Correlation between key indicators of continuous glucose monitoring and the risk of diabetic foot

doi:10.4239/wjd.v16.i3.99277

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World Journal of Diabetes

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World J Diabetes. Mar 15, 2025; 16(3): 99277
Published online Mar 15, 2025. doi: 10.4239/wjd.v16.i3.99277

Correlation between key indicators of continuous glucose monitoring and the risk of diabetic foot

Xin-Qian Geng, Shun-Fang Chen, Fei-Ying Wang, Hui-Jun Yang, Yun-Li Zhao, Zhang-Rong Xu, Ying Yang

Xin-Qian Geng, Shun-Fang Chen, Fei-Ying Wang, Hui-Jun Yang, Department of Endocrinology, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China

Yun-Li Zhao, Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education and Yunnan Province, Yunnan University, Kunming 650500, Yunnan Province, China

Zhang-Rong Xu, The Diabetic Center of PLA, The Ninth Medical Center of PLA General Hospital (306^th Hosp PLA), Beijing 100101, China

Ying Yang, Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China

Co-first authors: Xin-Qian Geng and Shun-Fang Chen.

Co-corresponding authors: Ying Yang and Zhang-Rong Xu.

Author contributions: Geng XQ and Chen SF designed the study and performed the statistical analysis; Chen SF, Wang FY, and Yang HJ collected the data; Geng XQ wrote the manuscript; Zhao YL supervised the study and validated the analysis; Xu ZR and Yang Y were responsible for revising the manuscript for important intellectual content and final approval of the version of the article to be published. All authors have read and approved the final manuscript. Geng XQ and Chen SF are co-first authors. Both Geng XQ and Chen SF played key roles in all stages of the research, including study design, data collection, analysis, and manuscript writing. Their work was crucial to the success of the research. Therefore, the co-first authorship is established to acknowledge their equal contributions to these core research activities. Our study encompasses a broad spectrum of expertise, with Yang Y bringing a deep understanding of endocrinology and the intricacies of continuous glucose monitoring, while Xu ZR specializes in podiatry and the specific risks associated with diabetic foot complications. This dual authorship ensures that inquiries regarding either the metabolic aspects or the clinical implications of our findings are addressed by the most knowledgeable party. Furthermore, the complexity and breadth of our data analysis require the input of both authors to fully respond to methodological and result-oriented queries. By designating two co-corresponding authors, we can ensure that the peer review process and subsequent correspondence are efficient and that all editorial and reader concerns are met with comprehensive and detailed responses. We believe this approach not only recognizes the equal contributions of both authors but also underscores the cross-regional collaboration that is central to our research.

Supported by Yunnan Province Academician (Expert) Workstation Project, No. 202305AF150097; the Basic Research Program of Yunnan Province (Kunming Medical University Joint Special Project, No. 202101AY070001-276; the National Natural Science Foundation of China, No. 82160159; the Key Project Program of Yunnan Province (Kunming Medical University Joint Special Project), No. 202301AY070001-013; the Major Science and Technology Project of Yunnan Province, No. 202202AA100004; and the Double First-class University Construction Project of Yunnan University, No. CY22624106.

Institutional review board statement: All experimental protocols were approved by Ethics Committees of the Affiliated Hospital of Yunnan University in compliance with the Declaration of Helsinki (No. 2022220).

Informed consent statement: Written consent was obtained from every participant and/or their legal guardian(s).

Conflict-of-interest statement: The authors declare no conflicts of interest.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The datasets used and/or analyzed in this study are available from the corresponding author upon reasonable request.

Corresponding author: Ying Yang, PhD, Chief Doctor, Professor, Department of Endocrinology and Metabolism, Affiliated Hospital of Yunnan University, Second People’s Hospital of Yunnan Province, No. 176 Qingnian Road, Kunming 650021, Yunnan Province, China. yangying2072@126.com

Received: July 18, 2024
Revised: November 9, 2024
Accepted: December 23, 2024
Published online: March 15, 2025
Processing time: 186 Days and 20.2 Hours

Abstract

BACKGROUND

Continuous glucose monitoring (CGM) metrics, such as time in range (TIR) and glycemic risk index (GRI), have been linked to various diabetes-related complications, including diabetic foot (DF).

AIM

To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus (T2DM).

METHODS

A total of 591 individuals with T2DM (297 with DF and 294 without DF) were enrolled. Relevant clinical data, complications, comorbidities, hematological parameters, and 72-hour CGM data were collected. Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF.

RESULTS

Individuals with DF exhibited higher mean blood glucose (MBG) levels and increased proportions of time above range (TAR), TAR level 1, and TAR level 2, but lower TIR (all P < 0.001). Patients with DF had significantly lower rates of achieving target ranges for TIR, TAR, and TAR level 2 than those without DF (all P < 0.05). Logistic regression analysis revealed that GRI, MBG, and TAR level 1 were positively associated with DF risk, while TIR was inversely correlated (all P < 0.05). Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels (P < 0.05). Additionally, achieving TAR was influenced by fasting plasma glucose, body mass index, diabetes duration, and antidiabetic medication use.

CONCLUSION

CGM metrics, particularly TIR and GRI, are significantly associated with the risk of DF in T2DM, emphasizing the importance of improved glucose control.

Keywords: Continuous glucose monitoring; Time in range; Glycemia risk index; Diabetic foot; Continuous glucose monitoring target achievement

Core Tip: The study investigated the relationship between continuous glucose monitoring (CGM) metrics, specifically time in range (TIR), and the risk of diabetic foot (DF) in individuals with type 2 diabetes mellitus. Our findings indicate that DF risk was inversely associated with TIR but positively correlated with glycemic risk index, mean blood glucose, and time above range (TAR) level 1. Achieving optimal TIR and TAR targets was negatively influenced by elevated white blood cell count and glycated hemoglobin A1c levels. These insights emphasize the importance of achieving optimal CGM targets for improved management of DF complications.