The Vascular Plaque Of T2DM And Changes Of Postprandial Lipid Metabolism

BackgroundHigh incidence of diabetes along with the continuous improvement of people’s living standards, aging population and changing lifestyle and showing a trend of rapid growth. It is not only the fifth largest cause of death, but also the current threat to global human health. And one of the most important chronic non-communicable diseases, only after the cancer and cardiovascular disease. According to the latest statistics from the International Diabetes Federation,510million people worldwide died from diabetes-related diseases, accounting for8.39%of all deaths in2013. The chronic complications investigation reported by the Chinese Medical Association Diabetes Society noted, the prevalence of complications were:hypertension34.2%, cardiovascular disease17.1%, cerebrovascular disease12.6%, lower extremity vascular disease5.2%in hospitalized patients with T2DM of our top three hospitals in2008. In addition, with ocular complications, renal complications and neuropathy, the overall prevalence rate of over70%.The results of a study on the causes of death in patients with T2DM also show:The deaths caused by cardiovascular diseases accounted for40.4%of mortality. The risk of cardiovascular disease in diabetic populations increased2-4times, and make the vascular disease to a more serious, more extensive, worse prognosis and age tend to be younger.Vascular disease is a common complication in patients with T2DM, but also one of the important reasons for their disability and death. Its onset may be associated with potential pathophysiological changes of high blood sugar, high cholesterol, and high hypertension. Such as oxidative stress, abnormal activation of the bypass sorbitol metabolism, increased end products of glycation and the production of much inflammatory cytokine. The main manifestations of systemic vascular intimal thickening and eventually lead to the formation of plaque in blood vessels, even loss, lesions involving the whole body, and eventually lead to cardiovascular and cerebrovascular events and peripheral vascular thrombosis. Meta-analysis of the results on the same plaque in blood vessels also showed thickening of the vascular plaque has become a strong indicator of cardiovascular events, especially for stroke and myocardial infarction occurred.Lots of research data are showed that abnormal lipid metabolism is closely related to the development of diabetic complications. Some scholars have already proposed a concept "Diabetes is a dangerous disease, such as coronary heart disease". The risk of major coronary events of simple diabetes is equivalent to the patients with coronary heart disease in the next10years. The risk of acute myocardial infarction or coronary death are fairly with the patients with old myocardial infarction. The UKPDS found that lipid metabolism, especially in low-density lipoprotein cholesterol levels elevated, is the primary risk factor in T2DM patients with coronary heart disease. As early as1979, foreign scholars have been proposed that "postprandial phase is the critical period of atherosclerosis". Diabetic patients have postprandial lipid metabolism disorders, before fasting lipid abnormalities. Teno S, Breschi S found that even the fasting lipid levels is normal in patients with T2DM, their postprandial hypertriglyceridemia remained an independent risk factor for early atherosclerosis. Therefore, even though fasting lipid levels were normal for T2DM patients, it also need to closely monitor their postprandial lipid metabolism. If necessary, diet or drug intervention can be used to reduce the incidence of cardiovascular events in patients with diabetes.Apart from blood glucose levels’rise in diabetic patients, the dyslipidemia is also common."Sugar toxic" and "toxic lipid" is further aggravated damage to the body’s own islet cells, inhibiting islet function, reducing the secretion of insulin. Now many studies have confirmed that the T2DM patients with dyslipidemia will have a certain improvement in lipid profile after controlling the blood sugar levels. Generally speaking, after hypoglycemic therapy alone, TG decreased significantly, LDL-C decreased about10%, TC and HDL-C no obvious improvement. Meanwhile glycemic control also have certain degree of improvement on lipid lipoprotein particle structure. Thus, we should work out appropriate hypoglycemic treatment programs for different patients with diabetes according to their individual differences, and continue to optimize their treatment programs in order to control blood glucose and lipid effectively.This study consists of three parts. Analysis of risk factors in type2diabetes mellitus of plaque. The application programs of hypoglycemic in patients with T2DM and their effect on blood sugar and lipids. The change of postprandial lipid after a fat meal in type2diabetes patients of normal fasting lipids. To find out the incidence of diabetic macrovascular disease, as well as blood sugar and lipids playing a role during the development of vascular plaque. The control of blood sugar and lipids and their relationship between them in diabetic patients. The metabolism of postprandial lipids in T2DM patients with Normal fasting lipids.Part one Incidence and risk factors for type2diabetes patients with vascular plaque analysisObjectiveTo investigate the incidence of type2diabetes in patients with vascular plaque and analyze its risk factors.Methods176patients with type2diabetes in our hospital were examined with high resolution color Doppler ultrasound to screen the intima media thickness of neck and lower limbs artery and divided into plaque group and the none-plaque group. Sex, age, smoking, course of disease, BMI, SBP, DBP, TG, TC, HDL-C, LDL-C, FBG, PBG, HbA1c and U-MA were anaiyzed. The relationship between the risk factors and vascular plaque was used COX regression analysis.Results1.72.7%of132patients were diagnosed with plaque;2. There was significant differences in age, course of disease, SBP, FBG, PBG, TG, LDL-C, HbA1c, U-MA between the two groups;3. Age, BMI, SBP, duration, FBG, PBG, TG, LDL-C, HbAlc, U-MA are linear correlation with vascular plaque thickness;4. COX regression analysis showed that age, smoking, SBP, PBG, TG, LDL-C were independent risk factors leading to plaque for T2DM patients.Conclusion1. Most of the patients of T2DM were diagnosed with plaque;2. The plaque for T2DM patients is related to many factors, which need to be controlled and prevented in the clinical treatment to delay the progress of macro-angiopathy. Part two The application programs of hypoglycemic in patients with T2DM and their effect on blood sugar and lipidsObjectiveObserve the application programs of hypoglycemic in patients with T2DM and their different effect on blood sugar and lipids.Methods426T2DM patients were randomly surveyed, and their basic data were collected, such as gender, age, height, weight, duration and other indicators of blood glucose, blood pressure and lipids.Results1.426cases of T2DM patients, the proportion of patients using different hypoglycemic program are as follows:Single oral medication group accounted for28.2%, two oral medication group15.0%, and more than triple oral group2.8%, oral medication joint insulin group20.2%, insulin alone33.8%.2. The most frequently used of oral hypoglycemic drugs is metformin58.2%, and the second is sulfonylurea26.5%. The best control of fasting blood glucose is two oral medication group, and significantly lower than the single oral medication group and oral combined insulin group (P<0.05). The best of2-hour postprandial blood glucose control is more than triple oral group, better than two oral medication group.3. There are significantly different between treatment regimen about the HbAlc(P0.001), the highest compliance rate is the two and above oral medication group, the lowest are single oral medication group and insulin group.4. The TG, TC and LDL-C of insulin group were significantly higher than oral medication group (P<0.05). There is no significant difference between the use of oral medication group.5. There is a linear correlation in insulin group, which FBG and PBG were associated with TG and TC.Conclusion1. The blood glucose was low when the T2DM patients are mainly using single oral hypoglycemic or insulin;2. Oral hypoglycemic exists certain role for lowering blood lipid;3. The blood glucose and lipid are interaction in diabetes patients. Part three The change of postprandial lipid after a fat meal in type2diabetes patients of normal fasting lipidsObjectiveTo investigate the change of postprandial lipid after a fat meal in type2diabetes patients of normal fasting lipid levels.MethodsSubjects were assigned to three groups:the observed groups of16type2diabetic patients with normal fasting lipids and24T2DM with fasting lipid abnormalities; the healthy control group of18normal subjects. The TC, TG, HDL-C, LDL-C, apoAl, apoB, SOD and MDA were determined on an empty stomach and2,4hours after a fat meal.Results1. Postprandial TG concentrations of the three groups are all raised and reach the highest after4hours. The diabetics with fasting dyslipidemia rise greatest, which was significantly higher than the other groups(P<0.05);2. Postprandial changes in TC,LDL-C and apoB were weak after the test meal. Compared with the other two groups, the diabetics with fasting dyslipidemia at a higher level(P<0.05);3. A slight postprandial decrease in HDL-C and apoAl was observed in three groups with no significant difference between themselves(P>0.05);4. SOD in diabetic patients is significantly lower than the control group, contrary to MDA.Conclusion1. Type2diabetes patients who have normal fasting blood lipids can exist abnormal postprandial lipid metabolism. It is necessary to measure their lipid levels in clinical;2. Diet control and lipid-lowering drugs are need to used for patients with T2DM if postprandial lipid levels is high, even their fasting lipid metabolism is normal;3. The capacity of antioxidant is weak in diabetes patients. Our conclusion are as following through the above tests.1. Most of the patients of T2DM were diagnosed with plaque, The plaque for T2DM patients is related to many factors, such as smoking, hypertension, blood glucose, blood lipid. Thus, not only controlling the blood sugar levels actively but also taking some intervention for the risk factors; 2. The FBG and HbAlc of two oral medication is the best among different treatment;3. Oral hypoglycemic exists certain role for lowering blood lipid;4. The compliance rate of blood glucose levels is low in patients with T2DM in our country;5. The blood glucose and lipid are interaction in diabetes patients;6. Dyslipidemia is a distinctive feature of T2DM patients, they may exist postprandial lipid metabolism disorders even when their fasting lipid levels is normal, it is necessary to measure their lipid levels in clinical;7. Diet control and lipid-lowering drugs are need to used for patients with T2DM if postprandial lipid levels is high, even their fasting lipid metabolism is normal.