2型糖尿病患者药物治疗现状及药学服务干预探析

目的探讨目前2型糖尿病患者药物治疗的现状以及药学服务干预的作用效果。方法 2013年8月—2014年7月该院收治了65例2型糖尿病患者。现特整理这些患者临床资料作为研究对象加以分析2型糖尿病的临床特点和药物治疗方法以及药学服务干预效果。对比分析患者经过药学服务干预前后的空腹血糖达标率、餐后两小时血糖达标率、糖化血红蛋白达标率以及低血糖症状患者的比例,以此衡量治疗效果和药学服务干预效果。结果通过记录患者在药学服务干预前后的空腹学让值、餐后两小时血糖值以及糖化血红蛋白达标率的情况来分析2型糖尿病患者的药物治疗结果以及药学服务干预的治疗效果。结果表明,经过药学服务干预后,患者低血糖发生率明显降低,差异具有统计学意义(P0.05)。结论药学服务干预对于提高2型糖尿病患者的药物治疗效果具有显著作用。     

2型糖尿病患者药物治疗的现状以及药学服务干预的作用效果

目的研究2型糖尿病患者药物治疗的现状以及药学服务干预的作用效果。方法将2017年6月—2018年5月期间本院接收的2型糖尿病患者70例作为观察对象,分析其药物治疗现状,并进行药学服务干预。将干预前、干预6个月后患者的血糖水平及达标率、低血糖反应发生率进行比较。结果干预6个月后2型糖尿病患者的空腹血糖、餐后2 h血糖、糖化血红蛋白水平以及低血糖发生率均低于干预前数据,差异有统计学意义(P0.05),血糖达标率则显著高于干预前,差异有统计学意义(P0.05)。结论目前口服降糖药仍是2型糖尿病患者的主要药物治疗方式,加强对患者的药学服务干预可使血糖水平控制在理想范围内,促使低血糖等不良反应发生率降低。     

药物治疗联合饮食、运动治疗对2型糖尿病患者血糖水平的影响

目的分析药物治疗联合饮食、运动治疗对2型糖尿病患者血糖水平的影响。方法将2015年1月—2016年12月收治的46例2型糖尿病患者作为研究对象并根据随机数字表法分组,分别23例。对照组采用单纯药物治疗,综合疗法组采用药物治疗联合饮食、运动治疗。比较两组2型糖尿病治疗总有效率;血糖水平达到正常范围时间;干预前后患者血糖水平、生活质量水平。结果综合疗法组2型糖尿病治疗总有效率高于对照组(P0.05);综合疗法组血糖水平达到正常范围时间短于对照组(P0.05);干预前两组血糖水平、生活质量水平相近(P0.05);干预后综合疗法组血糖水平、生活质量水平优于对照组(P0.05)。结论药物治疗联合饮食、运动治疗对2型糖尿病患者血糖水平具有降低作用,可促使血糖达标,改善患者预后和生活质量,值得推广应用。     

早期干预改变糖尿病

研究者不仅要把注意力放在2型糖尿病的治疗上,更要注重糖尿病的预防.2009年国际糖尿病联盟(IDF)第20次学术会议上,报道了2型糖尿病的早期干预--"早期干预改变糖尿病",共包括4个部分:生活方式干预在糖尿病预防中的作用,药物干预在糖尿病预防中的作用,英国前瞻性糖尿病研究(UKPDS)早期血糖控制的远期效果及改善和保存现有胰岛功能的潜能.     

社区干预对2型糖尿病控制的影响

目的 研究社区干预效果对2型糖尿病控制的影响.方法 随机选取该中心的两个居委,分别作为干预组和对照组,体检筛查出符合国际糖尿病诊断标准的2型糖尿病患者作为研究对象进行研究,干预组60例,对照组经52例.两组患者基本情况均无统计学差异.对照组仅进行疾病的常规药物治疗;干预组除给予相关治疗外,还给与相关的社区干预.随访干预1年后,测定患者空腹血糖(FPG)、餐后2h血糖(2 h PG),糖化血红蛋白(HbAlc)、血浆总胆固醇(TC)、甘油三酯(TG)的水平,进行对比分析.结果 干预组干预前后,与对照组于预后比较FPG、2 hPG、HbAlc,血浆TC,TG含量均下降,差异有显著性(P＜0.05).结论 对2型糖尿病患者进行社区干预,可以有效延缓糖尿病的控制.     

中医非药物疗法对2型糖尿病患者干预的研究进展

本文主要针对2型糖尿病的中医非药物疗法的相关文献的搜集和复习,综述了中医针灸疗法、中医食疗法、耳穴治疗法、八段锦运动疗法等多种中医非药物疗法对2型糖尿病患者干预的研究进展,研究资料表明,中医非药物疗法对于2型糖尿病的降糖及并发症的防治方面有着显著的疗效。为探索简单、安全、有效的干预措施提供了有效的信息。     

体检人群糖尿病前期非药物干预的研究

目的探讨体检人群糖尿病前期非药物干预的临床效果。方法选取该院在2013年6月—2015年5月期间通过健康体检发现的糖尿病前期客户作为研究对象,共104例,按照随机的原则将客户平均分成两组,对照组52例,建立健康档案,告知客户为糖尿病前期,未来有可能发展成为糖尿病,并嘱咐客户在饮食等方面多加注意,观察组52例,在对照组基础上采用综合的非药物干预措施,定期对客户进行随访,邀请客户参加糖尿病健康知识讲座等,随访两年,观察两组情况。结果干预前两组客户的血糖水平、血脂四项指标相比差异无统计学意义(P0.05),干预后两组客户的血糖水平、血脂四项指标均有所改善,且观察组改善更加明显,两组对比差异有统计学意义(P0.05);观察组血糖正常人数42例(80.77%),转为2型糖尿病患者数为3例(5.77%),对照组血糖正常人数30例(57.69%),转为2型糖尿病患者数为11例(21.15%),两组对比差异有统计学意义(P0.05)。结论对糖尿病前期客户及时进行非药物干预,可以有效预防或者延缓客户发展成为2型糖尿病,值得临床推广和应用。     

2型糖尿病药物初级预防的研究进展

近年来,2型糖尿病(T2DM)的初级预防研究取得了较大突破,药物干预的作用倍受重视。文章系统回顾了近40年来药物预防T2DM的研究进展,内容涉及磺脲类、双胍类、α葡萄糖苷酶抑制剂、噻唑烷二酮类、抗氧化剂、微量元素、降血压药和调脂药物等,其中一些有益的结果将为临床运用提供科学依据。     

新型磺脲类药物:从强化血糖控制到全面心血管保护

磺脲类降糖药自上世纪50年代问世以来,临床应用已经历了近半个世纪。由于磺脲类药物是针对2型糖尿病的基本致病环节——胰岛素分泌缺陷,因此,无论其单药治疗或与其他口服降糖药或胰岛素联合治疗,均被临床广泛应用。国际糖尿病联盟(IDF)、美国糖尿病学会(ADA)以及英国国立临床规范研究所(NICE)均推荐,将磺脲类药物作为大多数2型糖尿病患者的一线用药。.2型糖尿病的并发症.强化血糖控制的益处.磺脲类药物对心血管的影响.不同磺脲类药物对心血管保护作用.总结一、2型糖尿病的并发症糖尿病能引起严重的并发症,其中最为严重的是心血管并发症,…     

药物干预在糖尿病预防中的作用

目的研究药物干预在糖尿病预防中的作用,并分析其应用价值。方法选取该院自2010年6月—2012年6月80例糖尿病前期患者作为研究对象,将所有前期患者随机分为对照组和实验组,每组前期患者各40例,实验组采用药物干预方式对前期患者进行干预,对照组采用生活方式干预对前期患者进行干预,随访3年后比较两组前期患者的临床结果以及餐后2 h的血糖水平。结果 3年后两种干预方式都有一定的效果,但对照组中前期糖尿病患者转为糖尿病患者的数量显著大于对照组,组间差异有统计学意义(P0.05)。实验组前期患者餐后2 h血糖改善量显著优于对照组,组间差异有统计学意义(P0.05)。结论生活方式的干预对于糖尿病的预防虽有一定的作用,但是依从性较弱,而药物干预对于糖尿病的预防有显著效果,而且依从性较强,安全可靠,值得广泛推广。     

Progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screening programme in general practice: the ADDITION Study,Denmark

AIMS/HYPOTHESIS: To estimate the 1-year progression rates from both IFG and IGT to diabetes in individuals identified in a pragmatic diabetes screening programme in general practice (the ADDITION Study, Denmark [Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care]). METHODS: Persons aged 40-69 years were screened for type 2 diabetes based on a high-risk, stepwise strategy. At baseline, anthropometric measurements, blood samples and questionnaire data were collected. A total of 1,160 persons had IFG or IGT at baseline: 811 (70%) accepted re-examination after 1 year. Glucose tolerance classification was based on the 1999 WHO definition. At follow-up, diabetes was based on one diabetic glucose value of fasting blood glucose or 2-h blood glucose. RESULTS: At baseline, 308 persons had IFG and 503 had IGT. The incidence of diabetes was 17.6 and 18.8 per 100 person-years in the two groups, respectively. CONCLUSIONS/INTERPRETATION: IFG and IGT identified in general practice during a stepwise, high-risk screening programme for type 2 diabetes have high 1-year progression rates to diabetes. Consequently, intensive follow-up and intervention strategies are recommended for these high-risk individuals.     

Impact of the 1997 American Diabetes Association criteria on classification of glucose intolerance among Kuwaitis below 50 years of age

Type 2 (non-insulin-dependent) diabetes is emerging as a leading chronic non-communicable disease among the adult Kuwaiti population. Based on the World Health Organization and similar reports the projected estimates for subjects suffering from type 2 diabetes by the years 2000 and 2010 show a striking tendency to high rates of the disease in our area. We report the prevalence rates of glucose intolerance among a relatively young adult Kuwaiti population below 50 years of age and the effect of implementing the recent 1997 American Diabetes Association diagnostic criteria on the frequency of type 2 diabetes, impaired glucose tolerance and impaired fasting glucose among this group. The overall prevalence rate for the three categories of glucose intolerance reached as high as 15.8% (95% CI, 14.2 to 17.4). Age, though all subjects were below 50 years, parental history of type 2 diabetes, diastolic blood pressure and serum triglycerides were found to be significant associated risk factors for the development of type 2 diabetes. Obesity was an apparent significant factor associated with the three forms of glucose intolerance (p < 0.001). Obesity and physical inactivity were documented in both non-diabetic and more so in diabetic Kuwaiti adults, which should form the basis of any immediate intervention programme. An integrated approach to the prevention of the described critical risk factors associated with type 2 diabetes is highly recommended in Kuwait. Research, focused on genetics of type 2 diabetes in the highly susceptible Kuwaiti population, should be planned. Received: 18 December 1998 / Accepted in revised form: 14 June 1999     

The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1)

Aims/hypothesis Lifestyle modification helps in the primary prevention of diabetes in multiethnic American, Finnish and Chinese populations. In a prospective community-based study, we tested whether the progression to diabetes could be influenced by interventions in native Asian Indians with IGT who were younger, leaner and more insulin resistant than the above populations. Methods We randomised 531 (421 men 110 women) subjects with IGT (mean age 45.9±5.7 years, BMI 25.8±3.5 kg/m²) into four groups. Group 1 was the control, Group 2 was given advice on lifestyle modification (LSM), Group 3 was treated with metformin (MET) and Group 4 was given LSM plus MET. The primary outcome measure was type 2 diabetes as diagnosed using World Health Organization criteria. Results The median follow-up period was 30 months, and the 3-year cumulative incidences of diabetes were 55.0%, 39.3%, 40.5% and 39.5% in Groups 1–4, respectively. The relative risk reduction was 28.5% with LSM (95% CI 20.5–37.3, p=0.018), 26.4% with MET (95% CI 19.1–35.1, p=0.029) and 28.2% with LSM + MET (95% CI 20.3–37.0, p=0.022), as compared with the control group. The number needed to treat to prevent one incident case of diabetes was 6.4 for LSM, 6.9 for MET and 6.5 for LSM + MET. Conclusions/interpretation Progression of IGT to diabetes is high in native Asian Indians. Both LSM and MET significantly reduced the incidence of diabetes in Asian Indians with IGT; there was no added benefit from combining them. Electronic Supplementary Material Supplementary material is available for this article at     

不同糖代谢水平动态血糖谱的差异

目的研究不同糖代谢水平血糖谱差异,以便指导干预时机的选择。方法对糖耐量正常（NGT）、空腹血糖受损（IFG）、餐后血糖受损（IGT）、IFG＋IGT及新诊断T2DM患者的72小时动态血糖监测血糖谱进行分析。结果IFG＋IGT组血糖水平及血糖漂移显著高于NGT、IFG、IGT组（P〈0．05）。新诊断T2DM组血糖水平显著高于NGT、IFG、IGT、IFG＋IGT组（P均〈0．05）。新诊断T2DM组餐后及日内血糖漂移与IFG＋IGT组无显著差异（P〉0．05）。结论（1）随着糖代谢异常的加重,血糖水平升高,血糖漂移程度增加;（2）IFG＋IGT阶段应积极干预。     

Pathophysiology and aetiology of impaired fasting glycaemia and impaired glucose tolerance: does it matter for prevention and treatment of type 2 diabetes?

Prior to the development of type 2 diabetes, glucose levels increase into the prediabetic states of isolated impaired fasting glycaemia (i-IFG), isolated impaired glucose tolerance (i-IGT), or combined IFG/IGT. A better understanding of the aetiology and pathophysiology of the prediabetic states might give a basis for the development of individualised prevention and treatment strategies for type 2 diabetes. Several studies have examined mechanisms and potential aetiological factors leading to the development of the different prediabetic states. The pathophysiology of i-IFG seems to include the following key defects: reduced hepatic insulin sensitivity, stationary beta cell dysfunction and/or chronic low beta cell mass, altered glucagon-like peptide-1 secretion and inappropriately elevated glucagon secretion. Conversely, the prediabetic state i-IGT is characterised by reduced peripheral insulin sensitivity, near-normal hepatic insulin sensitivity, progressive loss of beta cell function, reduced secretion of glucose-dependent insulinotropic polypeptide and inappropriately elevated glucagon secretion. Individuals developing combined IFG/IGT exhibit severe defects in both peripheral and hepatic insulin sensitivity as well as a progressive loss of beta cell function. The aetiologies of i-IFG and i-IGT also seem to differ, with i-IFG being predominantly related to genetic factors, smoking and male sex, while i-IGT is predominantly related to physical inactivity, unhealthy diet and short stature. Since the transition from the prediabetic states to overt type 2 diabetes is characterised by a non-reversible vicious cycle that includes severe deleterious effects on glucose metabolism, there are good reasons to use the well-established aetiological and pathophysiological differences in i-IFG, i-IGT and IFG/IGT to design individualised preventive strategies.     

糖调节受损不同亚型胰岛素敏感性和胰岛素分泌的特点

糖调节受损包括单纯空腹血糖受损、单纯糖耐量受损和混合糖调节受损三个亚型.流行病学资料及病理生理研究提示各个亚型具有不同的胰岛素分泌和胰岛素敏感性特点.了解这些特点有助于早期干预以阻止或延缓糖调节受损向2型糖尿病发展的进程.     

胰岛素抵抗和认知功能障碍

近年来阿尔茨海默病(AD)已被学术界称为"3型糖尿病",这是由于AD具有和糖尿病相似的发病机制,即大脑胰岛素缺乏和胰岛素抵抗.糖尿病通过"肝-脑轴"将外周胰岛素抵抗向中枢"传递",从而促进认知功能障碍的发生,是AD重要的危险因素,而这种"传递"作用甚至可能在糖尿病前期--葡萄糖调节受损状态就已经存在.在认知功能障碍的防...     

Impaired beta cell glucose sensitivity and whole-body insulin sensitivity as predictors of hyperglycaemia in non-diabetic subjects

Aims/hypothesis The aim of this prospective study was to investigate predictors of deteriorating glucose tolerance in subjects of British extraction. Methods A total of 156 non-diabetic subjects (86 with a family history of type 2 diabetes) underwent a 75-g OGTT and anthropometric assessment at baseline and 5 years later. Pancreatic beta cell function and whole-body insulin sensitivity were studied by model assessment. Subjects were classified as progressors if glucose tolerance moved one or more steps from normal, impaired fasting glucose, impaired glucose tolerance and diabetes over the follow-up period. Results At baseline, the progressors (n=22) had increased adiposity and a higher proportion of familial diabetes and abnormal glucose tolerance than non-progressors. Baseline pancreatic beta cell sensitivity to changes in glucose (p<0.02) and whole-body insulin sensitivity (p<0.0001) were decreased in the progressors. Logistic regression revealed that baseline and follow-up changes in beta cell glucose sensitivity and insulin sensitivity, rather than the classical clinical predictors (adiposity, familial diabetes and glucose levels), were the key independent predictors of progression (explaining over 50% of the progression). Conclusions/interpretation Impaired pancreatic beta cell glucose sensing and whole-body insulin sensitivity predict progression to hyperglycaemia. Strikingly, these pathophysiological changes override the importance of the clinical risk factors and highlight potential metabolic targets for prevention strategies. An erratum to this article can be found at     

空腹血糖受损诊断标准下调的合理性分析

目的　探讨空腹血糖受损 (IFG)诊断点从 6.1mmol/L下调至 5 .6mmol/L的合理性。方法对1986年入选的 468名非糖尿病人群〔3 41例正常糖耐量 (NGT) ,12 7例糖耐量受损 (IGT)〕在 1988年 ,1990年和 1992年分别进行OGTT复查 ,测定空腹血糖 (FPG)及 2h血糖 (2hPG)。以COX模型分析不同基线血糖水平增加糖尿病的风险。结果　 (1) 10 9例 6年后发生糖尿病。COX成比例风险模型分析校正年龄、性别、体重指数 (BMI)影响后发现FPG与 2型糖尿病发病显著相关 (P =0 .0 0 0 1)。基线FPG 5 .6～ 6.0mmol/L组糖尿病发病危险性比FPG <5 .6mmol/L组已显著增加 ,RR为 3 .3 (95 %CI 2 .0～ 5 .3 ,P =0 .0 0 0 1)。 (2 )受试者工作特征 (ROC)曲线分析FPG预测糖尿病发病的最佳阈值是 5 .6mmol/L ,以FPG 5 .6mmol/L为诊断点IFG预报糖尿病发病的灵敏度、特异度、阳性预测值分别为 45 .0 % ,92 .8%和 65 .3 %。 (3 )NGT个体中COX成比例风险模型校正年龄、性别、BMI后显示 ,FPG分组 (5 .0～ 6.0mmol/L与 <5 .0mmol/L)与糖调节受损 (IGR ,包括IFG或IGT)发生显著正相关 (P =0 .0 0 7)。ROC曲线显示 ,FPG预测糖耐量恶化而进展为DM或IGR的最佳阈值为 5 .3mmol/L。结论　 (1)本组非糖尿病人群中FPG预测糖尿病发病的最佳阈值为 5 .6mmol/L     

Angiotensin converting enzyme inhibitors for prevention of new-onset type 2 diabetes mellitus: A meta-analysis of 72,128 patients

Backgroud

Angiotensin converting enzyme inhibitors (ACEIs) have been linked to reduced risk of new-onset diabetes, but the evidence was insufficient.

Objective and methods

The aim of this study was to evaluate the effect of ACEIs on the development of new-onset type 2 diabetes. Randomized controlled trials (RCTs) about ACEIs and new-onset diabetes were identified by electronic and manual searches.

Results

Nine RCTs with 92,404 patients (72,128 non-diabetic patients at baseline) were included in this study. Compared with control group, incidence of new-onset diabetes was significantly reduced in the ACEIs group [OR 0.80, (0.71, 0.91)], irrespective of achieved blood pressure levels at the follow-up. ACEIs therapy was associated with significant reduction in the risk of new-onset diabetes compared with beta-blockers/diuretics [OR 0.78, (0.65, 0.93)], placebo [OR 0.79, (0.64, 0.96)], or calcium channel blockers [OR 0.85, (0.73, 0.99)]. ACEIs treatment was associated with significant reduction in the risk of new-onset diabetes in patients with hypertension [OR 0.80, (0.68, 0.93)], coronary artery disease (CAD) or cardiovascular disease [OR 0.83, (0.68, 1.00)], or heart failure [OR 0.22, (0.10, 0.47)]. Among patients with impaired glucose tolerance or impaired fasting glucose, ramipril did not significantly reduce the incidence of diabetes [OR 0.91, (0.79, 1.05)], but significantly increased regression to normoglycemia.

Conclusion

ACEIs have beneficial effects in preventing new-onset diabetes. ACEIs provide additional benefits of lowering the risk of new-onset diabetes in patients with hypertension, CAD or other cardiovascular disease.