| Purpose:The symptoms,diet,sleep,blood glucose control and other general conditions of patients with early-onset type 2 diabetes mellitus(T2DM)were observed,and the incidence of macrovascular and microvascular complications were evaluated,so as to comprehensively understand the clinical epidemiological characteristics of patients with early-onset T2 DM.The incidence of T2 DM in patients and their family members was collected by questionnaire to investigate whether there was any correlation between different family history of diabetes,gender and age at diagnosis of T2 DM,and to evaluate the related factors of early onset of T2 DM.Non-targeted metabonomic techniques were used to explore the changes in metabolic profile of patients with early onset T2 DM.Methods:1.According to the investigation of T2 DM patients in the outpatient department of our hospital’s metabolic disease management center from October 2017 to September2020,patients were divided into early-onset T2 DM group and late-onset T2 DM group according to the diabetes diagnosis age of 40 years.The symptoms,carbonated drink intake,diet and sleep,smoking and drinking history,and body mass index of the two groups were compared.The macrovascular and microvascular lesions of the patients were analyzed and compared.2.The family history of T2 DM patients was further divided into father,mother,both parents,other diabetes and no family history of diabetes.The age of diagnosis of diabetes with different family history of diabetes was compared.Taking early onset T2 DM as the dependent variable,the family history of diabetes,gender,smoking history and drinking history as independent variables The related factors of early-onset T2 DM were evaluated.3.The newly diagnosed early-onset and late-onset type 2 diabetes mellitus were selected as the research objects,and the matched age,gender and low-risk population of diabetes mellitus were selected as the control group(Chinese Diabetes Risk Questionnaire score<25 points).LC-MS / MS was used to detect the difference of serum metabonomics.The LC-MS / MS data were extracted by XCMS software,and the difference data were analyzed by SIMAC-P software.The difference metabolites were identified based on the self built database of local standard,and the difference metabolites were annotated and analyzed by KEGG.Results:1.A total of 4222 patients with T2 DM were investigated,699 patients with early-onset T2 DM and 3523 patients with late-onset T2 DM.The proportion of obesity in patients with early-onset T2 DM was the highest(46.6%),and the proportion of positive family history was the highest(72.0%).Early onset T2 DM patients preferred carbonated drinks(17.8% vs 4.9%,p<0.001)and went to bed after 24:00 at night(31.3% vs17.3%,p<0.001).2.10.0% of the patients with early-onset T2 DM had coronary heart disease(CHD),and the age of diagnosis was 45.3 ± 8.9 years old.48.1% of the patients had hypertension,and the age of diagnosis was 37.6±9.8 years old.The positive rate of DPN check in 613 patients with early-onset T2 DM was higher than that in late-onset T2DM(43.6%vs30.2%,p=0.003).The positive rate of urinary ACR was higher in early-onset T2 DM group(10.7% vs 8.4%,p=0.047).A total of 2454 patients received and completed fundus screening.The positive rate of diabetic retinopathy(DR)screening was 23.6%.After balancing the factors of course of disease,gender,weight,smoking and drinking,and taking the age of DM diagnosis≥60 years as the reference,the positive OR value of DR was 1.626(1.197-2.207)in 40-60 years old patients with T2 DM,and the early-onset T2 DM was 2.245(1.563-3.226).3.A total of 3725 Han patients with T2 DM completed the investigation of family history,gender and age of diagnosis of diabetes.The age of diagnosis of male patients was earlier than that of female patients(51.7±11.2 vs 54.0±10.2,p< 0.001);the age of diagnosis of father and parents with family history of diabetes(47.5±11.0 and47.9±11.1)< mother with family history of diabetes(51.1 ±10.5)< other family history of diabetes and no family history of diabetes(54.7±10.3 and 54.1±10.5),p<0.05.After balancing gender,weight and other factors,with no family history of diabetes as reference,the OR values of early-onset T2 DM of mother,father and parents with family history of diabetes were 1.548(1.191-2.012)、2.7(2.058-3.543)and 2.844(1.971-4.104)respectively.4.A total of 21 patients with early-onset T2 DM,25 in the corresponding control group,48 in the late-onset T2 DM group,and 23 in the corresponding control group were included for non targeted metabonomics analysis.Compared with late-onset T2 DM,the increased metabolites in early-onset T2 DM patients included Deoxycholic acid,D-Ribose,Dihydroxyacetone,Vitamin E,Cholesterol 3-sulfate,2’-Deoxy-D-ribose,1-Stearoyl-sn-glycerol,L-Isoleucine,Betaine,L-Leucine,Thioetheramide-PC,L-Glutamine;the decreased metabolites included 3-Indolepropionic acid,Pristanic acid,Embelin,1,2,3-Benzenetriol,L-Carnitine.After KEGG analysis,related pathways involved in alanine,aspartate and glutamate metabolism,pyrimidine metabolism,nitrogen metabolism,D-Glutamine and D-glutamate metabolism,valine,leucine and isoleucine biosynthesis and degradation.Conclusion:1.A higher proportion of early-onset T2 DM patients had obesity and family history of diabetes.Early onset T2 DM patients could be combined with coronary heart disease and hypertension early.Early onset T2 DM is positively correlated with DR.2.Male patients with a family history of diabetes of their father and mother may be diagnosed earlier.Early onset of T2 DM is significantly associated with different family history of diabetes and gender.3.Compared with their respective healthy control groups,there are differences in metabonomics between early-onset T2 DM and late-onset T2 DM.The pathways involved include branched chain amino acids,energy metabolism,bile acid metabolism,etc.These metabolic differences need to be further verified,and the impact on early-onset T2 DM and its specific mechanism need to be further studied. |
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