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Effect of Metformin in Newly Diagnosed Type 2 Diabetes Mellitus

Author: GongYanPing
Tutor: LiChunLin
School: PLA Postgraduate Medical School
Course: Endocrine and metabolic diseases
Keywords: Type 2 diabetes mellitus Metformin Glucose fluctuations Insulin sensitivity Islet function
CLC: R587.1
Type: PhD thesis
Year: 2010
Downloads: 197
Quote: 0
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Abstract


Objective: To observe the newly diagnosed type 2 diabetes patients with short-term changes in their blood sugar, blood sugar fluctuations, insulin sensitivity and islet function given lifestyle combined with metformin, to analyze the possible impact of factors to provide a reference for a more rational use of drugs. : Newly diagnosed type 2 diabetes patients with 21 cases of normal glucose metabolism in the same age group, 5 cases volunteers as controls. Given lifestyle plus metformin in patients with type 2 diabetes (0.5g oral / day) for 12 weeks. Three weeks once outpatient follow-up of patients each week, once a month outpatient follow-up from the first four weeks. Before and after treatment are conducted to check the following: (1) to collect the general condition of patients; (2) continuous glucose monitoring system (CGMS) check: calculation of each time period the average blood sugar level, blood glucose variability indicators; (3) high insulin - normal glucose clamp test (positive euglycemic clamp): calculate the simple indicators of the value of M and assessment of insulin resistance; (4) intravenous glucose tolerance test (IVGTT): calculation of the first-phase insulin secretion (AIR) and simple indicators of the assessment of islet function. Comparing the above indicators in the treatment of patients with type 2 diabetes, the differences between after and glucose metabolism in normal. Results: (1) In general: After treatment, the patient's body weight, BMI, waist circumference and waist-to-hip ratio and treatment than decreased significantly (P lt; 0.05 or P lt; 0.01), but no significant changes in blood lipids. (2) blood sugar and its variability: ① After treatment the patient's average blood glucose, SD, and CV were significantly decreased (P lt; 0.01). ② CV-PBG and CV-night, is the most important blood glucose variability index. (3) Correlation analysis: the variability indicators HbAlc and AIR. Stepwise regression: MBG, PBG, CV-night affect blood glucose factors in HbAlc; M values, 2hINS and of Alb / Cr and HbAlc positively related, 2hCP with HbAlc negatively related. (3) insulin sensitivity: (1) M value of newly diagnosed patients with type 2 diabetes, approximately 71.8% of the glucose metabolism in normal, M value was significantly higher after treatment with normal glucose metabolism was no significant difference (P gt; 0.05). ② the comparison clamp process: insulin sensitivity and clamp the blood sugar levels of 30-60min. Mainly in three aspects: the insulin resistance of glucose infusion rate reached a plateau time delay, increased mutation rate and jaw after 1h glucose uptake rate decreased. ③ stepwise regression: M-PBG, M-FBG, MBG is associated with the value of M glycemic factors; age, waist-hip ratio, TG, LDL and M values ??related; the M value 2hINS negatively, negatively correlated with FINS . (4) islet function: ① AIR newly diagnosed patients with type 2 diabetes compared with normal glucose tolerance decreased and AIR increased significantly after treatment, but with normal glucose tolerance, there is still a significant difference (P lt; 0.01). ② IVGTT curve comparison: newly diagnosed diabetes point glucose were increased; increased basal insulin secretion after glucose loading insulin secretion but lack of peak reduction, delayed secretion; After treatment, the patient's insulin and blood sugar curve improved with normal glucose tolerance, but still there is a big gap. (3) stepwise regression: MBG, PBG, M-night, FINS, TC, SD and the value of M and AIR; h-duration, AIR, MBG, FBG and the value of M and DI. Conclusion: (1) blood sugar and its fluctuations: newly diagnosed patients with type 2 diabetes, blood glucose levels were significantly decreased after the application lifestyle plus metformin treatment, the variability decreases. The MBG and PBG affect the the HbAlc main indicators, blood sugar fluctuations is one of the factors independent of blood glucose levels affect HbAlc. Has an important role in the improvement of insulin resistance and pancreatic β-cell function decline in HbAlc. The HbAlc decline help delay the onset of diabetic microangiopathy. (2) insulin sensitivity: newly diagnosed patients with type 2 diabetes, insulin resistance, heavy after treatment significantly improved insulin sensitivity is increased in patients with liver and skeletal muscle insulin sensitivity. Improved insulin sensitivity and average postprandial blood glucose levels relationship most closely. With age, abdominal obesity, insulin sensitivity, blood lipid levels also have a certain impact. (3) islet function: β-cell function of newly diagnosed patients with type 2 diabetes, lifestyle plus metformin treatment can be limited to improve the quantity and quality of patients with insulin secretion. AIR postprandial glucose greater than the fasting blood glucose; AIR improvements in lower-day average blood glucose and blood sugar fluctuations. Glucose disposal capacity for newly diagnosed patients with type 2 diabetes, islet β cells than insulin sensitivity. (4) treatment recommendations: For newly diagnosed patients with type 2 diabetes, metformin is an effective and safe treatment options. Intensive glycemic control and lipid compliance, and help to improve insulin sensitivity, protection of pancreatic β-cell function and delay the onset of diabetic vascular complications.

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CLC: > Medicine, health > Internal Medicine > Endocrine diseases and metabolic diseases > Islet disease > Diabetes
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