动机性访谈在2型糖尿病患者运动疗法中的应用

目的:探讨动机性访谈(MI)在2型糖尿病患者运动疗法中的应用效果。方法:将60例2型糖尿病患者随机分为对照组和观察组各30例,均进行运动疗法指导。对照组给予常规健康教育,观察组给予MI。比较两组干预前后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、糖化血红蛋白(HbA1c)、体质指数(BMI)及运动依从性、生活质量评分。结果:观察组干预后FPG、2 hPG、HbA1c、BMI及运动依从性均优于对照组(P<0.05),生活质量中生理功能、心理精神、社会关系评分及总分与对照组比较差异有统计学意义(P<0.05,P<0.01)。结论:MI能有效提高2型糖尿病患者的运动依从性,改善病情,提高生活质量。     

Hand dysfunction in type 2 diabetes mellitus: Systematic review with meta-analysis

Background

People with type 2 diabetes mellitus frequently show complications in feet and hands. However, the literature has mostly focused on foot complications. The disease can affect the strength and dexterity of the hands, thereby reducing function.

不同方式联合药物治疗2型糖尿病继发性失效的疗效探讨

目的观察三种不不同方式联合磺酰脒类药物治疗继发性失效的2型糖尿病患者。进一步探讨其短期疗效。方法磺酰脲炎药物继发性失效的2型糖尿病患者66例,随机分成三组,A组（睡前NPH加二甲双胍再加拜唐苹）、B组（睡前NPH加二甲双胍）．C组（睡前NPH加二甲双胍再加达美康）。疗程3个月,治疗前、后测定FBG、PBG、Fc、Pc、CH、TG、LDL-TC、HDL-TC。结果A、B、C组,FBG、PBG、CH、TG、LDL-TC均明显降低,HDL-TC均明显升高（P〈0．05）,Fc、Pc差异无统计学意义（P〉0．05）。FBG下降的幅度C组〉A组,C组〉B组,PBG下降幅度A组〉C组〉B组。结论睡前小剂量应用中效胰岛素联合口服降糖药治疗SFS的2型糖尿病患者安全有效,可以改善胰岛素抵抗,以NPH加二甲双胍再加达美康联合降空腹血糖效果最佳,以NPH加二甲双胍再加拜唐苹联合降餐后血糖效果最优。     

Dapagliflozin combination therapy in type 2 diabetes mellitus

Type 2 diabetes mellitus (T2DM) is a progressive disease, and most patients ultimately require two or more antidiabetes drugs in addition to lifestyle changes to achieve and maintain glycemic control. Current consensus statements and guidelines recommend metformin as first-line pharmacotherapy for the treatment of T2DM in most patients. When glycemic control cannot be maintained with metformin alone, the sequential, stepwise addition of other agents is recommended. Agents such as thiazolidinediones or sulfonylureas have typically been added to metformin therapy. Although effective in reducing glycated hemoglobin, these drugs are often associated with adverse effects, most notably weight gain, and in the case of sulfonylureas, hypoglycemia. Sodium-glucose cotransporter 2 inhibitors, such as dapagliflozin, are the newest class of antidiabetes drugs approved for the treatment of T2DM. Dapagliflozin effectively improves glycemic control by increasing the renal excretion of excess glucose. In clinical trials, dapagliflozin has been well tolerated and has additional benefits of weight loss, low risk of hypoglycemia and reduction in blood pressure. This review discusses the clinical evidence and rationale for the use of dapagliflozin as add-on therapy in T2DM. The results suggest that dapagliflozin add-on therapy is a promising new treatment option for a wide range of patients with T2DM. Results from an ongoing cardiovascular outcomes trial are needed to establish the long-term safety of dapagliflozin.     

2型糖尿病人强化治疗中应用图文临床路径的效果评价

目的探讨图文临床路径在2型糖尿病人强化治疗中的效果。方法选择进行强化治疗的2型糖尿病人100例,分为2组,路径组(50例)应用图文临床路径进行医疗护理,对照组按常规医疗护理模式进行,比较两组病人的平均住院日,平均住院费用,病人满意度,糖尿病知识测评得分。结果两组病人的平均住院日,平均住院费用,病人满意度,糖尿病知识测评得分均有显著性差异(P<0.01;P<0.05)。结论2型糖尿病人强化治疗中应用图文临床路径可显著缩短平均住院日,降低平均住院费用,提高病人的糖尿病知识水平,提高病人满意度。     

The effect of resveratrol supplementation on C-reactive protein (CRP) in type 2 diabetic patients: Results from a systematic review and meta-analysis of randomized controlled trials

ObjectiveC-reactive protein (CRP) is considered to be an inflammatory marker in type 2 diabetes (T2D) and it is produced by liver cells. The evidence has suggested that resveratrol has anti-inflammatory effect. This study aimed to evaluate the effect of resveratrol supplementation on CRP level in patients with T2D using a systematic review and meta-analysis of randomized controlled trials.MethodsElectronic databases were completely searched using Medline, ISI Web of Science, EMBASE and Cochrane Library and Scopus until October 2019. Meta-analysis was performed using random-effects model and inverse variance method. Heterogeneity and publication bias were evaluated in selected studies. Sensitivity analyses and prespecified subgroup were conducted to evaluate potential heterogeneity. Meta-regression was performed to assess the effect of potential confounders on the estimated effect sizes.ResultsSix trials comprising a total of 491 subjects were included in this meta-analysis. The results showed significant reduction in the level of CRP [SMD (-0.34 mg/l) (95 % CI, -0.52, to -0.16) p < 0.05] in participants with T2D following supplementation with resveratrol. No significant publication bias was observed in the meta-analysis. Subgroup and sensitivity analyses indicated that the pooled effects of resveratrol supplementation on CRP level in T2D patients were affected by resveratrol dose and duration of resveratrol. Random-effects meta-regression did not indicate any significant association of CRP level with potential confounders including resveratrol dose, duration of treatment, age and gender of type 2 diabetic patients.ConclusionWe found a significant reduction in CRP level in patients with type 2 diabetes, who received resveratrol supplementation.     

"体卫结合"工作模式下对2型糖尿病患者运动干预的疗效评价

目的评价"体卫结合"工作模式下有氧及抗阻运动相结合的运动方式对2型糖尿病患者血糖及体质的疗效.方法随机选取社区2型糖尿病患者库中符合条件的受试者50例,建立"1+2+1"的模式干预小组,以有氧运动及抗阻运动相结合的方式规律运动干预6个月,以配对t检验比较受试者干预前后空腹血糖、血压、心率、体质量及脂肪量等相关体质指标的改变.结果经过6个月的运动干预后,受试者空腹血糖从(8.58±4.40)mmol/L下降至(6.29±1.72)mmol/L(P=0.032);体质量从(62.44±7.35)kg下降至(60.70±7.54)kg(P=0.008),其体成分中脂肪量明显下降,蛋白质含量明显上升,肌肉量及去脂体质量差异无统计学意义;此外,受试者运动干预后握力及坐位体前屈度均明显上升.干预后受试者体成分综合评分从(73.25±5.65)分上升至(75.48±5.04)分(P=0.010).结论有氧运动与抗阻运动相结合的运动干预方式能够有效降低血糖、体质量及脂肪量,增加肌肉力量及机体柔韧性,增强患者体质.这也反应了以社区为主导的"体卫结合"工作模式是慢性病管理及增强居民体质的有效手段.     

Association between serum Sestrin2 level and diabetic peripheral neuropathy in type 2 diabetic patients

BACKGROUNDDiabetic peripheral neuropathy (DPN) is a chronic and serious microvascular complication of diabetes linked to redox imbalance. Sestrin2, a novel inducible stress protein, participates in glucose metabolic regulation and redox homeostasis. However, the association between serum Sestrin2 and DPN is unknown.AIMTo explore the association between serum Sestrin2 and DPN in patients with type 2 diabetes mellitus (T2DM).METHODSA total of 96 T2DM patients and 39 healthy volunteers, matched by age and sex, participated in this cross-sectional study. Clinical features and metabolic indices were identified. Serum Sestrin2 was measured by ELISA. The association between Sestrin2 and DPN was studied. Correlation and logistic regression analyses were used to evaluate the associations of different metabolic indices with Sestrin2 and DPN.RESULTSThe 96 patients with T2DM were divided into DPN (n = 47) and patients without DPN (n = 49). Serum Sestrin2 was significantly lower in healthy volunteers than in all T2DM patients combined [9.10 (5.41-13.53) ng/mL vs 12.75 (7.44-23.80) ng/mL, P < 0.01]. T2DM patients without DPN also had significantly higher levels of Sestrin2 than healthy volunteers [14.58 (7.93-26.62) ng/mL vs 9.10 (5.41-13.53) ng/mL, P < 0.01]. However, T2DM patients with DPN had lower circulating Sestrin2 levels compared to T2DM patients without DPN [9.86 (6.72-21.71) ng/mL vs 14.58 (7.93-26.62) ng/mL, respectively, P < 0.01]. Bivariate correlation analysis revealed that serum Sestrin2 was positively correlated with body mass index (r = 0.672, P = 0.000), hemoglobin A1c (HbA1c) (r = 0.292, P = 0.000), serum creatinine (r = 0.206, P = 0.016), triglycerides (r = 0.731, P = 0.000), and fasting glucose (r = 0.202, P = 0.040), and negatively associated with estimated glomerular filtration rate (r = -0.230, P = 0.007). After adjustment for sex, age, HbA1c, and diabetes duration, multiple regression analysis revealed that Sestrin2 was independently correlated with body mass index and triglyceride levels (P = 0.000). Logistic regression analyses indicated that Sestrin2, diabetes duration, and high-density lipoprotein were strongly associated with DPN (odds ratio = 0.855, 1.411, and 0.041, respectively).CONCLUSIONOur results show Sestrin2 is decreased in T2DM patients with DNP. As lower Sestrin2 is independently associated with DPN, Sestrin2 may contribute to progression of DPN in T2DM patients.     

农村2型糖尿病患者生存质量的调查

目的了解农村2型糖尿病患者的生存质量并找出影响因素,为改善和提高农村2型糖尿病患者的生存质量提供依据。方法本研究采用非实验性的描述性研究便利抽取102例门诊农村2型糖尿病患者,对其生存质量进行调查,进一步分析疾病因素和人口学因素对患者生存质量的影响。结果农村糖尿病患者生存质量总体水平较差,生存质量总评分为（51．40±13．37）分;糖尿病对农村糖尿病患者的心理／精神维度影响最大;年龄、婚姻状况、文化程度、病程、并发症、饮食治疗、医疗费用支付方式、血糖监测等因素对农村糖尿病患者生存质量各维度的影响均有统计学意义（P〈0．05,P〈0．01）。结论农村2型糖尿病患者的生存质量较低,病程、并发症、医疗费用支付方式、年龄、婚姻状况、文化程度、饮食治疗、血糖监测等影响农村2型糖尿病患者的生存质量,提示护理人员应加强对农村糖尿病患者的心理疏导,从疾病因素和人口学因素方面重视改善农村2型糖尿病患者的生存质量。     

耳穴压豆联合五音疗法护理对2型糖尿病患者的干预效果

目的探讨耳穴压豆联合五音疗法护理干预对2型糖尿病患者的临床效果。方法选取2020年8月—2021年2月医院就诊2型糖尿病合并抑郁情绪的100例患者作为研究对象,按组间基本特征匹配原则分为对照组和观察组,每组50例。对照组予以常规护理,观察组在对照组基础上予以耳穴压豆及五音疗法干预。比较两组空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)、抑郁自评量表(SDS)评分、生存质量特异性量表(DSQL)评分、治疗有效率。结果治疗后两组FPG、2hPG、HbAlc含量均有下降,观察组上述血糖指标优于对照组,差异有统计学意义(P<0.05);治疗后两组SDS、DSQL评分均有下降,观察组SDS、DSQL评分优于对照组,差异有统计学意义(P<0.05);观察组临床疗效高于对照组,差异有统计学意义(P<0.05)。结论耳穴压豆联合五音疗法对2型糖尿病患者抑郁情绪的疗效较佳,可维持血糖的稳定,缓解抑郁情绪,提高患者生存质量。     

厌恶疗法对糖尿病患者饮食治疗依从性的影响

目的探讨厌恶疗法对糖尿病患者饮食治疗依从性的影响。方法将92例门诊糖尿病患者随机分为实验组48例,对照组44例,对照组患者采用集体授课的健康教育方式,实验组患者除接受常规糖尿病健康教育外,同时采用厌恶疗法。比较干预后3个月两组患者饮食治疗依从性、空腹血糖(fasting plasma glucose,FPG)、随机血糖(random plasma glucose,RPG)、糖化血红蛋白(glycosylated hemoglobinAlc,GHbA1c)变化情况及研究组患者焦虑、抑郁情况。结果干预后两组患者饮食依从性评分比较,差异具有统计学意义(P<0.001),实验组评分明显高于对照组;干预后两组患者各项代谢指标比较,差异具有统计学意义(均P<0.01),实验组明显优于对照组;实验组患者干预前后焦虑、抑郁评分比较,差异无统计学意义(均P>0.05)。结论厌恶疗法干预效果优于单纯理论知识讲解的健康教育方法,其可提高糖尿病患者饮食依从性,有利于糖尿病患者代谢的控制。     

Role of yoga for patients with type II diabetes mellitus: A systematic review and meta-analysis

To understand the role and efficacy of yoga in the management of type 2 diabetes mellitus, this meta-analysis was conducted. Electronic data bases searched were PubMed/Medline, ProQuest, PsycINFO, IndMED, CENTRAL, Cochrane library, CamQuest and CamBase till December 17, 2014. Eligible outcomes were fasting blood sugar (FBS), post prandial blood sugar (PPBS) and glycosylated haemoglobin (HBA1C). Randomized controlled trials and controlled trials were eligible. Studies focussing only on relaxation or meditation or multimodal intervention were not included. A total of 17 RCTs were included for review. Data from research articles on patients, methods, interventions- control and results were extracted. Mean and standard deviations were utilized for calculating standardized mean difference with 95% confidence interval. Heterogeneity was assessed with the help of I² statistics. χ² was used to rule out the effects of heterogeneity due to chance alone. Beneficial effects of yoga as an add-on intervention to standard treatment in comparison to standard treatment were observed for FBS [Standardized Mean Difference (SMD) −1.40, 95%CI −1.90 to −0.90, p ˂ 0.00001]; PPBS [SMD −0.91, 95%CI −1.34 to −0.48, p ˂ 0.0001] as well as HBA1C [SMD −0.64, 95%CI −0.97 to −0.30, p ˂ 0.0002]. But risk of bias was overall high for included studies. With this available evidence, yoga can be considered as add-on intervention for management of diabetes.     

2型糖尿病合并不同程度非酒精性脂肪性肝病的危险因素分析

目的 探讨2型糖尿病(T2DM)合并不同程度非酒精性脂肪性肝病(NAFLD)与血脂异常、肥胖和胰岛素抵抗的关系及其发病的危险因素.方法 对268例2型糖尿病患者,根据肝脏B超结果分为无脂肪肝组、轻度脂肪肝组、中重度脂肪肝组.记录患者身高、体重、腰围、臀围,进行空腹血糖(FBG)、糖化血红蛋白(GHbA_1c)、血总胆醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、丙氨酸氨基转移酶(ALT)、空腹胰岛素(FINS)测定,计算体重指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR).通过非条件Logistic回归进行NAFLD的危险因素分析.结果 无脂肪肝组、轻度脂肪肝组、中重度脂肪肝组BMl分别为(24.25±5.37)、(25.98±4.63)、(27.69±4.35)kg/m~2,WC分别为(83.36 ±8.27)、(88.36±7.96)、(92.36 ±9.35)cm,WHR分另为1.01±0.32、1.12 ±0.27、1.19±0.34,FINS分别为(18.47 ±7.13)、(23.01±9.89)、(29.26±11.94)μU/L,HOMA-IR分别为4.25±2.37、7.37±3.20、9.48±4.13.TC分别为(4.92±1.25)、(5.43±1.30)、(5.60±1.04)mmol/L;LDL-C分别为(2.91 ±0.90)、(3.32±0.83)、(3.57±0.73)mmol/L,TG分别为(2.02±1.03)、(2.68±1.47)、(3.49±1.86)mmol/L,ALT分别为(26.35±14.48)、(30.68±13.54)、(37.58±16.79)U/L.与无脂肪肝组相比,轻度脂肪肝组及中重度脂肪肝组BMI、WC、WHR、HNS、HOMA-IR、TC、LDL-C、TG、ALT均较高(P均<0.05).中重度脂肪肝与轻度脂肪肝组相比,BMI、WC、WHR、HNS、HOMA-IR、TG、ALT明显升高(P均<0.05).TG、WHR、HOMA.IR是NAFLD的危险因素(彻值分别为2.394、3.273、5.256,P均<0.05).结论 T2DM合并NAFLD患者存在明显的血脂紊乱、超重、中心性肥胖及胰岛素抵抗,TG、WHR、HOMA-IR是NAFLD发病的危险因素.     

糖尿病视网膜病变患者血清瘦素和脂联素的变化

目的 探讨糖尿病视网膜病变患者血清瘦素和脂联素水平的变化及其临床意义.方法 收集2012年11月至2013年11月在河北联合大学附属医院内分泌科就诊的2型糖尿病患者121例,其中糖尿病无视网膜病变41例,非增殖性视网膜病变40例,增殖性视网膜病变40例,另设健康体检者40名为对照组.采用ELISA法测定各组研究对象血清瘦素和脂联素.结果 实验组血清瘦素为(15.25±4.70) μg/L,较对照组[(6.15±1.70) g/L]增高,脂联素为(7.39±1.92) mg/L,较对照组[(11.10±1.46) mg/L]降低,差异均有统计学意义(t值分别为-11.696、11.216,P均＜0.01).无视网膜病变组、非增殖性视网膜病变组和增殖性视网膜病变组血清瘦素分别为(10.91±1.21)、(15.22±3.75)、(20.50±3.70)μg/L;脂联素分别为(9.61±1.35)、(7.11±1.18)、(5.34±1.36) mg/L,各组间比较差异均有统计学意义(F值分别为149.542、291.550,P均＜0.05).血清瘦素水平与血清脂联素水平呈负相关(r=-0.662,P.＜0.01).结论 血清瘦素和脂联素水平变化与糖尿病视网膜病变病变程度有关,二者可能成为糖尿病视网膜病变预测和疗效评估的重要指标.     

运动疗法对2型糖尿病病人血糖影响的研究进展

运动疗法是公认的可有效预防并控制2型糖尿病发生和发展的方法。对此作者主要论述运动疗法对2型糖尿病病人血糖的影响,包括运动的方法、强度、频率和时间。     

Autoantibodies to REG, a beta-cell regeneration factor, in diabetic patients

BACKGROUND: Regenerating gene (Reg) product, Reg, acts as an autocrine/paracrine growth factor for beta-cell regeneration. The presence of autoimmunity against REG may affect the operative of the regenerative mechanisms in beta cells of Type 1 and Type 2 diabetes patients. We screened sera from Type 1 and Type 2 diabetes subjects for anti-REG autoantibodies, searched for correlations in the general characteristics of the subjects with the presence of anti-REG autoimmunity, and tested the attenuation of REG-induced beta-cell proliferation by the autoanitibodies. MATERIAL AND METHODS: We examined the occurrence of anti-REG autoantibodies in patients' sera (265 Type 1, 368 Type 2 diabetes patients, and 75 unrelated control subjects) by Western blot analysis, and evaluated inhibitory effects of the sera on REG-stimulated beta-cell proliferation by a 5'-Bromo-2'-deoxyuridine (BrdU) incorporation assay in vitro. RESULTS: Anti-REG autoantibodies were found in 24.9% of Type 1, 14.9% of Type 2 and 2.7% of control subjects (P = 0.0004). There were significant differences between the autoantibody positive and negative groups in the duration of disease in the Type 1 subjects (P = 0.0035), and the age of onset in the Type 2 subjects (P = 0.0274). The patient sera containing anti-REG autoantibodies significantly attenuated the BrdU incorporation by REG (35.6 +/- 4.06% of the control), whereas the nondiabetic sera without anti-REG autoantibodies scarcely reduced the incorporation (88.8 +/- 5.10%). CONCLUSION: Anti-REG autoantibodies, which retard beta-cell proliferation in vitro, are found in some diabetic patients. Thus, autoimmunity to REG may be associated with the development/acceleration of diabetes in at least some patients.     

中国人载脂蛋白E基因多态性与2型糖尿病合并冠心病关系的Meta分析

目的本研究利用Meta分析的方法,综合评价中国人载脂蛋白E基因多态性与2型糖尿病合并冠心病的相关性。方法计算机及手工检索2014年12月以前中外有关中国汉族人群载脂蛋白E基因多态性与2型糖尿病合并冠心病关系的病例-对照研究。在评价纳入研究质量、提取有效数据后,采用Rev Man 5.0软件进行Meta分析。结果共纳入5个病例对照研究,包括2型糖尿病并冠心病组646例,2型糖尿病无冠心病组752例。Meta分析结果显示:文献无明显发表偏倚。携带载脂蛋白Eε3/3基因型的人群2型糖尿病并冠心病的发病风险降低(OR=0.51,95%CI:0.37~0.71),ε3/4基因型发病风险增高(OR=2.20,95%CI:1.52~3.20);ε4等位基因发病风险增高(OR=2.07,95%CI:1.49~2.87)。结论中国汉族人群载脂蛋白Eε3/3基因型、ε3/4基因型、ε4等位基因多态性可能与2型糖尿病合并冠心病的发病有关。