早期牙菌斑控制在2型糖尿病患者牙周病防治中的效果分析

目的进一步探讨和分析早期牙菌斑控制在2型糖尿病患者牙周病防治中的效果。方法选取该院于2011年11月—2013年11月期间收治的100例2型糖尿病患者,将患者平均分成对照组和观察组,每组各50例患者,观察组患者进行早期牙菌斑控制干预,对照组则不进行,对患者进行为期六个月的随访,观察患者牙周病控制情况,并进行分析。结果经治疗后,观察组患者牙周病控制较对照组好(P0.05),具有统计学意义。结论针对2型糖尿病患者,采取早期牙菌斑控制干预能够有效防止牙周病,有利于患者的口腔健康,同时,该措施在预防2型糖尿病患者牙周病方面具有积极的作用,在临床上具有极为重要的意义,值得推广。     

铁代谢与糖尿病早期微血管病变的相关性研究

目的 评估铁代谢相关指标在2型糖尿病早期微血管并发症中的作用.方法 收集2019年1月至12月就诊于哈尔滨医科大学附属第一医院内分泌科的2型糖尿病患者作为研究对象,共计141例.单纯2型糖尿病(T2DM)患者60例为T2DM组,非增殖期糖尿病视网膜病变(NPDR)患者47例为NPDR组,早期糖尿病肾病(EDN)患者34...     

趋化因子受体CCR5、CCR3在1型糖尿病患者中的表达

目的　研究Th1和Th2 细胞表面特征性的趋化因子受体CCR5、CCR3在 1型糖尿病发病机制中的作用。方法　对 15例新诊断的 1型糖尿病患者、10例 2型糖尿病患者以及 10例非糖尿病患者分离外周血单个核细胞 (PBMC)在体外培养 ,用流式细胞仪检测CD 4CCR5 及CD 4CCR3 淋巴细胞 ,并用酶联免疫吸附技术检测细胞培养上清中细胞因子IL 4、IFN γ的水平。结果　 1型糖尿病患者外周血中CD 4CCR5 淋巴细胞数显著高于 2型糖尿病患者和对照组 ,CD 4CCR3 显著低于其它两组 (均P <0 .0 5 )。 1型糖尿病患者和 2型糖尿病患者PBMC细胞上清液中的IFN γ水平高于对照组 (均P <0 .0 5 ) ,1型糖尿病患者IL 4水平低于其它两组 (P <0 .0 1)。结论　检测PBMC的CCR5、CCR3表达可以作为反映人类 1型糖尿病免疫活动的标志 ,从而为 1型DM的早期诊断和预防提供线索     

纤溶酶原激活物抑制物1与糖尿病肾病

糖尿病肾病 (DN)是糖尿病 (DM)常见的微血管并发症之一 ,但 DN是可以预防和早期干预治疗的。如果在微量白蛋白尿之前发现 DN并进行干预治疗 ,可以逆转 DN,甚至防止 DN的发生。因此 DN的早期诊断就显得尤为重要。本研究通过对 2型 DN患者 2 4 h的尿白蛋白 (u Alb) ,α1 -微球蛋白 (α1 - MG) ,β2 -微球蛋白 (β2 - MG) ,TH糖蛋白 (THP)和血浆纤溶酶原激活物抑制物 1(PAI- 1)等的测定 ,探讨它们对 DN早期诊断的价值以及在 DN发生、发展中所起的作用表 1　正常对照组与糖尿病各组临床及生化指标的比较 (x± s)项目 年龄(岁 ) …     

葡萄糖代谢与胰岛素敏感性和分泌功能之间的内在联系——解读2006年美国糖尿病学会(ADA)"Banting奖"演讲报告

Bergman教授等建立了反映葡萄糖和胰岛素相互作用机理和过程的最小模型法,利用该模型可以了解糖尿病患者的胰岛素敏感性和胰岛β细胞功能状态,对于临床医生早期预防β细胞功能衰竭、干预和治疗糖尿病起到了积极作用。他利用最小模型从3个方面阐述了糖尿病的发病机理:利用处置指数(DI)来预测2型糖尿病,发现一些候选基因决定DI;毛细血管内皮功能障碍可导致胰岛素抵抗;游离脂肪酸在调节肝脏葡萄糖产生中的作用。     

罗格列酮对糖尿病大鼠心肌组织水通道蛋白1表达的影响

目的 观察罗格列酮对糖尿病大鼠心肌组织水通道蛋白1 (AQP1)表达的影响,探讨罗格列酮对糖尿病大鼠早期心肌病变的干预作用.方法 将刚建立2型糖尿病模型的大鼠随机分为罗格列酮大、小剂量干预组各8例和模型组9例,以及正常大鼠10例,8 w后应用免疫组织化学和Western 印迹方法测定心肌组织AQP1的表达变化.结果 罗格列酮可降低血清心肌酶的释放,稳定心肌组织中AQP1蛋白的表达,且以大剂量组疗效显著,对早期糖尿病大鼠心肌具有一定保护作用.结论 罗格列酮可通过稳定早期糖尿病心肌组织中AQP1 蛋白的表达,在一定程度上缓解糖尿病心肌病变的发生与发展.     

脂肪因子镍纹样蛋白在糖尿病肾脏病中作用的研究进展

糖尿病肾脏病(DKD)是指糖尿病引起的慢性肾脏病, 是2型糖尿病的常见慢性并发症, 也是终末期肾病(ERSD)的主要原因。早期对DKD进行干预, 可减轻及延缓肾脏病变的进展。但目前临床在DKD的诊治方面仍存在诸多局限。因此, 对于DKD的早期诊断及干预的研究成为了糖尿病领域的热点问题。镍纹样蛋白(Metrnl)是一种新型脂肪因子, 其具有纠正脂代谢紊乱、降低炎症应答、改善胰岛素抵抗等生理作用, 在代谢性疾病中发挥着重要作用。Metrnl在DKD中的作用也逐渐被发现, 该文就Metrnl在DKD中的潜在作用进行综述, 以期为临床诊治提供更多思路。     

彩色多普勒超声在中老年2型糖尿病下肢血管病变诊断中的应用

2型糖尿病(T2DM)下肢血管病变是糖尿病最常见的慢性并发症之一,常累及肢体大、中、小动脉,并伴有周围神经病变,常因肢体缺血、缺氧,甚至坏疽、感染等病变而使患者失去正常的活动能力[1].据文献报道[2],下肢血管病变发生率达22％～46％,是糖尿病患者致残的主要原因之一.糖尿病下肢血管病变预防重于治疗,早期发现、早期诊断有重要的临床意义.彩色多普勒超声("彩超")能够对血管病变及早发现,以便早期干预[3].     

糖尿病肾病患者的血糖管理

糖尿病肾病(DN),是糖尿病微血管并发症之一,是欧美国家患者引发终末期肾功能衰竭(ESRD)的首要原因,也是糖尿病患者死亡的主要原因之一.DN发病隐匿,早期不易被发现,而临床一旦出现蛋白尿,肾功能减退进展迅速.高血糖是导致肾脏损害的根本原因,无论是1型或2型糖尿病,强化治疗高血糖可预防DN的发生,或延缓肾脏疾病的进展.尤其在DN的早期,降血糖对延缓DN发生发展的意义要大于降血压,因此DN患者的血糖管理至关重要.     

心钠素基因多态性与2型糖尿病肾病易感性的关联研究

糖尿病肾病是 2型糖尿病的主要晚期并发症之一 ,其确切发病机制及遗传学基础尚未完全阐明。在遗传学水平早期发现糖尿病肾病高危人群 ,并对其进行积极合理的治疗可预防或延缓糖尿病肾病的发生和发展。本研究通过对 2型糖尿病正常白蛋白尿组、临床肾病组 (包括微量白蛋白尿及大量白蛋白尿 )及正常对照组之间心钠素 (ＡＮＦ)基因Ｃ/Ｔ多态性频率差异的研究 ,旨在观察ＡＮＰ基因多态性与 2型糖尿病肾病之间的关联 ,进而评估该基因多态性在 2型糖尿病肾病中的作用。一、对象和方法1.对象 :据 1985年ＷＨＯ诊断标准确诊的 2型糖尿病患者 (ＤＭ组 …     

Nutrition interventions in early diabetic renal disease

Education and nutritional intervention play an important role in preventing and delaying the progression of renal disease in persons with diabetes. We need to identify those patients at risk or who have renal disease early, when interventions are most effective. Patients should visit a dietitian with expertise in diabetes to obtain an individual meal plan that focuses on those aspects that have the greatest impact on the disease: blood pressure control, blood glucose control, and moderate protein restriction.     

Hypertension in diabetes mellitus

Hypertension, commonly associated with diabetes mellitus, plays a major role in the severity and progression of diabetic complications. The frequency and impact of hypertension on the course of diabetic nephropathy, and the role of persistent microalbuminuria either as a predictor of future overt diabetic nephropathy or as a marker of incipient hypertension is reviewed. The special considerations for antihypertensive agents in diabetes as well as the rationale for early intervention using a "substitution" rather than "stepped-care" approach are discussed.     

2型糖尿病胰岛素治疗的时机

早期胰岛素强化治疗控制血糖,通过减轻糖毒性、脂毒性以及控制炎症,可以改变糖尿病并发症的自然病程,具有持久益处.因此,现在对于2型糖尿病胰岛素治疗的理念已经发生了很大变化,特别是对于诱导病情缓解和口服用药失效的2型糖尿病患者;为尽早和尽可能使血糖达标及恢复β细胞功能,应尽早启用胰岛素治疗.     

Pathogenesis of type 2 diabetes mellitus

"Common" type 2 diabetes mellitus is a multifactorial disease. Hyperglycemia is related to a decrease in glucose peripheral uptake, and to an increase in hepatic glucose production, due to reduced insulin secretion and insulin sensitivity. Multiple insulin secretory defects are present, including loss of basal pulsatility, lack of early phase of insulin secretion after intravenous glucose administration, decreased basal and stimulated plasma insulin concentrations, excess in prohormone secretion, and progressive decrease in insulin secretory capacity with time. These genetically determined abnormalities appear early in the course of the disease. Insulin resistance affects muscle, liver, and adipose tissue. For the same plasma insulin levels, peripheral glucose uptake and hepatic glucose production suppressibility are lower in diabetic patients than in controls. It results from aging of the population and from "western" lifestyle, with progressive increase in mean body weight, due to excess in energy intake, decreased energy expenses and low physical activity level. NEW ASPECTS: The role of beta-cell dysfunction, as well as the interplay between insulin secretory defect and insulin resistance are now better understood. In subjects with normal beta-cell function, increase in insulin needs secondary to insulin resistance is compensated by an increase in insulin secretion adjusted to maintain plasma glucose levels to normal. In subjects genetically predisposed to type 2 diabetes, failure of beta-cell to compensate for increased needs is responsible for a progressive elevation in plasma glucose levels, then for overt type 2 diabetes. This adaptative phenomenon is called beta-cell compensation of insulin resistance. The lack of compensation is responsible for type 2 diabetes. When permanent hyperglycemia is present, progressive insulin secretory failure with time ensues, due to glucotoxicity and to lipotoxicity. PERSPECTIVES: Simple changes in lifestyle, such regular moderate physical activity, and control of body weight, should permit to avoid the explosion in prevalence of type 2 diabetes. This has been evidenced by the results of prospective studies aiming at preventing conversion from impaired glucose tolerance to diabetes. In patients with permanent hyperglycemia not controlled by lifestyle changes, metabolic defects are the targets of specific therapy intervention with antidiabetic oral agents, such as insulin secretagogues, insulin sensitizers, and inhibitors of hepatic glucose production.     

Vitamin D and type 2 diabetes: Is there a link?

Prevention, or at least delay in onset of type 2 diabetes is possible by intensive lifestyle intervention. This is costly and labour intensive, and alternative methods of preventing diabetes have been sought. Vitamin D has important physiological effects aside from its effects on bone metabolism, including an important role in glucose homeostasis, insulin release and response. Observational data strongly support the role of vitamin D deficiency in the pathogenesis of type 2 diabetes. The time is ripe for a well conducted randomised controlled trial of vitamin D in high risk individuals to test the hypothesis that vitamin D delays the onset of type 2 diabetes.     

Reducing the risk of type 2 diabetes: early identification of high-risk individuals and treatment with acarbose

The severity of the type 2 diabetes epidemic is widely acknowledged. Demographic, social, and cultural changes around the world are driving a dramatic increase in the prevalence of type 2 diabetes. Consequently, there is increasing interest in defining the target population and developing strategies for preventing or delaying the disease. Impaired glucose tolerance (IGT), an asymptomatic condition early in the disease continuum of dysglycemia, is the best target for intervention, as it is a strong predictor for the development of both type 2 diabetes and cardiovascular disease (CVD). Identifying individuals likely to have IGT using risk-prediction tools is simple and cost-effective; diagnosis can be confirmed with an oral glucose tolerance test. Numerous trials have examined the benefits of intervention in IGT populations. Lifestyle modification and some pharmacologic therapies, such as acarbose, have been shown to significantly reduce disease progression. Acarbose therapy has also been associated with significant reductions in cardiovascular events and new cases of hypertension. Trials assessing the potential preventive effects of various therapies are ongoing, but current evidence confirms that early intervention in individuals with IGT can reduce the risks of type 2 diabetes and CVD. Identification of high-risk individuals should therefore be standard in general practice and, if IGT is diagnosed, therapeutic intervention should be initiated promptly.     

Metabolic syndrome, prediabetes and the science of primary prevention

This review provides an update on the metabolic syndrome and prediabetes. Compared to the downstream disorders, namely type 2 diabetes and cardiovascular disease (including coronary artery disease, cerebrovascular disease and peripheral vascular disease), prediabetes and the metabolic syndrome represent intermediate cardiometabolic states. The generally accepted working definitions, epidemiology, pathophysiology and clinical relevance of these intermediate conditions are discussed. Importantly, the review focuses on evidence-based strategies for preventing the cardiometabolic sequelae associated with prediabetes and the metabolic syndrome. The importance of lifestyle modification in the primary prevention of the metabolic syndrome and prediabetes is emphasized, and the interaction between genetics and lifestyle intervention in predicting outcomes is presented. In addition to discussing the evidence from landmark clinical trials, we identify methods for translating the success achieved in clinical trials to the community with regard to the prevention of diabetes and cardiometabolic risk. Future research needs are also highlighted. The overall goal is to foster an increased understanding of the prominent role of primary prevention in stemming the tide of cardiometabolic disorders in the society.     

Cardiovascular disease in patients who have diabetes

Although cardiovascular disease continues to be the major cause of morbidity and mortality in diabetes, the understanding that multiple risk factor intervention is the cornerstone of diabetes management is leading to significant benefits for patients. Aggressive goal setting for modifiable cardiovascular risk factors that cluster in patients with diabetes, such as dyslipidemia, hypertension, and a procoagulant state, and judicious selection of efficacious therapies have been shown to produce significant reductions in cardiovascular events, and in some cases mortality, in controlled clinical trials. Although effective control of hyperglycemia per se has at most modest impact, the choice and application of antihyperglycemic therapies add to the benefit. In addition, newer agents and early intervention in prediabetic and diabetic individuals hold promise for even greater success in the prevention of this important complication of diabetes.     

Global status of diabetes prevention and prospects for action: A consensus statement

Primary prevention of type 2 diabetes (T2D) should be achievable through the implementation of early and sustainable measures. Several randomized control studies that found success in preventing the progression to T2D in high‐risk populations have identified early and intensive intervention based on an individualized prevention model as the key factor for participant benefit. The global prevalence of both overweight and obesity has now been widely recognized as the major epidemic of the 21st century. Obesity is a major risk factor for the progression from normal glucose tolerance to prediabetes and then to T2D. However, not all obese individuals will develop prediabetes or progress to diabetes. Intensive, multicomponent behavioural interventions for overweight and obese adults can lead to weight loss. Diabetes medications, including metformin, GLP‐1 agonists, glitazones, and acarbose, can be considered for selected high‐risk patients with prediabetes when lifestyle‐based programmes are proven unsuccessful. Nutrition education is the cornerstone of a healthy lifestyle. Also, physical activity is an integral part of the prediabetes management plan and one of the main pillars in the prevention of diabetes. Mobile phones, used extensively worldwide, can facilitate communication between health professionals and the general population, and have been shown to be helpful in the prevention of T2D. Universal screening is needed. Noninvasive risk scores should be used in all countries, but they should be locally validated in all ethnic populations focusing on cultural differences around the world. Lifestyle interventions reduce the progression to prediabetes and diabetes. Nevertheless, many questions still need to be answered.     

Renin-Angiotensin-aldosterone system in diabetes and hypertension

Activation of the renin-angiotensin-aldosterone system (RAAS) is the primary etiologic event in the development of hypertension in people with diabetes mellitus. Modulation of the RAAS has been shown to slow the progression and even cause regression of the microvascular and macrovascular complications associated with diabetes mellitus. Early pharmacotherapy with agents that decrease RAAS activation in the adipose tissue have had a dramatic impact on the prevalence of diabetes related complications. Recent data show that preventing the development of "angry fat" can prevent not just hypertension but also type 2 diabetes mellitus and its associated complications. This review updates what is known about angry fat and the role of RAAS inhibition in preventing the metabolic sequelae of local RAAS activation.