Herranz-Antolín Sandra, Esteban-Monge Verónica, López-Virgos María Covadonga, Ramos-Garrido Sofía, Coton-Batres Clara, Lallena-Pérez Silvia, Torralba Miguel
Endocrinology and Nutrition Department, University Hospital of Guadalajara, Guadalajara, Spain.
Instituto de Investigación Sanitaria de Castilla la Mancha (IDISCAM), Toledo, Spain.
Endocrine. 2025 Aug 26. doi: 10.1007/s12020-025-04379-5.
To analyze the Time in Tight Range (TITR) (70-140 mg/dL) and the relationship between TITR-Time in Range (TIR) and assess their possible differences according to Coefficient of Variation (CV) in a cohort of patients with type 1 Diabetes Mellitus (DM) and Multiple Daily Injections in real life.
355 adult users of Continuous Glucose Monitoring (CGM) with at least one HbA1c (October 1, 2023-October 1, 2024) and glucose data in the 90 days prior were included.
Age 46.9 years (SD 13.6); 57.2% male; time of evolution 21.6 years (SD 12.6). Mean TITR was 38.4% (SD 14.6) and 20.3% had a TITR ≥ 50%. The correlation TITR-TIR was strong (β = 0.83; CI 95% 0.8-0.87; R Adjusted 0.89; p < 0.001) and varied according to CV [CV ≤ 36% (β = 0.88; CI 95% 0.83-0.93; R Adjusted 0.89; p < 0.001); CV > 36% (β = 0.84; CI 95% 0.81-0.87; R Adjusted 0.93; p < 0.001)]. The cutoff value for TIR to discriminate TITR ≥ 50% varied according to CV [(CV ≤ 36% 75.9% (sensitivity 98%, specificity 94%, AUC 0.99, p < 0.001); CV > 36% 70.5% (sensitivity 100%, specificity 98%, AUC 0.99, p < 0.001)]. The variables that were independently associated with TITR in CV ≤ 36% group were TIR (β = 0.74; CI 95% 0.57-0.9; p < 0.001) and mean glucose (β = -0.11; CI 95% -0.21 to -0.01; p = 0.045). However, in CV > 36% group were time of evolution (β = 0.04; CI 95% 0.01-0.07; p = 0.008), HbA1c (β = -0.63; CI 95% -1.22 to -0.4; p = 0.036; CV (β = 0.33; CI 95% 0.24-0.41; p < 0.001) and TIR (β = 0.84; CI 95% 0.74-0.93; p < 0.001).
The correlation between TITR-TIR was strong and higher in patients with CV > 36%. Cutoff value for TIR to discriminate TITR ≥ 50% and factors that were associated with TITR also differ depending on CV. It is essential to take glycemic variability into account when interpreting metabolic control data.
分析血糖控制在严格范围内（TITR）（70 - 140mg/dL）的时间以及TITR与血糖控制在目标范围内（TIR）的时间之间的关系，并根据变异系数（CV）评估它们在1型糖尿病（DM）且每日多次注射胰岛素的真实生活队列患者中的可能差异。
纳入355名连续血糖监测（CGM）成年使用者，这些使用者在2023年10月1日至2024年10月1日期间至少有一次糖化血红蛋白（HbA1c）数据，且有前90天的血糖数据。
年龄46.9岁（标准差13.6）；男性占57.2%；病程21.6年（标准差12.6）。平均TITR为38.4%（标准差14.6），20.3%的患者TITR≥50%。TITR与TIR的相关性很强（β = 0.83；95%置信区间0.8 - 0.87；调整后R值0.89；p < 0.001），并且根据CV有所不同[CV≤36%（β = 0.88；95%置信区间0.83 - 0.93；调整后R值0.89；p < 0.001）；CV > 36%（β = 0.84；95%置信区间0.81 - 0.87；调整后R值0.93；p < 0.001）]。用于区分TITR≥50%的TIR临界值根据CV而变化[（CV≤36%时为75.9%（敏感性98%，特异性94%，AUC 0.99，p < 0.001）；CV > 36%时为70.5%（敏感性100%，特异性98%，AUC 0.99，p < 0.001）]。在CV≤36%组中与TITR独立相关的变量是TIR（β = 0.74；95%置信区间0.57 - 0.9；p < 0.001）和平均血糖（β = -0.1；95%置信区间 -0.21至 -0.01；p = 0.045）。然而，在CV > 36%组中是病程（β = 0.04；95%置信区间0.01 - 0.07；p = 0.008）、HbA1c（β = -0.63；95%置信区间 -1.22至 -0.4；p = 0.036）、CV（β = 0.33；95%置信区间0.24 - 0.41；p < 0.001）和TIR（β = 0.84；95%置信区间0.74 - 0.93；p < 0.001）。
TITR与TIR之间的相关性很强，且在CV > 36%的患者中更高。用于区分TITR≥50%的TIR临界值以及与TITR相关的因素也因CV而异。在解释代谢控制数据时，考虑血糖变异性至关重要。
