol/l (h)	0.9 (0.1–3.0)	3.1 (1.1–6.5)	5.5 (2.6–10.6)	6.5 (3.2–10.3)	9.1 (5.8–12.7)
t_G<3.9mmol/l (h)	0 (0–0.4)	0 (0–0.4)	0.1 (0–0.9)	0.2 (0–1.0)	0.9 (0.1–2.4)
MODD (mmol/l)	1.2 ± 0.5	1.5 ± 0.6	2.0 ± 0.9	2.1 ± 0.9	3.3 ± 1.1

Data represent the mean ± SD or median (interquartile range) for each category; OHA, oral hypoglycaemic agent; T1DM, type 1 diabetes mellitus; T2DM, type 2 diabetes mellitus.

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Development of a New Metric for Continuous Glucose Monitoring That Enables Stratification of Antihyperglycaemic Therapies

Conclusions

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