Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, Pikeville Medical Center, Pikeville, Kentucky, USA
Department of Internal Medicine, University of Pikeville Kentucky College of Osteopathic Medicine, Pikeville, Kentucky, USA.
BMJ Open Diabetes Res Care. 2022 Jan;10(1). doi: 10.1136/bmjdrc-2021-002573.
Continuous glucose monitoring (CGM)-derived time in range (TIR) correlates with hemoglobin A1c (A1c) among patients with type 2 diabetes mellitus (T2DM); however, there is a paucity of data evaluating its association with microvascular complications. We conducted this systematic review to examine the association between TIR and microvascular complications of diabetic retinopathy (DR), diabetic nephropathy (DN), and diabetic peripheral neuropathy (DPN). We conducted a comprehensive literature search on PubMed, Scopus, and Web of Science online databases following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Full-text original articles that evaluated the association between CGM-derived TIR and risk of microvascular complications and were published between 2010 and June 2021 were included in our systematic review. The quality of the included studies was evaluated using the National Heart, Lung, and Blood Institute Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Data were analyzed using qualitative synthesis. Eleven studies on a total of 13 987 patients were included in the systematic review. The median sample size, baseline A1c, and diabetes duration were 466 patients (range: 105-5901), 8.2% (SD 0.5%), and 11.3 years (1.0), respectively. Majority of the studies were conducted in Asia (10 out of 11). Four studies evaluated the relationship between CGM-derived TIR and DR and CGM-derived TIR and DN, while seven studies evaluated the relationship between CGM-derived TIR and DPN. A 10% increase in TIR was associated with a reduction in albuminuria, severity of DR, and prevalence of DPN and cardiac autonomic neuropathy. In addition, an association was observed between urinary albumin to creatinine ratio but not with estimated glomerular filtration rate. This review summarizes recent evidence supporting an association between CGM-derived TIR and microvascular complications among patients with T2DM. A larger-scale multicenter investigation that includes more diverse participants is warranted to further validate the utility of TIR as a predictor of diabetic microvascular complications.
连续血糖监测 (CGM) 得出的时间范围内 (TIR) 与 2 型糖尿病 (T2DM) 患者的糖化血红蛋白 (A1c) 相关；然而，评估其与微血管并发症关联的数据却很少。我们进行了这项系统评价，以研究 TIR 与糖尿病视网膜病变 (DR)、糖尿病肾病 (DN) 和糖尿病周围神经病变 (DPN) 的微血管并发症之间的关联。我们按照系统评价和荟萃分析的首选报告项目的指南，在 PubMed、Scopus 和 Web of Science 在线数据库上进行了全面的文献检索。纳入了评估 CGM 衍生的 TIR 与微血管并发症风险之间关联的全文原始文章，且这些文章的发表时间在 2010 年至 2021 年 6 月之间。我们的系统评价纳入了 11 项研究，共计 13987 名患者。纳入研究的质量使用国家心肺血液研究所的观察性队列和横断面研究质量评估工具进行评估。使用定性综合法进行数据分析。系统评价纳入了 11 项研究，共 13987 名患者。其中中位数样本量、基线 A1c 和糖尿病病程分别为 466 例（范围：105-5901）、8.2%（标准差 0.5%）和 11.3 年（1.0）。11 项研究中有 10 项在亚洲进行。4 项研究评估了 CGM 衍生的 TIR 与 DR 之间的关系以及 CGM 衍生的 TIR 与 DN 之间的关系，而 7 项研究评估了 CGM 衍生的 TIR 与 DPN 之间的关系。TIR 增加 10%与白蛋白尿减少、DR 严重程度和 DPN 及心脏自主神经病变的患病率降低相关。此外，还观察到尿白蛋白与肌酐比值之间存在关联，但与估算肾小球滤过率无关。本综述总结了支持 CGM 衍生的 TIR 与 T2DM 患者微血管并发症之间存在关联的最新证据。需要更大规模的多中心研究，纳入更多不同的参与者，以进一步验证 TIR 作为糖尿病微血管并发症预测因子的效用。
