C-反应蛋白与2型糖尿病大血管病变的相关性研究

目的 探讨C-反应蛋白(CRP)与糖尿病大血管病变发生的关系。方法 用ELISA方法测定2型糖尿病(T2DM)患者、无糖尿病的大血管病变患者以及正常对照组的CRP水平变化。结果 T2DM伴有或不伴有大血管并发症患者以及无糖尿病的大血管病变患者间血清cRP水平无显著差异；大血管病变患者血清cRP水平较非大血管病变者明显增高。结论 cRP在T2DM大血管病变的发生发展中具有致病作用。     

C反应蛋白与2型糖尿病大血管病变危险因素的相关性研究

2型糖尿病(DM)合并大血管病变者血清C反应蛋白(CRP)水平明显高于2型DM无大血管病变组及正常对照组(P<0.01),2型DM无大血管病变组高于正常对照组(P<0.01)。提示CRP可能是2型DM和2型DM大血管病变的危险因子,炎症可能参与了2型DM及2型DM大血管病变的发生和发展。     

2型糖尿病及其大血管病变患者血清脂联素水平的研究

目的 探讨血清脂联素(ADP)水平及相关代谢指标与2型糖尿病(T2DM)及其大血管病变的相关性.方法 将80例2型糖尿病患者根据有无大血管病变分为无大血管病变组(30例)和伴大血管病变组(50例),并选取50例健康体检者作为对照组.检测空腹血糖(FPG)、血脂、C反应蛋白(CLRP)及血清脂联素等生化指标.酶联免疫法测定血清脂联素浓度,放射免疫法测定空腹胰岛素(FINS)浓度.计算稳态模式胰岛素抵抗指数(HOMA-IR).结果 T2DM组脂联素水平与对照组比较降低(P＜0.01);T2DM伴大血管病变组脂联素水平显著低于单纯T2DM组(P＜0.01).相关分析显示,脂联素与FPG、FINS、HOMA-IR及收缩压(SBP)呈负相关.多元逐步回归分析显示,脂联素与三酰甘油(TG)、FPG、CRP及HOMA-IR密切相关.结论 2型糖尿病及其伴大血管病变患者血清脂联素水平降低,脂联素可能延缓糖尿病及其大血管并发症的发生、发展,动态检测ADP水平对及早发现糖尿病大血管病变有临床意义.     

2型糖尿病大血管病变患者血清IL-17水平变化及意义

目的 探讨2型糖尿病(T2DM)大血管病变患者血清IL-17的表达水平及意义.方法 162例T2DM患者,根据是否合并大血管病变,分为大血管病变组90例和无血管病变组72例,另选同期健康查体者68例作为正常对照组.采用酶联免疫吸附法(ELISA)测定三组人群空腹静脉血中IL-17水平,统计IL-17与各临床指标间的关系,分析其影响因素.同时,根据T2DM大血管病变患者颈动脉内膜中层厚度,探讨有无颈动脉增厚对IL-17水平的影响.结果 T2DM合并大血管病变组血清IL-17水平显著高于无血管病变组及正常对照组,T2DM无大血管病变组高于正常对照组(P＜0.01).T2DM大血管病变患者中,颈动脉增厚组IL-17水平明显高于无颈动脉增厚组(P＜0.05).在大血管病变组IL-17与BMI、2hPG、hs-CRP、TG、LDL-C呈正相关,而与HDL-C呈负相关.多元逐步回归分析显示IL-17、hs-CRP和LDL-C是T2DM大血管病变的主要影响因素.结论 T2DM大血管病变组和颈动脉增厚组血清IL-17表达均增高,提示IL-17参与糖尿病大血管病变的炎症反应过程.IL-17可能是T2DM大血管病变的独立危险因素,在糖尿病大血管病变发生、发展中发挥重要作用.     

血清高敏C反应蛋白与2型糖尿病大血管病变的相关性

目的:观察高敏C反应蛋白(hs-CRP)在2型糖尿病(DM)及DM伴大血管病变时的浓度变化。方法:84例2型DM患者按有无大血管病变分为伴大血管病变组(A组)44例,不伴大血管病变组(B组)40例,另选30例健康者作为正常对照组(C组),均检测血清hs-CRP值及糖化血红蛋白、空腹血糖、总胆固醇、三酰甘油,高、低密度脂蛋白胆固醇。结果:A组血清hs-CRP水平明显高于B组及C组(均P<0·01),B组高于C组(P<0·01)。结论:hs-CRP对DM患者发生大血管病变的预测具有重要意义。     

sVCAM-1与2型糖尿病血管并发症关系的临床探讨

目的　探讨血清中可溶性血管细胞黏附分子 1(sVCAM 1)与 2型糖尿病 (T2DM)血管并发症的关系。　 方法 　应用酶联免疫吸附法 (ELISA)测定 86例T2DM患者和 40例健康对照者血清中sVCAM 1的水平。　 结果　所有T2DM患者血清中sVCAM 1水平显著高于健康对照组 (P <0 0 1) ;T2DM患者微血管病变组sVCAM 1水平明显高于无血管病变组 (P <0 0 5 ) ;T2DM患者大血管病变组sVCAM 1水平明显高于微血管病变组 (P <0 0 5 )。　 结论　sVCAM 1参与了T2DM血管并发症的发生发展。     

血清基质金属蛋白酶-9与2型糖尿病大血管病变的相关性研究

目的 探讨基质金属蛋白酶-9(MMP-9)与2型糖尿病(DM)大血管病变的关系。方法 采用酶联免疫吸附法测定了40例对照组和80例2型DM患者(其中单纯2型糖尿病者40例，大血管病变者40例)血清中的MMP-9，分析其与大血管病变危险因子之间的关系。结果 大血管病变组血清中MMP-9的水平显著高于单纯2型糖尿病组和对照组。MMP-9与TC、OX-LDL、血压呈正相关，与HDL-C呈负相关。结论 血清中MMP-9水平的检测对监测2型糖尿病大血管病变的发生、发展有重要的临床意义。     

内皮脂肪酶与2型糖尿病大血管病变的相关性

目的 探讨2型糖尿病患者血清内皮脂肪酶与糖尿病大血管病变的关系.方法 66例2型糖尿病患者根据有无大血管并发症分为大血管病变组(32例)及无大血管病变组(34例),30例健康者为对照组.采用酶联免疫吸附法测定各组血清内皮脂肪酶水平,并进行组间比较.结果 大血管病变组血清内皮脂肪酶水平(3.31±1.30 ng/L)显著高于无大血管病变组(2.54±1.11 ng/L)和对照组(2.36±0.91 ng/L,P＜0.05),无大血管病变组与对照组比较差异无显著性(P＞0.05).相关分析表明2型糖尿病血清内皮脂肪酶与糖化血红蛋白及高敏C反应蛋白呈明显正相关(r分别为0.54和0.59,P＜0.01),与高密度脂蛋白呈负相关(r=-0.36,P＜0.05).结论 血浆内皮脂肪酶增高可能参与2型糖尿病患者大血管病变的发生、发展.     

老年2型糖尿病白细胞介素-6、C反应蛋白、血管内皮生长因子与大血管病变的相关性

目的探讨老年2型糖尿病(T2DM)患者血清白细胞介素(IL)-6、C反应蛋白(CRP)、血管内皮生长因子(VEGF)的变化与大血管病变的相关性。方法 53例T2DM合并大血管病变的患者纳入观察组,45例T2DM未合并大血管病变患者纳入对照组,同期同龄正常体检者30例纳入正常组,比较三组血清IL-6、CRP、VEGF水平。结果与正常组相比,观察组和对照组的甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、空腹血糖(FPG)、餐后2 h血糖(2 h PBG)、CRP、IL-6及VEGF水平具有显著性差异(P<0.05);而与对照组比较,观察组仅FPG、2 h PBG、CRP、IL-6及VEGF水平显著升高(P<0.05)。CRP及IL-6水平与TC、LDL、FPG、2 h PBG呈正相关,与HDL、TG无相关性;VEGF水平与TC、LDL、FPG、2 h PBG呈正相关,与HDL呈负相关,与TG无相关性;CRP、IL-6及VEGF间相互呈正相关。结论 T2DM合并大血管病变患者血中CRP、IL-6及VEGF水平明显升高,CRP、IL-6及VEGF可能参与T2DM大血管病变的发生和发展,对大血管病变的预测具有一定的临床意义。     

2型糖尿病患者血清C反应蛋白与可溶性细胞粘附分子水平变化的临床意义

目的　探讨 2型糖尿病患者血清 C反应蛋白 (CRP)、可溶性细胞粘附分子水平变化及其与血管并发症的关系。方法　采用 EL ISA法检测 12 7例 2型糖尿病患者 (糖尿病组 )血清 CRP、可溶性血管细胞间粘附分子 - 1(s VCAM- 1)和可溶性细胞间粘附分子 - 1(s ICAM- 1)水平 ,并与 6 4例健康人 (对照组 )进行比较。结果　糖尿病组血清 CRP、s ICAM- 1、s VCAM- 1均明显高于对照组 ,有极显著性差异 (P <0 .0 1) ;有血管并发症者CRP、s ICAM- 1、s VCAM- 1明显高于无血管并发症者 (P<0 .0 1) ,大血管并发症、微血管并发症和大血管与微血管并发症并存者各指标比较差异均有显著性 (P <0 .0 1)。糖尿病组血清 CRP水平与 s ICAM- 1、s VCAM- 1水平变化呈正相关 (r =0 .5 76～ 0 .6 2 4 ,P <0 .0 1)。结论　血清 CRP、 s ICAM- 1、 s VCAM- 1相互作用、可能参与了糖尿病的发生与发展 ,并与血管并发症的发生与发展有密切关系     

Is diabetes always diabetes?

Diabetes is always taken to be a life-long diagnosis. In order to re-examine this question, 75 g glucose tolerance tests (OGTT) were performed twice on 37 previously confirmed diabetic patients (mean duration of diabetes of 4.6 years; range 1-15 years) with normal glycosylated haemoglobin levels on regular review. Weight loss since institution of a healthy diet was 7.6 +/- 4.8 kg (+/- SE). Normal glucose tolerance was found in 27% of patients and impaired glucose tolerance in 21% with no significant change on rechallenge. HbA1 was 6.3 +/- 1.5% (+/- SD) (normal < 7.5%) in patients with normal glucose tolerance compared to 7.0 +/- 0.9% (+/- SD) in those with impaired glucose tolerance, P < 0.05. The response of the OGTT in these patients varied with dietary intake and weight. Such individuals could be regarded as having perfectly controlled diabetes or alternatively to have been cured. The definition of diabetes should be reviewed to allow people to escape the diagnosis where permanent change in dietary habits is established.     

The cost of diabetes and diabetes care

The number of people with diabetes mellitus worldwide is estimated to be 221 million in 2010 compared to about 124 million in 1997. The dominant part of diabetic persons was in 1997 represented by Type 2 (97%). WHO expect the number of adults (20 years and older) with diabetes (i.e. a mix of Type 1 and 2) to rise to 300 millions in 2025 from 135 millions in year 1995. On average people with diabetes are three times more likely to be hospitalized than non-diabetic individuals. The risk for hospitalization is slightly diversified, venous complications being the least risky (1.7 times) and heart-related complications the most risky (3.1 times). The risk of premature death is higher for persons with diabetes compared to those without diabetes, and the life time expectancy is 10-15 times shorter. US data shows that diabetes is the leading cause of blindness and accounts for 40% of the new cases of end-stage renal disease. The risk for leg amputation is 15-40 times higher and the risk for heart disease and stroke is two to four times higher for people with diabetes compared with people without diabetes. Recent studies show that the health care expenditures are as much as five times higher for individuals with diabetes compared to individuals without diabetes. In Sweden in 1994, three times more resources were spent on treating complications compared to what was spent on control of the disease. Studies show that intensive treatments cost more than traditional treatment, but also cut costs substantially for the treatment of late complications. The main message was that early intervention and intensified treatment had a better effect on the late complications. The basic message is quite simple: diagnose more persons with diabetes earlier, introduce and improve treatment.     

Preventing type 2 diabetes after gestational diabetes

PURPOSE: The purposes of this article are to examine the epidemiology of gestational diabetes mellitus (GDM) and subsequent type 2 diabetes, identify risk factors for the development of GDM and subsequent type 2 diabetes, discuss protocols for postpartum screening, and recommend evidence-based interventions to delay or prevent type 2 diabetes after GDM. METHODS: A review of the research literature from 1995 to 2005 concerning gestational diabetes was done using MEDLINE, CINAHL, National Institutes of Health, and American Diabetes Association internet resources. The criteria set for selection included the following: the research explored risk factors for and epidemiology of gestational diabetes, the relationship of gestational diabetes and the subsequent development of type 2 diabetes, and/or the prevention of type 2 diabetes after GDM. RESULTS: Women with pregnancies complicated by GDM are at increased risk for subsequent development of type 2 diabetes. Research suggests that modification of lifestyle-based risk factors including obesity, poor nutrition, and lack of exercise can delay or prevent the onset of type 2 diabetes in these women. However, there is evidence that recommended postpartum screening protocols for women with GDM are not being followed; hence, those women at high risk for type 2 diabetes are not identified, and no intervention is undertaken to reduce their risks. CONCLUSIONS: Diabetes educators must play an integral role in increasing awareness of the need for postpartum screening and intervention for women with gestational diabetes. Only with early identification and intensive intervention can the devastating toll of diabetes be averted for many of these women.     

Precision diabetes: learning from monogenic diabetes

The precision medicine approach of tailoring treatment to the individual characteristics of each patient or subgroup has been a great success in monogenic diabetes subtypes, MODY and neonatal diabetes. This review examines what has led to the success of a precision medicine approach in monogenic diabetes (precision diabetes) and outlines possible implications for type 2 diabetes. For monogenic diabetes, the molecular genetics can define discrete aetiological subtypes that have profound implications on diabetes treatment and can predict future development of associated clinical features, allowing early preventative or supportive treatment. In contrast, type 2 diabetes has overlapping polygenic susceptibility and underlying aetiologies, making it difficult to define discrete clinical subtypes with a dramatic implication for treatment. The implementation of precision medicine in neonatal diabetes was simple and rapid as it was based on single clinical criteria (diagnosed <6 months of age). In contrast, in MODY it was more complex and slow because of the lack of single criteria to identify patients, but it was greatly assisted by the development of a diagnostic probability calculator and associated smartphone app. Experience in monogenic diabetes suggests that successful adoption of a precision diabetes approach in type 2 diabetes will require simple, quick, easily accessible stratification that is based on a combination of routine clinical data, rather than relying on newer technologies. Analysing existing clinical data from routine clinical practice and trials may provide early success for precision medicine in type 2 diabetes.     

Preventing diabetes in women with gestational diabetes

The immediate consequences of gestational diabetes on pregnancy are well known but the complications decades later for the mother and child are just now emerging. This trio of papers discuss the long-term consequences of gestational diabetes, the importance of screening this high risk group of women for type 2 diabetes, and the evidence for lifestyle, medications and breastfeeding for the prevention of type 2 diabetes in these women.     

Depression and diabetes distress in patients with diabetes

We aimed to identify the prevalence of comorbid depression, diabetes, and diabetes distress and assess glycemic control and rates of diabetes-related complications. While the presence of either depression or distress did not predict the level of glycemic control, certain macro- and microvascular complications were more prevalent with depression.     

Occurrence of diabetes mellitus in neurogenic diabetes insipidus

Summary The occurrence of a family history of diabetes mellitus, of overt diabetes mellitus and of impaired glucose tolerance was investigated in a group of 43 patients with neurogenic diabetes insipidus. Family history was positive in 16.2% of these, similar to that in control subjects; manifest diabetes mellitus was present in 9.3%, impaired glucose tolerance in 20%. This prevalence appears to be even more significant, considering the patients' mean age, 26.9±2.3 years.     

酮症起病的糖尿病

酮症起病是1型糖尿病的常见现象,而能够长期不依赖于胰岛素治疗是2型糖尿病的特点,兼有这两种特征的糖尿病患者,可能是独立于1型或2型糖尿病之外的一种新的糖尿病类型。     

淡化糖尿病的分型

现有的糖尿病分型有很大的局限性和逻辑上的矛盾,在临床工作中很不实用。分型对认识疾病和临床治疗有一定的帮助,但同时也限制了我们的思维空间。作者的意见并非要取消现有的分类方法,而是呼吁摒弃类别思维,淡化分型观念,把更多的精力放在糖尿病发病机理的研究上,更好的解决临床实际问题。2型糖尿病也包括免疫机制,而1型糖尿病也有非免疫机制——这并不是说这两种状况必须完全相同。