Relationship Between Long-term Blood Glucose Variability And Vulnerable Carotid Plaque In Elderly Patients With Type 2 Diabetes

ObjectiveThis study explored the relationship between long-term blood glucose variability and long-term hyperglycemia in elderly patients with type 2 diabetes,carotid artery vulnerable plaque and acute ischemic stroke.Methods1.The first part of the study included 538 elderly patients with type 2 diabetes who were hospitalized and outpatients of the Department of Geriatrics of Anhui Provincial Hospital from October 2014 to October 2019.Patients were tested for glycosylated hemoglobin(HbAlc)every quarter within one year before enrollment,and at least once a month for fasting blood glucose(FPG)and a 2-hour blood glucose(2hPPG)after breakfast,obtaining more than 12 FPG and 2hPPG values in total And 4 times HbAlc value.The long-term blood glucose level was evaluated by the average value of fasting blood glucose(M-FPG),the average value of blood glucose 2 hours after a meal(M-2hPPG),and the average value of glycosylated hemoglobin(M-HbAlc).Long-term blood glucose variability was evaluated using fasting blood glucose variation coefficient(CV-FPG),2-hour postprandial blood glucose variation coefficient(CV-2hPPG),glycosylated hemoglobin variation coefficient(CV-HbAlc).Coefficient of Variation(CV):=standard deviation/mean X 100%.Carotid artery plaques were detected by vascular color Doppler ultrasound,and the vulnerable scores of the plaques were calculated and divided into groups.Vulnerability scores>4 were divided into vulnerable plaque group(149 cases),and vulnerable scores were less than 4 points.Stable plaque group(389 cases).Laboratory testing of high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),total cholesterol(TC),uric acid(UA),etc.,measure height,weight and blood pressure,and collect age and gender through questionnaires,The course of diabetes,the history of hypertension and other clinical data.All data were statistically processed to explore the correlation between blood glucose parameters and other clinical parameters and carotid artery vulnerable plaque.2.All patients in the first part of the study were followed up by telephone every 3 months,with the shortest follow-up period of 1 year and the longest 5 years.The patients with acute ischemic stroke were recorded,and the final follow-up patients were divided into acute ischemic stroke onset group and non-onset group.The parameters of the onset group and the non-onset group were compared and analyzed to explore the risk diagnosis of acute ischemic stroke.The diagnosis of acute ischemic stroke was confirmed by diffusion-weighted imaging of head MRI in our hospital.Result1.The blood glucose parameters of the carotid artery vulnerable plaque group in elderly patients with type 2 diabetes:M-FPG,M-2hPPG,M-HbAlc,CV-FPG,CV-2hPPG,CV-HbAlc,all significantly higher than the stable plaque group(p value<0.05).Other parameters:the proportion of insulin application,age,hypertension,smoking,diabetes course,systolic blood pressure,LDL-C and UA were also significantly higher than those in the stable plaque group(p value<0.05).2.Pearson’s correlation analysis shows that blood glucose parameters:M-FPG(r=0.206),M-HbAlc(r=0.231),M-2hPPG(r=0.236),CV-FPG(r=0.054),CV-2hPPG(r=0.067),CV-HbAlc(r=0.298)are positively correlated with the plaque vulnerability score(p value<0.05),of which CV-HbAlc has the strongest correlation,and CV-FPG and CV-2hPPG are correlated The sex is weaker.Other parameters:UA(r=0.201),LDL-C(r=0.194),TC(r=0.097),age(r=0.091),duration of diabetes(r=0.077),systolic blood pressure(r=0.071),HDL-C(r=0.059)is correlated with the vulnerability score of plaque(p value<0.05).BMI(r=0.029),TG(r=0.013),DBP(r=-0.009)have no correlation with the plaque vulnerability score(p value>0.05).3.Establish a multiple linear regression model to correct for blood lipids,age,smoking,uric acid,hypertension and other clinical factors,CV-HbAlc(β=0.219,t=13.009,p=0.000),M-2hPPG(β=0.178,t=7.438,p=0.000),M-FPG(β=0.169,t--4.856,p=0.000),M-HbAlc(β=0.200,t=5.766,p=0.000)are independent carotid plaques Among the risk factors,CV-HbAlc is still the strongest.CV-FPG(β=0.029,t=1.001,p=0.192)and CV-2hPPG(β=0.073,t=1.105,p=0.072)are not independent risk factors for carotid plaque.The results also showed LDH(β=0.187,t=6.007,p=0.000),age(0=0.096,t=2.009,p=0.013).,hypertension(β=0.141,t=5.698,p=0.001)and UA(B=0.112,t=2.799,p=0.015)are also independent risk factors for vulnerable plaque formation.4.The overall study subjects were divided into three quantile groups according to CV-HbAlc level(T1 group,T2 group and T3 group).The incidence of vulnerable plaques ranged from T1 group(19.7%),T2 group(28.1%)to The T3 group(35.2%)gradually increased.A multivariate logistic regression model was established to analyze the incidence of vulnerable plaques in the three groups,and other clinical factors were gradually adjusted.The T1 group was used as a reference for comparison.The incidence risk OR of the T2 group was 1.39(95%CI:1.18-1.66);the incidence of the T3 group Risk OR:1.70(95%CI:1.27-2.38),and the risk of disease gradually increased(p for trend<0.001).5.In the second part of the study,69 cases were lost to follow-up,8 cases died,and 461 patients were included in the final study.There were 31 cases of acute ischemic stroke,including 11 cases of posterior circulation infarction and 20 cases of anterior circulation infarction.M-FPG,M-HbAlc,M-2hPPG,CV-FPG,CV-HbAlc in the disease group were significantly higher than those in the non-morbid group(p<0.05).The 461 patients were divided into three quantile groups according to the CV-HBA1c value(T1,T2 and T3).The incidence of acute ischemic stroke ranges from T1(5.4%),T2(6.6%)to T3 The group(8.8%)gradually increased.Conclusion1.Long-term glycosylated hemoglobin variation coefficient CV-HbAlc,long-term fasting hyperglycemia M-FPG,long-term postprandial hyperglycemia M-2hPPG,and long-term high glycosylated hemoglobin M-HbAlc are independent risks of carotid plaque in elderly patients with type 2 diabetes factor.2.Low-density lipoprotein LDL,age,hypertension,and uric acid UA are also independent risk factors for carotid plaque in elderly patients with type 2 diabetes.3.The correlation between long-term glycated hemoglobin variation coefficient CV-HbAlc and carotid artery vulnerable plaque is higher than that of long-term hyperglycemia M-FPG,M-2hPPG,M-HbAlc.4.Long-term fasting blood glucose variation coefficient CV-FPG and long-term postprandial blood glucose variation coefficient CV-2hPPG are linearly related to carotid artery vulnerable plaque,but they are not independent risk factors for vulnerable plaque.5.Long-term glycated hemoglobin variation coefficient CV-HbAlc can predict the risk of carotid plaque in elderly patients with type 2 diabetes.SignificanceThe aging society of our country is becoming more and more serious,and the prevalence of type 2 diabetes in the elderly is more than 20%.Acute ischemic stroke is a common complication of type 2 diabetes patients,which can cause physical disability,cognitive dysfunction and even death,and cause a huge burden on the family and society.Scholars have found that with the increase in blood glucose compliance rate in diabetic patients,the incidence of complications has not decreased simultaneously.Studies have shown that blood glucose variation is closely related to complications.The increased risk of cardiovascular and cerebrovascular events in patients with type 2 diabetes due to short-term blood glucose variation has been confirmed by multiple studies.Blood glucose variability exists for a long time,and the conclusions of related studies are not completely consistent.There is no definite evaluation index for long-term blood glucose variability.Whether long-term blood glucose variability and long-term hyperglycemia affect the macrovascular complications of type 2 diabetic patients is not yet known.Compared with carotid artery stenosis,carotid artery vulnerable plaque is considered to be more likely to cause cardiovascular and cerebrovascular end-point events,and carotid artery disease has become a window for studying macrovascular disease.Elderly patients with type 2 diabetes are prone to increase the blood glucose variation range due to factors such as aging,coexistence of multiple chronic diseases,and complicated drug application,while the elderly population has a weaker ability to perceive blood glucose variation.Too much emphasis on controlling blood glucose variability may lead to excessive use of hypoglycemic drugs in elderly patients with type 2 diabetes,and an increased risk of hypoglycemia.In-depth understanding of the relationship between long-term blood glucose variability and the onset of type 2 diabetic macroangiopathy and acute ischemic stroke will help this special population obtain more reasonable and precise individualized treatment strategies,and ultimately reduce and delay diabetes complications Production and progress.