2 型糖尿病患者的血糖管理指标（GMI）表现。
Performance of the Glucose Management Indicator (GMI) in Type 2 Diabetes.
机构信息
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Division of Endocrinology, Diabetes and Metabolism, Johns Hopkins School of Medicine, Baltimore, MD, USA.
出版信息
Clin Chem. 2023 Apr 3;69(4):422-428. doi: 10.1093/clinchem/hvac210.
BACKGROUND
The glucose management indicator (GMI) is an estimated measure of hemoglobin A1c (HbA1c) recommended for the management of persons with diabetes using continuous glucose monitoring (CGM). However, GMI was derived primarily in young adults with type 1 diabetes, and its performance in patients with type 2 diabetes is poorly characterized.
METHODS
We conducted a prospective cohort study in 144 adults with obstructive sleep apnea and type 2 diabetes not using insulin (mean age: 59.4 years; 45.1% female). HbA1c was measured at the study screening visit. Participants simultaneously wore 2 CGM sensors (Dexcom G4 and Abbott Libre Pro) for up to 4 weeks (2 weeks at baseline and 2 weeks at the 3-month follow-up visit). GMI was calculated using all available CGM data for each sensor.
RESULTS
Median wear time was 27 days (IQR: 23-29) for the Dexcom G4 and 28 days (IQR: 24-29) for the Libre Pro. The mean difference between HbA1c and GMI was small (0.12-0.14 percentage points) (approximately 2 mmol/mol). However, the 2 measures were only moderately correlated (r = 0.68-0.71), and there was substantial variability in GMI at any given value of HbA1c (root mean squared error: 0.66-0.69 percentage points [7 to 8 mmol/mol]). Between 36% and 43% of participants had an absolute difference between HbA1c and GMI ≥0.5 percentage points (≥5 mmol/mol), and 9% to 18% had an absolute difference >1 percentage points (>11 mmol/mol). Discordance was higher in the Libre Pro than the Dexcom G4.
CONCLUSIONS
GMI may be an unreliable measure of glycemic control for patients with type 2 diabetes and should be interpreted cautiously in clinical practice.Clinicaltrials.gov Registration Number: NCT02454153.
背景
血糖管理指标（GMI）是一种用于使用连续血糖监测（CGM）管理糖尿病患者的估计糖化血红蛋白（HbA1c）的指标。然而，GMI 主要是在患有 1 型糖尿病的年轻成年人中推导出来的，其在 2 型糖尿病患者中的表现特征描述不佳。
方法
我们对 144 名患有阻塞性睡眠呼吸暂停且未使用胰岛素的 2 型糖尿病成年人（平均年龄：59.4 岁；45.1%为女性）进行了一项前瞻性队列研究。在研究筛查就诊时测量了 HbA1c。参与者同时佩戴 2 个 CGM 传感器（Dexcom G4 和 Abbott Libre Pro）长达 4 周（基线 2 周和 3 个月随访就诊 2 周）。使用每个传感器的所有可用 CGM 数据计算 GMI。
结果
Dexcom G4 的中位佩戴时间为 27 天（IQR：23-29），Libre Pro 的中位佩戴时间为 28 天（IQR：24-29）。HbA1c 与 GMI 之间的平均差异较小（0.12-0.14 个百分点）（约 2 mmol/mol）。然而，这 2 种测量方法仅中度相关（r = 0.68-0.71），并且在任何给定的 HbA1c 值下 GMI 都存在很大的变异性（均方根误差：0.66-0.69 个百分点[7 至 8 mmol/mol]）。36%至 43%的参与者的 HbA1c 与 GMI 之间的绝对差值≥0.5 个百分点（≥5 mmol/mol），9%至 18%的参与者的绝对差值>1 个百分点（>11 mmol/mol）。Libre Pro 中的差异大于 Dexcom G4。
结论
对于 2 型糖尿病患者，GMI 可能是一种不可靠的血糖控制测量方法，在临床实践中应谨慎解释。临床试验注册编号：NCT02454153。
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