2型糖尿病并冠心病患者血浆同型半胱氨酸水平与单纯糖尿病患者及健康者比较

目的：了解糖尿病合并冠心病与单纯糖尿病患者糖尿病病程、血糖、血脂、血压、同型半胱氨酸、纤维蛋白原及超敏C反应蛋白水平的差异。方法：收集北京大学第一医院心内科2002-01／2004-12行冠状动脉造影者378例。根据冠状动脉造影显示，将糖尿病患者分为2组：冠状动脉直径减少≥50％为糖尿病合并冠心病组70例，男55例，女15例；冠状动脉直径减少&;lt;50％为单纯糖尿病组34例，男26例，女8例。选择同期本院健康体检者20人为对照组，均知情同意。①病例纳入时，询问其病程、年龄、吸烟情况、是否有冠心病家族史、高血压患病情况。②造影前空腹取血10mL．采用全自动生化仪测定血肌酐、空腹血糖、血脂和尿酸，乳胶增强免疫浊度法检测超敏C反应蛋白，Claus法检测纤维蛋白原，电化学发光法检测同型半胱氨酸。③分析糖尿病患者冠状动脉造影特点。④多组计量资料的显著性检验采用单因素方差分析和两两比较LSD法。变量间采用单因素直线相关分析。以病程、收缩压、空腹血糖、血脂、纤维蛋白原、同型半胱氨酸、超敏C反应蛋白为自变量，冠心病为因变量，进行多因素Logistic逐步回归分析。结果：按意向处理分析，进入结果分析2型糖尿病患者104例，健康者20例。①病程&;gt;5年例数：糖尿病合并冠心病组明显多于单纯糖尿病组[74％(52／70)，29％(10／34)，X^2=78．52，P&;lt;0．05]。②血超敏C反应蛋白、同型半胱氨酸、空腹血糖、三酰甘油、总胆固醇、纤维蛋白原及水平：糖尿病合并冠心病组明显高于单纯糖尿病组和对照组(P&;lt;0．05)，而高密度脂蛋白胆固醇水平明显低于单纯糖尿病组和对照组(P&;lt;0．05)。血同型半胱氨酸、总胆固醇水平：单纯糖尿病组明显高于对照组(P&;lt;0．05)。③2型糖尿病患者同型半胱氨酸与空腹血糖，三酰甘油、总胆固醇均呈显著正相关(r=0．178，0．238，0．258，P&;lt;0．05)，与高密度脂蛋白呈显著负相关(r=-0.283，P&;lt;0．05)。④多元Logistic回归分析显示糖尿病病程(OR=1．038，95％ CI:1.000～1.067)，收缩压(OR=1.064，95％CI：1．007～1．045)和血浆同型半胱氨酸水平(OR=1．896，95％CI：1．165～2．743)是2型糖尿病患者冠心病危险的独立预测因素。⑤70例糖尿病合并冠心病患者冠状动脉造影显示，冠状动脉双支和三支病变比例显著高于单支病变[36％(25／70)，44％(31／70)，19％(13／70)，X^2=56．84，P&;lt;0．05]；弥漫性病变发生高于局限病变和管状病变[56％(39／70)，26％(18／70)，14％(10／70)，X^2=45．86，P&;lt;0．05]。34例单纯糖尿病组冠状动脉造影显示冠状动脉硬化27例(79％)，正常7例(21％)。结论：①糖尿病合并冠心病患者较单纯糖尿病患者糖尿病病程长，血糖、血脂、血压、同型半胱氨酸、纤维蛋白原及超敏C反应蛋白水平更高。②2型糖尿病患者血浆同型半胱氨酸水平与血糖、血脂变化有关，且其变化与血糖、血脂变化可能存在共同的病理基础。③多因素分析结果显示病程、收缩压和血浆同型半胱氨酸水平是2型糖尿病患者冠心病的独立危险因素。④糖尿病合并冠心病患者冠状动脉多支弥漫性病变发生率较高。     

高同型半胱氨酸血症与糖尿病和冠心病关系的初步探讨

目的探讨糖尿病和冠心病与高同型半胱氨酸血症的关系。方法138例患者于冠状动脉造影前测定血浆Hcy及血脂、血糖等指标,将所有患者分为糖尿病合并冠心病组(33例)、单纯糖尿病组(19例)、单纯冠心病组(68例)和正常对照组(18例)4组,再根据冠状动脉造影将病变支数分为0、1、2和3支病变。结果糖尿病合并冠心病组及单纯冠心病组血浆Hcy水平较对照组比较均明显增高(P<0.01);糖尿病合并冠心病组血浆Hcy水平较单纯冠心病组和单纯糖尿病组Hcy水平均显著增高(P<0.01)。结论高同型半胱氨酸血症作为冠心病独立的危险因子,在预防和诊断糖尿病合并冠心病中具有重要的临床意义。     

冠心病合并或未合并糖尿病患者的临床特征分析

目的 了解冠心病合并或未合并糖尿病患者的临床特点.方法 根据患者是否合并糖尿病,将183例经冠状动脉造影证实的冠心病患者分为糖尿病组(66例)和非糖尿病组(117例),回顾性分析2组患者的临床特点.结果 糖尿病组低-高密度脂蛋白血症的发生率及空腹血糖水平高于非糖尿病组(均P<0.01),而且冠状动脉三支病变发生率(36.36%)与非糖尿病组(29.91%)比较差异无统计学意义.糖尿病组三支病变患者的病程明显长于单支病变患者(P<0.05);非糖尿病组三支病变患者的高血压、高尿酸血症、以及高胆固醇血症发生率明显高于单支病变患者(均P<0.05).结论 应该加强冠心病患者的各种危险因素的干预治疗,对于合并糖尿病的冠心病患者,应该注重对其高密度脂蛋白及血糖的调控.     

冠状动脉硬化易损斑块影响因素与急性冠状动脉综合征的关系

目的探讨冠状动脉硬化斑块稳定性的危险因素及其与急性冠状动脉综合征（ACS）的关系。方法选择112例冠心病患者按照斑块性质分为易损斑块组（A组）46例和稳定斑块组（B组）66例,按照疾病分为急性冠状动脉综合征52例为ACS组,稳定性冠心病60例为sCAD组,对比A组和B组临床资料,采用多因素分析冠状动脉硬化斑块稳定性危险因素,对比ACS组和sCAD组IVUS参数及与冠状动脉硬化斑块稳定性危险因素的关系。结果高血压、糖尿病、低密度脂蛋白胆固醇、脂蛋白a、纤维蛋白原、超敏C反应蛋白、同型半胱氨酸及吸烟与冠状动脉易损斑块形成有关,A组和B组差异均有统计学意义（P均＜0.05）。脂蛋白a、纤维蛋白原、超敏C反应蛋白和同型半胱氨酸是冠状动脉硬化斑块稳定性的独立危险因素（P均＜0.05）。 ACS组易损斑块率显著高于CAD组（P＜0.05）。 ACS患者脂蛋白a、纤维蛋白原、超敏C反应蛋白及同型半胱氨酸均与血管重塑指数呈正相关（r＝0.354,0.369,0.329,0.324）,与纤维帽厚度呈负相关（r＝-0.392,-0.401,-0.362,-0.384）,超敏C反应蛋白、同型半胱氨酸与斑块负荷呈正相关（r＝0.294,0.384）（P均＜0.05）。结论脂蛋白a、纤维蛋白原、超敏C反应蛋白及同型半胱氨酸与冠状动脉易损斑块形成及ACS的发生密切相关。     

血清游离脂肪酸与老年2型糖尿病患者并发冠心病相关危险因素分析

目的探讨血清游离脂肪酸(FFA)及同型半胱氨酸(Hcy)、C反应蛋白(CRP)、空腹血糖(FPG)、血脂等因素对老年2型糖尿病患者合并冠心病的影响。方法选取2015年1月1日至2015年12月31日已确认为2型糖尿病合并冠心病老年住院患者84例(A组),同期入院单纯2型糖尿病老年患者79例(B组),同时选取健康体检老年人50例为对照(C组),测定3组研究对象FFA、Hcy、CRP、空腹血糖(FPG)、血脂水平,通过Logistic回归分析其与2型糖尿病并发冠心病的相关性。结果 3组研究对象血清FFA、Hcy、CRP、FPG水平比较,差异均有统计学意义(F=86.150、22.970、34.970、65.060,P=0.000)。相关分析结果显示FFA、Hcy、CRP、FPG与老年2型糖尿病患者并发冠心病呈正相关(r=0.563、0.327、0.316、0.369,P=0.000)。Logistic回归分析显示FFA(OR=1.005,95%CI为1.003~1.008,P=0.000)、Hcy(OR=1.062,95%CI为1.008~1.119,P=0.024)、CRP(OR=1.165,95%CI为1.081~1.255,P=0.000)、FPG(OR=1.227,95%CI为1.046~1.440,P=0.012)是2型糖尿病合并冠心病的危险因素。结论 FFA、Hcy、CRP、FPG是老年2型糖尿病患者并发冠心病的危险因素,糖尿病患者严格控制血糖同时,积极控制FFA、Hcy、CRP水平可能延缓或减少冠心病并发症的发生。     

不同病程2型糖尿病患者血清同型半胱氨酸及血尿酸的水平变化

目的分析不同病程2型糖尿病患者血清同型半胱氨酸及血尿酸的水平变化。方法选取2016年1月~2016年12月在我院接受治疗的2型糖尿病患者180例。按照不同病程将患者分为低年限组(病程1年)、中年限组(病程1~5年)以及高年限组(病程10年)各60例,选择同期接受体检的健康人60例作为对照组,分析比较四组受检者的血糖检查结果、血清同型半胱氨酸以及血尿酸。结果 2型糖尿病组患者空腹血糖水平平均值、餐后2h血糖水平平均值以及糖化血红蛋白水平平均值均高于对照组,差异显著(P0.05);糖尿病各组患者及对照组受检者之间检查同型半胱氨酸、血尿酸数据差异均显著(P0.05),糖尿病病程延长,同型半胱氨酸以及血尿酸数据随之增长。结论血清同型半胱氨酸及血尿酸可作为检测糖尿病疾病严重程度的标志物。     

不同指标水平变化在2型糖尿病患者的意义

目的探讨不同指标水平变化在2型糖尿病患者中的意义。方法选取2015年1-12月该院门诊和住院2型糖尿病患者100例作为研究对象,另选取健康体检者100例作为对照组。采用全自动生化仪检测空腹血糖、糖化血红蛋白、胆固醇、三酰甘油、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、载脂蛋白A1、载脂蛋白B、脂蛋白a、同型半胱氨酸、超敏C反应蛋白水平,并进行对比分析。结果 2型糖尿病组血清高密度脂蛋白胆固醇、载脂蛋白A1水平明显低于对照组(P0.05);2型糖尿病组血清空腹血糖、糖化血红蛋白、三酰甘油、低密度脂蛋白胆固醇、载脂蛋白B、脂蛋白a、同型半胱氨酸、超敏C反应蛋白水平明显高于对照组(P0.05);而2型糖尿病组的血清胆固醇水平与对照组比较,差异无统计学意义(P0.05)。结论 2型糖尿病患者存在不同程度的脂质代谢异常,治疗2型糖尿病患者的过程中,除观察血糖水平外,还应关注血脂及同型半胱氨酸、超敏C反应蛋白水平,尽早发现并干预2型糖尿病患者的各种并发症的发生、发展。     

糖尿病患者血糖水平与冠心病的关系探讨

目的 探讨糖隶病合并冠心病患者血糖水平与冠状动脉病变的关系.方法 _2型糖尿病患者88例经冠状动脉造影检查确诊为冠心病患者42例,为冠心病组;46例确诊为未合并冠心病患者,为非冠心病组;_根据冠状动脉受累情况,分为1支、2支、3支、病变组;并测定空腹血糖(FBS)与餐后2小时血糖(PBS)水平,结果空腹血糖水平冠心病组与非冠心病组无差异,餐后:2小时血糖水平冠心病组高于非冠心病组;不同冠状动脉病塞组之间空腹血糖与餐后血糖均无差异.结论 .餐后2小时血糖水平与糖尿病合并冠心病患者冠状动脉病PBSFCMI.     

单纯老年2型糖尿病患者颈动脉硬化与血高同型半胱氨酸的相关性研究

目的:探讨单纯老年2型糖尿病患者颈动脉粥样硬化程度与血高同型半胱氨酸水平的相关性。方法:以单纯老年2型糖尿病患者50例为研究组,年龄、性别相匹配的无高血压、糖尿病患者50例为对照组,比较两组空腹血糖、血脂、高同型半胱氨酸及颈动脉壁内膜-中膜厚度(IMT)、动脉斑块Crouse积分。结果:与对照组相比,研究组的高同型半胱氨酸水平、颈动脉IMT、斑块Crouse积分及斑块检出率均明显增高(P0.05)。Logistic回归分析显示低密度脂蛋白(LDL)、空腹血糖(FPG)、高同型半胱氨酸均是颈动脉硬化的高危因素。结论:高同型半胱氨酸是老年2型糖尿病患者颈动脉硬化发生发展的危险因素。     

糖尿病患者冠状动脉病变与血浆致动脉粥样硬化指数的关系

目的探讨糖尿病患者冠状动脉病变与血浆致动脉粥样硬化指数(AIP)的关系。方法选取我院心血管内科自2017年1月至2019年10月接受冠状动脉造影术的糖尿病患者200例,按检测结果分为糖尿病合并冠心病组、糖尿病未合并冠心病组,比较AIP、血脂、冠心病危险因素的组间差异及其与冠心病之间的相关性。结果糖尿病合并冠心病组AIP、TG、高血压史高于糖尿病未合并冠心病组(P0.05),HDL-C明显低于糖尿病未合并冠心病组(P0.01),空腹血糖、TC、LDL-C、年龄、吸烟史2组间没有明显差异(P0.05);AIP与冠心病危险因素相关分析显示,AIP与TG、HDL-C有显著相关性(P0.01),单因素logistic回归分析显示,AIP、性别为糖尿病合并冠心病的危险因素,HDL-C为冠心病的保护因子。进一步经多因素logistic回归分析,并通过性别矫正,AIP为糖尿病合并冠心病独立危险因素,优势比OR为6.005(P0.05)。结论糖尿病患者脂代谢紊乱,AIP可作为糖尿病患者合并冠心病的独立预测指标,优于传统血脂指标。     

Withdrawal of pioglitazone in patients with type 2 diabetes mellitus

Background and objective: The remodelling of the adipose tissue by pioglitazone may be associated with the sustained therapeutic effects. We studied the effects of withdrawal of pioglitazone after 3‐month treatment on glucose, lipid and high‐molecular weight (HMW) adiponectin levels as well as liver function in patients with type 2 diabetes mellitus. Methods: Forty‐nine Japanese patients with type 2 diabetes mellitus were randomly assigned into the withdrawal group after 3‐month treatment with pioglitazone (15 or 30 mg daily) and the non‐withdrawal group. Results and discussion: Three‐month treatment with pioglitazone improved glycaemic control, homeostasis model assessment for insulin resistance (HOMA), dyslipidaemia and liver function tests in association with a marked increase in serum HMW adiponectin level. Three months later after the withdrawal of pioglitazone, however, fasting plasma glucose and HOMA increased, whereas serum HMW adiponectin decreased to the pretreatment levels. Dyslipidaemia also returned to the pretreatment level. On the other hand, liver enzymes at 3 months after the withdrawal remained lower after a mild rebound. In addition, the bone formation marker, serum bone‐specific alkaline phosphatase, was significantly reduced by pioglitazone treatment in post‐menopausal women. Conclusions: The present study suggests that 3‐month treatment with pioglitazone has no sustained beneficial effects except in liver function tests in patients with type 2 diabetes mellitus.     

2型糖尿病患者的心率变时性功能不全及其意义

目的:检测2型糖尿病患者运动时心率变时性功能不全情况。方法:2型糖尿病患者进行运动平板试验,计算其心率变时性反应指数,并与非糖尿病患者进行比较。结果:69例2型糖尿病患者心率变时性反应指数为0.74±0.16,明显低于对照组0.90±0.17(P<0.0001),提示2型糖尿病患者存在心率变时性功能不全,并且与有无心血管并发症及有无缺血性ST改变无关。结论:2型糖尿病患者较普遍存在运动心率变时性功能不全情况,可能与心脏自主神经损害有关。     

2型糖尿病患者血清抵抗素水平的变化研究

目的探讨人血清抵抗素水平与2型糖尿病的关系.方法 2型糖尿病患者48例和正常对照组47例,采用酶联免疫分析法检测空腹血清抵抗素、胰岛素水平;同时测血糖、血压、血脂、身高、体重,计算腰围、臀围、体重指数、腰臀比值和胰岛素敏感指数、胰岛素抵抗性、胰岛B细胞功能.结果 2型糖尿病组的体重指数、甘油三酯、血清抵抗素水平显著高于正常对照组（P＜0.05）;相关分析显示血清抵抗素水平与体重指数、腰围、空腹胰岛素、血压呈正相关.在正常对照组,血清抵抗素水平与胰岛素敏感指数、胰岛素抵抗性、胰岛B细胞功能相关.而且血清抵抗素水平在糖尿病肥胖组显著高于糖尿病非肥胖组和正常对照组（P＜0.05）.结论 2型糖尿病患者血清抵抗素水平升高,与肥胖相关,血清抵抗素可能是联系肥胖和2型糖尿病的重要因素.     

Acute coronary syndrome in patients with type 2 diabetes mellitus

According to evidence obtained from large epidemiological studies, an incidence rate of acute coronary syndrome (ACS) in diabetics is 2-3 times higher than in general population. Relevant invalidity and mortality is much higher than in patients free of diabetes. In type 2 diabetes mellitus a high risk of an unfavourable course and outcome of myocardial infarction was registered both within 30 postinfarction days and 1-3 years of follow-up. Poor prognosis persists despite adequate and early treatment. The results of the attempts to correct MI prognosis in diabetics by means of carbohydrate metabolism correction (multicenter trials DIGAMI-1, DIGAMI-2) are reviewed.     

Conjunctival flora in patients with type 1 or type 2 diabetes mellitus

Patients with diabetes mellitus (DM) are prone to infection because glucose in the skin, urine, mucous membranes, and tears promotes growth of microorganisms. Conjunctival flora develops soon after birth, and some saprophytic conjunctival flora play a pathogenic role when immune function is compromised, which can lead to serious infection. DM is one condition that may compromise immune status. In lacrimal function tests of DM patients, a decrease in breakup time (BUT) of lacrimal film and a decrease in Schirmer’s test results were seen. In the present study, conjunctival flora in patients with DM was compared with that in controls with regard to type and duration of diabetes and results of lacrimal function tests. Seventeen patients with type 1 DM (n=34 eyes), 66 patients with type 2 DM (n=132 eyes), and 50 control subjects (n=100 eyes) were included. The control group consisted of age-matched patients with no ophthalmologic problems other than refractive error. Clycosylated hemoglobin values were measured with highpressure liquid chromatography with the Hi-AUTOA1c analyzer (Kyoto Daiichi Kagatu Co., Ltd., Kyoto, Japan). Type and duration of diabetes and demographic data were recorded, and routine ophthalmologic examinations were performed; the BUT of lacrimal film was determined, and the results of Schirmer’s test were assessed. Microbiologic sampling was performed twice for both eyes with sterile cotton swabs. One sample was incubated in 2 mL of brain-heart infusion broth agar; the other was incubated for the presence of fungi in Sabouraud dextrose agar. Colony morphology, hemolysis, and Cram’s stain, as well as catalase, oxidase, and coagulase tests were performed. No growth was observed in 12 of 1 7 patients (35.4%) with type 1 DM, 28 of 66 patients (21.2%) with type 2 DM, and 25 of 50 control subjects (50%).Staphylococcus epidermidis (11.79%) andStaphylococcus aureus (11.7%) were the most frequently isolated organisms in the type 1 DM group, and Sepidermidis (24.2%) and Saureus (21.2%) were the predominant organisms in the type 2 DM group. In control subjects, Sepidermidis (22%), Saureus (12%), andCorynebacterium spp (10%) were the most frequently isolated organisms, and the number of eyes with growth of Saureus was significantly higher in the type 2 DM group than in the other groups (P<.01). Patients with diabetes are more prone to postoperative endophthalmitis than are nondiabetics, and preoperative application of antiseptic or antimicrobial agents to the conjunctiva may not sterilize the area. Impaired integrity of the posterior capsule may also increase the risk of endophthalmitis. Postoperative endophthalmitis is usually associated with gram-positive organisms (75%–80%); gram-negative organisms (15%–29%) and fungi (3%–13%) account for a smaller number of cases. A high rate of resistance to penicillin, ampicillin, and tetracycline was observed in Saureus isolates, although resistance to vancomycin was absent, rendering this molecule the most effective therapeutic option. In this study, Sepidermidis and Saureus were the 2 most frequently isolated organisms in patients with DM. It is concluded that the conjunctival flora in diabetic subjects differs from that in nondiabetic subjects. This should be considered preoperatively and postoperatively, and prophylactic and postoperative treatment should be administered accordingly to diabetic patients.     

2型糖尿病病人抑郁情况分析

糖尿病是一种严重影响人们心身健康的疾病 ,其患病率呈逐年上升的趋势 ,1994年— 1995年全国 2 5万人口 (>2 5岁 )调查发现 ,糖尿病和葡萄糖耐量降低 (IGT)病人各占 2 .5 % ,患病数较 15年前增长 3倍多 ,其后北京调查糖尿病患病率约 4% ,上海某社区约 5 % [1] 。然而糖尿病病因至今并不十分清楚 ,普遍认为与遗传、自身免疫和环境因素有关[1] 。流行病学表明 ,糖尿病与肥胖及负性生活事件有关[2 ] ,但糖尿病本身也可致抑郁症状的发生或加重[3 ] ,本文对 86例新诊断糖尿病病人的心理状况作了调查 ,现报告如下。1　对象与方法1.1　对象　随机…     

2型糖尿病患者人体成分的变化

目的 了解2型糖尿病患者与正常人体内成分的差异,进一步探讨肥胖与2型糖尿病的关系.方法 随机选取80例2型糖尿病患者(糖尿病组)及80例健康体检者(对照组),分别进行人体成分分析,包括体脂肪、内脏脂肪区域、骨骼肌、腰臀比及蛋白质、矿物质含量等指标,同时测定糖尿病患者的血糖、血脂、胰岛素抵抗指数、糖化血红蛋白.结果 糖尿病组体脂肪[(19.68 ±6.78) kg]、体脂百分比[(29.87±8.04)％]、肥胖程度[(115.93 ±15.94)％]、内脏脂肪区域[(104.48 ±36.19) cm2]、体质量指数[(24.85±3.51) kg/m2]、胸围[(94.06±7.86) cm]、腰围[(85.18 ±9.50) cm]、腰臀比(0.90±0.05)均明显高于对照组[体脂肪:(17.31 ±5.55) kg、体脂百分比:(27.38±6.47)％、肥胖程度:(108.88±13.80)％、内脏脂肪区域:(85.44±44.04) cm2、体质量指数:(23.43 ±3.10) kg/m2、胸围:(91.11 ±7.52) cm、腰围:(80.79±8.17) cm、腰臀比(0.86 ±0.05)](t值分别为2.55、2.30、3.12、2.86、2.73、2.28、3.12、4.76,P均＜0.05),而体质量控制[(-7.01 ±7.49)kg]、肥胖控制[(-8.53 ±6.66)kg]、肌肉控制[(1.52±1.43) kg]均低于对照组[体质量控制:(-4.08 ±6.79)kg、肥胖控制:(-6.39±5.78) kg、肌肉控制:(2.31 ±2.09) kg(t值分别为-2.59、-2.17、-2.15,P均＜0.05).糖尿病组尿酸与体质量控制、肥胖控制呈负相关(r值分别为-0.43、-0.42,P均＜0.01),与内脏脂肪区域、体脂百分比、腰臀比、体质量指数、肥胖程度、胸围、腰围、体脂肪呈正相关(r值分别为0.32、0.31、0.40、0.36、0.36、0.31、0.42、0.42,P均＜0.05),甘油三酯与体质量控制、肥胖控制呈负相关(r值分别为-0.44、-0.41,P均＜0.01),与体脂百分比、腰臀比、体质量指数、肥胖程度、胸围、腰围、体脂肪呈正相关(r值分别为0.27、0.35、0.46、0.46、0.35、0.42、0.42,P均＜0.05).结论 2型糖尿病患者的体脂肪含量及体脂肪分布与健康人有显著差异,中心性肥胖可能与糖尿病发生存在一定关系.     

Advantages of extended-release metformin in patients with type 2 diabetes mellitus

Metformin is a first-line pharmacological treatment for patients with type 2 diabetes mellitus because of its favorable overall profile, including its glucose-lowering ability, weight-neutral effects, and low risk of hypoglycemia; however, gastrointestinal (GI) intolerance may limit use in some patients. Extended-release metformin improves GI tolerability, allows once-daily dosing, and is currently available in multiple branded and generic formulations; however, it is more expensive than immediate-release metformin. Maximum plasma metformin concentrations are reached more slowly with the extended-release formulation compared with conventional immediate-release metformin, although both provide similar exposure at a given total daily dose. Extended-release metformin is as effective as immediate-release metformin in patients newly started on metformin and those switched from the immediate-release formulation, with similar weight-neutral effects. Tolerability is generally comparable, although patients switched from the immediate-release formulation--even those switched due to GI intolerance--are often better able to tolerate the extended-release formulation. Based on studies of extended-release formulations in other disease states, metformin extended-release formulation has the potential to improve patient adherence with a simpler dosing regimen and increased tolerability. Increased adherence may result in greater glycemic control, and in turn, improve outcomes and lower health care usage and costs. Extended-release metformin provides an appropriate option for patients with type 2 diabetes mellitus who require several medications to achieve glycemic control or manage comorbid conditions, and for those who have GI intolerance with the immediate-release formulation.     

2型糖尿病患者应用西格列汀的抗动脉粥样硬化效应

目的探讨口服降糖药物二肽基肽酶4(DPP 4)抑制剂西格列汀对接受胰岛素治疗的2型糖尿病患者颈动脉内膜中层厚度(IMT)的影响。方法本研究是一个前瞻性、随机、平行对照研究。接受胰岛素治疗后血糖控制不良的2型糖尿病患者172例,分为西格列汀治疗组84例和对照组88例,通过颈动脉超声评价治疗后12个月平均IMT变化。结果随访12个月后,西格列汀组IMT较基线明显降低,而对照组无明显变化。西格列汀组IMT较对照组明显降低(P＜0.05)。同时,西格列汀组降糖效应优于对照组(P＜0.05),而且低血糖和体质量增加等不良事件未见增多。结论对于接受胰岛素治疗的2型糖尿病患者,加用西格列汀治疗降低血糖同时可抑制颈动脉IMT进展。