2型糖尿病的病程及血糖控制与糖尿病性神经病变的关联
Association of Diabetic Neuropathy with Duration of Type 2 Diabetes and Glycemic Control.
作者信息
Nisar Muhammad Umer, Asad Ambreen, Waqas Ahmed, Ali Nazia, Nisar Anam, Qayyum Mohsin A, Maryam Hafsa, Javaid Mohsin, Jamil Mohsin
机构信息
Final year MBBS Student, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad.
Associate Professor, Dept. of Physiology, Yusra Medical & Dental College Near Kahuta Morr, GT Road, P.O Humak, Islamabad.
出版信息
Cureus. 2015 Aug 12;7(8):e302. doi: 10.7759/cureus.302.
INTRODUCTION
Diabetes mellitus is associated with severe microvascular and macrovascular complications with major implications for public health. Diabetic neuropathy is a very problematic complication of diabetes mellitus. It is associated with severe morbidity, mortality, and a huge economic burden. The present study was designed with two aims: 1) to analyze the association of diabetic neuropathy with the glycemic index (levels of fasting blood glucose, random blood glucose, and Hb1Ac) in patients with Type 2 diabetes, and 2) to analyze the association of diabetic neuropathy with time passed since the diagnosis of diabetes.
METHODS
This case-control study was undertaken between June 2013 and February 2015 in the Armed Forces Institute of Rehabilitation Medicine (AFIRM), Rawalpindi, Pakistan. Type 2 diabetics with an age range of 30-60 years were recruited from outpatient departments of AFIRM, Rawalpindi. Data were collected and recorded on a form with four sections recording the following: 1) demographics of patients and number of years passed since diagnosis of diabetes; 2) clinical examination for touch, pressure, power, pain, vibration, and ankle reflex; 3) nerve conduction studies for motor components of the common peroneal nerve and tibial nerve and the sensory component of median nerve and sural nerve; 4) glycemic index, including fasting blood glucose levels (BSF), random blood glucose (BSR) levels, and HbA1c levels. Data were analyzed in SPSS v. 20. Chi-square and phi statistics and logistic regression analysis were run to analyze associations between diabetic neuropathy and time passed since diagnosis of diabetes and glycemic index.
RESULTS
In total, 152 patients were recruited. One-half of those patients had neuropathy (76 patients) and the other half (76 patients) had normal nerve function. The mean (standard deviation [SD]) duration of diabetes was nine years (6.76), BSF levels 7.98 mmol/l (2.18), BSR 9.5 mmol/l (3.19), and HbA1c 6.5% (2.18). Logistic regression analysis predicted 87.5% of the model correctly. Duration since the diagnosis of diabetes and HbA1c levels were significantly associated with the diagnosis of neuropathy in diabetics.
CONCLUSION
The presence of diabetic neuropathy was significantly associated with HbA1c levels and the duration of diabetes.
引言
糖尿病与严重的微血管和大血管并发症相关，对公众健康有重大影响。糖尿病神经病变是糖尿病非常棘手的并发症。它与严重的发病率、死亡率以及巨大的经济负担相关。本研究旨在实现两个目标：1）分析2型糖尿病患者中糖尿病神经病变与血糖指数（空腹血糖水平、随机血糖水平和糖化血红蛋白）之间的关联；2）分析糖尿病神经病变与糖尿病确诊后经过的时间之间的关联。
方法
本病例对照研究于2013年6月至2015年2月在巴基斯坦拉瓦尔品第的武装部队康复医学研究所（AFIRM）进行。从AFIRM拉瓦尔品第门诊部招募年龄在30至60岁之间的2型糖尿病患者。数据收集并记录在一份有四个部分的表格上，记录内容如下：1）患者的人口统计学信息以及糖尿病确诊后的年数；2）触觉、压力觉、肌力、疼痛、振动觉和踝反射的临床检查；3）腓总神经和胫神经运动成分以及正中神经和腓肠神经感觉成分的神经传导研究；4）血糖指数，包括空腹血糖水平（BSF）、随机血糖（BSR）水平和糖化血红蛋白水平。数据在SPSS v. 20中进行分析。采用卡方检验、φ统计量和逻辑回归分析来分析糖尿病神经病变与糖尿病确诊后经过的时间以及血糖指数之间的关联。
结果
总共招募了152名患者。其中一半患者患有神经病变（76名患者），另一半（76名患者）神经功能正常。糖尿病的平均（标准差[SD]）病程为9年（6.76），空腹血糖水平7.98 mmol/l（2.18），随机血糖9.5 mmol/l（3.19），糖化血红蛋白6.5%（2.18）。逻辑回归分析正确预测了模型的87.5%。糖尿病确诊后的病程和糖化血红蛋白水平与糖尿病患者神经病变的诊断显著相关。
结论
糖尿病神经病变的存在与糖化血红蛋白水平和糖尿病病程显著相关。
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