| Background Some studies have found that there is a correlation between erythrocyte distribution width(red blood cell distribution width,RDW)and type 2diabetes mellitus(T2DM),but there are few reports on the relationship between RDW and chronic complications of T2DM[diabetic retinopathy(DR),diabetic nephropathy(DN),diabetic peripheral neuropathy(DPN),diabetic foot].Objective To explore the correlation between RDW and chronic complications in patients with T2DM and its influencing factors.Methods Using a retrospective study,A total of 225 eligible inpatients were collected at the First Affiliated Hospital of Dalian Medical University from October2017 to January 2023,All patients had access to age,sex,course of disease,blood pressure(SBP,DBP),erythrocyte distribution width(RDW),fasting venous blood glucose(FBG),glycosylated hemoglobin(HbA1c),body mass index(BMI),serum hemoglobin(Hb),low density lipoprotein(LDL-C),smoking and other related data.According to the standard of nano-discharge,220 cases were selected as the object of study.According to RDW,all participants were further divided into four quartile groups(Q1,Q2,Q3,Q4).The measured data with normal distribution were described by mean±standard deviation,and the inter-group comparisons were described by independent sample T-test or one-way ANOVA.Metered and skewed data were described by median,and non-parametric Kruskal-Wallis test was used for inter-group comparison.The counting data were expressed as examples and percentage,and the comparison between groups was made byχ~2 test.Taking the chronic complications of T2DM(DR,DN,DPN,diabetic foot)as dependent variables,binary Logistic regression analysis was performed to determine the independent influencing factors.Result1.General data:a total of 220 patients with T2DM were included(male 128 cases,accounting for 58.2%,female 92 cases,accounting for 41.8%),the age was 53.69±13.31 years(mean±standard deviation),BMI was 25.31±3.76(mean±standard deviation),and the median course of T2DM was 8 years.2.Laboratory materials:RDW(12.62±0.90%),SBP(134.84±15.59 mm Hg),DBP(84.00±9.33 mm Hg),FBG median(8.77 mmol/L),HbA1c(9.91±2.16%),LDL-C(2.99±0.89 mmol/L),Hb(141.28±16.52 g/L);82 patients(37.3%)had regular smoking in the week before admission.A total of 185 cases(84.1%)had chronic complications of at least one type of T2DM,80 cases(36.4%)had one type,60 cases(27.3%)had two types,43 cases(19.5%)had three types,and 2 cases(0.9%)had four types.Of these,99(45%)had DR,175(79.5%)had DPN,60(27.3%)had DN,and 5(2.3)had diabetic foot.3.Statistical analysis results:after RDW grouping,there were differences in age(P=0.013),course(P=0.000),SBP(P=0.012),Hb(P=0.000),DR(P=0.027)and DN(P=0.000)in Q1-Q4 group.No differences were found in gender(P=0.205),smoking(P=0.405),DBP(P=0.642),BMI(P=0.543),FBG(P=0.422),HbA1c(P=0.353),LDL-C(P=0.250),DPN(P=0.440)and at least one chronic complication(P=0.643).In the correlation analysis,RDW was positively correlated with age(r=0.18),course of disease(r=0.36)and SBP(r=0.18),but negatively correlated with Hb(r=0.36).Three binary Logistic regression models were used to study the influencing factors of chronic complications of T2DM(DR,DN,DPN).The results showed that RDW was the influencing factor of DR[model 1(95%CI)=1.572(1.154,2.142)]and DN[model 1(95%CI)=1.065(1.027,1.104)].Among them,RDW is an independent influencing factor with DN(model 3 or(95%CI)=1.597(1.086,2.349).There was no statistical correlation between RDW and DPN.The course of disease was the independent influencing factors of DR[model 3(95%CI)=1.106(1.054,1.161),DN[model 395%CI=1.060(1.009,1.113)and DPN[model 3 95%CI=1.124(1.053,1.200].SBP had no effect on DR and DPN,but it was an independent influencing factor of DN[model 3(95%CI)=1.037(1.009,1.065)].After adjusting for confounding factors,age became an independent influencing factor of DR[model 3(95%CI)=0.962(0.934,0.992)].At the same time,age has a certain influence on DPN[model 1(95%CI)=1.037(1.011,1.063)].In the subgroup analysis of DN,only in patients with a course of disease of more than 10 years(model 3(95%CI)=2.174(1.144,4.133))and poor control of HbA1c level(>7%)[model 3(95%CI)=3.729(1.570,8.857)]and age is over 45 years old[model 3(95%CI)=1.815(1.112,2.961)],RDW was an important influencing factor of DN in the three models.In addition,only in patients with poor control of HbA1c(>7%),the course of disease[model 3(95%CI)=1.073(1.019,1.130)]and SBP[model 3(95%CI)=1.036(1.006,1.066)]were the important influencing factors of DN in all three models.Conclusion1.There is a significant positive correlation between RDW and DN,which is an independent influencing factor of DN;there is a positive correlation between RDW and DR,but it is not an independent influencing factor of DR,while there is little relationship between RDW and DPN.2.RDW,diabetes duration and SBP were positively associated with DN prevalence of T2DM.Higher risks of DN for T2DM patients with a course of more than 10 years,poor control of HbA1c levels and T2DM patients over 45 years.3.A positive correlation between RDW and SBP,age and diabetes duration,and a negative correlation with Hb.4.This study is of great significance in using RDW as a monitoring index for the diagnosis,detection and treatment of T2DM and its chronic complications,especially for the diagnosis and treatment of DN.Because RDW is a cheap,non-invasive and convenient index,RDW can be considered to be included in the risk assessment of high-risk groups of diabetes,especially in the risk assessment of DN. |
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