Nocturnal blood glucose fluctuation of type 2 diabetes mellitus complicated with obstructive sleep apnea hypopnea syndrome increases the risk of microvascular complications

Abstract

Objective To investigate the association between blood glucose fluctuation and microvascular complications in type 2 diabetes mellitus patients complicated with obstructive sleep apnea hypopnea syndrome(OSAHS). Methods 55 patients(34 males and 21 females,with an average of (61±6) years old) complicated with OSAHS were enrolled as case group,and 55 patients (30 males and 25 females, with an average of (60±5)years old) without OSAHS were enrolled as control group.Blood glucose, blood lipid, glycosylated hemoglobin A1c (HbA1c),and 24 h urinary microalbumin (24 hUMA) was detected. Dynamic glucose monitoring system(CGMS) was used to monitor the values of mean amplitude of glycemic excursions (MAGE),standard deviation of blood glucose (SDBG), mean of daily differences (MODD),largest amplitude of glycemic excursions (LAGE),the low blood glucose time percentage( 7.8 mmol/L), high blood glucose time percentage(>11.1 mmol/L) and blood glucose fluctuation coefficient.Apnea hypopnea index (AHI) was monitored by polysomnography (PSG), microvascular complications of all patients were also detected.t test, χ2 test,variance analysis, Pearson product moment correlation analysis and Logistic multivariate analysis were used to evaluate the data. Results (1)The values of MAGE,SDBG, MODD,LAGE,low blood glucose time percentage(<3.9 mmol/L) and blood glucose fluctuation coefficient(F=28.137,26.226,19.802,17.734,29.132,29.404,all P<0.05) were significantly increased with the increase of AHI.(2)AHI was positively related with MAGE,SDBG, and blood glucose fluctuation coefficient (r=0.465,0.696,0.533,all P<0.05). (3) The incidence of microvascular complications in case group (81.8%) was significantly higher than that in control group (32.7%, χ2=27.08, P <0.05).(4) Logistic analysis showed that HbA1c(OR=9.646,95%CI:2.381-39.076), AHI(OR=7.435,95%CI:1.834-30.134), MAGE(OR=10.052, 95%CI:1.057-95.622), SDBG(OR=6.435,95%CI:1.414-29.287), LAGE(OR=12.199,95% CI:2.322- 99.613), blood glucose fluctuation coefficient (OR=8.511,95% CI:2.012- 35.787), the duration of diabetes (OR=11.769,95% CI: 3.642- 43.005) was the risk factor of T2DM compliaced with microvascular complication. Conclusions The merger of OSAHS could increase blood glucose fluctuation and frequency in T2DM patients.Nocturnal glucose fluctuation was associated with microvascular complications in T2DM patients complicated with OSAHS. Key words: Diabetes mellitus, type 2; Sleep apnea, obstructive; Blood glucose fluctuation; Microvascular complications