| Background : With an ageing population, urbanization, dietary factors, the change of lifestyle and environmental risk factors, the incidence of diabetes is fast growing in our country, according to the diabetes map of the international diabetes federation in 2013, the number of diabetes patients in China has reached 98.4 millions, to be home first place in terms of the total number of people with diabetes. Our country is mainly in type 2 diabetes mellitus(T2DM),which always coexists with obesity. Current numerous international studies results show that lose weight can significantly improve the insulin resistance, thereby lowering the risk of T2 DM morbidity, and lower the patient’s blood glucose and blood lipid spectrum, delay the progress of atherosclerosis, reduce cardiovascular events.So many factors related to control weight, such as leptin, adiponectin, incretin and nesfatin-1 received widespread attention and researched in recent years.Nesfatin-1 was firstly reported as adipokines in 2006 by the Japanese scholar Oh-I and his colleagues, which was widely attentioned due to its inhibition of feeding. Currently, the mechanism of nesfatin-1 to inhibit the action of the feeding has not been fully elucidated, but in recent years, many studies have shown that nesfatin-1 widely exists in numerous nuclei of feeding regulation in the hypothalamus and brainstem, at the same time a large number of existed in the peripheral of the digestive system, which have obvious correlation with the glucose metabolism, and involve in a variety of diseases such as obesity, insulin resistance, sleep and mood, myocardial infarction, tumor, hyperemesis gravidarum, inflammatory diseases.This paper discusses its relationships of blood glucose, blood lipid, obesity related to diabete. In order that, provide a new method of the prevention and therapy for diabetes and its complications.Objective 1. To observe the change of serum nesfatin-1 level before and after short-term insulin intensive treatment in patients with type 2 diabetes 2. To discuss the relationship of serum nesfatin-1 level with blood glucose, blood lipidsand diabetes related to obesity.Methods This experiment approved by the Shandong Academy of Medical Sciences Ethics Committee. According to the BMI,60 T2 DM patients up to experimental standard(aged 40-60 y, diagnosed ≤5y) with blood glucose uncontrolled(Hb A1c≥7%),divided into two groups: T2 DM with normal body weight(T2DM-NW group, n=30, male/female=14/16 BMI<24 kg/m2) and T2 DM with obesity(T2DM-OB group, n=30, male/female=16/14 BMI≥28 kg/m2), accepted two-week intensive insulin therapy, using multiple daily insulin injections(MDII): before meals with biosynthesis human insulin(Novolin R) and before going to bed with Isophane Protamine Biosynthetic Human Insulin injection(Novolin N).At the same time, given a unified type 2 diabetes diet nutrition management.To conform to continue the test, experimental subjects have to get target blood glucose in 3 to 5 days,(with FPG in 5-7mmol/L, 2h PG in 8-10 mmol/L),excluding did not achieve the target blood glucose in 3 to 5 days. And then compared and analyzed the change and relationship of fasting blood glucose(FPG), postprandial two-hour blood glucose(2h PG), hemoglobin A1c(Hb A1c), triglyceride(TG), total cholesterol(TC), homa beta cell function index(HOMA-β),insulin resistance index(HOMA-IR) and the serum nesfatin-1 before and after treatment between two groups.Results 1.Compared the clinical and experimental indexes between the two groups before treatment The results showed that: the body weight, BMI, TG, TC, HDL-C, serum nesfatin-1 level have significant difference in the two groups. The body weight, BMI, TC, TG in the T2DM-OB group have a significantly higher than that of T2DM-NW group, with statistical significance(P﹤0.05). The HDL–C, serum nesfatin–1 level in the T2DM-NW group were significantly higher than that of T2DM-OB group, with statistical significance(P ﹤0.05).Other indicators are not significant.2. Compared the clinical and biochemical indexes, serum nesfatin-1 levels before and after treatment. After treatment, the FPG, 2h PG, Hb A1 c, TC, TG, LDL-C, HOMA-IR and serum nesfatin-1 levels of both two groups were decreased dramatically,but body weight, BMI, FIN, HOMA-β were increased(P﹤0.05), the HDL–C in T2DM-OB group was higher than before treatment(P﹤0.05) 3. Correlation and multiple regression analysis the serum nesfatin-1 level and other experimental indexes before treatment. The Spearman correlation analysed the correlation of the serum nesfatin-1 level with other experimental indexes, the results showed that serum nesfatin-1 level was positively correlated with FPG, 2h PG(r = 0.295, 0.0257, P﹤0.05), and with the weight, BMI, TG, TC has significant negative correlation(r = 0.641, 0.770, 0.507, 0, 543, P﹤0.05), and the gender, age, course of the disease, Hb A1 c, HDL-C, LDL-C, FIN, HOMA-IR, HOMA-beta had no obvious correlation.Multiple stepwise regression analysis with the serum nesfatin- 1 levels as a dependent variable, the independent variables including gender, age, course of the disease, body weight, BMI, FPG, 2h PG, Hb A1 c, TG, TC, HDL-C, LDL-C, HOMA-IR, HOMA-β, showed that only BMI for independent factors affecting the level of serum nesfatin-1(P ﹤0.01).Conclusions(1) Intensive insulin therapy can significantly reduce serum nesfatin-1 level in patients with type 2 diabetes.After short-term insulin intensive treatment,which can remove the toxicity of high glucose, improve the function of islet beta cells, weaken IR, lower levels of serum nesfatin-1, that explain nesfatin–1 has relationship with the regulation of sugar metabolism, islet beta cell function and IR.(2)The serum nesfatin-1 level was significantly negative correlation with TG, TC, BMI, on the contrary, positively correlated with FPG, 2h PG, and BMI was the independent factors affecting the level of serum nesfatin-1(P〈0.01).So we can infer that nesfatin-1 may involved in the development of blood glucose, blood lipid metabolism disorders, obesity related to diabetes.(3)The serum nefatin-1level of T2DM-OB group significantly lower than that of T2DM-NW group(P﹤0.05).Explain nesfatin-1 is closely associated with body weight. |
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