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扫描式葡萄糖监测系统中目标范围时间与糖化血红蛋白的相关性

Relationship between HbA1c and the Time in Range Derived from Flash Glucose Monitoring System

    摘要
  • 摘要:
      目的  分析中国成人1型糖尿病(type 1 diabetes mellitus, T1DM)患者扫描式葡萄糖监测系统(flash glucose monitoring system, FGMS)衍生的目标范围时间(time in range, TIR)与糖化血红蛋白(glycated hemoglobin, HbA1c)的关系。
      方法  前瞻性收集并分析2018年10月至2019年3月北京协和医院内分泌科门诊招募的成人T1DM患者的临床资料。患者均测定HbA1c，并佩戴医院版FGMS 14 d，计算TIR以及葡萄糖变异系数(coefficient of variation, CV)等指标。采用Spearman法分析TIR与HbA1c的相关性，采用简单线性回归法分析TIR与HbA1c的关系。
      结果  共77例符合纳入和排除标准的T1DM患者纳入分析，HbA1c为(7.5±1.3)%，TIR为62.0(48.7，67.8)%，CV为(39.7± 8.1)%。Spearman相关性分析显示，HbA1c与TIR呈负相关(r=-0.645，P＜0.001)；线性回归方程为：HbA1c=10.58-0.05×TIR，TIR每增加10%，HbA1c下降0.5%。分层分析结果显示，血糖稳定(CV＜36%)/血糖不稳定(CV≥36%)患者的HbA1c与TIR均呈负相关(r=-0.774，P＜0.001；r=-0.560，P＜0.001)，且在血糖稳定的患者中二者相关性更强。对于同一TIR，血糖稳定者的HbA1c较血糖不稳定者更高。
      结论  在中国成人T1DM患者中，FGMS衍生的TIR与HbA1c呈负相关，可用于指导血糖管理，但TIR与HbA1c的相关性可能受血糖变异性影响。

     

    Abstract:
      Objective  To explore the relationship between HbA1c and time in range (TIR) derived from flash glucose monitoring system (FGMS) in Chinese adults with type 1 diabetes mellitus (T1DM).
      Methods  Adult T1DM patients attended the outpatient department of Peking Union Medical College Hospital (PUMCH) from October 2018 to March 2019 were included. HbA1c and data of FGMS were obtained at the same time. TIR was calculated, and the relationship between TIR and HbA1c was investigated by Spearman correlation and regression analysis.
      Results  A total of 77 patients who met the inclusion and exclusion criteria were included in the analysis. The average HbA1c was (7.5±1.3)%; TIR was 62.0 (48.7, 67.8)% and coefficient of variation(CV) was (39.7±8.1)%. TIR derived from FGMS had a negative liner correlation with HbA1c (r=-0.645, P < 0.001). The regression equation is: HbA1c=10.58-0.05×TIR. The HbA1c level is decreased by 0.5% for every 10% increase in TIR. TIR was negatively correlated with HbA1c in patients with both stable glucose (CV < 36%) and unstable glucose (CV≥36%), but the correlation coefficient between TIR and HbA1c in patients with stable glucose was higher. For a specific TIR, HbA1c was higher in patients with stable glucose.
      Conclusion  The FGMS-derived TIR could be helpful in the glucose management in Chinese adults with T1DM, and glucose variability should be taken into consideration while interpreting the relationship between TIR and HbA1c.

     

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