Analysis Of Characteristics Of Glucose And Lipid Metabolism In Type 2 Diabetes Mellitus Patients With Liver Cirrhosis

Objective: To investigate the characteristics of blood glucose and lipid metabolism in patients with type 2 diabetes mellitus(T2DM)complicated with liver cirrhosis,and the relationship between blood glucose,blood lipid and Child-Pugh classification.Method: Eighty-four patients with type 2 diabetes mellitus(T2DM)with liver cirrhosis who were hospitalized at the First Hospital of Jilin University from January 2011 to December 2017 were selected as cirrhotic patients;during the same period,patients with type 2 diabetes admitted to the Department of Endocrinology and Metabolism 91 Cases are listed as diabetics.Both groups received insulin intensive treatment,while excluding acute complications of diabetes,with severe heart,lung,renal insufficiency,and other endocrine diseases,incomplete data.The cirrhosis group was divided into three groups based on the Child-Pugh classification.Group A was Child-Pugh A grade,34 cases,group B was Child-Pugh B grade,and 29 cases,group C was Child-Pugh C grade,21 people.Collect relevant data of each group of patients,including gender,age,duration of diabetes,body mass index(BMI),hemoglobin A1c(Hb A1c),blood glucose before meals,blood glucose for two hours after meals(referred to as postprandial blood glucose),blood sugar before bedtime,low blood sugar levels,and the number and frequency of hypoglycemia in the first 3 days after admission Two groups of patients were recorded for total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),aspartate aminotransferase(AST),alanine aminotransferase(ALT),glutamine aminotransferase(GGT),albumin(ALB),total bilirubin(TB),total insulin dose(U/d),and body weight insulin dose [(U /kg.d)].The indicators of blood glucose fluctuations include standard deviation of mean blood glucose(SDBG),coefficient of variation of fasting blood glucose(CV-FPG),largest amplitude of glucose volatility(LAGE),postprandial blood glucose volatility(PPGE),and incidence of hypoglycemia.Statistical methods: Use Excel spreadsheets to enter data and establish databases after checking.SAS9.4 statistical software was used for data analysis.Result:(1)The two groups have no significant difference in fasting blood glucose.Compared with diabetic group,cirrhosis group had higher postprandial blood glucose and bedtime blood glucose,large amount of preprandial insulin,higher preprandial insulin consumption and and larger preprandial / basal ratio.(P <0.05).(2)The standard deviation of blood glucose(SDBG),maximum blood sugar volatility(LAGE),postprandial blood glucose volatility(PPGE)were higher in the cirrhotic group than in the diabetic group(P <0.05).There was no significant difference between the two groups in coefficient of variation fasting blood glucose(CV-FPG)(P >0.05).(3)There was no significant difference in fasting blood glucose,postprandial blood glucose,bedtime blood glucose and blood sugar fluctuation between three groups of A,B and C in cirrhosis group..(4)The levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C)and low-density lipoprotein cholesterol(LDL-C)in the liver cirrhosis group were lower than those in the diabetic group.The difference was statistically significant(P <0.05).Child-Pugh C levels of total cholesterol(TC),low density lipoprotein cholesterol(LDL-C)levels were significantly lower than Child-Pugh A level.The difference was statistically significant(P <0.05).Conclusion:(1)Type 2 diabetes mellitus patents with liver cirrhosis have higher postprandial blood glucose,and bedtime blood glucose after meals,and have greater fluctuations in blood glucose,and the amount of insulin before meal was large.(2)Type 2 diabetes patients with liver cirrhosis have higher preprandial insulin doses and have a larger preprandial/basal ratio.(3)Type 2 diabetes patients with liver cirrhosis have relatively low levels of total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),and low-density lipoprotein cholesterol(LDL-C).(4)Child-Pugh C levels of total cholesterol(TC)and low-density lipoprotein cholesterol(LDL-C)levels in type 2 diabetes mellitus patients with liver cirrhosis were lower than that of Child-Pugh A grade.(5)There was no significant relationship between Child-Pugh grade and blood glucose of type 2 diabetes mellitus patients with liver cirrhosis.