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Endocrinology 2018 Journal of Clinical and Molecular Endocrinology
ISSN: 2572-5432 Page 58
August 09-10, 2018
Madrid, Spain
11th International Conference on
Endocrinology and
Diabetology
Background & Aim: Minimizing blood glucose variation is key to
optimizing health outcomes for people with diabetes. Our aim is
to see if we could quantify the impact of BloodGlucoseMonitoring
Strips variability (BGMSV) at GP (General Practitioners) practice
level on the variabilityof reportedglycatedhaemoglobin (HbA1cV)
levels published in the National Diabetes Audit, and from that
estimate the impact on Blood Glucose Variability (BGV)
Materials & Methods: The overall GP Practice BGMSV was
calculated from the quantity of main types of BGMS being
prescribed combined with the published accuracy, as % results
within +/-% bands from reference value for the selected strip
type. An estimated HbA1c mean and variability (HbA1cV) was
calculated for each practice year from % results within HbA1c
bands published in the National Diabetes Audit for Type 1
diabetes (T1DM). The regression coefficient between the BGMSV
and HbA1cV was calculated. To allow for the aggregation of
estimated 3 tests/day over 13 weeks (i.e. 300 samples) of actual
Blood Glucose values up to the HbA1c, we multiplied HbA1cV
coefficient by √300 to estimate an empirical value for the impact
of BGMSV on BGV.
Results: 4,524 practice years with 159,700 T1DM patient years
where accuracy data was available for more than 80% of strips
prescribed were included, with overall BGMSV 6.5% and HbA1c
mean of 66.9 mmol/mol (8.3%) with variability of 13 mmol/
mol equal to 19% of the mean. At a GP practice level, BGMSV
and HbA1cV as % of mean HbA1c (in other words the spread of
HbA1c) were closely relatedwith a regression coefficient of 0.176,
p-value <0.001 .After correction for aggregation the equivalent
BGV correlation factor was calculated at 3. The comparable
figure previously found in an in-silico study was 2.7. Applying this
factor for BGMS to the national ISO accepted standard where
95% results must be ≤+/-15% from reference, revealed that for
BG, 95% results would ≤+/-45% from the reference value. So, for
a patient with BG target @10mmol/l using ISO standard strips,
on 1/20 occasions (average 1/week) their actual blood glucose
value could be >+/-4.5mmol/l from target, compared to the best
performing BGMS with BG >+/-2.2mmol/l from reference on 1/20
occasions.
Conclusions: Use of more variable/less accurate BGMS is
associated both theoretically and in practice with a larger
variability in measured BG and HbA1c, with implications for
patient confidence in their day to day monitoring experience.
Real world practice level data analysis confirms link between
variability within blood glucose monitoring strip (BGMS) and
glycosylated haemoglobin HbA1c in type 1 diabetes
Adrian H Heald1,2, Mark Livingston3, Anthony Fryer4, Gabriela Cortes5, Simon G
Anderson1, Roger Gadsby6, Ian Laing2 , Mark Lunt1 , Robert J Young7 and Mike
Stedman8
1University of Manchester, UK
2Salford Royal NHS Foundation Trust, UK
3Walsall Healthcare NHS Trust, UK
4Keele University, UK
5High Speciality Regional Hospital of Ixtapaluca, Mexico
6Warwick Medical School - University of Warwick, UK
8RES Consortium, UK
J Clin Mol Endocrinol 2018, Volume 3
DOI: 10.21767/2572-5432-C2-006