Prof Neale Cohen

Australian endocrinologists have endorsed the use of Ambulatory Glucose Profiling (AGP) to interpret complicated continuous glucose management (CGM) data and prevent hypoglycaemic events according to an expert consensus statement

The statement, developed by an AGP Working Party convened by the Australian Diabetes Society, comes off the back of recent internationally agreed upon CGM targets – and experts say knowing how to interpret the reports will become increasingly important.

Speaking to the limbic about the position statement, Professor Neale Cohen, Director of Clinical Diabetes at the Baker IDI, says endocrinologists need to look beyond the patient’s HbA1C in assessing the need for additional therapies.

“A patient’s A1C does not always tell the whole story so all endocrinologists treating diabetes absolutely need to be up-skilled in this area and if they’re not they probably shouldn’t be managing diabetes.”

The AGP, Professor Cohen says, is a standardised, single-page glucose report with a summary of statistics, a glucose profile graph and glucose daily calendar graphs.

Similar to an ECG for the heart, the AGP is consistent regardless of the CGM device used, adds Professor Cohen, who served as a member of the ADS AGP Working Party.

The main feature of the AGP is the glucose profile itself. Displayed as a waveform graph it shows a median glucose control line – the 25th to 75th percentiles, which represent 50% of the glucose readings over the analysis time period – typically 14 days – as well as confidence intervals around those, Professor Cohen explains.

Meanwhile the 10th to 90th percentiles identify any outliers that are contributing to the median result.

The strengths of the profile, says Professor Cohen, are in the ease of interpretation of median glucose levels, identifying both hyperglycaemic and hypoglycaemic glucose trends more comprehensively in a 24-hour period, and variability in glucose levels both between and within days.

“When I look at AGP reports the number one thing I’m looking for is an obvious pattern that I need to be alerted to.  By looking at the median line and at the confidence intervals you can very quickly get a feeling for whether there is a problem with a specific time of day or, if the confidence intervals are really wide and highly variable, if I’m going to need to look at this on a day-to- day basis.”

The statement also supports additional internationally recommended metrics to improve clinical use of the report including a definition of time in glucose target range (TIR) – the percentage of time spent (typically 70%) with blood glucose levels between 3.9 and 10.0 mmol/L as well as an optimal glycaemic variability target of no more than 36% for adults with type 1 diabetes.

The ADS statement provides several tools to help endocrinologists with these recommendations.

There’s an example of an ambulatory glucose profile and a step-by-step workflow to assist clinicians in undertaking the analysis of AGP reports in clinical practice

You can access the full statement here.