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Objective To investigate the association between dawn phenomenon and sleep disorders in elderly patients with type 2 diabetes mellitus (T2DM).Methods Three hundred and ninety-six T2DM patients aged 60-80 years were recruited from Department of Endocrinology,Huadong Hospital from January 2014 to January 2017.All cases used oral hypoglycemic drug more than 3 months,their glycosylated hemoglobin (HbA1c) was lower than 8.5％ and underwent continuous glucose monitoring for 72 h.The Pittsburgh sleep quality index (PSQI) scale was applied to evaluate sleep quality,and the PSQI＞7 was defined as the sleep disorder.There was dawn phenomenon in 165 cases (group Ⅰ) and no dawn phenomenon in 231 cases(group Ⅱ).The clinical data,blood glucose related indicators,homeostasis model assessment of insulin resistance (HOMA-IR) and PSQI scores were compared between two groups.The correlation between dawn phenomenon and sleep disorder was analyzed with Logistic regression.Results There were no significant differences in age,BMI,blood lipids,liver and kidney function,hypersensitive CRP(hCRP),serum cystatin and serum cortisol between the two groups (all P＞0.05).Patients in group Ⅰ presented a higher ratio of urinary protein/creatinine [1.3 (0.7,5.4) mg/mmol vs.1.1 (0.5,3.4) mg/mmol,t=-2.105,P=0.04],PSQI scores [(7.3±3.3) vs.(5.4±2.7),t=3.587,P＜0.01] and the incidence of sleep disorders [57.0％ (94/165) vs.25.1％ (58/231),x2=3.765,P＜0.01] than those in group Ⅱ.The HbA1c [(7.4±0.9)％ vs.(7.0±1.0)％,t=3.384,P＜0.01] and fasting glucose [(8.3±1.6) mmol/L vs.(7.0± 1.4) mmol/L,t=8.778,P＜0.01] were significantly higher in group Ⅰ than those in group Ⅱ;while the fasting insulin [(8.2±7.2) mU/L vs.(10.3±10.2) mU/L,t=-2.286,P=0.02] and nocturnal nadir [(5.7± 1.3) mmol/L vs.(6.6± 1.4) mmol/L,t =-6.331,P＜0.01] were lower than those in group Ⅱ.Pearson correlation analysis showed that dawn phenomenon was positively correlated with sleep disorders (r=0.323,P＜0.01).Logistic regression analysis showed that sleep disorders were associated with increased risk of dawn phenomenon (OR=4.143,95％CI:1.69-10.16,P＜0.0 1).Conclusion Sleep disorders may play a relevant pathological role in the occurrence of dawn phenomenon in elderly T2DM patients.
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Objective To investigate the levels of serum Wnt5a and Sfrp5 in elderly male patients with type 2 diabetes mellitus (T2DM), and identify associations between their levels and glycemic control. Methods A total of 67 elderly male T2DM patients and 65 nondiabetic subjects were studied. Participants were divided into four groups:normal control (NC group), T2DM patients were categorized by HbA1C quartile(Group Ⅰ: HbA1C<7％, Group Ⅱ:7％≤HbA1C < 9％, Group Ⅲ: HbA1C ≥9％). The serum Wnt5a and Sfrp5 concentrations were measured through ELISA. Influencing factors for Wnt5a and Sfrp5 were analyzed. Results Compared with the NC group, Wnt5a levels of elderly T2DM were decreased in groups Ⅱ and Ⅲ, in contrast, Sfrp5 levels were elevated in groups Ⅱ and Ⅲ than NC group(all P<0.05). Spearman correlation analysis suggested that Wnt5a levels were negatively correlated with HbA1C , GA, FPG, and 2hPG(r were -0.277, -0.298, -0.185, and -0.254 respectively, all P<0.05);Sfrp5 levels were positively correlated with HbA1C , GA, and FPG(r were 0.311, 0.247, and 0.200 respectively, all P<0.05) while negatively correlated with BMI and LDL-C( r were - 0.193 and - 0.190, both P< 0.05). Multivariate linear regression analysis showed that HbA1C was an independent association factor for Wnt5a, and FPG was an independent association factor for Sfrp5. Conclusions In the elderly male T2DM with worse glycemic control, Wnt5a levels were more decreased, and in contrast, Sfrp5 levels were elevated. This result indicated that Wnt5a and Sfrp5 may be associated with the level of glycemic control in elderly male T2DM patients.