The Effect Of Intensive Therapy With Insulin Pump On The Occurrence And Development Of Low Limb Vascular Disease In Newly Diagnosed Patients With Type 2 Diabetes Mellitus

Objective:This research was based on newly diagnosed patients with T2 DM. The selected patients were divided into two groups by looking up medical records according to treatment scheme of initial clinic visit. Cases with short-term insulin pump intensive glucose-lowering were recorded as strengthened group(Group A), and cases with other therapy to control blood glucose were recorded as non-strengthened group(Group B). By comparing the general clinical data, blood glucose and blood lipid controlling situations,serum homocysteine(Hcy) and lower extremity arterial disease(LEAD) score of the two groups, the effect and potential mechanisms of earlier intensive therapy with insulin pump on the occurrence and development of lower limb vascular disease in newly diagnosed patients with T2 DM were discussed. Evidence was provided for earlier improving metabolism memory effect of diabetic patients and delaying occurrence and development of macro vascular complications.Methods:By searching clinic and medical records, 523 patients with newly diagnosed T2 DM from Department of Endocrinology, General Hospital of Beijing Military Area Command from January 2002 to December 2013 were selected as research objects. According to the therapy of initial diagnosis, 249 cases treated with insulin pump reinforcement treatment were recorded as strengthened group(Group A).Patients in strengthened group were treated with insulin pump for about two weeks, then they were treated by oral hypoglycemic agents(OHA) or life style intervention to control blood glucose. 274 T2 DM cases treated with other methods in initial diagnosis were recorded as non-strengthened group(Group B). All patients’ medical records in initial diagnosis include general clinic data, Hcy and lower limb artery ultrasound results. From Dec. 2014 to Dec. 2015, patients accorded with the inclusion criteria were given return visit, and patients’ subsequent visit situations since having illness and all adjustment situations of the blood sugar reducing were collected, including presence of numbness, ache and ulceration of lower limbs. Age,course of disease, BMI, blood pressure and general biochemical indicators including FPG,Hb A1 c, TC, TG, HDL-C, LDL-C and HCY. All patients are tested for ABI, and imaging examination of lower limb vascular ultrasound or angiography, etc. simultaneously. We use ABI, lower limb vascular imaging examination and clinical symptoms to determine whether LEAD can be diagnosed, and to grade for patients’ lower limb vascular lesions(not meeting the diagnostic conditions was recorded as 0 score). Comparing and analyzing general data, HCY level and LEAD score of initial visit and return visit of patients from the two groups. The effect of different therapy on the occurrence and development of lower extremity arterial disease in newly diagnosed Patients with T2 DM was discussed.Results:1. Data comparing for initial visit:1.1 There was no statistical significance for age, systolic pressure(SBP), diastolic pressure(DBP), BMI, FPG, TC, TG, LDL-C, HDL-C and HCY difference of patients from Group A and B(P>0.05), Hb A1 c of Group A was higher than B(P<0.05).1.2 There was no statistical significance for score of LEAD of patients from Group A and B(P>0.05).2. Data comparing for return visit:2.1 There was no statistical significance difference for age, course of disease(CD),SBP, DBP, BMI, FPG, Hb A1 c, TC, TG, HDL-C level of patients from Group A an B(P>0.05).2.2 Comparing LDL-C, HCY and score of LEAD: Group A<Group B, the difference has statistical significance(P<0.05).3. Correlation analysis indicates: diabetes mellitus lower extremity arterial disease score has positive related to age, CD, SBP, FPG, LDL–C and HCY.4. According to course of disease, patients from group A and B were divided into three subgroups and score of LEAD was compared:(1)1≤CD≤5 years, Group A’s was higher, but the statistical difference was not significant(P>0.05);(2)6≤CD≤10years and CD>10years, score of Group A< Group B, the difference was statistical significance(P<0.05).Conclusion:1. Part of newly diagnosed T2 DM have already gotten diabetes mellitus lower extremity arterial disease.2. Earlier insulin pump intensive glucose-lowering treatment can improve islet cell function and oxidative stress responsed by improving metabolic memory effect of diabetes mellitus patients.3. Short-term insulin pump intensive treatment was utilized for eligible patients with newly diagnosed T2 DM may delay the occurrence and development of lower extremity arterial disease.