| Objective:To analyze the characteristics of type 1 diabetes mellitus,to study the changes of glucagon in the course of type 1 diabetes mellitus,and to explore the role of a-cell function in the pathogenesis of type 1 diabetes mellitus,and to provide a new idea for the diagnosis and treatment of type 1 diabetes mellitus.Method:117 patients with T1DM were retrospectively analyzed in the Department of endocrinology of the First Affiliated Hospital of Soochow University from January 2016 to June 2018.The patients' age,course of disease,BMI index?hemoglobin?insulin(fasting,30 minutes postprandial,120 minutes postprandial)?C-Peptide(fasting,30 minutes postprandial,120 minutes postprandial)?glucagon(fasting,30 minutes postprandial,120 minutes postprandial)?islet autoantibody(IAA?ICA?GADA?IA-2?ZnT8A),Thyroid autoantibody(TPOAb?TGAb?TRAb)?DK were recorded in detail.The basic characteristics of type 1 diabetes mellitus were analyzed,and the patients were divided into groups according to the course of disease.The level of glucagon in different groups were compared,and the statistical analysis was carried out by SPSS22.0 software.The counting data were expressed as(x±s).Two-sample t-test was used for comparison between the two groups,and one-way ANOVA was used for comparison among multiple groups.P<0.05 indicated that there was significant difference between the two groups.Results:1.The characteristics:there were 60 males and 57 females among 117 patients with type 1 diabetes mellitus,accounting for 51.3%and 48.7%respectively;the average onset age was 30.11 years old,the median onset age was 25 years old,and patients between the ages of 15 and 29 shared the most part,accounting for 50%.Patients with disease duration<5 years,5-10 years,?10 years accounted for 53.8%,26.5%,19.7%,respectively;Islet autoantibodies(at least one of IAA,ICA,GAD A,IA-2A,ZnT8A)were positive in 35%of the patients;Glycosylated hemoglobin was above 7%in 87.2%of the patients.;Ketosis occurred at least once in 75.2%of the patients;Fasting and postprandial insulin secretion was significantly decreased in more than 80%of the patients,and fasting and postprandial C-peptide secretion was significantly decreased in more than 90%of the patients.;Fasting and postprandial glucagon secretion decreased in more than 20%of the patients,and increased in more than 20%of the patients either.37.9%of the patients were positive for thyroid autoantibodies(at least one of TPOAb,TGAb and TRAb).2.The characteristics and influencing factors of glucagon secretion:?the basal and postprandial glucagon secretion was at the normal level in about 60%of the patients,about 20%of patients have increased fasting and post-prandial glucagon secretion,and another 20%of the patient's fasting and postprandial glucagon secretion decreased;?117 patients with T1DM were divided into three groups according to the course of disease:<5 years group(group 1),5-10 years group(group 2)and>10 years group(group 3).The mean levels of glucagon in fasting and postprandial in the three groups were measured by one-way ANOVA.The results showed that there were significant differences in fasting and postprandial(half hour and 2 hours)glucagon secretion among different course groups(P<0.05).The mean levels of glucagon in fasting and postprandial were the lowest in the three groups in the group with course>10 years and the highest in the group with course 5-10 years.Conclusion:1.The proportion of male and female patients with type 1 diabetes mellitus is roughly the same,,mostly young patients.About half of the patients had a course of less than 5 years,most of them had poor blood glucose control and a history of ketosis,and the positive rate of islet autoantibodies is low.The basic and postprandial insulin and C-peptide secretion of the vast majority of patients is significantly reduced,and the ?-cell function is exhausted.Nearly half of the patients have varying degrees of a cell secretion dysfunction.In the meantime some patients have autoimmune thyroid diseases.2.Patients with T1DM have abnormal secretion function of islet a cells.Glucagon levels and a cell function are related to the course of diabetes. |
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