Risk factors for microvascular and macrovascular complications in men and women with type 2 diabetes.

OBJECTIVE: To evaluate the importance of risk factors for microvascular and macrovascular complications, separated by sex, in type 2 diabetes. DESIGN: Cross-sectional surveys of diabetic patients registered with primary health services in 1995. SETTING: Three community health centres in Stockholm County. SUBJECTS: 407 subjects with type 2 diabetes in 1995. For 78 of these, data were also registered in 1992. MAIN OUTCOME MEASURES: Odds ratio (OR) by logistic regression for risk factors predicting microvascular and macrovascular complications, for age and duration in years. RESULTS: For microvascular complications, the most important factors were in men the duration of diabetes (OR 1.13, p < 0.001) and in women the duration of diabetes (OR 1.08, p < 0.001) and age (OR 1.04, p < 0.05). For macrovascular complications, the most important factors were in men, age (OR 1.09, p < 0.001) and hypertension (OR 4.85, p < 0.001) and in women, age (OR 1.08, p < 0.001) and duration of diabetes (OR 1.08, p < 0.01). CONCLUSIONS: Hypertension is more important among men and the duration of diabetes among women as risk factor for macrovascular complications in type 2 diabetes.     

2型糖尿病大血管并发症相关危险因素的特征

目的:分析2型糖尿病大血管并发症的相关危险因素,进一步分析其特征。方法:选择2001-10/2002-08河北医科大学第三医院收治的2型糖尿病患者118例,按有无大血管并发症分为2个亚组;进一步结合体质量指数(≥25kg/m2为肥胖,<25kg/m2为非肥胖)分为4个亚组;以58名健康人为正常对照组。各亚组及对照组患者的纤溶酶原激活物抑制物1水平用ELISA法、血浆凝血因子Ⅶ的凝血活性用一期生化法检测,同时比较各组临床、生化指标。结果:176例全部进入结果分析。①2型糖尿病组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于对照组[(86.27±26.65),(62.10±24.18)μg/L,t=5.80,P<0.01;(123.02±20.27)%,(105.64±16.88)%,t=5.64,P<0.01],血压、空腹血糖、空腹胰岛素、糖化血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇也明显高于正常对照组(P<0.01)。②糖尿病并大血管并发症组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于无大血管并发症组[(92.17±26.88),(80.65±23.95)μg/L,t=2.46,P<0.05;(124.22±20.89)%,(113.52±21.28)%,t=2.75,P<0.01],年龄、血压、腰臀比、腰股比、总胆固醇及低密度脂蛋白胆固醇均高于无大血管并发症组(P<0.05,0.01),而胰岛素敏感性指数低于无大血管并发症组(P<0.05)。③血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性在肥胖组高于非肥胖组,并且在同等体质量指数水平的2型糖尿病合并大血管并发症组高于无大血管并发症组(P<0.05)。结论:糖尿病合并大血管病变的患者比无大血管病变者胰岛素抵抗特征(中心性肥胖、血压升高、脂代谢异常等)更明显,并且血凝及纤溶系统的异常亦与大血管疾病的发生发展有关。     

2型糖尿病大血管并发症相关危险因素的特征

目的：分析2型糖尿病大血管并发症的相关危险因素，进一步分析其特征。 方法：选择2001—10／2002-08河北医科大学第三医院收治的2型糖尿病患者118例，按有无大血管并发症分为2个亚组；进一步结合体质量指数（≥25kg／m^2为肥胖，〈25kg／m^2为非肥胖）分为4个亚组；以58名健康人为正常对照组。各亚组及对照组患者的纤溶酶原激活物抑制物1水平用ELISA法、血浆凝血因子Ⅶ的凝血活性用一期生化法检测，同时比较各组临床、生化指标。 结果：176例全部进入结果分析。①2型糖尿病组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于对照组[（86．27&;#177;26．65），（62．10&;#177;24．18）μg/L，t=5．80，P〈0．01；（123．02&;#177;20．27）％，（105．64&;#177;16．88）％，t=5．64，P〈0．01]，血压、空腹血糖、空腹胰岛素、糖化血红蛋白、三酰甘油、总胆固醇、低密度脂蛋白胆固醇也明显高于正常对照组（P〈0．01）。②糖尿病并大血管并发症组血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性水平高于无大血管并发症组[（92．17&;#177;26．88），（80．65&;#177;23．95）μg/L，t=2．46，P〈0．05；（124．22&;#177;20．89）％，（113．52&;#177;21．28）％，t=2．75，P〈0．01]，年龄、血压、腰臀比、腰股比、总胆固醇及低密度脂蛋白胆固醇均高于无大血管并发症组（P〈0．05，0．01），而胰岛素敏感性指数低于无大血管并发症组（P〈0．05）。③血浆纤溶酶原激活物抑制物1和凝血因子Ⅶ的凝血活性在肥胖组高于非肥胖组，并且在同等体质量指数水平的2型糖尿病合并大血管并发症组高于无大血管并发症组（P〈0．05）。 结论：糖尿病合并大血管病变的患者比无大血管病变者胰岛素抵抗特征（中心性肥胖、血压升高、脂代谢异常等）更明显，并且血凝及纤溶系统的异常亦与大血管疾病的发生发展有关。     

2型糖尿病大血管并发症防治

糖尿病大血管并发症是2型糖尿病患者重要的致残和死亡原因,对糖尿病大血管病变的防治具有重要意义。由于大血管并发症发病机制复杂,对大血管病变的防治必须注重危险因素的全面干预。本文针对2型糖尿病大血管并发症的主要危险因素血糖、血脂、血压及抗血小板治疗的新进展做一综述。     

2型糖尿病住院患者慢性并发症危险因素分析

目的:分析大连地区2型糖尿病住院患者糖尿病慢性并发症的相关危险因素。方法:①收集2005-01/2006-12大连医科大学附属第二医院内分泌科住院2型糖尿病患者579例。符合1999年世界卫生组织糖尿病诊断标准,且对检测项目知情同意。②收集个人资料,测量体脂测量参数(体质量指数、腰围、臀围、股围)以及实验室检查指标(血糖、血脂、24h尿白蛋白、胰岛素敏感相关指标)。根据国际临床分类法,24h尿白蛋白情况,神经肌电图,彩超检查、头部CT、心电图以及酶学诊断糖尿病视网膜病变、糖尿病肾脏病变、糖尿病周围神经病变、糖尿病大血管并发症。③使用Logistic逐步回归分析各危险因子对糖尿病并发症的贡献大小。结果:糖尿病患者579例均进入结果分析,其中42.3%合并糖尿病视网膜病变,其中4.5%为增殖型视网膜病变;63.2%合并糖尿病周围神经病变;37.0%合并糖尿病肾脏病变;56.6%合并糖尿病大血管并发症。多因素Logistic回归分析结果:①糖尿病病程、收缩压、糖化血红蛋白、腰股比为糖尿病肾脏病变独立危险因素(偏回归系数分别为0.005,0.019,0.069,6.693,P<0.05￣0.01)。②糖尿病病程、糖化血红蛋白、空腹血糖、血总胆固醇、24h尿白蛋白为糖尿病视网膜病变独立危险因素(偏回归系数分别为0.014,0.158,0.536,0.039,0.006,P<0.05￣0.01)。③糖尿病病程、年龄、血总胆固醇、空腹血糖为糖尿病周围神经病变独立危险因素(偏回归系数分别为0.016,0.039,0.608,0.433,P<0.05￣0.01)。④年龄、体质量指数、胰岛素抵抗指数、空腹血糖、总胆固醇、24h尿白蛋白为糖尿病大血管并发症独立危险因素(偏回归系数分别为0.085,0.092,0.248,1.153,0.937,0.002,P<0.05￣0.01)。高密度脂蛋白胆固醇为糖尿病大血管并发症独立保护因素(偏回归系数为0.992,P<0.05)。结论:腰股比是糖尿病肾脏病变的主要危险因素,糖化血红蛋白、空腹血糖是糖尿病视网膜病变的主要危险因素,空腹血糖、总胆固醇是糖尿病大血管并发症和糖尿病周围神经病变的主要危险因素。     

2型糖尿病患者血清胎球蛋白A水平与大血管并发症的关系

目的 探讨胎球蛋白A(AHSG)在2型糖尿病大血管并发症中的可能作用,为预防和治疗糖尿病(DM)大血管并发症提供理论依据.方法 分别收集30例2型糖尿病大血管病变患者(DMM组)、38例2型糖尿病无大血管病变患者(DMN组)和30例健康对照组(C组)为研究对象;采用酶联免疫吸附试验测定各组血清AHSG水平.结果 DMM组、DMN组的血清AHSG浓度均较健康对照组明显升高,其中DMM组升高更明显(P<0.01);随着血清AHSG浓度升高,糖尿病伴发大血管病变发生率逐渐增加,二者呈正相关(P<0.01);血清AHSG浓度是独立的大血管病变预测因素(P<0.01),病程、高血压与大血管病变呈正相关(P<0.01).结论 血清AHSG可能参与了糖尿病大血管并发症的形成和发展.     

Differing associations of lipid and lipoprotein disturbances with the macrovascular and microvascular complications of type 1 diabetes.

OBJECTIVE: Cardiovascular disease (CVD) is increased in patients with type 1 diabetes, but lipid and lipoprotein patterns remain favorable. In contrast, nephropathy is associated with an adverse distribution. We compared the associations and predictive power of lipid and lipoprotein disturbances with these complications. RESEARCH DESIGN AND METHODS: A nested case-control study from the EURODIAB cohort of 140 case subjects with evidence of at least one complication and 84 control subjects with no complications were analyzed. Conventional and unconventional lipid and lipoprotein fractions, including apolipoprotein (apo)-A1, lipoprotein (Lp)-A1, LpA1/A2, apoB, and LDL particle size were measured centrally. RESULTS: CVD was only associated with increased LDL cholesterol (3.6 vs. 3.0 mmol/l, P = 0.02). In contrast, albuminuria was associated with elevated cholesterol, triglyceride, LDL, and apoB and with diminished LDL particle size. No disturbances in HDL and related lipoproteins were noted. In normoalbuminuric patients, CVD was not associated with any significant changes in lipids. CVD in macroalbuminuric patients was associated with increased triglyceride level (2.37 vs. 1.07 mmol/l, P = 0.001; P = 0.02 for CVD/albuminuria interaction) and LDL cholesterol (5.4 vs. 3.3 mmol/l, P = 0.005; P = 0.004 for interaction). Independent associations were observed for total cholesterol and for LDL particle size and albuminuria. CONCLUSIONS: Abnormalities in lipid and lipoprotein disturbances are more closely related to albuminuria than to CVD in patients with type 1 diabetes. Measurement of conventional parameters provide sufficient risk information. ApoB and LDL particle size offer limited extra information. HDL metabolism remains undisturbed in the presence of complications. These changes reflect associations with glycemic control, which is the key to understanding lipid and lipoprotein disturbances.     

Estimates of direct medical costs for microvascular and macrovascular complications resulting from type 2 diabetes mellitus in the United States in 2000

BACKGROUND: Diabetes mellitus is a chronic condition that affects the health of Americans and the US health care system on many levels. According to the American Diabetes Association, approximately 16 million Americans have diabetes mellitus. The onset of type 2 diabetes mellitus, which accounts for the vast majority (90%-95%) of cases, precedes diagnosis by a mean 7 years, with the disease typically manifesting during adulthood. It is not uncommon for people to first realize they have diabetes mellitus due to the appearance of a related complication. OBJECTIVE: The goal of this analysis was to estimate the direct medical costs of managing microvascular and macrovascular complications of type 2 diabetes mellitus in the United States in the year 2000. METHODS: Complication costs were estimated by applying unit costs to typical resource-use profiles. A combination of direct data analysis and cost modeling was used. For each complication, the event costs referred to those associated with the acute episode and subsequent care in the first year. State costs were the annual costs of continued management. Data were obtained from many sources, including inpatient, ambulatory, and emergency department care databases from several states; national physician and laboratory fee schedules; government reports; and literature. All costs were expressed in 2000 US dollars. RESULTS: Major events (eg, acute myocardial infarction--30,364 dollars event cost, 1678 dollars state cost) generated a greater financial burden than early-stage complica- tions (eg, microalbuminuria--63 dollars event cost, 15 dollars state cost). However, complications that were initially relatively low in cost (eg, microalbuminuria) can progress to more costly advanced stages (eg, end-stage renal disease--37,022 dollars state cost). CONCLUSIONS: Given the scope of diabetes mellitus in the United States and its impact on health care and budgets, it is important for policy makers to have up-to-date information about treatment outcomes and costs. The costs presented here provide essential components for any analysis examining the economic burden of the complications of diabetes mellitus.     

2型糖尿病大血管并发症与非高密度脂蛋白胆固醇关系的临床研究

目的 探讨非高密度脂蛋白胆固醇与2型糖尿病大血管并发症的关系及临床应用价值.方法 选择2型糖尿病患者120例,分为糖尿病无大血管并发症组60例(B组),糖尿病大血管并发症组60例(C组),并选择正常对照组100例(A组),检测各组血脂并计算非高密度脂蛋白胆固醇(non-HDL-C),通过比较分析non-HDL-C与2型糖尿病大血管并发症的关系及临床应用价值.结果 A组、B组、C组non-HDL-C水平依次升高,(3.04±0.62)mmol/L,(3.68±0.56)mmol/L vs(4.64±0.82)mmol/L(P<0.01);运用接收者工作特征(ROC)曲线对B、C组的血脂指标进行分析显示,C组non-HDL-C的曲线下面积最大,为0.845,且B、C两组问差异有统计学意义(P<0.01),临床应用价值较大.结论 non-HDL-C的增高是糖尿病大血管并发症的危险因素,有较高的临床应用价值.     

血浆脂联素水平与2型糖尿病及其大血管病变发生的相关性

目的：观察2型糖尿病及其并发大血管病变患者中的血浆脂联素水平，探讨血浆脂联素水平与2型糖尿病及其大血管病变的关系。 方法：选择2004-02／2005-02在广西医科大学附属第五医院内分泌科住院的2型糖尿病患者103例，根据是否合并大血管病变分为2组，糖尿病并大血管病变组49例，糖尿病无大血管病变组54例；同时选择在本院进行健康体检者35例作为对照组，均知情同意。测定以上观察对象的血浆脂联素水平应用放射免疫法，同时测定血糖、血压、血脂、C肽水平。比较各组间血浆脂联素水平、低脂联素血症发生率(以血浆脂联素水平<5mg／L判为降低)，分析其影响因素。探讨脂联素与糖尿病大血管并发症危险因素的相关性采用相关分析以及多元逐步回归分析。 结果：大血管病变组49例，无大血管病变组54例，正常对照组35例，全部进入结果分析。①各组血浆脂联素水平：糖尿病大血管病变组显著低于无大血管病变组和对照组[(4．08±3．24)mL／L，(6．69±4．42)mL／L，(16．37±3．03)mL／L，(t=3．440，17．606，P<0．01)]。无大血管病变组显著低于对照组(t=12．257，P<0．05)。②各组低脂联素血症发生率：大血管病变组、无大血管病变组均显著高于对照组[73．5％，40．0％，0(X~2=42．050，16．815，P<0．01)]，其中大血管病变组显著高于无大血管病变组(X~2=9．894，P<0．01)。③脂联素水平与糖尿病大血管并发症危险因素之间的相关性：血浆脂联素水平与收缩压呈负相关(r=-0．309，P<0．01)。 结论：2型糖尿病患者血浆脂联素水平降低，并发大血管病变者降低更加明显，且与糖尿病大血管病变的危险因素收缩压水平呈显著负相关，提示血浆脂联素与2型糖尿病及其大血管病变的发生发展密切相关。     

血清脂联素与2型糖尿病及其大血管病变的相关性研究

目的 测定正常人群与2型糖尿病及其大血管病变患者的血清脂联素水平,探讨脂联素与2型糖尿病及其大血管病变的相关性.方法 正常对照组102例,2型糖尿病组116例、2型糖尿病并大血管病变组123例,比较各组的血清脂联素水平,分析其影响因素.结果 ①型糖尿病组及其大血管病变组的血清脂联素水平[分别为(8.62±2.97)、(6.17±2.55)mg/L]较正常对照组[(10.03±4.41)mg/L]降低,大血管病变组的血清脂联素水平较2型糖尿病组更低,差异均有统计学意义(P均<0.05);②相关分析显示,脂联素水平与体重指数、腰臀比、胰岛素抵抗指数、空腹胰岛素、糖化血红蛋白、甘油三酯负相关(r值分别为-0.492、-0.581、-0.813、-0.754、-0.619、-0.387,P均<0.05);③多元逐步回归分析显示脂联素与胰岛素抵抗指数、空腹胰岛素、糖化血红蛋白呈负相关(r值分别为-0.828、-0.769、-0.631,P均<0.01).结论 2型糖尿病及其大血管病变患者的血清脂联素水平降低,低脂联素血症可能与2型糖尿病及其大血管病变相关,在糖尿病动脉粥样硬化的发生、发展过程中有重要作用.     

Normotensive women with type 2 diabetes and microalbuminuria are at high risk for macrovascular disease

OBJECTIVE: The excess risk of macrovascular disease and death associated with diabetes seems higher in women than in men. The pathogenesis for this risk difference has not been fully elucidated. We investigated whether female sex was associated with macrovascular disease and death, independently of known risk factors related to type 2 diabetes, nephropathy, or retinopathy in normotensive patients with type 2 diabetes and microalbuminuria. RESEARCH DESIGN AND METHODS: We conducted a prospective, prolonged follow-up study of a subgroup of 67 diabetic patients (46 men and 21 women) without established cardiovascular disease who participated in a larger clinical trial. Data were collected on current and past health, medication use, blood pressure, renal function, and HbA(1c) during the follow-up period of 4.7 +/- 0.8 (means +/- SE) years. The end point was a composite of death, cardiovascular disease, cerebrovascular events, and peripheral artery disease. RESULTS: Of the women, eight (38.1%) met the end point compared with six (13.4%) of the men (P = 0.02 for difference in event-free survival). The hazard ratio of women relative to men was 3.19 (95% CI 1.11-9.21), which further increased after adjusting for age, systolic blood pressure, BMI, smoking, total-to-HDL cholesterol ratio, urinary albumin excretion, and retinopathy. CONCLUSIONS: In our study population of normotensive patients with type 2 diabetes and microalbuminuria, female sex was associated with increased risk of fatal and nonfatal cardiovascular disease, independent of the classical cardiovascular risk factors, the severity of nephropathy or presence of retinopathy, or health care utilization.     

Postprandial hypertriglyceridemia and oxidative stress in patients of type 2 diabetes mellitus with macrovascular complications

BACKGROUND: Oxidative stress has been implicated in vascular complications of diabetes mellitus (DM). This study aims to evaluate the relationship between postprandial hypertriglyceridemia (PP-HTG) and oxidative stress in Indian patients of type 2 DM with macrovascular complications. METHODS: Plasma triglycerides (TG), thiobarbituric acid reactive substances (TBARS), erythrocyte reduced glutathione (GSH) and superoxide dismutase (SOD) were measured in fasting and postprandial (PP) state at 2, 4, 6 and 8 h after a high fat meal challenge in controls (Group I) and patients of type 2 DM without (Group II) and with macrovascular complications (Group III). RESULTS: Postprandial TGs increased significantly in patients with type 2 DM, which showed an exaggerated response to high fat meal challenge in Group III as compared to Group II. Highest PP-TBARS were also observed in Group III which correlated positively with TG. However, GSH and SOD were lower in both groups of diabetics as compared to controls. CONCLUSIONS: The magnitude of PP-HTG appears to be the major determinant of oxidative stress in type 2 DM, which along with a compromised antioxidant status may lead to endothelial dysfunction and macrovascular complications.     

血浆脂联素水平与2型糖尿病及其大血管病变发生的相关性

目的：观察2型糖尿病及其并发大血管病变患者中的血浆脂联素水平,探讨血浆脂联素水平与2型糖尿病及其大血管病变的关系.方法：选择2004-02/2005-02在广西医科大学附属第五医院内分泌科住院的2型糖尿病患者103例,根据是否合并大血管病变分为2组,糖尿病并大血管病变组49例,糖尿病无大血管病变组54例;同时选择在本院进行健康体检者35例作为对照组,均知情同意.测定以上观察对象的血浆脂联素水平应用放射免疫法,同时测定血糖、血压、血脂、C肽水平.比较各组间血浆脂联素水平、低脂联素血症发生率（以血浆脂联素水平＜5 mg/L判为降低）,分析其影响因素.探讨脂联素与糖尿病大血管并发症危险因素的相关性采用相关分析以及多元逐步回归分析.结果：大血管病变组49例,无大血管病变组54例,正常对照组35例,全部进入结果分析.①各组血浆脂联素水平：糖尿病大血管病变组显著低于无大血管病变组和对照组[（4.08&;#177;3.24）mL/L,（6.69&;#177;4.42）mL/L,（16.37&;#177;3.03）mL/L,（t=3.440,17.606,P＜0.01）].无大血管病变组显著低于对照组（t=12.257,P＜0.05）.②各组低脂联素血症发生率：大血管病变组、无大血管病变组均显著高于对照组[73.5%,40.0%,0（x^2=42.050,16.815,P＜0.01）],其中大血管病变组显著高于无大血管病变组（x^2=9.894,P＜0.01）.③脂联素水平与糖尿病大血管并发症危险因素之间的相关性：血浆脂联素水平与收缩压呈负相关（r=-0.309,P＜0.01）.结论：2型糖尿病患者血浆脂联素水平降低,并发大血管病变者降低更加明显,且与糖尿病大血管病变的危险因素收缩压水平呈显著负相关,提示血浆脂联素与2型糖尿病及其大血管病变的发生发展密切相关.     

血清脂联素与2型糖尿病及其大血管病变的相关性研究

Objective To understand the serum adiponectin levels in normal subjects and type 2 diabetes patients with macrovascular complications, to investigate the correlation between adipnectin and macrovascular complications in type 2 diabetes patients. Methods One hundred and two normal subjects, 116 type 2 diabetes patients and 123 type 2 diabetic patients with macrovascular complications were recruited in the current study. The serum adiponectin levels among three groups were compared, and the factors affecting the serum adiponectin were investigated. Results ①The serum adiponectin level was significantly lower in type 2 diabetic patients (8. 62 ± 2. 97) mg/L than that in normal subjects (10. 03 ± 4.41) mg/L, and was the lowest in type 2 diabetic patients with macrovascular complications(6. 17 ± 2. 55) mg/L(P < 0.05). ②Serum adiponetin level was negatively correlated with BMI,WHR,HOMA-IR,fasting insulin level, HbAlC and TG(r = -0.492, -0. 581, -0. 813, -0. 754, -0.619, -0.387, P<0.05). ③In a general multivariate regression, HOMA-IR fasting insulin and HbAlc.were negatively correlated with serum adipnectin level (r = - 0. 828, - 0. 769, - 0. 631, P < 0. 01). Conclusions The serum adiponectin level in type 2 diabetic patients is significantly decreased and even more in type 2 diabetic patients with macrovascular complications. These results suggest that lower serum adiponectin level is related to macrovascular complications in type 2 diabetic patients and maybe plays an important role in atherosclerosis in type 2 diabetic patients.     

血清脂联素与2型糖尿病及其大血管病变的相关性研究

Objective To understand the serum adiponectin levels in normal subjects and type 2 diabetes patients with macrovascular complications, to investigate the correlation between adipnectin and macrovascular complications in type 2 diabetes patients. Methods One hundred and two normal subjects, 116 type 2 diabetes patients and 123 type 2 diabetic patients with macrovascular complications were recruited in the current study. The serum adiponectin levels among three groups were compared, and the factors affecting the serum adiponectin were investigated. Results ①The serum adiponectin level was significantly lower in type 2 diabetic patients (8. 62 ± 2. 97) mg/L than that in normal subjects (10. 03 ± 4.41) mg/L, and was the lowest in type 2 diabetic patients with macrovascular complications(6. 17 ± 2. 55) mg/L(P < 0.05). ②Serum adiponetin level was negatively correlated with BMI,WHR,HOMA-IR,fasting insulin level, HbAlC and TG(r = -0.492, -0. 581, -0. 813, -0. 754, -0.619, -0.387, P<0.05). ③In a general multivariate regression, HOMA-IR fasting insulin and HbAlc.were negatively correlated with serum adipnectin level (r = - 0. 828, - 0. 769, - 0. 631, P < 0. 01). Conclusions The serum adiponectin level in type 2 diabetic patients is significantly decreased and even more in type 2 diabetic patients with macrovascular complications. These results suggest that lower serum adiponectin level is related to macrovascular complications in type 2 diabetic patients and maybe plays an important role in atherosclerosis in type 2 diabetic patients.     

Impact of white-coat hypertension on microvascular complications in type 2 diabetes

OBJECTIVE—The purpose of this study was to determine the impact of white-coat hypertension (WCH) on microvascular complications in type 2 diabetes.RESEARCH DESIGN AND METHODS—A cross-sectional study was conducted in normotensive patients and patients with WCH selected from a cohort of 319 type 2 diabetic patients. Normotension was defined by office blood pressure <140/90 mmHg and daytime blood pressure <135/85 mmHg on ambulatory blood pressure monitoring (ABPM). WCH was defined as office blood pressure ≥140/90 mmHg and daytime blood pressure <135/85 mmHg on ABPM. Subjects were evaluated for diabetic nephropathy (24-h urinary albumin excretion rate) and diabetic retinopathy (classified according to the Global Diabetic Retinopathy Group).RESULTS—Forty-six type 2 diabetic patients had WCH (14.4%; mean age 56.6 years; 45.3% men) and 117 had normotension (36.6%; mean age 55.8 years; 37.5% men). These groups did not differ in clinical and main laboratory characteristics. Systolic ABPM (24-h: 124.7 ± 6.7 vs. 121.0 ± 8.5 mmHg, P = 0.01 and daytime: 126.6 ± 7.2 vs. 123.2 ± 8.2 mmHg, P = 0.01) and blood pressure loads were higher in subjects with WCH than in the normotensive subjects. WCH was associated with an increased risk for macroalbuminuria (odds ratio 4.9 [95% CI 1.3–18.7], P = 0.01). On multivariate analysis models, WCH was associated with macroalbuminuria (2.0 [1.3–3.2], P = 0.02) and increased the risk for both nonproliferative and proliferative diabetic retinopathy (2.7 [1.2–6.6], P = 0.02 for any degree of diabetic retinopathy) after adjustments for confounding factors.CONCLUSIONS—Type 2 diabetic patients with WCH have an increased risk for diabetic retinopathy and diabetic nephropathy. Therefore, WCH should not be considered a harmless condition, and treatment should be considered.Hypertension is a major risk factor for both the onset and progression of chronic diabetes complications, and its treatment can prevent deleterious micro- and macrovascular outcomes (1,2). Abnormalities in blood pressure homeostasis demonstrated on ambulatory blood pressure monitoring (ABPM) have a better correlation with target organ lesions than ordinary office blood pressure measurements (3,4).Hypertensive patients with normal blood pressure values on ABPM, namely “white-coat hypertension” (WCH), have been historically considered to have a low risk profile for vascular complications. Consequently, subjects with WCH have been followed as normotensive individuals and, most of the time, do not receive treatment. However, emerging data from general population studies associate WCH with cardiac structural abnormalities (5) as well as increased risk for stroke and cardiovascular events (5).In type 1 diabetic patients, WCH is associated with the subsequent development of sustained hypertension and microalbuminuria (6). However, the repercussions of WCH in type 2 diabetic patients have not been reported. Therefore, the aim of this study was to characterize type 2 diabetic patients with WCH and determine its effects on chronic diabetes complications.     

2型糖尿病合并脂肪肝的危险因素分析

目的分析2型糖尿病发生脂肪肝的危险因素。方法130例2型糖尿病病人,分为糖尿病合并脂肪肝(DFL)组与糖尿病非合并脂肪肝(NDFL)组。结果DFL有关的危险因素包括体重、体质指数、腰臀比值、血压、空腹胰岛素、餐后2 h胰岛素、胆固醇、甘油三酯、载脂蛋白B、胰岛素抵抗指数(HOMA-IR),其中最主要的两个危险因素是体质指数、甘油三酯。结论影响DFL的因素很多,主要危险因素是甘油三酯和体质量指数,脂肪肝可能是糖尿病前的一个阶段。