目的:比较血糖自我监测(SMBG)与连续血糖监测(CGM)获得的时间范围(TIR),并探讨TIR与微量白蛋白尿结局的关系,HOMA-IR和HOMA-β测试。
方法:我们招募了400名2型糖尿病患者,连续3天通过SMBG和CGM进行血糖监测。TIR,TAR,通过从SMBG和CGM获得的葡萄糖数据分别计算TBR和其他血糖变化指数。通过口服葡萄糖耐量试验评价HOMA-IR和HOMA-β试验。尿微量白蛋白与肌酐比值在实验室完成。
结果:中位数(25%,TIRCGM和TIRSMBG的75%四分位数)分别为74.94(44.90,88.04)和70.83(46.88,87.50),没有显著差异,p=0.489;TIRCGM每增加1%,微量白蛋白尿的风险降低1.6%(95CI:0.973,0.995,p=0.006),TIRSMBG每增加1%,微量白蛋白尿的风险降低了1.3%(95CI:0.975,0.999,p=0.033).多元线性回归分析显示TIR(包括TIRCGM和TIRSBMG)与LnDI30和LnDI120水平呈独立正相关(p=0.000)。
结论:SMBG计算的TIR与CGM报告的结果高度一致,并且与微量白蛋白尿和HOMA-β的风险显著相关。较高的TIR四分位数与较低的微量白蛋白尿发生率以及较高的HOMA-β水平相关。对于CGM应用有限的患者,SMBG衍生的TIR可以替代CGM衍生的TIR,评估血糖控制。
OBJECTIVE: To compare the time in range (TIR) obtained from self-monitoring of blood glucose (SMBG) with that obtained from continuous glucose monitoring (CGM), and explore the relationship of TIR with microalbuminuria outcome, HOMA-IR and HOMA-β test.
METHODS: We recruited 400 patients with type 2 diabetes to carry out blood glucose monitoring by both SMBG and CGM for 3 consecutive days. TIR, TAR, TBR and other blood glucose variation indices were calculated respectively through the glucose data achieved from SMBG and CGM. The HOMA-IR and HOMA-β test was evaluated by an oral glucose tolerance test. Urinary microalbumin-to-creatinine ratio completed in the laboratory.
RESULTS: The median (25 %, 75 % quartile) of TIRCGM and TIRSMBG were 74.94(44.90, 88.04) and 70.83(46.88, 87.50) respectively, and there was no significant difference, p = 0.489; For every 1 % increase in TIRCGM, the risk of microalbuminuria decreased by 1.6 % (95%CI:0.973, 0.995, p = 0.006) and for every 1 % increase in TIRSMBG, the risk of microalbuminuria decreased by 1.3 % (95%CI:0.975, 0.999, p = 0.033). Stepwise multiple linear regression analysis showed an independent positive correlation between TIR (including TIRCGM and TIRSBMG) and LnDI30 and LnDI120 levels (p = 0.000).
CONCLUSIONS: The TIR calculated by SMBG was highly consistent with that reported by CGM and was significantly associated with the risk of microalbuminuria and the HOMA-β. Higher TIR quartiles were associated with lower incidence of microalbuminuria as well as higher lever of HOMA-β. For patients with limited CGM application, SMBG-derived TIR may be an alternative to CGM-derived TIR, to assess blood glucose control.