Correlation Analysis Of Time In Range And Plasma Arteriosclerosis Index In Type 2 Diabetes Mellitus

Research Background:Diabetes mellitus(DM)and Coronary artery disease(CAD)are both chronic metabolic diseases with high incidence,and their incidence has been on the rise recently,constituting a major public health burden.Diabetes mellitus(DM)can cause vascular diseases,especially coronary artery disease(CAD),which is a recognized risk factor for coronary artery disease.It is well known that people with diabetes have a two-to four-fold increase in death or morbidity from cardiovascular disease compared with the general population.The prevalence of diabetes is increasing worldwide,90 per cent of which is Type 2diabetes mellitus(T2DM),and the International Diabetes Federation(IDF)estimates that 536.6 million people were living with diabetes in 2021,and that number is expected to increase by 46 percent to 783.2million by 2045.Recent studies have found that intermittent exposure to high glucose is more likely to aggravate the course of cardiovascular complications of diabetes than continuous exposure to high glucose.Moreover,blood glucose fluctuations may have a serious impact on the occurrence and development of various chronic complications of diabetes through multiple ways.Glycosylated hemoglobin Hb A1 c may not fully reflect the significant fluctuation of blood glucose.Two important results from the data from the Time within the target range of glucose CGMS are glucose variability GV and Time in range TIR).GV is a common name for several measures of blood glucose fluctuation,which refers to the difference between peak and trough of blood glucose in a certain period of time,and is becoming an important dynamic parameter in diabetes control.TIR refers to the amount of time(usually expressed in minutes)or percentage of glucose within the target range(usually 3.9-10.0mmol/L)within 24 hours.TIR is incorporated into the blood glucose control target,which means raising the level of "blood glucose control compliance" to a new level of quantitative management of "stable blood glucose control compliance".Diabetic patients are prone to vascular complications,and interventions to control lipid levels have been shown to be particularly helpful in preventing coronary heart disease.Therefore,individual lipid risk factors have been recognized as valuable tools for predicting cardiovascular risk.There is considerable evidence that the atherogenic index of plasma AIP is a stronger predictor of the risk of atherosclerosis and coronary heart disease than other atherosclerotic indicators or lipoprotein cholesterol concentration alone.However,the key mechanism of atherosclerosis in patients with diabetes has not been clearly defined so far,and glucose variation may play a key role in the pathogenesis of atherosclerosis,with an additional risk of diabetes-related complications unrelated to Hb A1 c levels.Objective:To investigate the correlation between Time in range(TIR)and plasma arteriosclerosis index(AIP)in patients with type 2 diabetes mellitus(T2DM)and its influence on AIP.It provides a new breakthrough point and idea for the prevention of clinical complications such as atherosclerotic vascular complications of diabetes mellitus.Methods:1.A total of 265 T2 DM patients who were admitted to the department of Endocrinology in a hospital from January 2018 to September 2020 and wore Abbott Flash Glucose monitoring(FGM)were selected as subjects.2.Collect clinical data: Basic information of research subjects was collected,and the patient’s name,gender,age,diabetes course,height,weight and body mass index(BMI)were recorded.BMI),Hb A1 c,serum albumin(Alb),glutamic-pyruvic transaminase,glutamic-oxalacetic transaminase,TC,TG,LDL,HDL,creatinine,urea,uric acid(SUA),etc.AIP was calculated using the formula AIP=log(TG/HDL-C),and the results of cervical ultrasound were collected.Carotid intima-media thickness(IMT)in color Doppler ultrasound was used to determine the vascular condition.Normal carotid intima thickness was defined as IMT < 1mm,intima thickening was defined as IMT between 1-1.5mm,and atheromatous plaque formation was defined as IMT≥1.5mm.The main manifestations of atherosclerosis detected by ultrasound are: intima thickening and atherosclerotic plaque formation,so the latter two manifestations can be collectively referred to as carotid atherosclerosis.3.Grouping method: Blood sugar is obtained by FGM data and map,use blood sugar data calculated further Time in range(TIR)standard deviation(SDBG),blood glucose level,the average blood glucose fluctuation(MAGE)and the maximum blood sugar fluctuation(LAGE),etc.,the higher the TIR suggests that situation,the better blood sugar control,studies have shown that in adults,The 65-70% TIR obtained by CGM was roughly the same as the average blood glucose level reflected by an Hb A1 c of 53mmol/mol(7.0%).Therefore,for most patients with type 1 or 2 diabetes,TIR>70% was the recommended target,so we divided the groups with the threshold of 70% of TIR.A total of 176 patients,including 130 males and 46 females,were included in the blood glucose control standard group(group A)with TIR >70%;A total of 89 patients,including 66 males and 23 females,were included in the blood glucose control standard group(Group B)with TIR≤70%.Results:1.The results showed that Hb A1 c,SDBG,MAGE,CV,LAGE,TC,TG,LDL and AIP in group B were higher than those in group A(P < 0.05).TIR and HDL in group B were lower than those in group A(P<0.05).There were differences in carotid artery thickness between group A and B,with A higher proportion of normal carotid intima in group A and A higher proportion of carotid atherosclerosis in group B,with statistical significance(P < 0.001).2.Pearson correlation analysis showed that: TIR was negatively correlated with TC,TG,LDL,AIP,Hb A1 c,SDBG,LAGE,MAGE and CV levels(r:-0.198,-0.206,-0.179,-0.320,-0.859,-0.805,-0.700,-0.695,-0.475,P < 0.05),was positively correlated with HDL(r = 0.246,P < 0.05).3.Multiple linear regression analysis showed that TIR was linearly correlated with course of disease,BMI,HDL and AIP.Conclusion:1.TIR in patients with T2 DM can increase abnormal blood lipid levels and may lead to carotid atherosclerosis.2.Blood glucose fluctuation indicators in T2 DM patients are correlated with AIP.The smaller TIR is,the greater the blood glucose fluctuation is,and the higher AIP may increase the risk of diabetes with vascular complications.