2型糖尿病患者全天血糖漂移变化的动态血糖监测

目的探讨2型糖尿病患者全天血糖漂移变化细节及波动趋势的临床意义。方法采用动态血糖监测系统对325例2型糖尿病患者进行连续72h动态血糖监测,根据血糖波动系数分为≤2．0组和〉2．0组,记录两组患者的糖化血红蛋白、24h平均血糖、三餐前后平均血糖、最大血糖漂移幅度、平均血糖漂移幅度及漂移次数、血糖波动系数、不同血糖所占日内时间百分比,对比评价两组患者全天血糖漂移变化的特点。结果糖化血红蛋白不能反映血糖水平波动的幅度和频率,血糖波动系数〉2．0组较≤2．0组发生高血糖及血糖漂移≥11,1mmol／L的时间及幅度明显增多（P〈0．05）。结论动态血糖监测系统有助于详细评估2型糖尿病患者的血糖漂移变化趋势及特征,血糖波动是预测糖尿病慢性并发症的独立危险因素。     

Resistant Starch Consumption Effects on Glycemic Control and Glycemic Variability in Patients with Type 2 Diabetes: A Randomized Crossover Study

We previously observed beneficial effects of native banana starch (NBS) with a high resistant starch (RS) content on glycemic response in lean and obese participants. Here, we aimed to determine the effects of NBS and high-amylose maize starch (HMS) on glycemic control (GC) and glycemic variability (GV) in patients with type 2 diabetes (T2D) when treatments were matched for digestible starch content. In a randomized, crossover study, continuous glucose monitoring (CGM) was performed in 17 participants (aged 28–65 years, BMI ≥ 25 kg/m², both genders) consuming HMS, NBS, or digestible maize starch (DMS) for 4 days. HMS and NBS induced an increase in 24 h mean blood glucose during days 2 to 4 (p < 0.05). CONGA, GRADE, and J-index values were higher in HMS compared with DMS only at day 4 (p < 0.05). Yet, NBS intake provoked a reduction in fasting glycemia changes from baseline compared with DMS (p = 0.0074). In conclusion, under the experimental conditions, RS from two sources did not improve GC or GV. Future longer studies are needed to determine whether these findings were affected by a different baseline microbiota or other environmental factors.     

Effects of Acute Resistance Exercise with and without Whole-Body Electromyostimulation and Endurance Exercise on the Postprandial Glucose Regulation in Patients with Type 2 Diabetes Mellitus: A Randomized Crossover Study

Background: Long hyperglycemic episodes trigger complications in type 2 diabetes mellitus (T2DM) patients. Postprandial glucose excursions can be reduced by acute physical activity. However, it is not yet clear which type of exercise has the best effect on postprandial glucose levels. Methods: Six T2DM patients participated in three 20-min moderate-intensity exercise sessions after breakfast in a randomized order: resistance exercise with whole-body electromyostimulation (WB-EMS), resistance exercise without electromyostimulation (RES) and cycling endurance exercise (END). A continuous glucose monitoring system recorded glucose dynamics. Results: Postprandially-increased glucose levels decreased in all cases. Time to baseline (initial value prior to meal intake) was quite similar for WB-EMS, RES and END. Neither glucose area under the curve (AUC), nor time in range from the start of the experiment to its end (8 h later) differed significantly. A Friedman analysis of variance, however, revealed an overall significant difference for AUC in the post-exercise recovery phase (END seems to have superior effects, but post-hoc tests failed statistical significance). Conclusions: There are no notable differences between the effects of the different types of exercise on glucose levels, especially when comparing values over a longer period of time.     

高单不饱和脂肪酸型肠内营养剂用于2型糖尿病

目的探讨含高单不饱和脂肪酸的特殊类型肠内营养制剂(Glucerna)对2型糖尿病患者血糖、血脂等方面的影响。方法将60例行肠内营养支持的2型糖尿病患者随机分为对照组和研究组,采用间歇喂饲法,分别经鼻胃管重力滴注两种不同的肠内营养制剂(Nutrison和Glucerna),并于营养支持前、支持后第7、14天测定两组患者的空腹血糖(FBG)、餐后2小时血糖(2hBG)、糖化血红蛋白(GHb)、血清甘油三酯(TG)、胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)等指标。结果研究结束时,对照组FBG(7.57±2.12)mmol/L和2hBG(10.48±2.36)mmol/L比研究前略有升高,但差异不显著(P>0.05),GHb(7.47±1.22)%无明显改变(P>0.05)。研究组FBG和2hBG在营养支持后第7天已出现下降,到研究结束时分别降至(6.41±1.98)mmol/L和(9.20±2.38)mmol/L,明显低于研究前和对照组(P<0.05);GHb(7.05±0.78)%与研究前和对照组相比虽有所下降,但差异不显著(P>0.05)。整个研究期内两组患者血脂水平无明显变化(P>0.05)。结论高单不饱和脂肪酸型肠内营养制剂能够降低2型糖尿病患者的血糖水平,尤其是餐后血糖水平,在临床上比标准配方更适合糖尿病患者。     

160例2型糖尿病患者动态血糖监测的应用

目的动态监测2型糖尿病（T2DM）患者血糖漂移的细节及波动趋势,为合理的治疗方案提供临床依据。方法采用动态血糖监测系统（CGMS）对160例T2DM患者进行连续72h的血糖监测。结果CGMS所测的血糖与血浆血糖值及指端血糖值均呈显著正相关（r=0．90,r=0．89,P值均〈0．01）,24小时平均血糖值与HbA1c呈显著正相关（r=0．87,P〈0．01）。患者1天中血糖较高的时间段为早、中、晚餐后1～2h,尤其是早餐后2h最高。上午6时～11时是血糖高峰最集中（64．5％）的时间段,而在凌晨1时-6时出现血糖低谷值占59．5％,尤其是凌晨3时最低。空腹血糖〉7．8mmol／L及餐后血糖〉11．1mmol／L所占的时间百分比分别为60（18～100）％和92（38～100）％。结论动态血糖监测能较详细地显示T2DM患者血糖水平波动的特征,对拟定更为合理的治疗方案提供临床依据。     

160例2型糖尿病患者动态血糖监测的应用

目的动态监测2型糖尿病(T2DM)患者血糖漂移的细节及波动趋势,为合理的治疗方案提供临床依据。方法采用动态血糖监测系统(CGMS)对160例T2DM患者进行连续72h的血糖监测。结果CGMS所测的血糖与血浆血糖值及指端血糖值均呈显著正相关(r=0.90,r=0.89,P值均<0.01)。24小时平均血糖值与HbA1c呈显著正相关(r=0.87,P<0.01)。患者1天中血糖较高的时间段为早、中、晚餐后1～2h,尤其是早餐后2h最高。上午6时～11时是血糖高峰最集中(64.5%)的时间段,而在凌晨1时～6时出现血糖低谷值占59.5%,尤其是凌晨3时最低。空腹血糖>7.8mmol/L及餐后血糖>11.1mmol/L所占的时间百分比分别为60(18～100)%和92(38～100)%。结论动态血糖监测能较详细地显示T2DM患者血糖水平波动的特征,对拟定更为合理的治疗方案提供临床依据。     

Currents Nutritional Practices of Nutritionists in the Management of Type 2 Diabetes Patients at Public Health Centres in Padang,Indonesia

(1) Background: The interest in nutrition practices and education is slowly gaining traction among Indonesian nutritionists. However, there is a lack of local studies that evaluate nutritional practices, especially in the management of type 2 diabetes (T2DM). This cross-sectional study aimed to determine the nutritional practices among nutritionists and the adequacy of the current practices in the management of Type 2 Diabetes Mellitus (T2DM) patients at the Public Health Clinic in Padang (PHC), Indonesia. (2) Methods: An online survey form was distributed to all the nutritionists (n = 50) involved in the management of T2DM patients in their daily practices at the PHC. Socio-demographic characteristics, the current practice of T2DM, the need for DM nutrition education, and an evaluation questionnaire on the Indonesian Non-Communicable Diseases guideline and the Public Health Centre guideline were captured in the survey. (3) Result: A total of 48 completed survey forms were received, providing a response rate of 96% from the recruited nutritionists. One-third (37.5%) of the respondents counselled between one and ten patients per day. Nearly half (41.7%) conducted a monthly follow-up session for the patients at their respective PHC in the previous three months. Each nutritionist educated five to ten T2DM patients. The most common nutrition education topics delivered included appropriate menus (89.6%) as well as the etiology and symptoms of T2DM (85.5%). Almost all the nutritionists (93.8%) used leaflets and about 35.4% used poster education. Around 70.8% of counseling sessions lasted 30 min and two-thirds (66.7%) of the sessions included nutrition education. Based on the results, about half (52.1%) of them claimed that T2DM patients were reluctant to attend individual nutrition education. One-fifth of them (20.8%) claimed that it was because the T2DM patients were not interested in the tool kits and materials used. (4) Conclusions: T2DM patients are reluctant to attend individual nutrition education due to uninteresting tool kits and materials.     

The Individual Nutrition Education Needs among Patients with Type 2 Diabetes at the Public Health Centers in Padang,Indonesia: A Cross-Sectional Study

Background: The Indonesian Public Health Care (PHC) of Management Nutrition Therapy (MNT) guidelines describe that individual nutrition education is aimed to improve quality of MNT services. The guidelines were originally developed for non-communicable diseases (NCDs), not specially for type 2 diabetes mellitus (T2DM) purposes. The reluctance of patients with T2DM to attend individual nutrition education is a common public health care issue in Padang (Indonesia). Methods: The presented cross-sectional study aimed to determine the individual nutrition education needs among people with T2DM. A set questionnaire was distributed to 11 PHC selected from 11 districts in Padang and 179 patients with T2DM were recruited and interviewed. Results: Among the 179 patients with T2DM, 76.5% were females and housewives (49.2%), a slight majority (57.8%) were ≤58 years old and 45.9% had graduated from primary school. The highest numbers of patients with T2DM were in PHC Andalas (20.7%). Some 74.9% (134) of the people with T2DM routinely attended individual nutrition education classes for less than 30 min (60.3%). Patients with T2DM followed individual nutrition education at a PHC every 1–2 months (59.8%), and a majority of the individual nutrition education was given by a medical doctor (57.5%). In contrast, 42.3% of patients with T2DM did not attend individual nutrition education due to a lack of recommendation from a medical doctor and their reluctance (33.3%). Although a majority of patients with T2DM (62.6%) were satisfied with their individual nutrition education, (20.4% of patients with T2DM recommended the availability of booklets during individual nutrition education that can be read at home. Patients with T2DM needed individual nutrition education (88.8%) and the majority (25.1%) requested individual nutrition education topics about diabetes food recommendation. Even though patients with T2DM followed health professionals’ advice (78.2%), however, their HbA1c (76.5%) wasnot reduced. Patients with T2DM agreed that individual nutrition education can increase their knowledge (51.9%), unfortunately, they still have difficulty to control their blood glucose (5.6%). Conclusions: According to the patients with the T2DM perspective stated above, it is crucial to develop the tool kits and educate patients with T2DM following the Diabetes Nutrition Education (DNE) curriculum to improve glycemic control.     

上海市部分社区2型糖尿病患者自我管理效果评价

[目的] 评价上海市社区2型糖尿病患者自我管理项目实施效果,为在社区推广、开展该项目提供依据.[方法]于2014年8-9月,在上海市徐汇、闵行、松江及金山区的8个社区招募250名确诊2型糖尿病患者参加自我管理活动.对活动前后糖尿病防治知识、健康行为、健康状况和自我效能进行问卷调查,并检测空腹血糖和血压.比较自我管理活动前后的知识、行为和自我效能的变化采用两配对样本McNemar检验,比较活动前后血糖、血压的变化采用配对t检验.[结果]所有参加自我管理的患者中男性85人(34.0％),女性165人(66.0％);平均年龄为(68.04±8.91)岁;糖尿病肾病、视网膜病变、神经病变、下肢血管病变和糖尿病足5种糖尿病慢性并发症的患病率分别为1.6％、11.2％、7.2％、3.6％和1.2％,冠心病、脑卒中、高血压、高血脂和慢性阻塞性肺疾病5种慢性病的患病率分别为25.6％、12.4％、75.2％、26.0％和0.8％.活动前后患者糖尿病相关知识知晓率分别为46.7％和70.3％,差异有统计学意义(P＜0.05).活动结束时患者平均每周有3d以上进行自我血糖监测、平均每周有5d以上遵循糖尿病健康饮食要求、平均每周有5d以上进行30 min或以上的有氧运动和按时服药的比例较活动前明显升高(均P＜0.05).活动结束时患者自我效能得分较活动前升高,差异有统计学意义(P＜0.05).活动结束时患者空腹血糖平均水平较活动开始前下降了0.93 mmol/L;过去30d内由于疾病和紧张、压抑等不良情绪造成的健康状况不良的天数比活动前分别下降了0.77和0.51 d(均P＜0.05). [结论]自我管理可以有效地提高患者对糖尿病认知水平、自我管理能力及自我效能,改善患者的血糖水平和健康状况.     

2型糖尿病患者进食不同食物对餐后2h血糖的影响

目的 观察糖尿病患者进食不同种类的食物对餐后血糖的影响。方法 将150例2型糖尿病患者随机分成豆渣包组、标准馒头组和普通面包组，每组50例，分别进食不同种类的食物，测定其空腹血糖(FPG)和餐后2h血糖(2hPBC)。结果 3组的2hPBG有差别，以标准馒头组最高，普通面包组次之，豆渣包组最低；3组的2hPBG与FPG的差值也有差异，标准馒头组最高，普通面包组次之，豆渣包组最低。结论 糖尿病患者进食不同种类的食物对2hPBG有不同的影响，监测2hPBG比FPG更重要。     

2型糖尿病患者胃炎发生率及危险因素分析

目的通过病例对照研究分析2型糖尿病患者胃炎发生率及其危险因素。方法 450例2型糖尿病患者纳入研究。对照样本选用本院同时期非糖尿病患者并利用口服葡萄糖耐受实验排除糖尿病。病例与对照按性别、年龄及BMI匹配。结果胃炎在2型糖尿病患者中发生率为17.7%,对照中发生率为5.8%。单因素分析发现,胃炎危险因素包括年龄、性别、BMI、多次生产经历、家族胃炎患病史、高甘油三酯与胆固醇。多因素分析发现,年龄(RR=1.54,95%CI:1.1~2.1),女性(RR=1.6,95%CI:1.0~1.9),BMI(RR=1.5,95%CI:1.3~2.5)为胃炎发生的独立危险因素。结论 2型糖尿病患者胃炎发生率较高,年龄的增加,女性,高BMI为胃炎发生的独立危险因素。     

社区2型糖尿病患者血糖评估分析

目的了解社区糖尿病患者在血糖控制、用药、治疗及自我管理等方面的情况。方法单纯随机抽取社区管理的2型糖尿病患者103例,开展问卷调查、体格及实验室检查。结果调查对象的空腹血糖(FPG)、糖化血红蛋白(HbAlc)、血压(BP)及甘油三酯(TG)的控制达标率分别为65.05%、72.82%、9.71%与25.24%。结论社区2型糖尿病患者控制指标的总体情况不理想。下阶段的工作重点是提高社区糖尿病患者的并发症检出率,强化生活方式干预,提高病人的自我管理能力。     

Nutrients and Dietary Approaches in Patients with Type 2 Diabetes Mellitus and Cardiovascular Disease: A Narrative Review

Cardiovascular disease (CVD) is the most common cause of morbidity and mortality in developed countries. The prevalence of CVD is much higher in patients with type 2 diabetes mellitus (T2DM), who may benefit from lifestyle changes, which include adapted diets. In this review, we provide the role of different groups of nutrients in patients with T2DM and CVD, as well as dietary approaches that have been associated with better and worse outcomes in those patients. Many different diets and supplements have proved to be beneficial in T2DM and CVD, but further studies, guidelines, and dietary recommendations are particularly required for patients with both diseases.     

l-Glutamine and Whole Protein Restore First-Phase Insulin Response and Increase Glucagon-Like Peptide-1 in Type 2 Diabetes Patients

l-glutamine triggers glucagon-like peptide-1 (GLP-1) release from L cells in vitro and when ingested pre-meal, decreases postprandial glycaemia and increases circulating insulin and GLP-1 in type 2 diabetes (T2D) patients. We aimed to evaluate the effect of oral l-glutamine, compared with whole protein low in glutamine, on insulin response in well-controlled T2D patients. In a randomized study with a crossover design, T2D patients (n = 10, 6 men) aged 65.1 ± 5.8, with glycosylated hemoglobin (HbA1c) 6.6% ± 0.7% (48 ± 8 mmol/mol), received oral l-glutamine (25 g), protein (25 g) or water, followed by an intravenous glucose bolus (0.3 g/kg) and hyperglycemic glucose clamp for 2 h. Blood was frequently collected for analyses of glucose, serum insulin and plasma total and active GLP-1 and area under the curve of glucose, insulin, total and active GLP-1 excursions calculated. Treatments were tested 1–2 weeks apart. Both l-glutamine and protein increased first-phase insulin response (p ≤ 0.02). Protein (p = 0.05), but not l-glutamine (p = 0.2), increased second-phase insulin response. Total GLP-1 was increased by both l-glutamine and protein (p ≤ 0.02). We conclude that oral l-glutamine and whole protein are similarly effective in restoring first-phase insulin response in T2D patients. Larger studies are required to further investigate the utility of similar approaches in improving insulin response in diabetes.     

2型糖尿病患者血糖和氧化应激水平相关性研究

目的探讨2型糖尿病（T2DM）患者血糖和氧化应激的改变及临床价值。方法测定92例T2DM患者空腹血糖和餐后2 h血糖（FPG,2 hPG）、糖化血红蛋白（HbA1c）,超氧化物歧化酶（SOD）、丙二醛（MDA）,并将90例健康体检者作为对照组进行比较。结果 T2DM组空腹和餐后2 h SOD水平显著低于正常对照组,相比较差异有统计学意义（P〈0.05）;空腹和餐后2h MDA水平显著高于正常对照组,相比较差异有统计学意义（P〈0.05）;T2DM组中SOD与FPG2、hPG、HbA1c呈显著负相关（r=0.712、0.863、0.631,P=0.000、0.000、0.003）,MDA与FPG2、hPG、HbA1c呈显著正相关（r=0.672、0.583、0.471,P=0.000、0.000、0.004）。结论 2型糖尿病患者血糖与氧化应激水平有显著相关性,FPG2、hPG及HbA1c的改变影响2型糖尿病患者的氧化应激水平。     

对某社区老年2型糖尿病患者服药依从性调查分析

目的了解社区老年2型糖尿病患者服药情况及影响因素。方法专门医护人员采用问卷调查方式对某社区108例老年2型糖尿病患者服药依从性的调查记录。结果发现服药依从性良好者占33.3%、服药依从性差者占66.67%。结论加强对老年糖尿病患者的健康教育及社区医护人员的培训显得至关重要,提高服药依从性,从而提高患者的生活质量。     

对某社区老年2型糖尿病患者服药依从性调查分析

目的 了解社区老年2型糖尿病患者服药情况及影响因素。方法专门医护人员采用问卷调查方式对某社区108例老年2型糖尿病患者服药依从性的调查记录。结果发现服药依从性良好者占33．3％、服药依从性差者占66．67％。结论加强对老年糖尿病患者的健康教育及社区医护人员的培训显得至关重要,提高服药依从性,从而提高患者的生活质量。     

The Effect of Meal Frequency on the Fatty Acid Composition of Serum Phospholipids in Patients with Type 2 Diabetes

Objective: Fatty acids are important cellular constituents that can affect many metabolic processes relevant for the development of diabetes and its complications. We previously demonstrated a positive effect of eating just 2 meals a day, breakfast and lunch, compared to 6 small meals. The aim of this secondary analysis was to explore the effect of meal frequency on the fatty acid composition of serum phospholipids in subjects with type 2 diabetes (T2D).

Methods: In a randomized, crossover study, we assigned 54 patients with T2D to follow one of 2 regimens of a hypocaloric diet (?500 kcal/day), each for 12 weeks: 6 meals (A6) or 2 meals a day, breakfast and lunch (B2). The diet in both regimens had the same macronutrient and energy content. The fatty acid composition of serum phospholipids was measured at weeks 0, 12, and 24, using gas liquid chromatography. Insulin sensitivity was derived as an oral glucose insulin sensitivity (OGIS) index.

Results: Saturated fatty acids (mainly myristic and palmitic acids) decreased (p < 0.001) and n6 polyunsaturated fatty acids increased (p < 0.001) in response to both regimens but more with B2 (p < 0.001 for both). Monounsaturated fatty acids decreased (p < 0.05) and n3 polyunsaturated fatty acids increased (p < 0.001) in response to both regimens, with no difference between the regimens. An increase in OGIS correlated positively with changes in the proportion of linoleic acid in B2. This correlation remained significant even after adjustment for changes in body mass index (BMI; r = +0.38; p = 0.012).

Conclusions: We demonstrated that meal frequency affects the fatty acid composition of serum phospholipids. The B2 regimen had more marked positive effects, with saturated fatty acids and the ratio of saturated to unsaturated fatty acids decreasing more. The increase in linoleic acid could partly explain the insulin-sensitizing effect of B2 in T2D.     

Association between Hyperglycemia at Hospital Presentation and Hospital Outcomes in COVID-19 Patients with and without Type 2 Diabetes: A Retrospective Cohort Study of Hospitalized Inner-City COVID-19 Patients

This study aimed to determine the relationships among hyperglycemia (HG), the presence of type 2 diabetes (T2D), and the outcomes of COVID-19. Demographic data, blood glucose levels (BG) measured on admission, and hospital outcomes of COVID-19 patients hospitalized at Boston University Medical Center from 1 March to 4 August 2020 were extracted from the hospital database. HG was defined as BG > 200 mg/dL. Patients with type 1 diabetes or BG < 70 mg/dL were excluded. A total of 458 patients with T2D and 976 patients without T2D were included in the study. The mean ± SD age was 56 ± 17 years and 642 (45%) were female. HG occurred in 193 (42%) and 42 (4%) of patients with and without T2D, respectively. Overall, the in-hospital mortality rate was 9%. Among patients without T2D, HG was statistically significantly associated with mortality, ICU admission, intubation, acute kidney injury, and severe sepsis/septic shock, after adjusting for potential confounders (p < 0.05). However, only ICU admission and acute kidney injury were associated with HG among patients with T2D (p < 0.05). Among the 235 patients with HG, the presence of T2D was associated with decreased odds of mortality, ICU admission, intubation, and severe sepsis/septic shock, after adjusting for potential confounders, including BG (p < 0.05). In conclusion, HG in the subset of patients without T2D could be a strong indicator of high inflammatory burden, leading to a higher risk of severe COVID-19.