The Relationship Between Glucose Fluctuations,Arrhythmia And Lipid Metabolism In Elderly Type 2 Diabetic Patients

BackgroundAs the prevalence of diabetes increases year by year,people are paying more and more attention to glucose.Large clinical studies such as ACCORD and ADVANCE have shown that strict glycemic control will increase the risk of hypoglycemia and severe hypoglycemia will increase the risk of death.Domestic and foreign studies on blood glucose and cardiovascular disease are mostly directed to high glucose or hypoglycemia.In recent years,it has been reported in the literature that patients with type 2 diabetes mellitus(T2DM)may experience arrhythmias when they have hypoglycemia and hyperglycemia.However,the relationship between blood glucose fluctuations and arrhythmia in patients with T2DM is rarely reported.Insulin resistance is caused by disorders of lipid metabolism,which in turn causes diabetes.The disorder of lipid metabolism caused by insulin resistance in diabetic patients occurs mostly in hyperglycemia,and the relationship between blood glucose fluctuations and lipid metabolism has not yet been clarified.Insulin resistance is caused by disorders of lipid metabolism,which in turn causes diabetes,and most of the lipid metabolism disorders caused by insulin resistance in diabetic patients occur in hyperglycemia,and the relationship between blood glucose fluctuations and lipid metabolism is not yet clear.ObjectiveThe aim of this study was to analyze glycemic control,blood glucose fluctuations,and arrhythmia and lipid metabolism in elderly patients with T2DM using continuous glucose monitoring and 24-hour Holter report to investigate the relationship between blood glucose control,blood glucose fluctuations,and arrhythmia and lipid metabolism.Providing a theoretical basis for clinically reasonable blood glucose control and risk factors for atherosclerotic cardiovascular disease(ASCVD).Methods1.Objects and groupingA total of 104 T2DM patients who met the inclusion criteria from February 2002 to September 2017 were retrospectively collected.According to the WHO criteria,they were divided into elderly patients(EDM)and middle-aged diabetes mellitus(MDM).73 patients(70.19%)were in the EDM group.The average age was(81.08±5.36)years.Men 56 cases(76.71%))and women 17 cases(23.29%);MDM group 31 cases(29.81%),average age(56.68±5.24)years,male 22 cases(70.97%),female 9 cases(29.03%).2.Data collectionThe main clinical data,continuous glucose monitoring(CGM)report and Holter report related indicators were collected.The main parameters for calculating blood glucose fluctuations:standard deviations of blood glucose(SDBG),large amplitude of glycemic excursion(LAGE),mean amplitude of glycemic excursion(MAGE),and absolute means of daily differences(MODD).Analysis of arrhythmia during hospitalization based on the Holter report.Mainly include:maximum heart rate,minimum heart rate,average heart rate,QT interval,supraventricular arrhythmias(SVA),supraventricular premature beat(SPB),atrial bigeminy,(AB),Supraventricular tachycardia(SVT),atrial fibrillation(AF),ventricular premature beat(VPB),ventricular bigeminy(VB),ventricular tachycardia,VT),ventricular fibrillation(VF),ST segment changes,T wave changes and other indicators.3.Data classificationClassified according to the following criteria3.1 Blood glucose related indicators:Fasting blood glucose(FBG):FBG<4.4 mmol/L or FBG>7.0 mmol/L is not up to standard,HbAlc ? 7%is not up to standard,SDBG ? 1.4 mmol/L LAGE:? 5.7 mol/L,MAGE ? 3.9 mol/L,MODD ?1.4 mol/L were not met,and blood glucose ?3.9 mmol/L was hypoglycemia.3.2 arrhythmia type:SPB,VPB:? 30 times/h,or>720/24h is abnormal,AB,VB,AT,AF,SVT,VTand the QTc interval ? 440ms was abnormal.3.3 ST segment:The ST segment measurement point is selected 80 ms after the JS point of the QRS wave.Three waveforms are continuously measured and the average value is taken.In addition to avR leads ECG on the other two or more adjacent lead ST segment elevation 0.1mv(in the VI-V3 lead ? 0.3mv),ST segment depression ?0.05mv,avR lead ST elevation ?0.05mv is an abnormality,which is ST segment change.3.4 T-wave:The T-wave amplitudes of two adjacent leads with R-waves are<1/10 of that of the same-lead R-waves.T-waves are bi-directional or inverted and are abnormal,which are T-wave changes.4.Statistical analysisThe data were imported from Excel 2012 software.Shapiro-Wilk normality test and Levene homogeneity test of variance were performed on the data.Measured data satisfying normal distribution were expressed as mean±standard deviation(X±S),which was in accordance with the normal distribution.When the variances were equal,the groups were compared using the independent sample t-test,the four tables were chi-square test,Fisher's exact test probabilities.The correlation factors were analyzed using numerical variables using multiple linear regression,and the binary variables were analyzed with logistic regression.The inspection level is ? =0.05.All data were statistically analyzed using SPSS 19.0 software.Results1.General information1.1 Case Distribution The EDM and MDM groups included 73 patients(56 males and 17 females)and 31 patients(21 males and 9 females),with an average age of(81.08±5.36)years and(56.68±5.24)years respectively..1.2 Analysis of arrhythmia type SVA in 60 cases(57.69%)of all arrhythmia types,the most common,SPB 18 cases(17.31%),AB 46 cases(43.27%),SVT 24 cases(23.08%),AF3 cases(3.8%)There were 58 cases(55.77%)of VA,45 cases of VPB(43.27%),10 cases of VB(9.62%),and 4 cases of VT(3.8%).The QTc interval prolonged 66 cases(63.46%).1.3 EDM group and MDM group1)General data comparing BMI in MDM group(27.99±4.32kg/m2 versus 25.33±30.1 kg/m2)and diastolic blood pressure(76.52±13.64mmHg vs 68.77±9.36 mmHg)is higher than that in EDM group,P is less than 0.05,and the course of EDM group compared with MDM group(14.18±8.89y vs 10.41 ±6.42 y),the prevalence of hypertension and coronary heart disease was higher than that of MDM group(79.5%vs 58.1%,P=0.024,71.2%vs 22.6%,P<0.001).There was no statistical difference between the two groups in gender,systolic blood pressure,type of hypoglycemic agents used,and chronic complications of diabetes.Elderly patients with hypertension,coronary heart disease more common.2)Comparison of blood glucose fluctuation indicators.Compared with EDM group,SDBG and LAGE were higher than MDM group(2.40±1.00 mmol/L vs 1.97±0.75 mmol/L,P=0.036,9.59±3.35 mmol/L vs 8.04±2.67 mmol/L,P= 0.024),the difference was statistically significant.There was no statistical difference between MAGE and MODD between the two groups.Elderly patients are more prone to blood glucose fluctuations.3)Compared with the arrhythmia index The incidence of SVA(71.2%vs 25.8%,P<0.001),VPB(52.1%vs 22.6%,P=0.006),and VA(52.1%vs 25.8%,P=0.014)were higher in the EDM group.In the MDM group,the difference was statistically significant.Elderly patients are more prone to arrhythmias.There was no significant difference in the incidence of QTc interval,ST changes,and T wave changes between the two groups.2.Single factor analysis of blood glucose control,blood glucose fluctuations and arrhythmiaSDBG(93.9%vs 6.1%,P<0.001),MAGE(84.8%vs 15.2%,P=0.002),LAGE(93.9%vs 6.2%,P=0.001),MODD(80.3%vs 19.7%,P=0.003)the incidence of QTc prolongation in the non-compliance group was greater than that in the standard group,and the difference was statistically significant.There was no significant difference in the incidence of AA and VA between the SDBG,MAGE,LAGE,MODD and non-compliance groups.3.Univariate analysis of blood glucose control,blood glucose fluctuations,and lipid metabolism3.1 FBG FBG non-compliance group TG(1.75 ±1.17mol/L vs 1.27±0.61 mmol/L,P=0.036),TC(4.65±1.11 mmol/L vs 4.18±1.11 mmol/L,P = 0.007)is higher than the standard In groups,the difference was statistically significant.3.2 There was no significant difference in serum lipids between HbA1c HbA1c compliance group and non-compliance group.3.3 Blood glucose fluctuations MAGE substandard group's LDL-C higher than standard group's(2.63 ± 0.89 mmol/L vs 2.17 ± 0.83 mmol/L,P=0.023),the difference was statistically significant,the remaining indicators were not statistically significant.4.Multiple linear regression and Logistic regression analysis resultsThe effects of gender,age,duration,and body mass index(BMI)factors on the effects of arrhythmia type and lipid profile were shown.4.1 Blood glucose control and lipid metabolism HbA,c positive correlation with TC(?=0.525,P=0.023),TG(p=0.474,P=0.018),FBG and TC(?=0.534,P=0.019),TG(?= 0.482,P=0.015)positive correlation.FBG((?=0.3 82,95%CI:0.030-0.734),MAGE(?=0.435,95%CI:0.040-0.831)was positively correlated with LDL-C,P values were all less than 0.05.4.2 Blood glucose fluctuations and arrhythmia SDBG(OR = 9.711,95%CI:2.673-35.275),MAGE(OR = 3.917,95%CI:1.521-10.086),LAGE(OR = 7.295,95%CI:2.103-25.302)MODD(OR=1.065,95%CI:1.635-10.072)was positively correlated with the prolongation of QTc interval,P values were all less than 0.05.The above four indicators were independent risk factors for QTc prolongation.4.3 Blood glucose fluctuations and blood pressure MODD was positively correlated with DBP(?=4.755,P=0.039).Conclusions1.SVA is the most common type of arrhythmia in elderly T2DM patients,and VA,AB,VPB,and SVT are also more common.Patients with EDM are more likely to have SVA,VPB,and VA,and are more likely to have hypertension or coronary heart disease.2.Compared with MDM,EDM had lower FBG and HbA1c and they were more likely to have abnormalities in SDBG and LAGE,with greater fluctuations in blood glucose.3.Abnormal blood glucose fluctuation in patients with EDM are closely related to prolongation of QTc interval,DBP,and LDL-C.Reasonable control of blood glucose and reduction the blood glucose fluctuations may help to reduce the risk factors of ASCVD.