Calcium and magnesium status is not impaired in pregnant women

Deficiencies in calcium (Ca) and magnesium (Mg) are associated with various complications during pregnancy. To test the hypothesis that the status of these minerals is inadequate in pregnancy, a cross-sectional study was conducted of the dietary intake and status of Ca and Mg in pregnant women (n = 50) attending a general public university hospital in Brazil. Dietary intake was assessed from 4-day food records; levels of plasma Mg, erythrocyte Mg, and urinary Ca and Mg excretion were determined by flame atomic absorption spectroscopy; and type I collagen C-telopeptides were evaluated by enzyme-linked immunosorbent assay. Probabilities of inadequate Ca and Mg intake were exhibited by 58 and 98% of the study population, respectively. The mean levels of urinary Ca and Mg excretion were 8.55 and 3.77 mmol/L, respectively. Plasma C-telopeptides, plasma Mg, and erythrocyte Mg were within normal levels. Multiple linear regression analysis revealed positive relationships among urinary Ca excretion, Ca intake (P = .002) and urinary Mg excretion (P < .001) and between erythrocyte Mg and Mg intake (P = .023). It is concluded that the Ca and Mg status of participants was adequate even though the intake of Ca and Mg was lower than the recommended level.     

Magnesium Nutritional Status,Risk Factors,and the Associations with Glucose Parameters of Childbearing Women in the China Adult Chronic Disease and Nutrition Surveillance (2015)

Magnesium is an essential element and participates in many metabolic pathways. Inadequate magnesium levels may lead to various health problems such as type 2 diabetes (T2DM), hypertension, and cancer. But the role of Mg in childbearing women of China is still a relatively narrow researched field. We aimed to assess the Mg nutritional status, explore the risk factors of Mg deficiency, and the associations between Mg and glucose parameters among childbearing women in a nationally representative sample. A total of 1895 18–44 years childbearing women were recruited from the China Adult Chronic Disease and Nutrition Surveillance (2015). Multivariate logistic regression was used to explore the risk factors for Mg deficiency and estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for the risk of hyperglycemia. The mean value of Mg was 0.87 mmol/L and the prevalence of deficiency was 4.69%. The risk factors of Mg deficiency (Mg < 0.75 mmol/L) was city-type of rural (p = 0.045), while calcium (p = 0.001), LDL-C (p = 0.024), age group of 26–35 years (p = 0.016), 36–44 years (p = 0.006), and CNNM2 rs3740393 genotypes of GC (p = 0.027) were protective factors. It was also found that magnesium deficiency induces an increase in plasma glucose (p = 0.001). Compared with the reference range, Mg < 0.75 mmol/L would have a 6.53 fold risk for T2DM, a 5.31 fold risk for glucose-hyperglycemia, and a 9.60 fold risk for HbA1c-hyperglycemia. Consistently, there was a negative association between plasma Mg and blood glucose parameters in the dose–response study. More attention should be paid to the nutritional status of magnesium and the impact of magnesium deficiency on human health.     

糖尿病患者血浆糖化血红蛋白与微血管并发症的相关性

目的探讨2型糖尿病患者血浆糖化血红蛋白（HbAlc）水平与糖尿病微血管并发症的关系。方法选取本院208例2型糖尿病患者作为研究对象,测定患者空腹血糖血浆糖化血红蛋白（HbAlc）、尿微量白蛋白排泄率,并检查患者视网膜病变情况。统计分析HbAlc水平与患者微血管并发症发生率的关系。结果①208例患者中有眼部视网膜病变者（DR）31例,无视网膜病变（NDR）者177例,DR组HbAlc值为（6．539±1．377）％,NDR组HbAlc值为（5．588±0．577）％,差异有统计学意义（P〈0．05）;随HbAlc水平的升高,DR检出率呈增高趋势。②208例患者中有微量蛋白尿（UMA）的患者27例,无微量蛋白尿（N1mdA）患者181例,UMA组HbAlc值为（6．276±1．191）％,NUMA组HbAlc值为（5．696±0．766）％,差异有统计学意义（P〈0．05）;随HbAlc水平的升高,LIMA检出率呈增高趋势。结论2型糖尿病微血管并发症的发生与患者血浆糖化血红蛋白水平有关,控制糖化血红蛋白对于预防糖尿病微血管并发症有重要的意义。     

老年男性2型糖尿病患者骨质疏松相关因素分析

目的 探讨与老年男性2型糖尿病（type 2 diabetes mellitus,T2DM）骨质疏松（osteoporosis,OP）发生相关的因素。方法 选取老年男性T2DM患者288例,根据OP诊断标准分为骨量正常组（72例）、骨量减少组（118例）和骨质疏松组（98例）。测量身高、体重,计算体质指数（body mass index,BMI）;测定空腹血糖（fasting blood glucose,FBG）、糖化血红蛋白（glycosylated hemoglobinA1c,HbA1c）、甲状旁腺素（parathyroid hormone,PTH）、血清钙（serum calcium,Ca）、血清磷（serum phosphonium,P）、25羟维生素D （serum 25-hydroxyvitamin D,25-OH-VD）及尿白蛋白/肌酐（urinary albumin/creatinine ratio,ACR）,记录患者病程、降糖药物使用和糖尿病慢性并发症情况。结果 与骨量正常组比较,骨质疏松组和骨量减少组病程较长和HbA1c较高,BMI减低,差异均有统计学意义（均有P<0.05）。相关分析显示股骨颈、三角区、大转子、腰椎（lumbar vertebrae,L）2-4节骨密度（bone mineral density,BMD）与BMI均呈正相关（均有P<0.05）,但与HbA1C均呈负相关（均有P<0.05）。骨质疏松组糖尿病肾病、糖尿病视网膜病变发生率均高于骨量正常组、骨量减少组（均有P<0.05）;骨质疏松组糖尿病神经病变发生率高于骨量正常组（χ2=6.168,P=0.013）。Logistic回归分析显示BMI、HbA1c及糖尿病肾病与糖尿病骨质疏松发生相关（均有P<0.05）。结论 低BMI,血糖控制不佳和糖尿病肾病是老年男性T2DM患者OP发生的危险因素。     

Daily magnesium supplements improve glucose handling in elderly subjects.

We demonstrated similar plasma concentrations and urinary losses but lower erythrocyte magnesium concentrations (2.18 +/- 0.04 vs 1.86 +/- 0.03 mmol/L, P less than 0.01) in twelve aged (77.8 +/- 2.1 y) vs 25 young (36.1 +/- 0.4 y), nonobese subjects. Subsequently, aged subjects were enrolled in a double-blind, randomized, crossover study in which placebo (for 4 wk) and chronic magnesium administration (CMA) (4.5 g/d for 4 wk) were provided. At the end of each treatment period an intravenous glucose tolerance test (0.33 g/kg body wt) and a euglycemic glucose clamp with simultaneous [D-3H]glucose infusion and indirect calorimetry were performed. CMA vs placebo significantly increased erythrocyte magnesium concentration and improved insulin response and action. Net increase in erythrocyte magnesium significantly and positively correlated with the decrease in erythrocyte membrane microviscosity and with the net increase in both insulin secretion and action. In aged patients, correction of a low erythrocyte magnesium concentration may allow an improvement of glucose handling.     

Suggested Reference Ranges of Blood Mg and Ca Level in Childbearing Women of China: Analysis of China Adult Chronic Disease and Nutrition Surveillance (2015)

Background: Magnesium and calcium play a variety of biological roles in body functions. Reference values of these elements have not yet been systematically determined in China, especially in childbearing women. We proposed to establish the reference range of Mg, Ca, and Ca/Mg ratio in plasma and whole blood for 18–44 years healthy childbearing women in China. Method: A total of 1921 women of childbearing age (18–44 years) were randomly selected from the 2015 China National Nutrition and Health Survey by taking into account the regional types and monitoring points. Among them, 182 healthy women were screened out with a series strict inclusion criteria to study the reference ranges of elements. Fundamental indicators (weight, height, waist, blood pressure, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein, fast glucose, HbA1c, blood pressure, uric acid) and elements concentrations in plasma and whole blood were collected. The 2.5th to 97.5th was used to represent the reference range of Mg, Ca, and Ca/Mg ratio. Results: The reference range of Mg, Ca, and Ca/Mg ratio in plasma were 0.75–1.13 mmol/L, 2.27–3.43 mmol/L, and 2.41–3.44, respectively. Additionally, the reference range of Mg, Ca, and Ca/Mg ratio in whole blood were 1.28–1.83 mmol/L, 1.39–2.26 mmol/L, and 0.90–1.66, respectively. According to the established reference range, the prevalence of magnesium deficiency was 4.79% in 1921 childbearing women, 21.05% in type 2 diabetes, and 5.63% in prediabetes. Conclusion: The reference values of Mg, Ca and Ca/Mg proportion in plasma and entire blood of healthy childbearing women can be utilized as a pointer to assess the status of component lack and over-burden. The lower limit of plasma Mg is in good agreement with the recommended criteria for the determination of hypomagnesemia.     

2型糖尿病患者HbA1c是否达标对尿蛋白、血脂及肝酶的影响

目的 探讨2型糖尿病患者HbA1c是否达标对尿蛋白、血脂及肝酶的影响.方法 采用多阶段分层整群抽样方法 回顾性分析457例已确诊2型糖尿病患者的资料,根据HbA1c结果 判定分为未达标组与达标组,采集患者一般资料及实验室相关指标等进行比较.结果 两组患者的尿微量白蛋白、血清甘油三酯及肝酶学指标（谷氨酰转肽酶、碱性磷酸酶、谷草转氨酶）结果 差异有统计学意义[（189.8±235.3）mg/dl vs（38.9±85.5）mg/dl、（2.64±2.99）mmol/L vs（2.02±1.50）mmol/L、（41.7±52.9）U/L vs（29.7±24.9）U/L、（83.6±28.6）U/L vs（74.3±25.8）U/L、（26.7±19.1）U/L vs（22.0±10.5）U/L,P＜0.05].HbA1c与尿微量白蛋白、谷氨酰转肽酶、碱性磷酸酶呈正相关（r=0.209、0.115、0.11,P＜0.01）.尿微量白蛋白是影响2型糖尿病患者HbA1c达标的独立危险因素（OR=1.009,P＜0.05）.结论 HbA1c达标与否对血糖外多种因素均有影响.     

Hyperhomocysteinemia in poorly controlled type 2 diabetes patients

Elevated blood level of homocysteine is strongly related to an increased risk for atherosclerosis and cardiovascular disease. The role of homocysteine in Type 2 diabetes vascular complications remains unclear. Our objective was to investigate homocysteine levels in poorly controlled Type 2 diabetic patients, who are at increased risk of vascular complications development. Forty-four Type 2 diabetic patients with no symptoms of any cardiovascular disease were divided into 2 groups: 26 patients with poor metabolic control treated with oral agents (aged 66.8 +/- 5.4 yr, diabetes duration 11.9 +/- 4.1 yr, fasting plasma glucose 13.9 +/- 4.6 mmol/l, HbA1C 9.8 +/- 1.6%), 18 well-matched diabetic patients well-controlled with oral agents (aged 65.8 +/- 4.7 yr, diabetes duration 10.9 +/- 4.2 yr, fasting plasma glucose 7.3 +/- 2.4 mmol/l, HbA1c 6.6 +/- 0.7%). The controls were 12 healthy subjects. Fasting total plasma homocysteine and plasma insulin concentrations were measured. Plasma total homocysteine concentrations were significantly higher in poorly controlled than in well-controlled diabetic patients and controls (17.1 +/- 4.5 vs 8.2 +/- 3.9 and 6.5 +/- 4.9 micromol/l respectively, p < 0.001). Insulinemia showed an inverse correlation with homocysteine levels (8.3 +/- 5.2 vs 14.6 +/- 5.2 and 9.3 +/- 6.1 microlU/ml, p < 0.001; r = -0.32, p < 0.05). HbA1c values correlated positively with homocysteine concentrations in poorly controlled subjects (r = 0.41; p < 0.05). In conclusion, chronic poor metabolic control of Type 2 diabetes is characterized by elevation of plasma homocysteine concentration, which also inversely correlates with endogenous insulin levels. These results may add to the understanding of the increased frequency and mechanisms of vascular damage in diabetes mellitus.     

低镁血症与维持性血液透析患者死亡的相关性

目的 研究血清镁（Mg2+）与维持性血液透析（maintenance hemodialysis,MHD）患者全因死亡及心血管疾病（cardiovascular diseases,CVD）死亡之间的关系。方法 选取446名某科进行MHD治疗的患者为研究对象,记录其基线资料,并进行为期3年的随访。以Mg2+中位数（0.865 mmol/L）为界值,将其分为高镁组（Mg2+≥0.865 mmol/L）和低镁组（Mg2+＜0.865 mmol/L）。采用Kaplan-Meier生存曲线比较2组患者的生存率,利用COX回归模型分析患者全因死亡及CVD死亡的危险因素。结果 Kaplan－Meier生存曲线显示,高镁组患者的生存率显著高于低镁组患者(P＜0.05)。多因素Cox回归分析显示,以低镁组为参照,高镁组是MHD患者全因死亡（HR = 0.226,95%CI:0.072～0.705,P = 0.010）、CVD死亡（HR = 0.327,95%CI:0.119～0.895,P = 0.029）的保护因素。结论 血清镁与MHD患者的全因死亡及CVD死亡风险相关,可作为评估MHD患者死亡风险的有价值指标之一。     

The effects of insulin combined with glibenclamide on glucose and lipid metabolism in patients with Type II diabetes mellitus

We compared the effects of twice-daily insulin injections (n = 22) with combined insulin-glibenclamide therapy (n = 25) on glucose and lipid metabolism in 47 type II diabetic patients (age 69 (SD 9) years, BMI 25.5 (4.8) kg/m2, diabetes duration 9 (range 1-34) years) with secondary failure to sulphonylurea. After 6 months, weight gain averaged 4.2 kg (p less than 0.05), fasting blood glucose had decreased from 14.6 to 8.5 mmol/l (p less than 0.001), HbA1c from 10.9% to 8.1% (p less than 0.001). Twenty-one patients reached HbA1c levels less than 8.0%. Patients on insulin alone injected more insulin (42 vs 26 U daily, p less than 0.01). The decrease of fasting blood glucose and HbA1c was comparable in both groups (p less than 0.001). HDL-cholesterol increased (insulin: 1.10 to 1.24 mmol/l, combined therapy: 1.03 to 1.14 mmol/l, both p less than 0.01), while plasma triglycerides and NEFA decreased (p less than 0.01). Only in patients on insulin alone did total cholesterol decrease from 7.1 to 6.3 mmol/l (p less than 0.001), and LDL-cholesterol from 4.7 to 4.1 mmol/l (p less than 0.05). Apolipoproteins AI, AII and B did not show significant changes. Almost all patients reported improved wellbeing; no severe hypoglycaemias were observed.     

2型糖尿病视网膜病变相关因素Logistic回归分析

目的研究影响2型糖尿病视网膜病变（DR）的相关因素。方法对720例2型糖尿病患者的糖尿病病程、糖尿病家族史、心脑血管病史、吸烟史、居住地域等进行调查,测量血压、血脂、体质指数（BMI）、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、24h尿微量白蛋白等,检查糖尿病周围神经病变,并对上述DR相关因素进行Logistic回归分析。结果单因素Logistic回归分析结果显示,居住地域、糖尿病病程、血压、糖尿病周围神经病变、HbA1c、24h尿微量白蛋白与DR发生之间的联系有统计学意义（P〈0．05）;多因素Logistic回归分析结果显示,糖尿病病程、HbA1c、24h尿微量白蛋白与DR发生之间的联系有统计学意义（均P〈0．05）。结论糖尿病病程、HbA1c、24h尿微量白蛋白与DR发生相关。     

Riboflavin and riboflavin-derived cofactors in adolescent girls with anorexia nervosa

BACKGROUND: Thyroid hormones, riboflavin, riboflavin cofactors, and organic acids were assessed in girls with anorexia nervosa. OBJECTIVE: The objective was to examine the effect of malnutrition and low thyroid hormone concentrations on erythrocyte and plasma riboflavin metabolism and their relation with urinary organic acid excretion. DESIGN: Seventeen adolescent girls with anorexia nervosa [body mass index (BMI; in kg/m2): 14.8 +/- 2.2] and 17 age-matched, healthy girls (control subjects; BMI: 20.5 +/- 2.2) took part in the feeding study. Erythrocyte and plasma riboflavin as well as riboflavin cofactors (flavin mononucleotide and flavin adenine dinucleotide) were assessed by HPLC, whereas urinary organic acids were assessed by gas chromatography-mass spectrometry. RESULTS: Anorectic patients who began a feeding program had higher erythrocyte riboflavin (3.5 +/- 2.2 compared with <0.1 nmol/mol hemoglobin; P < 0.001), lower plasma flavin adenine dinucleotide (57.8 +/- 18.5 compared with 78.5 +/- 54.3 nmol/L; P < 0.05), and higher urinary ethylmalonic acid (7.12 +/- 4.39 compared with 1.3 +/- 2.8 micromol/mmol creatinine; P < 0.001) and isovalerylglycine (7.65 +/- 4.78 compared with 3.8 +/- 0.9 micromol/mmol creatinine; P < 0.05) concentrations than did control subjects. Triiodothyronine concentrations were low and negatively correlated with plasma riboflavin concentrations (r = -0.69, P < 0.01). Not all patients showed improvements in these biochemical indexes after 30 d of refeeding. CONCLUSIONS: The low triiodothyronine concentrations observed in anorexia nervosa could alter the extent of riboflavin conversion into cofactors, thus leading to high erythrocyte riboflavin concentrations, low plasma flavin adenine dinucleotide concentrations, and high rates of ethylmalonic acid and isovalerylglycine excretion.     

神经节苷脂治疗重症手足口病患儿临床疗效及NSE和S-100β蛋白变化

目的探讨神经节苷脂对重症手足口病(HFMD)患儿疗效,以及血清神经元特异性烯醇化酶(NSE)和血浆S-100β蛋白的影响。方法某院2011年4月—2014年6月收治的140例重症HFMD患儿随机分为常规治疗组和试验组,选择同期门诊体检健康儿童30例作为正常对照组。常规治疗组予以抗病毒、降颅压等治疗;试验组在常规治疗组基础上加用神经节苷脂,比较3组儿童NSE和S-100β蛋白水平,以及常规治疗组和试验组临床疗效。结果试验组总有效率为91.43%(64/70),高于常规治疗组78.57%(55/70)(χ2=4.54,P0.05)。重症HFMD患儿NSE及S-100β蛋白分别为(17.63±4.21)μg/L、(492.05±119.33)ng/L,均高于对照组[分别为(8.79±2.12)μg/L、(296.35±91.02)ng/L](均P0.01)。治疗前,常规治疗组和试验组患儿血清NSE、S-100β蛋白水平比较,差异均无统计学意义(均P0.05);治疗10 d后,两组患儿血清NSE、S-100β蛋白水平均低于治疗前(均P0.01),且试验组NSE、S-100β蛋白下降水平分别为(10.18±2.36)μg/L、(247.55±64.64)ng/L,均高于常规治疗组[分别为(5.87±3.03)μg/L、(113.97±43.44)ng/L](均P0.01)。结论神经节苷脂对重症HFMD患儿有明显的疗效,可有效降低脑组织损伤标志物NSE及S-100β蛋白。     

Glycaemic control in type II diabetic tube-fed patients with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids: a randomised controlled trial

OBJECTIVES: To investigate the effects of long-term treatment with a new enteral formula low in carbohydrates and high in monounsaturated fatty acids (MUFAs), in comparison with a standard formula, on glycaemic control in tube-fed type II diabetic patients. DESIGN: Randomised, double-blind, controlled, multi-centre trial.Setting:Early rehabilitation centres, primary care and nursing facilities. SUBJECTS:A total of 78 patients with insulin-treated type II diabetes with HbA(1C) > or =7.0% and/or fasting blood glucose >6.66 mmol/l, who required enteral tube feeding due to neurological dysphagia. INTERVENTIONS: Patients received 113 kJ (27 kcal)/kg of body weight of either test feed or an isoenergetic, isonitrogenous enteral formula (control) for 12 weeks. Glycaemic control (total daily insulin dosage (IU), fasting blood glucose, and HbA(1C)) and gastrointestinal tolerance were monitored daily. RESULTS: After 12 weeks, median values for changes from baseline were as follows (test group vs control group, 'data as available' analysis): total daily IUs -6.0 vs 0.0 (P=0.0024), fasting blood glucose (mmol/l) -1.59 vs -0.08 (P=0.0068); HbA(1C) (%) -0.8 vs 0.0 (P=0.0016). Both formulas were tolerated comparably. CONCLUSIONS:This study indicates that in tube-fed insulin-treated type II diabetic patients, the new low-carbohydrate, high MUFA formula results in a more effective glycaemic control than the standard diet, while being comparable in safety.     

罗格列酮减少2型糖尿病患者尿白蛋白排泄的临床疗效观察

目的观察罗格列酮对新诊断2型糖尿病患者尿白蛋白排泄的影响。方法新诊断2型糖尿病患者78例,随机分成罗格列酮治疗组（DM＋RSG组,n=40例）和格列吡嗪治疗组（DM＋GLP组,n=38例）,观察时间为6个月。所有患者在开始治疗前和治疗3个月及结束时检查空腹血糖（FPG）、早餐后2h血糖（PPG）、糖化血红蛋白（HbA1c）和尿白蛋白排泄率（UAE）,尿白蛋白排泄率用随机晨尿的尿白蛋白/尿肌酐（ACR）比值表示;比较24h平均收缩压（MASBP）和24h平均舒张压（MADBP）。结果治疗6个月后DM＋RSG组和DM＋GLP组FPG、PPG、HbA1c较治疗前明显下降（P〈0.01）,DM＋RSG组ACR由治疗前21.8±6.3mg/mmol降至14.6±4.8mg/mmol（P〈0.01）,DM＋RSG组治疗前后MASBP和MAD-BP降低值同DM＋GLP组治疗前后MASBP和MADBP降低值,经统计学分析均有明显的差异（P〈0.05）,经直线相关分析尿白蛋白排泄率同MASBP和MADBP呈直线正相关关系（r=0.521和0.489,P〈0.05）。结论本组研究发现罗格列酮具有减少尿白蛋白排泄的作用,提示罗格列酮具有预防和治疗2型糖尿病患者肾脏病变和心血管并发症的作用。     

Magnesium status in children and adolescents with coeliac disease without malabsorption symptoms

BACKGROUND & AIMS: Magnesium deficiency has been reported in coeliac disease (CD) with clinical symptoms. The aim of this study was to evaluate magnesium status in CD without malabsorption symptoms in patients aged 5-18 years. In the study participated 41 coeliac patients on a gluten-free diet (GFD) for a mean 11 years with IgAEmA (-) and normal villi, 28 patients with untreated subclinical (atypical) CD with IgAEmA (+) and villous atrophy, and 8 healthy subjects as a control group. METHOD: Magnesium status was examined by an intravenous Mg loading test, determination of serum and erythrocyte Mg concentrations, and urinary excretion. Steatorrhea was assessed by fecal fat excretion. Magnesium, calcium, protein, and fat intake were evaluated by a food frequency questionnaire. RESULTS: The frequency of magnesium deficiency as assessed by the magnesium loading test was: 19.6% in treated, 21.4% in untreated CD patients, and 25% in control group, similar in both sexes, sporadic in small towns (3.8%), frequent in large cities and rural villages (23.5% vs. 32.3%). Fat excretion was within normal limits. The following results were found, respectively: decreased serum magnesium concentration, 7.3% vs. 3.6% vs. 0%, decreased erythrocyte Mg concentration, 14.6% vs. 25% vs. 12.5%; decreased intake of magnesium, 29% vs. 32% vs. 0%. CONCLUSIONS: The frequency of magnesium deficiency was similar in pediatric patients who were treated for CD or in patients with subclinical CD, and in control group; magnesium deficiency in patients participating in our study depended on an imbalanced diet.     

Effects on diabetes management of a health-care provider mediated, remote coaching system via a PDA-type glucometer and the Internet

We conducted a randomized controlled trial for 12 weeks in patients with type 2 diabetes living in a rural part of Korea. The intervention group (n = 35) was managed by a diabetes centre which provided specialized management mediated by a primary health-care nurse who used a PDA-type blood glucometer with a bar code detector to measure the capillary glucose levels. The control group (n = 36) received usual care. Compared with baseline, HbA(1c) was significantly reduced at three-month follow-up in the intervention group (8.0% vs. 7.5%; P < 0.01), but not in the control group. Total cholesterol was significantly reduced in the intervention group (10.7 mmol/L vs. 10.4 mmol/L; P = 0.043). Fasting plasma glucose and triglyceride levels were lower at follow-up in both groups, but the difference was not significant. The new system could be implemented widely and would contribute to improving the quality of diabetes care, even in isolated rural areas.     

Association of Serum Magnesium with Insulin Resistance and Type 2 Diabetes among Adults in China

Magnesium is an essential mineral for the human body and a cofactor or activator for more than 300 enzymatic reactions, including blood glucose control and insulin release. Diabetes is a well-known global burden of disease with increasing global prevalence. In China, the prevalence of diabetes in adults is higher than the global average. Evidence shows that magnesium is a predictor of insulin resistance and diabetes. However, the majority of studies focus on dietary magnesium instead of serum magnesium concentration. We study the correlation of serum magnesium levels with insulin resistance and Type 2 diabetes. In this prospective cohort study, we included 5044 participants aged 18 years and older without insulin resistance (IR) and diabetes at the baseline from China Health and Nutrition Survey (CHNS). A fasting blood sample was taken for the measurement of both types of magnesium, fasting blood glucose, hemoglobin A1c (HbA1c), and fasting insulin. The homeostatic model (HOMA-IR) was calculated. Demographic characteristics of participants, and risk factors such as intensity of physical activities, smoking status, drinking habit, and anthropometric information were recorded. IR was defined as HOMA-IR ≥ 2.5, and Type 2 diabetes mellitus was defined as fasting plasma glucose ≥ 7.0 mmol/L or HbA1c ≥ 6.5%, or a self-reported diagnosis or treatment of diabetes. A total of 1331 incident insulin resistance events and 429 incident diabetic events were recorded during an average follow-up of 5.8 years. The serum magnesium concentration was categorized into quintiles. After adjusting for relevant covariates, the third quintile of serum magnesium (0.89–0.93 mmol/L) was correlated with 29% lower risk of incident insulin resistance (hazard ratio = 0.71, 95% CI 0.58, 0.86) and with a lower risk of Type 2 diabetes. Multivariable-adjusted hazard ratios (95% confidence intervals) for insulin resistance were compared with the lowest quintile of serum magnesium (<0.85). We found similar results when evaluating serum magnesium as a continuous measure. Restricted cubic spline (RCS) curves showed a nonlinear dose–response correlation in both serum magnesium levels and insulin resistance, and in serum magnesium levels and Type 2 diabetes. Lower serum magnesium concentration was associated with a higher risk of insulin resistance and diabetes.     

糖尿病性皮肤病对糖尿病肾病的筛查价值探讨

目的探讨糖尿病肾病（DN）的相关危险因素及糖尿病性皮肤病（DD）对DN的筛查价值。方法选择188例2型糖尿病（T2DM）患者,其中合并DN者78例（DN组）,无DN者110例（非DN组）。记录并比较两组患者的性别、年龄、糖尿病病程、吸烟情况、DD、体质量指数（BMI）、收缩压（SBP）、舒张压（DBP）、空腹血糖（FBG）、餐后2h血糖（2hPG）、三酰甘油（TG）、总胆固醇（TC）、糖化血红蛋白（HbA1c）、空腹c肽（Fc-P）等。以有无DN为因变量进行多因素Logistic回归分析。结果T2DM患者中DD与DN的发病率分别为47．34％（89／188）和41．49％（78／188）。而DN组中DD的发病率达79．49％（62／78）,而非DN组中为24．55％（27／110）,两组比较差异有统计学意义（P〈0．05）。DN组患者年龄、糖尿病病程、SBP、FBG、2hPG、HbA1c明显高于非DN组[（52．83±6．43）岁比（50．35±6．48）岁,（10．51±4．36）年比（6．484±3．25）年,（137．42±14．17）mmHg（1mmHg=0．133kPa）比（132．57±15．38）mmHg,（11．95±2．83）mmol／L比（10．28±1．98）mmol／L,（15．07±3．16）mmol/L比（13．51±2．75）mmol／L,（9．62±2．17）％比（8．634±2．08）％],FC-P低于非DN组[（1．76±0．89）μg／L比（2．01±0．72）μg／L],差异均有统计学意义（P〈0．05）。多因素Logistic回归分析结果显示,糖尿病病程、DD、FBG是影响DN的独立危险因素（OR=4．841,3．209,3．368,P〈0．01）。结论在T2DM患者中,DD与DN存在一定的相关性。对于T2DM患者存在DD时应注意DN的筛查。     

老年菌血症患者血小板及凝血功能的变化与意义

目的探讨重症监护室（ICU）老年菌血症患者血小板（PLT）及凝血功能的变化与临床意义。方法选择经实验室检测确认的 24例ICU老年菌血症患者为研究对象,比较其发生菌血症前后PLT及凝血功能的变化,以及不同病原体（革兰阳性球菌、革兰阴性杆菌和真菌）感染组、存活组与死亡组PLT及凝血功能的变化。结果发生菌血症后,老年患者PLT计数为（144.50±84.10）×109/L,部分活化的凝血酶原时间（APTT）为（47.04±14.60）s,凝血酶原时间（PT）为（18.63±8.92）s,纤维蛋白原（FIB）为（4.20±0.98）g/L,与基础值［分别为（233．18±78.20）×109/L、（33.98±7.36）s、（12.83±2.17）s、（3.16±0.79）g/L］比较,差异均有统计学意义（P＜0.05）;凝血酶时间（TT）无统计学差异（P＞0.05）。不同病原体感染组间PLT及相关凝血功能指标比较,差异无统计学意义（P＞0.05）。死亡组的PLT计数［（89.60±36.42）×109/L］低于存活组［（213.13±76.06）×109/L］,APTT值［（54.55±13.21）s］高于存活组［（35.93±7.03）s］（P＜0.05）,FIB及PT无统计学差异（P＞0.05）。结论PLT及部分凝血功能指标可作为辅助诊断老年菌血症的参考之一,并可在一定程度上判断预后。