Analysis Of Differences In Blood Glucose Homeostasis And Intestinal Flora In Newly-onset Type 2 Diabetes Mellitus With Qi-yin Deficiency Syndrome And Spleen Deficiency And Phlegm-Damp Syndrome

Part one: Differences in clinical information of new-onset type 2diabetes mellitus patients with qi-yin deficiency syndrome and spleen deficiency and phlegm-damp syndromePurpose:In recent years,the number of patients with type 2 diabetes has increased rapidly.Since there are few intervention factors for new-onset type 2 diabetes,it is more suitable to study the nature of the disease.This part explores the relationship between the syndrome of qi-yin deficiency and spleen deficiency and phlegm-dampness syndrome in new-onset type 2diabetes,also analyzes the nature of different symptoms of the same disease,and finds ideas for disease prevention and treatment.Method:From January 1,2019,to December 31,2021,258 new-onset type 2 diabetes patients in the Department of Metabolic Diseases,Shanxi Academy of Traditional Chinese Medicine were collected.Data with incomplete data were excluded,and a total of 166 new-onset type 2cases were screened according to the inclusion and exclusion criteria.Effective cases of diabetes.Establish a database to record the basic information of the included patients,including age,gender,height,weight,and Body mass index;record clinical test indicators,including liver function indicators,blood and kidney function indicators,four blood lipids,Hb A1 c,fasting and postprandial Two-hour blood glucose,fasting and two-hour postprandial insulin,urine microalbumin measurement,and homocysteine;Estimated Glomerular Filtration Rate estimated by CKD-EPI formula,Homeostasis model calculated by HOMA2 Calculator of B cell function,Homeostasis model of Insulin sensitive and Homeostasis model of Insulin resistance.Using SPSS 26.0 software to compare the data of newly diagnosed type 2 diabetes with qi-yin deficiency group and spleen deficiency and phlegm-dampness group,to find the relationship and difference between the two syndrome types.Result:1.The incidence of T2 DM is on the rise with the increase of age,male is higher than that of female,and the incidence of qi-yin deficiency syndrome is significantly higher than that of spleen deficiency and phlegm-damp syndrome after the age of 50.There was no significant difference in age,gender and height between the two groups,and they were comparable(P>0.05).2.There were no significant differences in serum uric acid,blood lipids,HOMA2-%B,urinary microalbumin,urinary Serum creatinine and homocysteine?between the two groups,and there was no statistical significance(P>0.05).3.The body weight,BMI index,ALT,AST,GGT,e GFR,INS and HOMA2-IR index of patients with spleen deficiency and phlegm-damp syndrome were significantly higher than those with Qi-yin deficiency syndrome,and the difference was statistically significant(P<0.05),but HOMA2-%S decreased significantly(P<0.001).Conclusions:1.The incidence of T2 DM increases significantly after the age of 50,and the number of males is more.2.The weight of the spleen deficiency and phlegm-dampness group increased slightly,and the liver and kidney function indexes were slightly increased.Regular review of weight management should be strengthened.3.Fasting insulin secretion increased,insulin resistance index increased,and insulin sensitivity was poor in the spleen-deficiency and phlegm-dampness group.Insulin and drugs of insulin secretion promoting should be avoided as much as possible when choosing a clinical program for T2 DM who is spleen-deficiency or phlegm-dampness syndrome.Part two: Analysis of blood glucose homeostasis and intestinal flora in newly-onset type 2 diabetes mellitus with qi and yin deficiency syndrome and spleen deficiency and phlegm dampness syndromePurpose:We used Time in range to evaluate the differences in blood glucose homeostasis among different types of new-onset type 2 diabetes mellitus patients.At the same time,we used16 s r RNA gene high-throughput sequencing technology to find the different species between different types of Type 2 diabetes mellitus,and to explore the cause of the syndrome.The key bacterial genera of phenotypic changes,and the biological nature of "same disease with different treatment" in T2 DM.Method:A case-control study was conducted,and 6 people in the newly diagnosed type 2 diabetes group with qi and yin deficiency,6 people in the spleen deficiency and phlegm-dampness group,and 12 people in the healthy group were set up.New-onset type 2 diabetes patients who were hospitalized in the Department of Metabolism,Shanxi Provincial Hospital of Traditional Chinese Medicine from January 2021 to December 2021,aged between 18 and65,signed the informed consent.After admission,the basic information of the patients,including age,gender,height,weight,body mass index,waist circumference,abdominal circumference and hip circumference,were recorded;clinical test indexes,including liver function indexes,blood and kidney function indexes,four items of blood lipids,and glycation were recorded.Hemoglobin,oral glucose tolerance test,insulin release test,C-peptide release test,urine microalbumin measurement and homocysteine;calculation of waist-to-hip ratio,abdominal circumference to height ratio;calculation of Estimated Glomerular Filtration Rate by CKD-EPI formula and calculation of Estimated Glomerular Filtration Rate by HOMA2 Calculator calculates Homeostasis model of B cell function,Homeostasis model of Insulin sensitive and Homeostasis model of Insulin resistance;The clinical syndrome type requires an attending physician or deputy chief physician to diagnose according to the inclusion-exhaust standard,and then the same chief physician conducts quality control to determine the syndrome type;all patients install Medtronic’s continuous blood glucose monitor for continuous blood glucose monitoring;finally,The first stool of the subjects after admission was collected for sequencing of intestinal flora.At the same time,healthy people were recruited into the society,aged between 18-65 years old,and all signed the informed consent.Record the basic information of healthy subjects,including age,gender,height,weight and body mass index,waist circumference,abdominal circumference,and hip circumference;record clinical test indicators,including liver function indicators,blood and kidney function indicators,four blood lipids,Hb A1 c,fasting glucose and fasting insulin;calculate waist-to-hip ratio,abdominal circumference to height ratio;calculate e GFR by CKD-EPI formula,calculate HOMA2-%B,HOMA2-%S and HOMA2-IR index by HOMA2 Calculator;collect biochemical tests on the day Early morning stool samples.All fecal specimens were stored in a-80℃ refrigerator in the Laboratory Department of Shanxi Academy of Traditional Chinese Medicine.After the specimens were collected,they were uniformly sent to Shanghai Pesennuo Biotechnology Co.,Ltd.to use 16 s r RNA gene high-throughput sequencing technology to analyze the intestinal flora.Gene Sequencing.Compare the differences between different groups and look for marker species.Result:1.There were no significant differences in age,gender,height,weight,waist circumference,abdominal circumference,and hip circumference among the healthy group,Qi-yin deficiency group,and spleen-deficiency and phlegm-damp syndrome groups(P>0.05).Among the groups,the spleen deficiency and phlegm-dampness group had the highest BMI index(P<0.05);the healthy group had the lowest waist-to-hip ratio and abdominal circumference-height ratio,and the difference was statistically significant(P<0.05).2.In terms of biochemical examination,the ALT of the spleen deficiency and phlegm-damp group was higher than that of the healthy group(P<0.05),and the GGT of the two new-onset diabetes groups was increased(P<0.05).In terms of renal function test,in terms of renal damage,urinary microalbumin was increased in the spleen-deficiency phlegm-damp group(P<0.05).3.In terms of blood sugar,the Hb A1 c white level in the two groups with new-onset T2 DM increased(P<0.01),but there was no statistical difference between the two groups(P>0.05);TIR in the spleen deficiency and phlegm-damp group was significantly decreased(P<0.05).),and the fasting blood glucose values?were significantly higher than those of the other two groups(P<0.01).4.In terms of islet function index,the islet B fine function index in both T2 MD groups decreased significantly(P<0.01);but the insulin sensitivity index in the spleen deficiency and phlegm-damp group was significantly decreased(P<0.01),and the insulin resistance index was also significantly decreased(P<0.01).increased(P<0.05).5.The results of gut microbiota sequencing showed that the species richness and diversity of gut microbiota in the newly diagnosed diabetes group were lower than those in the healthy group.There were significant differences(P<0.05),the healthy group was marked by Aggregatibacter,Pseudobutyrivibrio,and Faecalibacterium,while the Qi and Yin deficiency group was marked by Bacillus,Actinomyces,leuconostoc and Collinsella;while the spleen deficiency and phlegm-damp group had no specific markers Bacteria.Conclusions:1.Waist-to-hip ratio can be used as an important reference index for community diabetes screening and disease management.2.The level of TIR in the new-onset T2 DM group with spleen deficiency and phlegm-dampness was lower than that of the Qi-yin deficiency group,and the degree of insulin resistance was obvious.3.Compared with the healthy group,the species richness and diversity of the intestinal flora in the new-onset T2 DM group decreased compared with the healthy group,and the intestinal flora structure in the Qi-Yin deficiency group was significantly changed.4.The pathogenesis of Qi-Yin deficiency syndrome may be caused by inflammatory bacteria causing endogenous inflammatory responses in the intestinal tract,and the reduction of Prausnitzii can damage the structure and function of the intestinal barrier.Lipotoxicity induces an inflammatory state that damages islet B cells and leads to insulin resistance,which may be the main mechanism for the pathogenesis of spleen deficiency and phlegm-dampness syndrome.