Zhongguo quanke yixue (May 2023)
Characteristics and Influencing Factors of Glycemic Fluctuation in Patients with Coronary Heart Disease with Type 2 Diabetes during the Peri-PCI Period
Abstract
Background The glycemic fluctuation in peri-percutaneous coronary intervention (PCI) period is closely related to the short-term and long-term prognosis in patients with coronary heart disease (CHD). At present, there are few studies on glycemic fluctuation and its influencing factors in peri- PCI period in these patients. Objective To explore the characteristics and influencing factors of glycemic fluctuation during peri-PCI period in patients with CHD and type 2 diabetes (T2DM) . Methods One hundred and fifty-six patients undergoing PCI in the cardiology ward of Jiangsu Provincial People's Hospital from April 2021 to November 2021 were selected. General demographics were collected by general demographics questionnaire. Perioperative glycemic fluctuation was collected by glycemic data questionnaire. The patients were stratified according to the normal reference value range of blood glucose fluctuation evaluation indicators: normal standard deviation of blood glucose level (SDBG) group (<2.0 mmol/L, n=58) and high SDBG group (≥2.0 mmol/L, n=98) by the SDBG level; normal amplitude of postprandial glycemic excursions (PPGE) group (<2.2 mmol/L, n=28) and high PPGE group (≥2.2 mmol/L, n=128) by the PPGE; normal largest amplitude of glycemic excursion (LAGE) group (<4.4 mmol/L, n=39) and high LAGE group (≥4.4 mmol/L, n=117) by the LAGE. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The Hospital Anxiety and Depression Scale (HAD) was used to identify depression and anxiety. The Numeric Rating Scale (NRs) used to assess pain intensity in peri-PCI period. Pearson and Spearman correlation analyses were used to study the correlation of factors related to blood glucose fluctuation during the peri-PCI period. Multiple linear regression analysis was used to explore the factors associated with blood glucose fluctuation during the peri-PCI period. Results Normal and high SDBG groups had statistically significant differences in course of diabetes, use of glucose control regimen, mean values of HbA1c, changes in dieatary intake during perioperative period, operation start time, operation duration, and NRs score; as well as stent/balloon implantation prevalence (P<0.05). HbA1c in normal SDBG group was lower than that in high SDBG group. There were statistically significant differences in use of glucose control regimen, mean values of BMI and TC, as well as perioperative dietary intake between normal and high PPGE groups (P<0.05). The mean values of BMI and TC of normal PPGE group were higher than those of high PPGE group. There were statistically significant differences in the duration of diabetes, use of glucose control regimen, mean values of TC, HbA1c and NRS score between normal and high LAGE groups (P<0.05). The normal LAGE group had higher TC and lower HbA1c than high LAGE group. The results of repeated measures ANOVA showed that the mean values of SDBG, PPGE and LAGE on the day before PCI, the day of PCI and the day after PCI were significantly different (P<0.05). Correlation analysis showed that during the peri-PCI period, SDBG was positively correlated with age, NRs score and PSQI score (r=0.216, 0.188, 0.295, P<0.05). PPGE was positively correlated with age, duration of diabetes (rs=0.179, P<0.05) and NRs score (rs=0.165, P<0.05), and negatively correlated with BMI and TG (rs=-0.254, -0.196, P<0.05). LAGE was positively correlated with the duration of diabetes, HbA1c and HAD score (rs=0.355, 0.171, 0.158, P<0.05). Multiple linear regression analysis showed that age; diet, PSQI score, and the time from the final meal before PCI to the start of PCI were independent factors influencing SDBG, with an explanatory degree of 19.3% (P<0.05). Education level, BMI, glucose control regimen, the time from the end of PCI to the first meal after PCI, and the time from the final meal before PCI to the start of PCI were independent factors influencing PPGE, with an explanation degree of 21.3% (P<0.05). The duration of diabetes, systolic blood pressure, PSQI score, location of domicile, perioperative exercise time, NRs score, the time from the end of PCI to the first meal after PCI; and time of surgery initiation were independent factors influencing LAGE, with an explanation degree of 47.8% (P<0.05) . Conclusion The influencing factors of blood glucose fluctuation during the peri-PCI period in patients with CHD and T2DM may include age, diabetes course, systolic blood pressure, registered permanent residence, education level, BMI, diet, perioperative exercise time, sleep quality, pain level, the time from the end of PCI to the first meal after PCI; the time from the final meal before PCI to the start of PCI, time of surgery initiation, and glycemic control plan. Based on these factors, personalized plans can be designed to control blood sugar fluctuations to improve the prognosis.
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