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Time in range as a useful marker for evaluating retinal functional changes in diabetic retinopathy patients
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作者 Dan-Dan Zhu Xuan Wu +1 位作者 Xin-Xuan Cheng Ning Ding 《International Journal of Ophthalmology(English edition)》 SCIE CAS 2023年第6期915-920,共6页
·AIM:To elucidate the relationship between macular sensitivity and time in range(TIR)obtained from continuous glucose monitoring(CGM)measures in diabetic patients with or without diabetic retinopathy(DR).·ME... ·AIM:To elucidate the relationship between macular sensitivity and time in range(TIR)obtained from continuous glucose monitoring(CGM)measures in diabetic patients with or without diabetic retinopathy(DR).·METHODS:This was a cross-sectional study including 100 eyes of non-DR patients and 60 eyes of DR patients.An advanced microperimetry was used to quantitate the retinal mean sensitivity(MS)and fixation stability in central macula.TIR of 3.9-10.0 mmol/L was evaluated with CGM.Pearson coefficient analysis and multiple linear regression analysis were used to assess the correlation between TIR and retinal sensitivity.·RESULTS:In a comparison of non-DR patients,significant differences(P<0.05)were found in Hb A1c,TIR,coefficient of variation(CV),standard deviation of blood glucose(SDBG)and mean amplitude of glucose excursion(MAGE)values in DR patients.Besides,those DR patients had significantly poor best-corrected visual acuity(BCVA,log MAR,P=0.001).In terms of microperimetry parameters,retinal mean sensitivity(MS)and the percentages of fixation points located within 2°and 4°diameter circles were significantly decreased in the DR group(P<0.001,P<0.001,P=0.02,respectively).The bivariate contour ellipse area(BCEA)encompassing 68.2%,95.4%,99.6%of fixation points were all significantly increased in the DR group(P=0.01,P=0.006,P=0.01,respectively).Correlation analysis showed that MS were significantly correlated with Hb A1c(P=0.01).TIR was positively correlated with MS(r=0.23,P=0.01).SDBG was negatively correlated with MS(r=-0.24,P=0.01)but there was no correlation between CV and MAGE with MS(P>0.05).A multivariable linear regression analysis was performed to prove that TIR and SDBG were both independent risk factors for MS reduction in the DR group.·CONCLUSION:TIR is correlated with retinal MS reduction in DR patients,suggesting a useful option for evaluating DR progression. 展开更多
关键词 diabetic retinopathy time in range MICROPERIMETRY continuous glucose monitoring
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Relationship between hemoglobin glycation index and risk of hypoglycemia in type 2 diabetes with time-in-range in target
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作者 Bei-Si Lin Zhi-Gu Liu +6 位作者 Dan-Rui Chen Yan-Ling Yang Dai-Zhi Yang Jin-Hua Yan Long-Yi Zeng Xu-Bin Yang Wen Xu 《World Journal of Diabetes》 SCIE 2024年第10期2058-2069,共12页
BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predictin... BACKGROUND In patients with type 2 diabetes mellitus(T2DM),the risk of hypoglycemia also occurs in at a time-in-range(TIR)of>70%.The hemoglobin glycation index(HGI)is considered the best single factor for predicting hypoglycemia,and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.All participants underwent a 7-days continuous glucose monitoring(CGM)using a retrospective CGM system.We obtained glycemic variability indices using the CGM system.We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator.Patients were categorized into low HGI(HGI<0.5)and high HGI groups(HGI≥0.5)according to HGI median(0.5).Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.RESULTS We included 129 subjects with T2DM(54.84±12.56 years,46%male)in the study.Median TIR score was 90%.The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group;this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group.Multivariate analyses revealed that mean blood glucose,standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia.Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia.In addition,the optimal cut-off points for HGI,mean blood glucose,and standard deviation of blood glucose in predicting hypoglycemia were 0.5%,7.2 mmol/L and 1.4 mmol/L respectively.CONCLUSION High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR>70%.Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population. 展开更多
关键词 Hemoglobin glycation index HYPOGLYCEMIA Type 2 diabetes mellitus Continuous glucose monitoring time in range
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Research progress in the application of time in range: more than a percentage
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作者 Jintao Wan Jingyi Lu +2 位作者 Cheng Li Xiaojing Ma Jian Zhou 《Chinese Medical Journal》 SCIE CAS CSCD 2023年第5期522-527,共6页
Glucose monitoring is an important part of medical care in diabetes mellitus,which not only helps assess glycemic control and treatment safety,but also assists with treatment adjustment.With the development of continu... Glucose monitoring is an important part of medical care in diabetes mellitus,which not only helps assess glycemic control and treatment safety,but also assists with treatment adjustment.With the development of continuous glucose monitoring(CGM),the use of CGM has increased rapidly.With the wealth of glucose data produced by CGM,new metrics are greatly needed to optimally evaluate glucose status and guide the treatment.One of the parameters that CGM provides,time in range(TIR),has been recognized as a key metric by the international consensus.Before the adoption of TIR in clinical practice,several issues including the minimum length of CGM use,the setting of the target range,and individualized TIR goals are summarized.Additionally,we discussed the mounting evidence supporting the association between TIR and diabetes-related outcomes.As a novel glucose metric,it is of interest to compare TIR with other conventional glucose markers such as glycated hemoglobin A1c.It is anticipated that the use of TIR may provide further information on the quality of glucose control and lead to improved diabetes management. 展开更多
关键词 Diabetes mellitus time in range Continuous glucose monitoring
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Continuous glucose monitoring defined time-in-range is associated with sudomotor dysfunction in type 2 diabetes 被引量:4
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作者 Qing-Yu Guo Bin Lu +6 位作者 Zhan-Hong Guo Zhou-Qin Feng Yan-Yu Yuan Xu-Guang Jin Pu Zang Ping Gu Jia-Qing Shao 《World Journal of Diabetes》 SCIE CAS 2020年第11期489-500,共12页
BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the rel... BACKGROUND Time in range(TIR),as a novel metric for glycemic control,has robust relevance with diabetic complications.Diabetic peripheral neuropathy(DPN)is characterized by sudomotor dysfunction.AIM To explore the relationship between TIR obtained from continuous glucose monitoring(CGM)and sudomotor function detected by SUDOSCAN in subjects with type 2 diabetes.METHODS The research enrolled 466 inpatients with type 2 diabetes.All subjects underwent 3-d CGM and SUDOSCAN.SUDOSCAN was assessed with electrochemical skin conductance in hands(HESC)and feet(FESC).Average feet ESC<60μS was defined as sudomotor dysfunction(+),otherwise it was sudomotor dysfunction(-).TIR refers to the percentage of time when blood glucose is between 3.9-10 mmol/L during 1 d period.RESULTS Among the enrolled subjects,135(28.97%)presented with sudomotor dysfunction.Patients with sudomotor dysfunction(+)showed a decreased level of TIR(P<0.001).Compared to the lowest tertile of TIR,the middle and the highest tertiles of TIR was associated with an obviously lower prevalence of sudomotor dysfunction(20.51%and 21.94%vs 44.52%)(P<0.001).In addition,with the increase of TIR,HESC and FESC increased(P<0.001).Regression analysis demonstrated that TIR was inversely and independently linked with the prevalence of sudomotor dysfunction after adjusting for confounding values(odds ratio=0.979,95%CI:0.971-0.987,P<0.001).CONCLUSION The tight glycemic control assessed by TIR is of vitally protective value for sudomotor dysfunction in type 2 diabetes mellitus. 展开更多
关键词 time in range Sudomotor dysfunction SUDOSCAN Diabetic peripheral neuropathy Continuous glucose monitoring Diabetes mellitus Type 2
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Negative association of time in range and urinary albumin excretion rate in patients with type 2 diabetes mellitus:a retrospective study of inpatients 被引量:3
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作者 Sanbao Chai Shanshan Wu +4 位作者 Sixu Xin Ning Yuan Jianbin Sun Xiaomei Zhang Linong Ji 《Chinese Medical Journal》 SCIE CAS CSCD 2022年第9期1052-1056,共5页
Background:Time in range(TIR)refers to the time an individual spends within their target glucose range,which now has been popularized as an important metric to classify glycemic management and also recognized as an im... Background:Time in range(TIR)refers to the time an individual spends within their target glucose range,which now has been popularized as an important metric to classify glycemic management and also recognized as an important outcome of current diabetes therapies.This study aimed to investigate the association between TIR and the severity of the urinary albumin excretion rate(UAER)in patients with type 2 diabetes mellitus(T2DM).Methods:We retrospectively analyzed the data of 1014 inpatients with T2DM at the Department of Endocrinology and Metabolism of Peking University International Hospital,China.TIR was defined as the percentage of blood glucose within the target range of 3.90-10.00 mmol/L.Urine samples for assessment of UAER were collected for 3 consecutive days from the start of hospitalization.Results:The TIR values for patients with normal urine levels of albumin,microalbuminuria,and macroalbuminuria were 70%±20%,50%±20%,and 30%±20%,respectively(allP<0.001).The patients were stratified according to quartiles of TIR as follows:quartile(Q)1,<55%;Q2,55%-72%;Q3,73%-83%;and Q4,>83%.The incidences of microalbuminuria in Q1,Q2,Q3,and Q4 were 41.1%,21.6%,7.1%,and 5.5%(allP<0.001),respectively.The respective incidences of macroalbuminuria were 24.2%,1.1%,1.4%,and 0%(allP<0.001).In multinomial logistic regression analyses,TIR was significantly correlated with microalbuminuria(odds ratio[OR]0.58,95%confidence interval[CI]:0.52-0.65,P<0.001)and macroalbuminuria(OR 0.26,95%CI:0.18-0.38,P<0.001)after adjusting for age,sex,body mass index,diabetes duration,systolic blood pressure,and levels of triglycerides,glycosylated hemoglobin A1c,and creatinine.Conclusion:The proportion of blood glucose in TIR is closely related to the severity of UAER in patients with T2DM. 展开更多
关键词 time in range Type 2 diabetes Urinary albumin excretion rate Blood glucose
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Relationship between time in range and corneal nerve fiber loss in asymptomatic patients with type 2 diabetes 被引量:3
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作者 Wejing Zhao Jingyi Lu +4 位作者 Lei Zhang Wei Lu Wei Zhu Yuqian Bao Jjian Zhou 《Chinese Medical Journal》 SCIE CAS CSCD 2022年第16期1978-1985,共8页
Background: Corneal confocal microscopy (CCM) is a noninvasive technique to detect early nerve damage of diabetic sensorimotor polyneuropathy (DSPN). Time in range (TIR) is an emerging metric of glycemic control which... Background: Corneal confocal microscopy (CCM) is a noninvasive technique to detect early nerve damage of diabetic sensorimotor polyneuropathy (DSPN). Time in range (TIR) is an emerging metric of glycemic control which was reported to be associated with diabetic complications. We sought to explore the relationship between TIR and corneal nerve parameters in asymptomatic patients with type 2 diabetes (T2DM).Methods: In this cross-sectional study, 206 asymptomatic inpatients with T2DM were recruited. After 7 days of continuous glucose monitoring, the TIR was calculated as the percentage of time in the glucose range of 3.9 to 10.0 mmol/L. CCM was performed to determine corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length (CNFL). Abnormal CNFL was defined as ≤15.30 mm/mm2.Results: Abnormal CNFL was found in 30.6% (63/206) of asymptomatic subjects. Linear regression analyses revealed that TIR was positively correlated with CCM parameters both in the crude and adjusted models (all P< 0.05). Each 10% increase in TIR was associated with a 28.2% (95% CI: 0.595–0.866,P = 0.001) decreased risk of abnormal CNFL after adjusting for covariates. With the increase of TIR quartiles, corneal nerve fiber parameters increased significantly (allP for trend <0.01). The receiver operating characteristic curve indicated that the optimal cutoff point of TIR was 77.5% for predicting abnormal CNFL in asymptomatic patients.Conclusions: There is a significant independent correlation between TIR and corneal nerve fiber loss in asymptomatic T2DM patients. TIR may be a useful surrogate marker for early diagnosis of DSPN. 展开更多
关键词 Continuous glucose monitoring Corneal confocal microscopy time in range Type 2 diabetes
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Association between time in range and cancer mortality among patients with type 2 diabetes:a prospective cohort study 被引量:2
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作者 Yun Shen Chunfang Wang +8 位作者 Yaxin Wang Jingyi Lu Lei Chen Lei Zhang Wei Lu Wei Zhu Gang Hu Tian Xia Jian Zhou 《Chinese Medical Journal》 SCIE CAS CSCD 2022年第3期288-294,共7页
Background:Little was known about the association among time in range(TIR),time above range(TAR),time below range(TBR),and cancer mortality among patients with type 2 diabetes.We aimed to investigate the association a... Background:Little was known about the association among time in range(TIR),time above range(TAR),time below range(TBR),and cancer mortality among patients with type 2 diabetes.We aimed to investigate the association among TIR,TAR,TBR,and the risk of cancer mortality among patients with type 2 diabetes.Methods:A total of 6225 patients with type 2 diabetes were prospectively recruited in Shanghai,China.TIR was measured with continuous glucose monitoring at baseline and was defined as the average percentage of time in the target glucose range during a 24 h period.Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of cancer mortality.Results:During a mean follow-up of 7.10 years,we confirmed 237 death events related to cancer.The multivariable-adjusted hazard ratio(HR)for cancer mortality was 1.32(95%confidence interval[CI]:1.01-1.75)in patients with TIR≤70%compared with those with TIR>70%.When TIR was considered as a continuous variable,the multivariable-adjusted HR for cancer mortality associated with each 10%decrease in TIR was 1.07(95%CI:1.02-1.14).In the site-specific analysis,a significant association between TIR as a continuous variable and the risk of hepatocellular cancer was found(HR:1.24;95%CI:1.09-1.41).However,no relationship between hemoglobin A1c and cancer mortality was observed(HR:1.04;95%CI:0.97-1.10).Conclusions:The present study found an inverse association of TIR with the risk of cancer mortality among patients with type 2 diabetes.New evidence of TIR was added into the clinical practice that TIR may be an optimal target of glycemic control among patients with type 2 diabetes. 展开更多
关键词 time in range HBA1C Type 2 diabetes Cancer mortality Cohort study Hepatocellular cancer
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Association of point in range withβ-cell function and insulin sensitivity of type 2 diabetes mellitus in cold areas
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作者 Yanan Ni Dan Liu +1 位作者 Xiaona Zhang Hong Qiao 《Frigid Zone Medicine》 2023年第4期242-252,I0014,共12页
Background and Objective:Self-monitoring of blood glucose(SMBG)is crucial for achieving a glycemic target and upholding blood glucose stability,both of which are the primary purpose of anti-diabetic treatments.However... Background and Objective:Self-monitoring of blood glucose(SMBG)is crucial for achieving a glycemic target and upholding blood glucose stability,both of which are the primary purpose of anti-diabetic treatments.However,the association between time in range(TIR),as assessed by SMBG,andβ-cell insulin secretion as well as insulin sensitivity remains unexplored.Therefore,this study aims to investigate the connections between TIR,derived from SMBG,and indices representingβ-cell functionality and insulin sensitivity.The primary objective of this study was to elucidate the relationship between short-term glycemic control(measured as points in range[PIR])and bothβ-cell function and insulin sensitivity.Methods:This cross-sectional study enrolled 472 hospitalized patients with type 2 diabetes mellitus(T2DM).To assessβ-cell secretion capacity,we employed the insulin secretion-sensitivity index-2(ISSI-2)and(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,while insulin sensitivity was evaluated using the Matsuda index and HOMA-IR.Since SMBG offers glucose data at specific point-in-time,we substituted TIR with PIR.According to clinical guidelines,values falling within the range of 3.9-10 mmol were considered"in range,"and the corresponding percentage was calculated as PIR.Results:We observed significant associations between higher PIR quartiles and increased ISSI-2,(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,Matsuda index(increased)and HOMA-IR(decreased)(all P<0.001).PIR exhibited positive correlations with log ISSI-2(r=0.361,P<0.001),log(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index(r=0.482,P<0.001),and log Matsuda index(r=0.178,P<0.001)and negative correlations with log HOMA-IR(r=-0.288,P<0.001).Furthermore,PIR emerged as an independent risk factor for log ISSI-2,log(ΔC-peptide_(0-120)/Δglucose_(0-120))×Matsuda index,log Matsuda index,and log HOMA-IR.Conclusion:PIR can serve as a valuable tool for assessingβ-cell function and insulin sensitivity. 展开更多
关键词 time in range points in range self-monitoring of blood glucose β-cell function insulin sensitivity
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The Use of Standardized Reporting and Time-in-Range in the Management of Diabetes: A Consensus Report 被引量:1
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作者 Saud Al Sifri Adnan Alshaikh +8 位作者 Bassam Bin-Abbas Eman Sheshah Fahad Al Sabaan Mohammed Al-Dawish Mohammed Al-Dubayee Naweed Al-Zaman Raed A. Al-Dahash Saad Alzahrani Emad R. Issak 《International Journal of Clinical Medicine》 2021年第8期316-327,共12页
<strong>Introduction:</strong> The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. <stron... <strong>Introduction:</strong> The exhaustion of healthcare resources due to the rising prevalence in Saudi Arabia mandates the search for each method that can help in better control of diabetes. <strong>Methods:</strong> The gathered task force gath-ered to develop an explicit, evidence-based consensus for the use of time-in-range targets as guidance for better glycemic control while using continuous glucose monitoring (CGM). This article has the recommenda-tions of this expert panel.<strong> Results: </strong>HbA1c and self-monitoring blood glu-cose (SMBG) are not enough to detect blood glucose (BG) fluctuations on a daily basis. The incorporation of technology like FreeStyle Libre with its applications like Libre View is now used in many institutes in Saudi Ara-bia. This system is comprehensive and has all the standardized metrics needed. However, training and support are always needed. Barriers and challenges include the awareness & experience of the technology, the time barrier, the patients’ barriers, the technical barriers, and of course, the availability barrier. All the barriers and challenges should be dealt with by designing new training programs.<strong> Conclusion:</strong> The expert panel recom-mended using CGMs technology in people with type 1 diabetes (T1DM) children and adults, type 2 diabetes (T2DM) on multiple insulin injections, gestational diabetes (GDM) who need further glycemic control, and those at high risk for hypoglycemia. In addition, we recommend using them for a short period for those who require intensive BG control or during acute illness or stress. In addition, Ambulatory Glucose Profile (AGP) could be used as an educational tool for any individuals with DM to study the im-pact of certain elements of lifestyle modifications on their immediate BG level. 展开更多
关键词 DIABETES time in range Glycemic Control HBA1C
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