The Study For β Cell Function And Insulin Resistance In Impaired Glucose Regulation And The Metabolic Change Before And After Treatment In The Type 2 Diabetic Patients Mellitus

Impaired fasting glucose (IFG) and impaired glucose tolerance (IGT)are the pre-diabetes state. The pathogenesis of the Type 2 Diabetes isthe insulin resistance andβcell function failure. We collected thedata from an university community population who were screened fordiabetes and analyzed their BMI, WHR, blood glucose level, lipidsdisorder, insulin secretion and insulin resistance based on theHOMA-model in the different impaired glucose regulation group. Meantime,the diabetic patients being treated 3 years were investigated for theirblood glucose, lipids, blood pressure, and the prevalence of diabeticnephropathy, retinopathy change, as well as the insulin resistance andinsulin secretion.Part 1Investigation on the relationship among impaired glucose regulation,lipids disorder and insulin resistance,βcell dysfunction -----Community population-based studyObjective To analyze BMI, WHR, blood glucose level, lipids disorder, insulin secretionand insulin resistance based on the HOMA-model in the different impaired glucoseregulation group.Methods Six hundreds and seventeen subjects were from 1519 subjectsfinished the annually physical examination in 2005 and with the bloodglucose level≥5.6 mmol/L based on an university community survey with3851 population. All subjects were taken the blood for the fasting and2 hour postprandial blood glucose, insulin and fasting blood lipids, BUNand Cr. The demographic data including height, weight, waistcircumference and blood pressure was also collected.Results1. 1519 subjects of the 3851 population had the blood glucose≥5.6mmol/L. OGTT was carried out in 617 subjects (40.62%) among them. NGT,IFG, IGT, IFG+IGT and newly diagnosed DM were confirmed in 374(60.62%),60(9.72%), 59(9.56%), 41(6.65%)and 83(13.45%); totally, 243(39.38%) cases with impaired glucose regulation(IGR).2. The highest prevalence of IFG, IGT, IFG+IGT were found in thegroup with aged 60-70, with 15.63%, 13.75%, and 10.63% respectively.The highest prevalence of diabetes (27.35%) in the group aged 70-80.IGR prevalence was increased with the aging.3. No differences among the groups with IGR for sex.4. Highest prevalence of IFG (11.79%), IGT(11.02％) and IFG+IGT(8.16％) all was found in the group with BMI 18.5-23.9 kg/m2 and BMI 24-27.9 kg/m2, respectively. Highest DM prevalence was in the group with BMI≥28 kg/m2, parallelled increased with BMI.5. Grouping the patients according to the fasting glucose level, prevalence of IGT (11.23%), IFG (15.65%) and DM (50.63%) were highest in the groups with blood glucose 5.6-6.1 mmol/L, with 5.6-6.1 mmol/L and with≥7.0 mmol/L, respectively.6. Grouping the patients with IGR based on the blood pressure, prevalence of IFG (15.65%), IGT(13.00%) and DM (23.87%) were highest in the groups with blood pressure <130/80 mmHg, 130-139/80-89 mmHg and 140-159/90-99 mmHg, respectively. DM prevalence increased with the higher blood pressure.7. IFG and DM prevalence (9.13%,both) was highest in the group with hypercholesteremia only. In the group with hypertriglyceridemia, DM prevalence (12.50%) was highest, 8.33% and 8.33% for the IFG and IFG+IGT. In the mixing hypercholesteremia and hypertriglyceridemia group, prevalence of DM, IFG+IGT, IFG and IGT was 18.87%, 7.17%, 11.32,12.83%. DM prevalence increased with the higher triglycerides level.8. Fasting insulin level (9.10±6.31mU/l) was higher in DM than NGT group(6.78±6.83 mU/l), with significant difference, but no differences between the different groups with IGR. postprandial insulin level was 51.84±42.54 mU/l,52.05±40.82 mU/l,49.71±37.30 mU/l,53.78±41.73 mU/l for IFG,IGT,IGT+IFG,DM groups,with no significant differences among these groups, but higher than NGT significantly(32.79±35.79 mU/l). No differences of HOMA-IR among DM(0.80±0.82),IFG(0.64±0.72),IFG+IGT(0.61±0.77),IGT(0.35±0.68)groups, but all these obviously higher than NGT group(0.17±0.80).Nodifferences of HOMA-B among the IGT (3.97±0.69),NGT (3.95±0.78), IFG(3.84±0.72), IFG+IGT (3.80±0.78) groups, but all these higher thanNGT(3.69±0.88)group.Conclusions About 40% of these subjects in an university populationhad their blood glucose≥5.6 mmol/L. In these subjects with bloodglucose≥5.6 mmol/L, about 40% of them had IGR, including 13.45%diabetic patients. The highest prevalence of FG,IGT,IFG+IGT was foundin the group aged 60-70. The highest prevalence of DM in the group aged70-80 and increased paralleled with the BMI and aging, was associatedwith lipids disorder, particularly with hypertriglyceridemia. IRexisted in the pre-diabetes state and was worst in the DM, with mostsevereβcell function failure.Part 2Metabolic control,βcell function and the diabetic complicationschange after 3 year treatment in the Type 2 diabetic patientsObjective To analyze the metabolic control and theβfunction andtheir relationship with the diabetic complications after 3 yeartreatment in the Type 2 diabetic patientsMethods The patients who finished 3 year treatment and diabeticcomplications assessment were investigated for their blood glucose,lipids and blood pressure control and the insulin resistance,βcellfunction, and the change of the diabetic microvascular- andmacrovascular complications. The treatment on the target, including hypoglycemic and hypotensive agents, was evaluatedResults 233 male (56.4±9.9 yrs) and 178 female (56.7±10.7 yrs)patients were analyzed. The oral hypoglycemic agents (OHA) wereincreased obviously in these patients from 38％(only one kind of OHA),33％(2 kinds of OHA)and 7％(3 kinds of OHA)to 41％,40％and 13％, respectively,the percentage of insulin used from 9% to 19% after3 year. About 55％of the patients with hypertension not take anyhypotensive agent decreased to 38％after 3 year treatment. 31％,9％and 5％hypertensive patients with 1, 2 3 kinds of hypotensive agentsincreased to 35％,17％and 10％, with statistic differences. The agentsfor lipids disorder was taken in 33% of the patients with lipidsdisorder before and in 43 % of patients after 3 years. After 3 yearstreatment, the fasting and 2 hour postprandial blood glucose no changed.But patients with HbA1c on the target (< 6.5 %) from 23％to 30％,patients with HbA1c >7.5% were decreased from 50% to 42%. The patientswith hypertension had their blood pressure well controlled in 37% to40%. The percentage of the patients with uncontrolled hypertensiondecreased from 58% to 55%, no significant difference. HDL－C controlledon the target was found in 69% to 76% after 3 years. No significantchanges for the LDL-C, TC, TG, weight, WC. Visual acuity decreased andthe prevalence of the nephropathy (albuminuria) and retinopathyincreased from 15% to 23% and 26% to 33%, respectively. Fasting andpostprandial insulin decreased from 12.75±15.78 mU/l,48.20±38.16mU/l to 10.50±12.46,40.72±31.23 mU/l,HOMA-IR decreased from1.07±1.01 to 0.88±1.06, HOMA-B from 3.57±1.20 to 3.49±1.20. Conclusions The control of the blood glucose, blood pressure andlipids disorder is not satisfactory even if OHA, insulin treatment andlipids agents were used aggressively more in the clinic. IR improvedandβcell dysfunction continued after 3 year treatment. Retinopathyand nephropathy aggravated. Intensified treatment should be paid moreattention.SummaryFrom the population-based data, about 40% of the non-diabeticpatients were with the IGR, including 13.45% newly diagnosed diabetes.IR existed in the pre-diabetes state and aggravated in DM, as well asthe worst dysfunction ofβcell. Prevalence of DM increased obviouslywith higher BMI and aging, strongly relevant to lipids.disorder,particularly hypertriglycerides.After 3 year treatment, more patients accepted the OHA, insulin,hypotensive agents and lipids agents, but the control of blood glucose,lipids and other related risk factors were not satisfactory. IR wasdecreasing but no change for theβcell dysfunction.. Intensifiedtherapy on target should be paid more attention.