Initial Study On The Clinical Intervention Of Newly Diagnosed Aged Patients With Type2Diabetes

Objective The aim is to evaluate the clinical phenotype of newly diagnosed aged patients with type2diabetes, through case-control study, providing evidence for early clinical intervention.Patients and methodsPatient selection criteriaInclusion criteria:(1) Newly diagnosed patients with T2DM after75g oral glucose tolerance test (OGTT) checks in line with the1999WHO diagnostic criteria for diabetes;(2)40-year-old to75-year-old in age;(3) Glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA) and insulin antibodies (IAA) are negative;(4) No oral hypoglycemic agents.Exclusion criteria:(1)Acute complications of diabetes such as diabetic ketoacidosis,(2) Fasting blood glucose level>16.7mmol/1,(3) With acute or chronic severe liver, kidney, heart, brain, vascular complications and acute infectious diseases. Finally,85newly diagnosed wrinkly adults with type2diabetic patients were selected, dividing into two groups (4) cases of senile group aged60to75years, NEDM vs43cases of middle age group aged40to59years, NMDM).Study designAll patients were collected basic data, calculated body mass index, recorded the type and number of cases of comorbidities. The patients were divided into four categories based on the chief complaint.Fasting blood samples were collected to detect lipid profile, uric acid, glycosylated hemoglobin. Serum samples were obtained before and30minutes,120minutes after oral glucose for blood glucose, insulin, C-peptide, glucagon-like peptide-1(GLP-1), glucose-dependent insulin peptide (GIP) and glucagon glucagon (GC) levels. Calculating the area under the glucose curve (AUCg), the Ins curve (AUCi), C-peptide curve (AUCc), and insulin secretion index (HOMA-β), insulin resistance index (HOMA-IR), early insulin secretion index. Corresponding methods were used to detect chronic complications of diabetes.ResultsCompared with NMDM, NEDM exists the following characteristics:NEDM patients made complication symptoms or atypical symptoms as the first visit accounted for37.5%,26.2%, significantly higher than the NMDM of13.9%,16.3%, and the typical diabeticthe symptoms as the first visit, only28.6%, significantly lower than the44.2%of the NMDM.The NEDM patients had higher values of waist circumference, systolic blood pressure, levels of LDL-C and uric acid (P values were0.041、0.003、0.005、0.024respectively). Positive rate of chronic complications, macroangiopathy and comorbidities of senile were higher.FBG of NEDM elevated mildly (P=0.003), but0.5h and2h blood glucose markedly elevated(P values were0.013,0.049respectively).The levels of0.5h c-peptide,2h insulin, Oh GC, Oh GLP-1,0.5h GLP-1,2h GLP-1and Oh GIP and△Ins30/△Glu30were lower in NEDM than NMDM (P values were0.049,0.003,0.040,0.001,0.004,0.001,0.046,0.035respectively).Conclusion Compared with NMDM, NEDM has higher incidence of metabolic syndrome and obvious deterioration of early phase insulin secretion and incretins secretion. Objective Through case-control study to observe the DPP-4inhibitor (sitagliptin) on metabolism and pancreatic hormones and incretin in patients with newly diagnosed elderly type2diabetes mellitus (T2DM)Methods After the oral glucose tolerance test (OGTT) confirmed121newly diagnosed elderly patients with T2DM were randomized to receive sitagliptin, sitagliptin+metformin (n=61, S group) or metformin, metformin+glimepiride (60cases, G group) for24weeks, observed clinical data, metabolism of glucose, lipid uric acid and INS, C-P, GC, islet function index and GLP-1, GIP change.Results After24weeks of treatment, compared with baseline (1) metabolic indicators:GHbAlc%, each time point blood glucose of S group were significantly lower (P values were0.037,0.001,0.039,0.001respectively), blood lipids, uric acid levels were no statistically significant; GHbAlc%, blood glucose of each time point of G group were significantly lower (P values were0.023,0.001,0.001,0.001respectively), blood lipids, uric acid levels were no statistically significant.(2)Islet function:fasting and0.5h Ins level,0.5h C-P level, HOMA-β,△Ins30/△Glu30of S group were significantly higher (P=0.002,0.009,0.044,0.012,0.022respectively),0.5h,2hGC levels were significantly lower (P=0.015,0.012respectively); fasting and of0.5h Ins, fasting and2h C-P level of G group were significantly higher (P values were0.001,0.002,0.001,0.047respectively), GC levels of OGTT at each time point were significantly lower (the P value0.002,0.002,0.010respectively);(3) Incretin: GLP-1of OGTT at each time point were significantly increased (P values were0.001,0.041,0.028respectively); GLP-1of G group was no significant difference. Comparison between S and G group after24weeks of treatment (1) metabolic indicators:2hBG of G group was significantly lower than the S group (P=0.001), blood lipids, uric acid was no significant difference between the two groups;(2) islet function:2hlns level of G group was significantly higher than the S group (P=0.015);(3) incretin:fasting and2h GLP-1levels were significantly lower than the S group (P=0.003,0.015). The hypoglycemic events of S group was significantly lower than G Group. There were no severe hypoglycemic events.Conclusion For newly diagnosed elderly patients with T2DM, sitagliptin plus metformin treatment:(1) can get the similar clinical efficacy in, compared with glimepiride plus metformin,(2) can significantly improve islet cell function and incretin level,(3) hypoglycemic events was significantly reduced, and not increased body mass.