2型糖尿病患者降血糖治疗前后血皮质醇浓度的变化及其临床意义

目的探究2型糖尿病患者在进行降血糖的治疗前后其血皮质醇浓度变化及临床意义。方法选取该院2015年7月—2016年7月所收治的2型糖尿病患者80例,将患者分为观察A组和观察B组,每组40例,同样选取40名健康者作为对照组,对2型糖尿病患者在高血糖状态下及血糖控制稳定4个月后早上8点、下午4点和凌晨0点的血清皮质醇(F)浓度的检测。结果两组2型糖尿病患者在治疗前、后皮质醇存在昼夜节律,并且在高血糖状态下,早上8点、下午4点和凌晨0点的血皮质醇浓度高于对照组,比较差异有统计学意义(P0.05),在进行持续4个月的血糖控制后,无慢性并发症的患者均恢复正常;而对于病情较严重的有慢性并发症的患者,皮质醇并未恢复。结论对于2型糖尿病患者来讲,存在着皮质醇分泌功能紊乱,因此就要求临床治疗中应当注意其变化。     

初诊2型糖尿病患者午夜皮质醇水平与糖代谢和胰岛β细胞功能的关系

目的 探讨午夜皮质醇水平对初诊2型糖尿病患者糖代谢及胰岛β细胞功能的影响.方法 观察180例未经治疗的初诊2型糖尿病患者午夜血清皮质醇及次晨8:00血清皮质醇、果糖胺(FA)、75 g口服葡萄糖耐量试验(OGTY)的血糖、胰岛素曲线下面积,并与对照组进行比较.结果 2型糖尿病组晨8:00及午夜血清皮质醇浓度明显高于对照组[8:00(956.34±334.72 vs 579.43±83.86)nmol/L,0:00(316.20±248.20 vs 169.34±38.53)nmol/L,P＜0.01].偏相关分析显示,控制变量晨8:00血清皮质醇浓度的影响,午夜血清皮质醇浓度与FA正相关(r=0.38,P＜0.001);与OGTT葡萄糖曲线下面积正相关(r=0.43,P＜0.1301),与胰岛素曲线下面积负相关(r=-0.52,P＜0.001).结论 初诊2型糖尿病患者午夜0:00血清皮质醇浓度升高与血糖控制不佳及胰岛β细胞功能异常有关.     

成人2型糖尿病基础胰岛素起始调量期专家指导意见

正一、前言糖尿病是一种慢性进展性疾病,长期慢性高血糖可显著增加糖尿病患者慢性并发症发生的风险。多项研究均已证实,持续良好的血糖控制可减少糖尿病慢性并发症发生风险~([1-5])。当前我国2型糖尿病(T2DM)的管理现况是血糖控制水平差,     

波动性高血糖、代谢记忆与糖尿病慢性并发症

糖尿病治疗的核心是防治糖尿病慢性并发症,波动性高血糖通过刺激氧化应激,会增加患者产生代谢记忆及诱发糖尿病并发症的机率.代谢记忆已逐渐成为糖尿病治疗中新的挑战.一、波动性高血糖和糖尿病并发症血糖紊乱分为持续性高血糖和血糖波动为特征的波动性高血糖[1].波动性高血糖是指间歇性或阵发性高血糖状态,亦称血糖飘移.早期的研究多关注于长期慢性高血糖与并发症的关系,随着血糖监测手段的发展,糖尿病患者血糖波动逐渐为人们所重视.近年来的研究表明,波动性高血糖相对于持续性高血糖更能增加糖尿病患者发生并发症的危险性.糖尿病慢性并发症的发生、发展不仅与整体血糖水平相关,而且与血糖的波动性密切相关[2].血糖波动通过活化氧化应激、炎症反应损失内皮细胞参与糖尿病并发症的进展,因此,对血糖波动的正确认识、评价和积极控制将有助于减缓糖尿病并发症的发生.波动性高血糖导致糖尿病慢性并发症,可能与血糖波动产生氧化应激产物激活血管损伤的4条途径有关[3].     

长效胰岛素类似物在临床上的应用

正根据2010年国际糖尿病联盟(IDF)的统计资料显示,全世界糖尿病患者约2.85亿,中国糖尿病的发病率9.7%,糖尿病患者数量超过9200万~([1])。血糖控制不佳导致的高血糖的"代谢记忆"效应,促使并发症的发生和发展~([2])。早期血糖控制可减少1型糖尿病患者慢性微血管并发症的发生~([3]),研究~([4-5])显示,病程早期经过胰岛素强化治疗的1型     

餐后高血糖及其控制

糖尿病高血糖可有两种形式,一为空腹、餐后均有血糖升高,二为空腹血糖正常或微高而餐后血糖明显升高。由此可见,餐后高血糖是糖尿病患者的共性现象。只有血糖总体水平(包括空腹及餐后)得到良好的控制,才能有效地预防和延缓糖尿病慢性并发症的发生。而且糖血病早期往往仅有餐后血糖升高,所以重视检查餐后血糖,也是防止漏诊的重要措施。餐后2小时血糖(PBG)以控制在4.5～7.8mmol/L为最佳状态,7.9～8.9mmol/L较好。葡萄糖耐量减低(IGT)时,机体在较多时间内已超过上述水平。治疗不当的糖血病患者,进餐后高血糖状态持续的时间比空腹时正常血糖…     

脆性糖尿病的精细化管理

脆性糖尿病的特点为胰岛功能衰竭、血糖波动极大、严重低血糖与高血糖酮症交替出现, 其危害巨大, 给患者带来了沉重的心理负担, 且导致远期并发症的发生风险明显增高, 属于临床上的难治性糖尿病, 常见于1型糖尿病和长病程的2型糖尿病患者。脆性糖尿病患者均需胰岛素替代治疗, 在治疗中获得良好的血糖控制需要多方面的精细化管理。该文从血糖监测的精细化、胰岛素使用的精细化、结构化教育的精细化, 并结合当下新技术对难治性脆性糖尿病的管理进行阐述, 以期改善患者的血糖控制, 从而降低急慢性并发症的发生风险, 提高患者的生存质量。     

糖尿病患者血糖和血脂水平改善与血浆同型半胱氨酸水平的相关性

目的探讨2型糖尿病（T2DM）患者不同血糖状态及降血糖治疗对血浆同型半胱氨酸（Hcy）水平的影响。方法对225例无明确并发症和合并症的T2DM患者,分别测定FPG、2hPG、血脂、血浆Hcy。其中病程3个月内患者43例,进行药物等综合降血糖治疗3个月后再检测以上指标。统计分析血糖控制水平及随访前后糖脂指标变化和Hcy的关系。结果血糖控制良好的患者血浆Hcy水平较血糖控制差的显著降低（14．10±3．92vs15．44±4．28,P〈0．05）;新诊断的患者治疗后血浆Hey水平也较治疗前显著降低（14．18±4-2．26vs15．25±2．41,P〈0．01）,血糖控制较好的患者血浆Hcy水平仍较正常人偏高。相关分析显示,血浆Hcy水平主要与FPG和HbA1c正相关（分别r=0．193,0．274,P〈O．01）。结论糖尿病患者的血浆Hcy水平升高,良好控制血糖,可以降低血浆Hcy浓度。     

动态血糖监测系统的准确性评估

良好的血糖控制能延缓和（或）阻止糖尿病慢性并发症的发生。但是,不管是对1型还是2型糖尿病患者,良好的血糖控制是以严重的低血糖发生增加为前提条件,低血糖成为血糖控制达标的最大障碍。在糖化血红蛋白（HbA1c）控制良好的患者,常出现血糖波动,即出现不可预料的低血糖和高血糖;而且,低血糖尤其是无症状性低血糖,     

己糖胺通路在糖尿病细胞糖代谢异常中的作用

糖尿病状态下血糖的持续升高 ,是引起糖尿病慢性并发症的主要原因[1,2 ] 。除了造成糖尿病肾病、糖尿病视网膜病变、糖尿病神经病变等慢性血管并发症外 ,高血糖本身对机体血糖的控制存在不利的影响。研究发现 ,2型糖尿病时血糖的升高会引起胰腺 β细胞胰岛素的分泌减少 ,高血糖本身还进一步导致胰岛素抵抗 (ｉｎｓｕｌｉｎｒｅｓｉｓｔａｎｃｅ) ,而严格控制血糖能改善糖尿病患者外周组织对胰岛素的敏感性[3] 。高血糖对机体代谢及组织造成的这些不利影响称之为葡萄糖毒性作用 (ｇｌｕｃｏｓｅｔｏｘｉｃｉｔｙ) ,其作用机制目前还未完全阐…     

2型糖尿病患者糖皮质激素变化的临床研究

目的　探讨 2型糖尿病患者糖皮质激素分泌变化的规律及其临床意义。方法　测定 2 2名健康人 (对照组 )和 6 3例 2型糖尿病患者 (其中 39例 2型糖尿病无微血管病变、2 4例 2型糖尿病并微血管病变 )的血皮质醇 (F) ( 8Am、4Pm )、2 4h尿游离皮质醇 (UFC)及血糖 (FBG、2hPG)、HbA1c、TC和TG。结果　 2型糖尿病组的血F( 8Am、4Pm)及 2 4hUFC与对照组比较 ,差异有显著性 (P <0 .0 5 )。糖尿病有微血管病变组的 2 4hUFC的排量高于无微血管病变组 (P <0 .0 5 )。糖尿病组 2 4hUFC与HbA1c呈正相关 (r =0 .2 76 ,P <0 .0 5 ) ,与病程呈正相关 (r =0 .72 4,P <0 .0 1) ,与 2 4h尿微量白蛋白 (UAP)呈正相关 (r =0 .486 ,P <0 .0 1) ,与TG呈正相关 (r= 0 .42 1,P <0 .0 1)。结论　 2型糖尿病患者糖皮质激素水平增高 ,加重了糖代谢和脂代谢紊乱 ,使糖尿病患者的病情恶化 ,最终促使糖尿病并发症的发生。     

Early diagnosis and treatment of steroid-induced diabetes mellitus in patients with rheumatoid arthritis and other connective tissue diseases

Abstract

Purpose To reveal how often patients with rheumatoid arthritis (RA) or any of other connective tissue diseases (CTDs) who take prednisolone (PSL) manifest postprandial hyperglycemia, and to evaluate the effects of divided daily dose administration of PSL, and of acarbose and nateglinide, on RA patients.

Method The blood sugar (BS) levels of the patients were measured after meals. For in-patients who showed postprandial hyperglycemia, the daily dose of PSL was divided and nateglinide and/or acarbose were/was added if their BS levels did not improve sufficiently. The patients with BS levels that were well controlled for three months were compared with the patients with poorly controlled BS levels.

Results The BS levels of 78 patients, including 16 patients with diabetes mellitus (DM), were measured after meals, and 27 of them were newly diagnosed with DM. Five of 14 patients who took a steady dose of PSL showed high BS levels after lunch (over 200 mg/dl) without elevated HbA1c. The combination therapy of divided-dose PSL and nateglinide and/or acarbose improved postprandial hyperglycemia significantly. The period from the start of PSL administration to intervention was significantly longer in patients with good control at three months than the corresponding period in those with poor control.

Conclusion The prevalence of postprandial hyperglycemia was high in patients with RA/CTD taking PSL; accordingly, measurement of the BS level after each meal was valuable. Combination therapy of divided-dose PSL and nateglinide and/or acarbose improved postprandial hyperglycemia.     

Cardiovascular Effects of Metabolic Surgery on Type 2 Diabetes

Introduction Cardiovascular, together with renal disease, claims a significant proportion of morbidity and mortality in association with type 2 diabetes mellitus (T2DM) and obesity. To improve the long-term renal and cardiovascular outcome, there is the incorporation of bariatric surgery (BS), which seems to be a pivotal intervention.Areas Explored Cohort studies and randomized controlled trial (RCT) research of BS among patients with T2DM, were conducted by screening, and then information on renal effects and the cardiovascular outcome was gathered. Metabolic surgery (MS) and BS reduce both mortality and the risk of cardiovascular disorder, chronic kidney diseases and albuminuria. MS refers to a surgical approach, the primary intent of which is the control of metabolic alterations/hyperglycemia in contrast to BS which is a mere weight-reduction therapy. Patients suffering from poor glycaemic control and other macro and micro-vascular diseases will benefit from a surgical approach. The approach implicates hypertension glomerular remission, gut microbiota shift, reduced renal inflammation and fewer instances of chronic cardiac remodelling.Conclusion MS is beneficial where the main aim is to attain significant and long-lasting weight loss results. The RCTs have depicted the superiority which surgical mechanisms hold over medically-based therapy, for enhancing glycaemic control, and achieving remission of diabetes. This type of surgery improves life quality, reduces incidences of other obesity and diabetes related diseases like microvascular disases, sleep apnea, fatal disorder, and fatty liver disease.     

A comparative study of the glycemic control of various antidiabetic agents and the role of homocysteine in the therapy of type 2 diabetes mellitus

OBJECTIVES: The objectives of this study were to evaluate and to compare the glycemic control of various antidiabetic agents and the role of homocysteine in type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS: Two hundred forty patients with type 2 diabetes mellitus, divided into Groups 1-6 (n=40), received glipizide, glipizide-SR, glimepiride, glibenclamide, metformin, and insulin followed by an oral hypoglycemic agent, respectively. They were evaluated with respect to glycemic control, serum insulin, safety, and quality of life (QoL) for 24 weeks. Furthermore, poorly controlled patients with elevated serum homocysteine were divided into two groups, of which received folic acid for 4 weeks. RESULTS: Glipizide-SR significantly improved glycemic control at lower serum insulin levels, was well tolerated, and improved QoL. Metformin improved glycemic control and reduced insulin resistance in obese type 2 diabetes mellitus patients. Initial insulin therapy led to rapid reduction in hyperglycemia with reduced insulin resistance. Folic acid therapy significantly (P<.001) lowered elevated serum homocysteine levels in poorly controlled patients. CONCLUSIONS: Glipizide-SR emerged as the sulfonylurea of choice in lean type 2 diabetes mellitus patients, while metformin was preferable for obese type 2 diabetes mellitus patients. Short-course insulin therapy with subsequent oral hypoglycemic agent could obviate the need for continuous insulin therapy in poorly controlled type 2 diabetes mellitus patients. Folic acid constitutes an inexpensive and safe therapy for hyperhomocysteinemia in patients with type 2 diabetes mellitus.     

Evidence that diabetes mellitus favors impaired metabolism of zinc, copper, and selenium in chronic pancreatitis

Diabetes mellitus, a common complication of chronic pancreatitis, can disturb the metabolism of zinc, copper, and selenium. We analyzed the effects of hyperglycemia, malabsorption, and dietary intake on these factors in 35 men with alcohol-induced chronic pancreatitis complicated by insulin-treated diabetes mellitus (CP-D), 12 men with chronic pancreatitis but no diabetes (nondiabetic CP), 25 men with type 1 diabetes mellitus (type 1 DM), and 20 control subjects. Diabetes due to chronic pancreatitis was associated with decreased plasma zinc and selenium concentrations and with increased urinary copper excretion. Of the chronic pancreatitis patients, 17% had low plasma zinc, and 41% of them had low plasma selenium. None of the type 1 diabetic patients had low plasma concentrations of zinc, but 12% of them had a low selenium concentration. Hyperglycemia, as assessed by fasting plasma glucose and by plasma HbAlc, was responsible for the increased zinc excretion and the decreased superoxide dismutase activity. The perturbations of the copper, selenium, and zinc metabolism were particularly pronounced in subjects with chronic pancreatitis plus diabetes mellitus. We have yet to determine whether the differences in trace-element status contribute to the clinical expression of the disease.     

老年2型糖尿病合并侵袭性肺曲霉菌病误诊2例报告并文献复习

目的讨论侵袭性肺曲霉菌病的临床特征、诊断、治疗方法以及在老年2型糖尿病患者中发病的原因分析。方法报告2例老年2型糖尿病患者合并侵袭性肺曲霉菌病的误诊病例,同时进行相关文献复习。结果2型糖尿病作为慢性基础疾病是发生侵袭性肺曲霉菌病的危险因素。侵袭性肺曲霉菌病临床诊断应综合症状、实验室和影像学检查,确诊依靠病理结果。结论老年2型糖尿病患者若出现难以治愈的肺部感染,应想到侵袭性肺曲霉菌病的可能。侵袭性肺曲霉菌病死亡率高,应在有效地控制患者血糖指标和相关并发症的同时,积极抗真菌治疗,对于老年人必要时应用胸腺肽增强免疫力提高治疗效果。     

Epigenetic phenomena linked to diabetic complications

Diabetes mellitus (type 1 and type 2) and the complications associated with this condition are an urgent public health problem, as the incidence of diabetes mellitus is steadily increasing. Environmental factors, such as diet and exposure to hyperglycemia, contribute to the etiology of diabetes mellitus and its associated microvascular and macrovascular complications. These vascular complications are the main cause of the morbidity and mortality burden of diabetes mellitus. The DCCT-EDIC and UKPDS epidemiological studies correlated poor glycemic control with the development of vascular complications in patients with type 1 or type 2 diabetes mellitus. The findings of these studies suggest that early exposure to hyperglycemia predisposes individuals to the development of diabetic complications, a phenomenon referred to as metabolic memory or the legacy effect. The first experimental evidence for metabolic memory was reported >20 years ago and the underlying molecular mechanisms are currently being characterized. Interestingly, transient exposure to hyperglycemia results in long-lasting epigenetic modifications that lead to changes in chromatin structure and gene expression, which mediate these persistent metabolic characteristics.     

Consensus report of the joint workshop of the Italian Society of Diabetology,Italian Society of Periodontology and Implantology,Italian Association of Clinical Diabetologists (SID-SIdP-AMD)

Periodontitis has been defined as the Sixth complication of Diabetes Mellitus. Since both diabetes mellitus and periodontitis have a high prevalence in the general population, the Italian Society of Diabetology, the Italian Society of Periodontology and Implantology and the Italian Association of Clinical Diabetologists revised the present scientific literature in the present consensus report.A bi-directional interaction was demonstrated: Patients affected by type 1 and type 2 diabetes have a higher prevalence of periodontitis than the general population, due to several metabolic factors (e.g. chronic hyperglycemia, autoimmunity, dietary and life-style factors); similarly, periodontitis predisposes to type 2 diabetes mellitus mainly via the increase of systemic cytokines release. Conversely, improvement of metabolic control of diabetic patients delay the progression of periodontitis as well as periodontitis treatment reduces glycosylated hemoglobin levels in blood.Due to the bi-directional causal interaction between periodontitis and diabetes mellitus, a strict collaboration among dentists and diabetologists is required and strongly recommended. The inter-societies consensus proposes specific flow-diagrams to improve the treatment of patients and management of the general population regarding the issue of periodontitis and diabetes.     

Relationship between diurnal blood pressure variation and diurnal blood glucose levels in type 2 diabetic patients

BACKGROUND: Hypertension and hyperglycemia are established risk factors for progression of microangiopathies and macroangiopathies in type 2 diabetes mellitus. Cardiovascular risk is even more increased in diabetic patients with nocturnal nondipping or postprandial hyperglycemia. We therefore investigated the relationship between diurnal hyperglycemia and diurnal blood pressure (BP) variation in patients. METHODS: One hundred seven hypertensive type 2 diabetic patients received a 24-h ambulatory BP recording. In addition, a diurnal blood glucose profile was assessed under standardized conditions on the same day: before breakfast, 2 h after breakfast, before lunch, 2 h after lunch, before dinner, 2 h after dinner, at 10:00 pm, at midnight, and 3:00 am of the following day. Degrees of fasting and postprandial hyperglycemia were calculated as area under the curve. RESULTS: Nocturnal nondipping occurred in 73% of our patients. Nondippers showed higher postprandial blood glucose excursions than dippers (59.5 +/- 29 v 40.7 +/- 33 mmol h/L), whereas fasting hyperglycemia or glycosylated hemoglobin (HbA(1c)) were not significantly different (56.6 +/- 49 v 54.1 +/- 44 mmol h/L and 8.8% +/- 1.9% v 8.2% +/- 1.8% for nondippers and dippers, respectively). Nocturnal nondipping was associated with a higher urinary protein excretion and lower day/night heart rate ratio. Multivariate analysis revealed postprandial hyperglycemia as an independent predictor for nondipping. CONCLUSIONS: Postprandial rather than fasting hyperglycemia was associated with abnormal diurnal BP variation. These observations might favor treatment regimes targeted on postprandial hyperglycemia, which could restore dipping pattern.     

Cognitive function, dementia and type 2 diabetes mellitus in the elderly

Increasing numbers of people are developing type 2 diabetes mellitus, but interventions to prevent and treat the classic microvascular and macrovascular complications have improved, so that people are living longer with the condition. This trend means that novel complications of type 2 diabetes mellitus, which are not targeted by current management strategies, could start to emerge. Cognitive impairment and dementia could come into this category. Type 2 diabetes mellitus is associated with a 1.5-2.5-fold increased risk of dementia. The etiology of dementia and cognitive impairment in people with type 2 diabetes mellitus is probably multifactorial. Chronic hyperglycemia is implicated, perhaps by promoting the development of cerebral microvascular disease. Data suggest that the brains of older people with type 2 diabetes mellitus might be vulnerable to the effects of recurrent, severe hypoglycemia. Other possible moderators of cognitive function include inflammatory mediators, rheological factors and dysregulation of the hypothalamic-pituitary-adrenal axis. Cognitive function should now be included as a standard end point in randomized trials of therapeutic interventions in patients with type 2 diabetes mellitus.