Effects of insulin on peripheral and splanchnic glucose metabolism in noninsulin-dependent (type II) diabetes mellitus.

The mechanism(s) and site(s) of the insulin resistance were examined in nine normal-weight noninsulin-dependent diabetic (NIDD) subjects. The euglycemic insulin clamp technique (insulin concentration approximately 100 microU/ml) was employed in combination with hepatic and femoral venous catheterization and measurement of endogenous glucose production using infusion of tritiated glucose. Total body glucose metabolism in the NIDD subjects (4.37 +/- 0.45 mg/kg per min) was 38% (P less than 0.01) lower than in controls (7.04 +/- 0.63 mg/kg per min). Quantitatively, the most important site of the insulin resistance was found to be in peripheral tissues. Leg glucose uptake in the diabetic group was reduced by 45% as compared with that in controls (6.0 +/- 0.2 vs. 11.0 +/- 0.1 mg/kg leg wt per min; P less than 0.01). A strong positive correlation was observed between leg and total body glucose uptake (r = 0.70, P less than 0.001). Assuming that muscle is the primary leg tissue responsible for glucose uptake, it could be estimated that 90 and 87% of the infused glucose was disposed of by peripheral tissues in the control and NIDD subjects, respectively. Net splanchnic glucose balance during insulin stimulation was slightly more positive in the control than in the diabetic subjects (0.31 +/- 0.10 vs. 0.05 +/- 0.19 mg/kg per min; P less than 0.07). The difference (0.26 mg/kg per min) in net splanchnic glucose balance in NIDD represented only 10% of the reduction (2.67 mg/kg per min) in total body glucose uptake in the NIDD group and thus contributed very little to the insulin resistance. The results emphasize the importance of the peripheral tissues in the disposal of infused glucose and indicate that muscle is the most important site of the insulin resistance in NIDD.     

A clinical trial of continuous subcutaneous insulin infusion versus multiple daily injections in older adults with type 2 diabetes

OBJECTIVE: To compare the efficacy and safety of continuous subcutaneous insulin infusion (CSII) and multiple daily injection (MDI) in older adults with insulin-treated type 2 diabetes and to assess treatment satisfaction and quality of life. RESEARCH DESIGN AND METHODS: Adults (n = 107) > or =60 years of age (mean age 66 years) with insulin-treated type 2 diabetes (mean duration 16 years, BMI 32 kg/m(2), and HbA(1C) [A1C] 8.2%) were randomized to CSII (using insulin lispro) or MDI (using insulin lispro and insulin glargine) in a two-center, 12-month, prospective, randomized, controlled clinical trial. Efficacy was assessed with A1C, safety by frequency of hypoglycemia, and treatment satisfaction and quality of life with the Diabetes Quality of Life Clinical Trial Questionnaire and the 36-item short-form health survey, version 2. RESULTS: Forty-eight CSII subjects (91%) and 50 MDI subjects (93%) completed the study. Mean A1C fell by 1.7 +/- 1.0% in the CSII group to 6.6% and by 1.6 +/- 1.2% in the MDI group to 6.4%. The difference in A1C between treatment groups was not statistically significant (P = 0.20). Eighty-one percent of CSII subjects and 90% of MDI subjects experienced at least one episode of minor (self-treated) hypoglycemia (P = 0.17), and three CSII and six MDI subjects experienced severe hypoglycemia (P = 0.49). Rates of severe hypoglycemia were similarly low in the two groups (CSII 0.08 and MDI 0.23 events per person-year, P = 0.61). Weight gain did not differ between groups (P = 0.70). Treatment satisfaction improved significantly with both CSII and MDI (P < 0.0001), and the difference between groups was not statistically significant (P = 0.58). CONCLUSIONS: In older subjects with insulin-treated type 2 diabetes, both CSII and MDI achieved excellent glycemic control with good safety and patient satisfaction.     

胰岛素多次皮下注射和持续皮下输注治疗1型糖尿病的荟萃分析

背景:1型糖尿病患者须终生使用胰岛素,胰岛素多次皮下注射和持续皮下输注治疗1型糖尿病的优劣性尚存在争议.目的:系统评价胰岛素多次皮下注射和持续皮下输注治疗1型糖尿病的有效性和安全性.方法:计算机检索PubMed,EMBASE,Cochrane Library,CBM,CNKI,VIP数据库,追查纳入文献的参考文献,全面搜集有关胰岛素多次皮下注射和持续皮下输注治疗1型糖尿病的随机对照试验,用RevMan5.0软件进行统计分析.结果与结论:共纳入9篇随机对照试验(320例患者),经Meta分析显示:持续皮下胰岛素输注和多次皮下注射治疗1型糖尿病在糖化血红蛋白方面差异有显著性意义[SMD=-0.43,95%CI(-0.69,-0.18)],在胰岛素用量方面差异有统计学意义[WMD=-0,16,95%CI(-0.29,-0.03)].纳入研究均提示持续皮下胰岛素输注治疗1型糖尿病的治疗满意度更高.持续皮下胰岛素输注治疗比胰岛素多次皮下注射更能有效的控制1型糖尿病患者的血糖,且每天的胰岛素用量少患者的治疗满意度高.     

脂糖舒对2型糖尿病大鼠胰岛素抵抗的影响

目的:观察脂糖舒(ZTS)对2型糖尿病大鼠胰岛素抵抗的改善作用。方法:对2型糖尿病胰岛素抗性模型大鼠灌胃ZTS(1次/d),连续9周,同时以二甲双胍和格列齐特(达美康)及健康大鼠作对照,进行糖耐量试验,测定血浆葡萄糖(Glu)、胰岛素(Ins)、三酰甘油(TG)、游离脂肪酸(NEFA)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高密度脂蛋白胆固醇(HDL-C)含量,并称体质量和脂肪组织重量,计算胰岛素抵抗指数(IRI)。结果:脂糖舒、二甲双胍和格列齐特均能显著降低2型糖尿病大鼠(NIDDM大鼠)的高Ins、高Glu、高脂血症和降低IRI,升高HDL-c含量,抑制体质量和脂肪组织重量增长。其中,脂糖舒抑制病鼠体质量和脂肪组织质量增长以及降糖降脂(NEFA和LDL-c)和降IRI作用优于格列齐特(P<0.01或P<0.001)。与二甲双胍比较,脂糖舒降NEFA和TC作用较强(P<0.05),对其余指标包括降IRI作用与二甲双胍相当(P>0.05)且脂糖舒降IRI作用呈剂量依赖关系。结论:脂糖舒明显改善2型糖尿病的胰岛素抗性。     

Effects of multiple daily injection therapy with Humalog mixtures versus separately injected insulin lispro and NPH insulin in adults with type I diabetes mellitus

BACKGROUND: Injection of insulin lispro (LP) before meals provides a more physiologic insulin activity profile than regular human insulin, but the relatively short duration of action of LP may allow the blood glucose (BG) level to increase during the late postprandial period (4-7 hours after meals) unless basal insulin is optimally replaced. One approach to basal insulin optimization has been to combine small doses of NPH with LP before meals. When used in a similar fashion, premixed, fixed-ratio insulin preparations containing LP and NPL (an LP-based intermediate-acting insulin) may provide the basis for an optimized basal-bolus insulin regimen. OBJECTIVE: This study assessed mean late postprandial glycemic control during treatment with a premixed formulation consisting of a high proportion of LP (75% LP/25% NPL; H) and a premixed formulation consisting of a medium proportion of LP (50% LP/50% NPL; M). The H/M formulation was given before meals and was compared with treatment with preprandial LP + NPH (LP + N) in patients with type 1 diabetes mellitus (DM). METHODS: This multicenter, randomized, open-label, 2-period crossover study was conducted at 4 centers in Italy and 1 center in France. Patients eligible for the study had type 1 DM, were > or = 18 years of age, and had a glycosylated hemoglobin (HbA(1c)) <150% of the upper limit of normal. Patients were randomly assigned to 1 of 2 treatment sequences: LP self-mixed with NPH before meals plus NPH alone at bedtime for 8 weeks (LP + N) followed by preprandial H or M, plus NPH alone at bedtime for 8 weeks (H/M), or the opposite sequence. Assessments included 8-point self-monitored BG profiles, HbA(1c), and hypoglycemia (any sign or symptom of hypoglycemia or BG < 3.0 mmol/L [<54.0 mg/dL]). The primary outcome measure was the late postprandial BG value, calculated as the mean of the combined prelunch (late postbreakfast), predinner (late postlunch), and bedtime (late postdinner) values. RESULTS: A total of 89 patients with type 1 DM were enrolled (44 men, 45 women; mean [SD] age, 38.3 [12.8] years; mean [SD] body weight, 70.8 [11.6] kg; mean [SD] body mass index, 24.6 [3.0] kg/m(2); mean [SD] duration of diabetes, 17.8 [10.5] years; mean HbA(1c), 7.9% [0.88%]). The mean (SD) late postprandial BG values were similar between treatments (8.9 [2.1] mmol/L [160.3 (37.8) mg/dL] for H/M vs 9.0 [1.8] mmol/L [162.1 (32.4) mg/dL] for LP + N), as were the end point HbA(1c) values (7.8% [0.9%] for H/M vs 7.9% [0.8%] for LP + N). The rate of hypoglycemia was significantly higher during treatment with H/M, primarily because of episodes occurring between 12 PM and 6 PM, but was relatively low in both groups (mean/median rate per patient per 30 days: 2.87/2.14 for H/M and 2.11/1.07 for LP + N; P < 0.05). CONCLUSIONS: In this population of patients with type 1 DM, preprandial H/M provided an effective alternative regimen for prandial and basal insulin replacement. Late postprandial BG control, an indicator of basal insulin sufficiency, was similar to that achieved with an intensified regimen of LP + N injected separately before meals, and the end point HbA(1c) was similar between the 2 treatments.     

Insulin therapy, glycemic control, and cardiovascular risk factors in young Latin Americans with type 2 diabetes mellitus.

BACKGROUND: Type 2 diabetes has been linked to an increased risk of cardiovascular (CV) disease, but this risk has not been well documented in young patients, especially of Latin American descent. Also, the potential CV benefits of insulin therapy have not been evaluated in young patients with type 2 diabetes. The objectives of this study were to determine any gender-related difference in the presence of CV risk factors in young Latin Americans with poorly controlled type 2 diabetes and the effect of intensive insulin therapy on these CV risk factors. METHODS AND RESULTS: Fifty-seven Latin American patients with type 2 diabetes between the ages 18 and 45 years were evaluated at baseline. All women were premenopausal and had regular menstrual periods. The mean body mass index (BMI) was > 30 kg/m2 in both genders. Percent body fat, percent hemoglobin A1c, and lipoprotein profiles were similar between genders. Highly sensitive C-reactive protein (CRP) levels were elevated and similar between genders (p = .4). Leukocyte adhesion molecules (intercellular adhesion molecule 1, vascular adhesion molecule 1, E-selectin) and monocyte chemoattractant protein 1 were elevated, whereas adiponectin levels were below normal in both gender groups. Urinary albumin excretion was similar between genders and did not show any relationship with any of the variables. In women, there was a direct relationship between waist circumference and high-sensitivity CRP levels (rho = .53, p = .01). No other significant relationships were observed. Eighteen Latin American patients with type 2 diabetes completed up to 104 weeks of post-intervention with insulin monotherapy. In these patients, glycemic, lipoprotein, and anthropometric measurements were obtained every 12 weeks. Highly sensitive CRP, leukocyte adhesion molecules, and urinary albumin excretion, among other tests, were obtained every 52 weeks. At 52 and 104 weeks, body weight, BMI, waist circumference, and percent body fat increased in a parallel and significant manner. Despite a significant decrease in percent hemoglobin A1c (22.2%; p = < .0001), lipid and lipoprotein profiles, highly sensitive CRP, leukocyte adhesion molecules, and other nontraditional CV risk factors did not change significantly. CONCLUSIONS: In young, obese, Latino type 2 diabetic patients, improvement in glycemic control with insulin monotherapy was not associated with a parallel improvement in markers of vascular inflammation. Premenopausal Latino women with uncontrolled type 2 diabetes have CV risks comparable to Latino diabetic men of the same age. Obesity and underlying insulin resistance may counteract the potential CV benefits associated with insulin therapy in lean diabetic patients. Weight loss could be a potential therapeutic modality to improve CV risk in Latino type 2 diabetic patients, especially women.     

Use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injections versus continuous subcutaneous insulin infusion therapy: a prospective 6-month study

OBJECTIVE

To compare use of continuous glucose monitoring in subjects with type 1 diabetes on multiple daily injection (MDI) therapy versus continuous subcutaneous insulin infusion (CSII) therapy for 6 months.

RESEARCH DESIGN AND METHODS

Sixty type 1 diabetic adults with similar baseline characteristics, using either MDI (n = 30) or CSII (n = 30) therapy, were enrolled in this 6-month prospective study. Subjects were instructed to wear the DexCom SevenPLUS continuous glucose monitor at all times throughout the study. All subjects were initially blinded from the continuous glucose monitoring (CGM) glucose data. After 4 weeks of blinded CGM use, the CGM was unblinded, making glucose data available to the patient. The CGM remained in the unblinded state for the remainder of the study (20 weeks). Clinic visits occurred every 4 weeks, at which time A1C values were collected and CGM data were downloaded.

RESULTS

Mean baseline (± SD) A1C was 7.61 (± 0.76) and 7.63 (± 0.68) for CSII and MDI, respectively (P > 0.05). Without any significant therapy change, A1C decrease at 12 weeks was similar in both groups (P = 0.03). When compared with the blinded phase, unblinded use of CGM was associated with similar but significant reductions in glycemic control and variability parameters. In addition, both therapy groups had similar changes in mean glucose and glucose variability indexes at 3 and 6 months (ITT analysis, P > 0.05). Predefined per protocol analysis (sensor use at least 6 days/week) showed greater improvement in time spent in target range glycemia, 3.9–10.0 mmol/L (70–180 mg/dL), in the CSII group.

CONCLUSIONS

We conclude that CGM provides similar benefits in glucose control for patients using MDI or CSII therapy.For patients with type 1 diabetes using intensive insulin therapy (IIT), there are two approaches for insulin delivery: multiple daily injection (MDI) therapy and continuous subcutaneous insulin infusion (CSII) therapy (1,2). With both therapies, insulin is dosed using basal/bolus regimens. With MDI, a long-acting (basal) insulin analog is injected subcutaneously once or twice daily, providing a relatively constant insulin level. In contrast, CSII administers basal insulin by a continuous infusion of rapid-acting insulin that can be adjusted throughout the day based on an individual’s insulin requirements. In both approaches, basal insulin is adjusted to avoid hypo- and hyperglycemia during interprandial periods. Additionally, mealtime or “bolus” insulin is dosed based on several factors including anticipated meal carbohydrate content, current blood glucose, and postprandial glucose trends.Severe hypoglycemia is a concern for all people with type 1 diabetes. Despite performing frequent self-monitoring of blood glucose (SMBG) four or more times daily, severe hypoglycemic episodes increase by threefold in IIT patients regardless of the method of insulin delivery (2). The recently available continuous glucose monitoring (CGM) is a device that provides patients with the ability to view real-time glucose values, review recent glucose trends, and receive hypo- or hyperglycemic alarms. The CGM systems provide a complete real-time glucose profile by measuring glucose levels at 1- to 5-min intervals. This allows for an accurate, large-scale representation of overall glucose trends, as compared with the isolated values offered by fingerstick SMBG (3–5). Furthermore, CGM use has been reported in both controlled (6–8) and nonrandomized trials (9–12) to improve glucose control, reduce hypo- and hyperglycemic excursions (10,11), and improve glucose variability (13,14). Despite limited data, it is commonly believed that optimal diabetes management can best be achieved when a CGM is used by IIT patients, especially when combined with insulin pump (CSII) therapy.This prospective study was conducted comparing the usefulness of CGM in adult patients with type 1 diabetes using MDI or CSII.     

Optimization of treatment of patients with insulin-dependent diabetes mellitus using multiple injections of insulin

The use of various regimens of multiple insulin injections versus the regimen of a single injection resulted in more stable compensation of diabetes mellitus (glycemia stabilization), a decrease in insulin demand, smoothing over circadian glycemic variations, and correction of hypoglycemia. A choice of the number of injections and the time of administration depended on the type of a diabetic course, individual features of the patient's life style and work.     

胰岛素抵抗对合并2型糖尿病的非酒精性脂肪肝病患者发病的影响

目的比较2型糖尿病(T2DM)合并非酒精性脂肪肝病(NAFLD)患者空腹和糖负荷后胰岛素敏感性的变化情况,并探讨其独立危险因素。方法选取2013~2014年住院的T2DM患者299例,据腹部超声结果分为2组,其中合并NAFLD组(T2DM+NAFLD组)176例,单纯T2DM组123例。2组患者均测血脂,并行口服葡萄糖耐量(OGTT)和胰岛素释放试验,以胰岛素敏感指标(ISI)、定量检测胰岛素敏感性指数(QUICKI指数)、稳态模型评估的胰岛素抵抗指数(HOMA-IR)反映空腹胰岛素敏感性;稳态模型评估胰岛β细胞功能指数(HOMA-β)反映基础胰岛β细胞功能;Cederholm指数、Matsuda指数反映糖负荷后胰岛素敏感性;早期胰岛素分泌功能指数(ΔI30/ΔG30)、晚相胰岛素分泌功能指数(AUCI30-120/AUCG30-120)反映动态胰岛β细胞功能;以胰岛素抵抗指数(HIR)评估肝脏胰岛素抵抗程度。组间比较采用t检验或非参数检验,并行Logistic回归分析,筛查T2DM合并NAFLD患者的独立危险因素。结果与T2DM组相比,T2DM+NAFLD组HOMA-IR、HIR升高(P均<0.05),QUICKI指数、Matsuda指数、Cederholm指数、ISI降低(P均<0.05),血脂、FPG、PPG、HOMA-β、早相和晚相胰岛素分泌功能指数差异无统计学意义(P均>0.05)。Logistic回归结果显示Cederholm指数、Matsuda指数与T2DM伴NAFLD独立相关(OR值分别为0.956,0.840,P均<0.05)。结论糖负荷后胰岛素敏感性下降在T2DM合并NAFLD患者发病机制中所占贡献更大;伴T2DM的NAFLD患者动态胰岛素分泌功能均下降,机体代偿分泌胰岛素能力减低。     

胰岛素治疗对2型糖尿病患者骨代谢的影响

目的探讨胰岛素治疗对2型糖尿病患者骨代谢的影响及可能机制。方法收集547例2型糖尿病患者(口服降糖药188例:B组,应用胰岛素349例:C组)临床资料,测定骨密度(BMD)、空腹血糖、糖化血红蛋白、血钙、血磷、碱性磷酸酶,并对两组患者上述指标进行比较;另设健康对照组(A组)282例,与2型糖尿病患者骨密度进行比较。结果 (1)与健康对照组相比,2型糖尿病患者骨密度降低(P<0.05);(2)C组与B组相比,两组间骨密度无统计学差异,C组男女间比较,男性骨密度高于女性(P<0.05);(3)B组和C组血钙、血磷、血碱性磷酸酶无统计学差异,C组HbA1c明显低于B组(P<0.05);(4)2型糖尿病患者的骨密度与病程、年龄负相关,与体重正相关。结论女性、高龄、病程长、低体重是糖尿病合并骨质疏松的危险因素,胰岛素治疗对2型糖尿病患者骨代谢无明显影响。     

等热卡不同强度运动处方对2型糖尿病的治疗效果

摘要 目的：确定在相同能量消耗下,不同运动强度的运动处方对2型糖尿病（T2DM）患者的血糖水平、胰岛素敏感性及心肺适应能力的不同影响效果。 方法：55例没有运动习惯的T2DM患者,年龄(51.2±1.3)岁,被平均分到低强度组（50%VO2peak,n＝27）和高强度组（75%VO2peak,n＝28）,进行每周5次,每次消耗热量为240kCal,为期12周的运动训练。在训练前及最后1次训练结束后16—24h和15d分别进行口服葡萄糖耐量试验评价空腹血糖水平及胰岛素敏感性（ISI）等指标,并测定心肺适应能力。 结果：通过训练,两组在最后1次训练结束后16—24h所测得的ISI和心肺适应能力比较训练前均有明显改善,但两组的改善效果之间差异无显著性（低强度组24.3±0.9 vs.26.4±1.2;高强度组25.2±0.8 vs.27.5±1.1,P<0.05）。整体训练结束后15d较运动开始前,低强度组ISI（24.3±0.9 vs.26.2±1.1,P<0.05）和心肺适应能力（VO2peak 3.4±0.4 vs.4.8±0.5 vs.4.4±0.5,P<0.05）的改善效果比较差异有显著性,高强度组心肺适应能力的改善效果有显著性的延续(VO2peak 3.6±0.4 vs.3.5±0.4,P<0.05)。 结论：对于T2DM患者来说,在相同能量消耗下,无论是中等强度还是高强度的运动训练都起到改善胰岛素敏感性和心肺适应能力的作用,但总运动时间较长的中等强度运动训练对于改善胰岛素敏感性治疗效果的持续性要优于短时高强度的运动训练。     

Efficacy of sulfonylureas with insulin in type 2 diabetes mellitus

BACKGROUND: In subjects with type 2 diabetes mellitus, glycemic control deteroriates while patients use sulfonylurea drugs during the course of the disease. Adjunctive therapy with insulin at this stage requires a lesser daily insulin dose in comparison with insulin monotherapy while restoring desirable glycemic control. However, data regarding direct comparison between various sulfonylureas in this regard are lacking. OBJECTIVE: To examine comparative efficacies of adjunctive therapy with insulin in subjects with type 2 diabetes manifesting lapse of glycemic control while receiving various individual sulfonylurea drugs. METHODS: Four groups of 10 subjects, each presenting with glycosylated hemoglobin (HbA(1C)) >8.0% while using either tolazamide, glyburide, glipizide Gastrointestinal Therapeutic System (GITS), or glimepiride, were recruited. Two from each group were randomized to receive placebo; the others continued the same drug. Pre-supper subcutaneous 70 NPH/30 regular insulin was initiated at 10 units and gradually increased and adjusted as necessary to attain fasting blood glucose levels between 80 and 120 mg/dL and maintain the same range for 6 months. Fasting plasma glucose, plasma C-peptide, and HbA(1C) concentrations were determined prior to the addition of insulin and at the end of the study. Daily insulin dose and changes in body weight (BW) were noted at the end of the study, and the number of hypoglycemic events during the last 4 weeks of the study was determined.RESULTS: Daily insulin dose (units/kg BW), weight gain, and number of hypoglycemic events were significantly lower (p < 0.01) in subjects receiving sulfonylureas in comparison with placebo. However, the daily insulin dose alone was significantly lower (p < 0.05) with glimepiride (0.49 +/- 0.10; mean +/- SE) than with other sulfonylureas (tolazamide 0.58 +/- 0.12, glyburide 0.59 +/- 0.12, glipizide GITS 0.59 +/- 0.14). Finally, a significant correlation (r = 0.68; p < 0.001) was noted between suppression of plasma C-peptide level and the daily insulin dose among all participants. CONCLUSIONS: By lowering the daily insulin dose, sulfonylurea drugs appear to improve the sensitivity of exogenous insulin in subjects with type 2 diabetes mellitus manifesting lapse of glycemic control. Moreover, glimepiride appears to possess a greater insulin-sparing property than other sulfonylureas.     

Prevalence of peripheral neuropathy and its impact on activities of daily living in people with type 2 diabetes mellitus

Myanmar has one of the highest rates of diabetes in South‐East Asia. This study aimed to determine prevalence and background characteristics of diabetic peripheral neuropathy and neuropathic pain, their effect on the functioning of hands and feet, and the impact on activities of daily living in people with type 2 diabetes mellitus. A total of 975 participants attending the outpatient clinics of four hospitals in Myanmar were interviewed using questionnaires in the local language about pain and difficulties in daily activities. The participants also underwent tests of physical functioning of both hands and feet. There was a high prevalence rate of neuropathy (33.7%) and neuropathic pain (59.5%), with an increased risk in old age, longer duration of diabetes, and history of smoking. The common difficulties in daily activities were sleeping, climbing stairs, walking, and work or chores. Participants with diabetic neuropathic pain experienced more difficulties in specific activities using upper and lower extremities than did those without. Healthcare service in Myanmar should be focused on diabetic peripheral neuropathy, as it can lead to further disabilities.     

心理防御机制对2型糖尿病患者血糖的影响

目的：探讨心理防御机制对2型糖尿病患者血糖的影响。方法对192例2型糖尿病患者（观察组）和100名健康志愿者（对照组）采用一般健康状况‐28、防御方式问卷、状态‐特质焦虑问卷进行心理测试,并进行相关实验室检查。结果两组各量表评分比较差异有显著或极显著性（P＜0.05或0.01）。观察组焦虑症状检出率显著高于对照组（P＜0.01）,空腹血糖及糖化血红蛋白均高于正常值。观察组更多地使用不成熟防御方式来降低焦虑,血糖控制不理想。对照组成熟防御方式与皮质醇含量直接相关。结论2型糖尿病患者多存在有不同程度的焦虑情绪,常采用不成熟防御方式,对血糖控制不理想,通过调节患者的防御机制,提高成熟防御方式的应用,对缓解焦虑情绪,调控血糖具有重要作用。     

Control of postprandial glucose levels with insulin in type 2 diabetes

The importance of maintaining effective glycemic control in patients with type 2 diabetes mellitus (T2DM) is well known. It is increasingly recognized that postprandial hyperglycemia is an important component of the overall glycemic burden, though there is as yet a paucity of data showing that lowering of postprandial plasma glucose (PPG) reduces risk of T2DM complications. The contribution of PPG to overall glycemic control is greatest when glycated hemoglobin (HbA1c) is approximately 7% to 8%. Clinical studies show that targeting PPG can improve glycemic control and long-term prognosis in patients with T2DM. Guidelines for T2DM management now include target levels for PPG as treatment goals. One effective approach to PPG control is achieved using mealtime administration of insulin with a rapid onset of effect and a short duration of action, so that PPG excursions are limited without increased risk of hypoglycemia. Basal-bolus and biphasic insulin regimens achieve good PPG control, even in patients unable to reach glycemic targets with other treatments. Although clinical studies are increasingly including PPG as an endpoint, more interventional studies are needed to investigate the effect of different treatment regimens on PPG and the effect of PPG on clinical outcome. This will facilitate future recommendations for the most effective treatment of T2DM. Postprandial glucose is an important glycemic burden in many patients; routine targeting and regular monitoring has potential to ameliorate the cardiovascular complications of T2DM.     

2型糖尿病患者血糖对血脂的影响及相关性

目的 探讨2型糖尿病患者的血脂异常及血糖浓度对血脂的影响。方法 对90例住院的2型糖尿病患者的血脂、血糖、胰岛素、糖化血红蛋白（HbAlc）进行多因素逐步回归分析,将病人分为血糖控制良好、控制较差和控制差三组,采用方差分析法观察血糖浓度对血脂的影响。结果 2型糖尿病患者的糖化血红蛋白与甘油三酯（TG）、胆固醇（TC）、低密度脂蛋白（LDL）呈正相关且差异有统计学意义（P〈0．05）,与高密度脂蛋白（HDL）呈负相关（P〈0．05）;随着HbAle水平升高,TG、TC、LDL呈逐渐增高趋势,HDL呈下降趋势。结论 血糖浓度可影响2型糖尿病患者的血脂,控制血糖浓度的同时应注意其对血脂的影响。     

利拉鲁肽对2型糖尿病患者胰岛素抵抗的影响

目的探讨利拉鲁肽联合二甲双胍与单纯使用二甲双胍对2型糖尿病患者胰岛素抵抗的影响。方法收集30例2型糖尿病患者(使用利拉鲁肽联合二甲双胍治疗)为试验组,收集30例2型糖尿病患者(单纯使用二甲双胍治疗)为对照组,比较两组治疗前及治疗后3个月糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、血清脂联素、一氧化氮(NO)、内皮素(ET)水平变化情况。结果试验组HbA1c、HOMA-IR、NO、ET水平下降程度,以及血清脂联素水平上升程度均较对照组明显,差异均有统计学意义(P0.05)。结论利拉鲁肽较二甲双胍对2型糖尿病患者改善胰岛素抵抗的效果更为明显。     

Effects of alpha-glucosidase inhibition on meal glucose tolerance and timing of insulin administration in patients with type I diabetes mellitus

OBJECTIVE: Miglitol, an alpha-glucosidase inhibitor, delays absorption of carbohydrates. This study was undertaken to determine the potential of this agent as an adjunct to insulin in the treatment of diabetes. RESEARCH DESIGN AND METHODS: Twelve nonobese patients with insulin-dependent (type I) diabetes mellitus were randomly selected from the outpatient diabetes clinic. The patients were made euglycemic with the Biostator, and postprandial hyperglycemia was determined under the following conditions: protocol 1, subcutaneous injection of insulin (13 +/- 1 U) given 60 min before the meal, with insulin dosages determined by the Biostator; protocols 2 and 3 same as protocol 1 but with insulin given at the time of meal ingestion; protocols 4 and 5 same as protocol 1 but with insulin given 30 min before the meal. Miglitol (100 mg) was administered in protocols 2 and 4 and placebo in protocols 3 and 5. RESULTS: When insulin was given 30 min before the meal with miglitol (protocol 4) or placebo (protocol 5), plasma glucose increased from 4.94 +/- 0.16 to 5.94 +/- 0.55 mM and from 5.11 +/- 0.22 to 8.22 +/- 0.72 mM, respectively (P less than 0.01). When insulin was given at the time of the meal with miglitol (protocol 2) or placebo (protocol 3), plasma glucose increased from 5.44 +/- 0.27 to 7.77 +/- 0.5 mM and from 5.72 +/- 0.22 to 10.83 +/- 0.77 mM, respectively (P less than 0.01). When insulin was given 60 min before the meal (protocol 1), plasma glucose initially decreased from 5.61 +/- 0.38 to 4.33 +/- 0.33 mM and then increased to 6.94 +/- 0.66 mM after the meal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of glimepiride on insulin secretion and sensitivity in patients with recently diagnosed type 2 diabetes mellitus

BACKGROUND: The exact mechanism of the efficacy of glimepiride in the achievement of glycemic control has not yet been clearly defined. OBJECTIVE: This study was conducted to examine the influence of glimepiride on insulin secretion and sensitivity in patients with type 2 diabetes mellitus (DM) of recent onset. METHODS: This 24-week, open-label, controlled trial was conducted at the Division of Endocrinology and Metabolism, Veterans Affairs Medical Center (Phoenix, Arizona). Study participants were aged 32 to 75 years and had recent-onset (established by a short duration of symptoms 6 weeks to 6 months prior to the study) type 2 DM, or were age-matched healthy volunteers (control group). In the diabetic patients, glimepiride tablets were administered orally, initially at 2 mg once daily in the morning, with the dosage increased by 1 mg every 2 weeks until fasting plasma glucose (FPG) decreased to 6.7 mmol/L; the dosage was then maintained for the remainder of the 24-week study period. Oral glucose tolerance tests (OGTTs) were conducted in the control group and before treatment and at 24 weeks after the achievement and maintenance of glycemic control (glycosylated hemoglobin <7.0%) in the diabetic group. For OGTT, plasma insulin and glucose levels were determined after the subjects fasted overnight and then at every 15 minutes for 2 hours after glucose challenge. RESULTS: Fourteen diabetic men (mean [SEM] age, 50 [6] years; range, 32-75 years) and 10 male healthy controls (mean [SD] age, 48 [5] years; range, 30-68 years) were enrolled. In the DM group, FPG decreased significantly after treatment ( P<0.001); fasting plasma insulin was markedly elevated before treatment (P<0.001 vs controls) and decreased after treatment ( P<0.01) but did not normalize; first-phase insulin secretion was markedly inhibited before treatment ( P<0.001 vs controls) and normalized after treatment ( P<0.001) total insulin secretion significantly improved after treatment ( P<0.01) but did not normalize. Finally, the pretreatment insulin sensitivity index decreased significantly (P<0.01) after treatment and normalized in 6 of 14 patients (42.9%) with type 2 DM. CONCLUSIONS: In this study, glimepiride achieved desirable glycemic control in patients with recent-onset type 2 DM through improvement in insulin secretion and sensitivity.