The Relative Study Between Glycosylated Serum Protein, Eight-point Capillary Blood Glucose And Peripheral Neuropathy Of Type 2 Diabetes

Objective:Diabetic peripheral neuropathy is one of the common complications of type 2 diabetes. It is the major risk factors for leading to foot ulcers, infections and gangrene. Early detection and to strengthen the control of blood glucose and foot care can significantly reduce the incidence of foot ulcers and amputation, and improve the patient's quality of life. Researchs has shown that peripheral neuropathy is closely related to hyperglycemia, age, course of disease, smoking, vitamin deficiency, and genetic predisposition etc. To strictly control high blood sugar,in particular the control of fluctuations in blood glucose, can reduce or delay the occurrence and development of diabetic peripheral neuropathy.Glycosylated serum protein(GSP) can effectively reflect the patients' average blood glucose level in the past 2-3 weeks. It is one of the indicators of glucose metabolism disorders.24-hour blood glucose spectrum (7 point or 8 point method) is able to understand the blood glucose control situation of the day a little comprehensivly, and to a certain extent reflect the fluctuations in blood glucose. In order to understand the relationship between glucose metabolism disorders and diabetic peripheral neuropathy, we measured glycosylated serum protein and 8-point blood glucose in newly diagnosed type 2 diabetic patients with peripheral neuropathy, to explore the correlation between the two indicators and the relationship with peripheral neuropathy. This can provide a theoretical basis for early diagnosis, early prevention and treatment.Methods:Select 60 cases was hospitalized in Hebei Medical University Second Hospital patients with type 2 diabetes, they are all newly diagnosed and did not receive any intervention in diabetes treatment (diet, exercise and drugs, etc, of which 37 cases of male, female 23 cases, with an average age(53.90±12.86) years. All elected cases are in line with the 1999 WHO diagnostic criteria of diabetes, and have ruled out infection, smoking, acute metabolic disorders, liver and kidney disease, heart failure, cancer, rheumatoid autoimmune diseases, diabetic peripheral vascular disease(using color Doppler to detect carotid artery and lower extremity arteries), cerebral vascular disease, use hormones etc. All patients underwent electromyography, including the motor function of the right of the median nerve, ulnar nerve, the both sides of common peroneal nerve, and the sensory function of the both sides of the bilateral median nerve, ulnar nerve, common peroneal nerve and sural nerve. Analysis of its sensory nerve conduction velocity (SCV) and motor conduction velocity (MCV) and latency, amplitude, F-wave. The diagnostic criteria for diabetic peripheral neuropathy:1. meet the following five criteria: have a definite diabetes, or meet the diagnostic criteria for type 2 diabetes mellitus; Limbs or both lower extremities persistent pain and (or) sensory disturbance; One or both toe vibration perception diminished; Pairs of ankle reflex disappear; The peroneal nerve conduction velocity of the primary side (right-handed side) is a standard deviation lower than the normal value of the same age group.2. Or meet the diagnostic criteria for type 2 diabetes mellitus and two or more of the NCV examination is abnormal (excluding other causes of peripheral neuropathy). Assessment of disease extent:No lesions was normal;<5 abnormal EMG indicators were mild; 5-10 abnormal EMG indicators were moderate lesions;>10 abnormal EMG indicators were severe. According to the degree of diabetic peripheral neuropathy will be divided into three groups, non-peripheral neuropathy group(A group,20 cases), mild peripheral neuropathy group (B group,20 cases), moderate and severe peripheral neuropathy group (C group,20cases). All enrolled patients were taken early morning fasting venous blood of elbow and measured fasting plasma glucose(FPG), glycosylated hemoglobin(HbAlc), liver and kidney function, blood lipids, fibrinogen (FIB),β2-microglobulin (P2-MG) et al. And record the systolic blood pressure(SBP), diastolic blood pressure(DBP), age, sex, height, weight and other indicators.All subjects were given regular diabetic diet, and required patients to maintain the original sleep and exercise habits throughout the course of the study. All subjects were treated with intensive insulin therapy after they were admitted to hospital (insulin aspart and protamine bio-synthetic human insulin or insulin glargine). Meal time:Breakfast 7:00, lunch 11:00, supper 17:00. Fingertip blood glucose test time:6:00,20 minutes before lunch and supper (Before inject insulin),2h postprandial blood glucose,22:00, and 3:00 of the next day. One day after the subjects was hospitalized we start to test 8-point blood glucose, Measured every other day, a total of 7 times, After 7 times, we detect glycosylated serum protein (GSP) within 3 days. We have measured 8 point in the monitoring of day, each subjects to monitor a total of 56 data. If you have already started to monitor in the monitoring day, but there is a irregular discomfort or rarely eating or exercise behavior, you can choose another regularly day to monitor. If the participants accidentally forgotten individual monitoring points, we can test omissive monitoring points additionally in one day that similar patterns of life.Record and calculate the following data:1. all the blood glucose values of the monitoring day 2. the blood sugar targets of the next day when the subjects was hospitalized, Include the following:(1) MBG8:the mean blood glucose and standard deviation (SD) of the 8 point (2) drift range of postprandial blood glucose (PPGE):2h postprandial blood glucose minus the corresponding blood glucose before meals (3) the mean amplitude of glycemic excursions of the 8 point (MAGE8) (4) the largest amplitude of glycemic excursions of the 8 point (LAGE8) 3. the summary various indicators of the monitoring day, including the following:Fasting plasma glucose (FPG), blood glucose 2 hours after meals (PBG), the blood glucose of prelunch and predinner, the blood glucose of 22:00,3:00, MBG8, PPGE.All the data were deal with statistical software packages SPSS 13.0. Data expressed using average addition and subtraction standard deviation. Comparative analysis between the many groups using completely randomized design analysis of variance. Between the two groups were compared using two-sample t test. Whether or not has peripheral neuropathy (no=0, with=1) for the variables, disease risk factors for Logistic regression analysis. Correlation using Pearson correlation to analysis, P<0.05 has statistically significant.Result:1 The age, fibrinogen,β2-MG of C were significantly higher than A, B (P<0.05), between A and B showed no significant difference (P>0.05). B and C combined to one group, compared with A, between the two groups of age was significantly different (P<0.05). A, B, C comparison with the three groups of sex, body mass index, systolic blood pressure, diastolic blood pressure, fasting blood glucose, glycated hemoglobin, lipids was non-significant (P>0.05).2 Whether or not has peripheral neuropathy disease(no=0, has=1) as the dependent variables, age, body mass index, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, fibrinogen, GSP and other factors were analysis using Logistic regression. Only age (OR= 2.06, P<0.05) entered the regression equation, was risk factors of diabetic peripheral neuropathy. Other variables had no statistical significance.3 With or without peripheral neuropathy lesions compared, the SD, MAGE8, LAGE8, vary range in blood glucose after breakfast and supper of the next day when the subjects was hospitalized were significantly higher (P<0.05). Vary range in blood glucose after lunch,MBG8 had no significant differences.4 GSP was significantly correlated with FPG,2h postprandial and MBG8 of the summary various indicators of the monitoring day (OR values were 0.407, 0.374,0.403,0.446,0.543 P<0.05). GSP had no correlated with prelunch, presupper, blood glucose of 22:00 and 3:00, drift range of postprandial blood glucose, the average blood glucose of fasting blood glucose and 2h postlunch and the average blood glucose of fasting blood glucose and 2h postsupper (P >0.05).5 The GSP of C was significantly higher than A, B (P<0.05). A, B showed no significant difference (P>0.05). B and C combined to one group compared with A, between two groups of GSP were significantly different(P<0.05).Conclusion:1 Compared with patients without peripheral neuropathy there was a there is a more severe fluctuations in blood glucose levels in patients with peripheral neuropathy of type 2 diabetes who are newly diagnosed. The specific performance of it was the SD, MAGE8, LAGE8, vary range in blood glucose after breakfast and supper of the next day when the subjects was hospitalized were significantly higher, prompted that the fluctuations in blood glucose played an important role in the occurrence and development of type 2 diabetes peripheral neuropathy. In the subsequent clinical work, we should reduce the blood glucose smoothly to minimize fluctuations in blood glucose in patients.2 The age, fibrinogen,β2-MG of moderate and severe peripheral neuropathy group were significantly higher than non-peripheral neuropathy group and mild peripheral neuropathy group. In particular, age entered the Logistic regression equations and it's a risk factor of type 2 diabetes peripheral neuropathy. It showed that age, hypercoagulability, endothelial injury promoted the occurrence and development of peripheral neuropathy of type 2 diabetes.3 GSP is closely related to fasting blood glucose, the 2h postprandial and MBG8 can comprehensive reflect the blood glucose levels of the day, It showed that GSP is a good indicator to reflect the glycemic control recently, it has a clinical value.4 GSP of patients with peripheral neuropathy is higher than the patients without peripheral neuropathy. It showed that,GSP may be related to the occurrence and development of diabetic peripheral neuropathy.