| Objective:To explore the effect of four different hypoglycemic methods on diabetic nephropathy and analyze the risk factors.Methods: Patients with type 2 diabetic nephropathy stage III and IV,and HbA1 c in patients aged 9% or fasting plasma glucose above 11mmol/L from June 2014 to June 2016 in the Second Affiliated Hospital of Dalian Medical University Department of Endocrinology outpatient or hospitalized were randomly selected,whose plasma glucose were close to the standardin 120 casewith insulin pump therapy for one week.90 patients agreed to receive subcutaneous injection,according to 1:1:1 were randomly divided into basal insulin group,intensive insulin group,GLP-1 group,and more than 30 patients were DPP-IV inhibitor group.Every 3 months follow-up one times and treatment for 6 months.Patients were examined before and after treatment ofrandom urine albumin to creatinine ratio(UACR),serum cystatinC(CysC),HbA1 C,fasting plasma glucose(FPG),Body mass index(BMI),waist circumference,blood lipid and blood pressure(BP)index.Results:1?Comparison of renal effects before and after treatment: The UACR of the four groups were significantly decreased(P<0.05);GLP-1 group after treatment,UA decreased significantlyt(P<0.01),no statistically significant difference between the three groups after treatment(P<0.05);Four groups of patients with CysC were decreased,but the basal insulin group was not statistically significant(P >0.05),the other groups with significant difference(P<0.05);There was no significant change in CREA and eGFR in the four groups before and after treatment(P>0.05).Comparison between groups,GLP-1 group of the UA,UACR was greater than the other three groups,the difference was significant(P<0.05),three groups of the UA and UACR improvement were close(P >0.05);The improvement of CysC in GLP-1 group was similar to DPP-IV group(P >0.05),compared with the other two groups,the effect twas better than the other two groups(P<0.05).2?Comparison of plasma glucose before and after treatment: Four groups of patients with HbA1 c,FPG,2hPG were significantly decreased,FC-P increased,the difference was significant(P<0.05).Comparison between groups,The HbA1 C dcreased amplitude of basal insulin group was similar to DPP-IV group,Intensive insulin group was similar to GLP-1 group,the difference was not statistically significant(P >0.05).;The HbA1 C decreased amplitude in the GLP-1 group was significantly higher than the basal insulin group and the DPP-IV group(P<0.05);The decrease of HbA1 c in the intensive insulin group was significantly higher than the DPP-IV group(P<0.05),compared with basal insulin group,the difference was not statistically significant(P>0.05),The improvement of FPG in group GLP-1 was higher than that in basal insulin group and DPP-IV group,the difference was significant(P<0.05),compared with intensive insulin group,the difference was not statistically significant(P >0.05).Four groups of patients with a similar decline in 2hPG(P >0.05).3?Comparison of blood lipid before and after treatment: TC and TG in GLP-1 and DPP-IV group were significantly decreased(P<0.05),and GLP-1 group of LDL-C before and after the treatment significantly decreased,the difference was significant(P<0.05);TC,TG,LDL-C,LDL-C in other groups had no obvious change(P >0.05).Comparison between groups,TC,TG improvement rate of GLP-1 group was higher than the other three groups(P<0.05),the other three groups,the difference was not statistically significant(P >0.05).TC,TG improvement rate of GLP-1 group was higher than the other three groups,the improvement of LDL-C in GLP-1 group was higher than that in basal insulin group(P<0.05),compared with intensive insulin and DPP-IV group,the difference was not statistically significant(P >0.05).4?Compared of BMI,waist circumference and hip circumference before and after treatment: waist circumference?hip circumference and BMI of GLP-1 group after treatment were significantly lower than baseline,there was a significant difference(P<0.01);The waist circumference and BMI level of the intensive insulin group were significantly higher than the baseline level(P >0.05),the two other groups of waist and hip circumference and BMI before and after treatment have no obvious change(P>0.05).Comparison between groups,BMI?waist circumference and hip circumference of GLP-1 group significantly improved than the other three groups,there were significant differences(P >0.05).5?Comparison of blood pressure before and after treatment: SBP of GLP-1 group and DPP-IV group significantly reduced,the difference was significant(P<0.05),the two other groups of SBP before and after treatment have no obvious change(P>0.05);The four groups of SDP before and after treatment have no obvious change(P>0.05).Comparison between groups,the SBP decrease of GLP-1 group was close to DPP-IV group(P>0.05),curative effect was better than the two other groups,there were significant differences(P<0.05).6?UACR of patients with diabetic nephropathyas a dependent variable,multiple linear regression analysis was performed using Stepwise method,multi factor linear regression equation: Y=206.798X1+10.499X2 +7.355X3-792.841,Y on behalf of UACR,X1 on behalf of CysC,X2 on behalf of the course of disease,X3 represents waist.The influencing factors of UACR included waist circumference,course of disease and CysC,and positively correlated with UACR.Conclusion: 1 ? The four treatments can reduce the level of UACR,but the improvement of GLP-1 receptor agonist was more significant effect than other three methods,and can improve the level of blood uric acid,CysC etc.These results suggest that GLP-1 receptor agonist may have the effect of reducing microalbuminuria and improving renal function.2?Four kinds of treatment methods can effectively control plasma glucose,the improvmentof GLP-1 receptor agonist therapy was equivalent to intensive insulin,and better than the other two groups.GLP-1 receptor agonist and DDP-4 inhibitors have different degrees effect of weight loss,lowering blood lipids,restoring islet function,and reducing systolic blood pressure,and GLP-1 receptor agonist was better than DDP-4 inhibitors.3?The influencing factors of Diabetic nephropathy(phase III,IV)include disease duration,waist circumference and Cystatin C. |
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