住院2型糖尿病病人血糖波动异常与身体成分的相关性

Correlation between abnormal glucose fluctuation index and body composition in hospitalized patients with type 2 diabetes mellitus

目的探讨2型糖尿病病人血糖波动指数平均血糖波动幅度(MAGE)、血糖水平标准差(SDBG)与身体成分组分[体脂肪百分比、内脏脂肪面积(VFA)、骨骼肌含量(SMM)、细胞外水分等]的相关性。方法收集2018年6月至2019年12月在苏州大学附属第一医院内分泌科住院治疗的2型糖尿病病人189例(年龄范围为23~82岁;男113例,女76例),维持原降糖方案,分为正常血糖波动组116例(MAGE<3.9 mmol/L)和异常血糖波动组73例(MAGE≥3.9 mmol/L),比较两组临床资料,分析MAGE、SDBG与VFA、SMM等组分的关系。结果正常血糖波动组的体脂肪百分比[(38.5±4.5)%比(31.9±3.9)%]、VFA和SMM高于异常血糖波动组(P<0.05);Spearman相关分析结果表明,VFA和SMM分别与MAGE、SDBG呈负相关(P<0.01);分别以MAGE、SDBG为因变量,多重线性回归结果显示VFA是MAGE、SDBG的独立影响因素,随着VFA的增加,MAGE、SDBG逐渐降低(P<0.05);二元logistic回归结果显示VFA是2型糖尿病病人血糖波动异常发生的独立保护因素(P<0.05);而SMM不是血糖波动的独立影响因素(P>0.05)。结论内脏脂肪面积可能是2型糖尿病病人发生血糖波动的独立保护因素。

Objective To investigate the correlation between blood glucose fluctuation index(MAGE),standard deviation of blood glucose level(SDBG),and body composition[percentage of body fat,visceral fat area(VFA),skeletal muscle mass(SMM)extracellular water content,etc]in patients with type 2 diabetes mellitus(T2DM).Methods Total of 189 T2DM patients(age ranging from 23 to 82 years old,113 male and 76 female)admitted to the Department of Endocrinology of The First Affiliated Hospital of Suzhou University from June 2018 to December 2019 were enrolled in this study.Patients reated with the previous hypoglycemic agents,T2DM patients were assigned into nomal glucose fluctuation group(n=116,MAGE<3.9 mmol/L)and abnormal glucose fluctuation group(n=73,MAGE≥3.9 mmol/L).The clinical data were collected and compared among the two groups,and the relationship between MAGE,SDBG,VFA and SMM were analyzed.Results The percentage of body fat[(38.5±4.5)%vs.(31.9±3.9)%],VFA and SMM in nomal glucose fluctuation group were higher than those in abnormal glucose fluctuation group(P<0.05).Spearman analysis showed that VFA and SMM were negatively correlated with MAGE and SDBG,respectively(P<0.01).Successively using MAGE and SDBG as dependent variables,the multiple linear regression results showed that VFA was an independent influential factor of MAGE and SDBG,and MAGE and SDBG gradually decreased with the increase of VFA(P<0.05).Binary logistic regression showed that VFA was independent protective factor for abnormal glucose fluctuation index in type 2 diabetes patients(P<0.05).Conclusion Visceral fat area may be an independent protective factor for blood glucose fluctuation in T2DM patients.