| BackgroundObesity is a chronic metabolic disease which is affected by inheritance,environment and lifestyle,etc.The incidence of obesity has been rising in recent years,WHO noted that 42 million children under the age of five were overweight or obese in 2013,and about 1.9 billion adults were overweight in 2014 globally,of whom 600 million were obese.Type 2 diabetes is a chronic metabolic disease characterized by the long-term presence of hyperglycemia.Impaired glucose regulation,including impaired fasting blood glucose and impaired glucose tolerance,is an early stage of T2DM's development.As the course of the disease progresses,multiple organ and multisystem diseases such as the heart,kidney,and nervous system are often complicated,which seriously affects the quality and safety of life of patients.Multiple studies have confirmed that obesity is closely related to type 2 diabetes/pre-diabetes and is an independent risk factor for type 2 diabetes/pre-diabetes.However,some studies have suggested that obesity has different phenotypes,and not all obese patients will have metabolic abnormalities.There are differences in the risk and physique distribution of obesity-related diseases such as type 2 diabetes.ObjectsSearch the risk factors and major TCM constitutional types that cause elevated blood glucose in obese patients,adjusting from the control and treatment of related risk factors and conditioning of TCM physique,to improve the clinical indicators and then prevent and delay the progress of obesity patients with poor weight loss developing to pre-diabetes and diabetics.Methods1.Using the case-control study,88 obese patients with elevated blood glucose and normal blood glucose who were admitted to the endocrine clinic of Guang'anmen Hospital from January 2017 to January 2020,collect general data of patients,including name,sex,age,height,weight,heart rate,blood pressure,waist circumference,hip circumference,family history,disease history and signs and so on;2.Recorded the laboratory test in the two weeks before and after the treatment,including liver function,kidney function,blood lipid and pancreatic islet function;3.With the assistance of investigators with a bachelor's degree and above education background of TCM,the subjects of investigation should fill in the form of"TCM physique classification and judgment self-test form" by themselves or by investigators asking one by one to determine the patients' physique;4.According to the results of OGTT,the obese patients with elevated blood glucose were selected as the case group and the patients with normal blood glucose as the control group,analyze the differences of general information,signs,laboratory indexes and constitutions between the two groups to explore the risk factors and constitutions of obese people with elevated blood glucose.Results1.Correlation study of elevated blood glucose in obese patients(1)General information on obese patientsAmong 88 patients,there were more women than men.The ratio of male to female was 2:3.The average age of patients was 32.58 ± 9.64 years,the average BMI was(33.65±4.59)kg/m2,and the ratio of married and unmarried was 5:6.The majority of patients have a steady work(77.3%)and have a college education or above(75.0%).The dietary characteristics of obese patients are mainly meat-loving(71.6%),44 cases(50.0%)have almost no exercise,and the number of smoking(15.9%)and drinking(14.8%)is relatively small.(2)Correlation study of elevated blood glucose in obese patientsThe distribution of obesity with elevated blood glucose and normal blood glucose in terms of gender,marital status,education,work status,lifestyle,etiology,duration and family history of obesity,heart rate,hyperuricemia,liver function,and acanthosis nigricans has no significant statistically difference(P>0.05).Age,family history of diabetes,waist-to-height ratio,hypertension,high HOMA-IR,HOMA-? reduction and high TG are risk factors for elevated blood glucose in obese patients.Chi-square test or fisher's exact test shows:There was a statistical difference in the distribution of age between the elevated blood glucose group and the normal blood glucose group(P<0.05).The elevated blood glucose group was older than the normal blood glucose group.The proportion of patients over 30 years old in the elevated blood glucose group and normal blood glucose group were 69.0%and 41.3%,the OR value was 3.17(95%CI:1.32-7.64);The proportion of patients with elevated blood glucose had a family history of diabetes(35.7%)was higher than that in the normal blood glucose group(13.0%),and has different statistically significant(P<0.05),the OR value was 3.70(95%CI:1.28-10.75);The proportion of high waist-to-high ratio group(0.64?0.82)(64.3%)in the elevated blood glucose group was higher than that in the normal blood glucose group(39.1%),and has different statistically significant(P<0.05),and the OR value is 2.80(95%CI:1.18-6.65);The distribution of hypertension in the elevated blood glucose group and the normal blood glucose group was statistically different(P<0.05).The proportion of hypertension(69.0%)in the obese and elevated blood glucose group was higher than that in the normal glycemic group(23.9%),with an OR value of 7.10(95%CI:2.77-18.20);The proportion of high insulin resistance group(HOMA-IR>7.44)(35.7%)was higher than that of normal blood glucose group(13.0%),the OR value is 3.70(95%CI:1.28-10.75),and have different statistically significant(P<0.05);The proportion of HOMA-P<1 group(40.5%)in the elevated blood glucose group was higher than that in the normal blood glucose group(8.7%).The OR value was 7.14(95%CI:2.16-23.62),and had different statistically significant(P<0.05);The distribution of high TG in the elevated blood glucose group and the normal blood glucose group was statistically different(P<0.05).The proportion of elevated TG(76.2%)in the group with elevated blood glucose was higher than that in the group with normal blood glucose(37.0%),with an OR value of 5.46(95%CI:2.16-13.82).2.Danger TCM constitutions of elevated blood glucose in obese patients(1)General situation of TCM constitutionOverall situation:The constitution of obese patients was mainly concurrent constitution.Of the 88 cases,there were 54 cases with concurrent constitution,accounting for 61.4%of the total number,patients with 2 constitutions is 12 cases,accounting for 13.6%of the total;patients with 3 constitutions and above is 42 cases,accounting for 47.7%.and 34 cases were single constitution,which is 38.6%of the total number,and peace constitution is 9 cases(10.2%).Accumulate the frequency of the appearance of 9 types of constitutions.The frequency of occurrence of TCM constitutions is Phlegm Dampness constitution,53 times(23.7%),Damp Heat constitution,40 times(17.9%),Qi deficiency constitution,37 times(16.5%),Yin deficiency constitution,22 times(9.8%),Qi depression constitution,21 times(9.4%),Idiosyncrasy constitution,18 times(8.0%),Blood stasis constitution,12 times(5.4%),Peace constitution,11 times(4.9%)and Yang deficiency constitution,10 times(4.5%);Distribution of constitution between sexes,the difference between the distribution of Yang deficiency(2.9%VS 17.0%)and Qi deficiency(25.7%VS 52.8%)between men and women is statistically significant(P<0.05),the distribution of Yin deficiency is higher in women(30.2%)than in men(17.1%),and the proportion of Damp Heat is lower in women(39.6%)than in men(54.3%),but the difference is not statistically significant(P>0.05);Distribution of constitution between age:The proportion of Yin deficiency and Idiopathic constitution in the 30?60 years old(33.3%and 29.2%)is higher than the group under 30 years old(16.0%and 10.0%),and the significant is different statistically(P<0.05);Distribution of constitution between BMI:the proportion of Yang deficiency constitution(31.6%VS 5.8%)in patients with level 1 obesity(BMI?29.9 kg/m2)was higher than that in patients with level 2 obesity(BMI?30kg/m2),and the significant is different statistically(P<0.05),the difference was not statistical in the distribution of other constitutions between the two groups(P>0.05);Distribution of constitution between waist-to-height ratio,Yang deficiency constitution(23.3%VS 0.0%),Qi deficiency constitution(60.5%VS 24.4%),Phlegm Dampness constitution(74.4%VS 46.7%),Damp Heat constitution(60.5%VS 31.1%),Qi depression constitution(37.2%VS 11.1%)is higher in the low waist-to-height ratio group(0.49 to<0.64)than in high waist-to-height ratio group(0.64 to 0.82),while the distribution of the Peace constitution is the opposite(0.0%VS 24.4%).The significant was statistically different(P<0.05),and the difference was not statistical in the distribution of Yin deficiency constitution,Blood stasis constitution,and Idiosyncrasy constitution between the two groups(P>0.05);(2)Danger constitutions of elevated blood glucose in obese patientsThe frequency of TCM constitution distribution in people with elevated blood glucose is phlegm dampness constitution(47.6%),Qi deficiency constitution(45.2%),Yin deficiency constitution(40.5%),and damp heat constitution(40.5%),idiosyncrasy constitution(21.4%),Qi depression constitution(16.7%),peace constitution(16.7%),Yang deficiency constitution(7.1%),blood stasis constitution(7.1%);the distribution frequency of TCM constitutions of people with normal blood glucose is phlegm dampness constitution(71.7%),damp heat constitution(50.0%),Qi deficiency constitution(39.1%),Qi depression constitution(30.4%),and idiosyncrasy constitution(19.6%),blood stasis constitution(19.6%),Yang deficiency constitution(15.2%),Yin deficiency constitution(10.9%)and peace constitution(8.7%);Chi-square test or fisher's exact test shows:Yin deficiency is a dangerous constitution(OR=5.58,95%CI:1.83-17.00)in obese patients with elevated blood glucose,and is associated with elevated FPG,Qi depression is negatively correlated with elevated FPG and the proportion of Phlegm Dampness constitution in normal blood glucose is higher,and the difference is statistically significant.(P<0.05).3.Multi variate logistic regression analysis of influencing factors in obese patients with elevated blood glucoseAnalysis results show that hypertension(OR=5.92,95%CI:1.78-19.64),high TG(OR=5.71,95%CI:1.64-19.88),diabetic families history(OR=5.95,95%CI:1.46-24.34),age increase(OR=4.12,95%CI:1.14-14.85),high waist to height ratio(OR=3.44,95%CI:1.00-11.75)and Yin deficiency(OR=7.36,95%CI:1.49-36.30)are risk factors for obesity with elevated blood glucose(P<0.05)Conclusion1.Risk factors for elevated blood glucose in obese patients include age increase,high waist to height ratio,family history of diabetes,high levels of insulin resistance,decreased beta-cell function,hypertension,and high triglyceride levels.2.The TCM constitution of obese patients is mainly concurrent constitution.The top three most common constitutions are Phlegm Dampness constitution,Damp Heat constitution and Qi deficiency constitution.The distribution of TCM constitution has differences in gender,age,BMI and waist-to-height ratio.The proportion of Qi deficiency constitution in female obese patients is higher than that in men.Yin deficiency and Idiosyncrasy are positively correlated with age,while Yang deficiency are negatively correlated with BMI and waist height ratio;Qi deficiency,Phlegm Dampness,Damp Heat constitution,and Qi depressed are negatively correlated with waist-to-height ratio,while the Peace constitution is positively correlated with waist-height ratio;3.The first three biased constitutions in the obesity with elevated blood glucose group were Phlegm Dampness,Qi deficiency and Yin deficiency,and the first three biased constitutions in the obesity with normal blood glucose group were Phlegm Dampness,Damp Heat and Qi deficiency constitutions.Phlegm Dampness is more in the obesity with normal blood glucose group,Yin deficiency constitution is a dangerous constitution for obese patients to develop hyperglycemia and Yin deficiency is a dangerous constitution for obese patients with elevated FPG,while Qi depression is negatively correlated in obese patients with elevated FPG. |
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