Department of Endocrinology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
Endocrinology Department, Eastern Health, Melbourne, Victoria, Australia.
J Diabetes. 2023 Feb;15(2):133-144. doi: 10.1111/1753-0407.13355. Epub 2023 Jan 17.
Tight glycemic control during short-term intensive insulin therapy (SIIT) is critical for inducing diabetes remission in patients with newly diagnosed type 2 diabetes (T2D). This work aimed to investigate the role of time in range (TIR) during SIIT as a novel glycemic target by predicting clinical outcomes.
SIIT was given to 116 patients with newly diagnosed T2D, with daily eight-point capillary glucose monitored. Glycemic targets (fasting/premeal glucose, 3.9-6.0 mmol/L; 2 h postprandial blood glucose, 3.9-7.8 mmol/L) were achieved and maintained for 2 weeks. TIR was calculated as the percentage of glucose points within these glycemic targets during the maintenance period and was compared to TIR and TIR . Acute insulin response (AIR), HOMA-IR, HOMA-B, and disposition index (DI) were measured. Patients were followed up for 1 year to observe clinical outcomes.
TIR , TIR , and TIR were 67.2 ± 11.2%, 80.8 ± 9.2%, and 90.1 ± 6.2%, respectively. After SIIT, β-cell function and insulin sensitivity improved remarkably, and the 1-year remission rate was 55.2%. △AIR and △DI were positively correlated with all the TIR values, whereas only TIR was correlated with △HOMA-IR (r = -0.22, p = 0.03). Higher TIR but not TIR or TIR was robustly associated with diabetes remission; patients in the lower TIR tertile had an elevated risk of hyperglycemia relapse (hazard ratio 3.4, 95% confidence interval 1.6-7.2， p = .001). Only those with TIR ≥ 65% had a one-year remission rate of over 60%.
These findings advocate TIR ≥ 65% as a novel glycemic target during SIIT for clinical decision-making.
在新诊断的 2 型糖尿病（T2D）患者中，短期强化胰岛素治疗（SIIT）期间严格的血糖控制对于诱导糖尿病缓解至关重要。本研究旨在通过预测临床结局来探讨 SIIT 期间时间在目标范围内（TIR）作为新的血糖目标的作用。
对 116 例新诊断的 T2D 患者进行 SIIT，每日监测 8 点毛细血管血糖。血糖目标（空腹/餐前血糖，3.9-6.0mmol/L；餐后 2 小时血糖，3.9-7.8mmol/L）被实现并维持 2 周。TIR 定义为维持期内血糖达标范围内的葡萄糖点百分比，并与 TIR 和 TIR 进行比较。急性胰岛素反应（AIR）、HOMA-IR、HOMA-B 和处置指数（DI）进行测量。患者随访 1 年以观察临床结局。
TIR 、TIR 和 TIR 分别为 67.2±11.2%、80.8±9.2%和 90.1±6.2%。SIIT 后，β细胞功能和胰岛素敏感性显著改善，1 年缓解率为 55.2%。△AIR 和△DI 与所有 TIR 值呈正相关，而仅 TIR 与△HOMA-IR 相关（r=−0.22，p=0.03）。较高的 TIR 而非 TIR 或 TIR 与糖尿病缓解显著相关；TIR 较低三分位的患者发生高血糖复发的风险升高（危险比 3.4，95%置信区间 1.6-7.2，p=0.001）。只有 TIR ≥ 65%的患者 1 年缓解率超过 60%。
这些发现支持 TIR ≥ 65%作为 SIIT 期间新的血糖目标用于临床决策。
