Association between time in range, a novel measurement of glycemic control and islet secretory function in chinese patients with type 2 diabetes mellitus-An observational study

摘要

Aims: To explore the association between dynamic islet secretory function and TIR (time in range), a new valuable metric of glycemic control in type 2 diabetes (T2D). @@@ Methods: In this observational study 256 patients with type 2 diabetes were included and continuous glucose monitoring system (CGMS) were applied to monitor blood glucose and also the calculation of TIR [the time spent in an individual's target glucose range (usually 3.9-10 mmol/L)]. The participants were divided into 3 groups according to the tertiles of TIR, 85 cases with TIR >= 65.05% (T1 group), 86 cases with 41.84 < TIR <= 65.05% (T2 group) and 85 cases with TIR < 41.84% (T3 group). Serum glucagon (GLA(0h), GLA(0.5h), GLA(1h), GLA(2h), GLA(3h)), C-peptide (Cp-0h, Cp-0.5h, Cp-1h, Cp-2h, Cp-3h) concentration at different time points were measured after a 100 g standard steamed buns meal test to assess the pancreatic alpha cell and beta cell function. Spearman correlation analysis and multivariate linear stepwise regression analysis were adopted for statistical analysis. @@@ Results: The average age and diabetes duration of all the participants were separately 56. 09 +/- 13.8 years and 8.0 (4.0,15.0) years. Compared with patients in T1 group, participants in group T2 and T3 tend to have a lower concentration of C-peptide at all time points, as well as GLA(0h), GLA(2h) and GLA(3h) (p < 0.05). TIR was positively correlated with C-peptide at different time points, area under the curve of C-peptide in half an hour (AUC(Cp0.5h)), GLA(0h), GLA(3h), area under the curve of glucagon in half an hour (AUC(GLA0.5h)) (rs = 0.263, 0.414, 0.510, 0.587, 0.528, 0.360, 0.259, 0.144 and 0.208, respectively, p < 0.05) and was negatively correlated with the increment of serum glucagon from baseline at 0.5 h, 1 h and 2 h after the standard energy loaded (Delta GLA(0.5h), Delta GLA(1h), Delta GLA(2h)) (r(s) = -0.152,-0.172 and -0.203, respectively, p < 0.05). Cp-2h, Cp-0h and GLA(0h) were independent factors for TIR (beta = 6.558,6.930, 0.247, respectively, p < 0.01). @@@ Conclusion: Both islet alpha cell and beta cell secretory function have important influence on TIR, a novel vital index of glycemic fluctuation.

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