Effect Of Intensive Treatment On Microalbuminuira In Newly Diagnosis Type 2 Diabetics

Several studies indicate that macrovascular implications account for approximately 80% mortality in patients with type 2 diabetes. The risks for the development of macrovascular disease is in many aspect, including hyperglycemia, hypertension, dyslipidemia, smoking, overweight, endothelail dysfunction and genetic susceptibility. Over 50% type 2 diabetics are metabolism syndrome. The current opinion suggest that microalbuminuria is the early maker of kidney dysfunction,cardiovascular disease and cerebrovasualr disease,also is the strong predictor of cardiovascular events in patients with diabetes ,and is an important component of insulin resistant/metabolism syndrome. Microalbuminuria plays a significant role in the pathological mechanism of diabetes, hypertension, metaboloism syndrome.Clinical epidemiology shows that microalbuminuria occurs in 20% to 40% of persons with type 2 diabetes mellitus, but the mostly cause of death is ischemic heart disease. The risk of cardiovascular events mortality is fourfold in type 2 diabetes patients than normal urinary albumin excretion. The non-diabetes with microalbuminuria compare with the normal urinary albumin excretion group, the prevalence and mortality is greatly increased to the former. So microalbuminuria as an independent risk factor causes great attention in recent years. The American Diabetes Association recommends that patients with type 2 diabetes be tested for albuminuria at the time of initial diabetes diagnosis and yearly thereafter.The screen of 24-hour microalbuminuria is a simple, economic and noninvasive examination, it can be applied widely to early screen diabetic nephropathy and cardiovascular diseases. We screen microalbuminruia in 50 hospitalization patients with newly diagnosed type 2 diabetics to offer evidence for prevention and intervention of related risk factors. If we control these risk factors as early and effectively as possible, this has great guiding significance to the survival and prognosis in patients with diabetes.On the basis of WHO 1999,diabetic criteria and typing standard, we selected 50 newly diagnosed type 2 diabetes with abnormal microalbuminuria(29 males and 21 females) who came to the China-Japan Union Hospital of Jilin University from March,2007 to March 2008.Age is from 28 to 46 years old. They were excluded from pregnancy, tumor, trauma, acute infection, heart and liver diseases, urinary system infection, glomerulonephritis, prostatitis and the use of nephrotoxicity drugs which affected urinary albumin excretion. All people in the study were measured height, body weight, blood pressure. After the subjects had fasted 12 hours at the time examination, fasting and post-prandial glucose levels, cholesterol-total, serum triglycerides, serum low-density-lipid cholesterol and high-density-lipid cholesterol. All messurment data was delivered through means value standard errand and median, was analyzed by paired t test and Wilcoxon Mann-Whitney test. It has significant difference when p<0.05.The result was 21 smokers (42%) in subjects, 17 patients (34%) with hypertension. The mean time of Hospitalization was 16 days. All participants were under tight glucose, blood pressure and serum lipid controled, compared with before treatment, above items had significant difference. Microalbuminruia sharply decreased. The patients with hypertension compared with the patients without hypertension, microalbuminuria had significant difference, but after treatment, they had no remarkable difference. In the course of the hospitalization, 3 patients was hypoglycemia, but relieved rapidly after eating. 2 patients presented tussiculation when used ACEI, we replaced ARB to ACEI, tussiculation was disappeared. No one was hypersusceptibility to insulin. No drug eruption or increased of aminotransferase were caused by statins.Diabetes mellitus is one of the metabolic diseases, which affects the quality of life, brings great economic burden to individual, family and society. Manuel et al reported that the patients with diabetes were less 10 years than the patients without diabetes in the quality of life related life expectancy. The quality of life in patients with diabetes was closely related with complications. Diabetic Patients without complications had the similar quality of life with the same age group population. Diabetic with microvascular and marcrovascualr complications compared with above the crowd, the former had enormously lower quality of life. Microalbuminuria can predict diabetic complication, but also can forecast the development of diabetic nephropathy and arteriosclerosis ischemic cardiovascular events. The faster the development of microalbuminuria, the higher of the risk with end-stage renal failure, heart failure and cardiovascular mortality. It indicated that the key of the patients to get the general quality of life was the prevention and postponement of diabetic complications. Several studies reported that forepart multi-factor intensification intervention can effectively decrease the occurrence of cardiovascular and cerebrovascular endpoint events, thereby improve the quality of life, save medical expense. Domestic studies also approved multi-factor intensification intervention had many advantages superior to general intervention, moreover, the former had better cost/effect, was good for clinical choice. Accordingly, we treated newly diagnosed type 2 diabetes combined with microalbuminuria with multi-factor fortification intervention, got the satisfactory control on biochemical indicators and blood pressure in the shortest possible time, microalbuminuria decreased to normal range. Thereby the intervention decreases the risk of long-dated diabetic nephropathy and cardiovascular and cerebrovascular events, greatly improved the future quality of life with patients, accordingly reduced individual and country's medical expense.