Effect Of Vildagliptin Glycemic Control And Remission In Newly Diagnosed Type 2 Diabetics After Short-term Insulin Pump Therapy

Background and PurposeMost patients with type 2 diabetes, longer duration, and long-term use of hypoglycemic agents, can achieve target glycemic control is not high, but the best time delay insulin pump therapy, and because high blood sugar in patients with long-term condition, which toxic species with high blood sugar, accelerated β-cell function failure, so now for the treatment of type 2 diabetes has a new program, usually in newly diagnosed type 2 diabetes when he started to use insulin, so you can eliminate as soon as possible hyperglycemia toxicity, protection and restoration of β-cell function and reduces the likelihood of insulin resistance, save islet function, studies have shown that regardless of vildagliptin monotherapy, or in combination with metformin or thiazolidinediones, TZDs, can reduce 2 HbAlc diabetes patients. Based on this, the present study was to investigate insulin infusion (CSII) therapy to strengthen the process of joint use of vildagliptin (DPP-4 inhibitor) for the treatment of patients with type 2 diabetes value and application of continuous glucose monitoring system (Continuous dynamic glucose monitoring system, CGMS) comparing the combined group and the intensive therapy group in type 2 diabetes mellitus (T2DM) patients in the short-term differences in glycemic control and security. And programs to improve the islet P-cell function and insulin resistance in patients, and to improve glycemic control in patients with remission rate results were analyzed, the impact of patients after treatment with oral hypoglycemic drugs in the treatment of long-term glucose control situation on research.Method:Choose our hospital diagnosed 80 patients with type 2 diabetes (using the 1999 WHO diagnostic criteria for HbAlc 7-10%, FBG<15mmol/1) as an object of study, the program is divided into CSII and CSII+vildagliptin program 50mg bid, be for a period of 14 days of treatment, respectively, before and after treatment standard meal test and measurement of blood glucose changes, β-cell function, insulin, C-peptide secretion and other indicators, the analysis of blood glucose rate after stopping treatment groups, and compare the two groups in these indicators differences, the use of continuous glucose monitoring systems comparison and evaluation of type 2 diabetes vildagliptin combined effect of insulin pump therapy, efficacy and safety assessment. After 14 days of treatment for patients with careful blood glucose monitoring indicators and other projects, according to the insulin pump blood sugar is eased into remission in patients treated patients and continued to ease withdrawal observation group, patients continued therapy, CSII is not first remission metformin alone (1500mg/d), can not be combined with remission vildagliptin (50mg bid); remission followed up to the end of 12 weeks, remission and continued treatment during follow-up of patients without remission in accordance four weeks a follow-up requires the determination of basic information including the content, and its guidance and other aspects related to medication, at the end of 12 weeks of follow-up re-standard meal test understanding p-cell function, the two drugs are still unable remission with termination the group, the group recorded before the relevant baseline indicators measured results; CSII+vildagliptin group is not alone first remission vildagliptin (50mg bid), can not be combined with remission metformin (1500mg/d); remission follow-up observation until the end of 12 weeks, during follow-up requirements above; after the follow-up, according to the index data obtained for each follow-up, high- sugar compared between different groups, and oral medication discontinuation between groups remission time, glycemic control, β-cell function differences.Results:When patients were enrolled patient’s age, body weight was similar, HbAlc, body mass index (BMI), lipid profile (TG, CHOL, LDL-c, HDL-c), fasting plasma glucose (FPG),2-hour postprandial glucose (FPG2 differences) and other indicators of no significant (P> 0.05); strengthen mutual two lipid indicators before and after treatment:CSII group before and after treatment there is no significant difference in lipid parameters. CSII+vildagliptin group before and after treatment than before treatment total cholesterol levels decreased, there are significant differences in decline, no significant differences over the project. Two groups of patients before and after treatment, fasting plasma glucose (FPG),2h postprandial blood glucose (2hPG) were significantly decreased, P<0.05, comparison between groups FPG, 2hPG decline was no significant difference P> 0.05; groups were glycosylated hemoglobin (HbA1c) with no significant change compared to baseline, the differences were not statistically significant, there was no significant difference between groups. The average two-day comparison of peripheral blood did not see a significant difference (P> 0.05). After treatment, HOMA-IR decreased (p<0.05), HOMA-β were increased (p<0.01). Comparison between the two groups after treatment HOMA-IR, there was no significant difference (p> 0.05); Table 2-4. However, HOMA-β, the between-group comparison shows HOMA-P levels CSII+ vildagliptin group after treatment was significantly higher than the CSII group, statistically significant differences (p<0.05). Two groups of patients in the intensive treatment compliance rate of glucose in the process of comparison:3d compliance rate when CSII+vildagliptin group was significantly better than the CSII group (p <0.05),4d,5d and 5d over blood glucose rate not seen significant differences; in terms of the amount of insulin, CSII+vildagliptin dosage group was also significantly less than the CSII group (p<0.05). Standard meal test in two groups of patients before treatment to 0 minutes,30 minutes,60 minutes,120 minutes and 180 minutes without C-peptide levels significantly different (p> 0.05); 0 minutes and there was no significant difference between pre-treatment group after CSII therapy (p> 0.05), postprandial 30 minutes,60 minutes, there are 120 minutes, and 180 minutes before C-peptide levels significant difference compared with treatment (p <0.05); CSII+vildagliptin group after treatment fasting,30 minutes,60 minutes 120 minutes and 180 minutes were significantly different compared (p<0.05) and C-peptide levels before treatment; CSII+vildagliptin group after treatment for 60 minutes,120 minutes and 180 minutes C-peptide levels significantly compared with CSII group difference (p<0.05), specific values in the table below in Figure 2-6. C-peptide groups are the peak time of 120 minutes. CSⅡ+vildagliptin group hypoglycemia occur during treatment 14 times, CSII group of four passengers, passengers difference was statistically significant, p<0.05; CSⅡ+ vildagliptin group response times in terms of hypoglycemia was 10, compared with CSII group little difference was statistically significant, p<0.05, CSII group and CSII+vildagliptin group were not due to low blood sugar and stop the pump patients, the number of both 0; CSII+vildagliptin group the incidence of hypoglycemia was significantly better than CSII group, a significant difference, P<0.05.The use of glucose monitoring found that after one day of treatment, under well-controlled and FPG similar circumstances, CSII group before breakfast, after, after lunch, before dinner,0:00 and 3:00 the morning blood sugar decreased significantly, there was a significant difference (P<0.05); CSII+vildagliptin group of all time glucose values were significantly lower, there were significant differences (all P<0.05). Compared with the CSII group, CSII+vildagliptin group dinner before bedtime blood glucose decreased more significantly, the difference was statistically significant (P<0.05),3:00 blood sugar is higher than the CSII group (P <0.05), sleep the next morning before the blood sugar drops to a more gentle curve. Through continuous glucose monitoring results show that:CSII+vildagliptin group average daily blood glucose is lower than the CSII group, the difference was statistically significant (P<0.05); CSII group was significantly higher than the highest blood glucose CSII+vildagliptin group, the difference was statistically significant (P<0.05); CSII group was significantly lower than the lowest blood glucose CSII+vildagliptin group, the difference was statistically significant (P <0.05); CSII group compared with glucose above target number of periods CSII+ Ludwig column more than the statin group, the difference was statistically significant; CSII group sessions glucose below target number 2, CSII+vildagliptin group did not appear glucose values below the target time.After stopping the intensive therapy, patients in each group after 12 weeks of follow-up, results showed that:FPG at 12 weeks were able to achieve normal range, CSII remission, CSII+vildagliptin remission, remission vildagliptin+metformin group, Victoria denagliptin+metformin group therapy after remission with fasting blood glucose before treatment were significantly lower, the difference was statistically significant, P<0.05; metformin+vildagliptin remission, remission vildagliptin+metformin group decreased fasting blood glucose magnitude larger, but not statistically significant, P> 0.05; were no significant differences among the four groups, P> 0.05 2hPG can reach the normal range, CSII remission, CSII+ vildagliptin remission, metformin+Ludwig. column Ting remission, remission after vildagliptin+metformin treatment group were significantly lower comparing 2-hour postprandial blood glucose with before treatment, the difference was statistically significant, P<0.05; metformin+vildagliptin remission, Ludwig column Ting+metformin remission 2-hour postprandial glucose decreased greatly, but no statistical significance, P> 0.05; showed no significant difference between groups, P> 0.05. Glycated hemoglobin are declining, CSII remission, CSII+ vildagliptin remission, remission vildagliptin+metformin group, between vildagliptin+metformin remission group was not statistically significant, P> 0.05. CSII remission, CSII+vildagliptin remission, remission vildagliptin+metformin, vildagliptin+metformin in patients in remission, BMI had decreased, which metformin+vildagliptin remission decline more obvious, but there was no significant difference, P> 0.05. CSII remission, CSII+vildagliptin remission, remission vildagliptin+metformin, vildagliptin+metformin remission after treatment before treatment comparison with both triglycerides were decreased, but not statistically significant, P> 0.05; showed no significant difference between groups, P> 0.05. CSII remission, CSII+vildagliptin remission, metformin+vildagliptin remission, remission after vildagliptin+metformin treatment group total cholesterol before treatment with no clear downward trend, P> 0.05; between the two groups no significant difference, P> 0.05. CSII remission, CSII+vildagliptin remission, remission vildagliptin+metformin, vildagliptin+metformin group remission after treatment with high-density lipoprotein cholesterol before treatment was no clear downward trend, P> 0.05; between the two groups showed no significant difference, P> 0.05. CSII remission, CSII+vildagliptin remission, remission vildagliptin+ metformin, vildagliptin+metformin remission after treatment with low-density lipoprotein cholesterol before treatment declined significantly, but not statistically significant, P> 0.05; between the two groups showed no significant difference, P> 0.05. HOMA-IR:CSII remission, CSII+vildagliptin remission, metformin+ vildagliptin remission, remission after vildagliptin+metformin treatment group HOMA-IR with the downward trend evident before treatment, but was not statistically significance, P> 0.05, and HOMA-IR downward trend with the use of vildagliptin time-related; showed no significant difference between groups, P> 0.05. CSII+vildagliptin remission, remission vildagliptin+metformin group after treatment, HOMA-β with CSII remission, remission vildagliptin+metformin group were significantly increased, there was a significant difference between the two groups, P<0..05. CSII remission, CSII+vildagliptin remission, remission vildagliptin+metformin, vildagliptin+metformin remission after treatment were increased before AUCCP120 the same treatment, the difference was statistically significant, P<0.05; which CSII+vildagliptin group increased more significantly. Between the two groups was significant difference, P<0.05. CSII remission, CSII+ vildagliptin remission, remission vildagliptin+metformin group, AUCINS comparison were increased before treatment with vildagliptin+metformin remission after treatment, the difference was statistically significant, P<0.05; which CSII remission, CSII+vildagliptin remission, vildagliptin+metformin+vildagliptin remission with metformin group compared to alleviate increased more significantly. Between the two groups was significant difference, P<0.05. CSII hypoglycemia remission of 2 passengers; CSII+vildagliptin remission of a person of hypoglycemia were mild symptoms.Conclusion:Single-use insulin pumps and insulin pump program jointly vildagliptin glycemic control and remission of newly diagnosed type 2 diabetes short-term effect of insulin pump therapy for better, but the combined joint vildagliptin reversal for p-cell function more effective, and less likelihood of hypoglycemic events. Tips and conclusions can be displayed in real time CGMS patient’s blood sugar, blood sugar changes reflect trends to guide the application of CSII insulin can effectively control blood sugar steady and prevent large fluctuations in blood glucose and hypoglycemia. In stop after the start of treatment to strengthen drug treatment, regardless of vildagliptin monotherapy, or in combination with metformin, the situation can improve islet function in type 2 diabetic patients. But early this study only observed after treatment, as to whether this program has long-term remission of diabetes effect remains to be further studied.