Recurrent diabetic ketoacidosis

In a study over 15 years, 740 episodes of diabetic ketoacidosis occurred in 505 patients. A total of 113 patients had more than one episode. The majority (90%) of recurrences were within 4 years of the initial episode. Taking a definition of recurrent ketoacidosis as three or more episodes within 4 years, 39 patients were identified. Two subgroups appeared prone to such frequent recurrences, namely girls less than 20 years of age and women more than 59 years of age. A variety of causes of recurrent episodes was noted in the young patients but in the older patients other chronic illnesses complicated the diabetes. The need for good domiciliary supervision of elderly chronic sick patients who require insulin is emphasized.     

粘附分子与实验性糖尿病视网膜病变的初步研究

目的　探讨粘附分子在糖尿病视网膜病变（ Ｄ Ｒ） 发病中的作用。方法　应用链脲佐菌素（ Ｓ Ｔ Ｚ） 建立糖尿病大鼠模型,分别于成模后３ 个月和６ 个月时经光镜和透射电镜观察视网膜的形态学改变。应用免疫组化方法及微机图像处理系统,对视网膜组织细胞间粘附分子１（ Ｉ Ｃ Ａ Ｍ１） 及整合素族 Ｃ Ｄ６１ 的分布与含量进行动态观察与分析;应用流式细胞术测定循环血中粒细胞表面β２ 整合素族 Ｃ Ｄ１１ａ 、 Ｃ Ｄ１１ｂ 的表达。结果　病变３ 月组已有 Ｉ Ｃ Ａ Ｍ１ 及 Ｃ Ｄ６１ 的表达明显增加,并随病程延长表达进一步增多,而在正常对照组未见明显表达（ Ｐ＜ ０ ．０１） 。糖尿病大鼠粒细胞表面抗原 Ｃ Ｄ１１ａ 、 Ｃ Ｄ１１ｂ 阳性细胞群体所占的比例较对照组显著升高（ Ｐ＜ ０ ．００１） 。视网膜毛细血管基底膜厚度与 Ｉ Ｃ Ａ Ｍ１ 、 Ｃ Ｄ６１ 表达灰度值呈显著正相关（ ｒ ＝ ０ ．７７２ ,０ ．６９４ , Ｐ＜ ０ ．０５） 。结论　粘附分子与其配基过度表达,加重内皮细胞损伤及微血管栓塞,很可能是导致 Ｄ Ｒ 发生中进展性微血管病变的重要因素之一。     

Management of diabetic ketoacidosis in a teaching hospital

Abstract The aim of our study was to evaluate clinical management of diabetic ketoacidosis (DKA) in a teaching hospital. We followed all the patients hospitalised for DKA over six years (1995–2000), and we recorded clinical data, laboratory finding at entrance and clinical management. We compared the data to the standards set in guidelines. Our study showed an important delay of initiation of intravenous fluid (70% of cases), an under-replacement with intravenous fluid (69% of cases) and with potassium therapy (80% of cases), and an excessive use of alkali therapy. In conclusion, suboptimal management of DKA occurred in a large percentage of patients.     

加巴喷丁治疗糖尿病性神经痛的研究进展

糖尿病性神经痛是神经病理性疼痛的一个主要类型,患病人数多,治疗困难.加巴喷丁是一种新型的抗癫痫药物,目前被广泛应用十治疗糖尿病性神经痛,其镇痛机制尚未完全明确,对电压门控钙通道α2δ-1亚单位的调节作用可能是其主要作用机制.加巴喷丁治疗糖尿病神经性疼痛效果明确,不良反应轻微,是治疗糖尿病性神经痛较为理想的药物.     

Clinical predictive factors in diabetic kidney disease progression

Diabetic kidney disease (DKD) represents a major component of the health burden associated with type 1 and type 2 diabetes. Recent advances have produced an explosion of ‘novel’ assay‐based risk markers for DKD, though clinical use remains restricted. Although many patients with progressive DKD follow a classical albuminuria‐based pathway, non‐albuminuric DKD progression is now well recognized. In general, the following clinical and biochemical characteristics have been associated with progressive DKD in both type 1 and type 2 diabetes: increased hemoglobin A1c, systolic blood pressure, albuminuria grade, early glomerular filtration rate decline, duration of diabetes, age (including pubertal onset) and serum uric acid; the presence of concomitant microvascular complications; and positive family history. The same is true in type 2 diabetes for male sex category, in patients following an albuminuric pathway to DKD, and also true for the presence of increased pulse wave velocity. The following baseline clinical characteristics have been proposed as risk factors for DKD progression, but with further research required to assess the nature of any relationship: dyslipidemia (including low‐density lipoprotein, total and high‐density lipoprotein cholesterol); elevated body mass index; smoking status; hyperfiltration; decreases in vitamin D, hemoglobin and uric acid excretion (all known consequences of advanced DKD); and patient test result visit‐to‐visit variability (hemoglobin A1c, blood pressure and high‐density lipoprotein cholesterol). The development of multifactorial ‘renal risk equations’ for type 2 diabetes has the potential to simplify the task of DKD prognostication; however, there are currently none for type 1 diabetes‐specific populations. Significant progress has been made in the prediction of DKD progression using readily available clinical data, though further work is required to elicit the role of several variables, and to consolidate data to facilitate clinical implementation.     

Photoreceptors in diabetic retinopathy

Although photoreceptors account for most of the mass and metabolic activity of the retina, their role in the pathogenesis of diabetic retinopathy has been largely overlooked. Recent studies suggest that photoreceptors might play a critical role in the diabetes‐induced degeneration of retinal capillaries, and thus can no longer be ignored. The present review summarizes diabetes‐induced alterations in photoreceptor structure and function, and provides a rationale for further study of a role of photoreceptors in the pathogenesis of the retinopathy.     

欧米诺汗印法对糖尿病周围神经病变的早期诊断意义初探

目的评估泌汗神经功能检测在诊断2型糖尿病(T2DM)患者早期周围神经病变中的价值。方法分别采用DNS评分法和欧米诺汗印法(新型诊断膏贴,Neuropad)对218例T2DM患者进行外周神经病变评估及泌汗神经功能检测,计算欧米诺汗印法、10g单纤丝、振动觉、温度觉及针刺痛觉的单项检查相对于DNS评分法对周围神经病变诊断的灵敏度和特异度。结果糖尿病周围神经病变组欧米诺汗印法变色时间为19·1±8·1min,显著高于糖尿病无神经病变组的8·3±1·8min和对照组的3·9±0·8min(P<0·01);欧米诺汗印法测得的周围神经病变发病率为61·9%略高于DNS测得的57·8%。相对于DNS评分法,欧米诺汗印法诊断周围神经病变的敏感度为92·8%,特异度为82·2%阳性预告值82·6%;单项的10g单纤丝、振动觉、足背部温度觉及痛觉测试的灵敏度分别为69·0%、33·3%、67·4%和57·1%,特异度分别为81·5%、90·2%、80·4%和84·8%。欧米诺汗印法变色时间与DNS评分呈显著正相关(r=0·46,P<0·01),优于其他4种单项检查。结论欧米诺汗印法是一种简易、有重要参考价值的检测方法,其对糖尿病患者足部泌汗功能的检测有助于糖尿病周围神经病变的早期筛查。     

Semen analyses in adolescent diabetic patients

Summary We studied the semen quality and plasma testosterone levels (T) in 32 adolescent patients with insulin-dependent diabetes mellitus and in an aged-matched control group. Semen volume, motility and morphology were significantly lower in diabetics whereas seminal fructose and glucose were significantly higher. Even though the sperm count was lower in these adolescent diabetics, the difference was not significant when compared to the control group. No difference was observed in plasma testosterone levels. Patients were divided into two groups according to the presence of retinopathy and neuropathy, and degree of metabolic control. Spermiogram parameters, seminal fructose and glucose were lower in diabetics with neuropathy. No difference was observed in spermiogram parameters between diabetic patients with or without retinopathy, but seminal fructose, and glucose were lower in the former. All spermiogram parameters, as well as seminal fructose were lower in diabetics with poor metabolic control but seminal glucose was higher. No correlation was detected between clinical parameters (age at onset and duration of diabetes mellitus and time since first ejaculation), semen parameters, plasma T, glycemia and glycosuria. In conclusion, a deterioration of the quality of human semen occurs in adolescent diabetic patients. Neuropathy and poor metabolic control seem to be important factors of this deterioration. The presence of retinopathy does not correlate with T and semen quality. Supported in part by the Human Reproduction Programme/World Health Organization.     

糖尿病并发症发病过程中的补体活化作用

补体系统是机体免疫系统的重要组成部分，膜攻击复合物C5b-9是补体系统活化后形成的终末成分。近年来的研究表明，糖尿病慢性并发症患者的局部组织中均发现C5b-9的沉积，说明补体活化可能参与了糖尿病并发症的发生发展，本文就此作一综述，以期为糖尿病及其并发症的防治提供新的思路。     

老年2型糖尿病性下肢动脉病变的腔内治疗

目的 观察并总结腔内治疗老年2型糖尿病严重下肢动脉病变的临床疗效及技术经验.方法 收集2010年2月-2012年2月55例老年2型糖尿病性下肢动脉疾病患者,采用INVATEC-DEEP长球囊,进行下肢动脉经皮穿刺血管腔内成形术（percutaneous transluminal angioplasty,PTA）治疗,观察治疗前后的临床症状、体征及踝肱指数（ankle brachial index,ABI）的改变,并进行随访.结果 55例患者共55条肢体接受了腔内治疗,技术成功率为74.5％（41/55）,无并发症发生.共随访6m,失访率为0;其中,技术成功组所有患肢血供明显增加,相应节段肢体皮温升高,足背动脉搏动增强,麻木感和痛感显著减轻,生存率为95.1％,肢体存活率97.6％;技术失败组患者生存率为78.6％,肢体存活率71.4％,随访期间ABI为（0.78±0.13）.结论 腔内治疗老年2型糖尿病性下肢动脉疾病技术成功率高,临床疗效显著,但远期效果有待进一步随访.     

老年人糖尿病足80例临床分析

目的 探讨糖尿病足的起病诱因、临床特点、治疗及预后.方法 对80例糖尿病足患者临床资料进行回顾性分析.结果 53例患者为细菌感染;存在下肢动脉严重狭窄、闭塞(狭窄率70%以上)30例,髂动脉以下完全闭塞5例,腘动脉以下完全闭塞4例;糖尿病性周围神经病变65例;有明确诱因者72例(90.0%).痊愈40例,截肢20例,未愈出院12例,病情恶化死亡8例.结论 糖尿病足发生多数有诱因,预后与下肢动脉闭塞程度呈明显相关性,与感染情况及其他基础疾病严重程度呈相关性.应积极予控制血糖、抗感染、改善下肢血供、营养神经、局部处理、支持治疗等综合治疗.     

足部震动觉检查诊断糖尿病周围神经病变的价值

目的:探讨足部震动觉检查在糖尿病周围神经病变诊断中的应用价值。方法:根据入选标准选择2型糖尿病患者120例,所有对象均进行神经电生理检查及足部震动觉检查,比较两种诊断方法的结果有无显著差异。结果:两种检测方法所得结果之间存在正关联性(Φ=0.740,P0.01)和良好的一致性(κ=0.739,P0.01)。足部震动觉检查与神经电生理诊断方法检测结果之间的差异无显著性(75%∶73.3%,P0.05)。足部震动觉检查的灵敏度为94.32%,特异度为78.13%,Youden指数为0.7245,说明该方法的诊断效率较高。结论:足部震动觉检查无创伤,简便,效果好在糖尿病周围神经病变的诊断中有很好的应用前景。     

The association between taking a course or class in self-managing diabetes with diabetic ocular complications including diabetic retinopathy: A cross-sectional study

AimsDiabetes currently affects 30.3 million people in the United States. The objective of this study was to investigate the association between taking a course in self-managing diabetes and diabetic ocular complications including diabetic retinopathy diagnosis (OC-RD).MethodsThe sample was from the 2017 CDC’s BRFSS participants. We included adults who self-reported they had diabetes. The exposure included those who took a course in how to self-manage diabetes. The outcome was those told they had OC-RD by a doctor. Unadjusted and adjusted logistic regression analysis were used to calculate the odds ratios (OR) and 95% confidence intervals (CI).ResultsThe odds of OC-RD decreased by 30% for those who did not attend a course compared to those who did (OR 0.70; 95% CI 0.60?0.80). Patients who saw a doctor showed a 50% increase in the odds of OC-RD than those who did not (OR 1.50; 95% CI 1.20–1.90). Those earning above $15,000 had a 10% decreased likelihood of OC-RD every time income level increased.ConclusionsTaking a class on self-managing diabetes was associated with an increased risk of OC-RD in the diabetic population. Future studies may analyze how education will affect diabetic complications.     

糖尿病肾病并心肌损害的危险因素分析

目的 探讨糖尿病肾病（ＤＮ）并心肌损害的危险因素。方法 比较糖尿病肾病伴或不伴心肌损害的临床特征及其心肌损害的危险因素。结果 ＤＮ伴心肌损害组病程长（Ｐ〈０．０５），空腹血糖及糖化血红蛋白高（Ｐ〈０．０１），高血压发生率高（Ｐ〈０．０１），且肾脏损害越重，死亡率越高，血ＢＵＮ水平和继发高血压与ＤＮ的心肌损害直接相关。ＤＮ与糖尿病性心肌病的发生时间无并行关系。结论 糖尿病病程长，血糖控制不佳，高血压     

139例糖尿病足溃疡患者的死亡率及伴有并发症分析

目的 研究糖尿病足溃疡患者的死亡率和相关临床危险因素.方法 对2001年1月至2006年12月在解放军306医院内分泌科住院的163例糖尿病足溃疡患者进行随访,获得其截止2009年12月的生存状态及死亡时间.采用Kaplan-Meier生存曲线计算死亡率,并采用Cox风险比例模型判断死亡的预测因素.结果 163例患者中我们获得了139例患者(85.3%)截止2009年12月31日的随访资料,平均随访时间为(3.71±1.80)年.总共死亡55例(39.6%),其中男性39例,女性16例.5年死亡率为45.8%,平均生存时间为5.38年(95%CI 4.87～5.89),生存时间中位数6.83年.年龄、吸烟、高血压、冠状动脉疾病以及糖尿病肾病是死亡的独立预测因素.结论 足溃疡明显增加糖尿病患者的死亡率,而高龄、吸烟、合并高血压、冠心病、糖尿病肾病可以预测死亡.

Abstract：

Objective To determine the mortality and associated risk factors in the patients with diabetic foot ulcers. Methods One hundred and sixty-three patients with diabetic foot ulcers hospitalized from January 2001 to December 2006 were followed up until December 2009. Mortality rates were derived from Kaplan-Meier survival curves. The prognostic factors were evaluated with Cox proportional hazard model. Results Follow-up was successful in 139 out of 163 patients, with a mean follow-up period of(3.71 + 1. 80)years. 55 patients(39 males and 16 females)died during the follow-up. The 5-year mortality was 45.8% and mean survival time was 5.38 years(95% CI 4.87-5.89). The median survival time was 6.83 years. Age, smoking, hypertension, coronary artery disease, and diabetic nephropathy were found to be independent prognostic factors for mortality. Conclusions Diabetic foot ulcers increased the mortality of diabetic patients. Age, smoking, hypertension, coronary artery disease, and diabetic nephropathy were predictive risk factors for mortality.     

炎性反应与糖尿病肾病

传统观点认为,代谢异常及血流动力学障碍是糖尿病肾病的主要原因.近来研究认为,天然免疫介导的慢性、低水平炎性反应在糖尿病肾病的发生及发展中起核心作用.细胞黏附分子、生长因子、趋化因子和促炎细胞因子在糖尿病患者肾组织的表达增多,且血清和尿中的细胞因子和黏附分子的水平与白蛋白尿相关.研究发现一些抗炎药物在糖尿病动物模型中有肾保护作用.因此深入了解糖尿病肾病的发病机制,并转化到临床开发相应的治疗策略,将可延缓甚至阻止糖尿病肾病的发生和发展.     

血栓调节蛋白在糖尿病微血管病变中的变化

目的探讨血浆血栓调节蛋白（ＴＭ）在糖尿病性肾病患者中的变化以了解其在微血管病变发病中的意义。方法检测５８例２型糖尿病患者血浆ＴＭ与内皮素（ＥＴ）的水平,并与３０例正常人进行比较。结果（１）糖尿病组血浆ＴＭ水平明显高于正常对照组（Ｐ＜０．００１）,其中临床糖尿病肾病组血浆ＴＭ水平明显高于早期糖尿病肾病组（Ｐ＜０．００１）及尿白蛋白正常的糖尿病组（Ｐ＜０．０１）;（２）血浆ＴＭ水平与尿白蛋白排泄率、ＥＴ水平呈显著正相关（ｒ＝０．５３９０和０．５６５０,Ｐ均＜０．００５）。结论血浆ＴＭ水平测定对２型糖尿病性肾病的早期诊断和病情分析有重要的临床价值。     

Recent advances in the management of diabetic distal symmetrical polyneuropathy

There is now little doubt that poor blood glucose control is an important risk factor for the development of diabetic peripheral neuropathy (DPN). Furthermore, traditional cardiovascular risk factors for macrovascular disease appear to be associated with an increased risk of DPN. The recently established International Expert Group on Diabetic Neuropathy has recommended new criteria for the diagnosis of DPN in the context of clinical and research settings. Studies in experimental diabetes examining the pathogenesis of DPN have identified a number of metabolic abnormalities including polyol pathway hyperactivity, increased advanced glycation end‐point formation, alterations in the protein kinase C beta pathway through diacylglycerol and oxidative stress. There is now strong evidence implicating nerve ischemia as the cause of DPN. Studies in human and animal models have shown reduced nerve perfusion and endoneurial hypoxia. These endoneurial microvascular changes strongly correlate with clinical severity and the degree of nerve‐fiber pathology. Unfortunately, many compounds that have been effective in animal models of neuropathy have not been successful in human diabetic neuropathy. The only compounds found to be efficacious in human diabetic neuropathy, and are in clinical use, are the anti‐oxidant, α‐lipoic acid and the aldose reductase inhibitor, epalrestat. Overall, the evidence emphasizes the importance of vascular dysfunction, driven by metabolic change, in the etiology of DPN, and highlights potential therapeutic approaches. Epidemiological data on diabetic painful neuropathic pain (DPNP) are limited. In one population‐based study, the prevalence of DPNP, as assessed by a structured questionnaire and examination, was estimated at 16%. It was notable that, of these patients, 12.5% had never reported symptoms to their doctor and 39% had never received treatment for their pain. Thus, despite being common, DPNP continues to be underdiagnosed and undertreated. Pharmacological treatment of DPNP include tricyclic compounds, serotonin noradrenalin reuptake inhibitors, the anti‐oxidant α‐lipoic acid, anticonvulsants, opiates, membrane stabilizers, topical capsaicin and so on. Management of the patient with DPNP must be tailored to individual requirements and will depend on the presence of other comorbidities. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00083.x)