小肠电刺激对正常人血糖水平的影响及其可能的机制

目的研究小肠电刺激对健康成年人餐后血糖的影响及其可能的机制,探讨小肠电刺激对糖尿病可能的治疗作用。方法健康正常人6例,经鼻将带有刺激电极的鼻胃管植入十二指肠,给予150克葡萄糖水口服,并监测餐前及餐后2小时内静脉血糖及血清胰岛素水平,同时用B超监测胃排卒,每人均接受真性和假性小肠电刺激实验两次,同时记录餐后消化小良症状。结果小肠电刺激町显著降低餐后血糖水平及血清胰岛素水牛。给予真性小肠电刺激后,餐后90分钟内各时间点血糖水平显著低于假性电刺激时的血糖水平,血清胰岛素水平在服用糖水60分钟后明显低丁假性刺激组（P〈0．05）;小肠电刺激抑制胃排空,给予真性小肠电刺激时胃半排空时间为（40．67±5．72）分钟,显著高于假性小肠电刺激时的胃半排空时问[（27．33±4．03）分钟],P〈0．05;给P真性小肠电刺激时受试者消化不良症状总积分为（18．83±9．15）分,显著高于假性小肠电刺激时消化不良症状总积分[（6．83±4．92）分,P〈0．05。结论小肠电刺激叮降低健康正常人餐后血糖水平,可能是1种治疗糖尿病的新方法,其机制叮能与抑制胃排空等因素有关。     

罗格列酮对2型糖尿病合并高血压患者血压的作用

目的：运用胰岛素增敏剂罗格列酮治疗2型糖尿病伴高血压患者，研究其降压作用及降压机理。方法：38例2型糖尿病伴高血压患者，口服罗格列酮（文迪雅）4～8mg／d，共12周，观察治疗前后的血压、瘦素、血糖和胰岛素水平，计算胰岛素敏感指数和胰岛素抵抗指数，并进行分析比较。结果：罗格列酮治疗后收缩压和舒张压明显下降（P〈0．05）；甘油三酯（TG）、空腹血糖（FBG）、餐后血糖（PBG）、空腹胰岛素（FINS）和餐后胰岛素（PINS）均明显降低（P均〈0．05）；瘦素水平明显升高（P〈0．01）；胰岛素敏感性指数（ISI）显著升高（P〈0．05），胰岛素抵抗指数（IR）显著下降（P〈0．05）。结论：罗格列酮在降低血糖、改善胰岛索抵抗、提高胰岛素敏感指数的同时，具有升高瘦素水平和降低血压的作用。     

国外重要心血管杂志论文文摘

中等量运动对餐后血糖和胰岛素反应的影响ＡｍＪＭｅｄ＆Ｓｐｏｒｔｓ,2 0 0 2 ,4:42 3 .　　本文研究中等量运动 (2 0分钟 ,4 5 %ＶＯ2 ｍａｘ )的走路活动 ,能否降低一个标准餐后的血糖和胰岛素。空腹志愿者 (ｎ =2 1) ,食用一餐 (90 0热卡 ,5 7%碳水化合物 ,12 %蛋白质 ,31%脂肪 )。实验分 2天进行 ,一天餐后不运动 ,一天餐后运动 ,餐后 30分钟后 ,做2 0分钟走路活动。研究发现运动使餐后血糖明显下降 (12 3.5ｖｓ 14 3 0ｍｇ % ) ,血胰岛素也明显下降 (17.2ｖｓ 2 7.9)。运动后血糖下降以餐后 6 0分钟 ,90分钟最明显。本研究证明中等量…     

2型糖尿病患者不同时间血糖与糖化血红蛋白的相关性及其贡献

目的探讨2型糖尿病患者不同时间点血糖与糖化血红蛋白（HbAlc）的相关性及不同治疗方式时餐前和餐后血糖对HbAIc的贡献。方法选择2010年6月至2012年10月就诊的病程超过1年、治疗相对稳定的2型糖尿病患者256例,男119例,女137例,年龄（54±14）岁,平均病程4．5年,平均空腹血糖9．6mmol／L,平均HbAlc8．4％。按治疗方式不同将患者分为口服药物治疗组（84例）、基础胰岛素治疗组（80例）和预混胰岛素治疗组（92例）。各组再根据HbAlc的不同分成HbAlc〈7％组、7％≤HbAlc〈8％组、8％≤HbAlc〈9％组、HbAlc≥9％组。不连续3d监测全天三餐前后和睡前7个时问点的血糖谱,取3d的平均值,同时免疫比浊法测定HbAlc。对各个时间点血糖与HbAIc进行单因素相关分析。三餐前及睡前四点血糖连线与正常血糖5．6mmoUL平行线：岂间的面积为餐前血糖面积,三餐前和睡前四点血糖连线与三餐后血糖连线间的面积为餐后血糖面积,根据餐前血糖或餐后血糖面积与总高血糖面积的比值计算口服药物、基础胰岛素和预混胰岛素治疗组餐前和餐后血糖对HbAlc的贡献。结果本组患者各个时间点血糖与HbAlc水平存在明显相关性（r=0．38-0．76,均P〈0．05）,7点平均血糖与HbAlc相关性最强（r≥0．71,P〈0．05）。口服药物治疗组餐前、餐后血糖对HbAlc的贡献分别为59％-82％、18％～41％;预混胰岛素治疗组餐前、餐后血糖对HbAlc的贡献分别为60％-82％、18％～40％;基础胰岛素治疗组餐前、餐后血糖对HbAIc的贡献分别为38％～66％、34％～62％。趋势检验表明,口服药物、基础胰岛素和预混胰岛素治疗组餐前血糖对HbAlc的相对贡献随着HbAlc的增加而增加（F=67,46、168．51、84．05,均P〈0．05）,餐后血糖的相对贡献则相反。基础胰岛素治疗组在不同HbAIc状态下餐前血糖相对贡献较预混胰岛素治疗组低（HbAle〈7％组：38％比66％,Xz：5．94,P〈0．05;8％≤HbAlc〈9％组：63％比77％X2=5．88,P〈0．05;HbAlc≥9％组：66％比82％,,：5．51,P〈0．05）。基础胰岛素治疗组在不同HbAle状态下餐前血糖相对贡献较口服药物治疗组低（7％≤HbAlc〈8％组：50％比68％,爿。：5．56,P〈0．05;8％≤HbAlc〈9％组：63％比78％,∥：5．79,P〈0．05;HbAlc≥9％组：66％比82％,X2=6．28,P〈0．05）。结论HbAle与自我监测的各个时问点血糖明显相关,治疗方式及血糖控制状况影响餐前和餐后血糖对HbAlc的相对贡献。     

甘精胰岛素和3餐前胰岛素注射与胰岛素泵治疗对2型糖尿病疗效比较

目的比较胰岛素泵与基础胰岛素加3餐前胰岛素注射对疗效比较。方法将62例2型糖尿病患者分成两组,其中胰岛素泵组25例,基础加餐时胰岛素治疗组37例,治疗2周,比较两组血糖控制情况,血糖达标需要的时间,胰岛素用量及低血糖发生情况。结果两组不同给药途径治疗后空腹血糖、餐后血糖均有效控制,（P〈0．05）。两组达标时间、胰岛素用量、低血糖情况无统计学意义,（P〉0．05）但是胰岛素泵组的治疗费用明细高于常规治疗组（P〈0．05）。     

肝硬化糖代谢紊乱与肝功能Child—pugh分级关系研究

目的探讨肝硬化患者的血浆胰岛素、胰高血糖素和血糖变化以及与肝功能的关系。方法我们对86例肝硬化患者和29例正常人进行糖耐量试验及胰岛素释放试验,测定胰高血糖素,并对结果进行分析。结果肝硬化患者血糖在各个时间点均高于正常值,餐后1h、2h、3h差异有统计学意义（P〈0．05）。肝硬化失代偿组胰岛素水平均高于正常对照组（P〈0．05）。肝功能分级与糖耐量及胰岛素释放结果比较：3组空腹胰岛素水平均增高,3组比较差异有统计学意义（P〈0．05）。餐后各时点血糖及胰岛素水平均增高,胰岛素高峰延迟,差异有统计学意义（P〈0．05）。3组胰高血糖素比较差异有统计学意义（P〈0．05）。结论肝硬化病人不论是在空腹或在餐后都有高胰岛素水平。胰高血糖素亦较正常对照组增高。随着Child—pugh分级的增高,糖耐量降低逐渐加重,胰岛素及胰高血糖素水平亦更加突出。     

慢性肺心病急性加重期血糖、胰岛素、C-肽水平观察

目的 探讨慢性肺心病急性加重期病人胰腺分泌功能及其对血糖水平的影响。方法对78例慢性肺心病病人在急性加重期、缓解期分别测定其血胰岛素、C-肽和血糖水平，并进行比较。结果慢性肺心病急性加重期与缓解期相比，空腹血糖变化无显著差异（t=1．515，P〉0．05），但餐后2h血糖水平明显高于缓解期（t=8.84，P〈0．05）；急性加重期空腹胰岛素、C-肽水平较缓解期降低（P〈0．05），而餐后2h空腹胰岛素、C-肽水平明显高于缓解期（P〈0．05）。结论慢性肺心病急性加重期病人糖耐量明显降低。     

动态血糖监测甘精胰岛素治疗老年2型糖尿病的研究

目的通过动态血糖监测（CGMS），评估甘精胰岛素治疗老年2型糖尿病（T2DM）的疗效和安全性。方法对39例口服药联合治疗空腹血糖控制不佳的老年T2DM患者，加用甘精胰岛素（IG）和中性鱼精蛋白锌胰岛素（NPH）睡前皮下注射，治疗12周。治疗前后测定空腹血糖（FPG）、餐后2h血糖（2hPG）、糖化血红蛋白（HbAlc）、空腹C肽及餐后2hC肽等，并进行比较。结果治疗后，2组血糖和HbAlc均较治疗前下降（P〈0．05或P〈0．01），IG组血糖下降更明显（P〈0．05），2组HbAlc无明显差异（P〉0．05），IG组治疗后餐后2hC肽水平提高（P〈0．05）。CGMS显示IG组24h血糖曲线平缓，血糖达标时间延长，夜间低血糖的发生率低（P〈0．01）．血糖波动幅度小。结论IG作为老年T2DM患者的基础胰岛素替代治疗，血糖控制达标率高，胰岛素剂量控制更方便、安全，优于NPH。     

双相门冬胰岛素与预混入胰岛素的疗效对比研究

为期8周的随机、开放性比较研究。60例T2DM患者被随机分为以诺和灵30R治疗的A组、以诺和锐30治疗的B组和以诺和锐30治疗的C组，A组和B组采用每日早、晚餐前两次皮下注射方案，C组采用每日早、晚餐前及睡前三次皮下注射方案。比较两组患者7个时点血糖、HbA2c、低血糖事件及其他不良事件的差异。结果B组和C组三餐后血糖水平明显低于A组（P〈0．05）；B组和C组低血糖事件发生次数低于A组（P〈0．05）；C组空腹血糖明显低于其余两组（P〈0．05）。两组HbA2c指标、胰岛素用量及其他不良事件差异无统计学意义（P〉0．05）。结论诺和锐30对餐后血糖控制更满意，且低血糖事件发生率减少；睡前加用诺和锐30可较好控制空腹血糖。     

加用阿卡波糖对预混门冬胰岛素治疗的2型糖尿病患者血糖变异性及低血糖发生率的影响

选取已经接受至少3个月门冬胰岛素30注射液每日2次治疗的2型糖尿病患者30例,联合口服阿卡波糖2周,联合前后采用动态血糖检测的方法,计算血糖变异指标、平均血糖、低血糖人次、空腹及餐后平均血糖情况,评价联合治疗前后患者血糖波动情况、低血糖发生率及日均胰岛素用量的差异。结果联合阿卡波糖治疗后,平均血糖波动幅度、平均血糖水平、血糖最高值、平均餐后血糖均低于联合治疗前,血糖最低值高于治疗前,差异具有统计学意义（P〈0．05）,低血糖事件少于联合治疗前,差异具有统计学意义（P〈0．05）,日均胰岛素量和血糖标准差较前减少,但差异无统计学意义（P〉0．05）。结论接受门冬胰岛素30注射液每日2次治疗的2型糖尿病患者,联合使用阿卡波糖可以减少血糖变异性,增加血糖稳定性,降低低血糖风险,减少胰岛素用量。     

2型糖尿病患者餐后运动优化处方三因素三水平正交设计的试验研究

目的 观察运动对T2DM患者餐后血糖的影响,优化运动治疗处方。方法选择54例T2DM患者,采用数字随机表分为餐后非运动组与运动组,每组各27例,非运动组进行静息试验,运动组按照三因素（餐后开始运动时间A、运动持续时间B、运动强度c）三水平正交设计进行运动锻炼。以餐后150min内餐后血糖曲线下面积（AUC）为评价指标。结果（1）运动、非运动组AUC分别是（589．66±31．89）mmol／L·min和（616．34±36．48）mmol／L·min。（2）A因素三水平（A1：餐后10min;A2餐后20miniAs：餐后30min）中以凡最佳（P=0．018）。B因素三水平（B1：持续20mimB2：持续30miniB3：持续40min）中以B3最佳（P=0．016）。C因素的三水平（c1：4km／h速度步行,C2：6km／h速度步行,C3：8km／h速度步行）对AUC的影响差异无统计学意义（P=0．229）。结论运动可改善糖代谢,餐后20mim开始以4km／h的步行速度,运动40min可能是T2DM运动治疗的较好处方,但需个体化调节运动参数。     

Minimal influence of the time interval between injection of regular insulin and food intake on blood glucose control of type 1 diabetic patients on a basal-bolus insulin scheme.

The present study aimed at investigating the influence of the time interval between injection of regular insulin and meal ingestion on postprandial glucose changes and overall blood glucose control in patients with type 1 diabetes on intensive insulin therapy. Fifteen C-peptide negative subjects were submitted, in a randomized order, to two 6-week treatment periods in which regular insulin was injected either 5 minutes or 30 minutes before each of the three main meals, in combination with a bedtime NPH insulin injection. The changes in plasma glucose excursions following a breakfast test (Cmax, Tmax, Cmin, Tmin, AUC0-240 min) were similar in the two experimental protocols. Furthermore, no significant changes were observed in daily insulin dosages nor in glucose profiles obtained using home blood glucose monitoring. Only a tendency to a greater 90-minutes postprandial increase in blood glucose levels was observed when regular insulin was injected 5 minutes rather than 30 minutes before meal. Glycated haemoglobin levels were similar after each treatment period (7.6 +/- 0.2% versus 7.5 +/- 0.2%; NS) and no differences in the incidence or severity of hypoglycaemic episodes were noticed between the two insulin schemes. In conclusion, in type 1 diabetic patients who are rather well controlled with a basal-bolus insulin scheme, the injection of regular insulin 30 minutes before each main meal provides no significant advantage as compared to the injection of regular insulin 5 minutes before meal.     

2型糖尿病患者血糖波动对微血管病变的影响

目的探讨2型糖尿病患者血糖波动与微血管病变之间的关系。方法分析了822例2型糖尿病住院患者血压、血脂、全天7点血糖、体重指数、糖化血红蛋白、空腹胰岛素、尿白蛋白排泄率、餐前血糖曲线下面积和餐后血糖曲线下面积,采用稳态模式评价胰岛素抵抗。根据微血管病变数量分为无微血管病变组、1种微血管病变组、2种微血管病变组和3种微血管病变组。依据微血管病变数量、不同时间血糖曲线下面积进行分析。结果随着微血管病变数目增多,空腹血糖、尿白蛋白排泄率、收缩压、舒张压、体重指数和餐前血糖曲线下面积呈升高趋势（P〈0．05）。累加Logistic回归分析显示：舒张压和早餐后血糖曲线下面积是影响所有2型糖尿病患者微血管病变独立的危险因素。结论2型糖尿病患者微血管病变的发生发展可能与早餐后血糖波动密切相关。     

Glucoregulatory endocrine responses to intermittent exercise of different intensities: plasma changes in a pancreatic beta-cell peptide, amylin

Amylin, a peptide hormone released from the beta cells of the pancreas and cosecreted with insulin, is reported to inhibit the release of postprandial glucagon and insulin and to modulate gastric emptying. Changes in insulin and glucagon are important for controlling blood glucose levels under conditions in which metabolic rate is elevated, such as during and following exercise. Amylin may participate in the regulation of blood glucose levels in response to exercise, although the role of amylin has not been investigated. The purpose of the study was to determine the effects of a progressive, intermittent exercise protocol on amylin concentrations and to compare its response to circulating levels of insulin, glucagon, cortisol, and glucose. Seven well-trained males completed an intermittent exercise trial on a treadmill at four progressive exercise intensities: 60%, 75%, 90%, and 100% of maximum oxygen consumption (.VO(2)max). Blood samples were collected before exercise, after each exercise intensity, and for 1 hour following the exercise protocol. Subjects also completed a control trial with no exercise. Amylin and insulin rose from baseline (5.79 +/-.78 pmol/L and 4.76 +/-.88 microIU/mL) to peak after 100% .VO(2)max (9.16 +/- 1.35 pmol/L and 14.37 +/- microIU/ml), respectively and remained elevated during much of recovery. Thus, a progressive intermittent exercise protocol of moderate to maximum exercise intensities stimulates increases in amylin levels in well-trained individuals in a similar fashion to that of insulin, whereas glucagon concentrations only increase after the greatest exercise intensity, then quickly decline. Future studies should examine the effects of higher amylin concentrations in exercise recovery on glucoregulation.     

Predicting more accurately the overall glucose response to a lunch meal by using the postprandial glucose peak

Although the assessment of postprandial glycemia is clinically important, the most relevant time points with the smallest number of blood samples giving the highest predictive power have yet to be established. It has been suggested that a sample estimating the postprandial peak concentration would improve this predictive power compared to the usual recommended time points. In this study, we assessed the power of these time points to predict the glucose response to a meal mimicking everyday life. Subjects were 11 healthy young men (mean age, 22 +/- 1 years; body mass index, 21.7 +/- 1.8 kg/m(2)). Plasma glucose, insulin, and nonesterified fatty acids were measured by continuous collection of blood in tubes filled every 5 minutes for 240 minutes after a 2-item lunch meal consumed ad libitum on the first test day, and in the same amount 1 week later. The most relevant time point for the plasma glucose peak level was found at 45 minutes (mean interval, 47 +/- 3 minutes) and was not dependent on the energy intake at lunch. Its coefficient of variation was low (7.0% +/- 1.5%). The best predictive equation for the whole postmeal glucose area under the curve (AUC) was found at 120 minutes and involved glucose, insulin, and nonesterified fatty acids (r(2) = 0.89; P < 10(-7)). The 120-minute postmeal glucose profile constructed with the 0-, 45-, 90-, and 120-minute time points overlapped more accurately with the actual profile than did the time points normally used in the glucose tolerance test, and slightly improved the correlation between the calculated and the actual plasma glucose area under the curve (r = 0.96; P < 10(-7)). In conclusion, in healthy, young, lean male subjects, a blood sample collected 45 minutes after a spontaneous lunch meal estimates the postprandial plasma glucose peak and suggests that including the peak level along with 90- and 120-minute time points may improve the predictive power of the plasma glucose profile after a meal.     

应用动态血糖监测系统评价格列喹酮对新发2型糖尿病血糖波动的控制及其促泌作用

目的应用动态血糖监测技术评价不同磺脲类药物控制新发2型糖尿病餐后血糖波动的作用特征,对比其胰岛素促泌作用模式的差异,并分析二者的相关性。方法选取2008年3月至12月于解放军总医院门诊就诊病程小于1年的2型糖尿病患者40例,采用随机数字表法将所有研究对象分为3组,分别给予不同磺脲类药物干预1个月：格列喹酮组16例（60mg／早,30mg／晚）,格列齐特组13例（80mg／早,80mg／晚）,格列苯脲组11例（2．5mg／早,2．5mg／晚）。各组研究对象在干预前后均行动态血糖监测（CGMS）和葡萄糖耐量一胰岛素释放试验（OGTF-IRT,分别在服糖前30、0min、糖负荷后15、30、45、60、120和180rain留取静脉血标本）,同时采集空腹血送检各项代谢指标;对比干预前后血糖波动和胰岛素分泌特征的变化,组内治疗前后比较用配对t检验,组间比较采用方差分析。结果格列喹酮和格列奇特组干预后果糖胺较干预前分别下降了17．5％和14．8％[分别为（257±49）、（212±40）μmol／L;（2374-52）、（202±31）Ixmol／L;t=2．098、2．052,均P〈0．05];干预后3组糖化血红蛋白水平均有下降,但差异均无统计学意义（均P〉0．05）;干预后3组的平均血糖波动幅度（MAGE）、平均血糖（MBG）、平均血糖标准差（SDBG）、最大血糖波动幅度（LAGE）、空腹血糖变异系数（CV—FPG）均较干预前有不同程度的改善（均P〈0．05）,其中格列喹酮组和格列奇特组干预后MAGE降幅（分别为42．2％、36．6％）明显优于格列苯脲组的27．0％（分别为6．6±2．3,3．8±2．0;7．0±2．3,4．4±1．6;6．44-1．2,4．74-1．8;t=3．977、2．349、2．977,均P〈0．05）;干预后格列喹酮组和格列奇特组的血糖谱曲线相对平稳,血糖波动特征类似;格列苯脲组清晨空腹血糖偏低,而早餐后、晚餐后血糖升高明显强于其他2组,血糖曲线显著分离;格列喹酮干预后胰岛素分泌速率分别在30和60min达峰,120min降至基线水平;格列奇特与之非常类似;格列苯脲组胰岛素分泌速率达峰时间延迟,峰值更高,高胰岛素血症持续时间相对较长;MAGE与糖负荷后45、60min胰岛素分泌速率显著相关（r=-0．342、-0．386,均P〈0．05）。结论格列喹酮和格列奇特显著降低餐后血糖波动,改善平均血糖控制水平,与其刺激胰岛β细胞快速双峰分泌胰岛素的拟生理促泌模式有关;格列苯脲低血糖发生风险相对较大,与其强而持久的促泌作用有关。     

The impact of treatment on insulin release and relative peripheral resistance during the oral glucose tolerance test. A study of noninsulin-dependent diabetes mellitus and glucose intolerance

Using 75 g oral glucose tolerance tests (OGTTs), insulin release and relative peripheral resistance were studied in two groups of subjects before and after treatment; ten mostly obese subjects with glucose intolerance (GI), who had improved glucose tolerance after six months of diet and exercise with weight reduction; nine nonobese patients with noninsulin-dependent diabetes mellitus (NIDDM), who received a daily dose of 5 mg glipizide for three months. Total insulin release was measured as the total area under the insulin curve during the OGTT. The insulin response to glucose was expressed as the ratio of the incremental area under the insulin curve to that of the glucose curve above fasting levels (delta AUCI/delta AUCG), during the first 30 minutes and the latter part of the test. The glucose uptake rate (M) was measured as the difference between the glucose load and the increase of glucose in the glucose space after compared to before the OGTT. The relative peripheral resistance (rel-R) against glucose-uptake-promoting factors was expressed as 1/M. The main effects of therapy in the GI-group appeared to be a decrease of the mean rel-R value and a decrease of the mean total insulin release. This implies a mainly peripheral action of therapy at receptor and/or postreceptor levels. The mean [delta AUCI/delta AUCG]0-30 value was unchanged and the mean [delta AUCI/delta AUCG]30-120 value was only slightly increased at follow-up.(ABSTRACT TRUNCATED AT 250 WORDS)     

社区老年2型糖尿病患者合并轻度认知功能障碍危险因素分析

目的探讨分析2型糖尿病患者轻度认知功能障碍（mild cognitive impairment,MCI）的相关危险因素。方法以简易智能精神状态量表（MMSE）对社区老年2型糖尿病患者进行认知功能测评,收集MCI患者82例（MCI组）,认知功能正常者86例（NC组）。问卷调查受试者病史、年龄、糖尿病肾病、糖尿病足等资料;测定受试者血压、身高、体质量、血脂、血糖、胰岛素（Ins）、糖化血红蛋白（HbA1c）;计算胰岛素抵抗指数（HOMA-IR）、胰岛素分泌指数（HOMA-β）、体质量指数（BMI）、腰臀比（WHR）并筛查其危险因素。结果（1）与NC组比较,MCI组患者糖尿病病程、糖尿病肾病、空腹血糖（FBG）、餐后2h血糖（2hPBG）、空腹胰岛素（Fins）、HbA1c、HOMA—IR水平显著升高;而2组间年龄、糖尿病足、BMI、WHR、血压、餐后2h胰岛素（2hlns）、HOMA-B及血脂水平比较,差异均无统计学意义。（2）MCI患者MMSE量表评分与糖尿病病程、FBG、2hPBG、Fins、HOMA—IR具有相关性;而NC组仅发现与糖尿病病程、FBG相关。（3）Logistic回归分析显示糖尿病病程、FBG、HOMA-IR可能与糖尿病患者MCI独立相关。结论糖尿病病程、血糖控制水平、胰岛素抵抗程度等可能与2型糖尿病患者发生MCI密切相关,有效控制各危险因素有助于预防认知功能障碍的发生发展。     

Effects of oral contraceptives on glucoregulatory responses to exercise

Some of the effects of oral contraceptives (OCs) to alter glucoregulation may be ameliorated by exercise. To test this premise, the effects of acute aerobic exercise on postprandial glucose, insulin, and C-peptide responses (area under the curve [AUC]) were measured in 8 users of low-dose estrogen and progestin OCs (OC(+)) and 10 women not using OCs (OC(-)). They completed 2 randomly ordered intervention trials: (1) aerobic exercise on 3 consecutive days with a 2.5-hour, 75-g oral glucose tolerance test (OGTT) on day 4, and (2) no exercise for 3 days prior to the OGTT (control trial). The exercise was 50 minutes of treadmill walking at 70% (.-)VO(2max). The groups were similar in age (27 +/- 3 years), waist-to-hip ratio (0.74 +/- 0.01), and cardiorespiratory fitness (32.5 +/- 1.6 mL x kg body mass(-1) x min(-1)). Fasting plasma glucose, C-peptide, and insulin levels were similar (P >.05) between groups in the control trial. In both trials, glucose(AUC) was significantly greater (13%, P <.05) in OC(+). Exercise resulted in a significant (P <.05) decrease in fasting plasma glucose and insulin, insulin(AUC), glucose(AUC) x insulin(AUC), and C-peptide(AUC) in both groups, suggesting enhanced insulin action and/or reduced pancreatic insulin secretion. Hepatic insulin extraction ([C-peptide(AUC) - insulin(AUC)())]/C-peptide(AUC)) was increased following exercise only in OC(+). Thus, insulin action was enhanced in response to exercise in young sedentary women independent of OC use. The mechanisms for the acute exercise effect on insulin action may be different in OC users compared with normally menstruating women.     

瑞格列奈与甘精胰岛素联合治疗新诊断2型糖尿病的疗效观察

目的：比较新诊断2型糖尿病患者应用胰岛素促泌剂瑞格列奈单一治疗及联合长效胰岛素甘精胰岛素治疗12周后血糖水平的差异。方法纳入2012年1月~2013年1月北京军区总医院新诊断2型糖尿病患者48例,随机分为单药治疗组（n=24）及联合治疗组（n=24）,单药治疗组仅餐前口服瑞格列奈（初始计量0.5 mg）,联合治疗组除餐前服用瑞格列奈外,每晚8 pm皮下注射甘精胰岛素（初始计量6 u）。根据血糖水平调整用药剂量,治疗12周后观察两组空腹静脉血糖（FBG）水平、餐后2小时血糖（2 hPBG）水平、糖化血红蛋白（HbA1c）水平及血糖达标时间。结果与单药治疗组相比,联合治疗组FBG[（5.9±1.6）mmol/L vs.（6.8±1.5）mmol/L]、2 hPBG[（8.8±0.9）mmol/L vs.（9.2±0.8）mmol/L]、HBA1c[（7.4±0.5）% vs.（7.8±1.3）%]均更低,且血糖达标时间明显缩短[（6.1±1.3）d vs.（8.9±2.5）d]。结论胰岛素促泌剂与长效胰岛素联合治疗2型糖尿病初始治疗较单独应用胰岛素促泌剂效果更好,并能促使血糖尽快达标。