血糖波动与2型糖尿病亚临床周围神经病变的相关性

Correlation between glucose fluctuation and subclinical peripheral neuropathy in type 2 diabetes

目的 分析血糖波动与2型糖尿病(T2DM)亚临床周围神经病变(sDPN)的相关性。方法 纳入T2DM sDPN患者153例为sDPN组,无DPN T2DM患者186例为非DPN组,比较两组患者临床指标及血糖波动。多因素Logistic回归分析T2DM患者并发sDPN与血糖波动的关系,ROC分析血糖波动对T2DM患者合并sDPN的预测价值。结果 与非DPN组相比,sDPN组空腹血糖、平均血糖(MBG)、血糖标准差(SDBG)、血糖变异系数(CV)、平均血糖波动幅度(MAGE)、最大血糖波动幅度(LAGE)及葡萄糖高于目标范围(TAR)的时间更高,葡萄糖目标范围内时间(TIR)更低(P<0.05)。多因素Logistic回归分析显示,MBG、SDBG、CV、MAGE、LAGE及TAR为T2DM并发sDPN的危险因素,TIR为其保护因素。ROC曲线显示危险因素MAGE曲线下面积最大。结论 血糖波动与T2DM患者合并sDPN密切相关,关注血糖波动有助于早期发现和治疗糖尿病神经病变。

Aim To anylyze the correlation between glucose fluctuation and subclinical peripheral neuropathy(sDPN) in type 2 diabetes mellitus(T2DM). Methods 153 cases of T2DM patients with sDPN were included in the sDPN group, and 186 cases of T2DM patients without DPN were included in the non-DPN group, the clinical indexes and glucose fluctuations of the two groups were compared. Multivariate Logistic regression was used to analyze the relationship between T2DM patients complicated with sDPN and glucose fluctuation, and ROC was used to analyze the predictive value of glucose fluctuation on T2DM patients complicated with sDPN. Results Compared with the non-DPN group, the sDPN group had longer disease duration, more higher levels of fasting blood glucose, mean blood glucose(MBG), standard deviation of blood glucose(SDBG), coefficient of variation(CV) of blood glucose, mean amplitude of glycemic excursions(MAGE), largest amplitude of glycemic excursions(LAGE) and time above range(TAR);and lower level of time in range(TIR). Multifactorial Logistic regression analysis corrected for confounders showed that MBG, SDBG, CV, MAGE, LAGE and TAR were risk factors for sDPN, and TIR was its protective factor in T2DM patients. The ROC curve shows that the area under the MAGE curve of risk factor is the largest. Conclusion Glucose fluctuation is closely related to combined sDPN in T2DM patients and paying attention to the fluctuation of glucose fluctuation is helpful for early detection and treatment of diabetic neuropathy.