| Objective:To investigate the related blood glucose fluctuation parameters in different glycated hemoglobin(Hb A1c)by using the flash glucose monitoring system(Free-Style libre,flash glucose monitoring(FGM))in patients with type 2 diabetes(T2DM))Differences in control.In this study,the blood glucose standard deviation(SDBG),average blood glucose(MBG),intra-day blood glucose fluctuation range(MAGE),and the percentage of blood glucose fluctuation range within 3.9-10 mmol / L(TIR)within 24 hours were selected as relevant blood glucose fluctuation parameters..On this basis,further explore the correlation between homocysteine(HCY)and the above-mentioned blood glucose fluctuation parameters in different levels of Hb A1 c groupings,and provide a reference for accurate treatment of diabetes.Method:1.Research subjects and subgroups: The 95 subjects who participated in the study were all T2 DM patients who were hospitalized in the First Affiliated Hospital of Dalian Medical University from December 2018 to December 2019 and installed a transient scanning glucose monitoring system.The included patients were divided into three groups according to the degree of control of glycated hemoglobin(Hb A1c): Hb A1c≥8% was Hb A1 c high group,7% ≤Hb A1 c <8% was Hb A1 c middle group,Hb A1 c <7%was Hb A1 c low.Collect general information about patients: age,gender,insulin use,duration of diabetes,blood pressure measurements,height,weight,and calculate body mass index(BMI)based on height and weight.Collection of relevant biochemicalindicators of patients: including glycated hemoglobin(Hb A1c),blood lipids,fasting venous plasma glucose(GLU),homocysteine(HCY),and liver and kidney function.2.Acquisition and analysis of blood glucose fluctuation parameters: On the second day after the patient was admitted,a transient scanning glucose monitoring system was installed to monitor blood glucose for 14 consecutive days.The collected blood glucose data was collected and analyzed by the AGP software provided by FGM.An Excell table was established to record the blood glucose fluctuation parameters required by this study,including: average blood glucose(MBG): the average level of glucose concentration measured by the subject’s 24 h interstitial fluid.Standard deviation of blood glucose(SDBG): Represents the dispersion of blood glucose levels.It is the degree of fluctuation of all deviations from the average blood glucose during blood glucose monitoring.Intra-day blood glucose fluctuation range(MAGE): It is the average value of all blood glucose fluctuations within 24 hours based on the first effective fluctuation direction based on the blood glucose fluctuations with more than one SDBG.Time in range(TIR): The percentage of time in which the reference range is 3.9-10 mmol / L(70-180 mg / dl).The ratio or range of blood glucose measured by the patient in the TIR High,indicating smoother blood glucose control.Currently in the initial stages of clinical research.In order to analyze whether the specificity of blood glucose fluctuation parameters in the Hb A1 c high group,the Hb A1 c middle group,and the Hb A1 c low group is different,this study uses single-factor analysis of variance and LSD-t test to analyze.3.To determine whether there are differences in HCY in different levels of Hb A1 c subgroups,and the correlation between HCY and various blood glucose fluctuation parameters in the above subgroups: This study used single factor analysis of variance and LSD-t test to determine whether HCY was in the high Hb A1 c group Differences between the Hb A1 c middle group and the Hb A1 c low group;Pearson correlation analysis was used to further explore the correlation between HCY in the Hb A1 c high group,the Hb A1 c middle group,and the Hb A1 c low group with various blood glucose fluctuations.Result:1.Comparison of general information and related biochemical indicators of patients with different levels of Hb A1c:There were significant differences in venous fasting blood glucose(GLU): Hb A1 c high group> Hb A1 c middle group> Hb A1 c low group(10.60 ± 2.48VS7.53 ± 2.29VS6.10 ± 1.06,P <0.05);the course of disease and HCY in the Hb A1 c high group were significant Higher than Hb A1 c low group and Hb A1 c middle group(course of disease: 6.09 ± 5.59VS7.53 ± 5.30VS10.55 ± 4.47,HCY: 12.49 ± 4.20VS12.11 ± 3.22VS15.33 ± 4.37,P <0.05),and the course of disease There was no significant difference between HCY and Hb A1 c low group and Hb A1 c middle group(P> 0.05).There is no positive correlation between HCY and Hb A1 c.Insulin use: Hb A1 c high group> Hb A1 c middle group(P <0.05).There were no significant differences in other indicators(all P> 0.05).2.Comparison of various blood glucose fluctuation parameters in different levels of Hb A1 c groupings: Compared with the Hb A1 c low group,the Hb A1 c middle group:MBG increased(7.26 ± 1.54VS8.55 ± 0.57,P <0.05);compared with the Hb A1 c low group,the Hb A1 c high group: MBG,SDBG,MAGE,all increased(MAG: 7.26 ±1.54VS9.48 ± 1.27,SDBG: 2.16 ± 0.54 vs 2.71 ± 1.04,MAGE: 4.89 ± 1.29VS5.88 ±2.20,P <0.05);compared with Hb A1 c middle group,Hb A1 c high group: MAG,SDBG,MAGE Increase(MAG: 8.55 ± 0.57VS9.48 ± 1.27,SDBG: 2.14 ± 0.35VS2.71 ± 1.04,MAGE: 4.73 ± 0.95VS5.88 ± 2.20,P <0.05);only MAG and Hb A1 c showed a significant positive correlation.There was no significant correlation between TIR and Hb A1c(both P> 0.05).3.Correlation between HCY at different levels of Hb A1 c groupings and various blood glucose fluctuation parameters: In the low Hb A1 c group,HCY was correlated with SDBG,MAGE,and TIR(r were 0.517,0.652,-0.547,P <0.01);there was no significant correlation between HCY in the Hb A1 c group and blood glucose fluctuation parameters(P> 0.05);In the Hb A1 c high group,HCY only showed significant correlation with SDBG(r = 0.464)and TIR(r =-0.520)(both P <0.01).Conclusion:1.Glucose fluctuation parameters have different specificities in different levels of Hb A1 c groupings: MBG,SDBG,and MBG are more likely to respond to blood glucose fluctuations in the Hb A1 c low group and the Hb A1 c middle group(Hb A1 c <8%);when Hb A1 c ≥ 8%,MBG,SDBG,MAGE can reflect blood sugar fluctuations.MBG is an index for predicting the level of Hb A1 c staged control among various blood glucose fluctuation parameters.2.HCY has different correlations with various blood glucose fluctuation parameters in different levels of Hb A1 c groupings.When Hb A1 c is less than 7%,HCY is more advantageous in reflecting blood glucose fluctuations,which is related to SDBG,MAGE,and TIR.The difference between this and HBA1c-related blood glucose fluctuation parameters can better reflect that HCY can be used as an intuitive biochemical indicator to supplement the "blind spot" of Hb A1c-related blood glucose fluctuation parameters.TIR can also be considered as a reference index for clinical blood glucose fluctuation parameters.3.The application of instantaneous scanning glucose monitoring system in combination with HCY in clinical practice provides a feasible idea for achieving stable blood glucose control in patients with type 2 diabetes. |
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