Effects of seasonal and temperature variations on fasting blood glucose levels in patients with type 2 diabetes mellitus

doi:10.11958/20241962

Abstract

Abstract:

Objective To explore the impact of seasonal and temperature variations on fasting blood glucose (FPG) in patients with type 2 diabetes (T2DM). Methods A retrospective analysis was conducted on clinical data of 31 994 T2DM patients managed by community health service center in Minhang District, Shanghai, from January 1, 2020 to October 31, 2023. The effect of seasonal and temperature variations on FPG levels and blood glucose control was investigated in T2DM patients. Results A total of 72 334 FPG tests were conducted in 31 994 T2DM patients, with an average of 2.26 tests per person. The number of tests conducted in spring, summer, autumn and winter were 15 558, 34 018, 21 929 and 829, respectively. The FPG levels of T2DM patients were lower in summer and autumn compared to those of winter and spring (P < 0.05), while the FPG control rates were higher in summer and autumn compared to those of winter and spring (Bonferroni-corrected, P < 0.008). There were no significant differences in FPG levels and blood glucose control rates between spring and winter, or between summer and autumn. The results of the multilevel mixed-effect Logistic model analysis with FPG control status as the dependent variable revealed that the risk of uncontrolled FPG in T2DM patients during winter and spring was 47% (aOR=1.465, 95%CI: 1.156-1.855) and 51% (aOR=1.510, 95%CI: 1.384-1.645), respectively, which was higher than that of autumn. The levels of FPG and the incidence of FPG abnormalities reached peak in February and reached the trough in September. Both the FPG levels and the incidence of FPG abnormal exhibited a trend of increasing with the decrease of temperature, and with a lag effect observed. Spearman rank correlation test indicated that there was a negative correlation between FPG levels and incidence of abnormal FPG and the monthly average daily temperature one month lagged (r_s=-0.951, P<0.001 and r_s=-0.944, P<0.001). Conclusion FPG levels of T2DM patients exhibit a pronounced seasonal pattern of elevation during winter and spring, accompanied by a reduction in blood glucose control rates. FPG levels and the prevalence of abnormal FPG exhibit a negative correlation with the monthly average daily temperature, and there is a lag effect.

Key words: diabetes mellitus, type 2, fasting plasma glucose, glycemic control, season, temperature

CLC Number:

R446.1，R587.1

Figures/Tables 5

References 19

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季节	n		性别（男/女）^#	年龄（<60岁/60~64岁/65~69 岁/70~74岁/75~79岁/≥80岁）^#	婚姻状况（已婚/未婚或丧偶或离异/不详）^#	受教育程度（大学及以上/ 高中/初中/小学/不详）^#
春季	15 558		7 022/8 536	399/1 829/4 915/4 544/2 596/1 275	12 814/733/2 011	539/1 962/4 827/3 644/4 586
夏季	34 018		15 734/18 284	764/3 972/10 987/9 858/5 481/2 956	27 652/1 641/4 725	980/3 558/10 140/8 927/10 413^A
秋季	21 929		10 146/11 783	456/2 698/6 761/6 228/3 527/2 259^AB	18 358/1 274/2 297^AB	812/3 233/7 367/4 917/5 600^AB
冬季	829		432/397^ABC	43/144/240/239/99/64^ABC	709/29/91^B	37/170/296/125/201^ABC
χ²			18.450^＊	147.496^＊	172.648^＊	592.890^＊
季节	吸烟^#	饮酒^#	饮食习惯（荤素均衡/荤食为主/素食为主）	规律锻炼^#	久坐生活方式^#	腹型肥胖^#
春季	2 398（15.4）	933（6.0）	15 491/42/25	8 115（52.2）	7 292（46.9）	8 197（52.7）
夏季	5 358（15.8）	2 181（6.4）	33 871/94/53	17 604（51.7）	16 391（48.2）^A	16 131（47.4）^A
秋季	3 099（14.1）^AB	1 291（5.9）	21 806/84/39	10 967（50.0）^AB	10 868（49.6）^AB	10 147（46.3）^AB
冬季	154（18.6）^C	89（10.7）^ABC	821/5/3	447（53.9）	381（46.0）	459（55.4）^BC
χ²	35.227^＊	36.641^＊	10.480	24.166^＊	28.689^＊	183.167^＊
季节	糖尿病家族史^#		高血压	降糖药使用情况（不服药/ 口服/胰岛素/口服+胰岛素）^#	收缩压/mmHg	舒张压/mmHg
春季	7 514（48.3）		10 899（70.1）	1211/12168/923/1256	144.52±18.40	76.81±10.65
夏季	16 105（47.3）		24 097（70.8）	3305/26835/1728/2150^A	141.75±18.32^a	74.41±12.84^a
秋季	10 568（48.2）		15 460（70.5）	2202/17103/1137/1487^A	143.65±18.34^ab	76.67±11.45^b
冬季	447（53.9）^ABC		556（67.1）	87/641/34/67^A	143.16±16.48^ab	75.97±9.25^b
χ²或F	17.995^＊		8.013^＊	126.616^＊	95.389^＊	123.249^＊
季节	BMI/（kg/m²）		TG/（mmol/L）	TC/（mmol/L）	HDL-C/（mmol/L）	LDL-C/（mmol/L）
春季	25.25±3.38		1.71±1.28	5.04±1.17	1.46±0.38	2.98±0.95
夏季	24.84±3.35^a		1.80±1.34^a	4.88±1.13^a	1.37±0.35^a	2.91±0.93^a
秋季	24.88±3.36^a		1.75±1.31^ab	4.96±1.16^ab	1.43±0.38^ab	2.96±0.96^ab
冬季	25.45±3.25^bc		1.73±1.34	5.00±1.13^b	1.41±0.37^ab	2.98±0.92^b
F	59.040^＊		19.496^＊	76.081^＊	280.196^＊	27.253^＊

季节	n		性别（男/女）^#	年龄（<60岁/60~64岁/65~69 岁/70~74岁/75~79岁/≥80岁）^#	婚姻状况（已婚/未婚或丧偶或离异/不详）^#	受教育程度（大学及以上/ 高中/初中/小学/不详）^#
春季	15 558		7 022/8 536	399/1 829/4 915/4 544/2 596/1 275	12 814/733/2 011	539/1 962/4 827/3 644/4 586
夏季	34 018		15 734/18 284	764/3 972/10 987/9 858/5 481/2 956	27 652/1 641/4 725	980/3 558/10 140/8 927/10 413^A
秋季	21 929		10 146/11 783	456/2 698/6 761/6 228/3 527/2 259^AB	18 358/1 274/2 297^AB	812/3 233/7 367/4 917/5 600^AB
冬季	829		432/397^ABC	43/144/240/239/99/64^ABC	709/29/91^B	37/170/296/125/201^ABC
χ²			18.450^＊	147.496^＊	172.648^＊	592.890^＊
季节	吸烟^#	饮酒^#	饮食习惯（荤素均衡/荤食为主/素食为主）	规律锻炼^#	久坐生活方式^#	腹型肥胖^#
春季	2 398（15.4）	933（6.0）	15 491/42/25	8 115（52.2）	7 292（46.9）	8 197（52.7）
夏季	5 358（15.8）	2 181（6.4）	33 871/94/53	17 604（51.7）	16 391（48.2）^A	16 131（47.4）^A
秋季	3 099（14.1）^AB	1 291（5.9）	21 806/84/39	10 967（50.0）^AB	10 868（49.6）^AB	10 147（46.3）^AB
冬季	154（18.6）^C	89（10.7）^ABC	821/5/3	447（53.9）	381（46.0）	459（55.4）^BC
χ²	35.227^＊	36.641^＊	10.480	24.166^＊	28.689^＊	183.167^＊
季节	糖尿病家族史^#		高血压	降糖药使用情况（不服药/ 口服/胰岛素/口服+胰岛素）^#	收缩压/mmHg	舒张压/mmHg
春季	7 514（48.3）		10 899（70.1）	1211/12168/923/1256	144.52±18.40	76.81±10.65
夏季	16 105（47.3）		24 097（70.8）	3305/26835/1728/2150^A	141.75±18.32^a	74.41±12.84^a
秋季	10 568（48.2）		15 460（70.5）	2202/17103/1137/1487^A	143.65±18.34^ab	76.67±11.45^b
冬季	447（53.9）^ABC		556（67.1）	87/641/34/67^A	143.16±16.48^ab	75.97±9.25^b
χ²或F	17.995^＊		8.013^＊	126.616^＊	95.389^＊	123.249^＊
季节	BMI/（kg/m²）		TG/（mmol/L）	TC/（mmol/L）	HDL-C/（mmol/L）	LDL-C/（mmol/L）
春季	25.25±3.38		1.71±1.28	5.04±1.17	1.46±0.38	2.98±0.95
夏季	24.84±3.35^a		1.80±1.34^a	4.88±1.13^a	1.37±0.35^a	2.91±0.93^a
秋季	24.88±3.36^a		1.75±1.31^ab	4.96±1.16^ab	1.43±0.38^ab	2.96±0.96^ab
冬季	25.45±3.25^bc		1.73±1.34	5.00±1.13^b	1.41±0.37^ab	2.98±0.92^b
F	59.040^＊		19.496^＊	76.081^＊	280.196^＊	27.253^＊

季节	n	FPG/（mmol/L）	血糖控制^#
春季	15 558	8.38±2.61	5 012（32.2）
夏季	34 018	8.09±2.51^a	12 691（37.3）^A
秋季	21 929	8.07±2.51^a	8 279（37.8）^A
冬季	829	8.41±2.52^bc	270（32.6）^BC
年均值	72 334	8.15±2.53	26 252（36.3）
F或χ²		57.456^＊	152.232^＊

季节	n	FPG/（mmol/L）	血糖控制^#
春季	15 558	8.38±2.61	5 012（32.2）
夏季	34 018	8.09±2.51^a	12 691（37.3）^A
秋季	21 929	8.07±2.51^a	8 279（37.8）^A
冬季	829	8.41±2.52^bc	270（32.6）^BC
年均值	72 334	8.15±2.53	26 252（36.3）
F或χ²		57.456^＊	152.232^＊

变量	β	SE	Wald χ²	P	OR（95%CI）
冬季	0.382	0.121	3.16	0.002	1.465（1.156~1.855）
春季	0.412	0.044	9.32	<0.001	1.510（1.384~1.645）
夏季	-0.049	0.031	-1.57	0.116	0.952（0.897~1.012）
女	-0.439	0.043	-10.24	<0.001	0.645（0.593~0.701）
60~64岁	0.026	0.111	0.23	0.815	1.026（0.825~1.276）
65~69岁	-0.167	0.108	-1.54	0.123	0.846（0.685~1.046）
70~74岁	-0.226	0.109	-2.06	0.039	0.798（0.644~0.989）
75~79岁	-0.274	0.113	-2.42	0.015	0.760（0.610~0.949）
≥80岁	-0.411	0.120	-3.42	0.001	0.663（0.524~0.839）
未婚或丧偶或离异	0.010	0.084	0.12	0.907	1.010（0.856~1.191）
婚姻状况不详	0.031	0.065	0.47	0.636	1.031（0.908~1.171）
学历（初中）	-0.206	0.050	-4.11	<0.001	0.814（0.738~0.898）
学历（高中）	-0.366	0.063	-5.79	<0.001	0.694（0.613~0.785）
学历（大学及以上）	-0.394	0.104	-3.79	<0.001	0.674（0.550~0.827）
学历（不详）	-0.188	0.057	-3.33	0.001	0.829（0.742~0.926）
吸烟	0.035	0.059	0.60	0.550	1.036（0.923~1.163）
饮酒	0.205	0.081	2.54	0.011	1.228（1.048~1.439）
荤食为主	0.133	0.315	0.42	0.673	1.142（0.616~2.119）
素食为主	-0.676	0.426	-1.59	0.112	0.509（0.221~1.171）
规律锻炼	-0.193	0.086	-2.25	0.025	0.824（0.697~0.975）
久坐生活方式	-0.049	0.086	-0.57	0.571	0.952（0.806~1.126）
腹型肥胖	0.318	0.031	10.41	<0.001	1.374（1.294~1.459）
糖尿病家族史	-0.062	0.037	-1.67	0.094	0.940（0.873~1.011）
高血压	-0.320	0.044	-7.27	<0.001	0.726（0.666~0.791）
收缩压	0.010	0.001	12.60	<0.001	1.010（1.009~1.012）
TG	0.211	0.016	13.28	<0.001	1.235（1.197~1.274）
TC	0.319	0.016	19.68	<0.001	1.376（1.332~1.420）
HDL-C	-0.554	0.052	-10.66	<0.001	0.575（0.519~0.636）
2021年	0.080	0.039	2.05	0.041	1.083（1.003~1.169）
2022年	0.270	0.038	7.10	<0.001	1.310（1.217~1.412）
2023年	0.099	0.043	2.31	0.021	1.104（1.015~1.201）
常数项	-0.951	0.200	-4.75	<0.001	0.386（0.261~0.572）