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.
Diabetes Res Clin Pract. 2020 Mar;161:108032. doi: 10.1016/j.diabres.2020.108032. Epub 2020 Jan 30.
Although there is a linear relationship between time in range (TIR) and hemoglobin A1c (HbA1c), a great variability of calculated TIR values for a given HbA1c, and vice versa, has been reported. Whether glycemic variability accounts for part of this variability remains to be investigated.
The data of continuous glucose monitoring (CGM) from 2559 patients with type 2 diabetes was analyzed. Glycemic variability was assessed by glucose coefficient of variation (CV), and estimated HbA1C (eHbA1c) was calculated from mean sensor glucose.
A strong correlation between TIR and eHbA1c (r = -0.908) was observed. The slopes of regression lines fitted to TIR values as a function of eHbA1c differed significantly for individuals with varying degrees of CV, especially when patients were stratified as stable (CV < 36%) or unstable (CV ≥ 36%) glucose levels. For patients in the high- or low-range of eHbA1c, there was a high variability of TIR values according to CV.
Glycemic variability significantly mediates the relationship between TIR and eHbA1c, and should be taken into consideration when setting an individualized target of TIR.
尽管时间在目标范围内（TIR）与糖化血红蛋白（HbA1c）之间存在线性关系，但已报道对于给定的 HbA1c，计算出的 TIR 值存在很大的变异性，反之亦然。血糖变异性是否部分解释了这种变异性仍有待研究。
分析了 2559 例 2 型糖尿病患者的连续血糖监测（CGM）数据。通过血糖变异系数（CV）评估血糖变异性，并从平均传感器血糖计算估算的 HbA1c（eHbA1c）。
观察到 TIR 与 eHbA1c 之间存在很强的相关性（r = -0.908）。对于 CV 不同的个体，拟合 TIR 值作为 eHbA1c 函数的回归线斜率差异显著，尤其是当患者分层为稳定（CV < 36%）或不稳定（CV ≥ 36%）血糖水平时。对于 eHbA1c 处于高或低范围的患者，根据 CV，TIR 值的变异性很大。
血糖变异性显著调节 TIR 与 eHbA1c 之间的关系，在设定个体化 TIR 目标时应考虑到这一点。
