2型糖尿病合并低血糖无意识患者血糖达标时间与糖尿病视网膜病变的关系：一项单中心回顾性研究
Association Between Time in Range and Diabetic Retinopathy in Type 2 Diabetes Mellitus Patients with Hypoglycemia Unawareness: A Single-center Retrospective Study.
作者信息
Xu Chi, Dai Wu, Liu Yan, Zhang Rong, Shi Erlan, Shan Xiangxiang, Cao Yonghong
机构信息
Department of Endocrinology, Hefei Hospital Affiliated to Anhui Medical University (Hefei Second People's Hospital), Hefei, 230011, People's Republic of China.
The Fifth Clinical Medical College, Anhui Medical University, Hefei, 230032, People's Republic of China.
出版信息
Int J Gen Med. 2025 Jun 7;18:2911-2921. doi: 10.2147/IJGM.S498567. eCollection 2025.
AIM
Our study aimed to investigate the association between time in range (TIR) and diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) patients with hypoglycemia unawareness.
METHODS
This is a retrospective cross-sectional study. In our study, 298 T2DM patients with hypoglycemia unawareness were recruited from the Department of Endocrinology, Hefei Second People's Hospital from 01/09/2020 to 30/06/2023. Patients were divided into DR group (97 cases) and non-DR group (NDR, 201 cases). We compared the clinical data and blood glucose fluctuation indexes of the two groups. Meanwhile, we also observed these indicators, especially the prevalence of DR and the time below range (TBR) in groups with different TIR levels (Q1 group: TIR≤70%, 79 cases; Q2 group: 70%<TIR≤85%, 72 cases; Q3 group: 85%<TIR≤95%, 73 cases; Q4 group: TIR>95%, 74 cases). The influencing factors of DR in T2DM patients with hypoglycemia unawareness were analyzed by logistic regression.
RESULTS
TIR of DR group was significantly lower than that of NDR group (<0.05). And TIR was an independent protective factor for DR after correcting confounding factors in logistic regression analysis (=0.937, =0.032). ROC curve showed that the AUC of TIR for DR diagnosis prediction was 0.756. The comparison among TIR groups showed that the prevalence of DR in Q1 group was higher than that in Q2 to Q4 group; and the TBR in Q3 group was higher than that in other TIR groups (<0.05). Spearman analysis showed that TBR was negatively correlated with MG (=-0.221, <0.001). Only Q1 group (TIR≤70%) was a risk factor for DR in logistic regression with Q3 group as the reference group.
CONCLUSION
Lower TIR is associated with an increased risk of DR in T2DM patients with hypoglycemia unawareness. After weighing the risk of DR and TBR, TIR at 70-85% is the satisfactory range for T2DM patients with hypoglycemia unawareness.
目的
本研究旨在探讨低血糖无意识的2型糖尿病（T2DM）患者的血糖达标时间（TIR）与糖尿病视网膜病变（DR）之间的关联。
方法
这是一项回顾性横断面研究。在本研究中，2020年9月1日至2023年6月30日期间从合肥市第二人民医院内分泌科招募了298例低血糖无意识的T2DM患者。患者被分为DR组（97例）和非DR组（NDR，201例）。我们比较了两组的临床资料和血糖波动指标。同时，我们还观察了这些指标，特别是不同TIR水平组（Q1组：TIR≤70%，79例；Q2组：70%＜TIR≤85%，72例；Q3组：85%＜TIR≤95%，73例；Q4组：TIR＞95%，74例）中DR的患病率和低于目标范围时间（TBR）。通过逻辑回归分析低血糖无意识的T2DM患者DR的影响因素。
结果
DR组的TIR显著低于NDR组（＜0.05）。在逻辑回归分析中校正混杂因素后，TIR是DR的独立保护因素（=0.937，=0.032）。ROC曲线显示，TIR用于DR诊断预测的AUC为0.756。TIR组间比较显示，Q1组的DR患病率高于Q2至Q4组；Q3组的TBR高于其他TIR组（＜0.05）。Spearman分析显示，TBR与平均血糖（=-0.221，＜0.001）呈负相关。以Q3组为参照组进行逻辑回归分析时，只有Q1组（TIR≤70%）是DR的危险因素。
结论
低血糖无意识的T2DM患者中，较低的TIR与DR风险增加相关。在权衡DR风险和TBR后，70%-85%的TIR对低血糖无意识的T2DM患者来说是满意的范围。
Zotero 插件