影响2型糖尿病老年患者并发周围神经病变的logistic分析

目的 探讨2型糖尿病老年患者并发周围神经病变的影响因素。方法 选取2016年2月—2018年7月本院治疗的2型糖尿病老年患者120例作为研究对象,统计并发周围神经病变发生情况,根据有无发生周围神经病变分为DPN组57例和非DPN组63例,并对其影响因素进行调查分析。结果 DPN组患者与非DPN组患者的年龄、糖尿病病程、吸烟史、饮酒史、高血压病史、高血脂病史、BMI指数、FPG、HbA1c、UA水平差异有统计学意义(P<0.05),DPN组患者与非DPN组患者的性别、ALT、AST水平差异无统计学意义(P>0.05);Logisitic回归分析结果显示,年龄、糖尿病病程、吸烟史、饮酒史、高血压病史、高血脂病史、BMI指数、FPG、HbA1c、UA水平是2型糖尿病老年患者并发周围神经病变的影响因素。结论 年龄、糖尿病病程、吸烟史、饮酒史、高血压病史、高血脂病史、BMI指数、FPG、HbA1c、UA水平是2型糖尿病老年患者并发周围神经病变的影响因素,应积极采取有效措施进行控制糖尿病周围神经病变的发生与发展,提高2型糖尿病老年患者的生活质量。     

2型糖尿病临床路径管理工作细化分析

2型糖尿病的临床路径管理工作在北华大学附属医院已开展1年多，目前已处于稳步发展阶段，本文详细分析和细化本院2013年上半年2型糖尿病的临床路径管理工作的实施现状及实施效果，较具体的介绍了本院内分泌专科完善和实施2型糖尿病临床路径管理的实施计划，旨在推广经验，从而推动本院临床路径管理工作运行水平。     

In-Office Distal Symes Lesser Toe Amputation: A Safe,Reliable, and Cost-Effective Treatment of Diabetes-Related Tip of Toe Ulcers Complicated by Osteomyelitis

Diabetes-related tip of lesser toe ulcers have typically been associated with both underlying hammertoe contracture and peripheral neuropathy. The combination of digital deformity and neuropathy commonly results in non-healing, deep sores that frequently become complicated by osteomyelitis. We report on a well-known, but poorly reported, technique for surgical management of non-healing tip of lesser toe ulcers. After approval by the institutional review board, a review was performed of consecutive patients who had undergone office-based distal Symes toe amputation for a non-healing tip of lesser toe ulcer from January 2007 to December 2012. A variety of clinical, laboratory, and radiographic data were collected. A total of 48 consecutive patients (48 toe ulcers) were identified for inclusion in the present study. All patients had ulcers at the time of surgery, and no patient developed repeat ulceration of the involved digit postoperatively. Of the 48 patients, 44 (92%) had hammertoe deformity preoperatively. Also, 30 patients (63%) had positive probe-to-bone results, and 29 (97%) of these patients had culture or histologic findings positive for osteomyelitis. Of the 48 patients (48 ulcers), 73% had positive bone cultures, 69% had positive pathologic findings demonstrating osteomyelitis, and 100% had clean margins. Methicillin-resistant Staphylococcus epidermidis was the most common pathogen isolated (13 of 48, 27%). No patient required additional amputation related to the operative digit. The mean follow-up period was 28.79 months. Our results have shown that in-office distal Symes lesser toe amputation is a safe, reliable, and likely cost-effective treatment of non-healing tip of lesser toe ulcers complicated by osteomyelitis. This office-based procedure allows bone biopsy diagnosis, removes the non-healing ulcer, confirms clear margins regarding the osteomyelitis, and addresses the underlying toe deformity to minimize the chances of repeat ulceration.     

SGLT2 inhibition increases serum copeptin in young adults with type 1 diabetes

AimsCopeptin, a surrogate of vasopressin, is elevated in type 1 diabetes (T1D) and predicts kidney disease and cardiovascular mortality. Given the cardiorenal protective effects of SGLT2 inhibition (SGLT2i), our aim was to examine: 1) the relationship between serum copeptin, metabolic, renal and systemic hemodynamic parameters in adults with T1D; and 2) serum copeptin after SGLT2i with empagliflozin.Materials and methodsIn this post-hoc, exploratory analysis, serum copeptin, glomerular filtration rate (GFR_Inulin), effective renal plasma flow (ERPF_PAH), plasma renin angiotensin aldosterone system markers, HbA_1c, 24-hour urine volume and sodium excretion were measured in 40 participants with T1D (24.3 ± 5.1 years) during eu- and hyperglycaemia before and after 8 weeks of 25 mg of daily empagliflozin.ResultsHigher baseline copeptin correlated with higher HbA_1c, lower 24-hour urine volume and sodium excretion, after correcting for age, sex, systolic blood pressure, and HbA_1c. Copeptin concentrations increased in response to empagliflozin under euglycaemia (4.1 ± 2.1 to 5.1 ± 2.8 pmol/L, P = 0.0053) and hyperglycaemia (3.3 ± 1.4 to 5.6 ± 2.8 pmol/L, P < 0.0001). The rise in copeptin in response to empagliflozin correlated with change in 24-hour urine volume, but was independent of changes in fractional excretion of sodium and haematocrit.ConclusionsElevated serum copeptin was associated with worse glycaemic control and lower diuresis and natriuresis. SGLT2i increased serum copeptin in adults with T1D, and the rise correlated with change in diuresis, but not natriuresis and hemo-concentration. Further work is required to evaluate the clinical implications of elevated copeptin with SGLT2i, including whether it is simply a marker of diuresis or may contribute to cardiorenal disease long-term.