Tidemand Katrine Grønbæk, Laugesen Christian, Ranjan Ajenthen Gayathri, Skovhus Liv Boelskifte, Nørgaard Kirsten
Steno Diabetes Center Copenhagen, Copenhagen University Hospital, Herlev, Denmark.
Departement of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Diabetes Technol Ther. 2025 Jan;27(1):60-65. doi: 10.1089/dia.2024.0134. Epub 2024 Aug 7.
For people with type 1 diabetes (T1D), ensuring fast and effective recovery from hypoglycemia while avoiding posthypoglycemic hyperglycemia (rebound hyperglycemia, RH) can be challenging. The objective of this study was to investigate the frequency of RH across different treatment modalities and its impact on glycemic control. This cross-sectional real-world study included adults with T1D using continuous glucose monitoring and attending the outpatient clinic at Steno Diabetes Center Copenhagen. RH was defined as ≥1 sensor glucose value (SG) >10.0 mmol/L (180 mg/dL) starting within 2 h of an antecedent SG <3.9 mmol/L (70 mg/dL). The severity of the RH events was calculated as area under the curve (AUC) and separately for users of multiple daily injections (MDIs), unintegrated insulin pumps, sensor augmented pumps (SAPs), and automated insulin delivery (AID), respectively. Across the four groups, SAP and AID users had the highest incidence of RH (2.06 ± 1.65 and 2.08 ± 1.49 events per week, respectively) and a similar percentage of hypoglycemic events leading to RH events (41.3 ± 22.8% and 39.6 ± 20.1%, respectively). The AID users with RH events were significantly shorter compared with MDI users (122 ± 72 vs. 185 ± 135 min; < 0.0001). Overall, severity of RH was inversely associated with more advanced technology ( < 0.001) and inversely associated ( < 0.001) with time in target range (TIR). Groups with insulin suspension features experienced the highest frequency of RH; however, AID users tended to experience shorter and less severe RH events. The association between the severity of RH events and TIR suggests that RH should be assessed and used in the guidance of hypoglycemia management.
对于1型糖尿病（T1D）患者而言，确保低血糖快速有效恢复同时避免低血糖后高血糖（反弹性高血糖，RH）颇具挑战性。本研究的目的是调查不同治疗方式下RH的发生频率及其对血糖控制的影响。这项横断面真实世界研究纳入了使用持续葡萄糖监测且在哥本哈根斯滕诺糖尿病中心门诊就诊的成年T1D患者。RH定义为在前驱血糖<3.9 mmol/L（70 mg/dL）后的2小时内，≥1个传感器葡萄糖值（SG）>10.0 mmol/L（180 mg/dL）。分别针对多次皮下注射（MDI）使用者、非集成胰岛素泵使用者、传感器增强型泵（SAP）使用者和自动胰岛素给药（AID）使用者，计算RH事件的严重程度，以曲线下面积（AUC）表示。在这四组中，SAP和AID使用者的RH发生率最高（分别为每周2.06±1.65次和2.08±1.49次事件），且导致RH事件的低血糖事件百分比相似（分别为41.3±22.8%和39.6±20.1%）。发生RH事件的AID使用者与MDI使用者相比，显著缩短（122±72 vs. 185±135分钟；<0.0001）。总体而言，RH的严重程度与更先进的技术呈负相关（<0.001），与目标范围内时间（TIR）呈负相关（<0.001）。具有胰岛素悬浮功能的组RH发生频率最高；然而，AID使用者发生的RH事件往往持续时间更短、严重程度更低。RH事件严重程度与TIR之间的关联表明，应评估RH并将其用于低血糖管理的指导。
