| Background and Objective:The prevalence of Type 2 diatebetes mellitus(T2DM)has gradually increased in recent years,and the morbidity and mortality of complications have also increased.This poses a heavy burden on social and economic development.The risk of developing vascular disease and mortality are increased several times in diabetic patients compared with non-diabetic people.Type 2 diabetes and cardiovascular disease has become an important global public health problem.Therefore,active control of blood glucose and prevention and control of cardiovascular and cerebrovascular complications are particularly important for patients with type 2 diabetes.The study of the relationship between the occurrence of arteriosclerosis and glycemic control in patients with type 2 diabetes is of great significance in the prevention of cardiovascular and cerebrovascular complications.The carotid artery is one of the most important large and medium-sized arteries in the body.The occurrence of atherosclerosis is a window to observe arterial vascular sclerosis,and is considered to be an independent predictor of the risk of vascular events in type 2 diabetes and prognosis.In recent years,several studies have suggested that frequent blood glucose fluctuations have a greater impact on arteriosclerosis in patients with type 2 diabetes than continuous high blood glucose levels.In this study,we used the Continuous Blood Glucose Monitoring System(CGMS)to analyze the characteristics of 24-hour real-time dynamic blood glucose changes in different glycated hemoglobin(HbA1c)type 2 diabetic patients,to investigate the correlation between 24-hour dynamic blood glucose changes,carotid atherosclerosis and HbA1 c levels and the risk factors of carotid atherosclerosis in type 2 diabetes,which provides a basis for better control of blood sugar and prevention of atherosclerosis in patients with type 2 diabetes.Methods:Selected 72 patients with type 2 diabetes from October 2016 to December 2017 in Lanzhou University Second Hospital,include males 42 cases,females 30 cases,according to the diagnosis standards of WHO1999.All patients were asked about history and physical examination,general information was recorded,and biochemical indicators were measured.The Medtronic CGMS system was used to monitor the patient's blood glucose continuously for 72 hours.In the monitoring process,the blood glucose value of the fingertips was entered more than 4 times per day using the Bayer meter as the calibration.The data recorded by reading the Medtronic ipro2 Reacorder was used for analysis and calculation,and the average blood glucose level and related indicators of blood glucose monitoring were obtained.Subjects were divided into 3 groups according to different HbA1 c levels:Group I HbA1 c < 7% 21 cases,low-level group;Group II 7% ? HbA1 c < 10% 35 cases,is the intermediate level group;III group HbA1 c ? 10% 16 cases,high-level group.Match the gender,age,and hypoglycemic regimens of the three groups,compare the three groups of glycated hemoglobin with general data,carotid atherosclerosis,and dynamic blood glucose monitoring indicators,and then multi-factor non-conditional Logistic regression analysis was performed to investigate the risk factors of carotid atherosclerosis in type 2 diabetes patients.Carotid atherosclerosis was diagnosed by carotid intima-media thickness(CIMT),CIMT<1.0mm was defined as no intimal thickening,N=30 cases;CIMT?1.0mm was defined as carotid atherosclerosis,N=42 cases.Compare the blood glucose fluctuations in patients with different levels of carotid stiffness,and the correlation between different CIMTs and dynamic blood glucose monitoring indicators.Result:(1)The analysis of general data of high-level,middle-level,and low-level groups of HbA1 c shows that there is no significant difference in gender composition,age,body mass index,and hypoglycemic regimen between the three groups(P>0.05),explaining that each factor is well distributed among the three groups.While systolic blood pressure,diastolic blood pressure,fasting blood glucose,high-density lipoprotein,and carotid intima-media thickness were significantly different among the three groups(P<0.05).Comparison between groups shows that systolic blood pressure,diastolic blood pressure and fasting blood glucose were higher in high-and high-glycemic hemoglobin groups than in low-level groups.Carotid intima-media thickness is higher in highglycosylated hemoglobin groups than in low-level groups,and high-density Lipoprotein is lower than the low level group.Compared with the middle level group,the fasting blood glucose and carotid intima-media thickness are higher in the high-level group than in the middle-level group.(2)The Comparison among three groups of patients with dynamic blood glucose monitoring indicators shows that,in the low level of glycosylated hemoglobin group,MBG is 6.51±1.51mmol/L,SDBG is 1.46±0.42mmol/L,LAGE is 6.74±1.69mmol/L,the highest blood glucose is 11.05±2.00mmol/L;In the medium-level group,the MBG is 8.43±2.06 mmol/L,the SDBG is 2.01±1.05 mmol/L,the LAGE is 8.37±4.05 mmol/L,and the maximum blood glucose is 13.52±3.81 mmol/L.In the highlevel group,the MBG is 11.69±2.25 mmol/L,the SDBG is 2.34±1.10 mmol/L,the LAGE is 10.53±3.22 mmol/L,and the maximum blood glucose is 16.83±3.26 mmol/L.The results shows that with the increase of HbA1 c,the MBG,LAGE and the highest blood glucose increase in each group(P<0.01),and SDBG also increases with the increase of HbA1c(P<0.05).There is no significant difference in MAGE,the lowest blood glucose,and NGE among the three groups(P>0.05).Comparison between groups shows that the MBG,SDBG,MAGE,and the highest blood glucose levels in the medium-level group are higher than those in the low-level group(P<0.05);The MBG,SDBG,LAGE and the highest blood glucose are higher in the high-level group than in the low-level group(P<0.01).The MBG and the highest blood glucose are higher in the high-level group than in the middle-level group(P<0.01).(3)According to CIMT thickness,all patients are divided into CIMT ?1.0mm group and CIMT<1.0mm group,compare the differences in the indicators of dynamic blood glucose monitoring between the two groups,the MAGE,MBG,SDBG,and LAGE in the CIMT ? 1.0 mm group were greater than those in the CIMT <1.0 mm group,and the differences in MAGE,MBG,SDBG,and LAGE between the two groups were statistically significant(P < 0.01).(4)Correlation analysis shows that,there is a significant positive correlation between HbA1 c and MBG(r=0.811),SDBG(r=0.487),LAGE(r=0.476),and the highest blood glucose(r=0.603)(P<0.01),while The negative correlation between HbA1 c and the lowest blood glucose(r=-0.005)is not statistically significant(P>0.05).The correlation with MAGE(r=0.150)is not statistically significant(P>0.05).There is a positive correlation between gender(r=0.281,P<0.05),years(r=0.567,P<0.01),body mass index(r=0.264,P<0.05),systolic blood pressure(r=0.466,P<0.01),diastole pressure(r=0.348,P<0.01),glycohemoglobin(r=0.539,P<0.01),and low-density lipoprotein(r=0.643,P<0.01),MAGE(r=0.400,P<0.01)?MBG(r=0.661,P<0.01)?SDBG(r=0.580,P<0.01)?LAGE(r=0.570,P<0.01)and Carotid intima-media thickness,while there is a significant negative correlation between CIMT and high-density lipoprotein(r=-0.628,P<0.01).(5)Logistic regression analysis is performed using gender,age,BMI,hypertension,HbA1 c,LDL-C,HDL-C,and MAGE as independent variables,and Carotid intimamedia thickness as a dependent variable.HbA1c(OR: 0.704,95%CI:0.528~0.939),age(OR: 0.748,95%CI:0.612~0.914),MAGE(OR: 0.642,95%CI:0.445~0.928)enter the equation and P<0.05.,which suggests that age,HbA1 c and MAGE are independent risk factors for carotid atherosclerosis in type 2 diabetic patients.Conclusions:(1)HbA1c is closely related to the average blood glucose.With the increase of HbA1 c,the average blood glucose also gradually increases.Therefore,HbA1 c can accurately reflect the average blood glucose control of diabetics throughout the day.However,patients with lower average blood glucose may have large fluctuations in blood glucose.HbA1 c does not correlate with the mean blood glucose fluctuations.It is further explained that HbA1 c reflects the average blood glucose level and does not reflect the instantaneous change of blood glucose and its frequency and amplitude.However,reducing the maximum blood glucose fluctuation during the day reduces HbA1 c.Patients with HbA1 c < 7% need to be alert to the risk of hypoglycemia,and patients with HbA1 c ? 10% need to pay attention to blood glucose fluctuations.(2)Carotid intima-media thickness is positively correlated with HbA1 c in patients with type 2 diabetes,and HbA1 c is an independent risk factor for carotid atherosclerosis.(3)There is a correlation between blood glucose volatility and carotid intima-media thickness in patients with type 2 diabetes.The average blood glucose fluctuations are risk factors for carotid atherosclerosis independent of glycated hemoglobin.(4)HbA1c,blood glucose fluctuations and age are independent risk factors for carotid atherosclerosis in patients with type 2 diabetes,suggesting that blood glucose fluctuations and sustained hyperglycemia work together to participate in the development of arteriosclerosis in patients with type 2 diabetes. |
PDF Full Text Request