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Kalman DS 《The American journal of clinical nutrition》2003,78(1):192; author reply 192-192; author reply 193
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The labeling of both health claims that meet significant scientific agreement (SSA) and qualified health claims on conventional foods and dietary supplements requires pre-market approval by the US Food and Drug Administration (FDA). Approval by the FDA involves, in part, a thorough review of the scientific evidence to support an SSA or a qualified health claim. This article discusses FDA's evidence-based review of the scientific evidence on the role of chromium picolinate supplements in reducing the risk of type 2 diabetes. Based on this evidence-based review, FDA issued a letter of enforcement discretion for one qualified health claim on chromium picolinate and risk of insulin resistance, a surrogate endpoint for type 2 diabetes. The agency concluded that the relationship between chromium picolinate intake and insulin resistance is highly uncertain.  相似文献   

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目的 本研究通过对新疆维吾尔自治区乌鲁木齐市6 313名社区规范化管理糖尿病患者的现况调查及分析,了解该人群的整体状况,初步评价、分析管理血糖的效果。方法 随机抽取乌鲁木齐市20个社区卫生服务中心,该社区2型糖尿病(type 2 diabetes mellitus,T2DM)患者为研究对象,展开为期三个月(2017年3~6月)的规范化建档管理,收集T2DM患者的相关资料。结果 建档三个月后的血糖控制结果较建档时有差异,管理对血糖有效(t=3.46,P=0.023)。社区人员对其生活方式指导结果理想,指导后开展饮食控制和合理运动的有3 395和3 363人,分别达53.8%、53.3%。规律服药的患者有5 040人,达79.8%。综合代谢达标尤其血脂达标率不理想,甘油三酯(triglyceride,TG)达标率为12.6%,总胆固醇(total cholesterol,TC)为10.4%。多因素Logistic回归分析显示,管理人群空腹血糖不达标的危险因素是文化程度为初中、高中/技校/中专(均有P<0.05)。结论 社区规范化管理有效,低学历是血糖管理的危险因素。  相似文献   

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向雪松  刘岩  张雪松  张文众  王竹 《卫生研究》2015,(2):185-189,195
目的探讨生物素对2型糖尿病大鼠血糖以及糖代谢关键限速酶葡萄糖激酶(GCK)和磷酸烯醇式丙酮酸羧化酶1(PCK1)基因表达的影响。方法 90只健康Wistar大鼠根据血糖随机分为5组(正常对照组,模型组,生物素低、中、高剂量组)。正常对照组给予普通维持饲料,蒸馏水灌胃;模型组给予高脂高糖饲料,蒸馏水灌胃;生物素各剂量组给予高脂高糖饲料同时分别给予生物素0.6、3.0和6.0 mg/kg BW灌胃。在高脂高糖饲料喂养2月后,应用小剂量链脲佐菌素腹腔注射的方法建立2型糖尿病大鼠模型。于造模第10周进行OGTT实验后,处死大鼠。检测血糖、血清胰岛素、肝糖原、肌糖原等指标,用RT-PCR方法检测糖代谢关键限速酶GCK、PCK1基因的表达。结果与模型组相比,生物素各剂量组对空腹血糖、血清胰岛素没有影响,但生物素高剂量组血糖曲线下面积明显下降(P<0.05),餐后30 min血糖值也显著降低(P<0.05)。生物素中剂量组和高剂量组肌糖原含量明显下降(P<0.05)。生物素对糖代谢关键限速酶GCK、PCK1的表达有影响,分别出现了明显的基因表达上调和下调(P<0.05)。结论生物素可能通过影响糖代谢关键酶GCK和PCK1的活性,促进糖酵解和糖原合成而抑制糖异生,从而影响餐后血糖应答。  相似文献   

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McCulloch DK 《Hospital practice (1995)》2000,35(9):33-6, 41-4, 47-8; discussion 48-50
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Chromium picolinate (CrPic) and trace hexavalent chromium (Cr(VI)) content were characterized in VITA-1 and VITB-1, two new multivitamin and mineral supplement candidate reference materials from National Research Council Canada, by two methods of high performance liquid chromatography inductively-coupled plasma triple quadrupole mass spectrometry. The conditions for the separation of Cr(VI) from EDTA-complexed Cr(III) were optimized such that species interconversions were not observed during analysis. Following extraction with dilute NH4OH in water at pH 10 (for Cr(VI)) or 3:2 acetonitrile:water (for CrPic) and quantification by standard addition, it was concluded that CrPic accounted for 95–96 % of the Cr in VITA-1 and VITB-1, while Cr(VI) was not present above the detection limit of 0.13 μg Cr g−1. Using the two developed methodologies, commercially-available nutritional supplements, in the form of vitamin tablets and dried food supplements, were assessed, and it was determined that CrPic accounted for the majority (92 %–98 %) of the chromium present in the tablets, and that Cr(VI) concentrations were below the detection limit for all samples except for the powdered beets where it accounted for nearly half of the total Cr present.  相似文献   

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OBJECTIVE: To determine the effects of combined zinc (Zn) and chromium (Cr) supplementation on oxidative stress and glucose homeostasis of people with type 2 diabetes. DESIGN: Tunisian adult subjects with HbA1C > 7.5% were supplemented for 6 months with 30 mg/d of Zn as Zn gluconate or 400 microg/d of Cr as Cr pidolate or combined Zn/Cr supplementation or placebo. The effects of supplementation on plasma zinc (Zn), copper (Cu), selenium (Se), urinary Zn, Cr, plasma thiobarbituric acid reactive substances (TBARS), Cu-Zn superoxide dismutase (SOD) and Se glutathione peroxidase (GPx) in red blood cells, blood lipids and lipoproteins, HbA1C and fasting glucose were measured at the beginning of the study and after six months. RESULTS: At the beginning of the study, more than 30% of the subjects may have been Zn deficient with plasma Zn values less than 10.7 mircomol/L, whereas levels of plasma Cu, Se and antioxidant RBC enzyme activities were in the normal ranges. Following supplementation, there were significant decreases of plasma TBARS in the Cr (13.6%), Zn (13.6%) and Zn/Cr (18.2%) groups with no significant changes in the placebo group. The value for the TBARS of the control healthy Tunisian subjects was 2.08 +/- 0.04 micromol/L and that of the Tunisian subjects with diabetes was 3.32 +/- 0.05 micromol/L. This difference of 1.24 micromol/L between the control group and the subjects with diabetes was reduced from 36% to 50% in the three supplemented groups. Supplementation did not modify significantly HbAIC nor glucose homeostasis. No adverse effects of Zn supplementation were observed on Cu status. HDL cholesterol nor interactions in Zn or Cr. CONCLUSIONS: These data suggest the potential beneficial antioxidant effects of the individual and combined supplementation of Zn and Cr in people with type 2 DM. These results are particularly important in light of the deleterious consequences of oxidative stress in people with diabetes.  相似文献   

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Contemporary management of diabetes places heavy emphasis on control, particularly control of blood sugars and of food consumption. Interviews with people living with diabetes type 2 show how identity and social relationships are negotiated through what is often a contradictory language of control, surveillance, discipline and responsibility. People frequently discuss diabetes-related behaviour in terms that position themselves or others as disobedient children, or as wicked or foolish adults. These references occur alongside appraisals of the physical and social complexity of "compliance" with diabetic regimes and in some instances the difficulty of achieving effective control over blood sugar levels. Efforts to protect themselves from the stigmatising potential of diabetes may inadvertently undermine the agency of people who are already coping with a demanding discipline and a potentially disabling or life-threatening disease.  相似文献   

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PURPOSE OF REVIEW: The aim of this article is to evaluate food properties able to influence specific physiological targets that may be helpful for the prevention and management of overweight and diabetes. RECENT FINDINGS: Observational and intervention studies have clearly shown that type 2 diabetes can be prevented by lifestyle measures, including reduced energy intake to induce a modest but sustained weight reduction, together with changes in diet composition. SUMMARY: Foods can be regarded as functional if proven to affect beneficially one or more target functions in the body, beyond adequate nutritional effects, in a way relevant to improved state of health and well-being, reduction of risk of diseases, or both. Functional foods might have a particularly high impact for prevention or treatment of overweight and diabetes for which, more than in many other fields, the link between nutrition, biological responses and diseases is clearly established. Functional foods for obesity should be able to influence the energy balance equation regulated by the control of energy intake or of energy dissipated as heat (thermogenesis). For prevention of type 2 diabetes, several unmodified foods with functional properties have already been identified (low saturated fat products, vegetables, fruit, wholegrain foods, low glycemic index starchy foods). Overall, the available evidence on functional foods so far identified in this field is incomplete: the major gap is the lack of diet-based intervention trials of sufficient duration to be relevant for the natural history of diseases like overweight and diabetes.  相似文献   

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We evaluated the effect of a disease management (DM) program on adherence with recommended laboratory tests, health outcomes, and health care expenditures for patients with type 2 diabetes. The study was a natural experiment in a primary care setting in which the intervention was available to 1 group and then compared to the experience of a matched control group. Univariate analysis and difference in differences analysis were used to test for any significant differences between the 2 groups following a 12-month intervention period. A payer perspective was used to estimate the health care cost consequences based on hospital and physician utilization weighted by Medicare prices. The results were nonsignificant at the .10 level, except for compliance with recommended tests, which showed significant results in the univariate analysis. The intervention increased compliance with testing for HbA1c, microalbuminuria, and lipids, and decreased HbA1c value and the percent of patients with HbA1c >or=9.5%. The point estimates showed small reductions in health care cost; only reductions in costs for office visits were significant at the .10 level. We concluded that while there were signs of improvement in adherence to testing, the low effectiveness may be attributed to existing diabetes management activities in this primary care setting, high compliance rates for testing at the beginning of the study, and a steep learning curve for this complex, information-technology-based DM system. The study raises questions about the incremental gains from complex systems approaches to DM and illustrates a rigorous method to assess DM programs under "real-world" conditions, with control for possible selection bias.  相似文献   

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Vegetarian and vegan diets offer significant benefits for diabetes management. In observational studies, individuals following vegetarian diets are about half as likely to develop diabetes, compared with non-vegetarians. In clinical trials in individuals with type 2 diabetes, low-fat vegan diets improve glycemic control to a greater extent than conventional diabetes diets. Although this effect is primarily attributable to greater weight loss, evidence also suggests that reduced intake of saturated fats and high-glycemic-index foods, increased intake of dietary fiber and vegetable protein, reduced intramyocellular lipid concentrations, and decreased iron stores mediate the influence of plant-based diets on glycemia. Vegetarian and vegan diets also improve plasma lipid concentrations and have been shown to reverse atherosclerosis progression. In clinical studies, the reported acceptability of vegetarian and vegan diets is comparable to other therapeutic regimens. The presently available literature indicates that vegetarian and vegan diets present potential advantages for the management of type 2 diabetes.  相似文献   

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[目的]评价临床路径的方法在社区2型糖尿病管理中的效果。[方法]将\  相似文献   

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Obtaining the suggested glycemic control is the most important achievement in order to prevent cardiovascular complications in patients with type 2 diabetes. Monotherapy often fails after a period of treatment, so that multiple drugs are needed to achieve effective glycemic control. A number of oral glucose lowering drugs is now available such as metformin, sulfonylureas, non-sulfonylureas secretagogues (metiglinides derivatives), alpha-glucosidases inhibitors, and the newest agent: thiazolidinediones (TZD). The possible associations of oral glucose lowering drugs for optimal treatment of type 2 diabetes are briefly reviewed. In particular, the effects of different classes of drugs on cardiovascular risk factors (and particular hypertension and dyslipidemia) and well recognized cardiovascular disease markers in type 2 diabetes are analyzed: in this context TZD appear the more innovative drugs and have been shown to play a key role in the management of hypertension, dyslipidemia, inflammation and endothelial disfunction in diabetic patients. The possible adverse effects derived from the association of different drug classes are also considered.  相似文献   

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