Correlation Between Postprandial Blood Glucose Fluctuation And Peripheral Neuropathy In Newly Diagnosed Type 2 Diabetic Patients

Objective: Diabetic peripheral neuropathy(DPN)is one of the main chronic complications of diabetes mellitus.It is the main cause of foot ulcer and non-invasive amputation of lower limbs in diabetic patients,which seriously affects the prognosis of diabetes.At present,there are different reports on DPN prevalence in newly diagnosed diabetic patients.Therefore,this study will analyze the prevalence of DPN in newly diagnosed type 2 diabetic patients in our hospital.In recent years,more and more attention has been paid to the relationship between blood glucose fluctuation and DPN.In this study,the relationship between postprandial blood glucose fluctuation and DPN was observed through oral glucose tolerance test for hospitalized patients with newly diagnosed type 2 diabetes,and take the 2 hours blood glucose increment after glucose loading as indicators of postprandial blood glucose fluctuation.Methods: 262 newly diagnosed patients with type 2 diabetes who were admitted to the second hospital of Hebei Medical University from January 2018 to December 2019 without any treatment were selected.All the selected patients met the diagnostic criteria for diabetes proposed by the World Health Organization(WHO)in 1999.All of them excluded(1)Infection,acute metabolic disorder,heart,liver and kidney dysfunction,malignant tumor,immune rheumatic disease,hormone application,etc.(2)To exclude other causes of neuropathy,such as cervical and lumbar lesions(nerve root compression,spinal stenosis,cervical and lumbar degenerative changes),cerebral infarction,Guillain Barre syndrome,and serious arteriovenous lesions(venous embolism,lymphangitis),etc.(3)It is necessary to identify the neuropathy caused by neurotoxic effects of drugs,especially chemotherapy drugs.Systolic blood pressure(SBP),diastolic blood pressure(DBP),height and weight were measured and body mass index(BMI)was calculated After admission.Blood samples were collected to measure Hb A1 c,TC,TG,HDL,LDL,UA,Cr,FPG,2h PG,CGP,and calculate the difference between 2h PG and FPG.After admission,the subjects were collected for medical history,physical examination,electromyography and nerve conduction velocity,and according to the diagnostic criteria of diabetic peripheral neuropathy,the patients were judged to have DPN,and all the subjects were divided into the group of diabetic with peripheral neuropathy(DPN group)and the group of non diabetic with peripheral neuropathy(NDPN group).Compare the difference between the two groups in the level of 2h PG and 2h PG-FPG;Divide 2h PG-FPG into A,B,C and D groups according to the quartile,and compare the prevalence of DPN under different postprandial blood glucose fluctuation;and to explore the correlation between postprandial blood glucose fluctuation and glycosylated hemoglobin.Result:1.Among 262 newly diagnosed type 2 diabetic hospitalized patients,151 had DPN,so the prevalence of DPN was 57.6%.2.First,the DPN group and NDPN group were analyzed by single factor analysis.The results showed that the 2h PG and 2h PG-FPG in DPN group were significantly higher than those in NDPN group(P < 0.05).There was no significant difference in Hb Alc,BMI,SBP,DBP,TC,TG,HDL,LDL,UA,Cr,FBG and fasting C peptide between the two groups(P > 0.05).3.The significant variables 2h PG and 2h PG-FPG in univariate analysis were used as independent variables and the presence or absence of neuropathy as dependent variables to construct binary logistic regression.The results showed that 2h PG and 2h PG-FPG were positively correlated with DPN,and the values of their OR were 2.568 and 1.621 respectively.It is proved that 2h PG and 2h PG-FPG were independent risk factors of DPN.4.The prevalence of DPN in group A,B,C and D was compared.The results showed that with the increase of 2h PG-FPG,the prevalence of DPN increased,which was statistically significant.5.The Hb Alc of group A,B,C and D were compared.The results showed that there was difference between group D and group A,but there was no correlation between 2h PG-FPG and Hb Alc.Conclusion:1.The prevalence of DPN in newly diagnosed type 2 diabetic patients was 57.6% in our hospital.2.Postprandial blood glucose fluctuation represented by 2 hours blood glucose increment after glucose loading is the risk factor of DPN in type 2 diabetic patients,and the greater the amplitude of postprandial blood glucose fluctuation,the higher the prevalence of DPN.3.Hb Alc and postprandial blood glucose fluctuation reflect different aspects of blood glucose control,Hb Alc mainly reflects average blood glucose,and postprandial blood glucose fluctuation mainly reflects blood glucose variability.