The Relationship Between Parameters In Continuous Glucose Monitoring System Or Self-monitoring Of Blood Glucose And Type 2 Diabetic Retinopathy

Objective: By studying the relationship between parameters in Continuous Glucose Monitoring System(CGMS)or Self-Monitoring of Blood Glucose(SMBG)and the occurrence of retinopathy in patients with type 2 diabetes.Therefore,early and timely effective intervention can be carried out to formulate better blood sugar control goals,reduce the occurrence of type 2 diabetic retinopathy,improve the prognosis of diabetic patients,and improve the quality of life of patients.Methods: A total of 117 patients with type 2 diabetes who were hospitalized in the department of endocrinology,Subei People’s Hospital in Jiangsu Province from September 2018 to June 2020 were selected as the final study subjects.According to the results of the fundus examination,the patients were divided into two groups,namely the retinopathy group and the non-retinopathy group.Collect the patient’s general information,including gender,age,course of disease,fasting blood glucose,random blood glucose measured for the first time on admission,Hb A1 c,creatinine,etc.At the same time,all enrolled patients used a retrospective dynamic system monitoring system to continuously evaluate blood glucose fluctuations within three days,and record mean blood glucose(MBG),standard deviation of blood glucose(SDBG),variable coefficient(CV),largest amplitude of glycemic excursions(LAGE),and mean amplitude of glycemic excursions(MAGE),time in range(TIR)within the target glucose range.And synchronously record the self-glucose monitoring results during the three days,and calculate the MBG,SDBG,CV,LAGE,postprandial glucose excursion(PPGE),and interquartile range of blood glucose(IQR).SPSS 26.0 statistical software was used to compare the general data,biochemical indicators,CGMS-related parameters,and SMBG-related parameters between the two groups,as well as the relationship between the indicators and retinopathy;p<0.05 indicates that the difference is statistically significant.Results: 1.Comparing the two groups of patients with DR and without DR,the duration of diabetes,fasting blood glucose,random blood glucose,Hb A1 c,CHO,Cr and UMA in the DR group were higher than those in the non-DR group,while the eGFR level was lower than that in the non-DR group.In addition,there were significantly more patients with a history of hypertension in the DR group than those in the non-DR group(p<0.05).2.Among the CGMS parameters,the MBG,LAGE,and MAGE levels of the DR group were higher than those of the no DR group,while the TIR level was lower(p<0.05).Among SMBG parameters,the levels of MBG,SDBG,LAGE,PPGE,and IQR were higher in patients with DR than in patients without DR(p<0.05).3.The levels of MBG,CV and LAGE have a positive correlation in the two blood glucose monitoring methods(p<0.05),and MBG has the strongest correlation in the two blood glucose monitoring methods(r=0.420).The correlation between SDBG levels in the two blood glucose monitoring methods was not significant(r=0.180,p=0.053).In the paired t test,the levels of MBG,SDBG,CV,and LAGE were statistically different in the two blood glucose monitoring methods(p<0.05).4.Using binary multivariate logistic stepwise regression analysis,the results showed that TIR in CGMS parameters can be used as an independent protective factor for DR,and the incidence of DR is negatively correlated with TIR(p<0.05).Among SMBG parameters,MBG is an independent risk factor for DR,and the incidence of DR is positively correlated with MBG(p<0.05).5.Pearson correlation analysis showed that TIR was negatively correlated with fasting blood glucose,random blood glucose,HBA1 c,MBG,LAGE,MAGE in CGMS parameters,and MBG,SDBG,IQR,PPGE,and LAGE in SMBG parameters(p<0.05).Among SMBG parameters,MBG was positively correlated with diabetes course,fasting blood glucose,random blood glucose,HBA1 c,CGMS parameters,MBG,LAGE,MAGE,and SMBG parameters,SDBG,IQR,PPGE,and LAGE were positively correlated(p<0.05);and TIR was negative for CGMS parameters Correlation(p<0.05).6.TIR in the CGMS parameters is significant for judging the incidence of DR(p<0.05).The larger the TIR,the smaller the possibility of DR(AUC=0.652).The cutoff value of TIR to DR is 69.50%(sensitivity 0.679,specificity 0.656).Among the SMBG parameters,MBG has significant significance in determining the incidence of DR(p<0.05).The larger the MBG,the greater the possibility of DR(AUC=0.829).The cutoff value of MBG to DR is 9.75mmol/L(sensitivity 0.755,specificity 0.875).Conclusions: 1.The occurrence of type 2 diabetic retinopathy is affected by the course of the disease,fasting blood glucose,random blood glucose,Hb A1 c,blood lipids,blood pressure,eGFR and other factors.Among the CGMS parameters,MBG,LAGE,MAGE,TIR levels and the SMBG parameters,the levels of MBG,SDBG,LAGE,PPGE,IQR may also be related to the occurrence of DR.2.The parameters MBG,CV,and LAGE levels obtained by the two blood glucose monitoring methods have a certain consistency.3.In CGMS parameters,TIR is an independent protective factor that can be used as DR.The larger the TIR,the less likely the occurrence of DR.Among SMBG parameters,MBG is an independent risk factor for DR.The larger the MBG,the greater the possibility of DR.4.TIR as one of the parameters of CGMS and MBG as one of the parameters of SMBG,can be used as a predictive index for clinical evaluation of DR,and has certain guiding significance for judging type 2 diabetic patients with retinopathy.