药物和运动疗法对Ⅱ型糖尿病患者血糖的影响

目的：比较30例糖尿病患者有3种不同治疗方案中空腹血糖与餐后血糖值，以证明药物和运动疗法比单纯药物治疗有更加明显的降糖作用。方法：所有患者均进行3种实验。①口服达美康40mg后进食早餐，然后休息。②口服达美康80mg后进食早餐，然后休息。③口服达美康40mg后进食早餐，休息1h后中等速度步行1h.3种实验均在早餐前未服药时测空腹血糖，早餐后1和2h各测1次血糖浓度。结果：30例患者在3种实验中空腹血糖值相近，差异无显著性，早餐后2h 糖浓度显示，用达美康80mg后血糖浓度低于40mg的治疗，两者比较P＜0．05；用达美康40mg＋步行1h血糖浓度低于达美康40mg的治疗，两者比较P＜0．05；用达美康80mg治疗后血糖浓度与40mg＋步行1h相近，两者比较P＞0．05。结论口服降糖药治疗的糖尿病患者坚持适当的运动疗法，可减少用药量，血糖控制稳定时可使用最小药量维持。     

2型糖尿病合并高血压患者24h动态血压变化分析

目的：了解2型糖尿病合并高血压患者动态血压变化特点。方法：对118例2型糖尿病合并高血压患者,292例原发性高血压患者进行24 h动态血压监测,进行比较分析。结果：糖尿病合并高血压患者24 h平均收缩压、白天平均收缩压、夜间平均收缩压、24 h平均收缩压负荷、白天平均收缩压负荷、夜间平均收缩压负荷均高于原发性高血压患者,有统计学差异;血压昼夜节律与原发性高血压患者比较有统计学差异。结论：糖尿病合并高血压患者收缩压及收缩压负荷偏高,昼夜节律减弱或消失,因此应积极控制收缩压、收缩压负荷,恢复正常昼夜节律。     

血糖控制良好的2型糖尿病患者血糖波动分析

目的观察血糖控制良好的2型糖尿病患者血糖波动情况。方法选取62例2型糖尿病患者，根据其HbAlc值分为A、B、C、D四组。用动态血糖监测系统（CGMs）进行48h血糖监测，分析其血糖波动相关指标。结果D组的HbAlc显著大于其他三组，四组间的日内平均血糖波动幅度和日内血糖波动次数无差别。糖化血红蛋白与日内平均血糖波动幅度、日内血糖波动次数和日问血糖平均绝对差均不相关。结论血糖控制良好的2型糖尿病患者存在明显的血糖波动，主要是由餐后血糖升高引起。     

胃转流手术对超重2型糖尿病患者血糖影响因素分析

【目的】观察胃转流手术影响超重2型糖尿病患者血糖是否与手术引起的体重减低有关。【方法】超重2型糖尿病患者饮食控制组（A组16例）和胃转流手术组（B组16例）。两组患者年龄，体重，身体质量指数，糖尿病病程和干预后体重减少无差异。B组术前及术后1个月，A组减重前及减重后分别口服75克葡萄糖测定空腹及2h血糖，胰岛素，C肽，胰高血糖素样肽（GLP）-1水平。比较两组之间的差异。【结果】与A组比较，B组空腹血糖及2h血糖降低，空腹及2hGLP-1增长。【结论】胃转流手术后，更多的GLP-1释放可能与降低血糖有关，而非单纯与手术引起的体重减少有关。     

Sudden Cardiac Death in Patients With Type 1 Versus Type 2 Diabetes

ObjectiveTo investigate the association between type 1 diabetes mellitus (T1D) and type 2 diabetes mellitus (T2D) with risk of sudden cardiac arrest (SCA).MethodsIn a prospective community-based study of SCA from February 1, 2002, through November 30, 2019, we ascertained 2771 cases age 18 years of age or older and matched them to 8313 controls based on geography, age, sex, and race/ethnicity. We used logistic regression to evaluate the independent association between diabetes, T1D, T2D, and SCA.ResultsPatients had a mean age of 64.5±15.9 years, were 33.3% female and 23.9% non-White race. Overall, 36.7% (n=1016) of cases and 23.8% (n=1981) of controls had diabetes. Among individuals with diabetes, the proportion of T1D was 6.5% (n=66) among cases and 2.0% among controls (n=40). Diabetes was associated with 1.5-times higher odds of SCA. Compared with those without diabetes, the odds ratio and 95% CI for SCA was 4.36 (95% CI, 2.81 to 6.75; P<.001) in T1D and 1.45 (95% CI, 1.30 to 1.63; P<.001) in T2D after multivariable adjustment. Among those with diabetes, the odds of having SCA were 2.41 times higher in T1D than in T2D (95% CI, 1.53 to 3.80; P<.001). Cases of SCA with T1D were more likely to have an unwitnessed arrest, less likely to receive resuscitation, and less likely to survive compared with those with T2D.ConclusionType 1 diabetes was more strongly associated with SCA compared with T2D and had less favorable outcomes following resuscitation. Diabetes type could influence the approach to risk stratification and prevention of SCA.     

30%LCD饮食联合抗阻-有氧运动对老年2型糖尿病患者血糖稳定性及血脂水平的影响

目的研究30%低碳水化合物饮食(LCD)联合抗阻-有氧运动对老年2型糖尿病(T2DM)患者血糖稳定性及血脂水平的影响。方法选取2019年6月-2020年6月我科收治的149例老年T2DM患者作为研究对象,采用随机数字表法分为对照组74例(接受常规饮食护理及健康教育)和观察组75例(给予30%LCD联合抗阻-有氧运动)。比较两组血糖稳定性、血脂水平。结果观察组干预后CV、MAGE、PPGE、MODD、SDBG及TC、TG、HDL-C、LDL-C水平明显优于对照组(P<0.05)。结论30%LCD联合抗阻-有氧运动对老年T2DM患者有明显疗效,能够通过减少糖分摄入、加速脂肪氧化分解等机制,改善血糖稳定性及血脂水平,可应用于临床。     

改变饮食顺序对社区2型糖尿病患者血糖的影响

目的 探讨改变进餐饮食顺序对社区2型糖尿病患者血糖的影响.方法 选择居住在3506社区2型糖尿病患者238例,改变进餐饮食顺序:先食高纤维蔬菜,再进食含有蛋白质或脂肪的菜,最后食用含碳水化合物的主食,观察饮食顺序改变前后患者血糖的变化和改变饮食顺序的依从性.结果 改变饮食顺序后患者的空腹血糖,早餐、中餐与晚餐后2h血糖,糖化血红蛋白显著低于改变前(P<0.00),中餐和晚餐前血糖与改变前无明显差异(P>0.05),患者的依从性为95.0%.结论 未改变饮食总量,仅改变饮食顺序的方法有利于改善2型糖尿病患者的血糖,良好的依从性有利于患者的长期坚持.     

康复运动训练对急性脑卒中后疲劳患者日常活动能力的影响

目的探讨急性脑卒中后疲劳的有效治疗措施及其对患者日常活动能力的影响。方法对96例急性脑卒中后疲劳患者进行康复运动训练,根据患者实际情况制定康复运动训练内容与强度,并根据训练时日常生活活动能力的改善情况及时调整训练内容及强度。所有患者在康复运动训练治疗前及治疗1个月后均进行日常生活活动能力评分。结果患者经康复运动训练后,日常生活活动能力评分较其治疗前明显增加[(72.28±19.47)分比(15.36±8.09)分,P<0.05]。结论对急性脑卒中后疲劳患者给予针对性的康复运动训练,可改善患者日常生活活动能力。     

Perioperative Dexamethasone for Patients With Diabetes and Its Effect on Blood Glucose After Surgery

PurposeP Perioperative administration of single-dose dexamethasone helps reduce postoperative nausea and vomiting, inflammation, and pain. However, it is unclear which dose achieves these effects while minimizing the hyperglycemic impact in patients with diabetes. The purpose of this review was to elucidate the most appropriate perioperative dose of dexamethasone for diabetic patients, and whether it is necessary to withhold it in patients with poor glycemic control.DesignA systematic review.MethodsA literature search using PubMed and Cochrane Database of Systematic Reviews revealed 17 potential evidence sources. Eight sources met the inclusion criteria. Sources included one systematic review with meta-analysis, one randomized control trial, and six observational studies.FindingsEvidence suggests diabetic patients who receive dexamethasone perioperatively are more likely to develop postoperative hyperglycemia, with a maximum blood glucose increase of 30 to 45 mg/dL in the first 24 hours following a single dose. One study described increased blood glucose levels with escalating doses, but no other sources have supported that finding. The available studies were markedly heterogeneous in both design and proportion of diabetic subjects included, and most were of low quality.ConclusionsThere is not enough evidence to quantify the hyperglycemic effect of commonly used dexamethasone doses, and rigorous studies are needed to inform practice.     

电针对脑梗死患者日常生活活动能力的影响

目的探讨电针结合现代康复技术对脑梗死患者日常生活活动能力的影响.方法脑梗死患者105例分为综合康复组(n=35)、普通康复组(n=35)和对照组(n=35),综合康复组接受电针、康复训练、高压氧等综合治疗,普通康复组除电针外其余治疗同综合康复组,对照组未在院接受任何治疗.分别在治疗前、治疗后24 d、治疗后36 d 用功能独立性评定(FIM)和 Barthel指数进行评定.结果治疗后36 d,综合康复组 FIM 评分、Barthel指数评分较普通康复组、对照组改善更明显(P<0.01).结论在综合康复基础上结合电针,可进一步提高患者日常生活活动能力.     

Effects of a Single Bout of Interval Hypoxia on Cardiorespiratory Control and Blood Glucose in Patients With Type 2 Diabetes

OBJECTIVE

Hypoxia may cause functional autonomic imbalance in diabetes. Intermittent hypoxia (IH), a technique improving the adaptation to hypoxia, might improve cardiorespiratory reflexes and, ultimately, blood glucose concentrations in patients with type 2 diabetes. We tested whether a single bout of IH could initiate a long-lasting response potentially leading to better adaptation to hypoxia.

RESEARCH DESIGN AND METHODS

In 14 patients with type 2 diabetes without autonomic complications, we measured blood pressure, heart rate, oxygen saturation, chemoreflex (hypoxic and hypercapnic ventilatory responses, ventilatory recruitment threshold), and baroreflex sensitivity before, immediately after, and 3 and 6 h after a 1-h single bout of IH (6-min breathing of 13% oxygen mixture 5 times each separated by 6-min recovery). The measurements were repeated on a placebo day (at least 1 week apart, in random sequence) when subjects were only breathing room air (single-blind protocol).

RESULTS

IH significantly increased hypercapnic ventilatory responses and reduced ventilatory recruitment threshold, and increased oxygen saturation and blood pressures, whereas increases in heart rate variability and baroreflex sensitivity were not significant. Blood glucose significantly decreased after IH. No such changes were observed during the placebo day, except an increase in oxygen saturation. Some of the effects lasted 3 h after IH, and some even persisted until 6 h after IH.

CONCLUSIONS

A single bout of IH induced an initial adaptation to hypoxia, with improvement in cardiorespiratory reflexes and reduction in blood glucose. Patients with type 2 diabetes could potentially benefit from the application of a full (>2 weeks) IH intervention.In diabetes, abnormalities of the autonomic nervous system (ANS) represent one important complication of the disease (1) because it can predispose to severe cardiovascular events (2,3). ANS dysfunction is not exclusively induced by anatomic lesions but has an important functional component (4). Low oxygen content (hypoxia), described in most organs and tissues of diabetic patients (5–9), recently has been suggested as one cause of ANS abnormalities (10,11). As a consequence, improvement of existing hypoxia might improve autonomic abnormalities that, in turn, also might have consequences on glucose metabolism.One possible strategy to improve hypoxia could be the application of intermittent hypoxia (IH). IH improves exercise capacity in athletes, improves the acclimatization to high altitude in climbers (12,13), and improves ANS in various patients (14,15). The technique consists of intermittent exposures to hypoxic stimuli (3–5 times per day, lasting at least 5–6 min, and spaced at least by 5–6 min) repeated over 2–3 weeks. The principle of the method is like any other type of training: a given stress (here, hypoxia), if appropriately administered and spaced in time, creates a counter-regulatory response that lasts longer and, when repeated a sufficient number of times, leads to a sustained “training” effect (16). IH could increase resting oxygen saturation by increasing the ventilation and the chemoreflexes and, consequently, could reduce the sympathetic activation associated with hypoxia, as previously shown in patients with chronic bronchitis (17).However, until now the effects of IH in patients with type 2 diabetes are unknown, even though respiratory and cardiovascular reflexes (18–24) and molecular responses to hypoxia (25) have been found to be generally impaired. Therefore, performing a short course of IH might initiate a chain of events that may eventually lead to an “acclimatization” process (when prolonging IH to >1 day). The consequence of relieving hypoxia should be restoration and correction of the cardiorespiratory reflexes.If positive results could be found from this initial study performed in type 2 diabetic subjects without complications, then performing a full training period of IH could be justified in diabetes to test whether this intervention is able to prevent the development of diabetes complications.     

二苯乙烯对2型糖尿病大鼠降血糖作用的实验研究

目的探讨二苯乙烯对2型糖尿病降血糖作用。方法 50只Wistar雄性大鼠随机分为模型组(n=40)和对照组(n=10)。模型组大鼠口服脂肪乳20 ml/kg,连续40 d,分别在第41、42天时模型组大鼠腹腔注射链脲佐菌素120 mg/kg、100 mg/kg,各1次。建立模型后,将模型组大鼠随机分为4组,每组10只。分别灌胃给予二苯乙烯500 mg/kg、200 mg/kg、100 mg/kg和二甲双胍100 mg/kg。全自动生化分析仪测定血糖、血脂水平;分光光度计测肝糖元含量。结果 建模后,大鼠的血糖(Glu)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)水平分别升高140.89%、25.77%、275.52%、105.54%和31.25%(P<0.01);给予模型组大鼠二苯乙烯20 d后,血糖和血脂水平比给药前降低(P<0.05),肝糖元含量比对照组增加8.06%~16.17%。结论二苯乙烯具有降低2型糖尿病大鼠血糖和血脂、增加肝糖元含量的作用。     

规范胰岛素注射部位对2型糖尿病患者血糖的影响

目的 探讨规范胰岛素注射部位对2型糖尿病患者血糖的影响.方法 使用诺和胰岛素的2型糖尿病患者188例,随机分为观察组和对照组各94例.观察组每餐固定胰岛素注射部位:每日注射2次者,早晨进行腹部注射,晚上进行臀部注射;每日注射4次者,早晨和下午进行腹部注射,中午进行上臂注射,睡前进行臀部注射.对照组随机选择注射部位.观察两组患者血糖达标时间.结果 观察组血糖达标时间比对照组短(P=0.00).结论 规范胰岛素注射部位有利于控制2型糖尿病患者血糖,使患者血糖早日达标.     

双时相门冬胰岛素30对2型糖尿病患者血糖的影响分析

目的探讨双时相门冬胰岛素30对2型糖尿病患者血糖的影响。方法选取我院收治的60例经口服降糖药无法达到满意降糖效果的2型糖尿病人作为研究对象。在口服降糖药的基础上使用双时相门冬胰岛素30皮下注射治疗半年,观察记录患者血糖及相关指标的变化。结果经过半年的治疗,使用双时相门冬胰岛素30的患者的空腹血糖、餐后2h血糖、糖化血红蛋白、甘油三酯水平显著降低,糖化血红蛋白水平〈7%和≤6.5%者所占的比例显著提高,与治疗前差异明显,P〈0.05,具有统计学意义。结论服用口服降糖药血糖控制不理想的患者加服双时相门冬胰岛素30可以有效控制患者的血糖值,改善血脂代谢,同时有助于降低2型糖尿病并发症的发生几率,使用方便,安全性好。     

早期康复对脑卒中患者日常生活活动能力的影响

目的观察早期康复对急性脑卒中偏瘫患者日常生活活动能力（ADL）的影响。方法66例急性脑卒中偏瘫患者随机分为康复组（n=34）和对照组（n=32），均给予神经内科常规药物加针灸治疗，康复组在此基础上，于入院1周内辅以康复治疗，比较两组患者的疗效。结果康复组患者的疗效明显优于对照组，Barthel指数评分明显好于对照组（P＜0．01）。结论早期康复治疗可以明显改善急性脑卒中偏瘫患者的ADL。     

动机性访谈对2型糖尿病患者血糖影响的meta分析

目的系统评价动机性访谈在2型糖尿病（T2DM ）患者中应用的效果。方法计算机检索Co‐chrane Library、MEDLINE、EMbase、EBSCO host、CNKI、CBM、万方数据（检索时间从1989年1月至2013年12月）中关于动机性访谈对T2DM患者血糖控制影响的随机对照试验（RCT ）。由3名人员对文献质量进行严格评价和资料提取,对符合质量标准的文献进行M eta分析。结果共纳入7篇随机对照试验,试验组412例,对照组384例。与常规糖尿病（DM ）健康教育相比,动机性访谈可以明显的降低T2DM患者的血糖。糖化血红蛋白（HbA1c）[WMD＝－0．52,95％ CI（－0．85,－0．19）,P ＜0．01]、空腹血糖（FPG）[加权均数差（WMD）＝－0．97,95％ CI（－1．33,－0．60）,P ＜0．00001]和餐后2 h血糖（2hPG）[WMD＝－2．03,95％ CI（－2．58,－1．49）,P＜0．01]。结论动机性访谈可以改善T2DM患者的HbA1c、FPG和2hPG控制的情况。     

优质护理对2型糖尿病失眠患者血糖及睡眠质量的影响

目的:探讨优质护理对2型糖尿病失眠患者血糖及睡眠质量的影响.方法:选取2019年4月至2020年4月茂名市中医院收治的2型糖尿病失眠患者80例作为研究对象,按照随机数字表法随机分为对照组和观察组,每组40例,对照组实施基础护理,观察组实施优质护理,比较2组患者护理后的血糖水平和睡眠质量.结果:1)观察组患者护理后空腹血...     

A 10-s Sprint Performed After Moderate-Intensity Exercise Neither Increases nor Decreases the Glucose Requirement to Prevent Late-Onset Hypoglycemia in Individuals With Type 1 Diabetes

OBJECTIVE

To determine whether performing a 10-s sprint after moderate-intensity exercise increases the amount of carbohydrate required to maintain euglycemia and prevent late-onset postexercise hypoglycemia relative to moderate-intensity exercise alone.

RESEARCH DESIGN AND METHODS

Seven individuals with type 1 diabetes underwent a hyperinsulinemic-euglycemic clamp and performed 30 min of moderate-intensity exercise on two separate occasions followed by either a 10-s maximal sprint effort or no sprint. During the following 8 h, glucose infusion rate to maintain euglycemia and rates of glucose appearance and disappearance were measured continuously.

RESULTS

In response to exercise and throughout the 8-h recovery period, there were no differences in glucose infusion rate, blood glucose levels, plasma insulin concentrations, and rates of glucose appearance and disappearance between the two experimental conditions (P > 0.05).

CONCLUSIONS

A 10-s sprint performed after 30 min of moderate-intensity exercise does not affect the amount of carbohydrate required to maintain euglycemia postexercise in individuals with type 1 diabetes.Recently, we have shown that a 10-s sprint carried out before (1) or after (2) moderate-intensity exercise performed under hyperinsulinemic conditions opposes the fall in glycemia during early recovery, with no carbohydrate intake required to prevent blood glucose from falling postexercise. These findings suggest that sprinting may offer a novel approach for reducing the risk of exercise-mediated hypoglycemia in type 1 diabetes (T1D), and this approach has therefore been included in some recent guidelines for hypoglycemia prevention (3,4).One possible limitation of combining sprinting with moderate-intensity exercise to prevent postexercise hypoglycemia is that the reduced risk of early postexercise hypoglycemia may be offset by an increased risk of late-onset postexercise hypoglycemia (LOPEH) (5,6). In support of this view, a short sprint not only can deplete muscle glycogen stores to the same extent as prolonged exercise of low intensity (7,8) but also may enhance insulin sensitivity later during recovery, as suggested by the recent finding that insulin sensitivity is increased 24 h after a prolonged sprint (9). For these reasons, the objective of this study was to determine whether performing a 10-s sprint after moderate-intensity exercise increases the amount of carbohydrate required to maintain stable glycemia late during recovery, thus providing an indirect assessment of the risk of LOPEH. This is an important issue to address before advocating the use of sprinting in hypoglycemia prevention.     

Cost-effectiveness of Insulin Degludec Versus Insulin Glargine in Insulin-naive Chinese Patients With Type 2 Diabetes

Purpose

The goal of this study was to investigate the long-term economic outcomes of insulin degludec versus insulin glargine use in Chinese patients with type 2 diabetes mellitus (T2DM) whose oral antidiabetic drugs did not provide sufficient glycemic control.