老年2型糖尿病患者血清25-羟维生素D水平与葡萄糖目标范围内时间的相关性研究

A study on correlation between serum 25-hydroxyvitamin D level and time in target range of glucose in elderly patients with type 2 diabetes mellitus

中文关键词: 老年  维生素D  2型糖尿病  葡萄糖目标范围内时间  持续血糖监测  胰岛素抵抗  胰岛β细胞功能

英文关键词: elderly  vitamin D  type 2 diabetes mellitus  time in target range of glucose  continuous glucose monito-ring  insulin resistance  pancreatic β-cell function

中文摘要:

      目的 探讨老年2型糖尿病(T2DM)患者血清25-羟维生素D[25(OH)D]水平与葡萄糖目标范围内时间(TIR)的相关性.方法 选取2017年4月-2022年2月在南京医科大学金陵临床医学院内分泌科就诊的老年T2DM患者208例.每例受试者均接受了为期3 d的持续血糖监测(CGM)和血清25(OH)D水平的测定.通过CGM对TIR和血糖变异性(GV)参数进行了评估.根据受试者血清25(OH)D水平的三等分位切点,将其分为3组:G1组[25(OH)D水平＜21.19 ng/mL]、G2 组[21.19 ng/mL≤25(OH)D 水平＜25.52 ng/mL]和 G3 组[25(OH)D 水平≥25.52 ng/mL].此外,每位受试者均接受了 100 g标准馒头餐测试用来评估胰岛β细胞分泌功能.结果 G3组人群的TIR高于G1和G2组人群.相关分析结果显示,血清25(OH)D水平与TIR和葡萄糖在严格范围内的时间呈显著正相关.相反,血清25(OH)D水平与葡萄糖高于目标范围时间(TAR)、GV指标和糖化血红蛋白(HbA1c)呈负相关.血清25(OH)D与早期胰岛素分泌指数、30 min内C肽曲线下面积和180 min内C肽曲线下面积呈正相关.此外,Fisher's r-to-z检验结果显示,血清25(OH)D水平与TIR(r=0.352,P＜0.001)的相关性略强于其与HbA1c(r=-0.313,P＜0.001)和平均血糖波动幅度(r=-0.166,P＜0.001).多元逐步线性回归分析表明,血清25(OH)D水平是TIR、TAR和HOMA-β的独立影响因素.结论 较低的血清25(OH)D水平可能在老年T2DM患者血糖稳态失衡和胰岛β细胞分泌功能受损中发挥潜在作用.

英文摘要:

      Objective To investigate the correlation between serum 25-hydroxyvitamin D[25(OH)D]level and the time in range(TIR)of glucose in elderly patients with type 2 diabetes mellitus(T2DM).Methods A total of 208 elderly T2DM patients treated in Department of Endocrinology,Jinling Clinical Medical College of Nanjing Medical University from April 2017 to February 2022 were enrolled.All of them underwent 3-day continuous glucose monitoring(CGM)and serum 25(OH)D measurement.TIR and glycemic variability(GV)parameters were assessed via CGM.Based on the tertile cut-off points of serum 25(OH)D levels,the patients were divided into three groups:G1 group[25(OH)D level＜21.19 ng/mL],G2 group[21.19 ng/mL≤25(OH)D level＜25.52 ng/mL],and G3 group[25(OH)D leve1≥ 25.52 ng/mL].In addition,each subject underwent standardized 100 g steamed bread meal test to evaluate the secretory function of pancreatic beta cells.Results The G3 group exhibited significantly higher TIR compared to G1 group and G2 group(P＜0.05).The correlation analysis results showed that serum 25(OH)D level was significantly positively correlated with TIR and time in tight range,but was negatively correlated with time above range(TAR)of glucose,GV index and glycated hemoglobin A1c(HbA1c).Serum 25(OH)D level was also positively correlated with the early insulin secretion index,the area under the C-peptide curve within 30 min,and the area under the C-peptide curve within 180 min.The Fisher's r-to-z test results showed that the correlation between serum 25(OH)D level and TIR(r=0.352,P＜0.001)was slightly stronger than its correlation with HbA1c(r=-0.313,P＜0.001)and mean amplitude of glycemic excursions(r=-0.166,P＜0.001).Multiple stepwise linear regression analysis indicated that serum 25(OH)D level was an independent influencing factor for TIR,TAR and HOMA-β.Conclusion Lower serum 25(OH)D levels may play a potential role in the imbalance of blood glucose homeostasis and impaired pancreatic β-cell secretion function in elderly T2DM patients.