胰高血糖素与2型糖尿病病人胰岛素抵抗关系研究

目的　探讨胰高血糖素 (Glu)与 2型糖尿病 (DM)病人胰岛素抵抗 (IR)的关系。方法　对 1 0 0例 2型DM病人分别检测空腹及 75g葡萄糖粉负荷 2h血糖 (BG)、胰岛素 (Ins)、C肽、Glu。并以空腹血糖 /空腹胰岛素 (G/I) <6作为IR指标。将G/I<6 ,G/I≥ 6两组的Glu进行统计学的比较。结果　G/I <6组较G/I≥ 6组Glu空腹及糖负荷后均明显升高 (P <0 0 5 ,P <0 0 1 )。结论　Glu可能参与了 2型糖尿病IR的形成     

胰高血糖素在2型糖尿病发展中的作用探讨

本研究通过检测不同程度的2型糖尿病(T2DM)患者血胰高血糖素水平,旨在探讨胰高血糖素在2型糖尿病发展的不同阶段所起的作用。1对象与方法1·1研究对象:健康对照组15名,选取体检中心健康体检者;其中男性8名,女性7名,年龄35~68岁,平均(51±12)岁。其空腹血糖、尿常规、肝功能、肾     

2型糖尿病患者胰高血糖素水平检测的临床意义

目的探讨2型糖尿病患者空腹及馒头餐后血浆中胰高血糖素水平变化及意义。方法采用放射免疫法对140例2型糖尿病患者进行空腹及馒头餐后血浆胰高血糖素、血清胰岛素水平进行检测,并对二者不同时相结果进行比较。结果糖尿病患者空腹及餐后各时相胰高血糖素偏高比例均明显高于胰岛素水平低下患者比例（P〈0.05）。糖尿病患者空腹及餐后各时相胰高血糖素偏高者百分比与胰岛素水平低下者百分比分别为：空腹胰高血糖素为60%,（150±33）pg/ml,P〈0.01,胰岛素为4.29%,（4.4±0.8）mIU/L,P〈0.01;餐后1h胰高血糖素为91.86%,（154±37）pg/ml,P〈0.01,胰岛素为72.86%,（20.2±5.9）mIU/L,P〈0.01;餐后2h胰高血糖素为91.43%,（144±31）pg/ml,P〈0.01,胰岛素为38.57%,（15.1±3.4）mIU/L,P〈0.01;餐后3h胰高血糖素为71.43%,（141±30）pg/ml,P〈0.01,胰岛素2.86%,（4.1±0.74）mIU/L,P〈0.01。结论胰高血糖素异常升高是导致2型糖尿病患者血糖偏高的重要因素,检测胰高血糖素水平有助于临床准确判断糖尿病患者病情。     

沙格列汀对老年2型糖尿病患者胰高血糖素分泌功能的影响

目的 分析沙格列汀对老年2型糖尿病患者胰高血糖素分泌功能的影响.方法 选取就诊于我院门诊的2型糖尿病患者(T2DM)患者76例,在原有降糖方案基础上加用沙格列汀治疗,分析其对胰高血糖素分泌功能的影响.结果 治疗12周后,与治疗前对比,空腹、餐后30、60 min胰高血糖素下降明显,差异有统计学意义(P＜0.05);空腹...     

胰岛素对2型糖尿病患者胰岛A细胞分泌功能的影响

目的探讨胰岛素对2型糖尿病患者胰岛A细胞的分泌功能的影响。方法 2型糖尿病患者44例、健康体检者15例,其中44例糖尿病患者按治疗前空腹C肽水平分成低水平C肽组(D1)、中等水平C肽组(D2)、高水平C肽组(D3)。测定受试者晨间空腹血糖、胰岛素、C肽、胰高血糖素。糖尿病各组给予预混人胰岛素诺和灵30R替代治疗,根据血糖水平调节胰岛素用量,使用4周后停药24h后复查上述指标,观察治疗前后各指标的变化。结果①胰岛素治疗前糖尿病各组胰高血糖素水平均显著高于正常对照组(P<0.05)。②经胰岛素治疗4周后,糖尿病各组血浆胰高血糖素水平均下降,其中D1、D2组下降明显(P<0.05),而D3组下降不显著(P>0.05)。③治疗后糖尿病组3组间的胰高血糖素值差异不明显(P>0.05)。④糖尿病各组的治疗后的胰高血糖素值与对照组差异不显著(P均>0.05)。结论①外源性胰岛素的治疗可改善A细胞的分泌异常,部分纠正高胰高血糖素血症。②胰岛素治疗的尽早使用有利A细胞分泌异常的恢复。     

初诊2型糖尿病患者胰高血糖素水平的变化及临床意义

目的探讨初诊断2型糖尿病胰高血糖素水平的变化和其与胰岛素抵抗的关系。方法98例初诊断2型糖尿病患者和20例血糖正常的健康人,分别为糖尿病组和正常对照组,两组患者均行标准馒头餐试验,分别测定餐前0min和餐后30、60、120rain时点的血糖、胰岛素和胰高血糖素水平。结果（1）糖尿病组餐前0rain和餐后30、60、120rain的胰高血糖素水平与正常对照组对应的各时点比较,均显著增高,两组间差异有统计学意义。（2）糖尿病组餐后各时点胰高血糖素水平与胰岛素抵抗指数HOMA-IR相关。结论胰高血糖素分泌紊乱是2型糖尿病患者发生高血糖的重要因素,胰岛α细胞存在胰岛素抵抗。     

2型糖尿病患者胰高血糖素和胰岛功能对血浆Ghrelin的影响

目的：探讨胰高血糖素对2型糖尿病（T2DM）患者Ghrelin分泌的作用及T2DM病理状态对外周Ghrelin水平及其调节的影响。方法：选择T2DM患者38例、正常健康人（NC）30例进行胰高血糖素-C肽释放试验。同步取血测定血浆Ghrelin、血糖及C肽。结果：两组空腹C肽和Ghrelin水平差异无统计学意义（P=0.553,P=0.154）,但T2DM组6minC肽水平显著低于NC组（P〈0.001）,6minGhrelin水平高于NC组（P=0.002）;静注胰高血糖素后两组血糖、C肽均明显升高,差异有统计学意义（P〈0.001）,NC组Ghrelin则呈显著性下降（P〈0.001）,T2DM组Ghrelin前后对比无统计学差异（P=0.449）;腹围与空腹血浆Ghrelin水平（R=-0.343,P=0.004）呈负相关,是其独立预测因子。结论：外源性胰高血糖素使T2DM患者Ghrelin水平下降作用减弱,它对Ghrelin调节的改变可能一定程度上参与T2DM的病理生理发展。     

胰高血糖素与2型糖尿病及糖调节异常相关性的研究

目的研究胰高血糖素(GC)与2型糖尿病(T2DM)及糖调节异常(IGR)的相关性。方法 T2DM组(45例)、IGR组(28例)、对照组(30例)三组对象皆采取空腹糖尿量试验(OGTT)与左旋精氨酸试验(L-ArG)检测,对比分析三组检测结果。结果 T2DM组患者与IGR组患者在FBG、F、GC上与对照组有显著性差异(P<0.05);T2MD组患者FFA明显高于IGR组与对照组(P<0.05);T2DM组患者F明显低于对照组与IGR组(P<0.05)。结论 2型糖尿病与糖调节异常患者其血糖水平、胰高血糖素及游离脂肪酸水平皆明显高于正常人群,可见胰高血糖素与2型糖尿病及糖调节异常有着一定的相关性。     

治疗2型糖尿病的新颖化合物胰高血糖素样肽—1衍生物：NN2211在临床上的发展

胰高血糖素样肽-1（GLP-1）可促进胰岛素释放，降低血浆中的胰高血糖素水平，降低胃排空的速率，促进饱食感并刺激胰岛的生物合成和β细胞的增殖，因此，基于GLP-1的药物可用于2型糖尿病的治疗，在GLP-1任何C端用脂肪酸进行衍生，提高了与血浆蛋白的结合，从而提高基于GLP-1药物的作用时间，通过试验表明，多个化合物都具有较强的活性，并从中得到了活性最强的化合物NN2211，广泛的动物模型试验证明了NN2211具有降血糖和减轻体重的作用。同时还可增加或维持β细胞质量，NN2211在人体内降低血糖的长期作用正在进行Ⅱ期临床试验。     

基于胰高血糖素样肽-1药物在2型糖尿病治疗中的地位

<正>2型糖尿病(T2DM)是严重威胁人类健康的慢性疾病之一,其患病率在全球呈现快速增长的态势。我国T2DM的诊治现状是,大约1/3的T2DM患者得到诊断,诊断患者中只有1/3进行治疗,治疗的患者中仅有1/3能够达标。因此,我国糖尿病的防治面临巨大的挑战。胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)研究是近年来糖尿病新药研发领域的热点方向之一,基于GLP-1药物包括GLP-1受体激动剂和二肽基肽酶-4(dipeptidyl     

Reductions in individual work productivity associated with type 2 diabetes mellitus

BACKGROUND: Chronic diseases and their treatments may cause symptoms that impair performance but are too mild to affect outcome measures such as absences and workforce exit. OBJECTIVE: To assess the effect of type 2 diabetes mellitus on individuals' productivity when working, absences from work and the value of any lost work time. METHODS: Subjects were identified from claims data and enrolled over the phone. A telephone survey was used to elicit information about productivity at work, absences, diabetes history, comorbidities, job characteristics, employment history, demographics and healthcare utilisation. The sample consisted of 472 employed residents of New York state, USA, of whom, 445 worked at one major US corporation. Of the 472 participants, 78 had type 2 diabetes. All participants agreed to release their claims data for this study; participants with diabetes also consented to the release of clinical records. All data were linked at the individual level. Tobit regression was used to model work efficiency losses, the total productivity time lost and the value of that time. Absences were modelled using Poisson regression. Productivity was measured using absences from work and work efficiency. Work efficiency was assessed using the Osterhaus model. MAIN OUTCOME MEASURES AND RESULTS: Using the Osterhaus model of work productivity, type 2 diabetes was associated with a reduction in productivity at work. These productivity losses increased with the length of exposure to diabetes. Surprisingly, higher productivity losses among employees with diabetes did not translate into significantly higher productivity costs because the group with diabetes earned less. This likely reflects the prevalence of diabetes in populations. Among salaried people, very few reported working extra hours to make up for reduced productivity. Self-report biases may have been a factor in this finding. Type 2 diabetes was not associated with more frequent absences. Other factors that have strong effects on work efficiency are depression and colds, and job satisfaction. CONCLUSIONS: People with type 2 diabetes appear to experience incremental decrements in work performance that may affect their current and future health and performance. Lower incomes of participants with diabetes suggest that both people with diabetes and their employers bear the cost of any work efficiency losses.     

Bodyweight changes associated with antihyperglycaemic agents in type 2 diabetes mellitus.

The majority of patients with type 2 diabetes mellitus are overweight or obese at the time of diagnosis, and obesity is a recognised risk factor for type 2 diabetes and coronary heart disease (CHD). Conversely, weight loss has been shown to improve glycaemic control in patients with type 2 diabetes, as well as to lower the risk of CHD. The traditional pharmacotherapies for type 2 diabetes can further increase weight and this may undermine the benefits of improved glycaemic control. Furthermore, patients' desire to avoid weight gain may jeopardise compliance with treatment, thereby limiting treatment success and indirectly increasing the risk of long-term complications. This review evaluates the influences of established and emerging therapies on bodyweight in type 2 diabetes.Improvement in glycaemic control with insulin secretagogues has been associated with weight gain. On the other hand, biguanides such as metformin have been consistently shown to have a beneficial effect on weight; metformin appears to modestly reduce weight when used as a monotherapy. alpha-Glucosidase inhibitors are considered weight neutral; in fact, the results of some studies show that they cause reductions in weight.Thiazolidinediones (TZDs) are typically associated with weight gain and increased risk of oedema, while the impact of some TZDs, such as pioglitazone, on lipid homeostasis could be beneficial. Insulin, the most effective therapy when oral agents are ineffective, has always been linked to significant weight gain. Newly developed insulin analogues can lower the risk of hypoglycaemia compared with human insulin, but most have no advantage in terms of weight gain. The basal analogue insulin detemir, however, has been demonstrated to cause weight gain to a lesser extent than human insulin. The emerging treatments, such as glucagon-like peptide-1 agonists and the amylin analogue, pramlintide, seem able to decrease weight in patients with type 2 diabetes, whereas dipeptidyl peptidase-4 inhibitors seem to be weight neutral.In summary, while reduction of hyperglycaemia remains the foremost goal in the treatment of patients with type 2 diabetes, the avoidance of weight gain may be a clinically important secondary goal. This is already possible with careful selection of available therapies, while several emerging therapies promise to further extend the options available.     

The treatment of type 1 diabetes mellitus with agents approved for type 2 diabetes mellitus

Introduction: The management of type 1 diabetes remains a challenge for clinicians. Current practice is to administer insulin analogues to best mimic normal physiological insulin profiles. However, despite our best efforts the majority of individuals with type 1 diabetes continue to suffer from suboptimal glucose control, significant hypoglycemia and microvascular tissue complications of the disease. There is thus a significant unmet need in the treatment of T1DM to obtain better glycemic control.

Areas covered: We discuss the use of α-glucosidase inhibitors, dipeptidyl-peptidase inhibitors, glucagon-like peptide 1 agonists, biguanides, thiazolidinediones and sodium glucose co-transporter 2 inhibitors in individuals with T1DM.

Expert opinion: Non-insulin therapies present a unique and exciting adjunctive treatment for individuals with type 1 diabetes. Although data are scarce, the classes of medications discussed help to lower glucose, decrease glycemic excursions and in some cases improve body weight, along with allowing dose reductions in total daily insulin. Glucagon-like peptide 1 agonists and sodium glucose co-transporter 2 inhibitors, in particular, have been demonstrated to provide clinical improvements in individuals with T1DM and we feel their use can be explored in obese, insulin-resistant patients with T1DM, those with frequent and significant glycemic excursions or individuals with persistently elevated hemoglobin A1c.     

2型糖尿病及糖尿病肾病患者C反应蛋白水平观察

目的观察C反应蛋白水平在2型糖尿病及糖尿病肾病患者时的浓度变化。方法将63例2型糖尿病患者分为糖尿病组(32例)和糖尿病合并肾病组(31例),而以正常体检健康人作为对照组(31例),测定各组的空腹血糖(FPG)、餐后2h血糖(2hPG)、糖化血红蛋白(HbA1c)、血清C反应蛋白(CRP),将组间的C反应蛋白(CRP)进行统计学比较。结果糖尿病组及糖尿病并发肾病组血清C反应蛋白(CRP)均比正常对照组明显升高(P<0.01)。而糖尿病并发肾病组与糖尿病组相比亦明显升高(P<0.01)。结论CRP与糖尿病及其血管慢性并发症有关。     

2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的危险因素研究

目的探讨2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的危险因素。方法纳入112例2型糖尿病合并脑梗死患者,根据血小板聚集率将患者分为试验组(氯吡格雷抵抗组,25例)和对照组(氯吡格雷非抵抗组,87例)。2组患者持续口服硫酸氢氯吡格雷75 mg至少7 d,详细记录患者基本资料并进行美国国立卫生研究院卒中量表(NIHSS)评分和Alberta卒中项目早期电子计算机断层扫描(ASPECT)评分,用腺苷二磷酸(ADP)诱导光比浊法测定血小板聚集功能,并分析其相关性。结果试验组和对照组NIHSS评分分别为(3.91±4.95),(2.40±2.09)分,ASPECT评分分别为(11.57±6.05),(13.40±1.29)分,差异均有统计学意义(均P<0.05)。结论脑梗死严重程度及脑梗死面积是2型糖尿病合并脑梗死患者发生氯吡格雷抵抗的风险因素,脑梗死程度越严重、梗死面积越大在使用氯吡格雷进行二级预防时,对氯吡格雷抗血小板疗效的敏感性较低,需及时调整方案。     

胰岛素与2型糖尿病

英国前瞻性糖尿病研究（UKPDS）资料证实，在2型糖尿病（T2DM）的自然病程中，无论采取何种治疗措施，胰岛B细胞功能都进行性下降，意味着大多数T2DM患者最终需要胰岛素治疗。     

The role of galanin in metabolic disorders leading to type 2 diabetes mellitus

A large number of neurotransmitters have been identified that influence food intake when administered directly into the central nervous system of experimental animals. In some cases, there is evidence that endogenous release is stimulated by the presence of food in the gastrointestinal tract and that blockage of the signal results in an increase in meal size, indicating that these signals are likely to represent true satiety signals. Galanin, a 29-amino acid peptide originally isolated from porcine intestine, is widely distributed in the central and peripheral nervous systems and the endocrine system. While the precise physiological role of galanin in the daily pattern of feeding behavior still remains to be fully elucidated, there may be a correlation between galanin and metabolic disorders leading to type 2 diabetes mellitus.     

Lixisenatide for type 2 diabetes mellitus

INTRODUCTION: Type 2 diabetes mellitus (T2DM) is an increasing health problem worldwide. Glucagon-like peptide-1 (GLP-1) receptor agonists are an expanding drug class that target several of the pathophysiological traits of T2DM. Lixisenatide is a GLP-1 receptor agonist in development for once-daily treatment of T2DM. AREAS COVERED: Pharmacological, preclinical and clinical evidence demonstrating the applicability of lixisenatide for the treatment of T2DM are reviewed. Available data and pending clinical development are summarized, critically appraised and compared to competitor drugs. The most relevant papers and meeting abstracts published up to November 2010 are used as sources for this review. EXPERT OPINION: Efficacy and safety in T2DM are demonstrated with lixisenatide in monotherapy and in combination with metformin. However, limited data with the intended once-daily 20 μg subcutaneous dosing necessitate further evaluation of lixisenatide as add-on to various antidiabetic treatments. It remains to be established whether the slightly differing chemical properties compared to other GLP-1 receptor agonists including a rather short duration of action will be a disadvantage or maybe even an advantage, for example, when combined with long-acting insulin.