| ObjectiveThis study was based on continuous glucose monitoring and cardiopulmonary coupling-polysomnography to evaluate the occurrence of dawn phenomenon,blood glucose and sleep quality in inpatients with type 2 diabetes mellitus,and to explore the effects of dawn phenomenon on blood glucose control and complications.At the same time,the possible effects of growth hormone,cortisol,insulin,melatonin and sleep on dawn phenomenon were evaluated,and the main factors were explored.Methods200 patients with type 2 diabetes were selected from the Department of Endocrinology,Qilu Hospital of Shandong University from January 2018 to August 2019,and 172 patients with acute complications and cardio-cerebrovascular events were excluded.Finally,28 patients with type 2 diabetes who met the criteria were included.The general data,treatment,weight,waist-to-hip ratio(WHR)and other medical history were collected.and the level of hemoglobin,liver function(glutamic pyruvic transaminase,glutamic oxaloacetic transaminase),renal function(blood urea nitrogen,serum creatinine),uric acid,urine microalbumin creatinine ratio were testde.At the same time,the level of lipid metabolism indexes such as triglyceride,cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol and the indexes of islet function such as fasting C peptide and fasting insulin were measured.Diabetic complications were evaluated by mydriatic free fundus photography and motor nerve conduction velocity.The continuous glucose monitoring was carried out for all the patients for three days to obtain the blood glucose data and draw the blood glucose fluctuation curve,The parameters reflecting blood glucose level and blood glucose fluctuation were calculated,and the difference between nocturnal blood glucose and fasting blood glucose was calculated,and the net increment of blood glucose after breakfast was also used to evaluate the occurrence of dawn phenomenon.Blood samples were collected at 7:00 a.m.,1:00 p.m.,7:00 p.m.and 1:00 a.m.and the concentrations of growth hormone,cortisol,insulin and melatonin were detected.In addition,the sleep monitoring was completed by the cardiopulmonary coupling-polysomnography equipment,and to calculate indicators who can evaluate sleep quality.The patients were divided into two groups according to whether there was dawn phenomenon,and the general demographic data,lipid metabolism,islet function,endocrine hormones,sleep quality and their possible effects on dawn phenomenon were analyzed.Results1.A total of 28 patients with type 2 diabetes were included in this study,including 19 males and 9 females,the age is 49.61 ± 10.98years and the course of diabetes mellitus is 8.47±6.34 years,of which 13 patients(46.43%)had a course of disease of more than 10 years.There were 11 patients with dawn phenomenon and 1 patient with Sumujie phenomenon.There was no significant difference in sex,age,course of disease,body mass index,elevated blood pressure,waist circumference,waist-to-hip ratio,insulin combination,and incidence of diabetic retinopathy and diabetic peripheral neuropathy between two groups.The patients with dawn phenomenon group(DP)had larger bilateral carotid intima-media thickness(CIMT)than non-dawn phenomenon group(NDP),and the difference was statistically significant.Single-factor logistic regression analysis showed that the dawn phenomenon had a statistically significant effect on CIMT.2.There were no significant differences in hemoglobin,renal function,uric acid,glycated hemoglobin,lipid metabolism indexes and islet function related indexes(HOMA-IR,HOMA-?)between the two groups.3.Continuous glucose monitoring analysis showed that the monitoring results matched well with fingertip blood glucose,and there was no significant difference in the total number of blood glucose monitoring between the two groups.The Largest Amplitude Of Glycemic Excursions(LAGE),24-hour Mean Amplitude of Glycemic Excursions(MAGE),glucose coefficient of variation(CV)and glucose standard deviation(SD)in the dawn phenomenon group were higher than those in the non-dawn phenomenon group.And thd time in range was significantly lower than that in the group without dawn phenomenon(P?0.05).Taking dawn phenomenon as dependent variable and dynamic blood glucose fluctuation parameter as independent variable,Logistic regression analysis showed that the adverse effects of dawn phenomenon on MAGE,CV,SD and LAGE were statistically significant(P?0.05).4.The changes of cortisol concentration,melatonin concentration and insulin concentration in the two groups were basically the same in 7pm-1am.The concentration of serum growth hormone in the two groups showed an upward trend at 7pm-1am,and there was statistical significance at 7am between two groups.5.We evaluated the patients' sleep quality according to the data from CPC-PSG.The total number of wakes during the night sleep in the dawn phenomenon group was significantly higher than that in the non dawn phenomenon group,and the difference was statistically significant(P?0.05).The sleeping time,total sleep time,non rapid eye movement sleep period(REM)duration and the proportion of REM period in the DP group were all higher than those in the NDP group,and the sleep efficiency,stable duration,stable ratio and AHI index were lower than those in the DNP group.We found that the above indicators including the total number of wakes had no statistical significance on the occurrence of dawn phenomenon according to logistic regression analysis.ConclusionsDawn phenomenon in hospitalized patients with type 2 diabetes may increase the possibility of poor blood glucose control throughout the day.Among the factors affecting the occurrence of dawn phenomenon,the increase of growth hormone concentration in the morning is the main risk factor.The increase of the total number of awakening during sleep may be the sleep factor leading to dawn phenomenon,but age,sex,course of disease,combination of insulin and blood lipid metabolism have no significant effect on the occurrence of dawn phenomenon.The intima-media thickness of carotid artery in dawn phenomenon group was significantly higher than that in non-dawn phenomenon group,which may be a risk factor for the increase of carotid intima-media thickness. |
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