Postprandial Blood Glucose Fluctuation And Carotid Artery Intima-media Thickness In Correlation Analysis

Objective: Atherosclerosis is an important pathophysiological basis ofcardiovascular disease, at present, the carotid intima-media thickness has beenproposed as atherosclerosis alternative indicators, in recent years, more and moreattentions had been paid on the relationship between the blood glucose fluctuation andthe atherosclerosis. In this paper, we used the difference between2hPG and FPG,2hPG by oral glucose tolerance test (OGTT) as the postprandial blood glucosefluctuation index to explore the correlation of the blood glucose fluctuation and CIMT,To see if the postprandial blood glucose fluctuation can be a warning and screeningindex for AS through related with CIMT.Methods: Selection Chinese patients with type2diabetes cancer riskepidemiological studies of10300cases of community residents from August16,2011to December10,2011, according to the selection and exclusion criteria, the collectionstandard cases8449cases, tested for age, height,weight, body mass index, waist, hip,waist hip ratio, systolic blood pressure, diastolic blood pressure, heart rate, fastingplasma glucose,2h postprandial plasma glucose, glycosylated hemoglobin c, lipidprofiles, blood uric acid, urinary albumin, urine creatinine, calculating the differencebetween2hPG and FPG, urine trace albumin to creatinine ratio. Carotid artery intima-media thickness (CIMT) was evaluated by neck vascular color Dopplerultrasonography. The residents were divided into two groups: the normal group and thethickening CIMT group according to the CIMT, the level of2hPG, the differencebetween2hPG and FPG of the two CIMT groups were compared. The residents weredivided into3groups according to2hPG and FPG: the normal group,[Simple IGTgroup (group IGT1), IGT+IFG group (group IGT2)],[DM with postprandialhyperglycemia group (group DM1), DM with both fasting and postprandialhyperglycemia group (group DM2)]. Then according to the four percentile of thedifference between2hPG and FPG, the cases were divided into four groups: group Q1~group Q4. The thickened CIMT was compared by the two kinds method ofdividing groups. Analysis the relationship between the postprandial glucose fluctuationand CIMT.Results:1. The comparison of2hPG in the two different CIMT groups:(1)The2hPG in theCIMT normal group and CIMT thickening group were:1.98±0.36mmol/L,2.16±0.46mmol/L respectively. Compared with the CIMT normal group, the level of2hPG wassignificantly higher than that in CIMT thickening group (P<0.01).(2)The percentage ofnormal blood glucose in the CIMT normal group and CIMT thickening group were67.2%,48.7%respectively, the IGT1were15.3%,17.5%，the IGT2were5.1%,6.4%，the DM1were2.0%,3.0%, the DM2were10.3%,24.4%， There was significantlydifferent(χ2=366.748, P <0.01)；The proportion of normal blood glucose in the CIMTnormal group was significantly higher than that in CIMT thickening group (P<0.01).The proportion of IGT1、IGT2、DM1and DM2were significantly higher than that inCIMT normal group(P<0.05).(3) The level of CIMT of the thickened CIMT cases indifferent2hPG three groups were:0.13±0.09mm,(0.13±0.09mm,0.14±0.09mm),(0.14±0.10mm,0.15±0.09mm)respectively.Compared with the normal blood glucose group, The level of CIMT in group DM2wassignificantly higher (P <0.01), there were not significantly higher in group IGT1, groupIGT2, group DM1(P=0.939, P=0.128, P=0.172). Compared with the group IGT1, Thelevel of CIMT in group DM2was significantly higher (P<0.01), there were notsignificantly higher in group IGT2, group DM1(P=0.180,P=0.205). Compared with thegroup IGT2, The level of CIMT in group DM1, group DM2were not significantlyhigher (P=0.803, P=0.145). Compared with the group DM1, The level of CIMT ingroup DM2was not significantly higher (P=0.442).2. The comparison of the difference between2hPG and FPG in the two differentCIMT groups:(1)The the difference between2hPG and FPG in the CIMT normal groupand CIMT thickening group were:1.41(0.46-2.71)mmol/L,2.20(0.87-4.91) mmol/Lrespectively. Compared with the CIMT normal group, the level of the differencebetween2hPG and FPG was significantly higher than that in CIMT thickening group(P<0.01).(2)The CIMT normal group and CIMT thickening group, the percentage of Q1was30.2%,21.1%respectively, the Q2was29.0%,21.7%,the Q3was25.1%,25.3%, the Q4was15.6%,31.9%.There was significantlu different (χ2=334.103， P <0.01)；The proportion of Q1and Q2in the CIMT normal group was significantly higher thanthat in CIMT thickening group (P<0.01). The proportion of Q4was significantly higherthan that in CIMT normal group(P<0.01). The proportion of Q3was not significantlydifferent in the two CIMT groups(P=0.892).(3)The level of CIMT of the thickenedCIMT cases in different four groups were:0.13±0.09mm,0.13±0.10mm,0.13±0.09mm,0.15±0.09mm respectively. Compared with group Q1, The level of CIMT in group Q4was significantly higher (P<0.01), there were not significantly higher in group Q2, Q3(P=0.923, P=0.6282). Compared with group Q2, The level of CIMT in group Q4wassignificantly higher (P<0.01), there was not significantly higher in group Q3(P=0.699).Compared with group Q3, The level of CIMT in group Q4was significantly higher(P<0.01).3. Spearman correlation analysis revealed,2hPG, the difference between2hPG andFPG is positively correlated with CIMT，The R values were0.240、0.217, P<0.05.4. Multiple stepwise regression analysis, the results showed that age, height, waisthip ratio, SBP, HbA1c, LDL-C were positively correlated with CIMT, P <0.01;gender,DBP, HDL-C were negatively correlated with CIMT, P <0.01;2hPG, the differencebetween2hPG and FPG were not correlated with CIMT, P>0.05.Conclusions:1.2hPG, the difference between2hPG and FPG were positivelycorrelated with CIMT, but not the independent risk factors of carotid atherosclerosis.2. Age, height, waist hip ratio, SBP, DBP, HbA1c, LDL-C, HDL-C wereindependent risk factors of carotid atherosclerosis.