Time-divided hypoglycemia management derived by continuous glucose monitoring may reduce microvascular diseases in type 2 diabetes patients.

IF 3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Pub Date : 2025-05-09 DOI:10.1007/s12020-025-04250-7

Yuqiong Li, Liwei Cai, Qinkang Lu, Weikun Gong, Penghao Wang, Tao Chen, Wen Ye, Bingqi Li, Hui Zhu, Zhifeng Xu, Jin Xu, Lindan Ji

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Abstract

Purpose: To assess the association between hypoglycemia exposure and the risk of developing microvascular diseases (MVDs) in type 2 diabetes patients via continuous glucose monitoring (CGM), aiming to identify optimal hypoglycemia thresholds for improved glucose management.

Methods: A total of 174 type 2 diabetes patients underwent 2 weeks of CGM. Binary multivariate logistic regression assessed the association between hypoglycemia exposure and MVDs prevalence at thresholds of 3.0-3.9 mmol/L.

Results: After 14 days of monitoring, 79.9% of patients experienced hypoglycemia. The MVDs group had a significantly greater percentage of participants with hypoglycemia (glucose < 3.4 mmol/L: 57.6 vs. 39.8%, P = 0.023) and nocturnal hypoglycemia (glucose < 3.9 mmol/L: 62.1 vs. 46.3%, P = 0.043), with no significant difference in daytime hypoglycemia. After adjustment for confounders, only nocturnal hypoglycemia was independently associated with the risk of developing MVDs, and the prevalence of MVDs was positively associated with hypoglycemia severity. When the hypoglycemia threshold was reduced from 3.4-3.0 mmol/L, the odds ratio increased from 1.342 (1.026, 1.798) to 1.855 (1.141, 3.457). Further subgroup analysis revealed that nocturnal hypoglycemia below 3.4 mmol/L was a risk factor for the development of retinopathy and neuropathy (P < 0.05) but not for nephropathy.

Conclusion: Nighttime glucose levels below 3.4 mmol/L are strongly associated with a greater risk of developing retinopathy and neuropathy in type 2 diabetes patients. Thus, blood glucose management should be time-specific, with daytime levels maintained above 3.9 mmol/L and nighttime levels maintained above 3.4 mmol/L.

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持续血糖监测的分时低血糖管理可减少2型糖尿病患者微血管疾病。

目的：通过持续血糖监测（CGM）评估2型糖尿病患者低血糖暴露与微血管疾病（mvd）发生风险之间的关系，旨在确定改善血糖管理的最佳低血糖阈值。方法：174例2型糖尿病患者接受2周CGM治疗。二元多因素logistic回归评估了在3.0-3.9 mmol/L的阈值下低血糖暴露与mvd患病率之间的关系。结果：监测14天后，79.9%的患者出现低血糖。mvd组出现低血糖（葡萄糖< 3.4 mmol/L: 57.6% vs. 39.8%, P = 0.023）和夜间低血糖（葡萄糖< 3.9 mmol/L: 62.1 vs. 46.3%, P = 0.043）的比例显著高于对照组，而白天低血糖发生率无显著差异。在调整混杂因素后，只有夜间低血糖与发生mvd的风险独立相关，而mvd的患病率与低血糖严重程度呈正相关。当低血糖阈值从3.4 ~ 3.0 mmol/L降低时，优势比从1.342（1.026,1.798）增加到1.855（1.141,3.457）。进一步的亚组分析显示，夜间血糖低于3.4 mmol/L是2型糖尿病患者发生视网膜病变和神经病变的危险因素(P结论：夜间血糖水平低于3.4 mmol/L与2型糖尿病患者发生视网膜病变和神经病变的高风险密切相关。因此，血糖管理应该有时间特异性，白天维持在3.9 mmol/L以上，夜间维持在3.4 mmol/L以上。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

5.40%

发文量

295

审稿时长

1.5 months

期刊介绍： Well-established as a major journal in today’s rapidly advancing experimental and clinical research areas, Endocrine publishes original articles devoted to basic (including molecular, cellular and physiological studies), translational and clinical research in all the different fields of endocrinology and metabolism. Articles will be accepted based on peer-reviews, priority, and editorial decision. Invited reviews, mini-reviews and viewpoints on relevant pathophysiological and clinical topics, as well as Editorials on articles appearing in the Journal, are published. Unsolicited Editorials will be evaluated by the editorial team. Outcomes of scientific meetings, as well as guidelines and position statements, may be submitted. The Journal also considers special feature articles in the field of endocrine genetics and epigenetics, as well as articles devoted to novel methods and techniques in endocrinology. Endocrine covers controversial, clinical endocrine issues. Meta-analyses on endocrine and metabolic topics are also accepted. Descriptions of single clinical cases and/or small patients studies are not published unless of exceptional interest. However, reports of novel imaging studies and endocrine side effects in single patients may be considered. Research letters and letters to the editor related or unrelated to recently published articles can be submitted. Endocrine covers leading topics in endocrinology such as neuroendocrinology, pituitary and hypothalamic peptides, thyroid physiological and clinical aspects, bone and mineral metabolism and osteoporosis, obesity, lipid and energy metabolism and food intake control, insulin, Type 1 and Type 2 diabetes, hormones of male and female reproduction, adrenal diseases pediatric and geriatric endocrinology, endocrine hypertension and endocrine oncology.