2型糖尿病合并初治肺结核38例临床分析

目的 分析2型糖尿病合并初治肺结核患者的临床特点、诊断、治疗及预后.方法 回顾分析我院38例2型糖尿病合并初治肺结核住院患者病历资料.结果 肺结核发病率与糖尿病病程长短无关;血糖控制差、糖化血红蛋白高的患者,肺结核病灶范围广,多伴有空洞,痰菌阳性率高,血糖控制理想、糖化血红蛋白达标者(＜7%)抗结核治疗效果好.结论 糖尿病的早期诊断、早期治疗、早期达标是防治肺结核的关键,糖化血红蛋白应作为糖尿病合并肺结核治疗过程中一项重要的监测指标.     

社区2型糖尿病患者影响糖化血红蛋白达标率因素分析

目的调查社区2型糖尿病患者糖化血红蛋白达标情况,探讨影响糖化血红蛋白达标的相关因素,为进一步改善2型糖尿病的控制效果、制定合理治疗方案提供理论依据。方法对716例2型糖尿病患者进行糖化血红蛋白检测、实验室常规生化项目检查,包含空腹血糖、餐后2h血糖、甘油三酯、总胆固醇、尿素氮、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、尿肌酐、尿酸、尿微量白蛋白等,同时收集患者一般资料、治疗方案信息,依据糖化血红蛋白<7%达标标准,按性别、年龄、病程、治疗方案等分组讨论影响因素。结果 716例2型糖尿病患者的糖化血红蛋白达标率是42.1%;糖化血红蛋白与糖尿病患者病程、治疗方案相关,具有统计学意义(P<0.05);糖化血红蛋白达标率与空腹血糖、餐后2h血糖以及尿微量白蛋白正常与否密切相关。结论合理控制糖化血红蛋白值,可有效控制糖尿病及并发症的发生和发展。     

2型糖尿病患者糖化血红蛋白与血糖波动的关系

2型糖尿病患者的血糖波动与糖尿病慢性并发症的关联性,目前越来越被人们所关注。糖化血红蛋白(HbAlc)是目前糖尿病诊断、血糖控制、疗效评估的有效检测指标,本研究通过动态血糖监测(continuous glucose monitoring system,CGMS),旨在探讨2型糖尿病(type2diabetes mellituse,T2DM)患者血糖波动情况与糖化血红蛋白的关系,为进一步治疗提供依据。     

2型糖尿病患者糖化血红蛋白、餐后血糖与尿微量白蛋白／肌酐比值的相关性分析

目的探讨空腹血糖达标的2型糖尿病（T2DM）患者糖化血红蛋白（HbAlc）、餐后2小时血糖值（2hPBG）与尿微量白蛋白／肌酐比值（Malb／Cr）的关系。方法选择132例空腹血糖〈7．0mmol／L的T2DM患者及30例健康体检者,Malb测定用免疫比浊法,Cr用氧化酶法,HbAlc用亲和层析高效液相法,血糖用葡萄糖氧化酶法。分析比较两组以上四项指标的测定结果。结果全部T2DM患者Malb／Cr均高于正常对照组,2hPBG及HbAlc未达标者Malb／Cr明显高于2h PBG和HbAlc达标者,也高于2h PBG和HbAlc任一项达标者。结论T2DM患者FBG控制达标后,糖化血红蛋白及餐后血糖控制不好依然会使尿白蛋白排泄率增加,故糖尿病人要同时重视FBG、2hPBG、HbAlc及Malb／Cr的监测。     

糖化血红蛋白值测量的重要性及其价值

目的为了更好的了解现阶段中国2型糖尿病患者的糖化血红蛋白的达标现状并通过宣传普及糖尿病防治基本知识来提高糖化血红蛋白的达标率,从而进一步控制和改善患者的症状及远期并发症。方法在门诊随机式的抽取来惠州市中心人民医院治疗的2型糖尿病患者,进行一系列的调查与询问,以及查看过往病历来获取数据。结果有大部分的患者存在糖化血糖值不达标的情况,并且其中有大部分的患者的糖化血红蛋白是控制极差的。结论目前绝大多数的患者都不太重视对糖化血红蛋白的测量以及控制,从中我们应该加强对患者的教育以及宣传来改善现在的状况,进一步的使患者能够更好的控制血糖,延缓和减少并发症的发生。     

上海某社区2型糖尿病控制达标状况分析

目的:了解本社区家庭医生管理下的2型糖尿病患者血糖控制达标状况.方法:以本社区已与家庭医生签约的202例2型糖尿病患者为研究对象,其中男性63例,女性139例,年龄57～96岁,平均年龄(73±8)岁.收集和分析患者的基本情况以及血糖和血脂生化指标信息.结果:空腹血糖、餐后2h血糖、糖化血红蛋白、收缩压、舒张压、高密度脂蛋白胆固醇、甘油三酯、低密度脂蛋白胆固醇、体重指数的达标率分别是62.9％、58.4％、56.9％、68.3％、60.4％、67％、58.4％、22.8％、46.5％.根据《中国2型糖尿病防治指南(2013年版)》全面达标要求,5项及以上全部达标的只有46.0％.结论:糖尿病控制的全面达标率仍然不高.家庭医生应进一步加强健康教育活动,提高糖尿病控制全面达标率,以预防2型糖尿病并发症的发生.     

甘精胰岛素联合阿卡波糖治疗糖尿病合并冠心病的疗效观察

目的 比较甘精胰岛素联合阿卡波糖治疗与预混胰岛素(诺和灵30R)治疗2型糖尿病合并冠心病的疗效与安全性.方法 将94例2型糖尿病口服降糖药控制不能达标的患者随机分为两组.观察组为甘精胰岛素联合阿卡波糖;对照组为诺和灵30R组;两组以空腹血糖<7.0 mmol/L,同时对照组晚餐前血糖<7.8 mmol/L为目标;观察24周,观察血糖、低血糖的发生率、糖化血红蛋白及体重变化等指标.结果 两组餐后血糖无统计学的差异;而空腹血糖、糖化血红蛋白的控制,夜间低血糖的发生率、体重增加均观察组优于对照组.结论 甘精胰岛素联合阿卡波糖治疗口服降糖药物控制不佳的2型糖尿病合并冠心病的患者较诺和灵30R治疗,能较好的控制血糖、糖化血红蛋白且又可减少低血糖的发生,有良好的安全性.     

辽阳市2型糖尿病患者糖化血红蛋白控制状况观察

目的:了解辽阳市社区人群2型糖尿病(T2DM)患者血糖控制状况及相关影响因素,从而进一步控制和改善患者的症状及远期并发症.方法:选2011年3～6月到辽阳市辽阳中心医院门诊就诊的,符合入选和排除标准的400名单纯口服药治疗或口服药联合胰岛素治疗的2型糖尿病患者.检测糖化血红蛋白(HbA1c)、空腹血糖(FBG)、餐后2h血糖(2hPG)等,并填写相关信息表格.结果:在400例糖尿病患者中.男女比例相当.HbA1c控制达标者(HbA1c＜7)占20.5%.控制不达标者(≥7)占79.5％.91.75％调研对象过去一周末进行自我血糖监测;单纯口服药组的HbA1c达标率显著高于口服药联合胰岛素组(23.29％ vs 18.9％.P＜0.05);口服药联合类似物治疗组的HbA1c达标率显著高于口服药联合人胰岛素组(24.39％ vs 11.76％,P＜0.01).结论:糖尿病控制现状不容乐观:应进一步加强糖尿病防控教育与宣传,及时调整治疗方案,改善患者血糖控制状况.     

甘精胰岛素治疗老年2型糖尿病口服药物控制不佳的临床观察

目的探讨甘精胰岛素（来得时）治疗老年2型糖尿病口服药物效果不佳时的疗效。观察治疗前后血糖、糖化血红蛋白、血脂、体质量变化、低血糖发生情况等指标变化。方法选择38例老年2型糖尿病患者,在使用口服药物血糖控制不理想（FBG〉10.0mmol/L）的基础上加用来得时治疗,随访3个月。结果治疗后患者三餐前后血糖,睡前血糖、糖化血红蛋白均较治疗前明显下降（P〈0.01）,体质量变化不大,低血糖发生率低。结论老年2型糖尿病口服药物不达标时,应用来得时,可以有效控制血糖,平稳达标,低血糖发生率低。     

2型糖尿病患者持续皮下输注胰岛素达标剂量的相关因素研究

目的:探讨持续皮下输注胰岛素治疗2型糖尿病胰岛素达标剂量的相关因素,为临床估算胰岛素总剂量提供参考。方法:收集在我院治疗的78例应用皮下胰岛素泵治疗的2型糖尿病患者的胰岛素达标剂量数据,测定各临床指标,分析患者胰岛素达标剂量与糖化血红蛋白、空腹血糖、体重指数及体重的相关性。结果:患者血糖控制达标时的胰岛素总剂量与空腹血糖、体重指数呈正相关(P<0.05),其中空腹血糖与胰岛素达标剂量相关性最好,可用公式表示:胰岛素总量(u)=3.62×治疗前空腹血糖(mmol·L-1)。结论:2型糖尿病患者血糖控制达标时的胰岛素总剂量与空腹血糖最相关,因此临床可根据患者空腹血糖估算胰岛素达标剂量。     

老年2型糖尿病及其合并脑梗死血尿酸水平

目的探讨老年2型糖尿病及其合并脑梗死时血尿酸水平。方法选取32例健康老人,35例老年2型糖尿病患者,33例老年2型糖尿病合并脑梗死患者进行血尿酸水平测定,并分组进行分析。结果2型糖尿病组及糖尿病合并脑梗死组血尿酸水平明显高于对照组,P〈0.05,差异有统计学意义,糖尿病合并脑梗死组较2型糖尿病组血尿酸水平增高,P〈0.05,差异有统计学意义。结论血尿酸在老年2型糖尿病患者中升高,当糖尿病合并脑卒中时,血尿酸水平进一步增高。提示血尿酸是预测2型糖尿病脑血栓形成的重要因素。     

2型糖尿病及二甲双胍治疗对乳腺癌患者预后的影响

目的 探讨2型糖尿病与乳腺癌的关系,以及二甲双胍治疗对2型糖尿病合并乳腺癌患者预后的影响.方法 收集河北省人民医院自2014年1月到2015年12月之间乳腺癌合并2型糖尿病患者102例为2型糖尿病组,选取同时期就诊的乳腺癌非糖尿病患者106例为对照组,其中2型糖尿病组按治疗方案中是否使用二甲双胍分为二甲双胍组和非二甲双...     

Insulin aspart: a review of its use in the management of type 1 or 2 diabetes mellitus

Insulin aspart (NovoRapid, NovoLog) is a short-acting insulin analogue, which has a faster onset and shorter duration of action than regular human insulin. Insulin aspart administered immediately before meals provided significantly greater improvements in glycosylated haemoglobin and better postprandial glycaemic control than regular human insulin administered 30 minutes before meals, when used in a basal-bolus regimen with neutral protamine Hagedorn (NPH) insulin, in randomised, nonblind studies in patients with type 1 diabetes mellitus. In patients with type 2 diabetes, insulin aspart provided similar glycaemic control to regular human insulin, administered in a basal-bolus regimen with NPH insulin. Small studies suggest that the use of insulin aspart in combination with oral hypoglycaemic agents may be beneficial. Insulin aspart, administered by continuous subcutaneous insulin infusion (CSII) provided better glycaemic control than insulin aspart multiple daily injection regimens in patients with type 1 (but not type 2) diabetes, and had similar efficacy to CSII with insulin lispro or regular human insulin in type 1 diabetes. Limited studies show insulin aspart to be effective in children, adolescents and young adults with type 1 diabetes. Insulin aspart had a tolerability profile similar to that of regular human insulin in clinical trials. The incidence of major or nocturnal hypoglycaemic events reported in patients receiving insulin aspart was lower than that of regular human insulin in several studies.In conclusion, insulin aspart, administered immediately before meals in a basal-bolus regimen with NPH insulin, provided better long-term glycaemic control than regular human insulin administered 30 minutes before meals in patients with type 1 diabetes, and was as effective as regular human insulin in patients with type 2 diabetes. A significantly lower risk of hypoglycaemia was seen in several trials. Insulin aspart CSII provided better glycaemic control than insulin aspart multiple daily subcutaneous injection (MDI) in patients with type 1 (but not type 2) diabetes and had similar efficacy to CSII with insulin lispro or regular human insulin in type 1 diabetes. Insulin aspart is an effective and well tolerated alternative to regular human insulin and insulin lispro for the maintenance of glycaemic control in patients with type 1 or 2 diabetes.     

血糖控制对急性心肌梗死患者C反应蛋白及近期预后的影响

目的探讨伴2型糖尿病的急性心肌梗死患者血糖控制情况对高敏c反应蛋白（hs—CRP）水平及住院期间不良心血管事件产生的影响。方法110例急性心肌梗死患者分为3组,I组为不伴糖尿病组,Ⅱ组为伴2型糖尿病且血糖控制良好组,Ⅲ组为伴2型糖尿病且血糖控制不良组。观察3组患者既往糖化血红蛋白水平、入院后hs—CRP水平及不良心血管事件发生。结果Ⅱ组和Ⅲ组患者hs-CRP水平分别为（7．21±1．37）mg／L、（9．48±1．10）mg／L,明显高于I组（3．56±1．72）mg／L,差异有统计学意义（均P〈0．01）。I组、Ⅱ组和Ⅲ组不良心血管事件发生概率分别为13．5％（7／52）、31．6％（12／38）和60．0％（12／20）,Ⅱ组与I组比较P〈0．05,Ⅲ组与Ⅰ组比较P〈0．01。结论血糖控制不良可抬高伴2型糖尿病的心肌梗死患者hs—CRP水平,伴2型糖尿病的冠心病患者控制血糖可改善发生心肌梗死后的近期预后。     

糖化血红蛋白、胱抑素C联合测定在2型糖尿病肾功能中的研究

目的讨论HbA1c、CysC联合检测在2型糖尿病肾病中的意义。方法将246例在信宜市人民医院进行治疗的2型糖尿病患者依据是否合并肾病分为两组,2型糖尿病患者合并肾病组118人,无合并肾病组128人;治疗后按照患者糖化血红蛋白控制水平分为HbA1c<7.0%组和HbA1c>7.0%组;取自愿来信宜市人民医院进行健康体检的自愿者54名为对照组。对所有参加实验的人分别测定糖化血红蛋白和胱抑素C的水平。结果 2型糖尿病患者的HbA1c和CysC水平要高于对照组(P<0.05);合并有肾病的2型糖尿病患者组HbA1c和CysC水平要高于无肾病合并症的2型糖尿病组(P<0.05);经过治疗后,2型糖尿病合并有肾病的患者,HbA1c>7.0%组的CysC水平要明显高于HbA1c<7.0%组(P<0.05);治疗后,2型糖尿病合并肾病的患者,HbA1c<7.0%组的CysC水平要明显高于无肾病患者(P<0.05)。结论 HbA1c与CysC联合检测可以动态的检测糖尿病患者肾脏功能损害程度,严格调整血糖浓度,改善代谢有助于延缓糖尿病的肾功能损害。     

Influence of intensive versus conventional glucose control on microvascular and macrovascular complications in type 1 and 2 diabetes mellitus

In type 1 and 2 diabetes mellitus patients, hyperglycaemia is independently related to the development of microvascular and macrovascular complications. Glycaemic targets and the benefits of intensive versus conventional glucose control are under debate. The purpose of this review is to provide an overview of the randomized controlled trials and meta-analyses comparing the effects of intensive versus conventional glucose control on microvascular and macrovascular complications in type 1 and 2 diabetes. MEDLINE and Cochrane database searches were performed with a limit on randomized controlled trials or meta-analysis and keywords related to glucose control and diabetes. In addition, related articles and reference lists of relevant articles and guidelines were reviewed. Nine randomized controlled trials, three in type 1 and six in type 2 diabetes, and four meta-analyses in type 2 diabetes were reviewed. These studies included more than 30,000 patients. On the basis of these trials and meta-analyses, it can be concluded that intensive glucose control has a beneficial effect on microvascular complications (retinopathy, nephropathy, neuropathy) in both type 1 and type 2 diabetes patients. The risk reduction of developing a microvascular complication varied between 25% and 76%. Particularly in patients with type 2 diabetes, there was a 10-15% decrease in nonfatal myocardial infarction with intensive glucose control, but no effect on stroke, cardiovascular death or all-cause mortality was observed. There was a beneficial effect of intensive glucose control on cardiovascular disease in patients with type 1 diabetes in only one trial. In all studies, intensive glucose control was associated with at least twice the risk for serious hypoglycaemia than the conventional-control group. In conclusion, compared with conventional glucose control, intensive glucose control is associated with fewer microvascular complications in both type 1 and type 2 diabetes, a decrease in coronary events, especially in type 2 diabetes, and more serious hypoglycaemia.     

Carvedilol versus cardioselective beta-blockers for the treatment of hypertension in patients with type 2 diabetes mellitus

Treatment with beta-blockers is recommended to achieve and maintain adequate blood pressure control in patients with hypertension, and these agents have been shown to decrease cardiovascular risk factors in patients with both hypertension and type 2 diabetes mellitus. However, beta-blocker therapy also may worsen glycemic and lipidemic control and may lead to microalbuminuria. A recent study showed a better metabolic profile with carvedilol than with metoprolol in patients with both type 2 diabetes and hypertension in the presence of renin-angiotensin system blockade. This beneficial effect on metabolic components has been proposed as attributable to carvedilol's alpha-blocking effects or antioxidant properties. In this article, the pathophysiology of hypertension and type 2 diabetes and the association between them are reviewed, the pharmacologic properties of carvedilol are discussed, and clinical studies in the literature comparing carvedilol with selective beta-blockers in patients with both type 2 diabetes and hypertension are identified and evaluated. This information should be useful to practitioners when selecting the optimum beta-blocker for treating hypertension in patients with type 2 diabetes.     

同伴支持计划在2型糖尿病患者中的应用效果

目的：探讨同伴支持计划在2型糖尿病患者中的应用效果。方法93例2型糖尿病患者分为两组,对照组接受“医生-患者”模式的常规治疗;治疗组采用“医生-同伴帮扶组-患者”模式实施同伴支持计划治疗。于治疗前及治疗3个月后,比较两组患者的糖尿病综合控制指标达标率,并应用HOPE糖尿病知识问卷调查两组患者的糖尿病知识得分。结果治疗后,治疗组的SBP、FPG、2 h PG、TG、HDL-C、HbA1c、BMI达标率显著高于对照组（P＜0.05）,糖尿病认知、饮食知识、运动知识、用药知识、自我管理得分均显著高于对照组及治疗前（P＜0.01）。结论同伴支持计划应用于2型糖尿病患者可促进患者糖尿病综合控制指标达标,改善糖尿病患者的自我管理能力,增长其糖尿病相关知识,值得推广应用。     

糖尿病患者FBG﹑HbAlc和ADA水平分析及相关性研究

目的探讨糖尿病患者空腹血糖(FBG)、糖化血红蛋白(HbAlc)和腺苷脱氨酶(ADA)水平变化以及这三项指标的相关性。方法分别测定118例2型糖尿病患者,84例1型糖尿病患者FBG、HbA lc和ADA,并以90名健康人作对照。FBG用氧化酶法测定,HbAlc用层析法测定,ADA用速率法测定。结果2型糖尿病组:FBG、HbAlc和ADA与对照组比较均显著升高(P<0.01);1型糖尿病组:FBG、HbAlc与对照组比较有显著性差异(P<0.01),而ADA与对照组比较无统计学意义(P>0.05);2型糖尿病组ADA与1型糖尿病组比较显著升高(P<0.01)。2型糖尿病组中FBG与HbAlc有正相关关系(r=0.39,P<0.01),HbAlc与ADA有明显正相关关系(r=0.67,P<0.01);1型糖尿病组中FBG与HbAlc有正相关关系(r=0.48,P<0.01),ADA与HbAlc无相关性(r=0.11,P>0.05)。结论1型、2型糖尿病患者ADA水平差别明显。FBG、HbAlc和ADA联合检测,对鉴别诊断1型与2型糖尿病、衡量2型糖尿病患者血糖控制好坏有重要意义。     

Insulin detemir: a review of its use in the management of type 1 and 2 diabetes mellitus

Insulin detemir (Levemir) is a soluble long-acting human insulin analogue acylated with a 14-carbon fatty acid. The fatty acid modification allows insulin detemir to reversibly bind to albumin, thereby providing slow absorption and a prolonged and consistent metabolic effect of up to 24 hours in patients with type 1 or type 2 diabetes mellitus. Insulin detemir has a more predictable, protracted and consistent effect on blood glucose than neutral protamine Hagedorn (NPH) insulin, with less intrapatient variability in glycaemic control, compared with NPH insulin or insulin glargine. Insulin detemir, administered once or twice daily, is at least as effective as NPH insulin in maintaining overall glycaemic control, with a similar or lower risk of hypoglycaemia, especially nocturnal hypoglycaemia, compared with NPH insulin in patients with type 1 or type 2 diabetes. Insulin detemir also provides the added clinical benefit of no appreciable bodyweight gain in patients with type 1 diabetes and less bodyweight gain than NPH insulin in patients with type 2 diabetes. Insulin detemir is, therefore, a promising new option for basal insulin therapy in patients with type 1 or 2 diabetes.