Facilitating access to glucometer reagents increases blood glucose self-monitoring frequency and improves glycaemic control: a prospective study in insulin-treated diabetic patients.

AIMS: To investigate whether availability of glucometer reagents increases the frequency of self-blood glucose monitoring (SBGM) and improves glycaemic control in diabetic patients. METHODS: Sixty-two insulin-treated diabetic patients were randomized to two groups, matched for age, gender, education, income, type and duration of diabetes, years of insulin treatment, number of daily insulin injections, and haemoglobin (Hb)A1c. All patients were given a glucometer, but one group (no cost, NC) was provided glucometer test strips free of charge. The other group (control, C) had to purchase strips as they found it necessary. Both groups of patients were followed longitudinally at 2-monthly intervals for 12 months with measurement of blood glucose and HbA1c, and the frequency of SBGM was determined by downloading the glucometer memory. RESULTS: The SBGM frequency was significantly higher in the NC group vs. the C group during the first 4 months (2.0 +/- 0.2 tests/day vs. 1.4 +/- 0.1 tests/day, P<0.025). Mean HbA1c remained stable over the 12 months in the NC group, whereas an increase with time was observed in the C group. The difference in HbA1c between the two groups was significant (P<0.002) after 6 months. Random blood glucose measured at each visit and average glucose recorded by the glucometer were also lower in the NC group vs. the C group (P<0.005). There was a negative correlation between HbA1c and SBGM frequency, and HbA1c in patients testing at least twice a day was lower than in those testing less than twice a day (8.8 +/- 0.2% vs. 9.6 +/- 0.2%, P<0.001). CONCLUSIONS: In this prospective study, having easy access to glucometer strips provided free of charge to patients increased SBGM frequency. The relationship between HbA1c and SBGM frequency supports the view that SBGM is an essential tool in diabetes management.     

Comparison of the diagnostic criteria for diabetes mellitus, WHO-1985, ADA-1997 and WHO-1999 in the adult population of Asturias (Spain).

AIMS: To estimate the prevalence of diabetes mellitus with three diagnostic criteria (WHO-1985 and 1999 and ADA-1997), evaluate their concordance and analyse the sensitivity and specificity of the different screening strategies for diabetes. METHODS: A cross-sectional population study with two-step sampling. One thousand and 34 people were selected randomly. A 75-g oral glucose tolerance test (OGTT) was performed and venous blood samples were obtained fasting and at 2 h. RESULTS: The prevalence of known Type 2 diabetes mellitus (DM-2) is 4%[95% confidence interval (CI) 2.8, 5.1]. By WHO-1985 criteria the prevalence of unknown DM-2 is 5.9% (4.5, 7.4); by ADA-1997 criteria 3.5% (2.5, 4.6) and by WHO-1999 criteria 7.3% (5.8, 8.8). Diagnostic overlap and statistical concordance (coefficient K) are WHO-1985/ADA-1997 29.3%, K=0.42; WHO-1985/WHO-1999 80%, K=0.88; ADA-1997/WHO-1999 48%, K=0.63. If only fasting glucose was used (following ADA-1997), 36.3% of those with diabetes (2-h glucose > or =11.1 mmol/l) would be diagnosed. If OGTT was performed (i) in those with a fasting glucose between 6.1 mmol/l and 6.9 mmol/l (9.8% of the population) we would diagnose 66.6%, and (ii) in all those between 5.7 mmol/l and 6.9 mmol/l (18.9% of the population) 81.8% would be diagnosed. CONCLUSIONS: The ADA criteria decrease the prevalence of DM in the adult population of Asturias by 2.4% and concordance with the classical criteria (WHO-1985) was only 29.3%. Using fasting glucose only (ADA-1997) diagnoses 36.3% of those with diabetes. The recent recommendations of the WHO-1999 increases this to 66.6%. To improve the diagnostic strategy for diabetes and detect up to 81.8% of patients, we propose the use of OGTT for all those with a fasting glucose between 5.7 mmol/l and 6.9 mmol/l.     

抑郁症患者的血糖、血脂水平及其与症状关系的对照研究

目的了解抑郁症患者糖脂代谢的情况及其与精神症状的关系。方法以HAMD17和HAMA评定92例近期未服用精神药物的抑郁症患者的精神症状,了解他们简易体质参数、测定其空腹血糖和血脂,并与60例健康者组成的对照组进行比较。结果抑郁症组的甘油三酯(TG)、空腹血糖(FBS)值显著高于对照组(P＜0．001),而高密度脂蛋白胆固醇(LDL—ch)、载脂蛋白A1(ApoA1)值显著低于对照组(P＜0．01)；血浆总胆固醇(TC)、高密度脂蛋白胆固醇(HDL—ch)和载脂蛋白B(ApoB)两组之间无显著性差异(P＞0．05)；相关分析发现,抑郁症患者的HAMA总分、精神性焦虑因子分以及躯体性焦虑因子分与TG水平呈正相关(P＜0．01或P＜0．05)。结论抑郁症患者存在一定的糖脂代谢异常,临床医师应该对抑郁症患者的血糖、血脂进行监测,以便早期发现,早期治疗。     

磁处理酒对大鼠糖脂蛋白质代谢的影响

12只大白鼠空腹灌注大剂量磁处理酒(实验组1、2); 另外18只大白鼠同等条件下灌注非磁处理酒(对照组1、2)及自来水(空白组),对比研究表明,血清胆固醇及清蛋白含量变化无显著差异(P>0.05),而血清葡萄糖含量实验组低于对照组,差异显著(P<0.05),提示,大剂量非磁处理酒可使血糖升高,而磁处理酒对血糖含量无显著影响.     

Skeletal Muscle Adaptations to Physical Training in Type II (Non-insulin-dependent) Diabetes Mellitus

Seven middle-aged men with manifest type II diabetes mellitus underwent an endurance training programme for 10–15 weeks. The maximal aerobic capacity, as well as the endurance capacity, was improved by 10% (p<0.05). The intramuscular glycogen store increased by more than 80% (p<0.05) from 350 μmol/g dw (dry weight), and the activities of citrate synthase and 3-hydroxy-acyl-CoA dehydrogenase increased by more than 50% (p<0.05) and 30% (p<0.05). The activity of glycogen synthase was decreased by approximately 20% (p<0.05), whereas lactate dehydrogenase remained unchanged. Capillaries/fibre and fibre area increased by more than 50% (p<0.05) and 30% (p<0.05) leaving the area of supply constant. Training did not influence fasting blood lipids and glucose, glycosylated hemoglobin, oral glucose tolerance, and insulin response to an oral glucose load measured 72 hours post-exercise. It is concluded that patients with manifest type II diabetes, as normoglycaemic individuals, adapt to physical training. However, no persistent effect on glucohomeostasis and lipaemia is produced by short-term training in the diabetic patients.     

Short-term suppression of plasma free fatty acids fails to improve insulin sensitivity when intramyocellular lipid is elevated.

AIMS: Metabolic responses to manipulation of the plasma free fatty acid (FFA) concentration were assessed in six healthy men via cross-over design to determine whether FFAs independently influence insulin sensitivity. METHODS: Intramyocellular lipid (IMCL) was measured by proton magnetic resonance spectroscopy and insulin sensitivity via frequently sampled intravenous glucose tolerance test (IVGTT) after 67 h of two identical low carbohydrate/high fat (LC) diets which were used to elevate IMCL and plasma FFAs. To uncouple the influence of FFAs and IMCL on insulin sensitivity, FFAs were suppressed 30 min prior to and during IVGTT in one treatment [LC + nicotinic acid (NA)] by NA ingestion. RESULTS: Vastus lateralis IMCL was significantly elevated in LC (13.3 +/- 1.1 x 10(-3)) and LC + NA (13.5 +/- 1.1 x 10(-3)) (P < 0.01 for both), but was not different between conditions (P > 0.05). Plasma FFAs were raised in LC (0.79 +/- 0.08 mmol/l) and LC + NA (0.80 +/- 0.11 mmol/l) (P < 0.01 for both) and were significantly reduced by NA ingestion prior to (0.36 +/- 0.05 mmol/l, P < 0.01) and during IVGTT (P < 0.05) in LC + NA. Despite marked differences in plasma FFA availability, insulin sensitivity and glucose tolerance were not different between LC and LC + NA (P > 0.05 for both). CONCLUSIONS: Plasma FFAs appear to exert no immediate effect on insulin sensitivity/glucose tolerance independent of their action on intracellular lipid moieties. Further research is required to elucidate the duration of FFA suppression required to restore insulin sensitivity following lipid-induced insulin resistance.     

高糖通过活化半胱氨酸天冬氨酸蛋白酶3途径诱导人腹膜间皮细胞凋亡

目的 探讨高糖损伤人腹膜间皮细胞(HPMC)的机制。方法 (1)分离培养HPMC,以细胞形态、免疫细胞化学染色作细胞鉴定;(2)第2代HPMC分别经含1.5%、2.5%、4.25%葡萄糖的M199培养基培养48h后(以正常M199培养基和含4.25%甘露醇的M199培养基为对照),检测HPMC caspase-3活性和HPMC凋亡情况;(3)分别用25μmol/L、50μmol/L、和100μmol/LZ-VAD.fmk和4.25%葡萄糖共同刺激体外培养的HPMC(以DMSO和4.25%葡萄糖为对照),流式细胞仪观察HPMC凋亡情况,同时检测50μmol/L Z-VAD.fmk组和葡萄糖对照组caspase-3活性。结果 (1)HPMC caspase-3活性和凋亡率与葡萄糖浓度呈正相关(r分别为0.9506和0.9868,P<0.01),且HPMC caspase-3活性与凋亡率呈正相关(r=0.9860,P<0.01)。与M199对照组相比,2.5%葡萄糖组和4.25%葡萄糖组HPMC caspase-3活性和凋亡率显著增加(P<0.05),而1.5%葡萄糖组及4.25%甘露醇组HPMC caspase-3活性和凋亡率无显著差异(P>0.05)。(2)4.25%葡萄糖组caspase-3活性显著高于4.25%甘露醇组(P<0.05),但4.25%甘露醇组caspase-3活性与对照组相比无显著差异(P>0.05)。(3)与对照组相比,Z-VAD,fmk组HPMC凋亡率(P<0.05)和caspase-3活性(P<0.05)显著下降,且HPMC凋亡率与Z-VAD.fmk呈负相关(r=-0.8836,P<0.01)。结论 (1)高糖能以     

青中年人群微量白蛋白尿患病率与心血管疾病危险因素的关系

目的　探讨微量白蛋白尿患病率与心血管疾病危险因素的关系。方法　选择 775例 (男 32 6例 ,女 4 4 9例 )年龄 2 0～ 5 0岁的社区人群 ,测定其体重指数 (BMI)、血压、空腹血糖、血脂谱 ;收集晨尿检测尿白蛋白、尿肌酐浓度 ,并计算尿白蛋白 /尿肌酐的比率。根据有无高血糖、高血压或高三酰甘油 /低高密度脂蛋白胆固醇 (高TG/低HDL C)血症分为 4组 ,即正常组 (A组 )、1种代谢紊乱组 (B组 )、2种代谢紊乱组 (C组 )及代谢综合征组 (D组 ) ,评价微量白蛋白尿与代谢紊乱的关系。结果　①糖尿病患者微量白蛋白尿的患病率为 2 2 .2 % ,显著高于正常血糖者 (5 .2 % ,P =0 .0 0 2 ) ;高TG/低HDL C血症者微量白蛋白尿的患病率为 8.3% ,显著高于正常血脂者 (4.0 % ,P =0 .0 12 ) ;高血压患者与正常血压者的差异无显著性。②随代谢紊乱加重 ,尿白蛋白浓度显著升高 (协方差分析 ,P <0 .0 1) ,微量白蛋白尿患病率升高 (趋势分析 ,P =0 .0 0 3)。③ 4组间尿肌酐浓度、尿白蛋白 /尿肌酐的差异无显著性。结论　①糖尿病、高TG/低HDL血症人群的微量白蛋白尿的发病率显著升高。②随代谢紊乱加重 ,微量白蛋白尿患病率亦升高     

Fecal stream is essential for adaptive induction of glucose-coupled sodium transport in the remnant ileum after total proctocolectomy

Our previous studies demonstrated that sodium glucose cotransporter 1 (SGLT-1) was induced in the remnant ileum of total colectomized rats via the action of factors other than hyperaldosteronism. The aim of the present study was to clarify whether fecal stream is required for the enhancement of SGLT-1-mediated sodium transport. Twenty-seven pairs of ileal tissues were obtained from the proximal and distal side, respectively, of loop ileostomy after total proctocolectomy. Mucosae were mounted in an Ussing chamber to evaluate glucose-coupled sodium transport. Levels of SGLT-1 mRNA in proximal and distal mucosae were compared by Northern blotting. Villous height and crypt depth were measured to test for correlations between mucosal structure and SGLT-1-mediated sodium transport or mRNA expression levels. Both glucose-coupled sodium transport and expression of SGLT-1 mRNA were significantly lower in distal mucosae relative to proximal mucosae. In distal mucosae, villous height, but not crypt depth, was significantly lower than in proximal mucosae, demonstrating a positive correlation between villous height and SGLT-1 function and expression. Comparative studies of proximal and distal mucosae demonstrated that in addition to hormonal changes, fecal stream is required for full induction of the sodium transport system (which includes SGLT-1-mediated transport) in the remnant ileum following total proctocolectomy. Presented in part at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–19, 2005 (poster presentation). This work was supported by Grants-in-Aid for Scientific Research 10557118 and 14657295 from the Ministry of Education, Science and Culture of Japan to K. Fukushima, and by Kanae Foundation to K. Fukushima.     

高血糖对急性颅脑伤预后的影响

对ＩＣＵ收治的６１例急性闭合性颅脑伤患者入院２４ｈ血糖水平与急性期格拉斯哥昏迷评分、颅脑伤不同类型及预后进行分析。结果提示：格拉斯哥昏迷评分与血糖水平经回归分析呈显著负相关（ｒ＝－０．９６４，Ｐ＜０．０１）；不同类型颅脑伤患者以脑挫裂伤组血糖最高。高血糖组患者病死率明显高于非高血糖组，死亡组患者血糖明显高于恢复不良组及恢复良好组。作者认为，血糖测定有助于了解颅脑伤的严重程度，同时可以估计患者的预后，在颅脑伤的救治过程中加强血糖监测是必要的。