| Diabetes mellitus is a kind of environmental and genetic-related chronic metabolic diseases, of which 95% is type 2 diabetes mellitus. With the modern socioeconomic development and life style changes, the morbility of diabetes mellitus is increasing. It has become a serious public health problem of the world that impact on human health.The pathogenesis of type 2 diabetes mellitus has not been fully clarified, now widely recognizing that insulin resistance andβ-cell secretory dysfunction are the two significant links in its pathogenesis, and insulin resistance is considered to be the initiating agent which lead to type 2 diabetes mellitus, and throughout the whole process of the type 2 diabetes mellitus occurrence and development. Modern medical research has shown that obesity was closely related to type 2 diabetes mellitus and insulin resistance. Central obesity is a key point of onset. The plasma lipid level of obese patients is significantly higher. It shows that they have different degree of metabolic disturbance in vivo. Epidemiological investigations reveal that 85% diabetes mellitus patients are overweight or obese, 90% are with metabolic disturbance. In recent years, studies have shown that obesity and chronic inflammation are closely linked. The major initiation site of chronic inflammatory reaction which caused by obesity is in adipose tissue, especially visceral adipose tissue play a very important role in the production and regulation of inflammatory reaction. Adipose cells secret a variety of inflammatory cytokines, which prevent the signal transduction of insulin to product insulin resistance, and lead to the occurrence of type 2 diabetes mellitus. Therefore, as for those obese patients with type 2 diabetes mellitus, we could achieve weight relief, being hypoglycemic, and thus the destination of prevention and cure of the diabetes mellitus through regulating fat metabolism and improving the inflammation of adipose tissue .Of Chinese traditional medicine, the rational of yin-yang balance and the thinking mode of entirety concept, of determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs have a unique feature in the treatment of diabetes mellitus. A large number of studies have shown that traditional Chinese treatment had the effect features and predominance of multi-component, multi-channel, multi-target, relatively safe and smaller toxic side effects, thus showed a favourable therapeutic effect in the treatment of diabetes mellitus and insulin resistance.The topic combining discussion about etiology and pathogenesis of diabetes by ancient and modern physicians of traditional Chinese medicine, considerd that"six kinds of stasis and collaterals and subcollaterals block"would be the pathogenesis key point of traditional Chinese medicine for obese patients with type 2 diabetes mellitus and insulin resistance.At the pathogenesy of modern medicine, considerd that disorder of lipid metabolism and inflammation of adipose tissue might be one of the important reason for causing insulin resistance and type 2 diabetes mellitus. we detected the expression of gene and proteinum of adiponectin in abdominal adipose tissue those obese patients with type 2 diabetes mellitus by the techniques of immunohistochemistry, western blot and RT-PCR. We observed the effec of platelet activation in obese type 2 diabetic patients with massage combined with metformin by flow cytometry. We also detected the changes of IL-1βand FTO in peripheral blood mononuclear cells by real-time quantitative PCR, simultaneous detecting the changes of serum glucose, blood fat, FFA, TNF-α, IL-6 and CRP level, it aims at observing the therapeutic effect of massage combined with metformin and approach its mechanism of action in obese patients with type 2 diabetes mellitus, so as to providing new ideas and methods to prevention and cure insulin resistance in obese patients with type 2 diabetes mellitus.Findings were as follows:1 Clinical studies showed that:(1)Massage combined with metformin could significantly reduce the body weight and diminish waistline of obese patients with type 2 diabetes mellitus. It has a good curative effect of weight reduction. Its curative effect is better than metformin alone.(2)Massage combined with metformin could significantly reduce the blood glucose, HbA1c, TG, TC, FFA and HOMA-IR. It has a good effect of decreasing blood glucose, regulating lipid metabolismand improving insulin resistance. Its curative effect is better than metformin alone.(3)Massage combined with metformin could significantly reduce the levels of inflammatory factors of TNF-α, IL-6 and CRP, relieving inflammatory reaction and improving insulin resistance. Its curative effect is better than metformin alone.(4)Massage combined with metformin could up-regulation the lever of gene and proteinum of adiponectin, improve the body's sensitivity to insulin. Its curative effect is better than metformin alone.(5)Massage combined with metformin could improve activated state of platelet of obese patients with type 2 diabetes mellitus, prevent and delay the complication of blood vessel in type 2 diabetes mellitus.(6)Massage combined with metformin could reduce the express of mRNA of IL-1βand FTO in peripheral blood monouclear cells. It could play a effect of weight reduction, regulating metabolic disturbance, relieving inflammatory reaction, improving insulin resistance of type 2 diabetes mellitus. The effect is better than metformin alone.(7)The mechanism of action of massage might be as follows:①It could lessen body weight, correct metabolic disturbance, improve insulin resistance, decrease blood glucose.②It could directly repress inflammatory factors, or decreas the level of blood glucose and blood fat, reduce body weight, relief the venenous stimulus of blood glucose and blood fat,and thus eliminate or control the production of inflammatory factors, thereby improve insulin resistance.③Massage could prevent and delay the complication of blood vessel in type 2 diabetes mellitus through promote blood circulation,improve activated state of platelet.
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