| Type2diabetes mellitus is one of the important public health problem inthe world. In recent years, with the development of economy in our country,people living standard rise, low height of high fat diet, nervous rhythm of lifeand gradually reduce the way of life, and many other factors lead to a sharprise in the number of cases of type2diabetes. At present the whole world hasan estimated200million people with diabetes, and in the next10years, thenumber of deaths from diabetes will increase50%.Type2diabetes has becomeone of the most important diseases affecting the quality of life in China, whichis a major public health problem to solve. So on the discussion of type2diabetes treatment is particularly important. In patients withdiabetes, numerous choose oral hypoglycemic drugs, but due to lacking ofknowledge and influence factors related to the severity of the disease, somepatients with oral hypoglycemic agents alone has been difficult to maintainblood glucose control standard. There has been a large number of clinicalstudies confirmed that the efficency and safety of oral hypoglycemic drugscombined with basal insulin therapy. However, at present about one or twokinds of oral hypoglycemic drugs in treatment of patients in poor glycemiccontrol with insulin (A) or with premixed insulin (B) evidence of the efficacyare less. And the study on the effects of two kinds of schemes on pancreaticfunctions are less. This experiment will compare the above two kinds oftreatment efficacy, safety and effect on pancreatic function. Monocytechemoattractant protein-1(MCP-1), is a chemotactic and activating monocyte/macrophage C-C cell chemotactic facto, which promote the inflammatoryreaction. its in vivo in type2diabetic rats (pancreatic tissue or bloodcirculation) increased significantly, the chemotaxis of monocytes and T lymphocytes in the islet aggregation, and participate in the development ofinsulin resistance and diabetes. Amylin mainly synthesized and secreted by theislet βcells,by enhancing the expression of apoptosis gene P53andP21WAF1/CI P1, induce insulin resistance, promote the apoptosis of islet βcells, involve in the occurrence and development of type2diabetes. Thisexperiment by determination of MCP-1and amylin in Serum, to explore theinfluence on the function of pancreas witn A, B two plans.Objective:1. Observation of one or two kinds of oral hypoglycemicdrugs in treatment of patients with poor glycemic control with basal insulin orto premixed insulin treatment and the treatment efficacy between the two;2.The relationship between Serum MCP-1, amylin and pancreatic beta cellfunction, and the two kinds of insulin therapy on it.Methods: According to the inclusion and exclusion criteria to choose201206to201306months in the Department of endocrinology in our hospitaland a small amount of hospitalization for oral one or two antidiabetic therapyafter poor blood glucose control in patients with type2diabetes in148cases,With62male patients,86female patients,The average age of48.37±10.32years old,According to the principle of random assignment to continue theoriginal hypoglycemic drugs plus insulin group (A group),Stop theantidiabetic drug with premixed insulin group (B group),According to thelevel of glycosylated hemoglobin will be divided into A and B groups A1(7＜HbA1c≤10%), A2(10＜HbA1c≤13%) B1(7＜HbA1c≤10%) B2(10＜HbA1c≤13%) two subgroups,teat24weeks.Dosage adjustment of two groups,The fasting blood glucose reached and maintained at4.4-6.1mmol/L,Theserum was measured in0and24weeks of glycosylated hemoglobin, thestandard meal test of fasting and postprandial2H blood glucose, blood lipid(TG, HDL, LDL), amylin and MCP-1level.All subjects were measured withBP, BMI. Using t test or chi square test was used for data analysis, P <0.05was statistically significant.Results:1. Group A and group B in two groups before treatment, there were no significant differences in age, sex, BMI, FBG,2h, PBG and biochemicalindices.2. A group and B group after treatment than before treatment comparedto the HbA1c, FBG,2hPBG decreased significantly (P<0.05), but there wasno significant difference between the two groups (P>0.05).3. A group and B group after treatment of HbA1c compliance rates were59.4%,61.9%, there was no significant difference between the two groups(P>0.05).4. A group and B group after treatment than before treatment, comparedto TG, TC, LDL, HDL, SBP, DBP had no significant change (P>0.05), therewas no significant difference between the two groups (P>0.05).5. A group and B group after treatment than before treatment comparedto BMI increased (P<0.05), there was no significant difference between thetwo groups (P>0.05).6. A group and B group after treatment than before treatment comparedwith serum MCP-1and amylin levels have decreased significantly (P<0.05),there was no significant difference between the two groups (P>0.05).7. During the treatment, group B frequency of hypoglycemia weresignificantly higher than in group A (total hypoglycemic events:15vs3,17.9%vs4.7%, P<0.05),No severe hypoglycemia in A group, B groupoccurred4times of severe hypoglycemia;The average insulin dosage B groupis higher than that of A group (P<0.05).8. Two groups of amylin and HOMA-IRwere highly correlated,amylin and HOMA-β showed a moderate negative correlation; MCP-1showed low correlation with HOMA-IR, MCP-1was negatively correlatedwith HOMA-β. Amylin and MCP-1showed highly positive correlation.9. Data comparison among various subgroups： After treatment, A1(7＜HbA1c≤10%) HbA1c, HOMA-β, the standard rate of FINS is higher thanthat of A2(10<HbA1c≤13%),the difference was statistically significant(P<0.05);FBG, amylin, MCP-1, HOMA-IR, A1was lower than that of A2, thedifference was statistically significant (P<0.05); the incidence of hypoglycemia had no difference (P>0.05).There were no significantdifferences in B1compared with B2, A1and B1comparison of the data(P>0.05).Comparison of A2and B2, B2HbA1c, HOMA-β, the standard rateof FIN, the incidence of hypoglycemia is higher than A2, the difference wasstatistically significant (P<0.05); FBG, amylin, MCP-1, HOMA-IR lower thanA2, the difference was statistically significant (P<0.05).Conclusion:After one or two kinds of oral medications to treat patientswith poor glycemic control with basic insulin or to switch to premixed insulinto maintain blood glucose control in patients with up to standard, for HbA1cmore than10%of patients, with premixed insulin group than with basalinsulin group advantage;Amylin, MCP-1level responded tothe pancreasfunction a certain extent, The two groups after treatment than before treatmentamylin, MCP-1are decreased, show that two groups of pancreatic beta cellfunction recovered after treatment. |
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