Correlation Study Between HbA1c Level And TCM Tongue Diagnosis And Syndrome Types In Elderly Patients With T2DM

Objective:The purpose of this study is to investigate the relationship between glycosylated hemoglobin levels in elderly(≥60 years)T2DM patients and tongue diagnosis and syndrome classification in Chinese medicine,and to explore the glycosylated hemoglobin level and gender,age,duration of diabetes,medical history and complications of elderly T2DM.To clarify the correlation between HbA1c level and tongue signs and syndrome differentiation,so as to understand the distribution characteristics of tongue signs and syndromes of different degrees of glycosylated hemoglobin in elderly patients with type 2 diabetes mellitus,and to provide some reference for the treatment of type 2 diabetes mellitus.Method:This study collected 300 patients with glycosylated hemoglobin value greater than 6.3%in hospitalized patients with type 2 diabetes from June 1st,2018 to January 25,2019.According to the different degrees of glycated hemoglobin,the patients were divided into three groups:A,B,and C:group A was 6.3%<HbA1c≤7.5%,group B was 7.6%≤HbA1c≤8.5%,and group C was HbA1c≥8.6%.Collect the general situation:gender,age,BMI,duration of diabetes,combined disease,complications,history of tobacco and alcohol,and record the results of glycated hemoglobin.Record the patient’s tongue and tongue coating,TCM syndrome and syndrome differentiation(all the above tongue and tongue coating and syndrome differentiation are diagnosed by the deputy senior physician or above).According to the currently accepted authoritative syndrome diagnostic criteria "Guidelines for Clinical Research of New Drugs in Traditional Chinese Medicine(Trial)"(Zheng Xiao Yu,2002),TCM syndromes of type 2 diabetes are classified into:yin deficiency heat syndrome,dampness and spleen syndrome,gas Yin deficiency syndrome,yin and yang deficiency and blood stasis and water stasis,blood stasis and collaterals.The above data were all statistically analyzed using SPSS 20.0.Result:1.In this study,87 patients(29.0%)in group A,146 patients(48.7%)in group B,and 67 patients(22.3%)in group C.2.Gender analysis:45 males(50.5%)and 42 females(49.5%)in group A;68(46.6%)males and 78 females(53.4%)in group B;30 males(44.8%)in group C There were 37 females(55.2%);there was no significant difference in gender distribution between the three groups(P>0.05).3.Age analysis:44 cases(50.6%)in group A 60-69 years old,29 cases(33.3%)in 70-79 years old,14 cases(29.0%)≥ 80 years old;71 cases in group B 60-69 years old(48.6%),48 cases(32.9%)aged 70-79 years,27 cases(18.5%)≥80 years old;34 cases(50.7%)of 60-69 years old in group C,18 cases(26.9%)of 70-79 years old,≥80 15 years old(22.4%).There was no significant difference in the distribution of the three groups between the three groups(P>0.05).4.T2DM course analysis:A group≤5 years 15 cases(17.2%),5 to 10 years 23 cases(26.4%),10 to 20 years 28 cases(32.1%),>20 years 21 cases(24.1%);Group B≤5 years 15 cases(10.2%),5 to 10 years 15 cases(10.2%),10 to 20 years 76 cases(52.1%),>20 years 40 cases(27.4%);C group≤5 years 23 cases(34.3%),12 cases(17.9%)in 5 to 10 years,15 cases(22.3%)in 10 to 20 years,and 17 cases(25.3%)in>20 years.After examination,there were significant differences in the distribution of A,B and C groups in each course(P<0.05).Among them,the course of disease in group C was mainly distributed in≤5 years,and the course of disease in group B was mainly distributed in 10 to 20 years.5.Analysis of medical history:219 cases(73.0%)with hyperlipidemia,207 cases(69.0%)with hypertension,and 121 cases(40.3%)with coronary heart disease.A total of 36 patients(41.4%)in group A,59 patients(40.4%)in group B,and 26 patients(38.8%)in group C;60 patients(69.0%)in group A with hypertension,and 111 patients(76.0%)in group B There were 45 cases(67.2%)in group C,64 cases(73.6%)in group A of hyperlipidemia,115 cases(78.8%)in group B,and 46 cases(68.7%)in group C.After examination,there was no significant difference in the distribution of A,B,C combination and coronary heart disease,hypertension,and hyperlipidemia(P>0.05).6.Analysis of complications:32 patients(36.8%)in group A,58 patients(39.7%)in group B,and 37 patients(55.2%)in group C.After examination,there were differences in the presence or absence of diabetic retinopathy in the three groups(P<0.05).There was no statistically significant difference in diabetic retinopathy between groups A,B,and C(P>0.0167).There were 48 cases of diabetic peripheral neuropathy in group A,78 cases in group B,and 35 cases in group C.After testing,there was no significant difference in the prevalence of diabetic peripheral neuropathy between groups A,B and C(P>0.05).7.Analysis of tobacco and alcohol history:31 cases of smoking history in group A;50 cases of smoking history in group B;18 cases of smoking history in group C.Drinking history:15 cases of group A drinking history;Group B drinking history of 30 cases;Group C drinking history of 13 cases.After smoking,the smoking and drinking history had no significant effect on the distribution of A,B and C groups(P>0.05).8.Analysis of syndrome type of TCM:The distribution trend of group A is yin deficiency heat syndrome>dampness heat spleen syndrome>qi and yin deficiency syndrome>yin and yang deficiency and blood stasis syndrome>blood stasis syndrome.The distribution trend of group B is qi and yin deficiency syndrome>dampness and heat spleen syndrome>yin and yang deficiency and blood stasis syndrome>blood stasis syndrome>yin deficiency heat syndrome.The distribution trend of group C is yin and yang deficiency and blood stasis syndrome>blood stasis and collateral syndrome>qi and yin deficiency syndrome>damp heat spleen syndrome=yin deficiency heat syndrome.After testing,there were significant differences in the syndrome types between the three groups A,B and C(P<0.05).Among them,group A is mainly yin deficiency and heat syndrome,group B is mainly qi and yin deficiency syndrome;group C is mainly yin and yang deficiency and blood stasis.9.Tongue color analysis:The distribution trend of group A is red tongue>light dark tongue>light red tongue>dark red tongue>tongue.The distribution trend of group B is red tongue>light red tongue>dark tongue>dark red tongue>pale white tongue.The distribution trend of group C is pale tongue>dark red tongue>red tongue>pale white tongue>pale red tongue.After examination,the distribution of tongue color in groups A,B and C was significantly different(P<0.05).Among them,group A is mainly red tongue,group B is mainly red tongue and reddish,and group C is mainly light tongue.10.Tongue distribution:The distribution trend of patients in group A:crack tongue>thin tongue>fat tongue>tooth tongue>point tongue.The distribution trend in group B patients was:thin tongue>crack tongue>fat tongue>tooth tongue>old tongue.The distribution trend of patients in group C is:fat big tongue>tooth mark tongue>crack tongue>thin thin tongue>tender tongue.After testing,the distribution of the tongue shape of A,B and C groups was significantly different(P<0.05).Among them,group A is mainly cracked tongue;group B is mainly thin tongue;group C is mainly fat tongue.11.Distribution of mossy:The distribution trend of patients in group A is:thin moss>less moss>greasy moss>thick moss>peeling moss.The distribution trend of patients in group B was:thin moss>exfoliated moss>greasy moss>thick moss>dry moss.The distribution trend of patients in group C was:dry moss>thin moss>less moss>greasy moss>peeling moss.After testing,the distribution of A,B and C groups on each of the mosses was significantly different(P<0.05).Group A showed thin moss and greasy moss,group B showed thin moss,and group C mainly relied on dry moss.12.Group A had 59 cases of yellow moss and 28 cases of white moss.There were 73 cases of yellow moss in group B and 71 cases of white moss.Group C had 48 cases of white moss and 19 cases of yellow moss.After testing,the distribution of A,B and C in the moss color was significantly different(P<0.05).Conclusion:1.There was no significant difference in HbAlc level between elderly patients with T2DM and gender,age,history of coronary heart disease,history of hypertension,hyperlipidemia,diabetic retinopathy,diabetic peripheral neuropathy,smoking history and drinking history.2.Different levels of glycosylated hemoglobin were related to the course of disease:group A(6.3%<HbAlc<7.5%)was predominant for 5 to 10 years,group B(7.6%<HbA1c<8.5%)was predominant for 10 to 20 years,and group C(HbAlc<8.6%)was predominant for less than 5 years.3.There are significant differences between different levels of glycosylated hemoglobin and distribution of TCM syndromes:group A is mainly Yin deficiency and heat excess syndrome;group B is mainly Qi-Yin deficiency syndrome;group C is mainly Yin-Yang deficiency combined with blood stasis and water stopping syndrome.4.There are significant differences between different levels of glycosylated hemoglobin and the distribution of tongue diagnosis:(1)tongue color:group A is mainly red tongue,group B is mainly red tongue and light red tongue,and group C is mainly dark tongue.(2)Tongue shape:Cracked tongue was dominant in group A,thin tongue was dominant in group B and fat tongue was dominant in group C.(3)Coat quality:In group A,thin and greasy moss was dominant;in group B,thin moss was dominant;in group C,dry moss was dominant.(4)Coat color:yellow moss was dominant in group A,yellow moss was dominant in group B and white moss was dominant in group C.