Study On TCM Syndrome Types And Related Risk Factors Of Newly Diagnosed Diabetes Complicated With Diabetic Retinopathy

Objective: By collecting clinical data of newly diagnosed diabetic patients with diabetic retinopathy in the Department of Endocrinology,the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine in the past 7 years,comprehensive analysis was conducted to study the risk factors,pancreatic islet function status and TCM syndrome patterns of newly diagnosed diabetic patients with diabetic retinopathy.To gain a deeper understanding of the clinical characteristics of this part of patients with diabetic retinopathy(DR)and provide new ideas for the diagnosis,treatment and prevention of early onset.Methods: By consulting the cases,from January 1st,2013 to November 30 th,2019,the patients who were hospitalized in the Department of Endocrinology,Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine were screened for patients with newly diagnosed diabetes.Observation indicators of patients were carefully counted,including name,gender,age of onset,type of diabetes,with or without family history of diabetes,with or without DR,combined medical history(coronary heart disease,cerebral infarction,hypertension,hyperlipidemia,hyperuricemia),traditional Chinese medicine Type,tobacco and alcohol history,blood pressure,glucose tolerance test(OGTT)and insulin release test results,four blood lipids,thyroid function related indicators(T3,T4,TSH),glycated hemoglobin(HbA1c),liver function related indicators(ALT,AST),Renal function related indicators(MALB,SCr,UA),urine ketone body(KET),urine glucose(GLU)and other data,using a steady-state model to measure insulin resistance index(HOMA-IR),islet beta cell function(HOMA-% β)And Insulin Sensitivity Index(HOMA-% S),grouped according to the presence or absence of DR,using spss22.0statistical software for statistics Analysis.Results:1.According to the presence or absence of DR complications,patients were divided into a group of newly diagnosed diabetes without DR(group A)and a group of newly diagnosed diabetes with DR(group B).There were 45 cases in group A,aged 30-88 years,with an average age of 51.51 ± 13.86 years;group B,34 cases,aged 24-81 years,with an average age of 55.65 ± 12.77 years.There was no significant difference between the two groups in terms of age at onset,gender,type of diabetes,smoking history,drinking history,combined coronary heart disease,cerebral infarction,hyperuricemia and hyperlipidemia(P> 0.05).The family history of diabetes in group B was significantly higher than that in group A,with statistical significance(P <0.05).2.From the perspective of blood pressure,the difference in diastolic blood pressure between group A and group B is not statistically significant(P> 0.05);there are significant statistical differences in systolic blood pressure and history of hypertension(P <0.05),consider Hypertension is positively correlated with the onset of newly diagnosed diabetes combined with DR,especially increased systolic blood pressure.3.The results of OGTT,insulin release test and Hb A1 c results showed that the blood glucose measured at each time point and Hb A1 c in group A was significantly lower than that in group B,and the insulin secretion at each time point was significantly higher than that in group B.There were significant differences in blood glucose,Hb A1 c and insulin secretion between the two groups(P < 0.05),which was statistically significant.Hb A1 c and blood glucose were positively correlated with the occurrence of diabetic retinopathy,and insulin secretion was negatively correlated with diabetic retinopathy.According to the HOMA steady-state model analysis,the insulin secretion index of group B was significantly lower than that of group A,with statistical difference.Therefore,considering newly diagnosed diabetes with diabetic retinopathy is mainly related to reduced insulin secretion.4.There were no significant differences in blood lipids(total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein),uric acid,FT4,TSH,creatinine,and urine albumin in the two groups of patients(P> 0.05).There were significant differences in ALT,AST and FT3(P <0.05),which was statistically significant.ALT,AST and FT3 were negatively correlated with the incidence of diabetic retinopathy.5.According to the analysis of urine glucose and urine ketone bodies,27(60%)of the patients in group A had negative urine glucose,followed by 8(17.78%)of the patients with positive urine glucose(+++).Among the patients in group B,there were 7 patients with negative urine sugar,accounting for only 20.59%,and 24 patients with urine sugar(+++),with the highest detection rate accounting for about 70.59%.The urine sugar excretion in group B was significantly higher than that in group A.The number of urine ketone bodies in the positive range of the two groups was less,the statistical significance was smaller,and no specific analysis was made.6.Statistical analysis of TCM syndromes in patients with newly diagnosed diabetes combined with DR group.The number of patients with blood stasis syndrome is the largest,with 11 cases,accounting for 32.35%;followed by 9 patients with deficiency of qi and yin,accounting for 26.47%;the number of patients with Yin and yang deficiency syndrome is the smallest,only 1 case,accounting for 2.94%.It is suggested that the TCM Syndromes of newly diagnosed diabetic patients with DR are mainly blood stasis syndrome and Qi Yin deficiency syndrome.Conclusions:1.Through clinical statistical analysis,it was found that the relevant risk factors for diabetic retinopathy at the first diagnosis of diabetes were blood pressure,history of hypertension,family history of diabetes,blood glucose,insulin secretion,Hb A1 c,ALT,AST and FT3.2.Through the analysis of the HOMA steady state model,it was found that the HOMA-% β in the DR group at the initial diagnosis of diabetes was significantly lower than that in the non-DR group.This indicates that the decrease of islet β-cell secretion function is associated with DR in newly diagnosed diabetes.3.Analysis of TCM Syndrome Types in newly diagnosed diabetic patients with diabetic retinopathy.The number of patients with blood stasis syndrome is the largest,accounting for 32.35%;the second is the syndrome of deficiency of qi and yin,accounting for 26.47%;the number of patients with deficiency of yin and yang is the smallest,accounting for 2.94%.It is suggested that the TCM syndromes of newly diagnosed diabetic patients with DR are mainly blood stasis syndrome and qi and yin deficiency syndromes.It shows that DR is this virtual standard,mixed with virtual and real,which causes the disease together.