| ObjectiveInterpretative structural modeling(ISM) was applicated to explore the factors affecting integrated treatment for type2diabetes(T2DM), and the internal relations between them, and then, to provide theoretical guidance for diabetes treatment;At the same time, to analysis the correlation of nonalcoholic fatty liver disease (NAFLD) and diabetic peripheral neuropathy (DPN) in T2DM patients by using the method of retrospective cohort study,and then, to provide new clinical research direction for integrated rehabilitation treatment for T2DM.Methods1. the establishment of theoretical system:ISM was used to establish DESMD model system. Sef "what were the factors influencing integrated treatment for T2DM" as the key problem by ISM team established, select the influencing factors; then to establish the relevance of the influencing factors,through a combination of ISM team discussion and reference to the literature; adjacent matrix and reachable matrix were established based on the correlation of each factor; structure model was set up after decomposition of matrix; finally, DESMD model system was formed after ISM was established according to the structure model.2. the exploration of clinical application:The method of retrospective cohort study was used to explore the correlation between NAFLD and DPN in T2DM patients. Nearly three years in tianjin third central hospital readmission in patients with type2diabetes cases material was collected by retrospective approach, select208cases hospitalized twice interval for5years, and were in the hospital for the first time no merger cases of diabetic peripheral neuropathy, divided into merger of nonalcoholic fatty liver disease group (group A) and were not alcoholic fatty liver group (group B), to compare the two groups for the second time in the hospital the incidence of abnormal DPN, sensory, motor and SSR respectively, calculate the relative risk (RR), attributable risk (AR), attributable risk percentage (ARP), and use the Mantel-Haenszel layered analysis, bounded by age (40), and glycosylated hemoglobin (7%), get the adjusted RR value. Then, to compare whether NAFLD influence the grade of different neuropathy in patients with T2DM. Next, T2DM patients with NAFLD was divided into three groups by liver lipid contents using three points method,group Al, A2, A3group, each group according to the occurrence of DPN were divided into two groups, and Logistic regression analysis was used in each group respectively to explore the influence factors of T2DM patients with DPN in different degree of NAFLD.Finally,Logistic regression was used to study the effect of NAFLD and interaction of factors on the incidence of simple SSR abnormal.Results1.Theoretical research results:there were five aspects influencing integrated rehabilitation treatment for T2DM, including diabetes education, self-monitoring, exercise therapy, nutritional therapy, drug treatment, DESMD model system was formed through Boolean operation. The internal structure of five factors was presented as followed:the system was divided into three classes.as the third class, education had a leading role; as the second class, self monitoring was the hub of the model, through which education played its role; the first class were sports therapy, nutritional therapy and drug treatment, as the basis of diabetes treatment, they influenced each other, forming an organic whole.2. The clinical application of research results:Group A and group B had the same baseline. Cohort study data showed:the relative risk (RR) of merging of NAFLD in T2DM patients with DPN was1.63, and the attributable risk (AR) is25.30%, and the attributable risk percent (ARP) was38.61%. The RR of merging of NAFLD in T2DM patients with Sensory nerve conduction abnormalities was1.93, and the AR was21.24%, and the ARP was48.31%. The RR of low level of income was1.83, and AR is16.52%, and the ARP was45.24%. The RR of merging of NAFLD in T2DM patients with Motor nerve conduction abnormalities was1.58, and AR is3.82%, and the ARP was36.94%. The RR of merging of NAFLD in T2DM patients with SSR abnormalities was1.82, and AR is24.09%, and the ARP was45.07%. after adjustment for40years old, the RR of NAFLD in T2DM patients with DPN, sensory nerve conduction abnormalities, motor nerve conduction and SSR anomaly were respectively1.51,1.75,1.38and1.80, after adjustment for blood glucose control level (7%),the RR was1.40,1.61,1.21and1.76respectively.Different nerve conduction function in patients with DPN more showed that:in terms of sensory nerve conduction velocity, peroneal nerve and posterior tibial nerve in NAFLD group were below the other group (P<0.05);In terms of amplitude, ulnar nerve, peroneal nerve and posterior tibial nerve in NAFLD group were below the other group (P<0.05);In terms of motor nerve distal latency, posterior tibial nerve of the incubation period in NAFLD group was longer than the other group (P<0.05);In the distal amplitude, peroneal nerve and posterior tibial nerve amplitude in NAFLD group was lower than the other group (P<0.05);In terms of autonomic nerve amplitude, the right foot and left foot of amplitude in NAFLD group was below the other group (P<0.05). Logistic regression analysis found that HbAlc level, FFA, HOMA IR was the influence factors of in patients with T2DM combined mild NAFLD with DPN;FFA, HOMA IR, hsCRP level is the influence factors of in patients with T2DM combined moderate NAFLD with DPN,FFA, FIB, HOMA-IR, hsCRP level was the influence factors of in patients with T2DM combined severe NAFLD with DPN,NAFLD may through the lipid metabolic disorder and insulin resistance and inflammation affected the occurrence of DPN. Analysis risk factors for SSR abnormal,liver fat deposition, free fatty acids increasing,insulin resistance and inflammation in the body state may be the signs in T2DM patients combined NAFLD with simple SSR abnormal.Conclusion1.There were five aspects influencing integrated rehabilitation treatment for T2DM, including diabetes education, self-monitoring, exercise therapy, nutritional therapy, drug treatment,. In the system of integrated rehabilitation treatment for T2DM, education had a leading role, self-monitoring is the hub, exercise therapy, nutritional therapy and drug therapy are the core of foundation treatment, five factors through mutual influence, form a DESMD model system.2. The risk of T2DM patients with DPN of NAFLD was1.63times of T2DM without NAFLD patients,the incidence of DPN due to NAFLD in T2DM was25.30%,38.61%of the incidence of NAFLD was due to NAFLD in patients with T2DM who suffered NAFLD.3. The relative risk of abnormalities of sensory nerve conduction, motor nerve conduction and SSR were respectively1.93,1.58and1.82in T2DM patients with NAFLD.After adjustment for age and blood glucose control level, relative risk was reduced, which showed age40years old or more and blood glucose control level7%or more can increase the risk of neuropathy.4. In patients with DPN, lower limb nerve injury is more serious in T2DM patients with NAFLD.5. Different degree of of NAFLD may affect the occurrence of DPN through different mechanisms, the role of FFA and IR were throughout, blood sugar control levels played a role in mild NAFLD, along with the aggravation of NAFLD, the influence of inflammatory factor on DPN was more prominent.6. The liver fat deposition, free fatty acids increasing,insulin resistance and inflammation in the body state may be the signs in T2DM patients combined NAFLD with simple SSR abnormal. |
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