Semenova Julia F, Yushin Anton Yu, Korbut Anton I, Klimontov Vadim V
Laboratory of Endocrinology, Research Institute of Clinical and Experimental Lymphology-Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences (RICEL-Branch of IC&G SB RAS), 630060 Novosibirsk, Russia.
Biomedicines. 2024 Sep 3;12(9):2006. doi: 10.3390/biomedicines12092006.
The prevalence of overweight and obesity increases in people with type 1 diabetes (T1D). However, the impact of fat accumulation on glucose dynamics in T1D is poorly understood. We assessed continuous glucose monitoring (CGM) parameters in patients with T1D depending on their body weight, body composition, and insulin sensitivity. In 547 patients, including 238 overweight/obese individuals, CGM-derived time in range (TIR) and glucose variability (GV) were estimated. Body composition was assessed by DXA. Estimated glucose disposal rate (eGDR) was used as an indicator of insulin sensitivity. Overweight/obese patients, when compared to normal-weight ones, have a lower time below range (TBR) (<3 mmol/L), GV, and experienced fewer episodes of low glucose. In men, lower TIR, higher time above range (TAR), and GV reduction were associated with central adiposity assessed by total, trunk, and android fat mass. In women, gynoid fat mass only was associated with a lower TIR and higher TAR. The eGDR was a positive predictor of TIR and a negative predictor of TAR, TBR, and GV in men and women. In conclusion, adiposity in people with T1D is associated with a lower risk of CGM-confirmed hypoglycemia, higher TAR, and reduced GV. These features of daily glucose dynamics may be mediated by insulin resistance.
1型糖尿病（T1D）患者中超重和肥胖的患病率呈上升趋势。然而，脂肪堆积对T1D患者血糖动态变化的影响目前仍知之甚少。我们根据T1D患者的体重、身体成分和胰岛素敏感性评估了其连续血糖监测（CGM）参数。在547例患者中，包括238例超重/肥胖个体，估算了CGM得出的血糖达标时间（TIR）和血糖变异性（GV）。通过双能X线吸收法（DXA）评估身体成分。使用估算的葡萄糖处置率（eGDR）作为胰岛素敏感性的指标。与体重正常的患者相比，超重/肥胖患者血糖低于范围的时间（TBR，<3 mmol/L）、GV较低，且低血糖发作次数较少。在男性中，较低的TIR、较高的血糖高于范围的时间（TAR）以及GV降低与通过总体、躯干和男性型脂肪量评估的中心性肥胖有关。在女性中，仅臀部脂肪量与较低的TIR和较高的TAR有关。eGDR是男性和女性TIR的正向预测因子，以及TAR、TBR和GV的负向预测因子。总之，T1D患者的肥胖与CGM确认的低血糖风险较低、TAR较高和GV降低有关。日常血糖动态变化的这些特征可能由胰岛素抵抗介导。
