Department of General Medicine, Ramaiah Medical College, Bengaluru, Karnataka, India.
Department of Endocrinology, Ramaiah Medical College, Bengaluru, Karnataka, India.
Ann Afr Med. 2024 Jan-Mar;23(1):19-24. doi: 10.4103/aam.aam_117_23.
Time in range (TIR), a metric of continuous glucose monitoring (CGM) provides better information regarding the individual's glycemic variability than a static measure like glycated hemoglobin (HbA1c). TIR is emerging as an independent risk factor for diabetic complications, both microvascular and macrovascular complications independent of HbA1c. Hence, this study evaluates the association between TIR and cardiac autonomic neuropathy (CAN) in type 2 diabetic patients.
A total of 42 patients with type 2 diabetes mellitus were enrolled in this study and underwent a 3-day CGM using the "FreeStyle Libre Pro Flash Glucose Monitoring System Sensor" along with tests for CAN within the 3 days of attaching the CGM.
Out of 42 patients, 36 patients (85.7%) were diagnosed with CAN (early CAN 57.1% and definite CAN 28.6%) and the mean TIR was 64.4% ±23.5%. Out of those with TIR <70%, 42.9% were affected with definite CAN compared to only 14.3% among those with TIR >70%. Patients with more severe CAN were found to have a lower TIR (P = 0.115).
The study found a high prevalence of cardiac autonomic neuropathy (CAN) of around 85.7% in type 2 diabetes patients. Lower TIR values were associated with a higher incidence of definite CAN (42.9% vs. 14.3% in TIR <70% vs. >70% groups). The findings suggest TIR is inversely associated with the presence and severity of cardiac autonomic neuropathy in type 2 diabetic patients and also a potential link between TIR and CAN severity.
时间在范围内（TIR），连续血糖监测（CGM）的一项指标，比糖化血红蛋白（HbA1c）等静态指标提供了更好的个体血糖变异性信息。TIR 作为糖尿病并发症的独立危险因素正在显现，包括微血管和大血管并发症，与 HbA1c 无关。因此，本研究评估了 TIR 与 2 型糖尿病患者心脏自主神经病变（CAN）之间的相关性。
本研究共纳入 42 例 2 型糖尿病患者，使用“FreeStyle Libre Pro 闪光血糖监测系统传感器”进行 3 天 CGM，并在 3 天内附着 CGM 进行 CAN 测试。
42 例患者中，36 例（85.7%）被诊断为 CAN（早期 CAN 占 57.1%，明确 CAN 占 28.6%），平均 TIR 为 64.4%±23.5%。在 TIR<70%的患者中，42.9%患有明确的 CAN，而在 TIR>70%的患者中，这一比例仅为 14.3%。发现更严重的 CAN 患者 TIR 较低（P=0.115）。
本研究发现 2 型糖尿病患者的心脏自主神经病变（CAN）患病率高达 85.7%左右。较低的 TIR 值与明确 CAN 的发生率较高相关（TIR<70%组的发生率为 42.9%，而 TIR>70%组的发生率为 14.3%）。研究结果表明，TIR 与 2 型糖尿病患者心脏自主神经病变的存在和严重程度呈负相关，TIR 与 CAN 严重程度之间也存在潜在联系。
