Institute of Clinical Research, University of Montpellier, Montpellier, France.
Institute of Clinical Research, University of Montpellier, Montpellier, France.
Diabetes Metab. 2021 Mar;47(2):101173. doi: 10.1016/j.diabet.2020.06.004. Epub 2020 Jun 16.
This review aims to address the issue of whether or not the newer metrics, developed for continuous glucose monitoring [real-time CGM (rtCGM), intermittently scanned CGM (isCGM)], enhance assessment of the "glucose tetrad": Ambient hyperglycaemia, short-term glycaemic variability, postprandial glucose excursions and hypoglycaemia. The ever-increasing number of metrics offered with rtCGM and isCGM includes intermediate-term indicators referred to as "time in range" (TIR), the time spent in the range of 70-180mg/dL (TIR 70-180); time spent above the range of 180mg/dL (TAR>180); and time spent below the range of 70mg/dL or 54mg/dL (TBR<70 or TBR<54). The former two values are strongly correlated with HbA1c levels and can therefore serve as short- or medium-term markers of ambient hyperglycaemia, depending on whether glucose sensors are worn over periods of several days or weeks, respectively, whereas the latter indices (TBR<70 or<54) are more relevant for capturing hypoglycaemic events and quantifying their magnitude and duration, in contrast to random spot testing with self-monitoring of blood glucose. Nevertheless, although analyses of 24h glucose profiles by CGM provide a highly valuable method for quantifying postprandial glucose excursions and short-term glycaemic variability, neither of these factors can be fully represented by such TIR metrics. Thus, other metrics are clearly needed for more comprehensive assessment of glucose homoeostasis.
本综述旨在探讨新的指标是否能更好地评估“血糖四联征”:环境高血糖、短期血糖变异性、餐后血糖波动和低血糖。实时 CGM(rtCGM)和间歇性扫描 CGM(isCGM)提供的指标数量不断增加,其中包括被称为“血糖达标时间”(TIR)的中期指标,即 70-180mg/dL 范围内的时间(TIR 70-180);超过 180mg/dL 范围的时间(TAR>180);以及低于 70mg/dL 或 54mg/dL 的时间(TBR<70 或 TBR<54)。前两个值与 HbA1c 水平密切相关,因此可分别作为短期或中期环境高血糖的标志物,具体取决于血糖传感器分别佩戴数天或数周。而后两个指数(TBR<70 或<54)则更能捕捉低血糖事件并量化其幅度和持续时间,与自我监测的随机血糖检测相比。然而,尽管 CGM 分析 24 小时血糖谱提供了一种量化餐后血糖波动和短期血糖变异性的非常有价值的方法,但这些因素都不能完全由 TIR 指标来表示。因此,显然需要其他指标来更全面地评估血糖稳态。