Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Nov 15, 2020; 11(11): 489-500
Published online Nov 15, 2020. doi: 10.4239/wjd.v11.i11.489
Continuous glucose monitoring defined time-in-range is associated with sudomotor dysfunction in type 2 diabetes
Qing-Yu Guo, Bin Lu, Zhan-Hong Guo, Zhou-Qin Feng, Yan-Yu Yuan, Xu-Guang Jin, Pu Zang, Ping Gu, Jia-Qing Shao
Qing-Yu Guo, Bin Lu, Xu-Guang Jin, Pu Zang, Ping Gu, Jia-Qing Shao, Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, Nanjing 210002, Jiangsu Province, China
Zhan-Hong Guo, Yan-Yu Yuan, Department of Endocrinology, Jinling Hospital, Nanjing Medical University, Nanjing 210002, Jiangsu Province, China
Zhou-Qin Feng, Department of Endocrinology, Jinling Hospital, Southern Medical University, Nanjing 210002, Jiangsu Province, China
Author contributions: Guo QY, Lu B, and Gu P conceived and designed the research; Guo QY and Guo ZH analyzed and interpreted the data; Guo QY, Feng ZQ, Yuan YY, and Jin XG performed the statistical analysis; Guo QY wrote the manuscript; Zang P and Shao JQ critically revised the manuscript for key intellectual content; Guo QY was responsible for the integrity of the work; all authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81774134 and No. 81873174; Natural Science Foundation of Jiangsu Province of China, No. BK20150558 and No. BK20171331; Postdoctoral Foundation of Jiangsu Province of China, No. 1501120C; Jiangsu Province 333 Talent Funding Project, No. BRA2017595; and Young Medical Key Talents Project of Jiangsu Province, No. QNRC2016902.
Institutional review board statement: The study was approved by the Institutional Review Board (IRB) of Jinling Hospital, Nanjing University and was performed according to the Declaration of Helsinki.
Informed consent statement: This study is a cross-sectional study, so it is not applicable.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding authors and the senior author on reasonable request.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jia-Qing Shao, MD, PhD, Chief Doctor, Professor, Department of Endocrinology, Jinling Hospital, School of Medicine, Nanjing University, No. 305 East Zhongshan Road, Nanjing 210002, Jiangsu Province, China. shaojiaqing@nju.edu.cn
Received: July 27, 2020
Peer-review started: July 27, 2020
First decision: August 9, 2020
Revised: August 21, 2020
Accepted: September 18, 2020
Article in press: September 18, 2020
Published online: November 15, 2020
Processing time: 108 Days and 20.1 Hours
Abstract
BACKGROUND

Time in range (TIR), as a novel metric for glycemic control, has robust relevance with diabetic complications. Diabetic peripheral neuropathy (DPN) is characterized by sudomotor dysfunction.

AIM

To explore the relationship between TIR obtained from continuous glucose monitoring (CGM) and sudomotor function detected by SUDOSCAN in subjects with type 2 diabetes.

METHODS

The research enrolled 466 inpatients with type 2 diabetes. All subjects underwent 3-d CGM and SUDOSCAN. SUDOSCAN was assessed with electrochemical skin conductance in hands (HESC) and feet (FESC). Average feet ESC < 60 µS was defined as sudomotor dysfunction (+), otherwise it was sudomotor dysfunction (-). TIR refers to the percentage of time when blood glucose is between 3.9-10 mmol/L during 1 d period.

RESULTS

Among the enrolled subjects, 135 (28.97%) presented with sudomotor dysfunction. Patients with sudomotor dysfunction (+) showed a decreased level of TIR (P < 0.001). Compared to the lowest tertile of TIR, the middle and the highest tertiles of TIR was associated with an obviously lower prevalence of sudomotor dysfunction (20.51% and 21.94% vs 44.52%) (P < 0.001). In addition, with the increase of TIR, HESC and FESC increased (P < 0.001). Regression analysis demonstrated that TIR was inversely and independently linked with the prevalence of sudomotor dysfunction after adjusting for confounding values (odds ratio = 0.979, 95%CI: 0.971-0.987, P < 0.001).

CONCLUSION

The tight glycemic control assessed by TIR is of vitally protective value for sudomotor dysfunction in type 2 diabetes mellitus.

Keywords: Time in range; Sudomotor dysfunction; SUDOSCAN; Diabetic peripheral neuropathy; Continuous glucose monitoring; Diabetes mellitus; Type 2

Core Tip: Diabetic peripheral neuropathy (DPN) has posed a serious threat for the economy and development of society. SUDOSCAN is an emerging technique for the detection of DPN through detecting sudomotor function of the sweat gland. Glycemic control is an independent contributor to DPN. Time in range (TIR), as a continuous glucose monitoring-derived pivotal and emerging metric, has been proved to assess short-lived glycemic control. We preliminarily explored the relationship between TIR and sudomotor function, in order to provide a basis for future large-sample, multi-center research.