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Pathophysiology/complications
Associations between continuous glucose monitoring-derived metrics and diabetic retinopathy and albuminuria in patients with type 2 diabetes
  1. Satomi Wakasugi1,
  2. Tomoya Mita1,
  3. Naoto Katakami2,3,
  4. Yosuke Okada3,
  5. Hidenori Yoshii4,
  6. Takeshi Osonoi5,
  7. Keiko Nishida6,
  8. Toshihiko Shiraiwa7,
  9. Keiichi Torimoto3,
  10. Akira Kurozumi3,
  11. Masahiko Gosho8,
  12. Iichiro Shimomura2,
  13. Hirotaka Watada1
  1. 1Department of Metabolism & Endocrinology, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
  2. 2Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Suita, Japan
  3. 3First Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
  4. 4Department of Medicine, Diabetology & Endocrinology, Juntendo Tokyo Koto Geriatric Medical Center, Koto-ku, Japan
  5. 5Nakakinen Clinic, Naka, Japan
  6. 6Nishida Keiko Diabetes Clinic, Kitakyushu, Japan
  7. 7Shiraiwa Medical Clinic, Kashihara, Japan
  8. 8Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
  1. Correspondence to Dr Tomoya Mita; tom-m{at}juntendo.ac.jp

Abstract

Introduction Preventing the development and progression of diabetic microvascular complications through optimal blood glucose control remains an important challenge. Whether metrics based on continuous glucose monitoring are useful for the management of diabetic microvascular complications is not entirely clear.

Research design and methods This is an exploratory analysis of an ongoing prospective, multicenter, 5-year follow-up observational study. Study participants included 999 outpatients with type 2 diabetes who underwent continuous glucose monitoring at baseline. Associations between continuous glucose monitoring-derived metrics and the severity of diabetic retinopathy or albuminuria were investigated using multivariable proportional odds models.

Results The overall prevalence of diabetic retinopathy was 22.2%. Multivariate analysis with proportional odds models demonstrated that continuous glucose monitoring-derived metrics related to intraday and interday glucose variability are significantly associated with the severity of diabetic retinopathy, even after adjusting for various possible risk factors. However, significant relationships were not observed after adjusting for hemoglobin A1c (HbA1c) levels. The prevalence of microalbuminuria and macroalbuminuria was 20.3% and 6.7%, respectively. Similarly, multivariate analysis demonstrated that those metrics are significantly associated with the severity of albuminuria. These relationships remained significant even after further adjusting for HbA1c levels.

Conclusions Continuous glucose monitoring-derived metrics related to intraday and interday glucose variability are significantly associated with the severity of diabetic retinopathy or albuminuria in patients with type 2 diabetes. Thus, evaluating these metrics might possibly be useful for risk assessment of diabetic microvascular complications.

Trial registration number UMIN000032325.

  • diabetic retinopathy
  • albuminuria

Data availability statement

Data are available upon reasonable request. All data generated or analyzed during this study are included in this published article or in the data repositories listed in the References.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/bmjdrc-2020-001923

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    Data availability statement

    Data are available upon reasonable request. All data generated or analyzed during this study are included in this published article or in the data repositories listed in the References.

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    Footnotes

    • Contributors All authors contributed to the study design and were involved in all stages of manuscript development. SW and TM drafted the manuscript. MG, a statistician, was primarily responsible for data analysis. SW, TM, NK, YO, TO, HY, KN, TS, KT, AK, MG, IS, and HW also collected, analyzed, and interpreted the data; reviewed and edited the manuscript; and approved the final manuscript. HW is the principal guarantor of this work; he has full access to all study data and takes responsibility for the integrity of the data and the accuracy of data analysis. All authors have read and agreed to the publication of the manuscript.

    • Funding This study was financially supported by the Japan Agency for Medical Research and Development (AMED) under Grant Number JP20ek0210105 (to HW) and the Manpei Suzuki Diabetes Foundation (to HW).

    • Competing interests TO and HW have received research funds from Abbott Japan. HW is a member of the advisory board of Abbott Japan. All other authors declare no conflicts of interest.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.