在新诊断的2型糖尿病患者中评估短期胰岛素强化治疗期间血糖达标时间作为血糖目标的作用

Abstract

Abstract Background Tight glycemic control during short‐term intensive insulin therapy (SIIT) is critical for inducing diabetes remission in patients with newly diagnosed type 2 diabetes (T2D). This work aimed to investigate the role of time in range (TIR) during SIIT as a novel glycemic target by predicting clinical outcomes. Methods SIIT was given to 116 patients with newly diagnosed T2D, with daily eight‐point capillary glucose monitored. Glycemic targets (fasting/premeal glucose, 3.9–6.0 mmol/L; 2 h postprandial blood glucose, 3.9–7.8 mmol/L) were achieved and maintained for 2 weeks. TIRPIR was calculated as the percentage of glucose points within these glycemic targets during the maintenance period and was compared to TIR3.9–7.8mmol/L and TIR3.9–10.0mmol/L. Acute insulin response (AIR), HOMA‐IR, HOMA‐B, and disposition index (DI) were measured. Patients were followed up for 1 year to observe clinical outcomes. Results TIRPIR, TIR3.9–7.8mmol/L, and TIR3.9–10.0mmol/L were 67.2 ± 11.2%, 80.8 ± 9.2%, and 90.1 ± 6.2%, respectively. After SIIT, β‐cell function and insulin sensitivity improved remarkably, and the 1‐year remission rate was 55.2%. △AIR and △DI were positively correlated with all the TIR values, whereas only TIRPIR was correlated with △HOMA‐IR (r = −0.22, p = 0.03). Higher TIRPIR but not TIR3.9–7.8mmol/L or TIR3.9–10.0mmol/L was robustly associated with diabetes remission; patients in the lower TIRPIR tertile had an elevated risk of hyperglycemia relapse (hazard ratio 3.4, 95% confidence interval 1.6–7.2， p = .001). Only those with TIRPIR ≥ 65% had a one‐year remission rate of over 60%. Conclusions These findings advocate TIRPIR ≥ 65% as a novel glycemic target during SIIT for clinical decision‐making.

Keywords

• 初诊
• 缓解
• 短期胰岛素强化治疗
• 葡萄糖在目标范围内时间
• 2型糖尿病。