Effects Of Short-term Insulin Pump Intensive Treatment On The Incidence Of Long-term Cerebral Infarction In Newly Diagnosed Type 2 Diabetes Mellitus Patients

Objective1.Compare the therapeutic effect of different types of hypoglycemic therapy by collecting the data of different hypoglycemic therapy to the patients with newly diagnosed type 2 diabetes mellitus(T2DM).2.Compare the long-term morbidity of cerebral infarction through a retrospective follow-up of T2 DM patients with different treatment when they were given the diagnosis, analyze the related factors of cerebral infarction of T2 DM patients.MethodsReview the clinical data of 634 patients diagnosed by T2 DM in endocrine ward of Beijing General Hospital of PLA. The patients were divided into control group(345cases, N-CSII) and intensive therapy group(289 cases, CSII) according to whether the patients were given insulin pump treatment, compared the biochemical markers and clinical data between two groups. Investigated the effects of different treatment to the long-term morbidity of cerebral infarction in newly diagnosed T2 DM patients by Cox’s proportional hazards regression.Results1. Comparison of relevant data at the first visit1.1 General information of the two groups: age, gender, smoking, BMI(body mass index), FPG(fasting plasma glucose), 2h PG(2 hour postprandial blood glucose),Hb A1 c, HOMA-IR(insulin resistance index), TC(total cholesterol), TG(triglyceride),LDL-C(low density lipoprotein cholesterol), HDL-C(high density lipoprotein cholesterol) levels had no statistical significance(P > 0.05).1.2 Compared the clinical data before and after 2 week treatment in CSII group: FPG、2h PG, HOMA-IR, TC, TG, LDL-C levels were significantly decreased after treatment(P<0.05) except for HDL-C(P>0.05).1.3 Compared the clinical data before and after 2 week treatment in N-CSII group: FPG,2h PG, HOMA-IR, TC, TG, LDL-C levels were significantly decreased after treatment(P<0.05) except for HOMA-IR and HDL-C levels(P>0.05).1.4 Compared the two groups’ clinical data after treatment: the differences of FPG,2h PG, HOMA-IR and the time blood up to standard level were significant in two groups(P<0.05), it is easier to control blood sugar level in CSII group, insulin resistance modified better and the time that blood up to standard level is shorter. No differences of TC, TG, LDL-C, HDL-C in two groups(P>0.05).2. Comparison of related data at follow-up2.1 Compared the differences of morbidity of cerebral infarction, BMI, exercises,smoking, Hb A1 c, LDL-C, high blood pressure, hypoglycemic agents, aspirin,hypotensor, lipid regulating drugs. Morbidity of cerebral infarction was lower, exercises and diet control were better in CSII group, the differences were significantly(P<0.01).No differences of BMI, smoking, Hb A1 c, LDL-C, high blood pressure, hypoglycemic agents, aspirin, hypotensor and lipid regulating drugs in two groups(P>0.05).2.2 Cox’s proportional hazards regression analysis: take cerebral infarction as dependent variable(cerebral infarction, CI=1; no cerebral infarction, N-CI=0), gender, smoking,BMI, age, LDL-C, exercises, diet, high blood pressure, hypoglycemic agents, aspirin,hypotensor, lipid regulating drugs. Take group as independed variable, take Cox’s proportional hazards regression analysis at first, the differences of diet, Hb A1 c, high blood pressure were significant, then in light of step-by-step method, we did multi-parameter analysis, in newly diagnosed patients, CSII intensive treatment(HR=0.39,95%CI:0.17-0.89) and better diet control(HR=0.27,95%CI:0.12-0.59) were protect factors to cerebral infarction, higher Hb A1c(HR=2.83,95%CI: 1.36-5.89) and higher blood pressure(HR= 2.86,95%CI: 1.49-5.49) were risk factors.2.3 Morbidity of different cohort follow-up timeThe morbidity in cerebral infarction patients were 0.21 per 100 person-years if they were follow up less than 5 years, 0.77 per 100 person-years if they were follow up 5 to10 years, 0.81 per 100 person-years if they were follow up equal or more than 10 years.Conclusions1.The newly diagnosed T2 DM patients with severe hyperglycemia who were given short-term insulin pump intensive treatment had shorter time blood up to standard level and better hypoglycemic effect compared to oral hypoglycemic agents and subcutaneous insulin treatments.2.Short-term insulin pump intensive treatment could significantly improve insulin resistance for the newly diagnosed T2 DM patients with severe hyperglycemia.3.The newly diagnosed T2 DM patients who were given early short-term insulin pump intensive treatment but better blood sugar control had lower morbidity of cerebral infarction in long-term.4.The newly diagnosed T2 DM patients with early good glycemic control may form a better self-administration, and then reduce the occurrence of cerebral infarction.5.It can be reduce the occurrence of cerebral infarction to strengthen blood sugar and blood pressure control, improve self-administration ability.