11β-Hydroxysteroid dehydrogenase type 1-driven cortisone reactivation regulates plasminogen activator inhibitor type 1 in adipose tissue of obese women

BACKGROUND: Plasminogen activator inhibitor type 1 (PAI-1) is the main inhibitor of the fibrinolytic system and contributes to an increased risk of atherothrombosis in insulin-resistant obese patients. In adipose tissue, we have shown that PAI-1 is synthesized mainly in the visceral stromal compartment and is positively regulated by glucocorticoids. We have demonstrated that adipose tissue expression of 11beta-hydroxysteroid dehydrogenase type 1 (11beta-HSD-1), an enzyme that catalyzes the conversion of inactive cortisone to active cortisol, is exaggerated in obese patients. OBJECTIVES: We hypothesized that increased action of 11beta-HSD-1 in adipose tissue of obese subjects may contribute to PAI-1 overproduction. PATIENTS AND METHODS: Using in situ hybridization, we studied the expression of the mRNAs coding for PAI-1 and 11beta-HSD-1 in the stromal compartment of visceral adipose tissue obtained from obese women. The regulation of PAI-1 secretion from in vitro incubated tissue explants was also investigated. RESULTS: Regression analysis showed a significant positive linear relationship between PAI-1 and 11beta-HSD-1 mRNAs expression. In vitro incubation of adipose tissue explants demonstrated that cortisone stimulated PAI-1 gene expression and secretion, and that these effects were inhibited by co-incubation with the 11beta-HSD inhibitor, glycyrrhetinic acid. CONCLUSIONS: Our data demonstrate that 11beta-HSD-1-driven cortisone reactivation regulates adipose PAI-1 synthesis and secretion. They suggest that the increased PAI-1 synthesis and secretion observed in obese patients can be also related, at least in part, to an increased local conversion of cortisone to cortisol. Therefore, local cortisol metabolism in adipose tissue may be involved in increasing the risk of cardiovascular disease in obese subjects.     

Short-term cortisol infusion in the brachial artery,with and without inhibiting 11 beta-hydroxysteroid dehydrogenase,does not alter forearm vascular resistance in normotensive and hypertensive subjects

BACKGROUND: Vascular tone is increased in primary hypertension, and glucocorticoids affect vascular tone. Local cortisol availability is modulated by activity of 11 beta-hydroxysteroid dehydrogenase (11 beta-HSD). As this activity may be decreased in patients with primary hypertension, vascular sensitivity to cortisol may be increased in these patients. We studied the acute effect of cortisol on forearm vascular resistance (FVR) by infusing cortisol directly into the brachial artery, both with and without inhibition of 11 beta-HSD, in normotensive and hypertensive subjects. DESIGN: Twenty normotensive volunteers and 20 patients with primary hypertension participated in the study. After a 10-min infusion of vehicle (glucose 5%), cortisol was infused into the brachial artery in three stepwise increasing doses (3.5, 10.5 and 35 microg per 100 mL of forearm volume), each for 10 min. Next, the participants received placebo or 500 mg glycyrrhetinic acid (GA) orally, and 150 min later the same infusion schedule was repeated. Forearm vascular resistance was measured during the last 5 min of the infused vehicle and of each dose. Arterial and forearm venous plasma samples for measurement of cortisol and cortisone were taken at the end of the infusions of glucose 5% and the highest cortisol dose. RESULTS: In both normotensive and hypertensive subjects, neither the infusion of cortisol nor the administration of GA changed FVR. Also 2 h after the cortisol infusion there remained no change in FVR in both the normotensive and hypertensive groups who received placebo. Following the infusion of the highest cortisol dose, total plasma cortisone levels in the venous plasma were decreased compared with levels in the arterial plasma (36 +/- 3 and 49 +/- 4 nmol L-1, respectively, P < 0.05). The protein-bound venous cortisone was 37.1 +/- 4.8 nmol L-1 during the vehicle compared with 23.9 +/- 3.7 nmol L-1 during the cortisol infusion (P < 0.01), whereas the free cortisone level was not altered by the cortisol infusion. CONCLUSIONS: In both normotensive and hypertensive subjects, high-dose cortisol infusion both with and without 11 beta-HSD inhibition did not change FVR either immediately or after 2 h. We could not demonstrate in vivo 11 beta-HSD activity in the forearm vascular tissues. When binding of cortisone to CBG is changed, e.g. during cortisol infusion, arterio-venous changes in cortisone cannot reliably be used to assess (alterations in) local 11 beta-HSD activity.     

Platelet-derived growth factor (PDGF) in type 1 diabetes mellitus

In 10 patients with type 1 diabetes mellitus, platelet-derived growth factor (PDGF) was assessed using an in vitro assay based on the stimulation of DNA synthesis in the 3T3 mouse fibroblast cell line. beta-Thromboglobulin (beta-TG) was used as an index for platelet alpha-granules content. Platelet beta-TG content and PDGF were markedly decreased in diabetic patients while plasma beta-TG was increased as compared with control subjects. In diabetic patients, a significant negative correlation was found between plasma beta-TG level and beta-TG total platelet content, associated with a significant positive correlation between platelet beta-TG content and PDGF. These results suggest that PDGF release might be increased in diabetic subjects. This may account in part for the cell proliferation observed in diabetic angiopathy.     

Atrial natriuretic peptide increases albuminuria in type I diabetic patients: evidence for blockade of tubular protein reabsorption

BACKGROUND: It has been suggested that atrial natriuretic peptide (ANP) contributes to the glomerular hyperfiltration of diabetes mellitus. Infusion of ANP increases the urinary excretion of albumin in patients with type I diabetes mellitus (IDDM). Although the increased albuminuria is attributed to a rise in glomerular pressure, alterations in tubular protein handling might be involved. PATIENTS AND METHODS: We have studied the effects of ANP in nine microalbuminuric IDDM patients. After obtaining baseline parameters, ANP was infused over a 1-h period (bolus 0.05 microgram kg-1, infusion rate 0.01 microgram kg-1 min-1). Renal haemodynamics, sodium and water clearance and tubular protein handling were studied. RESULTS: The glomerular filtration rate (GFR) increased from 116.4 +/- 8.9 to 128.3 +/- 8.8 mL min-1 1.73 m-2, whereas the effective renal plasma flow (ERPF) decreased from 534.3 +/- 44.3 to 484.9 +/- 33.3 mL min-1 1.73 m-2 (P < 0.05). As a result, the filtration fraction was significantly higher during infusion of ANP. ANP attenuated proximal tubular sodium reabsorption. Urinary albumin excretion rose from 87.57 +/- 21.03 to 291.40 +/- 67.86 micrograms min-1 (P < 0.01). Changes in the urinary excretion of beta 2-microglobulin and free kappa light chains were more marked, the excretion of beta 2-microglobulin increasing from 0.28 +/- 0.21 to 51.87 +/- 10.51 micrograms min-1 (P < 0.01), and of free kappa-light chains from 4.73 +/- 1.74 to 46.14 +/- 6.19 micrograms min-1 (P < 0.01). CONCLUSIONS: The observed rise in albuminuria during infusion of ANP does not simply reflect a change in glomerular pressure, but might at least partly result from an attenuation of tubular protein reabsorption.     

11β-羟基类固醇脱氢酶1型在腹部脂肪组织中表达研究

目的探讨11β-羟基类固醇脱氢酶1型(11β-HSD1)在女性腹部皮下和内脏脂肪组织中的表达差异。方法收集腹部皮下和内脏脂肪组织共12对。Trizol法提取总RNA,进行定量逆转录PCR检测。结果 11β-HSD1在超重和正常体重妇女的脂肪组织中表达水平比较,差异均无统计学意义(t分别=-0.93、-1.12,P均>0.05),在皮下脂肪和内脏脂肪组织表达也差异统计学意义(t=-1.49,P>0.05)。结论 11β-HSD1与腹部脂肪堆积之间的关系尚不清楚。     

Kinetics of prebeta1 HDL and alphaHDL in type II diabetic patients

BACKGROUND: The aim of this study was to analyze the recycling of high density lipoprotein (HDL) in six type II diabetic patients compared with six control subjects by endogenous labelling of apolipoprotein A-I (Apo A-I) with stable isotope Apo A. MATERIALS AND METHODS: The -I-HDL kinetics were performed by infusion of (5.5.5-(2)H3)-leucine for 14 h. The prebeta1 and alphaHDL were separated by gel filtration fast protein liquid chromatrography system (FPLC). Kinetics of isotopic enrichment of Apo A-I were analyzed with a multi-compartmental model software (SAAM II, SAAM Institute, Seattle, WA). RESULTS: Plasma Apo A-I concentration was decreased in patients with type II diabetes as a result of a decrease in Apo A-I-alphaHDL (P < 0.05). Diabetic patients were also characterized by an increased relative contribution of Apo A-I in prebeta1 HDL (18.3 +/- 2.8% vs 11.9 +/- 3.7%, P < 0.01). The synthetic rate of prebeta1 HDL was slightly increased in diabetic patients compared with control (NS) and an increase of recycling rate of alpha to prebeta1 HDL was observed (11.67 +/- 3.14 d(-1) vs 7.09 +/- 4.51 d(-1), P < 0.05). The clearance rate of Apo A-I was higher in diabetic patients (P < 0.05 for Apo A-I-prebeta1 HDL and P < 0.005 for Apo A-I-alphaHDL). CONCLUSION: This study suggests that the usual increase in prebeta1 HDL in type II diabetic patients is mainly related to an increased conversion rate of alpha to prebeta1 HDL.     

1型糖尿病患者血浆外泌体蛋白质组学分析

目的探讨1型糖尿病(T1DM)患者与健康者血浆外泌体中蛋白质组学的差异。方法收集T1DM患者与健康者血浆各6例,用试剂盒分离外泌体,提取蛋白,TMT标记后,采用高效液相色谱-质谱联用鉴定T1DM患者与健康者血浆外泌体中蛋白表达的差异,并进行生物信息学分析。结果共检测到可定量蛋白质948个,并确定其中37个在T1DM患者血浆外泌体中表达上调,122个表达下调。差异表达的蛋白质涉及多个生物进程,集中于凝血与补体级联反应、胆固醇代谢及沙门氏菌感染等信号通路。结论鉴定出159个在T1DM患者血浆外泌体表达具有差异的蛋白质,为进一步阐明T1DM发病机制及治疗靶点筛选提供了新的候选分子。     

Left ventricular performance during exercise in long-term type 1 diabetic men: an echocardiography study

Summary. M-mode echocardiograms were recorded and digitized during semisupine bicycle exercise in 10 young (<40 years) long-term (≥12 years) type 1 diabetic men, without heart symptoms, and 10 controls. Recordings were done at rest, during workloads of 50 and 100 W and 1, 3 and 5 min post-exercise. The groups were comparable at rest. Exercise intervention caused a higher heart rate and systolic blood pressure response in the diabetics. Overall, diabetics had a smaller left ventricular (LV) end-diastolic dimension, but it did not change during exercise within either group; LV end-systolic dimensions (ESD), however, decreased in both. The fractional shortening, normalized peak shortening rate and systolic blood pressure/ESD ratio increased in both groups. However, fractional shortening was lower in the diabetics during peak exercise, while the two latter variables of LV systolic function were similar to the controls. Furthermore, fractional shortening during peak exercise remained lower in the diabetics even when adjusted for systolic blood pressure by covariance analysis. Therefore, the decreased LV performance during exercise in the diabetic subjects is most likely secondary to reduced LV diastolic filling, as indicated by their smaller end-diastolic dimension, rather than due to decreased contractility or a higher afterload.     

老年男性2型糖尿病患者骨密度与冠心病的相关性

目的探讨老年男性2型糖尿病患者骨密度与冠心病的相关性。方法102例老年男性2型糖尿病住院患者根据是否合并冠心病分两组,比较分析两组患者的腰1～腰4及右侧股骨颈的骨密度）,并采用多因素非条件Logistic回归分析骨质疏松与冠心病的相关性。结果合并冠心病组腰1～腰4和股骨颈的骨密度分别为（0．73±0．12）g／cm^2、（0．76±0．14）g／cm^2、（0．82±0．22）g／cm^2、（0．81±0．21）g／cm^2、（0．71±0．12）g／cm^2,未合并冠心病组骨密度分别为（0．86±0．17）g／cm^2、（0．92±0．22）g／cm^2、（0．96±0．23）g/cm^2、（0．98±0．25）g／cm^2、（0．80±0．13）g／cm^2,两组比较,差异均有统计学意义（t分别：-4．38、-4．32、-3．27-3．67、-4．30,P均〈0．05）。调整了年龄、体重指数、血脂、血钙、血磷后,经Logistic回归分析显示：骨质疏松和冠心病存在明显的相关性（OR=3．80,95％CI：1．50～9．61,P〈0．05）。结论老年男性2型糖尿病患者骨密度的降低可能跟冠心病的发生、发展有关。     

2型糖尿病患者血清胱抑素C与视网膜病变的关系

目的 探讨2型糖尿病患者血清胱抑素C(Cys C)与视网膜病变之间的关系,并分析其在糖尿病视网膜病变诊断中的临床价值.方法 选取360例2型糖尿病住院患者和149例健康对照者(NC组),2型糖尿病患者中不伴视网膜病变(NDR组)190例、伴视网膜病变(DR组)170例,检测各组腰臀比、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、糖化血红蛋白(HbA1 c)、Cys C等指标,分析Cys C与2型糖尿病视网膜病变的关系.结果 2型糖尿病患者组FBG、TC、TG、LDL-C、HbA1 c、Cys C高于NC组(P＜0.05);DR组血清Cys C水平明显高于NDR组(P＜0.05);同时多元logistic回归结果 表明,2型糖尿病视网膜病变的发生发展除了与年龄和糖尿病病程等呈正相关外,还与血清Cys C水平呈正相关(β=0.791,P＜0.05).结论 高血清胱抑素C水平是2型糖尿病视网膜病变的独立危险因素.     

血糖控制对2型糖尿病患者粪弹力蛋白酶1水平的影响

目的研究血糖控制对2型糖尿病患者粪弹力蛋白酶－1（E1）水平的影响。方法通过测定糖化血红蛋白选取血糖控制不良的2型糖尿病患者18例,在血糖控制前后分别测定空腹血糖、餐后血糖和粪E1水平,了解血糖对粪E。水平的影响。结果治疗前空腹和餐后血糖分别为（7．67±1．96）mmol／L和（14．66±1．98）mmol／L,治疗后空腹血糖和餐后血糖分别为（5．81±0．59）mmol／L和（7．65±1．48）mmol／L。治疗前后粪E1水平分别为（587．57±254．70）μg／g vs （626．71±297．49）μg／g,差异无统计学意义（P=0．360）,血糖控制前后2次粪E1水平相关（r=0．806,P=0．000）。个体不同时间粪E1水平的变异为0～35％,平均值为16．7％。结论短期血糖控制对粪E1水平无显著影响。     

Association between eating behaviour and current glycaemic control, body mass or autonomic nervous function in long-term type I and type II diabetic patients

This cross-sectional study was aimed at investigating the association between eating behaviour and current glycaemic control, body mass or autonomic nervous function in patients with type I and type II diabetes mellitus (DM). In 72 patients (31 type I DM, 41 type II DM) we investigated body mass index (BMI), serum cholesterol, serum triglycerides, haemoglobin A1c (HbA1c) and autonomic nervous function (seven standardized tests). The three-factor eating questionnaire was used to investigate cognitive control of eating behaviour (CC) and susceptibility to eating problems (SEP). The mathematical product of CC and SEP provides information about disinhibition of eating control (DEC). In type I DM, there was a correlation between SEP and age ( r =−0.536, P <0.01), SEP and duration (−0.441, P <0.05), SEP and HbA1c (0.438, P <0.05), and between DEC and duration (−0.371, P <0.05) and DEC and HbA1c (0.376, P <0.05). In type II DM, there was a correlation between SEP and BMI (0.401, P <0.01) and between DEC and BMI (0.429, P <0.01). Low CC was associated with autonomic nervous dysfunction in type I DM ( P =0.022). In type II DM, autonomic nervous dysfunction was associated with high SEP ( P =0.044). In conclusion, the correlation between eating behaviour and HbA1c or triglycerides in type I DM indicates that the questionnaire is able to address current parameters of diabetes control. Self-assessment of eating behaviour in type I and type II diabetic patients reveals associations between eating behaviour and autonomic nervous function.     

2型糖尿病视网膜病变患者血清脂联素水平的研究

目的 为观察血清脂联素水平的变化与2型糖尿病合并视网膜病变(DR)各期的关系.方法 采用ELISA法对113例2型糖尿病患者血清脂联素水平进行检测,其中2型糖尿病无DR患者30例(DM组)、2型糖尿病合并DR背景型患者45例(BDR组)、2型糖尿病合并DR增殖型患者38例(PDR组)和健康对照30例(NC组).结果 (1)DM组血清脂联素水平与NC组比较差异有统计学意义(P＜0.05);BDR组血清脂联素水平与DM组、NC组比较差异均有统计学意义(P＜0.05或P＜0.01);PDR组血清脂联素水平与BDR组、DM组、NC组比较差异均有统计学意义(P＜0.05或P＜0.01).(2)相关分析发现,2型糖尿病患者血清脂联素水平与收缩压、糖化血红蛋白、TG、TC、LDL-C成显著负相关,而与HDL-C成显著正相关.结论 2型糖尿病患者血清脂联素水平明显降低, 2型糖尿病合并DR后血清脂联素水平更低.脂联素可作为判断2型糖尿病合并DR损害程度的指标.     

血清对氧磷酶1活性与2型糖尿病患者颈动脉粥样硬化的关系

目的：探讨血清对氧磷酶1（paraoxonase 1,PON1）活性与2型糖尿病患者颈动脉粥样硬化的关系。方法2型糖尿病患者117例,根据颈动脉彩色多普勒超声测定结果,分为无动脉粥样硬化（AS）组38例,AS组79例;选择同期健康体检者75例（对照组）,测量血压、体质量指数（BMI）、腰臀比、空腹血糖、餐后2小时血糖、糖化血红蛋白、总胆固醇、甘油三酯（TG）、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸等各项指标,同时测定血清 PON1活性。分析血清PON1活性与颈动脉粥样硬化的关系。结果与对照组比较,糖尿病组血清 PON1（240．0±15．6） kU／L vs （229．5±19．6）kU／L、AS发生率（44．0％ vs 67．5％）、BMI（24．3±3．6）kg／m2 vs （25．8±3．2）kg／m2、腰臀比（0．89±0．05）vs （0．93±0．06）、收缩压（131．0±8．3）mmHg（1 mmHg＝0．133 kPa）vs （134．0±8．8）mmHg、TG （1．8±0．8）mmol／L vs （2．1±1．3）mmol／L等比较差异有统计学意义（P＜0．05）;AS组血清 PON1活性明显低于非AS组（235．5±19．9）kU／L vs （226．7±18．9）kU／L（P＜0．05）;糖尿病患者血清PON1活性与年龄呈负相关（r＝－0．382,P＜0．01）,与血清TG水平呈正相关（r＝0．223,P＜0．05）。结论2型糖尿病患者血清PON1活性显著下降,PON1活性降低与颈动脉粥样硬化发生密切相关。     

血浆纤维蛋白原与2型糖尿病患者下肢血管病变的关系

目的 探讨血浆纤维蛋白原(FIB)水平与2型糖尿病患者下肢血管病变相关性.方法 选择2型糖尿病患者240例,男132例,女108例,全部受试者均采用高分辨彩色多普勒超声检查判定下肢动脉病变程度,按下肢血管病变严重程度进行评分,所有入选病例分为2型糖尿病下肢血管病变组(病变组又分为轻度、中度和重度组)与非病变组,比较病变组与非病变组间血浆纤维蛋白原水平;同时根据纤维蛋白原水平,比较高纤维蛋白原水平和正常纤维蛋白原水平患者的下肢血管病变发生率及病变严重程度情况.结果 糖尿病下肢血管病变组纤维蛋白原水平显著高于非病变组(3.20±0.66)g、L VS(2.85±0.57)g、L(P＜0.01),高纤维蛋白原患者较正常纤维蛋白原的下肢血管病变发生率显著增加,病变程度更重(50.94%VS 26.20%,P＜0.05).结论 血浆纤维蛋白原升高是2型糖尿病下肢血管病变的重要危险因素之一.     

Helicobacter pylori masks differences in homocysteine plasma levels between controls and type 2 diabetic patients

BACKGROUND: Data in the literature have not clarified whether type 2 diabetes mellitus affects homocysteine plasma levels. Different variables able to influence homocysteine could be the cause of these controversial findings. An important but neglected confounding factor is Helicobacter pylori, which has been demonstrated to be a cause of elevated levels of homocysteine and which is prevalent in the Caucasian population, ranging from 30 to 40% incidence. Starting from these findings we wanted to verify whether differences in homocysteine levels exist between a type 2 diabetic population and a control group, taking into account the presence/absence of Helicobacter pylori. DESIGN: The study was carried out on a group of uncomplicated and normotensive type 2 diabetic patients (n = 30, 55.7 +/- 9.7 years) and on a control group (n = 43, 51.2 +/- 11.3 years). On these subjects we evaluated: main parameters of glyco- and lipo-metabolic balance, presence of Helicobacter pylori by 13C Urea Breath Test, plasma homocysteine, vitamin B12, folate and genetic polymorphism of methylenetetrahydrofolate reductase. RESULTS: Evaluating the two groups as a whole, significant differences in homocysteine were found when considering Helicobacter pylori presence/absence (14.0 +/- 6.5 vs. 10.6 +/- 4.7 micromol L-1, respectively, P < 0.01) without differences of vitamins and the genetic polymorphism of methylenetetrahydrofolate reductase. The positive interaction found among Helicobacter pylori, diabetes and homocysteine (P = 0.03) taking into account all the other evaluated confounding factors, demonstrates that a significant difference in homocysteine plasma levels exists between diabetics and controls (Helicobacter pylori-negative: diabetics 12.5 +/- 5.6 micromol L-1, controls 9.4 +/- 3.8 micromol L-1; Helicobacter pylori-positive: diabetics 13.6 +/- 5.8 micromol L-1, controls 14.3 +/- 7.0 micromol L-1). CONCLUSIONS: Type 2 diabetes seems to induce per se higher levels of homocysteine, which appears to be one of the factors responsible for the increased risk of vascular damage.     

中老年2型糖尿病患者骨密度变化

目的 了解中老年2型糖尿病(type 2 daibetes,T2DM)患者骨密度(bone mineral density,BMD)变化.方法 采用双能X线吸收法测定2 215例T2DM患者(男1 142例,女1 073例)腰椎正位1～4椎体(L1～4)、左侧髋部股骨颈(Neck)、大转子(Troch)、转子内区(Inter),髋部总体(Htot)和华氏三角(Wa rd) BMD.结果 ①中老年T2DM患者L1～4、Neck、Troch、Inter、Htot和Ward BMD在30岁以后随年龄增加而逐渐降低.各测量部位中Ward区BMD绝对值最低,是BMD变化的敏感的区域.②女性各测量部位BMD均低于男性(P＜0.01).男女L1～4、Inter、Htot、Neck、Troch、和Ward区BMD分别为0.88(0.10) vs 0.78(0.22)、1.12(0.19) vs 1.00(0.23)、0.96(0.16) vs0.83(0.15)、0.82(0.15) vs 0.73(0.18)、0.69(0.14) vs 0.57、0.60(0.18) vs 0.52(0.22).③按照体质量指数(BMI)分为4组后比较BMD,随着BMI值的增加,各测量部位BMD呈上升趋势.结论 中老年T2DM患者BMD骨峰值出现在30～40岁.T2DM患者女性BMD值在各个测量部位均低于男性.各部位BMD随BMI增加呈上升趋势.     

专病一体化护理在2型糖尿病患者中的应用效果

目的探讨专病一体化护理在2型糖尿病患者中的应用效果。方法选取2015年12月至2017年12月我院收治的84例2型糖尿病患者为研究对象,根据护理方式的不同将其分为对照组(42例,常规护理干预)与观察组(42例,常规护理+专病一体化护理干预)。比较两组患者护理后的血糖控制情况、疾病知识掌握程度、自护能力和生活质量。结果出院后1年,两组患者FBG、2 h PBG及HbA1c水平均明显降低,且观察组低于对照组,差异具有统计学意义(P<0.05);观察组患者的合理饮食、合理运动、正确用药、并发症管理及血糖自我检测评分均明显高于对照组,差异具有统计学意义(P<0.05);出院后1年,两组患者的自护能力评分和DMQLS评分均明显升高,且观察组高于对照组,差异具有统计学意义(P<0.05)。结论专病一体化护理在2型糖尿病患者中的应用效果显著,可以降低患者的血糖水平,提高患者的疾病知识掌握度及自护能力,改善患者的生活质量,值得临床推广。     

Global assessment for quality and safety of control in type 2 diabetic patients

BACKGROUND: HbA1c (glycated haemoglobin) suffers from obvious limitations in type 2 diabetic patients at risk of hypoglycaemia or requiring rapid therapeutic adjustments. This study was conducted to discern whether the monitoring of one particular plasma glucose (PG) value of the diurnal profile can be used in such situations. DESIGN: Four diurnal PG concentrations (at 08:00, 11:00, 14:00 and 17:00 h) were measured in standardized conditions in 480 (246 men, 234 women) noninsulin-using type 2 diabetic patients. Sensitivities for predicting treatment success, i.e. HbA1c<7%, with a specificity > or =90% were calculated and compared using receiver-operating characteristic (ROC) curves. RESULTS: The probabilities (areas under ROC curves) for predicting HbA1c<7% were significantly higher at 11:00, 14:00 and 17:00 h than at 08:00 h. The optimal PG cut-off values for predicting treatment success were, respectively, 6, 9, 7 and 6 mmol L(-1) at 08:00 h, 11:00, 14:00 and 17:00 h. In most patients the lowest PG values of the diurnal profile were at 17:00 h, and 17.5% of the patients with HbA1c<7% (54.5% of them treated with sulphonylureas) exhibited a PG value less than 4.4 mmol L(-1) at 17:00 h (P=0.0034 vs. the other timepoints). CONCLUSIONS: Glucose monitoring at 17:00 h, i.e. during the extended postlunch period, appears as a global marker of control in noninsulin-using type 2 diabetic patients both for detecting patients at risk of hypoglycaemia and for assessing the short-term quality of diabetic control.     

Frequency of angiotensin-converting enzyme gene polymorphism in Turkish type 2 diabetic patients

We aimed to investigate the angiotensin-converting enzyme (ACE) gene polymorphism, ACE activity and their associations with diabetic complications in Turkish patients with type 2 diabetes mellitus. A total of 143 patients and 133 controls were screened for ACE gene I/D polymorphism by using polymerase chain reaction. Serum ACE activities were determined spectrophotometrically. There was no significant difference in the distribution of ACE I/D genotypes between patients and controls. The patients with DD genotype had a higher ACE activity than those with ID and II. Hypertensive diabetic patients with DD genotype had higher ACE activities than those with ID and II. There was no significant difference in the distribution of ACE I/D genotypes between patients with and without nephropathy, retinopathy and hypertension except for patients with and without neuropathy. In patients with DD genotype, creatinine clearance correlated with duration of diabetes. The grade of retinopathy was correlated with duration of diabetes in DD and ID genotypes. The highest ACE activity was measured in hypertensive diabetics with DD genotype. ID genotype was suggested to be a risk factor and II was suggested to be protective for diabetic neuropathy. The DD and ID genotypes might be a predictor for the development of retinopathy in relation to duration of diabetes.