老年2型糖尿病患者的社区管理效果评价

目的探讨老年2型糖尿病患者社区管理的效果。方法选取沈阳市铁西区9个社区的老年2型糖尿病患者70人，采用健康教育、量化饮食疗法、量化运动疗法、合理用药、定期监测等健康改善措施，评价1年的干预效果。结果干预后，患者的糖尿病知识知晓率、行为控制等指标明显改善（P〈O．05），空腹血糖及餐后2h血糖水平均显著降低（P〈0．05）；糖化血红蛋白平均值及达标率明显改善（P〈O．01）。结论将高等医学院校的技术资源与社区的卫生资源相结合，提供个性化治疗方案，对社区老年2型糖尿病患者的病情控制具有显著效果。     

2型糖尿病社区综合干预的效果评价

目的探讨社区综合干预对2型糖尿病患者的防治效果。方法将北京市平谷区滨河社区建立健康档案的90例2型糖尿病患者分为干预组和对照组各45例,2组均进行常规药物治疗。干预组在药物治疗的基础上,进行糖尿病知识及健康防治教育,加强饮食运动量化干预,建立科学的生活方式并进行有效药物控制。结果干预组的空腹血糖、餐后2 h血糖及糖化血红蛋白明显低于对照组（P〈0.05）,干预组对糖尿病的认知及遵医行为明显优于对照组（P〈0.01）。结论综合社区干预可有效地控制2型糖尿病患者的血糖,延缓并发症的发生。     

Reducing the Incidence of Type 2 Diabetes Mellitus

The evidence base derived from the research literature has clearly established that type 2 diabetes mellitus may be prevented or delayed through pharmacological interventions and, most efficaciously, through lifestyle interventions. Unfortunately, efforts to translate the research results into programs that may be applied to the clinical or healthcare system setting are lacking. The purpose of this article is 3-fold: (i) to briefly review the results of the major trials conducted in the area of type 2 diabetes; (ii) to outline an approach that may guide the design and development of type 2 diabetes prevention programs for clinical care; and (iii) to present a protocol that may support the process of implementation in the practice setting.The literature review clearly delineates critical type 2 diabetes prevention program outcomes, i.e. modest weight loss, dietary changes, an increase in physical activity level and, in the case of pharmacological interventions, good adherence to medication regimens. Guided by evidence-informed approaches to translation, this article outlines a set of critical program design principles that guide the development of type 2 diabetes prevention programs, and are systematically included and recognized in the programs; these principles are termed the ‘4Ss’: (i) effect size; (ii) program scope; (iii) scalability; and (iv) long-term sustainability in the real-world setting.Based on additional literature that addresses operational feasibility and principles of design and evaluation, this paper describes a protocol that may help healthcare systems and care delivery settings design such prevention programs and successfully document desired impacts that are meaningful to their customers. The protocol is designed to include the total membership of a healthcare system and it systematically allows for the identification and stratification of the risk of developing type 2 diabetes. Individuals are assigned to one of three risk strata: (i) low risk of developing type 2 diabetes; (ii) high risk of developing type 2 diabetes; or (iii) active disease (already diagnosed with type 2 diabetes). The high-risk group is subsequently invited to participate in risk-reduction strategies that are designed to reduce the incidence of type 2 diabetes.     

Management of Type 2 Diabetes Mellitus

Type 2 diabetes mellitus is a progressive disease with an insidious onset. It is thought to affect up to 10% of European and North American populations with a significantly higher incidence in non-White than in White populations. Complications of the disease are associated with considerable morbidity and mortality and their management consumes significant healthcare resources.Data from the United Kingdom Prospective Diabetes Study have shown that intensive glycemic control reduces the microvascular complications of type 2 disease and that intensive management of fasting plasma glucose (FPG) levels is insufficient over time to provide such control. Recent studies have demonstrated that lowering postprandial plasma (PPG) glucose levels provides some additional glycemic control and recent epidemiologic data suggest reducing PPG levels may be associated with a reduction in mortality.In patients with type 2 diabetes mellitus inadequately controlled by diet and exercise, nateglinide significantly improved glycemic control compared with placebo; a beneficial effect on both FPG and PPG levels was observed. In active comparator studies, nateglinide has been shown to be as effective as metformin (in pharmacotherapy-naïve patients), acarbose and troglitazone in reducing glycosylated hemoglobin (HbA_1c) levels.When used in combination with metformin (in patients inadequately controlled on maximum dosages of metformin monotherapy) nateglinide significantly improves glycemic control compared with placebo. In addition, nateglinide has been shown to display pronounced additive effects when added to troglitazone or metformin in patients inadequately controlled by diet and exercise alone.Nateglinide was generally well tolerated in clinical trials. The most common adverse event was hypoglycemia, although the incidence was low in comparison with sulfonylureas. The incidence of hypoglycemia was increased in patients using nateglinide in combination with metformin.By controlling HbA_1c and PPG, nateglinide has the potential to provide substantial health and quality-of-life benefits; however, long-term outcome data and validated quality-of-life assessments are lacking. In economic modelling studies, the estimated cost-effectiveness ratios observed with nateglinide were well within the range for therapies considered to be cost-effective.In conclusion, nateglinide is a useful addition to the available treatments for type 2 diabetes mellitus. It significantly improved glycemic control in pharmacotherapy-naïve patients as well as in patients not adequately controlled by metformin alone; however, until long-term clinical data become available, nateglinide can only be considered as an adjunct to metformin in patients inadequately controlled on metformin alone in whom PPG levels are elevated. Nateglinide is well tolerated and has low potential to cause hypoglycemia and bodyweight gain.     

2型糖尿病患者及高危人群社区综合干预效果分析

目的评价综合干预对社区2型糖尿病患者和高危人群的控制效果，为社区慢性病干预提供建议。方法对东城区小黄庄社区的102例糖尿病患者和88名高危人群进行综合干预，包括：健康教育，定期体检，饮食，运动和心理等综合干预，对干预前后结果运用SPSS 11．5软件包进行统计分析，t检验。结果干预前、后相关知识，参与运动的人数均有显著改善，血压、血糖各项指标差异也有统计学意义。结论社区综合干预对糖尿病患者和高危人群有较好的控制效果，社区卫生站应该开展积极、有效的综合干预。     

Insulin Therapy in Patients with Type 2 Diabetes Mellitus

Objective: To support policy-making for patients with diabetes mellitus we compared the costs and effectiveness of initiation of insulin therapy in patients with type 2 diabetes mellitus in 2 settings in The Netherlands. Design: Retrospective cohort study. Setting: A shared-care setting and an outpatient care setting of a university hospital. Both settings are located in Amsterdam, The Netherlands. Patients: All patients with type 2 diabetes mellitus above 40 years of age who were transferred to insulin therapy in 1993 in both settings. Intervention: Initiation and monitoring of insulin therapy in patients with type 2 diabetes mellitus. Study perspective: Healthcare sector. Main outcome measures: Baseline and 12 months glycosylated hemoglobin (HbA_1c) values and fasting blood glucose levels, and direct healthcare costs of insulin therapy. Costs were expressed in 1996 Dutch guilders (NLG) [NLG1 = 0.5 US dollars ($US)]. Results: In the shared-care setting (n = 57) the per patient healthcare costs during 1 year of follow-up averaged NLG2467. In the secondary care setting (n = 45) healthcare costs averaged NLG2740. A sensitivity analysis demonstrated that healthcare costs per patient were in the same range in both settings, ranging from NLG2000 to about NLG3400 ($US1000 to $US1700). Mean HbA_1c values fell from 9.1 to 7.9% (shared-care setting; p < 0.05) and from 10.2 to 8.2% (secondary care setting; p < 0.05). The percentage of patients with poor glycemic control (HbA_1c >8.5%) decreased from 56 to 30% (shared-care setting) and from 76 to 36% (secondary care setting). The percentage of patients with good glycemic control (HbA_1c <7%) increased from 4 to 23% (shared-care setting) and from 2 to 18% (secondary care setting). Conclusions: The study shows that in the first year of insulin therapy in patients with type 2 diabetes mellitus, acceptable glycemic control (HbA_1c >8.5%) can be attained in the majority of patients in both a shared-care and a secondary care setting, at comparable low average costs per patient.     

社区2型糖尿病患者血糖评估分析

目的了解社区糖尿病患者在血糖控制、用药、治疗及自我管理等方面的情况。方法单纯随机抽取社区管理的2型糖尿病患者103例,开展问卷调查、体格及实验室检查。结果调查对象的空腹血糖(FPG)、糖化血红蛋白(HbAlc)、血压(BP)及甘油三酯(TG)的控制达标率分别为65.05%、72.82%、9.71%与25.24%。结论社区2型糖尿病患者控制指标的总体情况不理想。下阶段的工作重点是提高社区糖尿病患者的并发症检出率,强化生活方式干预,提高病人的自我管理能力。     

对某社区老年2型糖尿病患者服药依从性调查分析

目的了解社区老年2型糖尿病患者服药情况及影响因素。方法专门医护人员采用问卷调查方式对某社区108例老年2型糖尿病患者服药依从性的调查记录。结果发现服药依从性良好者占33.3%、服药依从性差者占66.67%。结论加强对老年糖尿病患者的健康教育及社区医护人员的培训显得至关重要,提高服药依从性,从而提高患者的生活质量。     

对某社区老年2型糖尿病患者服药依从性调查分析

目的 了解社区老年2型糖尿病患者服药情况及影响因素。方法专门医护人员采用问卷调查方式对某社区108例老年2型糖尿病患者服药依从性的调查记录。结果发现服药依从性良好者占33．3％、服药依从性差者占66．67％。结论加强对老年糖尿病患者的健康教育及社区医护人员的培训显得至关重要,提高服药依从性,从而提高患者的生活质量。     

健康管理对老年2型糖尿病并心理障碍治疗的影响

目的探讨健康管理对老年2型糖尿病并心理障碍治疗的影响。方法选取2016年05月—2018年05月在本院、新会区第三人民医院、佛山市顺德区明景糠尿病医院等门诊及住院受理的100例老年2型糖尿病并心理障碍患者作为研究对象,按照随机数字表的方法分为观察组(n=50)和对照组(n=50),两组均实施常规治疗和疾病指导宣教,观察组在此基础上加以实施健康管理,分别对两组患者管理前后的焦虑自评量表(SAS)、抑郁自评量表(SDS)、简易精神病量表(BPRS)及汉密顿抑郁量表(HAMD)进行客观的评估,同时测定两组患者治疗前后的空腹血糖、餐后2 h血糖和糖化血红蛋白等指标以及生活质量(SF-36)。结果比较管理前后的SAS、SDS、BPRS、HAMD等心理状态指标发现,观察组患者管理后的指标出现明显下降,较之管理前和对照组存在统计学差异(P <0. 05);两组管理前后的空腹血糖、餐后2 h血糖和糖化血红蛋白指标比较存在统计学差异(P <0. 05),管理后的组间比较亦差异明显(P <0. 05);此外,观察组和对照组的生活质量量表全部指标均存在明显差异(P <0. 05)。结论健康管理模式可以有助于改善老年2型糖尿病并心理障碍患者的不良心理症状及生理症状,并在一定程度上提高了患者的生活质量。     

Management of Hypertension in Patients with Diabetes Mellitus

Hypertension and diabetes mellitus are significant and independent risk factors for cardiovascular disease.Antihypertensive therapy reduces cerebrovascular and cardiovascular morbidity and mortality in patients with hypertension. Tight blood pressure (BP) control [target diastolic BP (DBP) ≤80mm Hg] reduced the incidence of major cardiovascular events by 51% compared with less tight control (DBP ≤90mm Hg) in patients with diabetes mellitus in the Hypertension Optimal Treatment (HOT) study. Similarly, in the UK Prospective Diabetes Study (UKPDS), tight BP control [mean systolic BP (SBP)/DBP = 144/82mm Hg] with captopril or atenolol reduced diabetes mellitus-related morbidity and mortality by 24% compared with less tight control (mean SBP/DBP = 154/87mm Hg). Importantly, the frequency of microvascular disease (including retinopathy) was reduced by 37% among those randomised to tight BP control in the UKPDS.In the diabetic subgroup in the Heart Outcomes Prevention Evaluation (HOPE) study, there was a 25% reduction in the composite end-point of death due to cardiovascular causes, or myocardial infarction or stroke during 5 years of treatment with ramipril 10 mg/day relative to placebo.Lisinopril is an ACE inhibitor indicated for use in hypertension, heart failure and post-myocardial infarction. As an antihypertensive agent the drug is effective and generally well tolerated in patients with type 1 or 2 diabetes mellitus and in those with early or overt nephropathy.In the Swedish Treatment of Old People (STOP) Hypertension 2 trial, there was no difference in the relative risk of cardiovascular death between those assigned to ACE inhibitors (lisinopril or enalapril), calcium channel blockers (felodipine or isradipine) or ‘conventional’ antihypertensive therapy (thiazide diuretics or β blockers); treatment effects did not differ significantly between diabetic and nondiabetic patients (10.9% of the 6614 patients had diabetes mellitus). Importantly, lower frequencies of nonfatal or fatal myocardial infarction [relative risk (RR) 0.77; 95% confidence interval (CI) 0.61 to 0.96] and congestive heart failure (RR 0.78; CI 0.83 to 0.97) were detected during 4 years’ treatment with lisinopril or enalapril than felodipine or isradipine in this study.Lisinopril reduced albumin excretion rates in patients with type 1 or 2 diabetes mellitus. In the 2-year EURODIAB Controlled Trial of Lisinopril in IDDM (EUCLID) study, albumin excretion rates decreased by 49.7% relative to placebo in normotensive patients with type 1 diabetes mellitus and microalbuminuria during treatment with lisinopril 10 to 20 mg/day. Progression of retinopathy was attenuated in normotensive patients with type 1 diabetes mellitus during treatment with lisinopril in this study.In conclusion, lisinopril, like other ACE inhibitors should be considered a first-line agent for reducing BP and attenuating nephropathy in patients with type 1 or 2 diabetes mellitus.     

Lipid Management in Patients with Type 2 Diabetes

Background

Diabetes is correlated with a high risk for cardiovascular disease (CVD). The management of diabetic dyslipidemia, a well-recognized and modifiable risk factor, is a key element in the multifactorial approach to preventing CVD in patients with type 2 diabetes. Diabetic dyslipidemia is characterized by elevated triglyceride levels, decreased high-density lipoprotein cholesterol levels, and elevated low-density lipoprotein cholesterol (LDL-C) levels.

Objectives

To describe the effective approach to the management of dyslipidemia in patients with diabetes to allow providers and payers to become familiar with the treatment goals for all the components of lipoproteins, to correctly initiate appropriate lipid-lowering medications based on treatment goals and lipid-lowering capability, and to apply the data presented in lipid clinical trials to the treatment of patients with diabetes.

Summary

Diabetes is associated with a 2- to 4-fold increase in risk for CVD. The risk factors for coronary artery disease (CAD) include hypertension, dyslipidemia, obesity, and smoking. Therefore, prioritizing and managing diabetic patients with CVD risk factors is vital.

Conclusion

LDL-C appears to have the greatest role in premature and early atherosclerosis and the development of CAD and must be treated as aggressively as hyperglycemia to reduce CAD risk. Becoming familiar with lipid treatment goals and the many therapies available today can help providers and payers implement the appropriate approach to managing diabetic dyslipidemia risk factors and reduce the burden of this disease.The prevalence of diabetes has increased dramatically in recent decades. This trend highlights the importance of prevention and appropriate therapy to reduce cardiovascular events in patients with diabetes. Reaching adequate blood glucose control is important in decreasing microvascular complications associated with diabetes; however, good lipid management is vital for reducing the incidence of cardiovascular events in patients with diabetes.1–4Cardiovascular disease (CVD) has been recognized as the most frequent cause of morbidity and mortality among those with diabetes. Diabetes is associated with a 2- to 4-fold increased risk for CVD and is identified as a coronary artery disease (CAD) risk equivalent.1–4The risk factors for CAD include hypertension, dyslipidemia, obesity, and smoking.1–3 Therefore, prioritizing and managing diabetic patients with CVD risk factors is extremely important. In dyslipidemia, serum low-density lipoprotein cholesterol (LDL-C) appears to have the greatest role in premature and early atherosclerosis and CAD development and must therefore be treated as aggressively as hyperglycemia to reduce CAD risk. In fact, improved control of LDL-C can reduce cardiovascular complications by 20% to 50%.5     

Cost-Effectiveness of a Technology-Facilitated Depression Care Management Adoption Model in Safety-Net Primary Care Patients with Type 2 Diabetes

Background

The Diabetes-Depression Care-Management Adoption Trial is a translational study of safety-net primary care predominantly Hispanic/Latino patients with type 2 diabetes in collaboration with the Los Angeles County Department of Health Services.

肥胖和2型糖尿病患者脂肪细胞素的变化

目的了解脂肪细胞素在肥胖及2型糖尿病(T2DM)患者血浆中的水平,探讨脂肪细胞素对肥胖及T2DM发生发展的作用。方法选择在沈阳医学院附属沈洲医院体检科、内分泌科门诊及住院患者作为研究对象:单纯肥胖组50名、肥胖合并T2DM组50名、对照组50名。检测其血浆脂肪细胞素水平,同时进行体格检查及血脂、血糖、血清胰岛素检测,并计算胰岛素抵抗指数。结果 3组受检者体质指数、血脂、血糖及血清胰岛素水平的差异均有统计学意义(P<0.05)。与对照组比较,单纯肥胖组血浆中脂肪细胞素水平及胰岛素抵抗指数升高,差异有统计学意义(P<0.01);与对照组及单纯肥胖组比较,肥胖合并T2DM组血浆中脂肪细胞素水平及胰岛素抵抗指数升高,差异有统计学意义(P<0.05)。血浆中脂肪细胞素与体质指数、甘油三酯、血糖、血清胰岛素及胰岛素抵抗指数呈正相关(P<0.05)。多元逐步回归分析显示,体质指数、甘油三酯、口服葡萄糖耐量试验2h血糖、血清胰岛素及胰岛素抵抗指数是脂肪细胞素的独立危险因素。结论血浆中脂肪细胞素水平的升高可能与肥胖和2型糖尿病的发病机制有关。     

2型糖尿病视网膜病变的视网膜厚度检测

在糖尿病视网膜病变,视网膜内外屏障的破坏导致液体积聚黄斑水肿是引起视力下降的一个重要原因.眼底检查和荧光素血管造影可以观察到黄斑水肿和血管渗漏,视网膜厚度分析仪(Retinal Thickness Analyzer,RTA)是一种激光扫描的可以快速无创获得后极部视网膜的厚度信息的仪器.     

糖尿病患者的群体健康管理

目的 对糖尿病患者实施健康管理,探寻行之有效的糖尿病患者的健康管理模式. 方法随机选取糖尿病患者120名.分为干预组60人与对照组60人.所有患者填写测查问卷、并测定身高、体重、餐后2 h血糖、糖化血红蛋白等客观指标.干预组实施为期3个月的健康管理,干预结束后,两组患者再次填写问卷,并测定相关客观指标. 结果干预组经健康管理后,其体重指数、血压值、糖化血红蛋白、空腹血糖值、餐后2 h血糖值均有显著下降,其中糖化血红蛋白、空腹血糖值、餐后2 h m糖值的改变差异有统计学意义(P<0.05).干预组经干预后生活质量评分有所降低,其改变差异有统计学意义(P<0.05).对照组生活质量评分较3个月前有所增加. 结论干顶组通过正规的健康管理后,其客观指标没有进一步恶化,而且有显著的好转,比较对照组差异有统计学意义.充分说明了糖尿病健康管理的重要性和有效性.其健康管理模式值得进一步的研究和推广.     

2型糖尿病患者尿微量蛋白检测的临床进展

2型糖尿病所致的肾病是糖尿病常见的、严重的微血管并发症,也是导致慢性肾功能衰竭的主要原因.糖尿病肾病早期常缺乏特异性的临床表现,用常规检查方法难以发现尿蛋白的阳性结果,对早期诊断有一定的困难.对2型糖尿病患者尿微量蛋白中微量白蛋白、免疫球蛋白G、转铁蛋白、视黄醇结合蛋白在糖尿病肾损害中的作用机制进行综述,证明糖尿病患者早期检测尿微量蛋白对糖尿病.肾病早期诊断、治疗和评估预后具有重要的临床价值.     

新诊断2型糖尿病患者血液流变学的检测分析

目的探讨新诊断2型糖尿病(T2DM)患者血液流变学特点。方法在某医院2009年1月-2010年12月的体检人群中,根据1999年WHO的糖尿病诊断标准选择新诊断的T2DM患者80例作为T2DM组;选择100例健康者作为对照组,检测两组血液流变学及相关生化指标并进行统计学分析。结果新诊断T2DM患者的空腹血糖(FPG)、总胆固醇(TC)、甘油三酯(TG)、尿酸(UA)均高于对照组,差异有统计学意义(P<0.05);血液流变检测指标全血黏度、血浆黏度、血沉方程K值、红细胞压积及纤维蛋白原均高于对照组,差异有统计学意义(P<0.05)。结论新诊断T2DM患者存在血液流变学的改变,表现为高黏血症。     

肥胖2型糖尿病患者血浆内脂素水平的变化

目的探讨肥胖2型糖尿病患者血浆内脂素水平的变化。方法采用ELISA法检测106例我院内分泌科住院T2DM患者（T2DM组）和100例本院门诊健康体检者（对照组）的血浆内脂素水平,同时检测两组患者血糖、血脂代谢参数水平。结果T2DM组非肥胖亚组与肥胖亚组的血浆内脂素水平分别高于对照组肥胖亚组与非肥胖亚组（P〈0．01）;T2DM肥胖亚组血浆内脂素水平高于非肥胖亚组,差异有统计学意义（P〈0．01）。多元线性逐步回归分析显示WHRD=3．412,P〈0．01）和FPG（t=2．245,P〈0．01）是影响血浆内脂素水平的独立相关因素。结论血浆内脂素水平变化与糖脂代谢关系密切,它可能在T2DM的发病机制中起着一定作用。     

2型糖尿病患者的血脂水平及其与脂质过氧化的关系

目的探讨2型糖尿病患者血脂水平与脂质过氧化的关系。方法采用病例鄄对照研究方法,检测了147例2型糖尿病患者及149例健康对照者的血脂水平。结果糖尿病组的血清总胆固醇[(4.488±1.608)mmol/L]及高密度脂蛋白胆固醇[(0.804±0.385)mmol/L]含量明显低于对照组[分别为(5.155±1.702)mmol/L、(1.307±0.435)mmol/L],而血清丙二醛含量[穴5.002±2.896雪mmol/L]和过氧化物歧化酶含量[(104.444±29.046)NU/ml]明显高于对照组[分别为(3.976±2.394)mmol/L熏(93.294±24.108)NU/ml]熏P<0.05;血清低密度脂蛋白与NO含量虽无差异显著性,但P值均接近于0.05。结论糖尿病患者的血脂水平和脂质过氧化的改变,可能与其并发症的发生有密切的关联。