脑卒中合并2型糖尿病患者自我管理知信行的调查

目的 调查研究脑卒中合并2型糖尿病患者自我管理知信行现状,为制定规范科学的自我管理方案提供参考。方法 采用便利抽样法,选取172例脑卒中合并2型糖尿病患者为研究对象,采用一般资料调查表、糖尿病患者自我管理知识态度行为评价简化量表进行问卷调查。结果 共回收141份有效问卷。研究对象的知识和行为得分处于中等水平,态度得分处于良好水平。多元线性回归分析显示,文化程度和中等强度运动是知识得分的影响因素（P<0.05）,文化程度、人均月收入是态度得分的影响因素（P<0.05）,文化程度、人均月收入、中等强度运动和较大强度运动是行为得分的影响因素（P<0.05）。结论 脑卒中合并2型糖尿病患者自我管理态度较好,自我管理知识和行为水平需进一步提高,医护人员应针对不同人群多渠道加强个体化健康宣教,通过有效提升患者自我管理知识水平,促进患者落实自我管理行为。     

Therapy Insight: type 2 diabetes mellitus and the risk of late-onset Alzheimer's disease

A number of well-designed epidemiological studies have linked type 2 diabetes mellitus (T2DM) with an increased risk of Alzheimer's disease (AD). Several mechanisms could help to explain this proposed link, including insulin and insulin resistance, inflammatory cytokines, and oxidative stress. Obesity or physical inactivity might also influence AD through effects on hypertension, insulin sensitivity or inflammation. Typical AD pathology, such as amyloid-beta deposits, might be exacerbated by insulin dysregulation, T2DM itself, or microvascular disease that is a consequence of T2DM. T2DM patients are not routinely evaluated for cognitive outcomes, and cognitive impairment in T2DM is rarely treated. Similarly, AD patients are not routinely evaluated for T2DM or hyperinsulinemia. Current treatments for AD have only modest benefits, and several drugs that target metabolic and inflammatory pathways are being evaluated, most notably the statins, which reduce LDL and inflammation but might not influence amyloid- deposition, an important precursor for AD. Although some evidence supports a potentially important role for peroxisome proliferative activated receptor agonists such as glitazones, at present there are no published randomized clinical trials in AD patients of any drugs that target insulin or insulin resistance. Clinical implications of the T2DM-AD link include cognitive evaluations of patients with T2DM, and potential benefits for such patients through treatment with statins or diabetes drugs that target insulin.     

Ankle-brachial index and brachial-ankle pulse wave velocity are risk factors for ischemic stroke in patients with type 2 diabetes

The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity(Ba PWV) and ankle-brachial index(ABI) are known to be associated with ischemic cardiovascular and cerebrovascular diseases, whether these measures predict the risk of ischemic cerebrovascular disease in diabetic patients remains unclear. 117 patients with type 2 diabetes were enrolled in this study. According to the results of head magnetic resonance imaging, the patients were divided into a diabetes-only group(n = 55) and a diabetes and ischemic stroke group(n = 62). We then performed ABI and Ba PWV examinations for all patients. Compared with the diabetes-only group, we found decreased ABI and increased Ba PWV in the diabetes and ischemic stroke group. Multivariate logistic regression analyses revealed that Ba PWV and ABI were risk factors for ischemic stroke in patients with type 2 diabetes. Our findings indicate that decreased ABI and increased Ba PWV are objective indicators of increased risk of ischemic stroke in patients with type 2 diabetes.     

Cognition in type 2 diabetes: Association with vascular risk factors, complications of diabetes and depression

Background

The role of variables like duration of diabetes, diabetic control and microvascular complications in the causation of cognitive decline in patients with type 2 diabetes is not well studied. The contribution of hypertension to the cognitive decline in nondemented diabetic patients is unclear.

Aims:

We wanted to see if cognition in patients with type 2 diabetes is associated with the duration of diabetes, control of diabetes, complications of diabetes, vascular risk factors, or depression. We also looked at association of noncompliance with cognition, and depression.

Settings and Design:

We recruited ambulant patients with type 2 diabetes who are 55 years or more in age from the weekly diabetic clinic. We excluded patients with past history of stroke.

Methods and Material:

We selected the time taken for the Trial A test, delayed recall on ten-word list from Consortium to Establish a Registry for Alzheimer''s Disease (CERAD), Rowland Universal Dementia Assessment Scale (RUDAS) and Centre for Epidemiologic Studies Depression scale (CES-D) screening instrument to assess these patients.

Statistical Analysis Used:

We utilized mean, standard deviation, Chi-square test and Pearson''s correlation for statistical analysis. We considered P < 0.05 to be significant.

Results:

RUDAS scores inversely correlated (r = −0.360) with CES-D scores (P = 0.002). Scores of the screening instrument for depression, the CES-D was associated with the duration of diabetes mellitus (P = 0.018), fasting blood glucose (P = 0.029) as well as with 2-hour post prandial blood glucose (P = 0.017).

Conclusions:

There is correlation between depression and global cognitive score. Depression seems to be associated with duration of diabetes and control of diabetes.     

Environmental vascular risk factors: new perspectives for stroke prevention

Despite intensive evaluation of acute stroke patients, perhaps only half of the attributable stroke risk is usually identified. In addition to traditional and non-traditional vascular risk factors-including most recently homocysteine, inflammation, and alterations of coagulation-a number of environmental risk factors for stroke have been identified in the last decade. In this update we review the following: lower education and poor socioeconomic status (probable surrogates for exposure to traditional high-risk behaviors such as smoking, poor nutrition, lack of prenatal control, absence of preventive medical and dental care, and non-compliance of treatment of conditions such as hypertension); depression, stress and affective disorders; obstructive sleep apnea; passive smoking and environmental pollution; infections, in particular periodontal diseases that increase C-reactive protein (CRP); raised body mass index (obesity); exercise, and diet. The possible role of high-fructose corn syrup in the epidemic of obesity in the USA is reviewed. Protective diets include higher consumption of fish, olive oil, grains, fruits and vegetables (Mediterranean diet), as well as probiotic bacteria in yogurt and dairy products. Careful attention should be given to the patient's environment looking for modifiable factors. The effects of clean environmental air and water, adequate diet and appropriate nutrition, healthy teeth, exercise, and refreshing sleep in the prevention of stroke and cardiovascular disease appear to be quite compelling. Although some of these modifiable risk factors lack evidence-based information, judicious clinical sense should be used to counteract the potentially damaging effects of adverse environmental vascular risk factors.     

Biological mechanisms of stroke prevention by physical activity in type 2 diabetes

The principal modifiable risk factors for stroke are hypertension, diabetes mellitus, hypercholesterolaemia, hyperhomocysteinaemia, smoking and limited physical activity. However, it is not clear whether physical inactivity is a risk factor per se, or because it predisposes to pathological conditions that are risk factors for stroke. The limited availability of effective therapeutic approaches for stroke emphasizes the crucial role of prevention of risk factors. The global burden associated with type 2 diabetes is large and continues to grow. Convincing epidemiologic data support the role of physical activity in preventing type 2 diabetes. The increasing evidence of physical activity in preventing diabetic complications, including stroke, has generated interest in the molecular basis underlying these beneficial effects. The aim of the present review is to discuss the biological mechanisms underlying the effect of physical activity in preventing stroke in type 2 diabetes.     

2型糖尿病并发脑梗死危险因素临床分析

目的探讨2型糖尿病并发脑梗死的危险因素。方法随机选取120例患者,分为2型糖尿病并发脑梗死者组(A组)和单纯2型糖尿病组(B组),每组60例。对所入选患者测量空腹血糖(FBG)、空腹胰岛素(FBI)、血流变、甘油三酯(TG)、血胆固醇(TCHO)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL),测量身高、体质量、血压,计算腹围指数(IBM)和胰岛素敏感指数(ISI),对所得结果进行分析。结果 2型糖尿病并发脑梗死患者其空腹血糖、甘油三酯、胆固醇、低密度脂蛋白、腹围指数、血压均高于单纯2型糖尿病者,而高密度脂蛋白、胰岛素敏感指数低于后者。结论高血压、高血糖、肥胖、高黏血症、高血脂、胰岛素抵抗是2型糖尿病并发脑梗死的危险因素。     

2型糖尿病合并缺血性脑卒中的临床特点

目的探讨2型糖尿病合并缺血性脑卒中的临床特点。方法回顾性分析100例2型糖尿病合并缺血性脑卒中患者临床资料。结果本组主要表现为感觉障碍83例(83%),肢体活动受限81例(81%),吞咽困难36例(36%),意识障碍28例(28%),失语20例(20%)。头颅CT检查发现大面积脑梗死39例(39%),腔隙性脑梗死32例(32%),多发性脑梗死29例(29%)。患者入院后均给予抗血小板聚集药物、脑保护、改善循环及降低血糖治疗。40例基本痊愈,21例显著进步,22例进步,17例无变化或恶化,总有效率为83%。结论 2型糖尿病合并缺血性脑卒中的主要临床表现为感觉障碍及肢体活动受限。CT主要表现为低密度病灶,局部脑水肿,可见占位效应,并以大面积脑梗死、腔隙性脑梗死为主。     

临床护理对2型糖尿病患者并缺血性脑卒中的影响

目的探讨针对性临床护理对2型糖尿病患者并缺血性脑卒中的影响。方法选择2012-01—2014-01我院收治的2型糖尿病并缺血性脑卒中者110例,将其随机分为研究组与对照组,每组各55例,对照组给予常规护理,研究组给予针对性临床护理干预,对比2组疗效。结果 2组患者治疗前空腹血糖、餐后2h血糖、收缩压和舒张压均高于正常值,且组间比较差异无统计学意义(P0.05),治疗后2组患者空腹血糖、餐后2h血糖、收缩压和舒张压均显著降低,且研究组上述指标显著低于对照组(P0.05)。研究组经过相应治疗及针对性临床护理干预后,总有效率为96.36%,明显高于对照组的81.82%(P0.05)。研究组Harris分值及Barthel分值均高于对照组(P0.05)。结论 2型糖尿病并缺血性脑卒中者给予针对性的临床护理干预,可以有效提高患者的肌体功能,加强日常生活能力,改善临床症状,适于临床推广。     

Peripheral neuropathy in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors

BACKGROUND: To estimate the prevalence and risk factors of peripheral neuropathy (PN) in people with type 2 diabetes mellitus. METHODS: A total of 810 patients with type 2 diabetes (289 men and 521 women) from Isfahan Endocrinology and Metabolism Research Centre outpatient clinics, Iran, were examined. Part of examination included an assessment of neurological function including neuropathic symptoms and physical signs and nerve conduction velocity. RESULTS: The prevalence of PN was 75.1% (95% confidence interval 72.1, 78.0). PN was associated with age, proteinuria, and duration of diabetes, insulin-treatment, and presence of any retinopathy and ischaemic heart disease (IHD). The age-adjusted prevalence rate of PN was 78% higher among patients with IHD, 64% higher among patients with any retinopathy, 66% higher among insulin-treated type 2 diabetes, and it was greater with duration of diabetes. Using a stepwise binary logistic regression model, age, duration of diabetes and proteinuria were significant independent predictors of PN. CONCLUSION: Peripheral neuropathy is a common complication in this population of Iranian type 2 diabetic patients. It increases with age, duration of diabetes and proteinuria.     

Magnesium:pathophysiological mechanisms and potential therapeutic roles in intracerebral hemorrhage

Intracerebral hemorrhage(ICH) remains the second-most common form of stroke with high morbidity and mortality.ICH can be divided into two pathophysiological stages:an acute primary phase,including hematoma volume expansion,and a subacute secondary phase consisting of blood-brain barrier disruption and perihematomal edema expansion.To date,all major trials for ICH have targeted the primary phase with therapies designed to reduce hematoma expansion through blood pressure control,surgical evacuation,and hemostasis.However,none of these trials has resulted in improved clinical outcomes.Magnesium is a ubiquitous element that also plays roles in vasodilation,hemostasis,and blood-brain barrier preservation.Animal models have highlighted potential therapeutic roles for magnesium in neurological diseases specifically targeting these pathophysiological mechanisms.Retrospective studies have also demonstrated inverse associations between admission magnesium levels and hematoma volume,hematoma expansion,and clinical outcome in patients with ICH.These associations,coupled with the multifactorial role of magnesium that targets both primary and secondary phases of ICH,suggest that magnesium may be a viable target of study in future ICH studies.     

Adenosine and neurotrauma: therapeutic perspectives

Cerebral ischemia studies demonstrating that stimulation of adenosine A1 receptors by either endogenously released adenosine or the administration of selective receptor agonists causes significant reductions in the morbidity and mortality associated with focal or global brain ischemias have triggered interest in the potential of purinergic therapies for the treatment of traumatic injuries to the brain and spinal cord. Preliminary findings indicate that activation of A1 adenosine receptors can ameliorate trauma-induced death of central neurons. Other avenues of approach include the administration of agents which elevate local concentrations of adenosine at injury sites by inhibiting its metabolism to inosine by adenosine deaminase, rephosphorylation to adenosine triphosphate by adenosine kinase; or re-uptake into adjacent cells. Amplification of the levels of endogenously released adenosine in such a 'site and event specific' fashion has the advantage of largely restricting the effect of such inhibitors to areas of injury-induced adenosine release. Another approach involving purinergic therapy has been applied to the problem of respiratory paralysis following high spinal cord injuries. In this instance, the adenosine antagonist theophylline has been used to enhance residual synaptic drive to spinal respiratory neurons by blocking adenosine A1 receptors. Theophylline induced, and maintained, hemidiaphragmatic recovery for prolonged periods after C2 spinal cord hemisection in rats and may prove to be beneficial in assisting respiration in spinal cord injury patients.