Objective:1.to investigate the clinical features of newly diagnosed T2DM patients.2.To explore the effects of BMI(obesity)and waistline(abdominal obesity)on TCM syndrome elements and islet function of newly diagnosed T2DM.3.To figure out the relationship between TCM syndrome elements and islet function of newly diagnosed T2DM.Method:This was a clinical cross-sectional study.The clinical characteristics—general conditions,symptoms and physical signs—of 171 newly diagnosed T2DM patients were investigated through TCM diagnosis means and instrumental measurement in the medical case report form.Through OGTT,glucose and insulin were tested to calculate G-AUC,I-AUC,HOMA IR,HOMA-β,QUICKI and ΔIns30/ΔPG30.Chi-square test,t-test of two independent samples,Pearson correlation analysis and simple linear regression analysis were used to analyze the differences between obesity and non-obesity patients,abdominal obesity and non-abdominal obesity patients in TCM syndrome elements and islet β-cell function,and the correlation between syndrome elements and objective indicators of Western medicine.Result:1.Clinical features:(1)general condition.171 newly diagnosed T2DM patients involved in this study of 96 males and 75 females,with an average age of(48.81±12.27)years,an average BMI of(27.15±4.09)kg/cm2,and an average waistline of(89.65±10.35)cm.(2)lifestyle.60.82%patients had a preference of special diet,and the top five appetences included "sweet" 49 cases(26.9%),"greasy"42 cases(24.56%),"salty" 35 cases(20.47%),"warm" 21 cases(12.28%)and "fried"18 cases(10.53%);102 patients(59.65%)rarely took exercise,47 patients(27.49%)sometimes took exercise,and 22 patients(12.87%)regularly took exercise.The overall obesity rate of patients who rarely exercise was significantly higher than that of patients who sometimes and regularly exercise(p<0.017).The overall abdominal obesity rate of patients who often exercise was significantly lower than that of patients who rarely exercise and sometimes exercise(p<0.017).More than 70%patients didn’t smoke or drink.120 patients(70.18%)didn’t have sleep problem.(3)complications and family history.67.25%patients suffered from other diseases.55 patients suffered from hyperlipidemia(32.16%),51 patients suffered from hypertension(29.82%),and 49 patients(28.65%)had a span of history of fatty liver.61 cases(35.67%)had a family history of T2DM.(4)TCM symptoms,tongue and pulse.In terms of dietary taste,137 cases(80.70%)felt "thirsty",including 34 cases(19.88%)"thirsty for cold" and 20 cases(11.70%)"thirsty for hot";35 cases(20.47%)were with "sticky mouth".In terms of discomfort in head and body,84 cases(49.12%)felt "tired and weak";As for urine and excrement,there were 34 cases(19.88%)with"frequent urination",and 28 cases(16.37%)with "loose stool".Moreover,86 cases(50.29%)had greasy tongue,and 40 cases(23.39%)had red tongue.103 cases(60.23%)had thready pulse.(5)TCM syndrome elements features.According to the ranking principle of TCM syndrome elements,most of elements were in level Ⅰaccounting for 53.29%;The distribution of syndrome elements showed that both"dampness" and "Yin deficiency" were 100 cases(58.48%),"heat" 59 cases(33.92%),"phlegm" 55 cases(32.16%),"Yang deficiency" 54 cases(31.58%),and "qi deficiency" 50 cases(29.24%)."Yin deficiency","dampness" and "liver" were the most common elements of three levels among deficiency,excess and position syndrome elements respectively.According to the results of combination of syndrome elements,11 patients had a single syndrome element,among which "dampness" was in the priority,and 87.13%patients had multiple syndrome elements.Among the combination of two syndrome elements,"Yin deficiency with heat" accounted for 4 cases at most.Among the combination of three syndrome elements,"Yin deficiency with heat and dampness" accounted for 4 cases at most.2.The effects of different obesity types on TCM syndrome element scores and islet β-cell function:(1)Comparison of TCM syndrome element scores.The score of"Phlegm" in the obesity group was higher than that in the non-obesity group(p<0.01).The score of "phlegm" and "spleen" score in the abdominal obesity group was higher than that in the non-abdominal obesity group(p<P0.05 or 0.01),and the score of "Yin deficiency" was lower than that in the non-abdominal obesity group(p<P0.05).(2)Comparison of islet β-cell function.The insulin in each phase,I-AUC,HOMA-IR and HOMA-β of the obesity group were higher than those of the non-obesity group(p<0.01),and the QUICKI was lower than that of the non-obese group(p<0.01).The fasting insulin and HOMA-IR of the abdominal obesity group were higher than those of the non-abdominal obesity group(p<0.01),and the QUICKI was lower than that of the non-abdominal obesity group(p<0.01).(3)Correlation between BMI and isletβ-cell function.Pearson correlation analysis manifested that BMI was positively correlated with lgI-UAC,lgHOMA-IR,lgHOMA-β and lg(ΔInS30/ΔPG30),with correlation coefficients of 0.282,0.364,0.293 and 0.174 respectively,and negatively correlated with QUICKI,with correlation coefficients of-0.342.Simple linear analysis showed that the regression fitting degree between BMI and lgI-UAC,lgHOMA-IR,lgHOMA-β,QUICKI and lg(ΔInS30/ΔPG30)was 8%,13.3%,8.6%,11.7%and 3%respectively.(4)Correlation between waistline and islet β-cell function:Pearson correlation analysis showed that waistline was positively correlated with LgHOMA-IR with a correlation coefficient of 0.325,and negatively correlated with QUICKI with a correlation coefficient of-0.297.The simple linear analysis results showed that the regression fitting degree between waistline and lgHOMA-IR and QUICKI was 10.60%and 8.80%respectively.3.The correlation between islet β-cell function and TCM syndrome elements.G-AUC was positively correlated with "Qi deficiency","Yang deficiency" and "Qi stagnation",with correlation coefficients of 0.209,0.169 and 0.176 respectively.LgI-AUC was positively correlated with "phlegm",with a correlation coefficient of 0.259.LgHOMA-IR was positively correlated with "heat" and "dampness",with correlation coefficients of 0.186 and 0.159 respectively.LgHOMA-β was negatively correlated with "Yang deficiency" and "cold",with correlation coefficients of-0.212 and-0.218 respectively,and positively correlated with "heat" and "phlegm" with correlation coefficients of 0.271 and 0.237 respectively.QUICKI was negatively correlated with "deficiency" and "heat" with correlation coefficients of-0.151 and-0.169 respectively.Lg(ΔInS30/ΔPG30)was negatively correlated with "Qi stagnation" with a correlation coefficient of-0.157,and positively correlated with"heart" with a correlation coefficient of 0.194.BMI was positively correlated with"phlegm","dampness" and "spleen" with correlation coefficients of 0.312,0.236 and 0.303 respectively,and negatively correlated with "liver" with a correlation coefficient of-0.220.Conclusion:1.clinical features:newly diagnosed T2DM patients prefer sweet and greasy food and don’t take exercise regularly.The main complications include hyperlipidemia,hypertension and fatty liver.T2DM has a genetic predisposition.The main symptoms cover thirst,thirst for cold,languid,frequent urination,loose stool,red with greasy tongue and thready pulse.The pathological features of newly diagnosed T2DM are the mixture of deficiency and excess,which is more related to excess.Yin deficiency with dampness-heat syndrome is the most common,and the main pathological viscera is liver.2.The effects of different obesity types on TCM syndrome element scores and islet β-cell function:(1)TCM syndrome elements.The syndrome element "phlegm"of newly diagnosed T2DM patients with obesity is obvious;the degree of "phlegm"and "spleen" in patients with abdominal obesity is high and "Yin deficiency" is low.Compared with BMI,the measurement of waistline has more reference value for the syndrome differentiation of newly diagnosed T2DM.(2)Islet β-cell function.Through comparing the correlation coefficients and the regression fitting degree of lgHOMA-IR with BMI and waistline,it can be found that BMI has a greater correlation with insulin resistance.3.The correlation between islet β-cell function and TCM syndrome elements and the correlation between BMI and TCM syndrome elements:"phlegm" and "heat" are positively correlated with HOMA-β;"Wet" and "heat" are positively correlated with HOMA-IR;BMI is positively associated with "phlegm","wet" and "spleen".The main pathological changes of patients with obvious Phlegm-heat or phlegm-dampness are insulin resistance,and the damage to pancreatic islet cell function is relatively low.The main pathological changes of newly diagnosed T2DM patients with obesity were phlegm-dampness in spleen. |