| ObjectType2diabetes (T2DM) is a chronic metabolic disease which is mainly characterized by carbohydrates and lipids metabolism disorders, as well as all sorts of acute and chronic complications.People paid close attention to glycosylated haemoglobin.A1C (HbA1c which was considered as gold standard for the treatment of high blood glucose) for a long time, however, it is unreasonable to contribute all the reasons of complications of T2DM to high level of HbAlc. nowdays people began to gradually attach more importance to glucose fluctuation in addition to HbA1c.Our research included two main parts:1.considering newly diagnosed type2diabetic patients with relatively ideal blood glucose level as the main subjects, explored influence of glucose fluctuation on FMD of arteriae brachialis and C reaction protein in newly diagnosed type2diabetic patients by comparing the divergences of FMD and the divergences of CRP between the two groups which respectively contained patients of two different degrees of glucose fluctuation-level.2. considering type2diabetic patients with Coronary Heart Disease (CHD) as the main subjects, explored Changes of blood glucose fluctuation and Correlation between Blood Glucose fluctuation and FMD of arteriae brachialis for them by comparing with type2diabetic patients without CHD who were matched in common clinical datas, such as HbA1c, duration of Type2Diabetes Mellitus to T2DM patients with CHD. We analysed influence and michanism of blood glucose fluctuation on vascular pathological changes of type2diabetic patients through the reaserch so it might provide theoretical evidences for the treatment of high blood glucose and the protection of type2diabetic patients’s blood vessel.Methods1.2.patients with type2diabetes who were diagnosed CHD by Coronary angiography detection recently in Internal Medicine-cardiovascular Department2were chosen to be the study subjects of group-T2DM2, then chose T2DM patients who were matched with subjects of group T2DM1in duration of T2DM and HbA1c without CHD (be exclusive CHD by Coronary angiography detection) to be subjects of group-T2DM1. Meanwhile, chose10Health check-persons of our hospital who met the following conditions:diagnosed as normal glucose tolerance(by standard ADA2003) by Oral Glucose Tolerance Test,be in a normal range for other metabolic index,be At the age of50-70. these10persons formed the NC group.All research subjects accepted FMD-detection of arteriae brachialis and a CGMS detection. Analysed the changes of glucose variability of group-T2DM2compared to group-T2DM1and group-NC, to explore the effects of glycemic fluctuation on FMD in group T2DM2.Detection of arteriae brachialis-FMD were done for all the subjects by high-resolution ultrasound (Prosound a10, ALOKA,JAPNESE) in the condition of ET technology in Ultrasonography Department of our hospital. The glycemic excursion parameters were obtained by the detection of a continuous glucose monitoring system (CGMS, Medtronic MiniMed Company). Detect serum biochemical index, Fasting insulin(FINS), Fasting blood glucose (FBG), glycosylated haemoglobin.A1C(HbAlc), C reaction protoen (CRP),and so on..Recorded the height (cm), weight (Kg),blood pressure (mmHg) of all the subjects.Homeostasis model HOMA-IR was used to estimate insulin resistance:HOMA-IR=FINS(uIU/mL)×FPG(mmol/L)/22.5. BMI(Kg/m2)=weight (Kg)/height (m)2.All datas were mean±standard deviation (X±s) that were analysed with software SPSS16.0. Comparisions between groups using independent-samples T-test, Comparisions among three groups using One Way-ANOVA, non-normally distributed variables (such as HOMA-IR) can be analysed after log-transformed. Pearson correlation was used for single factor correlation analysis. Multiple factors correlation analysis using multiple stepwise liner regression analysis.Result1. Comparison of Clinical data, FMD, CRP and CGMS parameters among the three groups Compared with NC-group, there were no significantly difference in age, Sex ratio,DBP(P>0.05), there were no significantly difference in TG between group-NC and group-T2DMl,but there was significantly higher level in group-T2DM2; There are significantly higher levels of HbA1c, FPG, HOMA-IR, LDL-C, HDL-C, SBP, CRP, MAGE, LAGE, MODD, MPPGE,IAUC70in group-T2DM2and group-T2DM1compared to group-NC, and lower levels of FMD in group-T2DM2and group-T2DM1compared to group-NC (P﹤0.05); there were no significantly difference in age, Sex ratio,DBP, HbA1c, FPG, HOMA-IR, TG, LDL-C, HDL-C, SBP between group-T2DM2and group-T2DM1(P>0.05), There were significantly higher levels of mean amplitude of CRP,glycemic excursions (MAGE), largest amplitude of glycemic excursions (LAGE), mean postprandial glucose excursion(MPPGE),and absolute means of daily differences (MODD), incremental area under the curve (IAUC70) below3.9mmol/L and lower levels of FMD in group-T2DM2compared to group-T2DM1(P﹤0.05)2.Correlation analysis in group-T2DM2Pearson correlation indicated as follow:(1).FMD are remarkblely negatively correlated with MAGE, LAGE, MPPGE, MODD, IAUC70, HOMA-IR, Duration of T2DM, HbA1c, TG, SBP, CRP (r=-0.520, r=-0.378, r=-0.367, r=-0.389, r=-0.344, r=-0.453, r=-0.367, r=-0.406, r=-0.403,r=-0.431, r=-0.776, P<0.05);(2). CRP are remarkblely positively correlated with MAGE,LAGE,MPPGE,MODD,HOMA-IR, Duration of T2DM,TG (r=0.543, r=0.566, r=0.454, r=0.406,, r=0.553, r=0.450, r=0.542, P<0.05);(3). HOMA-IR are remarkblely positively correlated with MAGE,LAGE,MPPGE,MODD (r=0.390, r=0.480, r=0.438, r=0.339, P±0.05);(4). HbAlc was not correlated with CGMS parameters.3.as FMD, CRP taken as the dependent variable respectively, the various relative factors as the independent variables, multiple stepwise liner regression analysis showed that MAGE, HOMA-IR,SBP were the independent impact factors of FMD; LAGE, was the independent impact factors of CRP. FMD=11.217-0.369MAGE-0.346HOMA-IR-0.447SBP; CRP=3.527+0.566LAGE.Conclusions1. The level of blood glucose fluctuation was enhanced in type2diabetic patients with coronary heart disease.2.Glycemic fluctuation maybe be one the factors tha influenced arteriae brachialis-FMD, and increased level of CRP maybe one of the reasons FMD’s decline caused by glucose fluctuation.3. HOMA-IR and SBP were the independent impact factors of FMD in addition to glucose fluctuation. |
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