Prevalence of Retinopathy and Proteinuria in Type 1 Diabetics in Iceland

ABSTRACT. The prevalence of retinopathy and proteinuria was assessed in 212 and 230 type 1 diabetics in Iceland respectively. They represent 78% and 84% of all such patients identified in the country. Retinopathy was present in 33.5%, background lesions only in 27.4% and more severe retinopathy in 6.1%. After 5–9 years of diabetes (mean 6.9) the prevalence of retinopathy was 18.8%, including 2.1% proliferative, and rose to 76.7% after 20 years or more of diabetes (mean 26.7), including 16.2% in the proliferative stage. Blindness was found in 2.4% of the patients. Diabetics diagnosed at the age of 0–19 years had a lower prevalence of retinopathy during their first 20 years of diabetes than those diagnosed later in life (p<0.05). Proteinuria was present in 14%, intermittent in 10% and continuous in 4%. After 10 years or more of diabetes (mean 19.3) the prevalence of intermittent and continuous proteinuria was 13.0% and 8.3%, respectively.     

酮症倾向的2型糖尿病研究进展

以自发性酮症起病的2型糖尿病具有1型和2型糖尿病的某些临床特征,其发生与重度胰岛素抵抗及胰岛β细胞功能不足有关。在中止胰岛素治疗后,部分患者可获得正常血糖缓解。测定胰岛自身免疫抗体和胰岛β细胞功能对自发性酮症起病的2型糖尿病的临床管理具有指导意义。     

PAX4基因多态性与胰岛自身抗体 阴性酮症倾向糖尿病的关系

目的：探讨配对盒4(paired box 4,PAX4) 基因多态性与胰岛自身抗体阴性酮症倾向糖尿病(KPD)的关系。方法：应用变性高效液相色谱法(DHPLC)筛查141例谷氨酸脱羧酶自身抗体（GAD-Ab）和蛋白酪氨酸磷酸酶自身抗体（IA-2Ab）阴性的KPD患者（KPD组）和112例非糖尿病对照者（NC组）的PAX4基因外显子3和9,对异常峰型者经测序证实其碱基改变。应用聚合酶链反应-限制性长度多态性分析（PCR-RFLP）法对141例KPD患者和308例对照者的PAX4基因A1168C多态位点进行等位基因和基因型频率分析。结果：在本组人群中未发现PAX4基因外显子3有变异。外显子9中的单核苷酸多态性（SNP）位点A1168C,引起错义突变P321H（rs712701）。 A1168C位点的C等位基因和CC基因型频率在KPD组与NC组间差异无统计学意义;按性别分层后,KPD组C等位基因和CC基因型频率差异均有统计学意义（P=0.009,0.028）;以年龄分层后,＜20岁组与≥20岁组比较C等位基因和CC基因型频率分布差异均有统计学意义（P=0.034,0.032）; 在CC基因型的KPD患者中,空腹C肽(FCP)水平高于AA基因型者,差异有统计学意义（P=0.005）。结论：本组中国南方汉族人群PAX4基因A1168C（P321H）多态性与胰岛自身抗体阴性KPD未见关联,但分层研究提示PAX4基因A1168C多态性对男性和＜20岁的KPD患者的发病可能有影响。     

Prognostic Factors and Retinopathy in Type 1 Diabetics in Iceland

ABSTRACT Prognostic factors, particularly those related to metabolic control, were analysed individually over a period of 12 months prior to fundus photography in 149 type 1 (insulin-dependent, ketosis-prone) diabetics in Iceland. Patients without retinopathy in their first 20 years of diabetes visited the Diabetic Clinic significantly more frequently than those with retinopathy (p<0.05). Mean blood sugar values and mean per cent body weight did not differ between patients with or without retinopathy. Few patients were obese. In patients with 5–9 years' duration of diabetes, retinopathy was first seen after 7.7±0.3 years (mean ± SEM). Those with retinopathy were significantly older at the time of the diagnosis of diabetes than those without eye lesions (p<0.025), a tendency also noted in those with 10–19 years' duration (p<0.10). Conversely, patients without retinopathy after diabetes for 20 years or more were significantly older at the time of diagnosis (p<0.02). They used significantly less insulin daily than those with retinal lesions (p<0.005) and 70 % were females. Subsequently, a significant (p<0.047) male excess was found to characterize a group of patients with proliferative retinopathy.     

非典型糖尿病研究进展

非典型糖尿病是一类以高血糖、酮症或酸中毒等急性症状起病,但伴有胰岛素抵抗,而胰岛素相关抗体阴性为特点的疾病,其短期内需胰岛素治疗,后可逐渐停用胰岛素治疗,改用口服药治疗或仅通过生活方式干预即可控制血糖,其被认为是不同于目前经典1型或2型糖尿病一种新类型。本文将围绕非典型糖尿病的流行病学、临床特点、病理生理机制、诊断及治疗的最新进展进行综述,有助于临床医生提高对于该病的认识,以防在临床工作中漏诊及误诊。     

酮症倾向的糖尿病患者胰岛自身抗体与胰岛功能的意义

目的探讨酮症倾向糖尿病（KPD）患者临床特征、自身抗体检出情况及胰岛8细胞功能。方法检测78例KPD患者血清谷氨酸脱羧酶抗体（GAD-Ab）、胰岛细胞抗体（ICA）、胰岛素自身抗体（IAA）、GP。任一抗体阳性为A＋，3种抗体均阴性为A-，空腹FGP≥0．333nmol／L为8＋，反之为β-。根据结果78例KPD患者分4组：A＋β＋；A＋β-；A—β＋；A-β-。比较各组的临床特征、自身抗体及胰岛功能。结果A-β＋组发病年龄最大，BMI、合并高血压和肥胖的百分率、TG、TC、TC—P和餐后C-P较高；A＋β-组发病年龄最轻，BMI、合并高血压和肥胖的百分率、C-P水平最低；A＋β＋组和A—β-组临床特征介于A＋β-组和A-β-组之间。结论KPD临床特点不同，自身免疫抗体和胰岛β细胞功能差异显著，提示应根据不同临床特点采取不同的治疗。     

Predictors of glycaemic control in indigent patients presenting with diabetic ketoacidosis

AIM: To derive predictors of good glycaemic control in patients presenting with diabetic ketoacidosis (DKA) followed prospectively in a specialized clinic. METHODS: One hundred and sixty-one adult patients were admitted during a 31-month period and followed for at least 12 months. After 1 year, the patients were classified into three groups: good control (GC) (HbA1c < or = 7%), intermediate control (IC) (HbA1c 7-9%) and poor control (PC) (HbA1c > 9%). Characteristics of patients in the three groups were compared both at baseline and during follow-up. RESULTS: At 12 months, 36% of the patients were classified as GC, 27% as IC and 37% as PC. GC patients had higher fasting serum C-peptide levels 0.7 +/- 0.54 compared to 0.38 +/- 0.29 and 0.16 +/- 0.21 nmol/l, respectively, for the IC and PC patients (p < 0.0001). A higher proportion GC patient had a C-peptide level greater than 0.33 nmol/l than that for IC and PC patients (86, 61 and 19%, respectively; p < 0.0001). Exogenous insulin was safely discontinued in 50, 30 and 3% of patients, respectively, in the GC, IC and PC groups (p < 0.0001). Compliance with life-style interventions was higher in the GC than that in IC and PC patients (87, 41 and 5%, respectively; p < 0.0001). In the logistic regression analysis, predictors of good glycaemic control were having baseline fasting serum C-peptide value > or =0.33 mmol/l, OR: 3.01 (95% CI 1.07-8.55, p = 0.03) and compliance with life-style interventions OR 12.66 (95% CI 3.73-51.57, p = 0.0001). CONCLUSION: Among adult patients with DKA, significant predictors of good glycaemic control are preserved beta-cell function and compliance with life-style modifications.