格列美脲联合胰岛素治疗2型糖尿病的临床观察

目的评价格列美脲联合胰岛素对2型糖尿病（T2DM）的临床疗效。方法 T2DM患者64例,均为单用胰岛素血糖控制欠佳者,随机分为观察组和对照组,观察组加用格列美脲2~4 mg/d,根据血糖调整胰岛素用量;对照组继续应用胰岛素治疗,并根据血糖加大剂量。12周后观察治疗前后空腹血糖（FBG）、餐后2 h血糖（2 hBG）、糖化血红蛋白（HbA1c）、体重指数（BMI）、每日胰岛素用量变化以及药物不良反应。结果治疗后观察组FBG、2 hBG、HbA1c较对照组明显降低,胰岛素用量减少（P〈0.05）;所有入选者共发生低血糖6例,其中观察组2例,对照组4例。结论 T2DM单用胰岛素血糖控制不佳者,加用格列美脲可显著改善血糖控制,低血糖发生率低,并可减少胰岛素用量。     

化学发光免疫分析测定胰岛素及C肽在2型糖尿病诊断中的临床应用

应用化学发光免疫分析测定50例2型糖尿病患者及30名正常人血清胰岛素和C肽含量并对测定结果进行分析,了解糖尿病患者糖代谢和胰岛β细胞的功能。结果显示,2型糖尿病患者空腹胰岛素和C肽高于正常人（P＆lt;0.05）,餐后1h对照组出现峰值,餐后2h糖尿病组达到高峰,餐后3h仍不能恢复至正常水平。结论：化学发光免疫分析检测胰岛素及C肽可用于临床,帮助糖尿病分型,判断病情严重程度及指导治疗。     

Efficacy of Topical Ofloxacin 0.3 % Administration on Conjunctival Bacterial Flora in Diabetic Patients Undergoing Intravitreal Injections

Purpose: This prospective, randomized case series study aims to evaluate the efficacy of ofloxacin 0.3% eye drops in eradication of conjunctival bacterial flora in diabetic patients undergoing intravitreal injections (IVI). Methods: Ninety-two diabetic patients (92 eyes) scheduled to undergo intravitreal injection of ranibizumab due to diabetic macular edema were enrolled in the study. Patients were randomly assigned to three different groups. Group 1 (n=32) received ofloxacin eye drops the day before before IVI (four times); patients in Group 2 (n=29) were administered ofloxacin one hour before IVI (every 15 minutes), while Group 3 (n=31) comprised patients that received combined administration of ofloxacin both one day and one hour before IVI (eight doses). Samples were collected from the injection site before and after antibiotic administration. Culture results from BACTEC broth and positive cultures in blood agar and Sabouraud’s dextrose agar plates were measured. Results: In Group 1, BACTEC broth positive cultures decreased from 84.4% at baseline to 50% after ofloxacin administration (p=0.007), and blood agar positive cultures reduced from 65.63% to 34.38% (p=0.02). In Group 2, positive cultures significantly decreased in BACTEC broth (from 79.3% at baseline to 48.28%; p=0.027) and in blood agar (from 68.97% to 37.13%; p=0.034). In Group 3, positive cultures decreased from 77.42% at baseline to 32.26% (p=0.0008) and from 58.06% at baseline to 22.58% (p=0.009) in BACTEC broth and blood agar, respectively. No microorganisms were isolated from Sabouraud’s dextrose agar plates. Conclusions: The combined one day/one hour (eight doses) ofloxacin administration in diabetic patients is extremely effective in reducing conjunctival bacterial flora. The application of topical ofloxacin for one day or one hour before IVI is also significantly effective.     

并发症体验对2型糖尿病患者疾病态度及血糖控制水平的影响

目的 探讨并发症体验对2型糖尿病患者对疾病态度、血糖控制水平的影响,为糖尿病临床护理提供参考依据。方法 方便选取125例2型糖尿病患者分为干预组（61例）和对照组（64例）。2组患者均给予2型糖尿病常规护理,同时干预组给予糖尿病并发症体验干预。对2组患者在入院时、出院时、出院后1个月、3个月、6个月5个时间点的疾病态度、糖化血红蛋白值进行比较。结果 共125例患者完成研究,干预后2组患者对疾病态度差异均有统计学意义（P<0.05）,在出院后3个月、6个月2组患者的糖化血红蛋白值差异有统计学意义（P<0.05）。结论 体验式学习可以改善2型糖尿病患者对疾病的态度,对控制患者的血糖水平具有明显效果。     

糖尿病患者行腔内激光闭合术联合高位结扎术治疗大隐静脉曲张临床分析

目的探讨2型糖尿病患者行腔内激光闭合术（endovenous laser treatment,EVLT）联合高位结扎术治疗大隐静脉曲张的可行性、安全性及有效性。方法分别对采用EVLT联合高位结扎术治疗的45例（52条肢体）合并2型糖尿病患者及同期45例（51条肢体）非糖尿病大隐静脉曲张患者的临床资料进行回顾性分析,并比较2组术前、术中及术后的情况。结果2组手术均获成功,症状缓解率100％,无下肢深静脉血栓形成、切口感染等。手术时间、住院天数、术后并发症等方面2组间差异无统计学意义（P〉0．05）。随诊1～4年,2组均无复发。结论腔内激光闭合联合高位结扎术治疗合并2型糖尿病的大隐静脉曲张患者安全、有效。围手术期必须严格控制血糖,术中需按操作规程施术,尽量避免各种并发症的发生。     

Untersuchungen zum Wirkungsmechanismus der kombinierten Gabe von Glibenclamid und Insulin bei Typ-II-Diabetikern mit Sekundärversagen auf die orale Behandlung

Summary In a double-blind placebo-controlled cross-over study eight type II diabetics (three men, five women), of whom six were at the point of late failure to oral treatment, were given an insulin infusion of 22 U human insulin/patient for 45 min (7 mU/kg × min); 30 min before infusion either glibenclamide (1 tablet Euglucon N) or placebo was administered. Glucose in venous blood, C-peptide, insulin, and glibenclamide concentrations in the blood plasma were simultaneously determined over a period of 210 min. The monitoring of glucose was handled using a Biostator.The insulin level reached a mean maximum of 400 to 500 µU/ml and was in a behavior of 100 µU/ml for 60 min. The areas under the concentration-time curves (AUCs) were practically identical in the two regimes. The blood glucose fell (in mean) from 260 mg/dl to 135 mg/dl and at the end of the experiment was in the range of 155 mg/dl. The glibenclamide concentrations reached maximal concentrations of 185 ng/ml 90 min after administration. The C-peptide concentrations fell in the placebo phase by more than 40%. In contrast, in the glibenclamide period there was at first a slight rise and later a slight marginal fall (initial, 2.0 ng/ml vs 1.9 ng/ml; 60 min, 1.3 ng/ml vs 1.8 ng/ml; 180 min, 1.2 ng/ml vs 1.8 ng/ml). Values after 90, 120, and 180 min were statistically different. The AUCs (0–180 min) were different (329 ng × min/ml vs 251 ng × min/ml). The inhibition of insulin secretion (measured by C-peptide) caused by exogenous insulin administration is largely abolished by glibenclamide. This mechanism could be a major cause for the reduction of the insulin requirement in type II diabetics that has been shown in numerous clinical studies during simultaneous treatment with glibenclamide.

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Abkürzungsverzeichnis C-Peptid Connectiv.-Peptid - AuC Fläche unter der Kurzve - SH Sulfonylharnstoffe - RIA radioimmunologische Bestimmung - HbA₁ glukosiliertes Hämoglobin Der Beitrag enthält Teile der Inaugural-Dissertation von Janet Klujko über Der Einfluß von Glibenclamid und Insulin auf die endogene Inselfunktion beim Typ II-Diabetes im doppelblinden Akutversuch, Fakultät für klinische Medizin Mannheim der Universität Heidelberg, 1984     

三维超声心动图对糖尿病患者的左心功能检测

运用三维超声心动图检测６５例人群（正常组２８例，糖尿病组２０例，糖尿病伴高血压组１７例）的左心功能，与正常组比较，糖尿病组和糖尿病伴高血压组的左室射血分数及舒张分数降低（ＬＶＥＦ Ｐ〈０．０１；ＬＶＲＦ Ｐ〈０．０５）；糖尿病组的累积局部收缩率占左室面积百分率与正常组相似，糖尿病伴高血压组较正常组低收缩段所占面积增加（Ｐ〈０．０５），而高收缩段所占面积减少（Ｐ〈０．０５）。与糖尿病组比较；糖尿病伴     

糖耐量减低及新诊断糖尿病人的特征比较

为探讨糖耐量减低（ＩＧＴ）和新诊断糖尿病人的临床特征,分析了１５５９例进行ＯＧＴＴ检查者中的３５０例ＩＧＴ和２５４例新诊断糖尿病人的多项临床指标,并与年龄、性别相匹配的３８０例糖耐量正常（ＮＧＴ）者以及既往已经诊断的１１９例老糖尿病人相比较。结果显示：ＩＧＴ组的血糖、血压、ＢＭＩ、甘油三酯、胰岛素水平都明显高于ＮＧＴ组,其高血压和肥胖的患病率均为ＮＧＴ组的１．４５倍。新诊断的糖尿病组由于未予临床干预治疗,其高血压患病率高达５１．１８％,冠心病患病率１７．３２％,其ＢＭＩ、收缩压、舒张压、胆固醇、甘油三酯、尿白蛋白、胰岛素水平都略高于老糖尿病组,因而这是一组急需早日诊断、及时干预治疗的临床危险人群     

Telemedicine Technologies for Diabetes in Pregnancy: A Systematic Review and Meta-Analysis

BackgroundDiabetes in pregnancy is a global problem. Technological innovations present exciting opportunities for novel approaches to improve clinical care delivery for gestational and other forms of diabetes in pregnancy.ObjectiveTo perform an updated and comprehensive systematic review and meta-analysis of the literature to determine whether telemedicine solutions offer any advantages compared with the standard care for women with diabetes in pregnancy.MethodsThe review was developed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework. Randomized controlled trials (RCT) in women with diabetes in pregnancy that compared telemedicine blood glucose monitoring with the standard care were identified. Searches were performed in SCOPUS and PubMed, limited to English language publications between January 2000 and January 2016. Trials that met the eligibility criteria were scored for risk of bias using the Cochrane Collaborations Risk of Bias Tool. A meta-analysis was performed using Review Manager software version 5.3 (Nordic Cochrane Centre, Cochrane Collaboration).ResultsA total of 7 trials were identified. Meta-analysis demonstrated a modest but statistically significant improvement in HbA1c associated with the use of a telemedicine technology. The mean HbA1c of women using telemedicine was 5.33% (SD 0.70) compared with 5.45% (SD 0.58) in the standard care group, representing a mean difference of −0.12% (95% CI −0.23% to −0.02%). When this comparison was limited to women with gestational diabetes mellitus (GDM) only, the mean HbA1c of women using telemedicine was 5.22% (SD 0.70) compared with 5.37% (SD 0.61) in the standard care group, mean difference −0.14% (95% CI −0.25% to −0.04%). There were no differences in other maternal and neonatal outcomes reported.ConclusionsThere is currently insufficient evidence that telemedicine technology is superior to standard care for women with diabetes in pregnancy; however, there was no evidence of harm. No trials were identified that assessed patient satisfaction or cost of care delivery, and it may be in these areas where these technologies may be found most valuable.     

2型糖尿病对雄性小鼠听觉功能及内耳Otoferlin、VGLUT3、Myosin Ⅶa蛋白表达的影响Myosin Ⅶa蛋白表达的影响

目的　观察2型糖尿病对雄性小鼠听觉功能,静纤毛超微结构和耳畸蛋白（Otoferlin）、囊泡谷氨酸转运体3（vesicle glumate transporter,VGLUT3）、肌球蛋白 Ⅶa（MyosinⅦa）蛋白表达的影响。方法　按体重将12只6周龄雄性C57BL/6J小鼠随机分为两组（对照组和糖尿病组,n=6）。对照组小鼠食用饲料含铁量为(8.26±67)mg/kg,糖尿病组小鼠食用饲料含铁量为(8.39±03)g/kg。在实验开始前及实验第4、8、12、16周时测定小鼠血糖,实验第16周时测定葡萄糖耐量及胰岛素耐量,测定听觉诱发电位。分离左侧耳蜗基底膜,用免疫荧光法观察Otoferlin、VGLUT3与Myosin Ⅶa在内外毛细胞的定位与分布。分离右侧半数耳蜗用作western blot分析蛋白表达,另外半数耳蜗分离基底膜,用扫描电镜观察内毛细胞静纤毛形态。结果　实验第8、12、16周,糖尿病组小鼠血糖水平升高,与对照组比较差异有显著性意义(P<0.05）。糖尿病组小鼠糖耐量减弱,胰岛素抵抗指数升高,与对照组比较差异有显著性意义(P<0.05）。糖尿病组小鼠听力诱发电位阈值在刺激频率为2和3 kHz时升高,与对照组比较差异有显著性意义(P<0.05）。糖尿病组小鼠内毛细胞静纤毛排列正常,未见紊乱及数目减少;糖尿病组Otoferlin在内毛细胞底部表达减少,与对照组比较差异有显著性意义(P<0.05）。 结论型糖尿病致雄性小鼠听觉功能损伤,可能与Otoferlin 蛋白在耳蜗毛细胞中表达下调有关。