300例糖尿病患者社区强化管理和治疗的疗效观察

目的　探索糖尿病社区强化管理和治疗的有效模式 ,提高糖尿病患者的治疗达标率 ,减少医药费。　方法　选择已经确诊的糖尿病患者 30 0例 ,按照同等病情分为强化管理和治疗组及普通治疗组。强化管理和治疗组采用量化饮食治疗、量化运动治疗、指导合理用药、健康教育和心理疏导 ,医生对患者一对一地指导等治疗方法 ;普通治疗组为药物治疗和一般性教育。观察两组连续治疗 3个月病情控制与药费情况。　结果　强化管理和治疗组患者的空腹血糖值平均为 6 .48mm ol/ L,明显低于普通治疗组的 7.6 0 mm ol/ L(P<0 .0 0 1) ;餐后血糖值平均为 8.5 9mm ol/ L,明显低于普通治疗组的 11.31m mol/ L (P<0 .0 0 1)。患者的血糖达到控制良好标准者占 48.4% ,明显高于普通组 2 0 .8% (P<0 .0 0 1)。血糖控制仍在不良状态的患者强化组为 2 6 .1% ,明显低于普通组的 47.7% (P<0 .0 0 1)。强化管理和治疗组糖化血红蛋白 (Hb A1c)平均为 (7.79± 1.13) % ,明显低于普通治疗组 9.31(± 1.85 ) % (P<0 .0 0 1)。 Hb A1c控制良好率为 5 2 .3%明显高于普通组的 18.8% (P<.0 0 1)。 BMI、腰围、血脂两组无明显差别。糖尿病患者的医药费强化管理和治疗组每人每月下降 5 9.9元 ,下降幅度为2 3.6 %。普通治疗组每人每月上涨 1.8元 ,上     

社区综合治疗105例糖尿病疗效观察

糖尿病患者105例,按同等病情分为综组和普组.综组采用量化饮食、运动、指导合理用药、健康教育和心理疏导等治疗方法;普组为药物治疗和一般性教育.观察6个月.结果综组FBG为6.5mmol/L,低于普组7.8mmol/L(P＜0.01);PBG为8.2mmol/L,低于普组的11.3mmol/L,HbA1c为7.7±1.3%,低于普组9.3±1.7%(P＜0.01);体重指数、腰围、血脂两组无明显差别.结论糖尿病的社区综合治疗疗效优越于普通治疗.     

社区老年糖尿病患者的综合治疗

目的 探讨以社区为基础、以全科医学理论为指导的老年人糖尿病治疗模式.方法 采用全科医学与专科相结合的治疗模式,从社区选择老年糖尿病患者122例(全科组),另在医院糖尿病专科门诊选择老年糖尿病患者124例(专科组),只接受专科治疗;进行18个月治疗观察.结果 18个月时,杜区组血压、空腹血糖(FBG)、糖化血红蛋白(HbA1c)、尿白蛋白排泄率(UAER)和抑郁症患病率均显著低于基线,收缩压(137.0±20.9)mm Hg对(133.3±12.9)mm Hg(P＜0.01);舒张压(78.1±12.0)mm Hg对(73.2±7.5)mm Hg(P＜0.01);FBG(9.3±3.5)mmol/L对(7.7±2.5)mmol/L(P＜0.01);HbA1c(7.1±2.3)%对(5.9±1.9)%(P＜0.01);UAER自然对数转换值(UAERLN)3.1±1.7对2.4±1.0(P＜0.01);抑郁症患病率23.0%对9.8%(P＜0.01).专科组仅FBG和UAERLn显著低于基线,FPG(11.2±4.0)mmol/L对(9.8±2.7)mmol/L(P＜0.05),UAERLN 3.0±1.3对2.8±1.5(P＜0.01);体质指数(BMI)则显著高于基线,(24.4±3.9)kg/cm2对(26.2±3.7)kg/cm2(P＜0.01);且专科组血压、FPG和HbA1c波动较大.结论 以社区为基础,专科与全科医学相结合的治疗模式是一种有效的老年人糖尿病治疗的整合模式.     

双时相门冬胰岛素30联合二甲双胍治疗基础胰岛素控制不佳的2型糖尿病患者:疗效及安全性评价

目的 评价既往基础胰岛素联合口服降糖药物(OAD)治疗血糖控制不佳的2型糖尿病患者转用双时相门冬胰岛素30(BIAsp30)联合二甲双胍治疗的疗效及安全性.方法 本试验为多中心、非随机、开放、单组治疗达标研究,包括2周筛选期、4周导入期和16周治疗期.既往使用基础胰岛素联合OAD治疗血糖控制不佳的2型糖尿病患者转用每日两次BIAsp30注射联合口服二甲双胍治疗.收集疗效及安全性数据进行统计学分析.结果 共293例患者(男154,女139)入选,平均年龄(54.0±9.6)岁,平均糖尿病病程(8.54±5.49)年,平均体重指数(24.89±3.28)kg/m2,HbA1c 8.16%±0.89%,122例既往使用基础胰岛素类似物,169例使用人中效胰岛素.经16周的治疗,平均HbA1C降幅达1.30%±0.96%(P＜0.01);HbA1C达到＜7.0%和≤6.5%的患者比例分别为60.4%和38.9%.患者8点血糖谱各点血糖值均有显著降低(P＜0.01),8点血糖均值由基线时的(10.53±2.58)mmol/L降至(7.79±1.58)mmol/L(P＜0.01),降幅为2.76 mmol/L.早餐和晚餐后血糖增幅显著下降,分别下降了1.73 mmol/L(P＜0.01)和1.28 mmol/L(P＜0.01),而午餐后的血糖增幅未发现显著性降低(-0.09 mmol/L,P=0.734 5).研究治疗中无严重不良事件和重度低血糖事件报告,总体低血糖发生率为2.68例/患者年;患者体重平均增加(0.76±0.14)kg(P＜0.01).结论 BIAsp30联合二甲双胍可显著改善基础胰岛素联合OAD血糖控制不佳的2型糖尿病患者的血糖控制,并具有良好的安全性.     

采用CGMS评价阿卡波糖对胰岛素治疗血糖波动的影响

62例2型糖尿病患者分别接受阿卡波糖联合胰岛素强化治疗(联合强化组)及单纯胰岛素强化治疗(单纯强化组),当血糖控制达标时,联合强化组日内平均血糖波动幅度(MAGE)、日间平均血糖绝对差(MODD)、日平均血糖标准差(SDBG)明显低于单纯强化组[(3.76±1.47)对(6.52± 1.57) mmol/L,(0.57±0.49)对(1.10±0.69) mmol/L,(1.44±0.60)对(2.42±0.92)mmol/L,均P＜0.01].联合强化组日平均血糖(MBG)明显好于单纯强化组[(7.08±0.69)对8.27±1.31)mmol/L,P＜0.01];疗程结束时联合强化组HbA1c水平好于单纯强化组(6.77％ -0.57％对7.21％±0.83％,P＜0.05),低血糖发生率较少(29％对48％,P＜0.01),体重指数较低[(24.14±2.7对27.63±3.41)kg/m2,P＜0.01].     

胰岛素泵治疗对初诊T2DM患者血糖及β细胞功能的影响

对24例初诊2型糖尿病患者进行胰岛素泵治疗10～14天.结果治疗后空腹(FBG)及餐后血糖(PBG)均明显下降(P＜0.001),HbA1c明显下降(P＜0.05),HomaB明显上升、HomaIR明显下降、AI30/△G30明显升高(P＜0.01),其中11例仅控制饮食和运动治疗随访6月后HbA1c 5.99±0.57、FBG 6.2±1.1mmol/L、PPG 7.8±2.4mmol/L.结论胰岛素泵治疗能尽快解除高糖毒性,显著恢复胰岛β细胞功能,减轻胰岛索抵抗.     

护理干预对糖尿病心理障碍的影响

选择2型糖尿病合并抑郁及焦虑症状患者40例,分为干预组20例及对照组20例,干预组除常规糖尿病药物治疗及护理外,给予系统的心理护理2～3周;对照组仅进行常规糖尿病药物治疗及护理,测治疗前后两组患者HAMD及HAMA评分.空腹血糖(FPG)、糖化血红蛋白(HbA1c).结果治疗后干预组及对照组抑郁及焦虑评分均减低,干预组改善更明显(P＜0.01).同时,两组FPG及HbA1c水平均有所下降,干预组下降幅度明显大于对照组(P＜0.01).结论护理干预可以明显改善2型糖尿病患者抑郁及焦虑症状,并有助于患者血糖的控制.     

强化生活方式干预对2型糖尿病疗效观察

目的 探讨在药物治疗的基础上强化饮食、运动干预对2型糖尿病患者疗效的影响.方法 选择无运动禁忌证的2型糖尿病患者65例,随机分为生活方式干预组（32例）和普通治疗组（33例）,检测患者空腹血糖（FPG）、胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-c）、高密度脂蛋白胆固醇（HDL-c）、体重指数（BMI）、糖化血红蛋白（HbA1c）及血压等指标,前后自身对照及组间对照评价其治疗效果.结果 （1）与单纯药物治疗组比较,生活方式干预组患者的体重、BMI、舒张压、FPG、HbA1c控制明显优于普通治疗组（P＜0.05）.（2）经过干预治疗后,2型糖尿病患者的体重、BMI、血压、FPG、HbA1c极显著下降（P＜0.01）.结论 严格的饮食控制,适量的运动干预能更有效地控制糖尿病患者血糖、HbA1c、血压和体重等危险因素.     

神经传导速度与HbA1c、AR、SOD、NO的相关性

选择糖尿病患者48例,同时测定血糖值、HbA1c水平、AR、SOD活性、NO和神经传导速度,统计分析上述各指标的相关性.结果直线回归分析发现神经传导速度与血糖、HbA1c水平、AR活性明显负相关(P＜0.01),与SOD活性、NO水平明显正相关(P＜0.01);将48例患者按神经传导速度分为三组,血糖、HbA1c、AR、SOD、NO轻、中组差异显著(P＜0.01),而中、重组无明显差异(P＞0.05).结论高血糖所致的蛋白非酶糖化、多元醇通路活性升高、氧化应激对早期DN的发生、发展起重要作用,NO可能参与糖尿病神经病变的形成.     

老年2型糖尿病患者动态血糖监测分析

目的 探讨老年2型糖尿病患者的动态血糖波动特点.方法 对老年2型糖尿病患者(老年组)92例和中青年2型糖尿病患者(中青年组)58例进行动态血糖监测,对比分析两组患者血糖谱特征及老年不同糖化血红蛋白(HbA1c)水平糖尿病患者的血糖谱特征.结果 (1)老年组与中青年组比较,血糖波动系数(BGFC)增大[(2.68±1.00)mmol/L对(2.12±0.74) mmol/L,t=-3.691,P＜0.001];餐后血糖漂移幅度(PPGE)增大,早餐后分别为 ( 5.96±2.47) mmol/L对(5.11±2.44) mmol/L(t=-2.058,P＜0.05),晚餐后分别为(5.17±2.15) mmol/L对 (4.16±2.28) mmol/L(t=-2.730,P＜0.01);餐后血糖达峰时间延长,早餐后(112.5±29.7) min对(97.0±27.2) min(t=-3.225,P＜0.01),中餐后(140.0±39.7)min对 (118.1±42.6) min(t=-3.195,P＜0.01);低血糖发生频率增加(26.3%对5.5%,P＜0.05);最大血糖漂移幅度(LAGE)增大,分别为(9.66±2.48) mmol/L对(8.40±3.13) mmol/L(t=-2.720,P＜0.01);(2)老年组患者随HbA1c下降,低血糖发生率增加(P＜0.05);随 HbA1c升高,血糖波动幅度增大;(3)HbA1c与空腹血糖(FBG)、日平均血糖(MBG)、高血糖时间比(PT7.8、PT11.1)、最低血糖(LBG)、最高血糖(HBG)、BGFC、PPGE、LAGE均正相关(r=0.899～0.289,均P＜0.001);逐步回归分析显示,MBG、FBG、PT7.8与HbA1c独立相关(校正的R2=0.807,P＜0.05).结论 老年2型糖尿病患者血糖波动幅度大,易发生餐后高血糖和夜间低血糖,动态血糖监测能较详细地显示患者的血糖水平及波动特征.

Abstract：

Objective To investigate the characteristics of the blood glucose fluctuation in elderly patients with type 2 diabetes mellitus (T2DM). Methods The 92 elderly patients with T2DM (the elderly group) and 58 young and middle-aged patients with T2DM (the non-elderly group) were monitored using the continuous glucose monitoring system(CGMS). The characteristics of glucose profiles of the two different age groups, and of the different glycosylated hemoglobin (HbA1c) level groups in the elderly were comparatively analyzed. Results (1)There was no significant difference in HbA1c level between the elderly group and the non-elderly group. Compared with the non-elderly group, the elderly group showed the increases in blood glucose fluctuant coefficient [BGFC, (2.68±1.00) mmol/L vs. (2.12±0.74) mmol/L, t=-3.691, P＜0.001], in postprandial glucose excursion (PPGE) of breakfast and supper [(5.96±2.47) mmol/L vs. (5.11±2.44) mmol/L, t=-2.058, P＜0.05; (5.17±2.15) mmol/L vs. (4.16±2.28) mmol/L, t=-2.730, P＜0.01], in the time to postprandial glucose peak of breakfast and lunch [(112.5±29.7) min vs. (97.0±27.2) min, t=-3.225, P＜0.01; (140.0±39.7) min vs. (118.1±42.6) min, t=-3.195, P＜0.01], in the frequency of hypoglycemia (26.3% vs. 5.5%, P＜0.05), and showed the largest amplitude of glycemic excursions [LAGE, (9.66±2.48) mmol/L vs.(8.40±3.13) mmol/L, t=-2.720, P＜0.01]. (2)In the elderly, along with decreased HbA1c, the incidence of hypoglycaemia increased (P＜0.05); And along with increased HbA1c, the amplitude of blood glucose fluctuation increased. There were significant differences in BGFC, PPGE of breakfast and lunch, and LAGE among different HbA1c level groups (P＜0.01, P＜0.05, P＜0.05, P＜0.001). (3)HbA1c was positively correlated with FBG, mean blood glucose (MBG), percentage of time at glycemia (PT7.8, PT11.1), the lowest blood glucose (LBG), the highest blood glucose (HBG), BGFC, PPGE and LAGE (r=0.899-0.289, all P＜0.001). Multiple stepwise regression analysis indicated that MBG, FBG and PT7.8 was the independent influential factor of HbA1c (adjusted R2=0.807, P＜0.05). Conclusions The elderly patients with T2DM are at a particularly high risk for postprandial hyperglycemia and nocturnal hypoglycemic episodes, CGMS could show glucose fluctuation characters of T2DM patients diurnally, and provide a clinical basis for reasonable therapy.     

胰岛素瘤的解剖分布特点分析

目的胰岛素瘤是最常见的胰腺神经内分泌肿瘤，因其临床表现多样，导致诊断困难。影像学诊断尤其是超声内镜(EUS)在胰岛素瘤的诊断中起着重要作用，拥有较高的敏感性和特异性。本研究拟通过明确胰岛素瘤的解剖分布特点，以期有助于提高影像学的诊断准确率和降低漏诊率，尤其是在教育和培训实践中对于EUS的学习者更具有指导价值。 方法回顾性分析解放军总医院第一医学中心病案资料数据库1993年1月至2019年11月经外科手术、病理确诊为胰岛素瘤的患者的临床资料，检索方法采取搜索术后病理诊断为"胰岛素瘤"的病例，通过查阅病例的方法，提取出胰岛素瘤的大小和解剖分布等数据，进一步分析其特点。 结果共检索到确诊为胰岛素瘤的患者116例，其中，男45例、女71例，年龄13～76岁，平均年龄(44.4±14.85)岁。胰岛素瘤单发110例(94.8%)、多发6例(5.2%)。位置分布：头颈部46例(39.7%)，单发45例、多发1例；体尾部68例(58.6%)，单发65例、多发3例；全胰腺多发2例(1.7%)。病变大小特点：最大径0.4～3.4 cm，平均大小(1.53±0.58)cm。≤1 cm 29例、>1 cm而≤1.5 cm41例、>1.5 cm而≤2.0 cm28例，≤3 cm 15例，>3 cm 3例。年龄与肿瘤的大小相关，≤44岁患者肿瘤平均大小为(1.36±0.51)cm、>44岁患者肿瘤平均大小为(1.70±0.60)cm，P<0.05。头颈部的肿瘤大于体尾部的肿瘤，头颈部肿瘤平均大小(1.66±0.63)cm，体尾部(1.42±0.52)cm，P<0.05。 结论胰岛素瘤在胰腺体尾部较头颈部更好发；绝大多数单发，但可以全胰腺多发；多数小于1.5 cm，肿瘤的大小与患者年龄和肿瘤的解剖分布相关。     

Pathogenesis of carcinoma of the papilla of Vater

Most adenomas and carcinomas of the small intestine and extrahepatic bile ducts arise in the region of the papilla of Vater. In familial adenomatous polyposis (FAP) it is the main location for carcinomas after proctocolectomy. In many cases symptoms due to stenosis lead to diagnosis at an early tumor stage. In about 80%, curative intended resection is possible. Operability is the most relevant prognostic factor. Most ampullary carcinomas resp. carcinomas of the papilla of Vater develop from adenomatous or flat dysplastic precursor lesions. They can be sited in the ampulloduodenal part of the papilla of Vater, which is lined by intestinal mucosa. They also can develop in deeper parts of the ampulla, which are lined by pancreaticobiliary duct mucosa. Intestinal-type adenocarcinoma and pancreaticobiliary-type adenocarcinoma represent the main histological types of ampullary carcinoma. Furthermore, there exist unusual types and undifferentiated carcinomas. Many carcinomas of intestinal type express the immunohistochemical marker profile of intestinal mucosa (keratin 7?, keratin 20+, MUC2+). Carcinomas of pancreaticobiliary type usually show the immunohistochemical profile of pancreaticobiliary duct mucosa (keratin 7+, keratin 20?, MUC2?). Even poorly differentiated carcinomas, as well as unusual histological types, may conserve the marker profile of the mucosa they developed from. These findings underline the concept of histogenetically different carcinomas of the papilla of Vater which develop either from intestinal- or from pancreaticobiliary-type mucosa of the papilla of Vater. Molecular alterations in ampullary carcinomas are similar to those of colorectal as well as pancreatic carcinomas, although they appear at different frequencies. In future studies, molecular alterations in ampullary carcinomas should be correlated closely with the different histologic tumor types. Consequently, the histologic classification should reflect the histogenesis of ampullary tumors from the two different types of papillary mucosa.     

Demonstration of the mechanism of action of biguanides

Summary Palmitic acid oxidation in rat diaphragm homogenate is depressed by biguanide concentrations that are still incapable of inhibiting oxidative phosphorylation. Glucose oxidation is not directly effected by the same biguanide concentrations: however, the inhibitory effect of palmitic acid on glucose oxidation is partly removed by biguanides. Inhibition of fatty acid oxidation, which accounts for most of the metabolic effects caused by these drugs, can be regarded as the fundamental mechanism of action of biguanides. There is some evidence suggesting that these drugs might interact with carnitine, thus preventing long-chain fatty acids from being transported across the mitochondrial membrane to the site of oxidation. Traduzione a cura degli AA.     

Lack of correlation of degree of villous atrophy with severity of clinical presentation of coeliac disease

BACKGROUND AND AIM: Both the clinical presentation and the degree of mucosal damage in coeliac disease vary greatly. In view of conflicting information as to whether the mode of presentation correlates with the degree of villous atrophy, we reviewed a large cohort of patients with coeliac disease. PATIENTS AND METHODS: We correlated mode of presentation (classical, diarrhoea predominant or atypical/silent) with histology of duodenal biopsies and examined their trends over time. RESULTS: The cohort consisted of 499 adults, mean age 44.1 years, 68% females. The majority had silent coeliac disease (56%) and total villous atrophy (65%). There was no correlation of mode of presentation with the degree of villous atrophy (p=0.25). Sixty-eight percent of females and 58% of males had a severe villous atrophy (p=0.052). There was a significant trend over time for a greater proportion of patients presenting as atypical/silent coeliac disease and having partial villous atrophy, though the majority still had total villous atrophy. CONCLUSIONS: Among our patients the degree of villous atrophy in duodenal biopsies did not correlate with the mode of presentation, indicating that factors other than the degree of villous atrophy must account for diarrhoea in coeliac disease.     

血吸虫童虫生长发育及其机制的研究进展

血吸虫童虫是宿主免疫系统攻击的重要靶标,包括皮肤型、肺型和肝门型童虫。宿主分子对童虫生长发育具有重要作用。童虫生长发育机制包括免疫调节、信号转导、性别发育及凋亡等。肌动蛋白、组织蛋白酶、烯醇化酶和葡萄糖基转移酶等分子为血吸虫童虫生长发育的重要分子。本文对血吸虫童虫生长发育及其机制的研究进展做一综述。     

氯硝柳胺悬浮剂的毒性评价

目的评价氯硝柳胺悬浮剂的毒性，为现场大规模应用灭螺提供依据。方法按照中华人民共和国国家标准GB 15670-1995《农药登记毒理学试验方法》和鱼类毒性试验方法进行。结果经口、经皮肤的LDso雌、雄性大鼠均>5 000 mg/kg，经呼吸道的LCso雌、雄性大鼠均>5 000mg/m3，该药经口、经皮肤、经呼吸道毒性均属微毒类药物；兔眼用药后，观察期内无不良反应，对眼无刺激性；皮肤用药后对皮肤无刺激性。与氯硝柳胺原药、氯硝柳胺乙醇胺盐原药和氯硝柳胺乙醇胺盐可湿性粉剂相比，氯硝柳胺悬浮剂对鱼急性毒性最低。结论氯硝柳胺悬浮剂属微毒类药物，对鱼的毒性低于其乙醇胺盐可湿性粉剂，适合于现场应用。     

124例耐多药结核分枝杆菌基因突变特征分析

目的对临床分离的耐多药结核分枝杆菌相关基因的突变特征进行分析。方法对124例耐多药结核分枝杆菌以及50株敏感株的耐药相关基因(包括异烟肼inh A、kat G、oxyR-ahp C间隔区以及利福平rpo B)进行序列测定,分析其基因突变情况。结果异烟肼耐药inh A基因突变率为14.5%;kat G基因突变率为70.2%(87/124),主要位于315位;oxyR-ahp C间隔区突变率为15.3%;inh A、kat G两种基因同时突变率75.0%,三种基因同时突变率为89.5%。利福平rpo B基因突变的检出率高达95.2%,突变主要发生在531、526、516位点。结论我省耐多药菌异烟肼耐药相关基因最常见突变为kat G 315、inh A C-T(-15)、axyR-ahp C间隔区(-10)C-T,利福平为rpo B531、526、516。结合MDR-TB耐药相关基因的特征分析,可以建立一种快速、准确、特异的适合于我省的检测结核菌耐多药性的新方法。     

Assessment of quality of life of parents of children with juvenile chronic arthritis

The aim of the study was to assess the quality of life (QOL) and the psychological status of parents of children with juvenile chronic arthritis (JCA). The QOL, anxiety and depression of the parents of 28 children with JCA were evaluated and compared to those of the parents of 28 healthy children. Mothers of JCA children and mothers of healthy children reported similar QOL. The reported anxiety and depression levels were similar for mothers and fathers in both groups. The parents of children with pauciarticular-type JCA reported lower QOL and higher levels of anxiety and depression than the parents of children with other types, namely polyarticular and systemic JCA. These findings may be explained by the fact that the pauciarticular patients had shorter disease duration and were less frequently seen in the outpatient clinic. The QOL of mothers of children with JCA was found to be slightly impaired in the group of children with pauciarticular JCA. Future larger studies are needed to confirm these results, as the number of subjects in the three groups was rather low. Received: 26 September 2001 / Accepted: 8 February 2002     

Numerical Simulation of the Effect of Rate of Change of Glucose on Measurement Error of Continuous Glucose Monitors

Background

A 5-day in-patient study designed to assess the accuracy of the FreeStyle Navigator® Continuous Glucose Monitoring System revealed that the level of accuracy of the continuous sensor measurements was dependent on the rate of glucose change. When the absolute rate of change was less than 1 mg•dl⁻¹•min⁻¹ (75% of the time), the median absolute relative difference (ARD) was 8.5%, with 85% of all points falling within the A zone of the Clarke error grid. When the absolute rate of change was greater than 2 mg•dl⁻¹•min⁻¹ (8% of the time), the median ARD was 17.5%, with 59% of all points falling within the Clarke A zone.

Method

Numerical simulations were performed to investigate effects of the rate of change of glucose on sensor measurement error. This approach enabled physiologically relevant distributions of glucose values to be reordered to explore the effect of different glucose rate-of-change distributions on apparent sensor accuracy.

Results

The physiological lag between blood and interstitial fluid glucose levels is sufficient to account for the observed difference in sensor accuracy between periods of stable glucose and periods of rapidly changing glucose.

Conclusions

The role of physiological lag on the apparent decrease in sensor accuracy at high glucose rates of change has implications for clinical study design, regulatory review of continuous glucose sensors, and development of performance standards for this new technology. This work demonstrates the difficulty in comparing accuracy measures between different clinical studies and highlights the need for studies to include both relevant glucose distributions and relevant glucose rate-of-change distributions.     

Study of constancy of hydrogen-consuming flora of human colon

The constancy of the hydrogen consuming flora of the human colon was studied in 15 healthy subjects via two measurements obtained 18 to 36 months apart. Hydrogen disappearance rate and the major products of H₂-consuming bacteria, methane and sulfide, were measured during incubation of fecal homogenates with excess hydrogen and sulfate. In 11/15, the hydrogen consumption rate and the predominant hydrogen-consuming pathway (methanogenesis, sulfate reduction, or neither) remained constant. However, major shifts in these pathways were observed in four subjects, with two losing and two gaining the ability to produce methane. Methanogenesis was associated with the highest hydrogen consumption rate. This study demonstrates that clinically unrecognizable, major alterations of the colonic flora occur in healthy subjects. Understanding of the factors responsible for these alterations might allow for therapeutic manipulation of the colonic flora.Supported in part by the Department of Veterans Affairs and NIDDKD RO1 DK 13309-25.