Journal
FRONTIERS IN ENDOCRINOLOGY
Volume 14, Issue -, Pages -Publisher
FRONTIERS MEDIA SA
DOI: 10.3389/fendo.2023.1264072
Keywords
continuous glucose monitoring (CGM); glycated hemoglobin (HbA1c); type 2 diabetes (T2D); average blood glucose concentration (aBG); average interstitial fluid glucose concentration (aISF)
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This study analyzed continuous glucose monitoring data and found that the standard model for estimating glycated hemoglobin levels was not reliable for the Indian population. Two new estimation methods were proposed and 95% confidence and prediction intervals were provided.
Introduction: The development of continuous glucose monitoring (CGM) over the last decade has provided access to many consecutive glucose concentration measurements from patients. A standard method for estimating glycated hemoglobin (HbA1c), already established in the literature, is based on its relationship with the average blood glucose concentration (aBG). We showed that the estimates obtained using the standard method were not sufficiently reliable for an Indian population and suggested two new methods for estimating HbA1c. Methods: Two datasets providing a total of 128 CGM and their corresponding HbA1c levels were received from two centers: Health Centre, Savitribai Phule Pune University, Pune and Joshi Hospital, Pune, from patients already diagnosed with diabetes, non-diabetes, and pre-diabetes. We filtered 112 data-sufficient CGM traces, of which 80 traces were used to construct two models using linear regression. The first model estimates HbA1c directly from the average interstitial fluid glucose concentration (aISF) of the CGM trace and the second model proceeds in two steps: first, aISF is scaled to aBG, and then aBG is converted to HbA1c via the Nathan model. Our models were tested on the remaining 32 datasufficient traces. We also provided 95% confidence and prediction intervals for HbA1c estimates. Results: The direct model (first model) for estimating HbA1c was HbA1(cmmol/mol) = 0.319 x aISF(mg/dL) + 16.73 and the adapted Nathan model (second model) for estimating HbA1c is HbA1c(mmol/dL) = 0.38 x (1.17 x ISFmg/dL) - 5.60. Discussion: Our results show that the new equations are likely to provide better estimates of HbA1c levels than the standard model at the population level, which is especially suited for clinical epidemiology in Indian populations.
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