Correlation Between Blood Glucose Fluctuation And Cardiac Autonomic Neuropathy In Patients With Type 2 Diabetes Mellitus

Objective:To explore the correlation between blood glucose fluctuation related indexes and cardiac autonomic neuropathy（DCAN）in patients with type 2 diabetes mellitus.Methods:A total of 343 patients with type 2 diabetes mellitus were selected as subjects.The sex,age,course of diabetes,fasting blood glucose（FPG）,fasting C peptide,glycosylated hemoglobin（Hb Alc）,triglyceride（TG）,total cholesterol（TC）,low density lipoprotein（LDL）,high density lipoprotein（HDL）,serum uric acid（UA）,serum creatinine（Scr）and urinary albumin creatinine ratio（UACR）were collected.Glucose fluctuation related indexes such as glucose within target range time（TIR）,glucose below target range time（TBR）,average blood glucose fluctuation range（MAGE）,blood glucose coefficient of variation（CV）,average blood glucose level（MG）,blood glucose standard deviation（SD）were obtained by dynamic blood glucose monitoring system.According to the results of Ewing test,all patients were divided into diabetic cardiac autonomic neuropathy group（DCAN group）and non-diabetic cardiac autonomic neuropathy group（NDCAN group）.The prevalence rate of DCAN was statistically analyzed,and the differences of clinical basic data and blood glucose fluctuation indexes between the two groups were compared.Multivariate Logistic regression was used to analyze the risk factors of DCAN.The predictive value of influencing factors on DCAN was analyzed by receiver operating characteristic（ROC）curve.Results:1.A total of 343 patients were enrolled in this study,including 201 cases in DCAN group and 142 cases in NDCAN group.The prevalence rate of DCAN was58.60%（201/343）.The age,diabetes course,UACR,MAGE,SD,CV and MG indexes of DCAN group were higher than those of NDCAN group,and TIR index was lower than that of NDCAN group,with statistical significance（P<0.05）.However,there were no significant differences in gender,blood pressure,BMI,FPG,fasting C-peptide,Hb Alc,TG,TC,LDL,HDL,UA,Scr and TBR between the two groups（P > 0.05）.2.Whether DCAN was used as the dependent variable,and the index with statistical difference between groups as the independent variable,the multivariate logistic regression analysis was conducted by Enter method.The results showed that the course of diabetes and MAGE were the risk factors of DCAN,and TIR was the protective factor of DCAN（P<0.05）.3.Further drawing ROC curve analysis,the results showed that the area under the curve（AUC）of diabetic course prediction DCAN was 0.643,the best diagnostic value was 4.50 years,the sensitivity and specificity were 72.60% and 53.50%,respectively,the AUC of MAGE predicted DCAN was 0.630,the best diagnostic value was4.46mmol/L,and the sensitivity and specificity were 50.70% and 69.00%,respectively.The AUC of DCAN predicted by tir was 0.684.The best diagnostic value was 76.48%,and the sensitivity and specificity were 71.10% and 59.20%,respectively（P < 0.05）.Conclusions:1.The prevalence of DCAN in patients with type 2 diabetes is high,which can be as high as 58.6%.The occurrence and development of DCAN patients is closely related to age,course of diabetes,UACR,MG,MAGE,SD,CV and TIR levels.2.The course of diabetes and MAGE are the risk factors of DCAN in patients with type 2 diabetes,and TIR is the protective factor.3.The course of diabetes,MAGE and TIR have certain clinical value in predicting the occurrence of DCAN.