ABSTRACT
Objective To investigate the relationship between lipid fluctuations of daily diet and insulin resistance in patients with type 2 diabetes mellitus(T2DM) with normal fasting lipid profile. Methods One hundred and ninety?eight cases patients with T2DM who were treated in the Endocrinology Department of the General Hospital of Benxi Iron and Steel Group Corporation from October 2012 to September 2014 were selected. Patients were divided into three groups according to fasting and postprandial 4 h triglyceride( TG4 h) level,the group with normal fasting TG and normal TG4 h with 38 cases,the group with normal fasting TG and rising TG4 h with 78 cases,the group with rising fasting TG and rising TG4 h with 82 cases. The control group was composed of healthy volunteers with 20 cases. The patients followed daily diet habits to eat,blood glucose, insulin and lipid level of fasting and 2 h,4 h after lunch were monitored. Homeostasis model insulin resistance index( HOMA?IR) was used as an index to evaluate insulin resistance,and the correlation analysis was carried out with fasting and dietary intake of postprandial lipid metabolism. Results (1)HbA1c,FPG,HOMA?IR,TG and insulin level in the patients of the group with normal fasting TG and normal TG4 h,the group with normal fasting TG and rising TG4 h,the group with rising fasting TG and rising TG4 h were higher than the control group (HbA1c:(8. 4±1. 9)%,(8. 2±2. 4)%,(7. 8±1. 8)% vs. (4. 3±0. 6)%);FPG:(8. 98±1. 93) mmol/L, (8. 62±1. 33) mmol/L,(8. 28±1. 26) mmol/L vs. (4. 82±0. 63) mmol/L;,HOMA?IR:11. 07±0. 11,6. 98 ±0. 08,3. 83±0. 09 vs. 1. 24±0. 16;TG:0 h TG:(2. 35±1. 85) mmol/L,(1. 60±0. 41) mmol/L,(1. 58±0. 46) mmol/L vs. (0. 82±0. 25) mmol/L;2 h TG:(3. 97±2. 96) mmol/L,(2. 98±1. 49) mmol/L,(1. 83±0. 62) mmol/L vs. (1. 22±0. 31) mmol/L;4 h TG:(4. 24±1. 57) mmol/L,(3. 15±1. 63) mmol/L,(1. 92±0. 53) mmol/L vs. (1. 16±0. 24) mmol/L;insulin(0 h insulin:(26. 51±3. 65) mU/L,(18. 18±6. 24) mU/L,(10. 31 ±2. 38) mU/L vs. (5. 87±1. 62) mU/L;2 h insulin:(59. 15±8. 34) mU/L,(43. 75±9. 83) mU/L,(34. 27 ±1. 61) mU/L vs. (25. 24±1. 98) mU/L;4 h insulin:(51. 22±6. 79) mU/L,(40. 06±7. 51) mU/L,(31. 06 ±1.77) mU/L vs. (13.36±1.37) mU/L;P<0.05). (2)WHR(0.90±0.08 vs.0.72±0.06),HOMA?IR, insulin level of fasting and 2 h,4 h after lunch,TG of 2 h,4 h after lunch in the group with normal fasting TG and rising TG4 h were higher than the group with normal fasting TG and normal TG4 h ( P<0. 05 ) . ( 3 ) BMI ((27. 3±3. 3) kg/m2 vs. (23. 1±1. 5) kg/m2),WHR(0. 96±0. 10 vs. 0. 72±0. 06),HOMA?IR,TG and insulin level of fasting and 2 h,4 h after lunch in the group with rising fasting TG and rising TG4 h were higher than the group with normal fasting TG and normal TG4 h( P<0. 05) . HOMA?IR,TG and insulin level of fasting and 2 h, 4 h after lunch in the group with rising fasting TG and rising TG4 h were higher than the group with normal fasting TG and rising TG4 h( P<0. 05) . ( 4) HOMA?IR was positively correlated with BMI,WHR,and fasting TG levels in the groups with diabetes(r=0. 297,0. 376,0. 326,P<0. 05). HOMA?IR was significantly positively correlated with TG of 2 h,4 h after lunch in the groups with diabetes( r=0. 529,0. 693,P<0. 05) . HOMA?IR was significantly positively correlated with BMI and WHR in the control group(r=0. 617,0. 728,P <0. 05). HOMA?IR was not significantly correlated with fasting and postprandial TG in the control group. Conclusion Postprandial lipid metabolism disorder after daily diet is in some of patients with T2DM with normal fasting lipid profile. Postprandial lipid metabolism disorder after daily diet is significantly positively correlated with insulin resistance in patients with T2DM. Insulin resistance may be one of the pathogenesis of postprandial dyslipidemia in patients with type 2 diabetes.
ABSTRACT
Objective To investigate the clinical effect and safety of alpha lipoic acid injection combined mecobalamin and prostaglandin E on type 2 diabetic patients complicated with diabetic peripheral neuropathy(DPN).Methods One hundred and sixty type 2 diabetic patients complicated with DPN in the General Hospital of Benxi Iron and Steel Group Corporation from Jan.2011 to Dec.2012 were randomly divided into the treatment group(n =80) and the control group (n =80).Three cases of the treatment group and 5 cases of the control group discharged early from the study because of their own reasons.There were 77 cases in the treatment group and 75 cases in the control group.On the basis of controlling blood glucose,patients in the two groups were given 500 μg mecobalamin combined with intramuscular injection once two days,as well as prostaglandinE 10 μg injection once a day.Patients in treatment group were added with 600 mg alpha lipoic acid for intravenous injection once a day for 10-14 days.Total symptom score (TSS),nerve conduction velocity,satisfaction and adverse reactions were evaluated before and after treatment.Results TSS score,tingling score,burning sensation score and hypoesthesia score,numb score in treatment group were (3.5 ± 2.5),(1.1 ± 0.4),(0.9 ± 0.7),(1.3 ± 0.4),(1.3 ± 0.9),significantly lower than those in control group (4.3 ± 2.1,t =2.11,P ＜0.05;1.5 ±0.5,t =1.86,P＜0.05;1.3 ±0.5,t =1.83,P ＜0.05;1.7 ±0.5,t =1.87,P ＜0.05; 1.9 ± 0.4,t =1.91,P ＜ 0.05).The median nerve conduction velocity,peroneal nerve motor conduction velocity,median nerve sensory conduction velocity,common peroneal nerve sensory conduction velocity of patients in treatment group were (53.6 ± 1.4) m/s,(49.6 ± 1.1) m/s,(47.3 ± 1.1) m/s,(48.2 ± 1.9) m/s,lower than those in control group((48.5 ±2.7) m/s,t =-4.94,P ＜0.05;(43.9 ±2.1) m/s,t =-5.36,P ＜0.05; (41.6 ± 1.8) m/s,t =-5.09,P ＜0.05;(43.2 ±2.5) m/s,t =-4.27,P ＜ 0.05,P ＜0.05).In the treatment group,97.4％ (75/77) physicians and 92.2％ (71/77) patients were satisfied with treatment effect,while in the control group,84.0％ (63/75) physicians and 78.7％ (59/75) patients were satisfied with treatment effect.During the study periods,there were 3 cases with facial flushing and 1 cases of dizziness in the treatment group,and 2 cases of facial flushing and 1 cases of dizziness in the control group.All adverse reactions were spontaneous remission without any special treatment.Conclusion Alpha lipoic acid intravenous drip is effective in term of treating type 2 diabetic peripheral neuropathy,and with high safety.