糖化血清白蛋白在2型糖尿病监测及诊断中的应用观察

目的 研究糖化血清白蛋白(GA)与糖化血红蛋白(HbA1c)、空腹血糖(FPG)及餐后2小时血糖(2hPG)的关系,探讨GA在糖尿病的诊断及血糖监测方面的价值.方法 对796例受试者行口服葡萄糖耐量试验(OGTT),测定FPG、GA、HbA1c和2hPG,分析各指标间的相关性及GA诊断糖尿病的最佳切点.结果 (1)GA与FPG、2hPG呈显著正相关(r值分别为0.625、0.644,P＜0.01).(2)GA诊断糖尿病的最佳切点为18.55％,敏感度为75.1％,特异度为80.7％.结论 GA、HbA1c与FPG、2hPG关系密切,GA是诊断糖尿病的一种高信度指标.     

Association of glycated albumin with the presence of carotid plaque in patients with type 2 diabetes

Aims/Introduction

Postprandial hyperglycemia is a potent risk factor for cardiovascular disease. Serum glycated albumin (GA) has been reported to reflect postprandial blood glucose fluctuations. In the present study, we assessed the possible correlation of GA with the presence of carotid plaque to evaluate the potential clinical usefulness of GA for predicting atherosclerotic cardiovascular complications in patients with type 2 diabetes.

Materials and Methods

Patients with type 2 diabetes (n = 236) admitted to Nippon Medical School Hospital (Tokyo, Japan) for glycemic control (aged 19–86 years, 81 females and 155 males) were examined. Clinical measurements were taken on admission. The presence of carotid plaque was assessed by ultrasonography.

Results

In patients with carotid plaque (n = 154), GA (P = 0.023) was higher than those without carotid plaque (n = 82). In contrast, neither fasting plasma glucose (P = 0.48) nor glycated hemoglobin (P = 0.41) was significantly different between the groups. The results of logistic regression analysis showed that GA (age‐ and sex‐adjusted odds ratio [95% confidence interval], 1.05 [1.01–1.09]; P = 0.017) and glycated hemoglobin (1.17 [1.01–1.37]; P = 0.036) were significantly associated with the presence of carotid plaque.

Conclusions

The positive correlation of serum GA with the presence of carotid plaque in type 2 diabetes suggests that GA will serve as a useful clinical marker for predicting diabetic cardiovascular complications.     

Glycated albumin and the risk of chronic kidney disease in subjects with Type 2 Diabetes: A study in North Indian Population

Aim

Glycated albumin (GA) suggested being alternative glycemic marker than haemoglobin A1C (HbA1c) in patients with chronic kidney diseases (CKD). We investigated the association between GA and the progression of diabetic nephropathy (DN) in T2DM subjects.

2型糖尿病患者动态血糖变化与糖化血红蛋白水平的相关性分析

目的探讨2型糖尿病患者动态血糖变化与糖化血红蛋白(HbAlc)水平的相关性,为预防2型糖尿病并发症的发生提供参考。方法选取2009-05～2011-05收治的18例2型糖尿病患者,采用动态血糖监测系统(CGMS)观察2型糖尿病患者血糖变化与HbAl c的相关性。结果经Pearson分析显示,HbAlc与日内血糖水平呈正相关(P0.05),与餐后血糖波动幅度(PPGE)无明显相关性(P0.05)。结论 CGMS能详细显示日内血糖波动情况,HbAlc能反映日内整体血糖水平。     

Serum enzymes of lysosomal origin as indicators of the metabolic control in diabetes: Comparison with glycated hemoglobin and albumin

Summary Several lysosomal enzymes (β-N-D-acetylglucosaminidase, β-D-glucoronidase, α-D-galactosidase, β-D-galactosidase, α-L-fucosidase, α-D-glucosidase, α-D-mannosidase, β-D-glucosidase), glycated albumin and glycated hemoglobin (HbA_1c) were determined in the serum of 81 insulin-dependent diabetics with different degrees of metabolic control (optimal, 21 patients; good, 39 patients; poor, 21 patients) and without signs of complications, and in 42 control subjects. All parameters examined increased in serum in inverse proportion to the degree of metabolic control. A highly significant correlation (p<0.01) was found between lysosomal enzymes and both glycated albumin and HbA_1c. All parameters correlated with hyperglycemia, glycated albumin having the highest γ-value (0.586) and lysosomal enzymes the lowest one. Unlike glycated albumin and HbA_1c, serum levels of lysosomal enzymes in patients with optimal metabolic control were undistinguishable or even lower than those of controls. A 2-month longitudinal monitoring of a patient who was hospitalized in conditions of poor metabolic control and adequately treated, proved that lysosomal enzymes diminished in serum parallel to glycated albumin and HbA_1c in relation to improvement of the metabolic situation. The conclusion is drawn that serum lysosomal enzymes are good indicators of the metabolic control of diabetic patients probably reflecting the overall metabolic state connected with insulin action rather than hyperglycemia.     

The association of glycated hemoglobin with mortality and ESKD among persons with diabetes and chronic kidney disease

Context

Diabetic kidney disease (DKD) is the leading cause of end stage kidney disease (ESKD) and is associated with a considerably shortened lifespan. While glucose-lowering therapy targeting glycated hemoglobin (HbA1c) <7% is proven to reduce the risk of developing DKD, its effects on complications of DKD are unclear.

Improvement of glycemic control after periodontal treatment by resolving gingival inflammation in type 2 diabetic patients with periodontal disease

Aims/Introduction: Chronic inflammation aggravates glycemic control in patients with type 2 diabetes mellitus. An increase or decrease in the release and activities of various inflammatory mediators, such as tumor necrosis factor (TNF)‐α, interleukin (IL)‐6, and C‐reactive protein (CRP), are presumed to be responsible for inducing insulin resistance. The purpose of the present study was to examine the effects of non‐surgical periodontal treatment incorporating topical antibiotics on glycemic control and serum inflammatory mediators in patients with type 2 diabetes mellitus with periodontitis. Materials and Methods: Periodontal inflammation and periodontal tissue destruction were evaluated by bleeding on probing (BOP) and the probing pocket depth (PPD), respectively. A total of 41 patients with type 2 diabetes and periodontitis received periodontal treatment with the topical application of antibiotics four times within a 2‐month period. A periodontal examination, including PPD and BOP, and venous blood sampling were carried out at baseline and at 2 and 6 months after periodontal treatment. Glycated hemoglobin (HbA_1c), and serum levels of high‐sensitivity (hs)‐CRP, TNF‐α and IL‐6 were analyzed. Results: A generalized linear model showed significant associations between the change in the HbA_1c values at 6 months after periodontal treatment, and the change in the BOP, baseline TNF‐α levels and the baseline mean PPD. Conclusions: As BOP is a marker of total gingival inflammation, these results suggest that non‐surgical periodontal therapy with topical antibiotics in patients with mild periodontitis might improve glycemic control by resolving periodontal inflammation. Such treatments might be insufficient for the amelioration of insulin resistance in type 2 diabetic patients with severe periodontitis. This trial was registered with the University Hospital Medical Information Network (no. UMIN000006693). (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2012.00209.x, 2012)     

2型糖尿病慢性肾脏疾病患者血浆心钠素水平的变化及其临床意义

目的 探讨不同时期糖尿病慢性肾脏疾病（CKD）患者血浆心钠素（ANP）水平变化及其临床意义. 方法 选取T2DM患者93例,根据UAER分为单纯糖尿病（DM）组30例、CKD 3期（CKD3）组31例及CKD 4期（CKD 4）组32例,另选健康体检者30名作为正常对照（NC）组.采用ELISA测定各组血浆ANP水平. 结果 （1）DM、CKD 3和CKD 4组ANP水平均高于NC组,且随UAER增加而增加[（280.89±43.66） vs （356.87±45.45） vs （414.95±57.52） vs （164.09±36.64） ng/L,P＜0.05];（2）ANP水平与病程、HbA1c、FPG、TG、BUN、Cr呈正相关（r=0.77、0.82、0.73、0.71、0.80、0.74,P均＜0.05）,与HDL-C呈负相关（r=-0.68,P＜0.05）. 结论 血浆ANP与CKD患者UAER正相关,FPG、HbA1c、BUN、Cr和TG是血浆ANP的独立正相关因子.     

非内分泌科室联合检测糖化血红蛋白与空腹血糖筛查高血糖方法的探讨

目的 探讨非内分泌科室联合检测HbA1c与FPG筛查高血糖的最佳方法. 方法 选取心内科和骨科新入院,且随机血糖≥7.0 mmol/L或FPG≥5.0mmol/L的非糖尿病患者,检测FPG、HbA1c、糖化血清蛋白（GA）,评估患者糖代谢状态. 结果 （1）心内科IGR、糖尿病和糖耐量正常（NGT）者分别为185例、178例、163名,骨科分别为116例、130例、107名.（2）75 g OGTT受试者工作特征曲线（ROC）显示,以FPG为诊断糖尿病切点,心内科为5.81 mmol/L,骨科为6.24 mmol/L;以HbA1 c为诊断切点,心内科为6.15％,骨科为5.75％;以GA为诊断切点,心内科为254.50μmol/L,骨科为250.89μmol/L.（3）FPG和HbA1c联合诊断价值与75 g OGTT比较有效性更高[曲线下面积（AUC＞0.8）]. 结论 HbA1c与FPG联合检测能进一步提高非内分泌科住院患者的高血糖筛查效率.     

25～65岁男性糖尿病慢性肾脏疾病对骨代谢影响的初步报告

目的 研究25～65岁男性糖尿病慢性肾脏疾病（CKD）不同阶段骨代谢指标的变化. 方法 将160例25～65岁男性T2DM患者分为UAlb/Cr＜30 mg/24 h组、UAlb/Cr 30～299 mg/24 h组和UAlb/Cr≥300 mg/24 h组,另选30名25～65岁健康男性作为正常对照（NC）组,测定血清骨钙素（OC）、工型前胶原N末端前肽（PINP）和β胶原特殊序列（β-Crosslaps）水平并进行分析. 结果 UAlb/Cr 30～299 mg/24 h组OC、PINP、p-Crosslaps水平较NC组降低[（12.12±4.47）vs（16.05±5.68）ng/ml、（33.19±12.04） vs （41.90±11.56）ng/ml、（0.26±0.12）vs（0.36±0.14）ng/ml,P＜0.05];UAlb/Cr 30～299 mg/24 h组PINP水平较UAlb/Cr ＜30 mg/24 h组降低[（40.51±15.94）ng/ml,P＜0.05]. 结论 25～65岁男性CKD早期骨代谢以低转换为主,后期逐渐转化为高转换.     

乙酰辅酶A羧化酶B基因rs2268388多态性与糖尿病慢性肾脏疾病的相关性研究

目的 探讨乙酰辅酶A羧化酶B(ACACB)基因rs2268388多态性与我国昆明地区汉族人群糖尿病慢性肾脏疾病(CKD)的相关性. 方法 选取T2DM患者248例,根据两次UAlb/Cr或24 hUAlb结果分为单纯T2DM组85例、CKD1组99例及CKD2组64例,另选取健康对照(NC)组70名.采用Taqman PCR(Three-star)法对各组ACACB基因rs2268388多态性进行检测,并比较分析各组基因型、等位基因频率、风险因素及相关临床和生化指标. 结果 (1)单纯T2DM、CKD各组C/T基因型频率均低于NC组(Z=-2.391,P=0.017);CKD1组和CKD2组ACACB基因rs2268388T/T基因型频率高于单纯T2DM组(Z=-2.522,P=0.012;Z=-4.981,P=0.001);CK D1组和CKD2组T/T基因型频率及各组等位基因频率比较,差异无统计学意义(P＞0.05).(2) Logistic回归分析表明,糖尿病病程、rs2268388T/T基因型、高TG、高HbA1 c及高SUA是CKD发生的危险因素. 结论 在昆明地区汉族人群中,ACACB基因rs2268388T/T基因型可能与CKD发生相关.     

Defining the relationship between average glucose and HbA1c in patients with type 2 diabetes and chronic kidney disease

Aims

To examine the relationship between average glucose (AG) and HbA_1c in patients with and without chronic kidney disease (CKD) and type 2 diabetes.

Materials and methods

43 patients with diabetes and CKD (stages 3–5) with stable glycaemic control, and glucose-lowering and erythropoiesis stimulating agent (ESA) doses, were prospectively studied for 3 months and compared to 104 age-matched controls with diabetes, without CKD from the ADAG study. Over 3 months, AG was calculated from 7 to 8 point self-monitored blood glucose measurements (SMBG) and from continuous glucose monitoring (CGMS), and mean HbA_1c was calculated from 4 measurements. AG and HbA_1c relationships were determined using multivariable linear regression analyses.

Results

The CKD and non-CKD groups were well matched for age and gender. Mean AG tended to be higher (p = 0.08) but HbA_1c levels were similar (p = 0.68) in the CKD compared with non-CKD groups. A linear relationship between AG and HbA_1c was observed irrespective of the presence and stage of CKD. The relationship was weaker in patients with stage 4–5 CKD (non-CKD R² = 0.75, stage 3 CKD R² = 0.79 and stage 4–5 CKD R² = 0.34, all p < 0.01). The inclusion of ESA use in the model rendered the effect of CKD stage insignificant (R² = 0.67, p < 0.01).

Conclusions

In patients with type 2 diabetes and CKD there is a linear relationship between HbA_1c and AG that is attenuated by ESA use, suggesting that ESA results in a systematic underestimation of AG derived from HbA_1c.     

2型糖尿病和糖尿病肾病患者肠道菌群失衡模式及功能变化的研究

目的研究和分析2型糖尿病(type 2 diabetes mellitus, T2DM)和糖尿病肾病(diabetic kidney disease, DKD)患者肠道菌群失衡模式,并观察肠道菌群功能变化。方法以随机数字法选取2018年9月至2019年10月我院收治的T2DM和DKD患者作为研究对象,并设定为T2DM组和DKD组,每组均纳入30例,同时选取健康体检者作为对照组,同样纳入30名,对三组的肠道菌群标志物进行对比和分析,同时对肠道菌群功能的变化进行总结。结果 (1)对照组与T2DM组、DKD组之间的肠道菌群多样性有显著性差异(P<0.05);(2)变化信号方面:T2DM组与DKD组变化存在大部分一致的情况(P<0.05),同时两组均出现了肠道菌群失衡模式,但T2DM以拟杆菌属增多为主要特点,DKD组则以乳杆菌属、史雷克菌属、厌氧棒状菌属和肠球菌属增多为主要特点;(3)T2DM组和DKD组患者肠道的功能变化存在一致性。结论 T2DM和DKD患者均存在特异性的肠道菌群失衡情况,其肠道功能变化无明显差异。     

Impact of empagliflozin in patients with diabetes and heart failure

Heart failure (HF) is a common disease with increased risk for mortality and morbidity among patients with type 2 diabetes mellitus (T2DM). Optimal glycemic control in this patient population is challenging as many available therapies can potentially exacerbate symptoms of HF. Empagliflozin is one in a novel class of agents, the sodium glucose co-transporter 2 (SGLT2) inhibitors, that lowers blood glucose by increasing urinary glucose excretion and improves glycemic control and lowers body weight and blood pressure. In the recent EMPA-REG OUTCOME trial, empagliflozin was shown to improve cardiovascular outcomes in patients with T2DM and established cardiovascular risk where it reduced HF hospitalizations and cardiovascular death, with a consistent benefit among patients both with and without baseline HF. Here, we review the empagliflozin data on HF outcomes and discuss potential mechanisms for its benefits in HF with a focus on the potentially significant impact that empagliflozin may have on the care of patients with T2DM and HF in the future.     

The high prevalence of unrecognized anaemia in patients with diabetes and chronic kidney disease: a population-based study

Background Anaemia occurs early in the course of diabetes-related chronic kidney disease (CKD). There is little evidence about the prevalence of anaemia in people with diabetes. The aim of this study was to assess the prevalence of anaemia, by stage of CKD, in the general diabetic population. Methods Haemoglobin (Hb) was measured on all glycated haemoglobin (HbA_1c) samples and the most recent (< 4 months) estimated glomerular filtration rate (eGFR) was obtained. Anaemia (at treatment level) was defined as Hb < 110 g/l or the use of erythropoetic stimulating agents (ESA). Results Twelve per cent (10–14%) of people had Hb < 110 g/l. The prevalence of anaemia increased progressively with worsening CKD. People with CKD stage 3 accounted for the largest number of people with anaemia; 18% (95% CI 13–24%) had Hb < 110 g/l. Those with eGFR < 60 ml/min/1.73 m² and not on ESA or dialysis were four (2–7) times more likely than patients with better renal function to have Hb < 110 g/l. The relation between Hb and eGFR became approximately linear below an eGFR of 83 ml/min/1.73 m², where, for every 1 ml/min/1.73 m² fall in eGFR, there was a 0.4 (0.3–0.5) g/l fall in haemoglobin. Conclusions This study demonstrates that anaemia, at levels where treatment is indicated, occurs commonly in people with diabetes and CKD stage 3 or worse. The screening for anaemia in current diabetes management should be extended.