The Clinical And Pathphysiology Characteristics Of Type 2 Diabetes Reaching The Glucose Target And Shifting From Insulin To Non-insulin Regimen:A Retrospective Case Records Based Study

Objective:To characterize the clinical features of the type 2 diabetes patients who changed insulin regimen to non-insulin regimen and thus reach target of glucose, and to evaluate, and to analyze the possible influence factors of the index evaluating the insulin sensitivity and B cell function of these patients.Method:Clinical data of 44 cases that coincide with the inclusion criteria have been retrospective analyzed. The laboratory examinations, the data from oral glucose tolerance test were analyzed to characterize their features and explore their possible influence factor to their insulin sensitivity and B cell function.Results:(1) A total of 44 cases were enrolled in this study, including 26 men and 18 women. They age from 45 to 83 years old. Their mean course of diabetes is 12.5 years (from 1 year to 30 year). Mean body weight:Male 76.4 kg, while female 74.6 kg. Mean BMI: Male 27.2 kg/m2, while female 26.9 kg/m2. No contraindication in drug-using has been observed.(2) Divided the individuals based on gender, age, course of diabetes, family history, HbA1c, FBG, BMI, dose of insulin and the final therapy, and the constituent ratio was analyzed.(3) Based on the sectionalization in the constituent ratio, subgroup analysis was used to recognize the differences of insulin sensitivity and B cell function between and among groups. It was found that male had relatively higher insulin resistance than female (P=0.018<0.05), while higher HbAlc (P=0.035< 0.05) with lower IGI60. BMI (P=0.001<0.05) influences the insulin resistance and B cell function that higher BMI has higher HOMA-IR, higher AUCins and lower ISI. The final therapy had relationship with BMI.(4) Indexes representing the B cell function:AUCINs has a positive linear relation with BMI (R2=0.129, P=0.025<0.05); IGI6o has a positive linear relation with HbAlc (R2=0.155, P=0.013<0.05); HOMA-B has a positive linear relation with BMI and TG while has a negative linear correlation with HbAlc and DBP (R2=0.470, P=0.035< 0.05).(5) Indexes representing insulin resistance:ISI has a linear relation with TG, LDL-C, HDL-C, CHOL, BMI and course of diabetes (R2=0.532, P=0.008<0.01), HOMA-IR has a linear relation with positive TG, BMI, and course of diabetes (R2=0.455, P=0.000 <0.01); HOMA-IS has a positive linear relation with BMI and TG, and a negative linear relation with DBP and HbAlc, (R2=0.258, P=0.038<0.05).Conclusions:(1) The characteristics of the Type 2 diabetes changing insulin regimen to non-insulin regimen to reach target of glucose:relative old age (median 60.5), long course of diabetes (median 10.5 years, maximum 30 years), high BMI (Male 27.23±2.48, Female26.87±3.55), severe insulin resistance (HOMA-IR median 3.57), and relative good B cell function (HOMA-B median 37.71).(2) BMI, blood pressure, course of diabetes and serum lipid are the influence factors of insulin resistance and B cell function.