HLA-DRB基因启动子区多态性与肺结核合并2型糖尿病的相关性

目的研究HLADRB基因启动子区序列与肺结核合并2型糖尿病的相关性。方法用PCRSSP法进行HLADRB基因分型,启动子区扩增产物直接测序。结果病例组DRB109等位基因的频率显著高于对照组(P<0.05)。病例组中DRB基因启动子区-65位碱基T和-8位AG杂合子的频率明显增加(P<0.05)。病例组中DRB109阳性标本-65位碱基T的频率明显增加,G明显减少(P<0.01);+39位碱基C明显增加,T明显减少(P<0.01)。结论DRB109等位基因及HLADRB启动子区多态性与肺结核合并2型糖尿病密切相关。     

Reactivation of tuberculosis is associated with a shift from type 1 to type 2 cytokines

The pattern of cytokines produced by T cells from mice with latent tuberculosis and during reactivation of tuberculosis was determined. A type 1 cytokine pattern was observed in T cells isolated from the lung of mice with latent disease. Reactivation of mycobacterial growth, by activation of the hypothalamic-pituitary-adrenal (HPA) axis, resulted in a shift from a type 1 to a type 2 cytokine pattern in both CD4 and CD8 T cells. Classification of the T cells based on their differential expression of CD45 and CD44 showed that the phenotypically different populations of CD4 and CD8 cells exhibited a type 1 cytokine pattern at latency and that reactivation of latent tuberculosis was associated with a shift in cytokines produced by these populations to a type 2 cytokine response. Control of mycobacterial growth resulted in a return to the type 1 cytokine pattern found during latent disease.     

Insulin gene VNTR, CTLA-4 +49A/G and HLA-DQB1 alleles distinguish latent autoimmune diabetes in adults from type 1 diabetes and from type 2 diabetes group

Recent research has underlined the need to explore pathogenic, genetic and clinical spectrum of adult onset autoimmune diabetes, also known as latent autoimmune diabetes in adults (LADA). We aimed to investigate whether genetic factors that are associated with type 1 diabetes (T1D) susceptibility, namely HLA-DQB1 alleles, cytotoxic T-lymphocyte antigen 4 gene (CTLA-4) and insulin gene (INS) polymorphisms, are also associated with an atypical subset of patients diagnosed with type 2 diabetes (T2D). The case-control study included 70 T1D, 305 T2D and 252 nondiabetic controls. The T2D group was divided into atypical T2D (LADA, n = 61) or typical T2D (n = 244) subgroups based on the presence of at least one pancreas-specific antibody. Our data suggested that HLA-DQB1 alleles of all three risk classes, INS variable number of tandem repeat (VNTR) I/I and CTLA-4 +49 GG or AG genotypes, were independent risk factors for developing LADA and could be used as a diagnostic tool to discriminate between LADA and T2D. Additionally, there was an increased association between LADA and CTLA-4 diabetes-susceptibility genotypes and decreased association with INS VNTR and high-risk HLA-DQB1 alleles, compared with T1D. Our study suggested the need for further investigation into the genetic background and functional genomics of LADA in comparison with T1D and T2D.     

Complex dietary polysaccharide modulates gut immune function and microbiota,and promotes protection from autoimmune diabetes

The dietary supplement and prebiotic values of β-glucan-rich products have been widely recognized and dietary approaches for modulating autoimmunity have been increasingly explored, we assess the impact of oral administration of high-purity yeast β-glucan (YBG) on gut immune function, microbiota and type 1 diabetes (T1D) using mouse models. Oral administration of this non-digestible complex polysaccharide caused a dectin-1-dependent immune response involving increased expression of interleukin-10 (IL-10), retinaldehyde dehydrogenase (Raldh) and pro-inflammatory cytokines in the gut mucosa. YBG-exposed intestinal dendritic cells induced/expanded primarily Foxp3⁺, IL-10⁺ and IL-17⁺ T cells, ex vivo. Importantly, prolonged oral administration of low-dose YBG at pre-diabetic stage suppressed insulitis and significantly delayed the appearance of T1D in non-obese diabetic (NOD) mice. Further, prolonged treatment with YBG showed increased Foxp3⁺ T-cell frequencies, and a significant change in the gut microbiota, particularly an increase in the abundance of Bacteroidetes and a decrease in the Firmicute members. Oral administration of YBG, together with Raldh-substrate and β-cell antigen, resulted in better protection of NOD mice from T1D. These observations suggest that YBG not only has a prebiotic property, but also an oral tolerogenic-adjuvant-like effect, and these features could be exploited for modulating autoimmunity in T1D.     

Prevalence of overweight/obesity and its associated factors among a sample of Moroccan type 2 diabetes patients

BackgroundObesity constitutes a major risk factor for the development of diabetes, and has been linked with poor glycaemic control among type 2 diabetic patients.AimsThis study examines the prevalence of overweight/obesity and associated factors in type 2 diabetic patients in the Beni-Mellal Khenifra region in Morocco.MethodsA questionnaire-based cross-sectional study was conducted in 2017 among 975 diabetes patients attending primary health centres. Demographic and clinical data were collected through face-to-face interviews. Anthropometric measurements, including body weight, height and waist circumference, were taken using standardized techniques and calibrated equipment.ResultsThe prevalence of overweight was 40.4%, the general obesity was 28.8% and the abdominal obesity was 73.7%. Using multivariate analysis, we noted that the general obesity was associated with female sex (AOR= 3,004, 95% CI: 1.761–5.104, P<0.001), increased age (AOR=2.192, 95% CI: 1.116–4.307, P<0.023) and good glycaemic control (AOR=1.594, 95% CI: 1.056–2.407, P=0.027), whereas abdominal obesity was associated wih female sex (AOR=2.654, 95% CI: 1.507–4.671, P<0.001) and insulin treatment (AOR=2.927, 95% CI: 1.031–8.757, P=0.048).ConclusionOverweight, general obesity and abdominal obesity were high among participants, especially among women. Taken together, these findings urge the implementation of a roadmap for this diabetic subpopulation to have a new lifestyle.     

葛根素治疗2型糖尿病的药理机制和临床进展

葛根素具有降血糖、降血脂、改善胰岛素抵抗、抗氧化应激、减轻炎性反应等作用。葛根素干预可部分改善糖尿病并延缓其并发的视网膜、肾脏、心血管及神经病变等并发症的发生发展,可能成为临床治疗糖尿病的有效药物。     

The impact of concurrent HIV and type II diabetes on immune maturation,immune regulation and immune activation

Chronic immune activation and inflammation are constant findings in people living with HIV (PLWH) and contribute to the risk of non‐AIDS‐related morbidities, including cardiovascular diseases (CVD). Type 2 diabetes (T2D) is also characterized by immune activation and inflammation. We aimed to investigate the impact of concurrent HIV infection and T2D on T‐cell subsets. The study included PLWH with T2D (HIV+T2D+, N = 25) and without T2D (HIV+T2D?, N = 25) and HIV‐negative controls with T2D (HIV?T2D+, N = 22) and without T2D (HIV?T2D?, N = 28). All PLWH in the study were receiving combination antiretroviral therapy. We examined T‐cell homeostasis by determining T‐cell subsets (immune maturation, immune regulation and immune activation) using flow cytometry. HIV+T2D? had lower proportion of Tc17 cells and higher proportion of apoptotic cells than HIV?T2D?. When comparing HIV+T2D+ and HIV+T2D? a lower proportion of CD4+ recent thymic emigrants (RTE) was found (p = 0.028). Furthermore, HIV+T2D+ had a higher proportion of non‐suppressive CD4+ Tregs compared to HIV+T2D? (p = 0.010). In conclusion, even in the setting of treated HIV infection, distinct immunological alterations are found. In PLWH with concomitant T2D, most alterations in T‐cell subsets were related to HIV and only few differences were found between PLWH with and without diabetes.     

2型糖尿病患者生存质量影响因素HMM模型的二次拟合

目的评价隐Markov模型在2型糖尿病不同发展阶段影响因素分析中的拟合稳健性。方法将697例2型糖尿病患者资料分成两个亚组,对2型糖尿病的资料用隐Markov模型进行重新拟合。结果两个亚样本模型参数相差基微。除职业因素外,有11项因素对2型糖尿病影响均有统计学意义（P〈0．05）;两个亚样本与原样本比较,其最大误差ME〈0．05,两次隐Markov模型拟合结果一致。结论隐Markov模型拟合2型糖尿病的数据有较好的稳定性,可以用于慢性病生存质量影响因素资料的分析。     

The changes in immune cell concentration during the progression of pre-diabetes to type 2 diabetes in a high-fat high-carbohydrate diet-induced pre-diabetic rat model

Pre-diabetes is a long-lasting condition that precedes type 2 diabetes (T2D). T2D has been shown to suppress the immune response. However, it remains unclear if immune activation occurs before the onset of T2D during the progression of the pre-diabetic state. This study sought to characterize the changes in general immunity occurring during the progression from pre-diabetes to T2D. Male rats were fed a high-fat high-carbohydrate diet for 20?weeks (pre-diabetes induction period) and kept on the same diet being monitored for a further 12?weeks (experimental period). Blood was collected for haemocytometer analysis on week 0, 4, 8, and 12 of the experimental period after which the animals were sacrificed. Plasma was collected from centrifuged blood for ELISA (TNF-α, CRP, P-selectin, CD40?L, fibrinogen, and IL-6). Blood neutrophils percentage significantly decreased at week 12 possibly due to recruited neutrophils migrating to an inflamed area such as visceral adipose tissue as further observed. Due to hyperglycaemia, there was significant increase in blood lymphocytes percentage at week 12. Blood monocytes percentage significantly increased at week 12. Monocytes recruited and circulated in blood due to hyperglycaemia for glucose uptake to decrease it from circulation. Blood eosinophils percentage significantly decreased at week 12. Eosinophils migrated to inflamed areas such as visceral adipose tissue as further observed. Blood basophils percentage significantly increased due to their recruitment and activation. TNF-α, CRP, and IL-6 increased significantly after 12?weeks. There was also upregulation of fibrinogen, P-selectin, and CD40L. The results of this study show that there are changes in immune cells concentration and that immune cells such as neutrophils and eosinophils migrate to inflamed areas such as adipose tissue. There is also upregulation of various inflammatory cytokines. Based on these findings, immune activation begins during the pre-diabetic state as there is upregulation of inflammatory markers.     

Prediction of prevalence of type 2 diabetes in Rwanda using the metropolis-hasting sampling

In this work, we predict the prevalence of type 2 diabetes among adult Rwandan people. We used the Metropolis-Hasting method that involved calculating the metropolis ratio. The data are those reported by World Health Organiation in 2015. Considering Suffering from diabetes, Overweight, Obesity, Dead and other subject as states of mathematical model, the transition matrix whose elements are probabilities is generated using Metropolis-Hasting sampling. The numerical results show that the prevalence of type 2 diabetes increases from 2.8% in 2015 to reach 12.65% in 2020 and to 22.59% in 2025. Therefore, this indicates the urgent need of prevention by Rwandan health decision makers who have to play their crucial role in encouraging for example physical activity, regular checkups and sensitization of the masses.     

A cluster randomised controlled trial of the effect of a treatment algorithm for hypertension in patients with type 2 diabetes

BACKGROUND: Good blood pressure (BP) control reduces the risk of complications in people with type 2 diabetes, yet many do not achieve this. Guidelines for managing hypertension recommend increasing antihypertensive medications until control is achieved, but the effect of such recommendations in routine primary care is unknown. AIM: To evaluate the effectiveness of a BP treatment algorithm in primary care patients with type 2 diabetes. DESIGN OF STUDY: A cluster randomised controlled trial of 1534 patients with type 2 diabetes. SETTING: Forty-two practices in Nottingham, UK. METHOD: Practices were randomised to continue usual care or to use a treatment algorithm designed so that practice nurses and GPs would increase antihypertensive treatment in steps until the target of 140/80 mmHg was reached. Participants were assessed by a clinical interview and case note review at recruitment and at 1 year. The primary outcome measure was the proportion of participants achieving target BP at 1 year. RESULTS: At 1 year there was no difference between the proportions of participants with well controlled BP in the intervention and control arms (36.6% versus 34.3%; P = 0.27). Mean systolic and diastolic blood pressures were identical in the two arms (143/78 mmHg). There was some evidence that participants in the intervention arm were more likely to be receiving higher doses of their antihypertensive drugs, although there was no significant difference in the number of different antihypertensive drugs prescribed. Participants in the intervention arm had a higher rate of primary care BP-related consultations over 12 months than those receiving usual care (rate ratio = 1.55, 95% confidence interval [CI] = 1.26 to 1.88, P<0.001). CONCLUSION: Despite increased monitoring and possibly higher doses of medication there was no improvement in blood pressure control. Improvements achieved by specialist nurse-led clinics in secondary care may not translate to people with type 2 diabetes in primary care settings.     

Self-reported effects of attending the Health Foundation's Co-Creating Health self-management programme for patients with type 2 diabetes mellitus in London,England

Introduction

The purpose of this study was to determine the impact of the Health Foundation''s Co-Creating Health (CCH) group self-management programme (SMP) for adult patients with type 2 diabetes on patient activation and quality of life.

Material and methods

We conducted a multisite longitudinal study of 283 patients (mean age 62.3 years, SD 11.1; 43% ethnic minority; 51% female). Primary outcomes were patient activation, and diabetes and health related quality of life. Secondary outcomes included health status, psychological distress, and self-management ability. Data were collected immediately before the first SMP session (baseline) and 6 months after completing the programme. Quantitative analyses were based on mixed models using intent-to-treat and per-protocol procedures.

Results

Sixty percent of patients who signed up for SMP completed the programme. Patient activation significantly improved 6 months after the SMP (p < 0.0001), and 60.2% of course completers showed meaningful improvement. Diabetes-related quality of life also improved significantly 6 months post course (p < 0.0001). About a quarter of SMP completers showed substantial improvement in self-management skills.

Conclusions

Attending the UK SMP for adults with type 2 diabetes leads to improvements in patient activation, diabetes-related quality of life, and improved confidence and ability to self-manage their condition. Improvement in patient activation is an important finding because activated patients participate in collaborative decision-making with their clinicians, report improved health-related behaviours and clinical outcomes, and better adhere to treatment.     

Defining the genetic contribution of type 2 diabetes mellitus

Type 2 diabetes mellitus is a common multifactorial genetic syndrome, which is determined by several different genes and environmental factors. It now affects 150 million people world wide but its incidence is increasing rapidly because of secondary factors, such as obesity, hypertension, and lack of physical activity. Many studies have been carried out to determine the genetic factors involved in type 2 diabetes mellitus. In this review we look at the different strategies used and discuss the genome wide scans performed so far in more detail. New technologies, such as microarrays, and the discovery of SNPs will lead to a greater understanding of the pathogenesis of type 2 diabetes mellitus and to better diagnostics, treatment, and eventually prevention.     

抗焦虑和抗抑郁治疗对2型糖尿病患者血糖水平的影响

目的 探讨抗焦虑和抗抑郁治疗对2型糖尿病患者血糖水平的影响.方法 将60例应用Zung抑郁自评量表(SDS)及焦虑自评量表(SAS)评定合并焦虑抑郁倾向的2型糖尿病患者随机分为对照组及治疗组,对照组单纯降糖治疗,治疗组降糖联合抗焦虑抑郁治疗,比较治疗前后焦虑抑郁指数SAS、SDS以及血糖的变化.结果 与治疗前比较,对照...     

2型糖尿病合并甲状腺功能减退的影响因素分析研究

目的：探究2型糖尿病(type 2 diabetes mellitus,T2DM)合并甲状腺功能减退的影响因素。方法：选择2013年1月至2015年6月在我院接受治疗的2型糖尿病患者784例。将2型糖尿病合并甲状腺功能减退的71例患者作为甲减组,甲状腺功能正常的713例患者作为T2DM组。比较甲减组和T2DM组患者的临床资料,用单因素分析和Logistic回归分析其影响因素。结果：2型糖尿病合并甲状腺功能减退的发病率为9.06%,其中临床甲减16例,为2.04%,亚临床甲减55例,为7.02%。比较甲减组与T2DM组患者的一般临床资料,发现2型糖尿病合并甲状腺功能减退与年龄、糖尿病病程、ABI、FCP、E/A、TC、TG、LDL-C、Lp(a)、S-CRP、UAER、TPO-Ab、性别、吸烟、冠心病、DN、DNP、DR、DF、PAD、DM治疗方式有关(P<0.05)。将2型糖尿病患者是否合并甲状腺功能减退作为因变量,将上述因素纳入Logistic多元回归分析,结果显示年龄、吸烟、胰岛素治疗、TPO-Ab是2型糖尿病患者合并甲状腺功能减退的独立危险因素。结论：年龄、吸烟、胰岛素治疗、TPO-Ab是2型糖尿病患者合并甲状腺功能减退的独立危险因素,2型糖尿病患者应定期进行甲状腺功能检查,以便及早诊断和干预甲状腺功能减退。     

Manifestations of type 2 diabetes in corneal endothelial cell density,corneal thickness and intraocular pressure

We sought to evaluate central corneal thickness (CCT), corneal endothelial cell density (ECD) and intraocular pressure (IOP) in patients with type 2 diabetes mellitus (DM) and to associate potential differences with diabetes duration and treatment modality in a prospective, randomized study. We measured ECD, CCT and IOP of 125 patients with type 2 DM (mean age 57.1±11.5 years) and compared them with 90 age-matched controls. Measured parameters were analyzed for association with diabetes duration and glucose control modalities (insulin injection or oral medication) while controlling for age. In the diabetic group, the mean ECD (2511±252 cells/mm²), mean CCT (539.7±33.6 µm) and mean IOP (18.3±2.5 mmHg) varied significantly from those the control group [ECD: 2713±132 cells/mm² (P<0.0001), CCT: 525.0±45.3 µm (P=0.003) and IOP: 16.7±1.8 mmHg (P<0.0001)]. ECD was significantly reduced by about 32 cell/mm² for diabetics with duration of >10 years when compared with those with duration of <10 years (P<0.05). CCT was thicker and IOP was higher for diabetics with duration of >10 years than those with duration of <10 years (P>0.05). None of the measured parameters was significantly associated with diabetes duration and treatment modality (P>0.05). In conclusion, subjects with type 2 DM exhibit significant changes in ECD, IOP and CCT, which, however, are not correlated with disease duration or if the patients receive on insulin injection or oral medications.     

他汀类药物在2型糖尿病综合治疗中的研究进展

2型糖尿病的患病率正在世界范围内逐年增加,同时与之相关的微血管并发症和大血管并发症发生率也显著增加.他汀类药物除了调脂作用以外,还可通过抑制炎症因子、保护血管内皮细胞功能及抗氧化应激等途径延缓糖尿病并发症发生发展,显著减少心血管事件.总体而言,及时启动他汀类药物对2型糖尿病的治疗是有益的,尤其是伴有心血管危险因素的糖尿病患者.     

脂联素多聚体及基因多态性与2型糖尿病

脂联素是新近发现的脂肪细胞分泌的特异性细胞因子,在机体糖和脂肪代谢、维持能量平衡过程中发挥重要作用。正常人脂联素基因序列中存在相当数量的等位基因单核苷酸多态性(SNPs),其中5′侧翼区-11377(C/G)和外显子2 45(T/G)遗传多态性与脂联素血浆水平以及与肥胖、2型糖尿病(type 2 d iabetes m ellitus,T2DM)和冠状动脉粥样硬化有关。脂联素在血浆中以高分子量(h igh molecu lar we ight,HMW)的多聚体和低分子量(low molecu lar we ight,LMW)的六聚体2种形式存在。HMW脂联素增加与胰岛素敏感性呈正相关,LMW脂联素的功能需要进一步探讨研究。