新诊断2型糖尿病患者葡萄糖目标范围内时间与糖化血红蛋白的相关性

Correlation between time in range and glycated hemoglobin in patients with newly-diagnosed type 2 diabetes mellitus

目的探讨新诊断2型糖尿病(T2DM)患者短期治疗后葡萄糖目标范围内时间(TIR)与3个月后糖化血红蛋白(HbA 1c-3m)的相关性。方法本研究为横断面研究。选取2018年1月至2022年9月于内蒙古自治区人民医院内分泌科住院的新诊断并开始治疗同时接受3个月随访、资料信息完整的94例T2DM患者作为研究对象。按照血糖所要达到的不同目标范围将TIR分为3组(TIR1:血糖在3.9~10.0 mmol/L之间的TIR,TIR2:血糖在3.9~7.8 mmol/L之间的TIR,TIR3:空腹、餐前或睡前血糖<6.1 mmol/L同时餐后2h血糖<8.0 mmol/L范围内的TIR),以HbA 1c-3m是否<6.5%将研究对象分为两组,比较两组的基线资料以及不同目标水平TIR的差异,分别采用Spearman相关分析、二元logistic回归模型分析各基线指标、短期治疗后3组TIR分别与HbA lc-3m的相关性,并绘制受试者工作特征(ROC)曲线分别评估短期治疗后不同TIR对HbA 1c-3m的预测价值。结果HbA 1c-3m<6.5%组与HbA 1c-3m≥6.5%组的TIR1[81.0(67.5,94.6)%比71.4(51.7,85.7)%]、TIR2[57.7(29.7,70.8)%比40.9(22.4,52.3)%]、TIR3[23.8(10.2,39.5)%比13.0(4.8,25.0)%]比较差异均有统计学意义。在所有新诊断的T2DM患者中,TIR1、TIR2、TIR3与HbA 1c-3m[6.4(6.1,6.9)%]均呈负相关(r值分别为-0.322、-0.348、-0.303,均P<0.01)。在校正相关混杂因素后,TIR1(OR=1.021,95%CI:1.002~1.041;P=0.034)、TIR2(OR=1.024,95%CI:1.006~1.043;P=0.011)、TIR3(OR=1.037,95%CI:1.010~1.065;P=0.008)均与HbA 1c-3m独立相关。以HbA 1c-3m<6.5%为目标值时,ROC曲线下面积分别为:TIR1为0.639(95%CI:0.528~0.751)、TIR2为0.671(95%CI:0.560~0.782)、TIR3为0.659(95%CI:0.549~0.770),当以HbA 1c-3m<7.0%为目标值时,ROC曲线下面积分别为:TIR1为0.730(95%CI:0.619~0.841)、TIR2为0.744(95%CI:0.642~0.846)、TIR3为0.701(95%CI:0.588~0.814),三者间曲线下面积差异均无统计学意义。结论对于新诊断的T2DM患者短期治疗后TIR与3个月后HbA 1c水平呈负相关,对其具有良好的预测价值。

ObjectiveTo explore the correlation between time in range(TIR)after short-term treatment and glycated hemoglobin after 3 months(HbA lc-3m)in patients with newly-diagnosed type 2 diabetes mellitus(T2DM).MethodsIn this cross-sectional study,a total of 94 patients with newly-diagnosed T2DM who received treatment in the Department of Endocrinology of Inner Mongolia Autonomous Region People′s Hospital were enrolled from January 2018 to September 2022.The patients were followed-up for 3 months and had complete medical record.TIR was divided into three groups according to different target ranges of blood glucose(TIR1:TIR with blood glucose between 3.9 and 10.0 mmol/L,TIR2:TIR with blood glucose between 3.9 and 7.8 mmol/L,TIR3:TIR with fasting,premeal or bedtime blood glucose<6.1 mmol/L and 2 h postprandial blood glucose<8.0 mmol/L).The patients were divided into two groups based on whether their HbA 1c-3m level was less than 6.5%,and the baseline data and variations in TIR for distinct target glucose levels were compared between the two groups.Spearman′s correlation analysis and binary logistic regression analysis were used to analyze the relationship between baseline indicators,TIR after short-term treatment and HbA 1c-3m.Receiver operating characteristic curve(ROC)was drawn to evaluate the predictive ability of different TIR after short-term therapy for HbA 1c-3m.ResultsThere were statistically significant differences in TIR1[81.0(67.5,94.6)%vs 71.4(51.7,85.7)%],TIR2[57.7(29.7,70.8)%vs 40.9(22.4,52.3)%]and TIR3[23.8(10.2,39.5)%vs 13.0(4.8,25.0)%]between patients with a HbA 1c-3m<6.5%and patients with a HbA 1c-3m≥6.5%(all P<0.05).Spearman correlation analysis showed that among all the patients with newly-diagnosed T2DM,TIR1,TIR2 and TIR3 were all negatively correlated with HbA 1c-3m[6.4(6.1,6.9)%](r=-0.322,-0.348,-0.303,respectively,all P<0.01).Logistic regression analysis showed that after adjusting for the confounding factors,TIR1(OR=1.021,95%CI:1.002-1.041;P=0.034),TIR2(OR=1.024,95%CI:1.006-1.043;P=0.011),TIR3(OR=1.037,95%CI:1.010-1.065;P=0.008)were all independently related to HbA 1c-3m.When HbA lc-3m<6.5%was taken as the target value,the area under the ROC curve:TIR1 was 0.639(95%CI:0.528-0.751),TIR2 was 0.671(95%CI:0.560-0.782),TIR3 was 0.659(95%CI:0.549-0.770),respectively.When HbA lc-3m<7.0%was taken as the target value,the area under the ROC curve:TIR1 was 0.730(95%CI:0.619-0.841),TIR2 was 0.744(95%CI:0.642-0.846),TIR3 was 0.701(95%CI:0.588-0.814).There was no significant difference in the area among the three statistics(P>0.05).ConclusionsFor newly-diagnosed T2DM patients,TIR after short-term treatment is negatively correlated with HbA 1c after 3 months and has good predictive value for it.