Improvement in quality of diabetes control and concentrations of AGE-products in patients with type 1 and insulin-treated type 2 diabetes mellitus studied over a period of 10 years (JEVIN)

Advanced glycation end (AGE)-products, a complex and heterogeneous group of compounds, have been implicated in diabetes-related long-term complications. Up to the present, only few data exist about serum levels of the AGE-proteins N- epsilon -carboxymethyllysine (CML) and pentosidine in selection-free populations of patients with type 1 and insulin-treated type 2 diabetes mellitus. In the present 10-year, population-based trial of patients with insulin-treated diabetes mellitus, serum CML and pentosidine levels were examined in correlation to the patients' quality of diabetes control and the prevalence of diabetes-related long-term complications. Jena's St. Vincent Trial (JEVIN) was started in 1989/1990. At this time, a centralised diabetes care system existed. After the baseline examination of 190 patients (83% of the target population) with insulin-treated diabetes mellitus, follow-up examinations were performed in 1994/1995 and 1999/2000. In 1994/1995, the CML concentration in patients with type 1/type 2 diabetes mellitus was 1096.47+/-405.50/1136.43+/-405.24 ng/ml. In 1999/2000, it was significantly lower (727.49+/-342.91 ng/ml, P=.033/743.76+/-312.47 ng/ml, P<.0001). The same tendency showed the AGE-protein pentosidine (type 1: 1994/1995 203.18+/-118.88 vs. 1999/2000 156.59+/-104.84 pmol/ml [P=.029], type 2: 1994/1995 189.72+/-67.66 vs. 1999/2000 151.54+/-127.73 pmol/ml [P=.020]). Parallel to the decrease in the mean concentration of the AGE-products CML and pentosidine mean HbA1c improved and the prevalence of diabetic long-term complications (retino-, neuro-, and nephropathy) remained comparable 1999/2000-1989/1990. Comparing the data of 1999/2000 with those from 1994/1995, there was not only a substantial improvement in patients' quality of diabetes control but also a decrease in the concentration of AGE-products. In patients with diabetes mellitus, the AGE-products seem to be mainly influenced by the quality of diabetes control. However, the most important parameter reflecting the risk for development and progression of diabetes-related long-term complications seems not to be the AGE-products, but patients' HbA1c.     

Structured diabetes therapy and education improves the outcome of patients with insulin treated diabetes mellitus. The 10 year follow-up of a prospective, population-based survey on the quality of diabetes care (the JEVIN Trial).

AIMS/HYPOTHESIS: JEVIN (Jena's St. Vincent Trial) is a prospective, 10 year follow-up, population-based survey of all insulin treated patients with type 1 and type 2 diabetes mellitus aged 16 to 60 years and living in the city of Jena (100,000 inhabitants), Thuringia, Germany. It aims to show the effects of implementation of the St. Vincent Declaration and to evaluate the effect of recent changes in the health care system and new treatment strategies. PATIENTS AND METHODS: 190 patients (83% of the target population), 244 patients (90%) and 261 patients (90%) were studied in 1989/90, 1994/95 and 1999/2000, respectively. RESULTS: Up to 1994/95, the HbA1c of patients with type 1 diabetes mellitus increased (1994/95: 8.50+/-1.80% versus 1989/90: 7.83+/-1.60%, p=0.002). For patients with type 2 diabetes mellitus, it remained constant (9.01+/-2.06% versus 9.17+/-1.60%, n. s.). During the period from 1994/95 to 1999/2000, there was a substantial improvement in the relative HbA1c of both, patients with type 1 (7.62+/-1.55%, p<0.0001), and with type 2 diabetes (7.57+/-1.29%, p<0.0001). Up to 1999/2000, 87.7% of the patients with type 1 (1989/90: 0%, 1994/95: 73.2%) and 96.6% of the patients with type 2 diabetes (1989/90: 0%, 1994/95: 89.7%) participated in TTP's. The incidence of acute and the prevalence of long-term complications remained constant. CONCLUSIONS: Results of the population-based, prospective trial to optimise patients' quality of diabetic control suggest: For patients with insulin treated type 2 diabetes mellitus, excellent treatment can be available by primary care physicians interested, educated and highly engaged in diabetes therapy. Moreover, structured diabetes therapy consisting of treatment and teaching programmes, regular self-monitoring, patients' insulin dose adjustment and patients' empowerment, should be offered to all patients with diabetes mellitus.     

Malignancies in patients with insulin-treated diabetes mellitus

In patients with diabetes mellitus, contradictory results have been reported indicating both increased and reduced risks of malignancies. In the present trial all insulin-treated diabetic patients (n = 2720) attending our centre since 1995 were studied. Of these patients, 28 (type 1/type 2: n = 1/27, 23 women) developed malignancies during insulin therapy: 11 patients developed cancer of the breast, 4 patients cancer of the pancreas, 3 patients cancer of the kidneys and 10 patients developed other malignancies. The characteristics of these patients [mean - SD (range)] were as follows: age 68.8 - 8.6 (52.0-87.0) years, diabetes duration 13.1 - 8.1 (0.5-29.0) years, duration of insulin therapy at the time of the diagnosis of malignancy 4.3 - 5.7 (0.5-24.0) years, insulin dosage 0.67 - 0.43 (0.11-1.72) IU/kg body weight, mean HbA1c 9.6 - 1.9 (6.8-14.9)% (HPLC, Diamat, normal range 4.4%-5.9%). The prevalences of nephropathy, retinopathy (non-proliferative: n = 7) and peripheral neuropathy were 35.7%, 25.0% and 46.4% respectively. When the features of the 27 patients with type 2 diabetes were compared with the characteristics of the type 2 diabetic patients (n = 117, 63 women) studied in a population-based survey of insulin-treated diabetic patients, also performed in the area of Jena [JEVIN; Schiel R et al. (1997a)] there were no significant differences in the duration of insulin therapy (JEVIN: 4.7 - 4.3 years, P = 0.64), insulin dosage (JEVIN: 0.55 - 0.27 IU/kg body weight, P = 0.08), mean HbA1c (JEVIN: 9.0 - 2.1%, P = 0.16) and the prevalences of long-term complications of diabetes. The quality of diabetes control in insulin-treated patients suffering from malignancies is comparable to that of a selection-free population of diabetic patients. Furthermore, in comparison to non-diabetic subjects our diabetic patients showed no altered risk for malignancies as a function of insulin dosage, the duration of diabetes or insulin therapy, the quality of diabetes control or the prevalence of long-term complications of the disease.     

The effect of interventions to prevent cardiovascular disease in patients with type 2 diabetes mellitus.

PURPOSE: Cardiovascular complications account for over 50% of mortality among patients with type 2 diabetes mellitus. We quantify the cardiovascular benefit of lowering cholesterol, blood pressure, and glucose levels in these patients. METHODS: We conducted a meta-analysis of randomized controlled trials in type 2 diabetes or diabetes subgroups, comparing the cardiovascular effects of intensive medication control of risk factor levels in standard therapy or placebo. We identified trials by searching MEDLINE (1966 to 2000) and review articles. Treatment details, patient characteristics, and outcome events were obtained using a specified protocol. Data were pooled using fixed-effects models. RESULTS: Seven serum cholesterol-lowering trials, six blood pressure-lowering trials, and five blood glucose-lowering trials met eligibility criteria. For aggregate cardiac events (coronary heart disease death and nonfatal myocardial infarction), cholesterol lowering [rate ratio (RR) = 0.75; 95% confidence interval (CI): 0.61 to 0.93) and blood pressure lowering (RR = 0.73; 95% CI: 0.57 to 0.94) produced large, significant effects, whereas intensive glucose lowering reduced events without reaching statistical significance (RR = 0.87; 95% CI: 0.74 to 1.01). We observed this pattern for all individual cardiovascular outcomes. For cholesterol-lowering and blood pressure-lowering therapy, 69 to 300 person-years of treatment were needed to prevent one cardiovascular event. CONCLUSION: The evidence from these clinical trials demonstrates that lipid and blood pressure lowering in patients with type 2 diabetes is associated with substantial cardiovascular benefits. Intensive glucose lowering is essential for the prevention of microvascular disease, but improvements in cholesterol and blood pressure levels are central to reducing cardiovascular disease in these patients.     

Glucagon-stimulated insulin secretion in patients with type 2 diabetes mellitus: support for the concept of glucose toxicity.

Parameters of blood glucose control and insulin secretion were evaluated in 114 patients with type 2 diabetes mellitus, who were no longer controlled satisfactorily by maximal doses of oral hypoglycaemic agents, and compared with those obtained in 11 healthy control subjects, 32 patients with recently-diagnosed type 2 diabetes, and 16 tablet-treated and 36 insulin-treated patients. Newly-diagnosed patients were slightly younger (60 +/- 13 yr) and had a slightly higher body mass index (29.4 +/- 6.5 kg/m2). Known duration of diabetes was 9 yr (range 1-37) in secondary failure, and 11 yr (range 1-31) in insulin-treated patients. Fasting blood glucose was the highest (13.8 +/- 2.8 mmol/l) in secondary failure and newly-diagnosed patients (12.6 +/- 3.8 mmol/l) compared to tablet-treated (8.7 +/- 3.3 mmol/l) and insulin-treated patients (9.6 +/- 3.2 mmol/l, p less than 0.05). HbA1c levels were comparably elevated. In insulin-treated patients, fasting plasma C-peptide levels were lower relative to the mutually comparable levels in the other 3 diabetic groups. Fasting plasma insulin levels did not differ between the 4 diabetic groups. C-peptide release after glucagon (C-peptide AUC) was comparable in all 4 diabetic groups, although in tablet-treated patients the ratio C-peptide AUC/fasting blood glucose was higher (p less than 0.05). We conclude that the clinical usefulness of determining residual insulin secretion in type 2 diabetic patients is limited, and that the similar reduction of insulin secretion in severely hyperglycaemic newly-diagnosed and secondary failure type 2 diabetic patients supports the concept of "glucose toxicity".     

Novel Metabolic Drugs and Blood Pressure: Implications for the Treatment of Obese Hypertensive Patients?

Hypertension and obesity often coexist, exposing patients to cardiovascular and metabolic risks, particularly type 2 diabetes mellitus. Moreover, obesity may render hypertensive patients treatment resistant. We review how drugs recently approved for obesity or type 2 diabetes mellitus treatment affect blood pressure. The weight-reducing drug lorcaserin induces modest reductions in body weight while slightly improving blood pressure. The fixed low-dose topiramate/phentermine combinations elicit larger reductions in body weight and blood pressure. Concomitant improvements in glucose metabolism, adiposity, and blood pressure differentiate the first clinically available SGLT2 inhibitor dapagliflozin from other oral antidiabetic drugs. Yet, the mechanisms through which metabolic drugs affect blood pressure and their interaction with antihypertensive drugs are poorly understood. Blood pressure-lowering effects of metabolic drugs could be exploited in the clinical management of obese hypertensive patients with and without type 2 diabetes mellitus, particularly in patients with difficult to control arterial hypertension.     

Cardiac transplantation in patients with insulin-treated diabetes mellitus.

BACKGROUND AND METHODS: As documented earlier the incidence of cardiac mortality in diabetic patients due to coronary artery disease is high. Cardiac transplantation for congestive heart failure due to coronary artery disease, cardiomyopathy, and valvular diseases is obviously a therapeutic option in patients suffering from insulin-treated diabetes mellitus. To shed more light on this problem we performed a retrospective analysis of 40 patients with insulin-treated diabetes mellitus (three type-1; 37 type-2: insulin-treated for at least three months before cardiac transplantation) referred to our transplant unit for cardiac transplantation between March 1989 and December 1996. RESULTS: Orthotopic cardiac transplantation was performed in 40 patients (4 women, 36 men) aged 32-73 years (mean 56 years) with an insulin-treated diabetes mellitus preexisting for 3-348 months (mean 65.1 months). Donor age ranged from 15 to 72 years (mean 35.5 years) matched for body weight and blood group. Overall mortality in this group was 40.0% with an early mortality of 12.5%. CONCLUSIONS: Our results show that type-1/2 insulin-treated diabetes mellitus preoperative to heart transplantation is not a contraindication in patients suffering from end-stage heart failure. Adequate therapy of diabetes mellitus as well as individual immunosuppressive therapy are important in order to minimize additional organ damage caused by the drugs themselves or resulting infectious complications.     

How to ADVANCE prevention of cardiovascular complications in type 2 diabetes

Patients suffering from type 2 diabetes are at increased risk of macrovascular and microvascular disease. This review assesses the available evidence for hypertension and hyperglycemia as risk factors for vascular disease in type 2 diabetes mellitus. Several studies showing a benefit of antihypertensive treatment and glucose-lowering therapy on the prevention of macrovascular and microvascular disease are discussed. However, questions remain concerning the overall balance of benefits and risks of intensive target-driven blood pressure and blood glucose control in type 2 diabetes. More well-powered intervention and prevention studies are therefore needed to provide the necessary reliable evidence to answer these questions. The Action in Diabetes and Vascular disease: PreterAx and DiamicroN modified release Controlled Evaluation (ADVANCE) study is discussed as a trial designed to resemble clinical practice that promises to provide answers concerning the value conferred by blood pressure-lowering therapy and intensive glucose control therapy in type 2 diabetes patients at high risk for cardiovascular disease.     

Comorbid conditions and glycemic control in elderly patients with type 2 diabetes mellitus, 1988 to 1994 to 1999 to 2004

OBJECTIVES: To compare the prevalence of type 2 diabetes mellitus in the U.S. elderly population between 1988 to 1994 and 1999 to 2004 and to assess glycemic control and comorbid conditions in this population.
DESIGN: Serial U.S. population-based cross-sectional surveys.
SETTING: National Health and Nutrition Examination Surveys (1988–1994 and 1999–2004).
PARTICIPANTS: Survey participants aged 65 and older with type 2 diabetes mellitus.
MEASUREMENTS: Glycemic control, measured as hemoglobin A1C (hA1C) less than 7%, prevalence of comorbid conditions, pharmacologic treatment rate, blood pressure, and serum cholesterol.
RESULTS: The prevalence of diagnosed type 2 diabetes mellitus in the U.S. elderly population increased from 12.0% to 14.1% ( P =.004) between 1988 and 2004. Many patients had comorbid conditions; in 1999 to 2004, 36.7% had nephropathy, 31.5% renal insufficiency, 20.2% history of myocardial infarction, and 17.9% heart failure. The proportion of patients treated with antihyperglycemic medication increased from 75.1% in 1988 to 1994 to 85.6% in 1999 to 2004 ( P <.001), and glycemic control rates also improved, from 44.7% to 54.8% ( P <.001). Greater improvement in glycemic control rates was evident in patients without comorbidities ( P <.001). Adjusted for patient characteristics, including duration of diabetes mellitus, patients with nephropathy or renal insufficiency were 40% less likely to achieve controlled hA1C as those without.
CONCLUSION: Despite improvements in the rates of treatment and glycemic control, approximately half of elderly patients diagnosed with type 2 diabetes mellitus have hA1C levels of 7% or higher. Many patients suffer from comorbid conditions, which may present a challenge for successful diabetes mellitus management.     

2型糖尿病患者6330例治疗依从性与代谢控制情况回顾性分析

目的了解近15年以来2型糖尿病患者治疗依从性及体质量、血糖、血压、血脂控制等代谢指标的发展变化,对加强糖尿病患者管理提供理论依据。方法对2型糖尿病患者6330（男性3085,女性3245）例进行回顾性分析,根据年份划分为3组：1994～1999年,2000～2004年,2005～2009年。结果三组分别有患者1253例（19.79%）、1865例（29.46%）和3212例（50.75%）,随时间进展,口服降糖药物治疗依从性有明显提高,采用胰岛素治疗的患者比例增加明显,空腹血糖、餐后2小时血糖、HbA1c和血压下降明显,总胆固醇略有下降,但是体质量指数、腰围和甘油三酯反而有所上升。全部患者空腹血糖、餐后2小时血糖和HbA1c达标率分别为16.9%、13.2%和25.7%。结论近10年来2型糖尿病患者血糖和血压控制情况较前有所改善,但患者代谢控制整体达标情况并不理想。糖尿病教育管理的重点应强化行为教育和干预,充分重视患者自我管理和行为改变。     

Hypertension and renal complications in type 2 diabetes

Diabetes mellitus and arterial hypertension are the leading causes of end-stage renal disease in industrialized countries. Although attention has focused on renal disease and insulin-dependent diabetes mellitus (type 1 diabetes), a silent epidemic of renal disease caused by type 2, noninsulin-dependent diabetes mellitus is rapidly developing. The course of renal function is heterogeneous in type 2 diabetic patients and reflects heterogeneous patterns of renal lesions. A subset of patients with microalbuminuria and proteinuria is characterized by the typical diabetic glomerulopathy usually observed in type 1 diabetic patients, with altered albumin excretion rate (AER), for example, glomerular basement membrane thickening and mesangial fractional volume expansion. These patients also have diabetic retinopathy and rapidly lose renal function despite tight blood pressure control. In contrast, a second subset of type 2 diabetic patients has normal or near-normal patterns of glomerular structure, despite abnormalities of AER comparable to those of the patients with diabetic glomerulopathy. Thus abnormalities of AER have a different renal prognostic value depending on the underlying renal structure. The patients with worse clinical prognosis and typical diabetic glomerulopathy also have diabetic retinopathy, whereas those with a better course of renal function quite often have no diabetic retinopathy. Several findings, albeit not unanimous, suggest that HbA1c levels above 7.5 to 8.0 % are closely associated with a rapid decay of renal function in type 2 diabetes. Tight blood pressure control plays a further important role in determining the progression of renal a damage in type 2 diabetes mellitus. Convincing evidence has been provided that drugs capable of inhibiting the renin-angiotensin hormonal system are quite effective in preventing and delaying the evolution of renal damage in both type 1 and 2 diabetes. Equally strong data support the view that other antihypertensive compounds such as beta-blockers and calcium antagonists also delay the progression of renal damage in diabetes mellitus. Whatever the drug used to treat hypertension, the majority of the authors conclude that blood pressure levels should be maintained below 130/85 mmHg in diabetic patients. While it is well established that uncontrolled diabetes underlies the development of diabetic nephropathy, newer evidence suggests that genetically determined susceptibility to hyperglycemia-caused glomerular injury is also necessary. More information on this issue will help to design new therapeutical approaches to treat hypertension and renal complications in type 2 diabetes.     

罗格列酮在老年2型糖尿病患者中的降压与内皮保护作用

目的 观察胰岛素增敏剂罗格列酮对老年2型糖尿病患者的降压作用及其对血管内皮的保护作用.方法 将104例无高血压史(未服用降压相关药物)的老年2型糖尿病患者按初诊收缩压(SBP)分为3组,理想血压组(SBP≤120 mm Hg,1 mm Hg=0.133 kPa)42例,例,前期高血压组(140mm Hg≥SBP>120 mm Hg)33例,轻度高血压组(160 mm Hg≥SBP>140 mm Hg)29例.维持原治疗不变,应用岁格列酮4 mg/d,治疗12周.测定治疗前、后SBP、舒张压(DBP)、空腹血糖(FBG)、糖化血红蛋白(Hb)Alc、稳态模型评估一胰岛素抵抗指数(HOMA-IR)、总胆固醇(TC)、低密度脂蛋白(LDL)、vWF、白细胞(WBC)计数、C反应蛋白(CRP)、非对称性二甲基精氨酸(ADMA)水平.结果 用药12周后,轻度高血压组治疗后SBP及DBP均较治疗前有所下降,差异有统计学意义(P<0.05).前期高血压组治疗后SBP 下降,有统计学意义(P<0.05),而DBP虽下降,但无统计学意义.3组FBG、HbAlC、HOMA-IR、TC、LDL较治疗前下降,差异有统计学意义(P<0.05).另外,治疗后vWF、WBC及CRP也较治疗前下降,筹异有统计学意义(P<0.05).结论 罗格列酮可以降低老年2型糖尿病患者的SBP及DBP,对于基础血压高者降压效果更为显著,同时还可改善内皮细胞功能,发挥保护内皮的作用.     

The value of self-monitoring of blood glucose: a review of recent evidence

AimsTo review the recent literature relating to the role of self-monitoring of blood glucose (SMBG) and glycemic control.MethodsMedline and EMBASE databases were searched between 1996 and June 2008 using terms that included diabetes mellitus, self-care, and blood glucose self monitoring. Both experimental and nonexperimental studies with HbA_1c as an outcome measure were included. A meta-analysis was performed on randomized controlled trials (RCTs) in type 2 diabetes which met the inclusion criteria.ResultsFrom 1102 relevant papers, 34 original containing 38 separate studies were identified as being published between 2000 and June 2008. There were 23 studies of type 2 diabetes and, of these, 13 were nonexperimental and 10 experimental, including six RCTs. The results of five of these RCTs in non–insulin-treated type 2 diabetic patients were combined in a meta-analysis with two earlier RCTs which yielded a significant pooled SMBG-related decrease in HbA_1c of ?0.22 (95% CI ?0.34% to ?0.11%).ConclusionsThe present meta-analysis showed an SMBG-related HbA_1c reduction in non–insulin-treated type 2 diabetes patients that was similar to that in previous systematic reviews but in a substantially larger patient sample. This finding is consistent with most observational studies of similarly treated patients.     

Efficacy of glimepiride in patients with poorly controlled insulin-treated type 2 diabetes mellitus

We retrospectively investigated the effects of adding glimepiride in patients with type 2 diabetes showing suboptimal control by insulin therapy. Of 63 patients with poorly controlled insulin-treated type 2 diabetes (baseline HbA1c, 8.4 +/- 0.6%), 32 were treated with insulin alone and 31 were given glimepiride in addition to insulin. HbA1c values, daily insulin dose, body weight, blood pressure, plasma lipid concentrations, and the number of hypoglycemic events were recorded at weeks 0, 12, 24, 36, 48, 60, and 72. HbA1c decreased by 1.1%, from 8.5 +/- 0.6% to 7.4 +/- 0.8% (P<0.0001) in patients treated with insulin plus glimepiride at 12 weeks, and improved glycemic control continued throughout the study. Required insulin dose was reduced significantly in patients treated with insulin plus glimepiride (from 29.4 +/- 14.5 to 22.3 +/- 12.1 units/day, P = 0.0187). Body weight increased significantly in patients treated with insulin plus glimepiride (from 57.0 +/- 8.7 to 59.5 +/- 9.2 kg, P = 0.0232). Adding glimepiride showed little effect on blood pressure, plasma total cholesterol, triglyceride, or HDL-cholesterol. Serum C peptide concentrations increased significantly in patients treated with insulin plus glimepiride (from 1.01 +/- 0.71 to 1.28 +/- 0.65 ng/ml, P = 0.0367). The number of hypoglycemic events did not differ between groups. Adding glimepiride to insulin therapy resulted in sustained improvement of glycemic control in patients with poorly controlled type 2 diabetes.     

Evaluation of dexterity in insulin-treated patients with type 1 and type 2 diabetes mellitus

Background

Daily routine for insulin-treated patients with diabetes mellitus requires correct performance of self-monitoring of blood glucose and insulin injections several times a day. Dexterity skills may play an important role in the performance efficacy of these procedures.

Methods

We collected data of insulin-treated (>10 years) patients with different age ranges [healthy controls, 14 female/11 male, age (mean ± standard deviation) 55 ± 7 years; type 1 diabetes mellitus (T1DM) patients, 12/13, 45 ± 9 years, disease duration 23.9 ± 6.5 years; T2DM patients, 8/17, 64 ± 6 years, 16.2 ± 6.9 years; T2DM patients (>70 years of age), 9/16, 75 ± 4 years, 19.7 ± 7.0 years]. After assessment of neuropathy (temperature, pain, and vibration perception), the patients participated in two dexterity test batteries [Jebsen–Taylor hand-function test (JHFT) and motoric performance series (MPS)].

Results

Patients with type 2 diabetes showed disturbed vibration perception as compared to the other groups. The dexterity results were influenced by age to a large extent. Older T2DM patients performed worst in the majority of the subtests (e.g., JHFT, writing nondominant hand: control, 40.8 ± 11.7 s; T1DM, 46.3 ± 50.9 s, not significant versus control; old T2DM, 68.1 ± 29.5 s, p < .05; young T2DM, 52.5 ± 26.2 s, p < .05). Patients with type 1 diabetes showed similar JHFT and MPS results than the 10-year-older control subjects and performed outside of the age-dependent normal reference range.

Conclusions

Manual skills and dexterity differed between the groups, and age-corrected reduced skills were common in both T1DM and T2DM patients in this study. Our findings underline the importance of considering dexterity and manual skills when designing medical devices for patients with diabetes mellitus.     

老年高血压合并2型糖尿病患者餐后血糖与血压关系的研究

目的探讨老年高血压合并2型糖尿病患者,餐后血糖与炎症因子C-反应蛋白、脉压、昼夜血压的关系及临床意义。方法选择单纯高血压、高血压合并2型糖尿病餐后高血糖患者及健康体检者各30例,均测定空腹血糖（FPG）、餐后2h血糖（2hPG）、空腹血浆胰岛素（FINs）、糖化血红蛋白（HbAlC）、血清C-反应蛋白（CRP）,计算胰岛抵抗指数（IRI）,高血压患者行动态血压监测（ABPM）。对各组的CRP、糖代谢指标、动态血压参数等进行统计学分析,并比较高血压合并2型糖尿病餐后高血糖患者治疗前后各项指标。结果高血压合并糖尿病组FPG、2hPG、FINS、IRI、HbAlC及CRP各指标与单纯高血压组及正常对照组比较差异有统计学意义（P〈0．05）,单纯高血压组FINS、IRI及CRP高于正常对照组,差异有统计学意义（P〈0．05）;与单纯高血压患者相比,高血压合并糖尿病餐后高血糖组患者脉压（PP）增大,非杓型比率高,差异有统计学意义（P〈0．05）;高血压合并糖尿病餐后高血糖患者治疗后PP、非杓型比率下降,与治疗前比较差异有统计学意义（P〈0．05）。结论高血压与糖尿病同样存在胰岛素抵抗,高血压合并糖尿病患者,餐后血糖与CRP水平、PP、血压昼夜节律异常相关,餐后血糖的控制可能有助于夜间杓型血压的恢复,延缓动脉粥样硬化的进程。     

老年高血压和糖尿病患者动脉僵硬度的影响因素分析

目的 评价老年高血压和(或)糖尿病患者动脉僵硬度及其影响因素. 方法 320例老年患者分为4组:对照组、糖尿病组、高血压组、高血压并存糖尿病组(联合患病组).收集年龄、体质指数、性别、吸烟、血压、脉压及平均动脉压,测定血清空腹血糖、血脂、糖化血红蛋白、超敏C反应蛋白等;并应用COLIN-VP1000动脉硬化测定仪测量入选者踝臂脉搏波传导速度(baPWV)以评价对动脉硬化的影响. 结果 联合患病组、糖尿病组、高血压组、对照组baPWV值分别为(2165.9±479.9)cm/s、(2158.6±386.9)cm/s、(1881.2±383.8)cm/s和(1667.2±279.3)cm/s,联合患病组、高血压组及糖尿病组的baPWV水平与对照组比较,差异均有统计学意义(F=8.473,P＜0.05),联合患病组与糖尿病组的baPWV值比较,差异无统计学意义,高血压组与糖尿病组及联合患病组的baPWV值比较,差异有统计学意义(均P＜0.05).联合患病组脉压、超敏C反应蛋白最高,与对照组比较,差异有统计学意义(均P＜0.05).多元线性回归分析结果显示,血清空腹血糖、平均动脉压、脉压、超敏C反应蛋白、低密度脂蛋白胆固醇与baPWV水平呈正相关(均P＜0.05). 结论 糖尿病、高血压是老年人动脉僵硬度增高的影响因素,而高血糖对老年人动脉僵硬度的影响可能起了更重要的作用.血糖、平均动脉压、脉压、超每C反应蛋白、低密度脂蛋白胆固醇均是影响动脉僵硬度的独立危险因素.     

成都地区322例老年2型糖尿病患者合并症的调查分析

目的了解成都地区老年2型糖尿病（T2DM）患者的各种慢性并发症及其相关危险因素。方法分别选取成都地区三级甲等医院的住院患者82例,门诊患者126例和社区的老年T2DM患者114例作为研究对象,采用面对面一人一表问卷式调查方法进行T2DM慢性并发症的记录并进行相关的统计分析。结果成都地区老年T2DM患者各种慢性并发症中以高血压（54．04％）、糖尿病神经病变（54．66％）、糖尿病视网膜病变（59．00％）及皮肤症状（59．32％）为最高。其次为糖尿病合并血脂紊乱（41．93％）、心血管病（31．99％）、呼吸系统疾病（26．09％）、消化系统症状（24．84％）和肾脏病变（24．84％）。各种慢性并发症发病率随着年龄的增长、糖化血红蛋白的升高、病程的延长及舒张压的升高而呈上升的趋势。结论成都地区老年2型糖尿病患者各种慢性并发症的发病率已接近或部分超过两方国家的平均水平。而DM病程及血糖、血压、血脂控制水平等因素与各种慢性并发症的发生发展均密切相关,因此应加强对老年2型DM患者相关危险因素的综合控制。     

Hypertension in type 2 diabetes mellitus in Isfahan, Iran: incidence and risk factors

BACKGROUND: Evidence on the long-term incidence of and risk factors of hypertension in diabetic patients is scarce and mainly derived from studies in developed countries. Evidence from developing countries is required for planning a well-co-ordinated approach to this public health problem in these countries. OBJECTIVE: The objectives of present study were to estimate the incidence of and risk factors for the development of hypertension in people with type 2 diabetes mellitus using routinely collected data from a clinical information system at Isfahan Endocrinology and Metabolism Research Centre, Iran. METHOD: During the mean (standard deviation (S.D.)) follow-up period of 2.9 (2.5) (range 1-11) years, 3202 diabetic patients (1315 male and 1887 female) from Isfahan Endocrinology and Metabolism Research Centre out patient clinics, Iran have been examined. The mean (S.D.) age of participants was 48.3 (10.6) years with a mean (S.D.) duration of diabetes of 6.5 (6.7) years at initial registration. Blood pressure was measured by standardised protocols, and hypertension was defined as at least in two consecutive measurements within 2 months a systolic and/or diastolic blood pressure of >or=130 and/or >or=80 mmHg and/or taking anti-hypertensive medication. RESULTS: Among the 3202 patients free of hypertension at initial registration who attended the clinic at least twice in the period 1992-2004, the incidence of hypertension was 20.8 (20.6 male and 20.9 female) per 100 person-years based on 9403 person-years of follow-up. The age-adjusted incidence rate of hypertension was 22% lower among insulin-treated than non-insulin-treated type 2 diabetes mellitus clinic attenders and it was greater with older age. Using a Cox's Proportional Hazards Model, male gender, and treatment regimen were significant independent predictors of hypertension. Smoking, duration of diabetes, age at diagnosis of diabetes, fasting blood glucose, glycosylated haemoglobin, BMI, proteinuria and creatinine, had no significant independent association with hypertension when other covariates were considered. CONCLUSION: These findings will help the identification of those patients at particular risk of hypertension and strongly support the case for vigorous control of blood pressure on type 2 diabetic patients.     

Pancreatic exocrine function in patients with type 1 and type 2 diabetes mellitus

Reduced exocrine pancreatic function has been observed in a high percentage of patients with type 1 diabetes in the past. There are only few data for type 2 diabetes available and they are contradictory. In this study we investigated exocrine pancreatic function in 105 controls and 114 with type 1 or type 2 diabetes mellitus by means of an indirect test (faecal elastase-1 concentration). This test has good sensitivity and specificity for moderate and severe pancreatic insufficiency as compared to the gold standard. Reduced faecal elastase-1 concentrations were found in 56.7% of type 1 patients, 35% of type 2 patients and 18.1% of the controls. Elastase-1 concentrations did not correlate with alcohol consumption, diabetes duration or diabetes therapy. The data found for type 1 patients correspond to those reported in earlier studies. The results for type 2 diabetics show that exocrine pancreatic function is also impaired in a high percentage in this group of patients. Pathogenic concepts to explain these findings as consequences of diabetes complications or insulin deficiency are still under debate. Observations from autopsies and the data of the controls in this study suggest that chronic pancreatitis might be a common problem. In consequence, diabetes secondary to exocrine disease could be much more frequent than believed so far. Received: 8 September 1999 / Accepted: 16 November 2000