江苏省社区人群中代谢综合征和吸烟对糖尿病发病的综合作用分析

目的 探讨代谢综合征和吸烟与糖尿病之间的关系及前两者之间的交互作用.方法 以江苏省多代谢异常和代谢综合征综合防治研究中随访时间满5年的人群为研究对象,对符合纳入标准且资料完整的3598名35～74岁基线非糖尿病患者,其中男1451名,女2147名,观察并分析其发展为糖尿病的危险与代谢综合征和吸烟之间的关系,并通过Logistic回归模型计算相乘交互作用指标和相加交互作用指标,用于评价代谢综合征和吸烟之间的交互作用.结果 在调整年龄、性别、家族史及吸烟、饮酒后,代谢综合征患者与非代谢综合征患者发生糖尿病的调整相对危险度为2.79(95%Cl:2.03～3.83),代谢综合征组分中高甘油三酯与高空腹血糖对糖尿病有显著影响,调整相对危险度分别为1.78(1.28～2.50)和3.72(2.70～5.13).代谢综合征组与非代谢综合征组中现吸烟者与不吸烟者相比发生糖尿病的调整相对危险度分别为3.03(1.69～5.45)和5.45(2.12～14.03).交互作用分析结果显示,相对超危险度比为5.57(0.37～11.50),归因比为0.44(0.16～0.72),交互作用指数为1.90(1.09～3.32).结论 代谢综合征和吸烟均为糖尿病的危险因素,当代谢综合征和吸烟同时存在时发生糖尿病的危险性明显增加,两者之间存在明显的相加交互作用.     

基于核磁共振的代谢组学研究在糖尿病的应用进展

代谢组学是继基因组学、转录组学和蛋白质组学之后,系统生物学的重要领域。代谢组学技术可使基因和蛋白表达的微小变化在代谢物水平得到放大,并将代谢信息与病理生理过程中生物学事件关联起来,从而了解机体生命活动的代谢过程。糖尿病是一种严囊威胁人类健康的代谢性疾病,利用代湔组学方法对糖尿病代谢产物进行分析,探索糖尿病及其并发症发生发展的机理,开拓了糖尿病研究的新视野。     

基于核磁共振的代谢组学在糖尿病中的应用

作为系统生物学的重要组成之一,代谢组学特别适用于糖尿病的研究.核磁共振(NMR)凭借其简便、无偏向性、信息量大、无损伤性等优点成为代谢组学中最重要的分析手段之一.通过对糖尿病生物样品(尿液、血液、唾液、组织提取液等)的NMR分析,可以获得其中内源性代谢产物(乳酸、肌酐、氨基酸、脂蛋白等)的综合信息,从而反映精尿病的病理代谢和生化反应规律.该方法已应用于糖尿病并发症的诊断、降糖药物的作用考察,以及糖尿病致病机制的研究等方面,具有广阔的发展前景.     

铁调素与2型糖尿病

铁过度累积可加重胰岛素抵抗,对2型糖尿病的发生、发展具有推动作用.铁代谢调节机制中涉及铁调素,它是铁代谢的核心调节剂,能抑制铁的吸收和释放.有研究发现,2型糖尿病患者血清铁调素水平较正常人升高,但关于铁调素参与2型糖尿病的机制目前研究甚少.通过对铁调素与2型糖尿病关系的研究发现,在2型糖尿病患者中铁调素与铁蛋白呈正相关.铁调素与糖代谢有关,其可能通过对铁代谢的调节在2型糖尿病中发挥一定作用,从而为2型糖尿病的防治提供新思路.     

代谢综合征世纪之争三年观

代谢综合征是一组心血管危险因素的聚集,包括胰岛素抵抗、肥胖(特别是中心性肥胖)、高血压、糖代谢紊乱和脂代谢紊乱.代谢综合征的历史已有80余年,但是2005年9月,美国糖尿病协会和欧洲糖尿病研究学会发表联合声明质疑代谢综合征的存在,由此引发了一场关于代谢综合征的世纪之争,现就近三年情况做一简述.     

代谢综合征(4)代谢综合征与Ⅱ型糖尿病(续完)

代谢综合征和Ⅱ型糖尿病是心血管疾病的重要危险因素,两类疾病共同的发病环节是胰岛素抵抗(IR),而代谢综合征患者是糖尿病发病的高危人群.肥胖尤其是腹型肥胖与IR和代谢综合征的发病密切相关.随着IR以及糖调节受损的加重,当空腹血糖或(和)餐后血糖达到糖尿病的诊断标准,即实现了由糖调节受损向糖尿病的转变.对代谢综合征治疗主要是改善生活方式,辅以药物,不仅可以预防糖尿病发病,还可以降低患者总体心血管危险性.     

儿童睡眠呼吸暂停与代谢综合征相关

既往研究证实,成人睡眠呼吸暂停可引起糖耐量异常、胰岛素释放减少和瘦素分泌改变,与糖尿病及代谢紊乱密切相关.但尚未确定儿童睡眠呼吸暂停是否与代谢综合征相关.Redline等纳入270名社区青少年(平均年龄13.6岁),对其进行整夜多导睡眠图监测和代谢综合征关键指标测定,并分析两者的关系.     

高糖代谢记忆与糖尿病并发症

高糖"代谢记忆"是影响糖尿病并发症的重要因素,早期血糖控制情况可对并发症产生持久影响.氧化应激和晚期槠基化终末产物(AGEs)是形成高糖"代谢记忆"的基础,同时也是高糖"代谢记忆"参与糖尿病并发症的主要途径.在氧化应激途径中,活性氧簇(ROS)激活与糖尿病并发症相关;在AGEs途径中,AGEs引发的后续效应介导并发症的发生.减弱氧化应激和AGEs的作用,清除有害的代谢记忆,有望成为延缓糖尿病慢性并发症的治疗措施.     

代谢综合征与脑血管疾病

代谢综合征(metabolic syndrome,MS)是以中心性肥胖或超重、糖尿病或糖代谢异常、高血压、血脂紊乱为主要组分的一组严重影响人类健康的临床症候群[1],严重地危害人体健康并降低人类的生活质量.MS与糖尿病、心血管疾病及脑血管疾病有着密切的关系.     

糖尿病钙代谢指标的变化及其临床意义

本文观察了91例糖尿病患者6项钙代谢指标的变化,并按病程、控制状况等不同情况分组观察对钙代谢指标的影响。结果表明,糖尿病患者有钙代谢异常,主要表现为AKP明显升高伴细胞内Ca降低、尿Ca排出增加而细胞外Ca变动不大。糖尿病控制差时钙代谢异常表现为细胞外总ca值升高、细胞内Ca值降低及AKP升高。认为淋巴细胞内Ca水平可能是反映糖尿病钙代谢紊乱的一个较好指标。     

Therapeutic approaches in the prevention of cardiovascular disease in metabolic syndrome and in patients with type 2 diabetes

PURPOSE OF REVIEW: The metabolic syndrome is commonly encountered in the United States. It has been estimated from a survey conducted nearly a decade ago that one in four American adults fulfill the criteria for the metabolic syndrome. As obesity has become more common, the prevalence of type 2 diabetes has increased, and these trends can be expected to translate into more cardiovascular disease in future years. The high cardiovascular risk that accompanies the metabolic syndrome and type 2 diabetes mandates comprehensive and aggressive preventive care. This article reviews evidence that treatments directed at the individual components of the metabolic syndrome will delay the progression to type 2 diabetes and will reduce the incidence of cardiovascular disease. RECENT FINDINGS: In overweight individuals with the metabolic syndrome, the onset of type 2 diabetes can be delayed by therapeutic lifestyle changes (weight loss and exercise), insulin sensitizers (metformin, troglitazone), angiotensin converting enzyme inhibitors (captopril, fosinopril, ramipril), and angiotensin receptor blockers (losartan, candesartan). Lipid altering therapies (statins, fibrates, and niacin) are especially efficacious for reducing cardiovascular events in metabolic syndrome and type 2 diabetes patients. SUMMARY: An aggressive multifactorial approach to cardiovascular risk factor modification facilitates a delay in the onset of type 2 diabetes and cardiovascular events among individuals with the metabolic syndrome.     

Gastrointestinal metabolic surgery for the treatment of type 2 diabetes mellitus

Medical therapy for type 2 diabetes mellitus is ineffective in the long term due to the progressive nature of the disease, which requires increasing medication doses and polypharmacy. Conversely, bariatric surgery has emerged as a cost-effective strategy for obese diabetic individuals; it has low complication rates and results in durable weight loss, glycemic control and improvements in the quality of life, obesity-related co-morbidity and overall survival. The finding that glucose homeostasis can be achieved with a weight loss-independent mechanism immediately after bariatric surgery, especially gastric bypass, has led to the paradigm of metabolic surgery. However, the primary focus of metabolic surgery is the alteration of the physio-anatomy of the gastrointestinal tract to achieve glycemic control, metabolic control and cardio-metabolic risk reduction. To date, metabolic surgery is still not well defined, as it is used most frequently for less obese patients with poorly controlled diabetes. The mechanism of glycemic control is still incompletely understood. Published research findings on metabolic surgery are promising, but many aspects still need to be defined. This paper examines the proposed mechanism of diabetes remission, the efficacy of different types of metabolic procedures, the durability of glucose control, and the risks and complications associated with this procedure. We propose a tailored approach for the selection of the ideal metabolic procedure for different groups of patients, considering the indications and prognostic factors for diabetes remission.     

Metabolic syndrome, diabetes and cardiovascular events: current controversies and recommendations

Metabolic syndrome is now present in up to 40% of the United States adult population and is associated with a nearly a two fold increase in cardiovascular events, independent of the presence of diabetes mellitus. The concept of the metabolic syndrome as clinical syndrome has recently been challenged, however, and controversy exists as to whether the metabolic syndrome adds to cardiovascular risk above and beyond the sum of its independent metabolic components. Given the epidemic of obesity in both industrialized and third world countries, this issue is of great importance. The current article puts this controversy into perspective and explores the association of metabolic syndrome with both accelerated cardiovascular risk and the risk of development of type 2 diabetes. The pathophysiology of the increased risk of cardiovascular disease in diabetes associated with metabolic syndrome is discussed and the importance of early recognition of metabolic syndrome and potential role of addressing insulin resistance is stressed. Clearly more data is needed, but it is safe to say that metabolic syndrome is a worldwide epidemic in association with central obesity and underlying insulin resistance, which will propel a marked increase in cardiovascular events and diabetes mellitus in the years to come. Further research is needed to understand the role of more aggressive therapy in preventing type 2 diabetes and cardiovascular events in the population.     

Preventing diabetes and atherosclerosis in sub-Saharan Africa: Should the metabolic syndrome have a role?

Obesity, hypertension, atherosclerosis, and type 2 diabetes mellitus are increasing in all regions of sub-Saharan Africa. The metabolic syndrome is a valuable tool in predicting atherosclerosis and type 2 diabetes in populations in Europe and North America. However, the applicability of the metabolic syndrome to African populations has not been studied. Prior to investing scarce funds into diagnosing and treating the metabolic syndrome, primary research needs to be designed to determine the prevalence of the metabolic syndrome and its ability to detect early, treatable disease in Africa. Assessment of these data should make it possible to determine if it is more effective to focus on the metabolic syndrome as a whole or on obesity, hypertension, atherosclerosis, and type 2 diabetes as individual conditions. This article is an overview of the presentation of metabolic syndrome variables in the Eastern, Western, and Southern regions of sub-Saharan Africa.     

Ghrelin in Type 2 diabetes mellitus and metabolic syndrome

The increasing prevalence of metabolic syndrome and the consequent cardiovascular diseases, like atherosclerotic diseases and Type 2 diabetes has stimulated an active search for novel risk factors. The hormones regulating energy balance are of special interest as potential risk factors for metabolic syndrome and Type 2 diabetes. Ghrelin is a peptide hormone from stomach with growth hormone releasing activity. It is also able to modify glucose and insulin metabolism, blood pressure levels, adipogenesis, and inflammatory processes in experimental conditions. Whether ghrelin has a role in the development metabolic syndrome and the associated diseases, is not known. This review will report the evidence for the role of ghrelin in the clustering of the components of the metabolic syndrome.     

Should the Metabolic Syndrome Patient with Prediabetes Be Offered Pharmacotherapy?

Impaired fasting glucose and impaired glucose tolerance reflect perturbations in glucose metabolism and define a prediabetic state in which risk for type 2 diabetes mellitus (T2DM) is increased. There is overlap between prediabetes and the metabolic syndrome, which itself increases the risk for T2DM and cardiovascular disease. The utility of medical interventions to prevent progression to diabetes in prediabetic individuals, many of whom also manifest metabolic syndrome, has been examined in several large clinical trials. Intensive lifestyle intervention consistently results in drastic reductions in the incidence of T2DM and reversal of metabolic syndrome. Additionally, pharmacotherapies—including metformin, acarbose, thiazolidinediones, glucagon-like peptide 1 receptor agonists, and renin-angiotensin inhibitors—also reduce diabetes incidence with variable effects on metabolic syndrome components. Taken together, we recommend that prediabetic patients undergo intensive lifestyle intervention, with the addition of pharmacotherapy based on the presence of specific features of the metabolic syndrome, for diabetes prevention.     

Metabolomics in diabetes research

Diabetes represents one of the most important global health problems because it is associated with a large economic burden on the health systems of many countries. Whereas the diagnosis and treatment of manifest diabetes have been well investigated, the identification of novel pathways or early biomarkers indicative of metabolic alterations or insulin resistance related to the development of diabetes is still in progress. Over half of the type 2 diabetes patients show manifestations of diabetes-related diseases, which highlight the need for early screening markers of diabetes. During the last decade, the rapidly growing research field of metabolomics has introduced new insights into the pathology of diabetes as well as methods to predict disease onset and has revealed new biomarkers. Recent epidemiological studies first used metabolism to predict incident diabetes and revealed branched-chain and aromatic amino acids including isoleucine, leucine, valine, tyrosine and phenylalanine as highly significant predictors of future diabetes. This review summarises the current findings of metabolic research regarding diabetes in animal models and human investigations.     

Nonischemic heart failure in diabetes mellitus

PURPOSE OF REVIEW: Diabetic patients with heart failure have a poor prognosis. Although it has been demonstrated in animal models that metabolic maladaptation plays a pivotal role in contractile dysfunction of the heart, the understanding of 'diabetic cardiomyopathy' and its treatment in humans remains incomplete. RECENT FINDINGS: Epidemiological studies show that structural changes in the left ventricle can be demonstrated before onset of clinical diabetes. Diastolic dysfunction is the earliest manifestation that is associated with increasing level of serum-free fatty acids and worsening glycemic control. Spectroscopic and histologic evidence in the human myocardium indicates a maladaptive metabolic response in diabetes, characterized by intramyocellular triglyceride accumulation. Studies also suggest a link between myocardial isoform switching, calcium homeostasis and altered metabolism in the development of heart failure. However, treatment directed at deranged metabolic control in diabetes is effective only in animals, and not in humans. SUMMARY: Although clinical studies suggest the existence of 'diabetic cardiomyopathy', it is still difficult to prove causality. However, animal models and human studies suggest that systemic metabolic derangements may lead to metabolic, functional and structural maladaptation of the heart. The exact mechanisms of heart failure in diabetes remain elusive.     

Lifestyle management in the metabolic syndrome

Type 2 diabetes and metabolic syndrome are two of the fastest growing public health problems in both developed and developing countries. Cardiovascular disease is the most prevalent complication of type 2 diabetes and the metabolic syndrome. Overweight, obesity, or weight gain has been shown to be an important risk factor for the development of type 2 diabetes and an important component of the metabolic syndrome. Physical inactivity is another important risk factor for the development of type 2 diabetes. Data from prospective studies have shown that at least 30 min/day of moderate to vigorous physical activity can prevent type 2 diabetes. Moderate or high levels of physical fitness are effective in preventing type 2 diabetes. Results from clinical trials have indicated that lifestyle changes, including dietary modification and increase in physical activity, can prevent type 2 diabetes. Analyses from prospective studies have confirmed that healthy diets are effective and safe ways to prevent type 2 diabetes and the metabolic syndrome. Public health messages, health care professionals, and the health care system should aggressively promote physical activity and responsible nutritional habits during occupation, leisure time, and daily life and prevent overweight and obesity.     

Metabolic syndrome: a closer look at the growing epidemic and its associated pathologies

Obesity is reaching epidemic proportions with recent worldwide figures estimated at 1.4 billion and rising year‐on‐year. Obesity affects all socioeconomic backgrounds and ethnicities and is a pre‐requisite for metabolic syndrome. Metabolic syndrome is a clustering of risk factors, such as central obesity, insulin resistance, dyslipidaemia and hypertension that together culminate in the increased risk of type 2 diabetes mellitus and cardiovascular disease. As these conditions are among the leading causes of deaths worldwide and metabolic syndrome increases the risk of type 2 diabetes mellitus fivefold and cardiovascular disease threefold, it is of critical importance that a precise definition is agreed upon by all interested parties. Also of particular interest is the relationship between metabolic syndrome and cancer. Metabolic syndrome has been associated with a plethora of cancers including breast, pancreatic, colon and liver cancer. Furthermore, each individual risk factor for metabolic syndrome has also an association with cancer. Our review collates internationally generated information on metabolic syndrome, its many definitions and its associations with life‐threatening conditions including type 2 diabetes mellitus, cardiovascular disease and cancer, providing a foundation for future advancements on this topic.