Li Yuqiong, Cai Liwei, Lu Qinkang, Gong Weikun, Wang Penghao, Chen Tao, Ye Wen, Li Bingqi, Zhu Hui, Xu Zhifeng, Xu Jin, Ji Lindan
Department of Science and Education, The Affiliated People's Hospital of Ningbo University, Ningbo, Zhejiang, P. R. China.
School of Public Health, Health Science Center, Ningbo University, Ningbo, Zhejiang, P. R. China.
Endocrine. 2025 May 9. doi: 10.1007/s12020-025-04250-7.
To assess the association between hypoglycemia exposure and the risk of developing microvascular diseases (MVDs) in type 2 diabetes patients via continuous glucose monitoring (CGM), aiming to identify optimal hypoglycemia thresholds for improved glucose management.
A total of 174 type 2 diabetes patients underwent 2 weeks of CGM. Binary multivariate logistic regression assessed the association between hypoglycemia exposure and MVDs prevalence at thresholds of 3.0-3.9 mmol/L.
After 14 days of monitoring, 79.9% of patients experienced hypoglycemia. The MVDs group had a significantly greater percentage of participants with hypoglycemia (glucose < 3.4 mmol/L: 57.6 vs. 39.8%, P = 0.023) and nocturnal hypoglycemia (glucose < 3.9 mmol/L: 62.1 vs. 46.3%, P = 0.043), with no significant difference in daytime hypoglycemia. After adjustment for confounders, only nocturnal hypoglycemia was independently associated with the risk of developing MVDs, and the prevalence of MVDs was positively associated with hypoglycemia severity. When the hypoglycemia threshold was reduced from 3.4-3.0 mmol/L, the odds ratio increased from 1.342 (1.026, 1.798) to 1.855 (1.141, 3.457). Further subgroup analysis revealed that nocturnal hypoglycemia below 3.4 mmol/L was a risk factor for the development of retinopathy and neuropathy (P < 0.05) but not for nephropathy.
Nighttime glucose levels below 3.4 mmol/L are strongly associated with a greater risk of developing retinopathy and neuropathy in type 2 diabetes patients. Thus, blood glucose management should be time-specific, with daytime levels maintained above 3.9 mmol/L and nighttime levels maintained above 3.4 mmol/L.
通过连续血糖监测（CGM）评估2型糖尿病患者低血糖暴露与微血管疾病（MVD）发生风险之间的关联，旨在确定改善血糖管理的最佳低血糖阈值。
共174例2型糖尿病患者接受了为期2周的CGM监测。二元多因素逻辑回归分析评估了在3.0 - 3.9毫摩尔/升阈值下低血糖暴露与MVD患病率之间的关联。
监测14天后，79.9%的患者发生了低血糖。MVD组低血糖（血糖<3.4毫摩尔/升：57.6%对39.8%，P = 0.023）和夜间低血糖（血糖<3.9毫摩尔/升：62.1%对46.3%，P = 0.043）的参与者比例显著更高，白天低血糖无显著差异。调整混杂因素后，仅夜间低血糖与发生MVD的风险独立相关，且MVD的患病率与低血糖严重程度呈正相关。当低血糖阈值从3.4毫摩尔/升降至3.0毫摩尔/升时，优势比从1.342（1.026，1.798）增加至1.855（1.141，3.457）。进一步的亚组分析显示，夜间血糖低于3.4毫摩尔/升是视网膜病变和神经病变发生的危险因素（P < 0.05），但不是肾病的危险因素。
2型糖尿病患者夜间血糖水平低于3.4毫摩尔/升与发生视网膜病变和神经病变的风险显著增加密切相关。因此，血糖管理应具有时间特异性，白天血糖水平维持在3.9毫摩尔/升以上，夜间血糖水平维持在3.4毫摩尔/升以上。
