改变目标：1型糖尿病成年人希望血糖严格达标吗？

Moving the Goalposts: Do Adults With Type 1 Diabetes Want Time in Tight Range?

作者信息

Tanenbaum Molly L, Pasmooij Mabelle B, Tam Rachel, Basina Marina, Hughes Michael S, Bishop Franziska K, Maahs David M

机构信息

Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California; Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California; Stanford University School of Medicine, Stanford Diabetes Research Center, Stanford, California.

Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California.

出版信息

Endocr Pract. 2025 Apr 18. doi: 10.1016/j.eprac.2025.03.006.

DOI:10.1016/j.eprac.2025.03.006

PMID:40548915

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12340569/

Abstract

OBJECTIVES

Our objective was to understand attitudes toward time in tight range (TITR: 70-140 mg/dL) among adults with type 1 diabetes. The perspectives of people with type 1 diabetes on TITR can inform educational approaches to introducing potential new continuous glucose monitoring (CGM) metrics in a way that optimizes glycemic and quality of life outcomes for people with type 1 diabetes.

METHODS

Focus groups with adult CGM users with type 1 diabetes elicited feedback on a potential shift to TITR. Groups were audio-recorded, transcribed, and analyzed using content analysis.

RESULTS

Participants were 33 adults (age 42.7 ± 16.7 years, 55% female, 91% non-Hispanic White, 23 ± 16 years living with diabetes, HbA1c 6.5 ± 0.6% (48 ± 6 mmol/mol)). Most (88%) used automated insulin delivery. Some approved of TITR for the potential to improve their long-term health. Concerns about TITR included increased management burden; risk of anxiety, hypoglycemia, disordered eating; and feelings of failure. Participants advocated for flexible, personalized clinical targets and better technologies, insulins, and access, to make TITR achievable for more people with type 1 diabetes.

CONCLUSIONS

Results indicate that TITR may be a welcome shift for some who are already using the tighter metric but may add risks and psychosocial and self-management burden even in a group of adults predominantly using automated insulin delivery and achieving current HbA1c goals. Including the perspectives of people with type 1 diabetes in decision-making around CGM metrics will be important for the implementation of new clinical targets to improve patient care.

摘要

目的

我们的目标是了解1型糖尿病成年人对血糖严格控制范围（TITR：70 - 140mg/dL）的态度。1型糖尿病患者对TITR的看法可以为引入潜在的新的持续葡萄糖监测（CGM）指标的教育方法提供信息，从而以优化1型糖尿病患者血糖水平和生活质量的方式来进行。

方法

对使用CGM的1型糖尿病成年用户进行焦点小组访谈，以获取关于向TITR转变的反馈。小组讨论进行了录音、转录，并采用内容分析法进行分析。

结果

参与者为33名成年人（年龄42.7±16.7岁，55%为女性，91%为非西班牙裔白人，患糖尿病23±16年，糖化血红蛋白6.5±0.6%（48±6mmol/mol））。大多数（88%）使用自动胰岛素输注。一些人认可TITR有可能改善他们的长期健康状况。对TITR的担忧包括管理负担增加；焦虑、低血糖、饮食失调的风险；以及失败感。参与者主张采用灵活、个性化的临床目标，以及更好的技术、胰岛素和医疗服务，以使更多1型糖尿病患者能够实现TITR。