Effects Of Different Metabolic Syndrome Components On Diabetic Kidney Disease In Type 2 Diabetes Mellitus

Objective: To investigate the correlation between different components of metabolic syndrome and diabetic kidney disease in type 2 diabetes.Methods: The clinical data of 1583 T2 DM patients hospitalized in the Department of Endocrinology and Metabolism of Dalian Central Hospital from January 1,2012 to January 1,2022 were collected by using the Yidu Cloud retrieval system for a retrospective cohort study.According to fasting glucose,triglyceride,high-density lipoprotein cholesterol,waist circumference,and hypertension at baseline,patients were divided into MS and NMS groups according to the diagnostic criteria for metabolic syndrome.(Since all patients included in this study were diabetic patients,if patients had two or more other components of metabolic syndrome besides blood glucose components,Is thought to have metabolic syndrome).The general data and laboratory test indicators of the two groups were compared,and the prevalence of MS and its components were compared.At baseline,there was no diabetes nephropathy.Follow-up is conducted once a year for 2-10 years to follow up the patients’ DKD prevalence.The incidence of DKD at the follow-up was counted,and the incidence of proteinuria and e GFR decline and simultaneous proteinuria and e GFR decline were compared between the five components and the outcome.Spearman correlation analysis was also performed.SPSS 27.0 was used for statistical analysis.The measurement data conforming to normal distribution were normal distribution,expressed as (?)±s.The non-normal distribution is represented by M(Q25-Q75);Count data rate representation.Independent sample t test was used to compare normal distribution of measurement data,and Mann-Whitney U test was used to compare non-normal distribution of measurement data.Counting data were compared by chi-square test.Cox proportional risk model was used for regression analysis: the starting time was defined as the first admission time,the end time as the last admission time,and the end event was the occurrence of DKD.Cox proportional risk model was used for regression analysis: the starting time was defined as the first admission time,the end time as the last admission time,and the end event was the occurrence of DKD.Firstly,the risk ratio assumption was made,and the single factor Cox regression analysis was performed on the selected risk factors,and then the multi-factor analysis was conducted to determine whether each component of metabolic syndrome was an independent risk factor for DKD.Finally,Kaplan-Meier survival curve was drawn to analyze the relationship between the number of MS components and the occurrence of DKD.P < 0.05 indicates a statistically significant difference.Results:Baseline results:1.Comparison of general clinical features of MS and NMSBaseline data totaled 1583 cases,including 952 males and 631 females.By comparing the general clinical features of MS and NMS,significant differences were found in the distribution of age,sex,body weight,BMI,WC,systolic blood pressure,diastolic blood pressure,FBG,GA,ALT,AST,TG,HDL-C,SUA,SCr,history of high blood,diabetic retinopathy,etc.All the differences were statistically significant(P <0.05).There were no significant differences in the distribution of height,diabetes course,Hb A1 c,Hb,TC,LDL-C,e GFR,smoking history,drinking history,and ACER/ARB consumption(P > 0.05).2.Prevalence of MS and its components in men and womenThere were 844 patients(53.31%)with metabolic syndrome at baseline,and the prevalence of central obesity,low HDL-C,hyper TGemia,hypertension and MS in females was higher than that in males,while the prevalence of hyperglycemia in females was lower than that in males(P<0.01).Follow-up results:1.Comparison of the incidence of proteinuria,decreased e GFR and both of them in different components of MSThe waist circumference of male ≥90cm,female ≥80cm(central obesity)compared with normal waist circumference microalbuminuria(49.1%vs21.8%),e GFR decreased(34.8%vs20.0%),both occurred simultaneously(22.4%vs10.8%),P<0.001;Microalbuminuria(49.6%vs30.0%)and e GFR decreased(35.1%vs24.4%)occurred simultaneously(22.1%vs14.7%)when HDL-C was < 1.03 in male and < 1.29 in female(low HDL-C emia)compared with normal HDL-C,P < 0.001;When TG was greater than 1.7mmol/L(hypertgemia),microalbuminuria(66.9%vs23.7%)and e GFR decreased(42.3%vs22.4%)compared with TG normal occurred simultaneously(27.3%vs13.2%),P < 0.001;Microalbuminuria(52.5%vs30.2%),e GFR decreased(39.8%vs22.7%),and both occurred simultaneously(26.5%vs16.6%)when hypertension was compared with normal blood pressure,P < 0.001;When fasting glucose was elevated,microalbuminuria(45.6%vs22.1%)and e GFR decreased(30.7%vs25.9%)compared with normal fasting glucose occurred simultaneously(20.9%vs10.6%),P < 0.05.2.Comparison of prevalence rates of DKD in different MS groupsThe 986 patients in MS group were divided into 11 groups according to different permutation combinations of MS components,and the overall mean of the 11 groups was statistically significant(P< 0.001).The pairwise comparison of the two components(Q1-Q6)showed that the incidence of Q6 had statistical significance with Q2 and Q3groups(P< 0.001),while the other groups had no statistical significance(P> 0.003).Combination of the three components(Q7-Q10)between two two comparison,Q7 and Q8,Q9 group,incidence of Q8 and Q9,Q10 group was statistically significant(P <0.001),and the rest have no statistical significance(P > 0.008).3.Correlation between different components of metabolic syndrome and endpoint diabetic nephropathyThe Spearman correlation analysis between different components of metabolic syndrome and endpoint diabetic nephropathy events showed that the occurrence of metabolic syndrome and diabetic nephropathy was statistically significant(P < 0.05).Waist circumference(r=0.065,P=0.010),TG(r=0.418,P < 0.001),hypertension(r=0.214,P< 0.001),elevated fasting blood glucose(r=0.262,P < 0.01)were positively correlated with microalbuminuria.Waist circumference(r=0.076,P=0.002),TG(r=0.193,P < 0.001),hypertension(r=0.184,P < 0.001),fasting blood glucose(r =0.072,P = 0.004)were positively correlated with e GFR decline.Waist circumference(r =0.066,P = 0.009),TG(r = 0.162,P < 0.001),hypertension(r = 0.174,P < 0.001),fasting blood glucose(r=0.167,P<0.001)were positively correlated with simultaneous microalbuminuria and e GFR decline.In addition,HDL-C was negatively correlated with microalbuminuria(r=-0.209,P < 0.001),e GFR decrease(r=-0.050,P < 0.01),simultaneous microalbuminuria and e GFR decrease(r=-0.063,P < 0.001).4.COX regression analysis4.1.Cox regression unifactor analysisFirstly,univariate analysis was conducted on factors that may affect the occurrence of DKD,and statistically significant influencing factors were selected(P< 0.05).Analysis showed that age,diabetes course,hypertension,smoking,glycosylated hemoglobin,triglyceride,high density lipoprotein cholesterol,fasting glucose,waist circumference were the factors affecting the occurrence of diabetic nephropathy.All included variables satisfied the Cox proportional risk assumption.4.2.Cox regression multivariate analysisIn the Cox regression univariate analysis,P<0.05 including age,disease course,smoking,hypertension,Hb A1 c,WC,HDL-C,TG and other factors,Cox multivariate analysis showed that systolic blood pressure of MS component was1.006(95%CI:1.002-1.01),HDL-C 0.531(95%CI: 0.91-0.686)and TG 1.061(95%CI :1.021-1.103)were independent influencing factors of diabetic nephropathy.In addition,age was 1.041(95%CI :1.033-1.049),duration of diabetes was1.014(95%CI :1.003-1.025),smoking was 1.179(95%CI :1.019-1.363),and glycosylated hemoglobin was 1.076(95%CI :1.034-1.12),uric acid 1.002(95%CI :1.001-1.003)were independent factors affecting the occurrence of diabetic nephropathy,and the difference was statistically significant(P < 0.05).5.Kaplan-Meier survival curveThe Kaplan-Meier curve was used to calculate the probability of diabetic nephropathy(DKD)for 10 years based on the number of metabolic syndrome(Mets)components.An increased number of MS components was associated with an increased risk of DKD(P<0.001).Conclusions:1.In patients with type 2 diabetes mellitus complicated with metabolic syndrome,MS component systolic blood pressure and TG are independent risk factors affecting the occurrence of DKD,while HDL-C is independent protective factor affecting the occurrence of DKD.2.TG is the primary component affecting DKD in MS,followed by systolic blood pressure.3.According to the K-M survival curve,the risk of DKD increased with the increase of the number of MS components.