葡萄糖在目标范围内时间和糖尿病足的相关性研究

Correlation between time in range and diabetic foot in patients with type 2 diabetes mellitus

目的 探讨目标范围内时间(TIR)等血糖波动指标和糖尿病足(DF)的相关性。方法 选取2020年1—12月在蚌埠医科大学第一附属医院内分泌科佩戴瞬感动态血糖监测的163例2型糖尿病(T2DM)住院患者为研究对象。按有无DF分为DF组(26例)和非DF组(NDF,137例);DF组再按Wagner分级分为Wagner 3级组(17例)和Wagner 4级组(9例)。所有患者行眼底照相和感觉阈值(VPT)测定,监测目标范围内时间(TIR)、高于目标范围时间(TAR)、低于目标范围时间(TBR)、葡萄糖变异系数(CV)和平均血糖波动幅度(MAGE),比较上述指标的差异。结果 DF组和NDF组TIR[(35.19±10.94)%vs.(44.79±10.60)%],CV[36.65(29.45,38.75)%vs.29.90(24.60,34.80)%]、TAR[(61.46±12.21)%vs.(54.01±11.22)%]、TBR[1.00(0.00,5.75)%vs.0.00(0.00,1.00)%]、眼底照相阳性比例(19/26 vs.96/137)和VPT异常比例(25/26 vs.45/137)比较差异均有统计学意义。Wagner 3级和4级组CRP和VPT异常比例高于NDF组,TIR低于NDF组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,CRP(OR=1.024,P=0.011)、眼底照相(OR=0.113,P=0.013)、VPT(OR=31.803,P=0.042)是DF的独立影响因素。结论 DF患者易合并DM视网膜病变和神经病变,感染是其独立危险因素;低TIR、高CV提示血糖控制差且波动,可能与DF发生有关。

Objective To investigate the correlation between glycemic variability such as time in range(TIR) and diabetic foot(DF).Methods The study included 163 inpatients with T2DM who underwent prompt dynamic blood glucose monitoring at the Department of Endocrinology,the First Affiliated Hospital of Bengbu Medical University between January 2020 and December 2020.The participants were divided into two groups based on the presence or absence of DF:the DF group(n=26) and the non-DF group(NDF,n=137).The DF group were divided into two sub-groups based on the Wagner classification:Wagner grade 3 group(n=17),Wagner grade 4 group(n=9).All patients underwent fundus photography and sensory threshold(VPT) measurement,additionally,their glucose levels were monitored using TIR,time above range(TAR),time below range(TBR),glucose coefficient of variation(CV) and mean amplitude of glycemic excursions(MAGE).The above indices were compared statistically.Results TIR [(35.19±10.94) % vs.(44.79±10.60) %],CV [36.65(29.45,38.75) % vs.29.90(24.60,34.80) %],TAR [(61.46±12.21) % vs.(54.01±11.22) %],TBR [1.00(0.00,5.75) % vs.0.00(0.00,1.00) %],fundus photography(19/26 vs.96/137) and abnormal proportion of VPT(25/26 vs.45/137),there were statistical differences between the DF and NDF groups.The rates of CRP and VPT were higher in the Wagner grade 3 and 4 groups compared to the NDF group.Additionally,the TIR was lower in both groups compared to the NDF group,with statistically significant differences.The results of the multiple logistic regression analysis indicate that CRP(OR=1.024,P=0.011),fundus radiography(OR=0.113,P=0.013) and VPT(OR=31.803,P=0.042) were independent influencing factors for DF.Conclusion DF can be complicated by DM retinopathy and neuropathy,and infection is an independent risk factor.A higher CV was observed with lower TIR,indicating poor and fluctuating blood glucose levels.This may be associated with the development of DF.