影响血糖控制良好的成年2型糖尿病患者糖化血红蛋白（HbA1c）与血糖管理指标之间关系的相关因素。
The related factors affecting the relationship between HbA1c and glucose management indicator in adult T2D patients with good glycemic control.
作者信息
Liu Zhigu, Lin Beisi, Chen Danrui, Yang Yanling, Jiang Wei, Yang Daizhi, Yan Jinhua, Yao Bin, Yang Xubin, Xu Wen
机构信息
Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
Department of General Practice, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
出版信息
Endocrine. 2025 Feb;87(2):609-618. doi: 10.1007/s12020-024-04083-w. Epub 2024 Oct 30.
PURPOSE
To explore the relationship between glucose management indicator (GMI) and HbA1c and find the affecting factors in adult T2D patients with good glycemic control.
METHODS
Adult T2D patients with both HbA1c < 7% and time in range (TIR) > 70% were retrospectively analyzed. A significant difference between GMI and HbA1c was defined as an absolute value of hemoglobin glycation index (|HGI|, HbA1c minus GMI) ≥ 0.5%. Factors associated with high |HGI| were determined by logistic regression analysis. The performance of possible factors in predicting high |HGI| was verified by ROC curve analysis. And the linear relationship between GMI and HbA1c was also investigated.
RESULTS
Of all the 94 patients (median HbA1c 6.18%, mean GMI 6.34%) included, 28.72% had an |HGI | ≥ 0.5% and only 15.96% had an |HGI | < 0.1%. Standard deviation of blood glucose (SDBG), a glycemic variability index, affected |HGI| (OR = 3.980, P = 0.001), and showed the best performance in predicting high |HGI| (AUC = 0.712, cutoff value = 1.63 mmol/L, P = 0.001). HbA1c was linearly correlated with GMI (β = 0.295, P = 0.004). Their correlation weakened after further adjusting for SDBG (β = 0.232, P = 0.012). Linear correlation between them was closer in patients with smaller SDBG ( < 1.63 mmol/L) than those with larger SDBG (P = 0.004).
CONCLUSIONS
Even in adult T2D patients with good glycemic control, the discrepancy between GMI and HbA1c existed. Their relationship was affected by glycemic variability. SDBG mainly accounted for this consequence.
TRIAL REGISTRATION
Chinese clinical trial registry ( www.chictr.org.cn ), ChiCTR2000034884, 2020-07-23.
目的
探讨血糖管理指标（GMI）与糖化血红蛋白（HbA1c）之间的关系，并找出血糖控制良好的成年2型糖尿病（T2D）患者中的影响因素。
方法
对糖化血红蛋白（HbA1c）<7%且血糖达标时间（TIR）>70%的成年T2D患者进行回顾性分析。GMI与HbA1c之间的显著差异定义为糖化血红蛋白指数（|HGI|，HbA1c减去GMI）的绝对值≥0.5%。通过逻辑回归分析确定与高|HGI|相关的因素。通过ROC曲线分析验证可能因素预测高|HGI|的性能。并研究了GMI与HbA1c之间的线性关系。
结果
纳入的94例患者（糖化血红蛋白中位数为6.18%，平均GMI为6.34%）中，28.72%的患者|HGI|≥0.5%，只有15.96%的患者|HGI|<0.1%。血糖标准差（SDBG）作为血糖变异性指标，影响|HGI|（OR=3.980，P=0.001），并且在预测高|HGI|方面表现最佳（AUC=0.712，截断值=1.63 mmol/L，P=0.001）。HbA1c与GMI呈线性相关（β=0.295，P=0.004）。在进一步调整SDBG后，它们的相关性减弱（β=0.232，P=0.012）。与SDBG较大的患者相比，SDBG较小（<1.63 mmol/L）的患者中二者的线性相关性更密切（P=0.004）。
结论
即使在血糖控制良好的成年T2D患者中，GMI与HbA1c之间仍存在差异。它们的关系受血糖变异性影响。SDBG是造成这种结果的主要原因。
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