An Australian cardiovascular risk equation for type 2 diabetes: the Fremantle Diabetes Study

Background: There is no valid cardiovascular disease (CVD) risk prediction equation for Australians with diabetes. The aim of this study is to develop and validate a multivariate risk function for 5‐year cardiovascular risk prediction in Australian type 2 diabetes patients. Methods: The Fremantle Diabetes Study is a community‐based longitudinal observational study. A total of 1240 type 2 diabetic patients (95.8% of the baseline cohort) with all required risk factor data were followed from baseline (1993–1996) for 5 years or until they experienced a cardiovascular event or died, whichever came first. CVD during follow up was defined as hospitalization for/with myocardial infarction or stroke, and death from cardiac or cerebrovascular causes or sudden death. Validation of the algorithm was performed on an independent diabetic cohort from the Busselton Health Study. Results: During 5570 patient‐years of follow up, 185 (14.9%) had at least one CVD event and 175 (14.1%) died (57.7% from CVD). Variables in the final model comprised age, sex, prior CVD, ln(urinary albumin : creatinine ratio), lnHbA_1c, ln(high density lipoprotein‐cholesterol), Southern European ethnic background and Aboriginality. The mean 5‐year predicted risk of a CVD event was 15.5%. Applied to the Busselton cohort, discrimination of the model was good (AUC = 0.84, P < 0.001) as was the goodness‐of‐fit (Hosmer–Lemeshow Ĉ‐test, P= 0.85) and accuracy (mean squared error (95% confidence interval) = 0.09 (0–0.76)). The positive and negative predictive values for a 10% 5‐year CVD risk cut‐off were 23.4% and 97.7% respectively. Conclusion: This simple diabetes‐specific 5‐year CVD risk equation is the first validated, population‐based Australian model. It should have a role in diabetes management in primary and specialist care.     

Abnormal glucose tolerance in a pediatric cystic fibrosis cohort: Trends in clinical outcomes and associated factors in the preceding years

Background and aimsDeterioration of anthropometric and lung function parameters was shown to precede the onset of cystic fibrosis-related diabetes (CFRD) in adults. In children, studies have been conducted in small cohorts with relatively short observation period. Study objectives were to document the longitudinal trends of anthropometric, pulmonary, nutritional and metabolic parameters from cystic fibrosis (CF) diagnosis to the ascertainment of abnormal glucose tolerance and identify parameters associated with the incidence of such abnormalities in a pediatric CF cohort.Methods and resultsRetrospective cohort study of 281 children with CF. Longitudinal trends of anthropometric, lung function, nutritional and metabolic data were generated from CF diagnosis to the ascertainment of abnormal glucose tolerance defined as the presence of either impaired glucose tolerance (IGT), unconfirmed CFRD or CFRD. Cox models and Kaplan–Meier curves were used to identify factors associated with developing abnormal glucose tolerance.Forty-five percent of cohort had normal glucose tolerance (NGT), 27% IGT, 10% unconfirmed CFRD and 18% CFRD. Children who developed CFRD displayed lower height z-scores from a very early age. Conversely, HbA1c levels began to rise closer to CFRD ascertainment. Height z-scores (HR: 0.45; CI 95% [0.29–0.69]) and HbA1c (HR: 2.43; CI 95% [1.86–3.18]) in years preceding ascertainment were associated with the risk of developing CFRD.ConclusionChildren who developed CFRD display distinctive trends for height z-scores from a very early age, whereas HbA1c appears as a marker of established glucose metabolism derangements.     

社区居住的老年糖尿病患者的营养状态评估

目的本研究拟探索社区居住的老年糖尿病患者的营养状况,并与非糖尿病老年人进行比较。方法纳入2013年至2014年在北京香河园社区居住的老年人820名为研究对象,依据是否患糖尿病分为2组:糖尿病组(n=170)和非糖尿病组(n=650)。该研究由接受过问卷调查培训并通过考核的研究助理在社区卫生服务中心或入户对老年人进行面对面访视。应用老年医学疾病累积评分量表(CIRS-G)进行慢病评分。应用微营养评估简表(MNA-SF)进行营养评估。依据体质量指数(BMI)不同,将糖尿病组患者分为5个亚组,与MNA-SF的营养评估结果进行χ~2分析。采用SPSS 20.0软件进行数据处理。结果 820名研究对象年龄65～97(75.4±6.7)岁,患病数(4.7±3.3)种,其中727名(88.7%)老年人可生活自理,其余可半自理。糖尿病组的CIRS-G评分显著高于非糖尿病组[(6.38±3.67)vs(4.28±3.09)分,P0.001]。糖尿病组和非糖尿病组营养不良(5.9%vs 6.3%)和营养不良风险(48.2%vs 45.8%)的发生率差异均无统计学意义(P0.05)。糖尿病组超重(38.2%vs 34.5%)和肥胖(19.4%vs 13.8%)的发生率均显著高于非糖尿病组(P0.05)。各糖尿病亚组患者营养状态与BMI水平差异无统计学意义(χ~2=10.394,P=0.238)。结论社区糖尿病老年人的营养不良发生率与非糖尿病的老年人无明显不同,约半数糖尿病老年人存在营养不良风险。糖尿病患者营养状态与BMI水平无明显相关性。     

银丹心脑通软胶囊治疗高脂血症合并糖尿病的Meta分析

目的系统评价银丹心脑通软胶囊治疗高脂血症合并糖尿病的疗效。方法计算机检索Cochrane图书馆、PubMed、EMbase、MedLine、CNKI、CBM、VIP、万方等数据库,纳入相关随机对照试验(RCT),进行质量评价,采用RevMan5.3软件分析数据。结果纳入8篇RCTs,共1272例受试者。与对照组比较,试验组血脂总疗效较高[RR=1.27,95%CI(1.16,1.39),P<0.00001],总胆固醇(TC)水平低于对照组[WMD=-1.32,95%CI(-1.74,-0.90),P<0.00001],三酰甘油(TG)水平低于对照组[WMD=-0.62,95%CI(-0.79,-0.45),P<0.00001],高密度脂蛋白胆固醇(HDL-C)水平高于对照组[WMD=0.32,95%CI(0.27,0.37),P<0.00001],低密度脂蛋白胆固醇(LDL-C)水平低于对照组[WMD=-0.65,95%CI(-0.83,-0.47),P<0.00001];试验组空腹血糖水平低于对照组[WMD=-1.27,95%CI(-1.54,-1.00),P<0.00001],餐后2h血糖水平低于对照组[WMD=-3.67,95%CI(-5.07,-2.28),P<0.00001],糖化血红蛋白水平低于对照组[WMD=-1.89,95%CI(-3.13,-0.64),P=0.003]。结论银丹心脑通软胶囊治疗高脂血症合并糖尿病疗效明显,能够有效改善血脂、血糖,对合并二甲双胍亚组TC、LDL-C、空腹血糖及合并常规治疗亚组的空腹血糖疗效相对确切。     

一年期低能量饮食对肥胖2型糖尿病患者胰岛素治疗后干预的影响研究

[摘要]目的：分析一年期低能量饮食对肥胖2型糖尿病患者胰岛素治疗后干预的影响。方法：回顾性分析236例体重指数(BMI)≥28 kg·m-2的2型糖尿病患者的临床资料,根据是否采取一年期低能量饮食进行分组;对照组占48.73%(115/236),采取普通糖尿病饮食;观察组占51.27%(121/236),采取一年期低能量饮食;对比两组患者治疗前后的体重、血压(收缩压、舒张压)、空腹血糖、空腹胰岛素、糖化血红蛋白、血脂(低密度脂蛋白、高密度脂蛋白L)、血尿酸、γ-谷氨酰转肽酶,并以体重变化值、体重变化百分率、用药情况(双胍类和磺脉类降糖药用量、停药率)作为观察指标。结果：治疗前,两组体重、血压、空腹血糖、空腹胰岛素、糖化血红蛋白、血脂、血尿酸、γ-谷氨酰转肽酶水平差异不显著(P＞0.05);治疗后,观察组体重轻于对照组,收缩压、舒张压、空腹血糖、空腹胰岛素、糖化血红蛋白、低密度脂蛋白、血尿酸、γ-谷氨酰转肽酶水平均低于对照组,高密度脂蛋白水平高于对照组,差异显著(P＜0.05);观察组体重变化值、体重变化百分率、停药率均大于对照组,双胍类和磺脉类降糖药用量均少于对照组,差异显著(P＜0.05)。结论：一年期低能量饮食对肥胖2型糖尿病患者胰岛素治疗后干预的效果显著,有效减轻患者的体重,改善代谢综合征,且减少降糖药用量,值得临床推广使用。 关键词：2型糖尿病;肥胖;低能量饮食;代谢综合征     

Incretin mimetics as a novel therapeutic option for hepatic steatosis.

BACKGROUND: Fat accumulation in the liver or non-alcoholic fatty liver disease (NAFLD) is regarded as a key pathogenic factor and component of the metabolic syndrome. It was reported that administration of the incretin mimetic exenatide reversed hepatic steatosis in an obese mouse model. We had the opportunity to study the effect of additional exenatide administration on liver fat content in a patient with type 2 diabetes. CASE REPORT: A 59-year-old male with poorly controlled type 2 diabetes was treated with exenatide in addition to metformin monotherapy. Following 44 weeks of exenatide therapy, mean the liver fat measured by liver spectroscopy declined from 15.8% to 4.3%. This dramatic decrease in liver fat was accompanied by significant beneficial changes in several cardiovascular disease risk factors and improvement of all liver enzymes, in particular alanine aminotransferase, the most important marker of liver steatosis. CONCLUSION: This case report suggests that the incretin mimetic exenatide decreases hepatic fat accumulation and may play a role in the future treatment of NAFLD, and the associated insulin resistance and cardiovascular risk factors in an ever-growing high-risk population.     

A paired-sibling analysis of the XbaI polymorphism in the muscle glycogen synthase gene

Abstract Aims/hypothesis. We have previously shown an association between a XbaI polymorphism in the muscle glycogen synthase gene (GYS1) and both Type II (non–insulin–dependent) diabetes mellitus and hypertension. Association studies are, however, hampered by the selection of the control group. To circumvent these problems we addressed the same question using a novel genotype discordant paired-sibling approach. Methods. We identified 122 sex-matched sib-pairs discordant for the Xba1 polymorphism among a new set of 743 Finnish subjects from 227 families with Type II diabetes and paired analyses were done by McNemar test of symmetry and by permutation tests. Results. Paired analysis showed that siblings with the A2 variant had more hypertension (p = 0.0067), obesity (p = 0.033) and microalbuminuria (p = 0.031) but not significantly more Type II diabetes (p = 0.27) than siblings with the A1 variant. Siblings with the A2 variant were more often treated by insulin (p = 0.050) or anti-hypertensive medication (p = 0.0060) or both. Diabetic A2 variant carriers had higher triglyceride (p = 0.023) and lower HDL cholesterol (p = 0.0059) concentrations and an earlier age at onset of diabetes (p = 0.022) than diabetic siblings with the A1 variant. In non-diabetic sib-pairs the presence of the A2 variant was associated with higher diastolic (p = 0.0014) blood pressure. Finally, the allele frequency of the XbaI polymorphism differed between 216 randomly chosen unrelated Type II diabetic patients and 115 unrelated healthy control spouses without a family history of Type II diabetes (12.7 vs. 6.5 %, p = 0.013). Conclusion/interpretation. The A2 allele of the XbaI polymorphism in the GYS1 confers an increased susceptibility to different features of the metabolic syndrome and Type II diabetes. [Diabetologia (1999) 42: 1138–1145] Received: 22 January 1999 and in final revised form: 21 April 1999     

Incidence of type 2 diabetes in southern Spain (Pizarra Study)

Background Few European studies have used an oral glucose tolerance test (OGTT) to examine the incidence of type 2 diabetes. We determined the incidence of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes in a population from southern Spain. Material and methods A population‐based cohort study was undertaken in Pizarra, Spain. Baseline data were recorded on age, sex, weight, height, waist and hip circumferences, and diabetes status for 1051 persons, of whom 910 were free of type 2 diabetes (at‐risk sample). Of these, 714 completed the 6‐year follow‐up study. Body mass index, waist‐to‐hip ratio and weight increase since baseline were calculated. The homeostasis model assessment equations were used to estimate the indices of insulin resistance and β‐cell function. Each person received an OGTT at baseline and after 6 years. Results Type 2 diabetes developed in 81 people for a total of 4253 person‐years, representing an incidence of 19·1 cases per 1000 person‐years (95% confidence interval, 15·3–23·6). Age and the presence of obesity, central obesity and carbohydrate metabolism disorders [IFG (cut off = 100 mg dL^?1, capillary blood glucose level), IGT or both] at baseline were significant markers for the onset of type 2 diabetes during follow‐up. After adjusting for these variables, multivariate analysis showed weight increase, waist‐to‐hip ratio and the indices of insulin resistance and β‐cell function were significantly associated with the risk for type 2 diabetes. Conclusions The incidence of type 2 diabetes in a population from southern Spain is high. It is probably associated with the high prevalence of obesity and weight increase in this population.