在真实环境中，1 型糖尿病成人的连续血糖监测指标与临床结局之间的关系。

Association between continuous glucose monitoring metrics and clinical outcomes in adults with type 1 diabetes in a real-world setting.

机构信息

University of Colorado Anschutz, Aurora, CO 80045, USA.

Eli Lilly and Company, Indianapolis, IN 46285, USA.

出版信息

Diabetes Res Clin Pract. 2024 Jun;212:111690. doi: 10.1016/j.diabres.2024.111690. Epub 2024 May 1.

DOI:10.1016/j.diabres.2024.111690

PMID:38697300

Abstract

AIMS

Continuous glucose monitoring (CGM) metrics can assist diabetes management. Consensus statements recommend > 70 % time in range (TIR) and ≤ 36 % glucose coefficient of variation (CV). However, how these targets perform in clinical practice is unknown. This retrospective, longitudinal cohort study analyzed relationships between TIR, CV, glycated hemoglobin (HbA1c), and hypoglycemia in a real-world setting.

METHODS

Data of 542 adults with type 1 diabetes who used CGM (January 2014-July 2020) were analyzed. Associations between TIR and HbA1c at the same and subsequent visits, incidence rate ratios (IRRs) for hypoglycemia at different CVs, and number of hypoglycemic events at cross-sections of HbA1c and CV were estimated by regression.

RESULTS

TIR was inversely related to HbA1c; for every 10 % increase in TIR, HbA1c was significantly reduced by 0.34 % (4 mmol/mol) and 0.20 % (2 mmol/mol) at the same and subsequent visits, respectively. Level 2 hypoglycemia was significantly reduced at CV < 30 %, 30-33 %, 33.1-36 %, and 36.1-40 %: adjusted IRRs vs CV ≥ 40.1 % of 0.14, 0.28, 0.32, and 0.50, respectively. Hypoglycemic events were reduced at lower CV across HbA1c levels and at higher HbA1c across CV levels.

CONCLUSION

This study quantifies HbA1c improvements with increased TIR and hypoglycemia reductions with improved CV in clinical practice.

摘要

目的

连续血糖监测（CGM）指标可辅助糖尿病管理。共识声明建议将>70%时间的血糖处于目标范围（TIR）和≤36%血糖变异系数（CV）作为目标。然而，这些目标在临床实践中的表现如何尚不清楚。本回顾性、纵向队列研究分析了 TIR、CV、糖化血红蛋白（HbA1c）和低血糖在真实环境中的关系。

方法

分析了 542 例使用 CGM 的 1 型糖尿病成人患者（2014 年 1 月至 2020 年 7 月）的数据。通过回归分析，评估了 TIR 与同一和后续就诊时 HbA1c 之间的相关性、不同 CV 下低血糖的发生率比（IRR），以及 HbA1c 和 CV 交叉点处低血糖事件的数量。

结果

TIR 与 HbA1c 呈负相关；TIR 每增加 10%，同一和后续就诊时 HbA1c 分别显著降低 0.34%（4mmol/mol）和 0.20%（2mmol/mol）。CV<30%、30-33%、33.1-36%和 36.1-40%时，2 级低血糖显著减少：与 CV≥40.1%相比，调整后的 IRR 分别为 0.14、0.28、0.32 和 0.50。在较低的 CV 水平下，随着 HbA1c 水平的降低，低血糖事件减少；在较高的 HbA1c 水平下，随着 CV 水平的升高，低血糖事件减少。