Division of Endocrinology and Metabolism, Department of Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Division of Endocrinology and Metabolism, Department of Medicine, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gwangmyeong, Korea.
Diabetes Metab J. 2024 May;48(3):429-439. doi: 10.4093/dmj.2023.0083. Epub 2024 Mar 4.
This study investigated the optimal coefficient of variance (%CV) for preventing hypoglycemia based on real-time continuous glucose monitoring (rt-CGM) data in people with type 1 diabetes mellitus (T1DM) already achieving their mean glucose (MG) target.
Data from 172 subjects who underwent rt-CGM for at least 90 days and for whom 439 90-day glycemic profiles were available were analyzed. Receiver operator characteristic analysis was conducted to determine the cut-off value of %CV to achieve time below range (%TBR)<54 mg/dL <1 and =0.
Overall mean glycosylated hemoglobin was 6.8% and median %TBR<54 mg/dL was 0.2%. MG was significantly higher and %CV significantly lower in profiles achieving %TBR<54 mg/dL <1 compared to %TBR<54 mg/dL ≥1 (all P<0.001). The cut-off value of %CV for achieving %TBR<54 mg/dL <1 was 37.5%, 37.3%, and 31.0%, in the whole population, MG >135 mg/dL, and ≤135 mg/dL, respectively. The cut-off value for %TBR<54 mg/dL=0% was 29.2% in MG ≤135 mg/dL. In profiles with MG ≤135 mg/dL, 94.2% of profiles with a %CV <31 achieved the target of %TBR<54 mg/dL <1, and 97.3% with a %CV <29.2 achieved the target of %TBR<54 mg/ dL=0%. When MG was >135 mg/dL, 99.4% of profiles with a %CV <37.3 achieved %TBR<54 mg/dL <1.
In well-controlled T1DM with MG ≤135 mg/dL, we suggest a %CV <31% to achieve the %TBR<54 mg/dL <1 target. Furthermore, we suggest a %CV <29.2% to achieve the target of %TBR<54 mg/dL =0 for people at high risk of hypoglycemia.
本研究旨在基于 1 型糖尿病（T1DM）患者的实时连续血糖监测（rt-CGM）数据，探讨预防低血糖的最佳变异系数（%CV），这些患者已经达到平均血糖（MG）目标。
对至少接受 90 天 rt-CGM 且有 439 个 90 天血糖谱的 172 名受试者的数据进行分析。采用受试者工作特征分析确定 CV%的截断值，以实现时间低于范围（%TBR）<54mg/dL<1 和 =0。
总体平均糖化血红蛋白为 6.8%，中位%TBR<54mg/dL 为 0.2%。与%TBR<54mg/dL≥1 相比，%TBR<54mg/dL<1 的血糖谱中 MG 显著升高，%CV 显著降低（均 P<0.001）。在整个人群中，MG>135mg/dL 和≤135mg/dL 时，实现%TBR<54mg/dL<1 的%CV 截断值分别为 37.5%、37.3%和 31.0%。在 MG≤135mg/dL 时，%TBR<54mg/dL=0%的截断值为 29.2%。在 MG≤135mg/dL 的血糖谱中，94.2%的%CV<31 的血糖谱达到%TBR<54mg/dL<1 的目标，97.3%的%CV<29.2%的血糖谱达到%TBR<54mg/dL=0%的目标。当 MG>135mg/dL 时，99.4%的%CV<37.3%的血糖谱达到%TBR<54mg/dL<1。
在 MG≤135mg/dL 的血糖控制良好的 T1DM 中，我们建议将%CV<31%作为实现%TBR<54mg/dL<1 目标的指标。此外，对于低血糖风险较高的患者，我们建议将%CV<29.2%作为实现%TBR<54mg/dL=0%的目标。
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