Glycosylated hemoglobin in a population-based study of diabetes

Glycosylated hemoglobin was measured in persons who participated in a population-based study of diabetic retinopathy in southern Wisconsin. There were 996 persons who were diagnosed prior to 30 years of age and who were taking insulin (younger onset), and 1,370 persons who were diagnosed at 30 years of age or older (older onset) who were examined from 1980-1982. Glycosylated hemoglobin was measured using a microcolumn technique. Mean glycosylated hemoglobin was highest in younger onset persons (10.9%), and lowest in older onset persons not taking insulin (9.0%). Only a small percentage of values for the diabetic persons fell within the range of values found in a nondiabetic comparison group. Mean glycosylated hemoglobin was found to be associated with retinopathy status but not with proteinuria.     

医联体医院专科与社区全科合作对糖尿病管理的效果与费用研究

目的：评估医联体中的医院专科和社区全科合作开展糖尿病管理的临床效果以及费用情况,为建立更为有效的社区慢性疾病管理模式提供科学依据。方法：糖尿病患者415名,随机分成联合管理组和对照组。研究空腹血糖、餐后2h血糖、糖化血红蛋白、血压等指标在管理1年前后的变化。采用成本效果分析中的倍差法（difference-in-difference）,以糖化血红蛋白为评估的关键指标,计算成本效果。结果：观察12个月时,联合管理组的空腹血糖、餐后2h血糖、糖化血红蛋白、收缩压和舒张压较干预前明显下降（P〈0．05）。联合管理组和对照组社区每年每例糖尿病患者的管理成本分别是412．14元和491．34元。结论：在医联体工作框架下,医院专科与社区全科联合管理糖尿病的做法具有较好的成本效果,可为其它慢性病管理所借鉴。     

Pramlintide in the management of insulin-using patients with type 2 and type 1 diabetes

In patients with diabetes, dysregulation of multiple glucoregulatory hormones results in chronic hyperglycemia and an array of associated microvascular and macrovascular complications. Optimization of glycemic control, both overall (glycosylated hemoglobin [A1C]) and in the postprandial period, may reduce the risk of long-term vascular complications. However, despite significant recent therapeutic advances, most patients with diabetes are unable to attain and/or maintain normal or near-normal glycemia with insulin therapy alone. Pramlintide, an analog of amylin, is the first in a new class of pharmaceutical agents and is indicated as an adjunct to mealtime insulin for the treatment of patients with type 1 and type 2 diabetes. By mimicking the actions of the naturally occurring hormone amylin, pramlintide complements insulin by regulating the appearance of glucose into the circulation after meals via three primary mechanisms of action: slowing gastric emptying, suppressing inappropriate post-meal glucagon secretion, and increasing satiety. In long-term clinical trials, adjunctive pramlintide treatment resulted in improved postprandial glucose control and significantly reduced A1C and body weight compared with insulin alone. The combination of insulin and pramlintide may provide a more physiologically balanced approach to managing diabetes.     

Predictors of improved HbA1c testing by primary care physicians

Measurement of glycosylated hemoglobin (HbA1c) among patients with diabetes mellitus contributes to attaining control of blood glucose, which in turn is associated with fewer complications. Here, we seek to identify physician and county level characteristics that predict increased HbA1c testing among Medicare beneficiaries with diabetes who did not have testing in the baseline year. Physicians in counties with more people on Medicaid, or with fewer physicians per capita tended to have less improvement in HbA1c testing among Medicare beneficiaries over the three year study period.     

Metabolic effects of the incretin mimetic exenatide in the treatment of type 2 diabetes

Interventional studies have demonstrated the impact of hyperglycemia on the development of vascular complications associated with type 2 diabetes, which underscores the importance of safely lowering glucose to as near-normal as possible. Among the current challenges to reducing the risk of vascular disease associated with diabetes is the management of body weight in a predominantly overweight patient population, and in which weight gain is likely with many current therapies. Exenatide is the first in a new class of agents termed incretin mimetics, which replicate several glucoregulatory effects of the endogenous incretin hormone, glucagon-like peptide-1 (GLP-1). Currently approved in the US as an injectable adjunct to metformin and/or sulfonylurea therapy, exenatide improves glycemic control through multiple mechanisms of action including: glucose-dependent enhancement of insulin secretion that potentially reduces the risk of hypoglycemia compared with insulin secretagogues; restoration of first-phase insulin secretion typically deficient in patients with type 2 diabetes; suppression of inappropriately elevated glucagon secretion to reduce postprandial hepatic output; and slowing the rate of gastric emptying to regulate glucose appearance into the circulation. Clinical trials in patients with type 2 diabetes treated with subcutaneous exenatide twice daily demonstrated sustained improvements in glycemic control, evidenced by reductions in postprandial and fasting glycemia and glycosylated hemoglobin (HbA(1c)) levels. Notably, improvements in glycemic control with exenatide were coupled with progressive reductions in body weight, which represents a distinct therapeutic benefit for patients with type 2 diabetes. Acute effects of exenatide on beta-cell responsiveness along with significant reductions in body weight in patients with type 2 diabetes may have a positive impact on disease progression and potentially decrease the risk of associated long-term complications.     

HbA1c in the monitoring of type 1 diabetic patients

We conducted this study to determine quality of glycemic control in patients with type 1 diabetes, based on evaluation of mean HbA1c. We enrolled 125 patients with type 1 diabetes who were hospitalized during the period from December 1998 to December 2001. Glycemic control was evaluated on mean of HbA1c in 82 patients and on mean of fasting glycemia values in 43 patients. Mean HbA1c was 9.9%. Mean of plasma fasting glycemia was 11 mmol/l. 22% of patients were perfectly or good controlled (HbA1c < or = 7% or HbA1c 7-7.5%). 12% had a moderate control (HbA1c 7.5 et 9%) and finally 66% of patients had a worse control (HbA1c > 9%). There was an excellent correlation between HbA1c and mean fasting glycemic values (p = 0.00028). Most of patients had unsatifactory control. We stressed on the absolute necessity of intensified insulin therapy and self-monitoring blood glucose.     

Hypoglycemia in the elderly with diabetes mellitus

Aging is associated with an increasing prevalence of chronic diseases, including type 2 diabetes mellitus and its chronic and acute complications. With changes observed in diabetes mellitus treatment goals and the lower levels of glycosylated hemoglobin recommended, the prevalence of hypoglycemia especially in patients treated with insulin has increased. Aging and changes in the physiologic reserves generate a decreased perception of symptoms associated with hypoglycemia, increasing the risk of unawareness or severe episodes. Traditionally, age was a risk factor for hypoglycemia, but in the population over 60 years, multiple comorbidities like chronic heart failure, malnutrition and renal failure are associated with increased risk of developing this acute complication. It is necessary to train doctors and nurses from all levels of care to recognize the specific clinical manifestation of low blood glucose that allow early detection and treatment, because this complication is associated with an increased hospital and 1-year after discharge mortality, with falls and cognitive impairment that directly affect the independence and functionality of older persons.     

Epidemiology and organization of health services: diabetes mellitus in a community of the city of Porto Alegre

This study sought to assess the conditions of processing and results in care for people aged over 20 diagnosed with diabetes mellitus and living in an area covered by the UBS Vila Gaúcha, in Porto Alegre. Disease control rate of interviewees with self-reported diabetes was assessed. Definition of this rate was established from arterial pressure values, glycosylated hemoglobin, abdominal circumference, and/or BMI. Of the 753 people aged over 20 years, 37 (4.9%; 95% CI 3.4 6.5) mentioned diabetes mellitus diagnosed by a physician. Disease control rate measurements were performed in 31 (83.8%) people. Results revealed 24 (77.4%) individuals with altered blood pressure levels, 25 (80.6%) with BMI equal to or above 25 kg/m2, 29 (93.5%) with abdominal circumference above normal and 18 (58.1%) with glycosylated hemoglobin equal to or above 8%. Diagrams were used to analyze disease control rate factors. Only one patient was classified as controlled. Diagram interpretation points to the need for policies and actions aiming to reduce body weight in the community, which would include practically all patients with diabetes.     

Effects of extended regimens of the contraceptive vaginal ring on carbohydrate metabolism

BackgroundThere are few publications on the metabolic effects of extended regimens of the contraceptive vaginal ring. The aim of this study was to assess changes in fasting plasma glucose levels and insulin concentration of women using the contraceptive vaginal ring continuously over a 1-year period.Study DesignThis prospective cohort enrolled 75 women (ages 18–37 years) who used a contraceptive vaginal ring releasing 120 mcg of etonogestrel and 15 mcg of ethinyl estradiol daily continuously for 84 days, followed by a 7-day ring-free interval, during 1 year. Fasting glucose and insulin levels were measured, and homeostatic model assessment was calculated at baseline and every 3 months during the 1-year study period. The repeated-measures analysis of variance test was used to analyze differences in the results of these exams over time.ResultsNone of the 75 participants had results outside the normal range in any of the assessments. There were no pregnancies during the 1-year period, and a total of 62 participants completed the study. There were no significant changes in mean fasting glucose levels (79.3 and 78.9 mg/dL at baseline and after 12 months, respectively), mean fasting insulin concentration (9.6 and 10.1 μU/mL) or mean homeostatic model assessment results (1.88% and 1.97%).ConclusionFasting plasma glucose concentration, insulin levels and homeostatic model assessment values of women using the vaginal ring on an extended regimen did not change significantly over a 1-year period.     

Effect of low-calorie versus low-carbohydrate ketogenic diet in type 2 diabetes

ObjectiveEffective diabetic management requires reasonable weight control. Previous studies from our laboratory have shown the beneficial effects of a low-carbohydrate ketogenic diet (LCKD) in patients with type 2 diabetes after its long term administration. Furthermore, it favorably alters the cardiac risk factors even in hyperlipidemic obese subjects. These studies have indicated that, in addition to decreasing body weight and improving glycemia, LCKD can be effective in decreasing antidiabetic medication dosage. Similar to the LCKD, the conventional low-calorie, high nutritional value diet is also used for weight loss. The purpose of this study was to understand the beneficial effects of LCKD compared with the low-calorie diet (LCD) in improving glycemia.MethodsThree hundred and sixty-three overweight and obese participants were recruited from the Al-Shaab Clinic for a 24-wk diet intervention trial; 102 of them had type 2 diabetes. The participants were advised to choose LCD or LDKD, depending on their preference. Body weight, body mass index, changes in waist circumference, blood glucose level, changes in hemoglobin and glycosylated hemoglobin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, uric acid, urea and creatinine were determined before and at 4, 8, 12, 16, 20, and 24 wk after the administration of the LCD or LCKD. The initial dose of some antidiabetic medications was decreased to half and some were discontinued at the beginning of the dietary program in the LCKD group. Dietary counseling and further medication adjustment were done on a biweekly basis.ResultsThe LCD and LCKD had beneficial effects on all the parameters examined. Interestingly, these changes were more significant in subjects who were on the LCKD as compared with those on the LCD. Changes in the level of creatinine were not statistically significant.ConclusionThis study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.     

糖化血红蛋白联合血清C肽检验在糖尿病诊断中的价值

目的探讨糖化血红蛋白联合血清C肽测验在糖尿病诊断中的价值。方法选取我院2016年2月至2019年2月收治的58例疑似糖尿病患者作为实验组,选择同期我院58名健康体检者作为对照组,对比分析两组患者的血清C肽、糖化血红蛋白及空腹血糖水平。结果实验组的糖化血红蛋白、空腹血糖水平分别为(9.35±1.73)%、(9.05±1.83)mmol/L,显著高于对照组的(5.48±1.23)%、(4.07±0.32)mmol/L(P<0.05)。实验组的血清C肽水平为(0.47±0.28)μg/L,显著低于对照组的(1.42±0.61)μg/L(P<0.05)。糖化血红蛋白及血清C肽联合诊断的敏感性、特异性高于单一诊断(P<0.05)。结论糖化血红蛋白联合血清C肽检验诊断糖尿病患者,可精准判断疾病病情、胰岛素分泌情况,其诊断价值高于单一检测,值得临床推广。     

妊娠期糖尿病孕期处理95例临床分析

目的:探讨妊娠期糖尿病的处理方法,以降低母儿并发症。方法:对1997年1月~2003年3月95例妊娠期糖尿病患者的临床资料进行回顾性分析。结果:单纯饮食控制51例,占53.7％;饮食控制加胰岛素治疗44例,占46.3％。饮食控制加胰岛素治疗组孕妇的年龄、糖化血红蛋白、新生儿畸形率均明显高于单纯饮食控制组(P<0.05)。终止妊娠的孕周亦较单纯饮食控制组小(P<0.05)。≥35周行羊水泡沫试验共45例,其中9例阴性,占20.0％。35周以后终止妊娠者新生儿吸入性肺炎、缺氧缺血性脑病明显减少(P<0.05)。结论:妊娠期糖尿病孕期应积极控制血糖,重视需胰岛素治疗患者的处理,检测胎肺成熟度,适时终止妊娠。     

抵抗素与2型糖尿病及糖尿病肾病的关系

目的检测2型糖尿病及糖尿病肾病患者血清中抵抗素水平,探讨血清中抵抗素与2型糖尿病及糖尿病肾病的关系。方法采用酶联免疫法检测40例2型糖尿病无并发症患者、30例2型糖尿病肾病患者及30例健康者的空腹血清中抵抗素和胰岛素水平,同时观测空腹血糖、糖化血红蛋白、胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、体质指数。结果2型糖尿病肾病组的血清中抵抗素水平与正常对照组相比及2型糖尿病无并发症血清抵抗素水平与正常对照组相比,差异均有统计学意义（均P〈0.01）,而2型糖尿病肾病组与2型糖尿病无并发症组相比,血清抵抗素水平差异无统计学意义（P〉0.05）。结论血清抵抗素参与了2型糖尿病及糖尿病肾病的发生,血清抵抗素与2型糖尿病及糖尿病肾病的关系密切。     

缓释糖类系统对高龄2型糖尿病管饲病人糖脂代谢的影响

目的:探讨缓释糖类系统对高龄2型糖尿病管饲病人糖脂代谢的影响. 方法:选择确诊为2型糖尿病的住院高龄老年管饲病人11例.在等能量的情况下,用含有缓释糖类系统的肠内营养制剂(益力佳)替代或部分替代原有的肠内营养支持液,1～3个月,观察病人血红蛋白、淋巴细胞计数、血清清蛋白、总蛋白、血糖、餐后2 h血糖、糖化血红蛋白、血脂、肾功能、电解质及胃肠道的变化. 结果:应用含缓释糖类系统的肠内营养制剂后病人的肾功能和电解质均无影响,总蛋白有所上升,使用前、后有显著性差异(P＜0.05).空腹血糖、餐后2 h血糖均有下降,差异有显著性意义(P＜0.05,＜0.001).血清三酰甘油、低密度脂蛋白、胆固醇、糖化血红蛋白均有下降,但差异无显著性意义(P＞0.05).高密度脂蛋白未出现明显的变化.肠内营养支持后,胃肠道不适症状均有不同程度的改善. 结论:含缓释糖类系统的肠内营养制剂,不仅能改善老年2型糖尿病管饲病人的糖代谢和脂代谢,还能帮助改善病人应用肠内营养后出现的胃肠道不适症状.     

OSAS与T2DM糖代谢和胰岛素水平关系的研究

目的 对阻塞性睡眠呼吸暂停综合征(OSAS)和2型糖尿病(T2DM)的糖代谢、胰岛素水平关系进行探究。方法 选取2015年9月1日至2017年3月1日收治的75例OSAS患者设为研究组,另选同期收治的75例非OSAS者设为对照组,检测2组糖代谢水平(FPG、2hPG)、糖化血红蛋白指标和胰岛素水平(FIN、2hINS),分析OSAS与T2DM之间的关系。结果 经检测后,对比2组糖代谢、糖化血红蛋白指标和胰岛素水平,发现研究组均比对照组高(P<0.05);研究组中OSAS重度者的糖代谢值和胰岛素值均比OSAS轻度者与OSAS中度者明显升高(P<0.05)。结论 OSAS在一定程度上能引发异常糖代谢与T2DM,紊乱程度越大,糖代谢、胰岛素值越高,可见OSAS和T2DM在糖代谢和胰岛素水平方面呈正相关关系。     

1494例社区居民代谢综合征现状调查及与糖化血红蛋白相关性研究

目的调查南昌社区居民20岁以上人群代谢综合征（MS）患病情况,探讨MS与糖化血红蛋白（HbA1C）的关系。方法于2008-2009年,在南昌市13个社区,采用单纯随机抽样方法选择1494例20岁以上长住社区居民为研究对象,进行流行病学问卷调查和体格检查,同时测定空腹血糖（FPG）、餐后2h血糖（2hPG）、HbA。血清胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL—C）、低密度脂蛋白胆固醇（LDL—C）、血尿酸（UA）、丙氨酸氨基转移酶（ALT）、门冬氨酸氨基转移酶（AST）等。结果本调查南昌社区人群MS、糖尿病（DM）、高血压（HBP）、超重和（或）肥胖、高三酰甘油血症、高胆固醇血症、低高密度脂蛋白血症、高低密度脂蛋白血症标化患病率分别为11．2％、8．4％、29．5％、25．5％、22．5％、20．3％、1．4％、13．3％。增龄、DM家族史、高血糖、高血压、超重和（或）肥胖、高三酰甘油血症及低高密度脂蛋白血症是MS的危险因素。MS与HbA1C水平呈正相关（r=0．319,P〈0．01）,HbA1C≥6．5％的人群MS患病率高达50．34％。结论本研究南昌社区人群具有较高的MS相关疾病的患病率;对HbA1C较高的社区居民应加强筛查,以加强对MS及相关疾病的防治。     

Guidelines vs practice in the delivery of diabetes nutrition care

The American Dietetic Association and the American Diabetes Association have published recommendations for the nutrition care of people with diabetes. However, the frequency of this care is rarely documented. As part of a study of diabetes care and education practices, the Michigan Diabetes Research and Training Center collected extensive data from 440 randomly selected adults who receive diabetes care from community physicians. These data provided a basis for comparison between diabetes nutrition care as recommended and as delivered in typical American communities. In this population (mean AGE = 61 years; 54% women), 89% (393) had non-insulin-dependent diabetes mellitus (NIDDM). Of these, 152 were managed with insulin (NIDDM/I) and 241 were not managed with insulin (NIDDM/NI). Most of the NIDDM/NI group was overweight (71%) and had elevated levels of glycated hemoglobin (62%) and serum cholesterol (53%). Yet they were significantly less likely than those with NIDDM/I to see a dietitian. The most frequently reported reason for not seeing a dietitian was that a physician had not referred them (53%). More than 90% of those with NIDDM/I or NIDDM/NI who were referred to a dietitian saw one. Because this population was from randomly selected communities, physicians, and patients, the results are probably generalizable to other regions of the United States. This study shows that in community practice, insulin use is the primary marker of the need for nutrition intervention, and the lack of physician referred to a dietitian is an important barrier to people receiving recommended diabetes nutrition care.     

Effect diet therapy on body weight reduction and metabolic control recommended for patients with type 2 diabetes mellitus treated with only diet

The aim of the study to assess the efficacy diet therapy recommended for patients who were recently found to have type 2 diabetes mellitus as well as the influence of the diet on metabolic control of the subjects. The study involved 35 patients of the Dietary Counseling Section of the Central Clinical Hospital of the Ministry of Internal Affairs and Administration in Warsaw. During the course of a 6-month observation, the following parameters were analyzed: body weight, BMI, WHR, indices of metabolic control, such as fasting and post-prandial glycemia, and the level of glycated hemoglobin (HbA1(c)). 6-month dietary intervention brought a decrease in body weight, and improvement in glycemia     

妊娠期糖尿病胎儿代谢的相关研究

目的:通过测定妊娠期糖尿病(GDM)脐血脂联素、胰岛素、C肽、糖化血红蛋白水平,探讨GDM对胎儿代谢水平的影响。方法:采用放射免疫法测定30例GDM患者及26例正常孕妇脐血脂联素、胰岛素、C肽水平,采用乳胶增强的免疫竞争抑制法测定脐血糖化血红蛋白水平。结果:GDM组脐血脂联素水平为(20.74±5.66)μg/ml,明显低于对照组(26.66±8.43)μg/ml,脐血胰岛素、糖化血红蛋白水平分别为(31.53±14.63)uIU/ml,(4.9±0.7)%,明显高于对照组,差异有统计学意义。两组脐血脂联素水平与脐血胰岛素、糖化血红蛋白呈明显负相关。结论:宫内暴露于GDM不良环境因素下可引起胎儿脂联素水平的下降及胰岛素、C肽、糖化血红蛋白水平的升高。胎儿代谢水平的改变影响了胎儿的生长发育,还可能与将来子代的代谢性疾病具有相关性。     

Are Eating Disorders More Prevalent in Females with Type 1 Diabetes Mellitus When the Impact of Insulin Omission Is Considered?

Although prevalence estimates vary in women with type 1 diabetes mellitus, studies suggest the occurrence of eating disorders is comparable between women with and without diabetes mellitus. A new study examined the association between eating disorders and type 1 diabetes mellitus in 12-19-year-old females with diabetes for at least 1 year. Subjects with diabetes were 2.4 times more likely than controls (without diabetes) to have a clinical eating disorder and 1.9 times more likely to have a subthreshold eating disorder. Moreover, mean glycosylated hemoglobin was higher in subjects with diabetes who had an eating disorder (9.4%) compared with those with diabetes without an eating disorder (8.6%).