The Evidence Base for Diabetes Technology: Appropriate and Inappropriate Meta-Analysis

When we are interested in making decisions about best use, comparative therapeutic efficacy, or cost-effectiveness of diabetes technologies such as insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] or continuous glucose monitoring, meta-analysis for the purpose of literature summary is inappropriate and may be misleading. Instead, “decision-making meta-analysis” is more appropriate and should involve either preselection of trials based on intended use [e.g., elevated baseline hemoglobin A1c or hypoglycemia rate for trials of multiple daily injections (MDI) versus CSII] or metaregression of summary effect sizes in different trials against potential effect-modifying covariates such as baseline risk, or models of the covariates that determine effect size using individual patient data. Appropriate meta-analysis should also only include trials that are of sufficient duration to accurately measure outcomes such as severe hypoglycemia, and they should not use obsolete technology that is of proven inferiority to current technology. The use of appropriate decision-making meta-analysis is illustrated by the change in the rate ratio for severe hypoglycemia in randomized controlled trials of MDI versus CSII in type 1 diabetes from 1.56 (95% confidence interval 0.96–2.55; p = .074) for literature-summary meta-analysis to 2.0 (1.08–3.69; p = .027) for decision-making meta-analysis of all patients and 3.91 (1.35–11.36; p = .01) for trials in children.     

妊娠期糖尿病孕妇应用胰岛素对血糖控制及母婴结局影响的观察

目的对妊娠期糖尿病孕妇采用胰岛素治疗,观察其对血糖控制及母婴结局的影响.方法200例妊娠期糖尿病孕妇分为对照组和观察组,各100例,对照组采用运动及饮食治疗,观察组在对照组治疗基础上采用胰岛素皮下注射,观察两组孕妇血糖控制情况及妊娠结局.结果空腹血糖和餐后2h血糖控制满意率观察组96.00%和89.00%,对照组76.00%和65.00%,观察组明显高于对照组（P〈0.05）.妊高征观察组7例（7.00%）,对照组28例（28.00%）;剖宫产观察组25例（25.00%）,对照组40例（40.00%）;胎膜早破观察组3例（3.00%）,对照组22例（22.00%）;新生儿窒息观察组1例（1.00%）,对照组5例（5.00%）;新生儿低血糖观察组5例（5.00%）,对照组26例（26.00%）;胎儿畸形观察组2例（2.00%）,对照组18例（18.00%）.观察组孕妇空腹血糖和餐后2h血糖控制满意率均明显高于对照组（P〈0.05）,妊娠结局明显改善（P〈0.05）.结论对妊娠期糖尿病孕妇采用胰岛素治疗,血糖水平能得到较好的控制,且能改善妊娠结局.     

地震期间急诊救治糖尿病酮症酸中毒伴高渗性昏迷1例

患者,男,19岁,身高175cm,体重100kg,系甘孜人。在雅安芦山"4.20"地震期间,因长途坐车,进食少、多次大量饮用冰糖雪梨等含糖高的饮料后,出现疲倦、四肢无力,自行休息,约4h后,上述症状无缓解并出现口渴、厌食、不能自行行走,家人带其至一家私人诊所治疗,给予其"生脉口服液"治疗,效差,患者晕倒。我院120接诊,给氧、建立     

Editorial on hemoglobin A1c, blood pressure, and lowdensity lipoprotein cholesterol goals in diabetics

The American Diabetes Association (ADA) 2013 guidelines state that a reasonable hemoglobin A1c goal for many nonpregnant adults with diabetes is less than 7.0% a hemoglobin A1c level of less than 6.5% may be considered in adults with short duration of diabetes, long life expectancy, and no significant cardiovascular disease if this can be achieved without significant hypoglycemia or other adverse effects of treatment. A hemoglobin A1c level less than 8.0% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced macrovascular and microvascular complications, extensive comorbidities, and long-standing diabetes in whom the hemoglobin A1c goal is difficult to attain despite multiple glucoselowering drugs including insulin. The ADA 2013 guidelines recommend that the systolic blood pressure in most diabetics with hypertension should be reduced to less than 140 mmHg. These guidelines also recommend use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in the treatment of hypertension in diabetics unless they are pregnant. Diabetics at high risk for cardiovascular events should have theirserum low-density lipoprotein (LDL) cholesterol lowered to less than 70 mg/dL with statins. Lower-risk diabetics should have their serum LDL cholesterol reduced to less than 100 mg/dL. Combination therapy of a statin with either a fibrate or niacin has not been shown to provide additional cardiovascular benefit above statin therapy alone and is not recommended. Hypertriglyceridemia should be treated with dietary and lifestyle changes. Severe hypertriglyceridemia should be treated with drug therapy to reduce the risk of acute pancreatitis.     

Diabetes is associated with high risk of severe adverse events during chemotherapy for cancer patients: A single-center study

Diabetes mellitus (DM) is a common comorbidity among cancer patients, but its impact on chemotherapy tolerance has not been widely studied. We aimed to compare the occurrence of severe grade 3/4 adverse events (G3/4 AEs) within 90 days of starting chemotherapy between patients with and without diabetes. We conducted a retrospective single-center study in Lille University Hospital Oncology Department, France. Patients who received the first cycle of chemotherapy for gastrointestinal, gynecological or cancer of unknown primary source between 1 May 2013 and 1 May 2016, were included. Overall, 609 patients were enrolled: 490 patients without diabetes (80.5%) and 119 patients with diabetes (19.5%). Within 90 days of starting chemotherapy, patients with diabetes had a significantly higher occurrence of AEs G3/4 compared to those with no diabetes (multivariate odds ratio [OR]: 1.57 [1.02-2.42], P = .04). More frequent G3/4 AEs in patients with diabetes were infection (26%), hematological disorders (13%), endocrine disorders (13%) and deterioration of the general condition (13%). In the year following the beginning of chemotherapy, patients with diabetes were twice as likely to be hospitalized as those without diabetes (univariate OR: 2.1 [1.40-3.15], P = .0003). After multivariate adjustment, diabetes was no longer significantly associated with the risk of hospitalization (P = .051). There were no differences between patients with and without diabetes regarding dose reduction and chemotherapy treatment delays (P = .61 and P = .30, respectively). Our study suggests the need for better consideration of DM in the personalized care plan to improve chemotherapy tolerance and quality of life of patients with DM.     

Effects of combination of zinc and vitamin A supplementation on serum fasting blood sugar,insulin, apoprotein B and apoprotein A-I in patients with type I diabetes

Background and aim There is accumulating evidence that shows the metabolism of zinc and vitamin A are altered in diabetes mellitus type I (DMTI), thus the present study was conducted to evaluate the effects of combination of zinc and vitamin A supplementation on serum fasting blood sugar (FBS), insulin, apoprotein B and apoprotein A-I in patients with DMTI.

Design Forty-eight, 7-year-old to 20-year-old patients with at least 2 years of DMTI history, without any metabolic condition or medicine intake with insulin treatment, participated in a randomized double-blind clinical trial for 12 weeks. They were divided into zinc and vitamin A (VAZ)-supplemented (10 mg elemental zinc per day and one-half of a 25,000 IU vitamin A tablet every other day) and/or placebo groups after matching for sex, age and DMTI duration. Nutrient intake was estimated using 24 h recall and was analyzed by food processor program. Serum apoproteins B and A-I, FBS and insulin levels were determined at the beginning and end of the trial.

Results There was significant increase in apoprotein A-I (P <?0.0001) and a significant decrease in apoprotein B (P <?0.0001) and apoprotein B/apoprotein A-I ratio (P <?0.0001) at the end of the study compared with baseline values in the VAZ group but apoprotein A-I had a significant increase (P <?0.0001) and the apoprotein B/apoprotein A-I ratio had a significant decrease (P = 0.02) at the end of study in the VAZ group compared with the control group

Conclusion It seems that combined zinc and vitamin A supplementation can improve serum apoprotein A-I, apoprotein B and the apoprotein B/apoprotein A-I ratio in patients with DMTI.     

糖尿病患病时间长短对老年患者术后认知功能的影响

目的探讨糖尿病患者患病时间长短对老年患者全身麻醉下行妇科手术后认知功能的影响。方法择期经全身麻醉下行妇科手术的糖尿病患者90例,ASAI～Ⅱ级,年龄65～80岁,按患糖尿病时间长短分为10年以上组(A组),5～9年组(B组),5年及其以下组(C组),各组均30例。用简易智能量表(MMSE)评估术前、术后8h、24h、3d的认知功能。结果三组患者术后24 h发生认知功能障碍比率分别为16.67%(5/30)、6.67%(2/30)和3.33%(1/30),差异有统计学意义(P<0.05)。结论糖尿病患病时间长术后发生认知功能障碍的比率明显高于糖尿病患病时间短的患者。