糖尿病前期中医证型及证素特点分析＊

目的 探讨糖尿病前期的中医证型及证素分布特点。方法 检索中国知网、万方及维普三大数据库中收录的自建库以来有关糖尿病前期证型的临床研究文献，对中医证型进行规范整理，建立数据库，提取证素，运用数据挖掘技术中的关联分析、聚类分析探究证素分布规律。结果 共纳入10篇文献，总有效病例1620例，证型经规范处理后整理为18个，主要证型为脾虚痰湿证。共提取证素13个，主要病位证素为脾，主要病性证素为气虚、湿和痰，关联分析显示脾—湿支持度和置信度最高，聚类分析结果可得到3个聚类组。结论 糖尿病前期病位在脾，气虚、脾、痰、湿是常见证素，临床诊治糖尿病前期应注重从脾论治，需辨证施治。     

Impaired function of fibroblast growth factor 23 / Klotho protein axis in prediabetes and diabetes mellitus: Promising predictor of cardiovascular risk

The discovery of clear molecular mechanisms of early cardiac and vascular complications in patients with prediabetes and known diabetes mellitus are core element of stratification at risk with predictive model creation further. Previous clinical studies have shown a pivotal role of impaired signaling axis of fibroblast growth factor 23 (FGF23), FGF23 receptor isoforms and its co-factor Klotho protein in cardiovascular (CV) complications in prediabetes and diabetes. Although there were data received in clinical studies, which confirmed a causative role of altered function of FGF-23/Klotho protein axis in manifestation of CV disease in prediabetes and type 2 diabetes mellitus (T2DM), the target therapy of these diseases directing on improvement of metabolic profiles, systemic and adipokine-relating inflammation by beneficial restoring of dysregulation in FGF-23/Klotho protein axis remain to be not fully clear. The aim of the review was to summarize findings regarding the role of impaired FGF-23/Klotho protein axis in developing CV complications in patients with prediabetes and type 2 diabetes mellitus. It has been elucidated that elevated levels of FGF-23 and deficiency of Klotho protein in peripheral blood are predictors of CV disease and CV outcomes in patients with (pre) diabetes, while predictive values of dynamic changes of the concentrations of these biomarkers require to be elucidated in detail in the future.     

Clearing hepatitis C virus with direct antiviral agents reduces cardiovascular events in patients with prediabetes. Commentary to Sasso and colleagues

Liver health is a key determinant of cardiovascular risk (CVR). Hepatic fibrosis is the shared common result of chronic hepatitis, irrespective of aetiology. Fibrosis profoundly distorts liver tissue architecture and perturbs hepatic physiology, dictates the course of chronic liver disease and is increasingly recognized as a CVR factor. The relative weights of pre-diabetes and hepatic fibrosis as risk factors for major adverse cardiac events (MACE) in patients with HCV remain an open issue. Sasso and Colleagues answered this research question by treating approximately half of 770 HCV positive pre-diabetic patients with direct antiviral agents (DAAs), while the rest served as historical controls. Data have shown that achieving HCV clearance with DAAs was associated with a 60% reduced risk of MACE, thereby implying that this antiviral strategy is recommended in HCV positive pre-diabetic patients, regardless of the severity of liver disease and concurrent CVR factors. This study paves the way for additional studies addressing the molecular patho-mechanisms and changes in the clinical spectrum involved in cardio-metabolic protection following HCV eradication in patients with pre-diabetes.     

Prediabetes and deprivation: A couple at high risk of diabetes

AimThe higher prevalence of diabetes in deprived populations is well documented but little is known about the risk of diabetes associated with deprivation among pre-diabetic subjects. The aim of the study was to evaluate the risk of diabetes in a population of deprived pre-diabetic patients.Methods2743 pre-diabetic subjects identified using the American Diabetes Association (ADA) criteria, 16 to 85 years old, 1656 non-deprived and 1087 deprived, had at least two health check-ups at an interval of 4.95 (2.04) vs 3.20 (1.71) years, P < 0.0001, respectively. At the first visit, socioeconomic status was assessed using the EPICES score to differentiate deprived and non-deprived subjects.ResultsAt the second visit, the prevalence of overt diabetes was 9.5% among deprived vs 5.1% in the non-deprived group (P < 0.001). After adjustment on confounding factors, deprivation was found independently associated with occurrence of diabetes [1.70 (1.15–2.51), P = 0.01]. Beyond social deprivation, Fasting Plasma Glucose and waist circumference were the main independent predictors of new-onset diabetes.ConclusionAfter 4 years of follow-up, among subjects with prediabetes, prevalence of diabetes was twice as high among deprived compared with non-deprived subjects. Deprived populations with pre-diabetes may require specific public health approaches to avoid the occurrence of overt diabetes.     

Impact of direct acting antivirals (DAAs) on cardiovascular events in HCV cohort with pre-diabetes

Background and aimsBeyond type 2 diabetes, even a condition of prediabetes is associated with an increased cardiovascular (CV) risk, and HCV infection coexistence represents an exacerbating factor. CV prognosis improvement in prediabetes represents a challenge, due to the increasing prevalence of this metabolic condition worldwide. Hence, we aimed to prospectively assess how direct acting antivirals (DAAs) could affect major cardiovascular events (MACE) in a prediabetic HCV positive cohort.Methods and resultsIn this prospective multicenter study, we enrolled HCV patients with overt prediabetes. We compared a subgroup of patients treated with DAAs with untreated prediabetic controls. We recorded all CV events occurred during an overall median follow-up of 24 months (IQR 19–34). 770 HCV positive prediabetic patients were enrolled, 398 untreated controls and 372 DAAs treated patients. Overall, the CV events annual incidence was much higher among prediabetic treated patients (1.77 vs. 0.62, p < 0.001), and HCV clearance demonstrated to significantly reduce CV events (RR: 0.411, 95%CI 0.148–1.143; p < 0.001), with an estimated NNT for one additional patient to benefit of 52.1. Moreover, an independent association between a lower rate of CV events and HCV clearance after DAAs was observed (OR 4.67; 95%CI 0.44–53.95; p = 0.016).ConclusionsHCV eradication by DAAs allows a significant reduction of MACEs in the prediabetic population, and therefore represents a primary objective, regardless of the severity of liver disease and CV risk factors.     

Gender differences in the modifiable risk factors associated with the presence of prediabetes: A systematic review

BackgroundPrediabetes is a risk state for the future development of type 2 diabetes. Previously, it was evident that the risk factors for diabetes differ by gender. However, conclusive evidence regarding the gender difference in modifiable risk factors associated with the presence of pre-diabetes is still lacking.AimsTo systematically identify and summarize the available literature on whether the modifiable risk factors associated with prediabetes displays similar relationship in both the genders.MethodsA systematic search was performed on electronic databases i.e. PubMed, EBSCOhost, and Scopus using “sex”, “gender”, “modifiable risk factors” and “prediabetes” as keywords. Reference list from identified studies was used to augment the search strategy. Methodological quality and results from individual studies were summarized in tables.ResultsGender differences in the risk factor association were observed among reviewed studies. Overall, reported association between risk factors and prediabetes apparently stronger among men. In particular, abdominal obesity, dyslipidemia, smoking and alcohol drinking habits were risk factors that showed prominent association among men. Hypertension and poor diet quality may appear to be stronger among women. General obesity showed stringent hold, while physical activity not significantly associated with the risk of prediabetes in both the genders.ConclusionsEvidence suggests the existence of gender differences in risk factors associated with prediabetes, demands future researchers to analyze data separately based on gender. The consideration and the implementation of gender differences in health policies and in diabetes prevention programs may improve the quality of care and reduce number of diabetes prevalence among prediabetic subjects.     

Effects of hepatitis B virus infection,alanine aminotransferase,aspartate aminotransferase and gamma-glutamyl transferase on prediabetes and diabetes mellitus: A cohort study

Introduction and objectivesThe purpose of this study was to confirm whether hepatitis B virus (HBV) infection and the levels of liver enzymes would increase the risk of prediabetes and diabetes mellitus (DM) in China.Materials and methodsA total of 10,741 individuals was enrolled in this prospective cohort study. Cox regression analysis was used to calculate the Hazard ratios (HRs) to evaluate the relationships between HBV infection and the risk of DM and prediabetes. Decision trees and dose response analysis were used to explore the effects of liver enzymes levels on DM and prediabetes.ResultsIn baseline population, HBV infection ratio was 5.31%. In non-adjustment model, the HR of DM in HBV infection group was 1.312 (95% CI, 0.529–3.254). In model adjusted for gender, age and liver cirrhosis, the HR of DM in HBV infection group were 1.188 (95% CI, 0.478–2.951). In model adjusted for gender, age, liver cirrhosis, smoking, drinking, the HR of DM was 1.178 (95% CI, 0.473–2.934). In model further adjusted for education, family income and occupation, the HR of DM was 1.230 (95% CI, 0.493–3.067). With the increases of levels of Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and Gamma-glutamyl transferase (GGT), the risk of prediabetes was gradually increasing (P_{non-linearity} < 0.05). There were dose-response relationships between ALT, GGT and the risk of DM (P_{non-linearity} < 0.05).ConclusionsHBV infection was not associated with the risk of prediabetes and DM. The levels of liver enzymes increased the risk of prediabetes and DM.     

Short-term effects of lifestyle intervention in the reversion to normoglycemia in people with prediabetes

AimsTo evaluate the short-term effect of lifestyle intervention in people with prediabetes.MethodsA stratified multistage sampling method was used in the recruitment of residents of the Jiangsu Province, China in 2017, who had no previous diagnosis of diabetes. Physical examination and laboratory tests were performed, and questionnaires were completed. Those with a prediabetes diagnosis at baseline were included in the cohort and participants were randomized to the intervention group or the control group. The intervention group received a lifestyle intervention strategy, which included exercise, diet and peer educations. The control group received general health education. Participants were followed up in 2018.ResultsA total of 2005 individuals were included in the analysis. At follow-up, there were 516 (36.7%) individuals in the intervention group and 207 (34.5%) individuals in the control group with normal blood glucose levels. The decline in waist circumference and fasting plasma glucose levels was significantly higher in the intervention group than in the control group. This was still observed after adjusting for variables (odds ratio 1.32, P = 0.02). Females or younger individuals who had lower body mass index and plasma glucose levels at baseline were more likely to reverse to normoglycemia at follow-up.ConclusionsCompared with a strategy of general health education, a lifestyle intervention strategy could reverse glucose levels to normoglycemia in individuals with prediabetes.     

2017年ACC/AHA高血压指南对贵阳城区40~79岁不同糖代谢状态人群高血压患病情况的可能影响

目的探讨2017年美国心脏病学会/美国心脏协会(ACC/AHA)指南提出的新的高血压诊断标准下贵阳城区40~79岁不同糖代谢状态人群的高血压患病情况,为高血压的诊断标准及高血压的治疗策略提供线索。方法回顾性分析了中国2型糖尿病患者肿瘤发生风险的流行病学(REACTION)研究贵阳分中心的10140名40~79岁居民,根据糖尿病病史及口服葡萄糖耐量试验结果分为血糖正常组、空腹血糖受损(IFG)组、糖耐量受损(IGT)组、IFG+IGT组、既往诊断糖尿病组及新诊断糖尿病组,计算在美国预防、检测、评估与治疗高血压全国联合委员会第七次报告(JNC 7)及2017年ACC/AHA的高血压指南标准下不同糖代谢状态人群的高血压患病情况。结果在JNC 7标准下,贵阳城区40~79岁血糖正常人群、糖尿病前期人群、糖尿病人群的高血压标准化患病率分别为8.19%、9.57%、8.19%。在2017年ACC/AHA标准下,高血压的标准化患病率分别为20.27%、16.35%、11.59%。相比之下,以血糖正常及IGT人群的高血压患病率增加最为显著。新增的高血压患者共1739例,其中25.8%需应用降压药物治疗。根据2010年第六次人口普查贵州省人口数据,估计贵阳市40~79岁糖尿病前期人群中新增的高血压患者约12.3万人,新增需治疗人数约2.0万人;糖尿病人群中新增高血压患者约6.8万人,新增需治疗人数约2.1万余人。结论2017年ACC/AHA高血压指南会使贵阳市城区40~79岁不同糖代谢状态人群的高血压患病率明显增加,糖尿病及糖尿病前期的高血压人群的需治疗比例也会相当高,社会医疗负担加重。