诺和龙干预空腹血糖异常的临床观察

作者将49例空腹血糖异常（IFG）患者作为对照组，予以控制饮食及运动，干预组56例除上述控制外，应用诺和龙0.5mg三餐时口服3月后复查口服糖耐量试验（OGTT）比较空腹血糖（FBG）、胰岛素（FINS），血压，血脂，尿微量白蛋白排泄率（Uaer）、肝、肾功能，观察诺和龙干预空腹血糖异常（IFG）的可行性、有效性及安全性。结果表明，诺和龙干预IFG简单、有效、安全、可行。     

不同切点空腹血糖受损中老年患者血浆干扰素γ和白介素4变化及其临床意义

目的 探讨辅助性T细胞1型/2型（Th1/Th2）免疫失衡在中老年IFG发病中的作用及与IR的关系.方法 根据FPG及2hPG将381例中老年糖尿病患者分为IFG1、IFG2、IGT、T2DM、糖耐量正常（NGT）组.ELISA检测血浆干扰素γ（IFN-γ）、白介素-4（IL-4）,同时检测胰岛素及HbA1c水平.结果 IFG1、IFG2、IGT组与NGT组比较,胰岛素抵抗指数（HOMA-IR）均增加（P＜0.05）,但3组间差异无统计学意义（P＞0.05）.T2DM组与其他组比较,HOMA-IR差异有统计学意义（P＜0.05）,IFG1、IFG2、IGT、T2DM组胰岛β细胞功能指数（HOMA-β）与NGT组比较均降低（P＜0.05）,IFG2组与IFG1组比较,IFN-γ升高（P＜0.05）,IL-4变化差异无统计学意义（P＞0.05）.结论 中老年IFG人群存在IFN-γ和IL-4升高,HOMA-IR与HOMA-β下降.     

Use of Drugs Related to the Treatment of Diabetes Mellitus and Other Cardiovascular Risk Factors in the Spanish Population. The Di@bet.es Study

Introduction and objectives

To assess the patterns of use of 8 therapeutic drug groups for the treatment of diabetes mellitus and other cardiovascular risk factors, and to identify sociodemographic and health determinants of their use in the overall Spanish population.

Methods

A representative sample of the Spanish population within the Di@bet.es study, a cross-sectional population-based survey, was included. Study variables: sociodemographic, clinical, and lifestyle data; physical examination, and an oral glucose tolerance test in patients without known diabetes mellitus. Furthermore, patients were systematically queried about current medication use, and 8 pharmacotherapeutic groups were evaluated: lipid-lowering therapy, antihypertensives, oral hypoglycemic agents, insulin, thyroid hormone, uricosurics, psychoactive drugs, and nonsteroidal anti-inflammatory drugs.

Results

Sixty-six percent of the Spanish population was taking at least one medication. Therapeutic drug use was associated with age, independently of the higher prevalence of diabetes mellitus, hypertension, or hyperlipidemia in older patients. Sex disparities were found in the use of lipid-lowering agents, allopurinol, levothyroxine, nonsteroidal anti-inflammatory drugs, and psychoactive drugs. Use of psychoactive drugs was related to education level, work status, physical activity, smoking, and alcohol consumption. Almost 30% of patients with diabetes mellitus were taking 6 or more medications daily. Diabetes mellitus was associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs.

Conclusions

Age and sex are the most important factors determining therapeutic drug use. Lifestyle patterns and sociocultural factors have an impact only on psychoactive drug use. Diabetes mellitus is associated with greater use of antihypertensives, lipid-lowering agents, and nonsteroidal anti-inflammatory drugs.     

Prevention of Type 2 diabetes: fact or fiction?

The growing prevalence of Type 2 diabetes with its high morbidity and excess mortality is imposing a heavy burden on healthcare systems. Because of the magnitude of the problem, obviating diabetes has been a long-standing dream. In the last decade, a number of intervention strategies have been shown to be effective for the prevention of diabetes in high-risk populations with prediabetes. Seven studies have now confirmed that lifestyle modifications, including weight-reducing diets and exercise programs, are very effective in precluding or delaying Type 2 diabetes in high-risk populations with impaired glucose tolerance (IGT). Two major trials are the Diabetes Prevention Study (n = 522) from Finland and the Diabetes Prevention Program (n = 3234) from the US. Both studies have shown that intensive lifestyle intervention could reduce the progression of IGT to diabetes by 58%. Furthermore, four currently-available drugs have been established as being effective in preventing diabetes in subjects with prediabetes. The Diabetes Prevention Program revealed that metformin 850 mg b.i.d. reduced the risk of diabetes by 31%. The STOP-NIDDM (Study To Prevent Non-Insulin-Dependent Diabetes Mellitus) trial (n = 1429) showed that acarbose 100 mg t.i.d. with meals decreased the incidence of diabetes by 36% when the diagnosis was based on 2 oral glucose tolerance tests. The XENDOS (Xenical in the Prevention of Diabetes in Obese Subjects) study examined the use of orlistat, an antiobesity drug, as an adjunct to an intensive lifestyle modification program in obese non-diabetic subjects. Orlistat treatment resulted in a 37% decline in the development of diabetes. More recently, the DREAM (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) study (n = 5269) demonstrated that rosiglitazone at 8 mg once/day in subjects with prediabetes (IGT and/or impaired fasting glucose) was effective in reducing the risk of diabetes by 60%. It can be concluded that Type 2 diabetes can be prevented or delayed through lifestyle modifications and/or pharmacologic interventions. This is a fact.     

Increased interleukin-10 but unchanged insulin sensitivity after 4 weeks of (1, 3)(1, 6)-β-glycan consumption in overweight humans

Obesity-induced insulin resistance has been suggested to be a systemic inflammatory condition with activation of the innate immune system. Animal studies indicate that certain dietary fibers such as (1,3)(1,6)-β-d-glycans (BDG) have potent effects on immune activity such as increasing the antiinflammatory cytokine interleukin-10 (IL-10) and reducing the secretion of inflammatory factors. Therefore, we hypothesized that BDG consumption improves inflammatory markers and insulin sensitivity in overweight and obese subjects with moderately increased levels of C-reactive protein, indicating subclinical inflammation. We screened 180 overweight and obese subjects for moderately increased C-reactive protein levels on 2 or more occasions, in the absence of any signs of acute infection. Twelve of the subjects met all inclusion criteria and were investigated in a randomized, double-blind, placebo-controlled, crossover design for 2 × 4 weeks (washout ≥4 weeks). Subjects ingested capsules containing 3 × 0.5 g of highly purified BDG or 3 × 0.5 g of placebo (waxy maize starch) daily. Maintenance of the normal diet of the participants and the correct intake of the capsules were monitored, using 6 × 3-day food recording and counting of the provided capsules. Predefined outcome measures were BDG-induced changes in pro and antiinflammatory markers in circulating blood and gene expression in adipose tissue and peripheral insulin sensitivity expressed as M value. The BDG consumption for 4 weeks significantly increased both circulating levels and adipose tissue messenger RNA (mRNA) expression of the antiinflammatory cytokine IL-10 in overweight and obese humans. Insulin sensitivity as well as circulating levels and mRNA expression of proinflammatory cytokines were unaffected by BDG treatment. Increased IL-10 after BDG consumption might be a contributing factor to the known beneficial effects of dietary fiber intake.     

重庆市9528例体检人群糖代谢特点临床研究

目的:探讨重庆市体检人群血糖水平与糖代谢异常状况及影响因素.方法:根据2003年WHO糖尿病诊断标准将9528例调查对象按病史及空腹血糖分为空腹血糖正常组(NGT组)、空腹血糖受损组(IFG组)和糖尿病组(DM组),了解体检人群中不同性别及不同年龄段糖代谢异常情况,采用多因素Logistic回归分析糖代谢异常与性别、年龄、体重指数(BMI)、血压和脂代谢的相关性.结果:9528例中NGT组8271例(86.81%),IFG组943例(9.89%)、糖尿病组314例(3.30%),其中体检人群男性糖代谢异常率明显高于女性,且随年龄增加空腹血糖水平异常发生有增加趋势(P＜0.0001).糖尿病组四项脂代谢异常的发生率均明显高于正常组,IFG组高TG,TC发生率高于正常血糖组.年龄、BMI、血压和血脂几项因素均对糖代谢异常发生率有显著影响;结论:糖代谢异常在重庆市体检人群中发生率较高.IFG和糖尿病患者脂代谢异常的发生率明显高于正常人.应加强对高危人群的定期体检,通过控制体重、血压、脂代谢异常等的相关因素以利于对糖代谢异常疾病的防治.     

Obstruction increases activation in the right inferior frontal gyrus

The right inferior frontal gyrus (IFG) is involved in intention understanding during interpersonal interactions. To examine how prior experience of cooperation and competition affects one’s right IFG activation in the subsequent interaction, using near-infrared spectroscopy (NIRS) we simultaneously measured paired participants’ bilateral IFG activations during a turn-taking game. Participant pairs were assigned to either one of two roles: a Builder taking the initial move to copy a target disk-pattern on monitor and the Partner taking the second move to aid in (cooperation) or to obstruct (competition) the Builder. The experiment consisted of two sessions. One participant (B-P) played as a Builder (B-) in session 1 and changed the role to the Partner (-P) in session 2, and vice versa for the paired participant (P-B). NIRS data in competition demonstrated that the Builder (B-) being obstructed in session 1 showed higher right IFG activation when (s)he took a role of obstructor (-P) in session 2 (the obstructed effect), whereas “the cooperated effect” was not revealed in cooperation. These results suggest that prior experience of being obstructed may facilitate understanding of the Builder and/or the obstructor’s tactical move, thereby increasing his/her right IFG activation when one is meant to obstruct in subsequent competitions.     

赣州市市直单位2 908成人糖尿病患病率调查研究

目的:调查赣州市市直单位成人的糖尿病患病率.方法:对赣州市公安局、中级法院、赣州市地方税务局等15家单位共2 908例成人进行空腹血糖(FBG)检查,并测量身高、体重,调查生活习惯及体力活动情况,其中FBG≥6.1mmol/L的人群或怀疑诊断者行口服葡萄糖耐量(OGTT)检查.结果:调查中的2 908例,其中糖尿病(DM)138人,糖耐量低减(IGT)194人,空腹血糖调节受损(IFG)134人,所查的糖尿病(DM)、糖耐量低减(IGT)、空腹血糖调节受损(IFG)患病率分别为:4.75%、6.67%、4.61%.其中糖尿病(DM)的患病率30岁以上随着年龄的增加而增高,同时随BMI增加、体力活动减少而升高.结论:赣州市市直单位成人糖尿病患病率为4.75%,肥胖、过多脂肪和蛋白质的摄入、运动量少是赣州市市直单位成人糖尿病的危险因素.     

The local properties of bold signal fluctuations at rest monitor inhibitory control training in adolescents

Inhibitory control (IC) plays a critical role in cognitive and socio-emotional development. Short-term IC training improves IC abilities in children and adults. Surprisingly, few studies have investigated the IC training effect during adolescence, a developmental period characterized by high neuroplasticity and the protracted development of IC abilities. We investigated behavioural and functional brain changes induced by a 5-week computerized and adaptive IC training in adolescents. We focused on the IC training effects on the local properties of functional Magnetic Resonance Imaging (fMRI) signal fluctuations at rest (i.e., Regional Homogeneity [ReHo] and fractional Amplitude of Low Frequency Fluctuations [fALFF]). Sixty adolescents were randomly assigned to either an IC or an active control training group. In the pre- and post-training sessions, cognitive (‘Cool’) and emotional (‘Hot’) IC abilities were assessed using the Colour-Word and Emotional Stroop tasks. We found that ReHo and fALFF signals in IC areas (IFG, ACC, Striatum) were associated with IC efficiency at baseline. This association was different for Cool and Hot IC. Analyses also revealed that ReHo and fALFF signals were sensitive markers to detect and monitor changes after IC training, while behavioural data did not, suggesting that brain functional changes at rest precede behavioural changes following training.