Lipid-lowering therapy in patients with type-2 diabetes mellitus

Diabetic dyslipidemia is mainly characterised by hypertriglyceridaemia, low HDL-cholesterol level, an increased small dense HDL concentration, i.e. by atherogenic dyslipidemia. Dyslipidaemia occurs in some two third of the type 2 diabetes cases. In the treatment of dyslipidaemia it is essential to control the diabetes, to reduce the intake of saturated fat and supplement it with monounsatured fat ty acid or complex carbohydrates. Based on the latest studies diabetes is considered the same risk as coronary heart disease and, therefore, diabetic dyslipidaemia should be treated in the same aggressive way. According to the simplified guidelines, after the diet--above 5.2 mmol/l cholesterol level--antilipaemic drugs, i.e. statin should be administered in order to achieve the primary goal of the therapy, namely the 2.6 mmol/l LDL-cholesterol level. In patients with combined II/b type hyperlipoproteinaemia statins are the drugs of first choice, fibric acid derivates being only considered in case of normal LDL-cholesterol level (< 3.4 mmol/l), if the HDL-cholesterol level is also low. Fibrate therapy is the first choice in the isolated hypertriglyceridaemia (> 2.3 mmol/l) as well as in type V. hyperlipoproteinaemia. On the basis of the guidelines far more patients with diabetes should be treated with lipid lowering therapy than before.     

格列齐特联合二甲双胍治疗老年2型糖尿病患者的效果

目的观察格列齐特联合二甲双胍治疗老年2型糖尿病(type 2 diabetes mellitus,T2DM)患者的效果。方法选取湛江中心人民医院收治的148例老年T2DM患者作为研究对象,按随机数字表法分成观察组(n=74)及对照组(n=74)。对照组给予二甲双胍治疗,观察组在对照组基础上联合格列齐特治疗。两组均治疗3个月,比较两组临床疗效,治疗前及治疗3个月后血液流变学相关指标、血管内皮指标、血脂指标水平及不良反应发生情况。结果观察组治疗有效率为97.30%,明显高于对照组的89.19%,差异有统计学意义(P<0.05);治疗后,观察组全血黏度高切、全血黏度低切、血浆黏度均明显低于对照组,差异均有统计学意义(P<0.05);治疗后,观察组一氧化氮、血管内皮生长因子、内皮素-1水平均明显低于对照组,差异均有统计学意义(P<0.05);治疗后,观察组高密度脂蛋白胆固醇、总胆固醇、三酰甘油、低密度脂蛋白胆固醇水平均明显优于对照组,差异均有统计学意义(P<0.05)。结论格列齐特联合二甲双胍治疗老年2型糖尿病患者能提高治疗有效率,降低血液流变学指标水平,改善血管内皮功能及血脂指标水平的效果优于单纯二甲双胍治疗效果。     

妊娠期糖尿病综合护理效果观察

目的研究饮食控制及健康教育综合护理对妊娠糖尿病(GDM)的作用。方法选择2011年1—12月来本院围产检查确诊并在院分娩的GDM患者77例,依随机原则将其分为2组,综合护理组38例采用严格饮食控制与综合健康教育,常规护理组39例仅采用健康宣教和常规护理,比较护理前后2组空腹血糖、餐后2 h血糖、糖化血红蛋白水平、并发症情况。结果综合护理组经综合护理后空腹血糖、餐后2 h血糖、糖化血红蛋白水平较护理前明显下降,也低于常规护理组(P<0.05),孕妇与围产儿并发症发生率也低于常规护理组。结论严格的饮食控制及健康教育有利于降低GDM孕妇的血糖,并减少孕妇和围产儿并发症的发生率。     

胰岛素联合二甲双胍对妊娠期糖尿病孕妇妊娠结局及新生儿的影响

目的分析二甲双胍对妊娠期糖尿病孕妇妊娠结局及新生儿的影响。方法选取2013年12月-2015年12月在该院就诊的妊娠期糖尿病孕妇120例为本次的观察对象,采取计算机随机分组法分为对照组与观察组,每组各60例。对照组采用胰岛素进行治疗,观察组在此基础上加用二甲双胍进行治疗,比较两组孕妇的妊娠结局及对新生儿的影响。结果治疗前两组孕妇血糖水平比较差异无统计学意义(P>0.05),治疗后观察组孕妇血糖控制明显优于对照组(P<0.05),观察组孕妇血糖控制率为91.67%,对照组为46.67%(P<0.05);观察组孕妇妊娠并发症、新生儿低血糖、新生儿黄疸发生率明显低于对照组(均P<0.05)。结论二甲双胍联合胰岛素治疗妊娠期糖尿病,能够有效改善血糖各项指标,同时还能够改善妊娠结局,值得临床推广应用。     

癌症合并糖尿病病人的营养治疗研究

目的:研究癌症合并糖尿病病人的营养治疗方法和效果.方法:对我院住院的155例癌症合并糖尿病病人进行了营养治疗和疗效观察.结果:所有病人治疗前、后的空腹血糖和餐后2 h血糖均有明显下降(P＜0.05);全部病人均能接受足够疗程的化疗、放疗和手术,未因身体条件差、糖尿病或并发症而中断治疗和延误手术.结论:合理的营养支持有助于控制癌症合并糖尿病病人的血糖,有效地改善其营养状况,提高其生活质量和对化、放疗和手术的耐受性.     

老年糖尿病合并牙周炎患者的综合治疗分析

目的;探讨老年糖尿病合并牙周炎患者治疗的临床疗效.方法;106名老年糖尿病合并牙周病患者,随机分成两组,其中一组在血糖的良好控制下进行牙周病的基础治疗;另一组在血糖未被控制下进行牙周病的基础治疗.结果:血糖控制组的临床疗效明显好于血糖未被控制组.结论:老年糖尿病合并牙周病患者综合治疗效果要优于单一的治疗效果     

老年患者的糖尿病教育

糖尿病是危害人体健康的一种常见病,轻无任何不适感觉,重可致残如眼底病变引起失明、下肢血管病变引起截肢等,更严重可死亡,如糖尿病合并高渗性昏迷时死亡率高达50％～60％。其病变可渡及到全身各组织器官,如眼、肾、神经系统、心血管系统、皮肢、牙齿、肌肉等;绝大多数糖尿病可以控制,但尚不能治愈。患糖尿病后,终身需要注意饮食合理和保持生活方式健康。     

糖尿病患者医院感染分析

目的 了解糖尿病患者医院感染发生情况，提高认识，降低医院感染发病率。方法 对328例糖尿病患者的住院资料进行回顾性凋查分析。结果 糖尿病患者的医院感染率为17．38％；感染部位前3位分别是呼吸道、泌尿道和胃肠道，占82.48％；高龄、住院时间长、入院前使用抗菌药物、糖尿病控制不佳、并发症及侵入性诊疗措施是糖尿病医院感染的危险因素。结论 积极治疗原发病与并发症、有效控制血糖、缩短住院时间、合理使用抗菌药物、尽量避免侵人性诊疗操作是防治糖尿病医院感染的关键。     

糖尿病患者医院感染危险因素及其临床特点

目的探讨糖尿病患者并发医院感染的危险因素，从而有效预防和控制糖尿病患者发生医院感染。方法回顾性调查某院2005年1月-2006年12月间出院的糖尿病患者病历，对其医院感染危险因素进行分析。结果共调查1247例糖尿病患者，其中53例发生医院感染，医院感染率为4．25％，明显高于同期全院医院感染率2．84％（χ^2=9，18，P〈0．01）。糖尿病患者医院感染部位以呼吸道最多见，共发生47例次；其次为胃肠道13例次，泌尿道11例次，皮肤黏膜1例次，口腔1例次。糖尿病患者并发医院感染与高龄（≥60岁）、住院时间长、糖尿病病程长、血糖控制不佳及有创诊疗有关。结论糖尿病患者医院感染率较高，应严格控制易感因素，并针对其危险因素重点监控。     

Cellular zinc in patients with diabetes mellitus

Although hyperzincuria appears to be a common finding in most diabetic subjects, plasma zinc concentration has been reported to be normal, increased, or decreased in these patients. In this study we assayed cellular zinc levels of diabetic subjects in order to assess zinc status. Zinc levels in plasma, lymphocytes, granulocytes, and platelets were lower than in controls. We also observed hyperzincuria in our subjects. The activity of nucleoside phosphorylase a zinc dependent enzyme, was decreased in the lymphocytes. Based on these data we conclude that our diabetic subjects were zinc deficient.     

Effect of non-surgical periodontal therapy on patients with type 2 diabetes mellitus

The AIM of this study was to evaluate the effect of non-surgical therapy on clinical variables and glycemic control on type 2 diabetics with chronic periodontitis. PATIENTS AND METHODS: Forty six type 2 diabetics with chronic periodontitis were randomized into two groups (group A and group B). Treatment included scaling and root planning for group A plus systematic use of doxycycline in both groups. Assessment was made prior to and 16 weeks following the therapy. RESULTS: Analysis of data showed that both groups had clinical and glycated hemoglobin (HbAlc) improvement after the treatment. Group A had a statistically significant reduction of plaque index and bleeding on probing scores compared with controls (P < 0.05) at 16 weeks. CONCLUSION: These results suggest that non-surgical therapy is of value in maintaining periodontal health and may be beneficial in reducing blood glucose level in type 2 diabetics with chronic periodontitis.     

Heart disease in patients with diabetes mellitus

When this journal appeared as the Journal of Chronic Diseases, major reviews were published from time to time that summarized the state of science about a particular topic or a current issue. Although the editorial policy then and now has given reports of original research the highest priority, our readers have always appreciated the value and convenience of summary, synthesis and interpretation afforded by papers such as this Commentary by Sniderman and his colleagues. As usual, letters and other comments will be welcome. W.O.S.     

Current role of metformin in treatment of diabetes mellitus type 2

Metformin-associated lactic acidosis is not necessarily due to metformin accumulation. It appears that mortality in patients receiving metformin who develop lactic acidosis is mostly linked to underlying disease. It has been suggested that metformin should be the first-line agent for the treatment of obese type 2 diabetic patients since metformin was associated with a significant decrease in macrovascular events and a reduction of all-cause mortality in the United Kingdom Prospective Diabetes Study (UKPDS) in a substudy. However, in this substudy no significant decrease in microvascular complications was observed in obese subjects with intensive metformin therapy. In addition, the use of metformin in combination with sulfonylurea seemed to be associated with excess risk of diabetes-related and all-cause mortality in obese subjects. Due to the discrepant and contradictory nature of the results in the obese patients and a lack of power the UKPDS offered no decision for any drug for initial therapy of type 2 diabetes. The main message of the UKPDS is that lowering of the blood glucose to the normal range is beneficial irrespective of the hypoglycaemic agent used. A rational approach to therapy in a type 2 diabetes patient who fails to sufficiently lower blood sugar with diet and weight loss is to begin therapy with a sulfonylurea or metformin and to add another oral agent if the desired glycaemic control is not achieved.     

糖尿病患者合并医院感染的临床特征分析

目的 探讨糖尿病患者医院感染的临床特征及预防措施.方法 回顾性分析1020例糖尿病患者的临床资料.结果 医院感染发生率10.78%(110/1020);以呼吸道感染46例次最高;单部位感染50例,2个部位18例,3个及3个以上部位6例;具有相关系统感染典型表现72例,38例症状不典型;病原学检查送检率为73.64%(81/110);病原微生物检出率为66.67%(54/81);年龄大、女性、病程长、血糖控制差、侵袭性操作、合并其他疾病、存在并发症、肾衰竭期、住院时间长易发生医院感染;预防性应用抗生素不能降低医院感染发生率;发生医院感染患者病死率(5.45%,6/110)高于无医院感染患者(1.54%,14/910).结论 糖尿病患者医院感染率高,可加重病情,必须积极治疗原发病,保护易感染人群,提高患者自身免疫力;合理应用抗生素,尽早寻求细菌学及药敏试验依据;严格执行无菌操作,减少侵袭性操作;缩短住院时间.