Department of General Medicine, Qilu Hospital of Shandong University, No.107, Wen Hua Xi Road, Jinan, Shandong, China.
Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
BMC Endocr Disord. 2021 Apr 27;21(1):83. doi: 10.1186/s12902-021-00753-2.
Little is known about whether the influence of glycemic variability on arrhythmia is related to age in type 2 diabetes mellitus (T2DM). Therefore, we aimed to compare the association between glycemic variability and arrhythmia in middle-aged and elderly T2DM patients.
A total of 107 patients were divided into two groups: elderly diabetes mellitus group (EDM, n = 73) and middle-aged diabetes mellitus group (MDM, n = 34). The main clinical data, continuous glucose monitoring (CGM) and dynamic ECG reports were collected. The parameters including standard deviation of blood glucose (SDBG), largest amplitude of glycemic excursions (LAGE), mean amplitude of glycemic excursions (MAGE), absolute means of daily differences (MODD), time in range (TIR), time below range (TBR), time above range (TAR), coefficient of variation (CV) were tested for glycemic variability evaluation.
In terms of blood glucose fluctuations, MAGE (5.77 ± 2.16 mmol/L vs 4.63 ± 1.89 mmol/L, P = 0.026), SDBG (2.39 ± 1.00 mmol/L vs 2.00 ± 0.82 mmol/L, P = 0.048), LAGE (9.53 ± 3.37 mmol/L vs 7.84 ± 2.64 mmol/L, P = 0.011) was significantly higher in EDM group than those of MDM group. The incidences of atrial premature beat, couplets of atrial premature beat, atrial tachycardia and ventricular premature beat were significantly higher in EDM group compared with the MDM group (all P < 0.05). Among patients with hypoglycemia events, the incidences of atrial premature beat, couplets of atrial premature beat, atrial tachycardia and ventricular premature beat (all P < 0.05) were significantly higher in the EDM group than those in the MDM group. In EDM group, TIR was negatively correlated with atrial tachycardia in the MAGE1 layer and with atrial tachycardia and ventricular premature beat in the MAGE2 layer, TBR was significantly positively correlated with atrial tachycardia in the MAGE2 layer (all P < 0.05). In MDM group, TAR was positively correlated with ventricular premature beat and atrial tachycardia in the MAGE2 layer (all P < 0.05).
The study demonstrated the elderly patients had greater glycemic variability and were more prone to arrhythmias. Therefore, active control of blood glucose fluctuation in elderly patients will help to reduce the risk of severe arrhythmia.
关于血糖变异性对心律失常的影响是否与 2 型糖尿病（T2DM）患者的年龄有关，目前知之甚少。因此，我们旨在比较中老年 T2DM 患者血糖变异性与心律失常之间的关系。
共纳入 107 例患者，分为老年糖尿病组（EDM，n=73）和中年糖尿病组（MDM，n=34）。收集主要临床资料、连续血糖监测（CGM）和动态心电图报告。检测血糖标准差（SDBG）、最大血糖波动幅度（LAGE）、平均血糖波动幅度（MAGE）、日间血糖平均绝对差（MODD）、血糖达标时间（TIR）、血糖低于目标时间（TBR）、血糖高于目标时间（TAR）、血糖变异系数（CV）等参数评估血糖变异性。
在血糖波动方面，EDM 组 MAGE（5.77±2.16mmol/L 比 4.63±1.89mmol/L，P=0.026）、SDBG（2.39±1.00mmol/L 比 2.00±0.82mmol/L，P=0.048）、LAGE（9.53±3.37mmol/L 比 7.84±2.64mmol/L，P=0.011）均显著高于 MDM 组。EDM 组房性早搏、房性早搏二联律、房性心动过速和室性早搏的发生率明显高于 MDM 组（均 P<0.05）。在发生低血糖事件的患者中，EDM 组房性早搏、房性早搏二联律、房性心动过速和室性早搏的发生率明显高于 MDM 组（均 P<0.05）。在 EDM 组，TIR 与 MAGE1 层的房性心动过速呈负相关，与 MAGE2 层的房性心动过速和室性早搏呈负相关，TBR 与 MAGE2 层的房性心动过速呈显著正相关（均 P<0.05）。在 MDM 组，TAR 与 MAGE2 层的室性早搏和房性心动过速呈正相关（均 P<0.05）。
本研究表明老年患者血糖变异性更大，更易发生心律失常。因此，积极控制老年患者血糖波动有助于降低严重心律失常的风险。
