晚餐后不同时段运动对2型糖尿病患者餐后血糖谱的影响

目的使用动态血糖监测（CGM）观察晚餐后0.5 h与晚餐后1 h短时中强度运动分别对2型糖尿病（T2DM）患者血糖谱的 影响。方法纳入15例平时缺乏运动的无严重并发症T2DM患者（9名男性,6名女性）,且均未使用胰岛素。将受试者随机分配 到晚餐后0.5 h运动组和晚餐后1 h运动组,进行0.5 h中强度运动,1周后交叉。运动强度设定为40%储备心律（HRR）。在饮食 标准化和药物治疗不变的条件下,通过CGM监测血糖。观察受试者晚餐后2 h平均血糖、高峰血糖及血糖曲线下面积（AUC） 等,同时观察餐后12 h平均血糖、血糖变异系数（CV）、平均血糖波动幅度（MAGE）。观察受试者是否出现夜间低血糖。结果 晚餐后0.5 h 运动组与晚餐后1 h 运动组,在餐后2 h 平均血糖、高峰血糖及血糖AUC方面均无统计学差异。但晚餐后1 h 运 动组餐后2 h即时血糖明显低于晚餐后0.5 h运动组（P=0.04）。同样,两组间餐后12 h平均血糖、CV及MAGE均无统计学差异, 且均无夜间低血糖发生。结论晚餐后0.5 h与晚餐后1 h进行短时中等强度运动对T2DM患者血糖谱影响无明显差异,均安全 有效。晚餐后1 h运动可能对降低餐后2 h血糖更有利,但对于易出现低血糖的患者餐后0.5 h运动可能更安全。     

2型糖尿病患者抗糖尿病药物治疗与血糖控制状况分析

目的了解2型糖尿病患者降糖药物用药现状,分析选择药物对血糖控制的影响,为合理治疗提供依据。方法调查入院时2型糖尿病患者群降糖药物使用状况、血糖控制水平及低血糖情况,根据用药情况分为胰岛素组和口服药组,比较胰岛素组和口服药组的血糖控制水平及低血糖的发生率。结果入选288例2型糖尿病患者,平均HbA1c 8.0%,血糖达标率36.8%。胰岛素组和口服药组的空腹血糖、餐后2 h血糖、体质量指数、HbA1c的控制水平相似。胰岛素组的病程明显长于口服药组([11.5±7.0)年vs(8.1±6.0)年],P=0.000)。口服药组的达标率明显优于胰岛素组(43.4%vs 27.0%,P=0.005)。胰岛素组的低血糖发生率高于口服药组(5.2%vs 1.2%,P=0.041)。结论 2型糖尿病患者群血糖达标率低,启动胰岛素治疗迟、超重和低血糖是影响血糖达标重要原因。     

Insulin-dependent (type I) diabetes mellitus.

Insulin-dependent (type I) diabetes mellitus is a chronic disease characterized by hyperglycemia, impaired metabolism and storage of important nutrients, evidence of autoimmunity, and long-term vascular and neurologic complications. Insulin secretory function is limited. Cell membrane binding is not primarily involved. The goal of treatment is to relieve symptoms and to achieve blood glucose levels as close to normal as possible without severe hypoglycemia. However, even with education and self-monitoring of the blood glucose level, attaining recommended target values (plasma glucose level less than 8.0 mmol/L before main meals for adults) remains difficult. Human insulin offers no advantage in glycemic control but is important in the management and prevention of immune-related clinical problems (e.g., injection-site lipoatrophy, insulin resistance and allergy) associated with the use of beef or pork insulin. Therapy with one or two injections per day of mixed short-acting or intermediate-acting insulin preparations is a compromise between convenience and the potential for achieving target plasma glucose levels. Intensive insulin therapy with multiple daily injections or continuous infusion with an insulin pump improves mean glycated hemoglobin levels; however, it increases rates of severe hypoglycemia and has not been shown to decrease the incidence of clinically significant renal, retinal or neurologic dysfunction. Future prospects include automated techniques of insulin delivery, immunosuppression to preserve endogenous insulin secretion and islet transplantation.     

正常人血浆葡萄糖及血清胰岛素对摄食不同食物的反应

研究20位正常人食用含75g碳水化合物的糯米、高梁、燕麦片、荞麦粉、筱麦粉及混合食物玉米芸豆、绿豆籼米和绿豆海带粳米后血浆葡萄糖和血清免疫反应性胰岛素的峰值。结果:①食用任何一种食物后,血糖高峰值均明显低于食用75g葡萄糖时的峰值;②除绿豆海带粳米,其它7种食物的胰岛素反应峰值均低于进食葡萄糖;③燕麦片、莜麦粉和荞麦粉的血糖指数明显低于粳米、面粉等主食,说明这几种食物有利于糖尿病患者的血糖控制。     

Hypoglycémie spontanée et insuffisance rénale chronique.

Although glucose intolerance occurs as a consequence of chronic renal failure, improvement of a diabetic state by deterioration of renal function is a well known phenomenon. Recently occasional cases of spontaneous hypoglycemia in patients with chronic renal failure have been reported; two such cases and the results of metabolic studies are described in this paper. Pituitary, thyroid and adrenal function appeared to be normal. The results of an oral glucose tolerance test were normal; an appropriate insulin response was demonstrated in one patient, and a slightly elevated basal insulin value with a delayed insulin response to oral administration of glucose was demonstrated in the other. An insulin tolerance test did not support the hypothesis of increased insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concentration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase insulin sensitivity as a factor, and the growth hormone response to hypoglycemia was normal. An intravenous glucagon test caused a subnormal increase in plasma glucose concnetration, and the intravenous administration of tolbutamide produced hypoglycemia without an increase in insulin values. The plasma alanine concentration was low and the proinsulin/insulin ratio was increased. The origin of this hypoglycemia is not clear but is probably multifactorial. However, low hepatic glycogen stores and inadequate gluconeogenesis due to substrate deficiency seem to be involved.     

基于信息化血糖监测系统建立血糖基准报告研究

背景　随着糖尿病患病率的增高，住院患者血糖管理已成为医院关注的焦点，但目前尚缺乏公认的绩效指标定义、指标测算和标准化血糖基准报告，影响了医院血糖管理持续质量改进。目的　基于信息化血糖监测系统（IGMS）构建血糖基准报告，一为同行建立标准化血糖报告提供方法学指导，二为同行提供血糖基准参考。方法　纳入2019年10月至2020年3月遂宁市中心医院安装了IGMS（该系统能自动上传血糖数据和按需求查阅血糖数据）的非重症监护病区（10个内科和7个外科）的糖尿病患者或高血糖患者（无糖尿病病史但随机末梢血糖超过11.1 mmol/L），排除住院第1天的血糖数据。采用群体（population）、患者（patient）和患者日（patient-day）三种模型报告理想血糖、高血糖和低血糖发生率，低血糖报告增加患者低血糖发生天数比、发生频次比和管理及时性比，采用四分位数分析不同病区的血糖数据，并与美国、澳大利亚、重庆和广东医疗机构的血糖数据进行比较。结果　三种模型平均血糖、理想血糖、平均高血糖和任意高血糖（>10.0 mmol/L、≥15.0 mmol/L、≥16.7 mmol/L）、任意低血糖（≤3.9 mmol/L、<3.0 mmol/L、<2.8 mmol/L、<2.2 mmol/L）比较，差异均有统计学意义（P<0.001）。17个病区任意低血糖≤3.9 mmol/L发生>3次者312例（3.9%），发生>3 d者202例（2.5%），复测血糖时间≤15 min者446例（5.6%），>30 min者2 187例（27.5%）。患者日任意高血糖≥15.0 mmol/L、任意低血糖≤3.9 mmol/L、理想血糖下四分位数分别为38.6%、5.5%和38.0%，上四分位数分别为21.5%、2.1%和58.1%。17个病区与美国、澳大利亚、重庆医疗机构的平均高血糖和任意高血糖（>10.0 mmol/L、≥15.0 mmol/L、≥16.7 mmol/L）、任意低血糖（≤3.9 mmol/L、<3.0 mmol/L、<2.8 mmol/L、<2.2 mmol/L）比较，差异均有统计学意义（P<0.05）。本研究内分泌病区和广东省某内分泌病区血糖、理想血糖、任意高血糖≥16.7 mmol/L、任意低血糖≤3.9 mmol/L比较，差异均有统计学意义（P<0.05）。结论　IGMS允许医疗机构建立全方位、标准化血糖报告。因目的不同，其选择模型也不同。群体模型更适用药物管理和风险管理人员，患者模型更适用个体化护理评估，患者日模型适用于某单元或单位进行质量改进方向和目标的制定。     

门冬胰岛素联合中性鱼精蛋白胰岛素在控制餐后血糖中的作用

目的 比较门冬胰岛素(IAsp)和可溶性人胰岛素(HI)分别联合中性鱼精蛋白胰岛素(NPH)在糖尿病治疗中的有效性和安全性.方法 220例来自全国5家医院的1型(T1DM)或2型糖尿病(T2DM)患者按1:1的比例随机分为两组,分别接受IAsp或HI联合NPH治疗.以空腹血糖(FPG)、餐后2 h血糖(2h PPG)、糖化血红蛋白(HbA1c)及低血糖事件作为评价指标.结果 IAsp/NPH组[(14.6±5.3)mmol/L比(8.4±4.1)nunol/L]较HI/NPH组治疗后2 h PPG改善更为显著[(14.9±3.9)mmol/L比(10.6±3.5)mmoL/L,P<0.05],且达标率分别为50.0%、25.5%(P<0.01).治疗后IAsp/NPH组[(9.3±1.4)%比(7.7±1.3)%]和HI/NPH组[(9.2±1.2)%比(7.7±1.2)%]HbA1c明显下降,但两组比较差异无统计学意义(P=0.437).达标率分别为24.5%和14.5%(P<0.05).在Imp/NPH组未见严重低血糖事件和其他不良事件,且夜间低血糖发生率更低(IAsp/NPH:3%,HI/NPH:4%).IAap/NPH组与HI/NPH组患者胰岛素日均剂量分别是0.60/0.23 IU/kg和0.65/0.24 IU/kg.结论 IAsp联合NPH能更好地控制餐后血糖,提高患者血糖达标率且不增加夜间低血糖和不良事件的风险.     

Metabolic effects of dietary fructose and sucrose in types I and II diabetic subjects

To learn more about the metabolic effects of dietary fructose and sucrose, 12 type I and 12 type II diabetic subjects were fed three isocaloric (or isoenergic) diets for eight days each according to a randomized, crossover design. The three diets provided, respectively, 21% of the energy as fructose, 23% of the energy as sucrose, and almost all carbohydrate energy as starch. The fructose diet resulted in significantly lower one- and two-hour postprandial plasma glucose levels, overall mean plasma glucose levels, and urinary glucose excretion in both type I and type II subjects than did the starch diet. There were no significant differences between the sucrose and starch diets in any of the measures of glycemic control in either subject group. The fructose and sucrose diets did not significantly increase serum triglyceride values when compared with the starch diet, but both increased postprandial serum lactate levels. We conclude that short-term replacement of other carbohydrate sources in the diabetic diet with fructose will improve glycemic control, whereas replacement with sucrose will not aggravate glycemic control.     

Influence of salt on glycaemic response to carbohydrate loading

The effect of dietary salt on glycaemic responses to different test meals was investigated. Eight healthy male volunteers ate four test meals on consecutive mornings and in random order; the meals were 50 g carbohydrate taken as a 20% glucose solution or as boiled macaroni with and without supplementation with 6 g salt. In contrast with other reports, no significant differences in peak plasma glucose concentrations or areas under the plasma glucose curves could be established. These findings do not support a beneficial effect of salt restriction on glycaemic control in diabetes.     

蛋白激酶Cα参与高糖致人系膜细胞癌胚纤维连接蛋白的表达

目的:研究高糖环境下人系膜细胞(HMC)蛋白激酶Cα(protein kinase Cα,PKCα)、癌胚纤维连接蛋白(oncofetal FN)表达水平,并进一步探讨PKCα与oncofetal FN mRNA之间的关系。方法:实验HMC分组如下:正常葡萄糖组(NG,5 mmol/L D-葡萄糖),渗透压对照组(LG,5 mmol/L D-葡萄糖+20 mmol/L L-葡萄糖),高葡萄糖组(HG,25 mmol/L D-葡萄糖),高葡萄糖+PKCα抑制剂组(HS,25 mmol/L D-葡萄糖+40μmol/L Safingol)。以激光共聚焦显微镜观察PKCα蛋白表达及转位,RT-PCR法检测oncofetal FN mRNA表达水平。结果:(1)与NG组对比,高葡萄糖可促进蛋白激酶Cα蛋白发生核转位,定量分析示HG组胞浆/胞核强度较NG组降低20%(P<0.05),高葡萄糖刺激诱导HMC oncofetal FN mRNA上调,为NG组的2.36倍(P<0.05)。(2)与HG组比较,HS组PKCα蛋白转位激活被抑制,胞浆/胞核荧光强度比值为HG组的1.15倍,HS组oncofetal FN mRNA表达较HG组降低45%(P值均<0.05)。结论:PKCα的激活参与高葡萄糖致人系膜细胞oncofetal FN的表达。     

甘精胰岛素、NPH胰岛素联合口服降糖药在2型糖尿病患者中的应用

目的在口服药物治疗的2型糖尿病病人中,比较加用甘精胰岛素或人NPH胰岛素使HbAlc达到7%的疗效和低血糖风险。方法在33例服用一种或2种口服降糖药但血糖控制仍然不良的2型糖尿病患者(HbAlc>7.5%)中,进行了这一随机、开放标记、平行、16周的试验,患者继续服用研究前的药物,但于每天睡前加用一次甘精胰岛素或人NPH胰岛素,使空腹血糖(FBG)达到≤100mg/dl(5.6mmol/L)的目标值。试验结果的观察指标为FBG、HbAlc、低血糖发生率和达到HbAlc≤7%并且没有发生有记录的夜间低血糖的患者百分数。结果终点时甘精胰岛素组和NPH胰岛素组的平均FBG(5.94Vs6.11mol/L)和HbAlc(6.68Vs6.79%)无明显差异,P>0.05。大多数用这两种胰岛素的患者都达到HbAlc≤7%的目标。但是,在HbAlc≤7%且没有发生有记录的低血糖(<4mmol/L)方面,甘精胰岛素组(69%)比NPH组(29%)高出一倍,P<0.05。甘精胰岛素组的经证实的夜间低血糖发生率也显著低于NPH组,P<0.05。结论口服降糖药治疗且血糖控制不良的2型糖尿病患者,睡前加用基础胰岛素,可使绝大多数患者血糖获得理想控制(HbAlc≤7%)。甘精胰岛素的夜间低血糖发生率明显低于NPH胰岛素。     

伴有糖尿病的规律血液透析患者血液透析过程中血糖变化：多中心横断面研究

背景　随着全球范围内糖尿病患病率快速升高,我国终末期糖尿病及须行血液透析患者数量日益增多,而与非糖尿病患者相比,伴有糖尿病者血液透析过程中血糖变化幅度较大且会对患者预后造成不利影响。目的　分析伴有糖尿病的规律血液透析患者血液透析过程中血糖变化。方法　选取2017年10月-2018年12月江苏省3家三级医院（东南大学附属中大医院、东南大学附属中大医院溧水分院、东南大学附属中大医院无锡分院）血液净化中心收治的伴有糖尿病的规律血液透析患者105例,其中3例患者血液透析过程中血糖数据缺失,最终纳入102例患者。所有患者采用无糖碳酸氢盐透析液并单纯采用胰岛素治疗,记录其透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖以分析血糖变化及低血糖、高血糖发生情况。结果　102例患者血液透析过程中血糖波动范围为1.6~27.8 mmol/L,平均为（8.4±3.2）mmol/L;22例（30次）出现低血糖,低血糖发生率为21.6%（22/102）,其中18例（23次）为无症状性低血糖,无症状性低血糖发生率为17.6%（18/102）;30例（47次）出现高血糖,高血糖发生率为29.4%（30/102）,其中透析前26次。低血糖患者透析前、透析1 h、透析2 h、透析3 h血糖低于非低血糖患者（P<0.05）,而低血糖与非低血糖患者透析结束时血糖比较,差异无统计学意义（P>0.05）;低血糖、非低血糖患者透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖比较,差异均有统计学意义（P<0.05）。高血糖患者透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖高于非高血糖患者（P<0.05）;高血糖、非高血糖患者透析前、透析1 h、透析2 h、透析3 h、透析结束时血糖比较,差异均有统计学意义（P<0.05）。低血糖患者透析日减停胰岛素、知晓低血糖定义者比例低于非低血糖患者,高血糖患者透析日减停胰岛素者比例高于非高血糖患者（P<0.05）。结论　伴有糖尿病的规律血液透析患者透析过程中低血糖（21.6%）、高血糖（29.4%）发生率均较高,且低血糖以无症状性低血糖多见,高血糖以透析前多见,透析日减停胰岛素、低血糖定义知晓率低是伴有糖尿病的规律血液透析患者血液透析过程中低血糖的可能相关因素,同时透析日减停胰岛素也是伴有糖尿病的规律血液透析患者血液透析过程中高血糖的可能相关因素。     

High-fibre diets for diabetic and hypertriglyceridemic patients.

Diets high in complex carbohydrate result in lower insulin requirements than the high-fat diets conventionally used to treat diabetes. Accompanying unacceptable increases in fasting triglyceride levels can be overcome by increasing the fibre content of the diet. In diabetics a diet providing 70% of energy from carbohydrate and containing 35 to 40 g of fibre per 1000 Cal will rapidly reduce the plasma glucose level and the requirement for insulin or sulfonylurea. It will also lower the serum cholesterol and triglyceride levels in individuals with hypertriglyceridemia. These improvements are maintained in patients following a modified high-carbohydrate, high-fibre diet providing 55% to 60% of energy by carbohydrate (75% of which is complex), 15% to 20% by protein and 20% to 30% by fat, with 25 g of plant fibre per 1000 Cal. With long-term use (for up to 48 months) of the maintenance diets patients maintained or corrected their body weight, and no nutritional deficiencies were observed.     

基于瞬感扫描式葡萄糖监测系统的血糖干预对2型糖尿病患者血糖波动的影响

背景　最新研究表明,血糖波动（血糖变异性）能够通过多种途径参与糖尿病慢性并发症的发生及发展。良好的血糖监测可以全面反映患者的血糖变化,而采取有效的血糖波动控制策略对糖尿病的防治至关重要。目的　探讨基于瞬感扫描式葡萄糖监测系统的血糖干预对2型糖尿病患者血糖波动的影响。方法　选取2019年1月-2020年1月合肥市第二人民医院收治的2型糖尿病患者100例,并采用随机数字表法将其分为对照组和研究组,各50例。研究组患者依据基于瞬感扫描式葡萄糖监测系统监测的血糖进行干预,对照组患者依据常规指尖血糖进行干预,对比两组患者干预第3、6、9天时空腹血糖变异系数（CV-FPG）、餐后血糖波动幅度（PPGE）、最大血糖波动幅度（LAGE）、平均血糖波动幅度（MAGE）,以及低血糖发生例次和血糖达标时间。结果　干预第3、6、9天,研究组CV-FPG、PPGE、LAGE及MAGE均低于对照组（P<0.05）;两组干预第6天CV-FPG、LAGE及MAGE均低于干预第3天,研究组干预第6天PPGE低于干预第3天（P<0.05）;两组干预第9天CV-FPG、PPGE、LAGE及MAGE均低于干预第3天,研究组干预第9天CV-FPG、PPGE及LAGE均低于干预第6天（P<0.05）。研究组患者低血糖发生例次少于对照组,血糖达标时间短于对照组（P<0.001）。结论　以瞬感扫描式葡萄糖监测系统为基础制定2型糖尿病患者的血糖干预措施可明显降低血糖波动幅度、缩短血糖达标时间、减少低血糖的发生,具有一定的临床应用价值。     

Changes in plasma inbulin related to the type of dietary carbohydrate in overweight hyperlipidemic male patients

Five patients with mild diabetes mellitus or angina pectoris were studied, each of whom consumed two sequential diets containing 40 to 50% carbohydrate. When 75% of the dietary carbohydrate was derived from food containing polysaccharides, the mean plasma insulin response to oral glucose was decreased relative to that seen following complementary diets providing carbohydrate mainly as simple sugars. Under both dietary conditions, glucose tolerance was improved compared to that seen prior to the study. These results suggest that with sugar restriction an improvement in the efficiency of the pancreatic beta-cell mechanism occurs. This effect may have been mediated by changes in the rate of secretion of pancreatic glucagon, or by an enteric secretogogue of insulin.     

睡前血糖预测2型糖尿病患者胰岛素泵治疗期间夜间低血糖的发生

目的 应用动态血糖监测系统(CGMS)探讨2型糖尿病患者胰岛素泵(CSⅡ)治疗期间睡前血糖与夜间低血糖发生的关系.方法 2006年7月至2008年6月257例上海交通大学附属第六人民医院住院的2型糖尿病患者,男156例,女101例,糖化血红蛋白(10.97±2.11)%,糖化血清白蛋白(31.88±7.51)%,入院后予胰岛素泵治疗同时进行动态血糖监测;根据CGMS监测结果中是否出现夜间低血糖事件分为低血糖组和无低血糖组,分析睡前血糖与夜间低血糖发生的关系.结果 (1)胰岛素泵治疗期间全天平均血糖(9.66±2.00)mmol/L,血糖标准差(2.98±1.03)mmol/L,血糖水平最高出现在早餐后(11.62±3.07)mmol/L,最低出现在夜间(8.06±2.43)mmol/L.(2)CGMS监测显示胰岛素泵治疗初期有118例患者共发生了243次低血糖事件,其中128次发生于夜间.(3)应用受试者工作曲线(ROC)分析睡前血糖预测夜间低血糖,当睡前血糖为5.9 mmol/L时约登指数最大,其敏感度为54.8%,特异度为77.8%.阳性预测值为44.3%,阴性预测值为84.2%.结论 (1)CGMS监测显示胰岛素泵治疗初期血糖波动仍较大,约1/2患者检出发生一次以上低血糖事件.(2)睡前血糖<5.9 mmol/L发生夜间低血糖的危险增加.     

Glycemic variability in insulin treated type 2 diabetes with well-controlled hemoglobin A1c and its response to further treatment with acarbose

Background  Glycemic variability, an HbA1c-independent risk factor, has more deleterious effects than sustained hyperglycemia in the development of diabetic complications. This study analyzed the characteristics of glycemic variability in type 2 diabetes mellitus (T2DM) with HbA1c <6.5% in duration of twice daily premixed insulin treatment and the effect of further treatment with acarbose.

Methods  Eighty-six T2DM patients who used premixed insulin analogue (insulin aspart 30) twice daily and had HbA1c <6.5% and 20 controlled subjects with normal glucose regulation (NGR) were monitored using the continuous glucose monitoring (CGM) system. The mean amplitude of glycemic excursions (MAGE), mean of daily differences (MODD) were used for assessing intra-day, inter-day glycemic variability. Hypoglycemia was defined as glucose level <3.9 mmol/L for at least 15 minutes in CGM. According to reference values of MAGE, T2DM patients were classified into two groups: low-MAGE group with MAGE <3.4 mmol/L (L-MAGE) and high-MAGE group with MAGE ≥3.4 mmol/L (H-MAGE). H-MAGE group received further treatment with acarbose for 2 weeks and was monitored a second time with CGM system.

Results  After first CGM, L-MAGE group had 41 cases, and H-MAGE group had 45 cases. The MAGE and MODD of T2DM group were all higher than those of subjects with NGR (P <0.01). Twenty-four percent (n=11) in H-MAGE group had a total of 13 hypoglycemic events, 10 of the 13 events occurred at night, meanwhile 5% (n=2) in L-MAGE group had a total of 2 hypoglycemic events, which also occurred at night (hypoglycemic events: 24% vs. 5%, χ²=6.40, P <0.01). MAGE value was correlated with hypoglycemia value and 2-hour postprandial plasma glucose value (r=–0.32 and 0.26, respectively, P <0.05). After further acarbose therapy and secondly CGM, MAGE and MODD values in H-MAGE group were all significantly decreased (40%, P <0.01, and 15%, P <0.05, respectively), but remained higher than in the subjects with NGR (P <0.05); 2% (n=1) had a total of 1 hypoglycemic event, incidence significantly decreased (2% vs. 24%, χ²=9.61, P <0.01).

Conclusions  CGM system can detect the glycemic variability and asymptomatic hypoglycemic events of T2DM with well-controlled HbA1c in duration of insulin treatment. Combination therapy of premixed insulin twice daily with acarbose can flat glycemic variability and decrease hypoglycemic events.

     

动态血糖监测联合胰岛素泵在60岁及以上糖尿病患者治疗中的应用

目的了解60岁及以上老年糖尿病患者联合应用动态血糖监测系统（CGMS）和胰岛素泵治疗的降糖疗效。方法将100例糖尿病患者分为CGMS组和对照组（各50例）,CGMS组佩戴3d CGMS同时使用胰岛素泵降糖治疗,根据CGMS监测结果调整胰岛素剂量;对照组行手指法测血糖（SMBG）,同时使用胰岛素泵降糖治疗,根据SMBG每日8次连续3d的监测结果调整胰岛素剂量。治疗2周后两组患者均用CGMS观察血糖控制情况。结果CGMS组患者24h平均血糖、平均血糖波动幅度（MAGE）均小于对照组[（6.6±2.3）mmol／L与（7.5±2.1）mmol／L,（3.9±0.9）mmol／L与（5.1±0.6）mmol／L,均P〈0.05];胰岛素用量低于对照组[（0.64±0.21）U／kg与（0.82±0.41）U／kg,P〈0.05];低血糖发生持续时间短于对照组[（20±3）min与（40±9）min,P〈0.05]。结论CGMS联合胰岛素泵治疗可以降低血糖,减少血糖波动,减少胰岛素用量,防止低血糖发生。     

糖尿病血液透析患者透析过程中低血糖发生情况及其影响因素研究

背景　糖尿病血液透析（HD）患者透析过程中易发生低血糖,尤其是无症状性低血糖,但目前关于糖尿病HD患者透析过程中发生低血糖影响因素的研究报道较少。目的　分析糖尿病HD患者透析过程中低血糖发生情况及其影响因素。方法　选取2017年1月-2019年12月在杭州市西溪医院血透中心行HD的糖尿病患者86例,均接受常规治疗、血糖控制治疗。监测所有患者在研究开始后1个月12次HD过程中（上机30 min内）血糖值,分析其低血糖发生情况及血糖变异性;糖尿病HD患者透析过程中发生低血糖的影响因素分析采用单因素分析和多元有序Logistic回归分析。结果　86例患者中40例未发生低血糖（未发组）,24例发生1次低血糖（偶发组）,22例发生≥2次低血糖（常发组）,低血糖发生率为53.5%（46/86）。三组患者年龄、体质指数（BMI）、子女情况、文化程度、用药依从性、照顾能力、血糖平均值（MBG）、血糖变异系数（CVBG）比较,差异有统计学意义（P<0.05）;多元有序Logistic回归分析结果显示,年龄增大〔OR=1.079,95%CI（1.000,1.160）〕、用药依从性差〔OR=13.250,95%CI（2.300,76.250）〕、照顾能力差〔OR=4.067,95%CI（1.090,15.300）〕、MBG<8.91 mmol/L〔OR=4.001,95%CI（1.250,12.850）〕是糖尿病HD患者透析过程中发生低血糖的危险因素,而BMI增大〔OR=0.776,95%CI（0.640,0.950）〕、CVBG<0.26〔OR=0.254,95%CI（0.080,0.790）〕是保护因素（P<0.05）。结论　糖尿病HD患者透析过程中低血糖发生率较高（为53.5%）,年龄增大、用药依从性差、照顾能力差、MBG<8.91 mmol/L是糖尿病HD患者透析过程中发生低血糖的危险因素,而BMI增大、CVBG<0.26是保护因素。     

高糖诱导的视网膜胶质细胞凋亡以及牛磺酸的防护效应研究

目的通过检测高糖和牛磺酸培养对大鼠视网膜胶质细胞凋亡的影响,探讨牛磺酸保护糖尿病引起视网膜损伤的机制。方法实验分为10组,分别为：5mmol/L葡萄糖培养组（正常葡萄糖）;5mmol/L葡萄糖＋（0.1、1和10mmol/L）牛磺酸培养组;25mmol/L葡萄糖培养组（高葡萄糖）;25mmol/L葡萄糖＋（0.1、1和10mmol/L）牛磺酸培养组;5mmol/L和25mmol/L葡萄糖＋20mmol/L甘露醇组。用免疫细胞荧光双标法鉴定胶质细胞,用Annexin-V/PI双染结合流式细胞检测技术检测大鼠视网膜胶质细胞的凋亡情况。结果与正常对照组相比,25 mmol/L高糖组胶质细胞凋亡明显,高糖组的早期凋亡细胞百分率为20.6%;加入0.1、1、10mmol/L牛磺酸干预后,高糖组细胞凋亡率分别降为16.4%、5.7%和7.6%,牛磺酸干预组胶质细胞凋亡率明显低于高糖组（P〈0.05）。结论体外高糖培养可诱导大鼠视网膜胶质细胞发生凋亡,而牛磺酸对胶质细胞凋亡具有保护效应。上述结果可为牛磺酸用于糖尿病早期视网膜病变的防治提供重要的实验依据。