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连续血糖监测评估的血糖变异性与 2 型糖尿病患者亚临床糖尿病多发性神经病的关系。

Association of glycemic variability assessed by continuous glucose monitoring with subclinical diabetic polyneuropathy in type 2 diabetes patients.

机构信息

Department of Endocrinology and Metabolism, Shanghai Clinical Center for Diabetes, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.

Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, China.

出版信息

J Diabetes Investig. 2022 Feb;13(2):328-335. doi: 10.1111/jdi.13652. Epub 2021 Sep 17.

Abstract

AIMS/INTRODUCTION: Diabetic peripheral neuropathy is a common diabetes-related microvascular complication. The relationship between peripheral nerve function and glucose variability is unclear. We investigated the association of glucose variability with subclinical diabetic polyneuropathy in a large-scale sample of patients with type 2 diabetes.

MATERIALS AND METHODS

We enrolled 509 individuals with type 2 diabetes who were screened for diabetic peripheral neuropathy and monitored using a continuous glucose monitoring system. Multiple glycemic variability parameters, including the mean amplitude of glycemic excursions, glucose standard deviation (SD ) and glucose coefficient of variation were calculated from 3-day glucose profiles obtained from continuous glucose monitoring. All participants underwent nerve conduction studies, and the composite Z-scores for nerve conduction parameters were calculated.

RESULTS

Multivariate logistic regression analyses showed that SD and the conventional risk factor hemoglobin A1c (HbA1c) were independently associated with abnormal nerve function, and the corresponding odds ratios (95% confidence interval) were 1.198 (1.027-1.397, SD ) and 1.182 (1.061-1.316, HbA1c), respectively. The composite Z-score of nerve conduction velocity and response amplitude obviously decreased with greater SD , and the composite Z-score of distal latency significantly increased with increasing tertiles of SD (all P trend <0.05). After adjusting for age, sex, body mass index, diabetes duration and HbA1c, SD was independently associated with nerve conduction velocity (β = -0.124, P = 0.021).

CONCLUSIONS

The SD is a significant independent contributor to subclinical diabetic polyneuropathy, in addition to conventional risk factors including diabetes duration and HbA1c.

摘要

目的/引言:糖尿病周围神经病变是一种常见的糖尿病相关微血管并发症。周围神经功能与血糖变异性之间的关系尚不清楚。我们在一项大规模的 2 型糖尿病患者样本中研究了血糖变异性与亚临床糖尿病多发性神经病的关系。

材料和方法

我们招募了 509 名 2 型糖尿病患者,他们接受了糖尿病周围神经病变筛查,并使用连续血糖监测系统进行监测。从连续血糖监测获得的 3 天血糖谱中计算出多种血糖变异性参数,包括血糖波动幅度的平均值、血糖标准差(SD)和血糖变异系数。所有参与者都进行了神经传导研究,并计算了神经传导参数的综合 Z 分数。

结果

多变量逻辑回归分析显示,SD 和传统危险因素糖化血红蛋白(HbA1c)与异常神经功能独立相关,相应的优势比(95%置信区间)分别为 1.198(1.027-1.397,SD)和 1.182(1.061-1.316,HbA1c)。SD 越大,神经传导速度和反应幅度的综合 Z 分数明显降低,SD 三分位数越高,远端潜伏期的综合 Z 分数显著增加(所有 P 趋势<0.05)。在调整年龄、性别、体重指数、糖尿病病程和 HbA1c 后,SD 与神经传导速度独立相关(β=-0.124,P=0.021)。

结论

除了包括糖尿病病程和 HbA1c 在内的传统危险因素外,SD 也是亚临床糖尿病多发性神经病的一个重要独立危险因素。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d3b1/8847148/e9c9b0c99fa0/JDI-13-328-g002.jpg

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