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.
【摘要】 目的 目前有关基础和餐后血糖升高以及血糖变异对成人1型糖尿病HbA1C 水平的贡献的证据有限。本研究旨在捕捉血糖波动模式，并量化这些因素对成人1型糖尿病HbA1C 水平的贡献。方法 收集并汇总了2项临床试验中的HbA1C 、连续血糖监测(CGM)和饮食日记数据。根据HbA1C 四分位数将可用数据集分为4组:组1(≤6.7%)、组2(6.7%~7.3%)、组3(7.3%~7.8%)和组4(≥7.8%)。将24小时血糖曲线下面积大于110 mg/dL(AUC>110 mg/dL)定义为总体高血糖，并根据餐后高血糖(PHG，餐后3小时期间AUC>110 mg/dL)和基础高血糖(BHG，剩余时间内AUC>110 mg/dL)进行分层。使用线性回归分析来估计HbA1c 变异中BHG、餐前血糖、PHG、血糖变异性和非血糖因素(年龄、体重指数、血红蛋白和病程)所解释的方差比例。结果 共纳入102例患者(男性/女性，34/68)的169 550条数据和2 409个餐次记录。年龄和病程分别为35.2±12.6岁和8.9(2.9,13.0)年，其中51.0%使用泵。总体而言，BHG高于PHG4倍(P均<0.05)，组间比较显示BHG呈逐渐增加的趋势(组1与组2、3、4，P=0.053, 0.086, 0.006)，从组1到4的空腹贡献分别为76.1%、82.6%、81.5%和84.3%。组2、3和4之间的增幅不显著(P>0.05)。分析中包括的因素解释了HbA1C 变异占总体的74%，其中空腹血糖占32.1%的方差，餐后血糖占24.4%的方差。在HbA1C >7.3%的情况下，BHG对HbA1C 的方差贡献更高，达到33.8%。结论 本研究提示，相比于餐后高血糖，基础高血糖能更好地预测成人1型糖尿病的整体血糖控制情况。随着HbA1C 水平的增加，基础高血糖的相对贡献逐渐增加，不同水平的血糖控制在1型糖尿病患者胰岛素调节方面的主要策略也不同。.
Keywords: 1型糖尿病; HbA1C; HbA1c; basal hyperglycemia; postprandial glucose; type 1 diabetes mellitus; 基础高血糖; 餐后血糖.
© 2023 The Authors. Journal of Diabetes published by Ruijin Hospital, Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.