Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patients

To evaluate the effects of 1-year treatment with orlistat plus L-carnitine compared to orlistat alone on body weight, glycemic and lipid control, and inflammatory parameters in obese type 2 diabetic patients. Two hundred and fifty-eight patients with uncontrolled type 2 diabetes mellitus (T2DM) [glycated hemoglobin (HbA(1c)) > 8.0%] in therapy with different oral hypoglycemic agents or insulin were enrolled in this study and randomized to take orlistat 120 mg three times a day plus L-carnitine 2 g one time a day or orlistat 120 mg three times a day. We evaluated the following parameters at baseline and after 3, 6, 9, and 12 months: body weight, body mass index (BMI), glycated hemoglobin (HbA(1c) ), fasting plasma glucose (FPG), postprandial plasma glucose (PPG), fasting plasma insulin (FPI), homeostasis model assessment insulin resistance index (HOMA-IR), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides (Tg), adiponectin (ADN), leptin, tumor necrosis factor-α (TNF-α), vaspin, and high-sensitivity C-reactive protein (Hs-CRP). We observed a better decrease in body weight, glycemic profile, HOMA-IR, LDL-C, and ADN and a faster improvement in FPI, TC, Tg, leptin, TNF-α, Hs-CRP with orlistat plus L-carnitine compared to orlistat alone. We also recorded an improvement in vaspin with orlistat plus l-carnitine not reached with orlistat alone. Orlistat plus L-carnitine gave a better improvement in body weight, glycemic and lipid profile compared to orlistat alone; furthermore, a faster and better improvement in inflammatory parameters was observed with orlistat plus L-carnitine compared to orlistat alone.     

有氧运动对2型糖尿病大鼠腓肠肌氧化应激及MAPKs信号通路的影响

目的:研究有氧运动对2型糖尿病大鼠胰岛素抵抗、腓肠肌氧化应激以及MAPKs信号通路的影响。方法:健康雄性Wistar大鼠30只,随机分为正常对照组(C组)、糖尿病对照组(DC组)和有氧运动组(DE组),其中C组以普通饲料喂养,DC组和DE组以高脂饲料喂养。4周后,对DC组和DE组大鼠采用单次注射链脲佐菌素(STZ)的方法建立2型糖尿病大鼠模型,继续高脂饲料喂养4周后,DE组大鼠进行无负重游泳训练6周,训练期间C组大鼠继续以普通饲料喂养,DC组和DE组大鼠继续以高脂饲料喂养。6周后,处死所有大鼠,测试空腹血糖(FBG)、空腹胰岛素(FINS)并计算胰岛素抵抗指数(HOMA-IR),测试腓肠肌超氧化物歧化酶(SOD)和谷胱甘肽过氧化物酶(GPX)活性及丙二醛(MDA)水平,RT-PCR法测试腓肠肌p38和JNK mRNA表达,Western-blot法测试腓肠肌ERK1/2和p-ERK1/2表达。结果:和C组相比,DC组大鼠FBG、FINS和HOMA-IR均显著升高,腓肠肌SOD和GPX活性显著降低而MDA水平显著升高,腓肠肌p38、JNK1、JNK2 mRNA相对表达量显著升高,p-ERK1、ERK2和p-ERK2相对表达量显著升高而ERK1相对表达量差异无统计学意义。与DC组相比,DE组大鼠FBG、FINS和HOMA-IR均显著降低,腓肠肌SOD和GPX活性显著升高而MDA水平显著降低,腓肠肌p38和JNK1 mRNA相对表达量显著升高而JNK2 mRNA相对表达量无统计学意义,腓肠肌p-ERK1、ERK2和p-ERK2相对表达量显著升高而ERK1相对表达量无统计学意义。结论:有氧运动可激活糖尿病大鼠腓肠肌MAPKs信号通路系统,增强机体抗氧化酶SOD和GPX活性,改善糖尿病大鼠氧化应激状态,降低其胰岛素抵抗水平。     

运动对糖尿病大鼠脑细胞膜胰岛素受体的影响

目的观察链脲佐菌素（ＳＴＺ）糖尿病大鼠脑细胞膜胰岛素受体的特性及运动训练对其的影响。方法３０只ＳＤ大鼠分为三组：糖尿病非运动组；糖尿病运动组；正常对照组。糖尿病运动组大鼠进行６周游泳训练。结果糖尿病运动组大鼠与糖尿病非运动组大鼠相比，血糖浓度明显降低，而二组糖尿病大鼠血胰岛素浓度均低于正常组。三组大鼠比较，脑细胞膜的胰岛素受体最大专一性结合、受体亲和力常数及受体浓度均无显著性差异。结论运动训练能降低糖尿病大鼠的血糖水平，但血糖、血胰岛素及运动对脑细胞膜的胰岛素受体无明显影响     

Contacting dropouts from type 2 diabetes care in public primary health care: description of the patient population

Objective: To characterize dropouts from type-2 diabetes (T2D) care in communal primary health care.

Design: An observational study.

Setting: In a Finnish city, patients with T2D who had not contacted the public primary health care system during the past 12 months were identified with a computer based search and contacted by a trained diabetes nurse.

Subjects: Dropouts from T2D treatment.

Main outcome measures: Demographic factors, laboratory parameters, examinations, medications, and comorbidities.

Results: Of the patients with T2D, 10% (n?=?356) were dropouts and 60% of them were men. Median HbA_1c was 6.5 (QR for 25% and 75%: 6.0, 7.7) %, (45 [42,61] mmol/mol). Of the dropouts, 14% had HbA_1c?≥?9.0% (75?mmol/mol), and these patients were younger than the other dropouts (mean age 54.4 [SD 10.8] years vs. 60.6 [9.4] years, p?Conclusions: Ten percent of T2D patients were dropouts of whom those with a poor glycaemic control were younger than the other dropouts. BP and LDL cholesterol concentrations were non-optimal among the majority of the dropouts. Metformin was prescribed less frequently to the dropouts than is usual for T2D patients. The comorbidities were equally common among the dropouts as among the other T2D patients.

• KEY POINTS

• Which kinds of patients are dropouts from type-2 diabetes care is not known.

• ??One-tenth of the patients with T2D were dropouts and they generally had good glycaemic control.

• ??Blood pressure and LDL cholesterol concentrations were non-optimal among the majority of the dropouts.

• ??Fourteen percent of these dropouts had HbA_1c > 9% (75?mmol/mol) and they were more often younger than the other dropouts.

     

<Emphasis Type="Italic">Morganella morganii</Emphasis>-associated arthritis in a diabetic patient

This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.     

Impact of a subcutaneous insulin protocol in the emergency department: Rush Emergency Department Hyperglycemia Intervention (REDHI)

Objective: We evaluated a hyperglycemia treatment protocol for use in the Emergency Department (ED) in patients with diabetes mellitus (DM) before admission to the hospital or discharge home. Methods: Fifty-four consecutive patients with a history of DM and an ED admission blood glucose (BG) > 200 mg/dL were treated with subcutaneous (SQ) insulin aspart every 2 h until BG was < 200 mg/dL. Point-of-care BG was measured immediately on ED admission and every 2 h until discharge home or hospital admission. The intervention group was compared with 54 historical controls with DM and an ED admission BG > 200 mg/dL. Results: One hundred percent of intervention patients received insulin aspart, whereas only 35% of historical controls received insulin therapy. In the intervention group, mean BG declined from 333 ± 104 mg/dL on ED admission to 158 ± 68 mg/dL on ED discharge. In the historical control group, mean BG decline was significantly less, from 322 ± 126 mg/dL on admission to 242 ± 79 mg/dL on discharge (p < 0.001). Sixty-nine percent of intervention patients and 67% of controls were subsequently admitted to the hospital. Mean hospital length of stay (LOS) in the intervention group was significantly less, 3.8 ± 3.3 days, compared with 5.3 ± 4.1 days in the control group (p < 0.05). Four intervention patients (7.4%) developed a BG < 70 mg/dL. Conclusion: A protocol for the treatment of acute hyperglycemia in the ED can be safely implemented. Subsequent inpatient LOS was reduced. Further randomized clinical trials of this intervention are warranted.     

社区2型糖尿病患者疾病知识掌握现状的调查分析

目的 了解社区2型糖尿病(DM)患疾病知识掌握现状，为社区糖尿病教育提供依据。方法 对社区2型DM患200例进行问卷调查，并对结果进行分析。结果 社区DM患疾病知识掌握情况总体较好，但疾病基础知识比较欠缺，是否接受过DM健康教育及化程度是影响掌握情况的因素。结论 应对社区DM患加强疾病基础知识和护理的宣传与教育，提高他们自我护理和病情监测的能力，以提高生活质量。     

Neonatal tumor necrosis factor alpha promotes diabetes in nonobese diabetic mice by CD154-independent antigen presentation to CD8(+) T cells

Neonatal islet-specific expression of tumor necrosis factor (TNF)-alpha in nonobese diabetic mice promotes diabetes by provoking islet-infiltrating antigen-presenting cells to present islet peptides to autoreactive T cells. Here we show that TNF-alpha promotes autoaggression of both effector CD4(+) and CD8(+) T cells. Whereas CD8(+) T cells are critical for diabetes progression, CD4(+) T cells play a lesser role. TNF-alpha-mediated diabetes development was not dependent on CD154-CD40 signals or activated CD4(+) T cells. Instead, it appears that TNF-alpha can promote cross-presentation of islet antigen to CD8(+) T cells using a unique CD40-CD154-independent pathway. These data provide new insights into the mechanisms by which inflammatory stimuli can bypass CD154-CD40 immune regulatory signals and cause activation of autoreactive T cells.