2型糖尿病血糖波动指标与体脂分布的关系

Relationship between fluctuation of blood glucose and adipose tissue distribution in type 2 diabetes mellitus

目的探讨2型糖尿病(T2DM)患者血糖波动指标与体脂分布的关系。方法收集T2DM患者102例,根据2017年《中国糖尿病患者血糖波动管理专家共识》计算出各项血糖波动指标,测量腹部皮下脂肪组织(SAT)和内脏脂肪组织(VAT)面积。根据VAT面积分为VAT<100 cm^(2)组和VAT≥100 cm^(2)组,比较两组间血糖波动指标与体脂肪分布和各项生化指标的差异,Pearson相关分析法分析血糖波动指标与体脂肪分布指标的相关性。结果与VAT<100 cm^(2)组相比,VAT≥100 cm2组身高、体质量、体质量指数(BMI)、体脂指数(FMI)、VAT、SAT、VAT/SAT、腰围、臀围、胰岛素抵抗指数(HOMA-IR)升高(P均<0.05)。Pearson相关分析显示,血糖水平标准差与VAT/SAT、HbA1c、HOMA-IR呈正相关(r分别为0.228、0.283、0.260,P均<0.05);餐后血糖波动幅度与胰岛β细胞功能(HOMA-β)呈负相关(r=-0.248,P<0.05);最大血糖波动幅度与VAT/SAT、HbA1c、HOMA-IR呈正相关(r分别为0.210、0.293、0.260,P均<0.05);血糖平均值与HbA1c、HOMA-IR呈正相关(r分别为0.516、0.412,P均<0.05),与胰岛素敏感指数(HOMA-ISI)呈负相关(r=-0.369,P<0.05)。结论血糖波动与VAT/SAT、HbA1c、HOMA-IR呈正相关;与HOMA-β、HOMA-ISI呈负相关;内脏脂肪面积越大血糖波动越大,SAT面积越大血糖波动越小,减少VAT和/或增加SAT可降低T2DM患者血糖波动。

Objective To investigate the relationship between fluctuation of blood glucose and adipose tissue distribution in type 2 diabetes mellitus(T2DM)patients.Methods Totally 102 T2DM patients were collected.According to the 2017 Expert Consensus on Blood Glucose Fluctuation Management of Chinese Diabetes Patients,blood glucose fluctuation index was calculated.Subcutaneous adipose tissue(SAT)area and visceral adipose tissue(VAT)area were measured.We divided the patients into the VAT<100 cm^(2) group and VAT≥100 cm^(2) group based on VAT area,and compared the differences of blood glucose fluctuation,adipose tissue distribution and clinical factors.Pearson correlation analysis was performed to analyze the correlation between blood glucose fluctuation index and clinical factors.Results Compared with the VAT<100 cm^(2) group,the height,body mass,body mass index(BMI),body fat index(FMI),VAT,SAT,VAT/SAT,waist circumference(WC),hip circumference(HC),and insulin resistance index(HOMA-IR)of the VAT≥100 cm2 group increased(all P<0.05).Pearson correlation analysis showed that,the standard deviation of blood glucose(SDBG)was positively correlated with VAT/SAT,HbA1C,and HOMA-IR(r=0.228,0.283,and 0.260,respectively;all P<0.05).The negative correlation was found between postprandial glycemic excursion(PPGE)and pancreatic isletsβcell function(HOMA-β)(r=-0.248,P<0.05).Large amplitude of glycemic excursion(LAGE)was positively correlated with VAT/SAT,HbA1c,HOMA-IR(r=0.210,0.293,and 0.260,respectively;all P<0.05);mean blood glucose(MBG)was positively correlated with HbA1C and HOMA-IR(r=0.516,0.412,respectively;both P<0.05),but was negatively correlated with HOMA-ISI(r=-0.369,P<0.05).Conclusions The blood glucose fluctuation is positively correlated with VAT/SAT,HbA1C,and HOMA-IR,and is negatively correlated with HOMA-βand HOMA-ISI.The larg-er the VST area,the greater the blood glucose fluctuation,and the larger the SAT area,the smaller the blood glucose fluc-tuation,suggesting that reducing VAT and/or increasing SAT can reduce the blood glucose fluctuation in T2DM patients.