2型糖尿病住院患者糖尿病肾脏疾病的发生率及危险因素分析

目的：分析2型糖尿病住院患者的糖尿病肾脏疾病（DKD）的发生率及危险因素,为临床糖尿病肾脏疾病的防治工作提供理论依据。方法：对2008年1月～2010年8月在上海交通大学附属第六人民医院内分泌代谢科住院的2型糖尿病患者测定血糖、肾功能、血脂谱、24h尿白蛋白等。应用简化肾脏病膳食改良试验（MDRD）公式计算肾小球滤过率（GFRMDRD）。所有患者均由眼科医生进行眼底摄片。按2007年美国肾脏病基金会（NKF）的糖尿病和慢性肾脏疾病的临床诊断治疗指南,将研究人群分为正常组（NCKD）、非糖尿病性肾脏疾病（NDRD）组及DKD组。结果：（1）共入选患者2225例,男1184例,女1041例;平均年龄为（60.5±11.7）岁。本研究人群中,DKD的发生率为15.4%,NDRD的发生率为18.5%。（2）DKD组患者的年龄、糖尿病病程、收缩压、血肌酐、总胆固醇（TC）、低密度胆固醇水平（LDL-C）、24h尿白蛋白量均显著高于NDRD组（P〈0.05）。（3）Logistic回归分析显示：糖尿病病程（OR=1.077,95%CI为1.059～1.096,P〈0.01）、收缩压（OR=1.039,95%CI为1.032～1.047,P〈0.01）、糖化血红蛋白（OR=1.092,95%CI为1.032～1.156,P〈0.01）、TC（OR=1.171,95%CI为1.050～1.306,P〈0.01）、HDL-C（OR=0.558,95%CI为0.369～0.844,P〈0.01）是DKD发生的独立危险因素。结论：为有效地延缓2型糖尿病肾脏病变的发生及发展,临床工作中要严格控制血压、血糖、血脂。     

Long-Term Results of Nail Brace Application in Diabetic Patients with Ingrown Nails

BACKGROUND Ingrown toe nail is a common foot problem; however, there are limited data concerning the treatment options for diabetic patients.
OBJECTIVE Because of the special attention given to avoidance of infection and ulceration of the foot in diabetics, we applied a new, simple nail device as a treatment option without any systemic treatment or surgical intervention.
METHODS AND MATERIALS We applied braces to 21 diabetic patients with ingrown toe nails. All had severe pain, erythema, and edema without suppuration or granulation tissue formation. Braces were applied until all the symptoms are cleared. We followed the patients for 2 years for the recurrence of symptoms and signs.
RESULTS All patients had immediate relief of symptoms once the brace was applied. After the dislocation of braces, 15 of 21 patients did not have any recurrences for 2 years. Six patients had recurrence of pain and ingrown nail and were willing to use the brace once more instead of having any operations.
CONCLUSION Nail brace application is a safe, simple, and inexpensive treatment option for diabetic patients with ingrown toe nails. Although there may be recurrences, patients are willing to use it for a second time as it is simple and pain free.     

Prevention and Treatment of Ulcerations of the Foot in Unilaterally Amputated Diabetic Patients

In unilaterally amputated diabetic patients the prognosis for the remaining leg is poor. Often the patients suffer from diabetic neuropathy, angiopathy and/or arteriosclerosis. Furthermore, the load pattern of the remaining foot is frequently abnormal. In order to assess the extent of the problem, as well as the possibility of preventive care, 20 patients in the outpatient clinic of the Steno Memorial Hospital were followed for a period of 17 months.

Eighteen patients showed signs of peripheral neuropathy and 19 an abnormal load pattern. Following preliminary assessment the dynamic load pattern of the ambulant patients was recorded and their shoes were fitted with a corrective insole made of Rubazote®. In the presence of ulcerations the insoles were continuously modified according to the diminishing size of the ulcer. Supplementary local dressing and systemic antibiotics were administered according to need.

Initially 11 patients had pedal ulcerations, 5 ischemic and 6 neuropathic. All of the neuropathic ulcerations healed during the period of observation and no new ulcerations were seen. Two of the ischemic ulcerations healed whereas the remaining 3 persisted. It is concluded that regulation of the pedal load pattern in unilaterally amputated diabetic patients has a considerable curative and preventive effect.     

Winograd Method Versus Winograd Method With Electrocoagulation in the Treatment of Ingrown Toenails

An important component of the Winograd surgical method for an ingrown toenail is total excision of the associated germinal matrix. However, this might not always be accomplished with the procedure. We hypothesized that the surgical results might be improved by adding electrocoagulation of the germinal matrix to the Winograd method. The objective of the present study was to compare the recurrence, satisfaction, and complication rates of the Winograd method with those of the Winograd method with electrocoagulation. We retrospectively evaluated the records of 102 patients with single Heifetz stage 2 or 3 ingrown toenails who had undergone surgery from January 2013 to October 2014 using 1 of these 2 methods. Of the 102 patients, 50 (49%) underwent the Winograd method and 52 (51%) underwent the Winograd method with electrocoagulation. The mean follow-up period of our patients was 12 (range 6 to 22) months. An ingrown toenail recurred in 3 patients (6%) in the Winograd group and in no patient in the Winograd with electrocoagulation group (p = .04). Among the patients in the Winograd group, 46 (92.0%) were satisfied or very satisfied. Among the patients in the Winograd plus electrocoagulation group, 49 (94.2%) were satisfied or very satisfied (p = .04). No complications developed in either group. In conclusion, the Winograd method for ingrown toenails results in high satisfaction rates, low recurrence rates, and low complication rates. The addition of electrocoagulation of the germinal matrix to the Winograd method could result in even lower recurrence rates, while maintaining high patient satisfaction and without increasing the risk of complications.     

Ⅱ型糖尿病患者勃起功能障碍的相关因素分析

目的：了解Ⅱ型糖尿病（T2DM）患者勃起功能障碍（ED）的发生情况,分析相关危险因素。方法：对75例T2DM已婚男性患者,根据国际勃起功能指数表（IIEF-5）以无记名问卷形式自我评分诊断有无ED,并分为两组,对比分析ED与临床一般情况和各生化指标的相关性。结果：T2DM患者ED发病率为62．7％,ED组的HbAlc、TC及LDL—C水平均高于非ED组,且ED组中吸烟者、饮酒者及并发高血压者所占比例明显高于非ED组。结论：T2DM患者中多种危险因素的并发增加了ED发生的概率,戒烟酒、健康饮食及控制血糖、血压、血脂等能有效预防T2DM患者ED的发生。     

影响初发2型糖尿病患者IIEF-5评分的相关因素分析

目的:探讨影响初发2型糖尿病(T2DM)患者国际勃起功能指数-5(IIEF-5)评分的相关因素。方法:调查149例初发T2DM患者的IIEF-5评分与年龄、体重指数(BM I)、空腹血糖(FPG)、口服葡萄糖耐量实验(OGTT)中2 h血糖(2hPG)、空腹血胰岛素(INS)、空腹C肽、糖化血红蛋白(GHbA1c)、血清睾酮(T)、雌二醇(E2)、T/E2、血清一氧化氮(NO)、红细胞醛糖还原酶(AR)、吸烟、酗酒、伴发疾病(包括高血压、高脂血症、高尿酸血症、心脏疾病、肝脏疾病等)、其他慢性并发症(糖尿病神经病变、糖尿病视网膜病变、糖尿病肾病等)、药物使用(包括β受体阻滞剂、钙通道阻滞剂、血管紧张素转换酶抑制剂及利尿剂等可影响阴茎勃起功能的药物)的关系。结果:吸烟组、患有并发症组、伴发疾病组、应用药物治疗组IIEF-5评分明显低于对照组(P<0.05),饮酒组与不饮酒组的IIEF-5评分比较差异无显著性(P>0.05)。年龄、BM I、FPG、2hFPG、INS、GHBA1C、AR与IIEF-5评分具有显著性负相关关系(P<0.05);NO与IIEF-5评分具有显著性正相关关系(P<0.05),T、E2、T/E2与IIEF-5评分无相关关系(P>0.05)。结论:多种因素影响初发T2DM患者的IIEF-5评分。     

糖尿病下肢深静脉血栓形成的相关因素分析及护理对策

目的探讨糖尿病（DM）下肢深静脉血栓形成（DVT）的相关因素并制订临床护理措施。方法对58例DM行双下肢^99mTc-MAA深静脉显像（和／或超声检查）,同期获取空腹血糖、血胆固醇、血三酰甘油等实验室资料及年龄、病程、下肢症状（肿胀、静脉曲张和DM足）等临床资料,分析各因素与DVT发生的关系。结果28例（48．3％）DM并发DVT;年龄、病程、血糖、血胆固醇、血三酰甘油、下肢症状与下肢DVT发病率有关（P〈0．05．P〈0．01）;血压、体重指数、糖尿病类型与DVT发病率关系不大（均P〉0．05）。结论高龄、长病程、高血糖、高胆回醇、高三酰甘油等危险因素相互累积易致下肢DVT,应尽早采取综合治疗措施,加强护理,以减少DVT并发症的发生。     

糖尿病下肢深静脉血栓形成的相关因素分析及护理对策

目的 探讨糖尿病(DM)下肢深静脉血栓形成(DVT)的相关因素并制订临床护理措施.方法 对58例DM行双下肢99mTc-MAA深静脉显像(和/或超声检查),同期获取空腹血糖、血胆固醇,血三酰甘油等实验室资料及年龄、病程、下肢症状(肿胀、静脉曲张和DM足)等临床资料.分析各因素与DVT发生的关系.结果 28例(48.3%)DM并发DVT;年龄、病程、血糖、血胆固醇、血三酰甘油、下肢症状与下肢DVT发病率有关(P<0.05,P<0.01),血压、体重指教、糖尿病类型与DVT发病率关系不大(均P>0.05).结论 高龄、长病程、高血糖、高胆固醇、高三酰甘油等危险因素相互累积易致下肢DVT,应尽早采取综合治疗措施,加强护理,以减少DVT并发症的发生.     

Different Risk Factors and Causes for Early Death after Initiating Dialysis in Diabetic and Non-Diabetic Patients

The mortality of patients with end-stage renal disease (ESRD) is especially high after the start of dialysis therapy, especially in diabetic patients. A part of these patients die within three months after initiating renal replacement therapy (RRT). In the present retrospective study we evaluated all patients with ESRD requiring RRT who died within 3 months after initiating the first RRT. A total of 42 patients who died such early after the start of dialysis treatment during the years 1995–2001 were included in the study. Of them, 28 subjects (age 66 + 11 years) were diabetics and 14 non-diabetics (age 76 + 10 years). Indications for the start of dialysis were end-stage renal failure (creatinine clearance < 10–12 mL/min or < 12–14 mL/min in diabetic patients) or fluid lung associated with chronic renal failure (creatinine clearance < 20 mL/min). Hyperhydration with fluid lung was the most common indication for dialysis therapy in patients with diabetes (64.3% versus 14.3%, p < 0.05). The vascular risk factors blood pressure and serum-lipids were similar in both groups; however, diabetic patients were younger than non-diabetic subjects. The prevalence of vascular diseases tended to be higher in the diabetic group, but difference was not significant (see ). Severe heart failure (NYHA stage III-IV) was more common among diabetics (42.8% versus 14.3%, p < 0.05). The incidence of sepsis (17.9% versus 14.3%) did not significantly differ between the groups. The most common cause of death was cardiovascular events in both diabetic and non-diabetic patients (71.5% and 64.2%, respectively). Heart failure was a more common cause of death in diabetic patients (39.2% versus 21.4%, NS). In conclusion, early death after the initiation of dialysis treatment was more common in patients with type 2 diabetes, though, the diabetic patients were less old. In the diabetic group fluid lung was more often indication for initiating dialysis therapy than in the non-diabetic group. In both, diabetic and non-diabetic patients, the most common causes of death are cardiovascular events.     

Use of Monofilament in the Detection of Foot Lesions in Older Adults

The purpose of this study was to compare Semmes-Weinstein monofilament testing between elderly and young patients in both a diabetic and nondiabetic population. Monofilament mapping (10 g) was performed on 115 patients: 74 who were greater than 60 years of age (47 with diabetes) and 41 who were younger than 60 years (20 with diabetes). Sensations were assessed at 15 predefined pressure/risk points. Sensations were found to have perfect correlation between the same point on the left and right foot (r = 1.0) for each of the 15 points. The data for the 15 points were divided in 2 subsets: one for 8 points similar to a validated method and another with 7 new points on the dorsum and ankle area. Scores on both subsets differed significantly by age group (P < .0001) and diabetes status (P < .001), with older patients and patients with diabetes having higher scores. Analysis of covariance was used to estimate 15-point scores for the 4 combinations of age group and diabetes status, adjusting for foot ulceration, callus, deformity, and ischemia. In older patients without diabetes, each subset score was used to detect future neuropathy if 4 or more points were insensitive. The detections agreed in 37 of 47 cases. In all 10 cases of disagreement, the 7-point subset detected no neuropathy, suggesting that inclusion of the additional points could improve diagnostic specificity. The significant differences noted between young and old patients suggest the importance of aging-related changes, and raise questions about current scoring methods for detection of neuropathy in older adults with diabetes.     

糖尿病便秘患者整体护理干预的效果探讨

目的探讨糖尿病便秘患者的有效干预方法。方法将124例糖尿病便秘患者随机分为对照组(56例)和干预组 (68例),采用自制问卷调查表进行问卷调查,了解糖尿病便秘患者的排便次数、性状,排便习惯、方式,膳食结构及运 动情况。对照组采用常规护理方法,观察组针对患者存在的问题采用护理干预,7周为1个干预周期。结果观察组 患者接受护理干预后膳食结构、排便情况、大便性状等与对照组比较,差异有显著性意义(均P<0.01);血糖、糖化血 红蛋白等指标与对照组比较,差异有显著性意义(均P<0.01)。结论护理干预能提高糖尿病便秘患者对疾病相关知 识的认知和自我管理能力,改变不良的行为和生活习惯,降低糖尿病便秘的发生率,提高生活质量。     

Risk Factors Associated With Major Lower Extremity Amputation After Osseous Diabetic Charcot Reconstruction

Patients with diabetic Charcot neuroarthropathy (CN) are at high risk for ulcerations and major lower extremity amputations (LEAs). Osseous reconstruction is an important component in ulcer healing and prevention; however, despite such efforts, major LEAs remain a serious postreconstruction concern. The aim of this study was to identify risk factors for major LEA in patients who underwent osseous Charcot reconstruction. A retrospective review was performed on 331 patients with the diagnosis of CN in the foot and ankle treated over a 16-year period. Two hundred eighty-five patients were included after exclusion of those without diabetes. Demographic data, anatomic wound location, surgical interventions, wound healing status, and the level of eventual amputation were recorded. Multivariate logistic regression and Fisher's exact test were used for analysis. All patients had diabetes, neuropathy, or CN and required osseous reconstruction. Risk factors and their respective odds ratios (ORs) are as follows: postoperative nonunion (OR 8.5, 95% confidence interval [CI] 2.2 to 33.5, 0.0023), development of new site of CN (OR 8.2; 95% CI 1.1 to 62.9; p?=?.0440), peripheral arterial disease (OR 4.3; 95% CI 1.7 to 11.0; p?=?.0020), renal disease (OR 3.7; 95% CI 1.6 to 8.8; p?=?.0025), postoperative delayed healing (OR 2.6; 95% CI 1.1 to 6.5; p?=?.0371), postoperative osteomyelitis (OR 2.4; 95% CI 1.0 to 5.9; p?=?.0473), or elevated glycated hemoglobin (OR 1.2; 95% CI 1.0 to 1.4; p?=?.0053). Independent risk factors found to be statistically significant for major LEA in diabetic CN in the setting of osseous reconstruction must be mitigated for long-term prevention of major amputations.     

1型糖尿病患者胰岛自身抗体与肾损害的相关性

目的：探讨1型糖尿病患者胰岛自身抗体与早期肾损害的相关性。方法：将133例1型糖尿病患者按尿白蛋白排泄率分成正常白蛋白尿组（NAU）,微量白蛋白尿组（MAU）和临床蛋白尿组（CAU）,测定空腹血糖、空腹胰岛素,24h尿微量白蛋白;谷氨酸脱羧酶抗体（GADA）,胰岛素抗体（IAA）和胰岛细胞抗体（ICA）;计算胰岛素抵抗指数（Homa-IR）和胰岛素敏感指数（ISI）,分析胰岛自身抗体与早期肾损害的关系。结果：NAU组GADA,ICA和IAA的阳性率显著低于CAU组和MAU组;CAU组FINs、HOMA-IR明显高于NAU和MAU组,ISI低于NAU组和MAU,P〈0.05。UAER与HOMA-IR呈正相关,与ISI呈负相关（P〈0.05）。结论：胰岛自身抗体阳性是发生糖尿病肾病的一个危险信号,胰岛素抵抗在其发生发展的过程中起重要作用。     

糖尿病患者团队管理模式在基层医院的应用

目的 探讨糖尿病患者团队管理模式在基层医院的应用效果。方法 将32例糖尿病患者与5名医护人员共同组成糖尿病团队．对患者实施1年团队管理。结果实施团队管理后患者空腹血糖、餐后2h血糖及糖化血清蛋白较实施管理前显著降低（均P〈0．01）。结论 对糖尿病患者实施团队管理可极大地提高患者的自我管理意识和管理能力,降低血糖，延缓并发症的发生，同时亦建立了良好的医患关系。     

Insulin-Dependent Diabetic Patients are at Increased Risk of Postoperative Hyperglycemia When Undergoing Total Joint Arthroplasty

BackgroundDiabetic patients are at an increased risk of prosthetic joint infection (PJI) after total joint arthroplasty (TJA). The relationship between insulin-dependence and PJI has not been investigated. We aimed at evaluating whether insulin-dependent diabetes mellitus (IDDM) patients were more susceptible to postoperative hyperglycemia and PJI than their non–insulin-dependent diabetes mellitus (NIDDM) counterparts.MethodsA retrospective review was conducted of diabetic patients undergoing TJA (hip or knee) from January 2011 to December 2016. Preoperative hemoglobin A1c (A1c) and postoperative glucose measurements were observed. Patients were stratified as IDDM or NIDDM. The A1c values that predicted hyperglycemia >200 mg/dL for each group were calculated. Primary end point was postoperative hyperglycemia >200 mg/dL and secondary end point was PJI.ResultsThere were 773 patients meeting inclusion criteria. The IDDM cohort had a higher preoperative A1c (6.97% vs 6.28%, P < .0001) and postoperative glucose (235.2 vs 163.5, P < .0001). IDDM patients were more likely to have postoperative hyperglycemia (63.84% vs 20.83%, P < .0001; odds ratio, 5.2; 95% confidence interval, 3.66-7.4). Overall, an A1c of >7.45% predicted postoperative hyperglycemia >200 mg/mL (odds ratio, 6.94; 95% confidence interval, 4.32-11.45). When separating our 2 cohorts, an A1c of >6.59% in IDDM, and >6.60% in NIDDM, was associated with an increased risk of postoperative hyperglycemia (P < .0001). PJI was similar between the 2 cohorts (2.52% vs 2.38%, P = .9034).ConclusionIDDM patients undergoing TJA are 5.2 times more likely to have postoperative hyperglycemia >200 mg/dL than their NIDDM counterparts, although increased risk of PJI was not found in this study. Despite the higher A1c and postoperative hyperglycemia in IDDM patients, there was found to be no clinical difference between A1c cutoff values for postoperative hyperglycemia between IDDM and NIDDM patients.     

Determinants of Protection Against Diphtheria in Adult Hemodialysis Patients

Diphtheria is of great epidemiological concern. Although mainly observed during childhood, unvaccinated adults and relatively immunocompromised patients are at increased risk for acquiring diphtheria. We aimed to determine the rates and certain determinants of protection against diphtheria in adult hemodialysis (HD) patients. Protection rates of 322 HD patients were compared with 65 diabetes mellitus type 2 (DM) patients and 65 healthy controls. A questionnaire was held in regard to smoking habits and alcohol intake. Antibody levels against diphtheria were assessed by an in-house ELISA and a concentration of ≥0.1 IU/mL was regarded as protective. Effects of age, gender and time being on dialysis on protection were assessed by logistic regression. Ratios of individuals with protective antibody levels were found to be 36% (116/322), 27.7% (18/65), and 52.3% (34/65) for HD, DM, and control groups, respectively. Hemodialysis patients had a significantly (p < 0.05) lower protection rate than healthy controls. In all study groups, there was a tendency of higher protection rate with increasing age. These low ratios of protected individuals in both HD and DM patient groups are alarming, as these patients generally have defects in vaccine responses, and carriage is important in the perpetuation of diphtheria. The protection status of these patient groups might be improved with additional vaccinations.     

糖尿病病人皮肤病变相关因素分析及防护

为探讨糖尿病病人皮肤病变的相关因素 ,制定有效的防护措施 ,对 40 0例糖尿病病人皮肤病变不同年龄段、糖尿病类型及血糖值与皮肤病变及其感染发生情况进行观察 ,并作相关分析。结果皮肤病变与年龄、糖尿病类型、血糖值有极显著相关性 (P<0 .0 0 5 ) ,年龄越大 ,血糖值越高 ,皮肤病变发生率越高。制定对皮肤感染切实有效的护理方法 ,如控制血糖、做好预防感染及皮肤护理等是防止和减少糖尿病皮肤病变及感染的关键     

糖尿病患者团队管理模式在基层医院的应用

目的探讨糖尿病患者团队管理模式在基层医院的应用效果.方法将32例糖尿病患者与5名医护人员共同组成糖尿病团队,对患者实施1年团队管理.结果实施团队管理后患者空腹血糖、餐后2 h血糖及糖化血清蛋白较实施管理前显著降低(均P<0.01).结论对糖尿病患者实施团队管理可极大地提高患者的自我管理意识和管理能力,降低血糖,延缓并发症的发生,同时亦建立了良好的医患关系.     

2型糖尿病患者发生小腿肌间静脉血栓的危险因素分析

目的:探讨2型糖尿病患者发生小腿肌间静脉血栓的危险因素。方法:回顾性分析2013年6月—2019年6月于济南市中医医院内分泌科及滕州市中医医院内分泌科住院治疗的90例2型糖尿病患者的临床资料,根据发生小腿肌间静脉血栓与否分为血栓组(n=30)与对照组(n=60),对比分析两组患者的性别、年龄、体质量指数、糖尿病病程等临床资料,进行单因素分析,组间比较有显著差异的单因素,代入二元Logistic回归分析进行独立危险因素检验。结果:两组患者在年龄、体质量指数、糖尿病病程、合并糖尿病周围神经病变人数、合并活动性溃疡人数、合并冠心病人数、合并高血压人数、吸烟人数、血糖控制方案、白细胞计数、血小板计数、凝血酶原时间、活化部分促凝血酶原激酶时间、纤维蛋白原、D-二聚体、纤维蛋白原降解产物、红细胞沉降率等方面组间比较差异无统计学意义(P0.05);在性别、合并糖尿病周围血管病变人数、糖化血红蛋白水平、超敏C反应蛋白水平差异有统计学意义(P0.05)。Logistic回归显示,糖化血红蛋白高水平、超敏C反应蛋白高水平为2型糖尿病患者发生小腿肌间静脉血栓的独立危险因素。结论:糖化血红蛋白高水平、超敏C反应蛋白高水平为2型糖尿病患者发生小腿肌间静脉血栓的独立危险因素。