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Objective:This study aimed to investigate the effect of lipohypertrophy induced by insulin injection on blood glucose fluctuation in patients with type 1 diabetes mellitus.Methods:A total of 80 patients with type 1 diabetes mellitus were recruited between June 2021 and December 2021 from the First Affiliated Hospital of Nanjing Medical University. And these patients all received insulin injection more than six months. Lipohypertrophy was assessed by ultrasound scanning, and blood glucose fluctuation was evaluated using the flash glucose monitoring system(FGM). Univariate analysis and multivariate linear regression were used to analyze the relationship of lipohypertrophy and and core indicators of blood glucose fluctuation.Results:Compared with patients without lipohypertrophy, patients with lipohypertrophy had higher mean amplitude of glycemic excursions(MAGE), coefficient of variation(CV), mean of daily differences(MODD), standard deviation(SD) of blood glucose, time above range(TAR), and high blood glucose index(HBGI; all P<0.05), while time in range(TIR) of glucose markedly become lower( P<0.01). Moreover, multivariate linear regression analysis showed that lipohypertrophy detected by ultrasound was an independent influencing factor of TIR( β=-9.423, P=0.032), MAGE( β=1.114, P=0.039), CV( β=4.304, P=0.041), MODD( β=0.717, P=0.046) after adjusting for age at diagnosis, duration of insulin injection, fasting C-peptide, and daily dose of insulin per unit weight. Conclusion:Lipohypertrophy increases glycemic variability and imposes negative impact on glycemic control rate in patients type 1 diabetes mellitus.
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Objective:To investigate the impact of short-term variability in fasting blood glucose (FPG) on the recent major cardiovascular adverse events (MACE) in patients with ST segment elevation myocardial infarction (STEMI) with different levels of glycated hemoglobin (HbA 1c) . Methods:Retrospective analysis was made on the patients with type 2 diabetes mellitus who underwent emergency percutaneous coronary intervention (PCI) due to STEMI from January 2016 to March 2020 in Shenzhen Hospital, Fuwai Hospital, Chinese Academy of Medical Sciences. The patients were divided into HbA 1c compliant group (<6.5%) and non-compliant group (≥6.5%). The blood glucose variability indexes defined included FPG variability score (FPG-VS), variability index independent of FPG mean (VIM) and mean fast plasma glucose (FPG-M). The logistic regression model was used to evaluate the relationship between different HbA 1c levels, blood glucose variability risk indicators, and MACE. Results:A total of 612 patients were ultimately included in the analysis. The blood glucose variability indicators (FPG-VS, VIM) of the HbA 1c non-compliant group (302 cases) were higher than those of the compliant group (310 cases): [FPG-VS: (0.7±0.3) vs (0.4±0.4), P<0.001, VIM: (0.4±0.2) vs (0.3±0.2), P<0.001], while there was no statistically significant difference in FPG-M between the two groups [(7.9±3.2) vs (8.0±3.9), P=0.221]. In the HbA 1c non-compliant group, the correlation between FPG-VS, VIM, and FPG-M and the risk of MACE within 30 days was 0.89(95% CI: 0.69-1.15), 1.21(95% CI: 0.65-2.25), and 1.06(95% CI: 0.97-1.16), respectively (all P>0.05). In the HbA 1c compliant group, FPG-VS was associated with an increase in MACE risk within 30 days ( P=0.04): for each increase in FPG variation ≥1 mmol/L, after multiple factor adjustment, the risk of MACE increased by 8% within 30 days ( OR=1.08, 95% CI: 0.71-1.65); Compared with FPG-VS<20%, FPG-VS≥80% increased the risk of MACE within 30 days by 33% ( OR=1.33, 95% CI: 0.21-8.25, P<0.01), while the correlation between VIM and FPG-M and the risk of MACE within 30 days was 1.65(95% CI: 0.96-2.83) and 1.15(95% CI: 0.98-1.35), respectively (all P>0.05). Conclusions:High FPG-VS is associated with the recent MACE risk in STEMI patients who do not meet HbA 1c standards. After reaching HbA 1c standards, FPG-VS remains an independent MACE risk factor.
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ABSTRACT Objective: We aimed to investigate the association between glucose coefficient of variation (CV) and mortality and disease severity in hospitalized patients with coronavirus disease-19 (COVID-19). Subjects and methods: Retrospective cohort study in a tertiary center of patients with COVID-19 admitted to designated departments between March 11th, 2020, and November 2nd, 2020. We divided patients based on quartiles of glucose CV after stratification to those with and without diabetes mellitus (DM). Main outcomes were length of stay and in-hospital mortality. Results: The cohort included 565 patients with a mean age of 67.71 ± 15.45 years, and 62.3% were male. Of the entire cohort, 44.4% had DM. The median glucose CV was 32.8% and 20.5% in patients with and without DM, respectively. In patients with DM, higher glucose CV was associated with a longer hospitalization in the unadjusted model (OR = 2.7, 95% CI [1.3,5.6] for Q4), and when adjusted for age, sex, comorbidities, and laboratory markers, this association was no longer statistically significant (OR = 1.3, 95% CI [0.4,4.5] for Q4). In patients with and without DM, higher glucose CV was associated with higher rates of in-hospital mortality in the unadjusted model, but adjustment for comorbidities and laboratory markers eliminated the association (OR = 0.5, 95% CI [0.1,3.4] for Q4 in patients with DM). Conclusion: Higher glucose CV was associated with increased in-hospital mortality and length of stay, but this association disappeared when the adjustment included laboratory result data. Glucose CV can serve as a simple and cheap marker for mortality and severity of disease in patients with COVID-19.
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Background: Fatigue is a common complaint among patients with diabetes mellitus (DM) that can undermine the daily functional activities of a person. The objectives of the study were to assess the fatigue in patients of newly diagnosed type 2 DM and to relate fatigue with blood glucose parameters (BGP) and glycemic control.Methods: A total 50 patients of type 2 DM, diagnosed as per American Diabetes Association 2011 criteria, were enrolled in the study group. Each subject was evaluated two times for fatigue using Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) scale. 1st assessment was at the time of enrollment and 2nd was done after achieving target control of type 2 DM. Values of Fasting blood glucose (FBG), postprandial blood glucose (PPBG), blood glucose variability (BGV) and glycosylated hemoglobin (HbA1c) were obtained for each subject at each assessment. Data collected was analyzed statistically.Results: Mean age of study group was 50.7±8.9 years with male to female ratio of 1.17:1. Mean values of MFSI-SF score at 1st and 2nd assessment were 14.10±17.97 and 4.64±14.06, respectively indicating a statistically significant improvement in fatigue (p<0.05) after achieving target control. Overall fatigue, general fatigue, emotional fatigue, and vigor score correlated significantly with glycemic control (HbA1c) with correlation coefficient (r) of 0.337, 0.351, 0 .339, and - 0.281, respectively (all p <0.05).Conclusions: Fatigue had a positive correlation with FBG, PPBG and BGV and HbA1c. A significant improvement in all the parameters of fatigue was noted after control of diabetic status.
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In June 2019, "The Journal of Clinical Endocrinology & Metabolism" published an article"Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic foot"[Peled S, Pollack R, Elishoov O, et al. J Clin Endocrinol Metab, 2019,104(11):5445-5452. DOI: 10.1210/jc.2019-00774] , with the permission of the original journal, we translated it into Chinese. This article studied the relationship of glycemic indices during hospitalization with amputations in patients with acute diabetic foot. The retrospective cohort study included 418 patients admitted with acute diabetic foot in the diabetic foot unit during 2015-2017. Information on demographic characteristics, medical history, laboratory tests, and point-of-care glucose measurements were collected. The primary outcomes were any or major amputation during hospitalization. 45496 glucose measurements were taken for 418 patients hospitalized with acute diabetic foot. Patients experiencing any hyperglycemia and any or severe hypoglycemia were more likely to undergo any or major amputations during hospitalization. High glycemic variability was associated with major amputations. Peripheral vascular disease, high Wagner score, and hypoglycemia were independent predictors of amputations. Older age, peripheral vascular disease, previous amputation, elevated white blood cell, high Wagner score, and hypoglycemia were independent predictors of major amputations. Hypoglycemia appeared to be an independent risk factor for any and major amputations. While it is unclear whether hypoglycemia directly contributes to adverse outcomes, efforts to minimize in-hospital hypoglycemic events are needed.
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In Nov 2019, " The Journal of Clinical Endocrinology & Metabolism" published an article " Association of inpatient glucose measurements with amputations in patients hospitalized with acute diabetic foot" [Peled S, Pollack R, Elishoov O, et al. J Clin Endocrinol Metab, 2019, 104(11): 5445-5452. DOI: 10.1210/jc.2019-00774], with the permission of the original journal, we translated it into Chinese. This article studied the relationship of glycemic indices during hospitalization with amputations in patients with acute diabetic foot. The retrospective cohort study included 418 patients admitted with acute diabetic foot in the diabetic foot unit during 2015-2017. Information on demographic characteristics, medical history, laboratory tests, and point-of-care glucose measurements were collected. The primary outcomes were any or major amputation during hospitalization. 45 496 glucose measurements were taken for 418 patients hospitalized with acute diabetic foot. Patients experiencing any hyperglycemia and any or severe hypoglycemia were more likely to undergo any or major amputations during hospitalization. High glycemic variability was associated with major amputations. Peripheral vascular disease, high Wagner score, and hypoglycemia were independent predictors of amputations. Older age, peripheral vascular disease, previous amputation, elevated white blood cell, high Wagner score, and hypoglycemia were independent predictors of major amputations. Hypoglycemia appeared to be an independent risk factor for any and major amputations. While it is unclear whether hypoglycemia directly contributes to adverse outcomes, efforts to minimize in-hospital hypoglycemic events are needed.
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Glucose metabolic disorder is a common issue in sepsis and it leads to an increase in mortality. However, the therapeutic methods of the glucose metabolic disorders in sepsis patients need to be improved. Studying the mechanism of glucose metabolism disorder, and adjusting the existing treatment measures are especially significant in curing the sepsis. This review summarizes recent animal experiments and clinical studies about glucose change after septic complications, focusing on the treatment of three disorders including hyperglycemia, hypoglycemia, and blood glucose variability. They definitely provide new ideas for the control of blood glucose in sepsis patients.
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BACKGROUND/AIMS: Recent studies have suggested an important role of adipokines in the development of insulin resistance and diabetes mellitus. The clinical relevance of adipokines on long-term outcomes in patients with diabetes and chronic kidney disease is uncertain. The purpose of this study was to identify a predictable factor in patients with long-term diabetic complications. METHODS: A total of 161 diabetic individuals were followed-up from 2002 to 2013. Circulating plasma levels of adiponectin, glypican-4, irisin, visfatin, and visit-to-visit glucose variability were measured in diabetic patients. Associations among adipokines and variable metabolic parameters and microvascular, and macrovascular complications were evaluated. RESULTS: Plasma adiponectin and glypican-4 levels were significantly increased in patients with renal insufficiency. These adipokines were negatively associated with estimated glomerular filtration rate and positively associated with urinary albumin excretion. The relative risk of renal progression to dialysis increased independently with increasing level of adiponectin. Glypican-4 and visfatin were not predictive of any microvascular or macrovascular complications. Glucose variability increased the risk of diabetic nephropathy and cerebrovascular complications. CONCLUSIONS: Adiponectin and glypican-4 were associated with renal function and might be able to predict renal progression. Glucose variability was a predictable factor for diabetic nephropathy and cerebrovascular complications.
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Humans , Adipokines , Adiponectin , Diabetes Complications , Diabetes Mellitus , Diabetic Nephropathies , Dialysis , Glomerular Filtration Rate , Glucose , Glypicans , Insulin Resistance , Nicotinamide Phosphoribosyltransferase , Plasma , Renal Insufficiency , Renal Insufficiency, ChronicABSTRACT
Objective To study the effect of sitagliptin on insulin resistance and glucose variability in elderly patients with type 2 diabetes mellitus(T2DM) requiring high-dose insulin therapy.Methods A total of 100 elderly patients with T2DM failing to reach the standard application of large-dose insulin(＞60 U/d) treatment for three months or more [glycosylated hemoglobin (HbA1c) ＞8.0％] was randomly divided into sitagliptin group and pioglitazone group.Patients in sitagliptin group(50 cases) were treated with sitagliptin for oral use,100 mg each time,once a day,and patients in pioglitazone group(50 cases) were treated with pioglitazone for oral use,15 mg each time,once a day.The insulin dose was adjusted according to the blood glucose level in the two groups.Two groups were treated for 12 weeks.The indicators in both groups were compared,including fasting blood glucose (FBG),2 hours postprandial glucose (2hPG),glycosylated hemoglobin (HbA1c),24 hours glucose area under the curve (AUC),blood glucose coefficient of variation (CV),fasting C-peptide (FCP),2 hours postprandial C-peptide (2hPCP),fasting glucagon (FGG),2 hours postprandial glucagon(2 hFGG),cholesterol (TC),triglyceride (TG),systolic blood pressure (SBP),diastolic blood pressure(DBP),blood uric acid(BUA),daily insulin dosage(DID),body mass index(BMI),incidence of hypoglycemia and drug adverse reactions.Results After 12 weeks of treatment,the levels of FPG,2hPG,HbA1c,AUC,CV,FGG,2hFGG,TC,TG,SBP,DBP,DID and BMI in the sitagliptin group were significantly decreased than those before treatment(P＜0.05 or P＜0.01);The levels of FPG,2hPG,H bA1c,AUC,CV and BUA in the pioglitazone group were significantly decreased than those before treatment (P＜ 0.0 5 or P＜ 0.01);Compared with the pioglitazone group,the levels of 2 hPG,HbA1c,AUC,CV,FGG,2 hFGG,TC,TG,SBP,DBP,DID and BMI were significantly decreased in the sitagliptin group(all P＜0.05),and the levels of FCP and 2hPCP in the sitagliptin group were higher than those in the pioglitazone group(all P＜0.01).The incidence of hypoglycemia in the sitagliptin group was lower than that in the pioglitazone group(x2 =4.039,P =0.045).The incidence of adverse reactions in the sitagliptin group was lower than that in the pioglitazone grouP(x2 =3.979,P=0.043).Conclusion Sitagliptin combined with insulin is better than insulin combined with pioglitazone in elderly patients with T2DM requiring the application of high-dose insulin therapy,and the combining treatment could decrease insulin resistance,insulin dosage and the incidence of hypoglycemia.
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Continuous glucose monitoring (CGM), an emerging technology for glucose monitoring, is able to reflect blood glucose level with a glucose sensor that monitors the glucose concentration in the subcutaneous tissue. Providing the continuous and comprehensive glycemic information, CGM shows unique advantages in the assessment of blood glucose fluctuations. CGM offers an effective supplement to the traditional monitoring approaches, which is of great significance in the study of the individualized treatment for patients and the research of the pathogenesis of diabetes mellitus.
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Objective To investigate the correlation between blood glucose variability and poor prognosis in diabetes patients with acute stroke. Methods A total of 1 5 5 diabetes patients with acute stroke were divided into glucose variability group(n= 92,GluSD≥1. 4 mmol/L)and non-glucose variability group(n= 63,GluSD<1. 4 mmol/L)according to the GluSD levels. Then,the subjects in glucose variability group were divided into three subgroups according to GluSD levels:the lowest tertile group (GluSD 1. 42~1. 87 mmol/L),the middle tertile group(GluSD 1. 43~2. 32 mmol/L)and the highest tertile group(GluSD 2. 33~2. 87 mmol/L). All patients accepted 72 h CGM after admission. NIHSS score, MoCA scale and Barthel index were used to assess short-term prognosis. Non-conditional logistic regression analysis was used to analyze the risk factors for poor prognosis. Results The levels of FPG [(8. 49± 1. 71 )vs (7. 33 ± 1. 58 )mmol/L],HbA1 c [(8. 61 ± 0. 55 )% vs (7. 14 ± 0. 43 )%]GluAve, GluMAGE,GluGLI and GluCV were higher in glucose variability group than in non-glucose variability group(P<0. 05 or P<0. 01 ). GluAve,GluMAGE,GluGLI and GluCV were higher in the highest tertile group than in the lowest tertile group (P<0. 05 ). With the increase of GluSD level,NIHSS score increased,MoCA score and Barthel index reduced (P<0. 05 ). Multivariate logistic regression analysis showed that age,HbA1 c,GluAve,GluCV and NIHSS score were risk factors for poor prognosis(P<0. 05 or P<0. 01). Conclusion Blood glucose variability is related to poor prognosis in diabetes patients with acute stroke,suggesting that reducing blood glucose fluctuations may be more beneficial to improve outcomes in the treatment of hypoglycemia.
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Objective To explore the correlation between the glucose variability and the severity of acute isolated traumatic brain injury(TBI). Method According to the inclusion/exclusion criteria,a total of 125 cases of acute isolated TBI admitted in Department of Neurosurgery of China Medical University from July 2012 to June 2015 were included. According to Glasgow coma scale(GSC),the patients were divided into five groups including control(GCS 15),mild(GCS 13?14),moderate(GCS 9?12),severe(GCS 6?8),and extra?severe(GCS 3?5)groups. Blood glucose control(including relief of the stress and the application of insulin)were carried out immediately. The average,standard deviation,and variation co?efficient of blood glucose of all groups were recorded at admission,48 hours and 3?7 days after hospitalization. The clinical records and glycemic in?dex were compared among different groups and during different periods,so as to analyze the relationship of the variability of glucose and the duration of hyperglycemia with the severity of TBI and the effects of glycemic intensive care management. Results The results of Kruskal Wallis test and Mann?Whitney Utest showed that the average,standard deviation,and variation coefficient of glucose in the extra?severe group and the severe group were statistically higher than those in the control group(P1). Conclusion The glucose variability in acute isolated TBI patients could be considered as the index of the severity of TBI.
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Objective To discuss the influence of different ways of low-dose corticosteroids infusion on hemodynamics, changes in blood glucose level and prognosis in patients with refractory septic shock. Methods A prospective single-blind randomized controlled trial was conducted. Refractory septic shock patients admitted to the Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from April 1st, 2013 to October 31st, 2014 were enrolled for the study. The patients were divided into control group and research group by random number table. Besides conventional treatment for septic shock, patients in control group were given 200 mg/d hydrocortisone intravenous infusion lasting for 2 hours, while those of research group were given 8.33 mg/h hydrocortisone per hour with an intravenous pump. Treatment lasted for 5 continuous days for both groups. The changes in heart rate ( HR ), mean arterial pressure ( MAP ), central venous pressure ( CVP ) and arterial blood lactic acid in both groups were observed at the time of enroldment and 6 hours, 24 hours, 48 hours, and 5 days after the treatment. With a dynamic blood glucose monitor, mean blood glucose ( MBG ) level, largest amplitude of glycemic excursions ( LAGE ), glucose variability ( GV ), and the ratio of hyperglycaemia time were recorded. The duration of shock, length of intensive care unit ( ICU ) stay, total length of hospital stay, and 28-day mortality of both groups were recorded. Results Seventy-nine septic shock patients were assigned to the treatment, with 41 in control group, and 38 in research group. Compared with control group, 6-hour MAP in research group was obviously lowered [ mmHg ( 1 mmHg=0.133 kPa ):66.31±4.38 vs. 68.58±4.86, t=1.062, P=0.033 ], but there were no significant differences in HR, MAP, CVP, lactic acid clearance and norepinephrine ( NE ) utilization rates at other time points between two groups. No significant difference in MBG was found between research group and control group ( mmol/L:8.69±2.14 vs. 9.95±3.87, t=1.771, P=0.080 ), but LAGE, GV, the ratio of hyperglycemia time in research group were significantly lower than those of the control group [ LAGE ( mmol/L ): 17.18±8.97 vs. 22.71±11.80, t = 2.331, P = 0.022; GV ( mmol/L ): 2.57±1.05 vs. 3.16±1.37, t=2.136, P=0.036;the ratio of hyperglycemia time:( 43.1±11.7 )%vs. ( 49.4±15.3 )%, t=2.044, P=0.044 ]. There was no statistical difference in the following features between research group and control group, such as the duration of shock ( days:3.47±0.98 vs. 3.61±1.07, t=0.605, P=0.547 ), length of ICU stay ( days:8.74±3.12 vs. 9.97±3.37, t = 1.543, P = 0.120 ), total length of hospital stay ( days: 18.34±9.27 vs. 19.58±9.83, t = 0.576, P = 0.566 ) and 28-day mortality rate ( 23.68%vs. 26.83%,χ2=0.103, P=0.748 ). Conclusions Compared with slow intravenous infusion, a continuous intravenous supplementation of small amount of hydrocortisone to patients with refractory septic shock could stabilize blood glucose levels and maintain metabolic balance efficiently. However, in both groups there was no significant difference in the efficiency in stabilizing hemodynamics, shortening shock duration, reducing ICU or hospital days and decreasing 28-day mortality.
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Glucose variability has been identified as a potential risk factor for diabetic complications; oxidative stress is widely regarded as the mechanism by which glycemic variability induces diabetic complications. However, there remains no generally accepted gold standard for assessing glucose variability. Representative indices for measuring intraday variability include calculation of the standard deviation along with the mean amplitude of glycemic excursions (MAGE). MAGE is used to measure major intraday excursions and is easily measured using continuous glucose monitoring systems. Despite a lack of randomized controlled trials, recent clinical data suggest that long-term glycemic variability, as determined by variability in hemoglobin A1c, may contribute to the development of microvascular complications. Intraday glycemic variability is also suggested to accelerate coronary artery disease in high-risk patients.
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Humans , Coronary Artery Disease , Diabetes Complications , Glucose , Oxidative Stress , Risk FactorsABSTRACT
Objective To investigate the effects of different medical nutrition therapy on blood glucose variability in elderly patients with type 2 diabetes .Methods Eighty‐five patients with type 2 diabetes were randomly divided into three groups ,29 cases in the control group ,27 cases in the low GI diet group ,29 cases in water‐soluble dietary fiber group .Each patient was established a individuality diabetic diet recipe according to the guidelines of medical nutrition therapy ,combined with oral hypoglycemic agents , The breakfast and dinner for patients in low GI diet group were completely instead of low GI diet ,while the breakfast and dinner for patients in water‐soluble dietary fiber group were added 10 g dietary fiber .Blood glucose ,blood lipid ,renal function and blood glu‐cose fluctuation were observed before and after one‐month intervention .Results Compared with before intervention ,the concentra‐tion of blood glucose after the intervention in each group were decreased (P < 0 .05) ,the glucose fluctuation index in low GI diet group and water soluble dietary fiber group decreased obviously after the intervention (P< 0 .05) .After the intervention ,average fasting blood glucose ,postprandial glucose average ,and mean blood glucose in low GI diet group were significantly lower than those in control group (P< 0 .05) ,Meanwhile ,the blood sugar standard deviation and MAGE in low GI dietary intervention group and in water‐soluble dietary fiber group were significantly lower than that of control group (P< 0 .05) .Conclusion On the basis of the di‐abetes diet recipes and oral drug treatment giving low GI dietary replacement therapy or adding water soluble dietary fiber ,for eld‐erly patients with type 2 diabetes ,could effectively control the blood glucose level ,and significantly reduce glucose variability .
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Objective To investigate the correlation between glucose variability and coronary stenosis in type 2 diabetes mellitus (T2DM) combined with coronary heart disease (CHD) patients.Methods Eighty patients with T2DM who had undergone coronary angiography were selected.According to the result of coronary angiography,the patients were divided into 2 groups:48 T2DM combined with CHD patients as CHD group,and 32 T2DM combined without CHD patients as control group.All patients underwent continuous glucose monitoring (CGM) for 72 h,and the mean blood glucose (MBG),standard deviation of blood glucose (SDBG),daily mean amplitude of glycemic excursion (MAGE),absolute means of daily differences (MODD),largest amplitude of blood glucose excursion (LAGE) and mean postprandial glucose excursion (MPPGE) were computed.The risk factor of coronary stenosis (using Gensini score) was analyzed.Results The LAGE,SDBG,MAGE,MPPGE,MODD in CHD group were significantly higher than those in control group:(11.4 ± 3.6) mmol/L vs.(8.2 ± 1.9) mmol/L,(3.4 ± 1.4) mmol/L vs.(1.9 ± 0.6) mmol/L,(7.1 ± 2.7) mmol/L vs.(4.8 ± 1.4) mmol/L,(6.6 ± 1.8) mmol/L vs.(4.6 ± 1.5) mmol/L,(3.3 ± 1.2) mmol/L vs.(2.5 ± 0.9) mmol/L,and there were statistical differences (P ＜ 0.05).There was no statistical difference in MBG between CHD group and control group:(10.2 ± 2.8) mmol/L vs.(9.3 ± 2.2) mmol/L,P ＞ 0.05.The Pearson correlation analysis result showed that the MPPGE,MODD and LAGE had positive correlation with Gensini score (r =0.509,0.357 and 0.338;P ＜ 0.05);and the LVEF had negative correlation with Gensini score (r =-0.372,P ＜ 0.05).Conclusions Glucose variability in patients with T2DM combined with CHD is markedly enhanced.MPPGE,MODD and IAGE are positively correlated with the severity of coronary stenosis.
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Objective The purpose of this study was to analyze the relation of blood glucose variability and 28-day mortality in patients with different degree sepsis. Methods From September 1, 2010 to September 30, 2012, all adult patients diagnosed with sepsis and treated at least 3 days in Emergency ICU (EICU) of the first affiliated hospital of Kunming Medical University were enrolled in the study. Then the blood glucose levels and the other requisite clinical data were obtained from historical electronic medical records of patients excluding the patients reached exclusive criteria. The maximum and mean of blood glucose, and the glucose variability (the standard deviation,SD of blood glucose) in each patient were calculated. The patients were assigned according to severity of sepsis, then the relationship between SD of blood glucose and 28-day mortality was statistically assessed. Results There was an important correlation between SD of blood glucose and 28-day mortality (OR=4.237, =0.021) . The glucose variability increased with the serious of sepsis ( = 0.016) . Conclusion Glucose variability is an independent predictor of 28-day mortality in septic patients. In addition, the severity of sepsis has a positive correlation with blood glucose variability.
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Objective To investigate the relationship between glucose variability and severity of coronary artery stenosis in patients with type 2 diabetes mellitus (T2DM).Methods One hundred hospitalized patients with T2DM(55 males and 45 females,39-81 years old) who had undergone angiography were included in the study from February 2012 to October 2012.They were divided into 2 groups:(1) 60 patients with coronary heart disease(CHD)as experimental group and (2) 40 patients without coronary heart disease as control group.All participants underwent selective coronary angiography to evaluate the severity of coronary artery stenosis (Gensini score) and continuous glucose monitoring(CGM) for 72 h.The correlation was analyzed between biochemical findings,and Gensini scores between the 2 groups.The comparison between 2 groups was performed with LSD test,correlation analysis with Pearson correlation and multiple stepwise regression analysis.Result Compared with the levels of largest amplitude of blood glucose excursion (LAGE),standard deviation of blood glucose (SDBG),mean amplitude of glycemic excursion (MAGE),postprandial glucose excursion (MPPGE),and absolute means of daily differences (MODD) in control group [(8.1 ± 2.1),(1.9 ± 0.5),(4.8 ± 1.3),(4.5 ± 1.4),and (2.4 ± 0.8) respectively],the levels in the experimental group[(11.3 ± 3.5),(3.2 ± 1.2),(7.0 ± 2.6),(6.4 ± 1.9),and (3.1 ± 1.3)] were higher respectively.MPPGE,MODD,LAGE,and C-reactive protein(CRP) were positively related to Gensini score(r were 0.498,0.246,and 0.227,all P＜0.05),while left ventricular ejection fraction (LVEF) was negatively related to Gensini score(r=-0.261,P＜0.05).Multiple stepwise regression analysis indicated that MPPGE and LVEF were independent risk factors of Gensini score (Y =59.727 + 11.779 × MPPGE-1.437 × LVEF).Conclusion Glucose variability in patients with T2DM and CHD was markedly enhanced.MPPGE was positively correlated with the severity of coronary artery stenosis in patients with T2DM and CHD.
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Objective To explore the correlation of blood glucose variability and TCM syndromes in type 2 diabetic patients. Methods A total of 64 type 2 diabetic patients from China-Japan Friendship Hospital during Jan. 2010 to Dec. 2013 with complete clinical data were measured by continuous glucose monitoring system (CGMs) for 3 days. Patients were divided into empirical group and deficiency group. The empirical group included heat excess and fluid deficiency syndrome, phlegm-dampness stagnation syndrome and blood stasis syndrome. The deficiency group included qi-yin deficiency syndrome and yin-yang deficiency syndrome. The mean blood glucose (MBG), and mean amplitude of glycemic excursions (MAGE) were compared between the groups and types in each group, and the correlation with TCM syndrome types were analyzed. Results There was no significant difference in MBG between two groups (P>0.05). MAGE in deficiency group was higher than that in empirical group (P0.05), but in deficiency group, MAGE in yin-yang deficiency syndrome was higher than that in qi-yin deficiency syndrome (P<0.05). Conclusion Blood glucose variability has no correlation with MBG in type 2 diabetic patients. Glucose showed significant variability in deficiency group, and the most serious glucose variability was found in type of yin-yang deficiency syndrome.
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Recently,basic and clinical researches have shown that blood glucose variability is an independent risk factor for diabetic complications.Thus,ideal control of blood glucose is not only to reach the HbA1Ctarget,but also to minimize blood glucose variability.Different glycemic parameters could be selectedaccording to different purpose of evaluation,in which the mean amplitude of glucose excursions(MAGE) and the standard deviation of blood glucose (SDBG) could be used as accurate and simple assessment parameters respectively.