Efficacy of Average Daily Risk Range (ADRR) to Estimate Glycemic Kinetics during Nighttime in Japanese Patients with Type 1 Diabetes Mellitus
Authors: IKEDA FUKI , KANAZAWA AKIO , IIDA MAYU , KAGA HIDEYOSHI , TAKAYANAGI NAOKO , SHIMIZU TOMOAKI , SHIRAKAWA CHIE , WATADA HIROTAKA 
Published: June 2018

Nocturnal hypoglycemia is a serious problem in the management of diabetes mellitus (DM). The average daily risk range (ADRR) was the value created to access blood glucose variability. ADRR can be calculated using self-monitoring blood glucose (SMBG) values and is reported to be sensitive to both hyperglycemia and hypoglycemia. However, the usefulness of ADRR in Asian type 1 patients with DM (T1DM) to detect nocturnal hypoglycemia has not been elucidated yet. In this study, we recruited 28 Japanese T1DM. All patients wore outpatient continuous glucose monitoring (CGM) for 6 days and performed SMBG, 3 times/day (before breakfast and dinner, and 2 hours after dinner) for 14 days. Based on these SMBG data, we calculated ADRR and assessed the correlation of ADRR with glucose kinetics. There were no significant correlations of ADRR with hypoglycemic and hyperglycemic frequencies during nighttime. However, there were significant correlations of ADRR with Standard Deviation (SD) (r=0.53, p = 0.003), and Coefficient of Variation (CV) (r=0.46, p = 0.015) of mean glucose during nighttime. In addition, although ADRR showed no significant correlation with hypoglycemic frequency during daytime, ADRR showed significant correlation with hyperglycemic frequency (r=0.47, p=0.012), mean glucose (r=0.40, p=0.033), SD (r=0.56, p = 0.002) and CV (r=0.39, p = 0.041) during daytime.
In conclusion, ADRR could be useful to detect glycemic variability during nighttime, however, it is useless to estimate risks of hypoglycemia and hyperglycemia during nighttime. Our data showed only limited usefulness of ADRR in clinical setting in Japanese T1DM.

Disclosure
F. Ikeda: None. A. Kanazawa: Speaker's Bureau; Self; Sanofi K.K., Kissei Pharmaceutical Co., Ltd.. M. Iida: None. H. Kaga: None. N. Takayanagi: None. T. Shimizu: None. C. Shirakawa: None. H. Watada: Advisory Panel; Self; AstraZeneca. Consultant; Self; Astellas Pharma US, Inc., AstraZeneca, Boehringer Ingelheim GmbH, Daiichi Sankyo Company, Limited, Sumitomo Dainippon Pharma Co., Ltd., Eli Lilly and Company, Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceuticals America, Inc., Kyowa Hakko Kirin Co., Ltd., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Novartis AG, Ono Pharmaceutical Co., Ltd., Sanofi, Sanwa Kagaku Kenkyusho Co., Ltd., Takeda Development Center Asia, Pte. Ltd.. Research Support; Self; Abbott, Astellas Pharma US, Inc., AstraZeneca, Bayer AG, Benefit One Health Care Co., Ltd., Boehringer Ingelheim GmbH, Bristol-Myers Squibb Company, Daiichi Sankyo Company, Limited, Sumitomo Dainippon Pharma Co., Ltd., Eli Lilly and Company, Kissei Pharmaceutical Co., Ltd., Kowa Pharmaceuticals America, Inc., Kyowa Hakko Kirin Co., Ltd., Johnson & Johnson Diabetes Institute, LLC., Merck Sharp & Dohme Corp., Mitsubishi Tanabe Pharma Corporation, Mochida Pharmaceutical Co., Ltd., Nitto Boseki Co., Ltd., Novartis AG, Novo Nordisk A/S, Ono Pharmaceutical Co., Ltd., Pfizer Inc., Sanofi, Sanwa Kagaku Kenkyusho Co., Ltd., Taisho Pharmaceutical Co., Ltd., Takeda Development Center Asia, Pte. Ltd., Terumo Medical Corporation.