Campbell Matthew D, West Daniel J, O'Mahoney Lauren L, Pearson Sam, Kietsiriroje Noppadol, Holmes Mel, Ajjan Ramzi A
Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, SR1 3SD UK.
Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
J Diabetes Metab Disord. 2022 Mar 31;21(1):573-581. doi: 10.1007/s40200-022-01015-1. eCollection 2022 Jun.
PURPOSE: The exact contribution of daily glucose exposure to HbA1c in people with type 1 diabetes (T1D) remains controversial. We examined the contribution of pre- and postprandial glycaemia, nocturnal and early-morning glycaemia, and glycaemic variability to HbA1c levels in T1D. In this analysis, we used clinical data, namely age, BMI and HbA1c, as well as glycaemic metrics (24-h glycaemia, postprandial, nocturnal, early-morning glycaemia, wake-up glucose, and glycaemic variability) obtained over a four-week period of continuous glucose monitoring (CGM) wear in thirty-two males with T1D. METHODS: The trapezoid method was used estimate the incremental area under the glucose curve (iAUC) for 24-h, postprandial (3-h period following breakfast, lunch, and dinner, respectively), nocturnal (between 24:00-04:00 AM), and early-morning (2-h period 2-h prior to wake-up) glycaemia. Linear regression analysis was employed whereby CGM-derived glycaemic metrics were explanatory variables and HbA1c was the outcome. RESULTS: Thirty-two T1D males (mean ± SD: age 29 ± 4 years; HbA1c 7.3 ± 0.9% [56 ± 13 mmol/mol]; BMI 25.80 ± 5.01 kg/m) were included in this analysis. In linear models adjusted for age and BMI, HbA1c was associated with 24-h mean glucose ( = 0.735, < 0.001), SD ( = 0.643, = 0.039), and dinner iAUC ( = 0.711, = 0.001). CGM-derived metrics and non-glycaemic factors explained 77% of the variance in HbA1c, in which postprandial glucose accounted for 32% of the variance explained. The single greatest contributor to HbA1c was dinner iAUC resulting in 0.6%-point (~7 mmol/mol) increase in HbA1c per SD increase in dinner iAUC. CONCLUSIONS: Using comprehensive CGM profiling, we show that postprandial glucose, specifically evening-time postprandial glucose, is the single largest contributing factor to HbA1c in T1D. TRIAL REGISTRATION NUMBER: NCT02204839 (July 30th 2014); NCT02595658 (November 3rd 2015).
目的:每日血糖暴露对1型糖尿病(T1D)患者糖化血红蛋白(HbA1c)的确切影响仍存在争议。我们研究了1型糖尿病患者的餐前和餐后血糖、夜间和清晨血糖以及血糖变异性对HbA1c水平的影响。在本分析中,我们使用了临床数据,即年龄、体重指数(BMI)和HbA1c,以及在32名患有T1D的男性连续佩戴四周动态血糖监测(CGM)期间获得的血糖指标(24小时血糖、餐后血糖、夜间血糖、清晨血糖、起床时血糖和血糖变异性)。 方法:采用梯形法估算24小时、餐后(分别为早餐、午餐和晚餐后3小时)、夜间(凌晨00:00 - 04:00之间)和清晨(起床前2小时)血糖的葡萄糖曲线下增量面积(iAUC)。采用线性回归分析,将CGM得出的血糖指标作为解释变量,HbA1c作为结果变量。 结果:本分析纳入了32名T1D男性(平均±标准差:年龄29±4岁;HbA1c 7.3±0.9% [56±13 mmol/mol];BMI 25.80±5.01 kg/m²)。在根据年龄和BMI进行调整的线性模型中,HbA1c与24小时平均血糖(β = 0.735,P < 0.001)、标准差(β = 0.643,P = 0.039)和晚餐iAUC(β = 0.711,P = 0.001)相关。CGM得出的指标和非血糖因素解释了HbA1c变异的77%,其中餐后血糖占所解释变异的32%。对HbA1c影响最大的单一因素是晚餐iAUC,晚餐iAUC每增加1个标准差,HbA1c增加0.6个百分点(约7 mmol/mol)。 结论:通过全面的CGM分析,我们表明餐后血糖,特别是晚餐后血糖,是1型糖尿病患者HbA1c的单一最大影响因素。 试验注册号:NCT02204839(2014年7月30日);NCT02595658(2015年11月3日)。
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