2型糖尿病及口服降糖药与痴呆发生风险的关系

2型糖尿病与老年痴呆的发生是密不可分的,而正确合理地使用口服降糖药(例如二甲双胍、噻唑烷二酮类、磺脲类、二肽基肽酶-4抑制剂等)在治疗2型糖尿病的同时还可能会有效降低患者将来罹患痴呆的风险,可为糖尿病的治疗提供新的思路和方向。     

对2型糖尿病门诊口服降糖药用药分析

目的分析探讨2型糖尿病门诊口服降糖药用药情况。方法选取2012年9月—2014年9月该院门诊收治的120例糖尿病患者作为研究对象,采用DDD分析法对该组患者2年内DDDs(药物使用频度)、DDC(药品限定日费用)等情况进行分析,并按照顺序排列。结果格列齐特、阿卡波糖、格瑞列奈片、格列吡嗪以及格列美脲、格列喹酮、二甲双瓜是门诊常用的口服降糖药物;药物种类包括双胍类、胰岛素增敏剂、第二代磺酰脲类、胰岛素促泌剂等,阿卡波糖、格瑞列奈片、格列齐特使用排名情况变化不大,格列吡嗪变化最大,其他药物两年之内的变化情况并不明显。结论针对2型糖尿病患者,门诊选择给药方案应根据患者实际血糖水平、胰岛素功能情况以及并发症发生情况等方面进行综合考虑,并选择针对性阶梯治疗方案。     

我院2型糖尿病高血压住院患者降糖药利用分析

目的 分析我院2型糖尿病高血压住院患者降糖药利用情况.方法 对江西省九江市第一人民医院2009年第一季度82例2型糖尿病高血压住院患者应用降糖药品种、数量、人均用药时间、合理用药情况等进行回顾性、DUR、DUE等分析.结果 19种药物有5种药品的DUI＜1,6种药品的DUI＞1,8种药品的DUI=1;降糖药中注射用胰岛素和口服降糖药中双胍类使用最多;58.5％的患者使用了两种或两种以上的降糖药.结论 我院2型糖尿病高血压住院患者使用降糖药基本合理.     

老年2型糖尿病患者口服降糖药方法的探讨

我科采用餐前顿服降糖药的方法来减少患者服药次数，同样能良好控制空腹和餐后血糖。现将研究的方法及结果报告如下。     

2型糖尿病合并冠心病患者如何选择磺脲类口服降糖药

本刊读者孙瑞文医师来信，问及2型糖尿病合并冠心病患者对磺脲类口服降糖药的选择问题，这个问题不仅涉及到对不同磺脲类药物作用机制的了解，而且也有实际的临床意义。因此，编辑部特请本刊副主编陈家伟教授解答，现连同孙瑞文医师来信一并于本期发表，希望引起更多读者的关注。欢迎广大读者提出自己工作中遇到的问题，编辑部将根据问题的内容约请有关专家进行解答。     

固定复方降糖药在2型糖尿病治疗中更具优势?北大核心CSCD

将不同作用机制的降糖药以固定比例制成固定复方制剂极大提高患者服药依从性,例如可以与二甲双胍组合形成口服固定复方制剂,与基础胰岛素组合形成固定复方注射液。这些不同病理生理机制和多个靶点的药物组合,使其药效作用最大化,抵消组分药物各自的不良反应,实现强效降糖,简化治疗程序,提高患者依从性,有较好的成本效益,是T2DM治疗的新趋势。     

甘精胰岛素联合降糖药治疗2型糖尿病15例疗效观察

2006年2。6月，我们对口服降糖药继发失效的2型糖尿病（T2DM）患者联合甘精胰岛素睡前皮下注射治疗，现报告如下。     

治疗2型糖尿病的口服降糖药

目前，降血糖的药物有六大类。 其中，五大类是口服降糖药，不同的降糖药通过不同的途径来达到降低血糖的作用。过去的几年。治疗2型糖尿病的口服药物明显增加。 另一类就是胰岛索。胰岛素一直以来以注射的形式用于临床，最近可吸入的胰岛素制剂也已问世，其他的使用形式还在研究之中。 为了便于广大糖尿病患者合理选择降糖药，本期对目前国内外广泛使用的六大类降糖药进行大盘点。     

糖尿病患者口服降糖药的治疗

2型糖尿病占全部糖尿病的 90 %以上 ,其中少部分 (约15 % )在早期阶段通过饮食、运动和减轻体重等疗法可以控制病情 ,而大多数需应用口服降糖药治疗。目前除了传统的磺脲类和双胍类外 ,还有一些新型口服降糖药 ,如α 葡萄糖苷酶抑制剂、胰岛素增敏剂、非磺脲类胰岛素促泌剂等。一、磺脲类1.种类和特点 :磺脲类自 2 0世纪 5 0年代中期开始应用以来 ,目前已有多种药物可供临床使用。第一代有甲磺丁脲(Ｄ86 0 )、氯磺丙脲。第二代有格列本脲、格列吡嗪、格列齐特、格列喹酮等 ,第二代磺脲类的主要特点为作用强 ,剂量小 ,副作用相对少。格列美脲…     

Management of heart failure and type 2 diabetes mellitus: Maximizing complementary drug therapy

Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular disease and occurs in ~25% of patients with heart failure (HF). Patients with co-morbid HF and T2DM are at elevated risk of adverse outcomes, making optimization of complementary drug therapies essential. While research is ongoing, recent advances in drug therapy, including the introduction of sacubitril/valsartan for HF with reduced ejection fraction and the finding of positive cardiovascular effects of glucose-lowering agents (particularly sodium-glucose co-transporter-2 [SGLT2] inhibitors) have the potential to transform pharmacologic management of co-morbid HF and T2DM. In this review, we provide a comprehensive overview of cardiovascular clinical trials of therapies for HF and diabetes mellitus to date and identify areas requiring further investigation. We also discuss the pathophysiologic overlap of the two diseases and explore the complementary therapeutic effects of HF and T2DM drugs, with a particular focus on sacubitril/valsartan and SGLT2 inhibitors.     

卡维地洛对糖尿病并发冠心病心力衰竭患者的影响

目的观察卡维地洛对2型糖尿病并发冠心病心力衰竭患者的心功能及血脂、血糖、胰岛素抵抗的影响。方法2型糖尿病并发冠心病心力衰竭患者105例,根据常规治疗基础上加用卡维地洛与否分为治疗组和对照组。治疗12个月,观察卡维地洛对心功能及血脂、血糖、胰岛素抵抗的指标变化。结果①卡维地洛用量平均（12±4）mg/d。②对心功能及心室重构的影响:与对照组相比,治疗组12个月左室射血分数较对照组显著升高[（50±4）%与（45±6）%,P<0.01],左室收缩末容积下降[（166±41）ml与（184±38）ml,P<0.01]。NYHA分级也明显改善。③治疗12个月后治疗组与对照组血脂及空腹血糖、胰岛素、胰岛素抵抗指数均无明显变化。结论卡维地洛能明显改善2型糖尿病并发冠心病心力衰竭患者的心功能和心室重构,而对其血脂及空腹血糖、胰岛素、胰岛素抵抗指数无明显影响,可以安全应用于2型糖尿病并发冠心病心力衰竭患者。     

慢性心力衰竭合并2型糖尿病对老年人认知功能水平的影响

目的 探讨慢性心力衰竭(CHF)合并2型糖尿病(T2DM)对老年人认知功能的影响.方法 选取2019年10月至2020年5月江苏省荣军医院住院康复及无锡市梁溪区家庭康复的老年CHF和(或)T2DM患者116例.根据是否合并CHF及T2DM分成3组:CHF组(n=47)、T2DM组(n=29)及CHF合并T2DM组(n=...     

慢性心力衰竭合并2型糖尿病患者心率变异性特点及其短期预后差异

目的探讨慢性心力衰竭合并2型糖尿病(T2DM)患者心率变异性(HRV)特点及其短期预后的差异。方法选取慢性心力衰竭患者105例,设为心力衰竭组,根据是否合并T2DM分为单纯心力衰竭组(57例)和合并T2DM组(48例),同时选取同时期住院的非心力衰竭的器质性心脏病患者40例,设为对照组,收集各组患者一般资料、心脏彩超及24 h动态心电图结果,包括窦性心律R-R间期标准差(SDNN)、窦性R-R间期总数与窦性R-R间期直方图的高度之比(TRI)、相邻窦性R-R间期差值的均方根(rMSSD)、相邻窦性R-R间期差值≥50 ms占窦性心律的百分比(PNN50),分别比较对照组和心力衰竭组患者及心力衰竭亚组中临床资料的差异,并分析合并T2DM组患者不同糖尿病病程HRV指标的差异。心力衰竭组随访观察3个月,比较两组患者因心力衰竭再住院率的差异。结果心力衰竭组病程、总费用、B型钠尿肽(BNP)、左心室舒张期末内径(LVEDd)、最慢心率、平均心率高于对照组,血红蛋白浓度(Hb)、左心室射血分数(LVEF)、心输出量(CO)、SDNN、TRI、rMSSD、PNN50低于对照组(P0.05),其中多因素Logistic回归分析表明病程、BNP、最慢心率为器质性心脏病患者心力衰竭存在的独立相关因素。合并T2DM组总费用、β受体阻滞剂使用例数、病程、空腹血糖、BNP、NYHAⅣ级例数、平均心率、最快心率高于单纯心力衰竭组,SDNN、TRI、rMSSD、PNN50低于单纯心力衰竭组(P0.05)。空腹血糖为心力衰竭患者是否合并T2DM的相关因素。糖尿病病程超过10年的患者,rMSSD、PNN50降低明显(P0.05)。合并T2DM组再住院率高于单纯心力衰竭组(P0.05)。结论慢性心力衰竭患者的心脏自主神经功能较非心力衰竭的器质性心脏病患者降低,T2DM可进一步导致慢性心力衰竭患者的HRV降低,导致心脏自主神经功能进一步受损,影响其短期预后。     

Abnormal myocardial perfusion and risk of heart failure in patients with type 2 diabetes mellitus

BACKGROUND:

Diabetes is a major risk factor for heart failure (HF), although the pathophysiological processes have not been clarified.

OBJECTIVE:

To determine the prevalence of HF and of abnormal myocardial perfusion in diabetic patients evaluated using technetium (99m) sestamibi single-photon emission computed tomography.

METHODS:

An observational cross-sectional study was conducted that included patients with type 2 diabetes mellitus who underwent echocardiography to diagnose HF and a pharmacological stress test with intravenous dipyridamole to examine cardiac scintigraphic perfusion abnormalities. Clinical and biochemical data were also collected.

RESULTS:

Of the 160 diabetic patients included, 92 (57.6%) were in HF and 68 (42.5%) were not. When patients were stratified according to the presence of abnormal myocardial perfusion, those with abnormal perfusion had a higher prevalence of HF (93%) than those with normal perfusion (44.4%) (P<0.0001). Patients with HF weighed more (P=0.03), used insulin less frequently (P=0.01), had lower total cholesterol (P=0.05) and high-density lipoprotein cholesterol concentrations (P=0.002), and a greater number of their myocardial segments showed abnormal perfusion (P≤0.001). More HF patients had a history of myocardial infarction (P<0.001) compared with those without HF. In a logistic regression analysis, the number of segments exhibiting abnormal myocardial perfusion was an independent risk factor for HF.

CONCLUSIONS:

The prevalence of HF in diabetic patients was high and HF predominantly occured in association with myocardial ischemia.     

Thiazolidinediones and congestive heart failure in veterans with type 2 diabetes

Aim: The thiazolidinedione (TZD) class of antihyperglycaemic agents has been shown to improve glycaemic control by improving peripheral insulin sensitivity but may worsen or precipitate congestive heart failure (CHF). Randomized controlled trials have shown an increased risk of CHF in patients treated with TZDs. The use of TZDs in clinical practice has the potential to increase morbidity and health care costs. The purpose of this study was to compare the incidence of CHF in TZD and non‐TZD‐treated patients in a clinical setting. Methods: A retrospective cohort study of all male patients with type 2 diabetes seen in the South Central US Veterans Administration health care network between 1 October 1996 and 31 December 2004. We constructed a Cox proportional hazards model to evaluate the impact of TZD therapy on time to incidence of CHF. Results: Of 3956 patients, 29% (n = 1157) developed CHF during the study period. The incidence of CHF was higher in patients who received TZD medications than in those who received TZDs. After adjustment for multiple cardiac risk factors, the hazard ratio for the development of CHF for TZD versus non‐TZD‐treated patients was 0.69 with a 95% confidence interval of 0.60–0.79. Conclusions: Patients in this cohort who received TZD medications had a lower incidence of heart failure than patients who did not receive TZDs.     

Secular trends in the utility of SGLT-2 inhibitors in heart failure patients with type 2 diabetes mellitus across Metro South Health hospitals in South-East Queensland

Background

The 2018 Australian Heart Failure (HF) guidelines strongly recommended commencing sodium-glucose co-transporter-2 inhibitors (SGLT-2is) in HF patients with type 2 diabetes mellitus (T2DM). The uptake of SGLT-2is for HF patients with T2DM in our health service is unknown.

Aims

To determine the adoption of the 2018 HF guidelines by assessing the temporal trends of SGLT-2is' usage in HF patients with T2DM at Metro South Health (MSH) hospitals, in South-East Queensland.

Methods

Retrospective analysis of all HF patients (ejection fraction (EF) < 50%) with T2DM who were managed within MSH hospitals between June 2018 and June 2021.

Results

A total of 666 patients met the inclusion criteria with 918 HF encounters. Mean age was 72 years and 71% were male (473/666). Mean EF was 30% (SD ± 11%), and mean estimated glomerular filtration rate was 48 mL/min/1.73 m² (SD ± 25). Fifty-four per cent (362/666) had contraindications to SGLT-2is. Among those without contraindications, there was a five-fold increase in the utility of SGLT-2is, 7% (2/29) before versus 38% (103/275) after implementation of the HF guidelines (P < 0.001). Patients on SGLT-2is were younger (64 years vs 69 years, P = 0.002) and had a lower number of HF hospitalisations (1.1 vs 2.1, P = 0.01).

Conclusions

During the study period, 54% of our HF patients with T2DM were not on SGLT-2is due to prescribing guidelines/limitations in the Australian context. We observed a five-fold significant increase in the uptake of SGLT-2is before and after implementation of HF guidelines among patients without contraindications to SGLT-2is. There were significantly fewer HF hospitalisations among patients on SGLT-2is compared to those without.     

Neighbourhood-level social deprivation and the risk of recurrent heart failure hospitalizations in type 2 diabetes

Background

The importance of type 2 diabetes mellitus (T2D) in heart failure hospitalizations (HFH) is acknowledged. As information on the prevalence and influence of social deprivation on HFH is limited, we studied this issue in a racially diverse cohort.

Methods

Linking data from US Veterans with stable T2D (without prevalent HF) with a zip-code derived population-level social deprivation index (SDI), we grouped them according to increasing SDI as follows: SDI: group I: ≤20; II: 21-40; III: 41-60; IV: 61-80; and V (most deprived) 81-100. Over a 10-year follow-up period, we identified the total (first and recurrent) number of HFH episodes for each patient and calculated the age-adjusted HFH rate [per 1000 patient-years (PY)]. We analysed the incident rate ratio between SDI groups and HFH using adjusted analyses.

Results

In 1 012 351 patients with T2D (mean age 67.5 years, 75.7% White), the cumulative incidence of first HFH was 9.4% and 14.2% in SDI groups I and V respectively. The 10-year total HFH rate was 54.8 (95% CI: 54.5, 55.2)/1000 PY. Total HFH increased incrementally from SDI group I [43.3 (95% CI: 42.4, 44.2)/1000 PY] to group V [68.6 (95% CI: 67.8, 69.9)/1000 PY]. Compared with group I, group V patients had a 53% higher relative risk of HFH. The negative association between SDI and HFH was stronger in Black patients (SDI × Race p_interaction < .001).

Conclusions

Social deprivation is associated with increased HFH in T2D with a disproportionate influence in Black patients. Strategies to reduce social disparity and equalize racial differences may help to bridge this gap.