The Serum Levels Of Inflammatory Factors As Well As The Effect By Insulin Pump Treatment On Factors In Newly Diagnosed Type 2 Diabetic Patients

Aims: Type 2 diabetes mellitus, in which is a gradual deterioration of glucose tolerance, is a serious metabolic disorder caused by multiple factors. It is associated with the progressive decrease inβ-cell function and increase in insulin resistance. However, the mechanism underline it still have not been explored clearly. Recently, more and more studies have reported that there should exist certain relationships between inflammatory factors and type 2 diabetes mellitus. Our objective is to make a further verification on this. Moreover, to evaluate the effects of short-term insulin pump intensive treatment or multiple subcutaneous insulin injection treatment on inflammatory factors(including hs-CRP,TNF-α,PAI-1)and insulin resistance as well asβ-cell function by observing the changes of the serum levels of inflammatory factors, fasting insulin, fasting plasm glucose, 2-h OGTT plasma glucose before and after intensive insulin pump treatment in newly diagnosed type 2 diabetic patients. Meanwhile to provide more definite data to support reasonable treatment in clinic.Methods: Sixty newly diagnosed T2DM subjects were divided into two groups randomly: (1).Continuous subcutaneous insulin group (CSII) (n=30). (2). Multiple subcutaneous insulin injection group (MSII) (n=30). All the patients were admitted to the hospital and treated by CSII or MSII for two weeks. They were carried out the oral glucose tolerance test (OGTT) before and after the treatment. Meanwhile, thirty subjects of NGT as control group (NC) (n=30). Serum levels of inflammatory factors (including hs-CRP,TNF-α,PAI-1), fasting insulin, fasting plasm glucose, 2-h OGTT plasma glucose, lipid profile, liver and kidney function in all subjects were measured before and after treatment. hs-CRP was measured by Latex-enhanced immunoturbidimetric assay (LEITD),TNF-αwas measured by Radio immuno assay (RIA), PAI-1 was measured by Enzyme linked immunosorbent assay (ELISA). HOMA-IR (Homeostasis model assessment) and HOMA-βwere calculated to evaluate insulin resistance(IR) status andβ-cell function respectively. Furthermore, the anthropometrical parameters such as body mass index (BMI), waist circumference (WC), blood pressure and life style were record.Results: (1).Compared with control group, the serum levels of hs-CRP, TNF-αand PAI-1 were significantly increased in T2DM group(P<0.01). (2).Before therapy, the patients in CSII and MSII were no significantly difference in age, BMI, WC, FPG, 2hPG, HOMA-IR, inflammatory factors (including hs-CRP,TNF-α,PAI-1), and other laboratory data(P>0.05). (3).After 2 weeks insulin therapy, the serum hs-CRP level were significantly decreased from 2.93±0.92ng/ml to 1.25±0.47ng/ml in CSII group(P<0.01), and 2.86±0.98ng/ml to 1.95±0.92ngm/l in MSII group(P<0.01); the serum TNF-αlevel were significantly decreased from 0.68±0.13ng/ml to 0.38±0.13ng/ml in CSII group(P<0.01), and 0.69±0.14ng/ml to 0.45±0.13ngm/l in MSII group(P<0.01); the serum PAI-1 level were significantly decreased from 113.24±34.11ng/ml to 40.13±16.44ng/ml in CSII group(P<0.01), and 128.78±39.36ng/ml to 83.51±30.54ng/ml in MSII group(P<0.01), respectively. (4).HOMA-IR were significantly decreased from 3.27±0.38 to 2.41±0.35 in CSII group(P<0.01) and 3.33±0.40 to 2.74±0.21 in MSII group(P<0.01); HOMA-βwas significantly improved from 2.56±0.69 to 4.04±0.64 in CSII group(P<0.01), and 2.59±0.79 to 4.74±0.44 in MSII group(P<0.01). (5).The serum TC level were significantly decreased from 5.17±1.37 to 4.24±1.05 in CSII group(P<0.01), and 4.69±1.18 to 4.22±0.86 in MSII group(P>0.05); the serum TG level were significantly decreased from 2.92±1.50 to 1.37±0.73 in CSII group(P<0.01), and 2.29±1.12 to 1.64±1.49 in MSII group(P>0.05);the serum LDL-C level were significantly decreased from 3.21±0.97 to 2.64±0.71 in CSII group(P<0.01), and 3.19±1.04 to 2.79±0.96 in MSII group(P>0.05), while no statistic difference were found in MSII group; the serum HDL-C level was decreased from 1.41±0.65 to 1.23±0.29 in CSII group(P>0.05),however, significantly increased from 1.20±0.29 to 1.39±0.42 in MSII group(P<0.05)。(6).The FPG level were significantly decreased from 14.44±1.42 to 6.05±0.87 in CSII group(P<0.01), and from 14.93±1.96 to 6.09±0.84 in MSII group(P<0.01); The 2hPG level were significantly decreased from 23.02±3.79 to 11.52±2.93 in CSII group(P<0.01), and from 21.29±4.83 to 12.06±3.22 in MSII group(P<0.01)。(7).The serum levels of inflammatory factors and HOMA-IR were significantly decreased in CSII group than in MSII group(P<0.01). The days of FPG and 2hPG were significantly shorter in CSII group than in MSII group(P<0.01). (8). In T2DM group, BMI and WC were positively correlated with HOMA-IR. (9).The serum levels of hs-CRP was positively correlated with days of FPG.Conclusion: (1).The serum level of inflammatory factors in newly diagnosed T2DM patients were significantly higher than in control group. The difference that between NGT and T2DM group, showed that these inflammatory factors might play an important role in the pathogenesis of T2DM and be the better observation of T2DM. (2). The correlation of BMI,WC with HOMA-IR showed that obesity and BMI may be important factors of T2DM. (3).Both intensive insulin therapy, could effectively improved blood glucose,HOMA-IR and HOMA-β, meanwhile, reduced the secrum level of inflammtory factors in newly diagnosed T2DM patients with severe hyperglycemia. However, CSII was more effective than MSII (P<0.01). The serum level of hs-CRP which was positively correlated with days showed that the shorter time of controling blood glucose were taken, the more decrease of inflammation were made. (4).The changes of serum inflammatory factors level before and after treatment present a new target of early prevention and therapy of T2DM and its complications.