继发失效2型糖尿病应用诺和锐30的疗效

对60例口服降糖药继发失效的2型糖尿病患者，停用口服药后改用诺和锐30皮下注射。用药10天后，病人的空腹血糖及餐后2h血糖显著下降（P〈0．01）。此时平均诺和锐30用量为38u／日，提示诺和锐30可有效控制继发失效的血糖水平。     

口服药联合甘精胰岛素治疗2型糖尿病观察

选择56例采用饮食控制及口服降糖药物治疗血糖控制不满意的2型糖尿病病例,给予每天注射一次甘精胰岛素治疗。结果表明,治疗后FBG、PBG、HbA1c均较前明显下降,P〈0.01,且低血糖发生率低。表明2型糖尿病使用甘精胰岛素有良好的效果和安全性。     

对2型糖尿病门诊口服降糖药用药分析

目的分析探讨2型糖尿病门诊口服降糖药用药情况。方法选取2012年9月—2014年9月该院门诊收治的120例糖尿病患者作为研究对象,采用DDD分析法对该组患者2年内DDDs(药物使用频度)、DDC(药品限定日费用)等情况进行分析,并按照顺序排列。结果格列齐特、阿卡波糖、格瑞列奈片、格列吡嗪以及格列美脲、格列喹酮、二甲双瓜是门诊常用的口服降糖药物;药物种类包括双胍类、胰岛素增敏剂、第二代磺酰脲类、胰岛素促泌剂等,阿卡波糖、格瑞列奈片、格列齐特使用排名情况变化不大,格列吡嗪变化最大,其他药物两年之内的变化情况并不明显。结论针对2型糖尿病患者,门诊选择给药方案应根据患者实际血糖水平、胰岛素功能情况以及并发症发生情况等方面进行综合考虑,并选择针对性阶梯治疗方案。     

治疗2型糖病尿口服药心血管病风险评估

糖尿病在血脂、血糖、血压控制不良的情况下,与心血管病具有相同的风险性。罗格列酮降糖药在临床应用过程中降糖同时使心血管最大收益。但是,仍要考虑对心血管的不良影响。严格掌握适应症,提示该研究应该进一步关注降糖药的心血管安全性。     

2型糖尿病及口服降糖药与痴呆发生风险的关系

2型糖尿病与老年痴呆的发生是密不可分的,而正确合理地使用口服降糖药(例如二甲双胍、噻唑烷二酮类、磺脲类、二肽基肽酶-4抑制剂等)在治疗2型糖尿病的同时还可能会有效降低患者将来罹患痴呆的风险,可为糖尿病的治疗提供新的思路和方向。     

老年2型糖尿病患者口服降糖药方法的探讨

我科采用餐前顿服降糖药的方法来减少患者服药次数，同样能良好控制空腹和餐后血糖。现将研究的方法及结果报告如下。     

格列吡嗪控释片治疗2型糖尿病有效性和安全性的多中心临床研究

目的 评价格列吡嗪控释片(瑞易宁)治疗2型糖尿病的有效性、安全性.方法 为多中心、开放性临床观察性研究.675例患者完成了本研究.对单纯生活方式干预(n=134)或已用非胰岛素促泌剂(n=305)治疗,但血糖控制不佳的患者,加用瑞易宁;对已用其他磺脲类或格列奈类促泌剂(n=236)治疗,但血糖控制不佳、安全性不好或生活...     

继发失效2型糖尿病应用诺和锐30的疗效

对60例口服降糖药继发失效的2型糖尿病患者,停用口服药后改用诺和锐30皮下注射.用药10天后,病人的空腹血糖及餐后2h血糖显著下降(P＜0.01).此时平均诺和锐30用量为38u/日,提示诺和锐30可有效控制继发失效的血糖水平.     

口服降糖药联合胰岛素治疗对2型糖尿病合并冠心病患者心血管不良事件的影响

目的探讨联合使用口服降糖药和胰岛素治疗对老年2型糖尿病(T2DM)合并冠心病患者心血管不良事件的影响。方法 T2DM合并冠心病患者102例,按照所采取治疗方法不同,将患者分为观察组与对照组各51例。给予对照组单独胰岛素治疗(日用胰岛素总量>30 U);给予观察组口服降糖药联合较低剂量胰岛素治疗(日用胰岛素总量≤30 U),随访6个月,比较两组空腹血糖、餐后2 h血糖、糖化血红蛋白、低血糖发生情况和心血管不良事件的发生率。结果与对照组相比,观察组心血管不良事件发生率明显下降(P<0.05);两组空腹血糖、餐后2 h血糖、糖化血红蛋白及低血糖发生率等差异无统计学意义(P>0.05)。结论对于老年T2DM合并冠心病患者,口服药联合小剂量胰岛素治疗明显优于单用大剂量胰岛素治疗,可明显降低心血管不良事件的发生率且降糖效果无明显降低。     

Cardiovascular disease in type 2 diabetes: challenge for treatment and prevention

Type 2 diabetes increases the risk of cardiovascular disease (CVD) two- to fourfold compared with the risk in non-diabetic subjects. Although type 2 diabetes is associated with a clustering of risk factors (small, dense low-density lipoprotein [LDL] particles, low high-density lipoprotein [HDL] cholesterol, high triglycerides, elevated blood pressure, obesity, central obesity, hyperinsulinaemia, hyperglycaemia, etc.), the cause for an excess risk of CVD remains unknown. Recent drug treatment trials have indicated that the lowering of total and LDL cholesterol and blood pressure is similarly beneficial in diabetic and non-diabetic subjects. The treatment of hyperglycaemia reduces micro- and macrovascular complications in type 2 diabetic patients. Beta-blocking agents, angiotensin-converting enzyme inhibitors, aspirin, and thrombolytic therapy are also effective in the treatment of CVD amongst diabetic patients.     

Cardiovascular biomarkers in clinical studies of type 2 diabetes

When planning cardiovascular (CV) studies in type 2 diabetes (T2D), selection of CV biomarkers is a complex issue. Because the pathophysiology of CV disease (CVD) in T2D is multifactorial, ideally, the selected CV biomarkers should cover all aspects of the known pathophysiology of the disease. This will allow the researcher to distinguish between effects on different aspects of the pathophysiology. To this end, we discuss a host of biomarkers grouped according to their role in the pathogenesis of CVD, namely: (1) cardiac damage biomarkers; (2) inflammatory biomarkers; and (3) novel biomarkers (oxidative stress and endothelial dysfunction biomarkers). Within each category we present the best currently validated biomarkers, with special focus on the population of interest (people with T2D). For each individual biomarker, we discuss the physiological role, validation in the general population and in people with T2D, analytical methodology, modifying factors, effects of glucose‐lowering drugs, and interpretation. This approach will provide clinical researchers with the information necessary for planning, conducting and interpreting results from clinical trials. Furthermore, a systematic approach to selection of CV biomarkers in T2D research will improve the quality of future research.     

Insulin glargine benefits patients with type 2 diabetes inadequately controlled on oral antidiabetic treatment: an observational study of everyday practice in 12,216 patients

AIMS: This observational study aimed to investigate the long-term efficacy and safety of adding insulin glargine (LANTUS((R))) to support oral antidiabetic (OAD) treatment in patients with type 2 diabetes in everyday practice. METHODS: A 9-month, open-label, multicentre, observational study, with an optional 20-month extension phase, in which add-on insulin glargine therapy was initiated in 12,216 patients with type 2 diabetes inadequately controlled on OADs. The insulin glargine dose was adjusted at the physician's discretion, reflecting everyday practice. The main outcome measures were changes in HbA(1c), fasting blood glucose (FBG), insulin dose and body mass index (BMI). RESULTS: At baseline, mean (+/- s.d.) age was 63.9 +/- 11.3 years; disease duration was >5 years in 47% of patients, 1-5 years in 39% of patients and <1 year in 10% of patients, while 4% of patients were newly diagnosed. Addition of insulin glargine to OAD therapy led to reductions in mean HbA(1c) (-1.5% from 8.7%) and FBG (-69 mg/dl from 202 mg/dl) levels after 3 months, which were maintained after 9 months [HbA(1c): -1.7%; FBG: -71 mg/dl (-3.9 mmol/l)] without an increase in BMI. Similar glycaemic control was observed after 20 months in the 2721 patients in the extension study. Adverse drug reactions were documented in 26 patients (0.2%). Of 47 adverse events documented, 19 were due to hypoglycaemia. CONCLUSIONS: In everyday practice, patients with type 2 diabetes who are inadequately controlled on OADs benefit from add-on basal insulin treatment with insulin glargine as they demonstrate improved glycaemic control without weight gain.     

Impact of demographic characteristics and antihyperglycemic and cardiovascular drugs on the cardiorenal benefits of SGLT2 inhibitors in patients with type 2 diabetes mellitus: A protocol for systematic review and meta-analysis

Background:It is unclear whether demographic characteristics and baseline use of hypoglycemic and cardiovascular drugs significantly affect the efficacy of sodium-glucose transporter 2 (SGLT2) inhibitors on cardiorenal outcomes in patients with type 2 diabetes mellitus (T2DM).Methods:Randomized trials assessing the efficacy of SGLT2 inhibitors on cardiorenal outcomes in adult patients with T2DM were included in analysis. Three endpoints of interest were major adverse cardiovascular events (MACE), hospitalization for heart failure or cardiovascular death (HHF or CV death), and kidney composite outcome (KCO). We performed random-effects meta-analysis using the aggregate data of hazard ratios (HRs) and 95% confidence intervals (CIs). Subgroup analyses were done according to 17 factors of interest, including 7 factors related to demographic characteristics and 10 related to baseline use of antihyperglycemic and cardiovascular drugs such as renin–angiotensin system (RAS) inhibitor. We conducted meta-regression analyses to calculate P values for subgroup differences.Results:Seven trials were included in this meta-analysis. Compared with placebo, SGLT2 inhibitors significantly lowered the risk of MACE (HR 0.90, 95% CI 0.84–0.97) regardless of demographic characteristics and baseline use of insulin, statin or ezetimibe, RAS inhibitor, beta-blocker, and diuretic (P_subgroup from 0.088–0.981); that of HHF or CV death (HR 0.78, 95% CI 0.71–0.85) regardless of demographic characteristics and baseline use of 10 antihyperglycemic and cardiovascular drugs (P_subgroup from 0.147–0.999); and that of KCO (HR 0.63, 95% CI 0.57–0.69) regardless of demographic characteristics and baseline use of statin or ezetimibe, RAS inhibitor, and diuretic (P_subgroup from 0.073–0.918).Conclusions:The cardiorenal benefits of SGLT2 inhibitors were consistent in a broad population of T2DM patients. The findings of this meta-analysis suggest that SGLT2 inhibitors should be recommended in T2DM patients for the prevention of cardiorenal events, regardless of various demographic characteristics and baseline use of various hypoglycemic and cardiovascular drugs.     

Effect of oral antidiabetic drug withdrawal in type 2 diabetes

Oral hypoglycaemic agents were withdrawn in 22 Type 2 diabetic patients to establish whether long-term use of these products is really necessary. Discontinuation of the drugs resulted in significant increases of HbA1 (8.1 +/- 1.1 to 11.3 +/- 2.4%) and fasting (9.1 +/- 2.1 to 13.6 +/- 4.0 mmol l-1) and postprandial (12.3 +/- 3.0 to 18.7 +/- 5.7 mmol l-1) plasma glucose levels after 12 weeks (all p less than 0.01). This was associated with a reduction of fasting (12.4 +/- 6.2 to 8.0 +/- 3.4 mU l-1) and postprandial (35.7 +/- 13.2 to 19.3 +/- 13.4 mU l-1) serum insulin concentrations, and fasting (0.8 +/- 0.4 to 0.5 +/- 0.2 nmol l-1) and postprandial (1.8 +/- 0.6 to 1.0 +/- 0.5 nmol l-1) serum C-peptide concentrations (all p less than 0.01). Only one patient did not show metabolic deterioration after drug withdrawal. In multivariate analysis no significant correlations could be found between measures of baseline diabetic control and the deterioration after drug withdrawal.     

Overnight CSII as supplement to oral antidiabetic drugs in type 2 diabetes

Aim:  To evaluate the potential advantages of a constant overnight subcutaneous delivery of insulin in type 2 diabetic patients who fail to achieve glycaemic control on oral antidiabetics.
Methods:  Ten type 2 diabetic patients treated with oral antidiabetic drugs without gaining sufficient glycaemic control were included in this three-period study. All patients received continuous subcutaneous insulin infusion (CSII) with a short-acting insulin analogue, 2 IU/h, for 8 h during three consecutive nights (period A). Based upon the results from period A, two additional dose regimens of three nights (period B and C) were studied in random order. Serum insulin aspart, human insulin and plasma glucose (PG) profiles were recorded.
Results:  In period A, fasting plasma glucose (FPG) was reduced from a mean ± s.d. (mmol/l) value of 11.6 ± 2.9 to 5.5 ± 1.6 (p < 0.0001) during the first night. No additional lowering of FPG was seen the two succeeding nights. FPG narrowed as the range before the infusion was 7.3–15.2 mmol/l compared with 3.6–6.1 mmol/l on the last morning after infusion. The variability in PG profile during the first and the last night of CSII was small and not significantly different. The rising insulin aspart was mirrored by a decrease in human insulin. In period B and C, similar tendencies as for period A were seen. In period A, two patients each experienced one mild hypoglycaemic episode.
Conclusions:  CSII with an insulin analogue overnight effectively reduced FPG without occurrence of major hypoglycaemia in type 2 diabetic patients who fail to achieve glycaemic control on oral antidiabetic treatment.     

Making sense of newer treatment options for type 2 diabetes

Over the past decade, several new medications have been developed to treat type 2 diabetes mellitus. Large‐scale outcome trials have been performed with patients at high cardiovascular risk to assess the cardiovascular safety of these agents. These trials are changing the landscape of diabetes therapy with evidence beyond safety to cardiovascular benefits of sodium‐glucose cotransporter 2 (SGLT‐2) inhibitors and some glucagon‐like peptide‐1 receptor agonists. This review provides an overview of incretin‐based therapies and SGLT‐2 inhibitors with a particular focus on the results of published cardiovascular outcome trials, which have also provided unique opportunities to evaluate uncommon but potentially serious adverse events of these newer agents. The cardiovascular benefits of SGLT‐2 inhibitors and some glucagon‐like peptide‐1 receptor agonists suggest that they may be the preferred choice, usually as an add‐on to metformin, for patients with type 2 diabetes mellitus at high cardiovascular risk.