Gut Microbiota and Subclinical Cardiovascular Disease in Patients with Type 2 Diabetes Mellitus

Type 2 diabetes (T2D) is associated with an increased risk of cardiovascular disease (CVD). The gut microbiota may contribute to the onset and progression of T2D and CVD. The aim of this study was to evaluate the relationship between the gut microbiota and subclinical CVD in T2D patients. This cross-sectional study used echocardiographic data to evaluate the cardiac structure and function in T2D patients. We used a quantitative polymerase chain reaction to measure the abundances of targeted fecal bacterial species that have been associated with T2D, including Bacteroidetes, Firmicutes, Clostridium leptum group, Faecalibacterium prausnitzii, Bacteroides, Bifidobacterium, Akkermansia muciniphila, and Escherichia coli. A total of 155 subjects were enrolled (mean age 62.9 ± 10.1 years; 57.4% male and 42.6% female). Phyla Bacteroidetes and Firmicutes and genera Bacteroides were positively correlated with the left ventricular ejection fraction. Low levels of phylum Firmicutes were associated with an increased risk of left ventricular hypertrophy. High levels of both phylum Bacteroidetes and genera Bacteroides were negatively associated with diastolic dysfunction. A high phylum Firmicutes/Bacteroidetes (F/B) ratio and low level of genera Bacteroides were correlated with an increased left atrial diameter. Phyla Firmicutes and Bacteroidetes, the F/B ratio, and the genera Bacteroides were associated with variations in the cardiac structure and systolic and diastolic dysfunction in T2D patients. These findings suggest that changes in the gut microbiome may be the potential marker of the development of subclinical CVD in T2D patients.     

新双源flash—CT评价冠心病合并2型糖尿病患者血管成像特点分析

目的：探讨评价冠心病（CHD）合并2型糖尿病患者冠状动脉CT血管成像（CTA）的特点。方法：筛选2012年6月至2013年6月冠状动脉造影检查确诊为冠心病的患者460例,其中合并2型糖尿病患者220例,无合并糖尿病患者240例,冠状动脉造影后2周内行新双源flash—CT冠脉成像,分析冠心病合并2型糖尿病患者冠状动脉CTA的诊断特点。结果：新双源flash—cT冠状动脉CTA对2型糖尿病并冠心病患者冠状动脉病变的特异性为88.4％。2型糖尿病并CHD患者的冠状动脉钙化较严重,病变支数多,随着钙化积分的增高,特异性有所下降,但冠状动脉血管成像对于介入治疗仍有指导作用。结论：新双源flash—cT冠状动脉CTA是诊断冠心病并2型糖尿病冠状动脉病变可靠、无创的检查方法,但严重钙化者要结合冠脉造影结果进行综合判断。     

Intake of Refined Carbohydrates and Whole Grain Foods in Relation to Risk of Type 2 Diabetes Mellitus and Coronary Heart Disease

Recent survey data indicate that more than 50% of all adult Americans are overweight or obese. In parallel with this epidemic of weight gain in the general population, the incidence rate of type 2 diabetes mellitus (DM) is rapidly rising. Although their precise contributions are unclear, dietary factors are thought to affect body weight and the development of insulin resistance. Recent epidemiological data indicate that diets rich in high-fiber whole grains are associated with lower risk of coronary heart disease (CHD) and type 2 DM. These data are consistent with results from recent metabolic experiments, suggesting favorable lipid profiles and glycemic control associated with higher intake of whole grains, but not with refined grains. It seems prudent, therefore, to distinguish whole-grain rather than refined-grain cereal products for the prevention of chronic diseases.     

Pleiotropic Effects of Thiazolidinediones: Implications for the Treatment of Patients With Type 2 Diabetes Mellitus

Abstract

Thiazolidinediones (TZDs) are insulin-sensitizing antidiabetes agents that act through the peroxisome proliferator–activated receptor-γ to cause a durable improvement in glycemic control in patients with type 2 diabetes mellitus. Although less well recognized, TZDs also exert a protective effect on β-cell function. In addition to their beneficial effects on glucose homeostasis, TZDs–especially pioglitazone–exert a number of other pleiotropic effects that make them ideal agents as monotherapy or in combination with other oral agents, glucagon-like peptide-1 analogs, or insulin. Pioglitazone improves endothelial dysfunction, reduces blood pressure, corrects diabetic dyslipidemia, and reduces circulating levels of inflammatory cytokines and prothrombotic factors. Pioglitazone also redistributes fat and toxic lipid metabolites in muscle, liver, β cells, and arteries, and deposits the fat in subcutaneous adipocytes where it cannot exert its lipotoxic effects. Consistent with these antiatherogenic effects, pioglitazone reduced major adverse cardiac event endpoints (ie, mortality, myocardial infarction, and stroke) in the Prospective Pioglitazone Clinical Trial in Macrovascular Events and in a meta-analysis of all other published pioglitazone trials. Pioglitazone also mobilizes fat out of the liver, improving liver function and histologic abnormalities in patients with nonalcoholic fatty liver disease and nonalcoholic steatohepatitis. Pioglitazone also reduces proteinuria, all-cause mortality, and cardiovascular events in patients with type 2 diabetes mellitus with a reduced glomerular filtration rate. These benefits must be weighed against the side effects of the drug, including weight gain, fluid retention, atypical fractures, and, possibly, bladder cancer. When low doses of pioglitazone are used (eg, 7.5–30 mg/d) with gradual titration, and physician recognition of the potential side effects are applied, the risk-to-benefit ratio is very favorable. Despite having similar effects on glycemic control, pioglitazone and rosiglitazone appear to have different effects on cardiovascular outcomes. Rosiglitazone has been associated with an increased risk of myocardial infarction, and its use in the United States is restricted because of cardiovascular safety concerns.     

Application of Mediterranean Diet in Cardiovascular Diseases and Type 2 Diabetes Mellitus: Motivations and Challenges

Objective: Cardiovascular disease (CVD) is the leading cause of disability and death in many countries. Together with CVD, Type 2 diabetes mellitus (T2DM) accounts for more than 80% of all premature non-communicable disease deaths. The protective effect of the Mediterranean diet (MedDiet) on CVD and its risk factors, including T2DM, has been a constant topic of interest. Notwithstanding, despite the large body of evidence, scientists are concerned about the challenges and difficulties of the application of MedDiet. This review aims to explore the motivations and challenges for using MedDiet in patients with CVD and T2DM. Design: An electronic search was conducted for articles about MedDiet published in PubMed, ScienceDirect, Scopus, and Web of Science up to December 2021, particularly on CVD and T2DM patients. From a total of 1536 studies, the final eligible set of 108 studies was selected. Study selection involved three iterations of filtering. Results: Motivation to apply MedDiet was driven by the importance of studying the entire food pattern rather than just one nutrient, the health benefits, and the distinct characteristics of MedDiet. Challenges of the application of MedDiet include lacking universal definition and scoring of MedDiet. Influences of nutritional transition that promote shifting of traditional diets to Westernized diets further complicate the adherence of MedDiet. The challenges also cover the research aspects, including ambiguous and inconsistent findings, the inexistence of positive results, limited evidence, and generalization in previous studies. The review revealed that most of the studies recommended that future studies are needed in terms of health benefits, describing the potential benefits of MedDiet, identifying the barriers, and mainly discussing the effect of MedDiet in different populations. Conclusions: In general, there is consistent and strong evidence that MedDiet is associated inversely with CVD risk factors and directly with glycemic control. MedDiet is the subject of active and diverse research despite the existing challenges. This review informs the health benefits conferred by this centuries-old dietary pattern and highlights MedDiet could possibly be revolutionary, practical, and non-invasive approach for the prevention and treatment CVD and T2DM.     

中医体质护理辅助治疗2型糖尿病合并冠心病血瘀质80例临床分析

目的：观察中医体质护理对2型糖尿病合并冠心病血瘀质患者D-二聚体（DD）、凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）、凝血酶时间（TT）、纤维蛋白原（FBG）、B型尿钠肽（BNP）的影响,探讨其对改善2型糖尿病合并冠心病血瘀质患者血液高凝状态的作用机制。方法：将104例2型糖尿病合并冠心病血瘀质患者按随机数字表法分为两组,对照组采用拜阿司匹林片,试验组在其基础上加用中医体质护理,4周为一疗程,共连续治疗2个疗程,观察治疗前后两组患者DD、PT、APTT、TT、FBG、BNP的变化。结果：两组治疗前DD、PT、APTT、TT、FBG、BNP比较差异均无统计学意义（P〉O.05）,治疗后试验组PT、APTT、FBG、TT、DD及BNP与对照组相比,差异均有统计学意义（P〈0.05）。结论：中医体质护理可有效延长PT、APTT、TT和FBG,并降低DD及BNP,改善2型糖尿病合并冠心病血瘀质患者的血液高凝状态,降低心血管事件风险。     

冠心病合并Ⅱ型糖尿病患者血清MMP-9及高敏C-反应蛋白表达变化及其临床意义

目的探讨冠心病（CHD）合并2型糖尿病（T2DM）患者血清基质金属蛋白酶-9（MMP-9）、高敏C反应蛋白（hs-CRP）的表达水平及其临床意义。方法选择我院内科收治的CHD合并T2DM患者45例,单纯T2DM患者40例,单纯CHD患者42例,另选择门诊健康体检者30例为正常对照组。采用酶联免疫吸附法（ELISA）和免疫散射比浊法检测血清MMP9和hs-CRP的表达水平。结果 CHD合并T2DM组血清MMP-9和hs-CRP的表达水平均显著高于单纯CHD组、单纯T2DM组及对照组（P〈0.05）,单纯CHD组和单纯T2DM组血清MMP-9和hs-CRP的表达水平均显著高于对照组。经Spearman分析,CHD合并T2DM组患者血清MMP-9与hs-CRP呈正相关（r=0.526,P〈0.01）。结论联合检测血清MMP-9与hs-CRP将更有利于早期监测糖尿病冠状动脉粥样硬化的发生和预测患者的预后。     

Oat Intake and Risk of Type 2 Diabetes,Cardiovascular Disease and All-Cause Mortality: A Systematic Review and Meta-Analysis

Cardiovascular disease (CVD) and type 2 diabetes (T2D) remain the top disease and mortality burdens worldwide. Oats have been shown to benefit cardiovascular health and improve insulin resistance. However, the evidence linking oat consumption with CVD, T2D and all-cause mortality remains inconclusive. We conducted a comprehensive systematic review and meta-analysis of prospective cohort studies to evaluate the associations between oat consumption and risks of T2D, CVD and all-cause mortality in the general population. Five electronic databases were searched until September, 2020. Study specific relative risks (RR) were meta-analyzed using random effect models. Of 4686 relevant references, we included 9 articles, based on 8 unique studies and 471,157 participants. Comparing oat consumers versus non-consumers, RRs were 0.86 (95% CI 0.72–1.03) for T2D incidence and 0.73 (95% CI 0.5–1.07) for combined CVD incidence. Comparing participants with highest versus lowest oat intake, RRs were 0.78 (95% CI 0.74–0.82) for T2D incidence, 0.81 (95% CI 0.61–1.08) for CHD incidence and 0.79 (95% CI 0.59–1.07) for stroke. For all-cause mortality one study based on three cohorts found RR for men and women were 0.76 (95% CI 0.69–0.85) and 0.78 (95% CI 0.70–0.87), respectively. Most studies (n = 6) were of fair to good quality. This meta-analysis suggests that consumption of oat could reduce the risk for T2D and all-cause mortality, while no significant association was found for CVD. Future studies should address a lack of standardized methods in assessing overall oat intake and type of oat products, and investigate a dose-dependent response of oat products on cardiometabolic outcomes in order to introduce oat as preventive and treatment options for the public.     

2型糖尿病并发冠心病影响因素的质量-数量Cox回归分析

目的探讨2型糖尿病并发冠心病的影响因素,为制定2型糖尿病性冠心病的预防和控制措施提供理论依据。方法采用质量-数量Cox回归模型对2型糖尿病并发冠心病的影响因素进行探讨。结果吸烟、喜食荤油、糖尿病家族史及高胆固醇水平是2型糖尿病并发冠心病的危险因素,RR值分别为2.125,2.263,1.802和1.197;多食蔬菜和适当增加业余体力活动量是其保护因素,RR值分别为0.634和0.713。结论调节脂代谢、多吃蔬菜和适当的体力活动能延缓2型糖尿病并发冠心病的发生。     

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。     

2型糖尿病患者牙周病治疗效果评估及其影响因素研究

目的探讨2型糖尿病患者的牙周病治疗效果及其影响因素。方法选择2009年1月-2011年6月东莞市石碣医院口腔科收治的2型糖尿病合并牙周病患者165例,根据牙周治疗是否有效,将患者分为有效组和无效组,收集两组患者的临床资料进行比较分析。结果有效组和无效组的年龄、患糖尿病年限、有无吸烟习惯、既往是否接受过牙周治疗、牙周治疗依从性、牙周治疗期间空腹血糖浓度控制情况、口腔卫生状况、精神压力状况间比较,差异有统计学意义（P〈0.05）。Logistic回归分析结果显示年龄、有无吸烟习惯、牙周治疗依从性、牙周治疗期间空腹血糖浓度控制情况是影响2型糖尿病患者牙周病治疗效果的独立因素。结论年龄、有无吸烟习惯、牙周治疗依从性、牙周治疗期间空腹血糖浓度控制情况是影响2型糖尿病患者牙周病治疗效果的独立因素。     

2型糖尿病并发症患者的生命质量及其影响因素

目的探讨2型糖尿病并发症患者的生命质量及其影响因素。方法采用特异性糖尿病生命质量量表,调查102例2型糖尿病并发症患者的生命质量。采用非条件Logistic回归模型对资料进行分析。结果2型糖尿病并发症患者生命质量普遍降低,年长患者的生命质量优于年轻患者。主食、荤油摄入过多、喜食咸味是2型糖尿病并发症患者低生命质量的危险因素,OR值分别为2.515,2.167,1.920.强化治疗、适当增加业余体力活动量是其保护因素,OR值分别为0.976,0.485。结论鼓励2型糖尿病并发症患者加强糖尿病治疗,适当增加业余体力活动,限制主食、荤油、盐的摄入,将有助于改善生命质量。     

生命质量对2型糖尿病并发症发生的作用

目的 探讨生命质量对2型糖尿病并发症发生、发展的作用.方法 采用特异性糖尿病生命质量量表,调查300例2型糖尿病人的生命质量,其中105例为2型糖尿病合并并发症患者.采用非条件Logistic回归模型对资料进行分析.结果 年龄、病程、生活事件、生命质量满意程度下降和影响程度增加是2型糖尿病并发症发生的危险因素,OR值分别为1.058,1.019,1.375,1.056,1.077,家庭月人均收入高、适量水果摄入是其保护因素,OR值分别为0.441,0.304.结论 鼓励糖尿病人适当地增加水果摄入,提高患者的收入心理调节能力,改善生命质量,将有助于预防或延缓2型糖尿病并发症的发生和发展.     

Assessment of Daily Food and Nutrient Intake in Japanese Type 2 Diabetes Mellitus Patients Using Dietary Reference Intakes

Medical nutrition therapy for the management of diabetes plays an important role in preventing diabetes complications and managing metabolic control. However, little is known about actual eating habits of individuals with type 2 diabetic mellitus (T2DM), especially in Japan. Therefore, we sought to (1) assess the dietary intake of individuals with T2DM, and (2) characterize their intake relative to national recommendations. This cross-sectional study involved 149 patients (77 males and 72 females) aged 40–79 years with T2DM recruited at a Kyoto hospital. Dietary intake was assessed using a validated self-administered diet history questionnaire. Under-consumption, adequacy, and over-consumption, of nutrients were compared to the age- and sex-based standards of the Japanese Dietary Reference Intakes. Among the results, most notable are (1) the inadequacy of diets in men with respect to intake of vitamins and minerals, likely owing to low intake of vegetables and fruits; (2) excess contributions of fat intake to total energy in both sexes; and (3) excess consumption of sweets and beverages relative to the national average. The prevalence of diabetes complications may be increasing because of a major gap between the typical dietary intake of individuals with T2DM and dietary recommendation.     

绝经后妇女2型糖尿病性激素变化与冠心病并发症关系

目的 探讨绝经后妇女2型糖尿病患者血清性激素水平变化与冠心病并发症关系。方法 测定25例绝经后妇女2型糖尿病并发冠心病（A组）、23例2型糖尿病未并发冠心病（B组）、20例绝经后正常妇女（C组）的血清雌二醇（E2）、孕激素（P）、促卵泡刺激素（FSH）、促黄体生成素（LH）、睾酮（T）;同时测定了血浆总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）及低密度脂蛋白胆固醇（LDL-C）。结果 A组与B组、C组比较显示、E2、HDL-C水平显著降低。P、FSH、LH、TC、LDL-C水平显著半高,线性相关分析显示E2与FSH、LH、TC、TG、LDL-C呈显著负相关,而与HDL-C呈显著正相关。结论 绝经后妇女2型糖尿病合并冠心病患者存在着严重的性激素失调及脂代谢异常,可能为绝经后妇女2型糖尿病并发症冠心病的原因之一。     

2型糖尿病合并冠心病患者调脂治疗达标情况分析

目的了解2型糖尿病（T2DM）合并冠心病（CHD）患者调脂治疗的达标情况。方法对6个月内接受过调脂治疗的161例合并CHD的T2DM患者进行血脂检测,并以2007年《中国2型糖尿病防治指南》为标准分析其达标情况。结果 LDL-C、HDL-C和TG水平分别为（2.71±0.67）、（1.15±0.43）和（2.06±0.87）mmol/L,经t检验,HDL-C水平达标（P〉0.05）,LDL-C和TG水平未达标（P均〈0.05）。LDL-C、HDL-C和TG的达标率分别为33.5%、65.2%和46.6%。结论 T2DM合并CHD患者调脂治疗达标率较低,需进一步提高患者对调脂治疗的依从性和医生应用调脂药物的水平。     

同型半胱氨酸与冠心病合并2型糖尿病患者心功能的相关性分析

目的研究同型半胱氨酸(HCY)与冠心病合并糖尿病患者心功能的关系。方法选取92例冠心病合并2型糖尿病患者测定HCY、脑钠肽(BNP),行超声心动图测定左心室射血分数(LVEF),按照美国纽约心脏病学会(NYHA)心功能分级标准分为心力衰竭(HF)组(63例)和无HF组(29例)。HF组又分为3个亚组:HFⅡ级组、HFⅢ级组、HFⅣ级组。结果 HF组患者HCY(19.5±8.0)μmol/L,显著高于无HF组(12.6±4.1)μmol/L,差异具有统计学意义(P<0.01)。HF组患者随心功能NYHA分级的增加,HCY水平逐步增高。HCY水平与心功能分级之间呈正相关(r=0.49,P<0.01),在控制年龄、性别变量后,HCY水平与心功能分级仍呈正相关(r=0.46,P<0.01)。HCY水平与LVEF呈负相关(r=﹣0.30,P<0.05)。HCY水平与BNP水平呈正相关(r=0.39,P<0.01)。结论冠心病合并2型糖尿病患者随心功能恶化,HCY水平逐渐增高。     

2型糖尿病患者社区干预效果分析

目的通过对2型糖尿病病因、合理用药、常见并发症的认识等宣教效果的分析探讨社区自我控制糖尿病的效果。方法对社区内确诊的126例糖尿病患者科学的干预,量化干预结果。定期监测空腹血糖、餐后2小时血糖、糖化血红蛋白、甘油三脂、总胆固醇。所有结果以PSSA软件进行统计学处理。结果接受6个月社区干预的2型糖尿病患者糖尿病基本知识掌握正确度明显提高(P<0.05),空腹血糖、餐后2小时血糖、糖化血红蛋白明显降低(P<0.05);甘油三脂、总胆固醇降低不明显(P>0.05),统计学显示无意义。结论①2型糖尿病患者通过科学的社区干预,糖尿病基本知识正确掌握度明显提高,空腹血糖、餐后2小时血糖、糖化血红蛋白明显降低。②由于多重原因,甘油三脂、总胆固醇降低不明显,调脂工作仍需加强。     

Sources of Protein and Polyunsaturated Fatty Acids of the Diet and Microalbuminuria in Type 2 Diabetes Mellitus

Background: Albuminuria excretion rate above the reference range and below albustix positive proteinuria (20–199 μg/min) is known as microalbuminuria and has been associated with an increased risk of death and progression to renal failure. Besides hyperglicemia and high blood pressure levels, dietary factors can also influence albuminuria.

Objective: To evaluate possible associations of dietary components (macronutrients and selected foods) with microalbuminuria in type 2 diabetic patients.

Methods: In this cross-sectional study, 119 normoalbuminuric [NORMO; 24-h urinary albumin excretion (UAE) < 20 μg/min; immunoturbidimetry] and 62 microalbuminuric (MICRO; UAE 20–199 μg/min) type 2 diabetic patients, attending the Endocrine Division, Hospital de Clínicas de Porto Alegre (Brazil), without previous dietary counseling, underwent 3-day weighed-diet records, and clinical and laboratory evaluation.

Results: MICRO patients consumed more protein (20.5 ± 4.4 vs. 19.0 ± 3.5% of total energy; p = 0.01) with a higher intake from animal sources (14.5 ± 4.7 vs. 12.9 ± 3.8% of total energy; p = 0.015) than NORMO patients. The intakes of PUFAs (8.6 ± 2.9 vs. 9.7 ± 3.3% of total energy; p < 0.03), PUFAs from vegetable sources (7.3 ± 3.4 vs. 8.6 ± 3.7% of total energy; p = 0.029), plant oils [0.2 (0.1–0.6) vs. 0.3 (0.1–0.9) mg/kg weight; p = 0.02] and margarines [3.3 (0–75.7) vs. 7.0 (0–51.7) g/day; p = 0.01] were lower in MICRO than in NORMO. In multivariate logistic regression models, adjusted for age, gender, presence of hypertension and fasting plasma glucose, intake of total protein (% of total energy; OR 1.104; 95% CI 1.008–1.208; p = 0.032) was positively associated with microalbuminuria. The intakes of total PUFAs (% of total energy; OR 0.855; 95%CI 0.762–0.961; p = 0.008), PUFAs from vegetable sources (% of total energy; OR 0.874; 95%CI 0.787–0.971; p = 0.012) and plant oils (mg/kg weight; OR 0.036; 95% CI 0.003–0.522; p = 0.015) were negatively associated with microalbuminuria.

Conclusions: In type 2 diabetic patients, the high intake of protein and the low intake of PUFAs, particularly from plant oils, were associated with the presence of microalbuminuria. Reducing protein intake from animal sources and increasing the intake of lipids from vegetable origin might-reduce the risk of microalbuminuria.