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Objective: To compare indices of the quality of glycemic control and their association with glucose complexity, using composite measures of glycemia and multiscale entropy derived from continuous glucose monitoring datasets. Study design: A retrospective cohort study. Methods: Continuous glucose monitoring data obtained during an observational study involved 256 subjects with type 1 (n = 22), type 2 diabetes (n = 222), and 12 non-diabetic control subjects. We compared the indices for the quality of glycemic control and determined their relationship with glucose profile complexity. The indices evaluated were: Low Blood Glucose Index, High Blood Glucose Index, Average Daily Risk Range (ADRR), Glycemic Risk Assessment Diabetes Equation (GRADE) scores, and the recently introduced Q-score. We used multiscale entropy analysis of the datasets to assess the relationship between glucose dynamics and the indices for the quality of glycemic control. Results: We categorized the study cohort into four groups according to the Q-score (≤ 5.9; Good, 6.0-8.4; Satisfactory, 8.5-11.9; Fair and ≥ 12.0; Poor). An increase in the Q-score was related with worsening of glycemic control as demonstrated by progressively elevated levels of the glucose exposure metrics HbA1c, mean glucose, and the glycemic variability measure %CV. In contrast, the multiscale entropy index decreased across the quality categories, attaining its lowest value at the highest Q-score regarded as Poor. ADRR, GRADE, and Q-score were highly correlated to one another and positively associated with the antidiabetes therapy (r = 0.424 to 0.469), but inversely correlated with the multiscale entropy (r = -0.337, p < 0.001; -0.286, p < 0.001; -0.353, p < 0.001). Conclusions: Indices assessing the quality of glycemic control yield a more comprehensive picture of glucose profiles than just defining a pre-specified target range or the mean value and its dispersion. The multiscale entropy complements these indices by providing insights into the dynamics of the glucoregulatory system not otherwise accessible.

Indices for Assessment of the Quality of Glycemic Control and Glucose Dynamics from Continuous Glucose Monitoring