门冬胰岛素30不同次数注射治疗2型糖尿病疗效差异观察

目的：观察门冬胰岛素30不同次数注射治疗2型糖尿病的疗效差异。方法选取2010年4月~2013年7月于本院采用门冬胰岛素30治疗的70例2型糖尿病患者为研究对象，将其随机分为A组（每天2次皮下注射组）35例和B组（每天3次皮下注射组）35例，然后将两组患者血糖控制总有效率及治疗前与治疗后的血糖、糖化血红蛋白水平、低血糖发生率进行统计及比较。结果 B组治疗后的血糖控制总有效率均高于A组，血糖、糖化血红蛋白水平则低于A组，而低血糖发生率也低于A组，差异均有统计学意义（P均＜0.05）。结论门冬胰岛素30每天3次皮下注射治疗2型糖尿病疗效的疗效相对较好，且低血糖的发生率也相对较低。     

胃癌合并2型糖尿病消化道重建后血糖变化观察

目的：观察采用不同消化道重建术式对于胃癌合并2型糖尿病患者术后血糖变化的影响。方法：胃癌合并2型糖尿病并行胃癌根治术患者共52例,根据术中消化道重建方式不同将上述患者分为3组,采用BillrothⅠ式吻合术22例为A组,采用BillrothⅡ＋Braun式吻合术18例为B组,采用Roux-en-Y吻合术12例为C组。观察所有患者术前﹑术后1个月﹑术后6个月﹑术后1年的空腹血糖（FBG）及餐后2 h血糖（2hPG）情况。结果：B、C组术后1个月、6个月及1年的FBG及2hPG均优于同时相点的A组（P〈0.01）;术后1年A、B和C组血糖控制有效率分别为22.7%、72.2%和75.0%,B、C组与A组比较,差异有统计学意义（P〈0.0167）。结论：采用BillrothⅡ＋Braun式吻合术或Roux-en-Y吻合术可有效降低胃癌合并2型糖尿病患者术后血糖水平。     

Roux-en-Y胃肠道重建手术对胃癌合并2型糖尿病患者血糖控制及胰岛素抵抗的影响

【摘要】〓目的〓探讨Roux?鄄en?鄄Y消化道重建手术对胃癌合并糖尿病患者血糖控制及胰岛素抵抗的影响。方法〓选择我院普外科住院的胃癌合并2型糖尿病患者31例,行胃癌根治及Roux?鄄en?鄄Y吻合消化道重建术,对比患者术前及术后6个月体重、体质指数(BMI)、空腹血糖(FPG)、空腹胰岛素(FINS)、空腹C肽(FCP0、餐后2小时血糖(2hPG)、餐后2小时胰岛素(2hINS)、餐后2小时C肽(2hCP)、糖化血红蛋白(HbA1c)及胰岛素抵抗指数(HOMA?鄄IR)等指标变化。结果〓术前31例患者中27例给予胰岛素治疗,2例给予口服药物治疗,2例给予单纯饮食运动控制血糖。术后6个月随访,14例患者继续给予胰岛素治疗,6例口服药物治疗,11例未使用任何降糖药物单纯饮食运动控制血糖良好,术前与术后间差异有统计学意义(P<0.05)。术后6个月研究对象体重、BMI、FPG、2hPG、FINS、2hINS、HbA1c及HOMA?鄄IR均明显低于术前水平(P<0.05),但术后6个月患者FCP及2hCP水平高于术前(P<0.05)。结论〓Roux?鄄en?鄄Y胃肠道重建术能改善胃癌合并2型糖尿病患者的血糖控制,减轻胰岛素抵抗。     

异体大鼠骨髓单个核细胞胰岛细胞移植治疗糖尿病

目的 观察异体骨髓单个核细胞和胰岛细胞通过肝脏和静脉途径移植后对糖尿病大鼠的治疗作用.方法 密度梯度离心法分离胰岛细胞,淋巴细胞分离液分离骨髓单个核细胞,28只糖尿病大鼠模型随机分为A、B、C、D组,A组在肝脏被膜下多点注射1000个胰岛细胞,B组在体外将1000个胰岛细胞和1×107个骨髓单个核细胞混合后在肝脏被膜下多点注射,C组通过尾静脉注射1000个胰岛细胞,D组在体外将1000个胰岛细胞和1×107个骨髓单个核细胞混合后通过尾静脉注射,移植后于不同时间点尾静脉测定随机血糖,比较不同细胞组合和移植途径之间对糖尿病的治疗作用.结果 A、B组血糖于术后3 d内开始下降,A组血糖可降至正常水平(7.98±2.28)mmol/L,血糖维持正常水平(3.71±0.95)d,B组降至(7.72±1. 75)mmol/L可维持(4.86±1.06)d,静脉移植组血糖于术后4 d内降至正常(7.35±1.40)mmol/L,可维持(7.85±1.46)d,D组静脉注射胰岛于4 d起效(7.00±0.83)mmol/L,血糖可降至正常水平可维持(14.10±1.21)d,各组间血糖随时间变化的趋势及维持正常水平的时间具有统计学意义(P＜0.05).结论 骨髓单个核细胞和胰岛混合细胞通过尾静脉移植对大鼠血糖维持正常时间最长,血糖控制水平最理想.     

老年2型糖尿病患者糖化血红蛋白及尿白蛋白与骨密度变化的分析

目的观察2型糖尿病老年男性患者血糖水平、糖化血红蛋白（HbAlc）、尿白蛋白排泄率（AER）与骨密度（BMD）变化的关系。方法老年2型糖尿病男性患者68例，对照组23例，分别测定血糖、HbAlc、AKP、Cr、尿AER值、骨密度。糖尿病患者根据HbAlc〈7％为Ⅰ组，若AER〈200μg／min为ⅠA组，AER〉200μg／min为IB组。HbAlc〉7％为Ⅱ组，若AER〈200μg／min为ⅡA组，AER〉200μg／min为ⅡB组。结果糖尿病组与对照组相比，骨密度显著降低（P〈0．01），糖尿病组ⅡB组BMD明显低于ⅡA组、ⅠA组、ⅠB组（P〈0．05）。结论糖尿病患者BMD比正常人显著降低，血糖控制不达标并AER升高患者的BMD下降比血糖控制达标尿蛋白阴性患者更为显著。     

早期胰岛素强化治疗2型糖尿病的临床疗效分析

目的:分析研究早期胰岛素强化治疗2型糖尿病的临床疗效及安全性.方法:将64例新诊断的2型糖尿病患者随机分为观察组和对照组各32例,观察组给予胰岛素强化治疗,对照组给予口服降糖药物治疗,两组疗程均为8周,观察两组临床效果.结果:治疗后空腹血糖、餐后2h血糖、糖化血红蛋白、糖化血清蛋白、体重指数和空腹C肽水平与治疗前比较均有改善,与对照组比较差异有统计学差异(P＜0.05).结论:早期胰岛素强化治疗2型糖尿病临床效果较好,使用安全,能有效控制血糖,减少并发症,提高了患者的生活质量.     

自体造血干细胞移植治疗1型糖尿病患者的护理

对8例1型糖尿病患者行自体造血干细胞移植治疗．包括CTX方案外周血造血干细胞的动员、干细胞的采集、CTX加ATG方案预处理及干细胞回输4个过程。结果8例1型糖尿病患者移植术后造血功能重建．步行出仓转内分泌科继续监测血糖。提示自体外周血干细胞移植治疗1型糖尿病是一种治疗与免疫有关的1型糖尿病的新方法，做好心理护理、严格执行无菌操作、加强基础护理、预防感染、密切观察病情变化是治疗成功的根本保证。     

早期短程胰岛素强化治疗新诊断2型糖尿病的临床观察

目的:观察短期胰岛素强化治疗初诊的2型糖尿病患者的疗效.方法:将新诊断的2型糖尿病患者70例随机分为两组,治疗组35例予胰岛素强化治疗,对照组35例给予口服降糖药物治疗,比较两组治疗前后空腹血糖(FPG).餐后2 h血糖(2hPG).糖化血红蛋白(HbAlc).空腹胰岛素(FINS).胰岛素抵抗指数(HOMA-IR)和胰岛素分泌指数(HOMA-β).结果:治疗后两组的血糖均下降,且控制在理想水平,但治疗组血糖达标时间较对照组明显快,差异有显著性(P＜0.05);两组胰岛β细胞功能指数均有改善,但治疗组较对照组改善明显,治疗组FINS.HOMA-β功能指数较对照组升高明显,差异有显著性(P＜0.05).结论:短期胰岛素强化治疗可更快速控制血糖达理想目标,显著改善胰岛β细胞分泌功能,比常规口服降糖药物更具优势.     

造血干细胞移植治疗1型糖尿病

1型糖尿病(type 1 diabetes mellitus,T1DM)是一种T细胞介导的胰腺β细胞破坏的自身免疫疾病,具有较高的发病率和死亡率.胰岛素的使用只是控制患者血糖水平,延缓糖尿病进展并不能治愈糖尿病.供体的短缺及预防排斥的长期免疫抑制限制了胰腺及胰岛细胞的移植.随着国内外对造血干细胞的深入研究,造血干细胞移植治疗1型糖尿病有着广泛的应用前景.     

药物联合饮食调控对脑梗死患者血浆同型半胱氨酸水平的影响

目的:饮食控制联合药物应用与单纯口服药物对脑梗死患者血浆同型半胱氨酸(Hcy)水平的影响。方法:将112例具有高Hcy血症的脑梗死患者随机分为A组(54例)、B组(58例),分别采用药物联合饮食调控治疗和单纯药物治疗。2周及4周后检测Hcy浓度。结果:A组、B组干预治疗4周,Hcy水平分别为12.23±3.72,18.84±3.90,均低于治疗前(均P<0.05),组间比较差异有统计学意义(P>0.05)。结论:饮食控制联合药物干预可更好的纠正高同型半胱氨酸血症。     

高分辨率CT观察不同来源干细胞移植治疗B型尼曼-皮克病儿童肺间质病变效果

目的 采用高分辨率CT （HRCT）观察不同来源干细胞移植治疗B型尼曼-皮克病（NPD）患儿肺间质病变的效果。方法 回顾性分析6例B型NPD患儿接受造血干细胞移植前后肺部HRCT资料,其中3例接受非亲缘脐带血干细胞移植治疗,3例接受亲缘单倍体骨髓+外周血干细胞移植治疗;于3个层面（主动脉弓层面、气管隆嵴层面及右膈顶层面）观察移植前后肺间质病变（表现为小叶间隔增厚、小叶中心阴影和小叶内线3种CT征象）累及范围并进行评分,计算各征象评分变化速率及征象评分均值变化速率。结果 接受干细胞移植后,6例患儿肺间质病变评分均较移植前呈明显下降趋势;其中3例接受非亲缘脐带血干细胞移植者肺部小叶间隔增厚、小叶中心阴影和小叶内线的征象评分变化速率及征象评分均值变化速率平均值（1.16分/月、1.33分/月、1.11分/月、1.24分/月）均高于3例接受亲缘单倍体骨髓+外周血干细胞移植者（1.14分/月、0.86分/月、0.88分/月、1.03分/月）。结论 干细胞移植可改善B型NPD患儿肺间质病变;非亲缘供体脐带血干细胞移植可能较亲缘单倍体移植治疗效果更佳。     

Tapering off prednisolone and cyclosporin the first year after renal transplantation: the effect on glucose tolerance.

BACKGROUND: Glucose intolerance is an untoward side effect of some immunosuppressive and anti-hypertensive drugs. The primary aim of the present prospective observational study was to test the hypothesis that tapering off prednisolone and cyclosporin (CsA) the first year after transplantation may have beneficial effects on glucose tolerance in renal transplant recipients. METHODS: Ninety-one non-diabetic recipients were included, and 87 patients underwent a 75 g oral glucose tolerance test both 10 weeks and 1 year after renal transplantation. The change over time in 2-h blood glucose was compared with a number of variables potentially influencing glucose tolerance. RESULTS: The proportion of glucose intolerant recipients was reduced from 55 to 34% during the study. Univariate linear regression analysis showed a significant association between the reduction in daily prednisolone dose down to 5 mg and decline in blood glucose (P=0.001), whereas weight gain was associated with increasing blood glucose (P=0.031). Each 1-mg reduction of prednisolone dose leads to an estimated decline in 2-h blood glucose of 0.12 mmol/l based on the multiple linear regression model (P=0.003). Twelve out of 22 patients with post-transplant diabetes mellitus (PTDM) at baseline improved to normal or impaired glucose tolerance. Ten PTDM-subjects who remained diabetic 1 year after transplantation had lower serum insulin levels during the oral glucose challenge, and five patients treated with anti-diabetic drugs at baseline required hypoglycaemic drugs also at follow up. The decline in CsA level of 100 microg/l and the lower number of patients treated with beta-blockers at follow-up, did not alter glucose tolerance significantly. CONCLUSIONS: Tapering off prednisolone, but not CsA, significantly improves glucose tolerance during the first year after renal transplantation.     

不同血糖浓度2型糖尿病患者胃转流Roux-en-Y吻合术疗效的研究

目的：观察不同空腹血糖（FPG）水平2型糖尿病（T2DM）患者胃转流Roux-en-Y吻合术（RYGBP）术后血糖变化及转归情况。方法：前瞻性选取胃部疾病合并T2DM患者行胃部分或全胃切除,残胃食管近端空肠Roux-en-Y吻合术25例,根据入院时FPG水平分为3组：A组（7.0 mmol/L≤FPG〈11.1 mmol/L）、B组（11.1 mmol/L≤FPG〈15.0 mmol/L）、C组（FPG≥15.0 mmol/L）。检测各组术前（0周）、术后1、4、8、12、24周FPG水平,评估患者术后转归情况。结果：各组术后FPG较术前均有明显下降（P〈0.01）,术后24周A组与C组比较,B组与C组比较,差异均有统计学意义（P〈0.01）;A组与B组比较,差异无统计学意义（P〉0.05）。所有患者RYGBP术后T2DM均有不同程度的改善,治愈率为72%。结论：从血糖改善方面评估,RYGBP对所有T2DM患者均有不同程度的改善,但FPG水平过高时控制效果较差。     

外源性胰岛素在老年2型糖尿病患者骨质疏松治疗中的作用

目的观察2型糖尿病患者骨质疏松患者治疗中,外源性胰岛素和口服降糖药物治疗对骨代谢、骨密度的不同影响。方法收集2013年8月至2015年8月在本院就诊的2型糖尿病合并骨质疏松患者98例,随机分为2组。A组阿仑膦酸钠、维D_3片联合胰岛素(诺和灵30R)治疗组,B组阿仑膦酸钠、维D_3片联合口服降糖药物(亚莫利)组。记录两组患者治疗前后第12周、24周、52周的空腹血糖(FPG)、糖化血糖蛋白(HbAlC)、体重指数(BMI)、碱性磷酸酶(AKP)、N端骨钙素(N-MID)、25(OH)D_2+D_3、血钙(Ca)及骨密度(BMD),并分析治疗后两组结果的差异。结果两组患者治疗第后12周FPG及Hb Alc较治疗前均显著下降(P0.05)。治疗后第24周,两组患者25(OH)D_2+D_3、体重指数(BMI)及骨密度(BMD)较治疗前显著增加(P0.05),A组较B组更明显(P0.05)。治疗后第52周,A组患者体重指数(BMI)、血钙(Ca)、25(OH)D_2+D_3、骨密度(BMD)较治疗前显著增加(P0.05),B组患者25(OH)D_2+D_3、血钙及骨密度(BMD)较治疗前显著增加(P0.05),A组患者体重指数(BMI)及骨密度(BMD)较B组显著增加(P0.05)。结论外源性胰岛素治疗较口服降糖药物在骨代谢、骨密度增高方面更有益。     

Effect of Liver Transplantation on Glucose Levels in Patients with Prediabetes or Type 2 Diabetes

Background

Liver transplantation (LT) may induce the occurrence of diabetes mellitus. It can be speculated, however, that the LT may have a beneficial effect on glucose metabolism. We therefore conducted a study to examine the changing trends in blood glucose levels before and after LT in patients with prediabetes or type 2 diabetes.

Methods

In this observational study, we enrolled 47 patients (38 prediabetes and 9 diabetes) who underwent LT. We compared the blood glucose levels between the pre-transplantation (24 months) and the post-transplantation (36 months) periods and analyzed the diverse factors affecting glucose levels.

Results

The glucose regulation worsened and insulin dose increased in patients with diabetes, which was notably seen during the steroid maintenance period. Following steroid withdrawal, however, there was a decrease in the insulin dose in 55.6% of the patients, and 33.3% of the patients converted from insulin to oral agents. Of the patients with prediabetes, 55.3% developed new-onset diabetes after transplantation (NODAT). However, 18.4% achieved a recovery of glucose levels to normal range. Of the 21 NODAT patients, 52.4% achieved a recovery of glucose level to the prediabetes range after steroid withdrawal. There was a significant correlation between the old age and the persistence of NODAT (P < .05).

Conclusions

LT may have a diverse effect on glycemia, which may lead to changes in glucose control methods. Therefore, glucose metabolism after LT may need to be differentiated by the underlying glucose disturbance status and the time after LT with or without steroid maintenance period.     

胃大部切除术对非肥胖2型糖尿病的治疗作用

目的:为明确胃大部切除术对非肥胖2型糖尿病及糖尿病前期患者的治疗作用,并探讨其作用机制。方法:回顾分析2001年1月至2007年5月收入山东大学齐鲁医院普外科接受过胃大部切除术的糖尿病及糖尿病前期患者的临床资料,分析患者的体重指数,比较术前、术后5d以及术后3个月血糖的变化情况及维持正常范围血糖所应用降糖药物的剂量变化。结果:接受胃大部切除术的糖尿病及糖尿病前期患者61例,体重指数(BMI)≤(24.25±3.06)kg/m2。围手术期未应用治疗性胰岛素和其他口服降糖药物的患者,其术后5d及术后3个月血糖水平较术前明显降低;应用治疗性胰岛素和其他口服降糖药物的患者,术后用药剂量减少。结论:胃大部切除术对改善非肥胖2型糖尿病患者的糖代谢有明显的效果。并且采用胃旁路吻合的患者比采用非胃旁路吻合患者糖代谢改善率显著提高。     

Perioperative management of diabetes in patients undergoing bariatric and metabolic surgery: a narrative review and the Cleveland Clinic practical recommendations

Bariatric and metabolic surgery is an effective treatment for patients with severe obesity and obesity-related diseases. In patients with type 2 diabetes, it provides marked improvement in glycemic control and even remission of diabetes. In patients with type 1 diabetes, bariatric surgery may offer improvement in insulin sensitivity and other cardiometabolic risk factors, as well as amelioration of the mechanical complications of obesity. Because of these positive outcomes, there are increasing numbers of patients with diabetes who undergo bariatric surgical procedures each year. Prior to surgery, efforts should be made to optimize glycemic control. However, there is no need to delay or withhold bariatric surgery until a specific glycosylated hemoglobin target is reached. Instead, treatment should focus on avoidance of early postoperative hyperglycemia. In general, oral glucose-lowering medications and noninsulin injectables are not favored to control hyperglycemia in the inpatient setting. Hyperglycemia in the hospital is managed with insulin, aiming for perioperative blood glucose concentrations between 80 and 180 mg/dL. Following surgery, substantial changes of the antidiabetic medication regimens are common. Patients should have a clear understanding of the modifications made to their treatment and should be followed closely thereafter. In this review article, we describe practical recommendations for the perioperative management of diabetes in patients with type 2 or type 1 diabetes undergoing bariatric surgery. Specific recommendations are delineated based on the different treatments that are currently available for glycemic control, including oral glucose-lowering medications, noninsulin injectables, and a variety of insulin regimens.     

Atrial natriuretic peptide in diabetic and nondiabetic patients with and without heart transplantation

BACKGROUND: Natriuretic peptides are useful markers for risk stratification of patients with heart disease. However, conflicting results have been reported about circulating atrial natriuretic peptide (ANP) concentration in heart transplant recipients. METHODS: To ascertain the effects of diabetes and acute insulin administration on plasma ANP concentrations in a model of heart denervation, we studied 12 diabetic (D-OHT) and 6 nondiabetic heart-transplanted (OHT) patients using the euglycemic-hyperinsulinemic clamp and oral glucose tolerance tests. Five patients with type 2 diabetes without heart transplantation (D) and 9 healthy subjects (NOR) matched for anthropometric features served as the controls. RESULTS: Means baseline plasma ANP concentration was higher in D-OHT (82 +/- 15 pg/mL) than in OHT or NOR (27 +/- 4 or 30 +/- 5; P < .01), but was not different than D (69 +/- 12; P = .82). During the clamp plasma ANP showed similar increases in all groups (49 +/- 4, 39 +/- 3, 59 +/- 4, and 49 +/- 3% in D-OHT, OHT, D, and NOR; P < .02 vs basal, P = NS among groups). Plasma osmolarity and catecholamines were also not different among groups and did not increase during the clamp. Fasting plasma ANP concentrations correlated with plasma glucose concentrations measured 120 minutes after oral glucose tolerance testing. CONCLUSIONS: Among heart transplantation recipients fasting plasma ANP concentrations were not different at 5 to 6 years after the surgical procedure than in nondiabetic controls. Increased ANP concentrations were observed among recipients with diabetes and among nontransplanted diabetic patients. Although the insulin-induced increment in ANP concentrations was not different among groups, circulating ANP was strongly associated with glucose tolerance status.     

Type 2 diabetes mellitus and insulin resistance: Stroke prevention and management

Opinion statement Clinically recognized disorders of glucose metabolism include impaired fasting glucose, impaired glucose tolerance (both termed prediabetes), and diabetes mellitus. Type 2 diabetes mellitus affects 6% to 13% of adults in the United States. Among patients with recent stroke, 70% will have known diabetes, occult diabetes (detectable on an oral glucose tolerance test), or prediabetes. Type 2 diabetes mellitus is associated with a two- to six-fold increased risk for first or recurrent ischemic stroke. The mechanisms for the association are myriad and include the effects of hyperglycemia on vascular tissues and coagulation, and aberrations in blood pressure regulation, lipid metabolism, endothelial function, vascular inflammation, lipid metabolism, smooth muscle cell proliferation, and fibrinolysis. The most effective strategies to prevent stroke among people with diabetes include blood pressure control, antiplatelet therapy, and statin therapy. Tight glycemic control is recommended to prevent microvascular disease, but the effect on macrovascular disease, including stroke, has not been proven. Target blood pressure should be less than 130/80. Antiplatelet therapy may be accomplished with 81 to 325 mg of aspirin daily or 75 mg of clopidogrel daily. Statins should be given in dosages effective to reduce lowdensity lipoprotein cholesterol to less than 100 mg/dL. For glycemic control, first line therapy for most patients is metformin, starting at 500 mg daily. With time, most patients will need two or three oral medications from different classes and many eventually will require insulin therapy. Prevention of diabetes may be best accomplished by identifying those at risk and modifying diet, weight, and exercise habits. Screening for prediabetes and diabetes is appropriate for men and women older than 45 years and all individuals with vascular disease. Insulin resistance and impaired insulin secretion is the major underlying defect in type 2 diabetes mellitus. It also affects 50% of nondiabetic subjects with a recent ischemic stroke. Emerging evidence has linked insulin resistance to the pathophysiologic derangements in type 2 diabetes mellitus that accelerate atherosclerosis. Treatment of insulin resistance with weight loss, exercise, or medication can correct these derangements, and represents a promising approach to stroke prevention.