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1.
《Clinical therapeutics》2014,36(11):1576-1587
PurposeIn the EASIE (Evaluation of Insulin Glargine Versus Sitagliptin in Insulin-Naïve Patients) trial, insulin glargine found a significant reduction in glycosylated hemoglobin compared with sitagliptin in patients with type 2 diabetes who are inadequately controlled with metformin. The objective of this study was to assess the cost-effectiveness of insulin glargine compared with sitagliptin in type 2 diabetes patients, from the perspective of the publicly funded Canadian health care system.MethodsThe IMS CORE Diabetes Model, a standard Markov structure and Monte Carlo simulation model, was used. The model used a lifetime horizon to capture the long-term complications associated with type 2 diabetes. The efficacy of insulin glargine and sitagliptin in terms of glycosylated hemoglobin reduction and corresponding rates of hypoglycemia were obtained from the EASIE trial. Health utility and cost data were obtained from recently published Canadian publications. Univariate and probabilistic sensitivity analyses were conducted.FindingsIn the lifetime base-case analysis, treatment with insulin glargine resulted in cost savings of $1434 CAD in 2012 and a gain of 0.08 quality-adjusted life years per patient. A probabilistic sensitivity analysis found the robustness of the base-case analysis, with 88% probability of insulin glargine being dominant (ie, cost savings and more quality-adjusted life years).ImplicationsInsulin glargine is a clinically superior and cost-effective alternative to sitagliptin in patients with type 2 diabetes who are inadequately controlled with metformin. 相似文献
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2型糖尿病和慢性肾脏病的相关性分析 总被引:1,自引:0,他引:1
目的:探讨2型糖尿病与慢性肾脏病(CKD)的相关性。方法:采用整群抽样方法调查了上海中心城区1039例30岁以上已确诊2型糖尿病患者,其中资料完整者共1005例患者,作为本研究对象。检测项目包括身高、体质量、腰围、臀围、血压、血糖、血脂、尿白蛋白肌酐比。采用不同的公式计算估算肾小球滤过率(eGFR)。采用卡方检验和Logistic回归分析进行统计。结果:(1)分别采用Cockcroft—Gault(C—G)公式、肾脏病膳食改良试验(MDRD)公式、根据中国人cKD患者校正后的MDRD(C-MDRD)公式计算eGFR,均显示低肾小球滤过率组(eGFR〈60ml/min/1.73m^2)较对照组年龄显著增高,病程显著延长,血尿素氮、血肌酐、血尿酸显著升高(P〈0.05)。(2)采用C—G公式、MDRD公式和c—MDRD公式计算得出3种公式计算的低肾小球滤过率组大量蛋白尿的比率分别是11.9%、39.2%和44.1%,糖尿病视网膜病变的比率分别是29.3%、46.4%和50%,后两公式的筛出率明显高于C—G公式,其中C—MDRD公式最高(P〈0.05)。(3)采用C—MDRD公式,逐步Logistic回归分析显示年龄、腰围、收缩压、肌酐和空腹血糖是CKD的独立危险因素,比数比(OR)值分别为1.014、1.020、1.028、1.010和1.129,P值均〈0.05。结论:MDRD公式和c-MDRD公式比CG公式能更好的评估糖尿病的血管病变,c-MDRD公式更具有优越性。2型糖尿病与慢性肾脏病密切相关。 相似文献
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目的:探讨新诊断2型糖尿病患者(T2DM)并非酒精性脂肪肝(NAFLD)的相关因素.方法:比较新诊断T:DM并NAFLD(DFL)和未合并NAFLD(NDFL)患者的各种生化指标,Logistic回归方法分析T2DM并NAFLD的相关因素.结果:与NDFL组相比较,DFL组的体重指数(BMI)、腰围、谷丙转氨酶(ALT)、谷草转氨酶(AST)、Ln(C肽曲线下面积)[Ln(CPAUC)]、甘油三脂(TG)和尿酸明显增高(P<0.05);DFL组腰围≥85 cm,BMI≥25 kg/m2,血脂异常、尿酸≥350μmol/L,代谢综合征和Ln(CPAUC)≥12的患者比例明显高于NDFL组(P<0.05);Logistic回归分析显示:腰围≥85 cm和Ln(CPAUC)≥12是新诊断T2DM并NAFLD的独立危险因素(P<0.05).结论:新诊断T2DM患者的NAFLD与各种代谢异常密切相关,胰岛素抵抗是其主要的危险因素,反映中心性肥胖的腰围可作为其一个重要的预测因素. 相似文献
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目的 通过对完全经胃管鼻饲的2型糖尿病患者发生低血糖的研究,发现并分析导致低血糖的因素,提出针对性的护理措施.方法 将2010年1月-2011年2月住院的老年2型糖尿病患者89例中发生低血糖的15例作为观察组,抽取在同期经胃管鼻饲,未发生低血糖的老年2型糖尿病患者30例作为对照组.均进行动态的血糖监测.对两组餐后2 h血糖低于6.1 mmol/L、合并感染、合并用药6种以上、并发症3种以上、肝肾功能异常、降糖药物更换、食品变换、活动量是否增加等指标进行统计学分析.结果 两组餐后2 h血糖低于6.1 mmol/L、合并感染、合用药物6种以上、肝肾功能异常共4个观察指标的比较差异有统计学意义(P<0.05或P<0.01).结论 经胃管鼻饲的老年2型糖尿病患者餐后2 h血糖低于6.1 mmol/L、合并感染、合并用药6种以上、肝肾功能异常时更加容易发生低血糖,有针对性、有重点进行预见性护理观察和处置,可以达到预防低血糖的发生. 相似文献
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目的:观察胰岛素联合瑞格列奈对磺脲类降糖药治疗失败的2型糖尿病患者的疗效。方法:75例磺脲类治疗失败的2型糖尿病患者随机分为两组,分别给予胰岛素及胰岛素联合瑞格列奈治疗,疗程12周。分别检测两组患者治疗前后FBG、2 h PBG和HbA1C水平,并记录胰岛素用量,评价胰岛素联合瑞格列奈的临床疗效。结果:两组患者血糖和HbA1C均控制良好,但与对照组相比,胰岛素联合瑞格列奈组患者餐后血糖下降更为明显,且胰岛素用量较对照组明显下降(P〈0.05)。结论:胰岛素联合瑞格列奈对磺脲类药物治疗失败2型糖尿病患者具有较好的疗效,同时可减少胰岛素用量。 相似文献
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目的 介绍交互式网络电视系统联合回授法在2型糖尿病老年患者笔型胰岛素规范注射中的应用效果。方法 选择我院内分泌科住院期间首次遵医嘱使用胰岛素的40例2型糖尿病老年患者,采取交互式网络电视系统联合回授法指导患者胰岛素注射。交互式网络电视系统平台联合回授法应用具体内容包括:成立健康教育小组,制订视频内容,视频制作及导入相关事宜,交互式网络电视系统平台联合回授法中解释、评估、澄清、理解4步骤有效实施。结果 40例2型糖尿病老年患者参与交互式网络电视系统平台联合回授法治疗周期为(8.00±2.31)d,胰岛素注射技能考核得分(81.56±6.91)分,40例患者在出院后均继续接受笔型胰岛素治疗。结论 交互式网络电视系统平台联合回授法可提高了2型糖尿病老年患者胰岛素治疗的自我管理能力,确保了胰岛素治疗的安全性。 相似文献
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2型糖尿病血清中游离脂肪酸与血糖及胰岛素抵抗关系的比较 总被引:2,自引:0,他引:2
陈继中 《实用临床医学(江西)》2005,6(4):13-15
目的:探讨2型糖尿病(2DM)患者血清中游离脂肪酸(FFA)浓度与胰岛素抵抗(IR)的关系。方法:采用放射免疫法(RIA)测定胰岛素浓度,已糖激酶法测定GLU,酶产色法测定空腹FFA浓度、2 hFFA浓度(PFFA)及其他生化指标。86例2 DM患者,50例健康对照组行口服葡萄糖耐量试验(OGTT)和胰岛素释放试验,计算30 min后胰岛素和GLU浓度变化的比值(△I30/△G30)、葡萄糖曲线下面积(AUCG)和胰岛素曲线下面积(AUCIN)。根据Cederholm公式计算胰岛素敏感指数(ISI)。结果:①与正常对照比较,2DM空腹和2 h FFA、AUCG、AUCIN、TG浓度显著升高(P<0.01);ISI、△I30/△G30显著降低(P<0.01)。②2DM患者FFA与AUCG、AUCIN呈显著正相关,与△I30/△G30、ISI呈显著负相关。结论:2DM患者空腹血清FFA、胰岛素浓度升高;高浓度FFA使葡萄糖刺激胰岛素分泌(GSIS)受损,血糖浓度升高;并且间接反映IR的程度。 相似文献
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伴有2型糖尿病的冠心病患者血中C反应蛋白的变化 总被引:1,自引:0,他引:1
目的了解伴有2型糖尿病的冠心病患者血中C反应蛋白(CRP)的变化,探讨糖尿病对CRP的影响.方法采用酶联免疫法对经冠状动脉造影证实的慢性稳定性心绞痛患者测定血清CRP,其中伴有2型糖尿病(DM)患者53例,无糖尿病患者38例.结果在冠心病患者中,DM较无DM者CRP显著增高;而且冠心病患者中DM合并陈旧性心梗者的CRP亦较无DM的陈旧性心梗者显著增高;单因素回归分析示CRP与血总胆固醇、低密度脂蛋白和甘油三酯水平显著正相关,而与HDL显著负相关.结论 CRP在糖尿病合并冠心病患者血中更显著增高,提示炎症反应在糖尿病致动脉粥样硬化形成中起重要作用. 相似文献
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目的探讨2型糖尿病(type 2 diabetes mellitus, T2DM)患者恐惧疾病进展(fear of progression, FOP)与血糖控制水平的关系,分析自我效能在两者间的中介作用,为优化患者血糖控制水平提供参考依据。方法采用便利抽样法选取245例住院的T2DM患者为调查对象,检测患者糖化血红蛋白(glycated hemoglobin, HbA1c)水平,采用一般资料调查表、FOP简化量表、糖尿病自我效能量表(diabetes management self-efficacy scale, DMSES)对患者进行调查。结果 245例患者HbA1c水平为(9.22±1.92)%,72.7%(178/245)的患者血糖控制不理想;FOP总分为(28.02±8.66)分,31.4%(77/245)患者因过度FOP而导致心理功能失调;DMSES总分为(130.85±37.27)分,64.5%(158/245)的患者得分处于中等水平。FOP与血糖控制水平呈正相关(r=0.207,P<0.01),自我效能与血糖控制水平呈负相关(r=-0.297,P<0.01),自我效能在FOP及血糖控制水平间存在完全中介作用(P<0.01)。结论 FOP显著影响T2DM患者血糖控制水平,且主要通过自我效能的完全中介作用实现。避免患者产生过度的FOP心理、提高自我效能水平是血糖控制良好的有效措施。 相似文献
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2型糖尿病合并代谢综合征组分与慢性肾脏病的相关性 总被引:1,自引:0,他引:1
目的:探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并代谢综合征(metabolic syndrome,MS)组分与慢性肾脏病(chronic kidney disease,CKD)的相关性。方法:对914例T2DM患者资料进行回顾研究,分析MS各组分及其它危险因素与CKD的关系。结果:(1)358例患者诊断为CKD,患病率为39.17%。(2)CKD组的年龄、总胆固醇、三酰甘油(TG)、低密度脂蛋白(LDL)、尿酸、糖尿病病程均显著高于非CKD组(P〈0.01)。(3)有高血压、冠心病、吸烟病史的患者CKD的患病率明显增高(P〈0.01)。(4)伴有MS组分的T2DM患者CKD的患病率明显高于不伴有MS组分的患者(40.90%比17.65%,P〈0.01)。(5)T2DM患者中,合并MS组分越多,发生CKD的危险性越高(P〈0.01)。(6)收缩压(SBP)、TG、LDL、年龄和糖尿病病程是T2DM患者中CKD发生的独立危险因素(P〈0.05)。结论:MS及其组分与CKD的发生、发展有着密切关系。SBP、TG、LDL、年龄和糖尿病病程是T2DM患者中CKD发生的独立危险因素。 相似文献
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《Postgraduate medicine》2013,125(4):74-83
AbstractIntensive glycemic control can reduce the risk of microvascular complications in patients with type 2 diabetes mellitus (T2DM). However, hypoglycemia induced by diabetes medications is recognized as a major limiting factor in the attainment of glycemic goals. Mild hypoglycemia is relatively common in patients with T2DM, and the prevalence of severe hypoglycemia increases with insulin treatment and can approach the prevalence seen in patients with type 1 diabetes. Mild hypoglycemia and the fear of hypoglycemia can have a substantial impact on the physical, mental, social, and economic well–being of patients with T2DM. Severe hypoglycemia is more serious and may be associated with an increased risk of dementia, cardiovascular events, and death. Insulin and insulin secretagogue therapies (eg, sulfonylureas and meglitinides) are the major causes of hypoglycemia in patients with T2DM. Other diabetes drugs, such as metformin, when used as monotherapy, have a low risk of hypoglycemia. Emerging experimental therapies, such as activators of the free fatty acid receptor 1, G protein–coupled receptor 119 agonists, glucokinase activators, inhibitors of 11β-hydroxysteroid dehydrogenase type 1, and sodium–glucose co–transporter 2 inhibitors, some of which have mechanisms of action consistent with a potential low risk of hypoglycemia, may help patients with T2DM achieve improved glycemic control. 相似文献
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中国北方汉族人高同型半胱氨酸血症与2型糖尿病并发冠心病的研究 总被引:1,自引:0,他引:1
目的探讨中国北方地区汉族人同型半胱氨酸(homocysteine,Hcy)与糖尿病并发冠心病发生的关系。方法研究对象均为北方汉族人群,包括92名糖尿病并发冠心病患者,67名糖尿病患者,80名冠心病患者和对照组95名健康人。应用荧光偏振免疫法(FPIA)测定Hcy水平,应用微粒子酶免分析免疫法(MEIA)测定血浆叶酸、维生素B12浓度。同时测定各种血脂。采用SPSS11.0软件进行统计学分析。结果糖尿病并发冠心病组(并发组)Hcy平均水平(中位数)(15.1μmol/L)显著高于对照组(11.7μmol/L)和糖尿病组(10.9μmol/L),而低于冠心病组(16.6μmol/L)(P<0.05),对照组与糖尿病组之间差别无统计学意义(P>0.05)。并发组叶酸、维生素B12明显低于正常对照组及糖尿病组,明显高于冠心病组(P<0.05)。Logistic回归分析显示高同型半胱氨酸血症、年龄、TC是糖尿病并发冠心病发生的独立危险因素,OR值分别为3.507,1.085,1.021。结论高同型半胱氨酸血症是中国北方地区汉族人2型糖尿病并发冠心病发生的独立危险因素,可能在糖尿病并发冠心病的发生、发展过程中起到一定作用。 相似文献
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目的:观察格列美脲对2型糖尿病患者心血管的保护作用并探讨其可能的机制。方法:112例T2DM患者随机分为格列美脲组(格列美脲+二甲双胍)和对照组(格列本脲+二甲双胍),观察治疗前后两者空腹及餐后两小时血糖(FBG,2hPBG)、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、HOMA模型胰岛素抵抗指数(HOMA-IR)、甘油三脂(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(HCY)、血浆脂联素的变化。结果:两组患者的TC、LDL-C、TG、FBG、2hPBG都较治疗前降低,连续服用6个月以上格列美脲的T2DM患者其血浆HCY、HOMA-IR、血糖水平明显下降,血浆脂联素水平明显升高,与对照组相比差异有统计学意义(P〈0.05)。结论:格列美脲能降低多项心血管危险因子水平,对血脂、HCY和动脉粥样硬化都有良性调节作用,其作用基础可能与改善胰岛素抵抗,增加血浆脂联素相关。 相似文献
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Intervention with Delivery of Diabetic Meals Improves Glycemic Control in Patients with Type 2 Diabetes Mellitus
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Saeko Imai Hana Kozai Mikuko Matsuda Goji Hasegawa Hiroshi Obayashi Chikako Togawa Toyomi Yamamura Kanji Watanabe Syuichi Miyatani Toshikazu Yoshikawa Shizuo Kajiyama 《Journal of Clinical Biochemistry and Nutrition》2008,42(1):59-63
The aim of this study was to investigate the effects of a diabetic meal delivery system on glycemic control over a 12 month period in patients with type 2 diabetes. A total of 77 patients with type 2 diabetes were assigned randomly into three dietary intervention groups: group M, diabetic meal delivery; group D, individual dietary counseling; and group C, conventional dietary education. In group M, HbA1c levels decreased significantly from 8.2 ± 1.2% to 7.4 ± 0.8% after 12 months (p<0.05), while in group D, HbA1c levels decreased significantly throughout the entire 12 month period, from 8.5 ± 1.7% at baseline to 7.4 ± 1.1% at the endpoint. Similarly, fasting blood glucose (FBG) levels decreased significantly between 1 and 12 months in group M (p<0.05), and decreased significantly during the entire 12 month period in group D (p<0.01). There were no significant changes in either HbA1c or FBG levels in group C. This study provides evidence that intervention with delivery of diabetic meals to patients with type 2 diabetes can be equally effective for achieving glycemic control as individual dietary counselling by a dietitian. Diabetic meal delivery can therefore be used successfully to provide diabetes education to outpatients. 相似文献
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Purpose
The goal of this study was to investigate the long-term economic outcomes of insulin degludec versus insulin glargine use in Chinese patients with type 2 diabetes mellitus (T2DM) whose oral antidiabetic drugs did not provide sufficient glycemic control.Methods
A published and validated Chinese diabetes health policy model, which reflects Chinese T2DM epidemiologic profiles, was used to assess the lifetime economic outcomes of microvascular and macrovascular complications and mortality. Efficacy and safety, medical expenditure, and utility data were derived from the literature, which were assigned to model variables for estimating the quality-adjusted life-years (QALYs) and costs, as well as incremental cost-effectiveness ratios. The analysis was conducted from the perspective of Chinese health care service providers. One-way and probabilistic sensitivity analyses were performed.Findings
Compared with insulin glargine, insulin degludec was associated with 0.0053 QALY at an additional cost of $3278 in our simulated cohort. This outcome resulted in an incremental cost-effectiveness ratio of insulin degludec over insulin glargine of $613,443 per QALY gained. The one-way sensitivity analyses indicated that the results were sensitive to several model inputs.Implications
Insulin degludec is unlikely to be cost-effective compared with insulin glargine for Chinese patients with T2DM whose disease is inadequately controlled with oral antidiabetic drugs. 相似文献17.
《Mayo Clinic proceedings. Mayo Clinic》2014,89(11):1564-1571
Hypoglycemia is a major problem associated with substantial morbidity and mortality in patients with diabetes and is often a major barrier to achieving optimal glycemic control. Chronic kidney disease not only is an independent risk factor for hypoglycemia but also augments the risk of hypoglycemia that is already present in people with diabetes. This article summarizes our current knowledge of the epidemiology, pathogenesis, and morbidity of hypoglycemia in patients with diabetes and chronic kidney disease and reviews therapeutic considerations in this situation. PubMed and MEDLINE were searched for literature published in English from January 1989 to May 2014 for diabetes mellitus, hypoglycemia, chronic kidney disease, and chronic renal insufficiency. 相似文献
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目的 观察吡格列酮联合门冬胰岛素30治疗2型糖尿病的疗效.方法 将55例单独胰岛素治疗3个月以上的2型糖尿病患者按随机数字表法分为对照组(n=25,门冬胰岛素30治疗)与治疗组(n=30,吡格列酮联合门冬胰岛素30治疗),2组患者接受相同的糖尿病教育,疗程均为3个月.观察2组患者治疗前后糖化血红蛋白(HbA1c)、甘油三酯(TG)、胰岛素用量及低血糖发生情况.结果 2组患者治疗后HbA1c、TG及胰岛素用量较治疗前均有改善(P<0.01),治疗组疗效优于对照组(P<0.05或P<0.01);治疗组的低血糖事件少于对照组.结论 与单独使用门冬胰岛素30相比,联合应用吡格列酮可以帮助2型糖尿病患者血糖、血脂达标的同时减少胰岛素用量,减少低血糖事件的发生. 相似文献
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2型糖尿病患者血清脂联素水平与胰岛素抵抗的关系 总被引:1,自引:0,他引:1
【目的】探讨2型糖尿病(T2DM)患者血清脂联素(APN)水平与肥胖、胰岛素及胰岛素抵抗的关系。【方法】采用病例对照研究,T2DM伴有肥胖组(DO)42例,T2DM不伴肥胖组(NDO)42例,正常对照组(NC)28名。检测三组对象血脂、血糖、空腹胰岛素(Fins)、APN水平。用HOMA模型公式计算胰岛素抵抗指数(HOMAIR)。【结果JDO组和NDO组的血清APN水平均明显低于NC组[DO组(8.02±3.57)mg/L,NDO组(8.35±2.68)mg/L比NC组(14.04±4.75)mg/L,均P〈O.01],DO组与NDO组APN水平差异无显著性。APN与体质指数(BMI)、腰围(w)、腰臀比(WHR)、空腹血糖(FBG)、甘油三脂(TG)、Fins、HO—MAIR呈显著负相关(P〈0.01),APN与高密度脂蛋白(HDL-C)呈显著正相关(P〈0.01)。多元逐步回归分析显示HOMAIR和WHR是血清APN浓度的主要影响因素。【结论】脂联素参与了胰岛素抵抗的发生,与2型糖尿病的发生相关。 相似文献