The Correlation Of C Peptide And Framingham Scores With Macrovascular Complications In Patients With Type 2 Diabetes Complicated With Metabolic Syndrome

Objective To compare the C peptide secretion characteristics and Framingham score of type 2 diabetes mellitus patients with metabolic syndrome and non metabolic syndrome,and to explore the correlation of C peptide level and Framingham score with macrovascular complications in type 2 diabetes mellitus patients.Methods 331 patients with type 2 diabetes mellitus patients were divided into non metabolic syndrome group(MS-group,126 cases)and metabolic syndrome group(MS+ group,205 cases)according to the 2013 CDS diagnostic criteria of metabolic syndrome,compared the difference of the two groups with age,sex,duration of diabetes,body mass index(BMI),fasting blood glucose(FPG),2 hour postprandial blood glucose(2h PG),glycosylated hemoglobin(Hb A1c),fasting C peptide(FCP),2 hour postprandial blood C peptide(2h CP)and insulin resistance index(HOMA-IR),total cholesterol(TCH),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),blood uric acid and other indicators and Framingham score.They were divided into two groups according to whether there were macrovascular complications,and the differences of the above indexes were compared between patients with or without macrovascular complications.Logistic regression analysis was used to explore the relationship between C peptide and macrovascular complications in type 2 diabetes mellitus.In the MS-group and MS+ group,the same multivariate analysis was conducted to observe the difference between C peptide and Framingham score and macrovascular complications in type 2 diabetes mellitus with metabolic syndrome and non metabolic syndrome.The diagnostic value of C peptide and Framingham score for macrovascular complications was studied by plotting the receiver operator characteristic curve(ROC),Z test in Med Calc software was used to compare the area under different ROC curves.SPSS20.0 was used for statistical analysis.Results Compared with MS-group,MS+ group has higher fasting C peptide level(1.00(0.58-1.71)vs0.68(0.40-1.16),P<0.001),postprandial C peptide level(2.55(1.58-4.12)vs2.09(1.20-2.64),P=0.001)and insulin resistance index(2.48(2.09-3.01)vs2.14(1.86-2.47),P<0.001).In addition MS+ group Framingham scores smoking(3.0(3.0,5.0)vs3.0(1.0,3.0),P<0.001),total cholesterol(2.0(0,4.0)vs1.0(0.0,2.0),P<0.001),high density lipoprotein cholesterol(2.0(1.0,2.0)vs0.0(0.0,1.0),P<0.001),systolic blood pressure(2.0(0.0,2.0)vs 1.0(0,2.0),P=0.01)group scores were higher than MS-group,the difference was statistically significant.Data from of MS-and MS+groups showed that type 2 diabetes with macrovascular complications has higher age,longer course of disease,and group MS+ had lower level of C peptide(P<0.05).FCP,Framingham score,duration of diabetes,fasting blood glucose,glycosylated hemoglobin,blood uric acid and BMI as independent variables,logistical regression analysis showed that FCP(OR=0.515(0.304-0.875),Framingham scores(OR=1.146(1.060-1.239),P<0.001)and long duration of diabetes(OR=1.072(1.023-1.123),P=0.003)were independent factors of macroangiopathy in type 2 diabetes mellitus;in group MS+ there were similar results to the overall study,FCP was a independent protective factors of macrovascular complications(OR=0.393(0.160-0.963),P=0.041),Framingham scores(OR=1.162(1.055-1.281),P=0.002)and duration of diabetes(OR=1.079(1.010-1.152),P=0.023)could increase the risk.However in group MS-,only duration of diabetes(OR=1.082(1.011-1.159),P=0.023)was independent factor,and no protective effect of FCP(OR=0.404(0.111-1.474),P=0.170)was found.The receiver operating characteristic curve(ROC)analysis showed that in group MS+ the area under the curve of Framingham scores was 0.703(P<0.001),and the best cut-off value was 12.5 points,the area under the curve of FCP was 0.640(P=0.001),and the optimal cut-off value was 0.935,the area under the curve of combination of the Framingham scores,FCP and the duration of diabetes was greater than the area under the curve of FCP and the duration of diabetes.Conclusions C peptide has protective effect on type 2 diabetic macroangiopathy,and in type 2 diabetic patients with metabolic syndrome,insulin resistance lead to compensatory secretion of C peptide levels,it can play protective effect on macrovascular disease.The Framingham scores is also a independent factor of type 2diabetic macroangiopathy,in group MS+ high Framingham scores corresponds to high risk of macrovascular complications,it can assist the diagnosis of macrovascular complications.