Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
Diabetes Technol Ther. 2020 Oct;22(10):768-776. doi: 10.1089/dia.2019.0499. Epub 2020 Apr 13.
As the use of continuous glucose monitoring (CGM) has increased, time in range (TIR) and other core CGM metrics are now emerging as the core metrics for clinical targets and assessing diabetic complications, beyond HbA1c. This study investigated the association between the CGM-derived TIR, hyperglycemia, hypoglycemia metrics, and albuminuria. A total of 866 subjects with type 2 diabetes who underwent 3 or 6 days of CGM and had urinary albumin-to-creatinine ratio (ACR) measurements were retrospectively reviewed. CGM metrics were defined according to the most recent international consensus. Albuminuria was defined as one or more of the ACR measurements being >30 mg/g. The overall prevalence of albuminuria was 36.6%. The prevalence of albuminuria was lower in subjects who achieved the target of TIR 70-180 mg/dL, time above range (TAR) >180 mg/dL, and TAR >250 mg/dL, as recommended by international consensus ( < 0.001). Multiple logistic regression analysis revealed that the odds ratio of having albuminuria was 0.94 (95% confidence interval: 0.88-0.99, for trend = 0.04) per 10% increase in TIR of 70-180 mg/dL, after adjusting for multiple factors, including glycemic variability. The results were similar for hyperglycemia metrics (TAR >250 mg/dL and TAR >180 mg/dL). TIR 70-180 mg/dL and hyperglycemia metrics are strongly associated with albuminuria in type 2 diabetes.
随着连续血糖监测（CGM）的应用增加，时间在目标范围内（TIR）和其他核心 CGM 指标现在已经成为除 HbA1c 之外评估糖尿病并发症和临床目标的核心指标。本研究调查了 CGM 衍生的 TIR、高血糖、低血糖指标与白蛋白尿之间的关系。回顾性分析了 866 例接受 3 或 6 天 CGM 检查且尿白蛋白与肌酐比值（ACR）测量值的 2 型糖尿病患者。CGM 指标根据最新的国际共识进行定义。白蛋白尿定义为 ACR 测量值中一项或多项>30mg/g。白蛋白尿的总体患病率为 36.6%。在达到 TIR 70-180mg/dL、TAR>180mg/dL 和 TAR>250mg/dL 的目标的患者中，白蛋白尿的患病率较低，符合国际共识建议（<0.001）。多因素逻辑回归分析显示，在调整了包括血糖变异性在内的多种因素后，TIR 70-180mg/dL 每增加 10%，白蛋白尿的比值比为 0.94（95%置信区间：0.88-0.99，趋势=0.04）。对于 TAR>250mg/dL 和 TAR>180mg/dL 的高血糖指标，结果相似。TIR 70-180mg/dL 和高血糖指标与 2 型糖尿病患者的白蛋白尿密切相关。
