Department of Endocrinology, Renji Hospital, Shanghai Jiaotong University, Shanghai 200127, China.
Atherosclerosis. 2010 May;210(1):302-6. doi: 10.1016/j.atherosclerosis.2009.11.015. Epub 2009 Nov 20.
Isolated hyperglycemia is associated with atherosclerosis in individuals with type 2 diabetes, but the relationship between postchallenge glucose excursion and atherosclerosis is less clear. This study examines the relationships between postchallenge glucose spikes (PGS), carotid intima-media thickness (IMT), and traditional risk factors for atherosclerosis in individuals with type 2 diabetes.
A total of 474 individuals with type 2 diabetes who were within the highest or lowest IMT distribution quartile were included. The Student's t-test, one-way analysis of variance (ANOVA), single variate and multivariate analyses were implemented to study the data. An additional healthy control group (n=896) was selected during routine health examination. They were Han nationality and unrelated to the diabetic patients.
(1) Compared with subjects of healthy control group, the subjects with type 2 diabetes had significantly higher levels of body mass index (BMI), waist-to-hip ratio (WHR), systolic blood pressure, triglyceride, total cholesterol, low density lipoprotein cholesterol (LDL-C), fasting plasma glucose (FPG), 120 min postchallenge glucose (PG120), hemoglobin A1c (HbA1c) and IMT (P < or = 0.01) and relatively lower levels of high density lipoprotein cholesterol (HDL-C) (P < or = 0.05). (2) According to the IMT which was measured by B-mode ultrasonography, the patients of type 2 diabetes could be divided into two subgroups: one was the subgroup of IMT > or = P(75) and another was the subgroup of IMT < or = P(25). Compared with subjects of IMT > or = P(25) subgroup, subjects being in the IMT > or = P(75) subgroup exhibited significantly increased age, WHR, diabetes duration, systolic blood pressure, total cholesterol, triglyceride, LDL-C, and significantly decreased HDL-C levels. And among all the plasma glucose variables, except for FPG and PG30, all the other variables (include PG60, PG120, PG180, PGS, HbA1C, under area curve of glucose) showed a significant increase in the IMT>/=P(75) subgroup. (3) A multivariate logistic regression analysis was performed to establish which were independently related with carotid IMT, and the results showed the PGS was identified as the strongest determinant of IMT from all the atherosclerosis risk factors. (4) PGS is significantly correlated to a variety of atherosclerosis risk factors.
This study identified several important associations between PGS and known risk factors for atherosclerosis and suggested that PGS is independently related to carotid IMT. Wide postchallenge glucose excursions may contribute to the development of atherosclerosis in individuals with type 2 diabetes, independent of other risk factors.
孤立性高血糖与 2 型糖尿病患者的动脉粥样硬化有关，但餐后血糖波动与动脉粥样硬化之间的关系尚不清楚。本研究旨在探讨 2 型糖尿病患者餐后血糖峰值（PGS）与颈动脉内膜中层厚度（IMT）及动脉粥样硬化传统危险因素之间的关系。
选择 IMT 分布最高或最低四分位数的 474 例 2 型糖尿病患者作为研究对象。采用学生 t 检验、单因素方差分析（ANOVA）、单变量和多变量分析等方法对数据进行分析。此外，在常规健康检查中选择了 896 例健康对照组。他们均为汉族，与糖尿病患者无关。
（1）与健康对照组相比，2 型糖尿病患者的体质指数（BMI）、腰臀比（WHR）、收缩压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇（LDL-C）、空腹血糖（FPG）、120 分钟餐后血糖（PG120）、糖化血红蛋白（HbA1c）和 IMT 均显著升高（P≤0.01），高密度脂蛋白胆固醇（HDL-C）水平显著降低（P≤0.05）。（2）根据 B 型超声测量的 IMT，将 2 型糖尿病患者分为两组：一组为 IMT≥P（75）组，另一组为 IMT≤P（25）组。与 IMT≤P（25）组相比，IMT≥P（75）组的年龄、WHR、糖尿病病程、收缩压、总胆固醇、甘油三酯、LDL-C 显著升高，HDL-C 水平显著降低。在所有血糖变量中，除 FPG 和 PG30 外，其他变量（包括 PG60、PG120、PG180、PGS、HbA1c、血糖下面积曲线）在 IMT≥P（75）组均有显著升高。（3）进行多元逻辑回归分析以确定与颈动脉 IMT 独立相关的因素，结果表明 PGS 是所有动脉粥样硬化危险因素中与 IMT 最相关的因素。（4）PGS 与多种动脉粥样硬化危险因素显著相关。
本研究确定了 PGS 与动脉粥样硬化已知危险因素之间的一些重要关联，并表明 PGS 与颈动脉 IMT 独立相关。广泛的餐后血糖波动可能是 2 型糖尿病患者动脉粥样硬化发展的一个重要因素，独立于其他危险因素。
