新诊断2型糖尿病患者治疗前后血糖水平的动态变化

目的探查2型糖尿病(T2DM)患者血糖漂移变化的特征。方法选取2002-11~2004-12上海交通大学附属第六人民医院22例新诊断T2DM患者采用动态血糖监测系统(CGMS)对其治疗前后均进行连续3d的血糖监测,进行自身前后对照分析。结果本组患者经2~3周治疗后,糖代谢紊乱明显缓解。22例患者治疗前后平均血糖值[(12.7±2.4)mmol/L对(7.3±0.9)mmol/L];日内血糖最高值[19.5±2.3)mmol/L对(11.0±1.7)mmol/L];血糖漂移最大幅度[(12.1±3.1)mmol/L对(7.1±2.0)mmol/L]。餐前及餐后的平均血糖水平及上述血糖参数之间差异均有显著性意义(P均<0.001)。治疗后血糖>7.8mmol/L及11.1mmol/L的时间百分比与治疗前比较均显著降低[(29(6~64)%对99(37~100)%,3(0~28)%对72(13~100)%,P均<0.001)]。结论动态血糖监测能评估T2DM血糖漂移变化的特征,有助于更有效地控制糖代谢紊乱。     

Prevalence and correlation of glycemic control achievement in patients with type 2 diabetes in Iraq: A retrospective analysis of a tertiary care database over a 9-year period

BackgroundThis study was designed to assess the achievement of a glycated hemoglobin (HbA1c) target in Iraqi type 2 diabetes mellitus (T2DM) patients via retrospective analysis of a tertiary care database over a 9-year period.MethodsA total of 12,869 patients with T2DM with mean (SEM) age: 51.4(0.1) years, and 54.4% were females registered into Faiha Specialized Diabetes, Endocrine and Metabolism Center(FDEMC) database between August 2008 and July 2017 were included in this retrospective study. Data were recorded for each patient during routine follow-up visits performed at the center every 3–12 months.ResultsPatients were under oral antidiabetic drugs (OAD; 45.8%) or insulin+ OAD (54.2%) therapy. Hypertension was evident in 42.0% of patients, while dyslipidemia was noted in 70.5%. Glycemic control (HbA1c <7%) was achieved by 13.8% of patients. Multivariate analysis revealed <55 years of age, female gender, >3 years duration of diabetes, HbA1c >10% at the first visit, presence of dyslipidemia, and insulin treatment as significant determinants of an increased risk of poor glycemic control. BMI <25 kg/m² and presence of hypertension were associated with a decreased risk of poor glycemic control.ConclusionUsing data from the largest cohort of T2DM patients from Iraq to date, this tertiary care database analysis over a 9-year period indicated poor glycemic control. Younger patient age, female gender, longer disease duration, initially high HbA1c levels, dyslipidemia, insulin treatment, overweight and obesity, and lack of hypertension were associated with an increased risk of poor glycemic control in Iraqi T2DM patients.     

Low HDL-cholesterol: a strong predictor of glycemic response to glitazone treatment in patients with type 2 diabetes

We performed a study in 102 people with type 2 diabetes aiming to determine “easy-to-use” predictive factors for glycemic response to glitazones. We found that low baseline HDL-cholesterol (<40 mg/L [1.04 mmol/L] in males, <50 mg/L [1.30 mmol/L] in females) was a strong independent predictor of glycemic response to glitazones (OR = 2.67 [2.02-3.52], p = 0.0004).     

The effectiveness of patient activation intervention on type 2 diabetes mellitus glycemic control and self-management behaviors: A systematic review of RCTs

BackgroundType 2 diabetes mellitus T2DM is a major health challenge and associated with several complications and mortality. Self-management behaviors SMBs such as healthy diet, physical activity, blood glucose self-monitoring, foot care and medication adherence are critical part of diabetic care. Empowered or activated patients, are more likely to practice better SMBs. However, the effectiveness of patient activation intervention on T2DM glycemic control and SMBs is not totally well understood.AimTo assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs.MethodA systematic search was undertaken through five databases to find relevant studies published between 2004 and 2018. We included randomized controlled trials with sample size ≥120 and follow up period of ≥12 months and assess the effectiveness of patient activation intervention on T2DM glycemic control and SMBs.Results10 RCTs were identified for analysis. The total sample size is 3728 and the combined mean age is 57.3 years. The combined mean BMI is 31.2 kg/m² (obese). Seven intervention demonstrated a significant reduction in HbA1c, ranged from 0.36 to 0.80%. All interventions presented an improvement in at least one self-management behavior.Discussion and conclusionPatient activation intervention showed a significant positive effect on T2DM glycemic control and SMBs, particularly physical activity, healthy diet, foot care and blood glucose self-monitoring. The effectiveness on SMBs was seen across different intervention strategies, modes of delivery, length of intervention, and number of providers. Better effectiveness on HbA1c was associated with poorly controlled participants, culturally tailored-intervention, and in-person sessions intervention combined with telephone calls follow up.     

Examining sex differences in glycemic index knowledge and intake among individuals with type 2 diabetes

Aim

We examined self-reported dietary behaviours and actual food intakes among adult men and women with type 2 diabetes participating in Alberta’s Caring for Diabetes (ABCD) Study.

Effects of concomitant drugs on sitagliptin-mediated improvement in glycemic control in Japanese patients with type 2 diabetes

AimsWe investigated to clarify factors associated with the efficacy of sitagliptin, a dipeptidyl peptidase (DPP)-IV inhibitor, for glycemic control including the confounding effect of concomitant drugs in patients with type 2 diabetes.MethodsWe included type 2 diabetes patients with HbA1c levels of ≥7% who were not under insulin treatment and were administered sitagliptin (50 mg/day for 6 months). Reduction or discontinuation of insulin sensitizers was not permitted during the study period. Outcomes included HbA1c level variations and attaining a target HbA1c level of <7%. Associated factors with each outcome were examined using multivariate analysis.ResultsOf the 313 patients enrolled in this study, 147 (47.0%) attained HbA1c levels of <7%. High baseline HbA1c levels were associated with HbA1c level variations but inversely associated with attaining the target HbA1c level of <7%. Concomitant use of an insulin sensitizer and a α-glucosidase inhibitor and maintenance of the baseline dose of concomitant drugs were significantly associated with each outcome.ConclusionsOur results suggest that concomitant sitagliptin administration (50 mg/day) will improve glycemic control if treatment is initiated before HbA1c levels deteriorate. Other medication should be continued at initiation of sitagliptin administration.     

Impact of age at menarche on obesity and glycemic control in Japanese patients with type 2 diabetes: Fukuoka Diabetes Registry

Aims/Introduction

A younger age at menarche is associated with obesity and type 2 diabetes in adult life. The impact of early‐onset menarche on obesity and glycemic control in type 2 diabetes has not been investigated. The present study examined the relationship between age at menarche and obesity and glycemic control in type 2 diabetes.

Materials and Methods

A total of 2,133 patients with type 2 diabetes aged ≥20 years were divided into groups according to age at menarche (≤11, 12, 13, 14 and ≥15 years). A retrospective cohort study examined the association of menarcheal age with adiposity and hemoglobin A_1c.

Results

Age at menarche was inversely associated with body mass index (BMI) and abdominal circumference (P < 0.001). Each 1‐year decrease in age at menarche was associated with a 0.25‐kg/m² and 0.6‐cm increase in BMI and abdominal circumference, respectively, using a multivariate‐adjusted model. Odds ratios for obesity and abdominal obesity significantly increased in participants with age at menarche ≤11 years after multivariable adjustments when age at menarche of 13 years was used as the reference (odds ratio 1.95, 95% CI 1.33–2.88, odds ratio 1.95, 95% CI 1.32–2.87, respectively). Younger age at menarche was significantly associated with higher hemoglobin A_1c (P < 0.001); however, the association was not statistically significant after adjusting for BMI.

Conclusions

Age at menarche of ≤11 years was associated with obesity after adjusting for confounding factors, and poor glycemic control associated with high BMI in type 2 diabetes. Age at menarche should be considered during clinical assessments.     

2型糖尿病患者合并代谢紊乱与血管并发症相关性分析

目的观察2型糖尿病(T2DM)患者合并代谢紊乱发生情况及其与血管并发症的相关性。方法采用2004年中华医学会糖尿病学分会(CDS)关于代谢综合征诊断标准,对230例T2DM患者按合并代谢紊乱多少分为单纯T2DM组(T2DM组,n=60)、T2DM合并1种代谢紊乱组(MS1组,n=97)、T2DM合并2种代谢紊乱组(MS2组,n=50)和T2DM合并3种代谢紊乱组(MS3组,n=23)四组,比较四组患者临床及生化检查指标,观察颈动脉内膜-中层增厚(C-IMT增厚)、糖尿病视网膜病变(DR)及糖尿病肾病(DN)发生率,采用多因素Logistic回归模型分析血管并发症与合并代谢紊乱关系。结果 T2DM合并1种代谢紊乱患者占42.2%、合并2种代谢紊乱患者占21.7%、合并3种代谢紊乱患者占10.0%。与T2DM组患者比较,合并其他代谢紊乱组患者的体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)、空腹血糖(FBG)、餐后2小时血糖(2hPG)、血尿酸(UA)、三酰甘油(TG)及总胆固醇(TC)水平显著增高,差异均有统计学意义(P0.05)。与MS1组患者比较,MS2组患者BMI、SBP、DBP、FBG、2hPG、UA、TG、TC及低密度脂蛋白胆固醇(LDL-C)水平增高,高密度脂蛋白胆固醇(HDL-C)水平降低,差异有统计学意义(P0.01);MS3组患者BMI、SBP、DBP、HOMA-IR、FBG、2hPG、UA及TG水平升高,HDL-C水平降低,差异有统计学意义(P0.01)。与MS2组患者比较,MS3组患者SBP、DBP、FBG、2hPG及UA水平升高,差异有统计学意义(P0.01)。随代谢紊乱组份的增加,C-IMT增厚、DR及DN等血管并发症的发生率增加(P0.01)。分别以C-IMT增厚、DR、DN为自变量,以BMI、SBP、DBP、FBG、2hPG、TG及HDL-C为因变量,采用二分类Logistic回归分析,结果显示SBP、DBP及2hPG是C-IMT增厚的独立危险因素;DBP和TG是DR的独立危险因素;SBP和TG是DN的独立危险因素。结论 2型糖尿病合并其他代谢紊乱与C-IMT增厚、DR及DN的发生相关。     

Periodontal disease and type 1 diabetes mellitus: Associations with glycemic control and complications: An Indian perspective

AimTo evaluate the frequency of periodontal disease in a group of patients with type 1 diabetes mellitus and its relationship with diabetic metabolic control, duration and complications.Materials and methodsA comparison was made of periodontal parameters (plaque index, bleeding index, pocket depth and attachment loss) in a group of diabetic patients versus a group of non-diabetics (n = 20). Statistical analysis was performed to evaluate the relationship between periodontal parameters and degree of metabolic control, the duration of the disease and the appearance of complications.ResultsDiabetics had greater bleeding index (p < 0.001), probing pocket depth (p < 0.001) and clinical attachment level (p = 0.001). Patients diagnosed for diabetes for shorter duration of time (4–7 years) showed bleeding index-disease severity correlation to be 1.760 ± 0.434.ConclusionPatients with type 1 diabetes have increased periodontal disease susceptibility. Periodontal inflammation is greatly increased in subjects with longer disease course, poor metabolic control and diabetic complications.     

RNA干扰技术及其在2型糖尿病中的应用

RNA干扰(RNAi)技术是基因分析和基因治疗的重要手段,它在2型糖尿病中的应用涉及功能基因组研究、2型糖尿病发病机制及其心血管并发症研究。RNAi具有高效特异性的特点。然而仍需克服如何避免RNAi衰减现象,如何合理调节多基因表达等困难。     

Relationship between glycemic control and chronic obstructive pulmonary disease in patients with type 2 diabetes: A nested case-control study

AimsTo evaluate the relationship between glycemic control and plasma glycated hemoglobin (HbA1c) levels in patients with type 2 diabetes mellitus (T2D) and the risk of chronic obstructive pulmonary disease (COPD).MethodsWe conducted a population-based, retrospective, nested, case-control study involving 124,876 patients with DM2 from the Canary Islands, Spain. From the cohort, we selected all COPD cases and, for each case, five control subjects who were COPD free. We analyzed the association between glycemic control, HbA1c level and incident COPD.ResultsA total of 1320 incidence cases of COPD (1.06%) were identified and matched individually with 6600 controls according to age and sex. After multivariate adjustment, the COPD risk increased among patients with poor glycemic control compared to patients with good glycemic control [HbA1c levels <7% (53 mmol/mol)] (OR 1.18; 95% CI: 1.03–1.36). In comparison with patients exhibiting HbA1c levels <7% (53 mmol/mol), the risk of COPD was higher among people with HbA1c levels of 7–8% (53–64 mmol/mol) (OR 1.24; 95% CI: 1.05–1.47) and 8–9% (64–75 mmol/mol) (OR 1.31; 95% CI: 1.04–1.66).ConclusionsPoor glycemic control reveals a weak association with increased risk of COPD in T2D patients.     

Effect of the combination of mitiglinide and metformin on glycemic control in patients with type 2 diabetes mellitus

Aims/Introduction: Mitiglinide is the newest drug in the meglitinide family. It increases the early‐phase insulin release through rapid association‐dissociation kinetics in the pancreatic β cells. The efficacy and safety of adding meglitinide to metformin monotherapy in patients with type 2 diabetes are unknown. Materials and Methods: We carried out a prospective, randomized, multicenter trial to assess the efficacy and safety of combined treatment with mitiglinide and metformin for patients with type 2 diabetes who showed inadequate glycemic control with metformin monotherapy. Subjects with glycated hemoglobin (HbA_1c) >7.0% after an 8‐week metformin run‐in phase were randomized to a 16‐week trial phase with metformin plus mitiglinide (Met + Mit) or metformin plus placebo (Met + Pcb). Results: Compared with the Met + Pcb group, the Met + Mit group showed a greater reduction in HbA_1c (?0.7 ± 0.6%vs?0.4 ± 0.7%, P = 0.002), fasting plasma glucose (?0.77 ± 1.76 mmol/L vs?0.05 ± 1.60 mmol/L, P = 0.015) and 2‐h postprandial glucose (?3.76 ± 3.57 mmol/L vs?0.84 ± 3.07 mmol/L, P < 0.0001). The proportion of the patients who achieved the target HbA_1c value of <7% at the end of the study was also higher in the Met + Mit group than the Met + Pcb group (49.3%vs 28.8%, P = 0.016). There were no differences in the adverse event rates between groups. Conclusions: Combination therapy with metformin and mitiglinide is effective and safe for the treatment of patients with type 2 diabetes who have inadequate glycemic control with metformin monotherapy. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00023.x, 2010)     

血糖控制对2型糖尿病病人骨转换的影响

目的 探讨血糖控制对２型糖尿病（ＤＭ）骨转换的影响。方法 测定４３例２型ＤＭ患者血骨特异性碱性磷酸酶（ＢＡＰ）、尿脱氧吡啶酚（ＤＰＤ）和血尿钙、磷、镁水平,并与正常组比较。结果 ２型ＤＭ患者血ＢＡＰ、尿ＤＰＤ以及钙、磷高于正常对照;治疗后ＢＡＰ、ＤＰＤ降低。ＢＡＰ和ＤＰＤ变化水平与糖化血红蛋白、尿糖和尿钙、磷变化水平正相关。结论 控制血糖能使２型ＤＭ患者骨转换降低。     

Sex- and gender-differences in chronic long-term complications of type 1 and type 2 diabetes mellitus in Italy

AimsThis review summarizes the contribution of Italian diabetologists devoted to a better understanding of the complex relationship linking sex/gender and long-term complications of type 1 (T1DM) and type 2 diabetes (T2DM) over the last fifteen years.Data synthesisMicrovascular and macrovascular complications of diabetes show sex- and gender-related differences, involving pathophysiological mechanisms, epidemiological features and clinical presentation, due to the interaction between biological and psychosocial factors. These differences greatly impact on the progression of diabetes and its long-term complications, especially in the cardiovascular, renal and liver districts.ConclusionA better knowledge of such sex- and gender-related characteristics is required for a more precise patient phenotypization, and for the choice of a personalized antihyperglycemic treatment. Despite such mounting evidence, current diabetes clinical guidelines do not as yet adequately consider sex/gender differences.     

Effect of oral vitamin D supplementation on glycemic control in patients with type 2 diabetes mellitus with coexisting hypovitaminosis D: A parellel group placebo controlled randomized controlled pilot study

Context

Vitamin D supplementation in type 2 diabetes mellitus patients may lead to improved glycemic control by improving insulin secretion and decreasing insulin resistance.

Effect of gender on treatment outcomes in type 2 diabetes mellitus

Aim

To evaluate the effect of gender on clinical outcomes in people with type 2 diabetes mellitus (T2DM) receiving antidiabetes therapy.

Methods

This is a pooled analysis from nine similarly designed phase 3 and 4 randomized, controlled studies evaluating insulin glargine and an active comparator (NPH insulin, insulin lispro, premixed insulin, oral antidiabetes drugs, dietary intervention) in adults with T2DM. Impact of gender on outcomes including HbA1c, fasting plasma glucose (FPG), weight-adjusted insulin dose, and hypoglycemia incidence was evaluated after 24 weeks of treatment.

Results

Overall, 1651 male and 1287 female individuals were included; 49.8% and 50.2% were treated with insulin glargine or comparators, respectively. Females receiving insulin glargine were less likely than males to achieve a glycemic target of HbA1c ≤ 7.0% (53 mmol/mol) (54.3% vs 60.8%, respectively, p = 0.0162); there was no difference between females and males receiving comparators (52.7% vs 51.3%, respectively, p = 0.4625). Females had significantly greater reductions in FPG (3.1 mg/dL, p = 0.0458), required significantly higher insulin doses (0.03 IU/kg, p = 0.0071), and had significantly higher annual rates of symptomatic (p < 0.0001), glucose-confirmed (<50 and <70 mg/dL) symptomatic (p = 0.0005 and p < 0.0001), and severe hypoglycemia (p = 0.0020) than males.

Conclusions

Females in this analysis had smaller reductions in HbA1c and were less likely to reach glycemic goals despite higher insulin doses and more hypoglycemic events than males. Differences in gender responses to therapy should be considered when individualizing treatment for people with T2DM.     

The effect of periodontal therapy on the improvement of glycemic control in patients with type 2 diabetes mellitus: A randomized controlled clinical trial

AIMS:

The purpose of this study is to investigate the effect of improved periodontal health on glycemic control in type 2 diabetes mellitus (type 2 DM) patients who have generalized periodontitis.

MATERIALS AND METHODS:

A total of 45 type 2 DM patients with generalized periodontitis were selected for the study. The selected patients were randomly assigned to three groups (groups A, B, and C) comprising 15 patients each: • Group A received treatment with scaling and root planing only. • Group B received treatment with scaling and root planing followed by systemic doxycycline. • Group C received no treatment (control group). The periodontal parameters recorded included plaque index, gingival index, probing pocket depth, and clinical attachment level. These parameters were recorded at baseline (day zero), at 1 month, and at the end of 3 months. The following metabolic parameters were recorded: fasting blood glucose (FBG), postprandial blood glucose (PPBG), and glycated hemoglobin. These were recorded at baseline (day zero) and at the end of 3 months.

STATISTICAL ANALYSIS:

All the parameters were subjected to repeated-measures ANOVA and Scheffe''s post hoc test.

RESULTS:

A statistically significant effect could be demonstrated for periodontal parameters for both group A and group B (treatment groups). Glycated hemoglobin values showed statistically significant decrease in treatment groups compared to the control group, with group B showing more significant decrease than group A.

CONCLUSIONS:

The results of this study showed that nonsurgical periodontal treatment is associated with improved glycemic control in type 2 DM patients.