Study On TCM Syndoromes Of Blood Glucose Fluctuation In Diabetic

Objective: Through multi-center clinical epidemiological investigation and research,systematically explore the types and distribution of TCM syndromes of diabetes blood glucose fluctuations,establish the distribution of their main syndromes,and provide a reference for better guiding TCM interventions for patients with blood glucose fluctuations in the future.The main detection indicators of the various syndromes of blood glucose fluctuation are compared and the correlation between each syndrome and related indicators is explored,so as to provide a possible objective reference basis for the preliminary judgment of each syndrome.Methods: From July 2020 to March 2021,patients were selected to attend the outpatient and ward of the Endocrinology Department of the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin Nankai District Traditional Chinese Medicine Hospital,Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital,Tianjin Beichen District Traditional Chinese Medicine Hospital,Tianjin Huanghe Hospital,Tianjin University of Traditional Chinese Medicine Second Affiliated Hospital,309 patients with diabetes blood glucose fluctuations who met the inclusion and exclusion criteria.All the enrolled patients were monitored for blood glucose at 7 points for 3 consecutive days without changing the hypoglycemic regimen,diet and exercise(before breakfast,lunch and dinner,2 hours after meals and 22:00 before bedtime)Blood glucose),calculate the average blood glucose fluctuation range(MAGE)based on the measured value.Fill in the "Clinical Questionnaire for Blood Sugar Fluctuations in TCM Syndrome" developed by the research group for all subjects.The collected content includes general information(demographic data,medical history,family history,exercise,life and eating habits,etc.),and information on four Chinese medicine consultations.(Hair,face,facial features,body,skin,urine and urine,etc.,pulmonary symptoms,spleen symptoms,liver symptoms,heart and brain symptoms,kidney symptoms,physical and other symptoms,tongue and pulse including pale tongue,red tongue,White fur,yellow fur,pulse string,pulse string,etc.),clinical related physical and chemical indicators(Hb A1 c,MAGE)and the results of OGTT and insulin excitability test collected from 60 insulin patients,and the insulin secretion index calculated by the steady-state model(HOMA-β),insulin resistance index(HOMA-IR),area under the C peptide curve(AUCC peptide).All data is entered by a dedicated person,an Excel database is established,and finally the data is created as an SPSS database.Perform univariate analysis of the four-diagnosis information,calculate the frequency of occurrence of each item,and directly include symptom items with a frequency of more than 10% into the next analysis.For items with a frequency of less than 10%,seek advice from TCM experts or subject persons Opinions are selected.The method of exploratory factor and cluster analysis is used,and the regression method is used to calculate the score of each case in the factor.Using the inter-group connection method,using Pearson correlation as the metric,the "rotating component matrix" was used for systematic clustering analysis.According to the results of factor analysis and clustering,combined with clinical knowledge,refer to the "Chinese Medicine Clinical Diagnosis and Treatment Terminology Part II: Syndrome" revised for the first time by the National Health Commission and the State Administration of Traditional Chinese Medicine in 2020,standardize the names of the syndromes,and establish blood glucose fluctuations Common TCM syndromes.According to the factor score,take the maximum value to establish the syndrome distribution.Analyze the influencing factors of patients with blood glucose fluctuations and compare the various TCM syndrome types of blood glucose fluctuations with clinical related indicators to provide a basis for TCM to prevent and treat blood glucose fluctuations.Results:(1)TCM syndrome analysis:(1)Based on the statistical results of factor analysis and cluster analysis,combined with experts and clinical theories,the name and distribution of the preliminary TCM syndromes of blood glucose fluctuations were determined as follows:Kidney Qi Deficiency Syndrome 56 Cases(accounting for 18.12%),113 cases(36.57%)with deficiency of both qi and yin,94 cases(30.42%)with deficiency of both heart and spleen,46cases(14.89%)with deficiency of both yin and yang;(2)Analyze general data between different syndrome types Differences in age,course of disease,BMI,Hb A1 c,and MAGE among the four groups were not different(P>0.05),and there were differences between genders(P<0.05);(2)Influencing factors of blood glucose fluctuation range:(1)Gender,age,The course of the disease,Hb A1 c and the average blood glucose fluctuation range are not related(P>0.05),BMI is related to MAGE(P<0.05).According to Kruskal-Wallis one-way ANOVA test analysis,as the BMI decreases,the MAGE value increases;(2)Islet function :HOMA-β is not correlated with MAGE(P>0.05),HOMA-IR is negatively correlated with MAGE(P<0.05),and AUCC peptide is negatively correlated with MAGE(P<0.05).Conclusion:(1)Most of the patients with blood glucose fluctuations mainly have the "deficiency of both qi and yin".In the middle and late stages,they can progress to the syndrome of deficiency of both heart and spleen,deficiency of kidney qi,and deficiency of both yin and yang.In combination,the results obtained are basically consistent with the clinical pathogenesis.This "preliminary exploratory study on common TCM syndromes of blood glucose fluctuations" provides a methodological reference for the further standardized research of this disease;(2)There are no statistically significant fluctuations in age,course of disease,body mass index,glycosylated hemoglobin,and average blood glucose among various syndrome types,and gender is statistically significant;(3)The four types of TCM syndromes have a certain correlation with related indicators.The deficiency of both the heart and the spleen may be associated with high levels of glycosylated hemoglobin.There is a clear correlation between the deficiency of kidney qi and males;in qi and yin In the two-deficiency syndrome and yin-yang deficiency syndrome,gender,age,course of disease,BMI,and Hb A1 c are not the influencing factors;(4)Age,course of disease,and glycosylated hemoglobin are not factors that affect the average blood glucose fluctuation range;(5)Body mass index is an influencing factor of the average blood glucose fluctuation range,and it is negatively correlated,that is,as the body mass index decreases,the average blood glucose fluctuation range is greater;(6)Pancreatic islet function is negatively correlated with blood glucose fluctuations,and patients with poorer islet function have greater average blood glucose fluctuations.