Effect of blood glucose fluctuation and homocysteine on type 2 diabetic urinary protein excretion

Abstract

Objective To investigate the effect of blood glucose fluctuation and homocysteine on urinary protein excretion in type 2 diabetic patients. Methods A total 105 patients with diabetic from January 2014 to June 2015 in our hospital. According to urine albumin/creatinine (UACR) levels were divided into normal proteinuria group, micro protein urine group and a large amount of proteinuria group. The age, duration of diabetes, systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), fasting blood glucose (FBG), triglyceride (TG), cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), homocysteine (HCY), glycosylated hemoglobin (HbA1c) were compared. At the same time, the three groups of patients for continuous 72 hours of dynamic blood glucose monitoring, observed the difference between the three groups of the average blood glucose level (MBG) and the daily average blood glucose excursion amplitude (MAGE). More comparison using single factor analysis of variance between groups, between two groups to compare the LSD method. Spearman method was used for correlation analysis, multiple factor analysis using multiple stepwise regression analysis. Results The diabetic duration[(12.85±6.3) years vs. (16.06±6.86) years vs. (8.42±4.17) years], SBP[(143.21±22.51) mmHg vs. (157.78±18.41) mmHg vs. (131.73±20.95) mmHg], DBP[(80.12±11.66) mmHg vs. (86.50±13.30) mmHg vs. (72.73±12.76) mmHg], TG[(2.38±0.98) mmol/L vs. (3.11±2.06) mmol/L vs. (1.75±0.81) mmol/L], HCY[(7.74±1.40) mmol/L vs. (9.55±1.46) mmol/L vs. (9.94±4.07) mmol/L], MBG[(8.45±1.68) mmol/L vs. (10.65±2.38) mmol/L vs. (14.41±5.40) mmol/L], MAGE[(9.30±1.47) mmol/L vs. (11.73±2.58) mmol/L vs. (25.15±18.45) mmol/L] of micro protein urine group and a large amount of proteinuria group were higher than those of normal proteinuria group (P<0.05). The diabetic duration[(12.85±6.3) years vs. (16.06±6.86) years], SBP[(143.21±22.51) mmHg vs. (157.78±18.41) mmHg], DBP[(80.12±11.66) mmHg vs. (86.50±13.30) mmHg], TG[(2.38±0.98) mmol/L vs. (3.11±2.06) mmol/L], HCY[(7.74±1.40) mmol/L vs. (9.55±1.46) mmol/L], MBG[(8.45±1.68) mmol/L vs. (10.65±2.38) mmol/L, MAGE[(9.30±1.47) mmol/L vs. (11.73±2.58) mmol/L] of micro protein urine group were lower than those of a large amount of proteinuria group (P<0.05). The Spearman correlation analysis showed that UACR was positively associated with diabetic duration, SBP, DBP, TG, HCY, MBG, MAGE (all P<0.05). In multiple stepwise regression analysis, diabetes duration (x1), SBP (x2), MBG (x3) and HCY (x4) were independent risk factors of UACR. Regression equation: ^y=-1.044+ 0.027x1+0.011x2+1.04x3+1.02x4. Conclusion There is a correlation between blood glucose excursion, HCY and urine protein excretion in patients with diabetic nephropathy. Key words: Diabetes mellitus; Blood glucose; Proteinuria; Cysteine