Quantification of the relation between continuous glucose monitoring observation period and the estimation error in assessing long-term glucose regulation.

Introduction: The integration of continuous glucose monitoring (CGM) into clinical practice has rapidly emerged in the last decade, changing the evaluation of long-term glucose regulation in patients with diabetes. When using CGM-derived metrics to evaluate long-term glucose regulation, it is essential to determine the minimal observation period necessary for a reliable estimate. The approach of this study was to calculate mean absolute errors (MAEs) for varying window lengths, with the goal of demonstrating how the CGM observation period influences the accuracy of the estimation of 90-day glycemic control.

Research design and methods: CGM data were collected from the DIABASE cohort (ZGT hospital, The Netherlands). Trailing aggregates (TAs) were calculated for four CGM-derived metrics: time in range (TIR), time below range (TBR), glucose management indicator (GMI) and glycemic variability (GV). Arbitrary MAEs for each patient were compared between the TAs of window lengths from 1 to 89 days and a reference TA of 90 days, which is assumed to reflect long-term glycemic regulation.

Results: Using 14 days of CGM data resulted in 65% of subjects having their TIR estimation being below a MAE threshold of 5%. In order to have 90% of the subjects below a TIR MAE threshold of 5%, the observation period needs to be 29 days.

Conclusions: Although there is currently no consensus on what is an acceptable MAE, this study provides insight into how MAEs of CGM-derived metrics change according to the used observation period within a population and may thus be helpful for clinical decision-making.