Analysis Of Metabolic Indexes And Dosage Of Insulin In The Patients During The Process Of Type 2 Diabetic Nephropathy

Objective:Observe changes of the dosage of insulin and the characteristics of metabolic index,in order to provide a reference index for the adjustments of exogenous insulin dosage and prevent the occurance of hypoglycemia in the middle and advanced stage of type 2 diabetic nephropathy patients.Material and method:1.The subjects:Information of 125 type 2 diabetic nephropathy patients who were hospitalized from January 2013 and December 2016 was collected in the medical record query system in our hospital.The Ranging of age was from 25 to 84 years,which mean age 53.5 ± 12.37 years,inculding 75 cases of men,who accounted for 60%,and female 50 cases,accounting for 40%.2.Inclusion criterion:(1)The patients should meet the diagnostic criteria of type 2 diabetes and diabetic nephropathy,which would be setted by world health organization(WHO);(2)The patients whose conditions were stable and blood sugar was controled only by insulin were included;(3)The patients whose clinical datas were completed were inculded.3.exclusion criterion:(1)All patients of type 1 diabetes were excluded;(2)The patients who used oral medications or the combination of oral medications and insulin to control their blood sugar were excluded;(3)The patients who used hormone were excluded;(4)The patients with liver disease,thyroid disease,hypothalamus disease and pituitary disease which could influence the level of blood sugar significantly were excluded;(5)The patients who were in the state of stress such as severe infection and sepsis and the patients who were with the diseases of other important organs were excluded;(6)The type 2 diabetic nephropathy patients who were in a critical condition were excluded;(7)The hemodialysis patients of type 2 diabetic nephropathy were excluded;4.Methods:the 125 cases of the type 2 diabetic nephropathy patients were divided into three groups according to the urinary albumin excretion rate(UAER):normal albuminuria group(UAER < 30 mg / 24 h),microalbuminuria group(30 mg / 24 h UAER < 300 mg / 24 h),a large number of albuminuria group(UAER ?300 mg / 24 h).Collect the datas of all of patients retrospectively:including gender,ages,the history of smoking,hypertension,vascular lesions,peripheral neuropathy,diabetic retinopathy and height(cm),weight(kg),body mass index(BMI),diabetes duration(years),fasting blood glucose(FBG),glycosylated hemoglobin(Hb A1c),cholesterol(TC),triglyceride(TG),low density lipoprotein(LDL),high-density lipoprotein(HDL),urea nitrogen(BUN),creatinine(Cr),uric acid(UA)and glomerular filtration rate(e GFR),urinary inhibition(Cys C)C,retinol binding protein 4(RBP4),the total dosage of insulin(U/d),the dosage of insulin of unit weight[U/kg·(d)],and recoding the level of blood sugar which was monitored in the 72 hours and the rates of hypoglycemic events during hospitalization.The objective of reseach is to compare the difference of related indicators and the characteristics of changes of insulin and blood sugar in the middle and advanced stage of type 2 diabetic nephropathy patients.5.Statistics:SPSS20.0 was used for statistic analysis.Measurement datas were presented in the form of x ± s,the SNKvariance analysis was used for comparison between groups.The count data were pressed in the form of rate(%),x2 testwas used for comparison between groups.p< 0.05 was regarded as significant.Pearson correlation analysis was used in the correlation analysis.Result:1.The comparation of general data between diffenrent groups.1.1 The comparation of duration of diabetes and groups of gender and the rate of smoking history,family history,and a large vascular lesions between diffenrent groups has no statistical significance(p>0.05).1.2 The comparation of the rate of hypertension,diabetic retinopathy,and peripheral neuropathy between diffenrent groups has statistical significance(p<0.05).2.The related parameters of renal function2.1 Levels of Cys C and RBP4In the three groups,the levels of cystatin C(Cys C)and retinol binding protein(RBP4)in large number of albuminuria group(group C)and microalbuminuria group(group B)were significantly higher than the levels in normal albuminuria group(group A)(p<0.05),the difference was statistically significant.And the levels of Cys C and RBP4 in a large number of albuminuria group were higher than the levels in microalbuminuria group(p<0.05),the difference was statistically significant.2.2 Levels of BUN?Cr?UAIn the three groups,the levels of blood urea nitrogen(BUN)and creatinine(Cr)and uric acid(UA)in large number of albuminuria group(group C)were significantly higher than the levels in normal albuminuria group(group A)(p<0.05),the difference was statistically significant.And the comparation of the levels of BUN and Cr and UA between microalbuminuria group(group B)and normal albuminuria group(group A)has no statistically significant(p<0.05).3.Levels of lipidIn the three groups,the levels of triglycerides(TG)and cholesterol(TC)and low-density lipoprotein cholesterol(LDL)in group C and group B were significantly higher than that of group A(p<0.05),the difference was statistically significant;and the levels of TG and TC and LDL in Group C were higher than group B(p<0.05),the difference was statistically significant.The levels of high-density lipoprotein cholesterol(HDL)in group C were significantly lower than that of group A and group B(p<0.05),and the levels of HDLin group Cwere lower than that of group B(p<0.05),the difference was statistically significant.4.Levels of e GFRIn the three groups,the levels of Glomerular filtration rate(e GFR)in large number of albuminuria group(group C)and microalbuminuria group(group B)were significantly lower than the levels in normal albuminuria group(group A)(p<0.05),the difference was statistically significant.And the levels of e GFR in a large number of albuminuria group were lower than the levels in microalbuminuria group(p<0.05),the difference was statistically significant.5.Levels of m ALBIn the three groups,the levels of micro-albuminuria(m ALB)in large number of albuminuria group(group C)and microalbuminuria group(group B)were significantly higher than the levels in normal albuminuria group(group A)(p<0.05),the difference was statistically significant.And the levels of m ALB in a large number of albuminuria group were higher than the levels in microalbuminuria group(p<0.05),the difference was statistically significant.6.Levels of the total dosage of insulin and the dosage of insulin of unit weightIn the three groups,the levels of insulin and the dosage of insulin of unit weight in group C was lower than that of group A(p<0.05),the difference was statistically significant.Hower,the levels of insulin and the dosage of insulin of unit weight between group C and group Band between group B and group A has no statistically significant difference(p>0.05).7.AUC of single index and multiple indices joint detection in early diagnosis of DN:AUC of joint detection of RBP4 and m ALB and Cys C is 0.569,which is higher than that of single index(Cys C and RBP4 and m ALB)and AUC of Cys C,and RBP4 is higher than that of BUN and Cr and m ALB in group B.8.Correlation analysis of some indexes:In the correlation analysis beween Cys C and RBP4 with e GFR and UAER and Cr,the results show that Cys C was positively correlated with UAER and Cr,but it was negatively correlated with e GFR,the difference was statistically significant(p<0.001).RBP4 is also positively correlated with UAER and Cr,but it was negatively correlated with e GFR,the difference was statistically significant(p<0.001).9.Comparation of levels of blood sugar and the incidence of hypoglycemia between diffenrent groupsThe incidence of hypoglycemia in group C was higher than that of group A,the difference was statistically significant(p<0.05);but there was no statistically significant difference between group A and group B and between group C and group B,(p>0.05).The comparation of the lowest level of blood sugar and the highest level of blood sugar and the fluctuation range of levels of maximum blood sugar in daytime has no statistical significance(p>0.05).Conclusion:1.The levels of Cys C and RBP4 may be used as a good indicator to assess early renal damage as m ALB.Its sensitivity and specificity were higher than BUN and Cr,which has negative correlation with e GFR and has positive correlation with e GFR and Cr significantly;2.Combined detection of Cys C,RBP4 and m ALB can reflect reflect the early renal damage better in patients with diabetic nephropathy;3.The incidence of hypoglycemia is high and the dosage of insulin is increased in the middle-advanced stage of type 2 diabetic nephropathy.