TIR不同切点评价2型糖尿病蛋白尿控制情况的分析

Analysis of the Control Situation of Proteinuria in Type 2 Diabetes Mellitus Evaluated at Different Pointcuts of TIR

目的 探讨2型糖尿病(type 2 diabetes mellitus, T2DM)患者葡萄糖目标范围内时间(time in range, TIR)的不同切点用以评价蛋白尿控制情况的相关分析。方法 通过对209例T2DM患者的资料进行横断面分析,使用持续葡萄糖监测(continuous glucose monitoring, CGM)技术评价TIR,用尿白蛋白/肌酐比值(urinary albumin/creatinine ratio, UACR)评价蛋白尿水平,根据各TIR切点进行分组后,分析比较各组蛋白尿(UACR≥30mg/g)的检出率情况。结果 根据TIR水平分为TIR≤40%、40%<TIR≤70%、70%<TIR≤85%及TIR>85%共4组。4组间糖化血红蛋白(glycated hemoglobin, HbA1c)、平均血糖(mean glucose, MG)、葡萄糖在目标范围之上时间(time above range, TAR)、平均血糖波动幅度(mean amplitude of glycemic excursions, MAGE)、血糖变异系数(coefficient of variation, CV)随TIR降低而增加(P均<0.05)。在研究人群中,共有50例(23.9%)患者UACR异常,异常UACR的患病率随TIR的降低呈逐渐升高(P<0.05),使用多因素Logistic回归校正了协变量后,与TIR≤40%组比较,异常UACR的风险在40%<TIR≤70%组、70%<TIR≤85%组、TIR>85%组分别降低了50.5%(OR=0.495,P=0.253)、71.7%(OR=0.283,P=0.038)、83.1%(OR=0.169,P=0.007)。结论 采用40%、70%、85%作为TIR切点有助于区分T2DM者蛋白尿风险水平。

Objective To explore the correlation analysis of different time in range(TIR)pointcuts of glucose in type 2 diabetes mellitus(T2DM)patients to evaluate the control situation of proteinuria.Methods The data of 209 patients with T2DM were analyzed in cross section,TIR was evaluated by continuous glucose monitoring(CGM),proteinuria level was evaluated by urinary albumin-creatinine ratio(UACR).The detection rate of proteinuria(UACR≥30mg/g)in each group was analyzed and compared according to the TIR pointcuts.Results According to the TIR level,the patients were divided into four groups:TIR≤40%group,40%85%group.Glycated hemoglobin(HbA1c),mean glucose(MG),time above range(TAR),mean amplitude of glycemic excursions(MAGE)and coefficient of variation(CV)of blood glucose increased with the decrease of TIR among the four groups(all P<0.05).In the study population,a total of 50 patients(23.9%)had abnormal UACR,and the prevalence of abnormal UACR increased gradually with the decrease of TIR(P<0.05).After adjusting for covariates using multivariate Logistic regression,compared with the TIR≤40%group,the risk of abnormal UACR decreased by 50.5%(OR=0.495,P=0.253),71.7%(OR=0.283,P=0.038),83.1%(OR=0.169,P=0.007)in the 40%85%group,respectively.Conclusion Using 40%,70%,and 85%as TIR pointcuts can help to distinguish the risk levels of proteinuria in patients with type 2diabetes.