| Part one The different effects of CSII with or without liraglutide on glycemic control and glycemic variability in newly diagnosed poorly controlled T2 DM patients with obesity or overweightObjective: To investigate the use of the flash glucose monitoring(FGM)system in hospitalized newly diagnosed poorly controlled type 2 diabetes mellitus(T2DM)patients receiving continuous subcutaneous insulin infusion(CSII),also to explore the different effects of CSII with or without liraglutide on glycemic control and glycemic variability(GV)in newly diagnosed poorly controlled T2 DM patients with obesity or overweight.Methods:1.The study was carried out in 60 hospitalized newly diagnosed poorly controlled T2 DM patients with obesity or overweight enrolled in the department of endocrinology in the Third Hospital of Hebei Medical University during March 2018 and September 2018.Subjects were fitted with FGM,and then randomized 1:1 to receive either CSII therapy(n=30)or liraglutide+CSII(n=30)therapy for 2 weeks.Liraglutide was increased every3 days from the initial dose of 0.6 mg/day to 1.2 mg/day up to 1.8 mg/day if there was no intolerance,such as vomiting or nausea.2.Every patient provided a full medical and medication history and underwent a physical examination(including body weight,height,and blood pressure)at study enrollment,hepatic and renal functions,blood glucose,glycosuria hemoglobin(Hb A1c),fasting insulin(FINS),serum lipid were detected,and body mass index(BMI)were calculated.Adverse effects,changes in body weight and insulin dose during the study were recorded.3.The FGM system was used to assess the glycemic control and GV indices for 2 weeks.Time in range(TIR),hyperglycemia rate,hypoglycemia rate,mean blood glucose concentration(MBG),estimated hemoglobin A1c(e Hb A1c),area under the curve(AUC),and measures of GV,including the standard deviation of the mean glucose(SD),coefficient of variation(CV),interquartile range(IQR),mean amplitude of glycemic excursions(MAGE),largest amplitude of glycemic excursions(LAGE),and mean of daily difference(MODD)were compared between the two groups.1,5-anhydroglucitol(1,5-AG)was measured by enzyme linked immunosorbent assay(ELISA)to assess the GV.Results: 1.There were no between-group differences in age,sex and BMI at baseline.Additionally,there were no significant differences between the two groups in Hb A1 c and FPG,blood pressure,lipid profile,C-peptide,fasting insulin,diabetic complications,or family history at the beginning of the study(all P>0.05);2.The estimated Hb A1 c and MBG,AUC decreased in both groups,especially in the CSII + liraglutide group(all P<0.05);3.The hyperglycemia rate(the percentage of time spent above 10.0mmol/L,13.9mmol/L,or 22.2mmol/L)decreased and the TIR increased in both groups,especially in the CSII + liraglutide group(all P<0.05).There was no difference in hypoglycemia rate(time spent below 2.8mmol/L,3.3mmol/L,or3.9 mmol/L)between the two groups(P> 0.05);4.SD,IQR,LAGE,and MODD were significantly lower in the CSII + liraglutide group than in the CSII group(all P<0.05);The 1,5-AG significantly increased in the CSII +liraglutide group(P<0.05);5.Body weight loss was significantly greater in the CSII + liraglutide group than in the CSII group(P<0.05);6.The daily insulin dosage in the CSII + liraglutide group was significantly lower than that in the CSII group(P<0.05).Conclusions:1.CSII with liraglutide group was superior to CSII group in improving glycemic control,TIR and other glycemic variability indices.2.The daily insulin dosage was significantly lower and body weight losswas significantly greater in the CSII + liraglutide group than in the CSII group.Part two The different effects of CSII with or without liraglutide on oxidative stress biomarkers and inflammation levels in newly diagnosed poorly controlled T2 DM patients with obesity or overweightObjective: To explore the different effects of CSII with or without liraglutide on oxidative stress biomarkers and inflammation levels in newly diagnosed poorly controlled T2 DM patients with obesity or overweight.Methods:1.According to the inclusion and exclusion standard,60 hospitalized newly diagnosed poorly controlled T2 DM patients with obesity or overweight were enrolled in the department of endocrinology in the Third Hospital of Hebei Medical University during March 2018 and September 2018.Subjects were randomized 1:1 to receive either CSII therapy(n=30)or liraglutide+CSII(n=30)therapy for 2 weeks.Liraglutide was increased every 3 days from the initial dose of 0.6 mg/day to 1.2 mg/day up to 1.8 mg/day if there was no intolerance,such as vomiting or nausea.2.Two oxidative stress biomarkers,4-hydroxynonenal(4-HNE)and8-hydroxydeoxyguanosine(8-OHd G)and inflammatory cytokine TNF-α were measured by ELISA at baseline and endpoint.Results: 1.The oxidative stress markers 8-OHd G and 4-HNE levels were comparable between the two groups at baseline(all P>0.05).The 8-OHd G and4-HNE levels were significantly decreased in both groups after treatment(P<0.05).The decreases in 8-OHd G and 4-HNE levels in the CSII +liraglutide group were significantly greater than the reductions in the CSII group(P<0.05);2.The baseline serum levels of TNF-α was comparable in CSII+ liraglutide group and CSII group(P>0.05).The TNF-α in the CSII +liraglutide group decreased significantly after treatment(P<0.05).Conclusions:CSII combined with liraglutide treatment was better than CSII alone group in decreasing oxidative stress markers and inflammatorycytokine TNF-α.Part three The different effects of CSII with or without liraglutide on adipocytokine levels in newly diagnosed poorly controlled T2DM patients with obesity or overweightObjective: To investigate whether liraglutide add-on to the CSII therapy would have different effects on adipocytokine(Omentin-1,PANDER)levels.Methods:1.This study was carried out in 60 hospitalized newly diagnosed poorly controlled T2 DM patients with obesity or overweight enrolled in the department of endocrinology in the Third Hospital of Hebei Medical University during March 2018 and September 2018.Patients were randomized1:1 to receive either CSII therapy(n=30)or liraglutide +CSII(n=30)therapy for 2 weeks.Liraglutide was increased every 3 days from the initial dose of0.6 mg/day to 1.2 mg/day up to 1.8 mg/day if there was no intolerance,such as vomiting or nausea.2.Omentin-1,PANDER levels were measured at baseline and after 2weeks’ different treatment.Results: 1.Omentin-1 levels were similar between the two groups at baseline.Compared with CSII alone group,it showed an increase in Omentin-1 in liraglutide +CSII group after treatment(P<0.05);2.PANDER levels were comparable between the two groups at baseline.Compared with CSII alone group,it showed a reduction in PANDER in liraglutide +CSII group after treatment(P<0.05).Conclusions:Compared with CSII alone group,it showed a reduction in PANDER and an increase in Omentin-1 in liraglutide +CSII group after treatment. |
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