Clinical Characteristics Of Type 2 Diabetes Mellitus With Primary Aldosteronism

0bjective:Type 2 diabetes mellitus(T2DM)is a type of diabetes whose characteristic have been defined that is insulin resistance accompanied with relative deficiency of insulin or inadequate secretion of insulin with insulin resistance.Primary aldosteronism(PA)is a disease that adrenal cortical adenoma or hyperplasia led to excessive secretion of aldosterone,resulting in water and sodium retention,fluid volume augmentation,increased blood pressure,and inhibition of the renin-angiotensin system,it is an important component of Secondary hypertension.With the development of society and the change of people’s life style,in China,the morbidity of type 2 diabetes and hypertension were increase constantly in population,and the proportion of both diseases were upto 40%～60%.In the hypertensive patients,PA is the third most common cause of secondary hypertension,because of the development of detection technology,the detection rate of PA keeps increasing.In clinical,we found that contrast with the general population,the morbidity of PA in patients of type 2 diabetes mellitus is higher,and PA it is easy to be missed or misdiagnosed,the outcome would delay patients treatment,and would have severe consequences.This study record of 82 patients diagnosed with type 2 diabetes mellitus with primary aldosteronism in May 2015 to August 2019,and 132 patients of T2 DM with essential hypertension(EH).We analyzed the differences of the two groups and summarized these patients’ clinical characteristics.Enhance the understanding of patients with T2 DM with PA,Furthermore,Maybe we can early correct diagnosis and timely treatment,thus to prevent the occurrence of serious adverse consequence.Methods:Refer to Chengde City Central Hospital endocrinology in May 2015 to August 2019 discharge registration handbook,and selected the patients clinical date,the patients conclude 82 cases of T2 DM with PA and 132 cases of T2 DM with EH hospitalized in the department of endocrinology.The patients of T2 DM with PA were case group,and the patients of T2 DM with EH were control group.In the medical record management section of these patients qualified data,filled in paper form,to record the data of patients,including the general information:gender,age,weight and height,duration of hypertension and diabetes duration,calculated body mass index(BMI)= weight(Kg)/height~2(m).And the clinical data: systolic blood pressure(SBP),diastolic blood pressure(DBP),glucose,fasting insulin,fasting plasma C-peptide,blood lipids,liver and kidney function,serum sodium,potassium,urinary potassium,fundus photography,urine trace albumin and other indicators,calculated Homeostasis model insulin resistance index(HOMA-IR)=[fasting insulin(m U/L)×fasting glucose(mmol/L)]/22.5.Use the SPSS 21.0 statistical software for data analysis and processing.The measurement data conforming to the normal distribution are expressed as mean ±standard deviation(±s),and the non-normal distribution is expressed as median quartile spacing M(Q1,Q3).The enumeration data are expressed in case Numbers(constituent ratios),T test was used for comparison of measurement data conforming to normal distribution,and non-parametric test was used for non-normal distribution.The counting data were compared by χ~2 test,and P <0.05 was considered statistically significant.Results:1.Comparison of data between T2 DM with PA group(case group)and T2 DM with EH group(control group)(1)there were no statistically significant differences in the groups of baseline data in sex composition,age,course of diabetes,course and grade of hypertension between the case group and the control group,indicating the comparability between the two groups.(2)In the case group,the random blood pressure,24-hour urine potassium and blood creatinine of the hospitalized patients were all higher than those in the control group,in addition,Body mass index and serum potassium were lower than the control group,those differences have the statistically significant(P<0.05).(3)In the case group,the number of cases of retinopathy and renal disease was higher than that in the control group,those differences have the statistically significant(P<0.05).And glycosylated hemoglobin and 2-hour postload glucose were lower,those differences have the statistically significant(P<0.05).But the fasting blood glucose and HOMO-IR were lower,with no significant difference.2.Comparison of clinical characteristics between normal potassium with hypokalemia in T2 DM with PA groupIn the T2 DM with PA,there was a statistical difference in gender composition between the two groups,in the normal potassium group,it concluded more males,women was more common in Hypokalemia.The difference has the statistically significant(P<0.05).Compared with the normal potassium group,the age of the patients in the hypokalemia group were older,the difference has the statistically significant(P<0.05).Patients in the hypokalemia group had higher levels of fasting glucose and LDL cholesterol.Patients in the hypokalemia group had lower levels of fasting insulin,fasting c-peptide and uric acid levels.Those differences have the statistically significant(P<0.05).Conclusions:Compared with the patients of T2 DM with EH,T2 DM with PA patients are more difficult to control blood pressure,more likely to have hypokalemia and increased urinary potassium excretion,and more likely to have damage to the target organs of the eyes and kidneys,but they have lower risk of obesity.This study also observed that: when the patient was combined with T2 DM,there was no significant difference in insulin resistance in PA and EH patients,but the T2 DM with EH patients had higher 2-hour postload glucose and glycosylated hemoglobin,meaning that this group’s blood glucose is poorly-controlled.In the T2 DM with PA,there was a statistical difference in gender composition between the two groups,the differences have the statistically significant.In the normal potassium group,it concluded more males.Hypokalemia was more common in women.and it is more likely to occur with advancing age.Compared with the normal potassium group,the patients in the hypokalemia group had higher fasting blood glucose level,lower insulin secretion function,and were more likely to be complicated with glucose metabolism disorder.Patients in the hypokalemia group had higher LDL cholesterol content and were prone to the disorder of lipid metabolism,and had lower levels of uric acid.In clinical practice,the T2 DM with EP patients take combinations of more than one antihypertensive agent,whose blood pressure is still difficult to control,in addition,they have the early appearance such as eye ground,kidney target organ damage,with hypokalemia and increase of urine potassium.These patients should be alert to the possibility of PA,and they need to screen the routine ARR,and further diagnostic tests should be conducted for abnormalities.The T2 DM with PA patients,if their blood potassium is lower than normal,they should be supplemented actively blood potassium,and tested their blood potassium regularly,to keep blood potassium at normal levels.In addition,for patients with hypokalemia,more attention should be paid to the monitoring and intervention of blood glucose and lipid.