| ObjectiveTo investigate the impacts of insulin therapy on glucagon in newly diagnosed type 2diabetic patients(nd-T2 DM patients)in the morning.Clarify the importance of insulin therapy on C peptide and glucagon in patients with type 2 diabetes mellitus.MethodsA total of 93 nd-T2 DM patients hospitalized in the department of Endocrinology,the Third Affiliated Hospital of Anhui Medical University,from February 2012 to November 2015 were selected(having not received any medications),and all these patients were confirmed according to the diagnostic and typing criteria of diabetics proposed by WHO in 1999.BMI = weight(kg)/height(m2);according to the standards of obesity defined by the Asia-Pacific Society of obesity in 2005,these patients were divided into two groups:(1)the non-obese T2 DM group: BMI <25kg/m2,45 patients,aging 34 to 73 years;(2)the obese T2 DM group: BMI≥25kg/m2,48 patients,aging 21 to 77 years.The normal control group had 12 persons.This study was conducted in accordance with the declaration of Helsinki.This study was conducted with approval from the Ethics Committee of Anhui Medical University.Written informed consent was obtained from all participants.All the patients were excluded from infection,stress,acute complications,severe cardiovascular diseases,liver,and kidney diseases,Severe gastrointestinal disease or a history of gastrointestinal surgery,or positive serum insulin antibody and/or glutamic acid decarboxylase antibody.And glucose metabolism related diseases,such as adrenal disease,thyroid disease,pituitary diseases.After 12-h fasting,the heights and body weights of all the subjects were measured by the same person at 7:00 the next morning;meanwhile,the serum triglyceride(TG),total cholesterol(TC),serum creatinine(s Cr),blood urea nitrogen(BUN),uric acid(UA),liver functionand hemoglobin A1(Hb Al C)were detected after sampling venous blood.The 100-g bread meal test was then performed,and then venous blood was sampled for the detection of Blood glucose(BG),C peptide(CP),and glucagon at different time points(in fasting(T0),30(T1),60(T2),120(T3),and 180-min(T4)after meal).After the admission,insulin therapy was performed,and the dose was adjusted according to the fingertip capillary blood glucose monitoring results;after smoothly controlled the blood glucose for one-two(13.5 ± 3.6 days)weeks,the above indexes were re-measured.ResultsComparison of general conditions and related indexes before the treatmentExcept for the age,the rest indexes in group T2 DM were all significantly higher than the control group(P <0.01).The comparison between the non-obese T2 DM group and the control group showed significant differences in Hb Al C and BMI(P <0.01)while no significant difference in age(P> 0.01).The comparison between the obese T2 DM group and the control group showed significant differences in Hb Al C and BMI(P<0.01)while no significant difference in age(P> 0.01).The comparison between the obese and non-obese T2 DM group showed no significant differences in age and Hb Al C(all P> 0.01)while significant difference in BMI(P <0.01).TC and TG in the obese and non-obese T2 DM group were significantly higher than the control group(P <0.01).Comparison of AUC of CP and glucagon before and after the treatmentCP in T2 DM patients was significantly lower than the control group(p <0.01).After the treatment,CP in T2 DM patients was lower than the control group(p <0.01),but significantly increased than that before the treatment(p <0.01),Figure 1A.Glucagon in T2 DM patients was higher than the control group(p <0.01).After the treatment,glucagon in T2 DM patients was significantly lower than the control group(p<0.01),and significantly decreased than that before the treatment(p <0.01).The AUCSUM of CP in the non-obese T2 DM group was significantly lower than the control group(p <0.01);after the treatment,the AUCSUM of CP was lower than the control group(p <0.01),but increased significantly than before(p < 0.01).The AUCSUM of CP in the obese T2 DM group was significantly lower than the control group(p <0.01);after the treatment,the AUCSUM of CP was still lower than the control group(p <0.01),but increased significantly than before(p < 0.01).The AUCSUM of glucagon in the non-obese T2 DM group(p <0.01)and the obeseT2DM group(p <0.01)was significantly higher than the control group.After the treatment,the AUCSUM of glucagon in the non-obese T2 DM group remained significantly higher than the control group(p <0.05),but decreased significantly than before(p <0.01);the AUCSUM of glucagon in the obese T2 DM group remained significantly higher than the control group(p <0.05),but showed no statistical significance than before.There were no statistically significant differences in glucagon between the obese and non-obese T2 Dm group before and after the treatment.Comparison of blood glucose,CP,and glucagon at different time points before and after the treatmentBefore the treatment,the blood glucose levels in the non-obese and obese T2 DM group showed significant differences when compared with the control group at different time points before the treatment(P <0.01),but the comparison between these 2 groups showed no significant differences.CP in the non-obese T2 DM group showed significant differences than the control group at T1(P <0.01),T2(P <0.01),and T3(P<0.01),and CP in the obese T2 DM group showed significant differences than the control group at T1(P <0.01),T2(P <0.01),and T3(P <0.05).Glucagon in the non-obese and obese T2 DM group showed significant differences when compared with the control group at all the time points(P <0.01),but the differences between these 2groups were not significant.After the treatment,the blood glucose levels in the non-obese and obese T2 DM group were still significantly higher than the control group(P <0.01),but significantly reduced than those before the treatment(P <0.01).CP: CP in the non-obese T2 DM group was significantly lower than the control group at T1(P <0.01),T3(P <0.01),and T4(P <0.01),but statistically significantly increased than those at all the time points before the treatment(P <0.01);CP in the obese T2 DM group was significantly lower than the control group at T1(P <0.01),T2,and T3(P <0.01),but statistically significantly increased than those at T3 and T4 before the treatment(P <0.01),.Glucagon: glucagon in the non-obese T2 DM group was significantly reduced than those before the treatment at T1(P <0.01),T2(P <0.01),and T3(P <0.01).Glucagon in the obese T2 DM group was significantly reduced than that before the treatment at T4(P <0.01).ConclusionNewly diagonosed type 2 diabetic patients(the non-obese patients and obse patients)had lower C peptide level and higher glucagon level.the serum glucagon level in the obesed nd-T2 DM patients was not declined significantly,The serum C peptide level was improved after insulin theraphy,the serum C peptide level in the non-obese nd-T2 DM patients was improved significantly,but that in the obesed-T2 DM patients was not improved significantly.The obesed-T2 DM patients need to seek new treatment or solution for diabetic.ObjectiveTo investigate the C peptide,and glucagon circadian variation in newly diagnosed type2 diabetic patients(nd-T2 DM patients)when taking the 100-g bread meal test in the morning and afternoon.Clarify the relationship between glucagon and glucose of type2 diabetes when taking the 100-g bread meal test and comparison between the glucagon levels in the morning and afternoon when taling the 100-g bread meal.MethodsA total of 73 nd-T2 DM patients hospitalized in the department of Endocrinology,the Third Affiliated Hospital of Anhui Medical University,from February 2012 to November 2015 were selected(having not received any medications),and all these patients were confirmed according to the diagnostic and typing criteria of diabetics proposed by WHO in 1999.these patients were radom divided into two groups: a group of 41 people,a group of 32 people.The normal control group had 12 persons.This study was conducted with approval from the Ethics Committee of Anhui Medical University.All the patients were excluded from infection,stress,cancer,autoimmune diseases,psychopathy,diabetic ketoacidosis,hyperosmotic coma,severe cardiovascular diseases,liver,and kidney diseases,Severe gastrointestinal disease or a history of gastrointestinal surgery,or positive serum insulin antibody.The heights and body weights of all the subjects were measured by the same person in the next morning;meanwhile,the serum total cholesterol(TC),triglyceride(TG),liver function、serum creatinine(s Cr),blood urea nitrogen(BUN),uric acid(UA),and hemoglobin A1(Hb Al C)were detected after sampling venous blood.After 8-h fasting,42 person group and normal control group take the 100-g bread meal test in the morning(7am),and then venous blood was sampled for the detection of Blood glucose(BG),C peptide(CP),and glucagon at different time points in fasting(T0),30(T1),60(T2),120(T3),and 180-min(T4)after meal.After 8-h fasting 38 persons group take the 100-g bread meal test in the afternoon(3pm),and then venous blood was sampled for the detection of Blood glucose(BG),C peptide(CP),and glucagon at different time points in fasting(T0),30(T1),60(T2),120(T3),and 180-min(T4)after meal.Result1.Comparison of general conditions and related indexesExcept for the age,the rest indexes in group T2 DM were all significantly higher than the control group(P <0.01).The comparison between the T2 DM patients taking bread meal at morning(am group)and afternoon(pm group)showed no significant differences in age,BMI,Hb Al C,TC and TG(all P> 0.05).2.Comparison of AUC of glucagon CP and glucose between three groups2.1Comparison of AUC of glucagon between three groupsGlucagon in T2 DM patients taking bread meal at morning(am group)was higher than the control group(p=0.016).glucagon in T2 DM patients taking bread meal at afternoon(pm group)was higher than the control group(p <0.01),glucagon in pm group was significantly higher than the am group(p <0.01).2.2 Comparison of AUC of CP between three groupsThe comparison between T2 DM patients taking bread meal at morning(am group)and the control group showed no significant differences in the AUCSUM of CP(p=0.357)).The AUCSUM of CP in the T2 DM patients taking bread meal at afternoon(pm group)was significantly lower than the control group(p <0.01),The AUCSUM of CP in pm group was significantly higher than the am group(p<0.01).2.3 Comparison of AUC of glucose between three groupsGlucose in T2 DM patients taking bread meal at morning(am group)was higher than the control group(p<0.01).glucose in T2 DM patients taking bread meal at afternoon(pm group)was higher than the control group(p <0.01),The comparison between pm group and am group howed no significant differences in glucose(p>0.05).3.Comparison of blood glucose,CP,and glucagon at different time points between three groups3.1Comparison of blood glucose between three groupsthe blood glucose levels in the T2 DM patients taking bread meal at morning(am group)showed significant differences when compared with the T2 DM patients taking bread meal at afternoon(pm group)at different time points(P <0.01),the blood glucose levels in the am group were lower than the pm group at 0min,30 min,60min(P =0.011,P<0.01,p=0.014),The comparison between the am group and the pm group showed no significant differences in blood glucose levels at 120 min,180min(p=0.538,p=0.073).3.2 Comparison of CP levels between three groupsThe cp levels in the am group were lower than the control group at30 min,60min,120min(p <0.01),the cp levels in the am group were lower than the control group at 180min(p=0.015),the cp levels in the pm group were higher than the control group at 0min(p<0.01),The comparison between the pm group and the control group showed no significant differences in cp levels at 30 min,60min,120 min,180min(p>0.05).The cp levels in the am group were lower than the pm group.3.3 Comparison of Glucagon levels between three groupsThe glucagon levels in the pm group were higher than the control group at0 min,30min,60 min,120min,180min(p <0.01),The glucagon levels in the am group were lower than the pm group at 0min,30 min,60min(p <0.01),120 min,180min(p =0.019),4.Comparison of blood glucose,CP,and glucagon levels at different time points in three groups4.1Comparison of blood glucose levels in three groupsThe blood glucose levels of control group were peaking at 60 min,Then declined to 180 min levels.The blood glucose levels of am group were peaking at 120 min,Then gradually declined to 90 min levels.The blood glucose levels of pm group were peaking at 60 min,Then gradually declined to 30 min levels.4.2Comparison of CP in three groupsThe CP levels of control group were peaking at 60 min,Then declined to 30 min levels.The CP levels of am group were peaking at 120 min,Then gradually declined to90 min levels.The CP levels of pm group were peaking at 60 min,Then gradually declined to 30 min levels.4.3Comparison of Glucagon in three groupsThe glucagon levels of control group were peaking at 30 min,Then declined to 0min levels.The CP levels of am group were peaking at 60 min,Then gradually declined to180 min levels.The CP levels of pm group were peaking at 60 min,Then gradually declined to 180 min levels.ConclusionThe glucagon levels were higher than the normal in newly diagnosed type 2 diabetic patients(nd-T2 DM patients)after taking 100-g bread meal test in the morning and afternoon.the glucagon levels in the afternoon were higher than in the morning,Indicated the glucagon secretion of nd-T2 DM patients was disordered,We detected the glucagon Secretion in newly diagnosed type 2 diabetic patients.It helps us to observe the changes of blood glucose levels in the paitients with diabetes mellitus deeply. |
