Opposite fates of fructose in the development of metabolic syndrome

This short review comments on the recently published work of Ishimoto et al regarding the opposing effects of fructokinase C and A isoforms on fructose-induced metabolic syndrome in mice. The framework for the commentary is the preexisting background of epidemiological and experimental data regarding the association between ingestion of fructose, as present in sweetened beverages, and the development of metabolic syndrome. The work of Ishimoto et al clearly confirms the negative effect of fructose on lipid and glucose metabolism, independently from the amount of energy provided by the ingested sugar. It also confirms the absolute requirement of liver fructose metabolism, driven by fructokinase activity, in order to develop the full spectrum of metabolic syndrome alterations.     

胰岛素抗炎机制研究进展

胰岛素是体内唯一降低血糖的激素,目前,临床上主要使用胰岛素治疗糖尿病.然而,胰岛素不仅是一个重要的代谢调节激素,而且是一个重要的抗炎因子.其发挥抗炎作用的具体机制可能为:直接调节炎性反应因子,抑制氧化应激,调节一氧化氮的表达,在血管水平发挥抗炎作用,促进辅助性T细胞(Th)-2的转化,抑制白细胞介素-6-信号转导与转录激活因子(IL-6-STAT)炎性反应通路,降低C反应蛋白水平,下调Toll样受体等.     

高血糖与动脉瘤性蛛网膜下腔出血后迟发性脑缺血

高血糖在动脉瘤性蛛网膜下腔出血(aneurysmal subarachnoid hemorrhage,aSAH)患者中很常见,而且与aSAH后迟发性脑缺血(delayed cerebral ischemia,DCI)具有重要联系,并可导致预后不良.文章对aSAH后血糖升高的机制、引发DCI的原因以及相应的治疗措施进行了总结.     

An exploratory study of health behaviors and the risks for triple H (hypertension,hyperlipidemia, and hyperglycemia) in young adults with disabilities between 20 and 39 years of age

Metabolic syndrome is highly prevalent and has important implications for the health care sector. However, information on the implications of metabolic syndrome for people with disabilities is limited. The purpose of this study was to explore the relationship between health behaviors and the risk for triple H (hypertension, hyperlipidemia, and hyperglycemia) in young adults with disabilities. The present study analyzed the annual health examination charts of 705 young adults with disabilities between ages 20 and 39 in Taiwan. Results found that the prevalence of hyperglycemia, hyperlipidemia, and hypertension in adults with disabilities was 5%, 15% and 17.7%, respectively. These prevalence figures were higher than those for the general population of the same age group in Taiwan. Multivariate logistic regression analyses revealed that almost none of the health behaviors were significantly correlated with the occurrence of triple H disorders among young adults with disabilities. Only one factor, BMI, independently predicted the occurrence of triple H disorders. We suggest that future studies should scrutinize the effects of health behaviors on triple-H disorders in people with disabilities to initiate personalize health promotion programs for this group.     

化疗相关性高血糖对急性淋巴细胞白血病患者生存状况的影响

目的 探讨急性淋巴细胞白血病(ALL)患者因化疗诱发的高血糖对预后的影响.方法 回顾性分析我院2010年1月至2015年2月收集的62例ALL患者临床资料,按照是否伴随高血糖分为无高血糖组30例和高血糖组32例,比较化疗前后两组患者的临床特征及化疗后生存状况.结果 化疗前,所有患者血糖水平均显示正常.化疗期间,无高血糖组患者血小板浓度低于50×109/L的发生率为30.00%(9例),感染发生率为40.00%(12例);高血糖组血小板浓度低于50×109/L的发生率为56.25%(18例),感染的发生率为65.62%(21例),高血糖组患者血小板降低和感染发生率显著高于无高血糖组(P<0.05);无高血糖组的血小板平均浓度为(88.21±7.94)×109/L,明显高于高血糖组的(52.79±8.73)×109/L,差异有统计学意义(P<0.05);两组患者在Zubrod评分、白细胞数目、是否出现肝肿大及核型Ph(+)等方面比较差异均无统计学意义(P>0.05);高血糖组复发率为28.13%(9例),无高血糖组患者无复发或死亡情况发生(P<0.05);无高血糖组患者的中位生存期为43.61个月,明显长于高血糖组患者的12.81个月,差异有统计学意义(P<0.05);高血糖组5年无疾病生存率为69.10%,明显低于无高血糖组的100.00%,差异有统计学意义(P<0.05).结论 化疗治疗ALL诱发高血糖症状会增加临床并发症风险,增加患者复发和死亡风险.     

Higher rate of hyperglycemia than hypoglycemia during Ramadan fasting in patients with uncontrolled type 1 diabetes: Insight from continuous glucose monitoring system

Background

Patients with uncontrolled type 1 diabetes mellitus (T1DM) are at a high risk for Ramadan fasting and are exempt from fasting; however, most still insist on fasting. The aim of this study was to examine glucose level fluctuations in those patients during Ramadan fasting using a real-time continuous glucose monitoring system (RT-CGMS).

Lowering of glucose in critical care: a randomized pilot trial

BACKGROUND: Similar to cardiac surgery patients, medical-surgical critically ill patients may benefit from intensive insulin therapy. The objectives of this pilot trial were to evaluate the feasibility of a randomized trial of intensive insulin therapy with respect to (a) achieving target glucose values in the 2 ranges of 5 to 7 and 8 to 10 mmol/L and (b) uncovering problems with the protocol in anticipation of a larger trial. SETTING: The trial was conducted in a 15-bed medical-surgical university-affiliated intensive care unit (ICU). METHODS: We included patients older than 18 years, expected to be in ICU for more than 72 hours, with a glucose value of more than 10 mmol/L within 48 hours of ICU admission. Exclusion criteria were diabetic ketoacidosis, severe hepatic failure or hepatic resection, pancreatitis, glucose of less than 2.2 mmol/L on admission to hospital, insulin infusion on admission to ICU, planned withdrawal of life support, and inability to obtain informed consent. Patients underwent concealed random allocation to a target glucose range of 5 to 7 or 8 to 10 mmol/L using pretested algorithms of insulin infusions. Dedicated glucometer measurement of arterial glucose values was calibrated daily to values measured in the laboratory. RESULTS: We enrolled 20 patients with a mean (SD) Acute Physiology and Chronic Health Evaluation (APACHE) II score of 32 (10.2); 14 were insulin-dependent pre-ICU, and all were medical admissions. Mean glucose values were different in the 2 groups (7.1 +/- 2.6 vs 9.4 +/- 2.1 mmol/L, P < .001). Although the intensive insulin therapy group had more glucose measurements performed than the control group, a similar proportion of values were within the target range (682 [42.4%] of 1607 values in the 5- to 7-mmol/L range; 250 [38.7%] of 660 values in the 8- to 10-mmol/L range, P = .35). Glucose values of less than 2.5 mmol/L developed 7 times in 5 patients, 4 of whom were in the intensive insulin therapy group; however, no adverse consequences were documented. As expected, there were no differences in clinically important outcomes. CONCLUSIONS: In this pilot trial of ICU patients with high illness severity, glucose values were in the 2 target ranges only 40% of the time, using well-accepted initiation and maintenance insulin infusion algorithms. A large randomized trial of glycemic control is feasible in this population to examine clinically important outcomes, but will require refined insulin algorithms and more comprehensive behavior change strategies to achieve target values.     

当归芍药散对糖尿病认知障碍性疾病的研究进展

经典古方当归芍药散最初记载于《金匮要略》,主要用于治疗妇科疾病。现代方剂学将其归入理血剂中,当归芍药散的临床使用范围已经大大拓宽。本文总结了当归芍药散治疗糖尿病认知障碍性疾病的研究,从其对胰岛素代谢,细胞凋亡,炎症损伤,糖尿病心肌病,雌激素的影响以及抗氧化作用,降血糖作用和对神经保护等方面进行了综述研究。     

Effective reduction in stress induced postoperative hyperglycemia in bariatric surgery by better carb loading

BackgroundPreoperative carbohydrate loading is a recommended component of enhanced recovery protocols (ERP’s), however the impact on postoperative stress-induced insulin resistance remains poorly studied in both diabetics and non-diabetics.MethodsUsing our ERP, a preoperative grape juice group (Grape) was compared to the use of 25 g maltodextrin/3 g citrulline (G.E.D.™, SOF Health, LLC) for carbohydrate loading.ResultsThe population included 171 patients (Grape n = 96; GED n = 75). Glycemic variability was significantly worse for the Grape group on POD 0 in both non-diabetic (70% vs 41%; p < 0.05) and diabetic patients (66% vs 34%; p < 0.05). Significantly more Grape patients required postoperative insulin regardless of diabetic status.ConclusionFollowing bariatric surgery, the impact of stress induced hyperglycemia is primarily on POD 0 in non-diabetics whereas the effect extends into POD 1 for diabetics. Preoperative loading with G.E.D.™ versus grape juice is associated with a significantly lower rate of glycemic variation and postoperative insulin requirement, demonstrating that drink composition and treatment process reduces the severity of postoperative stress induced hyperglycemia in bariatric surgery patients.