| Objective: To study the pituitary - adrenal axis variation of the patients with type 2 diabetes before and after dexamethasone suppression test and glucose loading test and plasma F and the INS, C-P and IR correlation in patients with type 2 diabetes. To evaluate the changes in HPA axis function . It is hoped to open up a new effective way that is the treatment of type 2 diabetes. Methods: All the people are the volunteers, outpatients and hospitalized patients selected from the June 2008 ~ September 2009 in the Sino-Japanese Friendship Hospital, Jilin University, Department of Endocrinology, Reference 1999WHO high blood sugar diabetes and other types of diagnostic criteria for sub-groups: normal control group: FPG <6.0mmol / L and OGTT in 2HPG <7.8mmol / L (total of 30 cases, 15 males and 15 females, aged 31-75 years old) ; type 2 diabetes: FPG≥7.0mmol / L and / or OGTT in 2HPG≥11.1mmol / L (total of 70 patients, 37 males, 33 females, aged 32-74 years). Use the chemiluminescence method, radioimmunoassay law to determine the serum cortisol (F) and adrenocorti- cotropic hormone (ACTH) (8Am, 4Pm, 12Pm and next 8Am ) and serum insulin (INS), C peptide (CP) and blood glucose levels in 70 patients with newly diagnosed type 2 diabetic patients and 30 volunteers (control group) o; by HOMA model of insulin resistance index: HOM-IR = FINS×FBG/22. 5, in order to reflect IR of the situation in patients with type 2 diabetes. Body mass index (BMI) = weight (Kg) / height 2 (m2) waist to hip ratio (WHR) = waist circumference (WC, cm) / hip circumference (HC, cm) .Statistical analysis: measurement data with the x±s, said group compared with a t or F test, test each set of variables normal circumstances, non-normal data were logarithmically transformed before analysis. Statistical software is the SPSS13.0 ,and the statistical methods include the analysis of variance and linear correlation analysis. Results: ( 1) shows no significant difference between the age groups, normal control group and type 2 diabetes group were respectively 52.64±8.58 and 53.19±7.29 years; no significant difference in gender composition, respectively, 15/15, and 37/33. Two groups of BMI were 24.37±3.36 and 26.48±3.74, including type 2 diabetes, BMI higher than the control group, the difference was significantly (P <0.01); two WHR were 0.83±0.17 and 0.93±0.28, including type 2 diabetes, the WHR higher than the normal control group, the difference was significantly (P <0.01); two systolic blood pressure were 114.79±21.87 and 137.34±18.76mmHg, including type 2 diabetes, the systolic blood pressure greater than the normal control group, the difference was significantly (P < 0.01); two diastolic blood pressure were 75.12±11.28 and 81.86±12.12mmHg, including type 2 diabetes,the diastolic blood pressure greater than the normal control group, the difference was significantly (P <0.01); two HOMA-IR were 2.48±1.18 and 5.96±1.93, including type 2 diabetes group higher than the control group, the difference was significantly (P <0.01). (2) the 8Am, 4Pm, 12 Pm plasma F and next 8Am Plasma F levels of the type 2 diabetic patients were significantly lower, but the difference compared with control group were significantly higher, the difference was significantly (P <0. 01). (3) the 8Am, 4Pm, 12 Pm plasma ACTH and next 8Am plasma ACTH levels of the type 2 diabetic patients were significantly lower, but the difference compared with control group were significantly higher, the difference was significantly (P <0. 01). (4) during the bread experiment with type 2 diabetes each time items of blood glucose, plasma INS, CP, and F was significantly higher, statistically significant difference (P <0. 01); normal control group G, INS, and the peak value of C-P appeared after the bread meal in 60min, while its peak in patients with type 2 diabetes in 120min, significantly fall behind the control group;the normal serum cortisol rhythm of the control group showed that it decreased behind the bread meal, 120min lowest.The serum cortisol rhythm in type 2 diabetic patients was slightly elevated, and continues to decline in the meal after 60min . (5) linear correlation analysis showed that the increased cortisol levels in patients with type 2 diabetes and the increased fasting blood glucose level were positively correlated (r = 0.46, P <0. 01),the increased cortisol concentrations to have nothing to do with the increased IR, INS, and CP levels . Among the cortisol and blood glucose, IR, INS in the normal control group were no linear correlation. Conclusion (1)the function of the hypothalamus - pituitary-adrenal axis in the patients with type 2 diabetes is confused. (2) the serum cortisol and ACTH levels in patients with type 2 diabetes, were higher than the control group, but its circadian rhythm of adrenocortical function is existed. (3) in patients with type 2 diabetes in the hypoglycemic treatment, while the understanding of their blood levels of cortisol, ACTH changes in the characteristics and targeted adjustment of the hypothalamus - pituitary-adrenal axis function, for the treatment of type 2 diabetes to open up a new and effective ways.
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