GMI/HbA1c比值与1型糖尿病微血管并发症的相关性研究
这项多中心横断面研究纳入1315例病程至少5年、使用连续血糖监测的1型糖尿病患者，按GMI/HbA1c比值三分位分组。高糖化组微血管并发症总患病率为38.9%，高于中糖化组28.2%和低糖化组23.7%。GMI/HbA1c比值与微血管并发症及眼部疾病独立相关。
要点
- GMI/HbA1c比值高者微血管并发症患病率更高，可用于风险分层。
- 高糖化组眼部疾病患病率31%，高于中糖化组20.2%和低糖化组19.7%。
- GMI/HbA1c比值与并发症相关，校正后OR为0.71。
核心结论
- GMI/HbA1c比值与1型糖尿病微血管并发症及眼部疾病独立相关。
研究设计与样本
- 多中心、横断面、观察性研究，纳入病程至少5年的1型糖尿病患者，HbA1c前56天连续血糖监测覆盖率不低于80%，共1315例。
主要发现
- 高糖化组微血管并发症总患病率为38.9%，高于中糖化组28.2%和低糖化组23.7%。
- 高糖化组眼部疾病患病率31%，高于中糖化组20.2%和低糖化组19.7%。
- 高糖化组肾病患病率14.9%，高于中糖化组8.3%和低糖化组6.2%。
- 高糖化组多发性神经病患病率10.6%，高于中糖化组6.8%和低糖化组3.4%。
关键数值与推荐
- GMI/HbA1c比值与微血管并发症相关，校正后OR 0.71，95%CI 0.61-0.81，p<0.001。
- GMI/HbA1c比值与眼部疾病相关，校正后OR 0.71，95%CI 0.61-0.82，p<0.001。
- 高糖化组平均年龄55.4岁，高于中糖化组53.4岁和低糖化组50.8岁，p<0.001。
- 高糖化组平均血糖156.3 mg/dL，中糖化组161.8 mg/dL，低糖化组166.1 mg/dL，p<0.001。
- 高糖化组葡萄糖目标范围内时间66.3%，中糖化组62.9%，低糖化组59.9%，p<0.001。
临床怎么用
- GMI/HbA1c比值可用于临床常规实践中对1型糖尿病患者进行并发症风险分层。
- 该参数有助于制定个体化控制目标和筛查策略。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
ABSTRACT Objective To clarify whether the glucose management indicator (GMI)/glycated haemoglobin (HbA1c) ratio (GMI/HbA1c ratio) is an independent predictor of microvascular complications in Type 1 diabetes (T1D). Design and Methods Multicentre, cross-sectional, observational study including subjects with T1D with at least 5 years of evolution, users of continuous glucose monitoring (CGM) with a coverage ≥ 80% 56 days prior to HbA1c. Logistic regression models were used to identify the factors independently associated with grouped microvascular complications and ocular disease. Results As per data, 1315 participants were included. Patients were classified into tertiles based on the GMI/HbA1c ratio. High glycators were older than intermediate and low glycators (55.4 vs. 53.4 vs. 50.8 years; p < 0.001), respectively. Differences were also observed among the three groups with regard to average glucose (156.3 vs. 161.8 vs. 166.1 mg/dL; p < 0.001), time in range (66.3% vs. 62.9% vs. 59.9%; p < 0.001), time in tight range (42.9% vs. 39.9% vs. 37.1%; p < 0.001), coefficient of variation (34.5% vs. 34.9% vs. 35.6%; p = 0.023), GMI (7% vs. 7.2% vs. 7.3%; p < 0.001) and HbA1c (8.1% vs. 7.3% vs. 6.6%; p < 0.001). In the high glycators group, the prevalence of microvascular complications was higher than in the intermediate and low glycators (38.9% vs. 28.2% vs. 23.7%; p < 0.001), respectively. Also, the prevalence of ocular disease (31% vs. 20.2% vs. 19.7%; p < 0.001), nephropathy (14.9% vs. 8.3% vs. 6.2%; p < 0.001) and polyneuropathy (10.6% vs. 6.8% vs. 3.4%; p < 0.001) was higher in high glycators, The GMI/HbA1c ratio was significantly associated with the presence of grouped microvascular complications (OR 0.71; 95% CI: 0.61–0.81; p < 0.001) and ocular disease (OR 0.71; 95% CI: 0.61–0.82; p < 0.001) after adjusting for clinical ad glucometric variables. Conclusions The GMI/HbA1c ratio is associated with microvascular complications in this study. These results highlight the potential of this parameter in routine clinical practice for stratifying the risk of complications and for establishing individualized control goals and screening strategies.
引用
- Diabetes, Obesity and Metabolism：Association Between the GMI/HbA1c Ratio and Microvascular Complications in Type 1 Diabetes: A Multicenter Cross‐Sectional Study
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。