Prediction of cardiovascular and total mortality in Chinese type 2 diabetic patients by the WHO definition for the metabolic syndrome

AIM: The aim of this study is to investigate the prevalence of metabolic syndrome (MES) in type 2 diabetic patients and the predictive values of the World Health Organization (WHO) and National Cholesterol Education Programme (NCEP) definitions and the individual components of the MES on total and cardiovascular mortality. METHODS: A prospective analysis of a consecutive cohort of 5202 Chinese type 2 diabetic patients recruited between July 1994 and April 2001. RESULTS: The prevalence of the MES was 49.2-58.1% depending on the use of various criteria. There were 189 deaths (men: 100 and women: 89) in these 5205 patients during a median (interquartile range) follow-up period of 2.1 (0.3-3.6 years). Of these, 164 (87%) were classified as cardiovascular deaths. Using the NCEP criterion, patients with MES had a death rate similar to those without (3.51 vs. 3.85%). By contrast, based on the WHO criteria, patients with MES had a higher mortality rate than those without (4.3 vs. 2.4%, p = 0.002). Compared to patients with neither NCEP- nor WHO-defined MES, only the group with MES defined by the WHO, but not NCEP, criterion had significantly higher mortality rate (2.6 vs. 6.8%, p < 0.001). Using Cox regression analysis, only age, duration of diabetes and smoking were identified as independent factors for cardiovascular or total death. Among the various components of MES, hypertension, low BMI and albuminuria were the key predictors for these adverse events. CONCLUSIONS: In Chinese type 2 diabetic patients, the WHO criterion has a better discriminative power over the NCEP criterion for predicting death. Among the various components of the MES defined either by WHO or NCEP, hypertension, albuminuria and low BMI were the main predictors of cardiovascular and total mortality.     

血清脂联素与新诊断2型糖尿病病人及代谢综合征患者的关系

目的对血清脂联素水平与新诊断2型糖尿病及代谢综合征患者的关系进行观察和分析。方法测定140例新诊断2型糖尿病患者与80例非糖尿病患者空腹血清脂联素及血糖、血脂、血压等指标，并分析各指标与脂联素的相关性。结果（1）新诊断2型糖尿病患者的血清脂联素水平显著降低。（2）随着代谢综合征指标的增多，脂联素含量呈下降趋势。（3）新诊断为糖尿病组中脂联素与代谢综合征、男性、体重指数呈负相关，与高密度脂蛋白胆固醇呈正相关。结论血清脂联素浓度与2型糖尿病及代谢综合征密切相关，低脂联素血症是糖尿病及代谢综合征的又一特征，在其发病中可能起重要的作用。     

血清尿酸水平对2型糖尿病一级亲属代谢综合征的预测价值

目的：观察2型糖尿病一级亲属中血清尿酸水平是否与代谢综合征（MS）的组成成分有关,明确在2型糖尿病一级亲属这一高危人群中尿酸能否成为预测MS的独立因子。方法招募年龄在40～70岁的2型糖尿病一级亲属322人,其中男性119人,女性203人,检测身高、体质量、血压、肝功、肾功、血脂以及口服糖耐量试验,计算体质量指数（BMI）。根据中华医学会糖尿病学分会关于MS的诊断标准（2004）诊断MS。结果在全部人群中,血清尿酸水平与身高、体质量、BMI、餐后2h血糖（2hPBG）、收缩压（SBP）、舒张压（DBP）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）有关（r＝0.376、0.450、0.285、0.127、0.244、0.225、0.395、-0.184,P＜0.05）,尿酸水平为365～537μmol/L（男性）及283～411μmol/L（女性）的MS患病率（男性62.1%,女性32.7%）明显高于0～274,275～320μmol/L（男性,30.0%,26.7%）及0～188,189～230μmol/L（女性,7.8%,9.6%）,尿酸水平在MS人群中明显高于无MS人群[（315.83±83.97） vs （251.80±75.21）μmol/L,P＜0.01]。不论男性还是女性,尿酸平均水平随着MS组成个数的增加而增高（P＜0.05）。尿酸对MS的单因素logistic回归分析中,比值比（OR）及95%可信区间为男性1.008（1.002？1.013,P＝0.005）、女性1.010（1.004？1.016,P＝0.001）。多因素logistic回归分析尿酸对MS的作用则不显著。结论尿酸与MS大部分组成部分相关, MS患者有较高的尿酸水平,但尿酸可能不是预测MS独立因素。     

The NCEP‐ATPIII but not the IDF criteria for the metabolic syndrome identify Type 2 diabetic patients at increased risk of chronic kidney disease

Aim To examine the association between chronic kidney disease (CKD) and the metabolic syndrome (MetS) using both International Diabetes Federation (IDF) and National Cholesterol Education Program's Adult Treatment Panel III (NCEP‐ATPIII) definitions in Chinese subjects with Type 2 diabetes. Methods Subjects with Type 2 diabetes were categorized according to the presence or absence of MetS by IDF or NCEP‐ATPIII criteria. CKD was considered present if glomerular filtration rate, calculated using the abbreviated equation developed by the Modification of Diet in Renal Disease study with Chinese modification, was < 60 ml/min per 1.73 m². Multivariate logistic regression analysis of the association between CKD and MetS by either definition was performed. Results Of 6350 subjects (mean age 55.1 ± 13.3 years), 3439 (54.2%) and 3204 (50.5%) had MetS by IDF and NCEP‐ATPIII definitions, respectively. Using the IDF definition, the presence of MetS was not associated with CKD [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.71, 1.29, P = 0.784]. In contrast, the association with CKD was significant when MetS was defined by the NCEP‐ATPIII definition (OR 1.75, 95% CI 1.37, 2.24, P < 0.001). In subjects who did not have MetS (n = 2911) as defined by IDF criteria, 997 fulfilled the MetS criteria of NCEP‐ATP III. The association with CKD was stronger, after adjustment for covariates, in these subjects (OR 1.42, 95% CI 1.03, 1.97, P = 0.032) compared with subjects who met IDF criteria of MetS. Conclusion In Type 2 diabetes, NCEP‐ATPIII, but not the IDF definition of MetS, identifies a subgroup of patients who have a higher risk of CKD.     

代谢综合征对老年糖尿病患者动脉僵硬度的影响

目的探讨老年糖尿病患者合并代谢综合征(MS)动脉僵硬度的变化及影响因素。方法选择老年糖尿病患者305例,根据是否合并MS分为MS组143例、非MS组162例;另选老年葡萄糖耐量试验正常者65例为对照组。检测颈-股脉搏波传导速度(PWV)、体重指数、腰围、血压、高敏C反应蛋白、血脂、空腹血糖、胰岛素及胰岛素抵抗指数,进行比较分析。结果 MS组和非MS组患者PWV明显高于对照组(P<0.05);随着MS组分增加,PWV呈阶梯样增加(P<0.05)。多元回归分析显示,PWV与年龄、血压、MS组分、高敏C反应蛋白、胰岛素抵抗指数及空腹血糖呈正相关(P<0.05)。结论老年糖尿病患者动脉僵硬度明显增加,合并MS加重动脉僵硬。     

Pulse pressure and mortality in hypertensive type 2 diabetic patients. A cohort study

HYPOTHESIS: Hypertension is a well-known cardiovascular risk factor in type 2 diabetic patients. It has been suggested that pulse pressure (PP) could be an independent cardiovascular risk factor in the general population, particularly in the elderly. An association between office PP and cardiovascular mortality has been previously reported in diabetic patients, while the relationship between ambulatory measurements of PP and all-cause mortality has not been assessed so far. AIM: To assess the relationship between ambulatory PP and all-cause mortality in diabetic patients with hypertension. METHODS: A cohort study was performed on a consecutive series of 435 diabetic outpatients. All patients underwent office blood pressure measurement (OBP) and 24-h ambulatory blood pressure monitoring (ABPM). Mortality was assessed through queries at the Registry Offices of the city of residence for each patient. Mean follow-up was 3.8 +/- 1.2 years. RESULTS: Fifty-eight patients (13.3%) died during the follow-up. Mortality was significantly (p < 0.05) higher in patients in the highest quartile and lower in patients in the lowest quartile, when compared to the intermediate quartiles, both for office and ABPM-PP. In a multivariate analysis, after adjustment for numerous variables (including current hypoglycaemic, antihypertensive statin and aspirin treatment), mortality was increased by 3.1 and 5.3% for each incremental mmHg of office PP (p < 0.05) and ABPM-PP (p < 0.001) respectively. CONCLUSIONS: High PP, assessed through office measurement or ABPM, was associated with increased mortality in hypertensive type 2 diabetic patients. In our sample, PP assessed with ABPM is a better predictor of mortality than office PP.     

Impact of metabolic syndrome risk factors in first-degree relatives of type 2 diabetic patients

OBJECTIVE: Family members of patients with an established diagnosis of type 2 diabetes mellitus (T2DM) are theoretically at risk of having the metabolic syndrome (MetS). A sample of these family members was studied from a population in a small township in Argentina, which has a high prevalence of T2DM. METHODS: We examined the clinical and metabolic characteristics of 132 first-degree relatives of T2DM patients (FDR) and 112 age-matched controls. The subjects were categorized according to the International Diabetes Federation (IDF) and National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria for MetS. RESULTS: The prevalence of MetS in the FDR group was 34.8 (IDF) and 26.5% (NCEP-ATPIII) respectively, which was significantly different to the prevalence in controls (p < 0.025). According to IDF criteria, the most prevalent factors among FDR subjects with MetS were low HDL-cholesterol (87%) followed by hypertriglyceridemia (69.5%). In the MetS group, which ranged between 20-29 years old (36%), the major risk factor in women was a low HDL-cholesterol serum level. In the MetS group, which ranged between 30-39 years old (44.4%), the most important risk factor in men was hypertriglyceridemia. CONCLUSION: This study revealed that the prevalence of MetS is high in young FDR adults, who need urgent preventive treatment, including lifestyle changes. The risk of developing T2DM is five times higher in non-diabetic people with MetS than in those without the syndrome.     

2型糖尿病患者合并代谢综合征与血清高敏C反应蛋白相关性分析

目的探讨2型糖尿病（T2DM）患者合并不同数目代谢综合征（MS）组分与血清高敏C反应蛋白（hsCRP）的相关性。方法将474例T2DM患者根据合并MS组分数目不同,分为不伴有其他MS组分的单纯T2DM（G0组）,合并1个组分（G1组）,合并2个组分（G2组）,合并3个组分组（G3组）,分析hsCRP与MS各组分之间的关系。结果随着合并MS异常组分的增多,hsCRP呈上升趋势（P〈0.01）;相关分析显示,hsCRP与体质量指数（BMI）、TG、SBP、TC、LDL、腰臀比、年龄呈正相关（P〈0.05或〈0.01）,与HDL水平呈负相关（P〈0.05）;多元逐步回归分析显示,BMI、TG、年龄为血清hsCRP升高的独立危险因素（P〈0.01）。结论 hsCRP可以作为T2DM患者MS发病风险的预测因子。     

The metabolic syndrome in type 2 diabetic patients in Gorgan: According to NCEP ATPIII and IDF definitions

AimsPeople with metabolic syndrome are at increased risk for developing diabetes mellitus and cardiovascular disease. The present study aimed to assess the metabolic syndrome in type 2 diabetes and compare them with two used methods of diagnostic criteria in Gorgan.MethodsThe study group included 293 type 2 diabetic patients whom referred to the Department of Diabetes Center in Golestan University of Medical Sciences (2011). The metabolic syndrome was determined according to ATPIII and IDF definitions.ResultsAccording to ATPIII and IDF criteria, the frequency of metabolic syndrome was 75.42% and 76.79%, respectively. According to ATPIII, the mean triglycerides, body mass index, systolic blood pressure and diastolic blood pressure were higher in subjects with metabolic syndrome than subjects without metabolic syndrome. According to IDF, the mean triglycerides, body mass index and males’ waist circumferences were higher in subjects with metabolic syndrome.ConclusionsThis study showed that females were more affected than males. This may be due to the specific characteristics in the lifestyle changes between females and males diabetic patients among Gorgan inhabitants. Females are less educated in comparison with males diabetic. The majority of females with metabolic syndrome were householder. It seems that they do less physical activity at home. In conclusion, it appears that the female need to change their life style in this area to halt the burden of cardiovascular complications in diabetic patients.     

代谢综合征患者颈动脉粥样硬化的观察

目的探讨代谢综合征（MS）患者颈动脉粥样硬化的特征。方法108例患者分别为MS 40例、高血压病（EH）33例、糖尿病（DM）35例,并以此相应分成3组,比较3组患者血脂改变及颈动脉超声检测结果,以125例健康体检者作对照组。结果MS组和DM组患者血浆TG水平均明显升高。DM组和MS组颈动脉阻力指数均显著升高,3组颈总动脉内-中膜厚度明显增厚。MS组患者斑块指数较单纯EH组明显增高。结论MS患者发生颈动脉粥样硬化的危险性较单纯高血压组明显增加。     

The relationship between mean platelet volume and metabolic syndrome in patients with type 2 diabetes mellitus: A retrospective study

This study aimed to investigate the association between mean platelet volume (MPV) and metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM). Data for 1240 patients with T2DM admitted to the Department of Endocrinology at the First Affiliated Hospital of Guangxi Medical University between January 1, 2017 and June 1, 2020 were collected retrospectively via electronic medical records, including demographic information, complete blood count, lipid profile, and glucose metabolism indexes. MetS was defined according to the Chinese Diabetes Society. Among the 1240 patients enrolled, 873 (70.40%) had MetS. MPV was significantly higher in patients with MetS (P < .001). For individual MetS components, MPV was significantly higher in the presence of abdominal obesity (P = .013) and hypertriglyceridemia (P = .026), but did not differ in the presence of elevated blood pressure (P = .330) or low high-density lipoprotein cholesterol (P = .790). Moreover, MPV was independently associated with MetS after adjustment for sex, smoking, alcohol drinking, white blood cell count, fasting C-peptide, and body mass index (odds ratio 1.174, 95% confidence interval 1.059–1.302). The odds ratio for MetS in the highest tertile, compared with the lowest MPV tertile, was 1.724 (95% confidence interval 1.199–2.479, P for trend = .003) after multiple adjustment. In stratified analyses, the positive correlation of MPV with MetS was significant only in patients who were older, male, or overweight, or who had poor glycemic control. In conclusion, high MPV was positively associated with the presence of MetS in patients with T2DM, particularly older, male, or overweight patients, or those with poor glycemic control.     

National Cholesterol Education Program and International Diabetes Federation definitions of metabolic syndrome in the prediction of diabetes. Results from the FIrenze-Bagno A Ripoli study

Background:  The International Diabetes Federation (IDF) proposed to modify the diagnostic criteria for metabolic syndrome (MS) previously issued by the National Cholesterol Education Program (NCEP). Aim of the present investigation is to compare the predictive value for diabetes of NCEP and IDF definitions of MS in a large sample of predominantly Caucasian subjects.
Methods:  A prospective observational study was performed on a cohort study (n = 3096) enrolled in a diabetes-screening programme, the FIrenze-Bagno A Ripoli study. All subjects with fasting glucose >126 mg/dl and/or post-load glucose ≥200 mg/dl (5.7%) were excluded from the present analysis. Follow-up of each subject was continued until diagnosis of diabetes, death or until 31 December 2005. Mean follow-up was 27.7 ± 11.3 months.
Results:  Among subjects enrolled, 13.7 and 25.2% were affected by MS using NCEP and IDF criteria respectively. During follow-up, 38 new cases of diabetes were diagnosed, with a yearly incidence rate of 0.5%. The relative risk for diabetes in subjects with MS was 10.10 [5.13; 20.00] and 7.87 [3.70; 16.7] using NCEP and IDF definitions respectively. After adjustment for age, sex, fasting glucose and waist circumference, NCEP-defined MS, but not IDF-, was significantly associated with incident diabetes (hazard ratio, 95% CI: 2.41 [1.01; 5.95] and 2.05 [0.80; 5.29] respectively).
Conclusions:  Although the reasons for the proposed changes in diagnostic criteria for MS are easily understandable, the newer IDF definition, while increasing estimates of prevalence of the syndrome, reduces the effectiveness of MS in identifying subjects at risk for diabetes. Further research is needed before the previous NCEP criteria are abandoned.     

Increased mean carotid intima media thickness in type 2 diabetes mellitus patients with non-blood pressure component metabolic syndrome: A preliminary report

AIMS:

Patients with type-2 diabetes mellitus have greater carotid intima media thickness and they are at risk for generalized atherosclerosis. This study aimed to compare the thickness of carotid artery intima media in type-2 diabetes mellitus patients with and without nonblood pressure component metabolic syndrome.

SETTINGS AND DESIGN:

This was a comparative observational study conducted in the Departments of Pharmacology and Physiology in the College of Medicine, Al-Mustansiriyia University in cooperation with Baghdad Teaching Hospital.

MATERIALS AND METHODS:

Forty-six diabetic patients of both sexes with systolic blood pressure < 130 mm Hg and diastolic blood pressure < 85 mm Hg were subjected to high resolution B-mode ultrasonography of the common and internal carotid arteries. Patients were grouped into those without metabolic syndrome (Group I) and with nonblood pressure component metabolic syndrome (Group II).

STATISTICAL ANALYSIS:

The two-tailed unpaired Student''s t-test was used in this study.

RESULTS:

Significantly high mean thickness was observed in the common carotid intima media (0.824 ± 0.155 mm) but not in the internal carotid arteries in group II patients compared to group I patients (0.708 ± 0.113 mm). Group II also had a significant number of patients with increased lesion intima media thickness (≥ 1.1 mm).

Conclusion:

The greater carotid intima media thickness observed in type 2 diabetes mellitus patients is related to the metabolic syndrome even in the absence of the blood pressure component.     

Cancer mortality reduction and metformin: a retrospective cohort study in type 2 diabetic patients

Aims: Few studies suggest that metformin decreases cancer mortality in type‐2 diabetic patients (T2DP). We explored the association between the type and duration of antidiabetic therapies and cancer and other‐than‐cancer mortality in a T2DP cohort, taking into account the competing risks between different causes of death and multiple potential confounding effects. The mortality rates were compared with the general population from the same area. Methods: In 1995, all T2DP (n = 3685) at our diabetes clinic in Turin (～12% of all T2DP in the city), without cancer at baseline, were identified. Vital status was assessed after a mean 4.5‐year follow‐up. Results: Metformin users had greater adiposity, while insulin users had more co‐morbidities. All‐cause‐ and cancer‐related deaths occurred in: 9.2 and 1.6% of metformin users, 13.1 and 3.0% of sulfonylureas users and 26.8 and 4.8% of insulin users, respectively. In a Cox regression model for competing risks, adjusted for propensity score, metformin users showed a lower cancer mortality risk [hazard ratio (HR) = 0.56; 95% confidence interval (CI) 0.34–0.94], while insulin was positively associated with other‐than‐cancer mortality (HR = 1.56; 95%CI 1.22–1.99). Each 5‐year metformin exposure was associated with a reduction in cancer death by 0.73, whereas every 5‐year insulin exposure was associated with 1.25‐fold increase in other‐than‐cancer death. Standardized mortality ratios for cancer and other‐than‐cancer mortality in metformin users were 43.6 (95%CI 25.8–69.0) and 99.1 (95%CI 79.3–122.5), respectively, in comparison with the general population. Conclusions: Metformin users showed a lower risk of cancer‐related mortality than not users or patients on diet only; this may represent another reason to choose metformin as a first‐line therapy in T2DP.     

Differential effect of glimepiride and rosiglitazone on metabolic control of type 2 diabetic patients treated with metformin: a randomized, double-blind, clinical trial

AIM: Accumulating evidence suggests that combination therapy using oral antidiabetic agents with different mechanisms of action may be highly effective in achieving and maintaining target blood glucose levels. The aim of our study is to evaluate the differential effect on glucose and lipid parameters of the association between glimepiride plus metformin and rosiglitazone plus metformin in patients affected by type 2 diabetes and metabolic syndrome. METHODS: Patients were enroled, evaluated and followed at two Italian centres. We evaluated 99 type 2 diabetic patients with metabolic syndrome (48 males and 47 females; 23 males and 24 females, aged 52 +/- 5 with glimepiride; 25 males and 23 females, aged 54 +/- 4 with cglitazone). All were required to have been diagnosed as being diabetic for at least 6 months and did not have glycaemic control with diet and oral hypoglycaemic agents such as sulphonylureas or metformin, both to the maximum tolerated dose. All patients took a fixed dose of metformin, 1500 mg/day. We administered glimepiride (2 mg/day) or rosiglitazone (4 mg/day) in a randomized, controlled, double-blind clinical study. We evaluated body mass index (BMI), glycaemic control, lipid profile [total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol and triglycerides] and lipoprotein parameters [apolipoprotein A-I and apolipoprotein B (Apo B)] during 12 months of this treatment. RESULTS: A total of 95 patients completed the study. Significant BMI decrease was observed at 12 months in glimepiride and rosiglitazone group (p < 0.05 and p < 0.01 respectively) as well as of glycated haemoglobin decrease (p < 0.05 and p < 0.01 respectively), mean fasting plasma glucose and postprandial plasma glucose levels (p < 0.05 and p < 0.01 respectively). A decrease in fasting plasma insulin and postprandial plasma insulin at 12 months (p < 0.05 and p < 0.01 respectively) compared with the baseline value in rosiglitazone group was observed. Furthermore, homeostasis model assessment index improvement was obtained only at 9 and 12 months (p < 0.05 and p < 0.01 respectively) compared with the baseline value in rosiglitazone group. Significant TC, LDL-C and Apo B improvement (p < 0.05 respectively) was present in glimepiride group after 12 months compared with the baseline values, and these variations were significant (p < 0.05) between groups. Of the 95 patients who completed the study, 8.5% of patients in glimepiride group and 12.5% of patients in rosiglitazone group had side-effects (p = not significant). Four patients had transient side-effects in glimepiride group and six patients in rosiglitazone group. Altogether, we did not have statistically significant changes in transaminases. CONCLUSIONS: The rosiglitazone-metformin association significantly improve the long-term control of all insulin-resistance-related parameters in comparison with the glimepiride-metformin-treated group. On the other side, glimepiride treatment is associated to a slight improvement in cholesterolaemia, not observed in the rosiglitazone-treated patients.     

代谢综合征三种诊断标准在2型糖尿病中的比较研究

目的比较WHO、美国国家胆固醇教育计划成人治疗组第三次指南(NCEPATPⅢ)及中华糖尿病学会(CDS)代谢综合征(MS)诊断标准在2型糖尿病(T2DM)中的应用。方法选择251例病程未超过1年、无临床心脑血管疾病的T2DM患者,比较三种标准的诊断差异,并比较稳态模型评估的胰岛素抵抗(IR)及大血管超声异常率与MS间的关系。结果采用WHO、CDS及ATPⅢ标准MS患病率分别为61.4%、61.8%及48.2%(P<0.01);中心性肥胖的诊断率分别为59.3%、59.8%及13.5%(P<0.01);WHO与CDS标准符合率为99.6%。应用ATPⅢ标准,有MS者其IR、空腹胰岛素及餐后2h胰岛素水平皆显著高于无MS者(P<0.05)。结论(1)三种标准诊断MS其差异有显著性;ATPⅢ标准诊断率低于另两者;WHO标准与CDS标准在中国T2DM人群可以通用。(2)ATPⅢ标准诊断中心性肥胖更严格,且可见IR与MS关系密切。     

老年糖尿病患者的胰岛功能变化

目的　探讨年龄对老年糖尿病患者胰岛分泌功能的影响。方法　 2型糖尿病患者 61 0例 ,按年龄分为 4组 :A组 <44岁 ;B组 45～ 59岁 ;C组 60～ 74岁 ;D组 75岁。并收集同期 NGT和 IGT患者共 1 92例作为对照。结果　 (1 )方差分析显示 ,随年龄增加老年糖尿病患者的体重、BMI、PINS、HOMA- IS明显增加 ,FBG、PBG、Hb A1 c显著降低 ,而 FINS、HOMA- IR、IAI各年龄组间差异无显著性。 (2 )协方差分析表明 ,仅控制 FBG的影响时 ,糖尿病患者各年龄组的 HOMA- IS仍有显著性差异 ,老年糖尿病患者的 HOMA- IS明显增加 ,而控制 BMI的影响后 ,各年龄组 HOMA- IS差异无显著性。 (3)糖尿病病程对 FINS、PINS、HOMA- IS的影响未达到显著性水平。 (4)决定 FINS的主要变量是 BMI,决定 PINS的主要变量是 BMI和 PBG。结论　老年糖尿病患者的胰岛素分泌功能主要决定于 BMI。年龄和糖尿病病程虽然对胰岛素分泌有负性影响但作用较弱 ,因此表现为伴随增龄的 BMI逐渐增加 ,胰岛素分泌功能也逐渐加强。校正 BMI的影响后 ,胰岛素分泌功能与年龄的关系不明显 ,但随糖尿病病程延长而逐渐减弱。     

Hyperglycaemia and mortality of diabetic patients with candidaemia.

AIMS: To determine whether the degree of hyperglycaemia has an impact on in-hospital mortality in diabetic patients with candidaemia. METHODS: A retrospective cohort study of 87 diabetic patients with candidaemia admitted between June 1995 and June 2003 was carried out at two medical centres. Patients were stratified into two groups: those with moderate hyperglycaemia (7 days post-candidaemia mean blood glucose < 13.9 mmol/l) and those with severe hyperglycaemia (7 days post-candidaemia mean blood glucose > or = 13.9 mmol/l). A stepwise logistic regression analysis was performed to determine whether the degree of hyperglycaemia was a significant predictor of mortality. RESULTS: During the follow-up period from admission till discharge, 34 (39.1%) patients had died. Nine (69.2%) of 13 patients with severe hyperglycaemia have died while 25 (33.8%) of 74 patients with moderate hyperglycaemia have died. Multivariate analysis identified three independent determinants of death; Apache II score > or = 23 [OR 8.1, 95% CI (2.6, 25.3), P = 0.0003], mean blood glucose levels 7 days post-candidaemia > or = 13.9 mmol/l [OR 6.8, 95% CI (1.2, 38.2), P = 0.03], and mechanical ventilation [OR 6.5, 95% CI (2.21), P = 0.03]. CONCLUSION: Severe hyperglycaemia is an important marker of increased mortality among hospitalized diabetic patients with candidaemia.