Effect Of Insulin And Insulin Secretagogues On Non-alcoholicFatty Liver In Patients With Type2Diabetes Mellitus

Background&Objective:The incidence of Type2diabetes mellitus (T2DM) is high currently， it can cause a variety ofcomplications. The T2DM patients with nonalcoholic fatty liver (non-alcoholic fatty liver disease, NAFLD)are very common, Chronic toxicity of high sugar plus fat can cause the disorder of inter-environment, andaccelerate the progression of diabetic macrovascular disease, It also will accelerate fibrosis progression offatty liver, lead to cirrhosis and liver cancer. Therefore the reseach on the T2DM with NAFLD is veryimportant. Insulin and insulin secretagogues are two kinds of medicines in treating T2DM, different sourcesof insulin may have different metabolic pathways in the body. So the impact of the hypoglycemic drugs onthe consolidated NAFLD is regarded as a important study.Insulin is one of the important drugs in the treatment of T2DM, whose hypoglycemic effect isaffirmtory. A insulin is seen as an important metabolic regulation hormone of Carbohydrate and lipid. Inaddition, insulin also has the function of promoting growth, proliferation, differentiation and promoting thesynthesis of fat. Exogenous insulin by subcutaneous injection metabolize in the liver after the systemiccirculation, whether the use of insulin in the treatment of T2DM increase the high insulin hematic diseaseor not？And in the background of this disease, If it will increase the liver lipid deposition? Insulinsecretagogues is another commonly used clinical medication which achieve hypoglycemic by pushingpancreas to secrete insulin,metabolized in the liver through the portal system, and then enter the systemiccirculation. Studies have shown that all the representative insulin secretagogues can ease insulin resistanceand lower blood lipid in different degrees, then how much the impact they will have on diabetic fatty liver?How to choose a preferable hypoglycemic scheme for patients with T2DM complicated with Fatty liver?The purpose of this study was to resolve the above questions.In this study, we compared the difference of the prevalence of NAFLD between patiens who haveused insulin or insulin secretagogues to lower glucose for six months with the help of Colour DopplerUltrasound checking. Then divided the cases of T2DM with NAFLD into2groups, who using insulin orinsulin secretagogues respectively. After six months follow-up, we observed the effect of insulin and insulin secretagogues on the hepatic fat deposition and then provided useful theoretical data for the treatmentstrategy of T2DM patients with NAFLD.Subjects and Methods:1.The research objectiveThe study population consiste of438patients who were diagnosed T2DM with NAFLD byColour Doppler Ultrasound in outpatient and inpatient department of endocrinology of our hospital from2012.4-2013.12, among which218is males,220is females, age form35to69years and the diabeteshistory is range from2to10years. Diabetes diagnosis were accord with diagnostic criteria of diabetesmade by the world health organization (WHO) in1999. Patients with fatty liver disease, NAFLD wereaccord with the standards of “nonalcoholic fatty liver disease diagnosis and treatment guidelines”revisedby the Chinese medical Hepatologyassociation in January2010about fatty liver and alcoholic liver diseasegroup. Every patient was completely introduced to the purpose、routine and possible risks of this studybefore he was selected in this study and signed the written informed consent.2.Groups:2.1A: Group of insulin treatment: A total of240cases who had been used insulin for treatmentfor more than six months when selected.B: Group of insulin secretagogues treatment: A total of198cases who had been used insulinsecretagogues for treatment for more than six months when selected.With the help of the Colour Doppler to exceed examination, compared the number of differencesbetween the two groups of patients with fatty liver disease.2.2Choose respectively113patients with fatty liver form each group, whose BMI,weights offatty liver, duration, blood lipid, blood sugar and other indicators almost matched each other. Group Acontinued to use insulin for treatment; Group B continued to use linsulin secretagogues for treatment.Inaddition to some diet and activity education, at the same time did not use other drugs which hadlipid-lowering and hepatic metabolism effects. The target of Glycemic control：FPG6-7mmol/L，2hFPG＜10mmol/L，HbAlc%＜7.5%. After six months, when the patients visited to hospital again, compared thesimilarities and differences of the outcomes by observing the changes of blood sugar, blood lipid andColour Doppler Ultrasound fatty liver imaging between two groups. Outcome:1.1The findings on the prevalence of non-alcoholic fatty liver: There were156T2DM patientswith NAFLD in A groups, the overall prevalence of fatty liver was65.0%. There were131T2DM patientswith NAFLD in B groups, the overall prevalence of fatty liver was66.2%.1.2Tracking results: After six months of treatment, both A and B groups exit one case with mildfatty liver, and the remaining112patients were stayed in each group.1.2.1Therapeutic dose: In group A, the mean dose of insulin was29±3U,In group B, we used the conventional therapeutic dose of linsulin secretagogues;1.2.2The target of Glycemic control：Group A: HbAlc%comments compliance rate:78%Group B: HbAlc%comments compliance rate:79%1.2.3Lipid changes：Group A: After six months, the level of TC、TG、LDL-C were better than before treatment（P＜0.05）, the level HDL-C was no significant improvement（P＞0.05）Group B：TC、TG、LDL-C are better than before treatmen（tP＜0.05）, HDL-C is no significantimprovement（P＞0.05）Compared with group B the level of TC、TG、LDL-C decreased significantly（P＜0.05）1.2.4Changes of fatty liver Colour Doppler Ultrasound: the results of group A suggested that severe fattyliver decreased from20to17cases(15%), moderate fatty liver reduced from55cases to48cases(12.8%), and that mild fatty liver was increased from37cases to45cases (21.6%),2cases recoveredto normal without fatty liver,12cases improved and the improvement rate was10.71%. In group B theresults suggested that severe fatty liver decreased from20to18cases (10%), moderate fatty liver from55cases to49cases (10.9%), and that mild fatty liver was increased from37cases to43cases (16.2%),2cases recovered to normal without fatty liver,10cases improved.fatty liver improvement rate was8.93%（P＞0.05）.Conclusion:1. Cross-sectional survey: In the T2DM population who used insulin and or insulin secretagogues, the prevalence of NAFLD were similar and high.Exogenous insulin did not aggravate the liver lipiddeposition.2.T2DM who used insulin or insulin secretagogues had different degrees of the improvement inblood sugar、 lipids、 HOMA-IR、 fatty liver，this might be the combined results of diet control, activitiesexercise and drug treatment.