The Impact Of Different Intensive Insulin Therapy On The Level Of Incretin In T2DM Patients

Object: To observe the effects of different intensive insulin therapy (CSII/MDI) in the rapid decrease ofplasma glucose, C-peptide, incretin (GIP and GLP-1). To explore the relationship of glucose, pancreas isletand insulin.Methods: Select totally46patients with T2DM who were treated in our hospital from May to November2013,divided into two groups,30patients in one group was given treatment of CSII,16patients in anothergroup was given treatment of MDI. All the patients were given intensive insulin therapy to glucose（simply‘after treatment’ for short）(FPG <7.0mmol/L and random plasma glucose <11.1mmol/L), implementedstandard diabetic diet and health education. We measured FPG, fasting C-peptide, GIP, GLP-1before andafter treatment.Record all subjects blood pressure (mmHg), BMI, WHR and measured TC, TG, LDL-C,HDL-C, HbAc1before treatment. Glucose was detected by glucose oxidase method, fasting C-peptide waschemiluminescent immunoassay (CLIA), GIP and GLP-1was double antibody sandwich ELISA. All datawere mean±standard deviation, tested normality and homogeneity of variance that were analyzed withSPSS17.0. Between groups using independent-samples t test, inter group before and after treatmentcompared with paired-samples t test.Results:1. Comparison between CSII group and MDI group before treatment, all general information, serumbiochemical parameters, HbAc1, FPG, fasting C-peptide, GIP, and GLP-1were not statistically different(P>0.05).2. Comparison between CSII group and MDI group after treatment, FPG, fasting C-peptide, GIP, GLP-1(P>0.05).3．Comparison between CSII group and MDI group, recovery time of glucose, average daily insulindosage, total insulin dosage, hypoglycemia were not statistically different(P>0.05).4. CSII group after treatment, FPG (mmol/L) before and after treatment decreased from12.14±3.46to6.54±0.50(P<0.05). Fasting C-peptide (nmol/L) before and after treatment increased from0.26±0.16to0.30±0.18(P<0.05). GLP-1(pmol/L) before and after treatment increased from12.99±1.58to17.82±1.79(P<0.05). GIP before and after treatment were not statistically different (P>0.05).5. MDI group after treatment, FPG (mmol/L) before and after treatment decreased from12.17±3.41to6.21±0.66(P<0.05). GLP-1(pmol/L) before and after treatment increased from13.07±2.10to18.13±1.34(P<0.05). Both were statistically significant. Fasting C-peptide and GIP before and after treatment were notstatistically different (P>0.05).6. Correlation analysis showed that BMI(r=-0.384,P＜0.01),and fasting C-peptide (r=-0.392,P＜0.01)were negative correlated with GLP-1in the T2DM patients.Conclusion:1. For T2DM patients, CSII and MDI have the similar effect in reduce plasma glucose, promote incretinsecretion and improve β-cell function. That was not affected by different intensive insulin therapy inpatients with T2DM. So the choice of patients with T2DM may become more and more.2. Intensive insulin therapy released glucose toxicity, while the levels of GLP-1and fasting C peptidewere significantly elevated in patients with T2DM, and there were observable correlations between GLP-1secretion and BMI, and C peptide.