The Impact Of Glucose Fluctimtion On Neurologic Impairment And The Short-term Prognosis Of Acute Eerchral Infarction In Type2Diabetes Mellitus

ObjectTo explore the mechanism of glucose fluctuation on large vascular lesions andprovide possible clues for clinically rational hypoglycemic and theoretical basis forprotection diabetics large blood vessels, Type2diabetic patients with acute cerebralinfarction were chosen as the main research object，and were compared with acutecerebral infarction in patients without type2diabetes as well as type2diabetes patientswithout acute cerebral infarction which had the general clinical data matching. CGMSsystem were used to explore the levels of blood glucose fluctuations of acute cerebralinfarction and its effection on the neurologic impairment and short-term prognosis.MethodsThe subjects were chosen from neurology and endocrinologist in our hospital andwere divided into4groups: Normal control group (Group D, NG,n=36), acute cerebralinfarction patients without type2diabetes (Group C, NDM-CI,n=54),type2diabeteswithout acute cerebral infarction (Group B,DM-NCI,n=36) and type2diabetes withacute cerebral infarction(Group A,DMCI,n=56). Normal control group were chosenfrom A medical center who were confirmed without diabetes through OGTT trial.Thenational institutes of health stoke scale(NIHSS) and modified Rankin scale(mRs) werecollected in group A and C at the time of0hour,24hour and14days. Continuous glucose monitoring system (CGMS) for72h was applied on all the subjects.The Index such as sE-slectin,fasting blood glucose(FBG), FIns(FINS), hemoglobinA1c (HbA1c), Homocysteine (HCY), C reactive protein (CRP) were calculated.Glycemic excursions were compared between group A, B,C and group D respectively.statistical software SPSS16.0were used to analysis data. Measurement data weredescribed as mean and standard deviation (x±s) or the median and the full range,count data were described as the number of cases, comparison between groups usingsingle factor analysis of variance or non-parametric statistical method, comparing onlytwo groups using LSD test, The multiple linear regression analysis was used to find thekey factors impacting on NIHSS and MAGE. The Logistic analysis was applied toexplore the factors impacting on the short-term prognosis of ACI.Result1. The comparison of generally clinical and biochemical data of each group(1) The clinical characteristics of type2diabetes with acute cerebral infarction(DMCI group) including men’s and women’s gender formation Ratio, average age,medical history, etc. These factors had no statistical difference compared with thecontrol group (P>0.05).Although body mass index (BMI) had no statistical differencecompared with healthy controls, metabolic disorders such as fasting bloodglucose,postprandial blood glucose, hemoglobin A1c, total cholesterol, low densitylipoprotein cholesterol were significantly increased compared with the normal group,(P<0.05), systolic pressure were also statistical increased compared with the normalgroup(P <0.05).(2) When compare with diabetes without cerebral infarction group (DMNCI), andacute cerebral infarction without type2diabetes(group NDMCI), the sex ratio, averageage, medical history, etc of acute cerebral infarction with type2diabetes (DMCI group)had no statistical difference (P <0.05), but the FIns, insulin resistance index, sE-slectin, homocysteine, urinary albumin to creatinine ratio, activated partial thromboplastin time,and c-reactive protein level of DMCI group were significantly higher than the other twogroups, the differences were statistically significant (P <0.05)2. The comparison of glucose fluctuation of each groupThe Mean Amplitude of Glycemic Excursions (MAGE), Standard deviation ofblood glucose (SDBG), absolute means of daily differences (MODD) of type2diabetesmellitus with acute cerebral infarction patients(group DMCI) were higher than thenormal group obviously, and the MAGE level in patients of group DMCI wereincreased significantly than group DMNCI，while the MAGE level of group NDMCIwere increased significantly than the normal group(P <0.01).The comparison ofMAGE, SDBG and MODD among each group were statistically significant(P <0.05).3.Multiple linear regression analysis indicated that MAGE is related with sE-slectin、FBG、CIMT、APTT、CRP、HCY、FIns、HOMA-IR、NIHSS、HbA1c(P <0.05)，while NIHSS is related with MAGE、SDBG、NEGE、MODD、sE-slectin、FBG、CIMT、APTT、CRP、HCY、HOMA-IR、HBA1C(P <0.05).4. The ACI patients were divided into groups according to their MAGE levels of3.9mmo1/l.The proportion of having a history of hypertension,stroke,hyperlipidemiawere higher in ACI patients with larger blood glucose excursions(P <0.01). The level offasting plasma glucose, insulin resistance index,glycosylated hemoglobinAlc,homocysteine were also higher in these patients. Over an average two weeksfollow-up, ACI patients with larger blood glucose excursions had higher mRS score.Differences between the two groups were significant(P <0.05).5. The cohort were divided into two groups: group1included56ACI patients with ahistory of DM, and the rest54patients, defined as group2, then each group werestratified into two subgroups according to their MAGE levels of3.9mmo1/L. ACIpatients having a history of DM with higher mRS scores compared to those with lowerMAGE levels. ACI patients in group2with higher mRS scores compared to those with lower MAGE levels. Differences between the subgroups were significant(P <0.05).6. Multiple regression analysis was made use of to show the impact factors of outcomesof patients with ACl. We found that HBA1C、NIHSS score and MAGE level had theindependent predictive values in the short-term prognosis.Conclusions1. Glucose fluctuation of type2diabetes with the acute cerebral infarction patientsadmitted to hospital early were larger than acute cerebral infarction without diabetespatients and type2diabetes without acute cerebral infarction patients, especially in3days admitted to hospital, while the rendering time were long and the the volatilitywere large,the prognosis were poor.2. Among acute cerebral infarction patients with type2diabetes,the larger glucosefluctuations were,the more serious effect the neurologic impairment was.3. Type2diabetes mellitus with acute cerebral infarction patients had high level ofsE-slectin, c-reactive protein,homocysteine, and insulin resistance, while they werehigher when glucose fluctuations were larger,which indicated that glucosefluctuations were associated with endothelial cell injury, inflammation, insulinresistance, participating in the process of the onset of acute cerebral infarction.