Department of Endocrinology, Institute of Endocrine and Metabolic Diseases, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, Clinical Research Hospital of Chinese Academy of Sciences (Hefei), Hefei, Anhui, China.
Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, China.
J Diabetes. 2023 Jun;15(6):465-473. doi: 10.1111/1753-0407.13388. Epub 2023 May 4.
AIM: Evidence for contribution of basal and postprandial glucose increment, and glycemic variability to glycated hemoglobin (HbA1c) among adults with type 1 diabetes (T1D) is limited. This study aimed to capture glycemic fluctuation patterns and quantify contributions of these factors to HbA1c levels among adults with T1D. METHODS: HbA1c, continuous glucose monitoring (CGM), and diet diaries were collected and pooled from two clinical trials. Available data sets were divided into HbA1c quartiles: group 1 (≤6.7%), group 2 (6.7%-7.3%), group 3 (7.3%-7.8%), and group 4 (≥7.8%). Area under curve above 110 mg/dL (AUC ) in 24-h profile was defined as overall hyperglycemia and stratified with postprandial hyperglycemia (PHG, AUC in 3-h period after meals) and basal hyperglycemia (BHG, AUC in remaining period). Linear regression analysis was used to estimate the proportion of variance in HbA1c explained by BHG, preprandial glucose, PHG, glycemic variability, and non-glycemic factors (age, body mass index, hemoglobin, and duration). RESULTS: A total of 169 550 glucose data in 2409 meals recorded from 102 patients (male/female, 34/68) were included. Age and duration were 35.2 ± 12.6 and 8.9 (2.9, 13.0) years, with 51.0% using pumps. Overall, BHG was four times higher than PHG (p all <.05) and between-group comparisons showed BHG exhibited a progressive increase (group 1 vs. 2, 3, 4, p = .053, .086, .006) with fasting contribution of 76.1%, 82.6%, 81.5%, and 84.3% from group 1 to 4. The increment was not significant among groups 2, 3, and 4 (p > .05). Factors included in analysis explained a total of 74% of the variance in HbA1c, in which BHG accounted for 32.1% of variance whereas PHG accounted for 24.4%. In group with HbA1c >7.3%, BHG accounted for a higher percentage with 33.8% of the variance in HbA1c. CONCLUSIONS: In our study, basal hyperglycemia better predicts overall glycemic control than postprandial hyperglycemia among adults with T1D. The relative contribution of basal hyperglycemia increased gradually with HbA1c increasing and predominant strategy for insulin titration among T1D is different among different levels of glycemic control.
目的：1 型糖尿病（T1D）成人中，关于基础和餐后血糖增量以及血糖变异性对糖化血红蛋白（HbA1c）的贡献的证据有限。本研究旨在捕捉血糖波动模式，并量化这些因素对 T1D 成人 HbA1c 水平的贡献。
方法：从两项临床试验中收集并汇总了 HbA1c、连续血糖监测（CGM）和饮食日记的数据。可利用的数据组分为 HbA1c 四分位数：组 1（≤6.7%）、组 2（6.7%-7.3%）、组 3（7.3%-7.8%）和组 4（≥7.8%）。24 小时谱中的 AUC 超过 110mg/dL 定义为总体高血糖，并分层为餐后高血糖（PHG，餐后 3 小时期间的 AUC）和基础高血糖（BHG，剩余时间内的 AUC）。线性回归分析用于估计 BHG、餐前血糖、PHG、血糖变异性和非血糖因素（年龄、体重指数、血红蛋白和病程）对 HbA1c 变异的解释比例。
结果：共纳入 102 例患者（男/女，34/68）2409 餐 169550 个葡萄糖数据。年龄和病程分别为 35.2±12.6 和 8.9（2.9，13.0）年，51.0%使用胰岛素泵。总体而言，BHG 是 PHG 的四倍（p 均<.05），组间比较显示 BHG 呈逐渐升高趋势（组 1 与 2、3、4 相比，p=.053、.086、.006），空腹时从组 1 到 4 的贡献分别为 76.1%、82.6%、81.5%和 84.3%。组 2、3 和 4 之间的增量无显著差异（p>.05）。分析中纳入的因素共解释了 HbA1c 总变异的 74%，其中 BHG 占 32.1%，PHG 占 24.4%。在 HbA1c＞7.3%的组中，BHG 占 HbA1c 变异的百分比更高，为 33.8%。
结论：在我们的研究中，基础高血糖比 T1D 成人的餐后高血糖更好地预测总体血糖控制。基础高血糖的相对贡献随着 HbA1c 的增加而逐渐增加，并且 T1D 中胰岛素滴定的主要策略在不同的血糖控制水平之间存在差异。
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