Jun Ji Eun, Lee You-Bin, Kim Jae Hyeon
Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Republic of Korea.
Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
J Diabetes Sci Technol. 2024 Oct 14:19322968241288579. doi: 10.1177/19322968241288579.
The glycemia risk index (GRI) is a new composite continuous glucose monitoring (CGM) metric for weighted hypoglycemia and hyperglycemia. We evaluated the association between the GRI and cardiovascular autonomic neuropathy (CAN) and compared the effects of the GRI and conventional CGM metrics on CAN.
For this cross-sectional study, three-month CGM data were retrospectively analyzed before autonomic function tests were performed in 165 patients with type 1 diabetes. CAN was defined as at least two abnormal results of parasympathetic tests according to an age-specific reference.
The overall prevalence of CAN was 17.1%. Patients with CAN had significantly higher GRI scores, target above range (TAR), coefficient of variation (CV), and standard deviation (SD) but significantly lower time in range (TIR) than those without CAN. The prevalence of CAN increased across higher GRI zones ( for trend <.001). A multivariate logistic regression analysis, adjusted for covariates such as HbA1c, demonstrated that the odds ratio (OR) of CAN was 9.05 (95% confidence interval [CI]: 2.21-36.96, = .002) per 1-SD increase in the GRI. TIR and CV were also significantly associated with CAN in the multivariate model. The area under the curve of GRI for the prediction of CAN (0.85, 95% CI: 0.76-0.94) was superior to that of TIR (0.80, 95% CI: 0.71-0.89, for comparison = .046) or CV (0.71, 95% CI: 0.57-0.84, for comparison = .049).
The GRI is significantly associated with CAN in patients with type 1 diabetes and may be a better CGM metric than TIR for predicting CAN.
血糖风险指数（GRI）是一种用于加权低血糖和高血糖的新型综合动态血糖监测（CGM）指标。我们评估了GRI与心血管自主神经病变（CAN）之间的关联，并比较了GRI和传统CGM指标对CAN的影响。
在这项横断面研究中，对165例1型糖尿病患者在进行自主神经功能测试前回顾性分析了3个月的CGM数据。根据特定年龄的参考标准，CAN被定义为至少两项副交感神经测试结果异常。
CAN的总体患病率为17.1%。与无CAN的患者相比，CAN患者的GRI评分、高于目标范围时间（TAR）、变异系数（CV）和标准差（SD）显著更高，但血糖达标时间（TIR）显著更低。CAN的患病率在较高的GRI区域中增加（趋势检验P<.001）。多因素逻辑回归分析在调整了糖化血红蛋白（HbA1c）等协变量后显示，GRI每增加1个标准差，CAN的比值比（OR）为9.05（95%置信区间[CI]：2.21-36.96，P=.002）。在多因素模型中，TIR和CV也与CAN显著相关。GRI预测CAN的曲线下面积（0.85，95%CI：0.76-0.94）优于TIR（0.80，95%CI：0.71-0.89，比较P=.046）或CV（0.71，95%CI：0.57-0.84，比较P=.049）。
GRI与1型糖尿病患者的CAN显著相关，并且在预测CAN方面可能是比TIR更好的CGM指标。
