血糖控制不佳2型糖尿病患者轻度认知障碍影响因素研究

目的探讨血糖控制不佳2型糖尿病患者(T2DM)轻度认知障碍(MCI)发生的影响因素,为疾病预防与控制提供依据。方法入选2014年10月至2015年5月安徽医科大学第一附属医院和第二附属医院内分泌科T2DM患者181例,其中男性105例,女性76例,年龄45～75(59.0±8.5)岁,采用长沙版蒙特利尔认知评估量表(MoCA)评定患者的总体认知,了解认知损害现状并根据得分分组分析影响因素。应用SPSS 16.0统计软件对数据进行分析。采用t检验或x2检验比较组间差异。单因素分析影响T2DM患者认知功能的因素,进一步采用logistic回归分析发生MCI的危险因素。结果血糖控制不佳T2DM患者的MCI患病率为52.5%(95/181)。单因素分析显示年龄、性别、文化程度、家庭人均月收入、饮酒、吸烟、脑梗死史、糖尿病周围神经病变、低血糖史和尿微量白蛋白/肌酐比值(A/C)比值与MCI相关(P0.05)。多因素logistic回归显示年龄与MCI正相关(OR=1.437,95%CI 1.017～2.029;P0.05),教育程度和低血糖史与MCI负相关(OR=0.326,95%CI0.197～0.539;OR=0.400,95%CI0.167～0.958;P0.05)。结论医务人员应关注血糖控制不佳T2DM患者的认知功能,及时采取措施延缓认知功能减退。     

达格列净对血糖控制不佳的2型糖尿病患者血糖波动的影响

目的观察血糖控制不佳的2型糖尿病患者加用达格列净后的血糖波动情况。方法选择血糖控制不佳的2型糖尿病患者40例,均为胰岛素联合2种不同作用机制的口服降糖药治疗后血糖仍未达标者。将患者随机分为观察组和对照组各20例,对照组在原治疗基础上加用阿卡波糖,观察组在原治疗基础上加用达格列净,连续治疗24周。治疗前后收集患者的临床资料,包括体质量指数(BMI)、收缩压(SBP)、舒张压(DBP)和每日胰岛素用量;采集空腹静脉血检测空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、空腹C肽(FC-P)、餐后2 h C肽(2hC-P)、尿酸(UA)、总胆固醇(TC)、甘油三酯(TG);采用动态血糖监测系统检测平均血糖波动幅度(MAGE)、血糖平均水平(MBG)、血糖标准差(SDBG)、最大血糖波动幅度(LAGE);观察治疗过程中发生的不良反应情况。结果治疗24周后,两组FBG、2hPG、HbA1c、BMI、SBP、DBP、每日胰岛素用量均较治疗前下降,且观察组低于对照组(P均<0. 05);两组FC-P、2hC-P均较治疗前上升,且观察组高于对照组(P均<0. 05...     

326例2型糖尿病人血糖控制不佳原因分析

本文通过问答式表格调查了二个基层医院326例已确诊为2型糖尿病病人血糖控制不佳的原因,发现最主要的原因是糖尿病人对这种疾病的无知.有诸多错误的观念存在,体现在血糖监测,饮食治疗,运动疗法及药物治疗的方方面面,说明宣传教育力度不够,不仔细.客观因素及疾病本身所引起的并发症及伴发病也有相当大的影响.     

血糖控制不达标2型糖尿病患者状况

了解血糖控制不达标2型糖尿病患者的状况,促进血糖达标,减少并发症。统计469例血糖控制不达标患者的一般资料、血糖和血脂、并发症及合并症、降糖方案（包括生活方式、药物治疗）、监测及治疗方案调整等情况,分析血糖控制不达标原因。469例患者平均FPG（12.96±4.71）mmol/L,平均Hb A1c（9.07±2.38）%,65岁以下患者Hb A1c高于65岁以上患者。81.9%患者出现至少一种微血管并发症,以DPN、DR最多见,42.0%合并心脑血管疾病、37.3%合并高血压病。能严格控制饮食、合理运动及定期参加糖尿病教育者分别为39.2%、33.3%和10.0%。66.7%患者采用口服降糖药物治疗,24.6%为单一口服药物,以磺脲类为主,12.1%应用不明成分药物或保健品治疗,联合口服药物以磺脲类及双胍类两种联合为主,14.1%存在同类药物不合理联合应用,胰岛素治疗者66.7%应用预混胰岛素2次皮下注射。仅有22.6%患者定期进行血糖监测并调整治疗。结论患者血糖控制差,并发症多,不良生活方式、治疗依从性差、治疗方案不合理、较少监测血糖是患者血糖控制不达标的主要原因。     

达格列净对血糖控制不佳的2型糖尿病患者血糖水平的影响

目的 探究血糖控制不佳的2型糖尿病(type 2 diabetes mellitus, T2DM)患者应用达格列净治疗对其血糖水平的影响。方法 选取2021年3月—2022年8月徐州市贾汪区人民医院收治的血糖控制效果不佳的T2DM患者108例,遵循随机数表分组原则分为对照组和观察组,每组54例。对照组采用常规降糖治疗(二甲双胍、阿卡波糖等),观察组在对照组基础上联合达格列净片治疗。比较两组血糖水平改善情况,并比较其治疗前及治疗12周后的血脂水平、胰岛素用量、体质指数(BMI),对比两组治疗期间低血糖发生情况。结果 治疗12周后,观察组空腹血糖(FPG)、餐后2 h血糖(2 hPG)及糖化血红蛋白(HbA1c)水平低于对照组,差异有统计学意义(P<0.05)。治疗12周后,观察组总胆固醇(TC)、三酰甘油(TG)及低密度脂蛋白胆固醇(LDL-C)水平均低于对照组,高密度脂蛋白胆固醇(HDL-C)水平高于对照组,差异有统计学意义(P<0.05)。治疗12周后,观察组胰岛素用量少于对照组,BMI低于对照组,差异有统计学意义(P<0.05)。观察组治疗期间低血糖总发生率为1....     

326例2型糖尿病人血糖控制不佳原因分析

本文通过问答式表格调查了二个基层医院326例已确诊为2型糖尿病病人血糖控制不佳的原因，发现最主要的原因是糖尿病人对这种疾病的无知。有诸多错误的观念存在，体现在血糖监测，饮食治疗，运动疗法及药物治疗的方方面面，说明宣传教育力度不够，不仔细。客观因素及疾病本身所引起的并发症及伴发病也有相当大的影响。     

强化血糖控制在2型糖尿病患者卒中预防中的作用

糖尿病是缺血性卒中的独市危险因素.流行病学研究表明,强化血糖控制能降低2型糖尿病患者的卒中风险.然而,目前的前瞻性临床试验却未能证实二者之间存在明确的因果关系.文章针对2型糖尿病患者强化血糖控制在卒中一级顶防和二级预防中作用的临床试验进行了综述.     

糖尿病实质上也是心血管病

近年来，人们对糖尿病危害性的认识已逐步深化。1999年，美国心脏学会明确提出“糖尿病是心血管病”的口号。2001年，在美国胆固醇教育计划中，糖尿病被列为冠心病的等危病变。     

构筑糖尿病心血管病的全面防线

临床研究发现，75％的糖尿病患者主要死因是心血管疾病，2型糖尿病因冠状动脉而造成的死亡率为其他疾病的3倍，由美国政府牵头进行的医学研究称，患糖尿病的女性得心血管疾病的几率是没有糖尿病女性的2～4倍。因此，糖尿病患者更应警惕心血管病。男性糖尿病患者     

踝肱指数异常增高的糖尿病患者心血管病危险因素研究

目的 分析踝肱指数（ABI）增高的糖尿病患者的心血管病危险因素。方法采用多普勒血流探测仪测定解放军第306医院2003--2005年门诊及病房收治的493例2型糖尿病患者的ABI，以ABI〈0．90为低ABI组（n=39），0．90≤ABI≤1．40为正常组（n=353），ABI〉1．40为高ABI组（n=101）；同时对心血管病危险因素进行分析。结果高ABI与正常ABI组比较，腰围、腰臀比、C反应蛋白、尿酸显著增高，吸烟率及高血压合并症发生率显著增加。结论ABI〉1．40的糖尿病患者有更多的动脉硬化危险因素，需要将这些患者与ABI〈0．90的患者同样重视。     

Increased Red Cell Aggregation in Diabetes Mellitus: Association with Cardiovascular Risk Factors

Red cell aggregation may be higher in diabetic patients and may predispose to cardiovascular disease. Red cell aggregation was measured by a simple photometric method in 122 diabetic patients and 100 matched control subjects, to determine its relationship to cardiovascular risk factors. Red cell aggregation was significantly increased in both Type 1 (4.3 ± 1.3 vs 3.4 ± 1.2, p < 0.002) and Type 2 diabetic patients (5.5 ± 1.5 vs 3.2 ± 1.3, p < 0.0001). In all diabetic patients aggregation correlated with triglycerides, VLDL, and inversely with HDL and in Type 2 diabetic patients also with body mass index, hypertension, and inversely with duration of diabetes. On multiple regression analysis, triglycerides and body mass index showed an independent association with red cell aggregation and in Type 2 diabetic patients smoking was also associated with increased red cell aggregation. It is concluded that increased red cell aggregation may be one mechanism by which some cardiovascular risk factors could promote cardiovascular disease in diabetes.     

The Relationships between Cardiovascular Risk Factors and Socio-economic Status in People with Diabetes

The hypothesis that the prevalence of cardiovascular risk factors in people with diabetes is inversely related to socio-economic status was tested. Demographic and biochemical data were collected on 1246 patients, aged 20–69 years, attending a hospital diabetes clinic. This is estimated to represent between 71 % and 78 % of all people of this age with a diagnosis of diabetes in the health authority. In total, 296 people were classified as Type 1 (insulin-dependent) diabetic patients (age of onset <31, now on insulin). Using data from the 1991 census a deprivation score was ascribed to each individual according to their area (enumeration district) of residence. The total study population was ranked by deprivation score and divided into quintiles. The relationships between means and quintiles of deprivation were assessed by ANOVA for linear trend, and between proportions and quintiles of deprivation by the chi-squared test for trend. In Type 1 diabetes increasing quintiles of deprivation were significantly related to mean serum cholesterol (p < 0.01) and proportion smoking (p < 0.01), and in Type 2 (non-insulin-dependent) diabetes to mean body mass index (p < 0.001), proportion smoking (p < 0.001), and proportion with proteinuria (p < 0.05). The need for health measures to prevent cardiovascular disease in people with diabetes is greatest in deprived areas.     

A Strategy for Arterial Risk Assessment and Management in Type 2 (Non-insulin-dependent) Diabetes Mellitus

People with Type 2 (non-insulin-dependent) diabetes mellitus die mainly from cardiovascular and cerebrovascular disease. Furthermore, the major burden of their symptoms arise from arterial disease, including peripheral vascular disease. However, management guidelines for Type 2 diabetes continue to focus on blood glucose control, which is only one of a number of arterial risk factors found with this type of diabetes. Clinically it is evident that blood glucose control continues to occupy centre-stage in the management of Type 2 diabetes as practised by many physicians. Even when arterial risk factors such as smoking or raised serum triglycerides are noted, their management is often relatively neglected. As part of the St Vincent Declaration Action Programme, a working group has sought consensus on the number and relative importance of arterial risk factors requiring management in quality diabetes care. The group seeks to assist those devising protocols and guidelines, records and quality systems, and those charged with directly advising and educating people with diabetes. Arterial risk factors that can be routinely identified and monitored, and modified by application of management protocols, include high blood pressure, high serum total and LDL cholesterol, low serum HDL cholesterol and raised serum triglycerides, poor blood glucose control, smoking, high body mass index and body fat distribution. Aspirin can modify hypercoagulability, but this is not easily monitored. Arterial risk factors that cannot be modified, but which have an impact on the intensity of management of other factors, include ethnic group, gender, and family history of arterial disease. Raised albumin excretion is an arterial risk factor and can be modified, but it is not clear whether this reduces cardiovascular risk. For many of the risk factors, levels of high, medium, and low risk can be set. These can be used, in consultation with the patient, to determine appropriate interventions and provide feedback on risk reduction resulting from successful management. © 1997 by John Wiley & Sons, Ltd.     

糖尿病患者糖化血红蛋白检测的临床意义

目的了解糖化血红蛋白（HbA1 c）的与糖尿病患者血糖水平、糖尿病并发症的发生以及院内感染的关系。方法 143例2型糖尿病患者按HbA1 c水平分为3组,分别检测血压和血糖、糖化血红蛋白等,同时对有无糖尿病并发症和院内感染进行评价。结果随HbA1 c水平升高糖尿病并发症的发生率和院内感染率随之升高,共58例糖尿病患者发生院内感染,感染率为40.56%,且各组感染均以肺部感染、泌尿系感染和皮肤感染为主。结论检测血液中糖化血红蛋白对2型糖尿病患者诊治具有指导意义。     

Needle Phobia in Type 1 Diabetes Mellitus

Needle phobia in patients with Type 1 (insulin-dependent) diabetes mellitus is difficult to manage. We report a case of long-standing needle phobia in a patient with 33 years of Type 1 diabetes mellitus who has developed very few vascular complications. Further studies are required to identify the prevalence of needle phobia in Type 1 diabetes mellitus. Once these individuals have been identified, appropriate psychological and physical treatments should be implemented, in the hope of making such individuals less fearful of the treatment of their condition. © 1997 by John Wiley & Sons, Ltd.     

Physical Activity and Glycaemic Control in Children with Diabetes Mellitus

The relationship between physical activity, glycaemic control, and skinfold thickness was studied in children with diabetes. Patients recorded details of activity in a home diary over a 6-day period, and provided eight serial capillary dried blood spots for glucose analysis during a 24-h period. Levels of activity were assessed using a semi-quantitative scoring scheme. No correlation was found between total activity score and glycaemic control. However, the activity score before 9 am showed significant correlation with mean blood glucose (p = 0.005) and fructosamine (p = 0.04). The time of rising in the morning showed significant correlation with blood glucose after lunch (p = 0.004) and with fructosamine (p = 0.04). A significant correlation was found between early morning activity and subscapular skinfold thickness. The association between activity and glycaemic control warrants further investigation, as it suggests that patients who engage in energetic activity early in the morning may achieve lower blood glucose and fructosamine levels than their less active peers.     

2型糖尿病患者合并勃起功能障碍对心血管病风险预测的研究

目的:了解2型糖尿病患者合并勃起功能障碍(ED)时是否有心血管病的风险. 方法:对2型糖尿病合并勃起功能障碍组(ED组)71例,2型糖尿病无勃起功能障碍组(非ED组)45例,测量其颈内动脉内膜中层厚度(IMT),同时测量身高、体重、血压、血脂、血糖、C肽等.比较两组间平均颈内动脉IMT及血糖、血脂等代谢指标. 结果:平均颈内动脉IMT比较:ED组明显厚于非ED组(P<0.05);血清总胆固醇、低密度脂蛋白胆固醇:ED组明显高于非ED组(p<0.05);在2型糖尿病患者中,ED评分与颈内动脉IMT呈负相关(r=-0.321,P=0.000). 结论:2型糖尿病患者合并ED时其患动脉粥样硬化的危险性要高于不合并ED者,2型糖尿病合并ED可能是心血管病的一个早期预警信号.