Relationship Between Hemoglobin Glycation Index And Carotid Intima-media Thickness In Patients With Type 2 Diabetes Mellitus

Objective:Hemoglobin glycation index(HGI)is the difference between the observed glycosylated hemoglobin Ale(HbAlc)and the estimated HbAlc according to plasma glucose level.We investigate the relationship between hemoglobin glycation index and carotid intima-media thickness in patients with type 2 diabetes mellitus,in order to provide clinical basis for using HGI to predict macro vascular complications of type 2 diabetes.Methods:A total of 862 patients with type 2 diabetes mellitus who were admitted to the endocrinology department of Clinical Medical College of Yangzhou University from January 2015 to June 2018 were enrolled.A randomized sample of 400 patients from 862 patients with type 2 diabetes mellitus was used to estimate the linear relationship between fasting plasma glucose(FPG)and HbAlc.We obtained a linear regression equation(HbAlc=0.452*FPG(mmol/L)+4.84).The remaining 462 patients with type 2 diabetes were selected as research subjects.We collected basic information of the patients including name,gender,age,duration of diabetes mellitus,weight,height,systolic blood pressure and diastolic blood pressure.The carotid intima-media thickness was measured by a color Doppler ultrasound.Venous blood was collected including HbAlc,fasting plasma glucose,fasting C-peptide,total cholesterol,triglyceride,high density lipoprotein-cholesterol,low density lipoprotein-cholesterol,serum uric acid and white blood cell count.The fasting plasma glucose of 462 patients was substituted into the corresponding linear regression equation to calculate the corresponding estimated HbAlc.HGI is the difference between the observed HbAlc and the estimated HbAlc.Patients were stratified in tertiles according to HGI value(%).They were three groups including low HGI group(L-HGI group),middle HGI group(M-HGI group)and high HGI group(H-HGI group)we compare the differences of baseline information in three groups.Binary logistic regression analysis was used to analyze the independent effects of HGI and other cardiovascular metabolic risk factors on carotid intima-media thickness.The data of this study were analyzed by SPSS 21.0 statistical software.A P value<0.05 indicated that the difference was statistically significant.Results:(1)There were no significant differences in gender,age,duration of diabetes mellitus,body mass index,systolic blood pressure,diastolic blood pressure,fasting plasma glucose,white blood cell count,high density lipoprotein-cholesterol and serum uric acid(P>0.05).(2)There were significant differences in HbAlc,2h postprandial glucose,fasting C-peptide,triglyceride,total cholesterol,low-density lipoprotein-cholesterol,carotid intima-media thickness and the proportion of carotid intima-media thickening(P<0.05).Compared with carotid intima-media thickness(0.73±0.22mm)in L-HGI group,carotid intima-media thickness(0.81±0.22mm)in M-HGI group and carotid intima-media thickness(0.83±0.22mm)in H-HGI group were statistically increased(P<0.05),compared with L-HGI(1.99±0.96 ng/ml),group and M-HGI group(1.87±1.02 ng/ml),the fasting C-peptide of H-HGI group(1.50±0.94ng/ml)was statistically decreased(P<0.05),the level of HbAlc and 2h postprandial glucose were increased in the order of L-HGI group,M-HGI group and H-HGI group and the difference was statistically significant(P<0.05),compared with L-HGI group,the level of carotid intima-media thickness,the proportion of carotid intima-media thickening,HbAlc,2h postprandial glucose,triglyceride,total cholesterol and low density lipoprotein-cholesterol were increased in H-HGI group and the difference was statistically significant(P<0.05).(3)Logistic regression analysis showed that elevated low-density lipoprotein-cholesterol,elevated triglyceride,elevated HGI,increased age and increased serum uric acid were independent risk factors for carotid intima thickening(P<0.05).Conclusions:In patients with type 2 diabetes,compared with low HGI group,the level of carotid intima-media thickness,the proportion of carotid intima-media thickening,HbAlc,2h postprandial glucose,triglyceride,total cholesterol and low density lipoprotein-cholesterol were increased in high HGI group.The independent risk factors of carotid intima-media thickening were low-density lipoprotein-cholesterol,triglyceride,HGI,age and serum uric acid.This study shows that HGI is expected to be one of the predictors of macrovascular complications of type 2 diabetes.