Risk Factors For The Occurrence Of Type 2 Diabetes Mellitus And Type 2 Diabetic Kidney Disease And Study On The Exon Mutation And Type 2 Diabetic Kidney Disease Of Yi In Kunming,Yunnan

Objectives:To explore the risk factors for T2 DM of Yi nationality in Kunming,Yunnan,and to further explore the risk factors for the progression of T2 DM to DKD.Methods: 80 patients with T2 DM who were hospitalized in the in the Second Department of Endocrinology,the First Affiliated Hospital of Kunming Medical University from September 2020 to January 2023 and met the inclusion and exclusion criteria of this study were selected as the study subjects.30 cases with normal physical examination in our hospital during the same period were enrolled as the normal control group.The anthropological and clinical data of the subjects were collected,and then the T2 DM group was divided into two groups according to whether the Uric Albumin Creatinine Ration,UACR ≥30ug/mg twice none in the same day: type 2diabetes mellitus without diabetic kidney disease group(52 cases)and diabetic kidney disease group(28 cases).The differences of each index between groups were analyzed.(1)Univariate analysis of sex,age,systolic blood pressure,diastolic blood pressure,body mass index(BMI),and C-peptide insulin resistance index(HOMA-IR(CP)],insulin resistance index(HOMA-IR),Triglyceride Glucose Index,beta cell function(HOMA-β),duration of diabetes mellitus,fasting plasma glucose(FPG),fasting insulin(FPI),glycosylated hemoglobin(Hb Alc),serum uric acid were performed between normal control group and type 2 diabetes mellitus group,type 2 diabetes mellitus group and diabetic kidney disease group.(2)Multivariate logistic regression analysis was performed for single factors with statistically significant differences to explore the risk factors affecting the occurrence of T2 DM and DKD.(3)Receiver operating characteristic(ROC)curve was used to analyze the predictive value of C-peptide insulin resistance index for DKD.Results: 1.Compared with the normal group,the proportion of males(70%)in the type 2 diabetes group of Yi nationality in Kunming,Yunnan was higher(P<0.05)than females(30%),while there was no significant difference in age,systolic blood pressure,diastolic blood pressure,blood urea,creatinine,and LDL between the two groups(P>0.05);The BMI,fasting blood glucose,glycated hemoglobin,blood uric acid,total cholesterol,triglycerides,and triglycerides glucose index of the type 2diabetes group were higher than those in the normal group,while the HDL and free cholesterol in the type 2 diabetes group were significantly lower than those in the normal population(P<0.05),multivariate logistic regression analysis found that HDL(OR:0.021;95%CI:0.001-0.348;P=0.007)was a protective factor for type 2diabetes;2.Compared with T2 DM and DKD of Yi nationality in Kunming,Yunnan,there was no significant difference in gender,age,systolic blood pressure,diastolic blood pressure,BMI,duration of diabetes mellitus,glycated hemoglobin,fasting insulin,blood urea,blood uric acid,total cholesterol,free cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein and triglyceride glucose index(P>0.05);The fasting blood glucose,fasting C-peptide,insulin resistance index,C-peptide insulin resistance index and serum creatinine were higher in the DKD group than those in the T2 DM group,and the differences were statistically significant(P<0.05),and the difference between H0MA-β was not statistically significant(P>0.05).Further,multivariate logistic regression analysis found that elevated C peptide insulin resistance index [HOMA-IR(CP)] was an independent risk factor for progression of T2 DM to DKD(OR=2.377;95%CI:1.351-4.182;P=0.003);3.The area under the ROC curve showed that: the area under the C peptide insulin resistance index OC curve was 0.74(95% CI: 0.630-0.831,P<0.001),the maximum approximate index was 0.4011,sensitivity 53.57%,specificity 86.54%.Conclusions:1.High density lipoprotein is a protective factor of type 2diabetes mellitus in Kunming Yi nationality;2.The C-peptide insulin resistance index was positively correlated with the development of DKD in T2 DM of Yi nationality in Kunming,Yunnan,and was an independent risk factor for DKD in Kunming,Yunnan.3.C-peptide insulin resistance index has a good predictive value for the occurrence of DKD in Yi nationality in Kunming,Yunnan.Objectives:To obtain the disease-causing genes related to DKD,further exploring the relationship between genetics and the occurrence of DKD,so as to provide evidence for the occurrence of DKD at the gene level and thus preventing the development of DKD.Methods: A total of 9 cases of Yi nationality in Shuanghe Township,Jinning District,Kun Ming,Yunnan were selected for the current investigation,including 3cases of NC group,3 cases of DKD and 3 cases of T2 DM.All subjects in the DM group and the DKD group had been clearly diagnosed with type 2 diabetes mellitus and their urine was randomly collected to measure urinary albumin/creatinine ratio(UACR)according to the Chinese Guidelines for the Prevention and Treatment of Type 2 diabetes mellitus(2020 edition),and were diagnosed as type 2 diabetic kidney disease with UACR ≥ 30ug/mg twice on different days,and included in the DKD group.Genomic DNA was extracted from the 9 subjects,and whole genome exon sequencing was conducted.Coexpression network analysis was conducted by bioinformatics analysis,and possible mutant genes and mutation sites were screened out.Results: After obtaining the whole exon sequencing data,excluding nonsense mutations,synonymous mutations,stop codon mutations,and mastic mutations,and excluding non-functional single nucleotide mutations,38 candidate single nucleotide missense mutations were found,among which 9 were unique in diabetic kidney disease.Through NCBI database,KEGG pathway and literature review,it was finally screened out that Tyrosine Kinase TYK2 may be related to the occurrence of diabetic kidney disease,and it is intricately related to the STAT3 gene in KEGG pathway.All three diabetic kidney disease patients in this study had heterozygous mutations in TYK2 gene rs2304256[c.1084G>T(p.Val362Phe)].Conclusion:The heterozygous mutation of TYK2 gene rs2304256[c.1084G>T(p.Val362Phe)] may be the pathogenic gene of diabetic kidney disease...