| Background and Purpose:The coefficient of variation(CV),an important indicator of glycemic variability,is closely related to diabetic complications and all-cause mortality.Therefore,it is particularly important to find the factors affecting glycemic variability in type 2 diabetes mellitus(T2DM).Methods:This study included 989 subjects with T2DM undergoing continuous glucose monitoring(CGM)in the Department of Endocrinology,Affiliated Hospital of Yunnan University from January 2017 to October 2022,and 716 subjects were screened to participate in this study.Demographic data and glucolipid metabolic indexes of the subjects were collected;pancreaticβ-cell function was assessed in parallel with the standard bun meal test and the homeostasis model assessment for insulin resistance(HOMA-IR)was calculated.All subjects were divided into two groups according to the CV values of CGM parameters,i.e.,CV<36%:606 cases and CV≥36%:110 cases.SPSS23 software was used to analyze the factors influencing the coefficient of variation of blood glucose in T2DM and further analyze the predictive value of pancreaticβ-cell function on target CV.Results:(1)Compared with the CV<36%group,the CV≥36%group had more diabetic complications(P=0.007);Hb A1c,time above range(TAR),time below range(TBR),standard deviation(SD),mean amplitude glycemic excursion(MAGE),mean of daily differences(MODD),largest amplitude of glycemic excursion(LAGE)and glucose management indicator(GMI)were higher(P<0.05);time in range(TIR)and body mass index(BMI)of glucose target were lower(P<0.05).There were no statistical differences between the two groups in sex,age,disease duration,waist circumference,hip circumference,fasting glucose,total cholesterol,triglycerides,HDL,LDL,aspartate aminotransferase,alanine aminotransferase,serum uric acid,serum creatinine and ACR(P>0.05).(2)Compared with the CV<36%group,the C-peptide values at each time point in the CV≥36%group,the area under the curve of C-peptide in in half an hour(AUC-Cp0.5h),the area under the curve of C-peptide in in 3 hours(AUC-Cp3h)and homeostasis model assessment of pancreaticβ-cell function(HOMA-β)were lower(P<0.05).There was no statistical difference in HOMA-IR between the two groups(P>0.05).(3)Spearman correlation analysis showed that CV was negatively correlated with HOMA-β,AUC-Cp0.5h,AUC-Cp3h,and C-peptide at each time point(Cp0h,Cp0.5h,Cp1h,Cp2h,Cp3h)(rs=-0.177,-0.238,-0.310,-0.178,-0.257,-0.276,-0.314,-0.294;p<0.001)and positively correlated with HOMA-IR(r_s=0.156,P<0.001).(4)Multiple stepwise regression analysis showed that Hb A1c,duration of diabetes,BMI and AUC-Cp3h were independent influences on CV(β=0.8582,0.016,-0.316,-0.120,P<0.05).(5)In the logistic regression model,whether CV was achieved or not was the dependent variable,and HOMA-IR,HOMA-β,AUC-Cp0.5h and AUC-Cp3h were the independent variables,respectively.After correcting for age,diabetic complications,duration of diabetes,BMI and Hb A1c,AUC-Cp0.5h remained an independent risk factor for the CV≥36%group(OR=0.683,95%CI 0.478-0.976,P=0.036).(6)To assess the predictive value of AUC-Cp0.5h and AUC-Cp3h for CV attainment in individuals with T2DM,a receiver-operating characteristic(ROC)analysis was performed.the AUC-Cp0.5h cut-off value was 0.735 ng/ml(AUC:0.631,95%CI 0.574-0.688,P<0.05).the AUC-Cp3h cut-off value was 13.355 ng/ml(AUC:0.633,95%CI 0.578-0.688,P<0.05).Conclusion:This study demonstrates that glycemic variability defined by the CGM parameter CV is associated with islet beta function in T2DM and that AUC-Cp0.5h is an independent risk factor for the CV≥36%group.individuals with T2DM are more likely to achieve CV when AUC-Cp0.5h is greater than 0.735 ng/ml or AUC-Cp3h is greater than 13.355 ng/ml. |
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