| Objective: To study the risk factors and the evaluated indexes of theinsulin resistance in different c-peptide levels of the first diagnosed patientswith type2diabetes.Methods: Choose399cases from the first diagnosed patients with type2diabetes from2000to2011who had received the OGTT, insulin and c-peptiderelease experiment. Different classifications of c-peptide response are as thefollowing: the common type, the highly reactive type, the lowly reactive type,the delayed type, the delayed highly reactive type, the delayed lowly reactivetype,and the type that the fasting c-peptide less than normal. Calculate thepercentage of different types.By the method of Homeostasis ModelAssessment（HOMA）to calculate the insulin resistance, islet B cell functionindex and the Whole Body Insulin Sensitivity Index (WBISI).The rest basicparameters include body fat percentage BF(%) and other biochemical indexessuch as blood lipid, liver function, the glycated hemoglobin (HbAlc) and so on.Separately compare the clinical indexes according to the following severalways: all the six types including the common type, the highly reactive type,the lowly reactive type, the delayed type, the delayed highly reactive type, thedelayed lowly reactive type is attributed to group A which includes345cases,and the type of the fasting c-peptide below normal is named group B including54cases; according to the insulin resistance if or if not>2these cases aredivided into two groups, respectively group α and group β.With SPSS17.0statistical software to analyze the data.The data according with the normaldistribution is analyzed by t test and the data not according with the normaldistribution is analyzed by rank sum test. Count materials are represented byfrequencies and percentages which are analyzed by the chi-square test.Riskfactors for insulin resistance of the two categories is analyzed by the logistic regression method. And the linear correlation is analyzed by using theSpearman correlation method.Results:1For each group which is divided by different c-peptide reaction types asfollowing: the common type, the highly reactive type, the lowly reactive type,the delayed type, the delayed highly reactive type, the delayed lowly reactivetype,and the type that the fasting c-peptide less than normal.The percentage ofthe total number is accounted for6%,5%,10%,22%,13%,30%,44%respectively. The delayed lowly reactive type is the most common type inhospital patients with type2diabetes, followed by the delayed type, the typeof the fasting c-peptide below normal, the delayed highly reaction type, thelowly reactive type,the highly reactive type,and the common type.2All the six types including the common type, the highly reactive type,the lowly reactive type, the delayed type, the delayed highly reactive type,and the delayed lowly reactive type is attributed to group A which includes345cases, and the type of the fasting c-peptide below normal is named groupB including54cases.Compare the age, BMI, duration, glycated hemoglobin,blood lipid, TG/HDL, ALT, IR, body fat distribution, WBINS, the patientshaving fatty liver, gender percentage and so on between the two groups.According to the t test results which shows that the p values of BMI, logIR,,logB cell function index, HbAlc and WBISI were less than0.05, the fivevariables have statistic differences between the two groups.The mean numbersof BMI, logIR and logB cell function index of group A are higher than groupB.On the contrary, HbAlc and WBISI of group A are lower than group B.Andaccording to the rank sum test rsults, the p values of TC, TG, ApoB, TG/HDL,ALT and the area of the insulin, c-peptide, glucose curve were less than0.05.Similarly these variables also have statistic differences between the twogroups. The mean ranks of TC, TG, ApoB, TG/HDL, ALT, the area of insulinand c-peptide curv of group A are higher than group B. The percentage ofpatients having fatty liver is different between the two groups,the percentageof group B is lower than group A.But there is no difference in gender percentage.3According to the insulin resistance if or if not>2, these cases aredivided into two groups, respectively group αand group β. Compare the age,BMI, duration, glycated hemoglobin, blood lipid, TG/HDL, ALT, body fatdistribution, WBINS, the patients having fatty liver, gender percentage and soon between the two groups. LogB cell function index, the body fat distributionand HbAlc have statistically significant differences between the two groupswith the p values all less than0.05by the t test. The mean numbers of LogBcell function index and the body fat distribution of group βare higher thangroup α. On the contrary, HbAlc of group β is lower than group α.And by therank sum test, the variables such as age, BMI, TG, LDL, Lpa, TG/HDL, ALT,FBG, INS0, INS120, c-peptide0, c-peptide120, WBISI and the area of theinsulin, c-peptide curve have statistically significant differences between thetwo groups with the p values were less than0.05respectively.The mean ranksof age, BMI, TG, LDL, Lpa, TG/HDL, ALT, FBG, INS0, INS120, c-peptide0,c-peptide120and the area of the insulin, c-peptide curve of group βare higherthan group α.On the contrary, WBISI of group β is lower than group α.Thepercentage of patients having fatty liver and the gender percentage are bothdifferent between the two groups. The percentage of patients having fatty liverof group αis lower than group β.And the percentage of male of group αishigher than group β.4Analyze the numbers of the highly reactive type+the delayed highlyreactive type and the lowly reactive type+the delayed lowly reactive typebetween group1and group2by the chi-square analysis.There are differences.The results for Pearson chi-square=22.628, df=1, p=0.000, p value is lessthan0.05.5These cases are divided into three categories according to BMIincluding normal:18.5<BMI≤23.9,overweight:24≤BMI<27.9and obesity:BMI≥28. The male in the gender is valued1and the female is valued0. Withinsulin resistance as dependent variable and the age, sex, BMI classification,TG/HDL, ALT as the independent variables, using the binary classification logistic regression analysis with the standard which is the αin=0.1, and αout=0.15,all the five variables can enter the regression equation. And the B valuefor each of them is0.026,-7.4,0.343,0.094,0.037, p value is0.004,0.002,0.025,0.006,0.004, odds ratio value is1.027,0.477,1.409,1.099,1.038.6With insulin resistance as the dependent variable and BMI,TG/HDL,body fat distribution, ALT, age as independent variables, the results show thatbetween the insulin resistance and BMI, body fat distribution, ALT, and agethere exist linear relations by Spearman correlation analysis,and the p valuefor each of them is0.000,0.000,0.000,0.044,and the r value for each of themis0.184,0.240,0.225,0.101. Among them,body fat distribution’s r value is thebiggest which means the strongest correlation, followed by ALT, BMI, age.Conclusion: BMI, body fat distribution, ALT and age have positivelinear relation with IR. Body fat distribution has a better correlation than BMI.TG/HDL, ALT, BMI, age and gender are related with insulin resistance, thefirst four are the risk factors correlated to IR, premenopausal female’s estrogenis a protective factor which presents that premenopausal female have a lowerIR than the male over all. But in postmenopausal female the risk of insulinresistance is even or higher than the maleTG/HDL, ALT as biochemical indexes have clinical convenience to beused as the evaluation indexes of insulin resistance of type2diabetes mellitus,with the combination of fat distribution and age there will be a moremeaningful value. |
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