| BackgroundThe major cause of death and complications in patients with type2diabetes mellitus (T2DM) is cardiovascular disease. Cardiovascular complications that are often associated with diabetes include heart failure, acute myocardial infarction (MI), peripheral vascular disease, and cerebrovascular disease. Many studies have also shown that in the general population and non-diabetic patients insulin resistance, as assessed by HOMA-IR, is an independent predictive factor of cardiovascular disease, independently from other known cardiovascular risk factors. However, few researches have focused on its effect on the progression of Macrovascular diseases (MVD) in T2DM. The aim of our study is to analysis the relationship between insulin resistance and coronary heart disease, and to explore the related factors of insulin resistance and β-cell function in T2DM patients.MethodsFrom April26,2004to January21,2013,355patients diagnosed as T2DM were consecutively enrolled in the study by the department of endocrinology and metabolism at the Qilu Hospital, which is affiliated to the Shandong University School of Medicine. Among these,157were men and198were women, the average age was64.20±9.08, ranging from41to87.146of them were diagnosed as coronary heart disease by medical history or an abnormal electrocardiogram,128of them neither had a acute myo-infarction or had a infarction history(PCI or CABG treatment is included), and the last81had only diabetes mellitus. HOMA-IR, IAI, FPG/FIns and TG/HDL were utilized for determining the state of their insulin resistance. Fasting plasma C peptide, Homa-Pand area under the curve of C peptide/insulin releasing experiment is used to evaluate the function of β cells. Laboratory test results were described and the multiple liner regression analysis was conducted to investigate the relationship between insulin resistance/βcell function and other clinical and laboratory figures.Results1.Compared with patients with only T2DM, patients with CHD exhibited a severer state of insulin resistance,a higher percentage of insulin treatment (55.5%versus24.7%, p=0.000) as well as a longer DM history (11.91±7.67versus8.79±7.50, p=0.010), higher TG(1.43,1.05-2.13versus1.30,0.89-1.73, p=0.023) and HDL(1.16±0.30versus1.29±0.27, p=0.001), higher fasting plasma glucose(8.14,6.34-10.41versus7.30,6.19-8.70, p=0.009), higher urine Alb(15.45,9.00-60.40versus10.0,9.0-63.6, p=0.003),WBC(6.79±2.10versus6.17±1.86, p=0.016)and FCp(1.76,1.13-2.71versus1.28,1.02-2.04, p=0.002).2. Compared with patients without a history of M1,CHD patients with a history of M1had a higher percentage of smoking (28.3%versus15.8%, p=0.012) and drinking (26.8%versus16.4%, p=0.038), a higher level of fasting plasma glucose(9.13±3.27versus8.25±2.84, p=0.022) and NEFA(64.76±24.37versus56.35±23.57, p=0.015).However, their performance of cholesterol panel is also better:TC(4.47±1.15versus4.98±1.30, p=0.001) and LDL(2.54±0.77versus2.96±0.97, p=0.001).3. We assessed the impact of conventional and novel risk factors on the coronary atherosclerosis progression by using a multivariate logistic regression analysis.The results revealed that DMhistory (OR=1.068, p=0.039),the prevalence of usage of insulin (OR=3.397, p=0.003), FCP (OR=1.798, p=0.007) and HDL (OR=0.140, p=0.008) were independent predictors of the occurrence of cardiovascular complications of T2DM patients.4. Longer DM history, insulin treatment, higherWBC and FCp as well as a negative drinking history were the independent risk factors of coronary heart disease in T2DM patients.5.Patients with CVD had a higher level of FCp(1.96±1.08versus1.56±0.86, p=0.002), and no significant difference is found between the DM+CAD and DM+MI group. However, compared with patients with DM only, patients with cardiovascular complications had a smaller area under the curve of C peptide(9.03±4.40versus11.72±5.07, p=0.003). No significant difference is found between the DM+CAD and DM+MI group.6. A larger BMI and an elevated level of TG were the related factors of FCp. A positive CHD history and larger BMI were the related factors of area under the curve of C peptide releasing experiment.ConclusionsPatients with Macrovascular diseases exhibited a higher level of insulin resistance, longer DM history and higher proportion of insulin treatment. Their FCp is also higher compared with DM patients. Nevertheless, their area under the curve of C peptide releasing experiment is lower.Longer DM history, insulin treatment, higher WBC and FCp as well as a negative drinking history were the independent risk factors of coronary heart disease in T2DM patients. |
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