Correlation Between Glycemic Fluctuation And Carotid Artery Plaque In Patients With Type 2 Diabetes Mellitus With Abnormal Carotid Intima-media Thickness

Objective: To investigate the correlation between carotid artery plaque and glycemic fluctuation in patients with type 2 diabetes mellitus(T2DM)with increased carotid intima-media thickness(CIMT).Methods: A total of 810 patients with T2 DM whose CIMT greater than greater or equal0.9 to 1 mm in the First People's Hospital of Hefei were enrolled into this study(521subjects with carotid artery plaque and 289 subjects with carotid artery plaque).The CIMT and carotid artery plaque were measured bilaterally with ultrasonography.The glucose variability was assessed by the standard deviation of blood glucose(SDBG),blood lipid,blood pressure,fasting blood glucose and glycated hemoglobind.Data analysis was performed using two sample t-test,Mann-Whitney U test,Chi-square test,logistic regression.Blood lipids,blood pressure,blood glucose,glycosylated hemoglobin,history of smoking and drinking,course of disease,age,sex,family history,bilateral carotid vascular ultrasound,etc.were recorded.Statistics of atherosclerosis progression were analyzed by univariate analysis.Variables of academic significance were evaluated by binary logistic regression to assess the effect of blood glucose fluctuations on carotid plaque formation in T2 DM patients with increased CIMT.Results: The age in T2 DM with increased CIMT group was significantly higher than T2 DM without increased CIMT group,the level of diastolic blood pressure(DBP)in T2 DM with increased CIMT group was significantly lower than T2 DM without increased CIMT group.The level of the level of systolic blood pressure(SBP),low density lipoprotein-C(LDL-C)and high density lipoprotein-C(HDL-C)in T2 DM with increased CIMT group was significantly higher than T2 DM without increased CIMT group,the illness years and the level of blood glucose variability between the two groups were statistically significant(P=0.000,0.004,0.025,0.027,0.017,0.000,both P<0.05).Logistic regression analysis showed that age,gender,disease duration and SDBG were independent risk factors for plaque formation(the first three OR values are 1.062,1.602,1.609,P<0.05).The OR value of plaque formation in patients with normal blood glucose fluctuations and higher level of blood glucose fluctuation(5mmol/L?SDBG<8mmol/L)was 1.835(95% CI=1.102 to 3.055,P<0.05).Conclusion: SDBG is an independent risk factor with plaque formation in patients with T2 DM whose CIMT are abnormal in addition to conventional risk factors,it involves in the pathogenesis of macrovascular injury.