Relationship Among Functional Changes Of HPA Axis In Overweight/Obese Patients With Type 2 Diabetes Mellitus With Anxiety And Depression And Its Correlation With TCM Syndromes

Objectives: This topic intends to study the functional changes of hypothalamus-pituitary-adrenal in overweight/obese patients with type 2 diabetes mellitus with anxiety and depression,so as to further explore the relationship with TCM syndromes,and further guide the clinical treatment of obesity type 2 diabetes mellitus.Methods: Using the method of cross-sectional study,the data collection was randomly selected from July 2017 to March 2019 for 126 patients with type 2 diabetes mellitus hospitalized with endocrine visits to the hospital affiliated to Chengdu University of Traditional Chinese Medicine.The data include the sociological population data questionnaire,the TCM four-consultation information record sheet,the anxiety self-rating scale(SAS)and the Depression Self-rating scale(SDS)and laboratory examination.According to SAS and SDS scores,overweight/obese type 2 diabetes mellitus was divided into four groups: Simple Type 2 diabetes Group,type 2 diabetes Anxiety Group,type 2 Diabetic Depression Group and type 2 diabetes depression and anxiety Co-disease Group.This topic uses SPSS22.0 to analyze the data statistically and discusses the functional changes of the HPA Axis in overweight/obese patients with type 2 diabetes mellitus with anxiety and depression,so as to further explore the correlation with TCM syndromes.Results: 1.At the end of the study,108 patients were eligible for inclusion criteria,including 63 males and 45 females.2.There was no significant difference in the distribution of gender,marriage,education and occupation among the four groups of type 2 diabetes patients(p>0.05).3.Comparing the results of age,waistline and BMI,it showed that there was no significant difference in age between four groups(p>0.05).The circumference of group C was compared with group A and B values(p<0.05).There was a statistically significant difference between group C,group D and group A(p<0.05).4.Comparing the results of fasting blood sugar,2 H blood sugar after meals,glycated hemoglobin and AGEs,it showed that The levels of HbA1 c,FPG and 2hPG in group B were higher than those in group A(p<0.05).The levels of AGEs and FPG in group C were higher than those in group A(p<0.05).The levels of FPG,2hPG,HbA1 c and AGEs in group D were higher than those in group A(p<0.05).5.Comparing the four groups of total cholesterol,triglycerides,high-density lipoprotein and low density lipoprotein,it showed that There was no significant difference between the four groups of TC and LDL levels(p>0.05).The TG level in group D was higher than that in group A(p<0.05).The HDL level in group D was lower than the other three groups and the difference was statistically significant(p<0.05).6.Compare four groups of insulin sensitivity,The HOMA-IR index of group B,group C and group D was higher than that of group A(p<0.05).The ISI level A group was higher than the other three groups,and the difference between the B group,the C group and the D group was statistically significant(p<0.05).7.Comparing the functional changes and correlation analysis of HPA,The ACTH levels in group B and group D were slightly higher than the other two groups(p<0.05).The A group and the COR level were lower than the other three groups,and the difference between the B group,the C group and the D group was statistically significant(p<0.05).Using Spearman correlation analysis,SAS and SDS are generally positively correlated with COR.8.There was no statistically significant difference in the distribution of TCM syndromes between the four groups according to the mental state(P>0.05).There was no significant difference in the BMI and waist circumference between the different syndrome types of Chinese medicine(P>0.05).9.The scores of TCM syndromes of type 2 diabetes patients were found to be higher than those of Qi and Yin deficiency syndrome and Yangxue dampness syndrome(P<0.05).The SDS scores of phlegm(wet)and heat phlegm syndrome were statistically significant(P<0.05).Binary logistic regression analysis showed that the higher the SDS value,the greater the probability of syndrome differentiation as yang deficiency and dampness syndrome.10.Compared with the HPA axis hormone levels in different TCM syndromes of type 2 diabetes patients,the ACTH level of liver stagnation and spleen deficiency syndrome was lower than that of Qi and Yin deficiency syndrome and Yang deficiency and dampness syndrome(P<0.05).The level of COR in liver stagnation and spleen deficiency was higher than that of Qi and Yin deficiency syndrome,Yang deficiency and dampness and dampness and heat syndrome(P<0.05).The syndrome of dampness,heat and spleen syndrome and phlegm(wet)heat syndrome was lower than that of qi and yin deficiency syndrome.COR level(P<0.05).Binary Logistic Regression Analysis The higher the ACTH and COR levels,the smaller the probability of syndrome differentiation as a wet(hot)heat syndrome.Conclusion:1.Overweight/obese patients with type 2 diabetes with anxiety and depression may result in decreased insulin sensitivity and increased difficulty in glycemic control.2.Patients with type 2 diabetes mellitus with anxiety and depression can increase the body and thus appear lipid metabolism disorder,triglycerides level increased,high-density lipoprotein level decreased.3.Overweight/obese patients with type 2 diabetes mellitus with anxiety or anxiety and depression have higher HPA axis function,elevated cortisol levels,and SAS and SDS are positively correlated with COR.4.The syndrome of liver stagnation and spleen deficiency may be higher than that of qi and yin deficiency syndrome and yang deficiency and dampness syndrome.SDS is the influencing factor of yang deficiency and dampness syndrome.ACTH and COR levels are phlegm(wet)heat syndrome.The influencing factors have clinical value for the diagnosis and treatment of traditional Chinese medicine for diabetic patients,but further evaluation is needed.5.Screening the mental status of overweight/obese type 2 diabetes mellitus is of great significance.Timely psychological intervention for type 2 diabetes mellitus patients with mental disorders is conducive to blood sugar control and improve prognosis.