Association of Time in Range, as Assessed by Continuous Glucose Monitoring, With Diabetic Retinopathy in Type 2 Diabetes

Jingyi Lu, Xiaojing Ma, Jian Zhou, Lei Zhang, Yifei Mo, Lingwen Ying, Wei Lu, Wei Zhu, Yuqian Bao, Robert A. Vigersky, Weiping Jia
2018 Diabetes Care  
OBJECTIVE Continuous glucose monitoring (CGM) has provided new measures of glycemic control that link to diabetes complications. This study investigated the association between the time in range (TIR) assessed by CGM and diabetic retinopathy (DR). RESEARCH DESIGN AND METHODS A total of 3,262 patients with type 2 diabetes were recruited. TIR was defined as the percentage of time spent within the glucose range of 3.9-10.0 mmol/L during a 24-h period. Measures of glycemic variability (GV) were
more » ... ssed as well. DR was determined by using fundus photography and graded as 1) non-DR; 2) mild nonproliferative DR (NPDR); 3) moderate NPDR; or 4) vision-threatening DR (VTDR). RESULTS The overall prevalence of DR was 23.9% (mild NPDR 10.9%, moderate NPDR 6.1%, VTDR 6.9%). Patients with more advanced DR had significantly less TIR and higher measures of GV (all P for trend <0.01). The prevalence of DR on the basis of severity decreased with ascending TIR quartiles (all P for trend <0.001), and the severity of DR was inversely correlated with TIR quartiles (r = 20.147; P < 0.001). Multinomial logistic regression revealed significant associations between TIR and all stages of DR (mild NPDR, P = 0.018; moderate NPDR, P = 0.014; VTDR, P = 0.019) after controlling for age, sex, BMI, diabetes duration, blood pressure, lipid profile, and HbA 1c . Further adjustment of GV metrics partially attenuated these associations, although the link between TIR and the presence of any DR remained significant. CONCLUSIONS TIR assessed by CGM is associated with DR in type 2 diabetes. Continuous glucose monitoring (CGM) continuously captures the glucose profile over a number of days and may be the best way to identify an individual's current glycemic status. Increasing evidence shows that the use of CGM improves glycemic control, with an unchanged or even decreased risk of hypoglycemia (1-3). The introduction of CGM has provided an opportunity to develop metrics of glycemic control that provide valuable information beyond that furnished by glycated hemoglobin A 1c (HbA 1c ). Among the metrics generated from CGM, time in range (TIR) refers to the time an individual spends within their target glucose range (usually 3.9-10.0 mmol/L), which provides valuable information about whether the frequency and duration of hypoglycemia or hyperglycemia improve over time. In addition, TIR
doi:10.2337/dc18-1131 pmid:30201847 fatcat:iw2aqhp2yncyxmxas5wpqbkhsi