From our combined team: Time in Range (TIR) may help to predict amputation and mortality risk #ActAgainstAmputation @USC @USC_Vascular @KeckSchool_USC

This from our combined Chongqing/Singapore/USC team. This adds additional data pointing to a relationship with glucose, morbidity and mortality in high risk diabetic foot patients.

Aims: To evaluate the association of time in range (TIR) with amputation and all-cause mortality in hospitalized patients with diabetic foot ulcers (DFUs) MATERIALS AND METHODS: A retrospective analysis was performed on 303 hospitalized patients with DFUs. During hospitalization, TIR, mean blood glucose (MBG), coefficient of variation (CV), time above range (TAR), time below range (TBR) of patients were determined from seven-point blood glucose profiles. Participants were grouped based on their clinical outcomes (i.e., amputation and death). Logistic regression was employed to analyze the association of TIR with amputation and all-cause mortality of inpatients with DFUs.

Results: Among the 303 enrolled patients, 50 (16.5%) had undergone amputation whereas 7 (2.3%) were deceased. Blood glucose was determined in 41,012 samples obtained from all participants. Patients who underwent amputation had significantly lower TIR, and higher MBG, CV, level 2 TAR and level 1 TBR whereas deceased patients had significantly lower TIR, and higher MBG and level 2 TAR. Both Amputation and all-cause mortality rate declined with an increase in TIR quartiles. Logistic regression showed association of TIR with amputation (P = 0.034) and all-cause mortality (P = 0.013) after controlling for 15 confounders. This association was similarly significant in all-cause mortality after further adjustment for CV (P = 0.022) and level 1 TBR (P = 0.021), respectively.

Conclusions: TIR is inversely associated with amputation and all-cause mortality of hospitalized patients with DFUs. Further prospective studies are warranted to establish a causal relationship between TIR and clinical outcomes in patients with DFUs. This article is protected by copyright. All rights reserved.

Keywords: all-cause mortality; amputation; diabetic foot; time in range.

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