The Study Of Glycemic Variability And Oxidative Stress In Patients With Type 2 Diabetes Mellitus By Using Continuous Glucose Monitoring

Objective:Throughthe application of continuous glucose monitoring（CGM-iPro?2,Medtronic MiniMed,USA）technology to observe changes in blood glucose fluctuations in three groups of patients with different glycated hemoglobin(HbA_1C)levels of type 2 diabetes（T2DM）,and to collect parameters reflecting different dimensions of blood glucose fluctuations:Maximum blood glucose fluctuation（LAGE）,standard deviation of blood glucose（SDBG）,mean blood glucose fluctuation（MAGE）,and mean absolute difference in daytime blood glucose（MODD）.The level of serum 8-hydroxydeoxyguanosine（8-OHdG）in the oxidative stress index was determined by enzyme-linked immunosorbent assay（ELASA）.The correlation between blood glucose fluctuation parameters and oxidative stress parameter 8-OHdG was analyzed.The occurrence and development of the disease explores the theoretical basis of prevention and treatment.Method:This study was reviewed and approved by the Ethics Committee of our hospital.All subjects signed informed consent.In this study,four blood glucose fluctuation parameters were obtained using CGM blood glucose spectrum,including:LAGE,SDBG,MAGE and MODD.The subjects were randomly divided into three groups:HbA_1CC low group,HbA_1CC middle group and HbA_1CC high group.The changes of blood glucose fluctuation parameters in patients with different HbA_1CC levels in T2DM were observed.The content of serum 8-OHdG in oxidative stress markers was determined by ELASA,and the correlation between oxidative stress level and blood glucose fluctuation parameters was analyzed.1.Subjects were included and grouped:120 patients with T2DM who were admitted to the Department of Endocrinology,Shanxi Medical College,Shanxi Medical University from August 2017 to August 1818,HbA_1CC between 5.5 and 8.5%,aged 18-75 years,no infection Severe liver and kidney dysfunction and other endocrine and metabolic diseases were divided into three groups according to the level of HbA_1C:5.5%<HbA_1C<6.5%for HbA_1CC low group,6.5%≤HbA_1C<7.5%for HbA_1CC medium group,7.5%≤HbA_1C≤8.5%is the HbA_1CC high group.General patient data were collected,including age,duration of diabetes,height,weight,waist circumference,hip circumference,systolic blood pressure（SBP）,and diastolic blood pressure（DBP）.2.Acquisition of blood glucose fluctuation parameters:All patients were monitored for 5 days using CGM-iPro?2,and the complete and stable monitoring values on days2-4 were used as the basis for calculating blood glucose fluctuation parameters,including LAGE,SDBG,and MAGE.And MODD.SDBG is the standard deviation of glucose values measured within 24 hours;LAGE is the difference between the maximum and minimum blood glucose levels;MAGE is the blood glucose fluctuation of screening 1hour SDBG with fluctuations in blood glucose fluctuations,according to the direction of the first effective fluctuation.The fluctuation range of blood glucose,MAGE is the average value of the effective blood glucose fluctuation range;MODD is the mean value of the absolute difference of the blood glucose values corresponding to the same time point in the blood glucose spectrum for 2 consecutive days.One-way ANOVA or LSD-t test was used to compare the differences in blood glucose fluctuation parameters between HbA_1CC low group,HbA_1CC middle group and HbA_1CC high group.3.Determination of oxidative stress indicators:All patients received fasting blood in the morning before CGM monitoring,measured liver and kidney function,and left enough supernatant to freeze in the-80°C refrigerator.After all the specimens were collected,the serum 8-OHdG content was determined by ELASA.The changes of8-OHdG between HbA_1CC low group,HbA_1CC middle group and HbA_1CC high group were compared by one-way ANOVA or LSD-t test.4.Correlation analysis between different HbA_1CC levels of blood glucose fluctuation and oxidative stress:Pearson correlation analysis was used to analyze the correlation between 8-OHdG in HbA_1CC low group,HbA_1CC middle group and HbA_1CC high group and various blood glucose fluctuation parameters.Result:1.Comparison of general and metabolic indexes of different HbA_1CC levels:There were no significant differences in age,course of disease,blood pressure,BMI,WHR and liver and kidney function between HbA_1CC low group,HbA_1CC middle group and HbA_1CC high group（P>0.05）).Baseline data between the three groups was comparable.2.Comparison of changes in blood glucose fluctuation parameters at different HbA_1CC levels:Compared with HbA_1CC low group,MAGE increased in HbA_1CC group（2.97±1.13 vs 3.73±1.51,P<0.05）,and there was no significant difference in LAGE,SDBG and MODD（P All were>0.05）;LAGE,SDBG,MAGE,and MODD were increased in the HbA_1CC high group compared with the HbA_1CC low group and the HbA_1CC high group（LAGE:5.06±1.73 vs 5.82±2.12 vs 7.61±2.58,SDBG:1.19±0.46 vs1.48）±0.66 vs 1.93±0.84,MAGE:2.97±1.13 vs 3.73±1.51 vs 4.67±1.75,MODD:1.20±0.44 vs 1.39±0.54 vs 1.93±0.86;P<0.05),and between HbA1C low and HbA_1CC The difference was not statistically significant（P>0.05）.3.Comparison of serum 8-OHdG levels in different HbA_1CC levels:Compared with HbA_1CC low group,serum 8-OHdG increased in HbA_1CC group and HbA_1CC group（209.12±66.05 vs 275.75±91.46 vs 400.13±138.68,P<0.01）There was a statistically significant difference between the HbA_1CC group and the HbA_1CC group（P<0.01）.4.Correlation analysis between serum 8-OHdG and blood glucose fluctuation parameters in different HbA_1CC levels:In the HbA_1CC high group,8-OHdG was positively correlated with MAGE（r=0.202,P=0.036）.Conclusion:1.At different HbA_1CC levels,the blood glucose fluctuation parameters reflect the sensitivity of blood glucose fluctuations.When HbA_1C≤7.5%,MAGE can reflect the fluctuation of blood glucose;when HbA_1C>7.5%,LAGE,SDBG,MAGE and MODD can reflect blood sugar.fluctuation.At low HbA_1C,MAGE can be used as a sensitive indicator of blood glucose fluctuations.2.As the level of HbA_1CC rises,the greater the fluctuation of blood glucose,the heavier the oxidative stress of the body.