连续血糖监测评估的时间范围内与 2 型糖尿病患者糖尿病视网膜病变的关系。
Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes.
机构信息
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China
出版信息
Diabetes Care. 2018 Nov;41(11):2370-2376. doi: 10.2337/dc18-1131. Epub 2018 Sep 10.
OBJECTIVE
Continuous glucose monitoring (CGM) has provided new measures of glycemic control that link to diabetes complications. This study investigated the association between the time in range (TIR) assessed by CGM and diabetic retinopathy (DR).
RESEARCH DESIGN AND METHODS
A total of 3,262 patients with type 2 diabetes were recruited. TIR was defined as the percentage of time spent within the glucose range of 3.9-10.0 mmol/L during a 24-h period. Measures of glycemic variability (GV) were assessed as well. DR was determined by using fundus photography and graded as ) non-DR; ) mild nonproliferative DR (NPDR); ) moderate NPDR; or ) vision-threatening DR (VTDR).
RESULTS
The overall prevalence of DR was 23.9% (mild NPDR 10.9%, moderate NPDR 6.1%, VTDR 6.9%). Patients with more advanced DR had significantly less TIR and higher measures of GV (all for trend <0.01). The prevalence of DR on the basis of severity decreased with ascending TIR quartiles (all for trend <0.001), and the severity of DR was inversely correlated with TIR quartiles ( = -0.147; < 0.001). Multinomial logistic regression revealed significant associations between TIR and all stages of DR (mild NPDR, = 0.018; moderate NPDR, = 0.014; VTDR, = 0.019) after controlling for age, sex, BMI, diabetes duration, blood pressure, lipid profile, and HbA. Further adjustment of GV metrics partially attenuated these associations, although the link between TIR and the presence of any DR remained significant.
CONCLUSIONS
TIR assessed by CGM is associated with DR in type 2 diabetes.
目的
连续血糖监测（CGM）提供了与糖尿病并发症相关的新的血糖控制衡量指标。本研究探讨了 CGM 评估的时间在目标范围内（TIR）与糖尿病视网膜病变（DR）之间的关系。
研究设计和方法
共招募了 3262 名 2 型糖尿病患者。TIR 定义为 24 小时内血糖处于 3.9-10.0mmol/L 范围内的时间百分比。同时评估了血糖变异性（GV）的指标。DR 通过眼底照相确定，并分为 )非 DR； )轻度非增殖性 DR（NPDR）； )中度 NPDR；或 )威胁视力的 DR（VTDR）。
结果
DR 的总体患病率为 23.9%（轻度 NPDR 为 10.9%，中度 NPDR 为 6.1%，VTDR 为 6.9%）。DR 更严重的患者 TIR 显著降低，GV 指标显著升高（所有趋势检验<0.01）。基于严重程度的 DR 患病率随 TIR 四分位的升高而降低（所有趋势检验<0.001），DR 的严重程度与 TIR 四分位呈负相关（ = -0.147；<0.001）。多分类逻辑回归显示，在控制年龄、性别、BMI、糖尿病病程、血压、血脂谱和 HbA 后，TIR 与所有阶段的 DR 均有显著关联（轻度 NPDR， = 0.018；中度 NPDR， = 0.014；VTDR， = 0.019）。进一步调整 GV 指标部分减弱了这些关联，但 TIR 与任何 DR 存在之间的关联仍然显著。
结论
CGM 评估的 TIR 与 2 型糖尿病患者的 DR 相关。
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