1型糖尿病患者血糖严格控制时间、血糖达标时间及糖化血红蛋白与蛋白尿的相关性：一项横断面研究

Associations of time in tight range, time in range, and glycated hemoglobin with albuminuria in type 1 diabetes: A cross-sectional study.

作者信息

Kim Ji Yoon, Kim Seohyun, Park Sang Ho, Lee Jin A, Cho So Hyun, Oh Rosa, Jang Myunghwa, Lee You-Bin, Kim Gyuri, Hur Kyu Yeon, Kim Jae Hyeon, Jin Sang-Man

机构信息

Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea.

Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Republic of Korea.

出版信息

Diabetes Res Clin Pract. 2025 Aug;226:112325. doi: 10.1016/j.diabres.2025.112325. Epub 2025 Jun 9.

DOI:10.1016/j.diabres.2025.112325

PMID:40499686

Abstract

AIMS

We aimed to establish an independent association between time in tight range (TITR) and the risk of albuminuria, and to compare the relationships of TITR, time in range (TIR), and glycated hemoglobin (HbA1c) with albuminuria in individuals with type 1 diabetes (T1D).

METHODS

This cross-sectional study analyzed 14-day raw continuous glucose monitoring (CGM) data from 615 individuals with T1D. Albuminuria was defined as a spot urine albumin-to-creatinine ratio ≥ 30 mg/g. Multivariable logistic regression models were used to estimate the odds ratios (OR) for albuminuria per 10 % increase in TITR and TIR.

RESULTS

The adjusted OR for albuminuria per 10 % increase in TITR was 0.98 (95 % confidence interval [CI], 0.96-0.99; p = 0.002). A comparable association was observed with TIR (adjusted OR, 0.97; 95 % CI, 0.96-0.99; p < 0.001). Restricted cubic spline analysis showed that albuminuria risk decreased with increasing TITR and TIR, plateaued near HbA1c 7 %, but further decreased at very high TITR and TIR levels, unlike HbA1c, which had a single threshold.

CONCLUSION

TITR is independently associated with the risk of albuminuria in T1D, exhibiting a similar pattern to TIR but a different pattern from HbA1c. Very high TITR and TIR may provide information predicting albuminuria risk beyond HbA1c levels.

摘要

目的

我们旨在确定血糖严格控制时间（TITR）与蛋白尿风险之间的独立关联，并比较TITR、血糖控制时间（TIR）和糖化血红蛋白（HbA1c）与1型糖尿病（T1D）患者蛋白尿的关系。

方法

这项横断面研究分析了615例T1D患者14天的原始连续血糖监测（CGM）数据。蛋白尿定义为随机尿白蛋白与肌酐比值≥30mg/g。采用多变量逻辑回归模型估计TITR和TIR每增加10%时蛋白尿的比值比（OR）。

结果

TITR每增加10%，蛋白尿的校正OR为0.98（95%置信区间[CI]，0.96 - 0.99；p = 0.002）。TIR也观察到类似的关联（校正OR，0.97；95% CI，0.96 - 0.99；p < 0.001）。受限立方样条分析表明，蛋白尿风险随着TITR和TIR的增加而降低，在HbA1c接近7%时趋于平稳，但在非常高的TITR和TIR水平时进一步降低，这与HbA1c有单一阈值不同。