Evaluation of the metformin initiation rate in veterans with newly identified type 2 diabetes

BackgroundAn estimated 35 million individuals in the United States have diabetes. The American Diabetes Association recommends metformin as first-line pharmacologic treatment. The primary objective of this study was to evaluate the metformin initiation rate in veterans with recently identified type 2 diabetes.MethodsVeterans with new onset type 2 diabetes were identified using National Veterans Health Administration Data. Retrospective information was obtained from those with a first A1C ≥ 6.5% (48 mmol/mol) between 2013 and 2018. Veterans with at least one additional A1C < 6.5% (48 mmol/mol) documented in the three years prior to the A1C diagnostic for diabetes were included in the analysis.ResultsA total of 144,180 veterans were included. Of those, 45,776 (31.7%) were started on metformin within one year of diabetes diagnosis. The median time to metformin initiation was 12 days and median time to initiation of any anti-hyperglycemic was 11 days. Approximately 16,000 veterans were referred for lifestyle interventions within 90 days.ConclusionMetformin initiation occurred in fewer patients than expected given metformin is a generic, well-tolerated medication recommended as first-line pharmacologic treatment option regardless of A1C. Further studies are needed to assess the barriers of initiating metformin at time of diabetes diagnosis.     

评价基础胰岛素、盐酸二甲双胍片联合治疗2型糖尿病效果

目的在2型糖尿病治疗中联合应用基础胰岛素+盐酸二甲双胍片,并分析其临床疗效。方法选取2018年10月—2020年9月在该院治疗的78例2型糖尿病患者,将其分为两组。对照组39例,采取基础胰岛素治疗;观察组39例,在此基础上,联合盐酸二甲双胍片治疗。结果观察组患者治疗3个月后FPG、2 hPG、HbA1c水平明显低于对照组,差异有统计学意义(P<0.05),且患者CRP、TNF-α、IL-6水平均明显低于对照组,差异有统计学意义(P<0.05);两组患者头晕嗜睡、下肢水肿、恶心呕吐、低血糖、血压波动等不良反应发生率差异无统计学意义(P>0.05)。结论基础胰岛素+盐酸二甲双胍片治疗可提高血糖控制效果,降低炎症因子水平,且安全性良好。     

二甲双胍联合炔雌醇环丙孕酮片对多囊卵巢综合征患者性激素和胰岛素水平的影响

目的:研究二甲双胍联合炔雌醇环丙孕酮片对多囊卵巢综合征(Polycystic ovarian syndrome,PCOS)患者性激素和胰岛素水平的影响。方法:选取2018年3月至2019年10月于我院就诊的PCOS患者135例,按照随机数字表法分为两组,对照组患者67例予以炔雌醇环丙孕酮片(每天1片)口服,研究组68例在对照组的基础上增加二甲双胍(每天0.85 g)口服。治疗3个疗程后,观察两组患者临床疗效、性激素水平、胰岛素水平、自然受孕率、不良反应。结果:研究组患者治疗后的临床有效率、受孕率明显高于对照组(P<0.05)。治疗后研究组黄体生成素(Luteinizing hrmone,LH)、睾酮(Testosterone,T)、卵泡刺激素(Follicle-stimulating Hormone,FSH)、胰岛素抵抗指数(Homeostasis model assessment insulin resistance,HOMA-IR)、空腹胰岛素(Fasting serum insulin,FINS)、空腹血清葡萄糖(Fasting plasma glucose,FPG)均显著低于对照组(P<0.05),雌二醇(Estradiol,E2)显著高于对照组(P<0.05)。两组患者不良反应发生率无显著差异(P>0.05)。结论:二甲双胍联合炔雌醇环丙孕酮片应用于PCOS患者可通过纠正性激素紊乱、改善胰岛素抵抗来提高临床疗效及自然受孕率,可临床推广。     

灵芝多糖联合二甲双胍对2型糖尿病模型大鼠氧化应激的影响

目的研究灵芝多糖联合二甲双胍对2型糖尿病大鼠氧化应激的影响。方法 采用斯泼累格·多雷（SD）大鼠高脂饮食4周后,腹腔注射小剂量链脲佐菌素30 mg.kg-1造模。成模后将大鼠随机分为模型对照组、灵芝多糖组（给予灵芝多糖600 mg.kg-1）、二甲双胍组（给予二甲双胍600 mg.kg-1）及联合用药组（给予灵芝多糖300 mg.kg-1＋二甲双胍300 mg.kg-1）,另设正常对照组。给药治疗12周末测量大鼠空腹血糖;测定血清超氧化物歧化酶（SOD）、丙二醛（MDA）、过氧化氢酶（CAT）、谷胱甘肽过氧化物酶（GSH-Px）、总胆固醇（TC）、三酰甘油（TG）水平。结果用药组空腹血糖水平均低于模型对照组（P<0.01）,其中联合用药组血糖显著低于单独用药组（P<0.01）。与模型对照组比较,用药组血清TC、TG水平明显下降（P<0.05或P<0.01）,与单独用药组比较,联合用药组血清TC、TG水平明显降低（P<0.05或P<0.01）;与模型对照组比较,用药组血清SOD水平明显升高（P<0.01）;与单独用药组比较,联合用药组血清SOD水平明显升高（P<0.05）。与模型对照组比较,用药组血清MDA水平明显降低（P<0.01）,联合用药组血清MDA较单独用药组明显降低（P<0.05）。与模型对照组比较,用药组血清CAT、GSH-Px水平明显升高（P<0.05或P<0.01）,联合用药组血清CAT、GSH-Px水平较单独用药组明显升高（P<0.05）。结论 灵芝多糖、二甲双胍联合用药能够有效对抗2型糖尿病大鼠体内氧化应激作用,效果优于单独用药,其机制可能与增强体内SOD、CAT、GSH-Px水平及调节血脂障碍有关。     

二甲双胍联合紫杉醇对人乳腺癌细胞凋亡及AMPK信号通路的影响

目的:探索二甲双胍联合紫杉醇对乳腺癌MCF-7细胞活力和凋亡的影响及其可能的机制。方法:采用不同浓度(2、5、10、20、40和80 mmol/L)二甲双胍作用于体外培养的MCF-7细胞,MTT法检测细胞的活力。采用2 mmol/L二甲双胍和2. 4 mg/L紫杉醇单独或联合处理细胞,并加入一磷酸腺苷活化的蛋白激酶(AMPK)信号转导通路抑制剂compound C。实验分为对照组、二甲双胍组、紫杉醇组、联合组和联合+compound C组;流式细胞术检测细胞的凋亡率,采用RT-qPCR和Western blot法检测Bax、Bcl-2和caspase-3的mRNA和蛋白表达量,Western blot检测AMPK和P21蛋白的表达量。结果:不同浓度二甲双胍(2、5、10、20、40和80 mmol/L)显著抑制乳腺癌细胞的活力(P 0. 05),且具有一定浓度依赖性。与对照组相比,2 mmol/L二甲双胍和2. 4 mg/L紫杉醇单独或联合均可显著抑制细胞活力并诱导其凋亡(P 0. 05),显著下调Bcl-2水平(P 0. 05),上调Bax和caspase-3水平(P 0. 05),促进AMPK和P21蛋白表达。联合使用的效果优于单独使用。加入AMPK抑制剂可削弱此作用。结论:二甲双胍联合紫杉醇可抑制乳腺癌MCF-7细胞活力,诱导其凋亡。此作用与激活AMPK信号转导通路并调节细胞凋亡信号通路有关。     

Advanced oxidation protein products (AOPPs) in juvenile overweight and obesity prior to and following weight reduction

Objectives

To evaluate the formation of advanced oxidation protein products (AOPPs) in juvenile overweight/obesity and obesity-related disorders and to investigate the effect of weight reduction on AOPPs.

Design and methods

AOPPs were determined in 114 overweight/obese children and adolescents without/with insulin resistance and metabolic syndrome and compared with 53 lean controls. Measurements were repeated following weight reduction program (diet/exercise, bran-enriched diet/exercise, and diet/exercise plus metformin).

Results

Overweight/obese subjects had higher AOPPs than lean controls, more elevated in patients with co-occurring metabolic syndrome. AOPPs positively correlated with central obesity, triglycerides, lipid peroxidation and insulin, and negatively with glucose to insulin ratio. AOPPs decreased following obesity intervention and ΔAOPPs correlated with ΔBMI%. AOPPs reduction was more pronounced in subjects on bran-enriched diet. Baseline AOPPs were a better predictor of clinically significant weight reduction than BMI%.

Conclusions

Juvenile overweight/obesity was associated with AOPPs accumulation, more pronounced in metabolic syndrome. Body mass reduction decreased oxidative stress, with bran-enriched diet being more effective than diet/exercise alone.     

当飞利肝宁胶囊联合二甲双胍治疗非酒精性脂肪性肝病的临床效果观察

目的：观察当飞利肝宁胶囊联合二甲双胍治疗非酒精性脂肪性肝病（ NAFLD）的临床疗效。方法选取2010年2月-2012年12月医院收治的 NAFLD 患者120例,接受当飞利肝宁胶囊联合二甲双胍治疗,观察患者治疗前后血清谷丙转氨酶（ALT）、谷草转氨酶（AST）、三酰甘油（TG）、总胆固醇（CHO）、超敏 C 反应蛋白（hs-CRP）变化情况,超声图像变化及药物不良反应。结果治疗后临床症状较治疗前明显改善者109例,有效率90.83%;治疗后超声影像表现较治疗前明显好转;ALT、AST、TG、CHO、hs-CRP 较治疗前显著改善,差异有统计学意义（P ＜0.05）。所有患者治疗期间均未出现不良反应。结论当飞利肝宁联合二甲双胍治疗 NAFLD 患者,血脂、肝功能、肝纤维化、超声等指标均有明显改善,疗效显著。