33例2型糖尿病合并高血压的临床护理心得

目的通过科学的健康指导和全方位的医护。对降低并发症的发生,提高患者的生活质量起到了积极作用。方法对33例2糖尿病患者进行心理教育、用药指导、饮食指导、运动指导等。结果患者对疾病相关知识有了详细的了解,生活质量大为提高。结论糖尿病合并高血压的治疗是终身性的,医护理人员应加强对患者的科学管理。通过健康教育,建立起关心健康的态度,形成健康的行为,从而使达到最佳的健康状态。     

高血压合并2型糖尿病患者动态血压状况

目的探讨高血压合并2型糖尿病患者24小时血压变化状况,指导临床用药。方法采用MOBIL-O-Graph动态血压监测仪监测40例原发性高血压病(EH组)和38例原发性高血压合并2型糖尿病(DM组)患者24小时血压,比较其24hSBP、24hDBP、dSBP、dDBP、nSBP、nDBP、血压负荷值、血压昼夜节律。结果24hSBP、24hDBP、dSBP、dDBP、白天血压负荷两组无差异(P>0.05),nSBP、nDBP、夜间血压负荷及血压昼夜节律存在差异(P<0.05)。结论高血压合并2型糖尿病患者夜间血压升高,夜间负荷值升高,血压昼夜节律发生改变。     

2型糖尿病并高血压与胰岛素抵抗的关系

目的　探讨高血压与胰岛素抵抗之间的关系。方法　2型糖尿病高血压组110例，正常血压组112例。测定FPG、FINS、TC、MAU、血压、计算BMI，并评价胰岛素抵抗和β细胞功能采用稳态模式评估法及改良胰岛素敏感性指数公式计算。结果　高血压组ISI显著低于正常血压组，HOMA－βcell、HOMA—IR显著高于正常血压组(P＜0.005)，正常体重者也有相同的结果(P＜0．05)。两组ISI与FPG、FINS、BMI均呈显著负相关(P＜0．05)，高血压组ISI与TC、TG呈弱负相关(P＜0．5)。结论　2型搪尿病伴高血压病人无论是否肥胖都存在胰岛素抵抗。肥胖病人胰岛素抵抗更为严重。     

2型糖尿病合并高血压病患者的临床危险因素分析

目的观察和探讨2型糖尿病合并高血压病的临床危险影响因素。方法选取65例2型糖尿病合并高血压病患者作为观察组,同期选取60例单纯2型糖尿病患者作为对照组,详细测量并记录两组患者一般情况,包括身高、体质量、BMI、颈围、腰围、臀围、腰臀比,同时测定两组患者血脂水平及尿酸(UA)水平并进行比较。并对观察组患者不同级别高血压组其一般情况、血脂及UA水平进行分析比较。结果观察组患者BMI、腰臀比均明显高于对照组(P<0.05),观察组患者TG、TC、LDL-C、UA均明显高于对照组,HDL-C明显低于对照组,两组差异具有统计学意义(P<0.05)。结论 2型糖尿病合并高血压病的临床危险因素包括BMI、TG、TC、LDL-C及UA等,因此,对于2型糖尿病患者,在积极控制血糖的同时,积极控制患者的BMI,并重视生化指标的监测,对2型糖尿病合并高血压病患者具有重要意义。     

Impact of adherence to antidepressants on healthcare outcomes and costs among patients with type 2 diabetes and comorbid major depressive disorder

Objective: To evaluate the association between adherence to antidepressants and an effect on clinical outcomes and healthcare costs in patients with major depressive disorder (MDD) and comorbid type 2 diabetes (T2D).

Methods: This retrospective study used MarketScan claims data from January 2012 to March 2014. Study entry was the first claim for an antidepressant and a diagnosis code for MDD and T2D in the prior 6 months. Adherence and persistence with antidepressant therapy in the first 180 days were defined as medication possession ratio (MPR)?≥?80% and length of therapy (LOT), with no treatment gap of >15 days, respectively. T2D control (HbA1c <7%), oral diabetes medication adherence, and healthcare costs were measured in the 12 month post-index period. The impact of antidepressant adherence and persistence on outcomes was assessed using multivariable analyses.

Results: Among the 1361 patients included, the mean age was 59 years and 55% were women. About one-third of the patients were adherent (35.9%, mean MPR?=?40%), persistent (32.0%, average LOT?=?100 days), and adherent/persistent (31.2%) on antidepressants. Being adherent, persistent, or adherent/persistent to antidepressants was associated with a two-fold improvement in adherence to oral diabetes medications. Of those with HbA1c data (n?=?121), adherence or adherence/persistence to antidepressants was associated with patients being five times more likely to have T2D control (odds ratio [OR]: 4.95; 95% confidence interval [CI]: 1.39, 17.59, p?=?.0134). Comparison between antidepressant-persistent and non-persistent patients was not significant. Mean difference in adjusted all-cause annual costs showed lower costs among antidepressant-adherent and adherent/persistent patients (adherent: -$350, 95% CI: -$462, -$247; adherent/persistent: -$1165; 95% CI: -$1280, -$1060).

Conclusions: Patients with better antidepressant adherence and adherence/persistence demonstrated better HbA1c control, with lower all-cause total and medical costs. Adherence, persistence, or adherence/persistence to antidepressants was associated with improved adherence to oral diabetes medications.     

2型糖尿病伴发胆囊结石的临床研究

目的：分析2型糖尿病伴发胆囊结石的临床手术情况和病情产生的原因。方法：选择2003年1月～2010年1月在本院进行治疗的2型糖尿病伴发胆囊结石的患者共52例,另外随机抽取了52例2型糖尿病无胆囊结石的患者组成对照组进行比较分析。结果：患者的糖尿病情况越严重诱发胆囊结石的情况也就越高,二者之间应该有着较为明显的联系。结论：高胰岛素与胆结石之间有直接关系,必须要重视对2型糖尿病伴发胆囊结石的预防和控制。     

老年高血压、糖尿病患者颈动脉粥样硬化与同型半胱氨酸水平的关系

目的探讨老年高血压、2型糖尿病患者颈动脉粥样硬化程度与血清同型半胱氨酸水平的相关性。方法用酶联免疫吸附法测40例高血压患者、40例2型糖尿病患者、40例高血压合并2型糖尿病患者、40例健康体检者血清Hcy水平,用彩色多普勒超声仪行颈动脉壁内膜-中膜厚度动脉斑块积分检查。结果高血压组、2型糖尿病组、高血压合并2型糖尿病组血清Hcy水平及颈动脉粥样硬化检出率明显高于正常对照组(P<0.01)。其中高血压合并糖尿病组血清HcY水平及颈动脉粥样硬化板块程度均高于高血压组及2型糖尿病组(P<0.01)。结论合并有2型糖尿病的老年高血压患者血清HcY水平与颈动脉粥样硬化检出率明显增高,且两者关系密切。     

Healthcare costs among adults with type 2 diabetes initiating saxagliptin or linagliptin: a US-based claims analysis

Objective: To compare healthcare costs of adults with type 2 diabetes (T2D) after initiation of saxagliptin or linagliptin, two antidiabetic medications in the dipeptidyl peptidase-4 inhibitor medication class.

Methods: Patients with T2D who were at least 18 years old and initiated saxagliptin or linagliptin (index date) between 1 June 2011 and 30 June 2014 were identified in the MarketScan Commercial and Medicare Supplemental Databases. All-cause healthcare costs and diabetes-related costs (T2D diagnosis on a medical claim and/or an antidiabetic medication claim) were measured in the 1 year follow-up period. Saxagliptin and linagliptin initiators were matched using propensity score methods. Cost ratios (CRs) and predicted costs were estimated from generalized linear models and recycled predictions.

Results: There were 34,560 saxagliptin initiators and 18,175 linagliptin initiators identified (mean ages 57 and 59; 55% and 56% male, respectively). Before matching, saxagliptin initiators had significantly lower all-cause total healthcare costs than linagliptin initiators (mean?=?$15,335 [SD $28,923] vs. mean =?$20,069 [SD $48,541], p?p?n?=?16,069 per cohort), saxagliptin initiators had lower all-cause follow-up costs than linagliptin initiators (CR?=?0.953, 95% CI?=?0.932–0.974, p?p?=?0.017; predicted costs?=?$3989 vs. $4159).

Conclusions: Adult patients with T2D initiating treatment with saxagliptin had lower total all-cause healthcare costs and diabetes-related medical costs over 1 year compared with patients initiating treatment with linagliptin.     

依那普利与氯沙坦联用治疗高血压并发2型糖尿病患者微量白蛋白尿的临床疗效

目的观察依那普利与氯沙坦联用治疗高血压并发2型糖尿病患者微量白蛋白尿的临床疗效。方法将60例高血压并发2型糖尿病伴微量白蛋白尿的患者随机分为两组,分别使用氯沙坦、依那普利两药联用为治疗组(n=30),单用依那普利为观察组(n=30),疗程16周。观察两组治疗前后各组患者的血压,治疗前后尿白蛋白排泄率(UAER)。结果两组血压均较治疗前明显降低(P<0.05),但治疗后两组血压间比较,差异无统计学意义(P>005);两组患者经治疗16周后平均UAER水平分别由(108±30)μg/min、(114±31)μg/min降至(74±28)μg/min、(92±26)μg/min(均P<0.01),治疗组降低程度更为显著(P<0.05)。结论氯沙坦联合依那普利治疗在有效降压的同时,能改善高血压并发2型糖尿病患者早期肾损害,提示有早期肾损害患者应尽早联合降压治疗。     

2型糖尿病对原发性高血压患者阿司匹林抵抗的临床影响

目的：探讨2型糖尿病对原发性高血压患者阿司匹林抵抗（AR）的临床影响。方法：选择诊断为原发性高血压患者96例,将其中患2型糖尿病患者38例设为观察组,将无糖尿病患者58例设为对照组,两组均服用阿司匹林100m州,共服用4周,治疗后检测血小板聚集率,对检查情况进行统计分析。结果：观察组与对照组治疗4周后比较,在阿司匹林半抵抗（ASR）发生方面,差异具有统计学意义（P〈0．05）;AR＋ASR发生方面,差异具有统计学意义（P〈0．01）。结论：2型糖尿病与阿司匹林抵抗的发生具有明显的相关性,提示合并2型糖尿病的原发性高血压患者会有较高的血栓性疾病发生可能,临床应给予充分重视。     

老年原发性高血压合并糖尿病患者凝血纤溶功能变化的研究

目的：探讨老年原发性高血压合并2型糖尿病患者凝血纤溶功能的变化,防止血栓栓塞性并发症的发生。 方法：测定30例正常对照组、50例老年单纯原发性高血压患者和50例老年原发性高血压合并2型糖尿病患者的血浆血管性血友病因子（vWF: Ag）、纤维蛋白原（Fbg）、凝血酶原片段1+2（F1+2）、组织型纤溶酶原激活剂（t-PA）及其抑制物内皮细胞型纤溶酶原激活物抑制剂（PAI-1）水平,三组之间进行比较。结果：血浆vWF、FIB、F1+2、t-PA、PAI-1水平三组之间差异均有显著性意义（P<0.01）。高血压合并糖尿病组、高血压组和对照组比较,血浆vWF、FIB、F1+2、t-PA、PAI-1水平均有明显变化（P<0.01）,高血压合并糖尿病组和高血压组比较,血浆F1+2、t-PA、PAI-1水平均有明显变化（P<0.05）。结论：老年原发性高血压合并2型糖尿病患者存在着凝血、纤溶功能紊乱,应定期监测上述指标,防止血栓栓塞性并发症的发生。     

中西药结合治疗2型糖尿病合并高血压的临床分析

目的 探讨中西药结合治疗2型糖尿病合并高血压的临床效果.方法 将98例2型糖尿病合并高血压患者随机分为两组,对照组49例给予常规治疗并加用口服卡托普利25～50 mg,3次/d,二甲双胍0.75～1.50 g/d;观察组49例则在对照组基础上采用中医辨证分型治疗,并比较两组临床疗效.结果 观察组总有效率为97.96%,对照组为81.63%,两组间比较,差异有统计学意义（P ＜ 0.05）;两组患者治疗后的血糖和血脂四项比较差异无统计学意义（P ＞ 0.05）,观察组患者的血压和心率与对照组比较差异有统计学意义（P ＜ 0.05）.结论 中西药结合治疗2型糖尿病合并高血压能有效降低血压与血糖水平,依从性好,安全可靠,副作用少,值得临床推广应用.     

Contraindications to metformin therapy among patients with type 2 diabetes mellitus

Objective The biguanide, metformin, is a commonly prescribed oral antihyperglycemic agent. However, there are several clinical conditions that are considered as contraindications to the use of metformin among patients with type 2 diabetes mellitus. The aim of this study was to investigate the presence and nature of contraindications to metformin therapy among patients with type 2 diabetes mellitus. Method A retrospective study of the medical files of diabetic patients available at Alwosta clinic, north Palestine was carried out. Information about disease and medication profile of the patients was retrieved and analyzed using SPSS during the study period in 2004/2005. Focus was on metformin users who have contraindications to metfromin therapy. Main outcome measure Presence and number of contraindications to metformin therapy. Results Two hundred and seventy-two type 2 diabetic patients were identified. One hundred and twenty four of those diabetic patients were metformin users. Approximately, 60% of patients in the metformin group had a least one contraindication. Congestive heart failure and renal impairment were the most quantitatively present contraindications. Conclusion Contraindications to metformin therapy are common among type 2 diabetic patients and mostly disregarded. Patients have to be critically assessed before starting therapy and in case of metformin prescribing; dose should be adjusted based on the presence of risk factors for metformin adverse effects.     

厄贝沙坦联合氨氯地平治疗老年高血压伴2型糖尿病的疗效

目的探讨厄贝沙坦联合氨氯地平治疗老年高血压伴2型糖尿病的疗效和安全性。方法 90例高血压伴2型糖尿病的老年患者随机分成3组,每组30例：对照组A单纯口服厄贝沙坦,对照组B单纯口服氨氯地平,观察组服用厄贝沙坦联合氨氯地平,以12周为1个疗程,对比三组的总有效率以及胆固醇、甘油三酯、低密度脂蛋白的变化,同时监测心率、血常规、尿常规、肝肾功能以及服药后的不良反应。结果治疗1个疗程后,对照组A和对照组B的总有效率比较,差异无统计学意义（P〉0.05）。观察组的总有效率高于对照组A和对照组B（P〈0.05）,三组不良反应的发生率差异无统计学意义（P〉0.05）。结论厄贝沙坦联合氨氯地平对老年高血压伴2型糖尿病疗效良好,且不良反应少。     

老年高血压并2型糖尿病患者动态血压特点

目的 了解老年高血压合并2型糖尿病患者动态血压特点.方法 使用无创动态血压监测仪对46例老年高血压并2型糖尿病患者(试验组)及46例1级高血压患者(对照组)进行24h动态血压监测.结果 试验组患者失去正常血压昼夜节律,尤以收缩压负荷、夜间收缩压升高为明显,与对照组相比,差异均有统计学意义(P<0.01,P<0.05).结论 对老年高血压合并2型糖尿病患者,降压治疗不仅要降低过高的血压,尚应24小时平稳降压和恢复其昼夜血压节律.     

Effects of an olmesartan medoxomil based treatment algorithm on 24-hour blood pressure control in patients with hypertension and type 2 diabetes

Abstract

Objective:

The BENIFICIARY (BENIcar safety and efFICacy evaluatIon: An open-label, single-ARm, titration study in patients with hypertension and tYpe 2 diabetes) study was conducted to evaluate the efficacy and safety of olmesartan medoxomil (OM) plus hydrochlorothiazide (HCTZ) in patients with hypertension and type 2 diabetes.     

原发性高血压合并2型糖尿病患者的心律失常66例临床分析

目的探究原发性高血压合并2型糖尿病患者的心律失常临床表现以及对此类患者的治疗方案。方法原发性高血压合并2型糖尿病患者66例设为观察组,仅有原发性高血压患者134例为对照组,对比两组研究对象心律失常构成比的差异;对观察组患者应用对症治疗方案,对照组采用常规降压治疗。观察两组临床治疗效果。结果观察组患者出现心房颤动59.1%以及房室传导阻滞19.7%等事件概率相对较高,而对照组患者出现室性早搏事件50.7%更高;观察组患者接受治疗后收到满意的临床治疗效果。结论原发性高血压合并2型糖尿病患者在临床上最常见心律失常表现为心房颤动,对此类患者应进行及时有效的治疗,能够收到突出的临床效果且不会出现严重不良反应,值得临床推广。