Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, The Second Xiangya Hospital of Central South University, Changsha, China.
Department of Urology, The Third Xiangya Hospital of Central South University, Changsha, China.
J Diabetes Investig. 2022 Mar;13(3):552-559. doi: 10.1111/jdi.13693. Epub 2021 Nov 7.
AIMS/INTRODUCTION: We aimed to explore the clinical factors associated with glycemic variability (GV) assessed with flash glucose monitoring (FGM), and investigate the impact of FGM on glycemic control among Chinese type 1 diabetes mellitus patients in a real-life clinical setting.
A total of 171 patients were included. GV was assessed from FGM data. A total of 110 patients wore FGM continuously for 6 months (longitudinal cohort). Hemoglobin A1c (HbA1c), fasting and 2-h postprandial C-peptide, and glucose profiles were collected. Changes in HbA1c and glycemic parameters were assessed during a 6-month FGM period.
Individuals with high residual C-peptide (HRCP; 2-h postprandial C-peptide >200 pmol/L) had less GV than patients with low residual C-peptide ( 2-h postprandial C-peptide ≤200 pmol/L; P < 0.001). In the longitudinal cohort (n = 110), HbA1c and mean glucose decreased, time in range (TIR) increased during the follow-up period (P < 0.05). The 110 patients were further divided into age and residual C-peptide subgroups: (i) HbA1c and mean glucose were reduced significantly only in the subgroup aged ≤14 years during the follow-up period, whereas time below range also increased in this subgroup at 3 months (P = 0.047); and (ii) HbA1c improved in the HRCP subgroup at 3 and 6 months (P < 0.05). The mean glucose decreased and TIR improved significantly in the low residual C-peptide subgroup; however, TIR was still lower and time below range was higher than those of the HRCP subgroup at all time points (P < 0.05).
HRCP was associated with less GV. FGM wearing significantly reduced HbA1c, especially in pediatric patients and those with HRCP. Additionally, the mean glucose and TIR were also found to improve.
目的/引言：本研究旨在探讨使用瞬态血糖监测（FGM）评估的血糖变异性（GV）与临床因素的关系，并研究 FGM 对中国 1 型糖尿病患者血糖控制的影响。
共纳入 171 例患者。从 FGM 数据中评估 GV。共有 110 例患者连续佩戴 FGM 6 个月（纵向队列）。收集糖化血红蛋白（HbA1c）、空腹和餐后 2 小时 C 肽及血糖谱。评估 6 个月 FGM 期间 HbA1c 和血糖参数的变化。
与低残余 C 肽（2 小时餐后 C 肽≤200pmol/L）患者相比，高残余 C 肽（2 小时餐后 C 肽>200pmol/L）患者的 GV 更小（P<0.001）。在纵向队列（n=110）中，HbA1c 和平均血糖降低，期间范围内时间（TIR）增加（P<0.05）。110 例患者进一步分为年龄和残余 C 肽亚组：（i）在随访期间，仅≤14 岁亚组的 HbA1c 和平均血糖显著降低，而该亚组的血糖低于范围时间在 3 个月时也增加（P=0.047）；（ii）在 HRCP 亚组中，HbA1c 在 3 个月和 6 个月时改善（P<0.05）。低残余 C 肽亚组的平均血糖降低，TIR 显著改善；然而，在所有时间点，TIR 仍然低于 HRCP 亚组，血糖低于范围的时间也高于 HRCP 亚组（P<0.05）。
HRCP 与较小的 GV 相关。FGM 佩戴显著降低 HbA1c，特别是在儿科患者和 HRCP 患者中。此外，平均血糖和 TIR 也有所改善。
