Time in Range in Relation to All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes: A Prospective Cohort Study

Jingyi Lu, Chunfang Wang, Yun Shen, Lei Chen, Lei Zhang, Jinghao Cai, Wei Lu, Wei Zhu, Gang Hu, Tian Xia, Jian Zhou, Jingyi Lu, Chunfang Wang, Yun Shen, Lei Chen, Lei Zhang, Jinghao Cai, Wei Lu, Wei Zhu, Gang Hu, Tian Xia, Jian Zhou

Abstract

Objective: There is growing evidence linking time in range (TIR), an emerging metric for assessing glycemic control, to diabetes-related outcomes. We aimed to investigate the association between TIR and mortality in patients with type 2 diabetes.

Research design and methods: A total of 6,225 adult patients with type 2 diabetes were included from January 2005 to December 2015 from a single center in Shanghai, China. TIR was measured with continuous glucose monitoring at baseline, and the participants were stratified into four groups by TIR: >85%, 71-85%, 51-70%, and ≤50%. Cox proportional hazards regression models were used to estimate the association between different levels of TIR and the risks of all-cause and cardiovascular disease (CVD) mortality.

Results: The mean age of the participants was 61.7 years at baseline. During a median follow-up of 6.9 years, 838 deaths were identified, 287 of which were due to CVD. The multivariable-adjusted hazard ratios associated with different levels of TIR (>85% [reference group], 71-85%, 51-70%, and ≤50%) were 1.00, 1.23 (95% CI 0.98-1.55), 1.30 (95% CI 1.04-1.63), and 1.83 (95% CI 1.48-2.28) for all-cause mortality (P for trend <0.001) and 1.00, 1.35 (95% CI 0.90-2.04), 1.47 (95% CI 0.99-2.19), and 1.85 (95% CI 1.25-2.72) for CVD mortality (P for trend = 0.015), respectively.

Conclusions: The current study indicated an association of lower TIR with an increased risk of all-cause and CVD mortality among patients with type 2 diabetes, supporting the validity of TIR as a surrogate marker of long-term adverse clinical outcomes.

© 2020 by the American Diabetes Association.

Figures

Figure 1
Figure 1
Multivariate-adjusted cumulative survival curves of all-cause (A) and cardiovascular (B) mortality by different levels of TIR. Adjusted for age, sex, BMI, diabetes duration, systolic blood pressure, triglyceride, HDL cholesterol, LDL cholesterol, smoking status, history of cancer and CVD, and use of antihypertensive drugs, aspirin, and statins.
Figure 2
Figure 2
HRs of all-cause mortality by different levels of TIR. TIR of 70% was set as the reference. Adjusted for age, sex, BMI, diabetes duration, systolic blood pressure, triglyceride, HDL cholesterol, LDL cholesterol, smoking status, history of cancer and CVD, and use of antihypertensive drugs, aspirin, and statins.

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Source: PubMed

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