Effects Of Waist Circumference、Visceral Fat And Islet Function On Metabolic Control In Patients With Newly Diagnosed Type 2 Diabetes Mellitus Under The Standardized Metabolic Disease Management Model

Objective:To analyze the control of metaolic indicators in newly diagnosed type 2 diabetes mellitius（T2DM）patients after standardized metabolic management center（MMC）management;To investigate the effect of different Waist circumference、Visceral fat area and islet function on metabolic index control in newly dignosed T2DM patients under the management mode of MMC.Methods:（1）A total of 248 newly diagnosed T2DM patients（course of disease ≤1 year）were enrolled in the management of MMC at the First People’s Hospital of Yunnan Province from 1 September 2019 to 30 December 2021.The metabolic control was analyzed at the time of enrollment and after six months of MMC management;（2）According to the waist circumference（WC）or visceral fat area（VFA）at the time of enrollment,it was divided into abdominal obesity group（AO,male waist circumference ≥90cm,female waist circumference ≥85cm）、non-abdominal obesity group（NAO）,visceral fat area increased group（VFA ≥100cm2）and normal visceral fat area group（VFA<100 cm2）.The metabolic indicators were analyzed after MMC management for six months.（3）Sixty-five TDM patients who met the baseline FPG<9mmol/L and HbAlc between 7%-11%were selected.According to the islet cell function index（HOMA-β）,they were divided into low HOMA-β group（T1）and high HOMA-0 group（T2）.The prognosis of metabolic indicators after MMC management for six months was analyzed.Results:（1）Among the 248 patients enrolled,the metabolic indicators were significantly improved after six months of MMC management,and the body mass index（BMI）decreased from（25.36±3.60）kg/m2 to（24.71±3.18）kg/m2,Systolic blood pressure（SBP）decreased from（128.93±16.12）mmHg to（120.81±13.68）mmHg,diastolic blood pressure（DBP）decreased from（82.92±11.92）mmHg to（76.94±9.12）mmHg,glycosylated hemoglobin（HbAlc）decreased from（10.59）±2.62)%to（6.85 ±1.05）%,triglyceride（TG）decreased from 2.09（1.24,3.15）mmol/L to 1.57（1.12,2.46）mmol/L,Low density lipoprotein（LDL-C）decreased from 2.92（2.31,3.56）mmol/L to 2.60（1.87,3.10）mmol/L（all P<0.05）.In terms of metabolic index compliance rate,BMI increased from 35.9%to 46.4%;BP increased from 28.6%to 57.7%;HbA1c increased from 9.3%to 73%;TG increased from 39.5%to 56.5%;LDL-C increased from 37.5%to 73%.50.8%（P<0.05）.（2）At baseline,Compared with NAO group,BMI、SBP、DBP、TG、UA、urinary albumin、HOMA-IR and VFA in AO group were significantly increased,while HDL-C was decreased（P<0.05）.After six months of MMC management,BMI decreased from（27.69±3.10）kg/m2 to（26.39±3.10）kg/m2,SBP decreased from（130.79±15.79）mmHg to（121.85±13.22）mmHg,and DBP decreased from（84.80±11.62）mmHg to（78.25±9.71）mmHg,HbAlc decreased from（10.46±2.72）%to（6.98±1.04）%,TG decreased from 2.41（1.57,3.33）mmol/L to 1.71（1.18,2.72）)mmol/L and LDL-C decreased from（3.01±0.96）mmol/L to（2.55±0.90）mmol/L（all P<0.05）.The BMI compliance rate increased from 3.8%to 21.1%;BP increased from 24.1%to 51.1%;HbAlc increased from 7.5%to 63.2%;TG increased from 32.3%to 48.9%;LDL-C increased from 32.3%to 49.6%（all P<0.05）.There was no significant decrease of BMI in NAO group,SBP decreased from（126.78±16.29）mmHg to（119.60±14.16）mmHg,DBP decreased from（80.73±11.94）mmHg to（75.43±8.16）mmHg,and HbAlc decreased from（10.74±2.51）%to（6.69±1.03）%,TG decreased from 1.83（1.04,3.03）mmol/L to 1.41（1.04,2.15）mmol/L,LDL-C decreased from（2.85±0.89）mmol/L to（2.57±0.86）mmol/L（all P<0.05）.BMI compliance rate did not increase;BP compliance rate increased from 33.9%to 65.2%;HbAlc increased from 11.3%to 72.2%;TG increased from 47.8%to 65.2%;LDL-C increased from 43.5%to 52.2%（all P<0.05）.Compared with the AO group,the NAO group had lower HbAlc levels[（6.69±1.03）%vs.（6.98±1.04）%]and more decrease values[-4.48（-5.61,-1.66）%vs-3.60（5.45,-1.17）%];DBP was lower（75.43±8.16）mmHg vs（78.25±9.71）mmHg,BP compliance rate was higher（65.2%VS 51.1%）;After Six months of MMC management,the HbAlc compliance rate in the Waist circumference compliance group was higher（77.5%vs 57.0%）（all P<0.05）.（3）When enrolled,compared with the normal visceral fat area group,the BMI、SBP、DBP、TG、UA、urinary microalbumin and HOMA-IR of the visceral fat increased group were significantly increased（all P<0.05）.In visceral fat area increased group,After six months of MMC management,BMI decreased from（27.45±3.39）kg/m2 to（26.12±3.30）kg/m2,SBP decreased from（131.33±15.95）mmHg to（121.63±12.97）mmHg,DBP decreased from（84.75 ± 12.02）mmHg to（78.25±9.97）mmHg,HbA1c decreased from（10.43±2.79）%to（7.15±1.02）%,TG decreased from 2.38（1.63,3.47）mmol/L to 1.73（1.26,2.57）mmol/L and LDL-C decreased from（2.96±0.86）mmol/L to（2.62±0.88）mmol/L（all P<0.05）.The BMI compliance rate increased from 12.7%to 28.6%;BP increased from 23.0%to 52.4%;HbA1c increased from 7.9%to 74.6%;TG increased from 29.4%to 50.8%;LDL-C increased from 32.5%to 47.6%（P All<0.05）.In the normal visceral fat area group,BMI did not decrease significantly,SBP decreased from（126.45± 15.98）mmHg to（119.95±14.37）mmHg,DBP decreased from（81.02 ± 11.56）mmHg to（76.42±8.90）mmHg,and HbA1c decreased from（10.75±2.44）)%decreased to（6.54±0.99）%,TG decreased from 1.69（1.06,3.03）mmol/L to 1.44（0.99,2.36）mmol/L,LDL-C decreased from 2.91（2.22,3.59）mmol/L to 2.54（1.74,3.08）mmol/L（both P<0.05）.There was no significant improvement in BMI compliance rate;BP compliance rate increased from 34.4%to 63.1%;HbA1c increased from 10.7%to 71.3%;TG increased from 50%to 64.8%;LDL-C increased from 42.6%to 54.1%（all P<0.05）.Compared with the visceral fat area increased group,the patients with normal visceral fat area had lower HbAlc levels after MMC management[（6.54±0.99）%vs（7.15±1.01）%],and more decreased values[-4.21（5.72,-2.14）%vs-3.28（-5.07,-0.87）%];DBP was lower（75.59±7.95）mmHg vs（78.25±9.97）mmHg,and BP compliance rate was higher（64.8%VS 48.4%）.（4）When enrolled,compared with the higher HOMA-β group,the lower HOMAβ group had higher HbA1c,lower BMI and HOMA-IR.After six months of MMC management,there was no significant improvement in BMI.TG and LDL-C in the lower HOMA-β group.SBP decreased from（128.24±20.47）mmHg to（122.0±15.01）mmHg,DBP decreased from（82.30±13.81）mmHg to（76.39±11.02）mmHg,and HbAlc decreased from（9.18±1.15）%to（6.90±0.91）%.The compliance rate of HbAlc increased from 0%to 72.7%,and the compliance rate of BMI increased from 3%to 63.6%（all P<0.05）.There was no significant difference in the compliance rates of BP、TG and LDL-C.In the higher HOMA-β group,BMI decreased from（26.96±2.93）kg/m2 to（25.82±2.56）kg/m2,SBP decreased from（132.03±15.12）mmHg to（119.97±13.67）mmHg,and DBP decreased from（82.81±10.19）)mmHg decreased to（76.38±9.05）mmHg,HbAlc decreased from（8.39±1.29）%to（6.86±0.70）%（all P<0.05）,and there was no significant difference in the changes of TG and LDL-C.The compliance rate of BP increased from 31.3%to 56.3%,and HbAlc increased from 0%to 68.8%（P<0.05）.There was no significant difference in the compliance rates of BMI.TG and LDL-C.Compared with the lower HOMA-β group,the TC value of the higher HOMA-β group after MMC management was 4.22（3.17,5.15）mmol/L vs 4.73（4.13,5.63）mmol/L,and the TC compliance rate was higher（62.5%VS 36.4%）.Conclusion:MMC management mode can effectively improve the comprehensive compliance rate of body weight、blood pressure、blood glucose and blood lipid in newly diagnosed T2DM patients.With the increase of waist circumference and visceral fat area,the weight、blood pressure、glucose and lipid metabolism disorders of newly diagnosed TDM patients are more serious.After six months of MMC standardized management,metabolic indexes of patients with different waist circumference、visceral fat area and islet function were well controlled.In addition,abdominal obesity waist circumference control can improve HbAlc compliance rate.