| Objective:To analyze the risk factors of insulin antibody(IA)in patients with Type 2Diabetes(T2DM),and explore the effect of IA on blood glucose fluctuations.Methods:A total of 1602 patients with definite diagnosis of T2 DM and determination of IA with complete data were included in the study,including 390 patients in the IA positive group and 1212 patients in the IA negative group,to analyze the risk factors of IA positive;In addition,742 patients with a history of exogenous insulin treatment within half a year before admission were selected from the study subjects,according to whether IA was positive or not,220 patients were divided into IA positive group and 522 patients were divided into IA negative group,to analyze the risk factors related to IA in insulin-treated patients and analyze the effect of IA on blood glucose fluctuations in insulin-treated patients.Results:One.Compare IA positive group with IA negative groupThis study included 1602 patients with T2 DM,divided into 390 cases of IA positive group and 1212 cases of IA negative group.General clinical data of the two groups were compared,among which gender,age,disease course,fasting insulin level,cholesterol,LDL,HDL,uric acid,and history of insulin treatment were statistically different in the two groups(P < 0.05).Whether or not IA was positive was used as the dependent variable,and the above statistically significant indicators were used as independent variables to carry out logistic analysis.The results suggest that the treatment of exogenous insulin is one of the risk factors for patients with IA positive(P <0.05).In addition,a longer course of disease,high fasting insulin,high cholesterol,high uric acid,and low levels of HDL may also be risk factors for IA positive development.Two.Comparison of IA positive group and IA negative group in insulin-treated patientsA total of 742 patients who received exogenous insulin treatment in the last half year were included,which were divided into the IA positive group(220 cases)and the IA negative group(522 cases)according to whether they were IA positive or not.1.Among the patients treated with insulin,general and clinical data were compared between the IA positive group and the IA negative group: age,course ofdisease,dose of insulin used before admission,cholesterol,LDL,HDL,uric acid,and free thyroxine showed statistical differences in the two groups(P < 0.05).2.The relationship between insulin and IA in insulin-treated patients: In insulin-treated patients,the insulin dose used before admission and the insulin dose required to reach the target blood glucose after admission were statistically different between the IA positive group and the IA negative group(P < 0.05).3.Analysis of relevant risk factors of IA in patients with insulin therapy3.1 In patients treated with insulin,IA level was used as the dependent variable,and Spearman rank correlation analysis was performed with other factors: it was found that age,disease course,cholesterol,uric acid,fasting insulin,insulin resistance index were positively correlated with IA level,and high density lipoprotein IA level was negatively correlated(P <0.05).3.2 In insulin-treated patients,logistic regression analysis was performed with IA positive as the dependent variable and factors with significant differences between IA-positive and IA-negative groups as independent variables.Course of disease,high cholesterol,high uric acid and low levels of high density lipoprotein.3.3 The course of disease and uric acid among the risk factors for IA-positive patients with insulin treatment mentioned above are grouped according to quartile assignment:The course of disease is divided into 4 groups with 1 = 0?4 years,2 =5?10 years,3 = 11?17 years,and 4 = 18?years.The positive rate of IA in different disease groups was different(P <0.01).Further comparison between the two groups showed that the positive rate of IA in the 5?10 year group was statistically different from the previous group(P <0.05).The risk of developing IA positive is higher when the patients who take insulin last more than 5 years.As the course of disease increased,IA level increased,and fasting c-peptide level and islet cell function index decreased.Divided into 4 groups based on serum uric acid level 1 = ?242umol / L,2= 243?310umol / L,3 = 311?375umol / L,4 = 376 umol / L?.The positive rate of IA in different uric acid groups was different(P <0.01).In further comparison,the positive rate of IA in the uric acid(376umol / L?)group was statistically different from that of the first three groups(P <0.05).Patients who take insulin have an increased risk of IA positive when their uric acid level is higher than 376 umol / L.As uric acid levels rise,IA levels rise.4.Relationship between IA and blood sugar fluctuation in patients treated with insulin:the standard deviation of blood glucose level(SDBG)and the maximum blood glucose fluctuation range(LAGE)were used as the parameters to evaluate the blood glucose fluctuation of patients.Among the insulin-treated patients,they were divided into IA-positive group and IA-negative group according to whether IA was positive or not.SDBG and LAGE of the two groups were statistically different(P<0.05).To analyze the degree of influence of different IA levels on blood glucose fluctuations,the Spearman rank correlation analysis was performed with SDBG and LAGE as dependent variables and IA levels as independent variables.The results suggested that SDBG was positively correlated with IA levels(P <0.05).Conclusion:The use of exogenous insulin is one of the major risk factors for IA positivity in T2 DM patients.In patients with T2 DM treated with insulin,there was no difference in the IA positive rate and IA level when using recombinant human insulin or insulin analogues.The IA-positive patients required a larger dose of exogenous insulin.Patients with T2 DM treated with insulin had a higher risk of being IA positive with longer diabetes,higher cholesterol levels,higher uric acid levels and lower HDL levels.In patients with T2 DM treated with insulin,blood glucose fluctuations are greater when IA is positive,and as IA levels increase,blood glucose fluctuations increase.IA is one of the factors that affect blood glucose fluctuations in T2 DM patients.The magnitude and frequency of changes in patients' blood sugar. |
PDF Full Text Request