目的:分析小范围内的时间(TITR),及其与1型糖尿病(T1D)患者接受高级混合闭环(AHCL)系统治疗的其他血糖参数的关系。
方法:对接受AHCL系统治疗至少3个月的儿童和成人T1D患者进行了一项前瞻性观察性研究。收集AHCL开始之前和之后的临床变量和血糖参数。
结果:共评估了117例患者。AHCL启动后代谢控制的比较显示HbA1c显着改善(6.9±0.9vs.6.6±0.5%,p<0.001),时间范围(TIR)(68.2±11.5vs.82.5±6.9%,p<0.001),TITR(43.7±10.8vs.57.3±9.7%,p<0.001),血糖管理指标(GMI)(6.9±0.4vs.6.6±0.3%,p<0.001),低于范围的时间(TBR)70-54mg/dl(4.3±4.5vs.2.0±1.4%,p<0.001),和时间超过范围(TAR)>180mg/dl(36.0±7.6vs.15.1±6.4%,p<0.001)。变异系数(CV)也有所提高(36.3±5.7与30.6±3.7,p<0.001),而140-180mg/dl之间的时间保持不变。总的来说,76.3%达到TITR>50%(100%儿科)。TITR和TIR与GRI的相关性分析显示出强正相关,由血糖变异性改变。
结论:AHCL系统在代谢控制方面取得了显著改善(93.9%患者中TIR>70%)。TIR的增加与TIR的140-180mg/dl的增加无关。尽管与TIR密切相关,TITR允许对所达到的控制水平进行更充分的区分,尤其是在初始代谢控制良好的人群中。TIR和TITR之间的相关性直接受血糖变异性程度的影响。
OBJECTIVE: To analyze the time in tight range (TITR), and its relationship with other glucometric parameters in patients with type 1 diabetes (T1D) treated with advanced hybrid closed-loop (AHCL) systems.
METHODS: A prospective observational study was conducted on pediatric and adult patients with T1D undergoing treatment with AHCL systems for at least 3 months. Clinical variables and glucometric parameters before and after AHCL initiation were collected.
RESULTS: A total of 117 patients were evaluated. Comparison of metabolic control after AHCL initiation showed significant improvements in HbA1c (6.9 ± 0.9 vs. 6.6 ± 0.5%, p < 0.001), time in range (TIR) (68.2 ± 11.5 vs. 82.5 ± 6.9%, p < 0.001), TITR (43.7 ± 10.8 vs. 57.3 ± 9.7%, p < 0.001), glucose management indicator (GMI) (6.9 ± 0.4 vs. 6.6 ± 0.3%, p < 0.001), time below range (TBR) 70-54 mg/dl (4.3 ± 4.5 vs. 2.0 ± 1.4%, p < 0.001), and time above range (TAR) > 180 mg/dl (36.0 ± 7.6 vs. 15.1 ± 6.4%, p < 0.001). Coefficient of variation (CV) also improved (36.3 ± 5.7 vs. 30.6 ± 3.7, p < 0.001), while time between 140-180 mg/dl remained unchanged. In total, 76.3% achieved TITR > 50% (100% pediatric). Correlation analysis between TITR and TIR and GRI showed a strong positive correlation, modified by glycemic variability.
CONCLUSIONS: AHCL systems achieve significant improvements in metabolic control (TIR > 70% in 93.9% patients). The increase in TIR was not related to an increase in TIR 140-180 mg/dl. Despite being closely related to TIR, TITR allows for a more adequate discrimination of the achieved control level, especially in a population with good initial metabolic control. The correlation between TIR and TITR is directly influenced by the degree of glycemic variability.