[Association of glycaemic variability and carotid intima-media thickness in patients with type 2 diabetes mellitus].

OBJECTIVE: To investigate the relationship between blood glucose fluctuations and carotid intima-media thickness (CIMT) in type 2 diabetic patients. METHODS: 64 patients with type 2 diabetes mellitus (T2DM) in the Department of Endocrinology and Metabolism, West China Hospital from July 2009 to March 2012 were recruited in this study. The CIMT were measured bilaterally with high-resolution ultrasonography. The glucose excursions were assessed by the following parameters obtained from the continuous glucose monitoring system (CGMS) for 72 h: mean blood glucose (MBG) and its standard deviation (SD), mean amplitude of glycemic excursion (MAGE), mean of daily differences (MODD). Glycosylated hemoglobin (HbAlc), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) of the participants were also determined. According to the levels of CIMT, 64 diabetic patients were classified into two groups: diabetes mellitus without atherosclerosis (A group, n = 37) and diabetes mellitus with atherosclerosis (B group, n = 27). The relationship between the parameters of glycaemic variability and CIMT was examined. RESULTS: (1) There were no differences between A group and B group with regard to gender composition, course of diabetes, body mass index (BMI), diabetic chronic complications, family history of diabetes, smoking, alcohol drinking, diastolic blood pressure (DBP), TG, TC, HDL-c, SD and MAGE (P > 0.05). A group had younger age and lower levels of systolic blood pressure (SBP), LN(LDL-c) and LN (MODD) than B group (P < 0.05). (2) Pearson correlation analyses showed that CIMT was positively correlated with age (r = 0.370, P = 0.005), LN (LDL-c) (r = 0.325, P = 0.009), SD (r = 0.251, P = 0.045) and LN (MODD) (r = 0.346, P = 0.005). (3) Age, smoking, LN (LDL-c) and LN (MODD) were identified as predictors for CIMT in the multiple linear regression analysis. CONCLUSION: Glucose excursions may contribute to the development of atherosclerosis in patients with type 2 diabetes, which is independent from HbA1c levels.

[The ultrasound image characteristics of lower extremities arteries in diabetic foot].

OBJECTIVE: To identify the ultrasound image characteristics of lower limb arteries in diabetic feet. METHODS: 189 patients with diabetic feet were recruited in this study. 375 lower limbs of the patients were classified into grade I-IV according to their Fontaine classifications and accepted Color Doppler Ultrasound examinations. Of the 375 lower limbs, 210 were classified as level I, 46 as level II, 43 as level III and 76 as level IV. The degree of artery stenosis was categorized into < or = 50% reduction in diameter, 51%-99% reduction in diameter and complete occlusion. The lesion characteristics of common femoral arteries, superficial femoral arteries, popliteal arteries, anterior tibial arteries, posterior tibial arteries, peroneal arteries and dorsalis pedis arteries were analyzed. The ultrasound scores of lower limbs arterial diseases were compared in the patients with different levels of Fontaine classifications. RESULTS: The incidence of plagues in lower extremities arteries was 97.60% (366/375). Most plaques (97.60%, 366/375) were distributed in crus arteries and the majority of plaques (59.47%, 223/375) were serious. The incidence of PAD was 63.73% (239/375). Crus vasculars involvement was more serious. The levels of Fontaine classifications of the lower limb arteries were associated with ultrasound vascular disease severity scores. The higher grade had higher scores. The lower limbs with at least one occlusive blood vessel in the patients with Fontaine grade I reached 30%. CONCLUSION: The Ultrasound image is an important screening tool for PAD in diabetic feet. It can estimate the type of plaques, the seriousness of artery diseases and the location of lesions. Because up to 30% diabetic feet with Fontaine I classifications have at least one occlusive blood vessel, the clinical manifestations do not provide enough evidence for the diagnosis of PAD.