Aspirin resistance in patients with type II diabetes mellitus

Background. Diabetic patients exhibit platelet hyperreactivity, which renders them resistant to antithrombotic treatments. We aimed to investigate the prevalence and predictors of aspirin resistance in diabetic patients.

Material and methods. A total of 93 diabetic and 37 non-diabetic participants were included into the study. Aspirin resistance was measured with a whole-blood desktop platelet function analyzer (PFA-100) with an epinephrine agonist.

Results. Altogether 41.9% patients with DM were aspirin non-responders. Aspirin resistance was observed in 43.2% of non-diabetic patients (p = 0.89). Presence of diabetes mellitus had no effect on aspirin response (RR 0.95 (95% CI 0.44–2.05), p = 0.89) in the whole study population. Hypercholesterolemia was the only predictor of aspirin resistance in multivariate analysis in diabetic patients (RR 3.09 (95% CI 1.17–8.16), p = 0.023).

Conclusion. The prevalence of aspirin resistance is comparable in diabetic and non-diabetic patients. Hypercholesterolemia is the only independent predictor of aspirin resistance in diabetic patients.     

Serum resistin levels in Syrian obese patients with diabetes mellitus type II

OBJECTIVE: To determine serum resistin levels in obese patients with diabetes mellitus type II. METHODS: We studied 87 subjects in an sectional study, divided into 3 groups: obese, obese diabetic and normal subjects. Their age, gender and body mass index were recorded. Serum resistin, insulin, glucose, cholesterol, high-density lipoproteins, low-density lipoproteins, triglyceride, urea and creatinine were measured. RESULTS: The mean +/- SD plasma resistin for the obese diabetic group is 7.32 +/- 3.74 ug/ml versus 4.25 +/- 1.77 ug/ml in the control group (p=0.021). Intro-group comparison of obese subjects (diabetics versus non-diabetics) revealed higher levels of resistin, glucose, triglyceride, cholesterol and low density lipoproteins in diabetic subjects, but no statistically significant difference of high density lipoproteins. Furthermore, resistin correlated significantly and positively with body mass index (r = 0.375; p<0.05), resistin correlated significantly and negatively with high-density lipoproteins (r = -0. 363; p<0.05). CONCLUSION: Serum resistin levels are increased in obese patients with type 2 diabetes compared with controls. Resistin appears to be a possible link between obesity and type 2 diabetes in humans.     

2型糖尿病合并非糖尿病性肾脏疾病--附33例2型糖尿病肾活检结果及文献复习

目的：分析探讨我国2型糖尿病（diabetes mellitus,DM）患者并发非糖尿病性肾脏疾病（non-diabetic renal disease,NDRD）的情况。方法：回顾性分析了本院近6年来33例接受肾活检的2型糖尿病患者的临床表现、病理和治疗情况。结果：33例DM患者中7例为糖尿病肾病（diabete nephropathy,DN）,22例为NDRD,两组患者在糖尿病的病程、肌酐清除率、血肌酐、血白蛋白水平、24h尿蛋白和糖尿病眼底、高血压及外周神经病变的发生率等方面差异均无显著性。NDRD患者更易出现血尿及非肾病范畴的蛋白尿。IgA肾病占本院NDRD的40.9％。结论：血尿和非肾病范畴的蛋白尿提示2型DM患者可能并发NDRD,IgA肾病可能是亚洲地区NDRD最常见的类型。     

百忧解对2型糖尿病心理障碍患者治疗的临床研究

目的了解百忧解对2型糖尿病患者心理障碍的治疗效果.方法选择2型糖尿病合并抑郁及焦虑症状患者40例随机分为百忧解组(22例)及对照组(18例),百忧解组除常规糖尿病药物治疗外辅以百忧解治疗12周,对照组仅进行常规糖尿病药物治疗,测治疗前后两组患者HAMD及HAMA评分、空腹血糖(FPG)、糖化血红蛋白(HbA1c)、肝肾功能及血尿便常规.结果治疗后百忧解组及对照组抑郁及焦虑评分均减低,百忧解组改善更明显(P＜0.01),同时两组FPG及HbA1c水平均有所下降,百忧解组下降幅度明显大于对照组(P＜0.01).结论百忧解可以明显改善2型糖尿病患者的抑郁及焦虑症状,有助于患者血糖的控制.     

百忧解对2型糖尿病心理障碍患者治疗的临床研究

目的　了解百忧解对 2型糖尿病患者心理障碍的治疗效果。方法　选择 2型糖尿病合并抑郁及焦虑症状患者 40例随机分为百忧解组 (2 2例 )及对照组 (18例 ) ,百忧解组除常规糖尿病药物治疗外辅以百忧解治疗 12周 ,对照组仅进行常规糖尿病药物治疗 ,测治疗前后两组患者HAMD及HAMA评分、空腹血糖 (FPG)、糖化血红蛋白 (HbA1c)、肝肾功能及血尿便常规。结果　治疗后百忧解组及对照组抑郁及焦虑评分均减低 ,百忧解组改善更明显 (P <0 .0 1) ,同时两组FPG及HbA1c水平均有所下降 ,百忧解组下降幅度明显大于对照组 (P <0 .0 1)。结论　百忧解可以明显改善 2型糖尿病患者的抑郁及焦虑症状 ,有助于患者血糖的控制。     

Non-insulin-dependent (type II) diabetes mellitus.

Non-insulin-dependent (type II) diabetes mellitus is an inherited metabolic disorder characterized by hyperglycemia with resistance to ketosis. The onset is usually after age 40 years. Patients are variably symptomatic and frequently obese, hyperlipidemic and hypertensive. Clinical, pathological and biochemical evidence suggests that the disease is caused by a combined defect of insulin secretion and insulin resistance. Goals in the treatment of hyperglycemia, dyslipidemia and hypertension should be appropriate to the patient's age, the status of diabetic complications and the safety of the regimen. Nonpharmacologic management includes meal planning to achieve a suitable weight, such that carbohydrates supply 50% to 60% of the daily energy intake, with limitation of saturated fats, cholesterol and salt when indicated, and physical activity appropriate to the patient's age and cardiovascular status. Follow-up should include regular visits with the physician, access to diabetes education, self-monitoring of the blood or urine glucose level and laboratory-based measurement of the plasma levels of glucose and glycated hemoglobin. If unacceptably high plasma glucose levels (e.g., 8 mmol/L or more before meals) persist the use of orally given hypoglycemic agents (a sulfonylurea agent or metformin or both) is indicated. Temporary insulin therapy may be needed during intercurrent illness, surgery or pregnancy. Long-term insulin therapy is recommended in patients with continuing symptoms or hyperglycemia despite treatment with diet modification and orally given hypoglycemic agents. The risk of pancreatitis may be reduced by treating severe hypertriglyceridemia (fasting serum level greater than 10 mmol/L) and atherosclerotic disease through dietary and, if necessary, pharmacologic management of dyslipidemia. Antihypertensive agents are available that have fewer adverse metabolic effects than thiazides and beta-adrenergic receptor blockers. New drugs are being developed that will enhance effective insulin secretion and action and inhibit the progress of complications.     

CHANGES OF NAILFOLD MICROCIRCULATION IN PATIENTS OF TYPE Ⅱ DIABETES MELLITUS WITH DIABETIC RETINOPATHY

OBJECTIVE: To study the changes of microcirculation in patients with diabetic retinopathy (DR). METHODS: Examination were performed in 153 cases of type I diabetes mellitus, among them, 72 cases were male, 81 cases were female, mean age 57.0+/-10.0 years, mean disease course 8.2+/-7.5 years. All cases were examined fundi by ophthalmologist, urinary albumin excretion rate (UAE) in 24 hours was measured by radioimmunoassay. Moreover, we examined the blood glucose, blood pressure, blood viscosity and observed the changes of naifold microcirculation. RESULTS: It was found that there were more evident disturbance of microcirculation, markedly slowed velocity of blood flow (P<0.05), significantly increased aggregation of blood cells (P<0.05) and exudation around the loop (P<0.05) in the group with DR, compared with the group without DR. CONCLUSION: It was more evident disturbance of nailfold microcirculation in patients with diabetic retinopathy.     

2型糖尿病合并脑梗死临床研究

目的研究2型糖尿病患者合并脑梗死的临床特点。方法选取我院2010年5月至2014年4月我院神经内科收治的150例2型糖尿病合并脑梗死的患者为研究组,另选取150例2型糖尿病未合并脑梗死在我院内分泌科门诊诊治的患者作为对照组,对两组患者的血压、血糖水平、血脂水平和并发症情况等进行分析比较。结果 2型糖尿病合并脑梗死的类型主要为腔隙性梗死;两组患者在血糖、血脂及血压等各项检测指标以及各类并发症的比较上,P均〈0.05,差异具有统计学意义。结论 2型糖尿病合并脑梗死患者主要与患者的血压、血脂、血糖水平相关,临床应采取相应的治疗,可改善2型糖尿病患者的预后。     

Obesity management in patients with type 2 diabetes mellitus

Obesity infrequently associated with type 2 diabetes mellitus and may cause insulin resistance, hypertension and other complications of obesity. So obesity management in Type 2 diabetes mellitus is essential. Prevention is a logical first step in the management of the obese Type 2 diabetic patient, such programs have had little long-term success. Diet, exercise and behavioral modification still form the cornerstones of treatment and relatively small weight loss results in improvement of all major obesity related co-morbidity's, including Type 2 diabetes. The obese diabetic patient faces extra impediments to weight loss, including the adverse effects of diabetic medication, poor glycaemic control and diabetes related complications. New drugs may offer some additional help, in general by providing the benefit associated with the weight loss as such, Bariatric surgery can produce major long-term weight loss in the severely obese subjects.     

2型糖尿病患者合并IgA肾病的临床病理分析

目的：了解2型糖尿病(DM)合并IgA肾病的临床病理特点。方法：总结分析13例DM合并IgA肾病的临床资料、病理改变及治疗反应。结果：DM可以合并IgA肾病,在我院糖尿病合并非糖尿病性肾损害(NDRD)中占46．3％。这些患者具有不同于糖尿病肾病的特点：①糖尿病病程一般短于5年;②都有不同程度的血尿;③高血压普遍存在;④组织学病变符合IgA肾病的病理改变,但血管病变较单纯IgA肾病患者严重。⑤表现肾病综合征但病理改变轻微的患者经糖皮质激素治疗后可完全缓解。结论：DM合并肾脏损害不等于全部都是糖尿病肾病,DM合并NDRD病例中IgA肾病常见,肾脏损害以IgA肾病为主,肾血管病变严重。临床表现肾病综合征的患者在充分考虑患者的临床特点、病理改变、严格控制血糖及血压的情况下,糖皮质激素或糖皮质激素联合细胞毒药物治疗是安全有效的,可以改善患者预后。     

Auditory impairment in patients with type 2 diabetes mellitus

BACKGROUND: We assessed the auditory function of 94 patients with type 2 diabetes mellitus and 94 age- and sex-matched healthy subjects. METHODS: To study the influence of the clinical characteristics of the disease on the auditory function, after a clinical interview with ophthalmological assessment, subjects were evaluated using pure-tone audiometry, speech audiometry, auditory brainstem responses, the Michigan Diabetic Neuropathy Score and albuminuria. The mean age when diabetes was diagnosed was 42.8 +/- 6.5 years (mean +/- SD) and the time elapsed since diabetes diagnosis was 7.2 +/- 5.4 years. RESULTS: Forty-eight patients (62%) had HbA1c >8%; diabetic retinopathy was evident in 14 patients (14%) and microalbuminuria was identified in 12 patients. Compared to healthy subjects, diabetic patients showed an increase of the perception threshold at 8000 Hz (p <0.01), higher hearing levels to discriminate at least 90% of 10 monosyllables (p <0.01), and longer latencies of wave V, interwave I-V and interwave III-V (p <0.01). Significant correlation was found between the hearing threshold at 8 KHz and patient age, and the former and the time elapsed since the diabetes was diagnosed (p <0.001). CONCLUSIONS: Patients with type 2 diabetes mellitus can have subclinical hearing loss and impaired auditory brainstem response, independent of peripheral neuropathy, retinopathy or nephropathy.     

成人隐匿性自身免疫性糖尿病与2型糖尿病临床特点的比较

目的探讨成人隐匿性自身免疫性糖尿病(LADA)的临床特点。方法对20例LADA患者和46例2型糖尿病患者的临床特点及并发症情况进行比较。结果LADA组与2型糖尿病组相比:起病年龄小[(46.6±8.48)岁对(52.74±7.60)岁, P<0.01],体重指数较低[(20.89±2.75)kg/m2 对(23.07 4-2.60)kg/m2,P<0.01],空腹及餐后2h c肽水平低分别为[(0.41±0.20)nmol/L对(0.61±0.30)nmol/L,(0.91±0.42)nmol/L对(1.65 ±0.83)nmol/L,P<0.01],HBA1c较高[(10.95±2.00)%对(9.56±2.30)%,P<0.05],出现自发酮症(6/20对2/46,P<0.01)及使用胰岛素治疗的比例较高(11/20对11/46,P<0.05),合并高血压和高脂血症的比例较低(分别为2/20对16/46、3/20对19/46,P<0.05),微血管并发症的患病率两组间差异无显著性。结论LADA患者具有起病年龄小、体重指数低、C肽水平低、易出现自发酮症,合并高血压和高脂血症的比例较少,微血管并发症的患病率与2型糖尿病相似。     

Myopia in young patients with type 1 diabetes mellitus

INTRODUCTION

This study aimed to evaluate the proportion of young patients with type 1 diabetes mellitus (T1DM) who have myopia, as well as the risk factors associated with myopia in this group.

METHODS

In this cross-sectional study, patients aged < 21 years with T1DM for ≥ 1 year underwent a comprehensive eye examination. Presence of parental myopia, and average hours of near-work and outdoor activity were estimated using a questionnaire. Annualised glycosylated haemoglobin (HbA1c), defined as the mean of the last three HbA1c readings taken over the last year, was calculated. Multivariate analysis using genetic, environmental and diabetes-related factors was done to evaluate risk factors associated with myopia.

RESULTS

Of the 146 patients (mean age 12.5 ± 3.6 years) recruited, 66.4% were Chinese and 57.5% were female. Myopia (i.e. spherical equivalent [SE] of –0.50 D or worse) was present in 96 (65.8%) patients. The proportion of patients with myopia increased from 25.0% and 53.6% in those aged < 7.0 years and 7.0–9.9 years, respectively, to 59.2% and 78.4% in those aged 10.0–11.9 years and ≥ 12.0 years, respectively. Higher levels of SE were associated with lower parental myopia (p = 0.024) and higher annualised HbA1c (p = 0.011).

CONCLUSION

Compared to the background population, the proportion of myopia in young patients with T1DM was higher in those aged < 10 years but similar in the older age group. Myopia was associated with a history of parental myopia. Environmental risk factors and poor glycaemic control were not related to higher myopia risk.     

Pathogenic factors in the development of type I and type II diabetes mellitus: 1990

The pathogenesis of IDDM and NIDDM indicates a distinct difference between these diseases. Viral illness is implicated in IDDM, linked with evidence for an immune deficiency. NIDDM is not linked to viral illness or autoimmunity but is highly influenced by the inheritance of a defect in insulin production.     

冠心病合并2型糖尿病患者冠状动脉造影特点的探讨

目的对比冠心病合并2型糖尿病患者与冠心病非糖尿病患者冠状动脉造影的特点。方法选择从2009年1月至2012年10月在江苏省丹阳市人民医院心内科行冠状动脉造影确诊为冠心病的2型糖尿病患者50例为观察组（DM组）,再随机抽取同时期我院经过冠状动脉造影明确为冠心病但不合并2型糖尿病的患者50例为对照组（NDM）,对患者的造影结果进行对比。结果与NDM组相比,DM组高血压、高血脂比例高于NDM组,EF值低于NDM组;DM组冠脉病变的多支病变、弥漫性病变比例高于NDM组,单支病变比例低于NDM组。结论 2型糖尿病能够使冠脉病变程度加重。     

Efficacy and safety of nateglinide in the treatment of type II diabetes mellitus

Nateglinide a new short-acting D-phenylalanine derivative represents a new chemical class of drugs for treating type 2 diabetes that is pharmacologically and therapeutically distinct from currently existing agents. Studies in normal patients and those with type 2 diabetes have shown that nateglinide reduces mealtime blood glucose excursions by physiologic regulation of insulin secretion. Nateglinide binds to and inhibits the K+(ATP) channel of the beta-cell, causing membrane depolarisation, with a subsequent influx of extracellular calcium that results in insulin secretion. A total of 105 patients in 5 centres with type II diabetes mellitus were taken according to the inclusion criteria and given drug treatment and were evaluated on their improvement in fasting and postprandial plasma glucose and glycosylated haemoglobin values for efficacy, besides physician's assessment of the overall safety and efficacy. Nateglinide in a dose of 60 mg before three main meals was given and increased to a maximum of 120 mg thrice daily over the first 3-4 weeks. Nateglinide had to be taken 10 minutes before meals. Duration of treatment was 12 weeks. The patients showed decrease in fasting plasma glucose from 2nd week onwards and reduction in glycosylated haemoglobin by 6th week onwards. Postprandial glucose reduction was also significant at the end of 12th week. The frequency of adverse effects was low and no serious adverse effects were encountered.     

2型糖尿病患者血清脂联素水平的变化

目的探讨人血清脂联素水平与2型糖尿病的关系。方法2型糖尿病患者47例和正常对照46例,两组年龄、性别匹配,采用酶联免疫分析法检测其空腹血清脂联素、胰岛素水平,同时测血糖、血压、血脂、身高、体重、腰围、臀围,计算体重指数(BMI)、腰臀比值和胰岛素敏感指数(ISI)、胰岛B细胞功能。结果2型糖尿病组的脂联素水平减低,脂联素水平在糖尿病超重组低于糖尿病正常体重组和对照组;相关分析显示脂联素水平与BMI呈负相关,与ISI正相关。结论脂联素做为脂肪组织分泌的一种细胞因子,在2型糖尿病患者中其血清水平降低,且与肥胖相关,因此提示脂联素水平增加对于肥胖及糖代谢紊乱的治疗可能是有益的。     

LADA与2型糖尿病患者临床特点的比较

目的：探讨成人隐匿性自身免疫性糖尿病（LADA）患者与2型糖尿病（T2DM）患者临床特点的差异。方法：对社区筛检出的46例LADA患者和同期筛检出的452例T2DM患者进行问卷调查、体格检查和实验室检查,并采用t检验分析两组均数的差异,采用x^2检验分析两组构成比的差异。结果：LADA患者中仅注射胰岛素的比例高于T2DM患者,差别有统计学意义;LA—DA患者的平均收缩压和极低密度脂蛋白胆固醇水平均低于T2DM患者,差别有统计学意义。结论：LADA与T2DM患者血压、血脂水平和注射胰岛素比例存在差异。