Cost-of-illness studies in diabetes mellitus

Several cost-of-illness (COI) studies related to diabetes mellitus have been performed over the last three decades. This review examines the results of these COI studies, identifies the strengths and limitations of the various methods utilised, and suggests future research that will help determine the economic burden of diabetes more accurately. Diabetes imposes a large economic burden on society. The economic cost of diabetes is estimated to be as much as dollars US 100 billion per year in the US alone (1997 values). This estimated cost has increased notably over time, primarily due to price inflation and the increasing prevalence of diabetes. Differing methodologies have significantly influenced the cost estimates and made comparisons between COI studies problematic. For example, early reports tended to rely exclusively on data where diabetes was listed as the primary diagnosis or reason for healthcare use. To better capture the costs associated with diabetes-related complications, later studies have included costs related to diabetes as a secondary or tertiary diagnosis using the attributable risk methodology. Given the types of long-term complications that are associated with diabetes, attempts at capturing these secondary costs are appropriate. However, estimates of attributable risk can be limited by the epidemiological data currently available. The tremendous economic burden of diabetes makes the disease an important clinical and public health problem. In order to formulate an effective response to this problem, it is important to track future economic trends as healthcare delivery, morbidity and mortality patterns evolve. Future research efforts should focus on refining methods to estimate costs, improving the interpretation of study findings, and facilitating comparisons between studies.     

Carbamylated erythropoietin to treat neuronal injury: new development strategies

Background: Carbamylated erythropoietin (CEPO) is a modified erythropoietin molecule not affecting hematocrit. It is a potentially important pharmacological agent that may be applied to the treatment of several diseases affecting central and peripheral system neurons. Objective: Carbamylated erythropoietin is a prime candidate for development because of its potent cell survival and function enhancing effects. This article reviews the preclinical development profile of CEPO in animal models to determine whether further clinical development is justified. Methods: The review spans a detailed analysis of patents and scientific publications related to CEPO in animal models. Results/conclusions: Use of CEPO in treating diseases such as stroke and traumatic brain and spinal cord injuries is important because these conditions affect millions of patients every year. Extensive preclinical studies support further clinical studies of CEPO for acute ischemic stroke. However, further studies are required for testing CEPO in patients with many other indications.     

新药研究开发中非临床研究的生物医学评价挑战

医药产业是发展快速的产业。近十年来，世界药品市场销售额以年均8％～10％的速度增长，2000年达3900亿美元。到2010年将达7600亿美元，年均增长达7．3％，远远高于GDP的增长速度。医药是高投入、高产出、高技术、高风险的行业。由于知识密集，技术标准高，准入门槛高，     

妊娠期糖尿病对早产新生儿大脑发育的影响

目的　探讨妊娠期糖尿病（GDM）对早产新生儿大脑发育的影响。方法　采用回顾性研究。选取2017年1月至2020年12月期间广州市第一人民医院新生儿科病房收治的GDM母亲所生早产新生儿为GDM组（45例,男24例,女21例）,选择同期出生、母亲无GDM,胎龄、身长及出生体质量等一般情况与GDM组相当的早产新生儿为对照组（45例,男24例,女21例）。采用t检验及χ²检验比较两组新生儿出生后7 d的新生儿行为神经测定（NBNA）评分,并于分娩3 d后行颅脑超声指标记录检测分析,查阅病例获取一般指标情况,分析GDM组新生儿发生大脑整体回声减低的影响因素。结果　GDM组新生儿胎龄（34.05±1.70）周,出生体质量（2.29±0.53）kg,身长（45.23±3.25）cm,对照组分别为（34.13±1.41）周、（2.26±0.35）kg、（45.50±2.03）cm,两组新生儿基本情况比较,差异均无统计学意义（均P>0.05）。GDM组新生儿出生后7 d的NBNA总评分为（35.43±1.07）分,显著低于对照组的（36.47±0.62）分（t=4.975,P<0.001）;GDM组新生儿脑整体回声减低发生率显著高于对照组［64.44%（29/45）比20.00%（9/45）］,差异有统计学意义（χ²=14.930,P<0.001）;多元线性回归分析显示,出生体质量与脑整体回声减低呈负相关,母亲GDM程度分级与脑整体回声减低呈正相关（均P<0.05）。结论　GDM母亲所生早产新生儿存在不同程度的脑发育不成熟现象,妊娠期高血糖环境对新生儿神经行为发育可能产生不良影响。     

基于网络药理学方法研究知母治疗2型糖尿病作用机制

目的 使用网络药理学技术探讨知母治疗2型糖尿病（T2DM）作用机制。方法 挖掘中药成分数据库中知母化学成分,获取化学成分的药代动力学参数用于构建药物的化学成分数据库;利用ADME模型筛选潜在活性分子;基于随机森林和支持向量机的方法预测活性分子作用靶点并构建知母化合物-靶点（C-T）网络;从多个人类疾病数据库检索T2DM相关靶点并构建疾病蛋白-蛋白相互作用（PPI）网络,构建知母活性-疾病靶点（C-D）网络;通过富集分析构建知母活性分子作用靶点-通路（CD-M）网络。结果 该研究得到的知母化学成分数据库一共有81个分子,通过ADME模型筛选得到15个活性分子,通过分析化合物作用靶点网络发现知母活性分子作用20个T2DM靶点蛋白,富集分析发现知母活性分子通过调控胰岛素通路、胰岛素抵抗通路、PI3K-Akt信号、NOS3通路、HIF-1通路、能量代谢等途径治疗T2DM。结论 知母可通过多成分、多靶点、多途径的协同作用治疗T2DM。     

Zinc complexes developed as metallopharmaceutics for treating diabetes mellitus based on the bio-medicinal inorganic chemistry

Biological trace metals such as iron, zinc, copper, and manganese are essential to life and health of humans, and the success of platinum drugs in the cancer chemotherapy has rapidly grown interest in developing inorganic pharmaceutical agents in medicinal chemistry, that is, medicinal inorganic chemistry, using essential elements and other biological trace metals. Transition metal complexes with unique chemical structures may be useful alternatives to the drugs available to address some of the incurable diseases. In this review, we emphasize that metal complexes are an expanding of interest in the research field of treatment of diabetes mellitus. Especially, orally active anti-diabetic and anti-metabolic syndrome zinc complexes have been developed and progressed since the discovery in 2001, where several highly potent anti-diabetic zinc complexes with different coordination structures have quite recently been disclosed, using experimental diabetic animals. In all of the complexes discussed, zinc is found to be biologically active and function by interacting with some target proteins related with diabetes mellitus. The design and screening of zinc complexes with higher activity is not efficient without consideration of the translational research. For the development of a clinically useful metallopharmaceutics, the research of zinc complexes on the long-term toxicity including side effects, clear-cut evidence of target molecule for the in vivo pharmacological action, and good pharmacokinetic property are essential in the current and future studies.     

优化复合纤维降低2型糖尿病胰岛素抵抗疗效观察

目的 :观察以复合纤维、沙棘皮及富铬酵母等为主要原料的优化复合纤维 (SFC) ,降低 2型糖尿病患者胰岛素抵抗 (IR)作用。方法 :将 4 5例参加糖尿病营养教育的 2型糖尿病患者随机分为两组 ,即治疗组和以对照组 ,治疗组于实验前 4周 ,对照组于实验后 4周提供优化复合纤维 ,每日 3次 ,每次 10 g ,临床治疗方案不变 ,并进行饮食指导 ,使饮食中纤维素含量基本一致 ,于实验的 0周、4周、8周测身高、称重 ,计算体质指数 (BMI) ,测定空腹血溏 (FBG)、餐后血糖 (PBG)、果糖胺 (FMN)、空腹胰岛素 (FINS)、胆固醇 (TC)、甘油三酯 (TG)、脂质过氧化物 (LPO) ,计算胰岛素敏感指数 (ISI)。结果 :优化复合纤维可明显升高 2型糖尿病患者ISI,降低FINS ,血糖、血脂和LPO及FMN ,各指标治疗前后对比及治疗组与对照组比较差别均有显著性意义。结论 :优化复合纤维具有降低 2型糖尿病患者IR及BMI ,改善糖脂代谢和减少体内脂质过氧化物的综合作用     

口服2型糖尿病药物的研究进展

文章简要介绍了2型糖尿病发病机制的最新研究结果。同时着重介绍了三大类口服2型糖尿病药物的研究现状。     

Renal glucose reabsorption inhibitors to treat diabetes

Current therapies to reduce hyperglycaemia in type 2 diabetes mellitus (T2DM) mostly involve insulin-dependent mechanisms and lose their effectiveness as pancreatic β-cell function declines. In the kidney, filtered glucose is reabsorbed mainly via the high-capacity, low-affinity sodium glucose cotransporter-2 (SGLT2) at the luminal surface of cells lining the first segment of the proximal tubules. Selective inhibitors of SGLT2 reduce glucose reabsorption, causing excess glucose to be eliminated in the urine; this decreases plasma glucose. In T2DM, the glucosuria produced by SGLT2 inhibitors is associated with weight loss, and mild osmotic diuresis might assist a reduction in blood pressure. The mechanism is independent of insulin and carries a low risk of hypoglycaemia. This review examines the potential of SGLT2 inhibitors as a novel approach to the treatment of hyperglycaemia in T2DM.     

Inhaled insulin--a new therapeutic option in the treatment of diabetes mellitus

The beneficial effects of maintaining an optimal glucose control on chronic complications of diabetes have been firmly established in patients with both Type 1 and 2 diabetes mellitus. Effective glucose control usually requires multiple daily injections of subcutaneous insulin. Limitations of these intensive regimens include inconvenience and poor patient adherence and acceptability. As a consequence, several alternative methods for insulin delivery have been developed with the aim of eliminating the pain, inconvenience and disruption of lifestyle associated with the need for insulin injections. Recent evidence suggests that intrapulmonary insulin delivery may be an effective, non-invasive alternative to subcutaneous regular insulin. In fact, clinical trials in the last few years have shown that intrapulmonary insulin was as good as subcutaneous insulin in controlling glucose levels in patients with both Type 1 and 2 diabetes mellitus. It was well-tolerated and, so far, there is no evidence of an increased risk of hypoglycaemia or adverse bronchopulmonary effects. Although the bio-availability of inhaled insulin is lower than that of subcutaneous insulin, the former has a more physiological pharmacokinetic profile than the latter. Inhaled insulin currently represents the most viable alternative insulin delivery method to preprandial subcutaneous injection.     

近几年治疗糖尿病热点靶点的研究进展

近年来糖尿病的发病率越来越高,对其研究也成为一大热点。综述治疗糖尿病的热点靶点在最近几年的研究进展,主要包括新型葡萄糖-钠协同转运蛋白2(SGLT2)、胰高血糖素样肽-1(GLP-1)、二肽基肽酶Ⅳ(DPP-Ⅳ)、过氧化物酶体增殖活化受体(PPAR)、蛋白酪氨酸磷酸酶-1B(PTP-1B)等,以期为其进一步研究和临床应用提供参考。     

新时期军队流行病学面临的挑战与发展趋势

军队流行病学是流行病学的一个分支，是流行病理论在军队卫生防疫工作中的应用和发展。军队流行病学的研究对象是部队全体指战员，其任务与一般流行病学基本相同，所不同的是，它不仅着眼于平时，而且包括战时的预防和传染病的扑灭，以及粉碎敌人的生物战争。近２０年来，随着改革开放，人民生活水平的不断提高，部队生活条件有了明显改善，同时由于战略方针的转移，军事训练的技术难度与强度加大，疾病谱发生了变化，以及现代流行病理论与研究方法的引入，军队流行病学得到了迅速发展与提高，并在部队常见病多发病的防治与保障部队官兵身心…     

Discontinued drug therapies to treat diabetes in 2014

Introduction: Available drugs partially attenuate the hyperglycemia characteristic of diabetes. However, successful approaches to treat the root cause or to cure or prevent diabetes remain elusive. Drug discovery and development programs continue to focus on mechanisms that impact specific symptoms of diabetes. In 2014, programs were discontinued for a variety of reasons and these discontinued programs are discussed herein.

Areas covered: A search of discontinued products in the metabolic area for 2014 identified mostly compounds that were being developed to treat diabetes (mostly type 2 diabetes). Candidates were identified through the use of PharmaProjects. The author also sought information using Google, PubMed, HighWire and ClinicalTrials.gov. The discontinued development programs that were identified were not numerous as in previous years and so they are presented here without segregation into categories.

Expert opinion: In general, the specific reasons for the discontinuation of these programs have not been clearly disclosed. In some cases, business considerations are given, whereas in others, there are specific safety issues that emerged which were not expected from nonclinical experience. In the final analysis, it is clear that all of these programs have been discontinued because the evidence does not favor the type of efficacy and risk:benefit ratio that justifies additional expenditures. There remains a clear need for precise addressable mechanisms to affect the root causes of diabetes.     

心理护理对糖尿病精神抑郁障碍的影响

目的研究对于精神分裂症合并糖尿病患者实施早期心理护理的应用效果。方法广州市民政局精神病院救治六区于2015年5月~2016年5月收治的精神分裂症合并糖尿病患者56例,随机划分普通组28例与心理组28例,普通组接受一般护理流程,对后组在前组基础上着重加强对患者心理护理,观察生存质量评分及抑郁评分。结果心理组患者抑郁症状评分较高(P0.05);普通组患者生存质量评分较低(P0.05)。结论对于精神分裂症合并糖尿病患者而言,对其进行全面基础护理干预,指导患者正确用药,做好心理护理措施,大部分患者心理抑郁状况改善良好且生存质量较高。