Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden.
Diabetes Technol Ther. 2021 Jun;23(6):425-433. doi: 10.1089/dia.2020.0577.
Although guidelines advocate similar continuous glucose monitoring (CGM) targets for insulin-treated persons with type 1 diabetes (T1D) and type 2 diabetes (T2D), it is unclear how these persons differ with respect to hypoglycemia, glucose variability, and other CGM metrics in clinical practice. We used data from 2 multicenter randomized-controlled trials (GOLD and MDI-Liraglutide) where 161 persons with T1D and 124 persons with T2D treated with multiple daily injections were included and monitored with masked CGM. Persons from both cohorts had similar mean glucose levels, 10.9 mmol/L (196 mg/dL) in persons with T1D and 10.8 mmol/L (194 mg/dL) in persons with T2D. Time in hypoglycemia (<3.9 mmol/L [70 mg/dL]) was 5.1% and 1.0% for persons with T1D and T2D, respectively ( < 0.001). Corresponding estimates for the standard deviations of mean glucose levels were 4.4 mmol/L (79 mg/dL) versus 3.0 (54 mg/dL) ( < 0.001), for coefficient of variation 41% versus 28% ( < 0.001), and for time in range 38.2% versus 45.3%, respectively ( = 0.004). Mean C-peptide levels were 0.05 nmol/L and 0.67 nmol/L ( < 0.001) for persons with T1D and T2D, respectively. Persons with T1D compared with persons with T2D treated with multiple daily insulin injections spend considerably more time in hypoglycemia, have higher glucose variability, and less "time in range." This needs to be taken into account in daily clinical care and in recommended targets for CGM metrics.
虽然指南提倡类似的持续血糖监测（CGM）目标用于胰岛素治疗的 1 型糖尿病（T1D）和 2 型糖尿病（T2D）患者，但在临床实践中，这些患者在低血糖、血糖变异性和其他 CGM 指标方面的差异尚不清楚。我们使用了来自 2 项多中心随机对照试验（GOLD 和 MDI-Liraglutide）的数据，其中包括 161 名 T1D 患者和 124 名接受多次每日注射治疗的 T2D 患者，并使用掩蔽 CGM 进行监测。来自两个队列的患者平均血糖水平相似，T1D 患者为 10.9mmol/L（196mg/dL），T2D 患者为 10.8mmol/L（194mg/dL）。T1D 患者低血糖（<3.9mmol/L [70mg/dL]）时间为 5.1%，T2D 患者为 1.0%（ < 0.001）。平均血糖水平标准差的相应估计值分别为 4.4mmol/L（79mg/dL）与 3.0mmol/L（54mg/dL）（ < 0.001），变异系数分别为 41%与 28%（ < 0.001），血糖达标时间分别为 38.2%与 45.3%（ = 0.004）。T1D 患者的平均 C 肽水平为 0.05nmol/L，T2D 患者为 0.67nmol/L（ < 0.001）。与接受多次每日胰岛素注射治疗的 T2D 患者相比，T1D 患者低血糖时间明显更长，血糖变异性更高，血糖达标时间更少。在日常临床护理和 CGM 指标的推荐目标中，需要考虑到这一点。
