血糖稳态受损的筛查：血糖控制的一种新指标。
Screening for Impaired Glucose Homeostasis: A Novel Metric of Glycemic Control.
作者信息
Kaufman Jaycee M, van Veen Lennaert, Fossat Yan
机构信息
Klick Inc., Toronto, Ontario.
Department of Science, Ontario Tech University, Oshawa, Canada.
出版信息
Mayo Clin Proc Digit Health. 2023 May 24;1(2):189-200. doi: 10.1016/j.mcpdig.2023.02.008. eCollection 2023 Jun.
OBJECTIVE
To investigate the use of a mathematical model of glucose homeostasis, fit to continuous glucose monitor data, as a metric of dysfunctional glycemic control.
PATIENTS AND METHODS
Three hundred eighty four participants recruited from 2 studies between October 2020 and June 2022 were equipped with a continuous glucose monitor, and interstitial glucose data were automatically collected for 2 weeks. The participants were assessed by a physician and diagnosed as being diabetic, prediabetic, or healthy according to the American Diabetes Association guidelines. A mathematical model of glucose homeostasis was fitted to the glucose data, and model parameter values were obtained. The participants were classified into the following 2 groups on the basis of their glucose homeostasis parameters: effective and impaired. Finally, glycemic variability metrics were compared with glucose homeostasis classification.
RESULTS
The homeostasis classification resulted in a specificity, sensitivity of individuals with prediabetes, and sensitivity of individuals with type 2 diabetes (T2D) of 0.78, 0.86, and 1.00, respectively, for women and 0.71, 0.86, and 1.00, respectively, for men. This sensitivity was similar to that of glycated hemoglobin A1c measurement (a sensitivity of 0.89 for women and 0.90 for men for prediabetes and a sensitivity of 1.00 for T2D) and superior to that of the oral glucose tolerance test (a sensitivity of 0.18 for women and 0.24 for men for prediabetes and a sensitivity of 0.75 for women and 0.86 for men for T2D). Overall, the individuals classified as impaired had increased glucose variability metrics than the individuals classified as effective (<.05).
CONCLUSION
The classification of glucose homeostasis on the basis of mathematical modeling of continuous measurements has promising applications as a new metric of dysfunctional glycemic control.
TRIAL REGISTRATION
clinicaltrials.gov Identifier: NCT04529239; clinical trial registry identifier: CTRI/2021/08/035957.
目的
研究使用适合连续血糖监测数据的葡萄糖稳态数学模型，作为血糖控制功能失调的一种衡量指标。
患者与方法
2020年10月至2022年6月期间从两项研究中招募的384名参与者配备了连续血糖监测仪，并自动收集了2周的组织间液葡萄糖数据。参与者由医生进行评估，并根据美国糖尿病协会指南被诊断为糖尿病患者、糖尿病前期患者或健康人。将葡萄糖稳态数学模型拟合到血糖数据上，并获得模型参数值。根据葡萄糖稳态参数将参与者分为以下两组：有效组和受损组。最后，将血糖变异性指标与葡萄糖稳态分类进行比较。
结果
稳态分类得出，女性糖尿病前期个体的特异性、敏感性以及2型糖尿病（T2D）个体的敏感性分别为0.78、0.86和1.00，男性分别为0.71、0.86和1.00。这种敏感性与糖化血红蛋白A1c测量的敏感性相似（糖尿病前期女性的敏感性为0.89，男性为0.90；T2D的敏感性为1.00），且优于口服葡萄糖耐量试验（糖尿病前期女性的敏感性为0.18，男性为0.24；T2D女性的敏感性为0.75，男性为0.86）。总体而言，分类为受损组的个体比分类为有效组的个体具有更高的血糖变异性指标（P<0.05）。
结论
基于连续测量的数学建模对葡萄糖稳态进行分类，作为血糖控制功能失调的一种新指标具有广阔的应用前景。
试验注册
clinicaltrials.gov标识符：NCT04529239；临床试验注册标识符：CTRI/2021/08/035957。
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