2型糖尿病患者术后胰岛素治疗方案的比较研究

目的:比较2型糖尿病患者术后3种胰岛素治疗方案的有效性、安全性和患者耐受性.方法:选择接受外科手术且术后禁食或进食不规律的2型糖尿病患者,分设胰岛素泵(CSⅡ)组、长效胰岛素(来得时)组和持续静脉输注胰岛素(CVⅡ)组,观察用药前后空腹血糖(FBG)和餐后血糖(PBG)的变化、血糖控制水平及低血糖发生率.结果:CSⅡ组和来得时组治疗后3、5、7及10天的FBG和PBG水平均较治疗前显著降低(P＜0.01),CVⅡ组治疗后3、5、7及10天的FBG水平较治疗前显著降低(P＜0.01),但仅治疗后第7天的PBG水平较治疗前显著降低(P＜0.05),其他时间点PBG水平均较治疗前无差别;治疗10天时,CSⅡ组FBG控制尚可,PBG控制良好,来得时组FBG和PBG控制均尚可,CVⅡ组均差;患者依从性:CSⅡ组较好,来得时组好,CVⅡ组较差;CSⅡ组无低血糖发生,来得时组和CVⅡ组分别发生1次和4次低血糖事件.结论:2型糖尿病患者术后禁食或进食不规律阶段,采用胰岛素泵和来得时均能有效控制血糖,且不易出现低血糖;使用静脉输注胰岛素治疗,血糖波动较大且患者依从性差;来得时是一种有效、安全且患者易接受的用于2型糖尿病患者术后治疗的药物.     

妊娠糖尿病患者抵抗素水平的改变及临床意义

[目的]探讨妊娠糖尿病患者抵抗素水平的改变及与胰岛素抵抗（IR）的关系。[方法]对42例妊娠糖尿病患者（gestational diabetes mellitus,GDM）、50例糖耐量正常的孕妇,进行葡萄糖耐量试验（OGTT）、胰岛素释放试验（IRT）,并测定血清抵抗素水平,同时稳态模型（HOMA）计算胰岛素抵抗指数（HOMA-IR）,分析血清抵抗素与GDM患者IR的关系。[结果]（1）GDM组抵抗素水平为（13.7±3.4）μg/L,对照组为（10.2±2.6）μg/L,两组比较差异有统计学意义（P〈0.05）。（2）GDM组HOMA-IR为（3.0＋1.1）,对照组为（2.6＋0.7）,两组比较差异有统计学意义（P〈0.05）。（3）GDM组Homa-IR与孕前体重指数（BMI）、空腹胰岛素、抵抗素呈正相关（P〈0.05或P〈0.01）。[结论]GDM患者血清抵抗素水平明显升高,且与GDM患者IR密切相关。     

Effects of diabetes mellitus on prognosis of the patients with colorectal cancer undergoing resection: a cohort study with 945 patients

Background Diabetes mellitus plays an important role in cancer prevalence and outcomes. The aim of this study was to evaluate the influence of DM on stages and outcomes among patients with colorectal cancer.Methods The study enrolled 945 patients who were diagnosed as having colorectal carcinoma from August 1994 to December 2002. In the cohort, 26 patients were diagnosed as having DM. With a median follow-up of 45.8 months,differences in overall survival and disease-free survival between the diabetes and non-diabetes groups were analyzed.Results Kaplan and Meier analysis showed that there were no significant differences between the two groups in overall survival rates at 3 years or 5 years. At 5 years, patients with DM, compared with patients without diabetes, experienced a significantly lower disease-free survival rate （34.2% diabetics vs. 55.1% non-diabetics; P=0.025）.Conclusions DM was associated with an increased risk of recurrence in patients with colorectal cancer.     

糖尿病对结直肠癌切除术后预后的影响：附945例队列研究

【摘要】研究背景：糖尿病在癌症的发生发展中起着重要的作用,这项研究的目的是评估糖尿病对结直肠癌患者的分期和预后的影响。方法：从1994年8月至2002年12月数据库登记的结直肠癌945例患者,其中26例同时合并糖尿病,平均随访时间为45.8个月,分析糖尿病组和非糖尿病组的总体生存率和无病生存率的差异。结果：Kaplan和Meier分析表明,在3年或5年总体生存率上两组间没有显著性差异。在5年中,合并糖尿病的患者与没有合并糖尿病的患者相比,其无病生存率明显要低（糖尿病患者34.2％,而非糖尿病患者55.1％,P=0.025）。结论：糖尿病与结直肠癌术后复发率高明显相关。     

Switching from human insulin to biphasic insulin aspart 30 treatment gets more patients with type 2 diabetes to reach target glycosylated hemoglobin <7%: the results from the China cohort of the PRESENT study

Background The clinical importance of glycaemic control in patients with diabetes has been well established. This study aimed to explore twice-daily biphasic insulin aspart 30 （BIAsp 30） for insulin initiation in patients with type 2 diabetes mellitus （T2DM） who had poor glycaemic control with human insulins （His）. We use data from a Chinese cohort of the PRESENT study.Methods In the 3-month study, Chinese subjects with T2DM started insulin therapy with BIAsp 30 in routine care. Glycaemic control was measured by glycosylated hemoglobin （HbA1c）, fasting plasma glucose （FPG） and posting plasma glucose （PPG）. The safety assessment included hypoglycaemia and other adverse events.Results A total of 1989 subjects previously treated with His were switched to BIAsp 30 for 3-month treatment. Mean HbA1c, FPG and PPG were significantly improved after the therapy. The overall rate of hypoglycaemia decreased at the end of the trial except for the patients previously treated with long-acting insulin. Most of the events were minor and diurnal hypoglycaemia. Only one serious adverse drug reaction （SADR）, a local hypersensitivity, was reported. The majority of the patients （296.7%） and physicians （≥84.7%） were either satisfied or very satisfied with the treatment using BIAsp 30 compared with previous HI therapy.Conclusion The BIAsp 30 treatment improved both glycaemic control and patients＇ satisfaction without increasing hypoglycaemia in T2DM subjects inadequately controlled by Hls.     

糖尿病并重症急性胰腺炎围手术期处理及胰岛素治疗

目的探讨糖尿病合并重症急性胰腺炎(SAP)的最佳治疗方案。方法对6例糖尿病并SAP患者在围手术期与外科密切配合,通过胰岛素强化治疗,严格控制血糖,预防各种并发症的发生。结果6例患者全部治愈,住院时间为35~50 d,平均42 d。结论糖尿病合并SAP患者,围手术期通过强化胰岛素治疗,控制血糖变化,预防各种并发症的发生,可有效的提高治愈率。     

肝源性糖尿病糖代谢异常的临床分析

目的 比较分析肝源性糖尿病与2型糖尿病患者血糖、胰岛素、C肽水平、胰岛素敏感指数、胰岛素抵抗指数,指导临床治疗.方法 肝源性糖尿病与2型糖尿病患者,均行OGTT试验,并计算胰岛素敏感指数、胰岛素抵抗指数.结果 肝源性糖尿病患者胰岛素敏感性高于2型糖尿病患者(P＜0.05),胰岛素抵抗指数低于2型糖尿病患者(P＜0.05).结论 肝源性糖尿病患者需降糖治疗时,应首先采用胰岛素治疗,与2型糖尿病患者相比,剂量应较小.     

Increased circulating myostatin in patients with type 2 diabetes mellitus

The changes of plasma myostatin levels in patients with type 2 diabetes mellitus(T2D) and their clinical correlation were investigated.We recruited 43 T2D patients and 20 age-matched healthy subjects.Plasma myostatin,lipid and glucose,and serum insulin were determined.T2D patients showed significantly higher fasting plasma glucose(FPG),serum insulin and triglyceride levels,and lower high-density lipoprotein levels than normal control subjects(P<0.01).Mean plasma myostatin level in T2D patients and health controls was(66.5±17.8) and(46.2±13.8) ng/mL,respectively.An unpaired t test showed that the increase of myostatin in the T2D patients was significant(P<0.001).In both healthy control and T2D groups,the female subjects showed higher myostatin levels than the male subjects.In the T2D patients,plasma level of myostatin was negatively correlated with body mass index(BMI,r=-0.42,P<0.01) and FPG(r=-0.51,P<0.01),but positively correlated with insulin resistance index(HOMA-IR,r=0.48,P<0.01).Up-regulation of plasma myostatin in the T2D patients and its correlation with BMI,FPG and blood insulin sensitivity suggests that plasma myostatin may be implicated in the pathogenesis of T2D and thus presented as a therapeutic target for treating the disease.Furthermore,circulating myostatin levels may be used as a biomarker for the disease.     

甘精胰岛素联合阿卡波糖治疗2型糖尿病的疗效观察

目的：观察甘精胰岛素联合阿卡波糖治疗2型糖尿病的临床疗效。方法：将42例口服降糖药物控制不佳的2型糖尿病患者,随机分为对照组和治疗组各21例,对照组采用预混胰岛素（诺和灵30R）治疗,治疗组采用甘精胰岛素联合阿卡波糖治疗。治疗12周,观察治疗前后血糖达标情况、低血糖发生事件、体重指数及腰围变化。结果：两组患者的FBG、2hPG、HbA1C均较治疗前明显降低（P＜0.01）,两组治疗达标率对比无意义,治疗组达标率高于对照组,且低血糖发生率低（治疗组2人（9.5％）,对照组5人（23.8％）, P＜0.05）。结论：甘精胰岛素联合阿卡波糖治疗2型糖尿病可显著改善胰岛β功能、降低血糖,低血糖发生率低,临床效果显著,是一种较为理想联合治疗方法。     

Comparison of bone mineral density and Fracture Risk Assessment Tool in Saudi women with and without type 2 diabetes mellitus: A cross-sectional study

Objectives:To compare the bone mineral density and the fracture risks in Saudi women with and without type 2 diabetes mellitus (T2DM).Methods:This cross-sectional study was carried out at Taibah Early Diagnostic Center, Al Madinah Al Munawarah, Saudi Arabia. A total of 465 women with and without T2DM aged ≥40 years who visited the center for a dual-energy X-ray absorptiometry scan between December 2020 and July 2021 were randomly selected. The 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture (HF) were calculated using the Abu Dhabi Fracture Risk Assessment Tool (FRAX) with and without adjustment for T2DM. The adjustment was made by setting rheumatoid arthritis as the equivalent risk for T2DM in the FRAX. Bone mineral density values and the FRAX scores were compared between women with T2DM and non-diabetes.Results:Of 465 women, 214 had T2DM, and 251 were non-diabetics. The mean age of women was 59.42±7.9 years. There were no significant differences in mean age, menopausal status, height, weight, and body mass index between T2DM and non-diabetic women. Bone mineral density values and the unadjusted FRAX scores were comparable between the 2 groups. However, after adjusting FRAX for T2DM, the FRAX for MOF and HF became significantly higher in T2DM women (p=0.000 and p=0.004).Conclusion:In Saudi women with T2DM, unadjusted FRAX underestimated the risk of MOF and HF. Type 2 diabetes mellitus should be included as one of the clinical risk factors for fracture in future versions of the FRAX score.     

Beneficial effects of a diabetes specific formula on insulin sensitivity and free fatty acid in patients with type 2 diabetes mellitus

Background This prospective, randomized, controlled study was designed to investigate the effects of a diabetes specific formula （Diason low energy： 313.8 k J/100 ml）, compared with a standard formula, on insulin sensitivity, serum C peptide, serum lipids and free fatty acid （FFA） in type 2 diabetics.
Methods In total of 71 type 2 diabetics completed the study. Enteral formulas were given orally as the sole source of nutrition to the subjects for 6 days. Venous blood samples （0.5, 1, 2, 3 hours） were collected at day -7 after a 75 g oral glucose tolerance test （OGTT）, day 1 after a standard test meal （1673.6 k J） and after 6 days of either the test diabetes specific formula or a standard formula. Plasma glucose, serum insulin, C peptide and lipids were.measured.
Results After the intervention period, the diabetes specific formula resulted in a significantly lower postprandial rise in blood glucose concentrations at 0.5 hour （P 〈0.05） and 1 hour （P 〈0.01）; significantly lower peak height of plasma glucose （P=0.05）; significantly lower plasma insulin concentrations at 0.5 hour （P〈0.01）, 1 hour （P〈0.01） and 2 hours （P 〈0.01）; and a significantly lower plasma insulin peak compared to controls; both OGTT and a standard test meal （P 〈0.05）. The glucose and insulin area under the curve after the diabetes specific formula compared to the standard formula were significantly lower. The C peptide level was lower after 6 days of both nutrition formulas compare to 75 g OGTT, but not different from the standard mixed meal. Both formulas were well tolerated.
Conclusions In summary the diabetes specific formula with a relatively high monounsaturated fatty acid and high multi fiber proportion significantly improved glycemic control. On top of this, the insulin sensitivity （HOMA-IS） was significantly improved and may therefore directly improve the impact on long term complications. The disease specific formula should therefore be the preferred option to be use     

三氯化铬对2型糖尿病患者红细胞胰岛素受体的影响

目的探讨三价铬改善糖代谢的作用机制。方法以血铬正常的健康人作对照，将63例血铬降低的T2DM患者的红细胞悬液与不同浓度的三氯化铬进行体外孵育，测定孵育前、后碘标INS与红细胞INS受体结合物的放射性，并进行Scatchard分析。结果T2DM组较对照组血铬显著降低（P〈0．01）；碘标INS与受体的最大特异性结合率及r1、r2均降低（P〈0．01），且空腹INS水平与受体的结合位点之间呈显著的负相关（r=-0．91，P〈0．05）。加入三氯化铬后，与“0”浓度组比较，“100”浓度组仅r1增加（P〈0．01），而“200”及“400”浓度组的最大特异性结合率及r1、r2均增加，k1及k2降低，均有统计学差异。结论三价铬可能通过增加受体的敏摩洼而增加INS与受体的结合率，从而改善IR调节糖代谢。     

PDCA循环改善老年糖尿病患者胰岛素注射技术的研究

目的：运用PDCA循环对老年2型糖尿病患者进行胰岛素注射技术行为的干预,提高患者胰岛素注射技术的规范性和准确性。方法：入选2011年7月至2012年6月采用胰岛素治疗的老年2型糖尿病住院患者104例,通过PDCA循环法进行胰岛素注射技术行为的干预。采用问卷调查方式,对比分析干预前、后患者胰岛素注射技术及血糖、糖化血红蛋白（HbA1c）等指标的变化。结果：与干预前比较,患者胰岛素注射技术的规范性和准确性明显提高（P〈0.01）,胰岛素及胰岛素笔存放的相关知识知晓率也有明显改善,血糖水平及低血糖发生率明显下降,差异有统计学意义（P〈0.01）。结论：PDCA循环应用于干预老年糖尿病患者胰岛素注射技术,可提高患者胰岛素注射技术的规范性和准确性以及治疗效果,改善患者胰岛素使用的依从性,降低低血糖的发生率。     

胰腺癌合并糖尿病的围手术期处理

目的 探索胰腺癌合并糖尿病患者围手术期血糖控制的安全方法.比较胰岛素两种疗法对胰腺癌合并糖尿病患者围手术期治疗效果.方法 对40例胰腺癌合并糖尿病患者围手术期治疗进行回顾性分析.其中18例采用多次皮下胰岛素注射(MSII)给药方式,22例应用胰岛素泵(CSII)连续皮下给药.结果 两种疗法均能有效控制胰腺癌合并糖尿病患者围手术期血糖.胰岛素泵连续注射比多次注射血糖达标时间短[CSII(5.20±1.20)d vs MSII(9.02±3.16)d,P＜0.05)],低血糖发生率低(CSII 13.18%vs MSII 22.22%,P＜0.05),术中及术后未进食阶段血糖波动小[CSII(5.67±1.36)vs MSII(7.52±4.18),P＜0.05)],术后并发感染和切口愈合不良并发症少(CSIl 4.55%vs MSII 16.67%,P＜0.05).结论 两种疗法均能有效控制胰腺癌合并糖尿病患者围手术期血糖.CSII比MSII更快更有效地控制高血糖,并减少低血糖和感染的发生率.     

Prevalence of metabolic syndrome in patients with psoriasis: a cross-sectional study in Singapore

INTRODUCTIONPsoriasis is a chronic inflammatory condition that affects the skin and joints, and is associated with cardiovascular risk factors, including metabolic syndrome (MetS). We aimed to assess the prevalence of MetS in patients with psoriasis and determine whether there was a correlation between psoriasis severity and MetS in a Singapore population.METHODSThis was a cross-sectional study of patients with psoriasis, aged 18–69 years, who attended a tertiary dermatology referral centre in Singapore from October 2007 to February 2009. Fasting glucose, lipids, blood pressure, Psoriasis Area and Severity Index, and body mass index were measured. MetS was diagnosed in the presence of three or more criteria of the modified National Cholesterol Education Program Adult Treatment Panel III.RESULTSAmong 338 patients with psoriasis, there were 238 (70.4%) men and 100 (29.6%) women, who were Chinese (n = 228; 67.5%), Malay (n = 52; 15.4%) and Indian (n = 58; 17.2%). The prevalence of MetS was 45.1%. MetS was 44% more prevalent in patients older than 50 years (p = 0.02). Malay patients with psoriasis were significantly more likely to have hypertriglyceridaemia, elevated fasting plasma glucose and abdominal obesity. There was no significant correlation between psoriasis severity and risk of MetS.CONCLUSIONThe prevalence of MetS in patients with psoriasis in Singapore was 45.1%, or nearly threefold higher than the Singapore general population. Patients with psoriasis should be screened yearly for MetS and any modifiable cardiovascular risk factors should be actively controlled.     

针刺对2型糖尿病患者胰岛素敏感的影响

目的探讨针刺对2型糖尿病患者胰岛素敏感的影响。方法 80例2型糖尿病人随机分为针刺组(n=40)和优降糖组(n=40),针刺组辨证施治12周,优降糖组根据血糖调节剂量持续12周,比较治疗前后体重、空腹血糖(fasting plasmaglucose,FPG)、糖化血红蛋白(glycosylated hemoglobin,GHb)、空腹胰岛素(fasting insulin,FINS),并计算体重指数(body mass in-dex,BMI)、胰岛素敏感指数(insulin sensitivity index,ISI)和稳态模型评估胰岛素抵抗(homeostasis model assessment-insulin re-sistance,HOMA-IR)指数评价胰岛素抵抗状态。结果治疗前针刺组和优降糖组的体重、BMI、FPG、GHb、FINS明显高于正常范围,两组间无统计学差异(P>0.05);治疗后两组FPG、GHb及HOMA-IR均明显下降,ISI明显回升,而针刺组体重、BMI均显著下降(P<0.01),优降糖组体重、BMI无明显下降(P>0.05)。治疗后针刺组FINS下降明显,优降糖组FINS有所上升。治疗后针刺组降低FPG、GHb水平与优降糖组比较无明显差异(P>0.05),而降低FINS的作用明显优于优降糖组(P<0.01)。结论 2型糖尿病患者存在胰岛素敏感指数下降,针刺对体重、FPG、FINS的调节可能是针刺治疗2型糖尿病改善胰岛素抵抗,增加胰岛素敏感的机制之一。     

冠心病患者并发Ⅱ型糖尿病所占比例的胰岛素水平分析

目的探讨冠心病(CHD)患者中,发生Ⅱ型糖尿病(NIDDM)的比例及其临床意义.方法用放射免疫分析法检测166例临床已确诊为冠心病患者和24例健康者的空腹及餐后2 h血胰岛素水平,根据病史、症状、血糖及胰岛素的水平,将166例冠心病患者划分为冠心病合并Ⅱ型糖尿病(CHD合并NIDDM)组和冠心炳未合并Ⅱ型糖尿病组(CHD未合并NIDDM).结果100例CHD合并NIDDM组空腹及餐后2 h的血胰岛素水平都极显著高于对照组(P＜0.01).Ⅱ型糖尿病患者所占的比例达60.4%.66例CHD未合并NIDDM组空腹及餐后胰岛素水平亦明显高于对照组(P＜0.01).结论在冠心病患者中存在高血胰岛素血症,但以合并Ⅱ型糖尿病所占比例为明显较高.检测血胰岛素,对冠心病患者合并糖尿病的预防、诊断、疗效评估均有重要的临床意义.     

老年维吾尔族食管癌合并糖尿病患者低血糖的预防护理

目的探讨预防老年维吾尔族晚期食管癌合并糖尿病患者围手术期发生低血糖的护理对策。方法对新疆医科大学附属肿瘤医院胸外科2009年1月—2011年1月收住的23例老年维吾尔族晚期食管癌合并糖尿病患者,采取加强低血糖的观察及处理措施、注重做好心理护理、严格按医嘱服降糖药、尊重民族风俗、指导合理膳食等个体化护理预防措施,观察护理效果。结果术后19例患者平稳渡过围手术期,2例术后颈部并发吻合口瘘,1例肺部感染,1例胸内吻合口瘘,1例发生轻微低血糖反应。结论对老年维吾尔族晚期食管癌合并糖尿病住院手术治疗的患者,指导合理膳食,严密观察血糖变化,实施科学有效的个体化预防护理措施,能降低术后低血糖的发生,促进患者早日康复。     

重组甘精胰岛素联合瑞格列奈治疗老年2型糖尿病疗效分析

目的:评价重组甘精胰岛素(长秀霖)联合瑞格列奈治疗老年2型糖尿病的临床疗效。方法:将110例口服降糖药控制不理想的老年2型糖尿病患者随机分为对照组与观察组,给予58例观察组患者重组甘精胰岛素(长秀霖)注射,给予52例对照组患者中效胰岛素诺和灵N注射,两组同时均口服瑞格列奈治疗。比较两组治疗4个月后血糖控制情况、达标时间及低血糖发生率。结果:观察组患者空腹血糖、餐后血糖及糖化血红蛋白显著优于对照组,比较差异具有统计学意义(P<0.05);观察组与对照组血糖达标时间分别为(6.59±1.12)周、(8.92±1.07)周(P<0.05);两组低血糖发生率分别为36.2%和76.9%,观察组显著少于对照组(P<0.01)。结论:相对于中效胰岛素诺和灵N,重组甘精胰岛素联合瑞格列奈治疗老年2型糖尿病血糖控制良好,低血糖发生率低,作为老年人胰岛素基础治疗,更具有选择优势。