Study On The Relationship Between 25-(OH) Vitd Level And LEAD In T2DM Patients With Different Nutritional Status, HbAlc Level

Objective: Based on the analysis of various biomedical data of 200 type 2 diabetes mellitus(T2DM)patients with different nutritional status and glycated hemoglobin levels in Shihezi,Xinjiang,address the correlation of lower extremity atherosclerotic disease(LEAD)and the level of 25-hydroxyvitamin D[25-(OH)VitD] level.This study is aiming to provide theoretical basis for researches about the feasibility of vitamin D supplementation to prevent LEAD in T2 DM patient groups.Methods: 200 cases of T2 DM patients who hospitalized in division of metabolism & endocrinology in First Affiliated Hospital,School of Medicine,Shihezi University from 2017 to 2019 were selected.On top of this,according to the results of their ankle brachial index and CONUT score,all the patients were divided into four groups,and each group contain 50 patients.Those groups are: 1)Normal nutritional status,non-lower extremity atherosclerotic disease(NLEAD).2)Malnutrition and NLEAD.3)Normal nutritional status and LEAD.4)Malnutrition and LEAD.25-(OH)VitD level and other laboratory biomedical indicators’ levels were compared among groups.Those patients were then divided into four groups based on HbA1 c level: 1)Normal blood sugar control,NLEAD,56 patients.2)Poor blood sugar control and NLEAD,44 patients.3)Normal blood sugar control,LEAD,45 patients.4)Poor blood sugar control,LEAD,55 patients.25-(OH)VitD level was compared among the four groups.All data were statistically analyzed using SPSS23.0 software,P<0.05 was considered statistically significant.Results: 1.1)Among the four groups of different nutritional status and LEAD status,normal nutritional status +LEAD group has higher level of systolic blood pressure(SBP),total cholesterol(TC),Cystatin C(CysC),low density lipoprotein cholesterol(LDL-C)and fructosamine compare to normal nutritional status+NLEAD group(P<0.05).Malnutrition+LEAD group has lower level of high-density lipoprotein cholesterol(HDL-C)and total lymphocyte count,but higher CysC level compare to malnutrition+NLEAD group(P<0.05).Compare with normal nutritional status+NLEAD group,malnutrition+NLEAD group has higher level of fasting C-peptide and CysC,as well as lower level of TC,LDL-C,HDL-C,total lymphocyte count and albumin(P<0.05).Furthermore,malnutrition+LEAD group has higher level of CysC,lower level of SBP,HbA1 c,fasten plasma blood glucose(FPG),TC,triglyceride(TG),LDL-C,blood phosphorus(P),fructosamine,total lymphocyte count and albumin(P<0.05).2)Among the four groups,the 25-(OH)VitD levels was compared.The 25-(OH)VitD level of normal nutritional status and LEAD group has no significant difference compare to normal nutritional status+NLEAD group(P>0.05).Compare to the malnutrition+NLEAD group,malnutrition+LEAD group has significantly lower level of 25-(OH)VitD(P<0.05).In particular,malnutrition + LEAD group has lowest level of 25-(OH)VitD in comparison with other three groups(P<0.05).3)Pearson correlation analysis showed that 25-(OH)VitD was negatively correlated with FPG and parathyroid hormone(PTH),and positively correlated with HDL-C,total lymphocyte count,and albumin(P <0.05).4)Spearman correlation analysis showed that the degree of25-(OH)VitD deficiency was positively correlated with the degree of malnutrition.The worse the nutritional status,the more severe the degree of 25-(OH)VitD deficiency(P <0.05).5)Logistic regression analysis of risk factors of LEAD in T2 DM combined with malnutrition: results showed that the course of disease and coronary heart disease were independent risk factors of LEAD,HDL-C and total lymphocyte count were protective factors of LEAD(P <0.05).2.According to blood glucose control indicators and LEAD status,patients were divided into four groups.There was no significant difference in 25-(OH)VitD level between the four groups of patients(P> 0.05)Conclusions: 1.The nutritional status of patients with type 2 diabetes was positively correlated with the level of 25-(OH)VitD and negatively correlated with lower extremity arterial disease.The malnutrition will affect the relationship between 25-(OH)VitD and lower extremity arterial disease,which should be paid great attention in clinical work.2.The effect of HbA1 c on the relationship between 25-(OH)VitD and lowerextremity arterial disease was limited.