| Objective:Explore the relationship between fasting blood glucose level and beta cell fuction and the independent factors in newly diagnosed type 2 diabetes patients.Methods:Collect newly diagnosed type 2 diabetes patients in the out-patient or in-patient department in the Union hospital of Wuhan. Then divide these patients into different teams according to their fasting blood glucose level. All patients will adopt OGTT+IRT test. Record the basic information about the patients at the same time,such as name、age、weight and so on. Calculate the related index according to the results of OGTT+IRT and apply statistical analysis to these data. Data are input by EPIDATA software, then analyzed by SPSS20.0 software. All data are described by mean ± standard deviation or percentage. Analysis of variance are used to compare the quantitative data。Explore the independent factors of beta cell function by multiple linear regression. P value less than 0.05 is considered statistically significant.Results:1、Collect 176 patients in total and the gender composition 、blood pressure、total cholesterol、creatine have no significant difference between each team. The mean age、triglyceride、LDL-C of each team are increasing with elevated fasting blood glucose level while the HDL-C is decreasing。BMI of the forth team is less than the other three teams. 2、Except the adjacent team, the compare between each team about the FIns、Fc、AUCI has significant difference.HOMA-β has no difference between the third and forth team. FIns、Fc、HOMA-β、AUCI are increasing with elevated fasting blood glucose level. 3、The HOMA-IR of forth team is higher than the other three teams. ΔI 30/ΔG 30 has a tendency to rise and fall with elevated fasting glucose level。4、The area under the insulin curve is decreasing with elevated fasting glucose level。The insulin releasing peak is delayed in 1、2 and 3 team. The forth team has no insulin releasing peak. 5、Age、FIns、HOMA-IR are independent factors of HOMA-β.FIns、FPG、triglyceride are independent factors of HOMA-IR.Conclusion:The onset of diabetes has a trend of younger and high incidence. We should strengthen the screening of diabetic high risk group.FPG is a simple 、 easy and economic indicator to evaluatethe islet function.It is of great significance to preliminary evaluate the islet function of patients as well as guide the clinical treatment.The higher the first diagnosis FPG,the worse its foundation and overall insulin secreting function.8.2 mmol/l of FPG is the turning point of the first phase insulin secretion, the first phase insulin secretion has a tendency for compensatory increase when FPG<8.2mmol/l and decline when FPG > 8.2 mmol/ l.11.1 mmol/l of FPG isthe turning point for insulin resistance, insulin resistance increase sharply when FPG > 11.1 mmol/l.Age, FIns, HOMA- IR are independent factors of insulin secretion function;FIns, FPG and triglycerides are independent factors of HOMA-IR.Severe hyperglycemia lessen the correlation between BMI and islet function.FIns may be an evaluation index of islet function more accurate than FPG.At the same time, glucolipid metabolism influence each other, so the treatment of T2 DM should advocate the comprehensive management, actively control the blood glucoseandblood lipidat the same time, especially LDL-C and HDL-C.At the beginning of the patients with type 2 diabetes in its diagnosis, base and overall insulin secretion have been severely damaged, especially the patients with FPG higher than 11.1mmol / l,for such patients early insulin intensive therapy which can quickly reduce blood glucose, blocking "glucose toxic" for further injury of the islet beta cells may protect the residual islet function so as to gain greater benefit.Objective: To study the effect of different insulin intervention strategies on islet beta cell function of newly diagnosis type 2 diabetesMethods:Collect newly diagnosed type 2 diabetes in the outpatient or inpatient department of the Union hospital from 2013 to 2015.All these patients have a level of blood glucose higher than 11.1mmol/l and are voluntary accepting insulin treatment.The patients are divided into different insulin intervention teams using the random number table method according to their selected order number.There are three plans of insulin intervention strategy : premixed insulin analogue 2 times daily injection group,base + dinner insulin 4 times daily injection group or based insulin plus oral medications group。Follow up for six months, the patients monitor fasting and 2h after meal blood glucoseand record the frequency of hypoglycaemia, every three months monitor Hb A1 c, half year review OGTT+IRT test.Record the mean time of achieving blood glucosetarget, maximum doses of insulin, glycosylated hemoglobin standard rate of tree monthes, incidence rate of hypoglycemia.Contrast the difference of effect on beta cell function especial on the first phase of insulin secretion between groups according to the results of two OGTT + IRT test.Observation data including FPG, 2h PG and FIns, Fc, Hb A1 c, HOMA IR, HOMA- beta, Δ I30 / Δ G30, AUCI.With EPIDATA software for data entry, spss20.0 statistical software for statistical analysis.All data are described by mean ± standard deviation or percentage.Using the single factor analysis of variance for the comparison of multiple sets of measurement data, using matching t test compares before and after treatment data, P < 0.05 is considered statistically significant.Results: 1、Select 30 severe newly diagnosed type 2 diabetes patients,27 of them complete follow-up visit.The meangender,age,BMI,Hb A1 c,triglycerideand LDL-C、HDL-C of different intervention groups have no significant difference.FPG、2h PG、Hb A1c、HOMA-IR have a significant reduction and FIns, Fc, HOMA-β,ΔI30/Δ G30, AUCI have a significantly increasing after 24 weeks treatment.Drawing Pre and Aft group AUC curve, overall insulin secretion significantly increases after treatment, insulin secretion peak value and the first phase insulin secretion increasesignificantly. 2、Different intervention groups have no obviously difference of ΔHb A1 c, ΔFPG、 Δ2h PG and ΔFIns、ΔFc、ΔAUCI、ΔHOMA- IR、ΔHOMA-βafter treatment.Comparison between groups,the difference of Δ(Δ I30/ΔG30) between basal insulin + oral drug group and base + meal insulin has statistically significance. 3、After 24 weeks of follow-up,all patients’ Hb A1 c fall by 2.58%in average.The ability to lower Hb A1 c of different intervention groups have no obvious difference.All patients’ weight are significantly increasing,basic insulin plus oral glucose-lowering drugs group has an average weight gain of 1.8 kg,premixed insulin group has an average weight gain of 2.6 kg,base+dinner insulin group has an average weight gain of 3.1 kg.The hopyglycima score is increasing by the order of the basal insulin+oral drug group、base+dinner insulin group、premixed insulin group.One patient of premixed insulin group has severe hypoglycemia during the night. 4、Premixed insulin group has the longest time of achieving blood glucose target, the lowest successful rate of 24 weeks Hb A1 c reaching the standard, the lowest successful rate of 24 weeks Hb A1 c reaching the standard without hypoglycemia.Basal insulin plus oral glucose-lowering drugs group has the least doses of insulin use,the highest successful rate of 24 weeks Hb A1 c reaching the standard without hypoglycemia. Base+dinner insulin group has the shortest time of reaching blood glucose target,the greatestt doses of insulin use,the highest successful rate of 24 weeks Hb A1 c reaching the standard.Conclusion: In conclusion,insulin therapy can obviously improve insulin resistance and insulin secretion function of severe newly diagnosed type 2 diabetes patients, especially the first phase insulin secretion function.Different ways of insulin treatment have no difference in improving the overall ability of insulin secretion, insulin resistance.But the ability of Base + meal insulin stratgy to improve the first phase insulin secretion is better than basic insulin plus oral glucose-lowering drugs plan.The effect ofinsulin therapy exist individual differences, some patients may give priority to improve the insulin resistance, some patients may give priority to improve the function of islet beta cells secrete, genetic background or blood glucose deteriorating environmental factors may relate to it.After 24 weeks follow up,all patients Hb A1 c have an average decrease of 2.58% which is higher than previous results of 1.5%~2.1%.We consider this difference is related to the higher basal Hb A1 c and smaller samples of our study.The ability of different therapies to decrease Hb A1 c have no significant difference.Premixed insulin therapy has a higher incidence of hypoglycemia as well as severe hypoglycemia which reduce the patients satisfaction and compliance of the treatment.For people with unregular lifestyle、poor compliance and self-management,this treatment is not recommended.Basal insulin + oral glucose-lowering drugs group has the lowest incidence of hypoglycemia and the least weight gain, it is a safe and effective way of initial insulin therapy, but the controltime of blood glucose and Hb A1 c reaching standard is longer,so that it may not apply to patient with serious FPG rise and insulin resistance.Base + meal insulin treatment can rapidly reaching the blood glucose and Hb A1 c standard.It’sa more appropriatein for newly diagnosed patients with high FPG, but more injection times reduce the patient’s acceptance, and it has more weight gain and higher risk of hypoglycaemia obviously.So it may be more appropriate to reduce insulin doses or changeto the basal insulin plus oral drug treatment after blood glucose reaching the target.To sum up, the choice of insulin intervention plan should fully consider the body heterogeneity, and setting individualized treatment plan. |
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