Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients
Association of glycaemic variability evaluated by continuous glucose monitoring with diabetic peripheral neuropathy in type 2 diabetic patients
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DOI：
10.1007/s12020-018-1546-z
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发表时间：
2018-05-01
期刊：
影响因子：
3.7
通讯作者：
Su, Jian-bin
中科院分区：
文献类型：
--
作者：
Hu, Yu-ming;Zhao, Li-hua;Su, Jian-bin
糖尿病周围神经病变（DPN）是糖尿病常见的微血管并发症，与血液病性紊乱有关。血糖变异性是糖尿病并发症的一个重要危险因素。我们在大规模的2型糖尿病患者样本中调查了血糖变异性与DPN的相关性。在这项横断面研究中，我们纳入了982例2型糖尿病患者，这些患者在2011年2月至2017年1月期间接受了DPN筛查，并通过动态血糖监测（CGM）系统进行了监测。从CGM获得的血糖曲线计算多个血糖变异性参数，包括血糖波动的平均幅度（法师）、每日差异的平均值（MODD）、血糖的标准差（SD）和24小时平均血糖（24小时MG）。在入选的2型糖尿病患者中，20.1%（n = 197）存在DPN，这些患者的法师、MODD、SD和24小时MG也高于无DPN的患者（p <0.001）。使用单变量和多变量logistic回归分析，发现法师和传统的风险，包括糖尿病病程，HOMA-IR和血红蛋白A1 c（HbA1 c）是DPN的独立贡献者，相应的比值比（95%置信区间）分别为4.57（3.48 - 6.01）、1.10（1.03 - 1.17）、1.24（1.09 - 1.41）和1.33（1.15 - 1.53）。受试者操作特征分析显示，法师预测DPN的最佳截断值为4.60 mmol/L，其敏感性为64.47%，特异性为75.54%，除糖尿病病程、HOMA-IR和HbA1c等常规危险因素外，法师评估的血糖变异性增加是2型糖尿病患者DPN的独立危险因素。
Diabetic peripheral neuropathy (DPN), a common microvascular complication of diabetes, is linked to glycaemic derangements. Glycaemic variability, as a pattern of glycaemic derangements, is a key risk factor for diabetic complications. We investigated the association of glycaemic variability with DPN in a large-scale sample of type 2 diabetic patients.In this cross-sectional study, we enrolled 982 type 2 diabetic patients who were screened for DPN and monitored by a continuous glucose monitoring (CGM) system between February 2011 and January 2017. Multiple glycaemic variability parameters, including the mean amplitude of glycaemic excursions (MAGE), mean of daily differences (MODD), standard deviation of glucose (SD), and 24-h mean glucose (24-h MG), were calculated from glucose profiles obtained from CGM. Other possible risks for DPN were also examined.Of the recruited type 2 diabetic patients, 20.1% (n = 197) presented with DPN, and these patients also had a higher MAGE, MODD, SD, and 24-h MG than patients without DPN (p < 0.001). Using univariate and multiple logistic regression analyses, MAGE and conventional risks including diabetic duration, HOMA-IR, and hemoglobin A1c (HbA1c) were found to be independent contributors to DPN, and the corresponding odds ratios (95% confidence interval) were 4.57 (3.48-6.01), 1.10 (1.03-1.17), 1.24 (1.09-1.41), and 1.33 (1.15-1.53), respectively. Receiver operating characteristic analysis indicated that the optimal MAGE cutoff value for predicting DPN was 4.60 mmol/L; the corresponding sensitivity was 64.47%, and the specificity was 75.54%.In addition to conventional risks including diabetic duration, HOMA-IR and HbA1c, increased glycaemic variability assessed by MAGE is a significant independent contributor to DPN in type 2 diabetic patients.