妊娠期糖尿病孕妇血脂水平测定

目的研究妊娠期糖尿病孕妇的血脂变化。方法选择正常孕妇4O例（对照组）,妊娠期糖尿病孕妇75例,测定空腹静脉血清胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白（HDL-C）、低密度脂蛋白（LDL-C）、载脂蛋白A（ApoA）、载脂蛋白B（ApoB）、脂蛋白a（Lp（a））水平。结果妊娠期糖尿病组与对照组相比,TC、TG、LDL-C、ApoB测定值升高（P〈0.05）,HDL-C、ApoA测定值降低（P〈0.05）,Lp（a）无统计学意义（P〉0.05）。结论血脂代谢异常可能在妊娠期糖尿病的发病中起一定作用。     

糖尿病患者高密度脂蛋白与受体结合的研究

目的和方法：对糖尿病Ⅰ组（ＨｂＡ１ｃ为７０６％±０６０％）Ⅱ组（ＨｂＡ１ｃ为１１９７％±１６５％）各７例及对照组（ＨｂＡ１ｃ为４８５％±０２０％）６例的高密度脂蛋白（ｈｉｇｈｄｅｎｓｉｔｙｌｉｐｏｐｒｏｔｅｉｎ，ＨＤＬ）糖化进行检测，同时将ＨＤＬ抗血清提纯为抗ＨＤＬＩｇＧ并用辣根过氧化物酶（ｈｏｒｓｅｒｄｉｓｈｐｅｒｉｏｘｉｄａｓｅ，ＨＲＰ）标记。用酶联免疫受体法测定ＨＤＬ与培养的人胚肺成纤维细胞（ｈｕｍａｎｌｕｎｇｆｉｂｒｏｂｌａｓｔ，ＨＬＦ）受体特异结合。结果：Ⅰ、Ⅱ组及对照组糖化值分别为３９２６±８１０、７２９４±６４０和２０４０±１１０Ｇｌｙｃｏｇｒｏｕｐ／ＨＤＬ，Ⅰ、Ⅱ组ＨＤＬ的细胞受体特异结合低于对照组（Ｐ＜００１），Ⅱ组低于Ⅰ组（Ｐ＜００１）。结论：糖尿病患者ＨＤＬ糖化高于正常人，但其与细胞受体的特异结合却下降     

Ibrolipim抗猪动脉粥样硬化的作用

目的：探讨合成化合物NO-1886(ibrolipim)调节贵州小香猪脂代谢异常及其抗动脉粥样硬化(AS)的作用机制。 方法： 贵州小香猪15头，按体重随机分为3组。分别喂普通猪饲料(CD)；高脂高蔗糖饲料(HFSD)和高脂高蔗糖饲料加1％ibrolipim。每月末采集血样，测定血脂浓度。第8个月末处死动物，用高效液相色谱(HPLC)分析血浆高密度脂蛋白中胆固醇酯的含量；苏丹Ⅳ染色观察主动脉脂纹的面积；油红O染色观察脂质在肝组织中的沉积。 结果： HFSD组血浆总胆固醇(TC)、甘油三酯(TG)和游离脂肪酸(FFA)浓度均高于对照组，主动脉可见脂纹，内膜增厚，内皮细胞损伤，内膜下有大量泡沫化细胞，肝细胞胞浆内大量脂质沉积；ibrolipim组血浆高密度脂蛋白胆固醇(HDL-C)水平高于对照组（其中胆固醇酯高于对照组,TG和FFA浓度低于对照组），肝细胞油红O染色见少量脂质沉积。 结论： Ibrolipim可能主要是通过降低血浆TG及升高HDL-C发挥其抗AS作用。     

Levels of prebeta-1 high-density lipoprotein are elevated in 3 phenotypes of dyslipidemia

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Triglycerides to High-Density Lipoprotein Cholesterol Ratio Can Predict Impaired Glucose Tolerance in Young Women with Polycystic Ovary Syndrome

PurposeThe triglycerides to high-density lipoprotein cholesterol (TG/HDL-C) ratio could be related to insulin resistance (IR). We previously reported that Korean women with polycystic ovary syndrome (PCOS) had a high prevalence of impaired glucose tolerance (IGT). We aimed to determine the cutoff value of the TG/HDL-C ratio for predicting IR and to examine whether the TG/HDL-C ratio is useful for identifying individuals at risk of IGT in young Korean women with PCOS.ResultsThe cutoff value of the TG/HDL-C ratio for predicting IR was 2.5 in women with PCOS. Among the women with PCOS who had normal fasting glucose (NFG), the prevalence of IGT was significantly higher in the women with PCOS who had a high TG/HDL-C ratio compared with those with a low TG/HDL-C ratio (15.6% vs. 5.6%, p<0.05).ConclusionThe cutoff value of the TG/HDL-C ratio for predicting IR was 2.5 in young Korean women with PCOS, and women with NFG and a high TG/HDL-C ratio had a higher prevalence of IGT. Therefore, Korean women with PCOS with a TG/HDL-C ratio >2.5 are recommended to be administered an OGTT to detect IGT even if they have NFG.     

Effects of biosynthetic human proinsulin on plasma lipids in type 2 diabetes mellitus

Summary Plasma cholesterol, triglycerides, HDL₂-cholesterol, and HDL₃-cholesterol were studied in 18 patients with Type 2 diabetes. Prior to entering the clinical trial, the study subjects were in stable control under a fixed mixture of 20% regular and 80% NPH (isophane) biosynthetic human insulin twice daily. The patients were randomized to treatment with either biosynthetic human proinsulin or biosynthetic human NPH insulin (controls) twice daily. Glucose control was kept constant in both groups throughout the study. Of the nine patients treated with proinsulin, eight exhibited a decrease of plasma triglycerides (median decrease by 0.13 mmol/l). In contrast, all nine controls showed a rise (median increase by 0.69 mmol/l) of plasma triglycerides (p<0.001). In keeping with the fall of plasma triglycerides, HDL₂-cholesterol rose in all but one proinsulin-treated patients. Both treatment modalities reduced HDL₃-cholesterol with a median decrease of 0.20 mmol/l (p<0.01) with proinsulin and 0.26 mmol/l with NPH insulin (p<0.05).We conclude that human proinsulin is able to reduce plasma triglycerides and to increase HDL₂-cholesterol in the majority of patients with Type 2 diabetes and thus appears to alter favourably risk factors for coronary heart disease.Abbreviations HDL High density lipoproteins - NPH insulin Neutral Protamine Hagedorn (isophane) insulin     

Hypolipidemic Activities of Ficus Racemosa Linn. Bark in Alloxan Induced Diabetic Rats

Ficus racemosa (Moraceae family) is used in traditional system of medicine for the treatment of several disorders including diabetes mellitus. The aim of the study was to investigate the antihyperglycemic and hypolipidemic activities of ethanolic extract of Ficus racemosa bark (FrEBet) in alloxan-induced diabetic rats. A total number of 30 animals were divided into 5 groups of six each. Diabetes mellitus was induced by single intraperitoneal injection of freshly prepared solution of alloxan monohydrate (150 mg/kg bw) dissolved in physiological saline in overnight fasted wistar rats. Dose dependent studies for FrEBet (100–500mg/kg bw) was carried out to find out the effective pharmacological dose (antidiabetic and hypolipidemic) to alloxan-induced diabetic rats. Blood glucose, plasma insulin, total cholesterol, phospholipids, triglycerides, free fatty acids, HDL cholesterol and LDL cholesterol levels in plasma, erythrocyte membranes, liver and kidney were determined by specific colorimetric methods. An increase in blood glucose was accompanied by an increase in total cholesterol, phospholipids, triglycerides, FFA and decrease in HDL choleterol in diabetic rats. Oral administration of FrEBet (300mg/kg bw) to diabetic rats restrored the status of blood glucose, lipids and lipoproteins to near normal range. Our investigation thus shows that FrEBet has potent antidiabetic and hypolipidemic effects in alloxan-induced diabetic rats and these effects were much comparable to that of the standard reference drug, glibenclamide.     

Increasing patient activation through diabetes self-management education: Outcomes of DESMOND in regional Western Australia

ObjectiveTo evaluate the effects of the Diabetes Education and Self-Management for Ongoing and Newly Diagnosed (DESMOND) program on patient activation in adults living with type 2 diabetes (T2D).Methods233 individuals attended a DESMOND program in 26 locations across regional Western Australia. Individuals completed the Patient Activation Measure (PAM) prior to and immediately after DESMOND participation.ResultsPatient Activation significantly increased by 9.7 points from pre to post DESMOND intervention (p < 0.001, z = −7.94). Of all participants who exhibited an increase in patient activation, 87% (n = 142) experienced a clinically significant (>5 point) increase. Post-DESMOND participation, an 86% reduction (from 6% −0.9%) in the proportion of participants scoring in the lowest PAM level (Level 1) was observed (p < 0.01).ConclusionDESMOND, a structured diabetes self-management education (DSME) program aimed at strengthening the role of people living with type 2 diabetes in self-managing their healthcare, significantly increased patient activation in a real-world setting.Practice implicationsIn line with international diabetes guidelines it is recommended that people living with T2D, particularly those with lower levels of activation, attend an evidence based DSME such as DESMOND to increase their capacity to effectively self-manage their condition.     

LDL-c/HDL-c对女性2型糖尿病患者颈动脉斑块形成的影响

目的:评估LDL-c/HDL-c(L/H)在女性2型糖尿病患者颈动脉斑块形成中的影响.方法:根据颈动脉彩色多普勒超声检查结果,将210例女性2型糖尿病患者,分为颈动脉斑块组100例,对照组(无颈动脉斑块)110例,收集一般临床资料以及颈动脉斑块的危险因素进行比较,采用单因素分析、logistic回归分析、绘制ROC曲线等方法评估L/H在临床中的优势.结果:两组之间入组人群年龄,病程,收缩压,HbA1c,UA,LDL-c,HDL-c及L/H差异均有统计学意义(P<0.05).两组BMI,TC,TG和舒张压比较差异无统计学意义(P>0.05);通过logistic回归分析,剔除混杂因素,年龄,HbA1c,UA,L/H的OR值分别为1.128,1.469,1.005,1.952,提示均为颈动脉斑块形成的危险因素.L/H的ROC曲线下面积(0.689)优于LDL-c(0.571),差异有统计学意义.结论:L/H在糖尿病血管病变的评估中,更加全面和准确,价值更高.     

The role of genetics and epigenetics in the pathogenesis of gestational diabetes mellitus

Diabetes mellitus (DM) is a heterogeneous group of disorders whose common trait is chronic hyperglycemia. Gestational diabetes mellitus (GDM) is one of the subtypes of DM that manifests during pregnancy. It is believed that 2%–5% of pregnancies worldwide are complicated with GDM, with the prevalence having significantly increased over the last decade. While the pathogenesis of the disease remains largely unknown, GDM is believed to be a result of interactions between genetic, epigenetic, and environmental factors. Linkage and association studies, including those that are genome-wide, have allowed us to identify complex genetic and epigenetic mechanisms that lead to the development of GDM. Multiple common variants in candidate genes such as potassium inwardly rectifying channel subfamily J, member 11 (KCNJ11), glucokinase (GCK), or hepatocyte nuclear factor 1α (HNF1A) have been found to increase the disease risk. In this review, we provide a detailed overview of the current knowledge concerning the influence of genetics and epigenetics on the development of GDM.     

糖尿病大鼠不同阶段心肌电学的改变

目的:探讨糖尿病(DM)易出现心律失常的可能机制。方法:SD雄性大鼠尾静脉注射四氧嘧啶(alloxan,50mg·kg^-1以生理盐水稀释)复制糖尿病模型,选择以年龄相匹配健康成年SD雄性大鼠尾静脉注射相同剂量的生理盐水作为对照组。分别观察2、4、6和8周4个不同时段。记录大鼠右心室乳头肌跨膜电位。结果:在糖尿病成模后第2周起,右室乳头肌动作电位时程(APD)复极化各水平均不同程度地长于正常大鼠(P<0.01),8周时较2周时更明显(P<0.05)。而去极化最大速率(V_max)超射值(OS)和动作电位幅度(APA)以及静息膜电位(RP)水平均无明显变化。结论:糖尿病大鼠右室乳头肌动作电位时程明显延长,而动作电位的过度延长可能是糖尿病易导致心律失常以及心源性猝死的主要原因,尤其是糖尿病晚期阶段。     

Deficiency of suppressor T-cells in insulin-dependent diabetes mellitus: an analysis with monoclonal antibodies

Peripheral blood from 25 patients with insulin-dependent diabetes mellitus was examined for any alteration in the proportions and or functions of immunoregulatory T-cell subsets, defined with monoclonal antibodies. Ten of 25 (40%) patients demonstrated deficiency of OKT8+ (suppressor/cytotoxic) T-cells. Eight of these 10 patients had abnormally high ratios of OKT4+/OKT8+ T-cells. Nine of 10 patients with abnormally low proportion of OKT8+ T-cells had deficient concanavalin A-induced suppressor cell activity against the proliferative response of autologous or allogeneic lymphocytes to phytohemagglutinin. No correlation was observed between the deficiency of suppressor T-cells and the control of diabetes. Therefore, it is likely that the deficiency of suppressor cells is related to insulin-dependent diabetes mellitus itself and not to the metabolic changes that are associated with diabetes mellitus. This study demonstrates both quantitative and qualitative deficiency of suppressor T-cells in at least some patients with insulin-dependent diabetes, that might play an important role in the pathogenesis and autoimmune manifestations of a proportion of patients with insulin-dependent diabetes mellitus.     

Patient-physician interpersonal processes of care at the time of diabetes treatment intensification and their links to patient outcomes

ObjectiveTo investigate how patient-physician interpersonal processes of care are related to levels of diabetes-related distress, diabetes medication-taking behavior, and HbA1c during conversations with patients about intensifying medication.MethodsWe randomly recruited 1270 patients from diabetes specialty clinics in Tehran, Iran who were taking an additional oral diabetes medication or starting insulin during the prior 3 months. This interviewer-administered cross-sectional survey assessed multiple aspects of patient-physician interpersonal processes, diabetes-related distress, and diabetes medication-taking. Clinical history and HbA1c were collected from electronic medical records. Regression estimates and Structural Equation Modeling were used to test associations.ResultsSome communication scales indicated a significant relationship with total diabetes distress (P < 0.001). Diabetes medication-taking was associated with less diabetes distress (adjusted odds ratio [aOR]=0.45, P < 0.001), lower Hurried Communication (aOR=0.72, P = 0.013), higher Elicited Concerns (aOR=1.30, P = 0.012), and higher Explained Results (aOR=1.41, P < 0.001) scores. SEM analyses showed medication-taking behavior was associated with a 0.68 decrease in HbA1c. Hurried Communication and diabetes distress were directly associated with HbA1c.ConclusionAspects of patient-physician interpersonal processes at the time of intensifying diabetes treatment may be related to experiencing less distress, effective medication-taking, and improved HbA1c.Practice implicationsThe results are intended to inform communication strategies that physicians might incorporate into practice.     

Directionality index of neural information flow as a measure of synaptic plasticity in chronic unpredictable stress rats

Type 2 diabetes and chronic heavy alcohol consumption each have been known to be associated with the impairment of hippocampus-dependent cognitive functions. Although both conditions often coexist clinically and there is accumulated evidence of a relationship between the two, the combined effect on hippocampal long-term potentiation (LTP) has not yet been investigated. We compared the effect of type 2 diabetes itself with that of type 2 diabetes with chronic heavy alcohol consumption on the hippocampal LTP using Otsuka Long-Evans Tokushima Fatty (OLETF) rat model, which resembles the characteristics of human type 2 diabetes. Ten of 16-week-old male OLETF rats were randomized into two treatment groups according to weight: the OLETF-Alcohol (O-A, n=5) and the OLETF-Control (O-C, n=5). The rats in the O-A group were fed Lieber-DeCarli Regular EtOH over a 10-week period and the amount of alcohol consumption was 8.42±2.52g/kg/day. To ensure the effect of poor glycemic control on LTP, intraperitoneal glucose tolerance test was performed after a 10-week treatment. The hippocampal LTP was measured by extracellular field excitatory post-synaptic potentials at Shaffer collateral (SC) synapses in the CA1 region. Although the O-A group showed significantly lower fasting and postprandial glucose (P<0.01 and P=0.02, respectively), the hippocampal LTP was more significantly attenuated in the O-A group than the O-C group (P=0.032). The results of this study suggested that chronic heavy alcohol consumption could potentiate the impairment of hippocampal LTP in individuals with impaired glucose tolerance or early type 2 diabetes, even though it did not aggravate, but did improve glycemic control. Clinical attention to chronic heavy drinking will be required in preventing cognitive impairment in individuals with type 2 diabetes.     

Ultrastructural studies of the rat submandibular gland in streptozotocin induced diabetes mellitus

Summary Increased fluid intake (polydipsia) is one of the classic symptoms of diabetes mellitus. Xerostomia (dry mouth) and resultant thirst are other symptoms of the disease and bear a close relationship to polydipsia. The xerostomia in individuals with diabetes is primarily due to decreased saliva flow which appears to be associated with degenerative changes in the salivary glands. This study examines the response of the rat submandibular gland to streptozotocin induced diabetes mellitus. Adult male rats were given a single I.V. dose of streptozotocin (65 mg/kg body weight) in citrate buffer (pH 4.5). Salivary glands were examined by light and electron microscopy at 4, 8 and 24 h and 3, 7, 14 and 21 days posttreatment. The changes in the acinar cells were characterized by an accumulation of secretory material within the cytoplasm. This secretory protein accumulation was followed by degenerative changes in the acinar cells which frequently resulted in cell death and replacement of secretory cells by connective tissue elements. The loss of secretory volume and potential changes in secretory kinetics are discussed with regard to the xerostomia, thirst and polydipsia exhibited by individuals with diabetes mellitus.This work was supported in part by N.I.H. grant DE-03933. We would like to thank Mrs. Valerie Every for her secretarial assistance.