Biology Reference
In-Depth Information
The model was also tested with various time intervals (e.g., 3 months or
6 months of prediction) and various criteria (e.g., probability of more
than two or more than three episodes) and gave similar results. We
concluded that the risks for subsequent SH are described well by a
Weibull distribution with scale parameter a in the range of
3 and
a shape parameter b in the range of 1.5 to 2.2, depending on the time
period and probability under consideration. Similarly, the risk for
subsequent moderate hypoglycemia was described well by a Weibull
distribution with scale parameter a in the range of
5to
2 and a
shape parameter b in the range of 1.0 to 1.3. These parameters have a
direct physiological meaning and reflect clinical reality: the scale
parameter reflects the frequency of events [e.g., more frequent events
will result in a larger parameter a (and moderate hypoglycemia is more
frequent than SH)], and the shape parameter b reflects the degree of
dependence between sequential events (e.g., a larger parameter means a
more dependent event). For example, it is known that past SH is a major
factor for future SH, but this is not true for moderate hypoglycemia.
1.4 to
2. Risk Categories for Future Significant Hypoglycemia
Consistent with the validation data, when the risk classes identified
by the probability model were aggregated into four clinically justified
risk categories for future significant hypoglycemia—minimal risk
(LBGI
1.1); low risk (1.1 < LBGI
2.5); moderate risk (2.5 < LBGI
5),
and high risk (LBGI
5)—it became evident the number of all
prospectively observed hypoglycemic episodes increased significantly as
the risk category increased. Table 5-3 presents the number of
symptomatic SH episodes in each of the risk categories.
>
We believe that this four-risk category version of our model is much
more convenient for patients and health care providers to interpret. This
categorization allows for distinguishing between subjects who have
practically no chance for significant hypoglycemia from subjects at
progressively increasing risk.
We conclude that routine SMBG data with a frequency of three to five
readings per day contain valuable information for the metabolic
control of people with T1DM and T2DM. Our models suggest such
Minimal Risk
(LBGI 1.1)
Low Risk (1.1 <
LBGI 2.5)
Moderate Risk (2.5 <
LBGI 5)
High Risk
(LBGI > 5)
Number of severe
hypoglycemic episodes
T1DM
0
0.35
0.68
4.24
T2DM
0.09
0.18
1.42
1.85
TABLE 5-3.
Number of prospectively observed significant hypoglycemic episodes per person per month, by risk category and by type of diabetes.
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