Relationship Between Nonalcoholic Fatty Liver Disease And Glucose Metabolism In Obese Patients And Effect Of Metabolic Surgery On Dynamic Blood Glucose In Type 2 Diabetes Mellitus Patients With Obesity

OBJECTIVE:To investigate the relationship between nonalcoholic fatty liver disease(NAFLD)and glucose metabolism in obese patients.Methods:Firstly,170 obese patients(BMI ≥ 28kg/m2)were divided into NAFLD group(n=134)and non-NAFLD group based on abdominal ultrasound.OGTT two-point blood glucose(FBG,2h-BG),two-point blood insulin(F-INS,2h-INS),two-point blood C-peptide(F-CP,2h-CP)and glycosylated hemoglobin(HbAlc)and triglyceride(TG),total cholesterol(CH),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and alanine aminotransferase(ALT)and aspartate transaminase(AST)were measured,HOMA-IR were calculated.Secondly,80 obese patients with NAFLD confirmed by liver pathology were divided into mild fatty liver group(F1.28 cases)and moderate to severe fatty liver group(F2-3.52 cases)according to the liver pathological.OGTT four-point blood glucose(FBG,0.5h-BG,1h-BG,2h-BG),four-point blood insulin(F-INS,0.5h-INS,1h-INS,2h-INS),four-point blood C-peptide(F-CP,0.5h-CP,1h-CP,2h-CP)and HbA1c,TG,CH,HDL-C,LDL-C and ALT,AST,glutathione transpeptidase(y-GT)and alkaline phosphatase(AKP)were measured,HOMA-IR were calculated.Analysis of the relationship between NAFLD and glucose metabolism.Results:The prevalence of T2DM in non-NAFLD group and NAFLD group was 47.2%and 76.1%,respectively(P<0.05);Patients with NAFLD had a higher BMI,FBG,PBG,HbAc1 ALT,AST and TG(All P<0.05).The prevalence of T2DM in F1 and F2-3 was 42.6%and 51.93%,respectively;F1,F2 and F3 patients was 42.6%,48.15%and 56%,respectively.The patients with moderate to severe fatty liver were younger and with a higher weight,BMI and longer waist circumference(P<0.05).The patients with moderate to severe fatty liver had trend of a higher OGTT four-point blood glucose and HbA1c.The patients with moderate to severe fatty liver had a higher value of F-INS,F-CP and insulin resistance(P<0.05).ISIm and DI 120 were significantly lower(P<0.05)in patients with moderate to severe fatty liver.The patients with moderate to severe fatty liver had a poor liver function.Binary logistic regression suggests that the insulin resistance index is an independent risk factor for moderate to severe fatty liver.Conclusion:In obese patients with NAFLD,glucose metabolism disorders was aggravated,with the increase of liver fat content,the insulin resistance,the disorder of glucose metabolism and the liver injury is aggravated,and they are easier to develop T2DM.OBJECTIVE:To investigate the effect of metabolic surgery on dynamic blood glucose in type 2 diabetes mellitus(T2DM)patients with obesity.Methods:14 patients underwent metabolic surgery performed the continuous glucose monitoring system(CGMS)before and 3 months after operation.The height,weight,BMI,waist circumference were recorded.Fasting plasma glucose(FBG),postprandial blood glucose(PBG),insulin release test of fasting insulin(F-INS),fasting C-peptide(F-CP),postprandial 2-hour insulin(2h-INS)and C-peptide(2h-CP),glycosylated hemoglobin(HbAlc)and triglyceride(TG),total cholesterol(CH),high and low density lipoprotein cholesterol(HDL-C and LDL-C)and uric acid(UA)were measured,HOMA-IR and HOMA-P were calculated.To observe the changes of dynamic blood glucose and the metabolism of glucose and lipid and the changes of islet function 3 months after metabolic surgery.Results:The mean blood glucose(MBG),the highest blood glucose(BGmax)and the lowest blood glucose(BGmin)were significantly lower(p<0.01),the percentage time of blood glucose ≥7.8 mmol/L and ≥11.1 mmol/L were significantly lower(P<0.01).The percentage time of blood glucose ≤ 3.9 mmol/L and the low blood glucose index(LBGI)were significantly higher(P<0.05),SDBG,LAGE and MAGE had no significant change(P>0.05).FBG,PBG and HbA1c decreased significantly(P<0.01),F-INS,F-CP and HOMA-IR were significantly decreased(P<0.05).The body weight,BMI and waist circumference were significantly lower(P<0.01).There was no significant change in HOMA-β(P>0.05).The levels of TG,CH and UA in patients were significantly lower(TG P<0.05,CH、UA P<0.01).Conclusion:The weight of patients in the early stage of metabolic surgery decreased significantly,and the glucose metabolism was improved obviously.