diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM12703diaendo-12703Research ArticleОбзорыReviewВремя нахождения в целевом диапазоне гликемии – инструмент оценки качества гликемического контроля при сахарном диабетеTime in range is a tool for assessing the quality of glycemic control in diabeteshttps://orcid.org/0000-0001-9253-8075СуплотоваЛ. А.SuplotovaL. A.

Суплотова Людмила Александровна, доктор медицинских наук, профессор, заведующая курсом эндокринологии кафедры терапии ИНПР, главный внештатный эндокринолог Тюменской области

Тюмень

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Liudmila A. Suplotova, MD, PhD, Professor

Tyumen

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suplotovala@mail.ruhttps://orcid.org/0000-0002-1932-1686СудницынаА. С.SudnitsynaA. S.

Судницына Анна Сергеевна, врач-эндокринолог, очный аспирант кафедры терапии ИНПР с курсом ультразвуковой, функциональной диагностики и эндокринологии

625000, г. Тюмень, ул. Одесская, д. 54

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Anna S. Sudnitsyna, MD

54 Odesskaya street, 625000 Tyumen

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dr.sudnitsyna@mail.ruhttps://orcid.org/0000-0001-7124-1176РомановаН. В.RomanovaN. V.

Романова Наталья Валерьяновна, кандидат медицинских наук , заведующая эндокринологическим отделением

Тюмень

Natalia V. Romanova, MD

Tyumen

 

n.v.romanova2014@yandex.ruhttps://orcid.org/0000-0002-5057-127XШестаковаМ. В.ShestakovaM. V.

Шестакова Марина Владимировна, доктор медицинских наук, профессор, академик РАН

Москва

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Marina V. Shestakova, MD, PhD, Professor

Moscow

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nephro@endocrincentr.ruТюменский государственный медицинский университетРоссияTyumen State Medical UniversityRussian FederationОбластная клиническая больница №2РоссияRegional Clinical Hospital №2Russian FederationНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian Federation202108072021243282290Copyright © Суплотова Л.А., Судницына А.С., Романова Н.В., Шестакова М.В., 20212021Суплотова Л.А., Судницына А.С., Романова Н.В., Шестакова М.В.Suplotova L.A., Sudnitsyna A.S., Romanova N.V., Shestakova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/12703

Появление систем непрерывного мониторирования гликемии (НМГ) привело к расширению диагностических возможностей. Внедрение технологии в клиническую практику позволило определять закономерности и тенденции экскурсий уровня глюкозы, получать надежные данные о краткосрочном гликемическом контроле. Учитывая большой объем информации, получаемой при использовании систем НМГ, было предложено более 30 различных показателей, характеризующих гликемическую изменчивость. Однако практическому врачу очень сложно интерпретировать полученные данные в связи с многообразием показателей и отсутствием их целевых значений. Первым шагом в стандартизации индексов явилось создание в 2017 г. Международного руководства по НМГ, где особую значимость приобретает показатель времени нахождения в целевом диапазоне (Time in range — TIR) (3,9–10,0 ммоль/л, реже — 3,9–7,8 ммоль/л). В 2019 г. с целью дополнить согласованные параметры и упростить интерпретацию данных, полученных с помощью НМГ, были подготовлены рекомендации к Международному консенсусу о времени нахождения в целевом диапазоне, где TIR был валидирован в качестве дополнительного компонента оценки гликемического контроля наряду с HbA1c. В этом литературном обзоре рассмотрены вопросы ассоциации TIR с развитием микро- и макрососудистых осложнений при сахарном диабете (СД) 1 и 2 типа. Также проанализирована взаимосвязь с другими показателями оценки гликемического контроля и рассмотрена зависимость TIR от инсулинотерапии. TIR является простым и удобным показателем с доказанной связью с микро- и макрососудистыми осложнениями СД и может быть рекомендован в качестве нового инструмента для оценки гликемического контроля. Главным препятствием для широкого применения TIR является недостаточное использование технологии НМГ у большинства пациентов с СД.

The presence of continuous glucose monitoring (CGM) systems has expanded diagnostic capabilities. The implementation of this technology into clinical practice allowed to determine the patterns and tendencies of excursions in glucose levels, to obtain reliable data concerning short-term glycemic control. Taking into consideration the large amount of obtained information using CGM systems, more than 30 different indicators characterizing glycemic variability were proposed. However, it is very difficult for a practitioner to interpret the data obtained due to the variety of indicators and the lack of their target values. The first step in the standardization of indices was the creation of the International Guidelines for CGM in 2017, where the Time in Range (TIR) (3,9–10,0 mmol/l, less often 3,9–7,8 mmol/l) was significant. To complement the agreed parameters and simplify the interpretation of obtained data using CGM, in 2019 the recommendations were prepared for the International Consensus on Time in Range, where TIR was validated as an additional component of the assessment of glycemic control along with HbA1c. In the literature review the issues of the association of TIR with the development of micro- and macrovascular complications in type 1 and 2 diabetes are considered. The relationship with other indicators of the glycemic control assessment was also analyzed and the dependence of insulin therapy on TIR was shown. TIR is a simple and convenient indicator, it has a proven link with micro- and macrovascular complications of diabetes and can be recommended as a new tool for assessing the glycemic control. The main disadvantage of TIR usage is the insufficient apply of CGM technology by the majority of patients with diabetes.

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The authors declare that there are no conflicts of interest present.