The Research Of The Mechanism Of Postprandial Hypotension And Acarbose In The Treatment In Elder Diabetes Mellitus

[Abjective] To observe the morbidity,risk factors,mechanism and treatment of acarbose in in elder diabetes mellitus with postprandial hypotension.[method]40senile diabetic patients with PPH were recruited.age from60to80.A11of them were given placebo or acarbose100mg at random before standard meals.To use a continuous glucose monitoring system(CGMS)to measure interstitial glucose,Holter to record the HRV (heart rate variability)in40cases of patients with T2DM and PPH.Blood pressure(BP)and heart rate(HR)were recorded for120minutes after meals in those PPH using non—invasive ambulatory blood pressure monitoring (ABPM) system. Subsequently insulin, c-peptide,glucogan-like peptide-1(GLP-1),epinephrine(E), norepinephrine(NE), dopamine (DA)were tested before and after meals.To use coefficient of variation (CV) and standard deviation(SD) to evaluate the variability of blood pressure. Correlation analysis was made between the maximum value of descendence of mean arterial blood pressure(MAP) and the above observation parameters.[Results]1. There were40PPH patients in53elder diabetic patients,the morbidity is76.9%.2.There was negative correlation between the maximum value of fall of MAP and postprandial E(p<0.05). There was negative correlation between the maximum value of fall of SBP and HRV index rMSSD, PNN50, BB50, HF (p<0.05),There was also positive correlation between the maximum value of fall of SBP and BGdiff2,MAGE which can reflex the fluctuation of blood glucose(p<0.05),and there was negative correlation between the maximum value of fall of SBP and postprandial INS(p<0.05).3.Acarbose reduced the magnitude of the fall and the persistence of low blood pressure in postprandial blood pressure.The magnitude of the fall in the acarbose group of SBP,DBP were lower(p<0.05); MAP were lower (p<0.01); the persistence of of SBP,DBP,MAP in acarbose group were shorter(p<0.05); the CV and SD of SBP,MAPand the CV of MAP in acarbose group were shorter(p<0.05). the SD of MAP were shorter (p<0.01).SD and CV of HR which can reflect the fluctuation of HR had diffirence(p<0.05), the magnitude in acarbose group were smaller,and much more stable.4.acarbose group the postprandial blood glucose peak time was delayed compared with placebo group(p<0.01),MBG2and BGdiff2are smaller(p<0.01).5.HRV in two groups are lower than normal,but there is no difference between the two groups both preprandial and postprandial,and there is no difference in postprandial HRV from preprandial in each group (p>0.05).6.There is no significant change in E,NE,DA,INS,CP between two groups both fasting and postprandial.(p>0.05), the postprandial GLP-1is higher in acarbose group.[Conclusions]1. The morbidity of PPH patients in elder diabetic patients was76.9%.2.PPH in elder diabetic patients may be related to impared function of autonomic nerves,the fluctuation of the blood glucose and insulin resistence.3.Acarbose is effective in treating the elder diabetic PPH patients which can reduce the magnitude of the fall and the persistence of low blood pressure in postprandial blood pressure. It can attenuate the fall of postprandial blood pressure and reduce the fluctuation of the blood pressure and delay the peak time of postprandial blood glucose.