The Relationship Between Hypoglycemia And Cardivascular Autonomic Neuropathy In Type 2 Diabetes And The Distribution Of TCM Symptoms

Objective: To explore the correlation between hypoglycemia and cardivascular autonomic neuropathy(DCAN)in patients with T2 DM,and investigate the TCM symptoms of DCAN,in order to provide a theoretical basis for the treatment of DCAN by TCM.Methods: This study was an observational study that enrolled 79 T2 DM patients who met the inclusion criteria from the Department of Endocrinology and Metabolism in Shandong Provincial Hospital.Clinical data of subjects,including gender,age,blood pressure,duration of diabetes,body mass index(BMI),blood glucose index,blood lipid index,fasting C-peptide(FCP),renal function index,and blood potassium concentration(K+),were collected by experienced clinicians.The time of glucose in the target range(TIR),the time of glucose below the target range(TBR),the coefficient of variation(CV)of glucose,the standard deviation(SD)of glucose and the number of hypoglycemic episodes were achieved through Continuous Glucose Monitoring System(CGMS)after admission.According to the diagnostic criteria of DCAN,TCM syndrome differentiation criteria of DCAN and the diagnostic criteria of hypoglycemia,hierarchical analysis was applied to 79 patients in this study,to study the hazard factors of DCAN and the distribution of TCM syndrome types of DCAN.Results: 1.In this study,40 patients were diagnosed with DCAN,while 39 patients were not diagnosed with DCAN.Therefore,the incidence rate of DCAN was 49.37%.Patients diagnosed with DCAN had a longer time of TBR and more frequent hypoglycemic episodes than those without DCAN.However,the TIR in DCAN group was significantly lower than that in non-DCAN group.In addition,compared with the non-DCAN group,the CV and SD of the subjects with DCAN group were significantly higher.After adjusting for age,BMI,fasting C-peptide and the number of hypoglycemic episodes,TBR and duration of diabetes were independently related with the incidence of DCAN in T2DM(P=0.034,OR=4.237;P=0.001,OR=1.475).ROC curve analysis showed that TBR=1.9% or diabetes duration=6.5 years,which could be used as a predictor of DCAN.2.In the study,39 patients were diagnosed as DCAN,containing 21 patients with heart and spleen deficiency and 18 patients with heart and kidney yin deficiency.Compared with DCAN of heart and kidney yin deficiency syndrome,the fasting C-peptide level and TG level of DCAN of heart and spleen deficiency syndrome were lower.3.In this study,53 patients had hypoglycemic episodes,and the incidence of hypoglycemia was 67.1%.Patients in the hypoglycemia group experienced longer TBR and more unstable CV than those without hypoglycemia.Conclusion: The incidence rate of DCAN in this study is 49.37%,and the incidence of hypoglycemic events is 67.1%.TBR and the duration of diabetes are independent risk factors for DCAN.TBR=1.9% and the duration of diabetes=6.5 years could be used as predictors of DCAN.In the study of TCM syndrome differentiation,DCAN of heart and spleen deficiency type and DCAN of heart and kidney yin deficiency type are more common in clinic.There are significant differences in fasting C-peptide and TG between the two syndrome types,which may serve as the basis for clinical syndrome differentiation and treatment of TCM.