Study On TCM Constitution And Syndrome Types Of Obese Patients With Type 2 Diabetes

Objective: In this study,through the identification of TCM constitution of obese patients with type 2 diabetes mellitus(T2DM),we aimed to explore the distribution law of TCM constitution and syndrome types of the patients,study the internal correlation between constitution and syndrome types of obese T2 DM,and analyze the correlation between constitution and general data and clinical indicators,so as to provide theoretical support for clinicians to prevent and treat obese T2 DM.Methods:1.A cross-sectional survey was conducted to investigate 200 patients who met the inclusion criteria of obese T2 DM in the outpatient and inpatient treatment of endocrinology department of Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine from January 2020 to December 2020.2.Identification of TCM constitution of obese T2 DM patients through TCM body mass table.Symptoms,tongue and pulse conditions of obese T2 DM patients were collected through the four diagnostic information questionnaire of traditional Chinese medicine(TCM),and syndrome types were diagnosed according to TCM syndrome differentiation standard.3.Collect general information of obese T2 DM patients,collate and record relevant clinical indicators.4.The results of the survey are recorded in the general information and survey judgment summary table,using Microsoft Excel to establish a database,to determine the data is saved after error.The data of this study were analyzed by SPSS26.0 statistical software.Results:1.The constitution proportion of TCM biased constitution of obese T2 DM patients from high to low is phlegm-dampness constitution(27.5%),damp-heat constitution(21.5%),qi deficiency constitution(15.0%),yin deficiency constitution(10.5 %),yang deficiency constitution(6.5%),blood stasis constitution(5.5%),qi stagnation constitution(4.0%),special intrinsic constitution(1%);Peace accounts for 8.5%.The physical distribution was correlated with gender,exercise status,BMI,WC,WHR,fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),Fins and HOMA-IR(P<0.05).The physical distribution was not correlated with age,course of disease,smoking history,alcoholism history,family history,complications,complications,2-hour postprandial blood glucose(2h PBG),Hb Alc,high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),FCP,and blood UA(P > 0.05).2.The distribution of TCM syndromes of obese T2 DM from more to less were : stagnation of heat in liver and stomach(47.0%),deficiency of both qi and yin(15.5%),gastrointestinal damp heat(14.5%),spleen deficiency and phlegm dampness(11.5%),phlegm and blood stasis(9.0%),deficiency of both yin and yang(2.5%).According to the test,different syndromes of obese T2 DM patients have significant differences in various TCM constitutions(P <0.05).3.Correspondence analysis of constitution and syndrome types :phlegm-dampness constitution is mostly manifested as stagnation of heat in liver and stomach;damp-heat and qi stagnation are mostly manifested as gastrointestinal damp-heat syndrome and liver-stomach stagnation-heat syndrome;Yang deficiency is mainly manifested as spleen deficiency and phlegm dampness syndrome,yin and yang deficiency syndrome;Qi deficiency and Yin deficiency are mostly manifested as Qi and Yin deficiency syndrome;Blood stasis is characterized by phlegm stasis syndrome.4.Correlation analysis between constitution and syndrome types :(1)Phlegm-dampness constitution,Yang deficiency constitution,blood stasis constitution were correlated with liver-stomach heat syndrome(P<0.05),and liver-stomach heat syndrome was more common in phlegm-dampness constitution.Liver-stomach stagnation heat syndrome is rare in blood stasis.(2)There was a correlation between qi deficiency and phlegm-dampness and qi-yin deficiency(P<0.05),and qi deficiency was more common in qi deficiency.Deficiency of both qi and yin is rare in phlegm dampness.(3)Damp-heat,qi stagnation and qi deficiency were correlated with gastrointestinal damp-heat syndrome(P<0.05),and gastrointestinal damp-heat syndrome was more common in damp-heat and qi stagnation.Gastrointestinal damp-heat syndrome in qi deficiency is rare.(4)Yang deficiency,phlegm-dampness and damp-heat were correlated with spleen deficiency and phlegm-dampness(P<0.05).Spleen deficiency and phlegm-dampness were more common in Yang deficiency and phlegm-dampness.Syndrome of spleen deficiency and phlegm dampness in damp-heat constitution is rare.(5)Blood stasis,damp heat and phlegm stasis syndrome were correlated(P<0.05),phlegm stasis syndrome was more common in blood stasis;Phlegm and blood stasis syndrome in damp-heat constitution is rare.(6)There was a correlation between yang deficiency and yin-yang deficiency(P<0.05).5.Comparison of TCM constitution and general clinical data of obese T2 DM : Male obese T2 DM patients are more than female patients,and the proportion of female is greater than male in yang deficiency,blood stasis and qi stagnation.Age distribution,the average age of onset was 61.15±10.42 years old,elderly patients(≥60 years old)accounted for 59 %,middle-aged patients(45-59 years old)accounted for 33 %,young patients(≤44 years old)accounted for 8%,with age,the incidence of biased constitution has an upward trend.In terms of exercise,130 patients with less exercise accounted for 65.7 %,indicating that most obese T2 DM patients have less exercise.The WC of Yang deficiency is much larger than that of Qi stagnation.WHR of patients with qi deficiency and yang deficiency is higher than other constitutions.6.Comparison of TCM constitution and clinical biochemical indexes of obese T2 DM : FBG and 2h PBG of phlegm-dampness constitution and damp-heat constitution were higher than those of other constitutions.TC level in patients with damp-heat syndrome was significantly higher than that in patients with mild syndrome(P=0.005,P<0.05).TG in patients with phlegm dampness and qi deficiency was different(P<0.05).LDL-C of patients with phlegm-dampness constitution was higher than that of other constitution types.There was difference in FINS between damp-heat and yin deficiency(P=0.028,P<0.05).There was no difference in FCP among different constitutions(P>0.05).The HOMA-IR of different constitutions was statistically significant(P=0.000,P<0.05).By pairwise comparison,the HOMA-IR of phlegm-dampness constitution was higher than that of damp-heat constitution,and significantly higher than that of qi deficiency constitution and yin deficiency constitution(P< 0.05).7.In the correlation analysis of phlegm-dampness,damp-heat and multiple factors,FBG and TG were positively correlated with phlegm-dampness,and the increase of TC and Fins led to an increase in the risk of forming damp-heat.Conclusions:1.TCM constitution of obesity type 2 diabetes is mainly phlegm-dampness constitution,damp-heat constitution,qi deficiency constitution and yin deficiency constitution.2.The most common TCM syndrome type of obesity type 2 diabetes is stagnation of liver and stomach heat syndrome,followed by Qi and Yin deficiency syndrome,gastrointestinal damp heat syndrome,spleen deficiency and phlegm dampness syndrome,phlegm and blood stasis syndrome,Yin and Yang deficiency syndrome.3.There is a correlation between TCM constitution and syndrome types of obese type 2 diabetes.The phlegm-dampness constitution is manifested in liver-stomach stagnation and heat syndrome and spleen deficiency and phlegm-dampness syndrome;damp-heat constitution is mainly manifested in gastrointestinal damp-heat syndrome;qi-yin deficiency syndrome is mainly manifested in qi deficiency;yang deficiency constitution is mainly manifested in spleen deficiency and phlegm-dampness syndrome and yin-yang deficiency syndrome;blood stasis constitution is mainly manifested in phlegm-stasis block syndrome;qi stagnation constitution is mainly manifested in gastrointestinal damp-heat syndrome.4.Obesity type 2 diabetes constitution is correlated with gender,exercise,BMI,WC,WHR,FBG,TC,TG,Fins and HOMA-IR.5.High FBG and high TG were the risk factors for type 2 diabetes with phlegm-dampness obesity,and high TC and high Fins were positively correlated with the occurrence of dampness-heat.