Geographical variation in the incidence of diabetes mellitus in Scottish children during the period 1977-1983

Routinely collected Scottish hospital discharge data were used to identify newly diagnosed cases of diabetes mellitus under the age of 19 years. In the period 1977-83 there were 2183 cases, an average annual incidence of 21.0 per 100,000 per annum. This rate is one of the highest reported and represents a continuation of the increase in incidence which occurred during the period 1968-76. Statistically significant geographical variation in incidence was observed with the higher incidence in the least densely populated areas. Seasonal variation in the month of first admission was evident in all except the under-five age group with peaks occurring in winter. An estimated 60% of newly diagnosed cases were readmitted within 5 years and the pattern of readmission was found to differ little between males and females or between age groups.     

糖尿病患者心率变异性的临床观察及评价

用心率变异性（ＨＲＶ）分析技术，观察糖尿病患者ＨＲＶ时域的六项指标变化：①ａｖｇＲＲ：ＲＲ间期平均值；②ＳＤＡＮＮ：４分钟ＲＲ平均值的标准差；③ＣＶ：变异系数；④ＳＤ：每４分钟ＲＲ间期标准差的平均值；⑤ＳＤＳＤ：ＳＤ的标准差；⑥ｒｍＳＡＳＤ：每４分钟内相邻ＲＲ间期差值作均方根后的平均值。Ⅱ型糖尿病患者２５例，正常对照组１８例，两组年龄相似。结果表明，糖尿病组的ＳＤ，ＳＤＡＮＮ及ｒｍＳＡＳＤ显著低于对照组，而ａｖｇＲＲ无显著变化。为分析记录时间上的差异性，选择８１例正常人，分成上午组（４５例）与下午组（３６例），除ＳＤＡＮＮ外，其余五项指标在上午组与下午组之间无显著差别。结论认为糖尿病患者的ＨＲＶ显著减小，说明ＨＲＶ对糖尿病有一定的临床应用价值。     

Clinical implication of alterations in serum Klotho levels in patients with type 2 diabetes mellitus and its associated complications

Aim

To investigate the clinical significance of serum α-Klotho and β-Klotho levels in patients with type 2 diabetes mellitus (T2DM) and its associated complications.

Pioglitazone initiation and subsequent hospitalization for congestive heart failure.

AIMS: Thiazolidinediones (TZD) have been associated with an expansion in plasma volume and the development of peripheral oedema. A recent study reported an association between the use of TZDs and development of congestive heart failure (CHF). The objective of this study was to determine if short-term use of pioglitazone, a TZD, is associated with increased risk of admission to hospital because of CHF in a well-characterized, community-based cohort of Type 2 diabetic patients without prevalent CHF. METHODS: A cohort study of all patients in the Kaiser Permanente Medical Care Program with Type 2 diabetes (Kaiser Permanente Northern California Diabetes Registry) who initiated any diabetes pharmacotherapy (n = 23 440) between October 1999 and November 2001. Only patients initiating single new therapies ('new users') were included to reduce confounding and create mutually exclusive exposure groups. We constructed Cox proportional hazards models (with sulphonylureas initiators specified as the reference group) to evaluate the impact of initiating new diabetes therapies on time-to-incident admission to hospital because of CHF, defined by primary hospital discharge diagnosis. RESULTS: Patients initiated pioglitazone (15.2%), sulphonylureas (25.3%), metformin (50.9%), and insulin (8.6%) alone, or as additions to pre-existing or maintained therapies. Three hundred and twenty admissions for CHF were observed during the follow-up (mean 10.2 months) after drug initiation. Relative to patients initiating sulphonylureas, there were no significant increases in the incidence of hospitalization for CHF in those initiating pioglitazone [hazard ratio (HR) = 1.28; 95% confidence interval (CI): 0.85-1.92] after adjusting for demographic, behavioural and clinical factors. There was a significantly higher incidence among those initiating insulin (HR = 1.56; 95% CI: 1.00-2.45) and lower incidence among those initiating metformin (HR = 0.70; 95% CI: 0.49-0.99). CONCLUSIONS: This study of patients with Type 2 diabetes failed to find evidence that short-term pioglitazone use was associated with an elevated risk of hospitalization for CHF relative to the standard, first-line diabetes therapy.     

Elevated concentrations of asymmetric dimethylarginine are associated with deterioration of glucose tolerance in women with previous gestational diabetes mellitus

OBJECTIVE: Women with previous gestational diabetes mellitus (GDM) have a high risk for development of type 2 diabetes mellitus. The endogenous nitric oxide synthase inhibitor asymmetric dimethylarginine (ADMA) could be related to disorders of the glucose metabolism. To evaluate if ADMA predicts deterioration of glucose tolerance in women with previous GDM and to assess concentration changes we analysed ADMA in women with previous GDM after delivery and after a median follow-up of 2.75 years (interquartile range: 1.47-4.60). DESIGN: Prospective cohort study. Subjects and methods. ADMA, symmetric dimethylarginine (SDMA) and L-arginine were determined in 77 women with previous GDM who underwent a 75-g oral glucose tolerance test 4 months after delivery and at follow-up. RESULTS: Deterioration in glucose tolerance was observed in 36% of the women with ADMA above and 11% of those with ADMA below the median (0.56 micromol L(-1); P = 0.008, log-rank test). ADMA correlated significantly with mean arterial blood pressure and nonsignificantly with body mass index (P = 0.050) but not with insulin resistance, fasting glucose, lipids or glomerular filtration rate. The fully adjusted hazard ratio for a decline of glucose tolerance during follow-up was 3.94 (95% CI: 1.16-13.37; P = 0.028) for subjects with ADMA above the median. SDMA and L-arginine were not associated with changes in the glucose tolerance status. ADMA and L-arginine decreased significantly during follow-up. CONCLUSIONS: High serum ADMA after delivery is associated with deterioration in glucose tolerance in women with previous GDM and declines in the following years.     

蛋白酪氨酸磷脂酶-1B基因Pro387Leu变异与2型糖尿病的相关性研究

目的　探讨广州地区汉族人中蛋白酪氨酸磷脂酶 1B(PTP 1B)基因Pro387Leu变异与2型糖尿病 (T2DM)的相关性。　方法　随机选取无亲缘关系的广州地区汉族人 5 6 7例 ,其中T2DM患者 32 9例 ,正常对照 2 38例 ,应用聚合酶链反应 限制性片段长度多态性 (PCR RFLP)进行Pro387Leu变异的检测。　结果　正常对照组PTP 1BLeu 387携带者及Leu 387等位基因频率分别是 0 8%、0 4 % ,T2DM组相应为 0 6 %、0 3% ,两组比较差异无统计学意义 (P >0 0 5 )。　结论　PTP 1B基因Pro387Leu变异与汉族人T2DM的发生不相关。     

Managing common endocrine disorders amid COVID-19 pandemic

Background and aimsThe novel coronavirus disease (COVID-19) pandemic and the resulting nationwide lockdowns have posed a major challenge to the management of pre-existing and newly diagnosed endocrine disorders. Herein, we have summarized the management approaches of common endocrine disorders amid the ongoing pandemic.MethodsWe have performed an extensive literature search for articles in PubMed, EMBASE and Google Scholar databases till 25 May 2020, with the following keywords: “COVID-19”, “diabetes mellitus”, “thyroid disorders”, “primary adrenal insufficiency”, “Cushing’s syndrome”, “pituitary tumors”, “vitamin D″", “osteoporosis”, “primary hyperparathyroidism”, “hypoparathyroidism”, “management”, “treatment” and “guidelines” with interposition of the Boolean operator “AND”.ResultsWe have summarized the most feasible strategies for the management of diabetes mellitus, thyroid disorders, primary adrenal insufficiency (including congenital adrenal hyperplasia), Cushing’s syndrome, pituitary tumors, osteoporosis, primary hyperparathyroidism and hypoparathyroidism amid the constraints laid down by the raging pandemic. In general, medical management should be encouraged and surgical interventions should be deferred whenever possible. Ongoing medications should be continued. Sick-day rules should be sincerely adhered to. Regular contact with physicians can be maintained through teleconsultations and virtual clinics.ConclusionsConsidering the burden of endocrine disorders in the general population, their management needs to be prioritized amid the ongoing COVID-19 pandemic.     

海水浴体疗操对老年2型糖尿病患者的心脏康复作用

目的:探讨海水浴体疗操运动对老年2型糖尿病(DM)患者的心脏康复作用。方法:应用本院设计的海水浴体疗操1套,对疗养期间62例老年2型DM患者(DM组)进行4疗程运动治疗。使用超声心动图仪观察患者体疗前、后LAD、EF、FS、E/A指标变化,并与健康老人(对照组)对照;使用常规心电图描记并观察DM组体疗前后的心电图变化。结果:DM组体疗前各指标较对照组有显著差异(P<0.01,P<0.05);体疗后与前对比:LAD缩小,E/A、FS、EF值明显增高,有非常显著统计学意义(P<0.01)。体疗后心电图窦性心律增至66.1％,Petfv1异常率减至24.2％,ST-T异常率减至17.7％,P均<0.01。结论:海水浴体疗操运动对DM患者心脏康复有较好疗效。     

自发酮症起病的糖尿病87例临床特征及分型探讨

目的探讨自发酮症起病的糖尿病的临床特征及分型。方法将2003-01～2004-05南京鼓楼医院收治的自发酮症起病的糖尿病患者(87例)根据自身抗体阳性与否,分为抗体阴性组(67例)及抗体阳性组(1A型糖尿病组)(20例)。抗体阴性的患者依据是否依赖胰岛素治疗,进一步分为胰岛素依赖组(27例)及非胰岛素依赖组(40例)。不同组别的临床特征、生化指标之间进行比较。结果抗体阴性组男性发生率显著高于女性;具明显的家族遗传倾向;起病时体重指数显著高于1型糖尿病组,甘油三酯水平高于其他两组;空腹及餐后2hC肽水平介于2型及1型糖尿病组之间。胰岛素依赖组较胰岛素非依赖组具更强的男性易患性;超重和肥胖患者所占比例较低;酮症程度较重;血糖及空腹C肽水平两组之间差异无显著性;3个月后空腹C肽水平,非胰岛素依赖组显著高于胰岛素依赖组。结论酮症起病的糖尿病依据抗体阳性与否,分为抗体阴性和抗体阳性酮症起病的糖尿病,后者即为1A型糖尿病。抗体阴性酮症起病的糖尿病可依据是否依赖胰岛素治疗,分为酮症起病的2型糖尿病和特发性1型糖尿病(1B型糖尿病)。     

胰升糖素试验在评价2型糖尿病病人胰腺β细胞功能中的作用

目的　探讨胰升糖素试验在评价 2型糖尿病 (T2 DM)病人胰腺 β细胞功能中的作用。　方法　 T2 DM病人 1 5 0例 ,空腹血浆血糖浓度 (FPG)大于 7.0 mm ol/ L。隔夜空腹取血测定 FPG、空腹血清 C肽 (C肽 1 ) ,静脉注射胰升糖素 1 m g,注射时间 1 m in,注射后 6 min取血测定血清 C肽 (C肽 2 )。计算前后差值 (Δ C肽 =C肽 2 - C肽 1 )。注射前后测定患者血压、脉搏 ,记录不良反应。　结果　 T2 DM病人注射胰升糖素后血清 C肽均升高。空腹 C肽与注射胰升糖素 6 m in后 C肽呈正相关 (P<0 .0 5 ) ,基础和刺激后 C肽浓度与 BMI呈显著正相关 (P<0 .0 5 )。 ΔC肽与空腹 C肽 (P<0 .0 5 )、注射后 C肽 (P<0 .0 1 )呈正相关 ,与病程呈负相关 (P<0 .0 5 )。血糖控制差组 (Hb A1 c≥ 7.0 % ,n=86 )与血糖控制好组 (Hb A1 c<7.0 % ,n=6 4 )相比 ,基础 C肽差异无显著意义 ,而刺激后 C肽和 C肽增加绝对值 ,血糖控制好组高于血糖控制差组 (P<0 .0 5 )。　结论　胰升糖素试验是一种判定胰腺 β细胞功能的较为简单、可靠、实用的方法