Patient baseline characteristics
EDM group (n = 73): 43 patients received insulin, 13 patients used insulin secretagogues and 17 patients used other oral hypoglycemic agents. 41 patients with coronary heart disease, 15 patients with cerebrovascular disease, 10 patients combined with coronary heart disease and peripheral arterial disease, and 7 patients with peripheral arterial disease.
MDM group (n = 34): 19 cases used insulin, 6 cases treated with insulin secretagogue and 15 cases used other oral hypoglycemic agents. 8 cases with coronary heart disease, 2 cases with cerebrovascular disease, 8 patients combined with coronary heart disease and peripheral arterial disease, and 16 cases with peripheral arterial disease.
Comparison of the clinical characteristics between patients in EDM and MDM groups
The BMI (25.68 ± 3.23 kg/m2 vs 27.29 ± 3.50 kg/m2, P = 0.021) and DBP levels (68.25 ± 9.21 mmHg νs 77.47 ± 14.41 mmHg, P = 0.001) of the EDM group were significantly lower, while the prevalence of hypertension (HP) (79.5% vs 52.9%, P = 0.005) were significantly higher than those of the MDM group. There was no significant difference in fasting blood glucose, hemoglobin A1c, uric acid, creatinine and blood lipid levels between the two groups. (Table 1)
Table 1
Comparison of general clinical data of EDM and MDM patients
Variables
|
EDM
|
MDM
|
P
|
n
|
73
|
34
|
|
Male [n,( %)]
|
56 (76.7)
|
22 (64.7)
|
0.536
|
Age(yrs)
|
81.08 ± 5.36
|
56.68 ± 5.24
|
< 0.001
|
BMI(kg/m)
|
25.68 ± 3.23
|
27.29 ± 3.50
|
0.021
|
SBP(mmHg)
|
142.03 ± 18.20
|
135.26 ± 23.12
|
0.139
|
DBP(mmHg)
|
68.25 ± 9.21
|
77.47 ± 14.41
|
0.001
|
Anti-diabetes drugs
|
|
|
|
sulfonylurea[n,(%)]
|
13(17.8)
|
6(17.6)
|
0.507
|
Insulin[n,(%)]
|
43(58.9)
|
19(55.9)
|
0.528
|
Others[n,(%)]
|
17 (35.6)
|
9 (26.5)
|
0.223
|
HP [n,(%)]
|
58 (79.5)
|
18 (52.9)
|
0.005
|
FBG(mmol/L)
|
7.21 ± 3.30
|
7.33 ± 3.05
|
0.649
|
HbAlC(%)
|
7.47 ± 1.70
|
7.69 ± 2.16
|
0.456
|
TC(mmol/L)
|
4.38 ± 1.16
|
4.69 ± 1.05
|
0.375
|
TG(mmol/L)
|
1.45 ± 0.94
|
2.01 ± 1.07
|
0.012
|
HDL-C(mmol/L)
|
1.23 ± 0.28
|
1.21 ± 0.41
|
0.830
|
LDL-C(mmol/L)
|
2.53 ± 0.89
|
2.57 ± 0.79
|
0.284
|
UA(umol/L)
|
335.16 ± 99.02
|
321.13 ± 91.65
|
0.501
|
Cr(umol/L)
|
80.07 ± 17.71
|
74.29 ± 25.65
|
0.655
|
BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; HP, hypertension; FBG, fast blood glucose; HbA1C, hemoglobin A1c; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; UA, uric acid; Cr, Creatinine. |
Comparison Of Hypoglycemia Between Edm And Mdm Groups
The incidences of grade 1 hypoglycemia (55.9% vs 64.7%, P = 0.403) and grade 2 hypoglycemia (15.1% vs 20.6%, P = 0.477) in EDM group were lower than those of the MDM group, but the differences were not statistically significant. For the occurrence time of hypoglycemia, 20 case-times occurred during the day and 23 case-times occurred at night in the EDM group, and in the MDM group, 13 case-times occurred during the day and 11 case-times occurred at night. (6am-10 pm during the day; 10 pm-6am at night).
Comparison of blood glucose fluctuation indicators between EDM and MDM groups
The SDBG (2.39 ± 1.00 mmol/L vs 2.00 ± 0.82 mmol/L, P = 0.048), LAGE (9.53 ± 3.37 mmol/L vs 7.84 ± 2.64 mmol/L, P = 0.011) and MAGE (5.77 ± 2.16 mmol/L vs 4.63 ± 1.89 mmol/L, P = 0.026) in EDM group were significantly higher than those of the MDM group. These results suggested that patients of EDM have greater blood glucose fluctuations. (Table 2)
Table 2
Comparison of the blood glucose variability index between the groups of EDM and MDM (mean ± SD)
Variables
|
EDM
|
MDM
|
P
|
n
|
73
|
31
|
|
SDBG(mmol/L)
|
2.39 ± 1.00
|
2.00 ± 0.82
|
0.048
|
LAGE(mmol/L)
|
9.53 ± 3.37
|
7.84 ± 2.64
|
0.011
|
MAGE(mmol/L)
|
5.77 ± 2.16
|
4.63 ± 1.89
|
0.026
|
MODD(mmol/L)
|
2.13 ± 1.09
|
1.72 ± 1.03
|
0.063
|
SDBG, Standard Deviations of Blood Glucose; LAGE = Large Amplitude of Glycemic Excursion; MAGE, Mean Amplitude of Glycemic Excursion; MODD, Absolute Means of Daily Differences. |
Comparison of heart rate and arrhythmia between EDM and MDM groups
The maximum heart rate (100.26 ± 13.73 vs 112.27 ± 20.75, P = 0.017) and average heart rate (67.93 ± 9.82 vs 73.22 ± 9.03, P = 0.026) in the EDM group were significantly lower than those in the MDM group. There was no significant difference of the minimum heart rate between the two groups. The incidences of atrial premature beat, couplets of atrial premature beat, atrial tachycardia, ventricular premature beat and couples of ventricular premature beat in the EDM group were significantly higher than those in the MDM group (all P < 0.05). The mean QTc interval (0.47 ± 0.01 vs 0.45 ± 0.00, P = 0.029) in the EDM group was significantly longer than that of the MDM group. (Table 3)
Table 3 Comparison of arrhythmia indicators between the groups of EDM and MDM
|
n
|
Maximal heart rate (mean±SD)
|
Minimal heart rate (mean±SD)
|
Mean heart rate (mean±SD)
|
APB
[M(Q1, Q3)]
|
Couplets of A
[M(Q1, Q3)]
|
AT
[M(Q1, Q3)]
|
EDM
|
73
|
100.26±13.73
|
51.84±9.99
|
67.93±9.82
|
135(35,382)
|
2(1,8)
|
1(0,3)
|
MDM
|
34
|
112.27±20.75
|
56.82±17.84
|
73.22±9.03
|
7(2,18)
|
0(0,0)
|
0(0,0)
|
P
|
|
0.017
|
0.222
|
0.026
|
<0.001
|
<0.001
|
<0.001
|
|
n
|
VPB
[M(Q1, Q3)]
|
Couplets of V
[M(Q1, Q3)]
|
VT
[M(Q1, Q3)]
|
Mean QTc (s)
(mean±SD)
|
EDM
|
73
|
25(3,303)
|
0(0,0)
|
0(0,0)
|
0.47±0.01
|
MDM
|
34
|
1(0,3)
|
0(0,0)
|
0(0,0)
|
0.45±0.00
|
P
|
|
<0.001
|
0.034
|
0.122
|
0.029
|
APB, atrial premature beats;Couplets of A, Couplets of atrial premature beats; AT, atrial tachycardia;VPB, ventricular premature beats; Couplets of V, Couplets of ventricular premature beats; VT, ventricular tachycardia.
Comparison of arrhythmias between EDM group and MDM group under different MAGE layers
In patients of MAGE1 (1.24–4.37 mmol/L), the number of atrial premature beat (P = 0.012) was significantly higher in the EDM group. In patients of MAGE2 (4.38–6.36 mmol/L), atrial premature beat (P < 0.001), couples of atrial premature beat (P < 0.001), atrial tachycardia (P = 0.001), and ventricular premature beat (P < 0.001) occurred significantly more frequent in the EDM group. The QTc interval (0.48 ± 0.01 s vs 0.45 ± 0.01 s, P = 0.047) was significantly longer in the EMD group. In patients of MAGE3 (6.37–13.66 mmol/L), we also found significant higher incidences of atrial premature beat (P < 0.001), couples of atrial premature beat (P < 0.001), atrial tachycardia (P < 0.001), and ventricular premature beat (P = 0.013) in EDM group. (Table 4)
Table 4
Difference in arrhythmia according to MAGE and the tertiles MAGE between the groups of EDM and MDM
Variables
|
EDM
|
MDM
|
P
|
n
|
28
|
8
|
|
MAGE1
|
APB [M(Q1, Q3)]
|
129(44.5,228)
|
18(4,51)
|
0.012
|
Couplets of A [M(Q1, Q3)]
|
2.5(1,7)
|
2(0,4.5)
|
0.256
|
AT [M(Q1, Q3)]
|
1(0,4)
|
0.5(0,1.5)
|
0.127
|
VPB [M(Q1, Q3)]
|
21(2,237.5)
|
0(0,49)
|
0.083
|
Couplets of V [M(Q1, Q3)]
|
0(0,0)
|
0(0,0)
|
0.279
|
VT [M(Q1, Q3)]
|
0(0,0)
|
0(0,0)
|
0.472
|
Mean QTc (s)(mean ± SD)
|
0.45 ± 0.01
|
0.46 ± 0.01
|
0.362
|
|
n
|
24
|
12
|
|
MAGE2
|
APB [M(Q1, Q3)]
|
108(23.5,450)
|
7(2,15.5))
|
<0.001
|
Couplets of A [M(Q1, Q3)]
|
2(0,5)
|
0(0,0)
|
<0.001
|
AT [M(Q1, Q3)]
|
1(0,3)
|
0(0,0)
|
0.001
|
VPB [M(Q1, Q3)]
|
97.5(4,923)
|
1.5(0,3)
|
<0.001
|
Couplets of V [M(Q1, Q3)]
|
0(0,0)
|
0(0,0)
|
0.221
|
VT [M(Q1, Q3)]
|
0(0,0)
|
0(0,0)
|
0.331
|
Mean QTc (s)(mean ± SD)
|
0.48 ± 0.01
|
0.45 ± 0.01
|
0.047
|
|
n
|
21
|
14
|
|
MAGE3
|
APB [M(Q1, Q3)]
|
210(46,750)
|
5.5(4,9)
|
<0.001
|
Couplets of A [M(Q1, Q3)]
|
4(1,28)
|
0(0,0)
|
<0.001
|
AT [M(Q1, Q3)]
|
2(1,7)
|
0(0,0)
|
<0.001
|
VPB [M(Q1, Q3)]
|
7(2,196)
|
0.5(0,4)
|
0.013
|
Couplets of V [M(Q1, Q3)]
|
0(0,0)
|
0(0,0)
|
0.259
|
VT [M(Q1, Q3)]
|
0(0,0)
|
0(0,0)
|
0.448
|
Mean QTc (s)(mean ± SD)
|
0.47 ± 0.01
|
0.45 ± 0.01
|
0.234
|
APB, atrial premature beats;Couplets of A, Couplets of atrial premature beats; AT, atrial tachycardia; VPB, ventricular premature beats; Couplets of V, Couplets of ventricular premature beats; VT, ventricular tachycardia. |
Comparison of arrhythmias in patients with hypoglycemic events between EDM and MDM groups
The maximum heart rate (99.52 ± 12.47 beat/min vs 111.83 ± 18.08 beat/min, P = 0.006) and mean heart rate (67.60 ± 9.28 beat/min vs 74.26 ± 8.93 beat/min, P = 0.007) in EDM patients were significantly lower than those of MDM patients, while the minimum heart rate was not significantly different. The incidences of atrial premature beat (P < 0.001), couples of atrial premature beat (P < 0.001), atrial tachycardia (P < 0.001) and ventricular premature beat (P = 0.002) in patients with EDM were significantly higher than those in the MDM group. (Table 5)
Table 5 Comparison of arrhythmias in patients with HE in groups of EDM and MDM
HE
|
n
|
Maximal heart rate (mean±SD)
|
Minimal heart rate (mean±SD)
|
Mean heart rate (mean±SD)
|
APB
[M(Q1, Q3)]
|
Couplets of A
[M(Q1, Q3)]
|
AT
[M(Q1, Q3)]
|
EDM
|
42/73
|
99.52±12.47
|
53.14±9.41
|
67.60±9.28
|
120(34,379)
|
2(1,6)
|
1(0,3)
|
MDM
|
23/34
|
111.83±18.08
|
58.09±17.19
|
74.26±8.93
|
7(2,22)
|
0(0,2)
|
0(0,0)
|
P
|
|
0.006
|
0.211
|
0.007
|
<0.001
|
<0.001
|
<0.001
|
HE
|
n
|
VPB
[M(Q1, Q3)]
|
Couplets of V
[M(Q1, Q3)]
|
VT
[M(Q1, Q3)]
|
Mean QTc (s)
(mean±SD)
|
EDM
|
42/73
|
14.5(2,278)
|
0(0,0)
|
0(0,0)
|
0.45±0.01
|
MDM
|
23/34
|
1(0,14))
|
0(0,0)
|
0(0,0)
|
0.46±0.01
|
P
|
|
0.002
|
0.199
|
0.302
|
0.135
|
HE, hypoglycemic event. APB, atrial premature beats;Couplets of A, Couplets of atrial premature beats; AT, atrial tachycardia;VPB, ventricular premature beats; Couplets of V, Couplets of ventricular premature beats; VT, ventricular tachycardia.