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Objective:To investigate the characteristics of blood glucose fluctuation and risk factors in type 2 diabetic patients with asymptomatic hypoglycemia.Methods:From September 2018 to July 2021, 342 patients with type 2 diabete mellitus who were hospitalized in the Department of Endocrinology of Hefei Hospital Affilitated to Anhui Medical University were enrolled for a retrospective study. The mean amplitude of glycemic excursions(MAGE), coefficient of variation (CV), 24 hour mean blood glucose level (MG), and time in range (TIR) were obtained by continuous glucose monitoring (CGM). According to the results of CGM and whether the patients have hypoglycemia symptoms, they were divided into three groups: no hypoglycemia group, symptomatic hypoglycemia group, and asymptomatic hypoglycemia group. The differences in blood glucose fluctuations were compared among the three groups. Multivariate logistic regression analysis was used to evaluate the risk factors in type 2 diabete mellitus patients with asymptomatic hypoglycemia. The predictive value of MAGE for asymptomatic hypoglycemia was analyzed by receiver operating characteristic (ROC) curve.Results:Compared with the non-hypoglycemia group, the TIR in asymptomatic hypoglycemia group was higher ( Z=-2.042, P=0.041). The asymptomatic hypoglycemia group had lower MG, higher MAGE and CV compared with the other two groups(all P<0.05). Multivariate logistic regression analysis showed that urinary albumin/creatinine ratio (UACR), MAGE, and CV were the risk factors for asymptomatic hypoglycemia, while MG was the protective factor. After adjustment for other risk factors, MAGE was still associated with asymptomatic hypoglycemia ( OR=1.111, 95% CI 0.999-1.235, P=0.049). The sensitivity and specificity of MAGE in predicting asymptomatic hypoglycemia were 0.769 and 0.776, respectively. Conclusions:Patients with asymptomatic hypoglycemia present with larger TIR and MAGE. MAGE, UACR, and CV were risk factors for asymptomatic hypoglycemia. Moreover, MAGE has some predictive value for the occurrence of asymptomatic hypoglycemia.
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@#Objective To explore the relationship between glycated hemoglobin (HbA1c) level and blood glucose fluctuations after coronary artery bypass grafting (CABG) and adverse events in non-diabetic patients, thus providing theoretical support for intensive preoperative blood glucose management in patients undergoing CABG surgery. Methods A total of 304 patients undergoing CABG with or without valvular surgery from October 2013 to December 2017 were enrolled in this prospective, single-center, observational cohort study. We classified them into two different groups which were a low-level group and a high-level group according to the HbA1c level. There were 102 males and 37 females, aged 36–85 (61.5±9.5) years in the low-level group, and 118 males and 47 females aged 34–85 (63.1±9.4) years in the high-level group. The main results were different in hospital mortality and perioperative complications including in-hospital death, myocardial infarction, sternal incision infection, new stroke, new-onset renal failure and multiple organ failure. To assess the effects of confounding factors, multivariate logistic regression analysis was used. Results Postoperative blood glucose fluctuation was more pronounced in the high-level group than that in the low-level group before admission [0.8 (0.6, 1.2) mmol/L vs. 1.0 (0.8, 1.8) mmol/L, P<0.01]. This study also suggested that the incidence of major adverse events was significantly lower in the low-level group compared with the high-level group (P=0.001). Multivariate logistic regression analyses to correct the influence of other confounding factors showed that HbA1c (OR=2.773, P=0.002) and postoperative blood glucose fluctuations (OR=3.091, P<0.001) could still predict the occurrence of postoperative adverse events. Conclusion HbA1c on admission can effectively predict blood glucose fluctuations in 24 hours after surgery. Secondly, HbA1c on admission and postoperative blood glucose fluctuations can further predict postoperative adverse events. It is suggested that we control the patient's preoperative HbA1c at a low level, which is beneficial to control postoperative blood glucose fluctuation and postoperative adverse events.
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Objective To analyze the present situation of glucose metabolism and the characteristics of blood glucose fluctuation in in-hospital type l diabetic patients (T1DM). Methods One hundred and forty-three hospitalized cases of T1DM patients from November 2012 to November 2016 were retrospectively analyzed.The percentage of adult-onset T1DM patients was 76.22%(109/143)and none adult-onset was 23.78%(34/143). The following data were collected: general information, the indexes of glucose metabolism and islet function.Seventy-two-hour continuous glucose monitoring(CGM) was carried on 40 patients as a subgroup.Results The average age was(40.29 ± 16.79)years.The onset age of diabetes was(33.57 ± 17.18)years.The disease duration was 4.0(1.0,10.0)years.The body mass index(BMI)was(20.68 ± 2.95)kg/m2.The fasting blood glucose(FBG)was(12.02 ± 5.40)mmol/L.The HbA1c was(9.80 ± 2.65)%.The fasting C-peptide was 0.08(0.01,0.38)nmol/L.The 2-hour postprandial C-peptide (C-P 2 h) was 0.12(0.01, 0.70) nmol/L. The anti-glutamic acid decarboxylase antibody was 12.08(8.16,20.56)μg/L.The islet-cell antibody was 4.85(2.66,12.07)μg/L.By using multivariate linear regression analysis, HbA1c were negatively related to the duration and BMI of T1DM. CGM: the mean blood glucose was (10.34 ± 2.97) mmol/L. The standard deviation of blood glucose was (2.89 ± 1.07) mmol/L. The mean amplitude glycemic excursions was (7.10 ± 3.09) mmol/L. The incidence of hypoglycemia was 10.00% (≤ 2.8 mmol/L) and 32.50% (≤ 3.9 mmol/L). Conclusions Adult-onset T1DM patients account for more than two-thirds. In-hospital T1DM patients have poor control of blood glucose, and they show the clinical characteristics of high blood glucose fluctuation and more hypoglycemia.
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Objective To figure out the status of blood glucose fluctuations in patients with type 2 diabetes mellitus(T2DM)and explore its influencing factors. Methods A total of 105 T2DM cases were subjected to multiple surveys with questionnaires pertaining to general patient information,diabetes self-management,medical responses and social support as well as rating scales for the Pittsburg Sleep Quality Index and positive and negative emotions.Furthermore,the continuous glucose monitoring system(CGMS, Medtronic) was used to examine their blood sugar dynamics. Results The outcome of dynamic blood sugar monitoring showed,the standard deviation of blood glucose(SDBG)concentration was(2.41±0.91) mmol/L,the mean amplitude of glycemic excursion(MAGE)per day was(4.01±1.86)mmol/L,the median of glycemic excursion (LAGE)was 5.3 mmol/L,the median of the M-value was 5.13 mmol/L,the median for the means of daily difference(MODD)was 1.84 mmol/L and the median for low blood glucose indexes (LBMI)was 1.08 mmol/L. According to the results derived from multiple stepwise regression analyses, which used blood sugar fluctuation parameters as the variances. The results showed that: annual family income,glycosylated hemoglobin A1c(HbA1c),and diabetes self-management were shown to account for 51.5% of total SDBG variations;HbA1c,diabetes self-management,annual family income,social support and obedience could account for 76.3% of total MAGE variations;HbA1c,negative emotions and annual family income could account for 63.8% of total LAGE variations;HbA1c,annual family income,diabetes self-management and educational status could account for 52.3% of total M-value variations; HbA1c, negative emotions, diabetes self-management, annual family income and sleep quality could account for 48.0% of total MODD variations; HbA1c, annual family income and gender could account for 20.4% of total LBMI variation. Conclusions The T2DM patients, by contrast, demonstrated greater blood sugar fluctuations. HbA1c, annual family income, diabetes self-management, sleep quality, negative emotions and obedience were the main determinants that affect such fluctuations.
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Objective To investigation the influence of diabetes-specific enteral nutrition on stress-induced blood glucose fluctuations and clinical outcomes in septic patients receiving mechanical ventilation.Methods This randomized controlled study included 76 septic patients using mechanical ventilation,who were randomized to a diabetes-specific enteral nutrition group(n=38)and a control group(n=38).Both groups received identical blood glucose control therapy,and blood glucose levels were monitored during the first 72 hours.Blood glucose concentration at admission(BGadm),mean blood glucose level (MBG),blood glucose standard deviation(BGSD),largest amplitude of blood glucose excursion(LABGE),glycemic lability index(GLI),and total dose of intravenous insulin for the two groups were compared.The duration of mechanical ventilation,the length of respiratory intensive care unit (RICU) stay,28-day mortality,the rate of hematogenous infection,and feeding intolerance(FI) were also compared.Results (1) BGSD (mmol/L),GLI,and the total dose of intravenous insulin were significantly lower in the diabetes-specific enteral nutrition group than in the control group (BGSD:1.99±0.99 vs.2.36 ± 1.24;GLI:31.2±17.6 vs.47.8 ± 23.6;the total dose of intravenous insulin:70.3 ± 12.3 vs.77.3 ± 12.6,respectively;t =2.356,4.512,-2.695,all P ＜ 0.05).(2) The duration of mechanical ventilation (9.8 ± 4.6) d,the length of RICU stay (16.2 ± 6.5) d,and 28-day mortality(15.7 ％)in the diabetes-specific enteral nutrition group were significantly lower than in the control group(12.6±2.7)d,(23.4±8.5)d,46.4％,respectively) (t =-4.361,4.664,x2 =4.343,all P＜0.05);the rate of hematogenous infection(5.3％)and FI(7.9％)were significantly lower in the diabetes-specific enteral nutrition group than in the control group (21.1％,28.9 ％,P ＜ 0.05).Conclusions Diabetes-specific enteral nutrition can help reduce stress-induced blood glucose fluctuations and improve the clinical outcomes of septic patients receiving mechanical ventilation.
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Objective To learn the injury severity and the possible mechanism of the thyroid tissue of DM rats with different levels of glucose levels. Methods Firstly,20 Wistar rats were treated with STZ to create the experimental diabetic rats models. Then,the DM rats were divided into two groups including the persistence hyperglycemia group(n = 10),and blood glucose fluctuation group(n = 10). Another 10 Wistar rats were treated as the control group. Rats were sacrificed after 12 week treatment. The bilateral thyroid were weighted and the blood biochemistry tests were conducted for detecting glucose level,lipid levels,and thyroid functions. The ultra - structure of thyroid tissue was observed using electron microscope. Results The MBG,LAGE,and SDBG of blood glucose fluctuation group and the persistence hyperglycemia group were all higher than the control group(P ﹤ 0. 05). The MBG of blood glucose fluctuation group were lower than the persistence hyperglycemia group(P ﹤ 0. 05),the SDBG and LAGE were higher than the persistence hyperglycemia group(P ﹤ 0. 05). The TC,FPG,and HbA1c levels of DM rats were significantly higher in blood glucose fluctuation group than in control group(P ﹤ 0. 05). TC ,FPG and TG levels of the DM rats in blood glucose fluctuation group were significantly lower than the rats in persistence hyperglycemia group(P ﹤ 0. 05). No significance of the free T3 and free T4 levels was observed between the diabetes rats in persistence hyperglycemia group and blood glucose fluctuation group. However,the free T3 and T4 levels were significantly lower in both model groups than in control group(P ﹤ 0. 05). The injury of follicular epithelial cells and loss of microvilli were observed in diabetes rats in both the hyperglycemia group and blood glucose fluctuation group. Conclusion The ultra - structure changes of thyroid gland tissues indicated that abnormal glucose and lipid metabolism could result in thyroid gland tissue injury,which is the potential mechanism. However,no difference of the thyroid function and ultra - structure were observed between the hyperglycemia group and blood glucose fluctuation group.
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Objective To investigate the influence of blood glucose fluctuation on ser202 phosphorylation sites of tau protein( p-Tau) in hippocampus of diabetic rats; to explore the possible mechanism of blood glucose fluctuation impacting on tau protein hyperphosphorylation. Methods Healthy male Sprague Dawley rats were randomly divided into normal control group ( NC group ) and diabetes group. After diabetic rats model was established, all the diabetic rats were randomly divided into diabetic continuous hyperglycemia group (DC group) and diabetic blood glucose fluctuant group ( DF group). Rats in DF group were given glucose solution intraperitoneal injection twice at regular time everyday. 30 minutes after each intraperitoneal injection, insulin subcutaneously injections were given. Rats in the NC group and DC groups were given the same volume of saline subcutaneous injection. Specimens were collected in 8 weeks, the levels of p-Tau and total tau in rat hippocampus were detected by immunohistochemical staining and Western blotting. The immunoreactive positive products were analyzed by image analysis system. Glycogen synthase kinase-3β(GSK-3β) mRNA was detected by realtime PCR. Results (1) Blood glucose fluctuation of rats in DC and DF group were greater than NC group. And the mean blood glucose, standard deviation of mean blood glucose (SDBG), and large amplitude of glycemic excursion (LAGE) levels were increased significantly compared to NC group, the difference has statistical significance ( all P < 0. 05). Compared with DC group, SDBG and LAGE levels of DF group were higher (both P<0. 05). HbA1C and insulin levels were no difference (P>0. 05). (2) Compared with NC group, the hippocampal p-Tau level of DC group and DF group were increased (P < 0. 05 ); Compared with DC group, the hippocampal p-Tau expression of DF group was increased ( P <0. 05). Compared with DC group, a higher hippocampal GSK-3β mRNA level was found in DF group ( P <0. 05). Conclusions On the basis of diabetes animal model, giving glucose solution intraperitoneal injection and insulin subcutaneously injection 30 minutes later twice at regular time everyday could establish experimental model of diabetic blood glucose fluctuation. Blood glucose fluctuation may aggravate the diabetic rats hippocampal p-Tau. The possible mechanism seems to be an up regulation of the GSK-3β.
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Objective To investigate the influence of blood glucose fluctuation on ser202 phosphorylation sites of tau protein( p-Tau) in hippocampus of diabetic rats; to explore the possible mechanism of blood glucose fluctuation impacting on tau protein hyperphosphorylation. Methods Healthy male Sprague Dawley rats were randomly divided into normal control group ( NC group ) and diabetes group. After diabetic rats model was established, all the diabetic rats were randomly divided into diabetic continuous hyperglycemia group (DC group) and diabetic blood glucose fluctuant group ( DF group). Rats in DF group were given glucose solution intraperitoneal injection twice at regular time everyday. 30 minutes after each intraperitoneal injection, insulin subcutaneously injections were given. Rats in the NC group and DC groups were given the same volume of saline subcutaneous injection. Specimens were collected in 8 weeks, the levels of p-Tau and total tau in rat hippocampus were detected by immunohistochemical staining and Western blotting. The immunoreactive positive products were analyzed by image analysis system. Glycogen synthase kinase-3β(GSK-3β) mRNA was detected by realtime PCR. Results (1) Blood glucose fluctuation of rats in DC and DF group were greater than NC group. And the mean blood glucose, standard deviation of mean blood glucose (SDBG), and large amplitude of glycemic excursion (LAGE) levels were increased significantly compared to NC group, the difference has statistical significance ( all P < 0. 05). Compared with DC group, SDBG and LAGE levels of DF group were higher (both P<0. 05). HbA1C and insulin levels were no difference (P>0. 05). (2) Compared with NC group, the hippocampal p-Tau level of DC group and DF group were increased (P < 0. 05 ); Compared with DC group, the hippocampal p-Tau expression of DF group was increased ( P <0. 05). Compared with DC group, a higher hippocampal GSK-3β mRNA level was found in DF group ( P <0. 05). Conclusions On the basis of diabetes animal model, giving glucose solution intraperitoneal injection and insulin subcutaneously injection 30 minutes later twice at regular time everyday could establish experimental model of diabetic blood glucose fluctuation. Blood glucose fluctuation may aggravate the diabetic rats hippocampal p-Tau. The possible mechanism seems to be an up regulation of the GSK-3β.
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[Summary] A total of 128 individuals with type 2 diabetes underwent continuous glucose monitoring for 3 consecutive days.The dawn phenomenon was defined by three different parameters according to the previous research:(1)the absolute increase of glucose level from nocturnal nadir to prebreakfast value(?G) above 20 mg/dl;(2)?G above 10 mg/dl;( 3 ) insulin requirement increased at least 20%.The participants were secondarily separated by presence/absence of a dawn phenomenon based on the definitions above.The impact on blood glucose fluctuation of different groups was assessed according to the standard deviation of blood glucose( SDBG) , the area under curve above 10 mmol/L ( AUC ) , and the mean amplitude of glycemic excursions ( MAGE ) , etc.The frequencies of dawn phenomenon were 64.8%(?G≥20mg/dl), 85.2%(?G≥10 mg/dl), and 59.4%(rise in insulin requirement≥20%)respectively.The impacts on SDBG, AUC, MAGE, and MODD were without statistical difference(P>0.05) between the presence and absence of the dawn phenomenon patients when?G≥10 mg/dl.However, the differences reached statistical significance(P<0.05) when ?G≥20 mg/dl and the increase in insulin requirement≥20%. Besides, the incidence of dawn phenomenon was positively correlated with HOMA-IR, HbA1C , and free C-peptide.Dawn phenomenon is a very frequent event in type 2 diabetes and not only impacts the overall glycemic control but also exaggerates glucose fluctuation.To be clinically relevant, ?G≥20mg/dl should be taken as the quantitative criterion of the dawn phenomenon.
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Objective Oxidative stress which participates in the development of diabetes and its complications can induce inflammation and increase the damage and apoptosis on cells and tissue by influencing multiple signaling pathways?Blood glucose fluctuation increased oxidative stress and aggravated damage and apoptosis on cells?The roles of glucagon?like peptide?1 ( GLP?1) receptor agonist can improve blood glucose fluctuation by playing multiple system physiological effects,such as,delaying gastric emptying,reducing appetite, food intake and body weight, enhancing glucose dependent insulin secretion, inhibiting glucose dependent glucagon secretion?In addition,GLP?1 can reduce oxidative stress state by reducing the reactive oxygen species, inhibiting oxidase activity,up?regulating anti?oxidative stress genes,increasing the level of antioxidant enzymes.
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Objective: To observe the protective effect of salvianolic acid B (Sal B) on pancreatic islet cells in diabetic rats with fluctuating blood glucose and the possible mechanisms implicated. Methods: Diabetes model in rats was established by feeding with high-sugar and high-fat diets combined with ip injection of streptozotocin (STZ). Then the rats were subjected to ip injection of insulin and/or ig administration of glucose at indicated time for 6 weeks to induce blood glucose fluctuation, with those in Sal B groups ig supplemented with Sal B 160 or 80 mg/kg. The contents of fasting blood glucose (FBG), fasting serum insulin (FINS), and glycosylated hemoglobin (GHb) and the levels of total anti-oxidant capacity (TAC), superoxide dismutase (SOD) activity, and malondialdehyde (MDA) in both serum and pancreatic tissues were determined with commercially available kits. Pathological changes and cell apoptosis in pancreatic islets were evaluated by HE staining and TUNEL staining, respectively. Protein levels of PDX-1 in pancreatic tissues were examined by Western blotting analysis. Results: Compared with the control group, the contents of FBG, GHb, and MDA in diabetic rats were increased significantly, while the levels of FINS, TAC, and SOD activity were decreased markedly (P < 0.01). Pancreatic islets in diabetic rats became decreased in size and number, while cell apoptosis in islets increased notably (P < 0.01). Protein level of PDX-1 was significantly decreased in pancreas of diabetic rats (P < 0.01). Supplementation with Sal B resulted in a significant decrease in FBG, GHb, and MDA contents and increase in FINS, TAC, and SOD activity in diabetic rats (P < 0.05, 0.01). Sal B significantly attenuated pathological changes and reduced cell apoptosis in pancreatic islets of diabetic rats, with the expression of PDX-1 protein up-regulated evidently (P < 0.05 or 0.01). Conclusion: Sal B can significantly ameliorate pancreatic pathological changes and improve pancreatic islet function in diabetic rats with fluctuating blood glucose, which might be attributed to attenuation of oxidative stress, up-regulation of PDX-1 expression, and suppression of islet cell apoptosis.
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[ ABSTRACT] AIM:To explore the mechanisms of fluctuant high blood glucose-induced apoptosis of hepatocytes. METHODS:SD rats were randomly divided into normal control group ( N) , stable high blood glucose group ( S) , fluctu-ant high blood glucose group ( F) and insulin group ( I) .Diabetic rats were induced by intraperitoneal injection of strepto-zotocin (65 mg/kg) , and the fluctuant high blood glucose animal model was induced by intraperitoneal injection of ordinary insulin and glucose at different time points every day.The blood glucose fluctuation patterns of the animals in F group with-in 12 weeks were similar every day and no significant difference of the HbA1c concentration was observed compared with S group, indicating that the fluctuant hyperglycemia was successfully established in F group.The activity of superoxide dis-mutase ( SOD) and glutathione peroxidase ( GSH-Px) , and the content of malondialdehyde ( MDA) and nitric oxide ( NO) in the homogenate of the liver tissues were detected by colorimetry.The mRNA and protein levels of JNK, p-JNK, Bax and Bcl-2 were examined by RT-PCR and Western blot.RESULTS:After 12 weeks, the increases in the intakes of food and water, the urine output, and the abnormal liver function were observed in S group, I group and F group.Compared with N group, the MDA level was increased, the content of NO and the activity of SOD and GSH-Px were decreased, and up-regu-lation of JNK mRNA and p-JNK and Bax proteins, and down-regulation of Bcl-2 were also found in S group, I group and F group.The above effects were more obviously showed in F group.CONCLUSION:Oxidative stress activates JNK-MAPK signaling pathway, which is involved in fluctuant high glucose-induced apoptosis of hepatocytes.
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Objective: To observe the effect of Yuquan Pill on the blood glucose fluctuation of diabetic patients receiving insulin therapy with the deficiency type of qi and yin. Methods: One hundred and six patients in Nanjing city hospital of traditional Chinese medicine from January 2012 to August 2014, with the diabetes mellitus in the view of Western medicine and with deficiency of both qi and yin diagnosis standard according to the theory of traditional Chinese medicine (TCM), were selected and randomly divided into treatment group and control group. The original insulin therapy of all subjects continues. The patients in treatment group were given Yuquan Pill, once daily. The patients in control group were not treated by Chinese materia medica, but kept corresponding follow-up. The course of treatment was 28 d. These indicators were to assess at the beginning and end of the research, including the mean blood glucose level (MBG), duration below low limit (DBLL), standard deviation of blood glucose (SDBG), largest amplitude glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE), and means of daily differencies (MODD). Results: In the treatment group, dry mouth and throat, fatigue, eat easy to hunger, shortness of breath, sweating, palpitation, cardiac heat, syndrome integral treatment of insomnia, and tongue were improved significantly compared with before the treatment (P < 0.05); The two groups after treatment, TCM syndromes of throat dry, feverish feeling in palms and soles, sweating, palpitations, insomnia, and tongue coating were better improved significantly in the treatment than those in the control group (P < 0.05). The MAGE of the patients in the treatment group decreased after the treatment compared with those before treatment (P < 0.05). The MAGE level was decreased apparently compared with the control group. Conclusion: This study shows that the fluctuation of blood glucose levels in diabetic patients receiving insulin therapy with the deficiency type of qi and yin can be improved by the treatment of Yuquan Pill.
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AIM:To observe the situation of rat retinal tissue DNA damage at early diabetic period, discuss the role of the blood glucose fluctuations, and provide a new method for studying the pathogenesis of diabetic retinopathy ( DR) . METHODS: SD rats were randomly divided into four groups:normal control group (NC), normal fluctuation group ( NF ) , diabetes group ( DM ) and diabetes fluctuation group ( DF ) . Diabetic models were established through intraperitoneal injection of STZ. A certain amount of glucose was injected in the rats of group NF and DF in an intraperitoneal mode three times a day after the model was established, thereby causing blood glucose fluctuations. Rats were killed and the retinal tissues were taken in the 8th week. Single cell gel electrophoresis ( SCGE ) technique was adopted for detecting DNA injury extent in the retina tissue. RESULTS:Groups NF and DF showed significant and regular fluctuations. The curve of blood glucose fluctuations was relatively stable. All values of MBG, SDBG, LAGE and M were significantly increased compared with group NC. Group DF was increased more significantly. It was statistically significant (P CONCLUSION: Rat retinal tissues have DNA injury during early diabetic period. DNA injury is gradually aggravated with blood glucose fluctuation. It indicates that high blood glucose and blood glucose fluctuation are involved in the mechanism of cell DNA injury, and they may be one of DR early event, have played a certain role in the incidence of DR.
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Objective To explore the effect of glucose fluctuation on resistin. Methods The phorbol-12-myristate-13-acetate(PMA)-activated and differentiated U937 cells were exposed to experimental condition for 3 days, three groups of cells were formed, each one receiving the following fresh medium every 6 hours, respectively: (1) continuous 11.1 mmol/L glucose concentration medium (Con group), (2)continuous 22.2 mmol/L glucose concentration medium (CHG group), (3) alternating 11.1 mmol/L glucose concentration and 22. 2 mmol/L glucose concentration medium every 6 hours (IHG group). The supernatants of cell mediam at the last 6 hours were collected to test resistin concentration. Besides, 92 subjects were selected and classified into three groups according to the results of oral glucose tolerance test:normal glucose tolerance group ( NGT group, n =30), impaired glucose tolerance patients (IGT group, n =31) and newly diagnosed type 2 diabetes patients (T2DM group, n =31). Blood glucose and serum resistin levels were measured at 0 h and 1 h during oral glucose tolerance test ( OGTT) to compare the glucose fluctuation (△Glu1-0) and the change of serum resistin level (△lnRes1-0) among the three groups. Results Resistin concentration in the Con , CHG and IHG group was (73.62 ± 5.07)ng/L, (97.78 ±7.00)ng/L and(212.49 ± 28. 81 )ng/L respectively and in IHG group it was higher as compared with the other two groups (P<0.05). △Glu1-0 in NGT, IGT and T2DM group was(2.31 ±2.30)mmol/L,(5.70 ±2.08)mmol/L and (8.41 ±2.63)mmol/L respectively; △Glu1-0 increased gradually in all the three groups (P<0.05). Serum resistin level from 0 h to 1 h in the NGT group was 6.41 (1.52-15.76) μg/L to 6. 96( 1.52-22. 70) μg/L, in the IGT group 5.47( 1.49-24. 09)μg/L to 9. 12( 1.27-21.94)μg/L and in the T2DM group 5.77( 1.11-30.10) μg/L to 9. 27(1.02-48.15)μg/L In the IGT and T2DM group serum resistin level increased from 0 h to 1 h (P<0.05), but no difference was observed in the NGT group (P>0. 05).△lnRes1-0 in these 3 groups was (0.05 ± 0.05) μg/L, (0.25 ± 0.04) μg/L and (0.37 ± 0.03 )μg/L respectively and the change in the T2DM group was significant as compared with that in the NGT group,△lnRes1-0 was positively correlated with △Glu1-0 (r = 0.23, P = 0.02). Conclusion Glucose fluctuation induced monocyte/macrophage to secrete resistin, greater the glucose fluctuation, greater the change of amplitude of serum resistin.
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AIM:To investigate the relationship between the fluctuation of blood glucose and the macrovascular complication of atherosclerosis (AS) in diabetic patients.METHODS:The individuals with different glucose tolerance were observed by continuous glucose monitoring for 3 days including the mean blood glucose (MBG) and its standard deviation (SD),mean amplitude of glycemic excursions (MAGE) and absolute means of daily differences (MODD).In addition,the intima-media thickness (IMT),intima smoothness as well as AS scores were measured respectively in bilateral common carotid arteries by means of high resolution B mode ultrasonography.RESULTS:The incidence of macrovascular complications in the subjects with impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes (T2DM) was significantly higher than those in the subjects with normal glucose tolerance (NGT),and a significantly difference between group IGT and T2DM was observed.The indexes detected by B mode ultrasonography were all increased gradually from NGT to IGT,then to newly diagnosed T2DM.The values of glycemic excursion were higher in IGT and T2DM group,especially in the subjects with diabetes than those in NGT group.In addition,multiple regression analysis showed that MAGE was significantly correlated with mean IMT and AS scores.CONCLUSION:Blood glucose fluctuation is associated with atherosclerosis.The patients with a larger range of blood glucose excursion have higher risks for developing atherosclerotic complications.The impaired glucose stability is a possible risk factor for atherosclerotic macroangiopathy in diabetes.