Distribution Characteristics Of TCM Syndrome Elements And Fluctuation Of Blood Glucose In Type 2 Diabetes Mellitus With Insomnia

Objective: Based on the investigation of type 2 diabetes mellitus(T2DM)patients,this paper discusses the distribution characteristics of TCM syndrome elements in T2 DM patients with insomnia.The score of TCM Syndrome elements,blood glucose fluctuation index and other laboratory indexes were compared between T2 DM patients with insomnia and T2 DM patients without insomnia.Through statistical analysis,the risk factors of insomnia in T2 DM and blood glucose fluctuation in T2 DM were explored,so as to provide prevention and treatment basis for T2 DM and its patients with insomnia.Methods: A cross-sectional study was conducted to collect patients with type 2 diabetes mellitus complicated with insomnia and controls who met the inclusion criteria from January2020 to December 2020 in the Department of Endocrinology,Xiamen Hospital of traditional Chinese medicine.The "Pittsburgh sleep quality index scale" and the "four diagnostic information collection form" provided by the syndrome element research base of Fujian University of traditional Chinese medicine were used to collect the sleep quality score,TCM four diagnostic information,demographic data and clinical data of 271 patients.The TCM syndrome element system was used to input data,and the corresponding syndrome element integral was obtained.According to the diagnosis of TCM syndrome elements,taking 100 as the general threshold(integral of syndrome element≥100),the charater of TCM syndrome elements and the location of TCM syndrome elements of T2 DM with insomnia were obtained.The differences of blood glucose fluctuation and other physical and chemical indexes between T2 DM with insomnia and T2 DM without insomnia were analyzed.At the same time,to explore the risk factors of insomnia in T2 DM and blood glucose fluctuation in T2 DM.SPSS22.0 software was used for analysis.The main methods included descriptive analysis,chi square test,t test,rank sum test,binary logistic regression analysis,etc.P < 0.05 was the significant difference.Results:1.A total of 271 patients with T2 DM were included in this study.Among them,124 patients with T2 DM and insomnia,accounting for 45.76%,were classified as insomnia group;147patients without T2 DM and insomnia,accounting for 54.24%,were classified as non insomnia group.2.Compared with the non insomnia group,the course of insomnia group was longer,and the difference was statistically significant(P<0.05).There was no significant difference in gender,age,BMI,systolic blood pressure and diastolic blood pressure between the two groups(P>0.05).3.The comparison of blood glucose fluctuation index and other physical and chemical indexes between the two groups showed that there was no statistical difference in the average blood glucose between the two groups,and they were all patients with hyperglycemia;the standard deviation of blood glucose level(SDBG),postprandial blood glucose fluctuation amplitude(PPGE)and maximum blood glucose fluctuation amplitude(lage)of insomnia group were significantly higher than those of non insomnia group,and the difference was statistically significant(P<0.01).There was no significant difference in total cholesterol(CHO),triglyceride(TG),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C),fasting C-peptide(C-P),glycosylated hemoglobin(Hb A1c),cortisol(COR)between the two groups.4.Logistic regression analysis suggests: smoking history,DN,COR are risk factors for insomnia.The probability of insomnia in T2 DM patients with a history of smoking is about 3times that of T2 DM patients without a history of smoking;the probability of insomnia in patients with DN is about 4 times that of T2 DM patients without DN;every 1 nmol/L increase in COR will cause insomnia The probability of increasing by 0.3%.5.Multiple linear regression analysis suggests: PSQI,HDL-C,LDL-C,and division of labor are important factors that affect the values of SDBG,PPGE,and LAGE.Among them,BMI,HDL-C and blood glucose fluctuation indicators are independently and negatively correlated,PSQI,LDL-C is independently positively correlated with blood glucose fluctuation indicators,mental work is a protective factor for blood glucose fluctuation indicators;Hb A1 c is independently positively correlated with SDBG and LAGE,and BMI is independently negatively correlated with SDBG and LAGE;age is independently positively correlated with PPGE.Women are a protective factor for values of PPGE.6.Among the 124 T2 DM patients with insomnia,the top ten TCM symptoms were as follows:75 cases of thirst(60.48%),68 cases of shallow sleeping(54.84%),66 cases of fatigue(53.23%),60 cases were blurred vision(48.39%),50 cases were numbness of limbs(40.32%),45 cases were dizziness(36.29%),38 cases were bitter mouth(30.65%),35 cases were nocturia(28.23%),33 cases were dry stool(26.61)%),33 cases of dry eyes(26.61%).7.Using the TCM syndrome element system to obtain the corresponding syndrome element scores,among the 124 T2 DM patients with insomnia,115 cases had scores ≥100,accounting for 92.74%,and 9 cases had scores less than 100,accounting for 7.26%;Among the 147 patients with T2 DM without insomnia,110 cases had a score of ≥100,accounting for 73.83%,and 37 cases had a score of less than 100,accounting for 25.17%.8.Among 115 T2 DM patients with insomnia whose score was more than or equal to 100,the frequency of the character of TCM syndrome elements ranked first from high to low were:Yin deficiency in 94 cases(75.81%),Qi deficiency in 56 cases(45.16%),dampness in 56cases(45.16%),heat in 51 cases(41.13%),blood deficiency in 45 cases(36.29%),phlegm in44 cases(35.48%).The frequency of the location of TCM syndrome elements ranked first from high to low were:,54 cases(43.55%)were liver,52 cases(41.94%)were kidney,20cases(16.13%)were spleen,12 cases(9.68%)were stomach and 12 cases(9.68%)were heart.9.The scores of syndrome elements such as yin deficiency,qi deficiency,blood deficiency,yang deficiency,qi stagnation and liver in the insomnia group were higher than those in the non-insomnia group,and the difference was statistically significant(P<0.05).However,there was no significant difference in the scores of dampness,heat,phlegm,kidney,spleen and other syndrome elements between the two groups(P>0.05).Conclusion:1.The blood glucose fluctuates greatly in patients with T2 DM and insomnia,among which smoking history,DN and COR are risk factors for insomnia in patients with T2DM2.PSQI score,LDL-C and Hb A1 c were positively correlated with blood glucose fluctuation index,while BMI and HDL-C were negatively correlated with blood glucose fluctuation index.The predictive value of blood glucose fluctuation of mental workers is lower than that of manual workers.3.The charater of TCM syndrome elements of T2 DM patients with insomnia mainly focus on Yin deficiency,Qi deficiency,dampness,heat,blood deficiency and phlegm;the location of TCM syndrome elements mainly focus on liver,kidney,spleen,stomach and heart.