儿童1型糖尿病糖化血红蛋白与持续葡萄糖监测衍生指标相关性分析

Correlation between glycated hemoglobin and continuous glucose monitoringderived metrics in children with type 1 diabetes mellitus

目的:分析儿童1型糖尿病(type 1 diabetes mellitus,T1DM)糖化血红蛋白(glycated hemoglobin,HbA1c)与持续葡萄糖监测(continuous glucose monitoring,CGM)衍生指标的相关性。方法:收集2019年8月至2020年10月在郑州大学附属儿童医院内分泌遗传代谢科门诊就诊,连续3个月应用扫描式葡萄糖监测系统(flash glucose monitoring system,FGMS)的儿童T1DM患儿临床资料,包括年龄、性别、病程、HbA1c、空腹血糖、空腹C肽、胰岛素给药途径,通过扫描式葡萄糖监测系统收集2周血糖在目标范围时间(time in target glucose range,TIR)、高血糖时间(time above target glucose range,TAR)、低血糖时间(time below target glucose range,TBR)、平均血糖(mean glucose,MG),分析HbA1c与TIR、TAR、TBR及MG的相关性。结果:研究共纳入应用FGMS的T1DM患儿118例,男54人,女64人,平均年龄7.7岁,平均病程2.5年,平均空腹C肽0.1 ng/mL,平均HbA1c6.7%,平均TIR 67.4%,平均TAR 21.4%,平均TBR 11.2%,平均MG 7.4 mmol/L;胰岛素泵组与皮下注射组相比,患儿年龄大(P=0.01)、病程长(P=0.01)、体质指数高(P=0.03),但空腹血糖低(P=0.03)、TIR水平高(P=0.03);总体HbA1c与TIR中度负相关(r=-0.571,P<0.01),与TAR高度正相关(r=0.720,P<0.01),与TBR无相关(P=0.210),与MG高度正相关(r=0.799,P<0.01);应用胰岛素泵患儿HbA1c与TIR、TAR、MG相关(r=-0.519、0.688、0.783),应用皮下胰岛素注射患儿HbA1c与TIR、TAR、MG亦相关(r=-0.648、0.763、0.820),均与TBR无相关;儿童HbA1c与TIR为60%时相对应的HbA1c为6.59%,TIR为70%时相对应的HbA1c为6.22%。结论:评估儿童T1DM血糖控制情况有必要联合HbA1c及CGM衍生指标共同评估。

Objective:To analyze the correlation between glycated hemoglobin(HbA1c) and continuous glucose monitoring(CGM)-derived metrics in children with type 1 diabetes mellitus(T1DM). Methods:Children with T1DM who wore flash glucose monitoring system(FGMS) for more than 3 months were collected from the Department of Endocrinology,Genetics and Metabolism,Children’s Hospital Affiliated to Zhengzhou University from August 2019 to October 2020. The clinical data including age,gender,diabetic duration,body mass index(BMI),insulin delivery method,fasting blood glucose,fasting C-peptide,HbA1c,time in target glucose range(TIR),time above target glucose range(TAR),time below target glucose range(TBR) and mean glucose(MG) were collected,and the correlation of HbA1c with TIR,TAR,TBR and MG was analyzed. Results:A total of 118 children were included in the study,including 54 boys and 64 girls,with an average age of 7.7 years,mean diabetic duration of 2. 5 years, mean fasting C peptide of0.1 ng/m L,mean Hb A1c 6.7%,mean TIR of 67.4%,mean TAR of 21.4%,mean TBR of 11.2%,mean MG of 7.4 mmol/L.Compared with children using subcutaneous insulin injection,children using insulin pump had older age( P = 0. 01), longer diabetic duration(P=0.01),higher BMI(P=0.03),but lower fasting blood glucose(P=0.03) and higher TIR(P=0.03). Hb A1c was in general negatively correlated with TIR(r=-0.571,P < 0.01),and positively correlated with TAR(r=0.720,P < 0.01) and MG(r=0.799,P < 0.01),but not correlated with TBR(P =0.210). Hb A1c was correlated with TIR,TAR and MG in children with insulin pump(r=-0.519,0.688,0.783) and children with subcutaneous insulin injection(r=-0.648,0.763,0.820),all of which were not correlated with TBR. Hb A1c levels corresponded to the recommended frequency in TIR of 60% and 70% were 6.59% and 6.22% respectively.Conclusion:The glycemic control of children with T1DM should be evaluated by combining Hb A1c and CGM-derived metrics.