1020-P：HbA1c 与血糖管理指标之间的差异随时间的变化--来自法国-比利时 347 例患者队列的研究结果

IF 6.2 1区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes Pub Date : 2024-07-19 DOI:10.2337/db24-1020-p

JEAN-PIERRE RIVELINE, GAETAN PREVOST, ANAIS ANDRIEU, MICHAEL JOUBERT, PHILIPPE ORIOT, ALFRED PENFORNIS, JEAN-CHRISTOPHE PHILIPS, JEAN-BAPTISTE JULLA, EMMANUEL COSSON

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引用次数: 0

摘要

实验室测量的 HbA1c 与通过连续血糖监测估算的血糖管理指标（GMI）之间存在差异的情况在临床实践中经常遇到。然而，其随着时间的推移而发生的变化尚不清楚。研究方法我们进行了一项多中心回顾性研究（9 个中心），收集了所有使用 FreeStyleLibre® 的糖尿病患者在 T0、T1 年和 T2 年随访期间的 HbA1c 和 GMI（90 天内计算）对数。主要研究终点是分析 3 个时间点的 HbA1c-GMI 平均值差异。同时还分析了血糖数据、临床参数和并发症。根据每个时间点的 HbA1c-GMI 差异对患者进行分类：阳性（PosD，HbA1c-GMI>+0.3%）、中性（NullD，HbA1c-GMI 从 -0.3% 到 +0.3%）、阴性（NegD，HbA1c-GMI<-0.3%），以及 3 个时间点的平均差异。组间比较采用方差分析进行评估。结果：我们共纳入 347 名患者（82% 为 1 型糖尿病），平均年龄为 51±17 岁，糖尿病病程为 20±13 年，HbA1c 为 7.6±1.0%，CGM 数据收集率为 90±9%，70-180 mg/dl 范围内时间（TIR）为 57±17%，GMI 为 7.4±0.8%。平均 HbA1c-GMI 随时间变化（T0：0.27%，T1 年：0.16%，T2 年：0.04%，P<0.0001）。考虑到所有患者在 3 个时间点的平均 HbA1c-GMI 差异，与 NegD 患者相比，PosD 患者的年龄更大，BMI 和 HbA1c 也更高。在 T0，患者的分布情况如下：168 名 PosD 患者（48.4%）、129 名 NullD 患者（37.2%）和 50 名 NegD 患者（14.4%）。在三个时间点保持同一组的 121 名患者（仅占队列的 34.8%）中，PosD 患者占 44.6%，NullD 患者占 38%，NegD 患者占 17.4%。结论只有三分之一的患者的 HbA1c 和 GMI 之间的差异随着时间的推移趋于稳定。在分析与 PosD 相关的所谓不良预后时，应考虑到这一点。披露 J. Riveline：董事会成员；雅培、诺和诺德公司、赛诺菲、礼来公司、美敦力、Dexcom 公司、Insulet 公司、液化空气公司、阿斯利康公司。G. Prevost：董事会成员；雅培。A. Andrieu：无。M. Joubert：雅培、美敦力、Dexcom 公司顾问。P. Oriot：研究支持；雅培。A. Penfornis：演讲人办公室；赛诺菲、Dexcom、Diabeloop SA。Board Member; AstraZeneca.诺和诺德、礼来糖尿病。诺和诺德、拜耳公司董事会成员。顾问团成员；雅培、赛诺菲。J. Philips：顾问；赛诺菲、诺和诺德、雅培、阿瓦齐亚、勃林格殷格翰、礼来公司。J. Julla：礼来糖尿病公司、诺和诺德公司发言人。赛诺菲董事会成员。E. Cosson：顾问团；雅培、阿斯利康、礼来糖尿病、诺和诺德、赛诺菲、罗氏诊断、诺华股份公司、安进公司。资助雅培糖尿病护理

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1020-P: Evolution over Time of the Discrepancy between HbA1c and Glucose Management Indicator—Findings from a Franco-Belgian Cohort of 347 Patients

A discrepancy between laboratory-measured HbA1c and Glucose Management Indicator (GMI), estimated from continuous glucose monitoring, is frequently encountered in clinical practice. However, its evolution over time is not yet known. Methodology: We conducted a multicenter retrospective study (9 centers) that collected pairs of HbA1c and GMI (calculated over 90 days) at T0, T1 year, T2 years of follow-up in patients with diabetes, all users of FreeStyleLibre®. The primary study endpoint was the analysis of the mean HbA1c-GMI differences at the 3 time points. Glucose data, clinical parameters, and complications were also analyzed. Patients were classified based on the HbA1c-GMI discrepancy: positive (PosD, HbA1c-GMI>+0.3%), neutral (NullD, HbA1c-GMI from -0.3 to +0.3%), negative (NegD, HbA1c-GMI< -0.3%) at each time point, and with the average differences over the 3 time points. Group comparisons were assessed using ANOVA. Result: We included 347 patients (82% type 1 diabetes), mean age of 51±17 years, diabetes duration 20±13 years, HbA1c 7.6±1.0%, 90±9% CGM data collected, Time in Range 70-180 mg/dl (TIR) 57±17%, GMI 7.4±0.8%. The mean HbA1c-GMI differed over time (T0: 0.27%, T1 year: 0.16%, T2 years: 0.04%, P<0.0001). Considering the mean HbA1c-GMI differences over the 3 time points for all patients, PosD individuals were statistically older, had higher BMI and HbA1c compared to NegD patients. At T0, the patients were distributed as follows: 168 PosD (48.4%), 129 NullD (37.2%), 50 NegD (14.4%). The 121 patients (only 34.8% of the cohort) who stayed in the same group at the three time-points were 44.6% PosD, 38% NullD and 17.4% NegD. Conclusion: In only 1/3 of patients does the difference between HbA1c and GMI appear to be stable over time. This should be taken into account when analyzing the supposed poor prognosis associated with PosD. Disclosure J. Riveline: Board Member; Abbott, Novo Nordisk A/S, Sanofi, Eli Lilly and Company, Medtronic, Dexcom, Inc., Insulet Corporation, Air Liquide, AstraZeneca. G. Prevost: Board Member; Abbott. A. Andrieu: None. M. Joubert: Consultant; Abbott, Medtronic, Dexcom, Inc. P. Oriot: Research Support; Abbott. A. Penfornis: Speaker's Bureau; Sanofi, Dexcom, Inc., Diabeloop SA. Board Member; AstraZeneca. Speaker's Bureau; Novo Nordisk, Lilly Diabetes. Board Member; Novo Nordisk, Bayer Inc. Advisory Panel; Abbott, Sanofi. J. Philips: Consultant; Sanofi, Novo Nordisk, Abbott, Avazzia, Boehringer-Ingelheim, Eli Lilly and Company. J. Julla: Speaker's Bureau; Lilly Diabetes, Novo Nordisk. Board Member; Sanofi. E. Cosson: Advisory Panel; Abbott, AstraZeneca, Lilly Diabetes, Novo Nordisk, Sanofi, Roche Diagnostics, Novartis AG, Amgen Inc. Funding Abbott Diabetes Care

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来源期刊

Diabetes 医学-内分泌学与代谢

CiteScore

12.50

自引率

2.60%

发文量

1968

审稿时长

1 months

期刊介绍： Diabetes is a scientific journal that publishes original research exploring the physiological and pathophysiological aspects of diabetes mellitus. We encourage submissions of manuscripts pertaining to laboratory, animal, or human research, covering a wide range of topics. Our primary focus is on investigative reports investigating various aspects such as the development and progression of diabetes, along with its associated complications. We also welcome studies delving into normal and pathological pancreatic islet function and intermediary metabolism, as well as exploring the mechanisms of drug and hormone action from a pharmacological perspective. Additionally, we encourage submissions that delve into the biochemical and molecular aspects of both normal and abnormal biological processes. However, it is important to note that we do not publish studies relating to diabetes education or the application of accepted therapeutic and diagnostic approaches to patients with diabetes mellitus. Our aim is to provide a platform for research that contributes to advancing our understanding of the underlying mechanisms and processes of diabetes.