Relationship Between Glycemic Variability And Type 2 Diabetes Mellitus With Metabolic Associated Fatty Liver Disease

BackgroundAt present,the prevalence of diabetes in China is increasing year by year.Among people aged eighteen and over,diabetes affects at least one of every ten people,while type2 diabetes mellitus（T2DM）accounts for the highest proportion of diabetes patients,up to90%.With the development of the times and economy,the prevalence of metabolic associated fatty liver disease（MAFLD）has also appeared an upward trend significantly,which has been as high as 25% in the general population around the world,liver fibrosis and liver cirrhosis even liver cancer can be the outcome.Non-alcoholic fatty liver disease（NAFLD）is known as the original name of MAFLD.The high incidence rate and the adverse consequence of disease progression have made it a new public problem.Although glycosylated hemoglobin（Hb A1c）has been widely valued as a standard index to evaluate long-term glycemic control,glycemic variability（GV）has attracted more and more attention in recent years because of better reflecting the oscillation state of blood glucose.Studying the correlation between GV and T2 DM with MAFLD not only has a deeper understanding of blood glucose management,but also provides a new basis for the prevention and treatment of T2 DM with MAFLD.ObjectivesThe aim of this study was to investigate the relationship between glycemic fluctuation and type 2 diabetes mellitus combined with metabolic associated fatty liver disease,and the risk factors of the latter were analysed.MethodsFrom January 2021 to October 2021,we retrospectively selected a total of 230 patients with type 2 diabetes hospitalized in the Endocrinology Department of the Third Affiliated Hospital of Xinxiang Medical University.They were divided into two groups according to whether suffering MAFLD.There were 77 cases in simple T2 DM group and 153 cases in T2 DM combined with MAFLD group.The gender,age,height,weight and other general clinical data of all subjects were recorded.We collected the required laboratory blood biochemical examination indexes and collated fingertip blood glucose monitoring values 7times a day,and then calculated SDBG,PPGE and LAGE according to the blood glucose value spectrum to reflect the trend of glycemic variability.In comparison with the differences of related indexes between simple T2 DM group and T2 DM combined with MAFLD group,and explored the correlation between GV and T2 DM combined with MAFLD by univariate and multivariate logistic regression analysis.Results1.The prevalence of MAFLD in hospitalized T2 DM patients was 66.5%.2.In terms of the general clinical data,contrasted with simple T2 DM group,the level of BMI in T2 DM combined with MAFLD group was higher,diastolic blood pressure has the same result.On the contrary,the levels of age and course of disease were lower in T2 DM combined with MAFLD group（P<0.05）,and there was no significant difference in gender and systolic blood pressure（P>0.05）.3.In terms of the indexes of glucose and lipid metabolism,FPG and TG in T2 DM combined with MAFLD group were higher（P<0.05）.About islet function,FINS,FC-P and HOMA-IR were also higher in that group（P<0.05）,the difference in TC,HDL,LDL and Hb A1 c between the two groups was insignificant（P>0.05）.4.Compared with the related indexes of liver function between the two groups,the total bilirubin,direct bilirubin,indirect bilirubin,ALB in T2 DM combined with MAFLD group were higher than those in simple T2 DM group,so were ALT and AST（P<0.05）.5.According to the reference values of SDBG,PPGE and LAGE,they were divided into normal group and abnormal group.The prevalence of MAFLD in abnormal groups were higher than in normal groups（70.3% vs 51.1%,69.7% vs 52.4%,69.1% vs 43.5%,P<0.05）.6.Multivariate logistic regression analysis showed that course of disease,BMI,total bilirubin,TG,FINS and SDBG were independent influencing factors of T2 DM combined with MAFLD（P<0.05）.Conclusions1.Glycemic variability is closely related to patients with T2 DM combined with MAFLD.Controlling glycemic variability may play a positive role in the prevention and treatment of MAFLD.2.T2 DM patients with MAFLD are more likely to have obesity,Insulin resistance is more serious and the disorder of glucose and lipid metabolism is more obvious,suggesting that health management has great clinical significance for MAFLD.