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Ambulatory Glucose Profile Report (AGP) Explained

The ambulatory glucose profile report (AGP) is a standardized graphical summary of continuous glucose monitoring data used to assess glucose control in patients with diabetes.

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The ambulatory glucose profile report (AGP) is a standardized graphical summary of continuous glucose monitoring data used to assess glucose control in patients with diabetes.

What Is the Ambulatory Glucose Profile Report?

The ambulatory glucose profile report (AGP report) is a standardized, visually structured summary of glucose data collected by a continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) device over a defined period – typically 14 days. It allows both patients with diabetes and their healthcare providers to quickly and comprehensively evaluate glucose patterns in everyday life.

The AGP report was originally developed by the International Diabetes Center and has since become the internationally recognized standard format in diabetes care. It is often compared to an ECG in cardiology: a single, standardized document that delivers the most important clinical information at a glance.

Structure and Content of the AGP Report

The AGP report consists of several sections that together provide a complete picture of glucose control:

Data summary: Information on the measurement period, number of days with data, and the percentage of time the sensor was active.
Glucose statistics: Key metrics including the overall average glucose, the estimated HbA1c (eA1c), glucose variability (CV, coefficient of variation), and the GMI (Glucose Management Indicator).
Time in Range (TIR): The percentage of time glucose levels were within the target range (70–180 mg/dL or 3.9–10.0 mmol/L), below it, or above it. TIR is considered the central measure of glucose control quality.
AGP curve (ambulatory glucose profile): A graphical overlay of glucose values from all measured days, showing the median, 25th/75th percentiles, and 10th/90th percentiles. This allows identification of recurring patterns such as hypoglycemia or hyperglycemia at specific times of day.
Daily glucose profiles: Individual day-by-day glucose traces that allow detailed analysis of outliers and special events.

Clinical Significance

The AGP report is a valuable tool in modern diabetes management. It helps assess the effectiveness of treatment, guide targeted therapy adjustments, and actively involve patients in self-management. Key clinical applications include:

Identifying hypoglycemia patterns: Recurring low glucose events (below 70 mg/dL) can be detected early and prevented through therapy modification.
Assessing glucose variability: High glucose fluctuations are recognized as an independent risk factor for diabetes-related complications.
Optimizing insulin therapy: The AGP highlights times of day where dosing adjustments may be needed – for example, in basal insulin or mealtime insulin settings.
Supporting patient-provider communication: The clear visual format makes it much easier to discuss glucose management with patients in a meaningful way.

Target Values and Recommendations

International diabetes organizations, including the Diabetes Technology Society and the American Diabetes Association (ADA), recommend the following AGP targets for most adults with diabetes:

Time in Range (TIR): > 70% of the time within 70–180 mg/dL
Time below Range (TBR): < 4% below 70 mg/dL, < 1% below 54 mg/dL
Time above Range (TAR): < 25% above 180 mg/dL, < 5% above 250 mg/dL
Glucose variability (CV): < 36%

Adjusted targets apply to special populations such as older adults, pregnant individuals, or children.

Usage and Requirements

The AGP report is automatically generated by CGM or FGM devices and their associated software. For a meaningful evaluation, a sufficient data density is required: at least 70% of possible readings over a 14-day period is recommended. The report can be reviewed directly during a clinical appointment or shared electronically between providers and patients.

References

Danne T. et al. - International Consensus on Use of Continuous Glucose Monitoring. Diabetes Care, 2017; 40(12): 1631–1640. DOI: 10.2337/dc17-1600
Battelino T. et al. - Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care, 2019; 42(8): 1593–1603. DOI: 10.2337/dc19-0028
American Diabetes Association - Standards of Medical Care in Diabetes 2024. Diabetes Care, 2024; 47 (Suppl. 1). Available at: www.diabetesjournals.org

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