二甲双胍联合甘精胰岛素治疗初诊2型糖尿病合并非酒精性脂肪肝临床疗效分析

随着人们生活条件的改善,2型糖尿病(T2DM)合并非酒精性脂肪肝(NAFLD)的发病率和诊断率逐年上升,发病率高达46％[1].T2 DM是以胰岛素抵抗为发病中心环节的高糖代谢紊乱症候群.随着糖尿病的流行,对其相关合并症的防治显得尤为重要.有研究资料显示,T2 DM患者易合并NAFLD,其原因与NAFLD大多数伴随胰岛素抵抗和代谢综合征相关[2-3].     

初发2型糖尿病患者血糖控制方案的合理选择

糖尿病的治疗不仅仅是降低血糖,更重要的是保护胰岛细胞功能,防止或延缓糖尿病并发症的发生.2型糖尿病(T2DM)主要是胰岛素分泌和胰岛素作用两者损害的结果.发病早期,第一时相胰岛素分泌几乎丧失而第二时相胰岛素分泌增强,这种早期胰岛素分泌功能的损害是糖尿病发病的独立危险因素,可预测糖尿病进程.对初发T2DM合理选择血糖控制方案,有助于恢复内源性胰岛素分泌功能,从而诱导病情缓解[1].     

天津市塘沽农村某社区老年人群筛查2型糖尿病患病及分布情况

糖尿病(Diabetes mellitus,DM)是由于胰岛素分泌缺陷和(或)胰岛素作用障碍所引起的以血糖升高为特征的慢性代谢性疾病。其中95%以上为2型糖尿病(Type 2 DiabetesMellitus,T2 DM)。T2 DM的发病机制主要是胰岛素分泌不足和胰岛素抵抗。随着人民生活水平的不断提高,近几十年来我国DM的发病率逐年上升,成为世界上DM患者最多的3个国家之一。我国DM患者约9240万人,DM前期患者近1.5亿人,但DM诊断率尚不足40%。T2 DM患者大多为老年人,且存在糖代谢及脂代谢紊乱。做好该人群的血糖管理对于提高我国T2 DM防治水平具有重要意义。为了解     

白细胞介素-10与2型糖尿病发病风险的关联性

2型糖尿病(T2DM)发病过程常伴随白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、干扰素-γ(IFN-γ)及肿瘤坏死因子-α(TNF-α)等细胞因子水平的改变,这些细胞因子能抑制胰岛素分泌、诱导β细胞凋亡及引起外周胰岛素抵抗,与T2DM的发生密切相关。白细胞介素-10(IL-10)作为一种重要的抑制性细胞因子,能够抑制IL-1β、IL-6、IFN-γ及TNF-α等细胞因子的合成以及作用的发挥,保护胰岛功能和改善外周胰岛素抵抗,在T2DM的发生发展过程中起着重要作用,本文对IL-10及其基因多态性与T2DM发生风险的关系进行综述。     

罗格列酮对胰岛素控制不良的2型糖尿病患者血浆HbA1c和IL-6及hsCRP的影响

目的　观察马来酸罗格列酮对单用胰岛素治疗血糖控制不良的 2型糖尿病 (T2DM)患者血浆糖化血红蛋白 (HbA1c)、白细胞介素 -6(IL -6)、高敏C反应蛋白 (hsCRP)及血脂 (包括Tch、TG、LDL -c和HDL -c)等因素的影响。方法　对经 4周标准化胰岛素治疗而血糖控制不良 (HbA1c≥ 7 5 %)的 40例T2DM患者加用罗格列酮治疗 ( 4mg/d) ,测定加用罗格列酮前和 12周后血浆HbA1c、IL -6、hsCRP及血脂浓度。HbA1c采用高压液相法测定 ,IL -6采用双抗体夹心酶联免疫吸附法 (ELISA)测定 ,hsCRP采用超敏免疫透射比浊法测定 ,血脂测定采用标准酶法。结果　⑴加用罗格列酮能使单用胰岛素控制不良的T2DM患者的血浆HbA1c水平平均降低 1 5 9%(P <0 0 0 0 1) ,而胰岛素用量减少 13 5 9%;⑵罗格列酮能降低T2DM患者的血浆炎症因子IL -6、hsCRP水平及TG和LDL -c水平 ( P <0 0 0 5～ 0 0 0 0 1)。结论　⑴罗格列酮能改善胰岛素控制不良的T2DM患者的血糖控制 ;⑵罗格列酮有独立于降糖作用之外的抗炎作用和调脂作用。     

Betatrophin在糖尿病中的研究进展

糖尿病(DM)是由多种原因引起的以高血糖为主的慢性代谢性疾病,目前治疗DM的手段主要以胰岛素及口服降糖药。最近一项动物实验研究发现,在胰岛素抵抗模型的小鼠体内,新发现一种叫做促代谢因子(Betatrophin)的分泌性蛋白,能促进小鼠胰岛B细胞增值,有望成为DM治疗的新靶点。     

胰岛素泵强化降糖与DPP-Ⅳ抑制剂改善2型糖尿病患者胰岛β细胞功能的研究进展

2型糖尿病(type 2 diabetes mellitus,T2DM)是一种由基因、环境等多种因素影响的、缓慢进展的慢性代谢性疾病,其发病的中心环节是胰岛素抵抗(insulin resistance,IR)和胰岛β细胞功能缺陷。持续性高血糖是诱发和加重胰岛β细胞功能衰竭的最主要因素,还可进一步增加IR,IR贯穿在T2DM发生发展的始终,β细胞分泌功能的缺陷则是其发病的必要条件,而β细胞功能逐渐衰竭又是DM病情逐渐进展的驱动力量。给予患者胰岛素泵联合二肽基肽酶(dipeptidyl peptidase,DPP)Ⅳ抑制剂治疗,可快速改善患者胰岛素分泌的第1时相、迅速降低糖毒性、减少胰高血糖素释放、保护及修复胰岛β细胞、增加胰岛素的敏感性、减少IR,同时兼顾不增加患者体重及保护患者心脑血管。     

β3肾上腺素能受体基因Trp64Arg突变与胰岛素抵抗相关

目的采用聚合酶链式反应-限制性酶切片段长度多态性(PCR-RFLP)技术,探讨β3肾上腺素能受体(β3 adrenergic re-ceptor,β3AR)基因Trp64Arg突变与中国人胰岛素抵抗(IR)的相关性。方法用PCR-RFLP技术,检测2型糖尿病组(DM组)和正常对照组(N组)β3AR基因型,并测量血糖(FPG)、血浆胰岛素(FINS)等临床生化指标。以FPG×FINS/22.5计算胰岛素抵抗指数(HO-MA-IR),以BM I<25的健康人HOMA-IR的75分位值为界,将DM组分为胰岛素相对敏感组及相对抵抗组。结果与无突变者相比,β3AR Trp64Arg突变携带者BM I升高,2组间WHR、血脂、血压、心率、病程及发病年龄差异无统计学意义。胰岛素相对抵抗组68例,占DM组的56.7%,提示2型DM患者大部分存在IR。胰岛素相对抵抗组β3AR Trp/Arg基因型频率明显高于胰岛素相对敏感组,提示β3AR Trp64Arg基因突变参与IR的发生。结论β3AR Trp64Arg突变参与中国人体重的调节,可能是IR的危险因素之一。     

云南省2型糖尿病患者糖尿病肾病发病情况及危险因素分析

目的 了解云南省2型糖尿病(T2DM)患者糖尿病肾病(DN)发病情况及其危险因素,为防治DN提供科学依据.方法 采用随机整群抽样方法,以云南省社区T2DM患者(年龄≥18岁,且均在云南省居住≥1年)为调查对象,于2019年1-3月进行问卷调查、体格检查及实验室检测,统计DN发病情况.采用x2检验及多因素非条件Logis...     

2型糖尿病脂肪肝与胰岛素抵抗的关系探讨

目的 探讨2型糖尿病(T2DM)患者非酒精性脂肪性肝病(NAFLD)的发生与胰岛素抵抗及血脂代谢紊乱的关系.方法 收集98例T2DM患者,全部病例经肝脏彩超扫描证实,将其分为T2DM合并NAFLD组(47例)与T2DM无NAFLD组(51例),另选取50例健康体检者作为对照组.检测三组体质指数(BMI)、三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FBG)、餐后2 h血糖(2hBG)、空腹血浆胰岛素(FINs)、糖化血红蛋白(HbA1c),计算胰岛素抵抗指数(HOMA-IR)、胰岛素敏感指数(HOMA-ISI)等,并进行比较.结果 T2DM合并NAFLD组FINS、HOMA-IR、TC、TG、LDL-C、BMI均高于T2DM无NAFLD组和对照组(P＜0.05);HOMA-ISI、HDL-C则低于T2DM无NAFLD组和对照组(P＜0.05);BMI、FINS、TC、TG、LDL-C与糖尿病脂肪肝呈显著正相关(r=0.628、0.735、0.841、0.762、0.850,P＜0.05),HOMA-ISI、HDL-C与糖尿病脂肪肝呈显著负相关(r=-0.351、-0.427,P＜0.05).结论 T2DM患者合并NAFLD与血脂代谢紊乱、胰岛素抵抗及肥胖等有关,减肥、降脂、改善胰岛素抵抗对防治糖尿病NAFLD具有重要意义.     

植物化学物防治2型糖尿病并发认知功能障碍作用及机制的研究进展

目的 对植物化学物防治2型糖尿病并发认知功能障碍的作用及机制进行综述。方法 以“2型糖尿病/ Type 2 diabetes mellitus / T2DM”、“胰岛素抵抗/ insulin resistance”、“线粒体/ mitochondria”、“内质网应激/ endoplasmic reticulum stress”和“植物化学物/ phytochemicals”等中英文为检索词,查阅2010—2020年收录于中国知网、万方数据库、维普资讯、Pubmed、Science Direct和Springer数据库的中英文文献。结果 T2DM的高血糖、胰岛素抵抗状态可引起神经元线粒体损伤、内质网应激、炎症和细胞凋亡,从而导致认知功能障碍发生。多酚类、皂苷类等多种植物化学物通过调节上述病理变化发挥认知保护效应。结论 植物化学物在T2DM引起的认知功能障碍动物模型中显示出一定的保护作用,为其有效防治提供了大量的实验室依据。但人群证据尚不充足。     

2型糖尿病与阿尔兹海默病相关性的研究进展

目的 分析2型糖尿病与阿尔兹海默病相关性的流行病学研究以及可能的关联机制,为疾病的预防以及后续相关研究提供参考.方法 以"2型糖尿病(type 2 diabetes mellitus)" "阿尔兹海默病(Alzheimer's disease)" "认知功能(cognition)"为关键词,检索PubMed、Embas...     

Social Constructions of Stigmatizing Discourse Around Type 2 Diabetes Diagnoses in Appalachian Kentucky

Type 2 diabetes is a growing problem among Appalachian Kentucky residents. Several issues contribute to diabetes disparities in the region, including lack of access to health care and geographic isolation. Previous studies also indicate that social stigma may be associated with type 2 diabetes. We used 28 semistructured interviews to explore how stigma is socially constructed across health status (diagnosed/undiagnosed). Perceived severity of the disease is high, yet the etiology of diabetes is not well understood. Thus, onset is perceived to occur “out of the blue,” and a positive diagnosis is perceived as having life-threatening consequences. Diagnosed participants, who had learned more about the disease’s etiology, prevention, and management, expressed intrapersonal stigma. In interpersonal situations, the visible indicators of a diabetes diagnosis (i.e., physical weight, insulin injection), rather than diagnosis status, tended to evoke stigmatizing interactions. These findings form the foundation for our recommendations for prevention messages in the region.     

关于2型糖尿病并发末梢神经病变危险因素的病例对照研究

糖尿病末梢神经病变(Diabetic Peripheral Neuropathy,DPN)是糖尿病常见并发症之一,不仅本身严重危害健康,有很高的病死率,而且与其他慢性并发症的发生发展关系密切。目的探讨2型糖尿病病人并发DPN的危险因素。方法采用以医院为基础的1:1配对病例对照研究方法。运用条件Logistic回归分析,建立主效应方程分析讨论DPN的危险因素。结果单因素Logistic回归分析表明,DPN发生的保护性因素包括:文化程度高、治疗方法力度大、现患冠心病、饮茶;危险因素包括:糖尿病病程长、血糖控制(HbAlc%)不良、使用胰岛素、合并糖尿病肾病、合并糖尿病视网膜病变、主诉眩晕症状、皮肤干燥、现患高血压、既往酮症、患糖尿病前肉类食物的摄入较多、既往吸烟(调查时已戒烟)、创伤经历、腰臀比WHR超标、血胆固醇(Chol)水平高。多因素Logistic回归分析示DPN发生的危险因素有6个:糖尿病病程、使用胰岛素、主诉眩晕症状、糖尿病前肉类食物摄入较多、饮酒以及既往创伤经历(手术、冻伤等)。结论DPN与多种因素相关,在2型糖尿病患者中,糖尿病病程长、使用胰岛素、主诉眩晕症状、糖尿病前肉类食物摄入较多、饮酒、既往创伤史会增加糖尿病神经病变的发生危险,我们应在DPN的防治过程中特别予以注意。     

Satisfaction with Treatment in Type 2 Diabetes Patients Requiring Insulin Treatment in Buenos Aires,Argentina

ObjectiveTo assess different dimensions of treatment satisfaction in patients with type 2 diabetes mellitus (T2DM) receiving insulin therapy.Study DesignCross-sectional study. We included 183 patients with T2DM followed by diabetes specialists in an ambulatory setting: 93 treated with neutral protamine Hagedorn insulin (NPH) and 90 with insulin glargine (IG). We used a Spanish version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) for Argentina.ResultsOverall treatment satisfaction was 30.04 (SD 5.40) for a maximum score of 36. The lowest score observed was for the satisfaction item “Flexibility of treatment” (4.7 out of 6, SD 1.27), and the highest score for the item “Recommending treatment to others” (5.39 out of 6, SD 1.23). In patients treated with IG, the overall treatment satisfaction score was 30.56 (SD 4.43); and 29.64 (SD 6.13) for those receiving NPH, not reaching a statistically significant difference. Perception of hypoglycemia was infrequent, with a mean score of 1.82 out of 6 (SD 1.62). For hyperglycemia, the mean score was 2.62 out of 6 (SD 1.54). In both cases, we found no difference between patients treated with IG and those treated with NPH insulin.ConclusionThis is the first study describing patient satisfaction with treatment in T2DM patients in Argentina. We have found levels of treatment satisfaction similar or greater to those described in developed countries. We expect that the results of this study may encourage physicians not to delay the initiation of insulin therapy in poorly controlled patients.     

Blackcurrant Improves Diabetic Cardiovascular Dysfunction by Reducing Inflammatory Cytokines in Type 2 Diabetes Mellitus Mice

Diabetic cardiovascular dysfunction is a representative complication of diabetes. Inflammation associated with the onset and exacerbation of type 2 diabetes mellitus (T2DM) is an essential factor in the pathogenesis of diabetic cardiovascular complications. Diabetes-induced myocardial dysfunction is characterized by myocardial fibrosis, which includes structural heart changes, myocardial cell death, and extracellular matrix protein accumulation. The mice groups in this study were divided as follows: Cont, control (db/m mice); T2DM, type 2 diabetes mellitus mice (db/db mice); Vil.G, db/db + vildagliptin 50 mg/kg/day, positive control, dipeptidyl peptidase-4 (DPP-4) inhibitor; Bla.C, db/db + blackcurrant 200 mg/kg/day. In this study, Bla.C treatment significantly improved the homeostatic model evaluation of glucose, insulin, and insulin resistance (HOMA-IR) indices and diabetic blood markers such as HbA1c in T2DM mice. In addition, Bla.C improved cardiac function markers and cardiac thickening through echocardiography. Bla.C reduced the expression of fibrosis biomarkers, elastin and type IV collagen, in the left ventricle of a diabetic cardiopathy model. Bla.C also inhibited TD2M-induced elevated levels of inflammatory cytokines in cardiac tissue (IL-6, IL-1β, TNF-α, and TGF-β). Thus, Bla.C significantly improved cardiac inflammation and cardiovascular fibrosis and dysfunction by blocking inflammatory cytokine activation signals. This showed that Bla.C treatment could ameliorate diabetes-induced cardiovascular complications in T2DM mice. These results provide evidence that Bla.C extract has a significant effect on the prevention of cardiovascular fibrosis, inflammation, and consequent diabetes-induced cardiovascular complications, directly or indirectly, by improving blood glucose profile.     

盎格鲁-凯尔特人群和中国人群2型糖尿病促发因素的对比研究

目的探讨盎格鲁-凯尔特人和中国人代谢综合征(IR)患病率和2型糖尿病促发因素。方法采用横断面研究,收集1992—2004年澳大利亚阿尔弗雷德王子医院和北京306医院门诊筛查糖尿病病程小于2a的病例资料,1016名盎格鲁-凯尔特人和1514名中国人,按发病时年龄分层后分析其IR(WHO标准)及其构成因素。结果在盎格鲁-凯尔特早发糖尿病病人中,IR患病率较高,且体质指数(BMI)与发病年龄呈显著负相关(r=-0.300;P<0.01),BMI每增加1kg/m2,发病年龄减小0.5岁。低发病年龄组可见IR患病率增加、甘油三酯(TG)升高以及高密度脂蛋白(HDL)降低;中国人发病年龄与BMI、IR、TG或HDL无关联。结论在凯尔特人中IR是2型糖尿病的重要促发因素,而在中国人中并非如此。提示中国人群中提早发生的beta细胞缺乏是糖尿病发病的更重要的促发因素。2型糖尿病具有异质性,因此,糖尿病的预防需要更多人种特异性的治疗策略。     

Treatment update: thiazolidinediones in combination with metformin for the treatment of type 2 diabetes

Type 2 diabetes mellitus (DM2) is characterized by excessive hepatic gluconeogenesis, increased insulin resistance and a progressive inability of pancreatic beta cells to produce sufficient insulin. DM2 evolves as a progression from normal glucose tolerance, to impaired glucose tolerance (IGT) to frank diabetes mellitus, reflecting the establishment of insulin resistance and beta cell dysfunction. Insulin resistance not only contributes to impaired glycemic control in DM2, but to the development of hypertension, dyslipidemia and endothelial dysfunction. Cardiovascular disease is the primary morbidity for patients with DM2. The onset of insulin resistance and cardiovascular insult likely occurs well before the onset of IGT is detected clinically. Biguanides and thiazolidinediones (TZDs) are two classes of oral agents for the management of DM2 that improve insulin resistance, and thus have potential cardiovascular benefits beyond glycemic control alone. Metformin additionally inhibits hepatic gluconeogenesis. The combined use of two of these agents targets key pathophysiologic defects in DM2. Single pill combinations of rosiglitazone/metformin and pioglitazone/metformin have recently been approved for use in the US and Europe. This article reviews the clinical data behind the use of metformin in combination with TZDs for the management of diabetes, its impact on vascular health, side effects and potential mechanisms of action for combined use.     

氨茶碱持续泵入联合胰岛素泵治疗慢性肺源性心脏病合并糖尿病的疗效

目的探讨氨茶碱持续泵入联合胰岛素泵治疗慢性肺源性心脏病(CPHD)合并2型糖尿病(T2DM)的疗效。方法选择CPHD合并T2DM 104例,按数字随机法分为两组。治疗组(n=52):氨茶碱持续泵入+胰岛素泵。对照组(n=52):氨茶碱静脉滴注+诺和灵R持续静脉滴注。比较两组临床疗效及糖尿病控制情况:目标血糖时间、胰岛素用量、低血糖发生率、心功能。结果①治疗组总有效率为86.54%,对照组为67.31%,2组差异有统计学意义(P0.05);②治疗组目标血糖达标快,低血糖发生率低,两组差异有统计学意义(P0.05)。结论氨茶碱持续泵入联合胰岛素泵治疗CPHD合并T2DM,方法适宜,疗效显著,安全性高。     

The effects of folate supplementation on glucose metabolism and risk of type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials

Purpose: Observationally, homocysteine is associated with higher risk of diabetes. Folate, which reduces homocysteine, is promising for the prevention and treatment of diabetes. Previous meta-analysis of three trials suggested folate might lower hemoglobin A_1c (HbA_1c). Methods: An updated systematic review and meta-analysis of placebo-controlled randomized trials was conducted. We searched PubMed using (“folate” or “folic acid”) and trial and (“glucose” or “diabetes” or “insulin” or “hemoglobin A_1c” or “HbA_1c”) in any field until February 3, 2017. We also conducted a bibliographic search of selected studies and relevant reviews. Relative risk of diabetes and mean differences in indicators of glucose metabolism between folate and placebo were summarized in a meta-analysis using inverse variance weighting with random effects. Heterogeneity, publication bias, and risk of bias were also assessed. Results: Eighteen trials of 21,081 people with/without diabetes were identified. Folate decreased fasting glucose (?0.15 mmol/L, 95% confidence interval [CI] ?0.29 to ?0.01), homeostatic model assessment–insulin resistance (?0.83, 95% CI ?1.31 to ?0.34), and insulin (?1.94 μIU/mL, 95% CI ?3.28 to ?0.61) but had no clear effect on diabetes or HbA_1c. Conclusions: Our study suggests a potential benefit of folate on insulin resistance and glycemic control; the latter requires examination in more high-quality trials.