Factors Influencing The Function Of β Cell In Patients With Type 2 Diabetes Mellitus And The Differences Of β Cell Function Among Different TCM Syndromes

Objective:The purpose of this study was to explore the factors that influence islet β cell function in patients with type 2 diabetes mellitus(T2DM)by clinical research and investigate the correlation between these factors and islet function.To explore the distribution characteristics of TCM Syndrome Types in patients with type 2 diabetes mellitus,and analyze the differences of islet function and other clinical indicators among different syndrome types.Methods:This study collected T2DM patients from the inpatient department of Jiangsu Hospital of traditional Chinese Medicine affiliated to Nanjing University of Traditional Chinese Medicine.According to the inclusion and exclusion criteria,513 cases were finally taken,including 262 males and 251 females.The patients’ name,hospital number,gender,age,course of disease,past history,symptoms,tongue coating,pulse were recorded by means of clinical examination.Basic vital signs and physical examination data were collected contains blood pressure,height and weight,and calculate body mass index(BMI).All the patients were asked stopped eating at 20:00 of the day before the blood test.At 6:00 of the next day,the elbow vein blood was extracted without eating food.And then complete the blood routine,liver function,renal function,blood lipid,thyroid function,HbA1C,fasting C-peptide test.Oral Glucose Tolerance Test(OGTT)was also carried out:Take containing 75 g glucose steamed bread orally in 10-15 minutes,and then take elbow venous blood at 30 minutes,60 minutes,120 minutes and 180 minutes respectively to measure C-peptide level.Evaluate the function of islet cells by calculating the area under the C-peptide curve of OGTT test;We also asked subjects to take the cleaning morning urine to detection the urinary microalbumin(mAb),urinary microalbumin/creatinine(UACR),urinary protein quantitative(UTP)and other indicators.Then we use statistical methods like correlation analysis and multiple linear regression to analyze the related factors affecting the function of β cell in T2DM patients.The research cases were divided into TCM syndrome types,we analyze the distribution characteristics of TCM syndrome types.And investigate the differences of islet function and other clinical indexes among different syndrome types by using variance analysis,rank sum test and binary logistic regression.Results:(1)The general characteristics of the included cases:513 cases of T2DM patients are finally included,262 of them are males,accounting for 51.07%of total,251 are females,accounting for 48.93%.The average age of the patients is 56.21 years old,belonging to middle-aged crowd,and the average course of disease is 8.37 years;the average BMI is 25.28kg/m2,belonging to the overweight range;the average HbA1C is 8.68%,which exceeded the comprehensive control target of type 2 diabetes in China;the average mALB,UACR and UTP are also beyond the normal range.(2)The correlation and partial correlation analysis of FCP,AUC30,AUC120 and AUC180 were carried out.The results showed that:sex,course of disease,BMI,HbA,c,serum creatinine(SCR)and uric acid(UA)are the influencing factors of β cell function.All the results are statistically significant(P<0.05).(3)According to the results.of correlation analysis,multiple linear regression analysis were carried out,and the results showed that:①After controlling other factors,the function of islet β cells decreased with the course of disease.And the course of disease was negatively correlated with the function of islet β cells,showing a statistical significance(P<0.05).②With the increase of BMI,SCR and UA,the function of β cell were gradually increased,which was positively correlated with the function ofβ cell(P<0.05).③There was a positive correlation between female and postprandial islet function.HbA1C was negatively correlated with postprandial islet function.The results show a statistically significant(P<0.05).(4)The results of TCM syndrome type distribution showed that the patients with Qi and Yin deficiency syndrome are the most,accounting for 48.15%of total,the distribution of Yin deficiency and dryness heat syndrome is similar to Yin and Yang deficiency syndrome.(5)Rank sum test and variance test were used to compare these three syndrome types,and then take further binary logistic regression.All the results showed that:With the transformation of Yin deficiency and dryness heat syndrome to Yin and Yang deficiency syndrome,the islet function of patients decreased gradually,the difference is statistically significant(P<0.001).Conclusion:1.By controlling other influencing factors,the course of disease was negatively correlated with the function of islets,and HbA1C was negatively correlated with postprandial islet function.2.Female was positively correlated with postprandial β cell function.BMI,creatinine and uric acid were positively correlated with islet function.3.The Qi and Yin deficiency accounts for the most in all the patients with diabetes.With the prolongation of the course of disease,the type of diabetes changes from Yin deficiency and dryness heat syndrome to Yin and Yang deficiency.4.With the continuous development of diabetes,the function of islet declines in the process of syndrome type from Yin deficiency and dryness heat syndrome to Qi and Yin deficiency and then to Yin and Yang deficiency.