The Association Between Visceral Adipose Tissue And Hypoglycemia In Type 2 Diabetes Mellitus

Objective:Hypoglycemia is the main obstacle to reach the standard of blood glucose in patients with type 2 diabetes mellitus.It is also a limiting factor to strengthen blood glucose control and reduce the risk of macrovascular and microvascular disease in type 2 diabetes mellitus.Identifying possible causes of hypoglycemia as early as possible and taking preventive measures can help reduce the risk of severe hypoglycemia.A large number of studies have confirmed that visceral fat?VAT?is closely related to type 2 diabetes mellitus?T2DM?and metabolic syndrome,but the relationship between VAT and hypoglycemia in type 2 diabetic patients has not been reported.The purpose of this study was to analyze the incidence of hypoglycemia in patients with T2DM in different body mass index?BMI?and VAT groups,and to explore the correlation between hypoglycemia and VAT and other risk factors affecting hypoglycemia.Methods:From July to December in 2018,a total of 204 patients with T2DM were enrolled in the department of endocrinology and metabolism in our hospital,including 118?57.8%?male and 86?42.2%?female with a median age of 60 years old.General data such as height,weight,waist circumference?WC?,hip circumference?HIP?were collected,BMI and waist hip ratio?WHR?were calculated,and the severity and frequency of hypoglycemia were investigated by questionnaires.Whether to take statins,angiotensin converting enzyme inhibitor?ACEI?,angiotensin II receptor antagonist?ARB?and calcium channel blocker?CCB?were recorded.Fasting C peptide?FCP?,postprandial 2h C peptide?PCP?,triglyceride?TG?,total cholesterol?TC?,high density lipoprotein cholesterol?HDL-C?,low density lipoprotein cholesterol?LDL-C?,glycosylated hemoglobin(HbA_1c),serum creatinine?Cr?and uric acid?UA?,VAT,subcutaneous fat?SAT?,carotid intima-media thickness?CIMT?,left and right arterial wave conduction?LPWV,RPWV?and left-right ankle-brachial index?LABI,RABI?were measured.The statistical analysis was carried out with SPSS 20.0 software.Independent sample t test or rank sum test was used to compare the measurement data,chi-square test was used to compare the counting data,and logistic regression analysis was used for multi-factor analysis.Pearson or Spearman correlation was used to analyze the correlation among variables.Bilateral test was used and the difference was statistically significant with P<0.05.Results:1.There was no significant difference in the incidence of hypoglycemia between the overweight BMI group??24kg/m²?and the normal BMI group?<24 kg/m²?.The incidence of hypoglycemia in abnormal VAT group?VAT?100cm²?were lower than that in normal VAT group?P<0.05?.2.Correlation analysis between VAT and other indicators.The results showed that VAT was positively correlated with FCP?r_s=0.407?,PCP?r_s=0.340?,TG?r_s=0.482?,BMI?r=0.777?,and negatively correlated with HbA_1c?r=-0.164?and HDL-C?r=-0.233?,all P<0.05.3.The levels of WC,HIP,WHR,FCP,PCP,TG,BMI,VAT and SAT in hypoglycemic group were lower than those in non-hypoglycemic group?P<0.05?,and the duration of T2DM,frequency of insulin use and fatty liver in hypoglycemic group were higher than those in non-hypoglycemic group?P<0.05?.4.Multivariate logistic regression analysis showed that the duration of diabetes is a risk factor for hypoglycemia?OR 2.082,95%CI:1.277-3.396?.VAT and SAT are protective factors for hypoglycemia?all P<0.05?.The OR values were 0.338?95%CI:0.181-0.634?and 0.411?95%CI:0.222-0.759?,respectively?all P<0.05?.Conclusions:VAT is closely related to hypoglycemia in patients with T2DM and is a protective factor for hypoglycemia.Low VAT can be used as a potential predictor for identifying and screening of patients with high risk of hypoglycemia attack in clinical practice.It is of great significance to give early warning of high risk of hypoglycemia and guide the application of hypoglycemic drugs in patients with low VAT level.