维生素D和糖尿病

维生素D最重要的功能是维持人体钙离子代谢的平衡。随着研究的深入,维生素D在炎性反应、自身免疫性疾病、胰岛素分泌及胰岛素抵抗等方面的作用已经成为研究的热点。维生素D缺乏或不足与糖尿病发病相关。维生素D可通过抑制炎性反应、促进胰岛素释放、减轻胰岛素抵抗等机制参与糖尿病的发病。大量的临床研究发现补充足量的维生素D不仅可以减少1型糖尿病和2型糖尿病的发病,而且还可以改善糖代谢,控制糖尿病相关症状。因此,维生素D可能在预防和控制糖尿病中起重要作用。     

维生素D和糖尿病

维生素D最重要的功能是维持人体钙离子代谢的平衡.随着研究的深入,维生素D在炎性反应、自身免疫性疾病、胰岛素分泌及胰岛素抵抗等方面的作用已经成为研究的热点.维生素D缺乏或不足与糖尿病发病相关.维生素D可通过抑制炎性反应、促进胰岛素释放、减轻胰岛素抵抗等机制参与糖尿病的发病.大量的临床研究发现补充足量的维生素D不仅可以减少...     

Profiles of smokers and non-smokers with type 2 diabetes: initial visit at a diabetes education centers

Aims

This study explores differences in psychosocial, behavioral and clinical characteristics among smoking and non-smoking individuals with diabetes attending diabetes education centers (DEC).

Methods

A questionnaire was administered to 275 individuals with type 2 diabetes attending two DECs between October 2003 and 2005. The participants’ characteristics were analyzed and multivariable linear and ordinal regressions were performed to adjust for variables correlated with smoking.

Results

Findings revealed that smokers, compared to non-smokers, had lower outcome expectations of the benefits of self-management, lower diastolic blood pressure, and followed their recommended diet and tested blood glucose levels less often than non-smokers. Smokers also had lower intentions to use resources outside and within the DEC.

Conclusions

Results demonstrate poorer self-care behaviors among smokers compared to non-smokers and further suggest cognitive and behavioral differences between smokers and non-smokers regarding participation and attitudes toward self-management practices. These findings identify issues that need to be addressed in diabetes self-management programs to allow for more effective interventions tailored to the healthcare needs of this specific population.     

维生素D与糖尿病和代谢综合征

自从在胰岛β细胞和免疫细胞中发现维生素D受体后,越来越多的证据表明维生素D缺乏的个体更易患糖尿病。流行病学研究显示,生命早期的维生素D缺乏与将来1型糖尿病的发病存在联系,而补充维生素D可以预防1型糖尿病,改善2型糖尿病的血糖控制。临床及动物模型研究证明,维生素D缺乏会损害胰岛素的合成和分泌,加重胰岛素抵抗,并增加代谢综合征的发病率,这表明维生素D在2型糖尿病发生和发展中具有不可忽视的作用。     

Apolipoprotein (a) levels in type 1 and type 2 diabetes mellitus

Type 1 and type 2 diabetes mellitus are both characterized by increased cardiovascular mortality and morbidity. Since several reports have indicated that apolipoprotein (a) [apo (a)] levels are positively associated with an increased risk of macrovascular disease, we investigated whether apo (a) levels are elevated in both types of diabetes mellitus and may thus represent an independent risk factor for atherosclerotic disease. Apo(a) concentrations in type 1 diabetic patients were not significantly different from matched controls (276±78 vs 149±46 units/l). Type 2 diabetic patients had considerably higher levels of apo (a) than matched controls (471±89 vs 221±61 units/l,P=0.06), though the difference was not statistically significant. However, concentrations of apo (a) were above 300 units/l in 36% of type 1 and 67% of type 2 diabetic patients, but in only 14% and 25% respectively of matched control subjects. Plasma triglycerides were positively and independently correlated with apo (a) levels in both diabetic and non-diabetic subjects. On the other hand, no significant correlation was found between apo (a) levels and glycosylated haemoglobin, total cholesterol or high density lipoprotein cholesterol in any of the groups studied. In conclusion, apo (a) levels are not significantly elevated either in type 1 or type 2 diabetic patients without proteinuria and in moderate metabolic control; however, levels above 300 units/l were 2.6 times more frequent in both types of diabetes mellitus than in carefully age-, sex-, and weight-matched control subjects.     

Prevalence of symptoms of depression and anxiety in a diabetes clinic population.

AIMS: To investigate the use of a short questionnaire to measure psychological symptoms in a busy clinic setting, and to examine the prevalence of these symptoms in adults with diabetes. The perceived need for psychological treatment services was also measured. METHODS: Adults (> 18 years) with either Type 1 or Type 2 diabetes were invited to complete a short demographic form and the Hospital Anxiety and Depression Scale (HADS) whilst waiting for their routine diabetes outpatients appointment. Complication status was measured via patients' medical records. Glycaemic control (HbA(1c)) was also recorded. RESULTS: A high response rate (96%) was achieved. Prevalence rates of psychological symptoms were high (overall 28% of study participants reported moderate-severe levels of depression or anxiety or both). Men were somewhat more likely to report moderate-severe depressive symptoms, whereas women reported more moderate-severe anxiety. A significant association between depression and poor glycaemic control was observed in the men, but not in the women. Regression analysis demonstrated that the interaction between sex and glycaemic control, HbA(1c) and sex were all significantly associated with depression and anxiety (R2 = 0.16 and 0.19, respectively). One-third of subjects reported that at the moment they would be interested in receiving counselling or psychotherapy if it was currently available at the diabetes clinic. CONCLUSIONS: This study has shown that the HADS is an appropriate questionnaire to use in a clinic setting in adults with diabetes. There may be a stronger association between glycaemic control and psychological symptomatology in men than in women. There remains a significant proportion of individuals with diabetes who require psychological support, which, if available, might help improve glycaemic control and thus overall wellbeing.     

Polymorphonuclear leukocyte membrane fluidity and cytosolic Ca2+ concentration in diabetes mellitus

We evaluated polymorphonuclear membrane (PMN) fluidity in 32 subjects with type 1 diabetes mellitus, 38 subjects with type 2 diabetes mellitus and 38 normal control subjects, by marking intact and unstimulated PMN cells with the fluorescent probe 1-[4-(trimethylamino)phenyl]-6-phenyl-1,3,5-hexatriene (TMA-DPH). We also evaluated PMN cytosolic Ca²⁺ content by marking intact and unstimulated PMN cells with the fluorescent probe Fura 2-AM. PMN membrane fluidity differentiated normal subjects from type 1 and 2 diabetic subjects. The PMN cytosolic Ca²⁺ concentration did not discriminate type 1 and 2 diabetic subjects from normal control subjects. No statistical correlation was found between PMN membrane fluidity and PMN cytosolic Ca²⁺ concentration in any of the groups of subjects, nor were significant correlations found between PMN membrane fluidity and cytosolic Ca²⁺ concentration in several plasma parameters (serum glucose, cholesterol and triglycerides). In conclusion, in type 1 and 2 diabetic patients we found a decrease in PMN membrane fluidity and this decrease, which was greater in type 2 diabetic patients, may be a marker of PMN dysfunction. Received: 1 December 1997 / Accepted in revised form: 24 June 1998     

Impaired stroke volume and aerobic capacity in female adolescents with type 1 and type 2 diabetes mellitus

AIM/HYPOTHESIS: This study was designed to determine whether type 2 diabetic adolescents have reduced aerobic capacity and to investigate the role of cardiac output and arteriovenous oxygen difference (a-vO(2)) in their exercise response. METHODS: Female adolescents (age 12-18 years) with type 2 diabetes mellitus (n = 8) and type 1 diabetes mellitus (n = 12) and obese (n = 10) and non-obese (n = 10) non-diabetic controls were recruited for this study. Baseline data included maximal aerobic capacity (cycle ergometer) and body composition. Cardiac output and a-vO(2) were determined at rest and during submaximal exercise. RESULTS: Diabetic groups had lower aerobic capacity than non-diabetic groups (p < 0.05). Adolescents with type 2 diabetes had lower aerobic capacity than the type 1 diabetic group. Maximal heart rate was lower in the type 2 diabetic group (p < 0.05). Exercise stroke volume was 30-40% lower at 100 and 120 beats per min in the diabetic than in the non-diabetic groups (p < 0.05). The a-vO(2) value was not different in any condition. CONCLUSIONS AND INTERPRETATION: Type 2 diabetic adolescents have reduced aerobic capacity and reduced heart rate response to maximal exercise. Furthermore, type 2 and type 1 diabetic adolescent girls have a blunted exercise stroke volume response compared with non-diabetic controls. Central rather than peripheral mechanisms contribute to the reduced aerobic capacity in diabetic adolescents. Although of short duration, type 2 diabetes in adolescence is already affecting cardiovascular function in adolescents.     

Genetics and pathogenesis of type 1 diabetes: prospects for prevention and intervention

Type 1 diabetes is etiologically a multifactorial disease caused by a complex interaction of genetic and environmental factors, with the former consisting of multiple susceptibility genes. Identification of genes conferring susceptibility to type 1 diabetes would clarify etiological pathways in the development and progression of type 1 diabetes, leading to the establishment of effective methods for prevention and intervention of the disease. Among multiple susceptibility genes, HLA and INS are particularly important because of their contribution to tissue specificity in the autoimmune process. DRB1*04:05‐DQB1*04:01 is associated with autoimmune type 1 diabetes, idiopathic fulminant type 1 diabetes and anti‐islet autoimmunity in autoimmune thyroid diseases, suggesting that this haplotype is associated with beta‐cell specificity in autoimmune diseases. Genes involved in the expression of insulin in the thymus contribute to beta‐cell‐specific autoimmune mechanisms in type 1 diabetes. These genes and pathways are important targets for tissue‐specific prevention and intervention of type 1 diabetes. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2011.00176.x, 2011)     

Lipids,lipoproteins and apolipoproteins in type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus

Summary Total plasma cholesterol, triglycerides, VLDL-C, VLDL-TG, HDL-C and the apoproteins A-I, A-II, B and D were measured in 111 male non-obese diabetic patients and in 90 male control subjects of similar age and body weight distribution. Forty-eight patients had Type 1 (insulin-dependent diabetes) and 63 had Type 2 (non-insulin-dependent diabetes); all were in stable metabolic control while following an appropriate diet and therapy with insulin or oral hypoglycemic agents. HDL-C, apoA-I, apoB and the apoA-I/apoA-II ratio were significantly increased in the Type 1 patients, whereas the VLDL-C/VLDL-TG and LDL-C/apoB ratios were decreased significantly. Type 2 diabetics showed low HDL-C and low apoA-I/apoA-II ratio, while the values of apoA-I, A-II, D and the VLDL-C/VLDL-TG ratio were significantly higher than in controls. Type 1 diabetics in ‘fair’ metabolic control presented higher values of TG, VLDL-C, VLDL-TG and apoB than patients in ‘good’ control: lower values of apoA-I and of the ratios apoA-I/apoA-II, apoA-I/apoB and LDL-C/apoB were recorded in the same subgroup. In Type 2 diabetics no significant differences were observed according to metabolic control, with the exception of a higher apo-D value in subjects in ‘fair’ control. The data obtained support the view that good metabolic control may be important for the prevention of a relevant derangement of lipoprotein components, particularly in Type 1 patients. Partially supported by grant No. 83.02521.56 fromConsiglio Nazionale delle Ricerche (CNR), Roma, Italy (Progetto Finalizzato di Medicina Preventiva e Riabilitativa).     

2型糖尿病的医学营养治疗

介绍2型糖尿病医学营养治疗的近年进展,认为主要应适当减少食物热卡及限制饱和脂肪酸＜7%,以控制血糖并降低心血管疾病危险等.     

PET技术在糖尿病研究领域中的应用

正电子发射断层成像（PET）技术是一种通过体外测量放射性元素在人体内的代谢轨迹,进行三维成像的无创检测技术。运用PET技术对注入人体的放射性元素进行断层扫描,采集数据及成像,可更深入地研究糖尿病的发病机制。PET技术还可用于研究糖尿病并发症如血管疾病、神经病变的发病机制及其早期诊断,并可评价降糖药物对糖尿病及部分并发症的干预疗效。     

Coeliac disease and Type 1 diabetes mellitus - the case for screening.

AIM: To review the relationship between coeliac disease and Type 1 diabetes mellitus with emphasis on prevalence of coeliac disease, presentation and implications for screening. METHODS: Papers collected over many years by the author have been included in the review and a literature search employing Medline was undertaken to August 2000. Search words used were coeliac disease and diabetes mellitus. RESULTS: Twenty papers exploring the prevalence of coeliac disease by serological screening of Type 1 diabetes in children, eight in adults and two including both groups were found. An additional 48 papers are included and relate to serological screening tests for coeliac disease, expressions and complications of coeliac disease, the value of GFD and the genetics of the two conditions. Unless formal screening studies are undertaken coeliac disease will not be diagnosed because patients are asymptomatic, have atypical symptoms or even in those with symptoms the diagnosis is overlooked. Based on small bowel biopsy, diagnosis the prevalence of coeliac disease in Type 1 diabetes in children is 1:6 to 1:103 and in adults 1:16 to 1:76. Patients may improve following the start of a gluten-free diet (GFD) in terms of symptoms, growth in children, serum antibody levels, haematological and biochemical indices, morphology of the small intestinal mucosa and control of diabetes. CONCLUSION: Coeliac disease commonly occurs in Type 1 diabetes. It is recommended that screening for coeliac disease should be part of the routine investigation and offered to all patients because of the high prevalence and the potential benefits of treatment with a GFD. This includes control of symptoms, stabilization of diabetes and prevention of complications associated with coeliac disease. The cost per patient diagnosed with coeliac disease from the existing population with Type 1 diabetes would be pound860 and for those newly arising pound950.     

Evaluation of unmet medical need among Japanese patients with type 2 diabetes mellitus and efficacy of Lixisenatide treatment among Asian type 2 diabetes mellitus patients

AimsThis study determined the unmet medical need of basal insulin therapy among type 2 diabetes patients who participated in the ALOHA study. Also a meta-analysis of the GetGoal-Duo1, -L, and -L-Asia trials was conducted to examine the impact of lixisenatide add-on treatment to basal insulin therapy ± OADs specifically among Asian type 2 diabetes patients.MethodsThe proportions of Japanese patients with an unmet need of diabetes management, defined as not achieving an HbA1c < 7% despite having a fasting plasma glucose (FPG) < 130 mg/dL, and without an unmet need, defined as having an endpoint HbA1c < 7%, regardless of FPG level, were determined for the ALOHA study population, which was conducted as a post-marketing survey for insulin glargine in Japan. For the meta-analysis, all Asian modified intent-to-treat patients with baseline and endpoint HbA1c measurements reported from the 3 GetGoal trials were included.ResultsAmong 1013 Japanese type 2 diabetes patients in the ALOHA study, 36% had an unmet need. In the GetGoal-Duo1, -L, and L-Asia trials, 237 Asian patients were treated with lixisenatide add-on treatment to basal insulin and 226 received placebo. Lixisenatide add-on treatment vs. placebo was associated with the following significant mean changes in efficacy outcomes at week 24: HbA1c: −0.6%, p = 0.005; FPG: −13.3 mg/dL, p = 0.004; PPG: −101.4 mg/dL, p < 0.001; weight: −0.5 kg, p = 0.018; basal insulin dose: −1.6 U, p < 0.001.ConclusionsLixisenatide add-on treatment may provide a viable option to address the unmet need of basal insulin therapy among Asian type 2 diabetes patients.     

Trends in the prevalence of type 2 diabetes mellitus and obesity in the Arabian Gulf States: Systematic review and meta-analysis

We report trends in type 2 diabetes mellitus and obesity in adults residing in the Arabian Gulf States. Among the Saudi population, the prevalence of diabetes increased from 10.6% in 1989 to 32.1% in 2009. Prevalence of the disease increased faster among Saudi men than women, with growth rates of 0.8% and 0.6% per year, respectively.     

Gestational diabetes and subclinical inflammation: evaluation of first year postpartum outcomes

Aim

The aim of this study was to evaluate the relationship between sublinical inflammation and glycemic status in patients with gestational diabetes mellitus (GDM).

Methods

Sixty-one patients with GDM and 40 healthy pregnant women were included in the study. Fasting blood glucose (FBG), insulin, high sensitivity C-reactive protein (hsCRP), lipid parameters and carotid artery intima-media thickness (CIMT) were measured. Fifty-five of the patients with GDM returned for a follow-up visit scheduled at 1-year post-partum. These patients were subjected to 75 g oral glucose tolerance test (OGTT) followed by an evaluation of metabolic and subclinical inflammatory parameters were evaluated.

Results

The mean FBG, insulin, homeostasis model assessment insulin resistance (HOMA-IR), triglyceride (TG), hsCRP levels and CIMT in the women with GDM were significantly higher than those in the control group. C-reactive protein and CIMT were positively correlated with insulin, HOMA-IR, glucose value at the time of the OGTT 50, prepregnancy body mass index, TG and FBG. Multivariate logistic regression analysis on patients with sustained hyperglycemia one-year postpartum revealed elevated hsCRP levels to be independent risk factors for the development of dysglycemia.

Conclusions

Elevated hsCRP levels could be predictors of progression to T2DM later in life in patients with GDM.     

青岛地区20～74岁人群糖尿病患病率调查

目的　了解青岛地区成人糖尿病 (DM )的患病率。　方法　采用分层随机整群抽样方法 ,在 2 0 0 1年 5月～ 2 0 0 2年 6月期间 ,横断面调查青岛地区 2县 5区 2 0～ 74岁居民 14 6 0 6名。除市南区的 2 170名居民直接采用口服 75 g葡萄糖耐量试验 (OGTT)进行筛查外 ,其余各点的 12 4 36名被调查者需先行指血筛查 ,当毛细血管血糖≥ 6 1mmol/L时进行OGTT确定诊断。　结果　青岛地区 2 0～ 74岁人群DM标化的患病率为 5 5 % ,其中 6 4 5 %为新诊断的DM。其中市南区居民DM、糖耐量受损 (IGT)、空腹血糖受损 (IFG)和糖调节受损 (IGR)的标化患病率分别为 9 1%、6 6 %、4 5 %和 11 1%。乡村居民DM的患病率低于城镇居民 (5 0 %比 6 1% ,P <0 0 0 1)。乡村中 ,女性患病率高于男性 (5 7%比 4 0 % ,P <0 0 1)。随着年龄的增加 ,DM的患病率逐渐增加。　结论　青岛地区DM患病率与 1994年及 1996年全国流行病学调查结果相比 ,青岛地区DM的患病率明显升高。随着地区的城市化和人口的老龄化程度进一步增加 ,DM患病率将有更大幅度的升高     

Ketoacidosis in young adults is not related to the islet antibodies at the diagnosis of Type 1 diabetes mellitus--a nationwide study.

AIMS: To test the hypothesis that there is lower prevalence of islet antibodies in subjects with newly diagnosed Type 1 diabetes mellitus in young adulthood than in children is associated with less severe diabetes at time of diagnosis. METHODS: This investigation was based on a nationwide study (Diabetes Incidence Study in Sweden) of 15-34-year-old newly diagnosed diabetic subjects. During 1992-1993, all diabetic subjects (excluding secondary and gestational diabetes) were reported on standardized forms, with information about clinical characteristics at diagnosis. The study examined islet cell antibodies (ICA) by indirect immunofluorescence, and autoantibodies to glutamic acid decarboxylase (GADA), tyrosine phosphatase-like antigen (IA-2A) and insulin (IAA) as well as C-peptide by radioimmunoassay. RESULTS: Blood samples were available from 78 patients with diabetic ketoacidosis (DKA) and 517 non-acidotic patients. The prevalence of ICA (63% vs. 57%), GADA (63% vs. 66%), IA-2A (35% vs. 44%) and IAA (20% vs. 15%) were very similar in patients with or without DKA. The median levels of the four autoantibodies did not differ between the two groups. High blood glucose (P < 0.001) and low C-peptide levels (P < 0.001) were the only parameters found to be related to DKA. CONCLUSIONS: The similarities in findings of newly diagnosed diabetic patients with or without DKA regarding ICA, GADA, IA-2A and IAA suggest that there is no relationship between the expression of antigenicity and the severity of beta-cell dysfunction. The lower prevalence of the four autoantibodies in 15-34-year-old diabetic subjects compared with previous findings in children is not explained by misclassification of diabetes type.     

Antibodies to pancreatic islet cell antigens in diabetes seen in Southern India with particular reference to fibrocalculous pancreatic diabetes

Fibrocalculous pancreatic diabetes (FCPD) is a type of diabetes secondary to tropical chronic non-alcoholic pancreatitis. Little is known about the aetiopathogenesis of FCPD. We studied glutamic acid decarboxylase antibodies (GAD-Ab) and islet cell antibodies (ICA) in patients with FCPD and compared the results with Type 1 (insulin dependent) diabetes mellitus, Type 2 (non-insulin-dependent) diabetes mellitus and non-diabetic subjects in Southern India. The prevalence of GAD-Ab was 7.0 % (95 % Confidence Interval (CI) 1.9–17.2) in FCPD, 47.5 % (CI 31.4–64.0) in Type 1 (p < 0.001 compared to FCPD), 5.6 % (CI 1.5–13.9) in Type 2 (non-significant (NS) compared to FCPD) and 0 % in controls. The prevalence of ICA was 6.3 % (CI 1.2–17.4) in FCPD, 53.8 % (CI 37.1–70.0) in Type 1 (p < 0.001 compared to FCPD), 9.9 % (CI 4.0–19.4) in Type 2 (NS compared to FCPD) and 4.7 % (CI 0.4–16.1) in controls. The data suggest that in FCPD, the frequency of auto-antibodies is low and its aetiology is probably not linked to autoimmunity in the majority of the patients. © 1998 John Wiley & Sons, Ltd.