中国 2 型糖尿病患者血糖控制的新型测量指标——达标时间与胰岛分泌功能的相关性：一项观察性研究。

Association between time in range, a novel measurement of glycemic control and islet secretory function in chinese patients with type 2 diabetes mellitus-An observational study.

机构信息

Department of Endocrinology, Jinling Hospital, Southeast University, School of Medicine, Nanjing, Jiangsu, China.

Department of Internal Medicine, Guangdong Second Provincial General Hospital, Guangzhou, Guangdong, China.

出版信息

Diabetes Res Clin Pract. 2021 Mar;173:108684. doi: 10.1016/j.diabres.2021.108684. Epub 2021 Feb 1.

DOI:10.1016/j.diabres.2021.108684

PMID:33539867

Abstract

AIMS

To explore the association between dynamic islet secretory function and TIR (time in range), a new valuable metric of glycemic control in type 2 diabetes (T2D).

METHODS

In this observational study 256 patients with type 2 diabetes were included and continuous glucose monitoring system (CGMS) were applied to monitor blood glucose and also the calculation of TIR [the time spent in an individual's target glucose range (usually 3.9-10 mmol/L)]. The participants were divided into 3 groups according to the tertiles of TIR, 85 cases with TIR ≥ 65.05% (T1 group), 86 cases with 41.84 < TIR ≤ 65.05% (T2 group) and 85 cases with TIR < 41.84% (T3 group). Serum glucagon (GLA, GLA, GLA, GLA, GLA), C-peptide (Cp, Cp, Cp, Cp, Cp) concentration at different time points were measured after a 100 g standard steamed buns meal test to assess the pancreatic alpha cell and beta cell function. Spearman correlation analysis and multivariate linear stepwise regression analysis were adopted for statistical analysis.

RESULTS

The average age and diabetes duration of all the participants were separately 56.09 ± 13.8 years and 8.0 (4.0,15.0) years. Compared with patients in T1 group, participants in group T2 and T3 tend to have a lower concentration of C-peptide at all time points, as well as GLA, GLA and GLA (p < 0.05). TIR was positively correlated with C-peptide at different time points, area under the curve of C-peptide in half an hour (AUC), GLA, GLA, area under the curve of glucagon in half an hour (AUC)(r = 0.263, 0.414, 0.510, 0.587, 0.528, 0.360, 0.259, 0.144 and 0.208, respectively, p < 0.05) and was negatively correlated with the increment of serum glucagon from baseline at 0.5 h, 1 h and 2 h after the standard energy loaded(△GLA, △GLA, △GLA)(r = -0.152,-0.172 and -0.203, respectively, p < 0.05). Cp, Cp and GLA were independent factors for TIR (β = 6.558,-6.930, 0.247, respectively, p < 0.01).

CONCLUSION

Both islet alpha cell and beta cell secretory function have important influence on TIR, a novel vital index of glycemic fluctuation.

摘要

目的

探讨动态胰岛分泌功能与血糖控制新指标时间在目标范围内（TIR）之间的关系。

方法

本观察性研究纳入了 256 例 2 型糖尿病患者，应用连续血糖监测系统（CGMS）监测血糖，并计算 TIR [个体目标血糖范围内的时间（通常为 3.9-10mmol/L）]。根据 TIR 的三分位值，将参与者分为 3 组，TIR≥65.05%（T1 组）的 85 例，41.84<TIR≤65.05%（T2 组）的 86 例，TIR<41.84%（T3 组）的 85 例。在 100g 标准馒头餐后，检测不同时间点的血清胰高血糖素（GLA、GLA、GLA、GLA、GLA）和 C 肽（Cp、Cp、Cp、Cp、Cp）浓度，评估胰岛α细胞和β细胞功能。采用 Spearman 相关分析和多元线性逐步回归分析进行统计学分析。

结果

所有参与者的平均年龄和糖尿病病程分别为 56.09±13.8 岁和 8.0（4.0，15.0）年。与 T1 组相比，T2 组和 T3 组患者在各时间点的 C 肽浓度以及 GLA、GLA 和 GLA 均较低（p<0.05）。TIR 与不同时间点的 C 肽呈正相关，C 肽半小时曲线下面积（AUC）、GLA、GLA、半小时胰高血糖素 AUC（r=0.263、0.414、0.510、0.587、0.528、0.360、0.259、0.144 和 0.208，p<0.05），与餐后 0.5、1、2 小时血清胰高血糖素增加值呈负相关（r=-0.152、-0.172 和-0.203，p<0.05）。C 肽、Cp 和 GLA 是 TIR 的独立影响因素（β=6.558、-6.930、0.247，p<0.01）。