Correlation Between Blood Glucose Fluctuation And Severity Of Vascular Disease In Type 2 Diabetic Patients With Normal HbA1c

Objective:This study mainly investigated the relationship between blood glucose fluctuation and the severity of vascular disease in patients with type 2 diabetes mellitus(T2DM),providing a new idea for the clinical prevention of diabetic vascular complications.Methods:A retrospective analysis of 164 patients who were admitted to the Endocrinology Unit of the First Affiliated Hospital of Soochow University from September 2017 to August 2019 and were diagnosed with T2DM was reviewed retrospectively.These patients are 24-85 years old,average age were 61.38±12.28 years old.Among them,86 cases(52.44%)were males,with an average age of 60.15±11.90 years old;78 cases(47.56%)were female,with an average age of 62.73±12.69 years old.All patients recorded their age,gender,course of disease,body mass index(BMI),history of hypertension,biochemical criterion and glycosylated hemoglobin(HbAlc)in detail.We calculated blood glucose fluctuation index by blood glucose value seven times a day,including standard deviation of blood glucose(SDBG),largest amplitude of glycemic excursions(LAGE),postprandial glucose excursion(PPGE).Ankle-brachial index(ABI)measurement and carotid artery ultrasound were performed for each patient during hospitalization,and the patients were divided into T2DM-only group,T2DM combined with one complication group,T2DM combined with two complications group.The differences in blood glucose fluctuation indexes between the groups were compared and the correlation between blood glucose fluctuations and T2DM vascular lesions was analyzed.Results:1.According to the results of ABI and carotid ultrasound,the 164 patients selected were divided into T2DM-only group(69 cases),T2DM combined with one complication group(74 cases),and T2DM combined with two complications group(21 cases).Three groups of patients SDBG(P<0.001),LAGE(P<0.001),and PPGE(P=0.006)were statistically significant.There were statistical differences between the three groups in age(P<0.001),ABI(P<0.001),carotid scores(P<0.001),the number of carotid plaques(P<0.001),the maximum plaque area of the carotid artery(P<0.001),TG(P=0.020),SCr(P=0.033),duration(P=0.007),hypertension(P<0.001),Hs-CRP(P=0.008),however,gender(P=0.101),BMI(P=0.789),TC(P=0.050),HDL-C(P=0.913),LDL-C(P=0.063),UA(P=0.531),HbA1c(P=0.637)were not statistically different.2.Spearman correlation analysis showed that SDBG,LAGE,PPGE were negatively correlated with ABI(r=-0.307,P<0.01;r=-0.339,P<0.01;r=-0.264,P<0.01).Spearman correlation analysis also showed that SDBG and LAGE were positively correlated with carotid scores(r=0.208,P<0.01;r=0.219,P<0.01),and positively correlated with the number of carotid plaques(r=0.222,P<0.01;r=0.235,P<0.01),which was positively correlated with the maximum plaque area of the carotid artery(r=0.215,P<0.01;r=0.224,P<0.01).3.Blood glucose fluctuations were divided into normal blood glucose fluctuation group(SDBG<2.0 mmol/L)and abnormal blood glucose fluctuation group(SDBG?2.0 mmol/L)according to the SDBG index.The ABI in the abnormal blood glucose fluctuation group was lower than that in the normal blood glucose fluctuation group(Z=-2.901,P=0.004).The carotid arterial score in the abnormal blood glucose fluctuation group was higher than that in the normal blood glucose fluctuation group(Z=-2.866,P=0.004).The number of carotid plaques in the abnormal blood glucose fluctuation group was more than that in the normal blood glucose fluctuation group(Z=-2.770,P=0.006).The maximum carotid plaque area in the abnormal blood glucose group was larger than that in the normal blood glucose group(Z=-3.018,P=0.003).4.The area under the receiver operating characteristic curve(ROC curve)predicted by SDBG for lower extremity arterial diseases was 0.916(95%confidence interval:0.861-0.971).The optimal cutoff value for SDBG was 2.16,the sensitivity was 92.0%,and the specificity was 74.1%.The area under the ROC curve predicted by LAGE for lower extremity arterial diseases was 0.924(95%confidence interval:0.865-0.983),the best boundary variable for LAGE was 6.35,the sensitivity was 88.0%,and the specificity was 84.2%.The area under the ROC curve predicted by PPGE for lower extremity arterial diseases was 0.737(95%confidence interval:0.629-0.845).The optimal cutoff value for PPGE was 2.16,the sensitivity was 41.3%,and the specificity was 81.3%.5.The area under the ROC curve predicted by SDBG for carotid plaque was 0.614(95%confidence interval;0.529-0.700).The optimal cutoff value for SDBG was 2.01,the sensitivity was 50.5%,and the specificity was 72.6%.The area under the ROC curve predicted by LAGE for carotid plaque was 0.619(95%confidence interval:0.534-0.704).The best cutoff value for LAGE was 6.05,the sensitivity was 24.0%,and the specificity was 82.2%.The area under the ROC curve predicted by PPGE for carotid plaque was 0.505(95%confidence interval:0.416-0.594).The optimal cutoff value for PPGE was 0.45,the sensitivity was 74.7%,and the specificity was 17.8%.Conclusions:1.SDBG,LAGE,and PPGE were significantly different between the T2DM-only group,the T2DM combined with one complication group,and the T2DM combined with two complications group,which increased with increasing complications.2.The greater the blood glucose fluctuations,the more severe the vascular disease in T2DM patients.