Study On The Relationship Between Diabetic Microangiopathy And Blood Glucose Fluctuation In Type 2 Diabetes Mellitus Patients And Its Influencing Factors

Objective: The purpose of this study was to investigate the relationship between blood glucose fluctuation and the time in range of blood glucose control(TIR: the time proportion of blood glucose control within3.9-7.8mmmol/l within 24h)with nonproliferative diabetic retinopathy(NPDR),diabetes kidney disease(DKD)and diabetic microangiopathy(DMAP)in type 2 diabetic patients,at the same time,tried to elucidate the risk factors of NPDR,DKD and DMAP.Methods: 122 patients with type 2 diabetes were enrolled in Endocrinology Department of Shaanxi Province People's Hospital from June 2017 to December 2018.All subjects were installed the dynamic blood sugar monitoring ipro-2 retrospectively.Basic data,biochemical indexes and dynamic blood glucose monitoring parameters(the largest amplitude of glycemic excursions(LAGE),standard deviation of blood glucose(SDBG),mean blood glucose(MBG),glycemic variability(GV),the total number of fluctuations in blood sugar(NGE),ATIR)of all patients were collected.According to the results of fundus examination,the patients were divided into NPDR group and retinopathy free group(NDR).According to the results of urinary microalbumin creatinine ratio(UACR),the patients were divided into DKD group and non-diabetes kidney disease group(NDKD).The patient of DMAP group was combined with NPDR and DKD,and the case control group.was combined with no retinopathy and no nephropathy.Independent sample t-test,chi-square test,rank sum test,Spearman correlation analysis,binary logistic regression analysis,ROC curve and other methods were used for data analysis.P<0.05 was considered statistically significant.Results:1.The course of disease,SBP,HDL-C,LAGE,MBG,SDBG,GV an d TIR of NPDR group were statistically different from that of NDR group(all P<0.05).Patients with NPDR had longer course,higher MBG,larger SDBG and lo-wer TIR(all P<0.05).The results of binary logistic regression analysis showed that MBG(OR=4.493,95%CI:1.253~16.112,P=0.021)was the independent risk fac-tor of NPDR,and HDL-C(OR=0.180,95%CI:0.057~0.564,P=0.003)was the ind-ependent protective factor of NPDR.The results of ROC curve showed that the AUC of MBG was 0.678(95%CI:0.583~0.774,P=0.001),and the AUC of HDL-C was 0.373(95%CI:0.272~0.473,P=0.016).2.Compared with NDK group,SBP,DBP,TC,HDL-C,LDL-C,blood ?2-M G,urine ?2-MG,urine albumin,urine ?1-MG were statistically different in DKD group(all P<0.05),while LAGE,MBG,SDBG,GV,NGE,TIR were not statistically different(all P>0.05).The results of binary Logistic regression analysis showed that blood ?2-MG(OR=3.427,95%CI:1.181~9.945,P=0.023),urine ?2-MG(OR=4.768,95%CI:1.367~16.622,P=0.014)and urine ?1-MG(OR=2.813,95%CI:1.127~7.025,P=0.016)were independent risk factors for DKD.Spearman correlation anal-ysis showed that blood ?2-MG,urine ?2-MG and urine ?1-MG were positively co-rrelated with UACR.The ROC curve showed that the AUC of UACR was 0.814(95%CI:0.731~0.897,P=0.001),blood ?2-MG was 0.684(95%CI:0.585~0.782,P<0.001),urine ?2-MG was 0.741(95%CI:0.652~0.830,P<0.001),and urine ?1-MG w-as 0.755(95%CI:0.668~0.841,P<0.001).In other words,blood ?2-MG has a low predictive value for DKD diagnosis,while UACR,urine ?2-MG and urine ?1-MG have a good predictive value for DKD diagnosis.Meanwhile,UACR>urine ?1-MG>urine ?2-MG.3.The course,SBP,DBP,HDL-C,LDL-C,blood ?2-MG,urine ?2-MG,urine albumin,urine ?1-MG,LAGE,MBG,SDBG,GV,TIR were statistically different in the DMAP group compared with the case control group(all P<0.05).Binary lo-gistic regression showed that SDBG(OR=8.337,95%CI:1.184~58.692),urine ?2-M G(OR=8.337,95%CI:1.184~58.692)and urine ?1-MG(OR=4.481,95%CI:1.218~16.485)were independent risk factors for DMAP(all P<0.05).Conclusion:1.With the increase of MBG level,the risk of NPDR increases.2.UACR was positively correlated with blood ?2-MG.The risk of DKD increases with increased blood,urine ?2-MG,and urine ?1-MG.UACR,urine ?2-MG,and urine ?1-MG have positive value for diagnostic prediction of DKD,and its sorting was UACR,urine ?1-MG,urine ?2-MG.Clinical detection of blood ?2-MG,urine ?2-MG,urine ?1-MG and UACR can be combined to improve the accuracy of early DKD diagnosis.3.The risk of DMAP increases with the increase of SDBG,urinary ?2-MG,and urinary ?1-MG.