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Assessment of canonical diurnal variations in plasma glucose using quantile regression modelling and Chronomaps

  • Mustafa Özçürümez ORCID logo EMAIL logo , Jasmin Weninger , Abdurrahman Coskun ORCID logo , Farhad Arzideh ORCID logo , Thomas Streichert ORCID logo , Antje Torge , Jan-Peter Sowa ORCID logo , Christin Quast ORCID logo , Ali Canbay ORCID logo , Mario Plebani ORCID logo and Martina Broecker-Preuss ORCID logo
Published/Copyright: December 6, 2024
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 3

Abstract

Objectives

Diurnal variation of plasma glucose levels may contribute to diagnostic uncertainty. The permissible time interval, pT(t), was proposed as a time-dependent characteristic to specify the time within which glucose levels from two consecutive samples are not biased by the time of blood collection. A major obstacle is the lack of population-specific data that reflect the diurnal course of a measurand. To overcome this issue, an approach was developed to detect and assess diurnal courses from big data.

Methods

A quantile regression model, QRM, was developed comprising two-component cosinor analyses and time, age, and sex as predictors. Population-specific canonical diurnal courses were generated employing more than two million plasma glucose values from four different hospital laboratory sites. Permissible measurement uncertainties, pU, were also estimated by a population-specific approach to render Chronomaps that depict pT(t) for any timestamp of interest.

Results

The QRM revealed significant diurnal rhythmometrics with good agreement between the four sites. A minimum pT(t) of 3 h exists for median glucose levels that is independent from sampling times. However, amplitudes increase in a concentration-dependent manner and shorten pT(t) down to 72 min. Assessment of pT(t) in 793,048 paired follow-up samples from 99,453 patients revealed a portion of 24.2 % sample pairs that violated the indicated pT(t).

Conclusions

QRM is suitable to render Chronomaps from population specific time courses and suggest that more stringent sampling schedules are required, especially in patients with elevated glucose levels.

Keywords: biological variation; diagnostic error; pre-analytical phase; diurnal variation; quantile regression analysis; plasma glucose
Corresponding author: Prof. Dr. med. Mustafa Özçürümez, Department of Medicine, University Hospital Knappschaftskrankenhaus Bochum GmbH, Ruhr-University Bochum, In der Schornau 23-25, 44892 Bochum, Germany, E-mail:

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: Study concept and design: MÖ, FA, AC; Acquisition of data: MÖ, TS, AT, MP; Statistical analysis and graphical presentation: FA; Analysis and interpretation of data: MÖ, FA, JW, JPS, CQ, MBP; Drafting of the manuscript: FA, ACo, JPS, CQ, MBP. Critical revision of the manuscript for important intellectual content: JW, ACo, TS, AT, JPS, CQ, AC, MP, MBP. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Use of Large Language Models, AI and Machine Learning Tools: None declared.

  5. Conflict of interest: The authors state no conflict of interest.

  6. Research funding: None declared.

  7. Data availability: The raw data can be obtained on request from the corresponding author.

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Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/cclm-2024-0970).

Received: 2024-08-20
Accepted: 2024-11-14
Published Online: 2024-12-06
Published in Print: 2025-02-25

© 2024 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2024-0970
Keywords for this article
biological variation; diagnostic error; pre-analytical phase; diurnal variation; quantile regression analysis; plasma glucose

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. Multi-cancer early detection: searching for evidence
  4. High sensitivity cardiac troponin assays, rapid myocardial infarction rule-out algorithms, and assay performance
  5. Reviews
  6. Consensus statement on extracellular vesicles in liquid biopsy for advancing laboratory medicine
  7. Copeptin as a diagnostic and prognostic biomarker in pediatric diseases
  8. Opinion Papers
  9. The Unholy Grail of cancer screening: or is it just about the Benjamins?
  10. Critical appraisal of the CLSI guideline EP09c “measurement procedure comparison and bias estimation using patient samples”
  11. Tumor markers determination in malignant pleural effusion: pearls and pitfalls
  12. Contribution of laboratory medicine and emerging technologies to cardiovascular risk reduction via exposome analysis: an opinion of the IFCC Division on Emerging Technologies
  13. Guidelines and Recommendations
  14. Recommendations for European laboratories based on the KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease
  15. Genetics and Molecular Diagnostics
  16. Expanded carrier screening for 224 monogenic disease genes in 1,499 Chinese couples: a single-center study
  17. General Clinical Chemistry and Laboratory Medicine
  18. How do experts determine where to intervene on test ordering? An interview study
  19. New concept for control material in glucose point-of-care-testing for external quality assessment schemes
  20. Vitamin B12 deficiency in newborns: impact on individual’s health status and healthcare costs
  21. Analytical evaluation of eight qualitative FIT for haemoglobin products, for professional use in the UK
  22. Colorimetric correcting for sample concentration in stool samples
  23. Reference Values and Biological Variations
  24. Assessment of canonical diurnal variations in plasma glucose using quantile regression modelling and Chronomaps
  25. Inconsistency in ferritin reference intervals across laboratories: a major concern for clinical decision making
  26. Establishing the TSH reference intervals for healthy adults aged over 70 years: the Australian ASPREE cohort study
  27. Hematology and Coagulation
  28. The EuroFlow PIDOT external quality assurance scheme: enhancing laboratory performance evaluation in immunophenotyping of rare lymphoid immunodeficiencies
  29. Clinical value of smear review of flagged samples analyzed with the Sysmex XN hematology analyzer
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  31. Evidence for stability of cardiac troponin T concentrations measured with a high sensitivity TnT test in serum and lithium heparin plasma after six-year storage at −80 °C and multiple freeze-thaw cycles
  32. Letters to the Editor
  33. Impact of high-sensitivity cardiac troponin I assay imprecision on the safety of a single-sample rule-out approach for myocardial infarction
  34. Why is single sample rule out of non-ST elevation myocardial infarction using high-sensitivity cardiac troponin T safe when analytical imprecision is so high? A joint statistical and clinical demonstration
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