Discordance between mean glucose and time in range in relation to HbA 1c in individuals with type 1 diabetes: results from the GOLD and SILVER trials.

Autor: Sterner Isaksson S; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Medicine, NU Hospital Group, Uddevalla, Sweden., Imberg H; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Mathematical Sciences, Chalmers University of Technology and University of Gothenburg, Gothenburg, Sweden.; Statistiska Konsultgruppen, Gothenburg, Sweden., Hirsch IB; University of Washington, School of Medicine, Seattle, WA, USA., Schwarcz E; Department of Internal Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden., Hellman J; Department of Medical Sciences, Uppsala University, Uppsala, Sweden., Wijkman M; Department of Internal Medicine and Department of Health, Medicine and Caring Sciences, Linköping University, Norrköping, Sweden., Bolinder J; Department of Medicine, Karolinska University Hospital Huddinge, Karolinska Institute, Stockholm, Sweden., Nyström T; Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden., Holmer H; Department of Medicine, Centralsjukhuset, Kristianstad, Sweden., Hallström S; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden., Ólafsdóttir AF; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden., Pekkari S; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.; Department of Medicine, NU Hospital Group, Uddevalla, Sweden., Polonsky W; Behavioral Diabetes Institute, San Diego, CA, USA., Lind M; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. marcus.lind@gu.se.; Department of Medicine, NU Hospital Group, Uddevalla, Sweden. marcus.lind@gu.se.; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. marcus.lind@gu.se.
Jazyk: angličtina
Zdroj: Diabetologia [Diabetologia] 2024 Aug; Vol. 67 (8), pp. 1517-1526. Date of Electronic Publication: 2024 Apr 26.
DOI: 10.1007/s00125-024-06151-2
Abstrakt: Aims/hypothesis: Previous studies have shown that individuals with similar mean glucose levels (MG) or percentage of time in range (TIR) may have different HbA 1c values. The aim of this study was to further elucidate how MG and TIR are associated with HbA 1c .
Methods: Data from the randomised clinical GOLD trial (n=144) and the follow-up SILVER trial (n=98) of adults with type 1 diabetes followed for 2.5 years were analysed. A total of 596 paired HbA 1c /continuous glucose monitoring measurements were included. Linear mixed-effects models were used to account for intra-individual correlations in repeated-measures data.
Results: In the GOLD trial, the mean age of the participants (± SD) was 44±13 years, 63 (44%) were female, and the mean HbA 1c (± SD) was 72±9.8 mmol/mol (8.7±0.9%). When correlating MG with HbA 1c , MG explained 63% of the variation in HbA 1c (r=0.79, p<0.001). The variation in HbA 1c explained by MG increased to 88% (r=0.94, p value for improvement of fit <0.001) when accounting for person-to-person variation in the MG-HbA 1c relationship. Time below range (TBR; <3.9 mmol/l), time above range (TAR) level 2 (>13.9 mmol/l) and glycaemic variability had little or no effect on the association. For a given MG and TIR, the HbA 1c of 10% of individuals deviated by >8 mmol/mol (0.8%) from their estimated HbA 1c based on the overall association between MG and TIR with HbA 1c . TBR and TAR level 2 significantly influenced the association between TIR and HbA 1c . At a given TIR, each 1% increase in TBR was related to a 0.6 mmol/mol lower HbA 1c (95% CI 0.4, 0.9; p<0.001), and each 2% increase in TAR level 2 was related to a 0.4 mmol/mol higher HbA 1c (95% CI 0.1, 0.6; p=0.003). However, neither TIR, TBR nor TAR level 2 were significantly associated with HbA 1c when accounting for MG.
Conclusions/interpretation: Inter-individual variations exist between MG and HbA 1c , as well as between TIR and HbA 1c , with clinically important deviations in relatively large groups of individuals with type 1 diabetes. These results may provide important information to both healthcare providers and individuals with diabetes in terms of prognosis and when making diabetes management decisions.
(© 2024. The Author(s).)
Databáze: MEDLINE
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