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Relationship between blood glucose control and collateral circulation formation after unilateral carotid stenosis or occlusion in elderly patients with type 2 diabetes mellitus

Luo Guojun;Zhang Lei;Tang Dingzhong;Liu Zhen;Hu Canfang;Department of Neurology, Jinshan Branch, Shanghai Sixth People's Hospital;  
Objective To investigate the relationship between blood glucose control and collateral circulation formation in elderly patients with type 2 diabetes mellitus(T2DM). Methods A total of 91 patients with severe stenosis or occlusion of unilateral internal carotid artery complicated with T2DM treated in the department of neurology of Jinshan branch of Shanghai Sixth People's Hospital from December 2017 to December 2019 were collected. They were divided into good collateral circulation group(n=65) and poor collateral circulation group(n=26), and the clinical data of the two groups were compared. According to the level of glycosylated hemoglobin(HbA1c) at admission, the patients were divided into HbA1c 6.0% group(n=27), 6% ≤ HbA1c 8% group(n=32), HbA1c ≥ 8% group(n=32), and the clinical characteristics and biochemical indexes of the three groups were compared.The relationship between the compensatory mode of collateral circulation and the scores of HbA1c and the National Institutes of Health Stroke Scale(NIHSS) was analyzed,and the independent risk factors of poor collateral circulation were analyzed by multivariate Logistic regression. Results The proportion of smoking history, hypertension history, hyperlipemia history, HbA1c, glycated albumin(GA), fasting blood glucose, total cholesterol(TC) and blood homocysteine contents in the poor collateral circulation group were significantly higher than those in the good collateral circulation group(χ~2/t/Z=6.720, 3.254, 6.031, 8.919, 3.063, 1.336, 2.290, 4.763; P 0.05), and left ventricular ejection fraction(LVEF) was significantly lower than that of the group with good collateral circulation(t=4.499, P 0.05). Compared with HbA1c 6% group, systolic blood pressure, diastolic blood pressure, TC, triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), blood homocysteine, GA and fasting blood glucose increased in 6% ≤ HbA1c 8% group and HbA1c ≥ 8% group, while LVEF decreased, the differences were statistically significant(all P 0.05). Compared with 6% ≤ HbA1c 8% group, systolic blood pressure, diastolic blood pressure, TC, LDL-C, blood homocysteine and fasting blood glucose in HbA1c ≥ 8% group increased, while LVEF decreased, the differences were statistically significant(all P 0.05). Compared with the non compensated group, the serum HbA1c level and NIHSS score of the first level compensated group, the second level compensated group and the third level compensated T2DM patients decreased in turn(all P 0.01). The HbA1c, history of hyperlipidemia, GA and fasting blood glucose were independent risk factors for poor collateral circulation in T2DM patients with unilateral carotid artery stenosis or occlusion(OR=1.267, 1.946, 1.285, 1.486; P 0.05). Conclusion Patients with poor collateral circulation have higher serum HbA1c levels. HbA1c, a history of hyperlipemia, GA, and fasting blood glucose are risk factors for poor collateral circulation in T2DM patients with unilateral carotid stenosis or occlusion.
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