The Impact Of Glucose Fluctuations In T2DM Patients With Lower Extremity Vascular Disease And The Reascerch Of Insulin Pump Intensive Intervention

ObjectiveThis study was to investigate the glucose fluctuations of Type 2 diabetic patients and diabetic lower extremity vascular lesions and insulin-like growth factor receptor-1(IGF-1R), malondialdehyde(MDA), serum homocysteine(Hcy), the level of vascular endothelial dependent vasodilation(FMD), and discuss the relationship between the glucose fluctation and the impact of glucose fluctuation on endothelial function, and observe the impact of the intervention of insulin pump on vascular endothelial function.Method:A total of 60 patients with T2 DM during March 2013 to May 2014 were entrolled in the study. Based on ultrasound results,all subjects were divided into T2 DM with lower extrmity vascular diasease group of 30 patients(A group) and T2 DM group of 30 patients(B group).We also selected 10 normal healthy person in the hospital at the same period for control group(C group).The 72 h continuous glucose mornitoring were performed resepectively for the Two groups before and after the intervention, and also continuous glucose monitoring to C group,compare and analysis glucose fluctuation parameters;The A, B groups were randomly divided into two subgroups(A1、A2、B1、B2),we use subcutaneous or insulin pump to give subgroups two kinds of intervention.Insulin therapy of two weeks before and after strengthening the simultaneous detection IGF-1R, MDA,Hcy, FMD.Compare the differences of indicators with different methods of insulin intervention before and after strengthen intervention.All inductees were to general biochemical tests.Compare the clinical data、blood glucose fluctuation index、endothelial function between C group and A group, group B and group A.Analyze the impact of glucose fluctation on vascular endothelial function and the impact of glucose fluctuations to vascular endothelial function in different interventions,and the differencese between two different kinds insulin interventions.Results1.1).The systolic and diastolic blood pressure、Hb A1c、 LDL-C、HDL、 Hcy、MDA、TG、 TC、MAGE、 MODD、 LAGE、SDBG of group A B were greater than that in the control group, FMD is less than the normal control group. The difference was statistically significant. P <0.05.2). The sex, age, duration, SBP, TC, LDL, HDL, MDA, IGF-1R, Hcy, FMD, MAGE,MODD, SDBG in A, B, C three groups was significant difference, Group A> Group B>Group C,(P <0.05). Hb A1 c in the two groups of A、B was no significant difference,(P>0.05).3).In C, B, A three groups,MAGE、LAGE、IGF-1R、MDA and Hcy showed an increasing trend, the differences were statistically significant(P <0.05), FMD 、 HDL showed a decreasing trend. The difference was statistically significant(P <0.05).2.1).After the inervention strengthen of insulin pump,Each index of glucose fluctation、IGF-1R、MDA、Hcy decreased, FMD increased. the difference was statistically significant P <0.05.2). After subcutaneous insulin strengthened,Each index of glucose fluctation、IGF-1R、Hcy、MDA decreased,FMD increased. the difference was statistically significant P <0.05.3). The group of the inervention strengthen of insulin pump can significantly reduce the range of glucose fluctation 、IGF-1R、 MDA、 Hcy, increased FMD,compared with subcutaneous insulin pump group. The difference was statistically significant, P <0.05.4). Two different severity diabetes have receptted different intensive insulin intervention,compared the improvement of the glucose fluctation and endothelial function.The MDA 、IGF-1R、Hcy、FMD、MAGE of group B improve obviously than group A.The difference was statistically significant, P <0.05.5). Correlation analysis shows that parameters of glucose fluctation、MDA、IGF-1R、Hcy were correlat obviously with FMD.The correlation was statistical significance. P <0.05.The FMD as the dependent variable, the index as an argument for multiple linear regression analysis of the final IGF-1R, MAGE, Hcy into the regression equation: FMD =8.390-0.342Hcy-0.108IGF-1R-0.385 MAGE.6). IGF-1R positively correlated with MDA, Hcy, LAGE was negatively correlated with FMD.Conclusion1. The glucose fluctuations may be an important risk factor for type 2 diabetes endothelial dysfunction, involved in the occurrence and development of lower extremity vascular lesions.2. Glucose fluctuations may damage vascular endothelium by aggravate oxidative stress,leading to endothelial dysfunction, thus accelerating the development of lower extremity vascular disease.3. Early insulin pump intervention may significantly improve endothelial function in the lower extremities of T2 DM by improve glucose fluctuation,reducing oxidative stress and endothelial cell injury.