Association of time in range and glucose management indicator with the risk of type 2 diabetic nephropathy

Acta Universitatis Medicinalis Anhui     font:big middle small

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Authors:Wang Shuqian, Hu Xiujuan, Yin Xiaorong, Cui Mengjie, Huang qinyi, Yin Yangliu, Hui Cancan, Cheng Yuwei, Zhang Ya, Sun Yan

Keywords:type 2 diabetic nephropathy;time in range;glucose management indicator;continuous glucose monitoring

DOI:10.19405/j.cnki.issn1000-1492.2023.10.030

〔Abstract〕 Objective To explore the association of time in range(TIR) and glucose management indicator(GMI) with the risk of type 2 diabetic nephropathy(DN). Methods The clinical data of 215 patients with type 2 diabetes mellitus(T2DM) were collected and analyzed. According to the results of estimated glomerular filtration rate(eGFR) and urinary albumin to creatinine ratio(UACR),they were divided into 117 patients with T2DM and 98 patients with DN. The clinical data,biochemical indicators and continuous glucose monitoring(CGM) indicators of the two groups were compared. Logistic regression was used to analyze the influencing factors of DN risk. The predictive value of TIR and GMI on the risk of DN was evaluated by receiver operating characteristic(ROC) curve. Results There were significant differences in age,duration of diabetes,systolic blood pressure,glycosylated hemoglobin(HbA1c),fasting plasma glucose(FPG),2 hour postprandial plasma glucose(2hPG),creatinine(Cr),UACR,eGFR between the two groups(P<0. 05). There were statistically significant differences between the two groups in the CGM indexes of GMI,mean absolute difference of mean of daily differences(MODD),glucose above target range time(TAR) and TIR(P<0. 05). The results of logistic regression analysis showed that TIR was a protective factor of DN. In the ROC curve analysis of TIR prediction DN,the area under the ROC curve was 0. 718(95% CI =0. 648 ~ 0. 789,P<0. 001),and the Yoden index was 0. 38. At this time,the sensitivity was 66. 7%,and the specificity was 71. 3%. In the ROC curve analysis of GMI prediction DN,the area under the ROC curve was 0. 701(95% CI = 0. 629 ~ 0. 774,P<0. 001),and the Yoden index was 0. 368. At this time,the sensitivity was 63. 3%,and the specificity was 73. 5%. Conclusion TIR and GMI are significantly associated with the risk of DN. Specifically,lower TIR and higher GMI increase the risk of DN.