Xie Puguang, Deng Bo, Zhang Xi, Li Yuyao, Du Chenzhen, Rui Shunli, Deng Wu, Boey Johnson, Armstrong David G, Ma Yu, Deng Wuquan
Department of Endocrinology, College of Medicine, College of Bioengineering, Chongqing Emergency Medical Center, Chongqing University Central Hospital, Chongqing University, Chongqing, China.
College of Electronic Information and Automation, Civil Aviation University of China, Tianjin, China.
Diabetes Metab Res Rev. 2022 Feb;38(2):e3498. doi: 10.1002/dmrr.3498. Epub 2021 Oct 8.
The aim of this study was to evaluate the association of time in range (TIR) with amputation and all-cause mortality in hospitalised patients with diabetic foot ulcers (DFUs).
A retrospective analysis was performed on 303 hospitalised patients with DFUs. During hospitalisation, TIR, mean blood glucose (MBG), coefficient of variation (CV), time above range (TAR) and time below range (TBR) of patients were determined from seven-point blood glucose profiles. Participants were grouped based on their clinical outcomes (i.e., amputation and death). Logistic regression was employed to analyse the association of TIR with amputation and all-cause mortality of inpatients with DFUs.
Among the 303 enrolled patients, 50 (16.5%) had undergone amputation whereas seven (2.3%) were deceased. Blood glucose was determined in 41,012 samples obtained from all participants. Patients who underwent amputation had significantly lower TIR and higher MBG, CV, level 2 TAR and level 1 TBR whereas deceased patients had significantly lower TIR and higher MBG and level 2 TAR. Both amputation and all-cause mortality rate declined with an increase in TIR quartiles. Logistic regression showed association of TIR with amputation (p = 0.034) and all-cause mortality (p = 0.013) after controlling for 15 confounders. This association was similarly significant in all-cause mortality after further adjustment for CV (p = 0.022) and level 1 TBR (p = 0.021), respectively.
TIR is inversely associated with amputation and all-cause mortality of hospitalised patients with DFUs. Further prospective studies are warranted to establish a causal relationship between TIR and clinical outcomes in patients with DFUs.
本研究旨在评估住院糖尿病足溃疡（DFU）患者的血糖达标时间（TIR）与截肢及全因死亡率之间的关联。
对303例住院DFU患者进行回顾性分析。住院期间，根据七点血糖谱确定患者的TIR、平均血糖（MBG）、变异系数（CV）、高于目标范围时间（TAR）和低于目标范围时间（TBR）。参与者根据其临床结局（即截肢和死亡）进行分组。采用逻辑回归分析TIR与住院DFU患者截肢及全因死亡率之间的关联。
在303例纳入研究的患者中，50例（16.5%）接受了截肢手术，7例（2.3%）死亡。从所有参与者中获取了41012份血糖样本。接受截肢手术的患者TIR显著降低，MBG、CV、2级TAR和1级TBR升高；而死亡患者TIR显著降低，MBG和2级TAR升高。随着TIR四分位数的增加，截肢率和全因死亡率均下降。在控制了15个混杂因素后，逻辑回归显示TIR与截肢（p = 0.034）和全因死亡率（p = 0.013）相关。在进一步分别调整CV（p = 0.022）和1级TBR（p = 0.021）后，这种关联在全因死亡率中同样显著。
TIR与住院DFU患者的截肢及全因死亡率呈负相关。有必要进行进一步的前瞻性研究，以确定DFU患者TIR与临床结局之间的因果关系。
