Hubbard法评价视网膜血管改变与高血压冠状动脉狭窄的相关性

目的 探讨Hubbard法评价高血压患者视网膜血管改变与64层螺旋CT冠状动脉造影诊断冠状动脉狭窄的相关性。方法选取行双源64层螺旋CT冠状动脉造影检查的110例高血压患者,对其进行眼底照相,并采用Hubbard法对视网膜血管进行详细评价,测定视网膜动脉狭窄程度、动静脉交叉压迫征严重程度和视网膜动静脉直径比值。结果73例（66．4％）高血压患者被诊断为冠状动脉狭窄。冠状动脉狭窄组的视网膜动脉狭窄程度和动静脉交叉压迫征的严重度,均较对照组明显增加（P〈0.05）。冠状动脉狭窄患者,随着狭窄程度的增加,视网膜动脉狭窄程度、动静脉交叉压迫征的严重度均明显增加（P〈0．05）。冠状动脉狭窄者视网膜动脉直径和动静脉直径比值均明显小于对照组（P〈0．05）,而视网膜静脉直径并无明显变化（P〉0．05）。另外,冠状动脉狭窄患者,随着狭窄程度的增加,视网膜动脉直径与视网膜动静脉比值均明显缩小（P〈0．05）。视网膜动脉狭窄对冠状动脉狭窄程度的阳性预测率为76．62％,灵敏度为80．82％;视网膜动静脉交叉压迫征的阳性预测值为89．74％,特异性为89．19％。结论采用Hubbard法评价高血压患者视网膜血管的改变,可以很好地间接反映冠状动脉的狭窄程度。该视网膜血管评价方法,可以用于高血压患者的冠心病普查,并为进一步施行64层螺旋CT冠状动脉造影检查提供依据。     

Retinal arteriolar narrowing and risk of coronary heart disease in men and women. The Atherosclerosis Risk in Communities Study

Context  Microvascular processes have been hypothesized to play a greater role in the development of coronary heart disease (CHD) in women than in men; however, prospective clinical data are limited. Objective  To examine the association between retinal arteriolar narrowing, a marker of microvascular damage from hypertension and inflammation, and incident CHD in healthy middle-aged women and men. Design, Setting, and Participants  The Atherosclerosis Risk in Communities Study, an ongoing prospective, population-based cohort study in 4 US communities initiated in 1987-1989. Retinal photographs were taken in 9648 women and men aged 51 to 72 years without CHD at the third examination (1993-1995). To quantify retinal arteriolar narrowing, the photographs were digitized, individual arteriolar and venular diameters were measured, and a summary arteriole-to-venule ratio (AVR) was calculated. Main Outcome Measure  Risk of CHD associated with retinal arteriolar narrowing. Results  During an average 3.5 years of follow-up, 84 women and 187 men experienced incident CHD events. In women, after controlling for mean arterial blood pressure averaged over the previous 6 years, diabetes, cigarette smoking, plasma lipid levels, and other risk factors, each SD decrease in the AVR was associated with an increased risk of any incident CHD (relative risk [RR], 1.37; 95% confidence interval [CI], 1.08-1.72) and of acute myocardial infarction (RR, 1.50; 95% CI, 1.10-2.04). In contrast, AVR was unrelated to any incident CHD in men (RR, 1.00; 95% CI, 0.84-1.18) or to acute myocardial infarction (RR, 1.08; 95% CI, 0.85-1.38). Conclusion  Retinal arteriolar narrowing is related to risk of CHD in women but not in men, supporting a more prominent microvascular role in the development of CHD in women than in men. Future work is needed to confirm these findings.      

Abnormal glucose metabolism and pancreatic cancer mortality

CONTEXT: Previous studies reported an increased risk of pancreatic cancer among persons with diabetes. Few data exist, however, on the association of postload plasma glucose concentration with pancreatic cancer, which could provide insight into the role of abnormal glucose metabolism in the etiology of pancreatic cancer. OBJECTIVE: To determine the independent association between postload plasma glucose concentration and risk of pancreatic cancer mortality among persons without self-reported diabetes. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: Employees of 84 Chicago-area organizations, with an average age of 40 years at baseline, were screened from 1963 to 1973 and followed up for an average of 25 years. A total of 96 men and 43 women died of pancreatic cancer among 20,475 men and 15,183 women, respectively. MAIN OUTCOME MEASURES: Relationship of pancreatic cancer mortality with postload plasma glucose levels. RESULTS: Compared with a postload plasma glucose level of 6.6 mmol/L (119 mg/dL) or less and after adjusting for age, race, cigarette smoking, and body mass index, the relative risks (95% confidence intervals) of pancreatic cancer mortality were 1.65 (1.05-2.60) for postload plasma glucose levels between 6.7 (120) and 8.8 (159) mmol/L (mg/dL); 1.60 (0.95-2.70) for levels between 8.9 (160) and 11.0 (199); and 2.15 (1.22-3.80) for levels of 11.1 (200) or more; P for trend=.01. An association appeared to be stronger for men than women. Estimates were only slightly lower after excluding 11 men and 2 women who died of pancreatic cancer during the first 5 years of follow-up. In men only, higher body mass index and serum uric acid concentration also were independently associated with an elevated risk of pancreatic cancer mortality. CONCLUSION: These results suggest that factors associated with abnormal glucose metabolism may play an important role in the etiology of pancreatic cancer. JAMA. 2000;283:2552-2558     

Relationship between fasting plasma glucose and glycosylated hemoglobin: potential for false-positive diagnoses of type 2 diabetes using new diagnostic criteria

Mayer B. Davidson, MD; David L. Schriger, MD, MPH; Anne L. Peters, MD; Brett Lorber, MPH

JAMA. 1999;281:1203-1210.

Context  New criteria for the diagnosis of type 2 diabetes mellitus have recently been introduced that lowered the diagnostic fasting plasma glucose (FPG) concentration from 7.8 to 7.0 mmol/L (140 to 126 mg/dL).

Objective  To determine if individuals with diabetes diagnosed by the new FPG concentration criterion would have excessive glycosylation (elevated hemoglobin [HbA_1c] levels).

Definitions  We determined the distribution of HbA_1c levels in individuals using 4 classifications: (1) normal by the new criterion (FPG concentration <6.1 mmol/L [110 mg/dL]); (2) impaired fasting glucose by the new criterion (FPG concentration of 6.1-6.9 mmol/L [110-125 mg/dL]); (3) diabetes diagnosed solely by the new FPG concentration criterion of 7.0 through 7.7 mmol/L (126-139 mg/dL); and (4) diabetes diagnosed by the previous FPG concentration criterion of 7.8 mmol/L (140 mg/dL) or higher.

Design  Cross-sectional analysis of 2 large data sets (NHANES III and Meta-Analysis Research Group [MRG] on the Diagnosis of Diabetes Using Glycated Hemoglobin) that contained individuals in whom FPG concentrations, 2-hour glucose concentrations using an oral glucose tolerance test, and an HbA_1c level were simultaneously measured. We cross-tabulated FPG concentrations (<6.1 mmol/L [110 mg/dL], 6.1-6.9 mmol/L [110-125 mg/dL], 7.0-7.7 mmol/L [126-139 mg/dL], and 7.8 mmol/L [140 mg/dL]) and HbA_1c levels separated into 3 intervals: normal, less than the upper limit of normal (ULN); slightly elevated, ULN to ULN plus 1%; and high, higher than ULN plus 1%.

Results  Among subjects with normal FPG concentrations, HbA_1clevels in the NHANES III (and the MRG) data sets were normal in 97.3% (96.2%), slightly elevated in 2.7% (3.6%), and high in 0.1% (0.2%). Among individuals with impaired fasting glucose, HbA_1c concentrations were normal in 86.7% (81.4%), slightly elevated in 13.1% (16.4%), and high in 0.2% (2.2%). Among diabetic patients diagnosed by the new FPG criterion only, HbA_1c levels were normal in 60.9% (59.6%), slightly elevated in 35.8% (32.8%), and high in 3.4% (7.6%). In diabetic patients diagnosed by the former FPG criterion, HbA_1c levels were normal in 18.6% (16.7%), slightly elevated in 32.5% (21.0%), and high in 48.9% (62.3%).

Conclusions  About 60% of the new cohort of diabetic patients in both data sets have normal HbA_1c levels. We believe that diabetes should not be diagnosed in those with FPG concentrations less than 7.8 mmol/L (140 mg/dL) unless excessive glycosylation is evident. Individuals without excessive glycosylation but with moderate elevations of FPG concentrations (6.1-7.7 mmol/L [110-139 mg/dL]) should be diagnosed as having impaired fasting glucose and treated with an appropriate diet and exercise. This diagnostic labeling achieves the goal of early intervention without subjecting these persons to the potentially negative insurance, employment, social, and psychological consequences of a diagnosis of diabetes mellitus.

     

Ten-year incidence of diabetes in older Australians: the Blue Mountains Eye Study

OBJECTIVE: To estimate the incidence of diabetes and impaired fasting glucose (IFG), and increased risk associated with the metabolic syndrome, in a representative population-based sample of older Australians. DESIGN, SETTING AND PARTICIPANTS: The Blue Mountains Eye Study examined 3654 residents aged 49 + years (82.4% response rate) during 1992-1994, and re-examined 2335 (75.1% of survivors) during 1997-1999 and 1952 (75.6% of survivors) during 2002-2004; 2123 participants with normal blood glucose levels at baseline were considered at risk of developing incident diabetes. Main outcome measures: Incident diabetes (or IFG) was defined in participants at risk who were newly diagnosed by a physician during the follow-up or found to have a fasting blood glucose level >or= 7.0 mmol/L (or 5.6-6.9 mmol/L). Kaplan-Meier cumulative 10-year incidence was calculated. RESULTS: The overall 10-year incidence of diabetes and IFG was 9.3% and 15.8%, respectively. Participants with metabolic syndrome at baseline had a higher risk of incident diabetes than those without metabolic syndrome (29.2% v 8.6%). Baseline factors associated with incident diabetes were elevated fasting glucose level (adjusted odds ratio [OR], 4.5; 95% CI, 3.4-6.1 per mmol/L), obesity (OR, 2.0; 95% CI, 1.3-2.8), diabetes family history (OR, 1.7; 95% CI, 1.2-2.5), current smoking (OR, 1.6; 95% CI, 1.0-2.7) and high density lipoprotein cholesterol level < 1.0 mmol/L (OR, 2.4; 95% CI, 1.5-3.8). Similar baseline factors were associated with incident IFG. CONCLUSION: This population-based study provides data on the incidence of diabetes and IFG in an older, predominantly white population, and confirms that metabolic and lifestyle factors are major risk factors for diabetes.     

Fasting serum glucose level and cancer risk in Korean men and women

Context  Diabetes is a serious and costly disease that is becoming increasingly common in many countries. The role of diabetes as a cancer risk factor remains unclear. Objective  To examine the relationship between fasting serum glucose and diabetes and risk of all cancers and specific cancers in men and women in Korea. Design, Setting, and Participants  Ten-year prospective cohort study of 1 298 385 Koreans (829 770 men and 468 615 women) aged 30 to 95 years who received health insurance from the National Health Insurance Corp and had a biennial medical evaluation in 1992-1995 (with follow-up for up to 10 years). Main Outcome Measures  Death from cancer and registry-documented incident cancer or hospital admission for cancer. Results  During the 10 years of follow-up, there were 20 566 cancer deaths in men and 5907 cancer deaths in women. Using Cox proportional hazards models and controlling for smoking and alcohol use, the stratum with the highest fasting serum glucose (140 mg/dL [7.8 mmol/L]) had higher death rates from all cancers combined (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.22-1.37 in men and HR, 1.23; 95% CI, 1.09-1.39 in women) compared with the stratum with the lowest level (<90 mg/dL [<5.0 mmol/L]). By cancer site, the association was strongest for pancreatic cancer, comparing the highest and lowest strata in men (HR, 1.91; 95% CI, 1.52-2.41) and in women (HR, 2.05; 95% CI, 1.43-2.93). Significant associations were also found for cancers of the esophagus, liver, and colon/rectum in men and of the liver and cervix in women, and there were significant trends with glucose level for cancers of the esophagus, colon/rectum, liver, pancreas, and bile duct in men and of the liver and pancreas in women. Of the 26 473 total cancer deaths in men and women, 848 were estimated as attributable to having a fasting serum glucose level of less than 90 mg/dL. For cancer incidence, the general patterns reflected those found for mortality. For persons with a diagnosis of diabetes or a fasting serum glucose level greater than 125 mg/dL (6.9 mmol/L), risks for cancer incidence and mortality were generally elevated compared with those without diabetes. Conclusion  In Korea, elevated fasting serum glucose levels and a diagnosis of diabetes are independent risk factors for several major cancers, and the risk tends to increase with an increased level of fasting serum glucose.      

Noninvasive glucose monitoring: comprehensive clinical results. Cygnus Research Team

CONTEXT: Intensive diabetes management using frequent blood glucose measurements to guide therapy has been shown to significantly improve short- and long-term outcomes. Development of a device that makes possible frequent, automatic, painless, and accurate measurements of glucose would facilitate intensive management. OBJECTIVE: To determine the accuracy of the GlucoWatch automatic glucose biographer (Cygnus Inc) compared with that of serial blood glucose measurements. DESIGN: Multicenter comparative study of the GlucoWatch biographer and the HemoCue blood glucose analyzer (Aktiebolaget Leo) performed between August 29 and October 17, 1998. Participants wore up to 2 biographers during the 15-hour study session and performed 2 fingersticks per hour for comparative blood glucose measurements. The biographers were calibrated with a single HemoCue measurement after a 3-hour warm-up period. Diet and insulin were manipulated to produce a broad glycemic range during the study. SETTING: Controlled clinical environment at 2 diabetes centers and 3 contract research organizations in the United States. PARTICIPANTS: A total of 92 subjects (mean [SD] age, 42.1 [15.1] years; 59.8% women) with type 1 or 2 diabetes requiring treatment with insulin. MAIN OUTCOME MEASURES: Mean error, mean absolute error, correlation, slope, and intercept using Deming regression, and clinical significance of differences between biographer readings and blood glucose measurements using the Clarke error grid. RESULTS: Results showed close tracking of blood glucose over a range of 2.2 to 22.2 mmol/L (40-400 mg/dL) for up to 12 hours using a single point calibration. The biographer readings lagged behind serial blood glucose values by a mean of 18 minutes. An analysis of 2167 data pairs shows a linear relationship (r = 0.88; slope = 1.03; intercept = -0.33 mmol/L [-6 mg/dL]) between biographer readings and serial glucose measurements. The mean absolute error between the 2 measurements was 15.6% (mean error [SD], -0.07 [1.82] mmol/L [-1 [33] mg/dL]), and 96.8% of the data fell in the therapeutically relevant regions of the error grid analysis. CONCLUSION: These results demonstrate close agreement between GlucoWatch biographer readings and blood glucose measurements using repeated fingerstick blood samples. The automatic, frequent, and noninvasive measurements obtained with the biographer provides more information about glucose levels than the current standard of care.     

Are racial differences in the prevalence of diabetes in adults explained by differences in obesity?

To determine whether the higher prevalence of diabetes found among blacks in the United States is explained by racial differences in obesity, we examined the prevalence of diabetes adjusted for adiposity, education, and income in a cohort of US Army veterans from the Vietnam era. Among 12,558 white men and 1677 black men, aged 30 to 47 years, blacks were more likely than whites to have diagnosed diabetes (adjusted prevalence ratio, 1.9; 95% confidence interval, 1.3 to 2.7). Within every age, adiposity, and socioeconomic stratum, blacks had a higher prevalence of diagnosed diabetes than whites. In a subgroup of veterans for whom fasting serum glucose values were measured, blacks were more likely than whites to have fasting hyperglycemia (fasting serum glucose value greater than or equal to 7.8 mmol/L) (adjusted prevalence ratio, 5.7; 95% confidence interval, 2.7 to 12.0). These data provide evidence that the higher prevalence of diabetes found among blacks is not explained by differences in obesity.     

Relation of impaired fasting and postload glucose with incident type 2 diabetes in a Dutch population: The Hoorn Study

CONTEXT: Persons with impaired glucose tolerance (IGT) are known to have an elevated risk of developing diabetes mellitus. Less is known about diabetes risk among persons with impaired fasting glucose (IFG) or with normal glucose levels. OBJECTIVE: To determine the incidence of diabetes in relation to baseline fasting and postload glucose levels and other risk factors. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study conducted from October 1989 to February 1992 among 1342 nondiabetic white residents of Hoorn, the Netherlands, aged 50 to 75 years at baseline, in whom fasting plasma glucose (FPG) levels and glucose levels 2 hours after a 75-g oral glucose tolerance test were measured at baseline and at follow-up in 1996-1998. MAIN OUTCOME MEASURES: Cumulative incidence of diabetes, defined according to the diagnostic criteria of the World Health Organization (WHO-1985 and WHO-1999) and the American Diabetes Association (ADA-1997), during a mean follow-up of 6.4 years, compared among participants with IFG, IGT, and normal glucose levels at baseline. RESULTS: The cumulative incidence of diabetes was 6.1%, 8.3%, and 9.9% according to the WHO-1985, ADA, and WHO-1999 criteria, respectively. The cumulative incidence of diabetes (WHO-1999 criteria) for participants with both IFG and IGT was 64.5% compared with 4.5% for those with normal glucose levels at baseline. The odds ratios for diabetes (WHO-1999 criteria), adjusted for age, sex, and follow-up duration, were 10.0 (95% confidence interval [CI], 6.1-16.5), 10.9 (95% CI, 6.0-19.9), and 39.5 (95% CI, 17.0-92.1), respectively, for those having isolated IFG, isolated IGT, and both IFG and IGT. In addition to FPG and 2-hour postload glucose levels (P<.001 for both), the waist-hip ratio also was an important risk factor for developing diabetes (P =.002). CONCLUSION: In this study, the cumulative incidence of diabetes was strongly related to both IFG and IGT at baseline and, in particular, to the combined presence of IFG and IGT.     

Prevalence of hyperuricemia and its relationship with metabolic syndrome in Thai adults receiving annual health exams

BACKGROUND: Associations between hyperuricemia, metabolic syndrome, cardiovascular disease and diabetes have been reported. Limited information, however, is available concerning the prevalence and correlates of hyperuricemia among Thai men and women. We sought to estimate the prevalence of hyperuricemia among a population of patients receiving annual health exams and to evaluate its relationship with metabolic syndrome (MetS). METHODS: We conducted a cross-sectional study of 1,381 patients (376 men and 1,005 women) who first participated in annual health examinations at the Preventive Medicine Clinic of the King Chulalongkorn Memorial Hospital in Bangkok, Thailand during the period July 1999 through February 2000. Hyperuricemia was defined as >7.0 mg/dL in men and >6.0 mg/dL in women. MetS was defined using the modified ATP III criteria. RESULTS: The overall prevalence of the hyperuricemia was 10.6%. The condition was more common in men than in women (18.4 vs. 7.8%). Among women, serum uric acid was statistically significantly correlated with body mass index (BMI), systolic and diastolic blood pressure, high-density lipoprotein-cholesterol, triglyceride and fasting plasma glucose (all p <0.05). Men with serum uric acid concentrations >6.7 mg/dL (upper quartile) had a 3.91-fold increased in risk of MetS (95% CI:1.36-11.23), as compared with those who had concentrations <5.1 mg/dL (lowest quartile). Among women, the risk of MetS increased at least 2-fold for concentration of serum uric acid concentrations >4.0 mg/dL (p for trend <0.001). CONCLUSIONS: Hyperuricemia is prevalent among Thai men and women receiving routine health exams. Additionally, serum uric acid is positively associated with MetS.     

Analysis of islet B cell reserve in patients with NIDDM

The plasma glucose and insulin response to oral glucose or carbohydrate meal tolerance tests were determined in 78 normal controls, 71 persons with IGT and 110 patients with NIDDM. The results showed that: (1) The fasting serum insulin levels and insulin/glucose ratio were all higher in persons with IGT than those in the normal controls, and they were normal in diabetics with fasting plasma glucose less than 7.8 mmol/L. In diabetics with fasting plasma glucose at 7.8-20.3 mmol/L, fasting insulin levels were within normal limit, but the values of insulin/glucose ratio were significantly decreased. (2) After glucose challenge, the values of serum insulin/glucose ratio were all increased in IGT, but were progressively decreased in diabetics as fasting plasma glucose gradually became higher. (3) Fasting serum insulin levels were increased in normal weight and over-weight individuals with IGT. But in those with diabetes, fasting insulin was increased in comparison with normal controls. When fasting plasma glucose was greater than 11.1 mmol/L, insulin/glucose ratio was decreased significantly. Our data suggests that the increased insulin secretion in persons with IGT was due to peripheral resistance and relative insulin insufficiency, and that hyperglycemia could compensate for B cell impairment.     

Diurnal variation in fasting plasma glucose: implications for diagnosis of diabetes in patients examined in the afternoon

Context  Current diagnostic criteria for diabetes are based on plasma glucose levels in blood samples obtained in the morning after an overnight fast, with a value of 7.0 mmol/L (126 mg/dL) or more indicating diabetes. However, many patients are seen by their physicians in the afternoon. Because plasma glucose levels are higher in the morning, it is unclear whether these diagnostic criteria can be applied to patients who are tested for diabetes in the afternoon. Objectives  To document diurnal variation in fasting plasma glucose levels in adults not known to have diabetes, and to examine the applicability to afternoon-examined patients of the current diagnostic criteria for diabetes. Design, Setting, and Participants  Analysis of data from the US population–based Third National Health and Nutrition Examination Survey (1988-1994) on participants aged 20 years or older who had no previously diagnosed diabetes, who were randomly assigned to morning (n = 6483) or afternoon (n = 6399) examinations, and who fasted prior to blood sampling. Main Outcome Measures  Fasting plasma glucose levels in morning vs afternoon-examined participants; diabetes diagnostic value for afternoon-examined participants. Results  The morning and afternoon groups did not differ in age, body mass index, waist-to-hip ratio, physical activity index, glycosylated hemoglobin level, and other factors. Mean (SD) fasting plasma glucose levels were higher in the morning group (5.41 [0.01] mmol/L [97.4 {0.3} mg/dL]) than in the afternoon group (5.12 [0.02] mmol/L [92.4 {0.4} mg/dL]; P<.001). Consequently, prevalence of afternoon-examined participants with fasting plasma glucose levels of 7.0 mmol/L (126 mg/dL) or greater was half that of participants examined in the morning. The diagnostic fasting plasma glucose value for afternoon-examined participants that resulted in the same prevalence of diabetes found in morning-examined participants was 6.33 mmol/L (114 mg/dL) or greater. Conclusions  Our results indicate that if current diabetes diagnostic criteria are applied to patients seen in the afternoon, approximately half of all cases of undiagnosed diabetes in these patients will be missed.      

Point-of-care testing of HbA1c and blood glucose in a remote Aboriginal Australian community

OBJECTIVES: To assess the accuracy of point-of-care (POC) measurements of capillary blood glucose and glycosylated haemoglobin (HbA(1c)) levels in a remote Aboriginal community with high diabetes prevalence. DESIGN: Cross-sectional study comparing POC capillary glucose and HbA(1c) results with those from corresponding venous samples measured in a reference laboratory. PARTICIPANTS AND SETTING: 152 residents aged 11-76 years (representing 76% of population aged over 11 years) had POC glucose measurement in November 2003; 88 with POC glucose level > or = 5.0 mmol/L, or self-reported diabetes, had POC HbA(1c) and laboratory glucose and HbA(1c) measurements. MAIN OUTCOME MEASURES: POC fasting capillary levels of glucose (HemoCue Glucose 201 analyser, Medipac Scientific, Sydney) and HbA(1c) (DCA 2000+ analyser, Bayer Australia, Melbourne); correlation and mean difference between capillary POC and venous blood laboratory measurements of glucose and HbA(1c). RESULTS: Mean and median POC capillary glucose levels were 7.99 mmol/L and 6.25 mmol/L, respectively, while mean and median laboratory venous plasma glucose concentrations were 7.63 mmol/L and 5.35 mmol/L. Values for POC capillary HbA(1c) and laboratory HbA(1c) were identical: mean, 7.06%; and median, 6.0%. The correlation coefficient r for POC and laboratory results was 0.98 for glucose and 0.99 for HbA(1c). The mean difference in results was 0.36 mmol/L for glucose (95% CI, 0.13-0.62; limits of agreement [LOA], - 2.07 to 2.79 mmol/L; P = 0.007) and < 0.01% for HbA(1c) (95% CI, - 0.07% to 0.07%; LOA, - 0.66% to 0.66%; P = 0.95), respectively. CONCLUSIONS: POC capillary HbA(1c) testing, in particular, offers an accurate, practical, community-friendly way of monitoring diabetes in rural and remote clinical settings. POC capillary glucose results should be confirmed by a laboratory test of venous plasma if the results are likely to significantly influence clinical decisions.     

2型糖尿病电子临床路径在社区的应用效果评估

目的 探索2型糖尿病电子临床路径的实证效果,为其在社区的进一步推广使用提供依据。 方法 选取2010年起与潍坊社区卫生服务中心全科医生进行家庭医生进行签约的糖尿病患者,从2016年6月—2017年5月入组其中264例为研究对象,采用随机数字方法随机分为电子临床路径组(132例)和对照组(132例),1年后对2组患者干预前后的体征、代谢指标进行比较。 结果 经过1年的电子临床路径规范化管理后,电子临床路径组的空腹血糖[(6.29±0.76)mmol/L]、糖化血红蛋白[(6.76±0.36)%]、低密度脂蛋白[(2.65±0.88) mmol/L]低于干预前[(7.80±0.65)mmol/L、(7.72±0.41)%、(2.81±0.93) mmol/L],差异均有统计学意义(均P<0.05);干预后,对照组的空腹血糖[(7.40±0.52)mmol/L]、糖化血红蛋白[(7.29±0.49)%]、低密度脂蛋白[(3.07±0.80) mmol/L],均高于电子临床路径组,差异均有统计学意义(均P<0.05)。 结论 电子临床路径不仅能够规范化全科医生的诊疗,强化对糖尿病患者的随访管理,还能提高患者的依从性和满意度。可考虑全面应用电子临床路径管理2型糖尿病患者,并向其他社区进行推广。      

C-reactive protein, interleukin 6, and risk of developing type 2 diabetes mellitus

CONTEXT: Inflammation is hypothesized to play a role in development of type 2 diabetes mellitus (DM); however, clinical data addressing this issue are limited. OBJECTIVE: To determine whether elevated levels of the inflammatory markers interleukin 6 (IL-6) and C-reactive protein (CRP) are associated with development of type 2 DM in healthy middle-aged women. DESIGN: Prospective, nested case-control study. SETTING: The Women's Health Study, an ongoing US primary prevention, randomized clinical trial initiated in 1992. PARTICIPANTS: From a nationwide cohort of 27 628 women free of diagnosed DM, cardiovascular disease, and cancer at baseline, 188 women who developed diagnosed DM over a 4-year follow-up period were defined as cases and matched by age and fasting status with 362 disease-free controls. MAIN OUTCOME MEASURES: Incidence of confirmed clinically diagnosed type 2 DM by baseline levels of IL-6 and CRP. RESULTS: Baseline levels of IL-6 (P<.001) and CRP (P<.001) were significantly higher among cases than among controls. The relative risks of future DM for women in the highest vs lowest quartile of these inflammatory markers were 7.5 for IL-6 (95% confidence interval [CI], 3.7-15.4) and 15.7 for CRP (95% CI, 6.5-37.9). Positive associations persisted after adjustment for body mass index, family history of diabetes, smoking, exercise, use of alcohol, and hormone replacement therapy; multivariate relative risks for the highest vs lowest quartiles were 2.3 for IL-6 (95% CI, 0.9-5.6; P for trend =.07) and 4.2 for CRP (95% CI, 1.5-12.0; P for trend =.001). Similar results were observed in analyses limited to women with a baseline hemoglobin A(1c) of 6.0% or less and after adjustment for fasting insulin level. CONCLUSIONS: Elevated levels of CRP and IL-6 predict the development of type 2 DM. These data support a possible role for inflammation in diabetogenesis.     

The relationships between erythrocyte membrane n-6 to n-3 polyunsaturated fatty acids ratio and blood lipids and C-reactive protein in Chinese adults: an observational study

Objective To investigate the relationships between erythrocyte membrane n‐6:n‐3 PUFAs ratio and blood lipids and high sensitivity C‐reactive protein (hs‐CRP).Methods The observational study consisted of a population‐based cross‐sectional study of 456 Chinese and a subsequent 1‐year follow‐up study of 171 subjects with the fasting plasma total cholesterol of 5.13‐8.00 mmol/L.Results In the cross‐sectional analysis,plasma low‐density lipoprotein cholesterol (LDL‐c) had a significant and negative association w...     

Hypoglycemia and the decision to drive a motor vehicle by persons with diabetes.

CONTEXT: Laboratory studies have shown impairments in driving performance among subjects with type 1 diabetes mellitus when their blood glucose (BG) level is between 2.6 and 3.6 mmol/L (47-65 mg/dL). However, to our knowledge, no data exist examining subjects' decisions to drive at various BG levels during their daily routine. OBJECTIVE: To examine type 1 diabetic subjects' decisions to drive during their daily routine based on perception of BG levels compared with actual measured BG levels. DESIGN AND SETTING: Two separate groups of patients were recruited 2 years apart from 4 academic medical centers. PARTICIPANTS: All subjects were adults with type 1 diabetes who were drivers and who performed at least 2 BG tests per day. Group 1 (initial) subjects (n = 65) had a mean (SD) age of 38.6 (8.9) years with a mean (SD) diabetes duration of 20.5 (10.6) years, were taking 38.8 (16.8) U/d of insulin, and had a mean (SD) glycosylated hemoglobin (HbA1) level of 10.0% (1.9%). Group 2 (replication) subjects (n = 93) were 35.8 (8.0) years old with a mean diabetes duration of 17.0 (10.6) years, were taking 40.0 (15.5) U/d of insulin, and had a mean (SD) HbA1 level of 8.5% (1.6%). Each subject used a handheld computer to record data on symptoms, cognitive function, insulin dosage, food, activity, estimated and actual BG levels, and whether he/she would drive. Data were entered 3 to 6 times per day for a total of 50 to 70 collections per subject during a 3- to 4-week period. MAIN OUTCOME MEASURES: Decisions to drive when subjects estimated their BG level to be less than 2.2 mmol/L (40 mg/dL), 2.2 to 2.8 mmol/L (40-50 mg/dL), 2.8 to 3.3 mmol/L (50-60 mg/dL), 3.3 to 3.9 mmol/L (60-70 mg/dL), 3.9 to 10 mmol/L (70-180 mg/dL), and more than 10 mmol/L (>180 mg/dL), and driving decisions when actual BG levels were in these ranges. RESULTS: Subjects stated they would drive 43% to 44% of the time when they estimated their BG level to be 3.3 to 3.9 mmol/L (60-70 mg/dL), and 38% to 47% of the time when their actual BG level was less than 2.2 mmol/L (40 mg/dL). Logistic regression analysis demonstrated that number of autonomic symptoms, degree of impairment on cognitive function tests, and BG level estimate predicted 76% to 80% of decisions to drive (P<.01 for all). Approximately 50% of subjects in each group decided to drive at least 50% of the time when their BG level was less than 3.9 mmol/L (70 mg/dL). CONCLUSIONS: Our data suggest that persons with type 1 diabetes may not judge correctly when their BG level is too low to permit safe driving and may consider driving with a low BG level even when they are aware of the low level. Health care professionals should counsel their patients about the risk of driving with hypoglycemia and the importance of measuring BG level before driving.     

北京市昌平区自然人群糖尿病视网膜病变患病率调查及危险因素分析

目的了解北京市昌平区自然人群糖尿病视网膜病变(diabetic retinopathy,DR)患病率及相关危险因素。方法根据2010年"昌平区卫生与人群健康状况调查",采用从166万昌平区常住自然人群中随机抽样18岁～79岁的8 155例健康受试者,其中3 760例空腹血糖≥5.6 mmol/L者参加本研究,最终2 551例受试者完成体格检查和血液生化指标的测定,包括空腹血糖(fasting plasma glucose,FPG),OGTT-2h血糖(oral glucose tolerance test 2h plasma glucose,OGTT-2hPG)和糖化血红蛋白(hemoglobin A1c,HbA1c),以及眼底检查,所有人选进行散瞳45°彩色眼底照相,以评价DR分级。结果 2 551例受试者中,已知糖尿病患者280例,新诊断糖尿病患者334例,糖调节受损(impaired glucose regulation,IGR)者853例。糖尿病和IGR患者的DR患病率分别为9.9%和1.2%。新诊断糖尿病患者DR患病率(2.7%)明显低于已知糖尿病患者(18.6%)。在糖尿病患者中,DR的发生与糖尿病病程[OR=1.49(95%CI:1.38～1.62)]、空腹血糖[OR=1.32(95%CI:1.22～1.43)]、2 hPG[OR=1.18(95%CI:1.12～1.24)]、HbA1c[OR=1.66(95%CI:1.45～1.90)],以及收缩压水平[OR=1.16(95%CI:1.02～1.31)]显著相关。结论本研究人群糖尿病和糖尿病前期患者DR患病率明显低于西方国家。糖尿病患者DR发生的主要危险因素是糖尿病病程、高血糖和高血压。     

Relationship of physical activity vs body mass index with type 2 diabetes in women

CONTEXT: Physical inactivity and body mass index (BMI) are established independent risk factors in the development of type 2 diabetes; however, their comparative importance and joint relationship with diabetes are unclear. OBJECTIVE: To examine the relative contributions and joint association of physical activity and BMI with diabetes. DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study of 37 878 women free of cardiovascular disease, cancer, and diabetes with 6.9 years of mean follow-up. Weight, height, and recreational activities were reported at study entry. Normal weight was defined as a BMI of less than 25; overweight, 25 to less than 30; and obese, 30 or higher. Active was defined as expending more than 1000 kcal on recreational activities per week. MAIN OUTCOME MEASURE: Incident type 2 diabetes, defined as a new self-reported diagnosis of diabetes. RESULTS: During the follow-up, 1361 cases of incident diabetes occurred. Individually, BMI and physical activity were significant predictors of incident diabetes. Compared with normal-weight individuals, the multivariate-adjusted hazard ratio (HR) was 3.22 (95% confidence interval [CI], 2.69-3.87) for overweight individuals and 9.09 (95% CI, 7.62-10.8) for obese individuals. For overall activity (kilocalories expended per week), compared with the least active first quartile, the multivariate-adjusted HRs were 0.91 (95% CI, 0.79-1.06) for the second quartile, 0.86 (95% CI, 0.74-1.01) for the third, and 0.82 (95% CI, 0.70-0.97) for the fourth (P for trend =.01). In the combined analyses, overweight and obese participants, whether active or inactive, had significantly elevated risks, compared with normal-weight active individuals. The multivariate-adjusted HRs were 1.15 (95% CI, 0.83-1.59) for normal-weight inactive, 3.68 (95% CI, 2.63-5.15) for overweight active, 4.16 (95% CI, 3.05-5.66) for overweight inactive, 11.5 (95% CI, 8.34-15.9) for obese active, and 11.8 (95% CI, 8.75-16.0) for obese inactive participants. CONCLUSIONS: Although BMI and physical inactivity are independent predictors of incident diabetes, the magnitude of the association with BMI was greater than with physical activity in combined analyses. These findings underscore the critical importance of adiposity as a determinant of diabetes.     

血清果糖胺测定在糖尿病诊断中的意义

目的:通过检测血清果糖胺水平,评价该指标在糖尿病诊断中的临床意义。方法:采用全自动生化分析仪对62例糖尿病患者及35名正常对照组分别进行空腹血糖、果糖胺及餐后2h血糖、果糖胺测定,比较两组间结果差异有无显著性。结果:正常对照组果糖胺值频数呈正偏态分布,参考范围:(1.86±0.23)mmol/L。糖尿病组测试结果:果糖胺异常率达91.6%,数值范围:(2.46±0.48)mmol/L,与正常对照组差异有显著意义(P<0.05)。对糖尿病史组,空腹血糖与餐后2h血糖相比差异有显著性(P<0.05);空腹果糖胺与餐后2h果糖胺相比差异无显著性(P>0.05)。结论:开展果糖胺试验可以反应患者测定前2周~3周内的平均血糖水平,且不受临时血糖浓度的干扰,可作为评价糖尿病近期内控制状况的一个灵敏可靠指标,因此,用于评价糖尿病短期控制程度及药物疗效具有很高的价值。