Evaluating the Adequacy of Coefficient of Variation and Standard Deviation as Metrics of Glucose Variability in Type 1 Diabetes Based on Data from the GOLD and SILVER Trials
Authors' conclusion
The SD of glucose values does not increase linearly with the MG during glucose-lowering therapy, suggesting that CV is not an optimal measure of GV. After adjusting for censored glucose values, CV remains reliable.
Study context
- Population
- Individuals with T1D from the GOLD and SILVER trials; glucose metrics from continuous glucose monitoring (CGM) and self-monitoring of blood glucose (SMBG)
- Participants
- 158 individuals
- Primary endpoint
- Adequacy of CV and SD as metrics of glucose variability across mean glucose levels
Methodological detailsGeneralized estimating equations for SD–mean glucose relationship; restricted cubic splines; censored Gamma model for values outside CGM detection range (<2.22 and >22.2 mmol/L)
- Generalized estimating equations for SD–mean glucose relationship; restricted cubic splines; censored Gamma model for values outside CGM detection range (<2.22 and >22.2 mmol/L)
Primary result
As reported in the abstract
- SD of glucose values showed a nonlinear relationship with mean glucose during CGM and SMBG (vs linear model)
- both P < 0.001
- Lack of fit of the constant coefficient of variation (CV) model most distinct at high glucose levels
- >12 mmol/L
- During SMBG, 25% reduction in mean glucose from 12 to 9 mmol/L associated with reduction in SD of glucose values
- 16% (95% CI 10%-21%)
Further findings
Underestimation of treatment effect on glucose variability (SMBG to CGM transition) vs censoring-adjusted estimates
- Ordinary CV underestimated treatment effect
- 30%
- Ordinary SD underestimated treatment effect
- 27%
Ordinary CV vs CV adjusted for nonlinear SD–mean glucose relationship (GOLD study)
- Ordinary CV underestimated treatment effect
- 11%
Mean glucose of included individuals
- Mean glucose
- 10.6 (SD 1.7) mmol/L
Original publication
Evaluating the Adequacy of Coefficient of Variation and Standard Deviation as Metrics of Glucose Variability in Type 1 Diabetes Based on Data from the GOLD and SILVER Trials. Diabetes Technol Ther. Published 18 March 2025. doi:10.
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