基于连续血糖监测的血糖变异性对血糖控制良好的 2 型糖尿病患者全因死亡率影响的前瞻性队列研究。
Impact of short-term glycemic variability on risk of all-cause mortality in type 2 diabetes patients with well-controlled glucose profile by continuous glucose monitoring: A prospective cohort study.
机构信息
Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.
Vital Statistical Department, Institute of Health Information, Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China.
出版信息
Diabetes Res Clin Pract. 2022 Jul;189:109940. doi: 10.1016/j.diabres.2022.109940. Epub 2022 Jun 1.
AIMS
To investigate the association between short-term glycemic variability (GV) and all-cause mortality in type 2 diabetes with well-controlled glucose profile by continuous glucose monitoring (CGM).
METHODS
In this prospective study, 1839 diabetes patients who reached percentage of time in the target glucose range of 3.9-10 mmol/L > 70%, percentage of time above range of 10 mmol/L < 25% and percentage of time below range of 3.9 mmol/L < 4% on CGM were enrolled and were classified into five groups by coefficient of variation for glucose (%CV) level: ≤20%, 20-25%, 25-30%, 30-35%, and > 35%. Cox proportional hazard models were used to estimate hazard ratios (HRs) of all-cause mortality risk associated with the different %CV categories.
RESULTS
At baseline, participants had mean age of 60.9 years and mean HbA of 7.3% (56 mmol/mol). A total of 165 deaths were identified during a median follow-up of 6.9 years. In multivariate Cox regression analysis, HRs associated with %CV categories were 1.00, 1.16 (95% CI 0.78-1.73), 1.38 (95% CI 0.89-2.15), 1.33 (95% CI 0.77-2.29) and 2.26 (95% CI 1.13-4.52) for all-cause mortality.
CONCLUSIONS
Greater %CV was associated with increased risk for all-cause mortality even among patients with seemingly well-controlled glucose status.
目的
通过连续血糖监测（CGM）研究 2 型糖尿病患者血糖短期变异性（GV）与全因死亡率之间的关系，这些患者的血糖控制良好，葡萄糖谱处于目标范围内的时间百分比（TIR）>70%，血糖>10mmol/L 的时间百分比（TAR）<25%，血糖<3.9mmol/L 的时间百分比（TBR）<4%。
方法
本前瞻性研究纳入了 1839 例通过 CGM 达到目标血糖范围 3.9-10mmol/L 时间百分比>70%，血糖>10mmol/L 时间百分比<25%，血糖<3.9mmol/L 时间百分比<4%的糖尿病患者，并根据葡萄糖变异系数（%CV）水平将其分为五组：≤20%、20-25%、25-30%、30-35%和>35%。采用 Cox 比例风险模型估计与不同%CV 分类相关的全因死亡率风险的风险比（HR）。
结果
在基线时，参与者的平均年龄为 60.9 岁，平均 HbA1c 为 7.3%（56mmol/mol）。在中位随访 6.9 年后共确定了 165 例死亡。在多变量 Cox 回归分析中，与%CV 分类相关的 HR 分别为 1.00、1.16（95%CI 0.78-1.73）、1.38（95%CI 0.89-2.15）、1.33（95%CI 0.77-2.29）和 2.26（95%CI 1.13-4.52）。
结论
即使在血糖控制良好的患者中，较大的%CV 与全因死亡率风险增加相关。
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