Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Centro de Investigación de Endocrinologia y Nutricion Clinica (CIENC). Facultad de Medicina, Universidad de Valladolid,., Valladolid, Spain.
J Diabetes Sci Technol. 2024 Sep;18(5):1063-1069. doi: 10.1177/19322968231154561. Epub 2023 Feb 16.
To evaluate the glycemia risk index (GRI) as a new glucometry in pediatric and adult populations with type 1 diabetes (T1D) in clinical practice.
A cross-sectional study of 202 patients with T1D receiving intensive treatment with insulin (25.2% continuous subcutaneous insulin infusion [CSII]) and intermittent scanning (flash) glucose monitoring (isCGM). Clinical and glucometric isCGM data were collected, as well as the component of hypoglycemia (CHypo) and component of hyperglycemia (CHyper) of the GRI.
A total of 202 patients (53% males and 67.8% adults) with a mean age of 28.6 ± 15.7 years and 12.5 ± 10.9 years of T1D evolution were evaluated.Adult patients (>19 years) presented higher glycated hemoglobin (HbA1c) (7.4 ± 1.1 vs 6.7 ± 0.6%; < .01) and lower time in range (TIR) (55.4 ± 17.5 vs 66.5 ± 13.1%; < .01) values than the pediatric population, with lower coefficient of variation (CV) (38.6 ± 7.2 vs 42.4 ± 8.9%; < .05). The GRI was significantly lower in pediatric patients (48.0 ± 22.2 vs 56.8 ± 23.4; < .05) associated with higher CHypo (7.1 ± 5.1 vs 5.0 ± 4.5; < .01) and lower CHyper (16.8 ± 9.8 vs 26.5 ± 15.1; < .01) than in adults.When analyzing treatment with CSII compared with multiple doses of insulin (MDI), a nonsignificant trend to a lower GRI was observed in CSII (51.0 ± 15.3 vs 55.0 ± 25.4; = .162), with higher levels of CHypo (6.5 ± 4.1 vs 5.4 ± 5.0; < .01) and lower CHyper (19.6 ± 10.6 vs 24.6 ± 15.2; < .05) compared with MDI.
In pediatric patients and in those with CSII treatment, despite a better control by classical and GRI parameters, higher overall CHypo was observed than in adults and MDI, respectively. The present study supports the usefulness of the GRI as a new glucometric parameter to evaluate the global risk of hypoglycemia-hyperglycemia in both pediatric and adult patients with T1D.
评估血糖风险指数（GRI）作为一种新的葡萄糖检测方法，用于评估儿科和成人 1 型糖尿病（T1D）患者的临床实践。
这是一项横断面研究，共纳入 202 例接受胰岛素强化治疗（25.2%持续皮下胰岛素输注[CSII]）和间歇性扫描（闪光）血糖监测（isCGM）的 T1D 患者。收集临床和葡萄糖 isCGM 数据，以及 GRI 的低血糖（CHypo）和高血糖（CHyper）成分。
共评估了 202 例患者（53%为男性，67.8%为成年人），平均年龄为 28.6±15.7 岁和 12.5±10.9 岁，平均 T1D 病程为 12.5±10.9 年。成人（>19 岁）患者的糖化血红蛋白（HbA1c）（7.4±1.1%比 6.7±0.6%；<.01）和时间在目标范围内（TIR）（55.4±17.5%比 66.5±13.1%；<.01）值低于儿科人群，变异系数（CV）（38.6±7.2%比 42.4±8.9%；<.05）较低。儿科患者的 GRI 显著低于成人（48.0±22.2 比 56.8±23.4；<.05），与更高的 CHypo（7.1±5.1 比 5.0±4.5；<.01）和更低的 CHyper（16.8±9.8 比 26.5±15.1；<.01）有关。与多次胰岛素注射（MDI）相比，分析 CSII 治疗时，CSII 组的 GRI 呈下降趋势，但无统计学意义（51.0±15.3 比 55.0±25.4；=162），CHypo 水平较高（6.5±4.1 比 5.4±5.0；<.01），CHyper 水平较低（19.6±10.6 比 24.6±15.2；<.05）。
在儿科患者和接受 CSII 治疗的患者中，尽管经典参数和 GRI 均显示出更好的控制，但与成人和 MDI 相比，CHypo 的总体发生率更高。本研究支持 GRI 作为一种新的葡萄糖检测参数，用于评估儿科和成人 T1D 患者的低血糖-高血糖整体风险。
