Study Of The Relationship Between β1-blocker And Serum Adiponectin Level Of Simplicity Type 2 Diabetes

Objective: The morbidity of diabetes is growing with the improvement of people's life quality. Increasing cardiovascular and cerebral vessels events morbidity and mortality were acted as one reason of the type 2 diabetes. Hypertension and diabetes are risk factors of atherosclerosis. Which medicine is applicable to treat hypertension in patients with diabetes, opinions are different.Sympathetic nerve system's active play an important role in cardiovascular event. Beta-blocker can reduce cardiovascular event by obstruct sympathetic nerve active to reduce these patients'mortality. But in traditional thinking beta-blocker have side effect on hypoglycemic awareness and recovery, insulin resistance and hyperglycemia, or blood lipid. So some physicians support the assertion that beta-blockers should be routinely contraindicated in diabetes. But lately, it reports that beta-blockers can indirect improve adiponectin in the extraorgan in the abroad and domestic literature. adiponectin is the only protected hormone of fat secrete, discovered by now. Adiponectin can improve insulin resistant, vascular endothelial function, diminish inflammation, alleviate atherosclerosis, and so on. Today, many Experiments show that non-selected beta-blocker have side effect on hypoglycemic awareness and recovery, insulin resistance and hyperglycemia, or blood lipid. But there is no clinical report on effect of selectedβ1-blocker on serum adiponectin, insulin resistance and blood lipid. In this study, measured type 2 diabetes serum adiponectin to know beta-blocker effect on serum adiponectin, more estimate beta-blocker effect on type 2 diabetes. By detecting type 2 diabetes patients serum adiponectin after and before applying beta-blocker or not applying beta-blocker.Methods : Subjects: According to the standard of diabetic diagnosis (WHO) in 1999, 100 type 2 diabetes mellitus patients were chosen from January 2005 to May 2006, in this study. All the subjects were divided into two groups (control group and experimental group) randomly. Their age ranged from 35 to 65. First of all, all patients must control their fasting blood glucose (FBG) below 7.0mmol/L, HbA1c below 7.0mmol/L for 3 months. Subjects with following disease were excluded⑴diabetes family history, hypertension and other cardiovascular and cerebrovascular diseases, kidney and liver function abnormal ,endocrine system disease;⑵chronic and acute complications of type 2 diabetes mellitus;⑶treat with oral hypolipidemic, thiazolidinediones, glucocorticoid, contraceptive agent, beta-receptor block or excitomotory agent, inject insulin in three months;⑷pregnancy woman. Physical and laboratory measure: All subjects were measured the following data⑴Height, weight, blood pressure (BP), wc, hipline were measured in all subjects and body mass index (BMI), waist hip ratio (WHR) were calculated. (2) Blood lipid, FBG, function of liver and kidney was tested in auto-biochemical analyzer. (3) Serum adiponectin was tested with ELISA. (4) Fasting blood insulin (FINS) and C-peptide were determined by ELISA, HOMA-IR was calculated with HOMA; HbA1c was measured with Bayer DCA2000+ analyzer. (5) Before study, all subjects were tested HbA1c, FBG, blood lipid, FINS, serum adiponectin. Experimental group and control group all kept the previous treatment during the study except experimental group was applied beta-receptor block. Subjects in experimental group took beta-blocker 12.5mg bid,which was raised to 12.5mg tid if subjects have not adverse effect. FBG, BP, electrocardiogram were monitored every week. According to FBG level, hypoglycemic agents were adjusted. The subjects could not tolerate metoprolol agent who were excluded from study. Those index were tested again 6 months later. (6) All data was analyzed by statistical software SPSS11.5 version. All data took homogeneity test for variance. Normal distributed data were presented as mean±SD. Because HOMA-IR,adiponectin were abnormal data,they were analyzed after log-transformed。It applied paired t-test to compare the change of variables before and after treatment and two-sample t-test to compare the change of variables between two groups. The correlation among serum adiponectin with other index applied correlation analysis.Results: Twenty-four subjects were excluded from the study. Six subjects could not tolerate metoprolol and eighteen subjects could not persist for various reasons. There were seventy-six for statistic analysis at last.1 Comparisons of study data for two groups1.1 There were no significant change in The FBG, HbA1c, BP, BMI and WHR before and after study in two groups, which had no statistical significance (P>0.05). There is no difference in two groups.1.2 Blood lipid: To compare TG,TC and HDL-C before and after metoprolol treatment, TG,TC and HDL-C decreased in experimental group, so did in control group, but the ascension in TG,TC and decrease in HDL-C in experimental group was more distinctness than in control group, which had statistical significance(P<0.05).1.3 HOMA-IR: To compare HOMA-IR before and after metoprolol treatment, HOMA-IR index increased in experimental group than before treatment, which had statistical significance (P<0.01), so did in control group, ascension in experimental group was more distinctness than in control group, which had statistical significance (P<0.05).1.4 Serum adiponectin1.4.1 To compare Serum adiponetin before and after metoprolol treatment, decreased after metoprolol treatment in experimental group than before treatment, which had statistical significance(P<0.01), so did in control group(P<0.05). That change in experimental group was more distinctness than in control, which had statistical significance (P<0.05).1.4.2 The relationship among serum adiponectin, blood glucose and blood lipid: Serum adiponectin correlated with gender (P<0.01) and negative correlated with BMI, WC, FINS, HOMA-IR, TG, WHR, age, course of disease (P<0.05- P<0.001), positive correlated with HDL-C. Serum adiponectin did not correlated with hipline, LDL-C。1.4.3 Definitive factor of serum adiponectin Considering age, gender, waistline, HOMA-IR, TG and HDL-C as independent and serum adiponectin as dependent variable, multiple variable regression showed that FBG, WC, HDL-C, gender and HOMA-IR(73.3%) could determine serum adiponectin alone.2 Influential factor of HOMA-IR: Considering age, gender, WC, TG, HDL-C and serum adiponectin as independent variable and HOMA-IR as dependent variable, multiple variable regression showed that blood serum adiponectin, TG, HDL-C and WC could enter into equation, which all accounted for HOMA IR variation by 86.7%. Serum adiponectin was the closest with HOMA-IR and accounted for HOMA-IR variation by 36.8%. 3 The serum adiponectin in experimental group and control group descended with the getting along of disease. After study completing serum adiponectin in experimental group was lower than in control group, which had statistical significance (P<0.01).Conclusions:1 Metoprolol could raise blood lipid, serum adiponectin, cut down HDL-C and augment insulin resistance.2 Serum adiponectin correlates with gender, it is higher in male than in female. Serum adiponectin correlates negatively with BMI,WC,FBG,WHR,FINS,HOMA-IR,TC. Serum adiponectin correlates positively with HDL-C。2 metoprolol cannot be at large applied in type 2 diabetes, Applying principia should be strict abided when it be applied in diabetes.