强化饮食和运动治疗控制肥胖2型糖尿病患者血糖水平的研究

目的 观察强化饮食和运动治疗与传统治疗肥胖2型糖尿病控制血糖的效果。方法 选取2型糖尿病患者100例随机分为2组．实验组采用超低热量饮食和超大量有氧运动．而对照组采用传统的药物和饮食运动治疗。实验组所有患者均进行7天住院糖尿病教育、饮食及运动指导，半年后监测血糖水平。结果 半年后，实验组血糖得到良好控制，体重指数也明显下降；而对照组血糖仅仅得到部分控制，体重指数改变不明显。结论 强化饮食和运动治疗相对于传统治疗肥胖2型糖尿病，控制血糖更理想，体重指数明显下降，且改善胰岛素抵抗。     

利拉鲁肽治疗93例超重或肥胖2型糖尿病患者的随访观察

目的 观察利拉鲁肽治疗超重或肥胖2型糖尿病患者的临床疗效、不良反应和依从性.方法 93例超重或肥胖2型糖尿病患者在原治疗基础上皮下注射利拉鲁肽0.6 mg/d,逐渐加量至1.2 ～1.8 mg/d,于1,4,12,54周随访利拉鲁肽对体重、血糖、原治疗方案的影响,记录不良反应和停药情况.结果 治疗1周后即有32.2％(29/90)的患者体重下降,治疗54周后8例患者体重由(86.50±11.66)kg降至(83.13±10.88)kg(t=3.32,P＜0.05);治疗12周后43例患者1,4,12周体重与0周相比均明显下降(P＜0.01);利拉鲁肽注射3d后空腹和餐后血糖即明显下降(t分别为4.30、6.90,P均＜0.01)并保持继续下降至12周(t分别为4.58、6.71,P均＜0.01);在治疗12周后24例联合胰岛素治疗的患者中胰岛素停用和减量者达83.3％ (20/24),仅2例与胰岛素联合使用时发生轻微低血糖.主要不良反应为厌食、恶心、呕吐、腹泻,以厌食最为常见,在4周内全部缓解,恶心、腹泻于5d内消失.23.7％(22/93)的患者因费用原因停用利拉鲁肽,占68.2％(15/22).结论 利拉鲁肽具有良好和迅速的减重、降糖作用,不良反应以胃肠道症状为主,为一过性,低血糖发生率低.     

肥胖、超重的2型糖尿病患者使用利拉鲁肽治疗的获益与风险分析

目的 通过相关指标分析肥胖、超重的2型糖尿病（T2DM）患者使用利拉鲁肽治疗的获益与风险。方法 回顾性筛选该院2018年7月—2021年6月收治的70例肥胖、超重的T2DM患者作为研究对象,依据治疗方案不同分为两组,每组35例。对比组给予二甲双胍治疗,研究组给予利拉鲁肽治疗,比较两组临床疗效、体质指数（BMI）、血糖、血脂及常见不良反应。结果 治疗后,相较于对比组,研究组总有效率更高、BMI和血糖指标及血脂指标水平改善更优,差异有统计学意义（P<0.05）。两组不良反应发生率对比,差异无统计学意义（P>0.05）。结论 采用利拉鲁肽治疗肥胖、超重T2DM,临床疗效更确切,安全性更可靠。     

低热量饮食对短病程超重或肥胖T2DM患者糖脂相关指标的影响

目的 探讨低热量饮食（LCD）对短病程超重或肥胖2型糖尿病（T2DM）患者糖脂相关指标的影响。方法选取病程5年内超重或肥胖T2DM患者62例,随机分为LCD组、对照组各31例。两组均给予二甲双胍联合短期胰岛素泵强化治疗,并进行中等强度体育运动,由营养科医师和DM专科医生共同制定食谱,LCD组总热量1 000～1 200 kCal/d,对照组总热量1 400～1 800 kCal/d。干预前及干预第26周检测两组糖化血红蛋白（HbA1c）、空腹血糖（FPG）、空腹C肽、餐后2 h血糖（2 h PG）、TC、TG、LDL-C、HDL-C,计算BMI、胰岛素抵抗指数（HOMA-IR）、胰岛功能指数（HOMA-ISLET）;用多频率生物电阻抗法测内脏脂肪面积;计算血糖缓解率、达标率及低血糖发生率。结果 干预后,两组血糖相关指标均较干预前改善（P均<0.05）,且LCD组FPG、2 h PG、内脏脂肪面积、HOMA-ISLET均优于对照组（P均<0.05）。干预前后两组组间体质量及血脂比较差异无统计学意义（P均>0.05）;干预后,LCD组体质量、TG、TC、LDL-C、HDL...     

短期极低热量限制对超重/肥胖2型糖尿病患者肠道菌群的影响

目的:探究短期极低热量限制(very low-calorie restriction,VLCR)对超重/肥胖2型糖尿病患者的代谢改善疗效,结合微生物多样性检测技术明确肠道菌群的变化,探讨VLCR临床疗效的机制。方法:纳入14例超重/肥胖2型糖尿病患者,住院进行9天VLCR(热量摄入300~600 kcal/d)。在VL...     

达格列净对超重及肥胖2型糖尿病患者的疗效

目的 探讨对超重及肥胖2型糖尿病患者采用达格列净进行治疗的临床疗效.方法 纳入对象为该院在2018年12月—2019年12月期间接收治疗的超重及肥胖2型糖尿病患者,共94例.对患者随机编号1～94号,其中单号为对照组(47例),采用利格列汀治疗,双号为观察组(47例),采用达格列净进行治疗.对比两组患者治疗的临床疗效,...     

一年期低能量饮食对肥胖2型糖尿病患者胰岛素治疗后干预的影响研究

[摘要]目的：分析一年期低能量饮食对肥胖2型糖尿病患者胰岛素治疗后干预的影响。方法：回顾性分析236例体重指数(BMI)≥28 kg·m-2的2型糖尿病患者的临床资料,根据是否采取一年期低能量饮食进行分组;对照组占48.73%(115/236),采取普通糖尿病饮食;观察组占51.27%(121/236),采取一年期低能量饮食;对比两组患者治疗前后的体重、血压(收缩压、舒张压)、空腹血糖、空腹胰岛素、糖化血红蛋白、血脂(低密度脂蛋白、高密度脂蛋白L)、血尿酸、γ-谷氨酰转肽酶,并以体重变化值、体重变化百分率、用药情况(双胍类和磺脉类降糖药用量、停药率)作为观察指标。结果：治疗前,两组体重、血压、空腹血糖、空腹胰岛素、糖化血红蛋白、血脂、血尿酸、γ-谷氨酰转肽酶水平差异不显著(P＞0.05);治疗后,观察组体重轻于对照组,收缩压、舒张压、空腹血糖、空腹胰岛素、糖化血红蛋白、低密度脂蛋白、血尿酸、γ-谷氨酰转肽酶水平均低于对照组,高密度脂蛋白水平高于对照组,差异显著(P＜0.05);观察组体重变化值、体重变化百分率、停药率均大于对照组,双胍类和磺脉类降糖药用量均少于对照组,差异显著(P＜0.05)。结论：一年期低能量饮食对肥胖2型糖尿病患者胰岛素治疗后干预的效果显著,有效减轻患者的体重,改善代谢综合征,且减少降糖药用量,值得临床推广使用。 关键词：2型糖尿病;肥胖;低能量饮食;代谢综合征     

研究标准化饮食护理在2型糖尿病肥胖患者中的应用

目的 分析标准化饮食护理在2型标准化饮食护理在2型糖尿病肥胖患者中的应用.方法 选择该院2019年1月—2020年1月100例诊治的2型糖尿病肥胖患者,将其分为试验组与对照组,每组50例,试验组采用标准化饮食护理,对照组采用常规护理,观察并对比两组患者的护理效果.结果 试验组患者的在空腹血糖及餐后2h的血糖均优于对照组...     

胰岛素治疗超重或肥胖2型糖尿病患者加用利拉鲁肽的临床疗效观察

目的观察经胰岛素治疗但血糖控制不佳的超重或肥胖T2DM患者加用利拉鲁肽的疗效及安全性。方法选取经胰岛素治疗但血糖控制不佳的超重或肥胖T2DM患者62例,分为利拉鲁肽治疗组30例和胰岛素治疗组32例。利拉鲁肽组在加用利拉鲁肽时,胰岛素剂量暂减30%,后根据血糖水平调整胰岛素和利拉鲁肽剂量。胰岛素组根据血糖水平调整胰岛素剂量。检测两组治疗前后体重、FPG、HbA1c、FC-P和胰岛素日用量等指标,记录低血糖发生情况及其他不良反应。结果利拉鲁肽组和胰岛素组体重、FC-P和胰岛素日用量差值比较差异有统计学意义[(4.7±6.4)vs(1.0±2.1)kg;(0.80±0.30)vs(0.16±0.08)ng/ml;(25.9±12.7)vs(12.1±5.7)U/d,P<0.05或P<0.01],FPG、HbA1c差值比较差异无统计学意义[(2.5±1.1)vs(2.9±1.6)mmol/L;(1.8±1.2)%vs(1.7±1.3)%,P>0.05]。结论对超重或肥胖T2DM患者,胰岛素联合利拉鲁肽与胰岛素加量降糖疗效相当,但利拉鲁肽可降低体重,改善胰岛细胞功能。     

利拉鲁肽和门冬胰岛素30对超重和肥胖2型糖尿病患者的疗效和安全性比较

目的比较人胰高糖素样肽-1（GLP-1）类似物利拉鲁肽和门冬胰岛素30与二甲双胍联合应用对超重和肥胖2型糖尿病患者的疗效和安全性。方法选取2012年3月1013至2012年6月2013住院的体质指数（BMI）〉25kg／m^2的2型糖尿病患者109例,按随机数字表法分为利拉鲁肽治疗组和门冬胰岛素30治疗组。其中利拉鲁肽治疗组52例,给予利拉鲁肽联合二甲双胍治疗,门冬胰岛素30治疗组57例,给予门冬胰岛素30联合二甲双胍治疗共24周,于用药前、用药4、12、24周后分别测定患者的空腹血糖（FPG）、餐后2h血糖（PPG）、糖化血红蛋白（HbAlc）、体重、腰围、血压、甘油三酯（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、肝功能、肾功能、C反应蛋白（CRP）、24h尿微量白蛋白（UMA）,记录用药期间低血糖发生情况和其他不良反应。采用t检验和重复测量资料方差分析进行数据分析。结果两组患者治疗3d后血糖均开始下降,24周后利拉鲁肽组和门冬胰岛素30组FPG分别下降（2．9±1．3）、（3．5±1．2）mmol／L（t=-3．2,P〈0．01）;PPG分别下降（4．2±3．7）、（4．5±2．8）mmol／L（t=-0．83,P〉0．05）;HbAlC分别下降（1．7±0．6）％、（1．9±0．8）％（t=-0．6,P〉0．05）。利拉鲁肽组体重下降（4．2±2．7）kg,门冬胰岛素30组体重增加（1．2±1．7）kg（t=-3．7,P〈0．05）。两组收缩压分别下降（5．2±4．4）、（1．8±2．3）mmHg（1mmHg=0．133kPa）（t=4．9,P〈0．01）。两组间舒张压差异无统计学意义。两组患者均出现TG、TC、LDL．C降低和HDL-C升高,但是组问差异均无统计学意义（均P〉0．05）。利拉鲁肽组比门冬胰岛素30组低血糖发生率低,但是两组间差异无统计学意义（3．8％比14．0％,t=-1．51,P〉0．05）。利拉鲁肽组患者的胃肠道不良反应多于门冬胰岛素30组,差异具有统计学意义（46．2％比1．8％,t=2．00,P〈0．05）。结论对超重和肥胖2型糖尿病患者,利拉鲁肽联合二甲双胍与门冬胰岛素30联合二甲双胍降糖效果相当,而利拉鲁肽能够更有效地降低患者体重和血压,同时具有良好的安全性。     

运动疗法在2型糖尿病治疗中的作用

目的探讨运动疗法在2型糖尿病治疗中的作用。方法对30例中年2型糖尿病患者在饮食和口服降糖药物治疗的基础上采用运动疗法。具体方法为3次／d快步行走，运动量=总摄入热量-日常生活消耗量 1737．5kJ，以最大心率(Hrmax)的60％作为靶心率，治疗前后检测各项相关指标变化。结果运动治疗2周后，30例患者的血糖、体重指数(BMI)、果糖胺及甘油三酯均明显下降，且无并发症发生。结论运动疗法可降低中年2型糖尿病患者的血糖，改善血脂代谢，方法安全可行。     

Management of obesity in patients with type 2 diabetes mellitus in primary care

AimsObesity and being overweight is the most powerful risk factor accounting for 80–90% of patients with type 2 diabetes mellitus (T2DM). The epidemic of obesity is driving the diabetes epidemic to alarming levels and primary care is becoming an important setting for obesity management in T2DM in India. Yet many primary care providers feel ill-equipped or inadequately supported to address obesity in patients with diabetes. This article reviews the most recent and strongest evidence-based strategies that may aid physicians in management of obesity in patients with T2DM in primary care.Material and methodsA systematic literature search of MEDLINE using the search terms Obesity, Obesity in T2DM, weight loss and Primary Care was conducted. The American Diabetes Association, National Institute for Health, National Institute of Health and Excellence (NICE), Scottish Intercollegiate Guidelines Network (SIGN) and World Health Organization websites were also searched. Most studies in this area are observational in design with few randomized controlled trials (RCTs). Articles and studies involving meta-analysis or RCTs were preferred over other types.Results and conclusionEffective weight management treatment in T2DM patient can be implemented in the primary care setting. Evidence based individualized lifestyle and pharmacologic measures supported by behavioral intervention and counseling with appropriate and informed surgical referrals has the potential to improve the success of weight management within primary care.     

Group education for obese patients with type 2 diabetes: greater success at less cost

It has been suggested that much effort expended in teaching diabetic diets is ineffective and wasteful. We have tested a different system by randomly allocating 75 newly diagnosed obese Type 2 diabetic patients to usual 'unstructured' clinic care or to group education by diabetes specialist nurses and a dietitian. Patients allocated to group education attended five 90-min group sessions during the first 6 months. Six months after diagnosis they had lost more weight (median (95% Cl), 7 (5.5-9) vs 2(1-5)kg, p less than 0.002) and were better controlled (HbA1:7.5 (7.0-8.1) vs 9.5 (8.7-10.4)%, p less than 0.001) than those randomized to the usual clinic system. At 1 year (after no further visits) the difference in weight loss was less (5.5 (4-6.5) vs 3 (2-4) kg, p less than 0.05) and diabetic control was similar (HbA1:9.0(8.2-9.8) vs 9.9(8.9-10.9)%. At 1 year only 14(39%) of the education group and 9(23%) of those attending the clinic had a fasting blood glucose less than 7.0 mmol l-1.     

Circulating leptin and insulin in obese patients with and without type 2 diabetes mellitus: relation to ghrelin and oxidative stress

Aim

This case control study aimed to investigate relationship between appetite hormones (ghrelin and leptin) and body mass index (BMI), insulin and oxidative stress in simple obese and type 2 diabetes (T2DM) obese patients.

Methods

Thirty healthy controls; 30 simple obese and 30 T2DM obese patients were enrolled. Demographic and clinical data of all participants were reported. Serum levels of fasting blood glucose (FBG), postprandial blood glucose (PBG), lipid peroxide (LPO) and nitric oxide (NO) were measured by chemical methods while, insulin, leptin and ghrelin by ELISA kits.

Results

Serum levels of insulin, leptin, LPO were significantly higher while, ghrelin was significantly lower in simple obese and obese patients with diabetes versus controls. Insulin resistance was found in 76.67% simple obese and 93.33% obese patients with diabetes. Ghrelin showed a positive correlation with PBG in controls; but negative correlation with BMI in simple obese and with NO in obese patients with diabetes. Positive correlations were found between LPO and FBG, insulin, homeostasis model assessment of insulin resistance (HOMA-IR) and between leptin and FBG in obese patients with diabetes.

Conclusions

Our results suggested that hyperinsulinemia and hyperleptinemia may be most important mechanisms in decreasing ghrelin and inducing oxidative stress in simple obese and T2DM obese patients.     

Predictors of sleep disorders among patients with type 2 diabetes mellitus

AimsThis study examined the prevalence of sleep disorders (SD) and self-reported sleep symptoms and risk factors among adult patients diagnosed with T2DM.MethodsData were obtained from the 2012 US National Health and Wellness Survey, an annual Internet-based survey. A total of 7239 participants reported a diagnosis of T2DM. Patients also provided information on diagnosis of SD (e.g., insomnia, sleep breathing disorder, other sleep conditions, etc.) and regularly experienced sleep symptoms (e.g., difficulty falling asleep, sleep apnea, daytime sleepiness, difficulty staying awake, etc.). Logistic regressions were used to examine factors associated with SD and symptoms.ResultsThe average age was 59.9 (standard deviation = 12.2), 59.5% were male, 24.4% were diagnosed with SD, 76.8% reported experiencing any sleep symptom regularly (difficulty falling asleep, 30.5%; sleep apnea, 17.4%; daytime sleepiness, 26.8%; difficulty staying awake, 10.1%). Logistic regression models showed the strongest predictors of diagnosed SD were obesity class (OC) III (OR = 2.20), White (OR = 1.92), OC II (OR = 1.57), smoking (OR = 1.57), lower income (OR = 1.49–1.19), unemployment (OR = 1.38), and comorbidities (OR = 1.35), all p < 0.05. The strongest predictors of any sleep symptom were OC III (OR = 2.22), OC II (OR = 1.78), lower income (OR = 1.74–1.24), female gender (OR = 1.72), OC I (OR = 1.60), White (OR = 1.54), and smoking (OR = 1.47), all p < 0.05.ConclusionsAlmost 25% of patients with T2DM were diagnosed with SD and over 75% reported experiencing at least one sleep symptom regularly. SD and symptoms were strongly associated with obesity, White ethnicity, gender, low income, and smoking. Interventions focusing on weight management and smoking cessation have shown to improve T2DM and may improve SD.     

Trends in the prevalence of type 2 diabetes mellitus and obesity in the Arabian Gulf States: Systematic review and meta-analysis

We report trends in type 2 diabetes mellitus and obesity in adults residing in the Arabian Gulf States. Among the Saudi population, the prevalence of diabetes increased from 10.6% in 1989 to 32.1% in 2009. Prevalence of the disease increased faster among Saudi men than women, with growth rates of 0.8% and 0.6% per year, respectively.     

对2型糖尿病患者启动胰岛素治疗的思考

在2型糖尿病的治疗中尽早启动胰岛素治疗,是血糖达标的需要,也是保护胰岛β细胞、恢复其功能,从而延缓糖尿病进展的需要。初诊2型糖尿病患者经过3个月的生活方式干预和优化的口服降糖药物治疗血糖仍不能达标时,即应启动胰岛素治疗。对代谢紊乱严重、血糖水平较高的患者,应及时启动胰岛素强化治疗。可供选择的胰岛素治疗方案很多,各有优缺点和适应人群,临床上应当因患者而异地选择适宜的起始治疗方案。如何依据糖化血红蛋白（Hb）A1c选择起始治疗方案,目前尚无定论。推荐当HbA1c≤8．5％时主要选择基础胰岛素,HbA1c〉8．5％时选择预混胰岛素或基础—餐时或持续皮下胰岛素输注（CSII）作为起始胰岛素治疗方案。     

格列美脲联合胰岛素治疗2型糖尿病的多中心临床研究

目的研究在接受胰岛素治疗的2型糖尿病患者中,联合应用格列美脲治疗的疗效及对胰岛素使用剂量的影响.方法为多中心、开放、自身对照的临床研究.100例胰岛素治疗剂量≥50 U/d(胰岛素单用或与≤2种非胰岛素促泌剂联合应用)的2型糖尿病患者,加用格列美脲治疗12周.结果 12周后,糖化血红蛋白(Hh)A1c由基线时的(8.89±1.77)%降至(7.02±0.86)%,下降了(1.86±1.43)%.以HbA1c≤6.5%和<7.0%为目标值,达标率分别为34%和59%,达标率增加31%和50%.胰岛素的剂量由基线时的66.0 U/d降至50.0 U/d,剂量减少26.67%.患者的全天血糖谱均明显改善.治疗期间,30例患者(30%)发生一般性低血糖68件·次,低血糖发生率为2.95次/(患者·年),无严重低血糖事件.受试者体重及体重指数均无明显变化.结论在胰岛素治疗的基础上联合应用格列美脲可有效降低2型糖尿病患者空腹血糖、餐后血糖水平,有利于患者实现HbA1c达标;同时可显著降低胰岛素用量,提高治疗的安伞性和耐受性.     

2型糖尿病患者血瘦素水平与高血压的相关性研究

选择122例2型糖尿病患者,分为合并高血压组和血压正常组,各组又分别分为肥胖和非肥胖亚组.测定其体重指数(BMI)、空腹血糖(FBG)和胰岛素、糖化血红蛋白(HbA1c)及血清瘦素水平,并作相关性分析.结果显示,2型糖尿病患者高血压组与非高血压组间血清瘦素水平无差异(P＞0.05);血清瘦素水平与BMI、空腹胰岛素呈正相关关系(P＜0.01),与血压无明显相关性(P＞0.05);但在合并高血压组,血清瘦素水平与HbA1c呈负相关关系(P＜0.05).提示2型糖尿病患者的血清瘦素水平与血压无明显相关性,但合并高血压患者长时间血糖控制不良可能会导致血清瘦素水平的下降.