The Impact Of Blood Glucose Fluctuations On The Degree Of Carotid Atherosclerosis In Type 2 Diabetes And The Effects Of Short-term Insulin Pump Intensive Intervention Study

Objective:In this study mainly through the observation of blood glucose concentration fluctuation, myeloperoxidase(MPO),8-hydroxydeoxyguanosine(8-OHd G) and intimamedia thickness score(IMT score) of type 2 diabetes mellitus(T2DM)with carotid artery porridge sclerosis(CAS) patients, investigate the relationship between blood glucose wave and the degree of carotid atherosclerosis as well as probable machanism, then observe the effect of insulin pump treatment on the blood glucose fluctuation,oxidative stress and inflammation level.Methods:The carotid intima-media thickness(CIMT) of 41 patients with T2 DM was detected by high frequency of color ultrasonic Doppler,from Beijing Military General Hospital of Endocrinology.The patients were divided into T2DM(T2DM,n=18,CIMT<1.0cm) and T2 DM consolidated CAS(DMCAS,n=23,CIMT≥1.0cm) according to CIMT=1.0cm of cut-off point.While choose15 cases of normal healthy people from our physical examination center as our normal control rule(NC),which are matched age and sex and not be diagnosed diabetes through oral glucose tolerance test(OGTT). We recorded the clinical data and detected serological indicator. The patients of T2 DM and DMCAS groups wore the continuous glucose monitoring system(CGMS) in the first 3 days after admission and the last three days of insulin pump short-term intensive treatment, while the NCgroup glucose monitoring and recording blood sugar fluctuation parameter. The patients of T2 DM and DMCAS groups, after the first three days admitted to hospital were given to short-term intensive treatment with insulin pump for 14 days and detect MPO and8-OHd G levels before and after the intervention. Comparison of clinical data, each serum markers, fluctuations in blood sugar levels among the three groups and observation of MPO,8-OHd G and fluctuations in blood glucose levels and changes after the intervention and insulin pumps,analysed the effect of fluctuations in blood glucose on MPO,8-OHd G and IMT score, as well as short-term intensive insulin pump therapy on blood sugar fluctuations, MPO and 8-OHd G levels.Results:1.Before the intervention by insulin pump① NC group,T2 DMgroup,DMCAS group,in the three groups, the differences of age,gender,body mass index(BMI),High-density Lipoprotein cholesterol(HDL-C),Total cholesterol(TC) had no statistical significance(P>0.05); three groups Triglyceride(TG),Low-density Lipoprotein cholesterol(LDL-C),IMT score,systolic pressure(SBP),diasolic pressure(DBP),MPO,8-OHd G in turn increased,the differences was statistically significant(P<0.05);glycosylated hemoglobin A1c(Hb A1c),CIMT among the three groups also showed an increasing trend,but Hb A1 c between T2 DM group and DMCAS group difference was not statistically significant(P>0.05),the difference of CIMT between NC group and DMCAS group was not statistically significant(P>0.05);between T2 DM and DMCAS groups,the course in turn increased, the differences was statistically significant(P<0.05).② NC group,T2 DM group,DMCAS group,mean amplitude of glycemic excursions(MAGE),largest amplitude of glycemic excursions(LAGE),absolute means of daily differences(MODD),mean postprandial glucose excursion(MPPGE) of the three groups in turn increased,the differences were statistically significant(P<0.05);standard deviation of blood glueose(SDBG) also showed a trend of increase among the three groups,but in the NC group there was no statistically significant difference with theT2DM group.③In the DMCAS group, the related analysis between MAGE and the observation index:the course,age,LDL-C,HDL-C,SDBG,LAGE,MODD,MPPGE,MPO,8-OHd G,CIMT,IMT score related to the MAGE(P<0.05).④In the DMCAS group,correlation and analysis of IMT points with the observation index:the course,age,LDL-C,HDL-C,MAGE,SDBG,LAGE,MODD,MPPGE,MPO,8-OHd G,CIMT associated with IMT score(P<0.05);the above indicators as independent variables, IMT score as the dependent variable,the final equation is:IMT score=2.811CIMT+0.431MAGE+0.004MPO-0.576 8-OHd G-2.537.2.After the intervention by insulin pump Comparison of blood glucose fluctuations,MPO,8-OHd G before and after intervention by insulin pump on diabebes patients: After the intervention with insulin pump, blood glucose fluctuations,MPO,8-OHd G were significantly decreased, the differences were statistically significant(P<0.05);after the intervention, compared with the DMCAS group,the variety of blood glucose fluctuations,MPO,8-OHd G were more obvious, the differences were statistically significant(P<0.05).Conclusions:1 The fluctuation of blood glucose was positively related to carotid atherosclerosis in patients with type 2 diabetes mellitus.2 The fluctuation of blood glucose in type 2 diabetic patients was obviously increased, which may aggravate the oxidative stress and inflammation in the body, and may be related to the progress of carotid atherosclerosis.3 The short-term intensive treatment with insulin pump can improve the patients with type 2 diabetes blood sugar fluctuations, reduce oxidative stress and inflammatory response, and diabetes without macrovascular lesions were reduced more significantly,should be early treatment by short-term intensive of insulin pump.