高校在职教职工体检空腹血糖统计分析与健康干预策略研究

目的：探讨定期查体及针对检测结果进行健康干预对高校教职工空腹血糖（FPG）的影响。方法：回顾性分析山东大学在职教职工2013年~2019年4次健康查体的空腹血糖（FPG）检测结果及健康干预方式,分析4次查体高血糖患病情况;不同职业人员健康干预效果;不同年龄组、不同性别高血糖患病情况;高血糖患病率与身体质量指数及家族史的关系;部分血糖持续增高患者原因。结果：后两次体检高血糖患病率明显降低,空腹血糖受损患病状况改善明显,FPG值≥7.0 mmol/L者患病状况无改善。教师、机关及管理人员2019年高血糖患病率及FPG均值与2013年相比有明显降低,但后勤工人高血糖患病率无降低,FPG水平居高不下。45~55岁年龄组男女患病率相当,其他年龄组男性高血糖患病率及FPG水平均明显高于女性。高血糖患病率与身体质量指数及家族遗传因素关系密切。随机抽取2013年及2019年查体两次FPG均≥8.0 mmol/L的患者12例,调查血糖未达标原因,主要为不了解糖尿病并发症的危害,对疾病不重视;对健康处方中的建议一知半解,不能正确执行;工作性质特殊,无法执行医嘱;对胰岛素有偏见,口服药物效果不理想的情况下,不愿意及时采取胰岛素治疗。结论：定期查体及针对检测结果进行健康干预可有效降低高校教职工高血糖发病率,需要针对后勤工人、更年期女性、身体质量指数超标及有相关疾病家族史等重点人群实施更加有效的干预措施。     

短期胰岛素强化治疗对围手术期高血糖患者胰岛β细胞功能的影响

【摘要】 目的 探讨短期胰岛素强化治疗对围手术期高血糖患者β细胞功能的影响。方法回顾性分析2011年1月~2013年7月我院短期胰岛素强化治疗围手术期高血糖的患者临床资料,其中采用持续性皮下胰岛素输注治疗患者25例(CSII组),采用多次皮下胰岛素注射治疗患者20例(MSII组)。治疗2周后,比较两组的血糖控制(FBG、2hPG、GSP)、β细胞功能、胰岛素敏感性指标以及TNF-α、IL-1β、CRP、APN的变化情况。结果〓CSII组与MSII组的FBG、2hPG、GSP水平均较治疗前显著降低,差异具有统计学意义(P<0.05);治疗后CSII组的FBG、2hPG、GSP水平与MSII组比较,差异不显著(P>0.05)。CSII组与MSII组的GSP、Homa-IR水平均较治疗前显著降低,Homa-β较治疗前显著升高,且与MSII组比较改善更显著(P<0.05);同样CSII组TNF-α、IL-1β、CRP水平与MSII组比较也改善更显著(P<0.05)。结论〓持续性皮下胰岛素输注治疗可有效控制血糖,显著改善胰岛β功能及提高胰岛素敏感性,其机制可能与下调炎性因子有关。     

Steroid hyperglycemia: Prevalence,early detection and therapeutic recommendations: A narrative review

Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.     

Differential risk factors and morbidity/mortality pattern in type 2 diabetes: A study among two Mendelian populations with different ancestry (India)

Background and aims:Association studies of type 2 diabetes mellitus (T2DM) with risk factors have shown variable results. Moreover, population-specific comparative investigations are negligible. Therefore, the present study aimed to evaluate the association of dyslipidemia and obesity with impaired fasting glucose (IFG) and T2DM among two ethnically, geographically and culturally different populations in India.Methods:This was a cross-sectional study among Jats and Meiteis, each inhabiting a separate geographical region. A total of 2371 individuals, age ≥30 years were recruited through household survey. Obesity variables were captured using anthropometric measurements while fasting blood (2.5 mL) was drawn to measure lipid and glucose levels using enzymatic assay by spectrophotometer. Participants were categorized under normal, IFG and T2DM groups, indicative of diabetes progression stages. Statistical analysis was performed using SPSS 16.0 version.Results:Significant differential distribution of lipid and obesity variables among IFG and T2DM in both populations were observed. Odds ratio revealed high TC and all obesity variables except BMI posed significant increased risk for T2DM among Jats. Abnormal TG, VLDL, WC, and WHtR posed significant increased risk for T2DM among Meiteis. Age-cohort wise prevalence of T2DM showed increasing trend at ≥60 years among Jats and decreasing trend at ≥60 years among Meiteis, suggesting a potential higher morbidity in the former and mortality in latter because of T2DM.Conclusions:The present study observed a differential association of risk factors for T2DM among Jats and Meiteis. This study emphasize the need to implement community-specific intervention programs for prevention, treatment and management of T2DM.     

Effect of Atorvastatin on blood ketone levels and glycemic control in patients with type 2 diabetes mellitus: A single arm pilot study

Background and aimsCholesterol and ketone bodies are synthesized in liver from a common precursor acetyl coenzyme A (acetyl-CoA). Statins by inhibiting cholesterol synthesis may lead to accumulation of acetyl-CoA in hepatocytes and its diversion towards ketogenesis. Ketone bodies may act as alternative energy source thus sparing blood glucose and contributing to hyperglycemia. The present study aims to assess the effect of Atorvastatin therapy on blood ketone levels and glycemic control in patients with T2DM.MethodsStudy included 24 statin naïve subjects with T2DM. They were prescribed tablet Atorvastatin at dose of 10 mg once daily at bedtime. Ongoing anti-diabetic medications were not changed. Estimation of blood ketones, urine ketones, fasting plasma glucose (FPG), post-prandial plasma glucose (PPG), glycated hemoglobin (HbA1c) and lipid parameters was carried out at baseline and at 3 months after starting Atorvastatin.ResultsThere was moderate but significant increase in blood ketones (0.16 ± 0.08 mmol/L vs. 0.26 ± 0.07 mmol/L; p-value = 0.0000), FPG (133.8 ± 17.91 mg/dL vs. 143.3 ± 22.99 mg/dL; p-value = 0.0016) and PPG (193.0 ± 36.54 mg/dL vs. 211.0 ± 49.51 mg/dL; p-value = 0.0344) after 3 months of Atorvastatin therapy. This was associated with significant reduction in serum total cholesterol and low density lipoprotein cholesterol.ConclusionThree months therapy with Atorvastatin at the dose of 10 mg once daily at bedtime in patients with T2DM resulted in moderate rise in blood ketone levels, FPG and PPG in addition to improvement in lipid parameters.     

胰岛素瘤切除术后出现糖尿病一例

患者发作性意识不清5年,多于空腹发作.入院后发作2次,血糖分别为0.92、1.04 mmol/L,胰岛素28.68、30.86 mU/L,补糖后缓解.CT示胰尾部一直径1.3 cm占位,诊断胰岛素瘤,肿瘤切除术后持续高血糖,诊断T2DM.     

肾上腺皮质腺瘤患者高血糖的患病率及术后改变情况的观察

目的 评价肾上腺皮质腺瘤患者高血糖的患病情况及术后改变。 方法 选取肾上腺醛固酮瘤（APA）患者65例、皮质醇瘤（CSA）患者43例及无功能瘤（NAA）患者24例行OGTT及检测激素测值,并与原发性高血压（EH）患者53例及正常对照（NC）者58名作比较。APA、CSA及NAA患者行肾上腺肿瘤摘除术后随访激素及OGTT,与术前比较。 结果 ⑴各组糖尿病患病率分为44.6%、48.8%、25.0%、24.5%及17.5%。⑵APA、CSA组激素水平与糖代谢测值有相关性。⑶将APA及CSA组分别分为伴和不伴高血糖亚组进行比较,APA组中伴高血糖亚组血醛固酮高于不伴高血糖亚组;CSA组中伴高血糖亚组血皮质醇高于不伴高血糖亚组。⑷随着术后激素水平的下降,APA、CSA组糖代谢测值也得到改善,NAA组激素及糖代谢测值手术前后比较差异均无统计学意义。3组术后高血糖患病率分为35.4%、32.6%及33.3%。 结论 功能性肾上腺皮质腺瘤（包括肾上腺醛固酮瘤和肾上腺皮质腺瘤）患者高血糖的患病率升高,其原因与激素的高分泌相关。手术摘除肿瘤,激素高分泌状态解除后,患者的高血糖情况得以改善。     

两类达标血糖控制对急危重患者预后的影响

目的 观察两类达标血糖控制对急危重患者预后的影响. 方法 选取2011年1月至2013年9月我院急诊重症监护室（EICU）急性生理学与慢性健康评分（APACHEⅡ）＞15分且合并高血糖的危重患者200例,分为胰岛素强化治疗（IIT）组和常规控制（CIT）组,比较两组近期死亡率、3d及7d后APACHEⅡ、严重并发症、低血糖、院内感染发生率、住院时间和费用等指标. 结果 IIT组住院时间和费用、院内感染发生率、呼吸衰竭、心功能不全、3d及7d后APACHEⅡ较CIT组低（P＜0.05）.两组低血糖总发生率比较差异有统计学意义（29％ vs 13％,P＜0.01）,严重低血糖发生率、死亡率比较差异无统计学意义. 结论 IIT可能为临床带来较多益处,但增加急危重患者低血糖风险,对降低总死亡率可能无明显影响.     

老年女性体质指数变化与高糖血症关系的五年随访研究

背景　糖尿病是临床常见病之一,相关研究发现高体质量人群常存在空腹血糖升高,但高体质量是否与高糖血症存在关系鲜有研究。目的　探讨老年女性体质指数（BMI）变化与高糖血症的关系。方法　选取2012年1-12月于武汉市武昌医院老年病科就诊的符合研究标准的65~76岁绝经女性300例。依据入组时空腹血糖将受试者分为血糖正常组（空腹血糖≤5.0 mmol/L,n=200）和预期血糖增高组（空腹血糖>5.0~<5.6 mmol/L,n=100）,随访5年（截至2018年1月）。随访终点事件为高糖血症。本研究高糖血症定义为空腹血糖≥5.6 mmol/L（≥100 mg/L）或前驱糖尿病糖化血红蛋白（HbA1c）≥6.0%。比较两组基线和随访截止时一般资料、实验室检查指标。探究老年女性发生高糖血症的影响因素。结果　两组年龄、糖尿病家族史、基线吸烟率、基线饮酒率、基线舒张压、基线低密度脂蛋白、基线高密度脂蛋白比较,差异无统计学意义（P>0.05）;预期血糖增高组基线BMI、基线收缩压、基线空腹血糖、基线三酰甘油高于血糖正常组（P<0.05）。两组随访截止时吸烟率、饮酒率、低密度脂蛋白、高密度脂蛋白、三酰甘油比较,差异无统计学意义（P>0.05）;预期血糖增高组随访截止时BMI、收缩压、舒张压、空腹血糖高于血糖正常组（P<0.05）。随访截止时,共32例受试者发生高糖血症。最大似然估计结果显示,BMI变化、收缩压、舒张压、空腹血糖、三酰甘油是老年女性发生高糖血症的独立影响因素（P<0.05）。结论　老年女性BMI变化是其发生高糖血症的独立影响因素,超重和肥胖的老年女性降低体质量能有效降低其高糖血症的发生风险。     

卒中后高血糖机制及其管理策略

脑卒中后应激性高血糖的发生严重影响到了患者的预后情况,本文阐述了卒中后高血糖发生及危害的机制假说,同时围绕卒中后血糖控制目标、血糖控制方式、预防低血糖发生等方面进行探讨。