Liraglutide Was Combined With Insulin Pump Clinic Treatment In Not Frist Diagnosed Type 2 Diabetes

Objectives:To observe the insulin pump and liraglutide combining with insulin pump the application of the first diagnosis in patients with type 2 diabetes in improving the situation of controling blood sugar levels and weight lossing before and after treatment.Assess on the combination of two drugs, clinical effect of patients who was not first type 2 diabetes. In order to find a more effective hypoglycemic and appropriate clinical doses, for clinically further to improve the clinical effect of in patients with not first diagnosed type 2 diabetes and reduce the drug adverse reactions to provide theoretical and experimental basis. Methods:1.Choose from January 2013 to January 2013 at department of Comprehensive Internal Medicine of Dongguan branch Hospital Affiliated to Yan’an university and TCM hospitals in the north of Yulin city hospital endocrinology of 45 patients of not first diagnosed type 2 diabetes.All patients have to eat diabetes diet, exercise, during the study period to disable the other oral glucose-lowering drugs and impact force active ingredient related.2.Select the 45 patients were randomly divided into two groups, one group is control group of 21 cases,the other group is experimental group of 24 cases Control group. The control group is only given insulin pump treatment, according to the adjustment of blood insulin dose.The experimental group is basis on insulin pump therapy to give liraglutide of 0.6 mg/d gradually increased to 1.2 mg/d.3.Respectively, compared two groups of patients before starting treatment and intervention treatment after 3 months of fasting plasma glucose(FPG), blood sugar 2 hours after meal(PBG2h), glycosylated hemoglobin(Hb A1c), fasting c-peptide(CP), 1 hour postprandial c-peptide(1h CP), fasting insulin, insulin 1 hour after the meal, beta cell function, insulin resistance(HOMA- beta), insulin resistance index(HOMA IR), blood lipid(TC, TG, HDL, LDL, blood pressure, body weight, body mass index(BMI), waist hip ratio(WHR), homocysteine(Hcy), trace albumin(m Alb). And record low blood glucose reaction times,gastrointestinal adverse reactionsin, liver function damage and so on in two groups of treatment; evaluation analysis of two groups before and after treatment islet beta cell function and improve insulin resistance.4.Statistical analysis Use SPSS22.0 statistical software package for statistical processing, measurement data using(x__±s), comparing between group use t test, counting information between groups use four tables x2 test. Inspection standard: α = 0.05, P < 0.05 was significant difference. Results:1.The comparison of two groups of baseline data, two groups of selected cases before treatment by gender, age, FPG, PBG2 h, Hb A1 c, CP, 1h CP, fasting insulin, 1 hour after the meal, HOMA-beta, HOMA IR, TC, TG, HDL, LDL, blood pressure, body weight, BMI, WHR, Hcy, m Alb and ALT、AST、GGT have no difference(P > 0.05).2. The experimental group before and after treatment the comparison of related parameters in oral glucose-lowering: FPG(11.97±3.59 vs6.29 ± 1.22), 2h BPG(16.34 ±5.62 vs7.36±2.17) and Hb A1c(11.97±4.59vs5.46±1.67),the difference is significant(P<0.05).The comparison of related parameters control in the aspect of hypoglycemic: FPG(11.29±3.82vs6.97±1.19), 2h BPG(16.86±5.17vs7.34±2.62) and Hb A1c(12.46±3.67vs5.57±1.59), the difference is significant(P<0.05).The experimental group and control group after treatment can effectively control the FPG, 2h PBG, Hb A1 c, it is no significant difference(P>0.05).Two groups of insulin, C-peptide and beta-cell function in the comparison of related parameters:the experimental group before and after treatment in the aspect of improve beta-cell function related parameters comparison: CP(1.93 ± 1.13 vs3.08 ± 0.98), 1h CP(2.30 ± 1.63 vs6.86 ± 1.64), fasting insulin(8.70 ± 0.85 vs24.17 ± 2.35), 1 hour after a meal insulin(24.87 ± 2.23 vs66.58 ± 2.08), HOMA-IR(4.17 ± 1.50 vs2.34 ± 1.23) and HOMA- beta(16.57 ± 11.50 vs34.76 ± 9.79), the difference is significant(P < 0.05). The control group before and after treatment in the aspect of improve beta-cell function related parameters comparison: CP(1.98±0.98vs2.43± 1.13),1h CP(2.86±1.64 vs6.30± 1.63), fasting insulin(9.15±0.15 vs18.20± 1.22), 1 hour after a meal insulin(23.95±1.31 vs46.55± 2.11), HOMA IR(4.20±0.23 vs2.77± 1.50)and HOMA- beta(16.80±10.97vs23.17±8.43), it is no difference(P>0.05).The experimental group and control group after treatment, the experimental group can effectively improve CP, 1h CP, fasting insulin, 1 hour after the meal insulin HOMA-IR, HOMA-beta and reduce the dosage of insulin, it is has difference(P < 0.05).3. The comparison of two groups of body weight, BMI and WHR:the experimental group before and after treatment in improving the body weight, BMI and WHR comparison:(83.63±11.22 vs76.38±15.33),(29.20±3.09vs25.01±3.12),(1.03±0.07 vs0.85 ±0.06), it is has significant difference(P< 0.05).The control group before and after treatment in improving the body weight, BMI and WHR comparison:(79.38± 15.33 vs.82.63 ±10.23),(29.01 ±3.12 vs29.54 ±3.10),(1.05 ±0.06 vs1.06 ± 0.07), it is has no difference(P>0.05).The experimental group compares with control group after treatment, the experimental group can effectively improve body weight, BMI and WHR, it is has significant difference(P < 0.05).4.The comparison of two groups of blood fats aspect related parameters:the experimental group before and after treatment the comparison of related parameters in the aspect of improving blood lipids: TC(5.47±1.39vs5.47±1.42), TG(4.59±3.09vs3.15±3.46), HDL(1.15±0.49vs1.87±0.30), LDL(3.34±1.23vs2.68±1.33),it is has significant difference(P< 0.05).The control group before and after treatment the comparison of related parameters in the aspect of improving blood lipids: TC(5.72±1.39 vs5.52±1.43), TG(4.18±3.46vs4.15± 3.13), HDL(1.07±0.30vs1.16±0.53), LDL(3.68 ±1.33 vs1.16±0.53), it is has no difference(P>0.05).The experimental group compares with control group after treatment, the experimental group can effectively reduce TC, TG, LDL, raise HDL, it is has significant difference(P < 0.05).5.The comparison of two groups of systolic blood pressure, Hcy, m Alb:the experimental group before and after treatment the comparison of systolic blood pressure, Hcy, m Alb(134.31 ±13.12 vs130.5±9.67),(11.97±5.59vs8.46±4.67),(50.42±8.55vs48.41±8.05),P<0.05, there is significant difference.The experimental group before and after treatment the comparison of diastolic blood pressure,(75.31 ±10.13 vs75.24 ±10.02),P﹥0.05, there is no significant difference.The control group before and after treatment systolic blood pressure, diastolic blood pressure, and the comparison of Hcy,m Alb,(130.5±9.67vs132.31±12.13),(75.43±10.52vs75.47±10.13),(12.46±4.67vs13.57±4.53),(51.23±8.54vs51.41±8.26), P>0.05,it is has no difference.The experimental group and control group after treatment, no significant changes in diastolic blood pressure,but the experimental group can effectively control the systolic blood pressure, Hcy and m Alb, there is significant difference(P < 0.05).6.Two groups of adverse reactions of comparison: during treatment 5 patients of the control group have a low blood glucose reaction, the incidence is 23.81%; 1 patients of the experimental group appears hypoglycemia, accounting of4.17%, it is significant difference(P < 0.05).During in treatment’process 8 patients of the experimental group have been nausea, diarrhea, accounted for 33.33%, 3 case of intolerance to exit; Four patients have been constipation symptoms, 16.67%; 1 case of patients with influenza-like symptoms(4.17% / 24) out of the experimental group, while the control group don’t have the above symptoms, therefore, the experimental group in the number of adverse symptoms was obviously higher than that of control group, it is significant difference(P < 0.05).ALT, AST, GGT of the two groups before and after treatment have no obvious abnormal. Conclusion:1.Insulin pump alone and the liraglutide combing with insulin pump therapy can control blood sugar,significantly lower Hb A1 c values in patients with not first diagnosed type 2 diabetes.2.Liraglutide combing with insulin pump therapy can reduce insulin dose, significantly improve beta-cell function and the insulin resistance.3.Liraglutide combing with insulin pump therapy can reduce the body weight and insulin resistance.4.Liraglutide combing with insulin pump therapy can more reduce the incidence of hypoglycemia than insulin pump therapy.