短期胰岛素强化治疗对磺脲类继发性失效患者β细胞功能的影响

目的:主要探讨短期胰岛素强化治疗对2型糖尿病磺脲类继发失效患者β细胞分泌功能的影响.方法:2型糖尿病磺脲类继发失效患者31例.停用原口服药后予以胰岛素强化治疗,疗程2周.通过检测治疗前后糖代谢参数,计算β细胞分泌功能和胰岛素抵抗状况等.结果:胰岛素强化治疗后血糖达标时间为(4.4±2.1)d,胰岛素剂量平均为(48.6±19.2)U/d,未出现显著不良反应.与治疗前比较,治疗后β细胞分泌功能和胰岛素抵抗均显著改善(P<0.01).结论:短期胰岛素强化治疗,可改善2型糖尿病磺脲类继发性失效患者的β细胞分泌功能和胰岛素抵抗.     

胰岛素强化治疗初发2型糖尿病的远期效果

糖尿病是以慢性高血糖为特征的代谢性疾病,其发病的中心环节是胰岛素抵抗和胰岛β细胞功能缺陷.而2型糖尿病早期β细胞功能的损害是可逆的,且部分初发的2型糖尿病患者通过短期胰岛素强化治疗,可以在停药后获得一段血糖接近正常的缓解期.作者自2010年6月至2011年7月采用胰岛素强化治疗初发2型糖尿病40例,取得较好效果.报道如下.     

胰岛素强化治疗在初诊2型糖尿病患者中的应用

近年来普遍认为胰岛素强化治疗应用于初诊的2型糖尿病患者能够改善胰岛β细胞功能,改善胰岛素抵抗(IR),显著提高血糖控制水平,大幅降低糖尿病并发症.各种强化治疗方案中又以胰岛素泵强化治疗疗效最佳.现将近年来胰岛素强化治疗特别是胰岛素泵强化治疗在初诊2型糖尿病患者中的应用进展综述如下.     

2型糖尿病患者胰岛素治疗的心理疏导

目的 探讨心理疏导对2型糖尿病患者接受胰岛素治疗的作用.方法 随机对15例拒绝胰岛素治疗的2型糖尿病患者进行心理调查,采取相应的护理对策,解除患者的心理顾虑,做好患者的心理疏导.结果 经过耐心的心理疏导,15例拒绝胰岛素治疗的2型糖尿病患者中14例接受了胰岛素治疗.结论 采取相应的护理对策,进行耐心的心理疏导对2型糖尿病患者接受胰岛素治疗十分重要.     

以甘精胰岛素为基础治疗老年2型糖尿病32例分析

目的 观察以甘精胰岛素为基础治疗方案治疗老年2型糖尿病的疗效.方法 对32例老年2型糖尿病患者用以甘精胰岛素为基础加口服降糖药物治疗方案治疗,比较治疗前后血糖等的变化.结果 使用以甘精胰岛素为基础治疗方案治疗老年2型糖尿病12周后,老年2型糖尿病患者血糖及糖化血红蛋白均明显下降,低血糖发生率低.结论 甘精胰岛素能更好地控制老年2型糖尿病患者的血糖及糖化血红蛋白,并有良好的安全性.     

2型糖尿病老年患者胰岛素治疗依从性现状及影响因素研究进展

介绍2型糖尿病老年患者胰岛素治疗依从性测评工具及现状,分析影响2型糖尿病老年患者胰岛素治疗依从性的相关因素有：患者因素、胰岛素治疗不良反应、医疗费用、生活管理、心理因素、家庭社会支持及医源性因素。2型糖尿病老年患者胰岛素治疗依从性普遍偏低,建议结合老年患者生理、认知功能减弱的特点,丰富健康教育形式,提高患者胰岛素治疗认知和注射技能,增加家庭和社会支持,引导患者积极应对不良反应,改善其胰岛素治疗依从性。     

阿卡波糖联合甘精胰岛素对2型糖尿病患者胰岛功能、血脂水平的影响及安全性

目的 观察阿卡波糖联合甘精胰岛素对2型糖尿病患者胰岛功能、血脂水平的影响及安全性.方法 选取2018年1月—2020年12月就诊的102例2型糖尿病,根据治疗方式不同分为对照组48例和研究组54例,对照组给予阿卡波糖联合普通胰岛素治疗,研究组给予阿卡波糖联合甘精胰岛素治疗.比较两组治疗前后胰岛功能[稳态模型胰岛素抵抗指...     

胰岛素泵治疗初诊2型糖尿病疗效观察

2型糖尿病是一种缓慢进展性疾病,胰岛β细胞功能衰竭和胰岛素抵抗是2型糖尿病发病的两个最重要因素,持续高血糖可继发导致或加重β细胞功能损害,甚而发生衰竭.如何保护β细胞的功能,延缓糖尿病病程的发展已成为糖尿病研究热点.研究发现,进行早期强化治疗,纠正代谢异常,可明显减轻高糖毒性及脂毒性,保护β细胞功能,从而有效缓解糖尿病病情,降低慢性并发症的发病危险[1].且短期持续胰岛素输注(CSII)可使约50%的初诊2型糖尿病患者获得长期缓解[2].本研究是通过对初诊2型糖尿病患者采用胰岛素泵强化治疗,与常规多次胰岛素皮下注射强化治疗组(MSII组)进行对照,比较2种短期强化治疗方式的疗效及不良反应.     

护理干预对糖尿病患者胰岛素抵抗和胰岛β细胞功能的影响

目的 探讨护理干预对糖尿病患者胰岛素抵抗及胰岛β细胞功能的影响.方法 选择2010年3～12月住院治疗的90例2型糖尿病患者作为研究对象.将所有患者随机分为对照组40例和干预组50例.对照组患者采用2型糖尿病住院患者常规治疗方法进行治疗,干预组患者在对照组常规治疗的基础上再进行护理干预以及治疗.比较2组患者治疗前、出院前及随访6个月的FBG、2 hBG、HbAlC、INS、HOMA-IR、HOMA-β变化情况,综合评价护理干预治疗对2型糖尿病患者胰岛素抵抗和胰岛β细胞功能的影响.结果 2组患者经住院治疗后,出院前各项指标均有改善,FBG、2 hBG、HbAlc和HOMA-IR明显下降,而INS、HOMA-β明显上升.但干预组患者改善更为明显,2组改善值比较差异有统计学意义.结论 对糖尿病患者在进行常规治疗的基础上,对其治疗过程中出现的问题采取针对性的护理干预,可以有效降低患者的胰岛素抵抗及提高胰岛β细胞的分泌功能,提升整体疗效.     

甘精胰岛素对老年2型糖尿病患者β细胞功能的影响

目的：探讨甘精胰岛素对于老年新诊断2型糖尿病患者的β细胞功能影响。方法：50例老年新诊断2型糖尿病患者随机分为2组：甘精胰岛素治疗组（G组）和门冬胰岛素30治疗组（N组）,进行为期2周的治疗,计算治疗前后患者的胰岛β细胞功能指数。结果：2组患者的胰岛功能均有一定程度的改善,与治疗前相比存在显著差异（P〈0.001）。但是治疗后,N组患者的糖负荷30min后胰岛素增量与葡萄糖增量的比值（ΔI30/ΔG30）较G组患者改善更为明显（P〈0.05）。结论：对于老年新诊断的2型糖尿病患者,早期用甘精胰岛素治疗有利于改善其胰岛β细胞功能。     

老年男性2型糖尿病患者认知功能损害的危险因素分析

目的调查老年男性2型糖尿病患者认知功能损害的危险因素,以预防该类患者功能损害的发生。方法目的性抽样选取2010年1-11月在解放军总医院内分泌科住院的老年男性2型糖尿病患者180例。采用简易生活量表(mini-mentalstate examinantion,MMSE)、临床痴呆量表(clinical dementia rating,CDR)、总体痴呆量表(global deterioate scale,GDS)对患者进行认知功能评价,根据认知功能评价将研究对象分为认知功能正常组与认知功能损害组。结果 180例患者中,认知功能正常48例,认知功能损害132例。年龄、脑卒中发生率、糖尿病病程、糖尿病微血管病变和低血糖反应发生率在两组老年男性2型糖尿病患者间差异有统计学意义(P<0.01)。结论老年男性2型糖尿病患者认知功能损害的发生率较高,与其相关的危险因素可能包括非糖尿病的相关因素和糖尿病的相关指标,故应做好相应的预防和护理工作,以提高其生活质量。     

抑郁症状在老年糖尿病患者衰弱与认知功能之间的中介作用

目的分析抑郁症状在老年2型糖尿病患者衰弱与认知功能之间的中介作用。方法采用衰弱表型(FP)、蒙特利尔认知评估量表(MoCA)、简版老年抑郁量表(GDS-15)对264例老年2型糖尿病患者进行调查。结果老年2型糖尿病患者认知功能障碍的发生率为56.1%,均分为(23.00±4.26)分,衰弱得分为(1.89±1.41)分,抑郁症状得分为(5.47±3.80)分。患者衰弱、抑郁症状得分与认知功能得分呈显著负相关(P<0.001),衰弱得分与抑郁症状得分呈显著正相关(P<0.001)。抑郁症状在衰弱与认知功能的关系中起部分中介作用,中介效应为-0.145,占总效应的29.9%。结论老年糖尿病患者认知功能障碍发生率高,减少个体衰弱、抑郁症状的发生是改善认知功能的有效途径。     

社区老年糖尿病患者认知衰弱现状及影响因素分析

目的 :调查社区老年糖尿病患者认知衰弱现状,并分析其影响因素。方法 :采用便利抽样法,选取郑州市某社区卫生服务中心260例老年糖尿病患者为研究对象,采用一般资料调查表、衰弱表型、蒙特利尔认知评估量表、临床痴呆评定量表进行调查。结果 :共回收255份有效问卷。研究对象中共有28例发生认知衰弱,认知衰弱发生率为11.0%。多因素Logistic回归分析显示,高龄(≥75岁)及抑郁是认知衰弱的危险因素,规律运动是认知衰弱的保护因素(P<0.05)。结论 :社区老年糖尿病患者认知衰弱发生率较高,社区医护人员应重视该人群认知衰弱的评估,及时采取针对性的整体干预措施,预防或减缓老年糖尿病患者认知衰弱的发生发展。     

老年缺血性脑卒中患者社会网络与认知功能的相关性研究

目的探讨老年脑卒中患者社会网络与认知功能及其各领域的相关性。方法采用简易精神状态检查量表(MMSE)、蒙特利尔认知评估量表(MoCA)、记忆与执行筛查量表(分为MES-M和MES-E)、语言功能量表(LAST)、社会网络量表(LSWS-6)对2018年8月-2019年5月复旦大学附属上海市第五人民医院收治的141例老年脑卒中患者进行评估;采用Pearson和Spearman相关对认知功能的影响因素进行单因素分析,基于社会网络影响健康结局的理论和单因素分析结果建立结构方程模型。结果研究对象中认知障碍与轻度认知障碍发生率分别为33.3%和94.3%。路径分析显示:年龄、婚姻状况、文化程度、有氧运动、抑郁状态、神经功能缺损评分(NIHSS)等直接和(或)间接影响老年患者认知功能,社会网络在文化程度与MMSE、MoCA、MES-M之间起中介作用,中介效应值分别为0.047、0.065、0.092,社会网络在抑郁状态与MMSE之间的中介效应值为-0.105。结论脑卒中后认知障碍在老年缺血性脑卒中患者中十分常见,受多种因素影响,抑郁状态和社会网络均对认知功能有显著影响,社会网络在抑郁状态与认知功能之间起中介作用。医护人员及其照顾者应注意加强老年患者社会交往活动,以延缓脑卒中后认知障碍进展过程。     

Relationship between blood levels of methyl donor and folate and mild cognitive impairment in Chinese patients with type 2 diabetes: a case-control study

Type 2 diabetes is a risk factor for Alzheimer’s disease and mild cognitive impairment. Folate insufficiency fosters a decline in the sole methyl donor, S-adenosylmethionine, and decreases methylation potential, which is associated with Alzheimer’s disease in non-diabetic patients. However, little is known in diabetic patients. We analyzed plasma levels of S-adenosylmethionine, S-adenosylhomocysteine and serum level of folate in 100 elderly type 2 diabetic patients with and without mild cognitive impairment. S-adenosylmethionine/S-adenosylhomocysteine ratio was used to reflect the methylation potential. Patients with mild cognitive impairment had significantly lower levels of S-adenosylmethionine, folate and S-adenosylmethionine/S-adenosylhomocysteineratios. Furthermore, logistic regression analysis indicated the plasma S-adenosylmethionine, S-adenosylmethionine/S-adenosylhomocysteine ratio and serum folate (OR, 0.96, 0.698, 0.72, respectively; p<0.05) were negatively associated with risk of mild cognitive impairment, even after adjusting for related covariates. In addition, folate level was positively correlated with S-adenosylmethionine and the S-adenosylmethionine/S-adenosylhomocysteine ratio (r = 0.38, 0.46, respectively; p<0.05) among patients within the middle tertile of folate levels (6.3–9.1 µg/L). These findings indicate mild cognitive impairment is associated with lower levels of S-adenosylmethionine, folate and weakened methylation potential; plasma S-adenosylmethionine and methylation potential may be predicted by serum folate within a suitable range of folate concentrations in diabetic patients.     

老年轻度认知障碍患者抑郁水平的调查与分析

目的了解老年轻度认知障碍(MCI)患者抑郁水平,分析其影响因素。方法采用蒙特利尔认知评估(MoCA)、日常生活能力量表(ADL)等对916例社区老人进行MCI的筛查和医学诊断,对确诊的154例患者采用老年抑郁量表(GDS-15)进行抑郁状况调查。结果老年MCI患者抑郁患病率为29.9%。多元线性回归显示,认知功能、日常活动能力和婚姻状况是老年MCI患者抑郁水平的重要影响因素。结论老年MCI患者抑郁发生率较高,应采取措施改善其心理健康水平。     

抑郁和焦虑与老年认知障碍患者认知水平的相关性分析

目的：探讨老年认知障碍患者抑郁和焦虑评估的临床价值，分析老年认知功能减退的可能影响因素。方法：筛选2019年6月至2021年11月期间在复旦大学附属华山医院老年医学科门诊就诊的可疑认知障碍老年人群，检测其认知水平、抑郁和焦虑评分及相关生化指标。按照认知水平分为3组：非认知障碍组、轻度认知障碍组（MCI）及痴呆组。完成认知水平测试（MMSE+MoCA)及焦虑和抑郁评估（PHQ-9+GAD-7），同时完成甲状腺功能、梅毒/艾滋病血清标志物、血同型半胱氨酸（HCY）、叶酸、维生素B12、自身免疫性脑炎抗体等血液生化学检查及尿液阿尔兹海默相关神经丝蛋白（AD7c-NTP）检测。结果：共入组242例可疑老年认知障碍患者，其中非认知障碍组37例，MCI组62例，痴呆组143例，三组人群抑郁检出人数分别为12例（32.4%）、30例（48.4%）和82例(57.3%)，焦虑检出人数分别为10例(27.0%)、24例（38.7%）和72例（50.3%），非认知障碍组和痴呆组之间具有显著差异；三组人群之间甲状腺功能、梅毒/艾滋病血清标志物、自身免疫性脑炎抗体异常率均无明显差异；三组人群之间HCY、叶酸、AD7c-NTP异常率具有显著性差异，但维生素B12异常率无显著性差异；多元Logistics回归分析显示，与非认知障碍组比较，MCI组与年龄和GAD-7评分呈正相关；痴呆组与年龄、HCY水平、PHQ-9和GAD-7评分等危险因素之间存在正相关；痴呆组与MCI组比较，GAD-7评分明显增高(p＜0.05)，而两组年龄、HCY、叶酸和PHQ-9评分之间无明显差异。结论：老年认知障碍患者易伴抑郁、焦虑等不良情绪，抑郁和焦虑情绪与年龄、认知功能及HCY和叶酸水平之间存在一定相关性。以上研究提示门诊接诊可疑老年认知障碍患者时，有必要对患者进行认知功能评估的同时完善抑郁和焦虑评估。     

Comparative study between depression in Korean elderly with mild cognitive impairment and normal cognitive function

This cross‐sectional comparative study compares differences in depression in the elderly with mild cognitive impairment and those with normal cognitive function in a community. Study subjects were drawn from elderly people visiting one particular public health center in Seoul, South Korea and included 81 people with mild cognitive impairment and 81 with normal cognitive function who were matched based on age, sex, education, and daily living activities. Study variables, including cognitive function, activities of daily living, instrumental activities of daily living, and depression, were measured with standardized instruments. Collected data were statistically analyzed with Student's paired t‐test and χ² test. The results showed no significant differences between these groups in terms of depression. Therefore, in community practice settings, nurses should understand that depression is not a manifestation of cognitive impairment and should develop effective nursing strategies to assess depression while considering other factors including age, sex, education, and daily living activities.     

A biethnic community survey of cognition in participants with type 2 diabetes, impaired glucose tolerance, and normal glucose tolerance: the New Mexico Elder Health Survey

OBJECTIVE: To determine whether elderly individuals with type 2 diabetes or impaired glucose tolerance are at increased risk for cognitive impairment compared with individuals with normal glucose tolerance. RESEARCH DESIGN AND METHODS: Elderly Hispanic individuals (n = 414) and non-Hispanic white individuals (n = 469) aged > or =65 years, randomly selected from the Medicare rolls of Bernalillo County (Albuquerque), NM, were recruited for an interview/examination that included an evaluation of glucose tolerance. Information on nine tests of cognitive function and two measures of depression allowed comparisons between diabetic status and these functions. Comparisons also were made between glycosolated hemoglobin concentrations and these cognitive tests in the 188 participants with diabetes. RESULTS: None of the mean scores on the tests of cognitive function was significantly lower in the participants with diabetes compared with those participants with normal glucose tolerance after adjustments for ethnicity, sex, age, level of education, and presence of depression, with or without elimination of those with dementia (Mini-Mental State Exam <18). Interestingly, participants with impaired glucose tolerance tended to score higher than those with normal glucose tolerance. No significant associations were found between glycosolated hemoglobin concentrations and cognitive test scores in participants with diabetes. CONCLUSIONS: We could not show any increased risk for cognitive impairment in participants with diabetes compared with those with normal glucose tolerance after adjustments for ethnicity, sex, age, education, and presence of depression, before or after elimination of dementia in this random sample from a biethnic population of predominantly community-dwelling elders.     

Battling insulin resistance in elderly obese people with type 2 diabetes: bring on the heavy weights

Exercise improves insulin resistance and has beneficial effects in preventing and treating type 2 diabetes. However, aerobic exercise is hindered in many type 2 diabetic patients because of advancing age, obesity, and other comorbid conditions. Weight lifting or progressive resistance training (PRT) offers a safe and effective exercise alternative for these people. PRT promotes favorable energy balance and reduced visceral fat deposition through enhanced basal metabolism and activity levels while counteracting age- and disease-related muscle wasting. PRT improves insulin sensitivity and glycemic control; increases muscle mass, strength, and endurance; and has positive effects on bone density, osteoarthritic symptoms, mobility impairment, self-efficacy, hypertension, and lipid profiles. PRT also alleviates symptoms of anxiety, depression, and insomnia in individuals with clinical depression and improves exercise tolerance in individuals with cardiac ischemic disease and congestive heart failure; all of these aspects are relevant to the care of diabetic elders. Moreover, PRT is safe and well accepted in many complex patient populations, including very frail elderly individuals and those with cardiovascular disease. The greater feasibility of using PRT over aerobic exercise in elderly obese type 2 diabetic individuals because of concomitant cardiovascular, arthritic, and other disease provides a solid rationale for investigating the global benefits of PRT in the management of diabetes.