Sebastian-Valles Fernando, Martínez-Alfonso Julia, Arranz Martin Jose Alfonso, Jiménez-Díaz Jessica, Hernando Alday Iñigo, Navas-Moreno Victor, Armenta-Joya Teresa, Fandiño García Maria Del Mar, Román Gómez Gisela Liz, Garai Hierro Jon, Lobariñas Luis Eduardo Lander, González-Ávila Carmen, Martinez de Icaya Purificación, Martínez-Vizcaíno Vicente, Marazuela Mónica, Sampedro-Nuñez Miguel Antonio
Department of Endocrinology and Nutrition, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid, Madrid, 28006, Spain.
Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Hospital Universitario de La Princesa, Talca, Chile.
Acta Diabetol. 2025 Feb;62(2):205-214. doi: 10.1007/s00592-024-02347-5. Epub 2024 Aug 6.
This study aimed to investigate the association between glucose metrics and diabetic retinopathy in type 1 diabetes (T1D) patients using flash continuous glucose monitoring (FGM) systems, including those maintaining glycated hemoglobin (HbA1c) within the target range.
We conducted a cross-sectional study involving 1070 T1D patients utilizing FGM systems. Data on clinical, anthropometric, and socioeconomic characteristics were collected and retinopathy was classified based on international standards.
Patients' mean age was 47.6 ± 15.0 years, with 49.4% of them being females. Within the cohort, 24.8% of patients presented some form of retinopathy. In the analysis involving the entire sample of subjects, male gender (OR = 1.51, p = 0.027), Time Above Range (TAR) > 250 mg/dL (OR = 1.07, p = 0.025), duration of diabetes (OR = 1.09, p < 0.001), smoking (OR = 2.30, p < 0.001), and history of ischemic stroke (OR = 5.59, p = 0.025) were associated with diabetic retinopathy. No association was observed between the coefficient of variation and diabetic retinopathy (p = 0.934). In patients with HbA1c < 7%, the highest quartile of TAR > 250 was independently linked to diabetic retinopathy (OR = 8.32, p = 0.040), in addition to smoking (OR = 2.90, p = 0.031), duration of diabetes (OR = 1.09, p < 0.001), and hypertension (OR = 2.35, p = 0.040).
TAR > 250 mg/dL significantly emerges as a modifiable factor associated with diabetic retinopathy, even among those patients maintaining recommended HbA1c levels. Understanding glucose metrics is crucial for tailoring treatment strategies for T1D patients.
本研究旨在使用闪光连续血糖监测（FGM）系统调查1型糖尿病（T1D）患者的血糖指标与糖尿病视网膜病变之间的关联，包括那些糖化血红蛋白（HbA1c）维持在目标范围内的患者。
我们开展了一项横断面研究，纳入了1070例使用FGM系统的T1D患者。收集了临床、人体测量学和社会经济特征数据，并根据国际标准对视网膜病变进行分类。
患者的平均年龄为47.6±15.0岁，其中49.4%为女性。在该队列中，24.8%的患者出现了某种形式的视网膜病变。在涉及所有受试者样本的分析中，男性（比值比[OR]=1.51，p=0.027）、血糖高于目标范围时间（TAR）>250mg/dL（OR=1.07，p=0.025）、糖尿病病程（OR=1.09，p<0.001）、吸烟（OR=2.30，p<0.001）和缺血性中风病史（OR=5.59，p=0.025）与糖尿病视网膜病变相关。未观察到变异系数与糖尿病视网膜病变之间存在关联（p=0.934）。在HbA1c<7%的患者中，除吸烟（OR=2.90，p=0.031）、糖尿病病程（OR=1.09，p<0.001）和高血压（OR=2.35，p=0.040）外，TAR>250的最高四分位数与糖尿病视网膜病变独立相关（OR=8.32，p=0.040）。
即使在那些维持推荐HbA1c水平的患者中，TAR>250mg/dL也显著成为与糖尿病视网膜病变相关的一个可改变因素。了解血糖指标对于为T1D患者制定治疗策略至关重要。
