葡萄糖在目标范围内时间与糖尿病足的相关性研究

Correlation between time in range and diabetic foot

目的:探讨葡萄糖在目标范围内时间(TIR)与糖尿病足之间的相关性。方法:收集2017年6月至2021年10月在西安医学院第一附属医院内分泌科住院的糖尿病患者,根据是否患有糖尿病足分为糖尿病足组和对照组。收集患者的一般资料和实验室检查结果,所有患者均接受连续3 d的动态葡萄糖监测,计算TIR、葡萄糖高于目标范围时间(TAR)、葡萄糖低于目标范围时间(TBR)、血糖变异系数(CV)、标准差(SD)、日间血糖平均绝对差(MODD)等指标,并采用 t检验、秩和检验或 χ^(2)检验比较,采用logistic回归分析评价TIR和糖尿病足的关系,采用Pearson或Spearman相关性分析评价相关性。 结果:共纳入450例糖尿病患者,其中对照组和糖尿病足组患者均为225例。与对照组相比,糖尿病足组患者男性较多、年龄较大、病程较长、收缩压较高、白细胞、血小板、低密度脂蛋白胆固醇、尿素氮、肌酐、合并糖尿病肾脏病、合并冠心病、糖化血红蛋白(HbA 1c)、TAR、CV、SD及MODD较高,而体重指数、血红蛋白、间接胆红素、白蛋白、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、估算的肾小球滤过率(eGFR)、TIR较低,差异均有统计学意义( P<0.05)。校正了年龄、病程、体重指数、HbA 1c等混杂因素后,TIR每增加10%,糖尿病足风险降低13.1%。校正混杂因素后,TIR与糖尿病足低级别组存在显著相关性,OR(95%CI)为0.985(0.972~0.999), P=0.035。随着TIR四分位数的上升,糖尿病足的患病率逐渐下降。TIR四分位数与糖尿病足患病风险呈负相关( r=-0.290, P<0.01)。糖尿病足患者TIR水平与患者收缩压( r=0.131, P<0.05)呈正相关,与白细胞( r=-0.146, P<0.05)、HbA 1c( r=-0.470, P<0.01)呈负相关。 结论:在糖尿病患者中,糖尿病足患者血糖变异性较高,TIR与糖尿病足显著相关,TIR四分位数与糖尿病足患病风险呈负相关。

Objective To investigate the relationship between time in range(TIR)of glucose and diabetic foot.Methods Diabetic patients hospitalized in the Department of Endocrinology,the First Affiliated Hospital of Xi′an Medical University from June 2017 to October 2021 were enrolled and divided into non-diabetic foot group(NDF group)and diabetic foot group(DF group)according to whether they had diabetic foot.General and biochemical data were collected before admission.All patients received continuous glucose monitoring for 3 days at admission.TIR,time above range(TAR),time below range(TBR),glucose variability coefficient(CV),standard deviation(SD),daytime blood sugar average absolute deviation(MODD)and so on were calculated.Chi-square test,U test and t test were used to compare the two samples.Results A total of 450 diabetic patients were included,of whom 225 were in NDF group and 225 in DF group.Compared with NDF group,patients in DF group had more males,older age,longer course of disease,higher systolic blood pressure,higher white blood cells(WBC),platelets,low density lipoprotein,urea nitrogen,creatinine,prevalence of diabetic nephropathy and coronary heart disease,glycated hemoglobin A1c(HbA1c),TAR(>10 mmol/L),CV,SD and MODD(P<0.05),while body mass index(BMI),hemoglobin,indirect bilirubin,albumin,cholesterol,triglyceride,high density lipoprotein,estimated glomerular filtration rate(eGFR)and TIR were lower(P<0.05).In the corrected model,DF risk was reduced by 13.1%for every 10%increase in TIR.After adjusting for confounding factors such as age,course of disease and HbA1c,TIR was significantly associated with lower grade diabetic foot group[OR(95%CI):0.985(0.972-0.999),P=0.035].With the increase of TIR quartile,the prevalence of diabetic foot decreased gradually.Spearman correlation analysis showed that TIR quartile was negatively correlated with the risk of diabetic foot(r=-0.290,P<0.01),TIR level of diabetic foot patients was positively correlated with systolic blood pressure,and negatively correlated with WBC and HbA1c.Conclusions Among diabetic patients,glycemic variability was higher in diabetic foot patients,TIR was significantly associated with diabetic foot,and TIR quartiles were negatively associated with the risk of diabetic foot disease.