Effects Of Glucose Variability On Diabetic Vasular Disease

Part 1 Effects of glucose variability on diabetic nephropathyObjective:To investigate the effects of blood glucose fluctuations on occurrence and development of diabetic nephropathy in patients with type 2 diabetes.Methods:A total of 84 individuals with type 2 diabetes were selected and divided into three groups by the level of 24h-urinary albumin excretion (normoalbuminuria,24h-UAE<30mg; microalbuminuria,30mg<24h-UAE<300mg; macro-albuminuria, 24h-UAE>300mg).The clinical data of these people, such as gender, age, course of disease, hemoglobin Ale, blood pressure (BP), blood lipid and body mass index (BMI),INS,C-peptide have no statistical difference.Self-monitoring of blood glucose (SMBG) was used to obtain fasting plasma glucose (FPG),2-hour postprandial plasma glucose (2hPPG) for 24 weeks and standard deviation of blood glucose (SDBG) were calculated.Results:No statistical difference of FPG or PPG were found among the three groups (p>0.05),but the SDBG of FPG were 1.21±0.56, 1.37±0.59 and 1.78±0.78 mmol/L, respectively in patients with normoalbuminuria, microalbuminuria and macroalbuminuria, and SDBG of 2hPPG were 1.60±0.58,1.61±0.84,and 3.15±0.68 mmol/L, respectively in patients with normoalbuminuria, microalbuminuria and macroalbuminuria. The SDBG between normoalbuminuria and microalbuminuria have no statistical difference (p>0.05),and SDBG in people with macroalbuminuria were higher than those with normoalbuminuria and microalbuminuria (p<0.001).It was indicated by correlation analysis that correlation coefficient between 24h-UAE and TC, SBP, DBP, FPG,2hPPG (breakfast),2hPPG(lunch),2hPPG(dinner), SDBG of FPG, SDBG of 2hPPG was 0.343,0.243,0.219,0.251,0.305, 0.252,0.313,0.537,0.732, respectively(p<0.05).The correlation coefficient between 24h-UAE and gender, age, history, BMI,HbAlc, TG, FINS,2hFINS,C-peptide,2hC-peptide was-0.085,0.195,0.048,-0.049,-0.005,0.099,0.136,-0.022,-0.004,0.112, respectively(p>0.05).With stepwise multivariate linear regression analysis, SDBG of 2hPPG, DBP and SDBG of FPG were identified as significant and independent risk factors for 24h-UAE (the value of p was 0.618,0.171,0.183, respectively).Conclusion:These findings initially suggested that blood glucose variability may increase the progression of diabetic nephropathy. Part 2 Relationship between glucose variability and Intima-Media Thickness of Carotid Artery in Type 2 Diabetic PatientsObjective:To investigate the relationship between blood glucose fluctuations and carotid intima media thickness (IMT) in type 2 diabetic patients.Methods:IMT of both sides carotid artery were measured by B-mode ultrasonography in type 2 diabetic patients,divided into two groups by the IMT(group A, IMT< 0.9 mm, and group B, IMT>0.9 mm).A total of 98 individuals with type 2 diabetes were selected, among which the clinical data such as gender, age, course of disease, smoking history, hemoglobin Alc, blood pressure (SBP and DBP), blood lipid and body mass index (BMI),INS,C-peptide,cholesterol (TC),triglycerides (TG), HDL-C,LDL-C have no statistical difference. Self-monitoring of blood glucose (SMBG) was used to obtain fasting plasma glucose (FPG), 2-hour postprandial plasma glucose (2hPPG) for 24 weeks and standard deviation of blood glucose (SDBG) were calculated.Results:No statistical difference of FPG were found between the two groups (p>0.05),but the PPG, SDBG of FPG and SDBG of PPG of patients in group B were higher than those in group A (p<0.05).It was indicated by correlation analysis that correlation coefficient between IMT and age, TC, TG, SBP, DBP, FPG,2hPPG (breakfast),2hPPG(lunch), 2hPPG(dinner), SDBG of FPG, SDBG of 2hPPG was 0.229,0.211,0.229, 0.227,0.236,0.219,0.245,0.343,0.245,0.503,0.786, respectively(p <0.05).The correlation coefficient between IMT and gender, history, BMI, HbA1c, HDL, LDL,FINS,2hFINS, C-peptide,2hC-peptide was-0.100,0.188,0.073,0.029,-0.183,0.197,-0.006,-0.039,-0.087,0.004, respectively(p>0.05). After adjustment of age, gender, history, BMI, HbAlc, the correlation coefficient between IMT andTC, TG, SBP, FPG, 2hPPG (breakfast),2hPPG(lunch),2hPPG(dinner), SDBG of FPG, SDBG of 2hPPG was 0.222,0.217,0.221,0.206,0.234,0.325,0.259, 0.489,0.764, respectively(p<0.05).,the correlation coefficient between IMT and DBP was 0.198(p>0.05).With stepwise multivariate linear regression analysis, SDBG of 2hPPG and TC were identified as significant and independent risk factors for IMT (the value ofβwas 0.773, 0.137, respectively).Conclusion:These findings suggested that blood glucose variability, especially SDBG of 2hPPG has a strong association with IMT of carotid rteries, and might be important predictor for early atherosclerosis in T2DM patients.