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[评估2型糖尿病血糖控制的合适血糖波动幅度(TIR)时间截点]

[The appropriate cut-off point of time in range (TIR) for evaluating glucose control in type 2 diabetes mellitus].

作者信息

Dai D J, Lu J Y, Zhang L, Shen Y, Mo Y F, Lu W, Zhu W, Bao Y Q, Zhou J

机构信息

Department of Endocrinology and Metabolism, the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai Clinical Center for Diabetes, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai 200233, China.

出版信息

Zhonghua Yi Xue Za Zhi. 2020 Oct 20;100(38):2990-2996. doi: 10.3760/cma.j.cn112137-20200619-01895.

Abstract

To investigate the appropriate cut-off point of time in range (TIR) for evaluating glucose control in type 2 diabetes mellitus (T2DM) patients, and analyze the prevalence of abnormal carotid intima-media thickness (CIMT) and diabetic retinopathy (DR) in different TIR categories. A total of 2 161 subjects with T2DM (1 183 males) were enrolled from hospitalized patients at the Department of Endocrinology and Metabolism of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University from January 2005 to February 2012. The age of the enrolled participants was (60.4±11.9) years. Each patient underwent continuous glucose monitoring (CGM) for three consecutive days, then TIR (3.9-10.0 mmol/L), time above range (TAR) and time below range (TBR) were calculated. Fundus photography and carotid artery Doppler ultrasound were performed to diagnose DR and abnormal CIMT (defined as CIMT≥1.0 mm), respectively. Multivariate logistic regression models were used to examine the independent association of different TIR groups with CIMT and DR. All subjects were divided into 4 groups according to TIR:≤40%, 41%-70%, 71%-85% and>85%. Significant linear trends in age, diabetes duration, body mass index (BMI), total cholesterol, glycated hemoglobin A1c (HbA1c), TAR and mean glucose (MG) existed among the 4 groups (all P(trend)<0.05). However, there was only a weak correlation between TIR and TBR (<3.9 mmol/L) (0.087, 0.001), and no significant association was observed between TBR (<3 mmol/L) and the TIR categories (P(trend)=0.378). The overall prevalence of abnormal CIMT and DR was 12.1% and 23.8%, respectively. The prevalence of abnormal CIMT in the 4 groups with ascending levels of TIR was 16.9% (59/349), 12.9% (96/746), 11.2% (57/510) and 9.0% (50/556) (P(trend)<0.001), respectively. And the prevalence of DR was 30.7% (107/349), 29.4% (219/746), 20.8% (106/510) and 14.9% (83/556), respectively (P(trend)<0.001). In the binary logistic regression model by adjusting confounding factors, compared with TIR≤ 40%, the risk of abnormal CIMT was reduced by 33.8% (0.662, 95: 0.456-0.963, 0.031), 40.8% (0.592, 95: 0.390-0.899, 0.014), and 45.0% (0.550, 95: 0.358-0.846, 0.006) in the other three groups, respectively. And the risk of DR was reduced by 2.9% (0.971, 95: 0.725-1.301, 0.844), 33.4%(0.666, 95: 0.479-0.924, 0.015) and 53.3% (0.467, 95: 0.331-0.657, 0.001), respectively. Using 40%, 70% and 85% as cut-off point of TIR helps stratify the risk of diabetic complications, and assess the glucose control (Poor: TIR≤40%; Unsatisfactory: TIR≤70%; Satisfactory: TIR>70%; Optimal: TIR>85%) in patients with T2DM.

摘要

为探讨评估2型糖尿病(T2DM)患者血糖控制的合适的血糖波动幅度(TIR)切点,并分析不同TIR类别中颈动脉内膜中层厚度(CIMT)异常和糖尿病视网膜病变(DR)的患病率。2005年1月至2012年2月期间,从上海交通大学附属第六人民医院内分泌代谢科住院患者中纳入了2161例T2DM患者(1183例男性)。纳入参与者的年龄为(60.4±11.9)岁。每位患者连续三天进行动态血糖监测(CGM),然后计算TIR(3.9-10.0 mmol/L)、高于目标范围时间(TAR)和低于目标范围时间(TBR)。分别进行眼底照相和颈动脉多普勒超声检查以诊断DR和CIMT异常(定义为CIMT≥1.0 mm)。采用多因素logistic回归模型检验不同TIR组与CIMT和DR的独立关联。所有受试者根据TIR分为4组:≤40%、41%-70%、71%-85%和>85%。4组患者在年龄、糖尿病病程、体重指数(BMI)、总胆固醇、糖化血红蛋白A1c(HbA1c)、TAR和平均血糖(MG)方面存在显著的线性趋势(所有P趋势<0.05)。然而,TIR与TBR(<3.9 mmol/L)之间仅存在弱相关性(0.087,P=0.001),且未观察到TBR(<3 mmol/L)与TIR类别之间存在显著关联(P趋势=0.378)。CIMT异常和DR的总体患病率分别为12.1%和23.8%。TIR水平升高的4组中CIMT异常的患病率分别为16.9%(59/349)、12.9%(96/746)、11.2%(57/510)和9.0%(50/556)(P趋势<0.001)。DR的患病率分别为30.7%(107/349)、29.4%(219/746)、20.8%(106/510)和14.9%(83/556)(P趋势<0.001)。在调整混杂因素的二元logistic回归模型中,与TIR≤40%相比,其他三组中CIMT异常的风险分别降低了33.8%(OR=0.662,95%CI:0.456-0.963,P=0.031)、40.8%(OR=0.592,95%CI:0.390-0.899,P=0.014)和45.0%(OR=0.550,95%CI:0.358-0.846,P=0.006)。DR的风险分别降低了2.9%(OR=0.971,95%CI:0.725-1.301,P=0.844)、33.4%(OR=0.666,95%CI:0.479-0.924,P=0.015)和53.3%(OR=0.467,95%CI:0.

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