The Study Of Correlation Between Time In Range And Type 2 Diabetic Kidney Disease

Objective:This study aims to analyze the correlation between the time in range(TIR)calculated from 9 points of fingertip blood glucose within 24 hours and type 2diabetic kidney disease(DKD),to provide a new reference for the prevention and treatment of type 2 diabetic kidney disease.Method:A total of 240 patients with type 2 diabetes mellitus(T2DM)aged between 18 and 65 years old(including 18 and 65 years old)who were admitted to our department from March 2019 to December 2020 were recrulted.The 240 patients were divided into 3 groups according to the range of urinary albumin/creatinine ratio(UACR),refer to the newly published Chinese Clinical Guidelines for the Prevention and Treatment of Diabetic Kidney Disease in 2019,respectively: 1)T2DM group(UACR<30mg/g),microalbuminuria group(UACR between 30mg/g and 300mg/g),3)Large albuminuria group(UACR>300mg/g).Each group had 80 patients.TIR was calculated from 9 points of fingertip blood glucose within 24 hours and the calculation method was the frequency/9 of blood glucose in the range of 3.9-10.0mmol/L.Fingertip blood glucose was measured by Terumo glucose meter in Japan.In addition to TIR,we also need to calculate time above range(TAR)and time below range(TBR)of glucose.Mean blood glucose(MBG),standard deviation of mean blood glucose(SDBG),glycemic variability(GV),and large amplitude of Glycemic excursions(LAGE)were calculated at the same time.General data of 3 groups of patients: gender,age,duration of diabetes,body mass index(BMI),systolic blood pressure(SBP)and diastolic blood pressure(DBP)were recorded.And blood biochemical indicators: fasting plasma glucose(FPG),glycosylated hemoglobin A1c(Hb A1c),triglyceride(TG),total cholesterol(TC),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),glomerular filtration rate(e GFR),uric Acid(UA),serum creatinine(SCr),and blood urea nitrogen(BUN).SPSS24.0 was used for statistical analysis of the above indicators.Results:1.The present study showed that compared with the T2 DM group,the microalbuminuria group and the macroalbuminuria group had greater blood glucose variability,i.e.,lower TIR,higher TAR,MBG,SDBG,and GV.According to the TIR range,the 240 subjects were divided into three groups,namely TIR1(TIR<33.33%),TIR2(TIR: 33.33%～66.67%),TIR3(TIR>66.67%),we found that UACR decreased gradually with the increase of TIR range,and the difference was statistically significant(P<0.001),UACR in TIR3 group was significantly lower than that in the other two groups,and the difference was statistically significant(P<0.001).EGFR in TIR3 group was significantly higher than that in the other two groups,and the difference was statistically significant(P<0.001).Spearman correlation analysis showed that UACR and TIR levels were negatively correlated(P<0.001),and was positively correlated with TAR,MBG,SDBG,LAGE,GV(P<0.001).2.In a multi-classification logistic regression model with type 2 diabetes as the reference group,TIR was significantly correlated with UACR severity after adjusting for gender,age,duration of diabetes,BMI,blood pressure,blood lipids,renal function indicators,fasting blood glucose and glycosylated hemoglobin A1 c levels(P<0.001),to further adjust the SDBG,GV,LAGE,as a continuous variable TIR and the contact between the trace and a large number of albuminuria is still significant.When the TIR as classification variables and TIR1 group as control group to classify multiple logistic regression analysis,the control of the age,duration of diabetes,BMI,blood pressure,blood lipid,renal function indexes,fasting blood glucose and hemoglobin A1 c levels,TIR group associated with the various stages of UACR independent.As a classifying variable,the association between albuminuria and TIR was not statistically significant after adjustment for SDBG and LAGE,but remained significant after adjustment for GV.TIR still had a significant effect on UACR after adjustment for glycemic variability.Conclusion:1.TIR was negatively correlated with DKD,and the incidence of DKD gradually increased with the decrease of TIR level.Even after adjusting for clinical risk factors such as blood lipids and hemoglobin A1 c,TIR level was still significantly correlated with the severity of UACR.This suggests that TIR measured by fingertip blood glucose may also be used as an important indicator for the evaluation of blood glucose control and prevention and treatment of diabetic kidney disease.2.GV,SDBG and LAGE were positively correlated with DKD,which was of certain significance for the evaluation of short-term blood glucose fluctuations.3.TC,UA and DKD were positively correlated,indicating that lipid and uric acid levels could not be ignored in preventing DKD.4.TIR and other blood glucose fluctuations measured by fingertip blood glucose within 24 hours are more economical,simple and equally accurate than CGM.