老年原发性高血压患者糖化血红蛋白与颈动脉粥样硬化的相关性分析

目的分析老年高血压糖化血红蛋白(HbA1c)与颈动脉硬化的关系。方法选择2017年1月-2018年1月前往厦门市嘉莲街道社区卫生服务中心全科就诊的原发性高血压患者90例,根据患者HbA1c分成研究组和对照组,HbA1c在6.0%-6.5%为研究组,共40例,HbA1c6.0%为对照组,共50例。比较两组总胆固醇(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)、尿微量白蛋白(U-ALB)、颈动脉内膜中层厚度(IMT)等。结果研究组年龄、体质指数(BMI)、IMT、TC、TG、LDL-C及U-ALB明显高于对照组(P0.05),研究组HDL-C明显低于对照组(P0.05),两组空腹血糖(FBG)及餐后2h血糖(PBG)比较无统计学差异(P0.05)。结论 HbA1c可能与IMT、TG、U-ALB及LDL-C等具有相关性,原发性高血压患者出现正常水平的高HbA1c,需预防颈动脉硬化的发生和发展。     

空腹血糖水平正常的老年人HbA1c水平与颈动脉粥样硬化的相关性

目的研究糖化血红蛋白(HbA1c)与空腹血糖正常的老年人颈动脉粥样硬化是否存在联系。方法通过横断面研究分析1 065名老年人,其中男320名,女745名,平均年龄71. 8岁。纳入研究的老年人的空腹血糖均低于100 mg/dl(5. 6 mmol/L)且HbA1c水平低于6.5%(48 mmol/mol),既没有心血管疾病史,也没有2型糖尿病史或降糖药物服用史。颈动脉粥样硬化通过超声检查颈动脉内膜中层厚度(IMT)评估病情。多变量线性回归分析HbA1c与颈动脉IMT之间的关系。结果除外性别、体重指数、收缩压、舒张压、三酰甘油、低密度脂蛋白胆固醇、吸烟和饮酒等因素影响外,血清HbA1c水平与颈动脉IMT正相关(β=0. 020,P=0. 045)。然而,空腹胰岛素水平和空腹血糖水平均与颈动脉IMT无关。结论在正常空腹血糖的老年人群中,HbA1c水平与颈动脉粥样硬化呈正相关。高水平的HbA1c是评估老年人颈动脉粥样硬化的有效指标。     

乌鲁木齐市哈萨克族、维吾尔族、汉族中老年人群糖化血红蛋白与颈动脉内膜中层厚度的相关性

目的对乌鲁木齐市哈萨克族、维吾尔族、汉族中老年人群糖化血红蛋白(Hb A1c)水平与颈动脉内膜中层厚度(IMT)进行相关性研究。方法选择乌鲁木齐市哈萨克族、维吾尔族、汉族中老年人群共计1 734人,年龄均≥45岁,全部人群需完善调查问卷,检测临床实验指标(包括糖化血红蛋白、空腹血糖、血脂),通过颈动脉超声测量颈动脉IMT。结果使用多变量线性回归模型,在调整了年龄、性别、族别、吸烟、饮酒、体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、三酰甘油(TC)、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)后,发现随着Hb A1c升高颈动脉IMT随之增加(回归系数为0.013,P=0.034),Hb A1c低水平组较高水平组颈动脉IMT约增加0.08 mm,哈萨克族比汉族人群颈动脉IMT约增加0.04 mm,哈萨克族比维吾尔族人群颈动脉IMT约增加0.06 mm。结论在哈萨克族、维吾尔族、汉族中老年人群中,Hb A1c与颈动脉IMT显著相关,且颈动脉IMT有民族差异性。     

非糖尿病冠心病患者糖化血红蛋白与颈动脉病变相关性分析

目的探讨非糖尿病冠心病患者糖化血红蛋白（HbA1c）水平与颈动脉病变的相关性。方法选择经冠脉造影明确诊断冠心病的非糖尿病患者275例,按照HbA1c水平以三分位法分为低水平组（HbA1c≤5.6%,n=103例）,中水平组（HbA1c：5.6%-5.9%,n=93例）,高水平组（HbA1c〉5.9%,n=79例）。颈动脉超声测定颈总动脉内膜中膜厚度（IMT）,分为正常对照组（IMT≤0.9mm）,轻度增厚组（IMT0.9mm-1.2mm）,明显增厚组或斑块形成组（IMT〉1.2mm）。分析HbA1c水平与颈动脉病变的相关性。结果 HbA1c高水平组中IMT〉1.2mm者共56例,占70.9%,比例大于中水平组（64例,占68.8%）,大于低水平组（67例,占65%）,但无统计学意义。经Pearson相关分析及偏相关分析,校正年龄、性别、吸烟状况、饮酒状况、心梗史、病变支数、空腹血糖、尿酸、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、高敏C反应蛋白、BMI（体重指数）等因素后,HbA1c水平与颈动脉内中膜及斑块厚度无显著关系。结论在非糖尿病的冠心病人群中,HbA1c水平与颈动脉内中膜及斑块厚度无明显相关性。     

上海市中老年人群中糖尿病发病与糖化血红蛋白基线值相关性的回顾性研究

目的研究中老年人群中糖尿病发病与糖化血红蛋白(HbA1c)基线值的相关性,并分析影响其检测结果的个体因素。方法在2009年通过多阶段分层随机抽样在上海地区调查了3219名≥50岁的上海常住居民。对空腹血糖受损(6.1mmol/L≤空腹血糖<7.0mmol/L)但调查前未被各级医疗机构诊断为糖尿病的调查对象,于2011年通过电话开展糖尿病发病率调查,并检测随访应答对象2009年所留血液样本HbA1c。结果基线人群自报糖尿病发病率为8.6%(278/3219)。2938名非糖尿病人中,空腹血糖受损病例为11%(313/2938)。对其中240名留有电话信息的调查对象于2011年开展电话随访,随访应答率为45%(108/240)。15%(16/108)在2年中新诊断为糖尿病。HbA1c≥6.5%的对象中有50%(6/12)发展为糖尿病,而HbA1c<6.5%的对象中仅有14%(10/72)(OR=6.4,95%CI:1.45～29.06)。多元线性逐步回归分析表明,HbA1c水平和三酰甘油水平呈显著正相关(r=0.176,P=0.026)。结论空腹血糖受损人群糖尿病发病率高于正常人群。基线HbA1c≥6.5%和新发糖尿病显著相关。空腹血糖受损人群应要求检测HbA1c以利于糖尿病的早期诊断和早期治疗。     

血清骨钙素、白细胞介素-18在不同糖耐量人群的变化及其与2型糖尿病颈动脉粥样硬化的关系

目的:比较血清骨钙素、白细胞介素-18(IL-18)在不同糖耐量人群的变化,并探讨其与2型糖尿病颈动脉粥样硬化的关系。方法:将140例研究对象根据口服葡萄糖耐量试验(OGTT)结果分成三组:正常对照组50例,糖尿病前期组30例,2型糖尿病组60例,2型糖尿病组又分为颈动脉内膜中层厚度(IMT)正常亚组26例、IMT增厚亚组34例。各组均测IMT、血清骨钙素、IL-18及糖化血红蛋白(HbA1c)、空腹血糖、OGTT 2h血糖(2hPG)、总胆固醇、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)等,并计算体重指数、胰岛素抵抗(IR)指数(HOMA-IR)、胰岛细胞功能指数(HOMA-β)。应用Pearson相关性及多元线性逐步回归模型对各指标进行分析。结果:从正常对照组到糖尿病前期组,再到2型糖尿病组,骨钙素逐渐降低(P均0.05),IL-18则逐渐上升(P均0.05)。骨钙素与HbA1c、空腹血糖、2hPG、HOMA-IR、总胆固醇、颈动脉IMT均呈负相关(r分别为-0.426、-0.582、-0.489、-0.456、-0.451、-0.559,P均0.05),与HOMA-β呈正相关(r=0.439,P0.05)。IL-18与体重指数、HbA1c、空腹血糖、2hPG、HOMA-IR、总胆固醇、甘油三酯、LDL-C、颈动脉IMT均呈正相关(r分别为0.395、0.693、0.880、0.715、0.667、0.734、0.326、0.471、0.857,P均0.05),与HOMA-β呈负相关(r=-0.678,P0.05)。2型糖尿病组中颈动脉IMT与IL-18、空腹血糖、HOMA-IR、总胆固醇、甘油三酯均呈正相关(r分别为0.817、0.415、0.356、0.396、0.362,P均0.05),与骨钙素呈负相关(r=-0.588,P0.05)。多元线性逐步回归分析显示,IL-18、骨钙素、总胆固醇、空腹血糖是颈动脉IMT的独立影响因素(回归系数分别为0.013、-0.011、0.044、0.044,P均0.05)。结论:血清骨钙素、IL-18参与糖脂代谢的过程,其水平与2型糖尿病颈动脉粥样硬化的发生和发展密切相关。     

老年2型糖尿病患者长期随访期间糖化血红蛋白控制达标的影响因素

目的 探讨老年2型糖尿病患者长期随访期间糖化血红蛋白(HbA1c)控制达标的影响因素。方法 选择2007年1月至2011年1月于中国人民解放军总医院第二医学中心住院,行动态血糖监测的200例老年男性2型糖尿病患者为研究对象。根据年龄(60岁≤年龄<70岁57例、70岁≤年龄<80岁51例、年龄≥80岁92例)、糖尿病病程(病程<10年57例、10年≤病程<20年89例、病程≥20年54例)、基线HbA1c(HbA1c<6.5%74例、6.5%≤HbA1c<7.5%72例、HbA1c≥7.5%54例)分别将患者分为3组。比较不同组别患者长期随访期间HbA1c水平的差异。采用SPSS 13.0统计软件进行数据分析。根据数据类型,分别采用方差分析或χ²检验进行组间比较。采用logistic回归分析随访期间HbA1c控制达标的影响因素。结果 平均随访12.5年。不同年龄组随访期间HbA1c均值、HbA1c控制达标率差异无统计学意义(P＞0.05);与糖尿病病程<10年组比较,糖尿病病程≥20年组随访期间HbA1c均值升高(P<0.01),HbA1c控制达标率降低(P<0.05);随着基线HbA1c增加,随访期间HbA1c均值逐渐增加(P<0.01),HbA1c控制达标率逐渐降低(P<0.01)。单因素logistic回归分析显示,糖尿病病程、基线HbA1c、空腹血糖、餐后2h血糖、血糖波动、胰岛素治疗是随访期间HbA1c控制达标的影响因素(P<0.01)。非条件多因素logistic回归分析提示,基线HbA1c(OR=5.73,95%CI 3.02~10.88,P<0.001)是随访期间HbA1c控制达标最重要的影响因素。结论 糖尿病病程、基线HbA1c、空腹血糖、餐后2h血糖、血糖波动、胰岛素治疗是老年2型糖尿病随访期间HbA1c控制达标的影响因素,其中基线HbA1c是最重要的影响因素。     

中重度阻塞性睡眠呼吸暂停综合征患者持续气道正压通气治疗前后糖化血红蛋白水平的变化

目的观察中重度阻塞性睡眠呼吸暂停综合征(OSAS)患者糖化血红蛋白(HbA1c)水平的变化,评估持续气道正压通气(CPAP)治疗对中重度OSAS患者HbA1c水平的影响。方法连续纳入2013年1月至2015年10月诊治的中重度OSAS患者330例。根据HbA1c水平将患者分为:6.0%(A组,n=116)、6.0%~6.5%(B组,n=110)和≥6.5%(C组,n=104)3组。所有患者行CPAP治疗3个月。治疗前后均行过夜多导睡眠监测和HbA1c检测。结果与A组比较,B组和C组的空腹血糖水平较高(P0.05),但B组与C组间的差异无统计学意义(P0.05)。CPAP治疗3个月后,C组HbA1c水平和血氧饱和度(SpO_2)≤90%时间占总睡眠时间百分比(T_(SpO_2)90%)明显低于治疗前(P0.05)。Pearson相关分析显示,年龄(r=0.44)、收缩压(r=0.57)、舒张压(r=0.50)、空腹血糖(r=0.64)、呼吸暂停低通气指数(AHI)(r=0.68)、平均SpO_2(r=-0.53)、最低SpO_2(r=-0.28)、T_(SpO_2)90%(r=0.35)与HbA1c水平相关(均P0.05)。多元线性回归分析显示,平均SpO_2(β=-0.907)和AHI(β=0.460)是HbA1c的影响因素(均P0.05)。结论中重度OSAS患者HbA1c水平与低氧血症严重程度相关。CPAP治疗3个月后,HbA1c≥6.5%的中重度OSAS患者有所改善。     

老年高血压合并糖尿病患者血压血糖水平与脂肪肝患病的相关性

目的探讨血压及血糖水平与原发性高血压合并糖尿病患者脂肪肝患病的关系。方法将同时患有糖尿病和原发性高血压860例年龄60岁的患者,按照其收缩压及糖化血红蛋白(Hb A1c)水平进行分组,将患者根据收缩压分组:血压严格控制组(血压130 mm Hg),血压一般控制组(血压130~139 mm Hg),血压未控制组(血压≥140 mm Hg);根据其Hb A1c水平分为血糖严格控制组(Hb A1c6.5%),血糖一般控制组(Hb A1c=6.5%~7.5%),血糖未控制组(Hb A1c≥7.5%)。同时对每位患者进行超声检查,记录脂肪肝的发病情况。结果多因素线性回归分析显示,年龄(X_1,β=0.027,P=0.010)、体重指数(BMI)(X_2,β=0.048,P=0.000)、收缩压(X_3,β=0.018,P=0.008)、Hb A1c(X_4,β=0.002,P=0.004)、总胆固醇(X_5,β=0.284,P=0.007)、甘油三酯(X_6,β=0.465,P=0.000)、低密度脂蛋白胆固醇(X_7,β=0.373,P=0.000)均与脂肪肝(Y)呈正相关,为脂肪肝形成的危险因素。结论血压、血糖水平是脂肪肝患病的危险因素之一,而血脂紊乱也在其中起着很重要的作用。     

糖化血红蛋白对高血压患者血压变异性和颈动脉硬化的影响

目的探讨糖化血红蛋白(HbA1c)水平对高血压患者血压变异性(BPV)和颈动脉硬化的影响。方法纳入福建医科大学附属第一医院住院高血压患者220例,行动态血压、颈动脉彩色多普勒超声、生化等检查,根据是否合并糖尿病及HbA1c水平,分为A组(单纯高血压,n=104)、B组(高血压合并2型糖尿病,HbA1c7.0%,n=63)、C组(高血压合并2型糖尿病,HbA1c≥7.0%,n=53),比较3组之间一般资料、BPV,采用多元线性回归分析颈动脉内膜中层厚度(IMT)的影响因素。结果与A组、B组比较,C组日间收缩压标准差(dSBPSD)[(14.5±4.0)比(12.9±3.3)、(12.7±2.9)mm Hg]、日间收缩压变异系数(dSBPCV)[(10.5±2.8)%比(9.7±2.4)%、(9.4±2.4)%]、24h收缩压加权标准差(24hWSD)[(13.6±3.4)比(12.6±2.9)、(12.3±2.6)mm Hg]较高,夜间血压下降更低[(4.3±8.8)、(4.0±6.7)比(0.9±8.9)mm Hg](均P0.05)。反杓型组颈动脉IMT、颈动脉硬化检出率高于非杓型组,非杓型组又高于杓型组[(1.20±0.27)、(1.09±0.23)比(0.91±0.20)mm;95.3%、80.9%比62.7%;均P0.05]。多因素线性回归分析结果显示,夜间平均收缩压(β=0.345)、老年(β=0.324)、HbA1c升高(β=0.190)、dSBPCV增加(β=0.140)是IMT的独立危险因素(均P0.01)。结论高血压合并2型糖尿病血糖未控制患者BPV升高,血压节律异常增加,颈动脉硬化程度加重。     

2型糖尿病患者24小时动态血糖变化与糖化血红蛋白水平的相关性

目的探讨T2DM患者24小时动态血糖变化与HbA1C水平之间的相关性。方法根据HbA1c水平将578名T2DM患者分为4个组,采用动态血糖监测系统（CGMS）监测患者全天血糖。结果组内分析显示,仅在7．5％≤HbA1c〈10．0％组及HbA1c≥10．0％组内HbA1c水平和高血糖曲线下面积、高血糖持续时间、平均血糖及血糖波动幅度呈正相关;仅在HbA1c〈6．5％组内HbA1c水平和空腹状态低血糖曲线下面积及持续时间呈负相关。结论当HbA1c处于不同区间内时,HbA1c水平与高血糖及低皿糖暴露、平均血糖水平及血糖波动幅度的相关性不同。     

Association of C-reactive protein with early-stage carotid atherosclerosis in Japanese patients with early-state type 2 diabetes mellitus

The aim of this study was to assess the association between high sensitivity-C-reactive protein (hs-CRP), a sensitive marker of inflammation, and early-stage carotid atherosclerosis, in patients with early-state type 2 diabetes mellitus. The study subjects were 75 patients with type 2 diabetes mellitus without obvious diabetic vascular complications, who were not on any medication, and whose HbA(1c) level was less than 6.5%. We evaluated the mean intima-media thickness (IMT) of the common carotid artery (CCA) by ultrasound B-mode imaging. Then, we investigated various factors associated with CCA-IMT including hs-CRP. Serum hs-CRP levels correlated well with factors strongly associated with insulin resistance such as homeostasis model assessment of insulin resistance (HOMA-IR), fasting insulin level, and body mass index. Serum hs-CRP also correlated with mean CCA-IMT and serum levels of soluble intercellular adhesion molecule-1. Multivariate regression analysis using mean CCA-IMT as the dependent variable identified only age, hs-CRP, and diastolic blood pressure as independent determinants of mean CCA-IMT. While hs-CRP associates with insulin resistance and subclinical atherosclerosis in ealy-state type 2 diabetes, our data suggest that hs-CRP is a useful marker of subclinical atherosclerosis in early-state type 2 diabetes mellitus independent of factors that directly reflect insulin resistance.     

Effects of lifestyle modification on metabolic parameters and carotid intima-media thickness in patients with type 2 diabetes mellitus

The aim of this study was to examine the effects of a 6-month intensive lifestyle modification intervention on metabolic parameters and carotid intima-media thickness (IMT) in patients with type 2 diabetes mellitus. Fifty-eight subjects with type 2 diabetes mellitus were randomly assigned to the intervention group or the control group. The subjects in the intervention group participated in a 16-week intensive lifestyle modification program and subsequent monthly meetings during the 6-month study period. Control subjects received basic dietary education and usual care. Anthropometric data, metabolic parameters, and carotid IMT were examined before the intervention and after 6 months. Lifestyle modification intervention group patients showed a significant reduction in HbA1c (-1.0% +/- 1.3% vs +0.1% +/- 1.2%, P = .002), fasting blood glucose (-1.6 +/- 1.5 vs +0.3 +/- 2.5 mmol/L, P = .001), and 2-hour postprandial plasma glucose (-2.1 +/- 2.5 vs +0.8 +/- 4.4 mmol/L, P = .003) compared with control patients after 6 months. Body weight (-2.0 +/- 2.6 vs +0.2 +/- 1.7 kg, P = .001), body mass index (-0.8 +/- 1.0 vs 0.0 +/- 0.8 kg/m2, P = .003), and systolic blood pressure (-8.2 +/- 15.9 vs +0.4 +/- 14.1 mm Hg, P = .041) were significantly decreased in the intervention group. A significantly reduced carotid mean IMT progression was seen in the intervention group after 6 months (-0.040 +/- 0.136 vs +0.083 +/- 0.167 mm, P = .007). Changes in HbA1c (r = 0.34, P = .028), fasting plasma glucose (r = 0.31, P = .045), and 2-hour postprandial plasma glucose (r = 0.37, P = .015) correlated with the mean carotid IMT change after adjustment for age and sex. In conclusion, a 6-month intensive lifestyle modification intervention in patients with type 2 diabetes mellitus resulted in improved glycemic control and decreased progression of carotid IMT.     

Glycated hemoglobin as a marker of subclinical atherosclerosis and cardiac remodeling among non-diabetic adults from the general population

Background

Elevated glycated hemoglobin (HbA1c) is associated with increased risk of cardiovascular disease (CVD) and mortality but little is known about potential mechanisms underlying the reported associations.

Methods

We used data from 1798 non-diabetic participants from the population-based cohort Study of Health in Pomerania (SHIP) to investigate cross-sectional and longitudinal associations of HbA1c with subclinical atherosclerosis (common carotid artery intima-media thickness [CCA-IMT]), cardiac structure (left ventricular mass [LVM]), and cardiac function (fractional shortening).

Results

Cross-sectional analyses revealed a positive association between HbA1c and mean CCA-IMT with a 0.02 mm (95% confidence interval: 0.01–0.04) increase in CCA-IMT per 1% increase in HbA1c, and a similar positive trend across HbA1c quartiles (overall p-value <0.01). We also observed a graded association between HbA1c and high CCA-IMT (>75th percentile) with an odds ratio of 1.42 (95% CI: 1.11–1.81) per 1% increase in HbA1c. Longitudinal analyses showed no consistent associations of baseline HbA1c with mean follow-up CCA-IMT. There were no consistent associations of HbA1c with cardiac remodeling in cross-sectional and longitudinal analyses, respectively.

Conclusions

The association between HbA1c and CCA-IMT in non-diabetic adults may be a crucial link between high-normal HbA1c levels and an increased risk of CVD and mortality.     

Impaired insulin sensitivity is an independent predictor of common carotid intima-media thickness in a population sample of elderly men

Most previous studies of associations between insulin sensitivity and common carotid artery (CCA) atherosclerosis have been conducted in small samples, have not used direct measurement of insulin sensitivity, and have yielded inconclusive results. We investigated associations of CCA intima-media thickness (IMT) and diameter (CCA-D) measured by B-mode ultrasound and insulin sensitivity measured by the euglycemic hyperinsulinemic clamp test together with risk factors of the insulin resistance syndrome in a community-based sample of 493 elderly men. The clamp glucose disposal rate was an independent predictor of CCA-IMT in multivariate models adjusting for blood pressure, smoking, serum cholesterol, and body mass index (1% decrease in CCA-IMT for a 1 unit increase in glucose disposal rate, P=0.009). Glucose disposal rate was significantly related to CCA-D in univariate (r=-0.11, P=0.02) but not in multivariate models. In conclusion, this study is the first to establish impaired insulin sensitivity, measured by the euglycemic hyperinsulinemic clamp test, as an independent predictor of CCA-IMT in a population-based sample of elderly men.     

藏族人群高血糖症与颈动脉粥样硬化的关系

目的:探讨藏族人群高血糖症与颈动脉粥样硬化的关系。方法:以拉萨市藏族人群为研究对象,进行临床调查、生化检查和颈动脉检查。检查并分析449例藏族人的糖耐量,糖基化血红蛋白、血压、血脂、空腹胰岛素含量和颈总动脉内中膜厚度。结果:根据糖耐量试验的结果,将研究对象分为3组:正常糖耐量组(NGT)352例,糖耐量低减组(IGT)62例,糖尿病组(DM)35例。患者糖耐量异常的程度越高,患者年龄越大(P<0.01),高血压发病率越高(P<0.05),胰岛素抵抗指数(HOMA-IR)越大(P<0.001),糖基化血红蛋白值越高(P<0.01),血糖(P<0.001)、甘油三酯浓度(P<0.05)越高,高密度脂蛋白-胆固醇水平越低(P<0.05)。IGT和DM组的颈动脉粥样硬化程度远比NGT组严重(P<0.001)。多元回归分析表明,增龄、胆固醇、甘油三酯、低密度脂蛋白、糖基化血红蛋白和胰岛素抵抗指数的自然对数ln(HOMA-IR)是颈动脉粥样硬化的独立危险因素(P<0.05)。结论:高糖血症的藏族人群动脉粥样硬化程度严重。糖基化血红蛋白、增龄、血脂异常、胰岛素抵抗是颈动脉粥样硬化的重要因素。     

A randomized trial of adding insulin glargine vs. avoidance of insulin in people with Type 2 diabetes on either no oral glucose-lowering agents or submaximal doses of metformin and/or sulphonylureas. The Canadian INSIGHT (Implementing New Strategies with Insulin Glargine for Hyperglycaemia Treatment) Study.

AIMS: Insulin is generally withheld until people with Type 2 diabetes are unresponsive to other therapies. However, its potential advantages suggest that it could be added earlier to achieve glycaemic goals; this possibility was tested in a clinical trial. METHODS: Consenting adults aged 18-80 years with Type 2 diabetes for at least 6 months, HbA1c of 7.5-11%, and on 0, 1 or 2 oral agents, were randomized to one of two therapeutic approaches for 24 weeks: evening insulin glargine plus self-titration by 1 unit/day if the fasting plasma glucose (FPG) was > 5.5 mmol/l; or conventional therapy with physician adjustment of oral glucose-lowering agents if capillary FPG levels were > 5.5 mmol/l. The primary outcome was the first achievement of two consecutive HbA1c levels 相似文献   

不同糖代谢状态人群糖化血清白蛋白与HbA1c的相关性分析

目的 探讨糖化血清白蛋白(GA)与HbA1c的关系,并初步建立不同HbA1c水平其相对应的GA值.方法 选取2006年10月至2009年4月来上海交通大学附属第六人民医院门诊进行口服葡萄糖耐量试验(OGTT)的受试者2 532名,其中正常糖调节组898例、糖调节受损组695例、新诊断2型糖尿病患者组939例.采用液态酶法测定GA水平,高压液相法测定HbA1c水平,分析GA与HbA1c之间的关系.结果 (1)2532例研究对象,HbA1c水平为(6.3±1.1)%,GA水平为(17.9±4.5)%,GA/HbA1c为2.85±0.51.(2)HbA1c、GA及空腹血糖、糖负荷后各时点血糖均显著正相关(r为0.567～0.776,P均<0.01).(3)GA与HbA1c呈显著正相关(r=0.701,P<0.01),其回归方程为GA=2.871×HbA1c-0.112,即HbA1c每升高1%,GA相应升高2.87%.HbA1c为6.5%时,对应的GA值为18.5%;以GA≤18.5%来预测HbA1c≤6.5%,其敏感性、特异性、阳性预测值、阴性预测值、准确度分别为82.32%、72.49%、86.48%、65.73%、79.19%.而当HbA1c为7.0%时,GA对应值为20.0%;当HbA1c7.5%时,GA对应值为21.4%.结论 初步建立了各Hbh1c水平其相应的GA值,为GA的临床应用提供了依据.     

Adiponectin is independently associated with glycosylated haemoglobin

BACKGROUND: In humans, adiponectin has been demonstrated to circulate in inverse proportion to the degree of insulin resistance. OBJECTIVE: To investigate the association between adiponectin and glycosylated haemoglobin (HbA1c) in a population-based study. DESIGN AND METHODS: Two hundred and ninety-seven individuals aged 30-75 years were enrolled in a cross-sectional study. They included patients with type 2 (non-insulin-dependent) diabetes mellitus and stable, good metabolic control (n=32) and individuals with glucose intolerance (n=54). Adiponectin was measured using a sandwich enzyme-linked immunosorbent assay (intra-assay and interassay coefficients of variation 3.3 and 7.4% respectively). RESULTS: Adiponectin correlated with age (r=0.161; P=0.006), body mass index (r=-0.197; P=0.001), diastolic blood pressure (r=-0.181; P=0.005), fasting glucose and HbA1c (r=-0.251 and r=-0.22 respectively; P<0.0001), high-density lipoprotein cholesterol (r=0.442; P<0.001) and serum triglycerides (r=-362; P<0.001). In multiple regression analysis, sex, age, fasting and post-load glucose, and adiponectin independently contributed to 40% of the variance in HbA1c. Among individuals with normal glucose tolerance, fasting glucose (P=0.0033), post-load glucose (P=0.0015), age (P=0.001) and adiponectin (P=0.0083) independently contributed to 21% of the variance in HbA1c. CONCLUSION: Adiponectin is significantly associated with altered glucose metabolism and independently contributes to the variance of HbA1c in a population-based manner.