Czas w zakresie docelowym glikemii: wykazanie korelacji z retinopatią cukrzycową w cukrzycy typu 2. Przegląd systematyczny z metaanalizą
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Streszczenie
Cel: W badaniach wykazano związek między kontrolą glikemii a progresją retinopatii cukrzycowej (DR, diabetic retinopathy), jednak zależność między stosowaniem ciągłego monitorowania glikemii (CGM, continuous glucose monitoring) a progresją DR pozostaje mniej zbadana. Niniejsze badanie przeprowadzono w celu oceny związku między czasem w zakresie wartości prawidłowych (TIR, time in range) a DR i jej implikacjami klinicznymi. Materiał i metody: Dokonano przeglądu systematycznego zgodnie z wytycznymi Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, przeszukując bazy danych, takie jak PubMed, EBSCO i ProQuest. Dodatkowo przeprowadzono wyszukiwanie ręczne. Do analizy włączono badania, w których opisywano TIR lub inne parametry pochodzące z CGM w powiązaniu z DR. Jakość każdego badania oceniano przy użyciu skali Newcastle–Ottawa (NOS, Newcastle–Ottawa Scale). Do przeprowadzenia metaanalizy z modelem efektów losowych użyto oprogramowania Review Manager 5.4. Wyniki: Wyniki metaanalizy 5 badań wskazały na istotne powiązania między wskaźnikami pochodzącymi z CGM a retinopatią cukrzycową. Obliczono średnie różnice wartości ocenianych parametrów i uzyskano następujące wyniki: TIR –6,44 (95% CI: –8,10; –4,78; p < 0,001), odchylenie standardowe (SD, standard deviation) 0,20 [95-procentowy przedział ufności (CI, confidence interval): 0,16, 0,24; p < 0,001), średnia amplituda wahań glikemii (MAGE, mean amplitude of glycemic excursion) 0,45 (95% CI: 0,31, 0,58; p < 0,001), współczynnik zmienności (CV, coefficient of variation) –0,99 (95% CI: 0,43, 1,55, p = 0,0006). Stratyfikacja według odsetka TIR (< 70% w porównaniu z ≥ 70%) wykazała iloraz szans wynoszący 2,06 (95% CI: 0,85, 4,97, p = 0,11) dla ryzyka retinopatii cukrzycowej, jednak był on statystycznie nieistotny.
Wnioski: Niższe wartości wskaźnika TIR są istotnie związane z DR u pacjentów z T2D. Z obecnością DRP powiązane były również wyższe wartości SD, MAGE i CV.
Słowa kluczowe: diabetic retinopathytype 2 diabetescontinuous glucose monitoring
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