Liu Yiwen, Yu Jie, Ma Chifa, He Shuli, Ping Fan, Zhang Huabing, Li Wei, Xu Lingling, Xiao Xinhua, Li Yuxiu
Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Department of Nutrition, Peking Union Medical College Hospital, Beijing, China.
Ann Transl Med. 2021 Apr;9(7):537. doi: 10.21037/atm-20-6344.
We aimed to investigate the associations of flash glucose monitoring (FGM)-derived metrics with lipid profiles and identify potential modifiers of these associations among adults with type 1 diabetes (T1D).
A cross-sectional study was conducted among 108 Chinese adults with T1D who used FGM for 14 consecutive days. The relationship between FGM-derived metrics and lipid variables and potential modifiers were identified using interaction and subgroup analysis.
Serum triglyceride level inversely correlated with time below range (glucose <3.9 mmol/L) and time in range (glucose 3.9-10.0 mmol/L) and positively correlated with time above range (glucose >10.0 mmol/L) (Spearman's r=-0.34, -0.25, 0.34, respectively, all P<0.01). Additionally, triglyceride levels had positive correlation with absolute measures of glycemic variability (GV) but not with the coefficient of variation for glucose (Spearman's r=0.12, P>0.05), a relative measure. Multivariate linear regression analysis adjusting for potential confounders including gender, age, disease duration, body mass index (BMI), daily insulin dose, fasting C-peptide, and dyslipidemia medication use showed that higher triglyceride level independently predicted decrease in time below range and time in range and increase in time above range (all P<0.01). Furthermore, interaction analysis found that the interaction between HbA1c and triglyceride was significant in the time below range (P for interaction =0.034). The association between triglyceride and time below range differed substantially after stratification by HbA1c, which was significant in those with HbA1c <7.0% whereas inconsequential among those with HbA1c ≥7.0%. In those with HbA1c <7.0% (n=44), the area under receiver operating characteristic curve of triglyceride predicting achievement of targets of time below range (<4%) was 0.856 (95% confidence interval 0.688-1.000, P=0.042) with an optimal cutoff value of 0.50 mmol/L (sensitivity 100%, specificity 66.7%, positive predictive value 94.4%).
In adults with T1D, HbA1c may be a potential modifier of the association between triglyceride and time below range, suggesting it might be necessary for those with HbA1c <7.0% accompanied by lower triglyceride levels to set a less intensive glycemic target to minimize risk of hypoglycemia.
我们旨在研究动态血糖监测（FGM）得出的指标与血脂谱之间的关联，并确定1型糖尿病（T1D）成人中这些关联的潜在调节因素。
对108名连续14天使用FGM的中国T1D成年患者进行了一项横断面研究。使用交互作用和亚组分析确定FGM得出的指标与血脂变量及潜在调节因素之间的关系。
血清甘油三酯水平与血糖低于范围的时间（血糖<3.9 mmol/L）和血糖在范围内的时间（血糖3.9 - 10.0 mmol/L）呈负相关，与血糖高于范围的时间（血糖>10.0 mmol/L）呈正相关（斯皮尔曼相关系数r分别为-0.34、-0.25、0.34，均P<0.01）。此外，甘油三酯水平与血糖变异性（GV）的绝对指标呈正相关，但与血糖变异系数（相对指标）无相关性（斯皮尔曼相关系数r = 0.12，P>0.05）。对包括性别、年龄、病程、体重指数（BMI）、每日胰岛素剂量、空腹C肽和血脂异常用药等潜在混杂因素进行校正的多变量线性回归分析显示，较高的甘油三酯水平独立预测血糖低于范围的时间和血糖在范围内的时间减少，以及血糖高于范围的时间增加（均P<0.01）。此外，交互作用分析发现，糖化血红蛋白（HbA1c）与甘油三酯之间的交互作用在血糖低于范围的时间方面具有统计学意义（交互作用P = 0.034）。按HbA1c分层后，甘油三酯与血糖低于范围的时间之间的关联存在显著差异，在HbA1c<7.0%的患者中具有统计学意义，而在HbA1c≥7.0%的患者中无统计学意义。在HbA1c<7.0%（n = 44）的患者中，甘油三酯预测血糖低于范围目标（<4%）达成情况的受试者工作特征曲线下面积为0.856（95%置信区间0.688 - 1.000，P = 0.042），最佳截断值为0.50 mmol/L（敏感性100%，特异性66.7%，阳性预测值94.4%）。
在T1D成人患者中，HbA1c可能是甘油三酯与血糖低于范围时间之间关联的潜在调节因素，这表明对于HbA1c<7.0%且甘油三酯水平较低的患者，可能有必要设定强度较低的血糖目标以将低血糖风险降至最低。
