Type 2 Diabetes Blood Sugar Fluctuation And The Research Of Tcm Syndrome Types

Literature Review:In this part, two reviews are reviewed:Etiology, pathogenesis and treatment based on syndrome differentiation of diabetes in traditional Chinese medicine were discussed. Advances in traditional Chinese medicine treatment for insulin resistance and the effects of fluctuant blood glucose on cardiovascular complications.Clinical Study One:Objective:To investigate the correlation of Chinese medicine syndrome type of Type2diabetes mellitus (T2DM) and glucose fluctuation, blood lipid, high-sensitivity C-reactive protein (hs-CRP) and the state of carotid atherosclerosis, which provides the Referenced criteria of dialectical analysis of T2DM.Methods:The total patient population consisted of98T2DM according to the diagnostic criteria of American Diabetes Association (ADA). In this case, there were in-hospital patients, aging25-85years old (58.06±13.23) from endocrinology department of Xiyuan Hospital, including51male and47female. All patients were divided into four traditional Chinese medicine (TCM) syndromes according to the clinical research guiding principle of Chinese medicine treatment for diabetes mellitus published by Ministry of Health of the People’s Republic of China in2002. There were34patients in Qi-Yin deficiency syndrome group,23in type of blood stasis in venation group,24in type of hot and humid trapped spleen group and17in type of yin asthenia and internal heat group. HbAlc, blood lipid level and hs-CRP level were determined after fasting for12h. Seven point (preprandial and120-min postprandial for each meal and bedtime) capillary glucose was measured, and the mean amplitude of glycemic excursions (MAGE) were calculated. Intima-media thickness (IMT) of carotid artery and plaques were measured using ultrasound of carotid artery. Body mass index (BMI) were calculated by height and weight. The SPSS Statistics13.0package was utilized to analyze the data. Differences among groups were analyzed using the one-way analysis of variance, followed by multiple comparisons by LSD test. Results were presented as mean±SD.. Results:①Patient profile. There were no statistically significant differences of age and sex. BMI was higher significantly than that in type of yin asthenia and internal heat group (P<0.05), with no significance in other two groups.②Blood glucose. There were no statistically significant differences of HbAlc level. MAGE from high to low was the type of blood stasis in venation gourp, the type of hot and humid trapped spleen group, the type of yin asthenia and internal heat group and the Qi-Yin deficiency syndrome group. Compared to the type of blood stasis in venation gourp, MAGE in the Qi-Yin deficiency syndrome group and the type of yin asthenia and internal heat group decreased significantly (P<0.05).③Blood lipid levels. The level of total cholesterol (TC) and triglyceride (TG) from high to low was the type of hot and humid trapped spleen group, the type of blood stasis in venation gourp, the Qi-Yin deficiency syndrome group and the type of yin asthenia and internal heat group. Compared to the Qi-Yin deficiency syndrome group and the type of yin asthenia and internal heat group, the level of TC and TG was increased significantly(P<0.05). There were no statistically significant differences of high-density lipoprotein cholesterol (LDL-C) and low-density lipoprotein cholesterol (LDL-C) among these four groups.④Carotid artery. The rate of incrassate IMT and atheromatous plaque of carotid artery from high to low was the type of blood stasis in venation gourp, the Qi-Yin deficiency syndrome group, the type of yin asthenia and internal heat group and the type of hot and humid trapped spleen group. Among them, the number of atheromatous plaque of carotid artery in the type of blood stasis in venation gourp was91.30%.Conclusions:Qi-Yin deficiency syndrome was common in the differentiation of TCM of T2DM. We found that glucose fluctuated significantly and carotid atherosclerosis seriously were found in the type of blood stasis in venation gourp. The most serious dyslipidemia was found in type of hot and humid trapped spleen.Clinical Study Two:Objective:To observe the correlations of blood serum LOX-1, AGEs, RAGE levels and the evaluation parameters of blood glucose(HbAlc and MAGE) in type2diabetes patients.Methods:Thiry-three diagnosed type2diabetic patients with stable glucose-lowering treatment were enrolled. Seven point (preprandial and120-min postprandial for each meal and bedtime) capillary glucose was measured with an ultra smart glucose meter (Bayer).The mean amplitude of glycemic excursions (MAGE) were calculated from7-point-daily capillary glucose profiles. HbAlc was measured by ion-exchange high-performance liquid chromatography. Levels of AGEs, RAGE and LOX-1in sera were examined by ELISA. The general indexes were measured and then the statistical analysis was conducted.Results:In simple correlation analysis, there were positive significant correlations between serum LOX-1, AGEs, RAGE levels and HbAlc and MAGE (P<0.01). Multivariate regression analysis showed that the LOX-1, AGEs, RAGE levels all increased linearly with increasing HbAlc and MAGE, and the standardized partial regression coefficient of HbAlc is higer than MAGE.Conclusions:There are obvious advanced glycation end products and LOX-1production in T2DM patients, which is not only related to blood glucose levels, but also blood glucose fluctuation. Blood glucose. fluctuation, which can aggravate the vascular endothelial dysfunction of T2DM patients, may be related to its effects of further inducing AGEs and LOX-1production and oxidative stress.