不同强度训练方式对2型糖尿病超重或肥胖者体成分及糖代谢影响的Meta分析

目的：系统评价高强度间歇训练(high-intensity interval training,HIIT)与中等强度持续性训练(moderate-intensity continuous training,MICT)对2型糖尿病超重或肥胖患者体成分、糖代谢相关指标干预效果，对比两种运动方式的改善效果，为2型糖尿病超重或肥胖患者运动处方的制定提供参考依据。方法：检索The Cochrane Library、Pub Med、EMbase、Web of Science、中国知网、中国生物医学文献数据库(CBM)、万方及美国临床试验注册中心数据库，搜集HIIT与MICT对2型糖尿病超重或肥胖患者体成分和糖代谢相关指标干预效果比较的随机对照试验，检索时间为各数据库建库至2022年6月。由2名研究者对所纳入的研究进行筛选、质量评价和数据提取，采用Rev Man 5.4软件对结局指标进行Meta分析。结果：(1)共纳入13项随机对照试验，包括371例患者，所纳入研究整体质量较高。(2)HIIT组与MICT组对体成分改善效果无显著性差异(体质量：WMD=2.44,95%CI:-3.01-7.89,P&...     

社区慢病管理对2型糖尿病患者糖化血红蛋白的影响

目的 研究探讨社区慢性病管理对2型糖尿病患者糖化血红蛋白的影响。方法 选取2016年6月~2017年6月在本社区门诊就诊的病程超过2年的2型糖尿病患者共248例,采取随机分组方式分为观察组（116例）和对照组（132例）。观察组纳入糖尿病慢病管理,对照组纳入普通管理组,采取常规糖尿病治疗,进行常规糖尿病宣教及解答。比较两组患者1年后的血糖控制达标率、糖尿病知识掌握及糖尿病患者治疗年平均花费。结果 观察组患者空腹血糖、餐后2 h血糖、糖化血红蛋白及甘油三酯、胆固醇的控制达标率均高于对照组,且患者年平均花费低于对照组,差异有统计学意义（P＜0.05）。结论 纳入慢病管理可以降低2型糖尿病患者用于治疗糖尿病的年人均费用,更好的控制血糖,提高糖尿病患者对糖尿病的认知,对2型糖尿病的治疗有较好的指导意义。     

新诊断2型糖尿病患者平均血糖的相关因素分析

目的:通过研究新诊断的2型糖尿病患者平均血糖(MBG)与糖化血红蛋白A1c(Hb A1c)及其它代谢、血糖波动指标的关系,分析影响该人群MBG的相关因素。方法:90例来自广东省4家医院的新诊断2型糖尿病患者,检测空腹血糖、血脂、胰岛素及OGTT 2 h血糖、胰岛素,并进行72 h的连续动态血糖监测,计算MBG以及血糖波动参数。结果:血糖波动参数[血糖标准差、平均血糖波动幅度、日间血糖平均绝对差(MODD)及血糖波动最大幅度(DMMG)]、Hb A1c、空腹血糖以及服糖后2 h血糖均与MBG相关(P0.01);逐步线性回归提示Hb A1c、MODD、DMMG及空腹血糖与MBG有最强关联性(P0.05)。纳入以上4个指标的线性拟合方程较仅纳入Hb A1c的线性拟合方程更精确。结论:影响我国新诊断2型糖尿病患者MBG的因素包括Hb A1c、空腹血糖、DMMG以及MODD。在临床上单纯依靠Hb A1c推算新诊断2型糖尿病患者的MBG可能存在误差。     

中药肉桂对2型糖尿病患者空腹血糖及血脂影响的Meta分析

目的 系统评价中药肉桂对2型糖尿病患者的空腹血糖及血脂影响.方法 从中国知网、万方、维普、PubMed、Medline、Cochrane等数据库,收集中药肉桂对2型糖尿病患者血糖、血脂影响的临床随机对照研究(RCT),检索时限为:建库-2020年4月.由2名研究者独立、严格按照纳排标准进行文献筛选、信息提取、质量评价,...     

住院2型糖尿病患者胰岛素强化治疗后的方案选择

目的:探讨住院2型糖尿病患者胰岛素强化治疗后的方案选择.方法:选取2019年4月至2020年4月我院收治153例2型糖尿病患者,随机分A组(甘精胰岛素联合口服降糖药物,n=51)、B组(口服降糖药物,n=51)、C组(预混胰岛素,n=51).对比三组治疗前后空腹血糖(Fasting plasma glucose,FPG)、糖化血红蛋白(Glycated hemoglobin,HbAlc)水平及稳态模型胰岛素抵抗指数(Insulin resistance of homeostasis model assessment,HOMA-IR)、稳态模型胰岛素 β 细胞分泌功能指数(HOMA-β).结果:患者治疗后FPG、HbAlc水平均逐渐下降(P<0.05);治疗3 m、12 m后HOMA-IR、HOMA-β 水平均低于治疗前,治疗3 m、12 m后HOMA-IR水平为:A组>C组>B组(P<0.05).结论:住院2型糖尿病患者胰岛素强化治疗后采取甘精胰岛素联合口服降糖药物治疗对改善胰岛β细胞功能效果更理想.     

腹腔镜胃转流术治疗2型糖尿病合并高血压

目的比较腹腔镜胃转流术与传统方法对2型糖尿病合并高血压患者的治疗疗效。方法将41例2型糖尿病合并高血压患者随机分为手术组和对照组,以糖化血红蛋白、血压、体重指数、血脂、左室质量指数、相对室壁厚度、左室射血分数为观察指标。结果与对照组比较,手术组糖化血红蛋白、血压、体重指数、血脂、E／A、左室质量指数上均有明显改善,其差异有统计学意义（P〈0．05）,对照组与手术组在左室射血分数上比较无统计学差异（P〉0．05）。结论腹腔镜胃转流术治疗2型糖尿病合并高血压患者可明显改善糖化血红蛋白、血压、体重指数、血脂、E／A、左室质量指数。     

血糖监控对2型糖尿病的临床意义

血糖水平是胰岛β细胞功能的直接反映,后者功能缺陷是2型糖尿病（T2DM）高血糖发生的主要机制,只有因它的缺陷不足以维持葡萄糖代谢稳态时才引起临床高血糖表现。本文以糖化血红蛋白（HbAlc）反映T2DM血糖控制水平、CGMS（动态血糖监测仪）监测血糖波动来观察血糖稳态定性,探讨血糖稳定性对胰岛β细胞功能的影响,     

2型糖尿病患者合并非酒精性脂肪肝与胰岛素抵抗的相关性

目的研究2型糖尿病合并非酒精性脂肪肝（NAFLD）患者的代谢特征、胰岛功能及胰岛素抵抗水平,并探讨其主要危险因素。方法根据肝脏B超结果,将113例2型糖尿病患者分为NAFLD组和非NAFLD组,比较两组之间的体质指数（BMI）、血脂、血糖、胰岛素、C肽、肝酶、尿酸、胰岛素抵抗、胰岛β细胞功能等指标,并采用Logistic回归分析2型糖尿病患者合并NAFLD的独立危险因素。结果 NAFLD组BMI、甘油三酯（TG）、空腹血糖（FBG）、餐后2h血糖（2hPG）、空腹胰岛素（FIns）和C肽（FCP）、丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、胰岛素抵抗指数（HOMA-IR）较非NAFLD组均显著升高,而年龄、高密度脂蛋白（HDL）则显著降低。Logistic回归显示年龄、BMI、TG、HOMA-IR与2型糖尿病患者合并NAFLD独立相关（OR=0.95,P=0.024;OR=1.24,P=0.024;OR=2.81,P=0.025;OR=11.96,P=0.001）,其中HOMA-IR是主要的危险因素。结论 2型糖尿病合并非酒精性脂肪肝患者存在更严重的肥胖倾向和代谢紊乱,而胰岛素抵抗是其主要危险因素。     

二甲双胍联合沙格列汀或格列美脲对新诊断合并腹型肥胖的2型糖尿病患者临床疗效对比

目的 比较二甲双胍联合沙格列汀或者格列美脲在新诊断合并腹型肥胖的2型糖尿病患者疗效与安全性。方法 选取2017年4月~11月在我院就诊新诊断合并腹型肥胖的T2DM患者100例,每组50例。采用随机数字表法分为实验组和对照组,实验组给予二甲双胍联合沙格列汀治疗,对照组给予以二甲双胍联合格列美脲治疗。比较两组FPG、2hPPG、HbA1C、FINS、HOMA-β,评估两组患者腰围（WC）、BMI、血压、血脂改善情况及服药期间低血糖发生情况。结果 91例患者完成治疗随访,其中对照组45例,实验组46例。与治疗前相比,两组患者HbA1C、FPG、PPG均降低（P＜0.05）,但两组间比较,差异有统计学意义（P＞0.05）;与治疗前相比,两组FINS、HOMA-β升高（P＜0.05）。与对照组相比,实验组FINS、HOMA-β有改善（P＜0.05）。治疗后,患者BMI、SBP、DBP、TG、LDL-C等指标比较,差异有统计学意义（P＞0.05）。治疗后实验组WC呈现降低趋势,而对照组均有不同程度的升高;与对照组比较,实验组治疗后WC降低（P＜0.05）,治疗期间实验组患者低血糖发生率（4.34%）低于对照组（20.00%）（P＜0.05）。两组均无严重不良事件发生。结论 对新诊断的合并腹型肥胖的T2DM患者,二甲双胍联合沙格列汀与二甲双胍联合格列美脲降糖疗效相当,但沙格列汀在缩小低腰围及改善胰岛功能方面具有优势,同时具有较低的低血糖发生率。     

The pathophysiology of type 2 diabetes mellitus: an overview

Type 2 diabetes mellitus is a heterogeneous disorder characterized by chronic hyperglycaemia. The aetiological heterogeneity is suggested by genetic inheritance and its interplay with environmental factors. Impaired insulin secretion and decreased insulin sensitivity are the main pathophysiological features, responsible for development of hyperglycaemia in type 2 diabetes. However, the genetic basis of these defects has been demonstrated only in small subgroups of patients. Whether impaired secretion or action of insulin is the primary defect in the majority of patients is not known, although it is generally agreed that defective insulin release is a requirement for the disease to develop.     

腹腔镜下胃转流术治疗2型糖尿病临床疗效评价

目的评价全腹腔镜下胃转流手术治疗2型糖尿病的临床疗效。方法对42例实施全腹腔镜下胃转流手术治疗的2型糖尿病患者,进行术前与术后的空腹及餐后2 h血糖、糖化血红蛋白、C肽、胰岛素和体重指数（BMI）等指标的比较分析。结果术后6个月空腹血糖、餐后2 h血糖、糖化血红蛋白较术前均有不同程度下降,与手术前比较相差显著（P〈0.05）,但是餐后血糖比空腹血糖下降得更快且显著;而空腹胰岛素、空腹C肽水平变化不明显;术前胰岛素、C肽水平高者效果更明显;手术治疗有效率100%,其中临床完全缓解率79.9%、临床部分缓解率20.1%。结论全腹腔镜下胃转流手术治疗2型糖尿病,近期临床疗效满意,是一种微创、安全、有效的外科治疗2型糖尿病的方法。     

线粒体DNA变异与2型糖尿病易感性的关联研究

目的研究湖北地区2型糖尿病（type 2 diabetes mellitus，T2DM）中线粒体基因突变的发生率及其相关性。方法采用聚合酶链反应一限制性片段长度多态性及DNA测序技术，对184例2型糖尿病患者和210名糖耐量正常的健康对照进行检测，并用mfold和tRNAscan-SE软件对检出的突变位点进行二级结构分析。结果MIND1 3316（G→A）、MIND1 3394（T→C）、D环区16189（T→C）变异率分别为3．26％、2．72％、36．9％，并首次在T2DM中发现4例MTTE14693（A→G）突变（2．17％）；对照组检出3316（G→A）突变2例（0．99％）、16189（T→C）变异56例（26．6％），朱检出3394、14693的点突变；两组间3394（T→C）、14693（A→G）、16189（T→C）变异率差别均有统计学意义（P〈0．05）；且T2DM组中16189（T→C）变异阳性者的胰岛素抵抗指数（HOMA→IR）值较16189（T→C）变异阴性组升高，差异有统计学意义（P=0．028）：多元回归分析显示该变异为参与HOMA→IR的独立变量（R2=0．043，P=0．037）。RNA二级结构预测发现，3394（T→C）和14693（A→G）突变使其相应的二级结构发生变化。结论3394（T→C）、14693（A→G）突变与T2DM的易感性有一定关联，16189（T→C）变异与湖北地区汉族人T2DM胰岛素抵抗相关。     

Metabolic bariatric surgery and type 2 diabetes mellitus: an endocrinologist's perspective

Traditional treatment of T2DM consisting of modification of diet, an exercise regimen, and pharmacotherapy has problems of poor lifestyle modifications and fail tend of treatment over time, now bariatric surgery is recommended for treatment of obese patients with T2DM because its great improvements on weight loss and metabolic. In this article, effects of bariatric surgery on diabetes and diabetes-related complications are reviewed.     

Glucose transport in human peripheral blood lymphocytes influenced by type 2 diabetes mellitus

Introduction: The objective of this study was to evaluate glucose transport into lymphocytes in healthy subjects and patients with type 2 diabetes mellitus (DM) treated either with diet only or with insulin and to propose peripheral blood lymphocytes as a convenient model for cellular glucose transport studies. Materials and Methods: Sixty subjects with type 2 DM, 30 treated with diet only and 30 with insulin, were investigated. Thirty healthy subjects matched for age, weight, and sex served as a control group. Deoxy-D-glucose, 2-[³H(G)] transport was studied in isolated peripheral blood lymphocytes. Expression of glucose transporters was ascertained by immunocytochemical identification and by Western blotting. Results: In lymphocytes from the control group, deoxy-D-glucose uptake increased gradually with the duration of the experiment. In diabetics treated with insulin, the maximal increase in deoxy-D-glucose uptake was observed after 30 min of the investigation, followed by a plateau phase. In diabetics treated with diet, deoxy-D-glucose uptake increased slowly during the first 30 min. The presence of GLUT1 and GLUT3 in lymphocytes was confirmed in this study. Conclusions: Glucose transport into lymphocytes is altered in type 2 DM. In lymphocytes from diabetics, the dynamics of deoxy-D-glucose uptake significantly differed from that in healthy subjects. There was also a significant difference between the diabetic groups, representing different modes of therapy and stages of the disease. Glucose transport into lymphocytes is apparently influenced by DM as well as by the mode of therapy. We suggest that peripheral blood lymphocytes may become a promising model for studies on glucose transport in diabetes.     

TNF-alpha polymorphisms and type 2 diabetes mellitus in Taiwanese patients

Type 2 diabetic mellitus (type 2 DM) comprises more than 95% of all Taiwanese patients with DM. Tumor necrosis factor-alpha (TNF-alpha) expression is linked with insulin resistance, and is under strong genetic control. The correlation between TNF promoter genotypes and type 2 DM is still controversial, because discrepancies among different studies exist. Ethnic differences play certain roles in these conflicting results, because the distribution of TNF promoter polymorphisms is different among study subjects with different racial origins. Therefore, we examined the relationship between the incidence of type 2 diabetes in Taiwanese and two polymorphisms of the TNF-alpha promoter region (positions -238 and -308) as well as the correlation between these polymorphisms and the patients' biochemical manifestations. Genomic DNA was extracted from peripheral blood cells of 261 Taiwanese patients with type 2 DM and 189 non-diabetic control study subjects, and their TNF promoter G-238A and G-308A polymorphisms were analyzed by PCR-RFLP analysis. No significant association between TNF-alpha G-238A and G-308A polymorphisms with type 2 diabetic incidence was observed. However, associations between TNF-alpha G-238A and low-density lipoprotein-cholesterol and between G-308A promoter polymorphism and high-fasting plasma glucose levels, using multiple linear regression analysis with adjustment for the subjects' age, sex, body mass index and diabetic status, were found. Our results suggested that though TNF-alpha G-238A and G-308A polymorphisms were not involved in the pathogenesis of type 2 DM, type 2 diabetic patients carrying TNFA-A or TNF-308*2 genotype might be more susceptible to diabetic complications such as atherosclerosis.     

Roux-en-Y gastric bypass for Chinese type 2 diabetes mellitus patients with a BMI,28kg/m~2:a multi-institutional study

Roux-en-Y gastric bypass surgery(RYGB) has been demonstrated to be successful for treating type-II diabetes2mellitus(T2DM) patients with a body mass index(BMI),30 kg/m,but reports of RYGB for T2 DM patients with22 a BMI,28 kg/mare lacking.T2 DM patients with a BMI,28 kg/mwere prospectively recruited to participate in this study in four hospitals.The endpoint was T2 DM remission(defined by fasting blood glucose(FBG) level,110 mg/d L and hemoglobin(Hb)A1c level,6.0% at 12 months postoperatively).Predictors of remission were investigated by univariate and multivariate analyses.Eighty-six patients were assessed.Eighty-five patients underwent RYGB,with one conversion to open surgery.We compared the values of various variables before and after2 surgery.The mean BMI decreased from 24.68±2.12 to 21.72±2.43 kg/m(P,0.001).Fifty-eight(67.4%) patients were not treated by drugs or insulin after surgery,and 20 patients(23.3%) had complete remission of T2 DM at12 months after surgery with an acceptable number of complications.The mean Hb A1 c level in the remission group was significantly lower than that in the non-remission group.Patients with a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level were more likely to have T2 DM remission in multivariate2 analyses.In conclusion,RYGB was effective and safe for treating T2 DM patients with a BMI,28 kg/m.Complete remission can be predicted by cases having a higher weight,lower Hb A1 c level,higher C-peptide level,and higher FBG level.     

Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review

Background

Despite the availability of evidence-based guidance, many patients with type 2 diabetes do not achieve treatment goals.

Aim

To guide quality improvement strategies for type 2 diabetes by synthesising qualitative evidence on primary care physicians’ and nurses’ perceived influences on care.

Design and setting

Systematic review of qualitative studies with findings organised using the Theoretical Domains Framework.

Method

Databases searched were MEDLINE, Embase, CINAHL, PsycInfo, and ASSIA from 1980 until March 2014. Studies included were English-language qualitative studies in primary care of physicians’ or nurses’ perceived influences on treatment goals for type 2 diabetes.

Results

A total of 32 studies were included: 17 address general diabetes care, 11 glycaemic control, three blood pressure, and one cholesterol control. Clinicians struggle to meet evolving treatment targets within limited time and resources, and are frustrated with resulting compromises. They lack confidence in knowledge of guidelines and skills, notably initiating insulin and facilitating patient behaviour change. Changing professional boundaries have resulted in uncertainty about where clinical responsibility resides. Accounts are often couched in emotional terms, especially frustrations over patient compliance and anxieties about treatment intensification.

Conclusion

Although resources are important, many barriers to improving care are amenable to behaviour change strategies. Improvement strategies need to account for differences between clinical targets and consider tailored rather than ‘one size fits all’ approaches. Training targeting knowledge is necessary but insufficient to bring about major change; approaches to improve diabetes care need to delineate roles and responsibilities, and address clinicians’ skills and emotions around treatment intensification and facilitation of patient behaviour change.