Deshmukh Harshal, Wilmot Emma G, Choudhary Pratik, Ssemmondo Emmanuel, Barnes Dennis, Walker Neil, Walton Chris, Ryder Robert E J, Sathyapalan Thozhukat
James Cook University, Townsville, Queensland, Australia.
Mackay Base Hospital, Mackay, Queensland, Australia.
Diabetes Care. 2025 Mar 1;48(3):437-443. doi: 10.2337/dc24-1833.
This study aimed to explore the relationship between time below range (TBR), impaired awareness of hypoglycemia (IAH), and severe hypoglycemia (SH).
This cross-sectional study analyzed data from individuals with diabetes using continuous glucose monitors (CGMs) in the Association of British Clinical Diabetologists audit. Hypoglycemia awareness was assessed via the Gold score (≥4 denoting IAH), and SH was defined as hypoglycemia requiring third-party assistance. Logistic regression was used to determine the association between TBR percentage (<70 mg/dL; 3.9 mmol/L) at first follow-up and follow-up Gold score and SH incidence. The Youden J index identified optimal TBR percentage cutoffs for detecting IAH and SH.
The study included 15,777 participants, with follow-up TBR and SH data available for 5,029. The median TBR percentage was 4% (interquartile range 2-6.6%), with 42% meeting the recommended TBR of ≤4%. Adjusted for age, sex, and BMI, TBR was significantly associated with SH (P < 0.001) and IAH (P = 0.005). Optimal TBR cutoffs for identifying IAH and SH were 3.35% and 3.95%, yielding negative predictive value (NPV) values of 85% and 97%, respectively.
Our findings support the international consensus recommending a TBR of <4% in type 1 diabetes, with high NPV values suggesting the utility of TBR in screening for SH.
本研究旨在探讨低于目标范围时间（TBR）、低血糖意识受损（IAH）和严重低血糖（SH）之间的关系。
这项横断面研究分析了英国临床糖尿病学家协会审核中使用连续血糖监测仪（CGM）的糖尿病患者的数据。通过Gold评分评估低血糖意识（≥4表示IAH），SH定义为需要第三方协助的低血糖。采用逻辑回归确定首次随访时TBR百分比（<70 mg/dL；3.9 mmol/L）与随访Gold评分及SH发生率之间的关联。约登指数确定了检测IAH和SH的最佳TBR百分比临界值。
该研究纳入了15777名参与者，其中5029名有随访TBR和SH数据。TBR百分比中位数为4%（四分位间距2 - 6.6%），42%的人符合推荐的TBR≤4%。经年龄、性别和BMI校正后，TBR与SH（P < 0.001）和IAH（P = 0.005）显著相关。识别IAH和SH的最佳TBR临界值分别为3.35%和3.95%，阴性预测值（NPV）分别为85%和97%。
我们的研究结果支持国际共识，即建议1型糖尿病患者的TBR<4%，高NPV值表明TBR在筛查SH方面的效用。
