基于人群健康管理视角分析促进2型糖尿病早诊早治措施经济性的国外研究进展

糖尿病已成为各国面临的四大非传染性疾病之一,其中最主要的类型是2型糖尿病,占糖尿病患者的90%以上。对其实行综合性治疗+管理的措施能够有效降低疾病的发生风险并延缓其发展进程,方便患者及早采取适当的干预措施。本文旨在对2型糖尿病早诊早治的范畴进行界定,并对国外已发表的有关2型糖尿病筛查、及早的血糖控制、并发症早诊早治、综合干预等经济学研究文献进行分析,以期为我国基于本国2型糖尿病患者的现状及实际开展的早诊早治措施的经济性研究提供参考,同时为促进患者的综合健康管理提供依据。     

微小RNA防治糖尿病并发症的研究进展

糖尿病是严重危害人类健康的慢性疾病,其并发症可导致多器官和组织损伤,是糖尿病患者死亡的主要原因.微小RNA(miRNA)作为一种新型的诊疗手段,在糖尿病及其并发症的病理发生发展中具有重要调节作用.与糖尿病相关的miRNA也正成为其并发症治疗的重要靶点.本文总结了miRNA在糖尿病心肌病和糖尿病肾病等并发症发生发展中的相关作用.     

糖尿病前期人群管理模式研究进展

糖尿病及其并发症为当前严重威胁公众健康的慢性非传染性疾病之一,其发病率逐年上升。糖尿病前期是由正常糖代谢进展为糖尿病的高危阶段,在此阶段进行有效干预是预防和延缓糖尿病发生的关键。本文在现有慢性病管理模式的基础上将自我管理、家庭参与式管理、社区群组管理、中医特色管理及新技术联合手段的管理方式进行归纳整理,对比分析各型管理方式所存在的优势与不足,以进一步探讨当前行之有效的糖尿病前期患者的管理方式。本文内容提示多形式综合糖尿病前期管理可降低其转化为糖尿病的发生率,应用前景广泛,而未来健康管理师加入社区健康管理团队将会是慢性病有效管理的一大突破。     

The Combined Effect of Dyslipidemia on the Incidence of Type 2 Diabetes: A Prospective Cohort Study in Northwest of China

Type 2 diabetes mellitus (T2DM) is a major non-communicable chronic disease in the population and is a major threat to global public health. According to the International Diabetes Federation[1], there were at least 463 million patients with diabetes between the ages of 20 and 79 in 2019, and this number will rise to 700 million by 2045. Dyslipidemia is the most important factor that influences T2DM. At present, cross-sectional studies are mainly used to determine the correlation between single lipid index, lipid ratio, and T2DM and its complications[2]. Few studies have focused on dyslipidemia and its aggregation patterns in relation to T2DM.     

糖尿病知识宣传教育在糖尿病防治中的重要性

糖尿病是一种由遗传原因和环境因素作用而累及全身,并需要长期治疗的疾病。目前,我国糖尿病的发病率呈明显上升趋势。疾病本身及其各种并发症正威胁着人们的健康,影响着人们的生活质量,如何才能遏制这个病魔？近几年,糖尿病领域专家和学者们总结出了糖尿病防治的五驾马车并行,成为控制疾病的有力武器。对孝感市中心医院住院的糖尿病患者采取以饮食治疗、体育运动、药物治疗、血糖自我定期监测、糖尿病知识教育即＂五驾马车并行＂为核心的宣传,对患者及家属进行全面系统的糖尿病健康知识教育,并在其出院后继续进行家庭健康随访,帮助患者建立良好的健康行为,达到最佳健康状态,提高生活质量;从而在缩短住院日,降低住院成本及减少再住院率方面取得较满意的效果;同时对全社会预防糖尿病,减少糖尿病发病率方面起到积极的作用。糖尿病目前虽还没有根治方法,但绝不是不治之症,糖尿病完全是一种可防可治的疾病,通过积极治疗,患者完全可以过正常人的生活,享受健康人的寿命。     

糖尿病健康教育研究进展

糖尿病是临床常见慢性代谢性疾病, 是失明、肾衰竭、心脏病发作、中风和下肢截肢的主要病因, 死亡率逐年增加, 据预测, 2030年, 糖尿病将成为第7主要死因.因此, 糖尿病的预防及治疗至关重要.近年来, 国内外相关研究表明, 通过开展糖尿病健康教育, 可以让患者及家属、高危人群掌握糖尿病的防治知识, 提高自我保健意识, 提高现症患者就诊率, 减少、延缓并发症的发生, 延长寿命, 降低糖尿病病死率, 同时提高糖尿病患者的生活质量, 健康教育作为糖尿病综合防治5项措施之一, 在糖尿病防治中发挥了重要作用.就糖尿病健康教育的对象、内容、作用、模式进行综述.     

Polysaccharides from the Green Alga Ulva lactuca Improve Antioxidant Balance and Bone Mineral Density in Diabetic Rats

Diabetes mellitus (DM), the 10th? leading cause of death worldwide, is a major and growing public health problem estimated to affect more than 578 million people in 2030 and 700 million people in 2045[1]. In diabetic animals, protein glycation and glucose autoxidation generate free radicals, which cause lipid peroxidation. Therefore, reactive oxygen species (ROS) can quickly accumulate, decrease antioxidant activity, and cause deterioration of kidney and liver function. A disrupted redox balance in cells also damages crucial biomolecules such as deoxyribonucleic acid (DNA), proteins and lipids. Oxidative stress (OS) is elevated in diabetes mellitus and may be a major factor in the development and evolution of the typical long-term pathophysiology of?diabetes?and?its?associated?complications[2].     

糠尿病现代饮食与运动治疗

糠尿病可引起很多并发症，其并发症危害性极大，糠尿病患对糠尿病的知识掌握越多，自我保健越好，就越能减少并发症的发生和延长生命，章记述了糠尿病患饮食和运动方向的现代观点。     

糖尿病诊断指标糖化血红蛋白的检测方法及临床意义

糖尿病目前已被国际社会列为人类健康头号杀手的非传染性疾病。血糖的检测在糖尿病的诊断、治疗及预防急性和慢性并发症中尤为重要。糖化血红蛋白（glycatedhemoglobin Alc，HbAlc）是反映既往2～3个月平均血糖水平的指标，用于评估长期血糖控制状况。目前HbAlc检测已经被推荐作为糖尿病诊断试验。现对HbAlC的检测方法及其临床意义作一综述。     

Management of Diabetic Retinopathy

Sub-Saharan Africa faces an epidemic of diabetes. Visual loss from diabetic retinopathy (DR) is both preventable and treatable. This article reviews the epidemiology and clinical features of DR and current evidence-based interventions in three areas: primary prevention of retinopathy by optimum medical management, early detection of pre-symptomatic disease and management of established retinopathy to prevent or mitigate visual loss. There are significant challenges to DR care in resource poor environments. Appropriate provision of effective interventions by health services can reduce social and economic costs associated with patient care.     

胃旁路手术治疗2型糖尿病研究现状

糖尿病是严重威胁人类健康的代谢性疾病,全球发病率已呈逐年上升趋势。胃旁路手术(GBP)在用于治疗肥胖症时,发现该手术可以治疗2型糖尿病。这一成果受到全世界医学界的关注,为2型糖尿病彻底根治带来新的希望。欧美国家和我国都用这种方法治疗2型糖尿病患者,且疗效显著,无不良反应。改进GBP手术方式和探讨治疗2型糖尿病机制是今后研究的重点。     

Coronary artery stenting in diabetes mellitus--unfavourable clinical outcome due to increased rate of myocardial ischemia and percutaneous interventions

Diabetes mellitus is one of the major risk factors for cardiovascular diseases. The aim of this study was to analyze if diabetic patients, compared to nondiabetic patients, have a worse angiographic and clinical success rate and a reduced clinical and angiographic outcome at three-months follow-up after coronary artery stenting according to postprocedural complications, recurrent angina, myocardial ischemia, restenosis and revascularization. A total of 307 unselected patients with coronary artery disease and myocardial ischemia who underwent intracoronary stenting were included in this study. Diabetes was present in 49 patients. Morphological criteria, angiographic results and clinical in-hospital outcome did not differ significantly between both groups. At follow-up diabetics presented significantly more often recurrent angina and myocardial ischemia. The rate of restenosis and target lesion revascularization was not different. Among diabetics, the rate of percutaneous coronary interventions because of different lesions was significantly increased. Diabetes does not reduce the angiographic result initially and at follow-up after coronary artery stenting. Diabetes mellitus limits the clinical outcome because of recurrent angina, myocardial ischemia and the need of coronary interventions.     

口服降糖药物治疗糖尿病的若干进展

糖尿病已成为一种严重影响人类健康的疾病。目前，我国糖尿病患者人数已达3千万，且其发病率正在逐年增加，因此，治疗该病和控制其并发症是十分重要的。随着分子生物学的发展，口服降糖药物的研制及使用也取得很大进展，许多新型口服剂已应用于临床。本文就口服降糖药物治疗糖尿病的进展作一综述。     

Prospects for research in diabetes mellitus

Diabetes mellitus is the sixth leading cause of death in the United States, and morbidities resulting from diabetes-related complications such as retinopathy, kidney disease, and limb amputation cause a huge burden to the national health care system. Identification of the genetic components of type 1 and type 2 diabetes is the most important area of research because elucidation of the diabetes genes will influence all efforts toward a mechanistic understanding of the disease, its complications, and its treatment, cure, and prevention. Also, the link between obesity and type 2 diabetes mandates a redoubled effort to understand the genetic and behavioral contributions to obesity.     

Diabetes and atherosclerosis: epidemiology,pathophysiology, and management

CONTEXT: Complications of atherosclerosis cause most morbidity and mortality in patients with diabetes mellitus. Despite the frequency and severity of disease, proven medical therapy remains incompletely understood and underused. OBJECTIVE: To review the epidemiology, pathophysiology, and medical and invasive treatment of atherosclerosis in patients with diabetes mellitus. DATA SOURCES: Using the index terms diabetes mellitus, myocardial infarction, peripheral vascular diseases, cerebrovascular accident, endothelium, vascular smooth muscle, platelets, thrombosis, cholesterol, hypertension, hyperglycemia, insulin, angioplasty, and coronary artery bypass, we searched the MEDLINE and EMBASE databases from 1976 to 2001. Additional data sources included bibliographies of identified articles and preliminary data presented at recent cardiology conferences. STUDY SELECTION: We selected original investigations and reviews of the epidemiology, pathophysiology, and therapy of atherosclerosis in diabetes. We selected randomized, double-blind, controlled studies, when available, to support therapeutic recommendations. Criteria for data inclusion (168 of 396) included publication in a peer-reviewed journal or presentation at a national cardiovascular society-sponsored meeting. DATA EXTRACTION: Data quality was determined by publication in peer-reviewed literature. Data extraction was performed by one of the authors. DATA SYNTHESIS: Diabetes mellitus markedly increases the risk of myocardial infarction, stroke, amputation, and death. The metabolic abnormalities caused by diabetes induce vascular dysfunction that predisposes this patient population to atherosclerosis. Blood pressure control, lipid-lowering therapy, angiotensin-converting enzyme inhibition, and antiplatelet drugs significantly reduce the risk of cardiovascular events. Although diabetic patients undergo revascularization procedures because of acute coronary syndromes or critical limb ischemia, the outcomes are less favorable than in nondiabetic cohorts. CONCLUSIONS: Since most patients with diabetes die from complications of atherosclerosis, they should receive intensive preventive interventions proven to reduce their cardiovascular risk.     

妊娠期糖尿病130例诊治分析

目的:通过筛查早期诊断和治疗妊娠期糖尿病,减少母婴并发症,提高产科质量。方法:回顾性分析我院2008年1月至2008年12月诊治的妊娠期糖尿病130例,与随机选择同期中非妊娠期糖尿病,无内外科并发症的孕妇130例,就产科并发症如妊娠期高血压疾病、羊水过多、胎儿窘迫、巨大儿的发生率与对照组相比。结果:两组病例孕产妇并发症及对胎儿影响无显著性差异。结论:通过早期筛查诊断和治疗妊娠期糖尿病,适当放宽剖宫产指征,可以很好地控制母婴并发症的出现。     

自我尿糖监测在2型糖尿病患者管理中的应用价值

糖尿病是一种威胁人类健康的常见病和多发病,控制和管理不佳会出现多系统并发症,给家庭和社会带来沉重的负担。自我尿糖监测（SMUG）是2型糖尿病患者在日常生活中监测病情、调控饮食、合理用药的重要手段。本文介绍了SMUG的由来和发展演变过程,叙述了其效果和优势,归纳了其影响因素,总结了其使用方法和注意事项。文中指出SMUG作为一种古老的监测技术,因其无痛、价格低廉、患者依从性好,不失为一种适宜的技术;提出在我国基层经济欠发达地区或无法实现血糖监测的人群,应该正确认识SMUG的意义和价值,建议基层医务人员和政府部门要正确引导、支持和推广,同时应鼓励广大专业人员进行相关方面的研究,更好地确定规范的监测方法、标准、应用注意事项等,让这种适宜技术发挥更大的卫生经济学价值。     

SGLT2抑制剂达格列净在心血管疾病中的应用进展

糖尿病与心血管疾病关系密切,治疗糖尿病的药物对心血管预后也有不同的影响。SGLT2抑制剂达格列净是治疗2型糖尿病的新药,目前有较多研究显示其能明显降低心血管风险事件的发生,特别是能明显改善糖尿病伴心力衰竭患者的临床症状、减少住院率和死亡率,还能改善心肌缺血、抑制心肌重塑、降低血压、减轻体重,对血脂、尿酸等均有不同程度的影响。达格列净对心血管系统作用是多方面的,获益也是多方面的,有望成为治疗糖尿病伴心血管疾病的理想药物。     

糖尿病血管重构机制及其药物防治的研究进展

糖尿病是以高血糖为特征的代谢性疾病,糖尿病相关的代谢异常可引起一系列血管并发症,是糖尿病患者死亡的主要原因。糖尿病诱导的血管重构和功能异常是糖尿病血管并发症的主要原因。糖尿病治疗药物二甲双胍、钠-葡萄糖协同转运蛋白2抑制剂、胰高血糖素样肽1受体激动剂、二肽基肽酶4抑制剂以及天然产物和传统中药均可改善血管重构和功能异常,并显著降低糖尿病患者的死亡率。本文对糖尿病血管重构、血管功能障碍的病理机制以及药物疗法的研究进行综述。     

妊娠期糖尿病25例临床分析

目的:探讨妊娠期患者预防糖尿病的措施。方法:以25例妊娠期糖尿病患者作为研究组,非妊娠期糖尿病患者30例作为对照组。用2χ检验。结果:对孕妇影响及新生儿影响方面,研究组与对照组比较,有高度显著性差异(P<0.01)。结论:提示妊娠期糖尿病的母婴并发症明显增加。进行糖尿病筛查,及时发现妊娠期糖尿病,较好控制血糖,加强围生期妊娠期糖尿病孕妇的管理,可降低妊娠期糖尿病母婴的并发症和降低剖宫产率。