Energy Expenditure in Type 2 Diabetic Patients on Metformin and Sulphonylurea Therapy

Insulin and sulphonylurea therapies have both been reported to cause weight gain in Type 2 diabetic patients whereas metformin does not have this adverse effect. The mechanism for this difference is unclear. We have investigated in a cross-over study the effect of sulphonylurea and metformin therapy on energy expenditure and body composition in 10 Type 2 diabetic patients (7 females, 3 males) of various weights (mean body mass index 33.4 (SD 7.6 kg m^?2)). Free living total energy expenditure was measured over 14 days by the doubly labelled water method adjusted for urinary glucose energy losses and resting energy expenditure by ventilated hood indirect calorimetry. Overall, total energy expenditure (12.88 ± 4.17 vs 13.1 ± 3.69 MJ 24 h^?1) and resting metabolic rate (7.30 ± 1.75 vs 7.23 ± 1.74 MJ 24 h^?1) were similar on metformin and sulphonylurea therapy, respectively. When adjusted for differences in fat free mass, resting metabolic rate on sulphonylurea therapy was slightly but significantly lower (mean difference ?5.5 kJ 24 h^?1 kg^?1, 95% CI ?1.2, ?9.9 kJ 24 h^?1 kg^?1, p < 0.05). Fat free mass also increased significantly by 1.3 kg (95% CI 0.4, 2.4 kg, p < 0.05) when on sulphonylurea therapy, thus compensating for the lower resting metabolic rate per kg fat free mass to leave overall resting metabolic rate unchanged compared to metformin therapy. We also investigated the effect of adding metformin to six Type 2 diabetic patients already on insulin. This did not lead to any measurable changes in any of the components of energy expenditure. Our results suggested that the weight gain of 0.8 kg with sulphonylurea was secondary to a relatively greater energy intake and/or metabolizable energy availability, possibly augmented by a slightly lower resting metabolic rate when adjusted for differences in fat free mass.     

Fluoxetine in the Treatment of Obese Type 2 Diabetic Patients

In a 12-month randomly allocated double-blind trial in 19 obese Type 2 diabetic patients, fluoxetine 60 mg daily compared to placebo produced a significant fall in median body weight after 3 months (3.8 kg), 6 months (6.5 kg), 9 months (7.1 kg), and at 1 year (5.8 kg). Median fasting blood glucose and HbA_1c levels fell significantly after 3 months (1.9 mmol l^?1 and 1.7 %, respectively) and 6 months (1.8 mmol l^?1 and 1.7%) but neither showed a significant difference to placebo after 9 or 12 months therapy with fluoxetine. There were no significant changes in serum cholesterol levels in the year but patients on fluoxetine showed a significant fall in serum triglyceride level (0.5 mmol l^?1 after 3 months therapy but not thereafter. Compared to placebo there was a significant fall in median energy intake on fluoxetine after 3 months (257 kcal day^?1) and 6 months (199 kcal day^?1) but this difference was not significant at 9 or 12 months. There was also a significant fall in carbohydrate intake after 3 months (30 g day^?1) and 6 months (23 g day^?1) on fluoxetine as well as a significant fall in carbohydrate intake expressed as a percentage of the total daily energy intake; 5.9% at 3 months, 6.1% at 6 months, and 4.0% at 9 months. There were no significant effects on protein or fat intake except a significant increase in the intake of fat expressed as a percentage of daily energy intake, 5.9% after 6 months. Two of the nine patients on fluoxetine dropped out of the study due to gastrointestinal side-effects. Fluoxetine might prove to be a useful adjunct therapy in obese Type 2 diabetic patients where short-term weight loss and fall in carbohydrate intake and an improvement in glycaemia are indicated.     

恩格列净和西格列汀治疗肥胖的2型糖尿病患者的临床效果比较

目的 比较恩格列净联合二甲双胍和西格列汀联合二甲双胍治疗合并肥胖的2型糖尿病患者的疗效和安全性.方法 选取2019年3月—2020年3月该院诊治的合并肥胖的2型糖尿病患者48例,按随机数字表将患者分为两组,A组24例,予恩格列净联合二甲双胍治疗,B组24例,予西格列汀联合二甲双胍治疗,疗程12周;对比两组患者治疗后的临...     

A Study of Fluoxetine in Obese Elderly Patients with Type 2 Diabetes

In order to establish the safety and efficacy of fluoxetine in subjects over 60 years of age with Type 2 diabetes, a randomized, double-blind, parallel study of 30 obese subjects was undertaken, comparing the use of fluoxetine 60 mg daily with placebo. Subjects were diet controlled with an HbA₁ < 14% (reference range 6–9%) and BMI > 29 kg m². Those taking fluoxetine had a median weight loss of 2.6 kg at 3 months (p < 0.001) and 3.9 kg at 6 months (p < 0–02), compared with weight loss in the placebo group of 0.1 kg and 0.0 kg at 3 and 6 months, respectively. Improved glycaemic control was also demonstrated in the fluoxetine group compared with placebo, initial HbA₁ levels of 8.0% vs 8.7% (NS) falling at 4 months by 0.9% (p < 0.02) and at six months by 0.9% (p < 0.02). No sustained improvement in fasting blood glucose levels was demonstrated. Reporting of adverse events was similar in both groups. Fluoxetine in the short term aids weight loss and improves glycaemic control without a significant increase in adverse events in elderly Type 2 diabetic subjects.     

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...     

标准化饮食护理在2型糖尿病肥胖患者中的应用分析

目的探讨标准化饮食护理在2型糖尿病肥胖患者中的应用分析。方法将2019年3—12月在该院内分泌科治疗的107例2型糖尿病肥胖患者随机分为两组,对照组45例使用常规护理,在此基础上,观察组62例使用标准化饮食护理,比较两组干预后的血糖及血脂指标、体重相关指标、自我管理能力。结果观察组干预后FPG、2 hPG、HbAlc、TC、TG水平均明显低于对照组,差异有统计学意义(P<0.05);观察组干预后体重、BMI、腰围均明显小于对照组,差异有统计学意义(P<0.05);观察组干预后饮食知识知晓、营养膳食执行、营养膳食态度、合理运动等自我管理能力指标均明显高于对照组,差异有统计学意义(P<0.05)。结论标准化饮食护理在2型糖尿病肥胖患者中的应用效果显著,能有效控制血糖、降低血脂、减轻体重、增强患者的自我管理能力,具有积极的临床意义。     

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,...     

Caloric restriction or resveratrol supplementation and ageing in a non-human primate: first-year outcome of the RESTRIKAL study in Microcebus murinus

A life-long follow-up of physiological and behavioural functions was initiated in 38-month-old mouse lemurs (Microcebus murinus) to test whether caloric restriction (CR) or a potential mimetic compound, resveratrol (RSV), can delay the ageing process and the onset of age-related diseases. Based on their potential survival of 12 years, mouse lemurs were assigned to three different groups: a control (CTL) group fed ad libitum, a CR group fed 70% of the CTL caloric intake and a RSV group (200 mg/kg.day^–1) fed ad libitum. Since this prosimian primate exhibits a marked annual rhythm in body mass gain during winter, animals were tested throughout the year to assess body composition, daily energy expenditure (DEE), resting metabolic rate (RMR), physical activity and hormonal levels. After 1 year, all mouse lemurs seemed in good health. CR animals showed a significantly decreased body mass compared with the other groups during long day period only. CR or RSV treatments did not affect body composition. CR induced a decrease in DEE without changes in RMR, whereas RSV induced a concomitant increase in DEE and RMR without any obvious modification of locomotor activity in both groups. Hormonal levels remained similar in each group. In summary, after 1 year of treatment CR and RSV induced differential metabolic responses but animals successfully acclimated to their imposed diets. The RESTRIKAL study can now be safely undertaken on a long-term basis to determine whether age-associated alterations in mouse lemurs are delayed with CR and if RSV can mimic these effects.     

Changes in Glucose Disposal and Cellular Insulin Binding in Obese Black Southern African Patients with Type 2 Diabetes Mellitus Before and After Sulphonylurea Therapy

Peripheral insulin action and cellular insulin binding were studied in 10 newly detected, obese, black, Southern African women with Type 2 diabetes mellitus before and after midterm oral sulphonylurea therapy and in five obese, non-diabetic controls. Glucose disposal (assessed by the euglycaemic insulin clamp technique) was significantly reduced in diabetic patients compared to control subjects (4.4 ± 0.5 vs 6.4 ± 0.5 mg kg^-1 min^-1, p < 0.05), and increased after 1 and 3 months of sulphonylurea therapy to 6.8 ± 0.6 mg kg^-1 min^-1 (p = 0.01) and 6.3 ± 0.7 mg kg^-1 min^-1 (p = 0.04), respectively. The major change in the binding kinetics of insulin to peripheral monocytes was an increase in the mean receptor concentration in the diabetic patients which was significant after 3 months of therapy (0.2 ± 0.08 to 0.6 ± 0.01 nM, p = 0.05). The basal plasma C-peptide concentration was significantly lower in the diabetic patients than in the controls and remained so following sulphonylurea therapy, despite significant reductions in fasting glucose and HbA_-1 concentrations. We conclude that newly diagnosed, obese, black Southern Africans with Type 2 diabetes showed diminished peripheral glucose disposal which increased following sulphonylurea therapy. This was accompanied by an increase in insulin receptor concentration but not with changes in basal insulin secretion.     

达格列净、利拉鲁肽对超重或肥胖2型糖尿病合并冠心病患者的糖脂代谢的影响

目的 探讨达格列净、利拉鲁肽对超重或肥胖2型糖尿病合并冠心病患者的糖脂代谢的影响.方法 随机纳入2018年6月—2020年1月该院就诊的160例超重或肥胖2型糖尿病合并冠心病患者为研究对象,分两组,每组80例.所有患者均口服盐酸二甲双胍片(格华止)≥1500 mg/d,达格列净组启始予5 mg,根据血糖情况调整药物剂量...     

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.     

西格列汀联合二甲双胍治疗肥胖型2型糖尿病的疗效及对体脂含量情况分析

目的 研究肥胖型2型糖尿病患者联合采用西格列汀、二甲双胍治疗的临床效果.方法 选择2018年10月—2020年4月该院100例肥胖型2型糖尿病患者为研究对象,采用随机数表法分成常规组和治疗组,每组50例.常规组予二甲双胍治疗,治疗组予二甲双胍+西格列汀治疗.比较两组治疗效果、血糖指标、体脂含量、胰岛功能指标及不良反应....     

The Relationship Between Obesity,Plasma Immunoreactive Insulin Concentration and Blood Pressure in Newly Diagnosed Indian Type 2 Diabetic Patients

The association of blood pressure with clinical and biochemical measures was studied in 185 newly diagnosed Type 2 diabetic patients, 74 impaired-glucose-tolerant (IGT) and 128 non-diabetic control subjects. Hyperglycaemic subjects were older than control subjects (controls 40 (24–59) years, IGT 48 (29–64) years, diabetic 43 (29–60) years, median (5th-95th centile) both p < 0.05). They were also more obese (body mass index (BMI) controls 23.5 kg m^?2 (17.2–29.9), IGT 26.0 kg m^?2 (19.8–33.9), diabetic 24.2 kg m^?2 (19.3–32.2)) and with a greater waist-hip ratio (controls 0.83 (0.70–0.98), IGT 0.88 (0.75–0.98), diabetic 0.89 (0.75–1.00)). Blood pressure was significantly higher in both IGT (systolic 127mmHg (108–162), diastolic 80 mmHg (66–99)) and diabetic patients (systolic 130 mmHg (104–160), diastolic 84 mmHg (66–102)) compared to non-diabetic controls (systolic 120 mmHg (100–151), diastolic 80 mmHg (60–94)). Univariate analysis showed that in diabetic patients systolic blood pressure was related to age (r = 0.17, p < 0.05), BMI (r= 0.23, p < 0.01) and plasma immunoreactive insulin (fasting and post glucose, r= ? 0.25, p<0.01) but not to C-peptide concentrations; diastolic blood pressure to BMI (r= 0.35, p < 0.001), waist-hip ratio (r = 0.23, p < 0.01) and plasma immunoreactive insulin (fasting r= 0.30, p < 0.001, post glucose r = ? 0.20, p < 0.05) but not to C-peptide concentrations. Multivariate analysis revealed that systolic blood pressure in diabetic patients was related to BMI (p < 0.01) and fasting immunoreactive insulin (p < 0.05) while diastolic blood pressure was related to BMI (p < 0.001) and waist-hip ratio (p < 0.01). Thus, blood pressure is associated with obesity even in our relatively non-obese population and it is also associated with plasma immunoreactive insulin concentrations. The mechanism of these associations remains to be established.     

Whole-body Glucose Metabolism in Obese Patients with Type 2 Diabetes Mellitus: the Impact of Hypertension and Strict Blood Glucose Control

We have examined the impact of hypertension and blood glucose control on insulin sensitivity in obese Type 2 (non-insulin-dependent) diabetic patients. Glucose metabolism in the basal state and in response to insulin was examined using the euglycaemic, hyperinsulinaemic (2 mU kg^?1 min^?1) clamp technique in combination with 3-[3H]-glucose infusion and indirect calorimetry in 60 obese Type 2 diabetic patients (30 normotensive patients and 30 hypertensive patients on antihypertensive treatment) and 10 obese normotensive control subjects. In the basal state and during hyperinsulinaemia, glucose disposal rates (total, oxidative, and nonoxidative) were similar in Type 2 diabetic patients with or without hypertension (230 ± 83 vs 270 ± 114 mg m^?2min^?1 (NS), 83 ± 28 vs 95 ± 7 mg m^?2 min^?1 (NS), 148 ± 70 vs 180 ± 89 mg m^?2 min^?1 (NS), treated hypertensive vs normotensive subjects, respectively). However, compared to obese control subjects (403 ± 65 mg m^?2 min^?1) both groups of diabetic patients had significantly decreased insulin-stimulated glucose disposal rates (p < 0.005). Even in a subset of Type 2 diabetic patients with long-term (> 6 months) near normal blood glucose control (HbA_1c < 6.1 %) significant defects were detectable in whole-body glucose and lipid metabolism when compared to control subjects. These results indicate that treated hypertension does not significantly aggravate the insulin insensitivity that is already present in Type 2 diabeted mellitus. Furthermore, Type 2 diabetic patients with long-term good metabolic control continue to demonstrate insulin insensitivity in peripheral tissues.     

Coagulation Activation in Type 2 Diabetes Mellitus: the Higher Coronary Risk of Female Diabetic Patients

Thrombophilia in diabetic patients is a well-recognized phenomenon which constitutes an additional risk of coronary heart disease. This study included 1980 ethnic Chinese people (835 male, 1145 female); age range: 45 to 69 years, including 280 Type 2 diabetic patients (male 125, female 155). Haemostatic parameters measured were fibrinogen, prothrombin time, activated partial thromboplastin time (APTT), factor VIIc, factor VIIIc, antithrombin III, and plasminogen. Compared with a control group, male diabetic patients showed significantly shorter APTT (25.6 ± 3.7 vs 27.5 ± 3.6 s, p<0.001), and elevated factor VIIIc (171.1 ± 77.48 vs 131.16 ± 52.23%, p<0.0001), whereas female diabetic patients showed significantly shorter APTT (24.9 ± 4.2 vs 26.5 ± 3.9 s, p<0.001) and elevated fibrinogen (10.6 ± 3.3 vs 9.8 ± 2.6 μmol 1^?1, p<0.05), factor VIIc (150.4 ± 68.7 vs 135.3 ± 32.3%, p<0.001), factor VIIIc (190.1 ± 92.6 vs 141.1 ± 62.4%, p<0.0001), and plasminogen (140.3 ± 41.9 vs 128.4 ± 38.7%, p<0.01). This study showed that Chinese diabetic patients had coagulation activation, and that female diabetic patients seemed to constitute a higher risk group for coronary heart disease than males.     

Twenty-four-hour energy expenditure in Pima Indians with Type 2 (non-insulin-dependent) diabetes mellitus

Summary To assess the impact of Type 2 (non-insulin-dependent) diabetes mellitus on energy metabolism, 24-h energy expenditure, basal metabolic rate and sleeping metabolic rate were measured in a respiratory chamber in 151 Pima Indians, 102 with normal glucose tolerance (67 male/35 female, (mean ± SD) 28±7 years, 99±24 kg, 32±9% body fat) and in 49 with Type 2 diabetes (22 male/27 female, 35±11 years, 107±33 kg, 39±7% body fat), after at least 3 days on a weight maintaining diet. After adjustment for differences in fat-free mass, fat mass, age and sex, 24-h energy expenditure, basal metabolic rate and sleeping metabolic rate were significantly higher in diabetic patients than in control subjects (72 kcal/day, p<0.05; 99 kcal/day, p<0.005; 99 kcal/day, p<0.001 respectively). Spontaneous physical activity was similar in both groups whereas the thermic effect of food, calculated as the mean energy expenditure corrected for activity throughout the day above sleeping metabolic rate and expressed as a percentage of energy intake, was significantly lower in Type 2 diabetic patients (17.1±7.1 vs 19.8±5.6%, p<0.05). Adjusted values of 24-h energy expenditure, basal metabolic rate and sleeping metabolic rate were correlated with hepatic endogenous glucose production (r=0.22, p<0.05; r=0.22, p<0.05; r=0.31, p<0.01 respectively). Therefore, increased basal and sleeping metabolic rates, resulting in increased 24-h sedentary energy expenditure may play a role in the weight loss so often observed in Type 2 diabetic subjects in addition to the energy loss from glycosuria.     

唑来膦酸与利拉鲁肽联合治疗2型糖尿病合并骨质疏松患者的临床应用效果

目的探讨唑来膦酸与利拉鲁肽联合治疗2型糖尿病合并骨质疏松患者的临床应用效果。方法选取2019年4月—2020年4月该院收治的50例2型糖尿病合并骨质疏松患者,根据蒙特卡罗随机将患者分为对照组(n=25)和观察组(n=25),两组均进行胰岛素联合唑来膦酸治疗,对照组采取常规方案治疗,观察组在对照组基础上增加利拉鲁肽,持续3个月治疗后进行BMD的检测。比较两组治疗效果。结果治疗后观察组Ca、ALP和BMD较对照组升高对比差异有统计学意义(P<0.05);FBG、HbA1c、2 hPBG与治疗前相比全部有降低,差异有统计学意义(P<0.05)。结论对有骨质疏松的2型糖尿病患者,临床可采用唑来膦酸联合利拉鲁肽治疗,疗效较为理想,可明显提高骨密度,降低骨质疏松性骨折的风险,同时降低血糖,可在临床应用。     

Clinical and Metabolic Characteristics of Type 1 and Type 2 Diabetes: An Epidemiological Study From the Närpes Community in Western Finland

Clinical and metabolic characteristics of all known Type 1 and Type 2 diabetic patients in a well-defined area in Western Finland are described. Retrospective data from the time of diagnosis and follow-up data were examined. Overall prevalence of diabetes was 25.4 cases per 1000 population. Patients were defined as having Type 1 or Type 2 diabetes based upon early insulin requirement and C-peptide levels. Applying these criteria 84% of the patients had Type 2 diabetes. Onset before the age of 40 years was observed in only 3% of Type 2 diabetic patients. This age limit therefore had a sensitivity of 97% and a specificity of 90% in correctly predicting Type 2 diabetes. At diagnosis, hypertension was observed in 2% of Type 1 and in 75% of Type 2 diabetic patients; the corresponding numbers at follow-up were 6 and 63%. At investigation, 27% of Type 1 and 22% of Type 2 diabetic patients had microalbuminuria. Retinopathy was observed in only 12% of Type 2 compared with 54% of Type 1 diabetic patients. The presence of retinopathy was associated with longer diabetes duration both among Type 1 and Type 2 diabetic patients. A significant decrease in C-peptide concentration was observed in Type 2 diabetic patients with increasing diabetes duration. The data therefore suggest that Type 2 diabetes is associated with a deterioration of beta-cell function with time.     

UK Prospective Diabetes Study. IV. Characteristics of Newly presenting Type 2 Diabetic Patients: Male Preponderance and Obesity at Different Ages

The characteristics of newly presenting Type 2 diabetes mellitus have been examined in 1857 newly diagnosed diabetic patients aged 25–65 years inclusive. The males were less obese than the females (121% vs 141% IBW, respectively), but a male-dominated sex ratio of 1.54 was found. Taking into account the prevalence of obesity in the general population, males had a 2.5-fold relative risk of presenting with diabetes, although with increasing obesity the male preponderance was lost. Presentation increased with age up to the age of 55 years. Patients presenting at all ages had similar glycaemia and were similarly obese. Those presenting at a younger age were usually particularly obese in relation to the general population. Obese patients were less physically active than normal weight patients. Type 2 diabetes had a seasonal variation of presentation with a peak in January to April.