Rapid progression of type 2 diabetes and related complications in children and young people—A literature review

Type 2 diabetes (T2D) is suggested to progress faster in children and young people vs type 1 diabetes (T1D) in the same age group and T2D in adults. We reviewed the evidence base for this. A literature search was performed of PubMed‐indexed publications between 2000 and 2018, for the terms “pediatric” and “T2D.” Results were combined and filtered for those relating to “progression.” Searches of abstract books from Latin American and Asian congresses were performed to include these populations. Pediatric populations were defined as <25 completed years of age. Of the articles and congress abstracts found, 30 were deemed relevant. Dividing the studies into categories based on how T2D progresses, we found the following: (a) yearly beta‐cell function deterioration was shown to be 20% to 35% in children with T2D compared with 7% to 11% in adults with T2D, despite similar disease durations; (b) retinopathy progression was likely dependent on diabetes duration rather than diabetes type; however, nephropathy, neuropathy and probably hypertension progressed faster in youth‐onset T2D vs T1D. Nephropathy progression was similar to adults with T2D, allowing for disease duration. Youth with T2D had a worse cardiovascular (CV) risk profile than youth with T1D, and a faster progression to CV death. (c) Progression to treatment failure was faster in youth‐onset T2D vs adult‐onset T2D. Substantial evidence exists for faster progression of T2D in pediatric patients vs T1D or adult‐onset T2D. New treatments targeting the pathology are needed urgently to address this issue.     

Therapeutic plasma exchange for exogenous insulin antibody syndrome in combined variable immunodeficiency: a case report

A 32-year-old male with type I diabetes presented with profound hypoglycemia due to exogenous insulin antibody syndrome in the setting of newly-diagnosed common variable immunodeficiency. Immunomodulatory therapy was not initially effective, but after the initiation of plasma exchange hypoglycemia resolved, and glucose lability improved.     

Minireview: Current status of endoscopic duodenal mucosal resurfacing

Several strategies are being pursued to overcome the alarming pandemics of obesity and type 2 diabetes (T2D). In recent years, duodenal mucosal resurfacing (DMR) has shown its potential to improve glycemic indices. Following animal studies, which demonstrated feasibility and safety, the procedure has been applied in two human studies. The DMR procedure has been considered feasible and safe in humans with a limited occurrence of complications and adverse events. Reductions in glycated haemoglobin, weight, fasting plasma glucose, and alanine transaminase have been proven at different follow-up time-points. The length of the ablation may induce different outcomes, having the patients with long duodenal segment ablated showed greater beneficial effects. The current evidence does not still prove the apparent insulin-sensitizing mechanism explaining the impact of the DMR procedure on hepatic glucose production. However, the initial findings have demonstrated a positive risk-benefit ratio and an effect on the treatment of metabolic diseases, such as T2D. Future studies should clarify the mechanisms underlying the positive effects and durability of the treatment using controlled trial conditions on larger number of patients.     

Perioperative management of diabetes

Diabetes is a complex, chronic metabolic disorder affecting approximately 9.3% of the adult population with the estimated number of adults with diabetes worldwide having more than tripled since 2000. This increase has largely been attributed to global urbanization and lifestyle changes. Diabetes affects 10–15% of the surgical population. These patients are frequently elderly, have complex medical co-morbidities and present for both high-risk elective and emergency surgery. This multisystem disease poses a significant challenge to both anaesthesia and surgery with patients with diabetes demonstrating higher morbidity and mortality rates compared to their non-diabetic counterparts. It is crucial that good glycaemic control is maintained throughout the perioperative period as this has been shown to correlate with positive patient outcomes. It is well-recognized that a co-ordinated, multidisciplinary approach aimed at optimizing every point in the patient pathway from GP referral to post-discharge care is required to obtain the best outcomes for the surgical patient with diabetes. The anaesthetist has a key role in the perioperative diabetes multidisciplinary team. Patients themselves are well experienced in manging their own diabetes and should be involved in doing so whenever possible.     

基于网络药理学的小陷胸汤治疗2型糖尿病的药理机制

目的:利用网络药理学探索小陷胸汤治疗2型糖尿病(T2DM)的药理机制。方法:在中药系统药理学技术平台(TCMSP)网站检索小陷胸汤的主要活性成分、对应的作用靶点及靶标基因,通过人类基因数据库(Gene Cards)获得T2DM的相关靶标基因,将药物活性成分靶点与T2DM靶点相映射,获得交集靶点即为小陷胸汤作用于T2DM的预测靶点。利用Cytoscape 3. 7. 1软件构建药物活性成分-交集靶点网络模型,选出关键活性成分。利用STRING网站构建交集靶点蛋白相互作用网络(PPI),选出关键靶点基因。利用DAVID 6. 8在线工具对交集靶点进行基因本体(GO)分析和基于京都基因与基因组百科全书(KEGG)通路富集分析。结果:小陷胸汤作用于T2DM的活性成分有30个,相关靶点156个,关键有效成分14个,关键靶点基因18个。GO分析显示,小陷胸汤治疗T2DM潜在基因的生物功能主要涉及转录调控、氧化应激、蛋白结合和炎症反应等;KEGG通路富集显示小陷胸汤治疗T2DM影响的通路主要有缺诱导因子-1(HIF-1)信号通路,肿瘤坏死因子(TNF)信号通路,Toll样受体信号通路,甲状腺激素信号通路,磷脂酰肌醇氧3激酶/蛋白激酶B(PI3K/Akt)信号通路,乙肝,丙肝,酪氨酸激酶受体2(Erb B)信号通路,钙离子信号通路和核转录因子-κB(NF-кB)信号通路等。结论:小陷胸汤治疗T2DM机制可能是通过抑制炎症因子分泌,参与抗炎反应,降低氧化应激,升高细胞内钙离子浓度,阻断胰高血糖素信号通路,激活PI3K/Akt通路等来改善胰岛素抵抗,提高胰岛素敏感性,降低血糖。     

延续护理在2型糖尿病患者中的应用效果及并发症发生率影响观察

目的:研究对2型糖尿病患者实施延续护理的效果。方法:选取2018年1月~2018年12月在某院治疗后出院的2型糖尿病患者120例展开研究,按护理施差异分为两组,对照组常规护理,观察组在常规护理基础上实施延续护理,对比分析护理效果、护理后并发症发生率以及生活质量改善情况。结果:经护理后观察组血糖各指标均明显低于对照组(P<0.05);观察组发生率21.6%,对照组发生率41.6%(P<0.05);护理后观察组生活质量各项评分均明显高于对照组(P<0.05)。结论:对2型糖尿病患者实施延续护理效果显著,值得推广。     

木丹颗粒联合甲钴胺对2型糖尿病周围神经病变气虚络阻证的疗效及对神经电生理和氧化应激指标的影响

目的探究木丹颗粒联合甲钴胺对2型糖尿病周围神经病变气虚络阻证的疗效及对神经电生理和氧化应激指标的影响,为2型糖尿病周围神经病变的诊疗提供临床指导。方法前瞻性选择自2016年1月至2018年3月衡水市第五人民医院收治的160例2型糖尿病周围神经病变(气虚络阻证)患者作为研究对象。按随机数表法,将患者随机分成观察组100例和对照组60例。对照组采用甲钴胺结合常规降糖治疗,观察组在对照组基础上加用木丹颗粒,疗程4周。比较两组治疗前后的多伦多临床评分系统(TCSS)和患者下肢神经的传导速度,血清超氧化物歧化酶(SOD)和丙二醛(MDA)等氧化应激指标,观察两组肌电图疗效。结果治疗前,两组患者TCSS评分、运动神经传导速度和血清SOD、MDA水平比较,差异无统计学意义(P>0.05);治疗后,两组患者上述各指标均显著改善(P<0.05)。与对照组相比,观察组患者TCSS评分显著降低,SOD水平显著上升,MDA水平显著降低,两组比较差异有统计学意义(P<0.05)。治疗后,观察组患者下肢神经传导速度(MCV、SCV)和肌电图疗效明显优于对照组,两组比较差异有统计学意义(P<0.05)。结论木丹颗粒联合甲钴胺治疗2型糖尿病周围神经病变气虚络阻证效果显著,可明显改善患者临床症状,提高神经传导速度和抗氧化应激能力,值得临床推广。     

Optimisation of the organ donor and effects on transplanted organs: a narrative review on current practice and future directions

Mortality remains high for patients on the waiting list for organ transplantation. A marked imbalance between the number of available organs and recipients that need to be transplanted persists. Organs from deceased donors are often declined due to perceived and actual suboptimal quality. Adequate donor management offers an opportunity to reduce organ injury and maximise the number of organs than can be offered in order to respect the donor's altruistic gift. The cornerstones of management include: correction of hypovolaemia; maintenance of organ perfusion; prompt treatment of diabetes insipidus; corticosteroid therapy; and lung protective ventilation. The interventions used to deliver these goals are largely based on pathophysiological rationale or extrapolations from general critical care patients. There is currently insufficient high-quality evidence that has assessed whether any interventions in the donor after brain death may actually improve immediate post-transplant function and long-term graft survival or recipient survival after transplantation. Improvements in our understanding of the underlying mechanisms following brain death, in particular the role of immunological and metabolic changes in donors, offer promising future therapeutic opportunities to increase organ utilisation. Establishing a UK donor management research programme involves consideration of ethical, logistical and legal issues that will benefit transplanted patients while respecting the wishes of donors and their families.