血清hs-CRP、Hcy与妊娠期糖尿病及妊娠结局的关系

目的：探讨联合检测超敏C反应蛋白( hs-CRP)和同型半胱氨酸( Hcy)水平在妊娠期糖尿病( GDM)诊断及对妊娠结局的预测价值。方法选择2012年1月至2014年3月在安吉县第三人民医院门诊接受检查的GDM患者35例作为观察组;选择同期经临床排除GDM的正常孕产妇35例作为对照组。检测两组患者的hs-CRP和Hcy、空腹血糖和胰岛素水平,并跟踪两组妊娠结局。结果观察组患者空腹血糖、胰岛素、hs-CRP 和 Hcy 水平均高于对照组,均有显著性差异( t 值分别为13.07、12.02、3.65和12.02,均P<0.05);观察组不良反应发生率为34.3%(12/35),对照组为11.4%(4/35),具有显著性差异(χ2=5.19,P<0.05)。有16例发生不良妊娠结局,其与54例正常妊娠者的hs-CRP和Hcy水平比较均明显增高,并有显著性差异( t值分别为7.88、14.17,均P<0.05)。结论妊娠女性的hs-CRP和Hcy水平与GDM发生具有密切联系,且高水平hs-CRP和Hcy对不良妊娠结局具有一定的预测作用,应该引起产科注意。     

Relationship between response of gamma-glutamyltransferase to alcohol consumption and levels of fasting plasma glucose

To examine whether the response of fasting plasma glucose (FPG) to alcohol consumption differs among individuals, a cross-sectional study was conducted in 6100 men with a body-mass index below 24 who did not take medication for diabetes. Information regarding current medication and lifestyle habits was obtained by a self-reported questionnaire. The subjects were divided into four groups according to their level of alcohol consumption: non-drinkers, light drinkers (1–188 ml/week), intermediate drinkers (189–377 ml/week), and heavy drinkers (378 ml/week). The frequency of subjects with an FPG of 110 mg/dl or more rose significantly as alcohol consumption increased, from 6.7% in non-drinkers to 10.1% in intermediate drinkers and 12.1% in heavy drinkers. In contrast, when only the subjects with a γ-glutamyltransferase level of less than 40 IU/L were analyzed, no difference was observed in the frequency of subjects with an FPG level of 110 mg/dl or more among the four groups. Multiple logistic regression analysis also revealed similar results. The findings suggested individual variability in the response of FPG to drinking. Appropriate levels of drinking could be different among individuals.     

消渴清颗粒联合恩格列净治疗2型糖尿病的临床研究

目的探讨消渴清颗粒联合恩格列净治疗2型糖尿病的临床疗效。方法选取2019年7月—2020年7月商丘市第三人民医院收治的150例2型糖尿病患者为研究对象,根据用入院号的奇偶数分成对照组(75例)和治疗组(75例)。对照组口服恩格列净片,10 mg/次,1次/d;治疗组在对照组治疗基础上口服消渴清颗粒,6 g/次,3次/d。两组均经8周治疗后进行效果评价。观察两组的临床疗效,比较两组治疗前后血糖相关指标、血糖波动指标和血清学因子的变化情况。结果经治疗,治疗组的总有效率为98.67%,明显高于对照组(82.67%,P<0.05)。经治疗,治疗组空腹血糖(FPG)、餐后2 h血糖(2 h PG)、糖化血红蛋白(HbAlc)、胰岛素(FINS)水平均较治疗前显著降低(P<0.05);治疗后,治疗组血糖相关指标低于对照组(P<0.05)。经治疗,两组HOMA-β均增高,而HOMA-IR均降低(P<0.05);治疗后,治疗组HOMA-β高于对照组,而HOMA-IR低于对照组(P<0.05)。经治疗,两组患者血糖标准差(SDBG)、平均血糖波动幅度(MAGE)、24h血糖波动次数(NGE)及24h血糖平均绝对差(MODD)均较治疗前显著降低(P<0.05);且治疗后,治疗组血糖波动指标显著低于对照组(P<0.05)。经治疗,两组血清趋化素、生长分化因子-15(GDF-15)、单核细胞趋化蛋白-1(MCP-1)、淀粉样蛋白A(SAA)水平均显著降低,但1-磷酸鞘氨醇(SIP)显著升高(P<0.05);治疗后,治疗组趋化素、GDF-15、MCP-1、SAA水平低于对照组,而SIP高于对照组(P<0.05)。结论消渴清颗粒联合恩格列净治疗2型糖尿病患者具有较好的临床疗效,可有效降低患者血糖水平,改善机体趋化素、GDF-15、MCP-1、SAA、SIP水平,并有效保护胰岛β细胞功能,有着良好的临床应用价值。     

Beyond fasting plasma glucose: The association between coronary heart disease risk and postprandial glucose,postprandial insulin and insulin resistance in healthy,nondiabetic adults

Objective

Prediabetes is defined by elevations of plasma glucose concentration, and is aimed at identifying individuals at increased risk of type 2 diabetes and coronary heart disease (CHD). However, since these individuals are also insulin resistant and hyperinsulinemic, we evaluated the association between several facets of carbohydrate metabolism and CHD risk profile in apparently healthy, nondiabetic individuals.

Methods

Plasma glucose and insulin concentrations were measured before and at hourly intervals for eight hours after two test meals in 281 nondiabetic individuals. Insulin action was quantified by determining the steady-state plasma glucose (SSPG) concentration during the insulin suppression test. CHD risk was assessed by measurements of blood pressure and fasting lipoprotein profile.

Results

For purposes of analysis, the population was divided into tertiles, and the results demonstrated that the greater the 1) fasting plasma glucose (FPG) concentration, 2) incremental plasma insulin response to meals, and 3) SSPG concentration, the more adverse the CHD risk profile (p < 0.05). In contrast, the CHD risk profile did not significantly worsen with increases in the incremental plasma glucose response to meals.

Conclusions

In nondiabetic individuals, higher FPG concentrations, accentuated daylong incremental insulin responses to meals, and greater degrees of insulin resistance are each associated with worse CHD risk profile (higher blood pressures, higher triglycerides, and lower high density lipoprotein cholesterol concentrations). Interventional efforts aimed at decreasing CHD in such individuals should take these abnormalities into consideration.     

Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions

Background

Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography.

Methods and Results

We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (< 2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (β = − 0.31, P < 0.01) and presence of the diabetes (β = − 0.57, P < 0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r = − 0.15, P = 0.04), fasting glucose level (r = − 0.27, P = 0.001), postprandial glucose level (r = 0.43, P < 0.001), hemoglobin A1C level (r = − 0.34, P < 0.001), LDL cholesterol level (r = 0.22, P = 0.009), mitral A velocity (r = − 0.27, P = 0.001) and Tei index (r = − 0.19, P = 0.02), whereas mitral E/A ratio, mitral Em (r = 0.18, P = 0.02), mitral Em/Am ratio (r = 0.23, P = 0.004) were significantly and positively correlated with CFR.

Conclusion

CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.     

Glycaemic control and hypoglycaemia with insulin glargine 300 U/mL versus insulin glargine 100 U/mL in insulin-naïve people with type 2 diabetes: 12-month results from the EDITION 3 trial

AimTo explore if efficacy and safety findings for insulin glargine 300 U/mL (Gla-300) versus insulin glargine 100 U/mL (Gla-100), observed over 6 months in insulin-naïve people with type 2 diabetes, are maintained after 12 months.MethodsEDITION 3 was a phase 3a, randomized, multicentre, open-label, parallel-group, treat-to-target study of once-daily Gla-300 versus Gla-100 (target fasting self-monitored plasma glucose, 4.4–5.6 mmol/L [80–100 mg/dL]). Participants completing the initial 6-month treatment phase continued their previously allocated basal insulin.ResultsOf 878 participants randomized, 337/439 (77%) and 314/439 (72%) assigned to Gla-300 and Gla-100, respectively, completed 12 months of treatment. Improved glycaemic control was sustained until 12 months in both treatment groups, with similar reductions in HbA_1c from baseline to month 12 (difference: −0.08 [95% confidence interval (CI): −0.23 to 0.07] % or −0.9 [−2.5 to 0.8] mmol/mol). Relative risk of experiencing ≥ 1 confirmed (≤ 3.9 mmol/L [≤ 70 mg/dL]) or severe hypoglycaemic event with Gla-300 versus Gla-100 was 0.86 (95% CI: 0.69 to 1.07) at night and 0.92 (0.82 to 1.03) at any time of day. For events with a glycaemic threshold of < 3.0 mmol/L (< 54 mg/dL) these numbers were 0.76 (0.49 to 1.19) and 0.66 (0.50 to 0.88). A similar pattern was seen for documented symptomatic events. No between-group differences in adverse events were identified.ConclusionOver 12 months, Gla-300 treatment was as effective as Gla-100 in reducing HbA_1c in insulin-naïve people with type 2 diabetes, with lower overall risk of hypoglycaemia at the < 3.0 mmol/L threshold.     

A short message service (SMS) intervention to prevent diabetes in Chinese professional drivers with pre-diabetes: A pilot single-blinded randomized controlled trial

Aim

To determine the efficacy of delivering short-message service (SMS) to provide diabetes-related information in reducing the risk of developing diabetes in Chinese professional drivers with pre-diabetes.

Methods

A pilot single-blinded randomized controlled trial was conducted in Hong Kong between 05/2009 and 04/2012. Professional drivers with impaired glucose tolerance (IGT) were randomly allocated to either a SMS group receiving messages comprising knowledge and lifestyle modification on diabetes or to a control group with usual care. Primary outcomes were the incidence rate of diabetes mellitus over 12 and 24 months period.

Results

Fifty-four, out of 104 professional drivers recruited, were randomly allocated to intervention group. Fewer subjects developed diabetes at 12 months in intervention group (5.56%) compared to control group (16.00%). Relative risk (RR) of diabetes onset was 0.35 (95%CI: 0.10–1.24) and the number needed to treat (NNT) for preventing one diabetes was 9.57. At 24 months, RR increased to 0.62 (95%CI: 0.24–1.61) with a NNT of 10.58. Logistic regression showed a significant odds ratio of 0.04 (P = 0.021) for intervention group compared to control group at 12-month follow-up for completers and a non-significant odds ratio of 0.34 (P = 0.303) at 24-month follow-up.

Conclusions

The SMS program proved to have potential to reduce the risk of developing diabetes at 12 months but additional measures should be integrated to prevent or delay disease progression.     

理中化痰丸联合多潘立酮治疗糖尿病胃轻瘫随机平行对照研究

[目的]观察理中化痰丸联合多潘立酮治疗糖尿病胃轻瘫疗效。[方法]使用随机平行对照方法,将76例门诊及住院患者按就诊顺序编号法随机分为两组。对照组38例多潘立酮10mg/次,3次/d,饭后30min口服。治疗组38例理中化痰丸(党参、石菖蒲、生姜、法半夏、茯苓各15g,干姜、炒白术各18g,砂仁12g,炙甘草9g,大枣6g),1剂/d,水煎200mL,饭后2h口服;症状消失后,1剂/d,隔日1次;多潘立酮治疗同对照组。连续治疗30d为1疗程。观测临床症状、FPG、2hPG、HbA1c、复发率、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效17例,有效18例,无效3例,总有效率92.11%。对照组显效11例,有效16例,无效11例,总有效率71.05%。治疗组疗效优于对照组(P0.05)。FPG、2hPG及HbA1c两组均有改善(P0.05),治疗组改善优于对照组(P0.05)。[结论]理中化痰丸联合多潘立酮治疗糖尿病胃轻瘫方面效果显著,值得推广。