| Objective:To assess the effect of the hemodialysis(HD) on glucose metabolism in type 2 diabetic patients with end-stage renal disease(ESRD),and preliminary studying mechanisms by detecting the correlation of hormone levels.Methods:1、The study group comprised of 65 patients with ESRD who were about to start the long-term HD therapy,according to the cause of diabetes mellitus they were assigned to two groups:diabetic nephropathy(DN) group and non-DN group, which DN group 30 cases who were type 2 diabetic patients,35 cases in non-DN group.The fasting plasma glucose(FPG),hemoglobin A1c(Hb A1c),fasting insulin(FINS),fasting C-peptide(FCP), glucagon-like peptide-1(GLP-1),glucagon(GC) and other general indicators were assessed before the first HD session and repeated after the first 3 months of the therapy.2、For 12 patients of our hospital HD therapy in DN group when they entered regular HD therapy, inserting real-time continuous glucose monitoring system(CGMS) to observe the blood sugar fluctuations during HD session, and assessing the plasma glucose(PG),insulin(INS),C-peptide(CP),GLP-1,GC levels from peripheral venous blood in HD starting, 2 hours after initiation of HD and the end of HD.Results:1、60 patients completed the study, of which 28 cases in DN group and 32 cases in non-DN group. General information of patients in 2 groups showed body mass index(BMI) was higher in DN group than that in non-DN group(P<0.05),sex and age were no statistically significant difference.2 、 Biochemical indicators,before HD therapy comparison showed,serum creatinine(Scr),urea(Ur) and intact parathyroid hormone(i PTH) were lower in DN group than those in non-DN group(P<0.05),while uric acid(UA),electrolyte and blood lipid were no significant difference in 2 groups(P>0.05).After 3 months of HD therapy,Scr and i PTH were lower in DN group than those in non-DN group(P<0.05),other indicators were no statistically significant difference(P>0.05).Before and after HD therapy comparison,Scr,Ur,UA,i PTH,low-density lipoprotein cholesterol(LDL-C) and serum phosphorus was significantly lower than those before HD therapy in 2 groups(P<0.05),but total cholesterol(TC),high density lipoprotein cholesterol(HDL-C), triglycerides(TG),serum sodium,serum potassium and serum calcium were no statistically significance difference in 2 groups(P>0.05).3、Glucose metabolism and correlation of hormone levels,before HD therapy comparison showed,FPG, Hb A1 c and homeostasis model correlation of assessment of insulin resistance(HOMA-IR) were higher in DN group than those in non-DN group(P<0.05), but homeostasis model assessment of β-cell function(HOMA-β) was lower in DN group than that in non-DN group(P<0.05),FINS, FCP, GLP-1 and GC were no statistically significant difference in 2 groups(P>0.05). After 3 months of HD therapy, FPG, Hb A1 c, FINS and HOMA-IR were higher in DN group than those in non-DN group(P<0.05), FCP and HOMA-β were lower in DN group than those in non-DN group(P<0.05), GLP-1 and GC were no statistically significant difference in 2 groups(P>0.05). Before and after HD therapy comparison, FCP and HOMA-IR were lower than those before HD therapy in 2 groups(P<0.05),there was no statistically significant difference among FPG, Hb A1 c, HOMA-β,GLP-1, GC than those before HD therapy in 2 groups(P>0.05),but FINS was lower in DN group(P<0.05) and no significant difference in non-DN group(P>0.05).For the correlation analysis of HOMA-IR and GLP-1, GC showed, changes of HOMA-IR had a significant positive correlation with GLP-1(r=0.384, p<0.05) and GC(r=0.392, p<0.05) in DN group,these parameters did not significantly correlate in non-DN group.4、CGMS showed a significant decrease during HD session in 12 cases of DN group, the average decrease levels of PG and the same period of CGM value(5.15 ± 3.42mmol/Lvs5.16 ± 3.28 mmol/L) in HD starting and the end of HD were no significant difference(P> 0.05), but the average levels of PG and the same period of CGM value comparison(9.54 ± 3.45mmol/Lvs10.46 ± 3.10mmol/L) showed CGM value was significant higher than PG(p<0.05).According to the international organization for standardization(ISO) of blood glucose monitoring system of standard, the point accuracy of CGMS was 69.44%(25/36),the further analysis showed that when PG≤6.8 mmol/L the point accuracy was only 20%( 2/10),and when PG>6.8mmol/L the point accuracy was 88.46%(23/26), there was a significant positive correlation between CGM value and PG during HD therapy(r= 0.976, p <0.05), according to the linear equation when PG<5 mmol/L then CGM value <6.49mmol/L.5、12 patients in DN group had no symptom of hypoglycemia during HD session, only one case experienced asymptomatic hypoglycemia(the end of HD PG was 3.7 mmol/L, CGM value was 6.6mmol/L).PG and the correlation of hormone levels changes during HD session showed,PG,INS and CP were sustained decrease, pairwise comparisons of HD starting, 2 hour after initiation of HD and the end of HD were significant decrease(P<0.05).The level of GLP-1 was declined the begining and next maintained stable during HD session, there were significant decrease both points from HD starting to 2 hour after initiation of HD and HD starting to the end of HD(P<0.05),the comparison between the end of HD and 2 hour after initiation of HD was no difference(P>0.05).There were no statistically significant difference among HD starting, 2 hour after initiation of HD and the end of HD for GC(P>0.05).The correlation analysis of PG and INS, CP, GLP-1, GC during HD session showed, a significant positive correlation between PG and insulin(r= 0.495, p<0.05), but there were no correlation in PG with CP, GLP-1, GC.Conclusion:1、There were no significant difference in Hb A1 c and FPG of type 2 diabetic patientswith ESRD before and after 3 months of HD therapy,but the insulin resistance was improved,and improving of insulin resistance may be correlated with GLP-1 and glucagon.2、During HD session,PG,INS and CP were sustained decrease significantly, GLP-1 was decrease in 2 hour after initiation of HD and then maintain a stable level, GC was no significant changes in type 2 diabetic patients with ESRD.3、There was a good correlation between CGM value and PG in type 2 diabetic patientswith ESRD during HD session, CGMS can be used for blood glucose monitoring during HD session in type 2 diabetic patients with ESRD, but CGM value was higher than the actual PG concentration when PG≤6.8mmol/L.When CGM value<6.49mmol/L,regardless of whether patients have symptom of hypoglycemia, the PG concentration should be detected immediately,and actively prevent the episode of hypoglycemia. |
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