Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2024; 15(10): 2058-2069
Published online Oct 15, 2024. doi: 10.4239/wjd.v15.i10.2058
Relationship between hemoglobin glycation index and risk of hypoglycemia in type 2 diabetes with time-in-range in target
Bei-Si Lin, Zhi-Gu Liu, Dan-Rui Chen, Yan-Ling Yang, Dai-Zhi Yang, Jin-Hua Yan, Long-Yi Zeng, Xu-Bin Yang, Wen Xu
Bei-Si Lin, Zhi-Gu Liu, Dan-Rui Chen, Yan-Ling Yang, Dai-Zhi Yang, Jin-Hua Yan, Long-Yi Zeng, Xu-Bin Yang, Wen Xu, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, Guangdong Province, China
Xu-Bin Yang, Department of Endocrinology and Metabolism, The Third Affiliated Hospital (Zhaoqing Hospital), Sun Yat-sen University, Zhaoqing 526000, Guangdong Province, China
Co-first authors: Bei-Si Lin and Zhi-Gu Liu.
Co-corresponding authors: Xu-Bin Yang and Wen Xu.
Author contributions: Yang XB and Xu W drafted and revised the manuscript and contributed to the conception and design of this article; Lin BS, Liu ZG, Chen DR, and Yang YL contributed to the case collection and database organization; Lin BS, Liu ZG, and Yang DZ were responsible for statistical analysis of the data; Lin BS, Liu ZG, Yan JH, and Zeng LY interpreted the results. All authors read and approved the final manuscript. Lin BS and Liu ZG have contributed equally to this work as co-first authors. They both played a critical role in literature reviews, data collection and analysis as well as composition writing. Yang XB and Xu W have contributed equally to this work. They both provided guidance and supervision to the design of this study. Moreover, their funding support provided a guarantee for the smooth implementation of this study. The authors are grateful to all the doctors, nurses, technicians, and patients for their dedication to this study.
Supported by Investigator-initiated Trial Research Funds from Eli Lilly and Co. and Amylin Pharmaceuticals, Inc., No. A1570; and Natural Science Foundation of Guangdong Province, No. 2018A030313915.
Institutional review board statement: The study was reviewed and approved by the ethics committee of the Third Affiliated Hospital of Sun Yat-sen University, No.[2020]02-107-01.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wen Xu, MD, PhD, Doctor, Professor, Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, No. 600 Tianhe Road, Tianhe District, Guangzhou 510630, Guangdong Province, China. xwen@mail.sysu.edu.cn
Received: June 2, 2024
Revised: August 13, 2024
Accepted: September 6, 2024
Published online: October 15, 2024
Processing time: 115 Days and 19.3 Hours
Abstract
BACKGROUND

In patients with type 2 diabetes mellitus (T2DM), the risk of hypoglycemia also occurs in at a time-in-range (TIR) of > 70%. The hemoglobin glycation index (HGI) is considered the best single factor for predicting hypoglycemia, and offers new perspectives for the individualized treatment of patients with well-controlled blood glucose levels that are easily ignored in clinical settings.

AIM

To investigate the relationship between HGI and hypoglycemia and the implications of HGI on hypoglycemia in T2DM with TIR > 70%.

METHODS

All participants underwent a 7-days continuous glucose monitoring (CGM) using a retrospective CGM system. We obtained glycemic variability indices using the CGM system. We defined HGI as laboratory hemoglobin A1c minus the glucose management indicator. Patients were categorized into low HGI (HGI < 0.5) and high HGI groups (HGI ≥ 0.5) according to HGI median (0.5). Logistic regression and receiver operating characteristic curve analyses were used to determine the risk factors for hypoglycemia.

RESULTS

We included 129 subjects with T2DM (54.84 ± 12.56 years, 46% male) in the study. Median TIR score was 90%. The high HGI group exhibited lower TIR and greater time below range with higher hemoglobin A1c than the low HGI group; this suggests more glycemic excursions and an increased incidence of hypoglycemia in the high HGI group. Multivariate analyses revealed that mean blood glucose, standard deviation of blood glucose and HGI were independent risk factors for hypoglycemia. Receiver operating characteristic curve analysis indicated that the HGI was the best predictor of hypoglycemia. In addition, the optimal cut-off points for HGI, mean blood glucose, and standard deviation of blood glucose in predicting hypoglycemia were 0.5%, 7.2 mmol/L and 1.4 mmol/L respectively.

CONCLUSION

High HGI was significantly associated with greater glycemic excursions and increased hypoglycemia in patients with TIR > 70%. Our findings indicate that HGI is a reliable predictor of hypoglycemia in this population.

Keywords: Hemoglobin glycation index; Hypoglycemia; Type 2 diabetes mellitus; Continuous glucose monitoring; Time in range

Core Tip: Our study focused on the relationship between hemoglobin glycation index and hypoglycemia in patients with type 2 diabetes and time-in-range > 70%. Our findings suggest that a high hemoglobin glycation index was significantly associated with greater glycemic excursions and increased hypoglycemia and was the best predictor of the occurrence and severity of hypoglycemia in this population.