Relationship Between Blood Glucose Drift And High-sensitivity C Reactive Protein In Patients Of Increasing Fasting Blood Glucose With Type2Diabetes Mellitus

Objective: To observe the blood glucose drift in patients of increasing fastingblood glucose with T2DM using continuous glucose monitoring system(CGMS)andanalyze the reason of increasing fasting blood glucose，investigate the relationshipbetween blood glucose drift and high-sensitivity C reactive protein.Methods：40patients with T2DM from endocrinology department,3rd section inthe first one hospital of Dalian Medical University were enrolled. The fasting bloodglucose were more than10.0mmol/L. The fingertip blood glucose at0,2,4oclock of thenight were tested and CGMS were weared for3days. The patients were tested7timesbefore and after three meals and before sleep every day. The fingertip blood glucosewas called self blood glucose monitoring (SMBG).The treatment plans were notchange during the patients weared CGMS. Fasting plasma glucos（eFPG）、glycosylatedhemoglobin（HbA1c）、total cholesterol（TC）、triglyceride（TG）、high densitylipoprotein cholesterol（HDL-C）、low density lipoprotein cholesterol（LDL-C）、lipoprotein a（Lpa）、glutamic pyruvic transaminase（ALT）、glutamic oxalacetictransaminase（AST）、blood uric acid(UA)、blood urea nitrogen(BUN)、blood serumcreatinine(Cre) were measured by automatic biochemical analyzer. Serumhigh-sensitivity C reactive protein(hs-CRP) levels were determined with immuneturbidimetric method.The fingertip blood glucose were tested by glucosemeter(excellence model). All the patients were divided into three groups based on thevalue of HbA1c. HbA1c≤8.5%,8.5%＜HbA1c≤10.0%,HbA1c＞10.0%belongs togroup A、B、C seperately.The clinical features and blood glucose drift parameters inthree groups were observed. The midnight hypoglycemia and the reason of the increasing fasting blood glucose were analyzed according to the CGMSmap.According to the value of mean attitude of glucose excursion (MAGE) patientswere divided into two groups, low blood glucose drift group (MAGE＜3.9mmol/L)and high blood glucose drift group(MAGE≥3.9mmol/L). The differences of clinicalfeatures between two groups were discussed and the correlation of hs-CRP and bloodglucose fluctuations were analysed.Results:1.There were no statistically significant differences between CGMS andSMBG value，whether at0、2、4oclock in the midnight or7timepoints in daytime (P>0.05)。2. Hypoglycemia occurred in7persons for14times according to CGMS,including4person-times during the daytime,10person-times at night. However,hypoglycemia occurred in3persons for4times according to SMBG, including2person-times during the daytime,2person-times at night. The monitoring incidence ofhypoglycemia is35.0%by CGMS and10.0%by SMBG.3.According to the CGMS, in all hypoglycemia,8person-times had symptoms,6person-times without the symptoms, called unrecognized hypoglycemia(HUN), amongwhich incidence of HUN was42.9%.The incidence of hypoglycemia at night was71.4%.4.Reasons of the increasing fasting blood glucose:37cases were lesshypoglycemic drugs at night, accounted for92.5%.2cases were somogyi phenomenon,accounted for5.0%.1case was dawn phenomenon, accounted for2.5%.5.Course of DM,there were no statistically significant differences among threegroups of Ages、BMI、FPG、TC、TG、LDL-C、HDL-C、Lpa、ALT、AST、BUN、UA、Cre、MAGE、standard deviation of blood glucose (SDBG)、absolute means ofdaily differences (MODD),hs-CRP and24hMBG in B group were higher than those ofA group,in C group were higher than in B group，in C group were higher than in Agroup（F=4.708，F=4.127，P＜0.05）.The incidence of hypoglycemia was the highestin C group then in A group and the last in B group.6.Course of DM, there were no statistically significant differences ofAges、BMI、FPG、HbA1c、TC、TG、LDL-C、HDL-C、Lpa、ALT、AST、BUN、UA、Cre betweenhigh blood glucose drift group and low blood glucose drift group. hs-CRP levels andBMI were significant higher in high blood glucose drift group than those in low blood glucose drift group（t=-2.55，t=-3.97，P＜0.05).The incidence of macrovascularcomplications in high blood glucose drift group was more than that in low bloodglucose drift group. There were no statistically significant differences between thosegroups（χ2=0.34,P＞0.05）.7.Pearson correlation analysis showed that hs-CRP and MAGE、HbA1c、BMIwerepositively correlated(P＜0.05)。 Multiple linear regression analysis showed thatHbA1c、BMI were the risk factors that influence hs-CRP(P＜0.05).Conclusion:1.Compared with SMBG, CGMS values are accuracy and much more excellent indiscovering hypoglycemia,especially HUN.2.There are no correlations between HbA1c and blood glucose drift parameters inthe patients of inceasing fasting blood glucose with T2DM. HbA1c and MAGE aretwo separate indicators to assess blood glucose control.3.hs-CRP levels are higher in higher HbA1c group and high blood glucose driftgroup,they are positively correlated with HbA1c and MAGE. HbA1c is the risk factorthat influence hs-CRP.