Effects Of Insunlin Pump Alone And In Combination With Exenatide In Overweight People With Newly Diagnosed Type 2 Diabetes

Background:Insulin pump (Continuous subcutaneous insulin infusion, CSII) suitable for treatment of newly diagnosed type 2 diabetes (Type 2 diabetes mellitus, T2DM), CSII mainly pulsatile release simulate continuous basal secretion of insulin and meal time.24 hours of injection, the pulse fasting insulin secretion, physiological state, can eliminate insulin resistance, insulin dose reduction, effectively eliminate the high sugar poison, reduce the incidence of hypoglycemia. The downside is that islet p cells can not be repaired, even after intensive glycemic treatment success in the short term, long-term high glycemic load will continue to increase the burden on islet cells β, not long to effective blood sugar control, the final choice or return oral hypoglycemic agents or insulin to control blood sugar.Glucagon-like peptide-1 (Glucagon-like peptide-1, GLP-1) originated in the a cell glucagon original gene, through translation, cut-generated glucagon, glucagon by twelve duodenum, ileum, the colon L cells enzymes to form such peptides. It is mainly in the brain, liver, stomach, pancreatic islet cell, intestine. Such peptides increased β-cell responses, diet stimulate GLP 1-secretion, thus contributing to β cell glucose-dependent insulin secretion, reducing postprandial blood glucose play a role, but also reduces the load of β cells. Because such peptides increase stomach fullness, reduce appetite, reduce postprandial islet a cells secrete glucagon. inhibition of glucagon secretion lead to liver glycogen output reduction, promotion of gastric emptying. GLP-1 is rapidly inactivated in the body, usually 1-2 minutes to useless, therefore, not suitable for the treatment of T2DM. Research also found that GLP-1 analogs with enhanced glucose-dependent insulin secretion, reducing postprandial glucagon secretion, delay gastric emptying, reduce food intake, weight loss, recovery phase insulin secretion and improve cell function, the cell proliferation (animal model) and so on, at the same time easy to inactivate in vivo. Glucagon-like peptide-1 analogues appear, for the treatment of T2DM provides a new drug. Currently glucagon-like peptide-1 analogue, there are two, Exenatide (Exenatide) and liraglutide.Because of CSII therapy associated with obesity is not conducive to the T2DM, and easy to relapse, while Exenatide adapted with obesity T2DM, the two combined CSII is more suitable than single longer control blood sugar levels associated with obesity onset T2DM. this study is intended to onset obesity with T2DM patients in this study, by CSII alone or in combination Exenatide, compare both the degree of glycemic control, improved insulin function, during treatment and other aspects of economic impact.Purpose:Tracking of the effect exenatide combined with CSII therapy on T2DM.Methods:We selected the early T2DM patients who visited Endocrinology clinicin the second Hospital of Jilin University between October 1,2012-October 1,2014,A total of 178 cases,Including 82 male patients,and female patients 96,Patient age range for 18-72 years old,Their average age was about 45,the patients diagnostic standard was as same as WHO diabetes diagnostic criteria, and signed informed consent treatmentThe patients were randomly divided into two groups, the insulin pump (CSII) and exenatide plus insulin pump (ECSII).Insulin pump usage amount:basic amount=Body weight(kg)x(0.4-0.6)x0.5,Additional quantity before each mealthe:base quantity×1/3, Method of application of exenatide injection:subcutaneous injection 5ug Within 1 hour before breakfast and supper meal.we check body mass index(BMI)、waistline(WC)、blood pressure、fasting blood-glucose(FPG)、2-hour post-meal blood glucose(2hPG)、Glycated hemoglobin index(HbAlc、c-peptide(cp) (empty stomach and Postprandial2h)、HOMA-βandblood fat before treatment. Subcutaneously implanted insulin pump therapy for the CSII group for probably2-3weeks,made fasting blood glucose between 4.0-6.0mmol/L,postprandial blood glucose between 4.5-8.0mmol/L,than removed the insulin pump, record the number of average length of hospital and hospitalization expenses,we use the same reatment for ECSII group,but applicate of exenatide at the same time, before the dinner given by subcutaneous injection within 1 h, the starting dose is 5ug,2times/d.MadeFasting blood glucose between 4.0-6.0mmol/L, postprandial blood glucose between 4.5-8.Ommol/L,than removed insulin pump,but exenatide continue toapplying(for one month). Also records the average length of hospital stay and average cost of hospitalization and treatment of patients admitted to hospital before fasting plasma glucose (FPG), postprandial blood glucose (2hBG), glycated hemoglobin index (HbAlc), C-peptide (fasting and postprandial 2h), islet β-cell function (HOMA-β), body mass index (BMI), waist circumference (WC), blood lipids and blood pressure recorded in detail, measured 2-3 weeks after treatment of these indicators as a control, because white is to assess HbAlc near 8-average of 12 weeks of blood sugar, so it is not recorded in 2-3 weeks after treatment, then discharged after GAIP and IP at 12 weeks of follow-up indicators of the tracking.Results:After 12 weeks of treatment,we compared every indicators of ECSII group and CSII groups between before and after treatment,at the same time,we calculated the average hospitalization days of the two groups and hospitalization expenses.We found that FPG,2hPBG,HbAlc,weight,WC,BMI,triglyceride(TG),cholesterol(TC) and ow-density lipoprotein (LDL-C) were significantly decreased(P<0.05),FC-P,2hC-P were all increased significantly(P<0.05).Systolic blood pressure (SBP) and diastolic blood pressure (DBP) had different degree drop after treatment(P<0.05).But the CSII group indicators improved more significantly than CSII group (P<0.05),high-density lipoprotein (HDL-C) increased(P<0.05), the hospitalization days and hospitalization expenses of ECSII group were also obviously below the contrast group(P<0.05).Conclusion:It has a significant effect when use exenatide combined with insulin pump to treat the patients with T2DM, this therapeutic method make theblood glucose levels of the patients have a good control, and enhance the islet function,It can also reduce the patient body mass index.This treatment playsan active role in improving high cholesterol levels and high blood pressure at the same time.