个体化医学营养治疗(MNT)对妊娠糖尿病患者血糖的影响

目的探讨个体化医学营养治疗(MNT)对妊娠糖尿病患者血糖的影响。方法 97例妊娠糖尿病(GDM)患者,进行个体化医学营养治疗,观察干预前后GDM患者空腹血糖、三餐后2h血糖、HbA1c的变化。结果 GDM孕妇个体化医学营养治疗干预后的血糖情况均较干预前明显改善(P<0.05)。结论个体化MNT对GDM具有积极的治疗作用,能有效控制餐后血糖。     

Hyperuricaemia and development of type 2 diabetes mellitus in Asian population

Recently, meta‐analysis studies reported that hyperuricaemia is associated with higher incidence of type 2 diabetes mellitus (T2DM), however, there are limited data on the Asian population. The aim of this observational study is to estimate the long‐term impact of hyperuricaemia on the new‐onset T2DM and cardiovascular events. This study is based on a single‐centre, all‐comers, and large retrospective cohort. Subjects that visited from January 2004 to February 2014 were enrolled using the electronic database of Korea University Guro Hospital. A total of 10 505 patients without a history of T2DM were analyzed for uric acid, fasting glucose and haemoglobin (Hb) A1c level. Inclusion criteria included both Hb A1c <5.7% and fasting glucose level <100 mg/dL without T2DM. Hyperuricaemia was defined as a uric acid level ≥7.0 mg/dL in men, and ≥6.5 mg/dL in women. To adjust baseline confounders, a propensity score matching (PSM) analysis was performed. The impact of hyperuricaemia on the new‐onset T2DM and cardiovascular events were compared with the non‐hyperuricaemia during the 5‐year clinical follow‐up. After PSM, baseline characteristics of both groups were balanced. In a 5‐year follow‐up, the hyperuricaemia itself was a strong independent predictor of the incidence of new‐onset T2DM (HR, 1.78; 95% CI, 1.12 to 2.8). Hyperuricaemia was a strong independent predictor of new‐onset T2DM, which suggests a substantial implication for a correlation between uric acid concentration and insulin resistance (or insulin sensitivity). Also, hyperuricaemia is substantially implicated in cardiovascular risks and the further long‐term cardiovascular events in the crude population, but it is not an independent predictor of long‐term cardiovascular mortality in the matched population.     

Higher rate of hyperglycemia than hypoglycemia during Ramadan fasting in patients with uncontrolled type 1 diabetes: Insight from continuous glucose monitoring system

Background

Patients with uncontrolled type 1 diabetes mellitus (T1DM) are at a high risk for Ramadan fasting and are exempt from fasting; however, most still insist on fasting. The aim of this study was to examine glucose level fluctuations in those patients during Ramadan fasting using a real-time continuous glucose monitoring system (RT-CGMS).

First approved inhaled insulin therapy for diabetes mellitus

The long-term benefits of tight glycemic control in preventing microvascular and macrovascular complications are well established in both Type 1 diabetes mellitus (Type 1 DM) and Type 2 diabetes mellitus (Type 2 DM). Nonetheless, achievement of recommended haemoglobin A1c (HbA(1c)) goals (< or = 6.5 - 7.0%) has remained elusive, especially in patients with diabetes who require insulin therapy. Delayed/suboptimal titration of insulin is partly related to poor acceptance of multiple injection regimen by both physicians and patients. EXUBERA (human insulin [rDNA origin]; Pfizer), the first approved inhaled insulin for the treatment of diabetic patients, has been shown to be safe and as effective as regular/rapidly acting insulin in improving glycemic control. In addition to controlling postprandial glucose excursions, EXUBERA exerts a major action to reduce fasting plasma glucose (FPG) concentration. Thus, it has the potential to be used as a monotherapy in Type 2 DM, as well as in combination with an insulin sensitizer in Type 2 DM or in combination with long-acting insulin in both Type 2 DM and Type 1 DM.     

Antenatal oral glucose‐tolerance test values and pregnancy outcomes

Objective The aim of the present study was to explore the impact of individual blood glucose values (n = 4; i.e. fasting and 1, 2 and 3 h following oral glucose administration) obtained during antenatal oral glucose‐tolerance testing, together with two different sets of criteria used for diagnosis of gestational diabetes mellitus (GDM) — Carpenter and Coustan Criteria (CCC) and National Diabetes Data Group (NDDG) criteria — in predicting pregnancy outcomes and maternal insulin need. Setting Al Ain Hospital, United Arab Emirates. Results The maternal and neonatal outcomes indicated that the number of abnormally elevated antenatal OGTT values obtained during the diagnosis of GDM was significantly correlated with development of a number of pregnancy complications. Data analysis also indicated that the number of abnormal diagnostic antenatal OGTT values using CCC was significantly correlated with development of postpartum diabetes mellitus (P = 0.044) within 6months of delivery. The number of abnormal OGTT values significantly contributed to insulin need during the index pregnancy (P < 0.05). The CCC approach was more sensitive than the NDDG methodology for predicting the onset of GDM and a number of the associated complications. Conclusions The study highlighted the importance of abnormal values for antenatal OGTT in identifying the need for insulin management in women with GDM.     

门冬胰岛素30强化治疗对初诊2型糖尿病患者胰岛功能的影响

目的:探讨短期门冬胰岛素30强化治疗对初诊2型糖尿病患者胰岛β细胞功能的影响。方法:对30例初诊2型糖尿病患者每日注射2次门冬胰岛素30,强化治疗2周,治疗前后分别进行口服葡萄糖耐量试验(OGTT)及胰岛素释放试验,测定0,30,120 min的血糖和胰岛素值,分别以稳态模型法β细胞功能指数(HOMA-β)评估β细胞功能,以稳态模型法胰岛素抵抗指数(HOMA-IR)评估胰岛素抵抗状况,以早相胰岛β细胞分泌指数(△I30/△G30,糖负荷30min净增胰岛素与净增葡萄糖的比值)评估早期胰岛素分泌能力。结果:经过短期门冬胰岛素30强化治疗后,患者空腹血糖(FPG)、餐后2 h血糖(2 hPG)、HOMA-IR均明显下降(P<0.05);而HOMA-β、△I30/△G30显著升高(P<0.001)。结论:短期门冬胰岛素30强化治疗能够明显改善初诊2型糖尿病患者胰岛分泌功能,减轻胰岛素抵抗,改善糖代谢。     

Feasibility and outcomes of insulin therapy in elderly patients with diabetes mellitus.

The use of insulin in elderly patients raises special considerations. Most people who develop diabetes mellitus late in life have type 2 diabetes mellitus, in which there is some residual endogenous insulin secretion. This pancreatic insulin secretion, when present, stabilises their metabolic status. However, some elderly people lose virtually all their endogenous insulin secretory capacity over time, or may even have type 1 (autoimmune) diabetes mellitus with no endogenous insulin. Generally, older patients with diabetes mellitus can be managed for years, often decades, with nutritional therapy and oral agents. More options exist now than did previously. In addition to a variety of sulfonylureas, there is metformin, troglitazone, and/or alpha-glucosidase inhibitors, that are viable options to be used before turning to insulin. The goals of insulin therapy in the elderly must be considered. When hyperglycaemia causes symptoms (polyuria, polydypsia and bodyweight loss) blood glucose levels are generally >200 mg/dl, and insulin is needed if maximal doses of oral agents have been used. Insulin is also indicated when hyperglycaemia puts patients at risk of hyperosmolar states, for example, when blood glucose is >300 mg/dl during a normal day. Clinical judgement dictates whether to use insulin to control glycaemia in the attempt to avoid long term complications such as neuropathy, retinopathy or nephropathy. In people with relatively short life expectancy, major comorbities and no sign of diabetic complications, the risk may be small. On the other hand, in patients for whom neuropathy, in particular, is a major risk, controlling glycaemia (with insulin if necessary) does reduce that risk. Most patients with type 2 diabetes mellitus can be managed with relatively simple insulin regimens thanks to their endogenous insulin secretion. A single bedtime dose of neutral protamine Hagedorn (NPH) insulin, with or without continuation of daytime oral agents, may control fasting blood glucose. A pre-mix combination of NPH and Regular insulin such as 70/30 or 50/50 may be used pre-meal. More customised, 'intensive' insulin regimens are needed when the glycaemia is unstable. Hypoglycaemia is clearly the most significant risk of insulin therapy. If mild and easily treated, it is of no real concern. On the other hand, nocturnal hypoglycaemia, and, in particular, hypoglycaemia unawareness, are clear signs that the insulin regimen should be modified. In summary, insulin therapy may be necessary, and can be used effectively, in elderly patients. However, risk:benefit considerations must be taken into account when deciding which patients to treat with insulin and what insulin regimen to use.     

初诊2型糖尿病患者体质指数对胰岛素泵治疗效果的影响

目的观察不同体质指数（BMI）的初诊2型糖尿病（T2DM）患者短期胰岛素泵强化治疗的效果。方法将60例初诊2型糖尿病患者按照BMIt〉25kg·m^-2分为肥胖组（OB组）与非肥胖组（NOB组）,每组30例。两组均进行1周的胰岛素泵强化治疗,检测入院时空腹血糖（FBG）、空腹胰岛素（FINS）和空腹C肽（FCP）,糖化血红蛋白（HbA1c）等生化指标,比较两组血糖达标时间,达标时胰岛素用量以及两组7个时点血糖水平和一日内血糖水平标准差（SDBG）的差异。结果两组血糖达标时间和7个时点的血糖无明显差异,但OB组胰岛素用量明显高于NOB组（P〈0．05）,而SDBG较NOB组小（P〈0．05）。结论初诊肥胖型T2DM患者较非肥胖型T2DM患者血糖波动性较小,胰岛储备功能较好,但是胰岛素用量较大。     

妊娠期妇女葡萄糖筛查试验及胰岛素释放水平分析

目的观察孕24～28周孕妇行葡萄糖筛查试验（GCT）时空腹和服糖后血糖、胰岛素水平，了解胰岛素抵抗的程度，分析葡萄糖筛查试验在妊娠糖尿病的诊断价值。方法550例孕24～28周孕妇行葡萄糖筛查试验，其中58例孕妇同时采用免疫发光法检测了胰岛素释放水平。结果GCT正常孕妇的空腹血糖水平（4．36±0．33）mmol／L明显低于健康非妊娠育龄妇女（4．82±0．38mmol／L）（P〈0．05），GCT异常孕妇（4．53±0．35）mmol／L空腹血糖水平分别与GCT正常孕妇和健康非妊娠育龄妇女比较，均无显著性差异（P〉0．05）。GCT异常孕妇112例，其中GDM13例，占总数2．4％，妊娠期合并糖耐量减低（GIGT）30例，占总数5．5％。GCT异常孕妇空腹和服糖后1h胰岛素水平分别为8．1±3．5mIU／L、94．5±42．7mlU／L，明显高于GCT正常孕妇5．4±1．6mlU／L、36．3±20．2mlU／L（P〈0．05）。结论妊娠期妇女会呈现“加速饥饿状态，并以空腹时的相对性低血糖现象为临床特征。GCT筛查异常孕妇经过OGTY不能诊断为GDM和GIGT者的孕妇随孕周发展，仍有可能进一步发展为GDM。     

NLRP3 Inhibitor Tranilast Attenuates Gestational Diabetes Mellitus in a Genetic Mouse Model

Background and ObjectiveThis study was designed to explore the protective effects of a clinically available NLR family Pyrin domain-containing receptor 3 (NLRP3) inhibitor, tranilast, in gestational diabetes mellitus (GDM) mice.MethodsWe used pregnant C57BL/KsJdb/+ (db/+) female mice as GDM mice, then orally administered 20 mg/kg of tranilast or metformin daily for 2 weeks. A glucose tolerance test and an insulin resistance test were used to evaluate the severity of diabetes in tranilast/metformin-treated GDM mice. After delivery, newborn mice were counted and weighed to measure their protective role on the reproductive outcome of GDM mice. Next, we determined the expression of NLRP3 and proinflammatory cytokines in the visceral adipose tissue and placenta of GDM mice using western blot and quantitative real-time-polymerase chain reaction. Furthermore, we determined the proinflammatory cytokines in the serum using an enzyme-linked immunosorbent assay.ResultsTranilast significantly ameliorated GDM symptoms, including maternal body weight, hyperglycemia, insulin insufficiency, glucose intolerance and insulin resistance, enlarged litter size, and reduced litter body weight. Additionally, tranilast remarkably reduced the elevated expression of NLRP3 and proinflammatory cytokines.ConclusionsOur data clarified the protective role of the NLRP3 inhibitor, tranilast, on GDM by inhibiting the activation of the NLRP3 inflammasome as well as inflammatory responses. The findings mean tranilast might serve as a therapeutic drug to treat GDM.     

甘精胰岛素治疗门诊初发2型糖尿病疗效观察

目的探讨门诊首次诊断2型糖尿病人应用胰岛素治疗的方法.方法42例初发2型糖尿病患者分别应用甘精胰岛素联合阿卡波糖和门冬胰岛素治疗12个月,比较两组治疗前后空腹血糖、餐后血糖、糖化血红蛋白(HbA1c)、低血糖发生率.结果两组血糖和HbA1c均下降,两组间比较无统计学差异,但甘精胰岛素组低血糖发生较少.结论对于门诊初发2型糖尿病人,应用甘精胰岛素联合阿卡波糖能良好控制血糖,且低血糖发生率较低.     

初诊2型糖尿病合并代谢综合征患者治疗前后血清ghrelin水平的变化

目的 研究初诊2型糖尿病合并代谢综合征患者血浆血糖、血清胰岛素水平、血脂、胰岛β细胞功能及血清ghrelin水平的变化.方法 同步测定初诊2型糖尿病患者34例,其中合并代谢综合征(MS)患者15例治疗前、治疗后6个月静脉糖耐量试验(IVGTT)时血清、胰岛素、ghrelin、血浆血糖及三酰甘油(TG)、总胆固醇(TC)...     

糖代谢异常孕妇380例临床分析

目的 探讨孕妇糖代谢异常与妊娠并发症的关系及应用胰岛素改善妊娠结局的情况.方法 380例糖代谢异常孕妇按照糖代谢异常情况分为糖尿病合并妊娠24例(DM组)、妊娠期糖尿病164例(GDM组)、妊娠期糖耐量异常192例(GIGT组),观察三组妊娠并发症发生情况;同时将380例孕妇分成饮食加胰岛素治疗136例(胰岛素组)、单纯饮食控制244例(饮食组)进行妊娠结局对比分析.结果 DM组、GDM组、CIGT组的子痫前期发生率分别为41.7%(10/24)、15.9%(26/164)、15.6%(30/192),早产发生率分别为41.7%(10/24)、18.3%(30/164)、20.7%(38/192),差异均有统计学意义(均P<0.05);巨大儿、羊水过多、胎儿宫内窘迫发生率三组比较,差异无统计学意义(均P>0.05);DM组新生儿窒息、低血糖的发生率均高于GDM组和GIGT组(均P<0.01).胰岛素组新生儿出生体重平均为(2.9±1.3)kg,低于饮食组(3.8±1.0)kg,差异有统计学意义(P<0.05).结论 孕妇早产、子痈前期发生率、新生儿窒息、低血糖发生率与糖代谢紊乱有关,胰岛素的应用可以改善糖代谢异常孕妇的妊娠结局.     

甘精胰岛素联合口服降糖药治疗糖尿病的疗效

目的：探讨首次诊断2型糖尿病患者应用甘精胰岛素联合口服降糖药物治疗的疗效。方法：45例初发的2型糖尿病患者分别应用甘精胰岛素联合二甲双胍或阿卡波糖治疗3个月，比较两组治疗前后空腹血糖、餐后血糖、糖化血红蛋白（HbA1c）、低血糖发生率。结果：两组治疗后血糖和HbA1c均下降，与治疗前比较有统计学差异；治疗后血糖、HbA1c和低血糖发生率，两组间比较无统计学差异。结论：对于初发2型糖尿病患者，应用甘精胰岛素联合二甲双胍或阿卡波糖均可良好控制血糖，且低血糖发生率较低。     

超敏C反应蛋白细胞间黏附分子-1与妊娠糖尿病患者胰岛素抵抗的关系研究

目的研究炎症因子超敏C反应蛋白(hs-CRP)、可溶性细胞间黏附分子-1(sICAM-1)与妊娠糖尿病(GDM)患者胰岛素抵抗的关系,探讨GDM的发病机制。方法比较72例GDM(GDM组)、66例妊娠期糖耐量减低组(GIGT)和64例口服葡萄糖耐量试验(OGTT)正常的孕妇(NGT组)的血清hs-CRP、sICAM-1、血糖(FBG)及空腹胰岛素(FINS)水平,计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果 GDM组血清HOMA-IR、FBG、FINS、hs-CRP、sICAM-1、OGTT时体质量增加值(GWG)均高于GIGT组(P<0.01),且GIGT组高于NGT组(P<0.01)。多元线性逐步回归分析显示HOMA-IR受hs-CRP、sICAM-1影响。结论 GDM患者血清hs-CRP、sICAM-1水平显著升高,加重了胰岛素抵抗。     

脂联素和抵抗素与妊娠期糖代谢异常的相关性研究

目的探讨脂联素、抵抗素与妊娠期糖代谢异常及它们之间的关系,为糖尿病的筛查、预测及估计预后提供理论基础。方法门诊随机抽取孕周24～28周的孕妇120例为研究对象,分为妊娠期糖尿病（GDM）组,糖耐量异常（GIGT）组及糖耐量正常孕妇（NGT）组,测血清和脐血脂联素和抵抗素。结果GDM组和GIGT组血清抵抗素水平显著高于NGT组,脂联素显著低于NGT组。糖代谢异常孕妇血清、脐血脂联素水平及抵抗素水平均呈正相关,3组孕妇血清、脐血的脂联素与抵抗素水平呈负相关。GIGT、GDM组血清脂联素浓度与胰岛素抵抗指数、体重指数、空腹血糖和空腹胰岛素呈负相关,而抵抗素与其呈正相关。结论脂联素是妊娠期糖尿病的保护因子之一,而抵抗素可促进它的发生发展,二者起相反作用。孕妇血清脂联素、抵抗素的水平可影响其在脐血中水平,进而干扰胎儿的宫内生长发育。     

Effects of ezetimibe added to on-going statin therapy on the lipid profile of hypercholesterolemic patients with diabetes mellitus or metabolic syndrome

OBJECTIVE: To conduct a post-hoc assessment of the lipid-modifying effects of adding the cholesterol absorption inhibitor, ezetimibe, to on-going statin therapy in patients with diabetes mellitus (DM) or metabolic syndrome (MetS). RESEARCH DESIGN AND METHODS: This was a post-hoc analysis of data from a randomized, double-blind, placebo-controlled trial designed to evaluate the low-density lipoprotein cholesterol (LDL-C)-lowering efficacy and safety of adding ezetimibe 10 mg/day versus placebo to ongoing, open-label statin treatment for 8 weeks in hypercholesterolemic patients. Qualifying LDL-C levels and target LDL-C goals were based on National Cholesterol Education Program risk categories. The DM subgroup were patients who entered the study with a prior diagnosis of DM. Patients were classified as having MetS if they met 3 or more of the following criteria at baseline: triglycerides (TG) > or = 150 mg/dL (1.69 mmol/L); high-density lipoprotein cholesterol (HDL-C) < 40 mg/dL (1.04 mmol/L) for men or < 50 mg/dL (1.29 mmol/L) for women; fasting serum glucose (FSG) > or = 110 mg/dL (> or = 6.1 mmol/L); a diagnosis of hypertension or taking hypertension medication or blood pressure > or = 130/> or = 85 mmHg; waist circumference > 88 cm (women) or > 102 cm (men). DM patients were excluded from the MetS subgroup analysis. MAIN OUTCOME MEASURES: The objectives were to assess the effects of treatment on plasma concentrations of LDL-C and other lipid variables, and on the percentage of patients achieving LDL-C target levels at the end of the study. RESULTS: Of 769 patients enrolled in the original study, there were 191 (24.8%) with DM and 195 (25.4%) with MetS. Regardless of subgroup, ezetimibe + statin was significantly more effective than statin alone at lowering plasma levels of LDL-C, non-HDL-C, total cholesterol, apolipoprotein B, and triglycerides (between-group p < 0.001 for all). For all lipid parameters, the relative treatment effects were generally consistent regardless of DM or MetS status. Significantly more ezetimibe than placebo patients in all subgroups achieved prespecified LDL-C goals (p < 0.001 for all), and although more patients in the DM and MetS groups, respectively, achieved the goal compared with their non-DM and non-MetS counterparts [83.6% (DM) versus 67.2 (non-DM) and 71.8% (MetS) versus 65.6% (non-MetS)], these differences were not significant after adjusting for differences in baseline LDL-C levels. Ezetimibe was well-tolerated and had a favorable safety profile in all subgroups. CONCLUSIONS: The co-administration of ezetimibe with statins, a therapeutic regimen that inhibits both the absorption and synthesis of cholesterol, offers a well-tolerated and efficacious treatment to lower LDL-C in patients with DM and MetS.     

吡格列酮对糖调节受损、初发2型糖尿病患者胰岛素敏感性和血清同型半胱氨酸的影响

目的探讨吡格列酮对糖调节受损、初发2型糖尿病患者胰岛素敏感性、血脂和血清同型半胱氨酸的影响。方法随机选取糖调节受损、初发2型糖尿病患者118例,糖调节受损患者58例,初发2型糖尿病患者60例。使用吡格列酮治疗12周,观察治疗前后胰岛素抵抗指数（Insulin Resistance Index,HOMA-IR）、血脂水平、血清同型半胱氨酸等指标的变化。结果吡格列酮治疗12周后HOMA-IR和血清同型半胱氨酸较治疗前降低（P〈0.05）,HDL-C升高（P〈0.01）。结论吡格列酮能降低糖调节受损及初发2型糖尿病患者的血清同型半胱氨酸水平,改善胰岛素抵抗及血脂代谢。     

个体化健康教育对妊娠糖尿病患者血糖及自我管理能力的影响

目的 评价个体化健康教育对妊娠糖尿病患者血糖及自我管理能力的影响.方法 对49例妊娠糖尿病患者采用个体化健康教育方式进行教育指导,采用糖尿病患者自我管理行为量表评价患者自我管理水平,定期检测血糖、糖化血红蛋白等指标,观察治疗前后血糖、糖化血红蛋白的变化.结果 43例患者干预后血糖、糖化血红蛋白较干预前明显改善,自我管理水平均较干预前明显提高（P＜0.05）,6例患者经治疗后血糖控制不满意,加用胰岛素治疗.结论 健康教育对妊娠糖尿病患者尤为重要,个体化教育可以提高妊娠糖尿病患者自我管理水平,改善血糖控制状况.     

初发2型糖尿病合并高血压患者血清内脂素、网膜素和TNF-α水平的变化*

【摘要】 目的 探讨初发2型糖尿病（T2DM）合并高血压患者血清内脂素、网膜素和肿瘤坏死因子（TNF）-α水平的变化及意义。方法 初次诊断为T2DM的患者106例,分为T2DM组54例和T2DM合并高血压组（DM+H组）52例。所有受试者测定血压、身高、体质量、血脂、尿酸,并行口服葡萄糖耐量试验与胰岛素激发试验,同时取血测定空腹与服糖120 min 血糖、胰岛素、内脂素、网膜素和TNF-α水平。计算体质指数（BMI）和稳态模型胰岛素抵抗指数（HOMA-IR）。结果 （1）与T2DM组相比,DM+H组空腹及服糖120 min血清内脂素和TNF-α水平明显升高,网膜素水平明显降低（P < 0.05）。（2）内脂素和TNF-α均与收缩压、腰围、空腹胰岛素和HOMA-IR呈正相关,而网膜素与舒张压、腰围、空腹胰岛素和HOMA-IR呈负相关。（3）多元线性回归分析显示,空腹胰岛素水平是空腹与高糖刺激下内脂素的影响因素,而收缩压则主要影响空腹内脂素水平;空腹网膜素主要受HOMA-IR 和舒张压影响,而腰围、HOMA-IR、血尿酸是高糖刺激下血清网膜素的影响因素;空腹与120 min TNF-α 的影响因素分别为BMI和空腹胰岛素。结论 初发T2DM合并高血压患者血清内脂素、网膜素和TNF-α水平明显改变,其可能通过多种途径参与了糖尿病并发高血压的病理过程。