Impact Of Glucose Fluctuations And Gait Abnormalities On Diabetes And Its Complications

AimsAlthough many domestic and foreign research results suggested that the current incidence of type 1 diabetes is low in China,due to the huge population in our country,the type 1 diabetes population is still large,and patients with type 1 diabetes rely on insulin treatment,accompanied by prominent blood glucose fluctuations.At present,researches about type 1diabetes mainly focuses on the relationship between glucose fluctuations and glycemic control and chronic complications.Few studies have concentrated on the relationship between blood glucose fluctuations and acute complications such as hypoglycemia and ketosis.The first part of this study is to explore the impact of different continuous dynamic blood glucose monitoring methods on blood glucose control in type 1 diabetes,and to find sensitive blood glucose fluctuation indicators to help alert the occurrence of acute complications such as hypoglycemia and ketosis.While,blood glucose control in patients with type 2 diabetes is more stable,but chronic complications such as blood vessels and nerves are more common as the patients are older and complicated with more comorbidities.This study intends to use a non-invasive,simple and convenient wireless gait test to help evaluate lower extremity complications of type 2 diabetes.MethodsBoth are multicenter,control,prospective clinical studies.Patients with type 1 diabetes were randomly divided into the Ipro2 group(60 cases)and the transient sensory group(60 patients).They were required respectively to wear Ipro2 and transient blood glucose monitors,collecting basic clinical and biochemical data,recording the treatment plans.They were followed up every six months.Effects of two different continuous dynamic glucose monitoring methods on acute complications such as hypoglycemia and ketosis were analysed.Gait was examined among 1861 participants with or without T2DM from three study centers.Subjects with NGT(n=282)and IGT(n=70)were taken as control groups,patients with T2DM were divided into 4 groups:DM(n=1266),DPN(DM complicated with diabetic peripheral neurapathy,n=144),LEAD(DM complicated with lower extremity artery disease,n=50)and DPN+LEAD(n=49).The clinical characteristics and gait items were assessed and compared among these six groups.Analyses of variance were employed to verify possible differences of gait parameters between groups and conditions.Stepwise multivariate regression analysis was performed to reveal possible predictors of gait deficits.ROC curve analysis was employed to find any discriminatory power of step time for the occurrence of DPN.ResultsThe results of type 1 diabetes research suggested that:in the transient sensory group,the patients had lower fasting blood glucose(9.01 vs.7.71mmol/l),lower postprandial blood glucose(11.85 vs.9.07 mmol/l),and decreased urine ketone body positive rate(36.67%vs.15.00%,p<0.05).Wearing transient blood glucose monitors and longer duration of diabetes indicated lower risk of ketosis.In the transient blood glucose monitors group,time in range was shorter,hypoglycemia sustained longer,and the relative hypoglycemic fear behavior was more significant(p<0.05).With the extension of hypoglycemia time(TIR),the fluctuation of blood glucose gradually increased(p<0.05).The results of multivariate stepwise regression analysis showed that the greater the hypoglycemic index and coefficient of blood glucose variation,the longer the hypoglycemic time.In addition,our study also found that long-term fluctuations in blood sugar(glycated hemoglobin)have a more significant effect on the occurrence of ketosis than short-term fluctuation index(instability index,LI).The results of type 2 diabetes research suggested that:In participants burdened with DPN or LEAD,step time increased,cadence decreased,and walking speed decreased sharply(p<0.05).Patients complicated only with LEAD showed an increased duty-factor?double stance(32.51%,p<0.05).And the results displayed lower SD_A(1.32 vs.1.57,p<0.01)and SD_B(0.38vs.0.51,p<0.01)of subjects with both DPN and LEAD.Stepwise multivariate regression models showed that independent variables were sex,age and leg length(p<0.01).While,VPT was listed as significant independent predictor of step time,SD_A and SD_B(p<0.05).And ABI was documented as significant independent predictor of stride length,duty-factor?Double stance,SD_A and SD_B(p<0.05).ROC analysis was explored to find the discriminatory power of step time for occurrence of DPN.The AUC value was 0.752(95%CI:0.562-0.654,p<0.01)and the cut-off point was 526.13ms,sensitivity was 82.20%,and specificity was56.60%.Only when the vascular disease of the lower extremities were extremely serious(ABI<0.6),obvious reduced stride length was detected.Taking normal ABI as a reference,there was a close correlation between CAD and low ABI groups(OR value 17.59;95%confidence interval:5.22-83.88).In female patients,OR increased to 24.40(95%confidence interval:6.79-60.32;P<0.01).ROC analysis between ABI and CAD showed that the AUC value was 0.804(95%CI:0.730-0.878;P<0.001),the cut-off point was 1.045,Youden index was 0.512,sensitivity was 79.69%,specificity 71.52%.Conclusions1.It is recommended that patients with type 1 diabetes choose a transient continuous glucose monitor.With the extension of the total time of hypoglycemia,blood glucose fluctuations gradually increased.The risk of ketosis is more closely related to the long-term fluctuation of blood glucose(Hb A1c).2.The multiple-center,large-sample randomized and controlled trial demonstrated that a more conservative gait style was observed during the 10-m walk on the flat land among diabetes complicated with DPN and/or LEAD.In addition to sex,age and leg length,VPT and ABI were distinct factors that associated with altered gait parameters.Increased step time could be explored to distingusih the occurrence of DPN.Only when ABI<0.6,significantly reduced stride length was observed.In addition to decreased stride length,lower ABI levels indicated an increased risk of CAD,especially in female patients.