Relative contributions of fasting and postprandial glucose increments, glycemic variability, and non-glycemic factors to HbA1c in individuals with type 1 diabetes 基于1型糖尿病患者的空腹和餐后血糖增量、血糖变异性和非血糖因素对HbA1C的相对贡献

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM Journal of Diabetes Pub Date : 2023-05-04 DOI:10.1111/1753-0407.13388

Yongwen Zhou, Mao Zheng, Hongrong Deng, Xueying Zheng, Sihui Luo, Daizhi Yang, Xiaodong Mai, Wen Xu, Jinhua Yan, Jianping Weng

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Abstract

Aim

Evidence for contribution of basal and postprandial glucose increment, and glycemic variability to glycated hemoglobin (HbA1c) among adults with type 1 diabetes (T1D) is limited. This study aimed to capture glycemic fluctuation patterns and quantify contributions of these factors to HbA1c levels among adults with T1D.

Methods

HbA1c, continuous glucose monitoring (CGM), and diet diaries were collected and pooled from two clinical trials. Available data sets were divided into HbA1c quartiles: group 1 (≤6.7%), group 2 (6.7%–7.3%), group 3 (7.3%–7.8%), and group 4 (≥7.8%). Area under curve above 110 mg/dL (AUC_>110mg/dL) in 24-h profile was defined as overall hyperglycemia and stratified with postprandial hyperglycemia (PHG, AUC_>110mg/dL in 3-h period after meals) and basal hyperglycemia (BHG, AUC_>110mg/dL in remaining period). Linear regression analysis was used to estimate the proportion of variance in HbA1c explained by BHG, preprandial glucose, PHG, glycemic variability, and non-glycemic factors (age, body mass index, hemoglobin, and duration).

Results

A total of 169 550 glucose data in 2409 meals recorded from 102 patients (male/female, 34/68) were included. Age and duration were 35.2 ± 12.6 and 8.9 (2.9, 13.0) years, with 51.0% using pumps. Overall, BHG was four times higher than PHG (p all <.05) and between-group comparisons showed BHG exhibited a progressive increase (group 1 vs. 2, 3, 4, p = .053, .086, .006) with fasting contribution of 76.1%, 82.6%, 81.5%, and 84.3% from group 1 to 4. The increment was not significant among groups 2, 3, and 4 (p > .05). Factors included in analysis explained a total of 74% of the variance in HbA1c, in which BHG accounted for 32.1% of variance whereas PHG accounted for 24.4%. In group with HbA1c >7.3%, BHG accounted for a higher percentage with 33.8% of the variance in HbA1c.

Conclusions

In our study, basal hyperglycemia better predicts overall glycemic control than postprandial hyperglycemia among adults with T1D. The relative contribution of basal hyperglycemia increased gradually with HbA1c increasing and predominant strategy for insulin titration among T1D is different among different levels of glycemic control.

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Relative contributions of fasting and postprandial glucose increments, glycemic variability, and non-glycemic factors to HbA1c in individuals with type 1 diabetes 基于1型糖尿病患者的空腹和餐后血糖增量、血糖变异性和非血糖因素对HbA1C的相对贡献

目的:在1型糖尿病(T1D)成人中，基础和餐后葡萄糖增加以及血糖变异性对糖化血红蛋白(HbA1c)的贡献证据有限。本研究旨在捕捉血糖波动模式，并量化这些因素对成年T1D患者HbA1c水平的影响。方法收集并汇总两项临床试验的HbA1c、连续血糖监测(CGM)和饮食日记。可用数据集分为HbA1c四分位数:1组(≤6.7%)、2组(6.7% - 7.3%)、3组(7.3%-7.8%)和4组(≥7.8%)。24小时曲线下超过110mg/dL (AUC>110mg/dL)的区域被定义为整体高血糖，并分为餐后高血糖(PHG，饭后3小时内AUC>110mg/dL)和基础高血糖(BHG，饭后3小时内AUC>110mg/dL)。采用线性回归分析估计由BHG、餐前血糖、PHG、血糖变异性和非血糖因素(年龄、体重指数、血红蛋白和持续时间)解释的HbA1c变异比例。结果共纳入102例患者(男/女34/68)2409餐中169 550份血糖数据。年龄(35.2±12.6)岁、病程(8.9)岁(2.9、13.0)岁)，51.0%使用泵;总体而言，BHG比PHG高4倍(p均< 0.05)，组间比较显示BHG呈进行性增加(1组vs. 2,3,4, p =。0.053, 0.086, 0.006)，空腹贡献率分别为76.1%，82.6%，81.5%，84.3%。2组、3组和4组间差异无统计学意义(p > 0.05)。分析中包含的因素共解释了HbA1c方差的74%，其中BHG占方差的32.1%，PHG占方差的24.4%。在HbA1c为7.3%的组中，BHG占HbA1c方差的比例更高，为33.8%。结论:在我们的研究中，基础高血糖比餐后高血糖更能预测成年T1D患者的总体血糖控制。随着HbA1c的升高，基础高血糖的相对贡献逐渐增加，不同血糖控制水平的T1D患者首选胰岛素滴注策略不同。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.