Management of intermittent claudication with pentoxifylline: meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the efficacy of pentoxifylline therapy in improving the walking capacity of patients with moderate intermittent claudication. DATA SOURCES: A search of MEDLINE for trials published between 1976 and 1994 inclusive, and a bibliographic review of all articles retrieved. STUDY SELECTION: Randomized, placebo-controlled, double-blind clinical trials were selected that evaluated the pain-free walking distance (the distanced walked on a treadmill before the onset of calf pain) and the absolute claudication distance (the maximum distance walked on a treadmill) among patients with moderate intermittent claudication. Twelve study groups in 11 trials were included in the analysis. DATA EXTRACTION: In addition to information regarding the trial design, patient characteristics, dosages and treatment periods, the means and standard deviations were collected for both the pain-free walking and absolute claudication distances. Trial quality was also assessed. DATA SYNTHESIS: Overall, there was a statistically significant improvement in the pain-free walking distance after pentoxifylline therapy (weighted mean difference 29.4 m [95% confidence interval (CI) 13.0 to 45.9 m]); this finding was based on a total sample of 612 patients (308 in the treatment groups and 304 in the control groups). A significant improvement was also noted in the absolute claudication distance (weighted mean difference 48.4 m [95% CI 18.3 to 78.6 m]); this was based on a total sample of 511 patients (258 in the treatment group and 253 in the control group). In a sensitivity analysis of the pain-free walking distance, significant treatment effects and no statistically significant heterogeneity were found when only trials were included that were "medically eligible" (involved patients with stage II disease and a pain-free walking distance of 50 to 200 m). In a similar sensitivity analysis of the absolute claudication distance, the two conditions resulting in a significant treatment effect and no significant heterogeneity were the inclusion of "medically eligible" trials and those with a shorter treatment duration (13 weeks or less). CONCLUSION: Pentoxifylline therapy may be efficacious in improving the walking capacity of patients with moderate intermittent claudication. However, properly conducted clinical trials are required to provide a true estimate of the benefit.     

丙酮酸钙对小鼠力竭运动能力的研究

[目的]探讨补充3周丙酮酸钙对于小鼠力竭运动能力的影响。[方法]雄性小鼠40只,随机分为4组,分别为安静对照组、运动对照组、丙酮酸钙组、运动丙酮酸钙组。给药组每天灌胃给予600 mg/（kg.d）的丙酮酸钙共3周。3周末进行力竭运动实验,测各组运动至力竭时间,并取右侧腓肠肌组织和肝脏组织分别测肌糖原、肝糖原。[结果]与运动对照组（106.85±24.66）min比较,运动给药组（166.95±31.18）min鼠运动至力竭时间明显延长,运动能力提高,差异有显著性意义（P〈0.001）。运动前丙酮酸钙组肌糖原、肝糖原含量、超氧化物歧化酶（SOD）含量明显高于安静对照组,差异有显著性意义（P〈0.05）。运动力竭后各组肌糖原、肝糖原含量没有明显差异。与运动对照组比较,运动给药组SOD明显升高,差异有显著性意义（P〈0.05）。运动对照组肝脏丙二醛（MDA）的含量均高于其他三组,差异有显著性意义（P〈0.01）;运动给药组MDA含量明显低于运动对照组,差异有非常显著性意义（P〈0.001）。血清钙浓度各组间差异无显著性意义（P〉0.05）。[结论]补充3周丙酮酸钙能明显提高小鼠力竭运动能力,其可能的原因是提高运动前肌糖原和肝糖原水平。     

Insulin adjustment by a diabetes nurse educator improves glucose control in insulin-requiring diabetic patients: a randomized trial

BACKGROUND: Diabetic patients taking insulin often have suboptimal glucose control, and standard methods of health care delivery are ineffective in improving such control. This study was undertaken to determine if insulin adjustment according to advice provided by telephone by a diabetes nurse educator could lead to better glucose control, as indicated by level of glycated hemoglobin (HbA1c). METHODS: The authors conducted a prospective randomized trial involving 46 insulin-requiring diabetic patients who had poor glucose control (HbA1c of 0.085 or more). Eligible patients were those already taking insulin and receiving endocrinologist-directed care through a diabetes centre and whose most recent HbA1c level was 0.085 or higher. The patients were randomly assigned to receive standard care or to have regular telephone contact with a diabetes nurse educator for advice about adjustment of insulin therapy. RESULTS: At baseline there was no statistically significant difference between the 2 groups in terms of HbA1c level (mean [and standard deviation] for standard-care group 0.094 [0.008] and for intervention group 0.096 [0.010]), age, sex, type or duration of diabetes, duration of insulin therapy or complications. After 6 months, the mean HbA1c level in the standard-care group was 0.089 (0.010), which was not significantly different from the mean level at baseline. However, the mean HbA1c level in the intervention group had fallen to 0.078 (0.008), which was significantly lower than both the level at baseline for that group (p < 0.001) and the level for the standard-care group at 6 months (p < 0.01). INTERPRETATION: Insulin adjustment according to advice from a diabetes nurse educator is an effective method of improving glucose control in insulin-requiring diabetic patients.     

Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure: A randomized trial

CONTEXT: Exercise training in patients with chronic heart failure improves work capacity by enhancing endothelial function and skeletal muscle aerobic metabolism, but effects on central hemodynamic function are not well established. OBJECTIVE: To evaluate the effects of exercise training on left ventricular (LV) function and hemodynamic response to exercise in patients with stable chronic heart failure. DESIGN: Prospective randomized trial conducted in 1994-1999. SETTING: University department of cardiology/outpatient clinic in Germany. PATIENTS: Consecutive sample of 73 men aged 70 years or younger with chronic heart failure (with LV ejection fraction of approximately 0.27). INTERVENTION: Patients were randomly assigned to 2 weeks of in-hospital ergometer exercise for 10 minutes 4 to 6 times per day, followed by 6 months of home-based ergometer exercise training for 20 minutes per day at 70% of peak oxygen uptake (n=36) or to no intervention (control group; n=37). MAIN OUTCOME MEASURES: Ergospirometry with measurement of central hemodynamics by thermodilution at rest and during exercise; echocardiographic determination of LV diameters and volumes, at baseline and 6-month follow-up, for the exercise training vs control groups. RESULTS: After 6 months, patients in the exercise training group had statistically significant improvements compared with controls in New York Heart Association functional class, maximal ventilation, exercise time, and exercise capacity as well as decreased resting heart rate and increased stroke volume at rest. In the exercise training group, an increase from baseline to 6-month follow-up was observed in mean (SD) resting LV ejection fraction (0.30 [0.08] vs 0.35 [0.09]; P=.003). Mean (SD) total peripheral resistance (TPR) during peak exercise was reduced by 157 (306) dyne/s/cm(-5) in the exercise training group vs an increase of 43 (148) dyne/s/cm(-5) in the control group (P=.003), with a concomitant increase in mean (SD) stroke volume of 14 (22) mL vs 1 (19) mL in the control group (P=.03). There was a small but significant reduction in mean (SD) LV end diastolic diameter of 4 (6) mm vs an increase of 1 (4) mm in the control group (P<.001). Changes from baseline in resting TPR for both groups were correlated with changes in stroke volume (r=-0.76; P<.001) and in LV end diastolic diameter (r=0.45; P<.001). CONCLUSIONS: In patients with stable chronic heart failure, exercise training is associated with reduction of peripheral resistance and results in small but significant improvements in stroke volume and reduction in cardiomegaly. JAMA. 2000.     

瑞格列奈治疗68例2型糖尿病的疗效观察

目的:探讨瑞格列奈治疗2型糖尿病的临床疗效,并评价其安全性。方法:选取2008年10月～2012年7月我院收治的2型糖尿病患者204例,按数字表法随机分为观察组与对照组,各102例。所有患者在严格控制饮食以及运动疗法的基础上,观察组口服瑞格列奈治疗,对照组给予格列齐特。疗程均为12周,12周后比较两组患者的空腹血糖(FPG)、餐后2h血糖(PBG)、糖化血红蛋白(HbA1c)、体重指数(BMI)及不良反应。结果:治疗后观察组和对照组的FPG、HbA1c较治疗前均有显著下降(P<0.05),组间比较差异无统计学意义(P>0.05);与对照组相比,观察组患者的PBG显著下降(P<0.05);两组疗效比较差异无统计学意义(P>0.05)。观察组低血糖反应发生率明显低于对照组,差异具有统计学意义(P<0.05)。结论:采用瑞格列奈治疗2型糖尿病,降血糖疗效显著,且安全可靠,同时具有良好的顺应性,值得临床推广。     

心肺运动试验在指导2型糖尿病患者精准化运动中的效果

目的:探索心肺运动试验在指导2型糖尿病患者精准化运动中的效果。方法:选择接受心肺运动试验的2型糖尿病患者60例，随机分为对照组和干预组，每组30例。对照组给予患者常规运动指导，干预组根据患者心肺运动试验结果给予精准化指导。运动3个月后，比较两组患者试验前后的糖化血红蛋白（HbA1c）、BMI、峰值摄氧量（VO2peak）、峰值氧脉搏（O2Pulsepeak）、无氧阈（AT）、峰值潮气量（VTpeak）结果，统计患者运动过程中不良事件发生情况。结果:3个月后与基线比较，对照组患者HbA1c、BMI、O2Pulsepeak、VTpeak的变化有显著差异（P＜0.05），VO2peak、AT的变化无差异（均P＞0.05），干预组所有数值变化显著（均P＜0.05）；干预组除HbA1c（P＞0.05）外，其余数值较对照组改善程度明显（P＜0.05）；不良事件中，两组患者低血糖的发生无差异（P＞0.05），对照组心脏危险事件明显高于干预组（均P＜0.05）。结论:两种运动方式均能降低患者血糖水平，但是根据心肺运动试验结果指导2型糖尿病患者的精准化运动，更能有效提高患者心肺功能，减少运动过程中不良事件发生率。     

运动后糖尿病患者下肢经皮氧分压变化的趋势

目的：研究运动对2型糖尿病患者下肢经皮氧分压（ tcpO2）的影响,以探索运动时的tcpO2动态变化对糖尿病患者循环障碍的诊断价值。方法：用踩踏功率自行车运动干预方法观察了12例2型糖尿病患者（24条下肢）以及3名正常成人（6条下肢）腓肠肌tcpO2的变化情况,同时检测静息状态下的踝肱比（ ABI）和定量振动阈值（ QST）。根据患者ABI水平将患者肢体分成＞0.9而≤1.3亚组、0.7～0.9亚组和＜0.7亚组3组,比较分析各组tcpO2变化情况。结果：所有糖尿病患者的tcpO2水平在运动过程中均出现下降趋势,而正常组则出现上升趋势。在静息状态下,tcpO2运动前后的变化值与ABI呈线性相关,但与QST并无线性关系。在ABI＞0.9而≤1.3亚组tcpO2在运动早期出现轻度升高,但随即下降到基础水平;在ABI为0.7～0.9亚组,tcpO2在运动初期即出现下降;在ABI＜0.7亚组则出现快速下降。结论：在运动中测量tcpO2水平有助于对糖尿病患者微循环储备功能的判断。     

Type 2 diabetes in Singapore: the role of exercise training for its prevention and management

The prevalence of type 2 diabetes has been increasing in Singapore and is a major risk factor for cardiovascular disease. Exercise training is an important therapeutic modality for managing glycaemic control and improving cardiovascular health among persons with type 2 diabetes. It may also help to prevent or delay the onset of this harmful condition. This review examines the evidence and possible mechanisms by which exercise training produces these benefits, and gives a brief review of appropriate exercise activities.     

2型糖尿病患者甲状腺激素水平的临床分析

【目的】分析2型糖尿病患者甲状腺激素水平与糖化血红蛋白和尿微量白蛋白/肌酐比值的关系,探讨糖尿病和甲状腺疾病的关系。【方法】选取2010年1月-2012年5月在住院的2型糖尿病患者527例,分别以HbA1C、尿A/C分组,测定FT3、FT4、TSH、HbA1c、尿A/C。【结果】随着HbA1C升高FT3逐渐降低,TSH逐渐升高,各组之间统计均有差异,而HbA1C≤7.0%组与HbA1C≥10.0%组有显著差异（P〈0.01）;随着尿A/C的升高FT3逐渐降低,TSH逐渐升高,各组之间统计均有差异,而尿A/C〈30 mg/g组与尿A/C≥300 mg/g组有显著差异（P〈0.01）。【结论】2型糖尿病患者甲状腺激素水平的变化与HbA1C及尿A/C密切相关。 更多还原     

中医药治疗2型糖尿病合并抑郁的系统评价

[目的]系统评价中医药治疗2型糖尿病合并抑郁的临床疗效与安全性。[方法]计算机检索维普数据库、中国知网、万方数据库、中国生物医学文献数据库、Pubmed、Cochrace Library,纳入中医药治疗2型糖尿病合并抑郁的随机对照试验,检索时限均从建库至2015年12月,对纳入研究的资料进行评价,用Rev Man 5.3软件进行分析。[结果]共纳入符合要求的9篇文献,合计593例患者。Meta分析结果显示,与对照组相比,中医药治疗2型糖尿病合并抑郁在总有效率、用药后汉密尔顿(HAMD)评分变化:糖化血红蛋白(Hb A1c)变化水平:不良反应方面具有一定的优势,差异均有统计学意义。[结论]现有研究文献表明试验组对2型糖尿病合并抑郁在总有效率、HAMD、Hb A1c变化方面优于对照组,同时在不良反应发生率方面,低于对照组。     

2型糖尿病患者的个体化运动处方

运动对控制2型糖尿病具有重要作用,运动治疗是现代糖尿病管理的主要内容之一.2010年岁末,美国运动医学会和美国糖尿病协会联合发表2型糖尿病运动最新指南,中华医学会糖尿病分会也在<中国2型糖尿病防治指南>中对运动进行明确规定.指南的落实需要个体化的运动处方和运动方案.本文对个体化运动处方的制定、抗阻运动、糖尿病并发症患者...     

Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study

OBJECTIVE: To assess the effectiveness of the management of type 2 diabetes in an urban Australian setting. DESIGN AND SETTING: The Fremantle Diabetes Study (FDS), a community-based longitudinal observational study. PATIENTS: 531 FDS participants with type 2 diabetes, with mean age, 62.4 years (95% CI, 40.9-79.3 years), 54% male, median diabetes duration 3.0 years (interquartile range [IQR], 0.7-7.0 years), with valid data from the baseline FDS assessment and five subsequent annual reviews between 1993 and 2001. MAIN OUTCOME MEASURES: Glycated haemoglobin (HbA(1c)) levels at annual review visits before and after change in blood glucose-lowering therapy. RESULTS: Over 2893 patient-years of follow-up, 97 patients (18%) progressed from dietary management to therapy with oral hypoglycaemic agents (OHA), and 45 (9%) progressed from OHA to insulin therapy, after a median duration of diabetes of 4.0 years (IQR, 2.9-5.5 years) and 8.1 years (IQR, 5.5-13.0 years), respectively. Median HbA(1c) concentrations (IQR) at the review before OHA or insulin were started were 7.7% (6.9%-8.8%) and 9.4% (8.0%-10.7%), respectively. At the next annual review, HbA(1c) levels in the two groups had fallen to 7.4% (6.5%-8.1%) and 7.9% (7.2%-9.5%), respectively (P < or = 0.001). Intensification of therapy was associated with beneficial changes in serum lipid profiles, but not with an increase in frequency of hypoglycaemia. CONCLUSIONS: Most Australian patients with type 2 diabetes may be spending most of the duration of their disease with suboptimal glycaemic control (HbA(1c) > 7.0%), despite the availability of a range of effective therapies, including insulin.     

Exercise in prediabetes

Exercise as a therapeutic modality in the management of type 2 diabetes is well established. However, exercise has emerged as an important tool to prevent, or at least, to delay the onset of type 2 diabetes. This has been borne out by a few recent clinical trials. Exercise improves insulin sensitivity besides having beneficial effects on many cardiovascular risk factors. A sedentary adult at high risk for developing diabetes may benefit from at least 30 minutes of daily moderate-intensity exercise.     

运动对1型糖尿病大鼠心肌细胞中磷酸受纳蛋白表达的影响

目的观察运动对1型糖尿病大鼠心肌细胞中磷酸受纳蛋白（PLB）表达影响及其意义。方法40只健康SD大鼠随机分为正常对照组、运动对照组、糖尿病组及糖尿病＋运动组4组,每组10只。糖尿病大鼠模型复制成功后第4天开始跑台运动,于运动第4周末心脏采血收集血清,放射免疫法测定血清胰岛素水平,RT—PCR和Western-blotting法检测心肌细胞中磷酸受纳蛋白的表达。结果与正常对照组比较,糖尿病组血糖、糖化血清蛋白水平升高（P〈0．01）,血清胰岛素水平降低（P〈0．01）,心肌细胞PLB mRNA和蛋白表达无显著变化（P〉0．05）,糖尿病＋运动组血糖及糖化血清蛋白水平均升高（均P〈0．01）,心肌细胞中PLB mRNA和蛋白表达上调（P〈0．01）。与糖尿病组比较,糖尿病＋运动组血糖及糖化血清蛋白水平均降低（均P〈0．05）,PLB mRNA和PLB蛋白表达水平均升高（均P〈0．05）。结论运动对1型糖尿病大鼠心肌损伤有防治作用,其机制与运动能上调PLB基因表达可能有关。     

运动康复疗法对糖尿病患者的影响

目的：观察运动疗法对2型糖尿病患者体重指数、血糖、糖化血红蛋白、胰岛素水平的影响。方法将入选的40例2型糖尿病患者随机分为治疗组和对照组,每组20例,对照组仅给予单纯药物治疗,治疗组在常规药物治疗基础上辅以每周3~4次有氧运动,训练45 min。分别于治疗前和治疗后的第2,4,6,8周检测各项相关指标变化。结果治疗组患者的体重指数均较对照组明显降低（P〈0.01）,空腹血浆胰岛素水平亦下降（P〈0.05）。结论运动疗法能明显改善2型糖尿病患者的体重指数、血糖、糖化血红蛋白、胰岛素、甘油三酯、总胆固醇等指标,对糖尿病患者的恢复具有重要意义。     

2型糖尿病视网膜病变的相关因素分析

目的探讨2型糖尿病患者糖尿病视网膜病变(DR)的相关危险因素。方法测定225例2型糖尿病患者糖化血红蛋白(HbA1c)、血糖、血压、血脂、尿微量白蛋白(UAER)等各项生化指标并检测眼底,根据眼底病变程度将患者分为糖尿病无视网膜病变组(NDR)、背景期视网膜病变组(NPDR)及增殖期视网膜病变组(PDR),比较各组糖尿病病程、HbA1c、血糖、血压、血脂及UAER与DR的关系。结果NDR组150例(66.7%),NPDR组63例(28.0%),PDR组12例(5.3%);单因素分析显示年龄、病程、UAER、SBP和DBP在3组中差异有显著性(P<0.05),而在HbA1c、BMI、FPG、FINS、TG、TC、LDL-C和Homa-IR差异无显著性(P>0.05);Logistic回归显示病程、UAER、DBP是DR的独立危险因素。结论糖尿病病程、UAER、DBP与DR密切相关,是DR的独立危险因素。     

短期胰岛素泵强化治疗对初诊2型糖尿病患者预后及胰岛β细胞功能的影响

[目的]观察经2周短期应用胰岛素泵治疗的初诊2型糖尿病(T2DM)1年后的血糖控制情况、胰岛β细胞功能及胰岛素敏感性变化。[方法]初诊2型糖尿病患者32例经持续皮下胰岛素输注(CSII)强化治疗2～4周后,继之分别以胰岛素、口服降糖药(OHA)、单纯生活方式控制血糖,观察1年后的血糖控制情况、胰岛β细胞功能及胰岛素敏感性的差别。[结果]CSII治疗2周期间胰岛素用量差异有显著性意义(P<0.05);3组治疗后1年的FPG、2hPBG、HbA1c、FCP、2hCP、HOMA-β、HOMA-IR平均值各组间比较,差异无显著性意义(P>0.05);1年后转归为:18例(56.25%)仅予生活方式干预;14例(43.75%)予OHA,无1例应用胰岛素。[结论]对伴有明显高血糖的初诊T2DM患者应用短期CSII治疗,1年后不需再用胰岛素治疗,且多数患者不需应用任何降糖药物,仍可获得满意血糖控制,胰岛β细胞功能得到恢复。     

糖尿病合并肺结核患者相关因素分析

目的:探讨糖尿病患者并发肺结核的相关因素,为临床糖尿病患者肺结核的防治提供客观证据。方法:选择2型糖尿病合并肺结核患者87例作为观察组,单纯2型糖尿病患者84例作为对照组,对比两组糖尿病病程、血糖控制情况、近3个月糖化血红蛋白(HbA1c)、糖尿病家族史、饮食情况、糖尿病并发症、饮酒、吸烟、结核病传染源接触史、结核病家族史、近3月来应激事件、日常体育锻炼、体重指数等因素之间的差异。结果:观察组与对照组在糖尿病家族史、是否饮酒、近3个月内应激事件等方面无统计学差异(P均>0.05);在糖尿病病程、日常血糖控制、HbA1c、饮食控制、糖尿病并发症、是否吸烟、结核接触史、结核家族史、日常体育锻炼、体重指数等方面差异显著(P均<0.05),具有统计学意义。其中日常血糖控制、饮食控制、糖尿病并发症、是否吸烟、结核接触史、结核家族史、日常体育锻炼等为糖尿病合并肺结核的独立危险因素。结论:严格控制血糖及饮食、积极治疗并发症、戒烟、加强肺结核相关知识的宣传教育、坚持适当体育锻炼对糖尿病合并肺结核的预防具有重要意义。