Therapeutic experience with fluconazole in the treatment of fungal infections in diabetic patients

Diabetes mellitus is associated with a higher incidence of certain infections, including fungal infections like rhinocerebral zygomycosis (RCZ) and cutaneous candidosis. As the pathophysiology of increased susceptibility to infection of diabetic patients is very complex, a general therapeutic approach is not existing yet. Appropriate diabetes control remains as the best preventive measure. Nevertheless, effective drug therapy is very often required. Fluconazole has proven efficacy in prophylaxis, treatment and suppressive therapy of both systemic and superficial fungal infections, especially in candidosis and cryptococcosis. Therefore it is used routinely against fungal infections in diabetes (FID). Clinical efficacy of fluconazole against cutaneous candidosis, oropharyngeal candidosis (OPC) and vulvovaginal candidosis (VVC) has been confirmed in more than 100 studies, involving more than 10,000 patients (pts). The overall success rate is 90%, with a mean dosage of 100-200 mg/d. In severe cases, e.g. in OPC in late-stage AIDS pts or in recurrent VVC, higher dosages of up to 800 mg/d may be required. In the treatment of RCZ, therapeutic experience with fluconazole is limited. Four diabetic pts have been treated with dosages of 200-300 mg/d and all of them recovered. Nevertheless, treatment of RCZ should include surgical debridement combined with aggressive antifungal therapy. In conclusion, proven efficacy and the excellent safety profile justify the routine use of fluconazole in the treatment of FID.     

老年2型糖尿病患者冠脉钙化积分与血清护骨素水平的关系

目的探讨老年2型糖尿病患者冠脉钙化积分与血清护骨素水平的相关性。方法 45例老年2型糖尿病住院患者随机分为2组,冠脉钙化积分正常组和冠脉钙化积分异常组,采用两样本t检验比较不同冠脉钙化积分分组间血清护骨素水平的差异,采用多元线性回归分析老年2型糖尿病患者冠脉钙化积分的影响因素。结果老年2型糖尿病患者冠脉钙化积分异常组的血清护骨素水平(4.07±0.61)ng/L高于冠脉钙化积分正常组(2.78±0.59)ng/L,差异有统计学意义(P<0.05),血清护骨素水平、高密度脂蛋白、三酰甘油是冠脉钙化积分的影响因素(P<0.05)。结论血清护骨素水平与老年2型糖尿病患者大血管并发症相关联,护骨素在老年2型糖尿病患者大血管并发症的发生发展中起一定作用。     

Self-efficacy remains a vital factor in reducing the risk of dialysis in type 2 diabetes care

Studies have provided promising outcomes of the pay-for-performance (P4P) program or with good continuity of care levels in diabetes control.We investigate the different exposures in continuity of care (COC) with their providers and those who participate in the P4P program and its effects on the risk of diabetes diabetic nephropathy in the future.We obtained COC and P4P information from the annual database, to which we applied a hierarchical linear modeling (HLM) in 3 levels adjusted to account for other covariates as well as the effects of hospital clustering and accumulating time.Newly diagnosed type 2 diabetes in 2003At the individual level, those with a higher Diabetes Complications Severity Index (DCSI) score have a higher likelihood of diabetic nephropathy than those with a lower DCSI (OR, 1.46), whereas contrasting results were obtained for the Charlson Comorbidity Index (CCI) (odds ratio[OR], 0.88). Patients who visited family physicians, endocrinologists, and gastroenterologists showed a lower likelihood of diabetic nephropathy (OR, 0.664, 0.683, and 0.641, respectively), whereas those who continued to visit neurologists showed an increased risk of diabetic nephropathy by 4 folds. At the hospital level, patients with diabetes visiting primary care clinics had a lower risk of diabetic nephropathy with an OR of 0.584 than those visiting hospitals of other higher levels. Regarding the repeat time level, the patients who had a higher COC score and participated in the P4P program had a reduced diabetic nephropathy risk with an OR of 0.339 and 0.775, respectively.Diabetes control necessitates long-term care involving the patients’ healthcare providers for the management of their conditions to reduce the risk of diabetic nephropathy. Indeed, most contributing factors are related to patients, but we cannot eliminate the optimal outcomes related to good relationships with healthcare providers and participation in the P4P program.     

Evaluation of Time-Course Changes of Gingival Crevicular Fluid Glucose Levels in Diabetics

A minute volume such as a few hundred nano-litres of gingival crevicular fluid (GCF) will evaporate within one minute at room temperature after collection. In order to investigate the feasibility of a method for noninvasive blood glucose measurement using this fluid, a fabricated GCF-collecting device, and the time-course changes of blood and GCF glucose levels in diabetics were evaluated. As a result of improvement in the GCF-collecting device such that the color of a filter paper changed from white to black upon collection of the sample, the completion of the collecting procedure could be visually confirmed. Using this device, we succeeded in collecting 200 nl of GCF within 30 s, despite the fact that GCF is usually secreted at a rate between 2 and 3 l per tooth per hour. This method could be applicable for collecting small volume of other biological fluids. The time-course changes of blood and GCF glucose levels in ten type 2 diabetic subjects were examined, the correlation coefficient, R, between both glucose levels was 0.878. The result proved to be similar to that for normal healthy subjects in a previous study. A significant time difference between the two glucose levels was not observed. In diabetes period of 4.8 ± 1.7 years, the influence of the disease on the GCF glucose level was minimal. Furthermore, from the ROC curve analysis, both sensitivity and specificity showed favorable results. It was suggested that the measurement of GCF glucose levels was a promising screening method for diabetics.     

130例老年2型糖尿病患者长期用药依从性的调查与分析

目的：初步分析老年2型糖尿病患者住院期间及院外继续使用口服降糖药的情况。方法：选取2016年11月-2017年10月在山西省人民医院内分泌科住院的60岁以上的2型糖尿病患者为研究对象,采用调查问卷方式,与患者面对面问答并记录内容;待患者出院后每3个月进行一次电话随访,获取药物使用情况,共随访12个月。借助Logistic回归分析方法预测影响老年2型糖尿病患者长期用药依从性的相关因素。结果：共有130名患者符合纳入标准,用药依从性差在各时间段的表现形式不一致。独居无人监护、家庭月收入<2 500元、服药种类≥3种、用药不良反应是影响老年糖尿病患者用药依从性的独立危险因素。结论：针对老年糖尿病患者,应在出院后7~9个月再次给予详细的用药教育来保证长期用药依从性。不同阶段给予针对性用药宣教,同时还需要家庭和社会的共同支持,才能最终获得更佳的治疗结局。