2型糖尿病患者精氨酸刺激试验与胰高血糖素刺激试验的安全性比较

目的探讨2型糖尿病患者精氨酸刺激试验（AST）与胰高血糖素刺激试验（GST）的安全性。方法对68例2型糖尿病患者进行AST和GST,检测其血糖、C肽水平,记录不良反应。结果两种试验前患者空腹血糖水平无统计学差异（P〉0.05）;AST各时间点血糖水平比较差异有统计学意义（P均〈0.01）;AST后患者各时间点血糖水平低于GST后6 min（P〈0.01）;两种试验前后患者C肽水平无统计学差异（P〉0.05）。AST不良反应发生率明显低于GST（P〈0.05）。结论AST评估胰岛B细胞功能与GST结果接近,但安全性更好。     

空腹高血糖对2型糖尿病患者精氨酸刺激试验的影响

目的探讨2型糖尿病(T2DM)血糖水平与胰岛素释放的关系,以了解葡萄糖毒性对胰岛β细胞分泌功能的影响。方法观察146例T2DM患者精氨酸刺激后真胰岛素(TI)、胰岛素原(PI)水平的变化。以胰岛素抵抗(IR)指数作为估测IR的简易参数,并比较T2DM患者在不同FPG状态下,胰岛素分泌减退的检出率的差异。结果(1)T2DM主要表现为IR伴胰岛素分泌不足。(2)比较不同FPG水平T2DM人群中精氨酸刺激后胰岛素分泌减退的检出率:当FPG≥11mmol/L时其检出率明显增加,提示高浓度葡萄糖抑制胰岛素分泌功能的阈值可能在11mmol/L左右。结论葡萄糖毒性作用干扰对β细胞分泌功能的判断,因此,在临床上将T2DM患者的FPG控制在11mmol/L以下进行精氨酸刺激试验,能较为确切地反映其真正的胰岛β细胞功能。     

精氨酸刺激试验与胰高血糖素刺激试验对β细胞功能评估的比较

通过对68例2型糖尿病患者进行精氨酸刺激试验(AST)和胰高血糖素刺激试验(GST)，比较其对胰岛β细胞功能的评价，发现精氨酸刺激后C肽于3min达高峰，此峰值与胰高血糖素刺激后6min C肽差异无统计学意义，而且以精氨酸刺激试验3min C肽是否大于0.6nmol／L作为选择治疗方案的参考(与GST结果接近)，与临床符合情况较好。     

精氨酸刺激试验在不同糖代谢状态人群的临床应用

目的探讨精氨酸刺激试验能否用于评价胰岛β细胞储备功能及其判断标准。方法分别检测225人空腹及盐酸精氨酸刺激后2、4、6 min时血糖(PG)、真胰岛素(TI)、C肽(CP)水平的变化,其中正常糖耐量组(NGT)39名、糖耐量受损组(IGT)29例、1型糖尿病组(T1DM)11例,新诊断2型糖尿病组(NT2DM)43例和原诊断2型糖尿病组(PT2DM)103例。结果(1)NGT组空腹TI/PG显著高于IGT组(P<0.05),但两组的空腹CP/PG差异无统计学意义(P>0.05)。空腹CP/PG在T1DM、NT2DM、PT2DM组显著低于NGT、IGT组(均P<0.01),并且PT2DM组显著低于NT2DM组(P<0.01)。(2)精氨酸刺激后T1DM组无快速TI、CP分泌。其余各组在刺激后TI/PG、CP/PG除IGT组与NGT组差异无统计学意义(P>0.05)外,NT2DM、TP2DM组均显著低于NGT、IGT组(均P<0.01),并且2 min时PT2DM组亦显著低于NT2DM组(均P<0.01)。(3)精氨酸刺激后TI/PG、CP/PG的增值及曲线下面积在NGT、NT2DM、PT2DM三组间差异有统计学意义(均P<0.01)。结论(1)精氨酸刺激试验可用于判别和评估不同糖代谢状态人群胰岛β细胞功能,尤其是DM人群β细胞功能的判别。(2)精氨酸刺激后TI/PG值及其峰值/空腹值、TI/PG的增值和曲线下面积均可能作为评价β细胞功能异常的指标,其中以TI/PG的增值和曲线下面积为佳。     

2型糖尿病对急性冠状动脉综合征患者血钾的影响

目的　对比分析 2型糖尿病患者与非糖尿病患者在急性冠状动脉综合征 (ACS)早期血钾水平的变化。方法　对 1999年 1月至 2 0 0 3年 3月进行急诊冠状动脉介入治疗的连续 745例ACS患者 ,以症状持续时间、2型糖尿病和院前 β 受体阻滞剂使用进行分层。 结果　 2型糖尿病ACS患者的血清钾水平较非糖尿病ACS患者明显高〔(4 .3 4± 0 .48)mmol/Lvs (4 .0 0± 0 .5 2 )mmol/L ,P <0 .0 5〕。多变量分析表明 ,2型糖尿病是血清钾水平的独立预测因素 (OR 1.70 ,95 %CI :1.40～ 2 .10 ,P <0 .0 1)。非糖尿病ACS患者在发病 6h内血钾水平随症状持续时间进行性升高〔≤ 2h :(3 .61± 0 .5 1)mmol/L ;2～ 4h :(4 .10± 0 .45 )mmol/L ;4～ 6h :(4 .2 2± 0 .5 1)mmol/L(与≤ 2h比 ,均P <0 .0 1)〕 ,2型糖尿病或院前服用 β 受体阻滞剂治疗患者这种趋势不明显。结论　在ACS早期 ,2型糖尿病患者不出现非糖尿病患者的早期血钾降低 ,反映了 2型糖尿病患者存在交感神经功能障碍。     

2型糖尿病患者血皮质醇水平的变化及其意义

分别测定37例T2DM患者8：00、16：00、0：00血皮质醇以及空腹血糖。结果：T2DM患者血皮质醇水平明显高于正常人，8：00、16：00（P〈0．05），0：00（P〈0：01）；且T2DM患者8：00、0：00血皮质醇浓度与空腹血糖呈正相关。结论：T2DM患者存在皮质醇分泌的紊乱并导致空腹血糖升高。     

2型糖尿病患者血皮质醇水平的变化及其意义

分别测定37例T2DM患者8：00、16：00、0：00血皮质醇以及空腹血糖。结果：T2DM患者血皮质醇水平明显高于正常人，8：00、16：00（P〈0．05），0：00（P〈0：01）；且T2DM患者8：00、0：00血皮质醇浓度与空腹血糖呈正相关。结论：T2DM患者存在皮质醇分泌的紊乱并导致空腹血糖升高。     

心电图服钾试验诱发高血钾1例

1病例资料患者,女,54岁。来我院体检中心做体格检查。体检:腹部B超、胸片、血尿便常规、肝肾功能检查均无异常发现。心电图检查见窦性心律,心率75次/min,Ⅱ、Ⅲ、aVF、V1～4导联T波倒置,V5～6导联T波平坦,见图1。考虑T波改变为功能性改变,故做     

血清谷氨酸脱羧酶抗体滴度与初诊成人2型糖尿病患者第一时相胰岛素分泌的关系

探讨不同血清谷氨酸脱羧酶抗体(GAD-Ab)滴度与初诊成人2型糖尿病患者第一时相胰岛素分泌(1PH)的关系.对1 053例初诊2型糖尿病患者,按GAD-Ab滴度分为3组,其中抗体阳性组(GAD-Ab≥1 U/ml)71例、抗体阴性1组(0相似文献   

糖尿病酮症酸中毒合并高血钾心电图分析

本报告糖尿病酮症酸中毒合并高血钾心电图改变5例。     

2型糖尿病患者血浆Apelin-12水平与血糖的关系

目的探讨2型糖尿病患者血浆脂肪细胞因子Apelin-12水平变化及其与血糖的关系。方法选取2012年1月至2015年6月在民航总医院内分泌科住院的41例2型糖尿病患者作为研究对象,并招募44例健康对照者作为对照组。根据有无合并冠心病、脑血管病及高血压病将2型糖尿病患者再分为2型糖尿病合并心脑血管疾病组(21例)和单纯糖尿病组(20例)。酶联免疫吸附法测定Apelin-12的水平,测定其糖化血红蛋白、总胆固醇、甘油三酯、低密度脂蛋白以及空腹和餐后2 h血糖、C肽的水平,并对以上指标进行相关性分析。结果与对照组相比,2型糖尿病患者血浆Apelin-12水平显著降低(t=2.70,P=0.01); 2型糖尿病合并心脑血管疾病组血浆Apelin-12的水平与单纯糖尿病组差异无统计学意义(t=-0.44,P=0.67)。多元逐步回归分析显示,在2型糖尿病患者中,空腹血糖与Apelin-12相关(B=-0.12,β=-0.42,t=-2.03,P=0.04)。结论 2型糖尿病患者血浆Apelin-12水平显著降低且与空腹血糖呈负相关。     

血糖波动与氧化应激对2型糖尿病微血管病变的影响

目的探讨血糖波动与氧化应激对2型糖尿病微血管病变的关系。方法选择2型糖尿病患者109例,根据尿白蛋白排泄率(UAER)分为3组:正常白蛋白尿组(A组)、微量白蛋白尿组(B组)和大量白蛋白尿组(C组)。健康体检者30例为对照组。糖尿病患者给予胰岛素治疗12周,检测干预前后血压、空腹血糖(FPG)、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)、血脂、糖化血红蛋白(HbA1c)、平均血糖波动幅度(MAGE)、超氧化物歧化酶(SOD)、丙二醛和UAER。结果胰岛素干预后,A组、B组和C组FPG、HbA1c、HOMA-IR、TG较治疗前明显下降(P<0.05);B组和C组SOD较治疗前明显增高,丙二醛、UAER、MAGE较治疗前明显下降(P<0.05,P<0.01)。MAGE与HOMA-IR、UAER、丙二醛呈正相关,与SOD呈负相关(P<0.05,P<0.01);logistic回归分析显示,年龄、病程、收缩压、HbA1c、HOMA-IR、MAGE、丙二醛是导致2型糖尿病患者蛋白尿严重程度的独立危险因素,SOD是保护因素。结论血糖波动与体内氧化应激密切相关,氧化应激参与糖尿病微血管病变的发生、发展。     

The blood glucose lowering effects of exercise and glibenclamide in patients with Type 2 diabetes mellitus

Physical exercise is associated with a fall in serum insulin levels, whereas sulphonylurea administration increases insulin release. To date, the opposing effects of exercise and sulphonylurea administration have not been systematically studied in Type 2 diabetic patients, who are not infrequently treated with sulphonylureas. In this study nine patients with Type 2 diabetes mellitus were subjected to four treatments in random order on separate days: (A) endurance exercise after the administration of 3.5 mg glibenclamide; (B) as A but given only 1.75 mg glibenclamide; (C) as A but with placebo; (D) rest and administration of 1.75 mg glibenclamide. Exercise and placebo resulted in only a small decrease in glycaemia. Rest and administration of 1.75 mg glibenclamide led to a moderate but steady fall in blood glucose concentrations. If glibenclamide administration and exercise were combined, blood glucose concentrations declined more markedly. Serum insulin concentrations showed a physiological decrease during exercise and placebo administration. If patients rested after administration of glibenclamide serum insulin levels rose and remained elevated. When exercise and glibenclamide were combined the rise in serum insulin levels was blunted and insulin levels fell once exercise was begun. Thus, exercise attenuates the glibenclamide induced increase in serum insulin in moderately hyperglycaemic Type 2 diabetic patients. Nevertheless, exercise has a substantial hypoglycaemic effect in glibenclamide treated Type 2 diabetic patients. © 1998 John Wiley & Sons, Ltd.     

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.     

药食同源主食与传统主食对2型糖尿病患者餐后血糖的影响比较

目的比较药食同源主食与传统主食对2型糖尿病(T2DM)患者餐后2小时血糖(2h-PBG)的影响,为T2DM主食多样化选择提供科学依据。方法入选2012年9月至2013年2月在四川大学华西医院内分泌科住院的T2DM患者150例,其中男性80例,女性70例,年龄(60.5±13.2)岁,随机分为3组即玉米组(A组)、荞麦组(B组)和药食同源组(C组),每组50例。试验期2 d,第1天三组患者均摄入统一制作的糖尿病套餐,第2天各组患者在临床治疗不变的情况下将原早餐中的素菜包子分别替换为等量重的玉米馒头(A组)、荞麦馒头(B组)和药食同源馒头(C组),其余膳食不变。分别测定食用前后空腹血糖(FBG)及2h-PBG,并对三种早餐馒头进行感官评价。应用SPSS 18.0统计软件对数据进行分析。组间比较采用自身配对《检验、成组设计t检验、单因素方差分析或x~2检验,两两比较采用SNK法。结果三组患者食用馒头前后FBG差异无统计学意义(P=0.217;P=0.986)。相比食用馒头前,食用馒头后B组(荞麦)患者2h-PBG水平下降,但差异无统计学意义[(9.00±2.43)vs(9.71±3.09)mmol/L,P0.05],C组患者下降明显,差异有统计学意义[(7.82±2.52)vs(9.96±2.33)mmol/L,0.05]。C组(药食同源)患者食用馒头后的2h-PBG水平显著低于A组和B组,差异有统计学意义(P=0.011)。相比A组和B组患者,C组患者对早餐馒头的色泽、气味、口感、韧性和口味差评人数多,差异有统计学意义(P0.05),但总评价差异无统计学意义(P0.05)。结论药食同源主食调控血糖的效果优于传统的荞麦和玉米。     

The effect of real-time continuous glucose monitoring on glycemic control in patients with type 2 diabetes mellitus

Background:

Real-time continuous glucose monitoring (RT-CGM) improves hemoglobin A1c (A1C) and hypoglycemia in people with type 1 diabetes mellitus and those with type 2 diabetes mellitus (T2DM) on prandial insulin; however, it has not been tested in people with T2DM not taking prandial insulin. We evaluated the utility of RT-CGM in people with T2DM on a variety of treatment modalities except prandial insulin.

Methods:

We conducted a prospective, 52-week, two-arm, randomized trial comparing RT-CGM (n = 50) versus self-monitoring of blood glucose (SMBG) (n = 50) in people with T2DM not taking prandial insulin. Real-time continuous glucose monitoring was used for four 2-week cycles (2 weeks on/1 week off). All patients were managed by their usual provider. This article reports on changes in A1C 0–12 weeks.

Results:

Mean (±standard deviation) decline in A1C at 12 weeks was 1.0% (±1.1%) in the RT-CGM group and 0.5% (±0.8%) in the SMBG group (p = .006). There were no group differences in the net change in number or dosage of hypoglycemic medications. Those who used the RT-CGM for ≥48 days (per protocol) reduced their A1C by 1.2% (±1.1%) versus 0.6% (±1.1%) in those who used it <48 days (p = .003). Multiple regression analyses statistically adjusting for baseline A1C, an indicator for usage, and known confounders confirmed the observed differences between treatment groups were robust (p = .009). There was no improvement in weight or blood pressure.

Conclusions:

Real-time continuous glucose monitoring significantly improves A1C compared with SMBG in patients with T2DM not taking prandial insulin. This technology might benefit a wider population of people with diabetes than previously thought.     

Effect of insulin on blood rheology in non-diabetic subjects and in patients with type 2 diabetes mellitus

We evaluated the effect of insulin on platelet function, blood viscosity, and filterability in healthy subjects and in patients with Type 2 (non-insulin-dependent) diabetes mellitus. Fifteen diabetic patients were free from cardiovascular complications (group A), while the other 15 patients had both clinical and measured evidence of coronary or peripheral vascular disease (group B); 15 non-diabetic subjects served as controls. On blood samples taken without stasis, maximal platelet aggregation to 1.25 μmol l⁻¹ ADP, blood and plasma viscosity, and blood filterability were measured in basal conditions, and after incubation of blood, plasma or platelet-rich plasma with insulin at two physiological concentrations (120 and 480 pmol l⁻¹). Compared with healthy subjects, the diabetic patients of group B had higher values of blood (p < 0.01) and plasma (p < 0.05) viscosity, and platelet aggregation response to ADP (p < 0.01), as well as lower values of blood filterability (p < 0.01). The diabetic patients of group A had values intermediate between normal subjects and the patients of group B. In non-diabetic subjects, insulin significantly decreased platelet aggregation and blood viscosity at low shear rates (22.5 s⁻¹) (p < 0.01 for both), and had no significant effects on other parameters. In the diabetic patients of group A, insulin decreased blood viscosity at high (225 s⁻¹) rates of shear (p < 0.01) and increased blood filterability (p < 0.01). The effects of insulin were not dose-related. In the diabetic patients of group B, none of the parameters evaluated was significantly influenced by insulin. Type 2 diabetic patients present many abnormalities of the rheologic properties of blood. The beneficial effects of insulin on platelet aggregation and blood viscosity are not evident in Type 2 diabetic patients, especially those with vascular complications and this may be relevant to the development of those complications. © 1997 John Wiley & Sons, Ltd.     

血糖波动与老年人糖尿病血管并发症的研究进展

对于早期2型糖尿病患者,强化降糖治疗可以降低糖尿病微血管和大血管慢性并发症的发生风险。但老年糖尿病患者多伴有重要脏器功能减退、多种疾病共存、用药复杂、血糖波动幅度大及易发低血糖等特点,而过大的血糖波动和严重的低血糖被认为与糖尿病血管并发症密切相关。因此新的治疗理念认为,对于病程较长的老年2型糖尿病患者,在控制血糖的基础上,应减少血糖波动和严重低血糖的发生,从而减少糖尿病慢性并发症的发生发展。     

Effect of nebulized albuterol on blood glucose in patients with diabetes mellitus with and without cystic fibrosis

Over 90% of cystic fibrosis (CF) patients are treated with bronchodilators, and 6% have diabetes. Some with asthma also have diabetes, and most are treated with bronchodilators. Systemic administration of adrenergic agents can cause increases in blood glucose, but the effect of inhaled agents is unclear. A double-blind study was performed on 10 patients with type 1 diabetes mellitus (DM) without CF (3 male, 7 female, mean age 25.5 years) and 9 patients with insulin-dependent CF-related diabetes (CFRD) (8 male, 1 female, mean age 21.9 years). On 2 separate days before 9 AM fasting and the morning dose of insulin, 2.5 mg of albuterol or nebulized placebo were given. Blood glucose was measured by finger stick with a glucose reflectance meter before and 15, 30, 45, and 60 min after treatment. No significant changes from baseline or differences between placebo and albuterol occurred in either group. The mean maximum increase from baseline in DM was 20 mg/dl on placebo, and 38 mg/dl on albuterol; in the CFRD, the respective changes were 7 and 7 mg/dl. Two DM patients had a > 50 mg/dl increase on albuterol vs. placebo; no CFRD patients had differences of such magnitude. DM patients had greater increases from baseline than CFRD patients on placebo and albuterol. Differences reached statistical significance at 30 and 45 min on placebo, and 45 min on albuterol. Albuterol 2.5 mg by nebulizer causes no clinically significant increases in blood glucose in DM or CFRD patients. Diabetes patients without CF have a significantly greater increase of glucose with time (placebo or albuterol) than CFRD patients.     

Prediction of lowest nocturnal blood glucose level based on self-monitoring of blood glucose in Japanese patients with type 2 diabetes

Aims

Continuous glucose monitoring (CGM) is not available for all patients with type 2 diabetes (T2D) at risk of nocturnal hypoglycemia (NH). This study was performed to predict the lowest nocturnal blood glucose (LNBG) levels.