Shan Xiangxiang, Yao Shenhang, Hu Ben, Xu Chi, Cao Yonghong, Dai Wu
Department of Endocrinology, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, 230011, People's Republic of China.
The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, Anhui, 230032, People's Republic of China.
Diabetes Metab Syndr Obes. 2025 Jul 29;18:2585-2596. doi: 10.2147/DMSO.S526784. eCollection 2025.
To investigate the correlation between time in range (TIR) and the risk of cardiovascular autonomic neuropathy (CAN) development in patients with Type 2 diabetes mellitus (T2DM).
This prospective cohort study enrolled patients with type 2 diabetes mellitus (T2DM) hospitalized and followed at the Department of Endocrinology, Hefei Hospital of Anhui Medical University, between September 2020 and July 2024. All participants underwent standardized cardiovascular autonomic neuropathy (CAN) assessment via the Ewing test, and time in range (TIR) was derived from baseline continuous glucose monitoring (CGM) data. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CAN incidence, adjusted for relevant covariates.
Over a median follow-up of 25.0 months, 123 of 196 participants (62.8%) were diagnosed with CAN. The CAN group exhibited longer diabetes duration, lower time in range (TIR) and body mass index (BMI), higher time above range (TAR), mean glucose (MG), urinary albumin-to-creatinine ratio (UACR), and higher insulin use rates. Participants with low TIR were older, had longer diabetes duration, and displayed: 1. Higher fasting plasma glucose (FPG), HbA1c, and LDL-C levels; 2. Elevated glycemic variability (MAGE, CV, LAGE, SD, MG, TAR) via continuous glucose monitoring (CGM); 3. Greater likelihood of insulin therapy. All differences were statistically significant (P < 0.05). Multivariable Cox regression analyses, adjusted for key covariates (eg, age, HbA1c, insulin use), demonstrated an inverse association between TIR and CAN incidence.
Lower TIR is an independent risk factor for CAN in T2DM patients, with higher TIR levels associated with reduced CAN risk (P < 0.05).
探讨2型糖尿病（T2DM）患者血糖达标时间（TIR）与心血管自主神经病变（CAN）发生风险之间的相关性。
本前瞻性队列研究纳入了2020年9月至2024年7月期间在安徽医科大学附属合肥医院内分泌科住院并接受随访的2型糖尿病（T2DM）患者。所有参与者均通过尤因试验进行标准化的心血管自主神经病变（CAN）评估，血糖达标时间（TIR）来自基线连续血糖监测（CGM）数据。采用Cox比例风险回归模型估计CAN发病率的风险比（HRs）和95%置信区间（CIs），并对相关协变量进行调整。
在中位随访25.0个月期间，196名参与者中有123名（62.8%）被诊断为CAN。CAN组患者的糖尿病病程更长，血糖达标时间（TIR）和体重指数（BMI）更低，血糖高于目标范围时间（TAR）、平均血糖（MG）、尿白蛋白肌酐比值（UACR）更高，胰岛素使用率也更高。血糖达标时间（TIR）较低的参与者年龄较大，糖尿病病程较长，并且表现出：1. 空腹血糖（FPG）、糖化血红蛋白（HbA1c）和低密度脂蛋白胆固醇（LDL-C）水平较高；2. 通过连续血糖监测（CGM）显示血糖变异性升高（平均血糖波动幅度、变异系数、血糖波动幅度、标准差、平均血糖、血糖高于目标范围时间）；3. 胰岛素治疗的可能性更大。所有差异均具有统计学意义（P<0.05）。经关键协变量（如年龄、HbA1c、胰岛素使用情况）调整后的多变量Cox回归分析表明，血糖达标时间（TIR）与CAN发病率呈负相关。
较低的血糖达标时间（TIR）是T2DM患者发生CAN的独立危险因素，血糖达标时间（TIR）水平越高，CAN风险越低（P<0.05）。
