Effect Of Early Insulin Pump Intensive Therapy On The Long-term Carotid Atherosclerosis And Hypoglycemic Therapy In Newly Diagnosed Type 2 Diabetic Patients

Objective:The aim of this study was to observe the effect of early insulin pump therapy on newly diagnosed type 2 diabetic patients about the long-term development of carotid atherosclerosis, and to assess the efficacy of early therapy with insulin pump or oral hypoglycemic agents on long-term glycemic control and beta-cell function. Furthermore,the other objective was to investigate whether the different early therapy methods had an influence on secular hypoglycemic therapy. In order to provide evidence for newly diagnosed diabetic patients with long-term prevention of macrovascular complications and effective control of blood glucose, type 2 diabetic patients treated with insulin pump or oral antidiabetic drugs were compared by a return visit.Methods:This study used retrospective research method. According to the medical record system in General Hospital of Beijing Military Area Command, we reviewed newly diagnosed type 2 diabetic patients in the Department of endocrinology from 2002 to2010.In total, 531 type 2 diabetic patients were studied by a return visit from 2014 to2015. 273 cases were divided into intensive treatment group(CSII) and 258 cases were in non intensive group(OAD) based on the early application of hypoglycemic therapy.Assessments of carotid artery intima-media thickness(CIMT) and carotid plaque were done using B-mode ultrasonography. The clinical data, carotid intima-media thickness,plaque detection rate, insulin resistance index(HOMA-IR) and islet beta cell function(HOMA-β) between the two groups were compared. The drug treatment and glycemic control status and influencing factors of carotid atherosclerosis were analyzed.Results:1.Analysis of diagnostic data, comparison between the two groups in age, gender,disease duration, blood pressure, body mass index(BMI), total cholesterol(TC),triglyceride(TG), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), fasting blood glucose(FPG), fasting insulin(FINS) index and insulin resistance(HOMA-IR), islet beta cell function(HOMA-β) and carotid intima-media thickness(IMT), plaque detection rate, there were no significant differences(P>0.05). The glycosylated hemoglobin(HbA1c) of CSII group was higher than that of the OAD group(P<0.05). Among 531 cases of newly diagnosed T2 DM,positive rate of carotid artery atherosclerotic plaque was 29.00%. The positive rate of carotid atherosclerotic plaque of CSII group was 29.67%, the positive rate was 28.29% in the OAD group.2.Analysis of return detection index, age, gender, course of disease, blood pressure,BMI, TC, TG, HDL-C, LDL-C, FPG, HbA1 c between CSII and OAD group had no significant difference(P>0.05). The average duration of diabetic patients was(8.98±2.57)years in the follow-up observation, the shortest duration was 5 years, the longest duration was 13 years.3. Compared carotid atherosclerosis index in two groups, IMT in CSII group was(0.72±0.28) mm, IMT value of OAD group was(0.77±0.25) mm, the difference was statistically significant(P<0.05). Carotid artery plaque detection rate of CSII group was40.29%, this index of OAD group was 49.61%. Compared carotid artery plaque detection rate between the two groups, the difference was statistically significant.(P<0.05).4. Comparison of FPG, HbA1 c, HOMA-IR(CP), HOMA-β(CP) in the return visit,there were no significant difference between the two groups(P>0.05). HOMA- β(CP)of CSII group was better than OAD group(P=0.012). Regard HbA1c≤6.5% as benign blood glucose control point, compliance rate of CSII group was 22.71%; same index of OAD group was 14.34%, the level of blood glucose between the two groups was significantdifferent(P=0.013).5.The intensive treatment group was treated by CSII, 118 patients had drug free remission, remission rate was 43.22%; patients used one kind of oral hypoglycemic drugs accounted for 44.69%, combined with two kinds of oral medicine was 12.09%. OAD group was treated with oral antidiabetic drugs,the rate of using one kind of oral hypoglycemic drugs was 79.07%, the rate of combined with two kinds of oral medicine was 16.28%, the drug free remission rate was 4.65%.6. The rate of drug free remission was 5.13% in CSII group during the follow-up visit,the rate of oral medicine treatment was 63.37%, the rate of oral medicine combined with insulin treatment was 27.84%, only use the insulin treatment was 3.66%. All patients in OAD group during the follow-up visit were required to use drug, the rate of oral medicine treatment was 55.43%, oral hypoglycemic drugs combined with insulin therapy was 24.03%, insulin treatment was 20.54%. Comparison of hypoglycemic drugs treatment between two groups was significant different(P<0.01).7. Analysis of carotid artery in patients, IMT was associated with the observed indicators: IMT was positively correlated with age, HbA1 c, HOMA-IR, LDL-C, and negatively correlated with HOMA- β.Conclusions:1.About 29.00% newly diagnosed type 2 diabetic patients with carotid atherosclerosis,which suggests that type 2 diabetes could combine with macroangiopathy and should be early diagnosis and timely treatment.2. The newly diagnosed type 2 diabetic patients use insulin pump therapy in early can reduce long-term carotid artery intima-media thickness, may delay the occurrence of vascular disease in diabetes.3. Newly diagnosed type 2 diabetic patients treated by insulin pump were superior to patients taked oral antidiabetic drugs in the long-term islet beta function.4. Newly diagnosed type 2 diabetic patients with early intensive treatment can affect long-term hyperglycemia treatment and exist long-term drug free remission.