老年代谢综合征患者血脂、体重指数及脉压与糖尿病患病情况的关系

目的探讨老年代谢综合征(MS)患者血脂、体重指数(BMI)以及脉压与其糖尿病(DM)患病情况的关系。方法将2011年6月至2014年6月该院收治的老年MS患者220例按是否合并DM分为DM组(n=125)和DM组(n=95)。分析两组空腹血糖(FPG)、血脂、BMI、脉压差等,并对老年MS患者并发DM的危险因素进行单因素和多因素分析。结果 DM组平均FPG、糖化血红蛋白(Hb A1c)、BMI、年龄、总胆固醇(TC)和甘油三酯(TG),均高于DM组,而DM组的脉压低于DM组(P0.05)。单因素分析结果显示,老年MS患者并发DM的危险因素包括TC、TG、年龄、BMI、脉压、高血压等,Logistic回归分析结果显示老年MS患者并发DM的危险因素包括TC、TG、BMI、脉压、高血压等。结论老年MS患者血脂、BMI以及脉压均为其合并DM的危险因素,血脂、BMI以及脉压可用于老年MS患者并发DM的预测。     

代谢综合征患者的血清瘦素

目的观察代谢综合征(MS)患者血清瘦素水平,探讨其与肥胖、糖脂代谢,血压的关系以及瘦素在代谢综合征发病中的作用.方法选取MS患者77例,非MS患者100例,测定瘦素水平并分析其与血压、血糖、血脂及体重指数(BMI),腰围(WC)的相关性.结果代谢综合征组瘦素水平(12.8±4.0)ng/mL明显高于非代谢综合征组(7.7±3.0)ng/mL,瘦素水平随代谢异常组合个数增多而增加,血清瘦素浓度与性别、BMI、WC、血糖、收缩压、舒张压、总胆固醇、甘油三酯呈显著正相关.经多元逐步回归分析,血清瘦素浓度的影响因素为:性别、BMI、WC、血糖和甘油三酯.结论代谢综合征患者血清瘦素水平明显增高,且与性别、体重指数、血脂、血糖相关,瘦素与代谢综合征的诸多指标高度相关,提示高瘦素血症可能是代谢综合征的又一重要组成成分,代谢综合征患者存在瘦素抵抗并可能在代谢综合征发病中扮演重要角色.     

农村地区老年2型糖尿病代谢综合征患者发病危险因素

目的探讨农村地区老年2型糖尿病(T2DM)代谢综合征患者发病危险因素。方法回顾性分析2010年1月至2014年1月该院就诊的235例农村地区老年T2DM患者,其中合并代谢综合征组(MS组,125例)和非代谢综合征组(非MS组,110例),对比分析两组患者的性别、年龄、糖尿病病程、体重指数(BMI)、血压收缩压(SBP)、舒张压(DBP)、血脂〔总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)〕、空腹血糖(FPG)、糖基化血红蛋白(HbA1c)、尿酸(UA)、空腹C肽(FCP)、空腹胰岛素(FINS)、超敏C反应蛋白(hs-CRP)等因素。结果 MS组与非MS组的平均年龄、性别、SBP、DBP、糖尿病病程比较差异无统计学意义(P>0.05);但MS组的体重指数(BMI)显著性高于非MS组患者(P<0.01);MS组FPG、1、2 h的餐后血糖、FINS及胰岛素抵抗(HOMA)均显著性高于非MS组(P<0.01),β细胞功能显著性低于非MS组(P<0.01);MS组血清TC、TG、LDL-C均显著性高于非MS组(P<0.05)、HDL-C显著性低于非MS组(P<0.01);MS组UA、hs-CRP、HbA1c、FCP均显著性高于非MS组(P<0.01)。多因素Logistic回归分析,BMI、UA、TC、TG、LDL-C、HDL-C为最危险因素。结论与非MS组相比,合并MS的农村地区老年糖尿病患者的BMI、UA相对较高,脂质代谢紊乱,更容易出现相关心血管并发症。     

老年代谢综合征患者糖尿病患病情况及影响因素分析

目的探讨老年代谢综合征(MS)患者与糖尿病(DM)患病的关联性,为老年人DM的预测和防治提供依据。方法收集广州某干休所参加体检普查的57例老年MS患者(试验组)和57名正常老年人(对照组)的血糖指标数据,根据空腹血糖受损(IFG)和DM诊断标准,分析观察MS患者中DM患病情况及影响因素。结果试验组的总胆固醇、体质量指数、腰围、三酰甘油、低密度脂蛋白胆固醇(LDL-C)、血糖、血压水平均明显高于对照组,而高密度脂蛋白胆固醇(HDL-C)明显低于对照组(P<0.05或P<0.01)。57例MS患者中,IFG患者9例(5.8%),DM患者8例(14%),与对照组比较,IFG和DM的发生率均有显著增加(P<0.01)。结论 MS为DM的危险因素,加强老年患者的饮食调节和药物降低血脂可能有利于减少DM的发生。     

代谢综合征患者的血清瘦素

目的观察代谢综合征(MS)患者血清瘦素水平,探讨其与肥胖、糖脂代谢,血压的关系以及瘦素在代谢综合征发病中的作用。方法选取MS患者77例,非MS患者100例,测定瘦素水平并分析其与血压、血糖、血脂及体重指数(BMI),腰围(WC)的相关性。结果代谢综合征组瘦素水平(12.8±4.0)ng/mL明显高于非代谢综合征组(7.7±3.0)ng/mL,瘦素水平随代谢异常组合个数增多而增加,血清瘦素浓度与性别、BMI、WC、血糖、收缩压、舒张压、总胆固醇、甘油三酯呈显著正相关。经多元逐步回归分析,血清瘦素浓度的影响因素为:性别、BMI、WC、血糖和甘油三酯。结论代谢综合征患者血清瘦素水平明显增高,且与性别、体重指数、血脂、血糖相关,瘦素与代谢综合征的诸多指标高度相关,提示高瘦素血症可能是代谢综合征的又一重要组成成分,代谢综合征患者存在瘦素抵抗并可能在代谢综合征发病中扮演重要角色。     

代谢综合征各组分与老年人糖尿病关系的队列研究

目的 分析老年人代谢综合征(MS)及各组分与2型糖尿病(DM)发生的关系. 方法 队列研究,2007年对2001年参加调查的人群进行随访.用2005年国际DM联盟(IDF)颁布的全球统一标准诊断MS. 结果 基线MS与DM发生密切相关,RR(95% CI)为4.70(3.23～6.85).MS各组分与DM相关性最密切的是空腹血糖.单因素分析中.当血糖水平≥5.60 mmol/L时,RR(95% CI)高达9.68(6.59～14.23);在多因素分析中,当血糖水平为5.60～6.09 mmol/L时,RR值(95% CI)为5.49(3.38～8.92),而≥6.1 mmol/L时,RR值(95% CI)增大至14.44(9.29～22.44).当MS组分聚集数从1、2、3、4个上升到5个时,RR值可分别从2.92、5.67、12.28、19.52上升至37.83. 结论 MS增加患DM的风险,而空腹血糖增高同为DM发生重要的危险指标.     

北京大兴长子营地区老年糖尿病流行病学调查研究

目的 了解北京大兴农村地区老年糖尿病（DM）和空腹血糖受损（IFG）发生的情况和特点.方法 纳入大兴长子营地区60岁以上人群3036例,通过问卷调查统计糖尿病知晓以及治疗情况、吸烟情况、检查身高和体重,计算体重指数（BMI=体重/身高2）;水银血压计测量血压;酶法检测空腹血糖、总胆固醇（TC）、甘油三酯（TG）、血尿酸（UA）;直接法检测高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）、改良苦味酸法检测血肌酐（Cr）;全自动血液分析仪测定白细胞总数（WBC）和血小板总数（PLT）.结果纳入人群中IFG患者358例、DM患者712例,DM的知晓率、治疗率和控制率分别为64.10%、61.10%和19.94%.DM患者、IFG患者与血糖正常人群的BMI、血压、TC水平均无差异;与血糖正常的人群相比,IFG和DM患者吸烟指数更高,TG、LDL-C、UA、WBC、PLT水平升高（P＜0.05）,DM患者TG高于IFG患者,HDL-C水平低于正常血糖人群.结论 ①大兴长子营地区老年T2DM知晓率和治疗率较高,但控制率较低;②老年T2DM患者较正常血糖人群心血管危险因素更多;③IFG期心血管危险因素与T2DM接近.     

生命网在代谢综合征干预中的临床意义

采用生命网干预治疗2型糖尿病(T2DM)并代谢综合征(MS)患者,评估其体质量指数及(或)腰臀围比值、血压、血糖、血脂、尿微量白蛋白、血尿酸等因素对心血管疾病的影响.结果 人网干预治疗后2 a,各因素评分均明显转归.提示生命网是干预MS患者心血管疾病危险因素的有效方法.     

上海市松江区机关事业单位代谢综合征的流行特征

目的:探讨上海市松江区事业单位代谢综合征(MS)的流行特点。方法:采用整群随机抽样方法对上海市松江区事业单位2 662名20岁以上成人进行问卷调查,并测其身高、体重、血压、空腹血糖、血脂、尿酸。MS诊断采用2004年中华医学会糖尿病学分会制定的标准,了解MS的患病率及发病危险因素。结果:MS标化患病率为13.63%,男性患病率明显大于女性(20.59%比9.11%,P<0.01)。且MS中各组分的患病率男性都显著大于女性(P<0.01)。MS的患病率随着年龄和体质量指数(BMI)的增长而增加。多元回归分析结果表明,BMI、血糖、三酰甘油、收缩压、低密度脂蛋白、舒张压、年龄、血尿酸和血总胆固醇含量均为MS的危险因素。结论:上海市松江区事业单位MS患病率达13.63%,肥胖是MS主要危险因素。     

2型糖尿病患者γ-谷氨酰转肽酶与胰岛素抵抗的相关性

目的 探讨γ-谷氨酰转肽酶(GGT)与2型糖尿病(T2DM)以及胰岛素抵抗(IR)的相关性.方法 选择104例T2DM患者和74例正常人,检测身高、体重、血压、GGT及其他生化指标,比较两组间所测指标的差异性,并分析IR与各因素的相关性.结果 经Pearson相关分析,体重指数(BMI)、SBP、DBP、空腹血糖(FPG)、空腹C肽、尿酸(UA)、GGT、甘油三酯(TG)与胰岛素抵抗指数(IRI)呈正相关,其中GGT与IRI显著相关(r=0.369,P＜0.01),有显著的统计学意义.多元逐步线性回归分析显示血压、BMI、GGT与IR密切相关.结论 在排除其他肝病的影响因素后,GGT可以作为IR的独立预测指标,GGT有可能成为T2DM发生危险因素的预测指标.     

Weight change and blood glucose concentration as markers for pancreatic cancer in subjects with new-onset diabetes mellitus: A matched case-control study

ObjectivesTo evaluate the potential of blood glucose levels and weight change before the onset of diabetes as predictors of pancreatic cancer among subjects with new-onset diabetes, that is, cancer-related diabetes versus normal type 2 diabetes.MethodsWe conducted a case-control study among subjects with new diabetes in the United Kingdom-based Clinical Practice Research Datalink. Cases were pancreatic cancer subjects with diabetes for ≤2 years before the cancer diagnosis (i.e., cancer-related diabetes). Controls were cancer-free, type 2 diabetic subjects matched to cases on age, sex, and diabetes duration. We calculated adjusted odds ratios (aORs) for pancreatic cancer as a function of both weight change and blood glucose before the onset of diabetes.ResultsWeight loss of 10.0%–14.9% at diabetes onset was associated with an aOR for pancreatic cancer of 3.58 (95% CI 2.31–5.54), loss of ≥15.0%, with an aOR of 4.56 (95% CI 2.82–7.36), compared with stable weight. Blood glucose levels of ≤5.1 mmol/L or 5.2–5.6 mmol/L before diabetes onset were associated with an increased risk of a pancreatic cancer diagnosis, with aORs of 2.42 (95% CI 1.60–3.66) and 2.20 (95% CI 1.45–3.35), respectively, when compared with blood glucose levels ≥6.3 mmol/L within >2–3 years before cancer detection.ConclusionsWeight loss as well as blood glucose levels in the normal range (and thus rapid development of hyperglycemia) before diabetes onset may be predictive of pancreatic cancer-related diabetes and may help target which subjects with new diabetes to refer for pancreatic cancer screening examinations.     

Obesity and pancreatic diseases

Obesity is defined as BMI (calculated as weight in kg divided by height in m2) more than 30, and overweight is defined as BMI of 25-29.9. Obesity has been considered as a risk factor for pancreatic diseases, including pancreatitis and pancreatic cancer. Severe acute pancreatitis is significantly more frequent in obese patients. Furthermore, obese patients develop systemic and local complications of acute pancreatitis more frequently. The underlying mechanisms are increased inflammation and necrosis from increased amount of intra- and peri-pancreatic fat. In addition, obesity is a poor prognostic factor in acute pancreatitis, and overweight before disease onset appears to be a risk factor for chronic pancreatitis. Overweight and/or obesity are associated with greater risk of pancreatic cancer and younger age of onset. Physical activity appears to decrease the risk of pancreatic cancer, especially among those who are overweight. Long-standing diabetes increases the risk of pancreatic cancer. The pathogenic mechanism is that obesity and physical inactivity increase insulin resistance. In a state of hypersinulinemia, increased circulating level of insulin-like growth factor-1 induces cellular proliferation of pancreatic cancer. Obesity is associated with negative prognostic factor and increased mortality in pancreatic cancer. However, there are controversies regarding the effects of obesity on long-term post-operative results in the patient with pancreatic cancer.     

Diabetes associated with pancreatic ductal adenocarcinoma is just diabetes: Results of a prospective observational study in surgical patients

BackgroundIdentification of a specific diabetes signature associated to pancreatic ductal carcinoma (PDAC) could be a key to detect asymptomatic, early stage tumors. We aim to characterize the clinical signature and the pathogenetic factors of the different types of diabetes associated with PDAC, based on the time between diabetes and cancer diagnosis.MethodsProspective observational study on 364 PDAC patients admitted to a referral center for pancreatic disease. Hospital and/or outpatient medical records were reviewed. Blood biochemical values including fasting blood glucose, insulin and/or C-peptide, glycosylated hemoglobin and anti-islet antibodies were determined. Diabetes onset was assessed after surgery and during follow-up.ResultsThe prevalence of diabetes in patients was 67%. Considering 174 patients (47.8%) already having diabetes when diagnosed with PDAC (long duration, short duration, concomitant), the clinical and biochemical profile was similar to that of patients with type 2 diabetes (T2D). Diabetes was associated with known risk factors (i.e., age, sex, family history for diabetes and increased BMI) and both beta-cell dysfunction and insulin resistance were present. Considering 70 patients (19.2%) with onset of diabetes after PDAC diagnosis (early and late onset), the strongest predictor was the loss of beta-cell mass following pancreatectomy in patients with risk factors for T2D.ConclusionDifferent types of diabetes according to the time between diabetes and PDAC diagnosis are clinical entities widely overlapping with T2D. Therefore, the success of a strategy considering diabetes onset as a marker of asymptomatic PDAC will largely depend on our ability to identify new diabetes-unrelated biomarkers of PDAC.     

Screen detected subjects with type 2 diabetes and impaired glucose tolerance have more adverse cardiovascular risk than subjects with impaired fasting glucose especially when they are obese: the ADDITION Netherlands study

AIMS: To determine cardiovascular risk of screen detected subjects with type 2 diabetes (T2DM), impaired glucose tolerance (IGT) and impaired fasting glucose (IFG). To examine whether BMI is an effect modifier regarding the relation between level of glucose regulation and cardiovascular risk factors. METHODS: From 2002 to 2003, 29,251 persons, aged 50-70 years, participated in a population-based diabetes screening programme. Diagnosis was based on the 1999 WHO criteria. Characteristics were assessed of 285 subjects with T2DM, 175 with IGT and 218 with IFG. RESULTS: IFG did not resemble IGT and T2DM regarding weight and blood pressure. BMI (kg/m2) was 27.3+/-4.4, 29.5+/-5.7, 30.7+/-5.6 in IFG, IGT, DM, respectively; systolic blood pressure (mmHg) 150+/-25, 161+/-24, 162+/-23; diastolic blood pressure (mmHg) 84+/-12, 89+/-12, 90+/-11. The poorer the glycaemic control, the worse levels of BMI, blood pressure and lipids. When BMI was higher, cardiovascular risk factors were more adverse, especially in subjects with diabetes. CONCLUSIONS: Subjects with IFG had lower blood pressure and weight than subjects with IGT and T2DM suggesting IFG is a condition with less risk to develop cardiovascular diseases. Effect modification by BMI was found.     

Analysis of selected risk factors of coronary artery disease in a healthy population aged 35-55 years

BACKGROUND: This report comprises an analysis of results of examinations performed as a part of a cardiovascular disease prevention programme funded by the National Health Fund. AIM: To determine the relationship between body mass index (BMI) and blood pressure, blood glucose and lipid metabolism abnormalities in an ethnically homogeneous population of males and females aged 35 to 55 years with sense of full health without prior diagnosis of cardiovascular disease or diabetes. METHODS: The study was carried out in the population of a 175,000-resident city during 9 months, involving 1080 subjects (696 females and 384 males) aged 35 to 55 years (mean age - 47.2+/-5.4). The following variables were assessed: systolic and diastolic blood pressure, body weight and height, BMI, fasting blood glucose, total cholesterol, triglycerides and HDL cholesterol levels. RESULTS: The studied male population had significantly higher blood pressure, blood glucose, total cholesterol, triglycerides and lower HDL cholesterol levels compared to age-matched females. The female population was found to have a more prominent relationship between increased BMI and blood pressure, blood glucose and serum cholesterol levels than males. Significant differences in favour of females regarding systolic blood pressure, blood glucose and serum cholesterol failed to be present in the obese women subgroup (no statistically significant differences were found compared to obese males). In females aged 45 to 55 years, significantly higher body weight, blood pressure as well as blood glucose, cholesterol and triglyceride levels were observed than in younger women (35-45 years old). CONCLUSIONS: Overweight and obesity are associated with increase of arterial blood pressure, lipid metabolism disturbances and elevation of blood glucose. The relationship between BMI and studied risk factors was influenced by age and gender. Menopause is associated with increasing body weight and unfavourable evolution of studied risk factors.     

新诊断2型糖尿病患者综合管理6年后的达标情况及影响达标的因素分析

目的 观察新诊断T2DM患者综合管理6年后代谢指标的达标情况并分析其影响因素.方法 157例新诊断T2DM患者专人管理并定期随访,给予综合干预.结果 （1）随访6年后SBP、DBP、FPG、2 hPG、HbA1 c、TG、TC、LDL-C水平较干预前降低,HDL-C升高（P＜0.05）.随访6年后与新诊断时达标率比较,SBP：75.2％vs52.9％,DBP：66.9％vs40.8％,BP：61.8％ vs 33.1％,FPG：59.2％vs19.7％,2hPG：74.5％vs22.9％,HbA1c：52.9％vs29.9％,TC：59.2％vs37.6％,TG：58.6％vs 36.3％,HDL-C：69.4％vs43.3％,LDL-C：52.9％vs29.3％,BMI：42.7％vs38.9％.（2）糖尿病知识得分、运动和血糖监测次数与血糖不达标呈独立负相关.（3）不达标组颈动脉内膜-中层厚度（IMT）增厚发生率高于达标组;不达标组DR、糖尿病慢性肾脏疾病（CKD）发生率高于达标组.结论 长期综合管理可提高T2DM患者血糖达标率.血糖、BP、血脂和BMI不达标可增加糖尿病血管并发症的发生.     

Birth weight and cardiovascular risk factors in an epidemiological study

Summary Low birth weight has been proposed as a risk factor for development of non-insulin-dependent diabetes mellitus, hypertension, and cardiovascular disease in the adult. To ascertain the extent to which birth weight was associated with cardiovascular risk factors, we examined 620 subjects (median age 48 years) in a cross-sectional study. Of these 317 were offspring of diabetic patients and 303 were offspring of non-diabetic control subjects. Known risk factors for development of cardiovascular disease were correlated to birth weight and examined as dependent variables by multiple linear regression. Age, body mass index (BMI), subjects gender along with parental gender, diabetes status of the parents, and birth weight were independent variables. The variance of the risk factors as dependent variables explained by age, gender, and BMI as independent variables was examined and birth weight was added as an independent variable. We found birth weight was inconsistently correlated to the different risk factors in the different groups of subjects. When adjusted for age, BMI, subject's gender, parental gender, and the diabetes status of the parents, birth weight was negatively correlated to fasting blood glucose. In offspring of diabetic patients the explained variance of risk factors did not change as we added birth weight to the model. In offspring of non-diabetic subjects we found that the explained variance of diastolic blood pressure, fasting blood glucose, HbA_IC, and cholesterol increased 1–3 % as birth weight was added to the model. We conclude that birth weight may not be a major risk factor for development of hypertension and cardiovascular disease in our population. [Diabetologia (1996) 39: 1598–1602]     

强化生活方式干预对2型糖尿病疗效观察

目的 探讨在药物治疗的基础上强化饮食、运动干预对2型糖尿病患者疗效的影响.方法 选择无运动禁忌证的2型糖尿病患者65例,随机分为生活方式干预组（32例）和普通治疗组（33例）,检测患者空腹血糖（FPG）、胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、体重指数（BMI）、糖化血红蛋白（HbA1c）及血压等指标,前后自身对照及组间对照评价其治疗效果.结果 （1）与单纯药物治疗组比较,生活方式干预组患者的体重、BMI、舒张压、FPG、HbA1c控制明显优于普通治疗组（P＜0.05）.（2）经过干预治疗后,2型糖尿病患者的体重、BMI、血压、FPG、HbA1c极显著下降（P＜0.01）.结论 严格的饮食控制,适量的运动干预能更有效地控制糖尿病患者血糖、HbA1c、血压和体重等危险因素.     

Role of Metabolic Surgery in Less Obese or Non-Obese Subjects with Type 2 Diabetes: Influence Over Cardiovascular Events

Bariatric surgery was initially developed as a tool for weight reduction only, but it is gaining increasing popularity because of its remarkable effect on glucose metabolism in morbidly obese and less obese patients. Recent publications have shown the good results of metabolic surgery, creating a new field of clinical research that is currently overflowing in the medical community with outstanding high-quality data. In morbidly obese population, there is compelling data on long term cardiovascular risk reduction and mortality, coming from longitudinal prospective studies and systematic reviews. Numbers range from 33 to 92 % of decrease in fatal and nonfatal cardiovascular events . In low body mass index (BMI) diabetics, there is an increasing number of reported good outcomes after metabolic surgery with the aim to treat type 2 diabetes (T2DM). There is scarce information on cardiovascular outcomes in non–morbidly obese subjects, but the extraordinary glucose, lipid and blood pressure control in the published series are suggesting good long-term effects on cardiovascular risk profile and mortality. The papers review was comprehensive, including the available randomized controlled trials, long-term prospective series and systematic reviews.     

Risk of macrovascular and microvascular complications in Type 2 diabetes: results of longitudinal study design

Type 2 diabetes is associated with the increased risk of microvascular and macrovascular complications. The aim of this study was to determine risk factors for the development of long-term complications of Type 2 diabetes. We analyzed medical records of all patients, who came with newly diagnosed Type 2 diabetes to one regional outpatient diabetes clinic from 1980 to 1994 (n=2175). The data, such as fasting plasma glucose, total cholesterol, triglyceride, blood pressure and body mass index (BMI), were assessed. Also, the time from the diagnosis of Type 2 diabetes to the occurrence of complications was obtained. Using the regression model in the survival analysis, we examined which of the risk factors determined the rate of the development of nephropathy, proliferative retinopathy, cardiovascular disease and stroke. Patients with higher fasting plasma glucose and higher mean blood pressure had higher risk of developing nephropathy and proliferative retinopathy. Higher mean arterial blood pressure was associated with higher rate of stroke and cardiovascular disease. High total cholesterol increased the hazard of coronary artery disease and proliferative retinopathy. In conclusion, blood pressure and fasting plasma glucose are major risk factors for microvascular complications in Type 2 diabetes. An increased blood pressure determined the macrovascular complications in Type 2 diabetes, but the effect of increased fasting plasma glucose could not be proved.