The guiding significance of selecting hypoglycemia drugs in accord to analysis of pancreas islet function characteristics in initial diagnosed type 2 diabetic patients
10.3969/j.issn.1008-9691.2019.03.020
- VernacularTitle:分析初次诊断2型糖尿病患者胰岛功能特点对选择降糖药物的指导意义
- Author:
Rui HAO
1
;
Yin LIU
Author Information
1. 天津市红桥医院心内科
- Keywords:
Type 2 diabetes mellitus;
Insulin resistance;
Hypoglycemic agents;
Major cardiovascular adverse events
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2019;26(3):334-337
- CountryChina
- Language:Chinese
-
Abstract:
Objective By analyzing the pancreas islet function characteristics of initial diagnosed type 2 diabetes patients to provide guidance of selecting hypoglycemic drugs to lower the risk occurrence of main cardiovascular adverse event(MACE)in patients with coronary arterial atherosclerotic cardiac disease (coronary disease) combined with diabetes mellitus. Methods The clinical data of 769 initial diagnosed type 2 diabetic patients admitted to Tianjin Hongqiao Hospital from January 2013 to July 2018 were retrospectively analyzed. The patients were divided into a synchronous group (542 patients) and a non-synchronous group (227 patients) according to whether the insulin and C-peptide secretion peak times were synchronized or not. The pancreas islet function characteristics of the two groups were analyzed, the differences in the levels of total cholesterol (TC), triacylglycero(TG), glycosylated hemoglobin (HbA1c),oral glucose tolerance test (OGTT), serum insulin release (INS), C-peptide detection index, peak times of insulin and C-peptide, insulin resistance index of steady state model (HOMA-IR), steady-state insulin secretion index (HOMA-β) , and quantitative insulin sensitivity test index (QUICKI) were compared between the two groups; Logistic binary regression analysis was used to screen out the risk factors that could be related to the impact of whether the peak value times of insulin and C peptide being synchronous or not in initial diagnosed type 2 diabetic patients. Results The TC in the synchronous group was significantly higher than that in the non-synchronous group (mmol/L: 4.96±1.20 vs. 4.78±1.06), and the HbA1c was obviously lower than that in non-synchronous group (0.077 5±0.016 6 vs. 0.082 7±0.018 6), the differences being statistically significant (all P<0.05). The blood glucose, insulin levels of the two groups gradually increased with time and peaked at 120 minutes, and then went down, and the blood glucose level of the synchronous group was significantly lower than that of the non-synchronous group (mmol/L:15.52±3.39 vs. 16.18±3.97), while the levels of insulin in the synchronous group were significantly higher than those in the non-synchronous group (mU/L: 92.19±78.34 vs. 55.99±49.86, both P<0.05). After 120 minutes, the level of C-peptide in synchronous group was significantly higher than that in non-synchronous group (μg/L: 2.34±0.52 vs. 2.16±0.59), and lasted to 180 minutes (μg/L: 9.96±4.71 vs. 8.99±4.33). The peak time of insulin in the synchronous group was significantly delayed than that in non-synchronized group (minutes: 125.54±28.02 vs. 93.30±40.91), but the C-peptide secretion peak time was earlier (minutes: 125.54±28.07 vs. 145.11±32.61), the differences being statistically significant (all P<0.05). There were no significant differences in HOMA-IR, QUICKI between the two groups [HOMA-IR:(4.31±3.35)% vs. (4.15±3.46)%, QUICKI: 0.32±0.04 vs. 0.33±0.05, both P>0.05], and the HOMA-β of synchronous group was significantly higher than that in the non-synchronous group [(88.64±67.53)% vs. (76.59±69.41)%, P<0.05], ISI in synchronous group was significantly lower than that in non-synchronous group (3.98±0.66 vs. 4.14±0.74, P<0.05). Logistic regression analysis showed that the factors of affecting the synchronization of insulin and C-peptide release were insulin peak time and C-peptide peak time [insulin peak time: odds ratio (OR) = 1.077, 95% confidence interval (95% CI)=1.066-1.088; peak time of C peptide: OR=0.928, 95%CI=0.918-0.938]. Conclusion The degree of insulin resistance in synchronous group is higher than that in non-synchronous group; and the secretion function of pancreas islet beta cells in non-synchronous group is lower than that in synchronous group; the more stronger insulin resistance is, the more synchronous the release curve of insulin and C-peptide is.
