الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Several recent studies had raised the question that fluctuation in the plasma glucose level (glucose variability), irrespective of the magnitude of hyperglycemia, may confer an additional risk factor that affect the development of micro- and macro-vascular diabetic complications. Currently, several tools had been developed to evaluate short-term blood glucose variations. Among these measures are the mean amplitude of glucose excursions (MAGE) and continuous glucose monitoring (CGM). So, our study aimed to evaluate GV in patients with type 2 diabetes by two different methods and correlates its relationship with heart rate variability as indicator of CAN and to find the effect of other factors involved at the course of the study e.g. age, duration of DM, HbA1c, smoking, gender lipid profile,and Alb/Cr ratio. To achieve this target, the study recruited forty patients with type 2 diabetes mellitus treated with oral anti-diabetic medications and hadn’t neither thyroid dysfunctions, anemia nor any acute illness. All participants were subjected to: A- Careful history: Including data about patient’s (age, duration of DM, diabetic symptoms (e.g. polyuria, polydipsia), symptoms related to autonomic neuropathy (e.g. resting tachycardia, postural hypotension, persistent vomiting, and nocturnal diarrhea) and clinical examination including evaluation for neuropathy. B- Routine laboratory investigations: Were done for patients including: FPG, PPG, CBC, S. creatinine, B. urea, lipid profile, and Alb/Cr ratio. C- Heart rate variability evaluation: Using 24 hour holter ECG monitoring and analysis of both time and frequency domain indices. D- Glucose variability evaluation: Using MAGE and CGM. In our study: Patient with ECG evidence of reduced HRV had significant higher age, BMI, duration of DM, FPG, PPG, HbA1c, S.creatinine, B.urea, LDL, S.triglyecrides and Alb/Cr ratio and significant lower HDL. Our study found that patient with evidence of reduced HRV had insignificant higher MAGE. Finally continuous glucose monitoring in the present study revealed that patient with ECG evidence of reduced HRV had significant higher variability of recorded glucose readings (SDMG). The main limitation of the study is its cross-sectional design that does not allow for causal relationships to be identified. Hence, the observed associations may only serve as hypothesis generating. The second limitation of our study that, patients of our study should be evaluated for both HRV and GV after tight control of their diabetes by achieving the goal HbA1c to eliminate any relationship between HRV and long term GV. : GV, evaluated CGM, was a significant risk factor for cardiac autonomic dysfunction in patients with type 2 diabetes. In spite of the standard use of HbA1c in glucose monitoring, selfmonitoring of blood glucose (the base of MAGE calculation) and CGM assessment are suggested to be incorporated in glucose follow up. In conclusion, the present study showed that HRV is associated with GV in patients with type 2 diabetes with a relatively short course of disease. This association may explain that, GV is a cause of different diabetic complications, although other explanations could also apply. Prospective studies are needed to further investigate the importance of GV in the pathogenesis of autonomic dysfunction and other long-term complications of diabetes.