2型糖尿病合并甲状腺功能异常的临床分析

目的 探讨T2DM合并甲状腺疾病的患病情况及临床特点. 方法 回顾性分析420例住院T2DM患者甲状腺功能相关指标及临床资料. 结果 （1）T2DM患者甲状腺疾病患病率16.67％;甲状腺功能异常患病率15.71％.甲状腺功能异常患病率甲亢组3.57％,甲减组8.10％,低T3综合征组4.05％.甲减组中,亚临床甲减甲状腺功能异常患病率（4.52％）最高,女性甲状腺疾病及甲状腺功能异常的患病率均高于男性（P＜0.05）.（2）与T2DM组相比,T2DM合并甲状腺疾病组病程及胰岛素泵治疗时间增加,C-P120min水平降低;两组UAlb 30～299 mg/24 h差异有统计学意义（P＜0.01）.（3）甲亢组DPN患病率最高,低T3组年龄最大,且合并冠心病史发生率最高（P＜0.05）. 结论 T2DM合并甲状腺疾病患病率较高,甲状腺功能异常表现形式多样,对T2DM患者进行早期甲状腺功能的筛查具有临床意义.     

2型糖尿病患者和甲状腺疾病患者血浆脂联素水平变化

在肥胖型糖尿病、非肥胖 2型糖尿病、甲亢、甲减和正常对照 5组病例测定空腹血脂联素、甲状腺激素、胰岛素等指标。结果显示,脂联素与体重指数、血脂及FT4 密切相关。糖尿病人群脂联素与体重指数比胰岛素更相关。     

糖尿病患者合并甲状腺功能异常的机制及其影响

糖尿病患者甲状腺功能异常的发生率是非糖尿病患者的2～3倍.甲状腺激素与糖代谢多个环节密切相关.糖尿病患者合并甲状腺功能异常时不仅加重机体的糖代谢异常,而且可以增加心血管疾病的风险.早期发现糖尿病患者潜在的甲状腺功能异常并及时纠正,可避免患者出现血糖控制紊乱及严重的合并症.     

2型糖尿病相关认知障碍与血糖管理

认知功能障碍包括轻度认知障碍、阿尔兹海默症和痴呆症,越来越被认为是2型糖尿病的一种重要的共病或并发症,影响血糖管理。本文旨在综述有关2型糖尿病与认知功能障碍、血糖控制之间的关系,危险因素的筛查和诊断,认知功能障碍患者的2型糖尿病管理(考虑高龄和老年人虚弱体质)以及新出现的预防疗法。良好的血糖控制与及早的认知测试是2型糖尿病管理的重要组成部分,对患者应当实施个性化策略,包括患者教育、血糖监测、根据日常情况(包括体育锻炼)适当调整饮食和药物。     

2型糖尿病胰岛功能障碍与基于肠促胰素的治疗

多项研究显示,胰岛细胞功能障碍(α细胞及β细胞)对2型糖尿病的发生发展起决定性作用.β细胞功能障碍主要表现为胰岛素分泌的缺陷,α细胞功能障碍则主要是进餐后胰升糖素的分泌未得到有效抑制.因此,胰岛功能障碍是2型糖尿病治疗的重要靶点.研究显示,基于肠促胰素的药物,包括胰升糖素样肽1( GLP-1)受体激动剂及二肽基肽酶4(DPP-4)抑制剂能恢复胰岛细胞对葡萄糖的敏感性,有效改善血糖控制.期待此类药物对胰岛功能改善的更多研究.     

Prevalence of thyroid disorders among patients with diabetes in rural South India

Background & aimsDiabetes mellitus (DM) and thyroid disorders are the most common endocrine disorders in clinical practice. Unrecognized thyroid disorders have an adverse effect on metabolic functions. The aim of the study is to demonstrate the prevalence of thyroid disorders in individuals with diabetes mellitus.MethodsA prospective observational study, conducted at Sree Sidhi Vinayaka Diabetic Center, between September 2013 to December 2019. A total of 5037 patients attended the outpatient clinic, among which 2470 met the inclusion criteria. All patients underwent a clinical and laboratory evaluation.ResultsA total of 2321 individuals with diabetes had consented to be the part of the study, 102 had Type 1 diabetes mellitus (T1DM) and 2219 Type 2 diabetes mellitus (T2DM). The mean age was 48.4 ± 10.7, among which 1128 females and 1193 are males. 79.9% (1853) individuals with diabetes were euthyroid; 13.8% (321) subclinical hypothyroidism; 3.4% (79) clinical hypothyroidism, and 2.9% (68) were having hyperthyroidism. 14.1% of T2DM had subclinical hypothyroidism, in contrast, clinical hypothyroidism was common in T1DM (6.9%).ConclusionA high index of suspicion for thyroid dysfunction in diabetics should be considered to screen for thyroid function in them for early detection and effective management of both the conditions.     

Frequency of Thyroid Dysfunction in Diabetic Patients: Value of Annual Screening

A randomly selected group of 1310 adult diabetic patients attending a diabetic outpatient clinic received annual screening for thyroid disease, by estimating serum free thyroxine and TSH concentrations. The overall prevalence of thyroid disease was found to be 13.4%, and was highest (31.4%) in Type 1 diabetic females, and lowest in Type 2 diabetic males (6.9%). As a direct result of screening, new thyroid disease was diagnosed in 6.8% (89 patients) of the population screened; the commonest diagnosis was subclinical hypothyroidism (4.8%), followed by hypothyroidism (0.9%), hyperthyroidism 0.5%), and subclinical hyperthyroidism (0.5%). Female patients with Type 1 diabetes had the highest annual risk of developing thyroid disease (12.3%), but all patient groups had a higher incidence of thyroid dysfunction, compared to that reported in the general population. This study suggests that thyroid function should be screened annually in diabetic patients to detect asymptomatic thyroid dysfunction which is increased in frequency in a diabetic population.     

肝酶异常与中国成人胰岛素抵抗和糖尿病患病相关

目的 了解肝脏酶学异常与中国成人胰岛素抵抗、胰岛素分泌和2型糖尿病(T2DM)患病是否存在独立的相关关系.方法 研究人群来自2007年6月至2008年5月中国糖尿病和代谢综合征研究数据库,年龄≥20岁的中国成人共计16 035例(男6 611例,女9424例).受试者均测定身高、体重、腰围、血压、血脂谱、血清谷丙转氨酶(ALT)、谷草转氨酶(AST)和γ-谷氨酰转肽酶(GGT),并进行口服糖耐量试验,测定空腹和负荷后血糖和血清胰岛素.采用SUDAAN统计软件进行加权分析.结果 除糖尿病患病率不随AST水平升高外,糖尿病前期和糖尿病的患病率均随ALT、GGT水平升高而呈显著上升趋势(糖尿病患病率在ALT三分位组由低到高分别为5.1％、6.9％和12.7％,P＜0.001).ALT和GGT从最低三分位到最高三分位,胰岛素抵抗指数(HOMA-IR)呈显著上升趋势(1.3、1.4和1.7,P＜0.001),胰岛素敏感指数(Mutsuda ISI)呈显著下降趋势(8.8、7.9和6.7,P＜0.001).ALT、AST和GGT水平与胰岛素分泌指数无明显关系.在分别进行的Logistic回归分析模型中,调整了年龄、性别、饮酒、体质指数、腰围后,显示ALT和GGT最高三分位组较最低三分位组患糖尿病前期的优势比(OR)分别为1.69(95％CI 1.27～ 2.26)和3.33(2.00～ 5.53),患糖尿病的OR值分别为2.70(1.87～ 3.90),1.99(1.05～ 3.77),但AST各组间糖尿病前期和糖尿病OR值无显著差异.结论 肝酶ALT和GGT异常与中国成年人胰岛素抵抗和糖尿病患病独立相关.     

血清胆红素与甲状腺激素在糖尿病患者中的变化及意义

目的探讨2型糖尿病（T2DM）患者血清胆红素和甲状腺激素水平的变化及临床意义。方法检测87例T2DM患者和45例健康人血清胆红素和血清甲状腺激素。结果 T2DM患者FT3和IBIL水平分别为2.6±1.1pmol/L和5.0±2.8μmol/L,显著低于正常对照组的4.8±1.0pmol/L和8.8±2.6μmol/L（P〈0.05）;血糖控制差的患者FT3和IBIL水平较低（P〈0.05）;轻症糖尿病组FT3和IBIL水平分别为3.03±1.21pmol/L和7.51±3.17μmol/L,而重症组治疗前分别为1.91±0.86pmol/L和6.25±2.85μmol/L,治疗后为3.55±1.29pmol/L和8.11±3.06μmol/L。结论 FT3和IBIL水平变化与T2DM病情密切相关,可为临床诊治提供参考依据。     

Increased prevalence of ventricular fibrillation in patients with type 2 diabetes mellitus

Diabetes mellitus (DM) is an independent risk for cardiovascular disease. Furthermore, patients with DM have increased risk for ventricular arrhythmia that is thought to be secondary to coronary artery disease (CAD) or congestive heart failure (CHF). We hypothesized that DM may cause ventricular arrhythmias independent of CAD or CHF. Using a large database, we evaluated the occurrence of ventricular fibrillation in patients with DM adjusting for CAD and CHF. We used patient treatment files (PTF), documents of inpatients' admissions containing discharge diagnoses (ICD-9 codes) from all Veterans Health Administration Hospitals. The patients were stratified in two groups: ICD-9 code for DM (293 124) and a control group with ICD-code for hypertension (HTN) but no DM (552 623). ICD-9 codes for ventricular fibrillation were used for this study. We performed uni- and multivariant analysis adjusting for comorbid conditions. Ventricular fibrillation was present in 563 (0.2%) vs 781 (0.1%) in the control group. Using multivariate analysis, DM remained independently associated with ventricular fibrillation (odds ratio: 1.7; confidence interval: 1.5–1.9; P < 0.000). Patients with DM have significantly higher prevalence of ventricular fibrillation independent of CAD or CHF, which in part may explain the higher risk of sudden death in patients with DM.     

The relationship between mean platelet volume with microalbuminuria and glycemic control in patients with type II diabetes mellitus

Microalbuminuria is the best predictor of diabetic nephropathy development in patients with type II diabetes mellitus (DM). It is also accepted as an indicator of diabetic microangiopathy. Increased activation of platelets has been suggested to be involved in the pathogenesis of vascular complications. In light of these findings, this study was designed to investigate the association of microalbuminuria — an indicator glycemic control and microangiopathy — with mean platelet volume (MPV). Subjects underwent laboratory analyses and their MPV, HbA1c, serum creatinine, fasting, and postprandial blood glucose levels and 24-hour urine albumin levels were recorded. All statistical analyses were performed using SPSS v13.0 for Windows XP. Mann–Whitney U-test, student's t-test, spearman correlation analysis, ROC analysis, categorical regression analysis, and chi-square test were used for statistical evaluations. The study included 354 patients with type II DM. The median MPV value of microalbuminuria-positive patients was 9 (8–9.5)?fl while MPV of patients without microalbuminuria was 8.5 (8–9.2)?fl and the difference was statistically significant (p?=?0.004). We determined positive correlation between MPV and 24-hour urine microalbuminuria (r?=?0.14, p?=?0.009). There were no significant differences between patients with HbA1c levels below and above 7% in terms of MPV (p?>?0.05). We determined no correlation between MPV and HbA1c levels (r?=??0.36, p?=?0.64). This study determined a significant positive relationship between microalbuminuria — a microvascular complication of diabetes — and MPV. No significant correlation was identified between poor glycemic control and MPV in diabetic patients. However, we are in the opinion that the association between poor glycemic control and MPV in type II diabetic patients should be investigated in prospective studies with larger samples.     

吸烟对男性2型糖尿病患者血糖控制的影响

对757例男性2型糖尿病患者进行糖尿病病史、吸烟状况、体力活动、饮食控制和与糖代谢有关的实验室检查，发现每日吸烟数量与空腹血糖(FBG)、餐后2h血糖(2hPBG)、HbAic正相关。     

2型糖尿病患者高甘油三酯血症-腰围表型与甲状腺功能异常的关系

目的 探讨2型糖尿病患者高甘油三酯血症-腰围表型(HTWC)与甲状腺功能的关系.方法 选取2型糖尿病患者808例,以血甘油三酯≥1.7 mmol/L、腰围男性≥85 cm或女性≥80 cm为切点,分为4组:正常组(n=162)、单纯高甘油三酯组(n=112)、单纯腹型肥胖组(n=262)、HTWC组(n=272).测量所有患者身高、体重、腰围、血压;检测血糖、血脂、促甲状腺激素、游离T3、游离T4、甲状腺过氧化物酶抗体水平,计算体重指数以及稳态模型评估-胰岛素抵抗指数(HOMA-IR).结果 HTWC组体重指数、收缩压、腰围、HOMA-IR、促甲状腺激素、甲状腺过氧化物酶抗体均高于其他3组(F=5.537～53.038,P均＜0.05),而高密度脂蛋白-胆固醇、游离T4显著低于其他3组(F=8.561,4.399,P均＜0.05),且HTWC组亚临床甲状腺功能减退症和甲状腺抗体阳性发生率较其余3组明显升高(x2=4.348,4.774,P均＜0.05).Logistic回归分析显示HTWC是2型糖尿病发生亚临床甲状腺功能减退症的危险因素(优势比=1.461,95％CI:1.073 ～ 1.990,P=0.016).结论 在2型糖尿病患者中,HTWC与甲状腺功能异常存在相关性,并可增加亚临床甲状腺功能减退症的患病风险.     

口服降糖药治疗血糖控制不佳的2型糖尿病患者联用艾塞那肽安全性和疗效观察

目的 观察口服降糖药(OADs)治疗血糖控制不佳T2DM患者联用艾塞那肽的临床疗效及安全性. 方法 对40例OADs治疗血糖控制不佳且BMI＞23 kg/m2的T2DM患者加用艾塞那肽治疗12周,测定治疗前后相关指标;稳态模型评估胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能指数(HOMA-β). 结果 加用艾塞那肽治疗12周后,FPG、2 hPG、HbA1 c、HOMA-IR、BMI、TG较治疗后下降[FPG(8.77±1.92)vs (7.49±1.14) mmol/L;2 hPG(16.55±3.24)vs(14.69±1.50) mmol/L;HbA1 c(8.91±1.37)％vs(7.94±0.90)％;HOMA-IR (1.44±0.41)vs(1.24±0.25);BMI (30.34±2.91)vs(29.41±2.59) kg/m2;TG(2.21±1.34)vs(1.59±0.51)mmol/L] (P＜0.01);2 hIns及HO-MA-β较治疗前增加[(5.96±0.65)vs(6.10±0.46)pmol/L;(3.81±0.54)vs(4.01±0.32)](P＜0.05或P＜0.01).所有病例均无严重低血糖事件发生. 结论 使用OADs治疗血糖控制欠佳的T2DM患者加用艾塞那肽可降低血糖、BMI及TG,同时改善胰岛β细胞功能和IR,且安全性较好.     

2型糖尿病患者甲状腺激素水平的变化情况及影响因素分析

目的 探讨T2DM患者甲状腺激素水平的变化情况及影响因素. 方法 随机选取T2DM患者（T2DM组）60例及正常体检者（NC组）60名进行比较,另将T2DM组按性别、年龄及病程进行划分,观察血清游离三碘甲腺原氨酸（FT3）、血清游离甲状腺素（FT4）、促甲状腺激素（TSH）水平,并进行统计学分析. 结果 T2DM组体内FT3水平低于NC组（t=2.033,P＜0.05）;T2DM组男女间各甲状腺激素指标比较,差异均无统计学意义;T2DM组＞60岁者FT3水平低于40～60岁者（t=2.619,P＜0.05）;T2DM组病程＞10年者FT3水平低于＜10年者（t=3.196,P＜0.05）. 结论 T2DM患者甲状腺功能指标的变化表现为FT3降低;高龄、病程长的T2DM患者比非高龄且病程短者FT3水平降低.     

老年2型糖尿病住院患者甲状腺功能异常及其影响因素的临床分析

目的 观察和分析老年2型糖尿病（T2DM）住院患者甲状腺功能异常及其影响因素。方法 对2014年10月至2015年5月在中日友好医院内分泌科住院的190例既往无甲状腺病史、年龄≥60岁的老年T2DM患者的甲状腺功能状况和相关临床指标进行调查和分析。结果 （1）在190例患者中,甲状腺功能异常比例为38.4%（73例）,其中低T3综合征为22.1%（42例）,原发性甲状腺功能减退症（甲减）为15.8%（30例）。（2）3组人群相比较,低T3综合征组糖化血红蛋白（HbAlc）明显高于其他两组,年龄、病程大于甲状腺功能正常组;甲减组甲状腺过氧化物酶抗体（TPOAb）和（或）甲状腺球蛋白抗体（TGAb）阳性率为最高,达到70%（均P＜0.05）。（3）3组血清25羟维生素D（25-OH-vit D）水平均处于缺乏状态。（4）logistic回归分析显示年龄与低T3综合征发生呈正相关（OR＝2.77,P＝0.012）;TPOAb（OR＝4.13,P＝0.026）、TGAb（OR＝3.57,P＝0.026）与甲减发生呈正相关。结论 老年T2DM住院患者甲状腺功能异常发生率较高,存在自身免疫因素易发生甲减;高龄患者更易发生低T3综合征;未看到维生素D缺乏在各组患者中的差异。     

血清睾酮水平在中青年男性2型糖尿病伴勃起功能障碍患者中的临床意义

调查53例50岁以下男性2型糖尿病患者伴勃起功能障碍(ED)与血总睾酮、游离睾酮等指标的关系.结果显示,在各有关因素匹配下,伴与不伴ED患者总睾酮[(14.11±5.81对14.97±4.93)nmol/L]、游离睾酮[(9.31±8.84对8.72±5.33)pg/ml]差异均无统计学意义,提示睾丸雄激素可能不是中青年2型糖尿病患者ED发生的重要因素.     

老年2型糖尿病患者认知功能障碍影响因素分析

目的探讨老年2型糖尿病(T2DM)患者认知功能障碍发生的影响因素。方法回顾性分析2017年6月至2018年5月首都医科大学宣武医院内分泌科2型糖尿病患者204例,根据简易版蒙特利尔认知评估(MoCA)量表结果分为认知功能障碍组98例和认知功能正常组106例。记录2组患者实验室检查结果,慢性肾脏病流行病学合作研究(CKD-EPI)公式计算估算肾小球滤过率(eGFR)。采用SPSS 19.0统计软件对数据进行分析。组间比较采用t检验、Mann-Whitney U检验或χ~2检验。多因素logistic回归分析认知功能障碍的危险因素。结果认知功能障碍组相比认知功能正常组患者年龄[(68.4±7.7)vs(66.0±6.7)岁]、骨质疏松[35.71%(35/98)vs 19.81%(21/106)]和eGFR60 ml/(min·1.73 m~2)比例[26.53%(26/98)vs 12.26%(13/106)]高,MoCA分值[(20.36±4.07)vs(27.02±1.49)分]和受教育时间[(8.85±4.14)vs(12.35±3.30)年]低,差异均具有统计学意义(P0.05)。多因素logistic回归分析结果表明年龄(OR=1.05, 95%CI 1.01～1.10;P=0.011)和eGFR60 ml/(min·1.73 m~2)[OR=2.15, 95%CI 1.08～4.26;P=0.029]为老年2型糖尿病患者认知功能障碍的独立危险因素。结论年龄和eGFR60 ml/(min·1.73 m~2)是老年2型糖尿病患者认知功能障碍的危险因素,控制患者血糖同时要监测患者肾功能,预防认知功能障碍的发生和进展。     

老年2型糖尿病患者微量白蛋白尿与胰岛素抵抗的关系

目的了解老年２型糖尿病患者的微量白蛋白尿（ＭＡＵ）与胰岛素抵抗的关系。方法对血压正常的３０例老年２型糖尿病合并ＭＡＵ患者与２６例未合并ＭＡＵ患者的空腹血糖、胰岛素、胰岛素敏感性指数（ＩＳＩ）和血脂等进行比较分析,并对所有患者的尿白蛋白排泄率（ＵＡＥＲ）与有关因素进行多元回归分析。结果２型糖尿病合并ＭＡＵ组ＩＳＩ（－４．９９±０．４８）显著低于未合并ＭＡＵ组（－４．７６±０．４８,Ｐ＜０．０５）,而且ＩＳＩ与ＵＡＥＲ呈独立相关〔标准偏回归系数（β）＝－０．３９７,Ｐ＜０．０１〕。结论在血压正常的老年２型糖尿病患者中,胰岛素抵抗是ＭＡＵ的独立危险因素。