Relationship Between Non-alcoholic Fatty Liver Disease And Glycemic Variability And TCM Syndrome Differentiation In Patients With Type 2 Diabetes Mellitus

Objectives: Objective It is to investigate the relationship between non-alcoholic fatty liver disease(NAFLD)and Glycemic Variability and TCM syndrome differentiation in patients with type 2 diabetes,trying to provide reference for clinical treatment.Methods: This study randomly selected 150 cases of patients with T2DM,who match the inclusion and do not meet exclusion standard,and are from Chengdu university of traditional Chinese medicine in the time from March 2017 to 2020.Relevant dates include General clinical data,laboratory indicators,7-point fingertip blood glucose for three consecutive days and TCM four-consultation information were collected.According to whether combined non-alcoholic fatty liver disease had divided into simple T2DM group and T2DM + NAFLD group.The clinical characteristics were compared and analyzed,including the correlation between non-alcoholic fatty liver disease and blood glucose fluctuation and TCM syndromes in patients with type 2 diabetes.Results:1.Compared between the two groups,gender,age and duration of diabetes were statistically significant(P > 0.05);BMI and waist circumference in the T2DM + NAFLD group were significantly greater than simple T2DM group,(P < 0.05).2.There was a difference in liver function between the two groups;the levels of ALT,AST and GGT in the T2DM + NAFLD group were higher than those in the simple T2DM group,and the difference was statistically significant(P < 0.05).3.Comparing the levels of blood lipids between the two groups,the level of HDL-C in T2DM + NAFLD group was higher than that simple T2DM group,and the average level of HDL-C in simple T2DM group was higher than that T2DM + NAFLD group,and the difference was statistically significant(P < 0.05).There was no significant difference in TC and LDL-C between the two groups(P > 0.05).4.Comparing the blood glucose levels of the two groups,there were no significant differences in Hb A1 c,1h PG,2h PG and 3h PG between the two groups(P > 0.05),and the average level of fasting blood glucose in T2DM + NAFLD group was higher than that simple T2DM group(P < 0.05).5.Comparing the blood glucose fluctuation levels of the two groups,the average SDBG,PPGE and LAGE of T2DM + NAFLD group were significantly higher than simple T2DM group(P < 0.05).There was no significant difference in CV-FPG and MODD between the two groups(P > 0.05).6.Comparing the related indexes of islet function between the two groups,the levels of HOMA-IR and FINS in the T2DM + NAFLD group were higher than those in the simple diabetes group(P < 0.05).7.There was a statistical difference in the distribution of TCM syndromes between the two groups(P < 0.05),while the TCM syndromes of the T2DM + NAFLD group were mainly concentrated in the phlegm-dampness syndrome and the liver-depression and spleen-deficiency syndrome?8.Binary multivariate logistic regression showed that:(1)SDBG,waist circumference,BMI,TG and HOMA-IR were risk factors for type 2 diabetes mellitus complicated with nonalcoholic fatty liver disease,and SDBG was an independent risk factor.(2)Type 2 diabetes patients with liver depression and spleen deficiency syndrome and phlegm-dampness mutual-junction syndrome were more likely to have non-alcoholic fatty liver.9.Quartiles were divided according to SDBG level.With the increase of SDBG level,the prevalence of NAFLD,TG,waist circumference and BMI were increased,and there were statistical differences(P<0.05).10.Logistic regression analysis of type 2 diabetes mellitus with or without nonalcoholic fatty liver disease in different TCM syndromes:The higher the waist circumference and TG level,the greater the probability of combined NAFLD in T2DM with phlegm-dampness syndrome;the larger the waist circumference and HOMA-IR,the higher the probability of combined NAFLD in T2DM with Qi-Yin deficiency syndrome;the higher the FPG and HOMA-IR levels,the greater the probability of combined NAFLD in T2DM with liver-depression and spleen deficiency syndrome;the higher the TG level,the greater the probability of combined NAFLD in heat-excessive injury syndrome,Qi deficiency and blood stasis syndrome.Conclusions: 1.Glycemic variability is an independent risk factor for NAFLD in type 2 diabetic patients.2.Obesity,insulin resistance and lipid metabolism disorder are the main risk factors for type 2 diabetes complicated with nonalcoholic fatty liver disease.Moreover,NAFLD is associated with waist circumference and insulin resistance higher than BMI.3.The occurrence of NAFLD in patients with type 2 diabetes is associated with TCM syndrome differentiation.And the common TCM syndromes of type 2 diabetes mellitus patients with NAFLD are phlegm-dampness mutual junction syndrome,liver depression and spleen deficiency syndrome.It may provide a reference for TCM syndrome differentiation and treatment of type 2 diabetes mellitus complicated with NAFLD.