Maia Ariana, Subias Andujar David, Yuste Cristina, Albert Lara, Vilaverde Joana, Cardoso Maria Helena, Rigla Mercedes
Serviço de Endocrinologia, Diabetes e Metabolismo, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
Endocrinology Department, Parc Taulí Hospital Universitari, Sabadell, Spain.
J Diabetes Sci Technol. 2024 Mar 19:19322968241236456. doi: 10.1177/19322968241236456.
Hybrid closed-loop systems (HCLS) use has shown that time in range (TIR) tends to improve more during the nighttime than during the day. This study aims to compare the conventional TIR, currently accepted as 70 to 180 mg/dL, with a proposed recalculated time in range (RTIR) considering a tighter glucose target of 70 to 140 mg/dL for the nighttime fasting period in T1DM patients under HCLS.
We conducted a retrospective study that included adults patients receiving treatment with Tandem t:slim X2 Control-IQ. Daytime TIR was characterized as glucose values between 70 and 180 mg/dL during the 07:01 to 23:59 time frame. Nighttime fasting TIR was specified as glucose values from 70 to 140 mg/dL between 00:00 and 07:00. The combination of the daytime and nighttime fasting glucose targets results in an RTIR, which was compared with the conventional TIR for each patient. The 14 days Dexcom G6 CGM data were downloaded from Tidepool platform and analyzed.
We included 22 patients with a mean age of 49.7 years and diabetes duration of 24.7 years, who had been using automatic insulin delivery (AID) HCLS for a median of 305.3 days. We verified a mean conventional TIR of 68.7% vs a mean RTIR of 60.3%, with a mean percentage difference between these two metrics of -8.4%. A significant decrease in conventional TIR was verified when tighter glucose targets were considered during the nighttime period. No significant correlation was found between the percentage difference values and RTIR, even among the group of patients with the lowest conventional TIR.
Currently, meeting the conventional TIR metrics may fall short of achieving an ideal level of glycemic control. An individualized strategy should be adopted until further data become available for a precise definition of optimal glucose targets.
混合闭环系统（HCLS）的使用表明，血糖在目标范围内（TIR）的时间在夜间往往比白天改善得更多。本研究旨在比较传统的TIR（目前认为是70至180mg/dL）与重新计算的血糖在目标范围内的时间（RTIR），后者考虑了1型糖尿病（T1DM）患者在HCLS下夜间禁食期更严格的血糖目标70至140mg/dL。
我们进行了一项回顾性研究，纳入了接受Tandem t:slim X2 Control-IQ治疗的成年患者。白天的TIR定义为07:01至23:59时间段内70至180mg/dL的血糖值。夜间禁食TIR定义为00:00至07:00之间70至140mg/dL的血糖值。白天和夜间禁食血糖目标的组合得出RTIR，并将其与每位患者的传统TIR进行比较。从Tidepool平台下载并分析了14天的德康G6连续血糖监测（CGM）数据。
我们纳入22名患者纳入研究，平均年龄49.7岁，糖尿病病程24.7年，使用自动胰岛素输送（AID）HCLS的中位时间为305.3天。我们验证了传统TIR的平均水平为68.7%，而RTIR的平均水平为60.3%，这两个指标之间的平均百分比差异为-8.4%。当在夜间考虑更严格的血糖目标时，传统TIR显著降低。即使在传统TIR最低的患者组中，百分比差异值与RTIR之间也未发现显著相关性。
目前，达到传统TIR指标可能不足以实现理想的血糖控制水平。在获得进一步数据以精确界定最佳血糖目标之前，应采用个体化策略。
