2型糖尿病合并冠心病患者心血管危险因素控制现状的调查

目的:根据指南要求,调查2型糖尿病合并冠心病患者主要心血管危险因素的控制情况,分析影响血糖的相关因素。方法:采用横断面调查方法,对收集的2型糖尿病合并冠心病者421例进行问卷调查、体格检查及血液检查,以获取一般资料、血糖、血压、血脂及体质量等。按指南标准计算各指标达标率。结果:HbA1c、收缩压、舒张压、HDL-C、TG、LDL-C和BMI的达标率,分别是61.9%、43.2%、69.3%、62.4%(男性)/50.1%(女性)、43.3%、63.1%和29.1%(男性)/32.9%(女性)。影响血糖的因素有饮食运动控制、规律用药和知晓血糖控制目标。结论:2型糖尿病合并冠心病患者控制现状与指南要求仍有差距,可通过加强患者的自我管理和糖尿病知识的认知,提高治疗质量。     

The prevalence of retinopathy and associated medical risk factors in type I (insulin-dependent) diabetes mellitus

The prevalence of diabetic retinopathy and the associated medical risk factors, such as age at onset and duration of diabetes, metabolic control, blood pressure, albumin clearance and serum creatinine, were studied in 501 patients with type I diabetes mellitus. The prevalence of retinopathy, characterized as simplex, maculopathy, preproliferative, and proliferative, was 60.5%. Patients with retinopathy were younger at the onset of diabetes, and had a longer duration of disease. In patients with more than 10 years of diabetes, proliferative retinopathy was more frequent if onset was before they were 15 years old, despite the fact that the duration of diabetes did not differ. Patients with severe retinopathy had worse metabolic control, and were more frequently treated for hypertension. In addition, the systolic blood pressure was elevated in all groups of patients with any type of retinopathy, whereas the diastolic blood pressure was elevated only in patients with more severe forms. Patients with severe retinopathy also had higher levels of albumin clearance.     

老年2型糖尿病合并冠心病的危险因素分析

目的 探讨老年2型糖尿病(T2DM)合并冠心病的危险因素.方法 选择2010年8月至2012年8月我院收治的120例2型糖尿病患者为研究对象,根据是否合并冠心病将其分为两组,对两组患者的临床资料进行比较分析,探讨影响T2DM合并冠心病的危险因素.结果 观察组的病程、BMI、SBP、TG、HDL-C、LDL-C、UA等指标与对照组相比差异有统计学意义(P＜0.05).Logistic回归分析结果显示,糖尿病合并冠心病的危险因素为病程＞10年、高血压、高血脂、高血清尿酸.结论 病程＞10年、高血压、高血脂、高血清尿酸为老年2型糖尿病合并冠心病的危险因素.     

Association of C-reactive protein with coronary heart disease risk factors in patients with type 2 diabetes mellitus

The assessment of markers of systemic inflammation, such as C-reactive protein (CRP) and interleukin 6 (IL6), could be used to identify persons at high risk of coronary heart disease (CHD). This study evaluates the relationship of CRP and IL6 with CHD risk factors in patients with type 2 diabetes mellitus (DM) with CHD and age and sex matched type 2 DM controls without CHD. CRP, IL-6, total plasma homocysteine (tHcy), lipoprotein (a) [Lp(a)] and sialic acid (SA) were determined in 55 type 2 diabetic patients with CHD and 51 age- and sex-matched type 2 diabetic controls without CHD. Multivariate and logistic regression analyses were used to relate these markers with CHD risk factors. CRP (P=0.02) and tHcy (P=0.03) were significantly higher in patients with CHD compared with the control group even after correction for age and sex. IL6, Lp(a), SA and lipid parameters were not significantly different between the two groups of patients. After adjustment for potential confounders, the odds ratio (OR) for elevated CRP was 2.00 (95% confidence interval [CI], 1.12-3.58) (P=0.02) but the OR for IL6 was 3.41 95% CI, 0.70-17.17 (P=0.14). Partial correlation analyses of CRP and IL6 with other variables showed significant correlation of CRP with tHcy, and SA in patients with CHD only. Our results support the inclusion of CRP (high-sensitivity assay), in the risk assessment of diabetic subjects.     

2型糖尿病合并冠心病危险因素分析

目的 分析２型糖尿病合并冠心病危险因素。方法 应用多因素Ｌｏｇｉｓｔｉｃ回归,分析了４０５例２型糖尿病患者有关冠心病的危险因素。结果 （１）２型糖尿病病人冠心病发生率为２６．２％;（２）年龄,糖尿病病程,高血压,体重指数,空腹血清Ｃ肽,甘油三酯,血清尿酸７个因素与Ⅱ型糖尿病病人冠心病发病有关。结论除了常见的冠心病危险因素外,为了防止２型糖尿病病人冠心病的发生,亦应注意控制高胰岛素血症,高甘油三酯血     

Correlation of cardiorespiratory fitness with risk factors for cardiovascular disease in children with type 1 diabetes mellitus

The objective of this study was to correlate CRF with cardiovascular risk factors in T1DM children.MethodsFifty children and adolescents aged between 9 and 17 years with no diabetes complications and a mean diabetes duration of 4.6 years were selected. Antropometric, sexual maturation and blood pressure data were evaluated. CRF level was assessed with a 20-m shuttle run test. Laboratory tests were performed to verify fasting lipids and glycated hemoglobin. Statistical analyses were made with Pearson partial correlation, t test, and one-way ANOVA, with p ≤ 0.05.ResultsAfter adjustment for body adiposity and sexual maturity, inverse correlations among CRF and TC, TG, TC/HDL-C, TG/HDL-C, non-HDL-C, and SBP were statistically significant. Variables differing by sex included weight Z score, BMI Z score, skinfold thickness, percentage of body fat, and DBP. Boys had higher CRF compared to girls. CRF and TC differed significantly by sexual maturation status.ConclusionAn inverse and significant relationship between CRF and most lipid profile's components and SBP in poor controlled T1DM children and adolescents was found, independently of body adiposity.     

2型糖尿病发生冠心病相关危险因素的研究

目的探讨2型糖尿病患者发生冠心病的相关危险因素。方法选择2型糖尿病患者150例,根据是否合并冠心病分为2组,单纯2型糖尿病患者组(A组)82例和2型糖尿病合并冠心病患者组(B组)68例。另选择同期健康体检者60例作为对照组,测定各组的同型半胱氨酸、高敏C反应蛋白、凝血酶原时间、活化部分凝血酶时间、纤维蛋白原和D-二聚体。结果与对照组比较,A组和B组患者同型半胱氨酸、高敏C反应蛋白和D-二聚体差异有统计学意义(P<0.05);与A组比较,B组同型半胱氨酸、高敏C反应蛋白和D-二聚体差异有统计学意义(P<0.05)。多因素logistic回归分析显示,同型半胱氨酸、高敏C反应蛋白和D-二聚体均为冠心病的危险因素。3组凝血酶原时间、活化部分凝血酶时间、纤维蛋白原比较差异无统计学意义(P>0.05)。结论同型半胱氨酸、高敏C反应蛋白和D-二聚体均是2型糖尿病患者发生冠心病的高风险因素。     

Albuminuria and associated medical risk factors: A cross-sectional study in 476 type I (insulin-dependent) diabetic patients. Part 1

Albumin concentration in a morning urine sample was analyzed in a cross-sectional study in 476 insulin-dependent diabetic patients. The following groups of patients were defined: A) normal urinary albumin (urine albumin <12.5 mg/L); B) high normal albuminuria (12.5–30 mg/L); C) microalbuminuria, ie, incipient nephropathy (31–299 mg/L); and D) clinical nephropathy (≥300 mg/L). The prevalences of incipient and clinical diabetic nephropathy were 24.8 and 14.4%, respectively. There were no differences in clinical parameters such as age, age at onset or duration of diabetes, blood pressure, serum creatinine, or HbA_1c levels between groups A and B. The frequency of retinopathy in these groups was 55 and 50%, respectively. In group C, there were increases in age, duration of diabetes, blood pressure, serum creatinine, and HbA_1c levels. The frequency of retinopathy was higher (80%), and more patients had severe forms (47%). In group D, there were further increases in all parameters and, in addition, younger age at onset of diabetes. The frequency of retinopathy was 97%, and severe forms of retinopathy were more common (86%). Seventeen percent of the patients were treated for hypertension. These patients were older, had longer duration of diabetes, and had higher levels of blood pressure, serum creatinine, and urinary albumin, as well as a younger age at onset of diabetes than patients not requiring antihypertensive treatment.     

Urinary transferrin excretion in type 1 (insulin-dependent) diabetes mellitus.

Urinary excretion of transferrin and albumin was studied by radioimmunoassay in 47 adult patients with Type 1 diabetes and 28 control subjects. Median (range) urinary transferrin excretion rate was significantly elevated in the diabetic group 0.58 (0.02-2663.3) micrograms min-1 compared with the control group 0.04 (0.01-0.28) micrograms min-1, p less than 0.001. Urinary transferrin:creatinine ratios (x 10(2)) were different in diabetic 47 (0.6-958.0) micrograms mmol-1 and control groups 0.7 (0.06-2.3) micrograms mmol-1, p less than 0.001). There were correlations between urinary transferrin and albumin excretion rates in diabetic (r = 0.78, p less than 0.001) and control groups (r = 0.81, p less than 0.05). Forty (85%) diabetic patients had elevated transferrin excretion rates, 18 (38.3%) had elevated albumin excretion rates. All diabetic patients with elevated albumin excretion rates had elevated transferrin excretion rates. Twenty-one (77.8%) of the patients with normal albumin excretion rates had elevated transferrin excretion rates. Urinary excretion of N-acetyl-beta-D-glucosaminidase was greater in diabetic patients than control subjects (142 vs 58 mumol h-1 l-1, p less than 0.001). There were correlation between transferrin and N-acetyl-beta-D-glucosaminidase excretion (r = 0.67, p less than 0.01) and albumin and N-acetyl-beta-D-glucosaminidase excretion (r = 0.63, p less than 0.01) in the diabetic group. Elevated urinary transferrin excretion rate may be a marker for renal dysfunction in diabetes mellitus.     

Use of fluorquinolones is associated with a reduced risk of coronary heart disease in diabetes mellitus type 2 patients.

AIMS: The aim of the present study was to investigate whether use of specific antibiotic drugs decreases the risk of coronary heart disease in diabetes mellitus type 2 patients. METHODS AND RESULTS: Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and hospitalizations for all 450,000 residents of eight Dutch cities. In a nested case-control study among diabetes mellitus type 2 patients, 244 cases with a first hospitalization for coronary heart disease and 686 controls without coronary heart disease matched on age, sex, calendar time, and registration date in PHARMO RLS were selected. Use of antibiotic drugs among cases and controls was determined over 3 years prior to the event. Use of fluorquinolones for more than 14 days compared to no use of fluorquinolones was associated with a lower risk of coronary heart diseases (OR(adj)=0.30 (95%CI: 0.12-0.75)). No association between tetracycline, macrolide and lincosamide treatment, or other antibiotic drugs (penicillins, cephalosporines, sulphonamides and trimethoprim), and the risk of coronary heart disease was found. CONCLUSION: Our results suggest that treatment with fluorquinolones in doses commonly prescribed in routine clinical practice is associated with a reduction in the risk of coronary heart diseases among diabetes mellitus type 2 patients.     

Meta-analysis of type 1 diabetes mellitus and risk of cardiovascular disease

BackgroundIndividuals with diabetes have a high risk of cardiovascular disease (CVD). However, the association between type 1 diabetes mellitus (T1DM) and the risk of CVD has not been well addressed. This meta-analysis aimed to investigate the association between T1DM and CVD.MethodsWe searched the PubMed and EMBASE for studies that examined the association between T1DM and CVD until October 2020. We calculated the pooled risk ratios (RRs) with confidence intervals (CIs) from individual studies based on a random-effects model.ResultsWe included 10 observational studies involving 166,027 patients with T1DM, and individuals were matched controls from the general population. Among T1DM patients, the RR of CVD was 5.09 (95% CI, 3.72–6.96), of coronary heart disease (CHD) was 9.38 (95% CI, 5.56–15.82), and of myocardial infarction was 6.37 (95% CI, 3.81–10.66). The RR of heart failure was 4.29 (95% CI, 3.54–5.19), of atrial fibrillation was 1.36 (95% CI, 1.17–1.59), and of stroke was 4.08 (95% CI, 3.42–4.86). Moreover, there was an increased RR among females for CHD, CVD, myocardial infarction, and stroke associated with T1DM.ConclusionsThis study suggests that T1DM is associated with an increased risk of several types of CVD. However, the possible mechanisms for the increased risk of CVD remain unclear.     

中国退休军人2型糖尿病患者心血管病风险控制现状

目的了解中国退休军人2型糖尿病患者血糖、血压、血脂的控制率及抗血小板的治疗现状。方法2012年3至8月对我国18个地区军队门诊部或干休所进行问卷调查,收集军队退休干部中2型糖尿病患者的一般资料、病史、心血管病危险因素、相关实验室检查结果以及治疗方案等资料。分析统计受试者血糖、糖化血红蛋白（HbAlC）、血压和血脂的控制率及阿司匹林的应用率。对影响综合达标的相关因素进行logistic回归分析。结果共收回有效问卷4976份。受访者均为确诊的2型糖尿病患者（男性占77．0％）,其中46．0％的受访者自我血糖监测频率≥1次／周,16．5％监测频率〈1R／月;以最近一次检测的HbAlc值统计,HbAlc〈7．0％的控制率为45．3％;受访者血压控制率（〈140／80mmHg,1mmHg=0．133kPa）为33．9％;低密度脂蛋白胆固醇（LDL-C）控制率（〈2．6mmoVL）为63．3％,血压、血糖、血脂三项综合控制率为10．0％。59．8％的受访者有心脑血管病史,其中阿司匹林使用率为64．3％;无心脑血管病史受访者中,心血管病高危患者（50岁以上男性或60岁以上女性）占94．1％,其阿司匹林使用率为56．7％。使用阿司匹林有助于提高综合达标率（比值比=1．382,95％可信区间：1．131—1．688,P=0．002）。结论中国退休军人系统管理的2型糖尿病患者有良好的综合管理制度,定期查体、监测血糖、血压、血脂、应用阿司匹林,四项达标率高,这将有利于预防糖尿病并发症。     

Plasma lipoprotein abnormalities in type 1 (insulin-dependent) diabetes mellitus

Lipoprotein abnormalities may well contribute to the increased risk of coronary heart disease, cerebrovascular disease and peripheral vascular disease observed in type 1 (insulin-dependent) diabetes mellitus. The spectrum of diabetes-associated changes in lipoprotein metabolism is discussed. The plasma levels of lipoprotein cholesterol and triglycerides are largely influenced by the degree of glycaemic control. With poor metabolic control, plasma cholesterol and triglycerides are frequently elevated. In contrast, in well-regulated patients without micro- and macrovascular complications lipid levels are generally normal or even favourable, although lipoprotein composition abnormalities can persist despite intensified insulin treatment. With the development of diabetic nephropathy the cardiovascular risk increases markedly and this complication is associated with increased concentrations of cholesterol and of the atherogenic lipoprotein species, lipoprotein(a), and low levels of high-density lipoprotein cholesterol. The rationale for treatment of lipid disorders in diabetes mellitus is based upon results of trials conducted primarily in non-diabetic populations. It is hoped that with increased recognition of dyslipidaemia and aggressive therapeutic measures the overkill in diabetes mellitus from macrovascular diseases will be reduced.     

HLA antigens and risk factors for nephropathy in Type 1 (insulin-dependent) diabetes mellitus

Summary This study of risk factors for diabetic nephropathy in juvenile Type 1 (insulin-dependent) diabetes mellitus compares two carefully characterised groups of patients, one with proteinuria (n = 23), the other a control group (n = 24) with no evidence of nephropathy despite more than 25 years of diabetic life. No significant difference was observed between the groups in any HLA-A, -B or -DR antigen or Bf allotype. DR3 was present in 87% of patients with proteinuria and 75% of the diabetic control group; DR4 was present in 48% of patients with proteinuria and 63% of diabetic controls; BfFl was present in 17% of patients with nephropathy and 9% of the diabetic control group. Compared with the control group, patients with proteinuria had significantly higher mean diabetic-clinic blood glucose concentrations before the diagnosis of microvascular disease, a significantly earlier age at diagnosis of diabetes, and had more often been treated with once-daily as opposed to twice-daily insulin regimens. Susceptibility to nephropathy in Type 1 diabetes appears to be determined by the quality of metabolic control and age of onset of diabetes; although the number of subjects studied was relatively small no evidence was found of any influence of HLA or Bf phenotype.     

Smoking and risk of coronary heart disease among women with type 2 diabetes mellitus

BACKGROUND: Although the association between smoking and increased risk of coronary heart disease (CHD) is well established in the general population, this relationship is less well-defined among individuals with diabetes. OBJECTIVE: To assess the relationship between cigarette smoking and risk of CHD among women with type 2 diabetes mellitus in the Nurses' Health Study cohort. METHODS: The Nurses' Health Study, a prospective cohort study of 121,700 US female registered nurses surveyed in 11 states and followed up from July 1, 1976, through July 1, 1996, involved a total of 6547 women diagnosed as having type 2 diabetes mellitus. Incident cases of CHD were our main outcome measure in this study. RESULTS: We documented 458 incident cases of CHD (200 fatal CHD-related cases and 258 nonfatal myocardial infarctions) during 20 years (68,227 person-years) of follow-up. We found a dose-response relationship between current smoking status and risk of CHD among diabetic women. Compared with never smokers, the relative risks (RRs) for CHD were 1.21 (95% confidence interval [CI], 0.97-1.51) for past smokers, 1.66 (95% CI, 1.10-2.52) for current smokers of 1 to 14 cigarettes per day, and 2.68 (95% CI, 2.07-3.48) for current smokers of 15 or more cigarettes per day in multivariate analyses (P<.001 for trend). The multivariate RR of CHD among diabetic women who had stopped smoking for more than 10 years was similar to that among diabetic women who were never smokers (RR, 1.01; 95% CI, 0.73-1.38). In secondary analyses involving diabetic and nondiabetic women, the multivariate-adjusted RR of CHD for those with diabetes who currently smoked (> or = 15 cigarettes per day) compared with those who never smoked was 7.67 (95% CI, 5.88-10.01). CONCLUSIONS: Cigarette smoking is strongly associated with an increased risk of CHD among women with type 2 diabetes mellitus. Furthermore, quitting smoking seems to decrease this excess risk substantially; women with diabetes should be strongly advised against smoking.CK     

Association of parental cardiovascular risk factors with offspring type 1 diabetes mellitus insulin sensitivity

AimThis study aimed to determine whether the insulin resistance (IR) and lipid profiles in Type 1 Diabetes (T1D) offspring are associated with IR and other cardiovascular risk factors in their parents.MethodsThis study included 99 T1D patients (19.6 ± 4.0 yrs.), 85 mothers and 60 fathers. Parents' IR was assessed by HOMA-IR, and the insulin sensitivity in T1D patients was assessed by the estimated Glucose Disposal Rate (eGDR).ResultsThe eGDR in the T1D offspring was negatively related to age (p = 0.023), weight (p = 0.004), LDL (p = 0.026), and microalbuminuria (p = 0.019). Maternal Type 2 Diabetes (p < 0.001) and HOMA-IR (p = 0.029) were negatively related to eGDR in their T1D offspring. The maternal HOMA-IR and the proband's eGDR were positively (p = 0.012) and negatively (p = 0.042) associated with the birth weight of the T1D offspring, respectively. We didn't find an association with the fathers' profiles.ConclusionsIn a cohort of offspring with T1D the insulin sensitivity was related to the IR, lipid profile, and the presence of T2D only in their mothers. Precocious screening and treatment of these risk factors beyond glycemic control will benefit T1D with this background.     

Microalbuminuria and cardiovascular risk factors in type 2 diabetes mellitus

Prospective studies have shown that increased urinary albumin excretion is a risk factor for cardiovascular morbidity and mortality in patients with Type 2 diabetes mellitus, but the nature of the association remains unknown. Eighty-five patients aged less than 65 years and not treated with insulin were studied. The overnight albumin excretion rate (AER) was measured in each patient and analysed in relation to several putative risk factors for cardiovascular disease. AER was used both as a continuous variable and after dividing patients into high-risk (AER greater than or equal to 10 micrograms min-1) and low-risk (AER less than 10 micrograms min-1) groups. By both methods of analysis AER was significantly correlated with both seated and supine diastolic blood pressure levels and with resting heart rate. Body mass index and waist-hip ratio appeared higher and HDL-cholesterol lower in the at-risk group, but differences were not statistically significant. The level of Factor VII was not significantly lower in the at-risk group. Little of the cardiovascular risk associated with raised AER can be attributed to associations with conventional risk factors.     

Type 1 (insulin-dependent) diabetes mellitus with coexisting autoimmune thyroid disease in Japan.

Type 1 diabetes mellitus is known to be a heterogenous disease which is frequently complicated with other autoimmune thyroid diseases (AITD). The present study was designed to investigate the clinical characteristics and HLA antigens in Japanese Type 1 diabetic patients with AITD. Subjects were 25 Type 1 diabetic patients with AITD (13 Graves' disease and 12 Hashimoto's thyroiditis) and 32 Type 1 diabetic patients without AITD. Compared with Type 1 diabetic patients without AITD, age at onset of diabetes was later and positive ICA persisted much longer in the diabetic patients with AITD. Compared with normal controls, DR9 was increased in the patients with AITD, while DR4 was increased in those without AITD. Type 1 diabetic patients with AITD were characterized by the late onset of diabetes, persistent ICA and increased association with DR9. These results suggest that immunological and genetic heterogeneity may exist within Japanese Type 1 diabetic patients.