Impact of time in tight range on all-cause and cardiovascular mortality in type 2 diabetes: A prospective cohort study

IF 5.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM Diabetes, Obesity & Metabolism Pub Date : 2025-01-27 DOI:10.1111/dom.16212

Jinghao Cai MD, Jiechen Liu MPA, Jingyi Lu PhD, Jiaying Ni BS, Chunfang Wang BS, Lei Chen MS, Wei Lu BSN, Wei Zhu BSN, Tian Xia MS, Jian Zhou PhD

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Abstract

Aims

Currently, there is a lack of evidence regarding time in tight range (TITR) and long-term adverse outcomes. We aimed to investigate the association between TITR and the risk of all-cause and cardiovascular mortality among patients with type 2 diabetes.

Materials and Methods

A total of 6061 patients with type 2 diabetes were prospectively recruited in a single centre. TITR was measured with continuous glucose monitoring (CGM) at baseline and was defined as the percentage of time in the target glucose range of 3.9–7.8 mmol/L (70–140 mg/dL) during a 24-h period. Cox proportion hazard regression models were used to examine the association between TITR and the risk of all-cause and cardiovascular mortality.

Results

During a median follow-up period of 10.9 years, 1898 (31.3%) death events were confirmed, with 689 (11.4%) due to cardiovascular mortality. The restricted cubic spline revealed significant linear relationships between lower TITR and higher risks of all-cause and cardiovascular mortality (p for linearity <0.01). In the fully adjusted model including glycated haemoglobin A1c, each 10% decrease in TITR was associated with 4% (95% confidence interval, 1.01–1.06) increased risk of all-cause mortality and 4% (95% confidence interval, 1.00–1.08) increased risk of cardiovascular mortality. Subgroup analyses showed that the linear relationship between TITR and all-cause mortality risk was sustained in patients with haemoglobin A1c <7.0% and patients with fasting plasma glucose <7.0 mmol/L.

Conclusions

Lower TITR is associated with an increased risk of all-cause and cardiovascular mortality in patients with type 2 diabetes, indicating that tight glycaemic control within the physiological range may be crucial for reducing long-term mortality risk, especially in those with seemingly well-controlled diabetes.

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近程时间对2型糖尿病全因死亡率和心血管死亡率的影响：一项前瞻性队列研究

目的：目前，缺乏关于窄范围时间（TITR）和长期不良后果的证据。我们的目的是研究TITR与2型糖尿病患者全因死亡率和心血管死亡率之间的关系。材料和方法：在单个研究中心前瞻性地招募了6061例2型糖尿病患者。TITR在基线时通过连续血糖监测（CGM）测量，定义为24小时内血糖在目标范围3.9-7.8 mmol/L （70-140 mg/dL）内的时间百分比。采用Cox比例风险回归模型检验TITR与全因死亡率和心血管死亡率之间的关系。结果：在10.9年的中位随访期间，确认死亡事件1898例（31.3%），其中心血管死亡689例（11.4%）。限制三次样条显示，较低的TITR与较高的全因和心血管死亡风险之间存在显著的线性关系（p为线性关系）。结论：较低的TITR与2型糖尿病患者全因和心血管死亡风险增加相关，表明在生理范围内严格控制血糖可能对降低长期死亡风险至关重要，特别是对于那些似乎控制良好的糖尿病患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes, Obesity & Metabolism 医学-内分泌学与代谢

CiteScore

10.90

自引率

6.90%

发文量

319

审稿时长

3-8 weeks

期刊介绍： Diabetes, Obesity and Metabolism is primarily a journal of clinical and experimental pharmacology and therapeutics covering the interrelated areas of diabetes, obesity and metabolism. The journal prioritises high-quality original research that reports on the effects of new or existing therapies, including dietary, exercise and lifestyle (non-pharmacological) interventions, in any aspect of metabolic and endocrine disease, either in humans or animal and cellular systems. ‘Metabolism’ may relate to lipids, bone and drug metabolism, or broader aspects of endocrine dysfunction. Preclinical pharmacology, pharmacokinetic studies, meta-analyses and those addressing drug safety and tolerability are also highly suitable for publication in this journal. Original research may be published as a main paper or as a research letter.