Association of continuous glucose monitoring-derived time in range with major amputation risk in diabetic foot osteomyelitis patients undergoing amputation

Abstract

Objective: The metrics generated from continuous glucose monitoring (CGM), such as time in range (TIR), are strongly correlated with diabetes complications. This study explored the association of perioperative CGM-derived metrics with major amputation risk in patients with diabetic foot osteomyelitis (DFO). Methods: This study recruited 55 DFO patients with grade 3–4 wounds according to the Wagner Diabetic Foot Ulcer Classification System, all of whom underwent CGM for 5 days during the perioperative period. The CGM-derived metrics were defined in accordance with the most recent international consensus recommendations. Results: Patients with major amputation had significantly less TIR and higher time below range (TBR) (all p < 0.05). In binary logistic regression analyses, a lower TIR was associated with the risk of major amputation (odds ratio: 0.83 (95% confidence interval: 0.71–0.99), p = 0.039). This association remained statistically significant after adjustments for age, sex, body mass index, type of diabetes, smoking, drinking, durations of diabetes and DFU, ankle-brachial index, albumin, estimated-glomerular filtration rate, Society for Vascular Surgery wound, ischemia, and foot infection (WIfi) stage, multidrug-resistant organisms, and hemoglobin A1c. Further adjustment for the mean amplitude of glycemic excursion (MAGE) reduced this association. TBR was also independently associated with the risk of major amputation (odds ratio: 1.60 (95% confidence interval: 1.17–2.18), p = 0.003); this association persisted after adjustment for MAGE. Conclusion: Perioperative TIR (3.9–10.0 mmol/L) and TBR (<3.9 mmol/L) were significantly associated with major amputation in hospitalized patients with DFO.

Use of continuous glucose monitors in low‐ and middle‐income countries: A scoping review

“…42 The 10 observational studies focused on glycaemic surrogates, and five reported significant reductions in the frequency of hypoand hyper-glycaemia events, as well as less glucose variability. 20,21,30,31,34 One observational study also included the assessments of health outcomes and reported that hypoand hyper-glycaemia profiles were negatively associated with diabetes complications after controlling for potential confounders. 31 3.3.2 | CGM benefits in combination with other treatments and devices 13 reports aimed to describe CGM benefits in combination with other devices or treatments.…”

“…The pre‐post study focusing on T2DM showed a reduction in HbA 1c levels after 3 months 42 . The 10 observational studies focused on glycaemic surrogates, and five reported significant reductions in the frequency of hypo‐ and hyper‐glycaemia events, as well as less glucose variability 20,21,30,31,34 . One observational study also included the assessments of health outcomes and reported that hypo‐ and hyper‐glycaemia profiles were negatively associated with diabetes complications after controlling for potential confounders 31 …”

“…China contributed with seven studies, [16][17][18][19][20][21][22] Colombia with five, [23][24][25][26][27] India with four, [28][29][30][31] Brazil [32][33][34] and Turkey [35][36][37] with three each, and Argentina, 38 Bosnia and Herzegovina, 39 Georgia, 40 Malaysia 41 and Mexico, 42 with one study each (Table 1). Only one report was published in 2002, 32 and the number of reports per year increased steadily, reaching eight reports in 2021, [17][18][19]22,26,31,40,42 and five reports up to July 2022.…”

“…Only one report was published in 2002, 32 and the number of reports per year increased steadily, reaching eight reports in 2021, [17][18][19]22,26,31,40,42 and five reports up to July 2022. 20,30,34,36,38 Overall, seven reports presented results of experimental studies (five randomized trials and two quasiexperimental [pre-post]) 16,17,19,22,27,41,42 ; two reports focused on cost-effective analysis 23,37 and the remaining 18 were observational in nature. The number of participants in the studies varied between 20 and 5072, whereas follow-up time ranged from 14 days to 18 months.…”

Relationship Between Time in Range and Dusk Phenomenon in Outpatients with Type 2 Diabetes Mellitus

“…Several studies have explored the relationship between the TIR and biochemical parameters of blood glucose such as HbA1c, glycated albumin, and 1,5-anhydro-d-glucitol [25][26][27][28][29] as well as metrics derived from CGM such as the GMI, ambulatory glucose profile indexes, and the CV. 26,[30][31][32] Concurrently, a steadily increasing amount of evidence emerged indicating that the TIR can predict the risk of chronic complications of diabetes such as diabetic retinopathy, 33 diabetic polyneuropathy, 34,35 diabetic foot amputation, 36,37 macrovascular disease, 38 and even cancer mortality. 39 We further divided our patients into those with a TIR of ≤70% (non-target group) and those with a TIR of >70% (target group) according to the 70%TIR boundary mentioned above.…”