ObjectiveTo explore the morbidity rate and risk factors of proliferative diabetic retinopathy (PDR) in type 2 diabetes.MethodsThe clinical data of patients, with PDR in 2739 consecutive cases of type 2 diabetes diagnosed in this hospital from 1994 to 2001 were analyed retospectively. The diagnosis of diabetic retinopathy (DR) was confirmed by ophthalmoscopy and fundus fluorescein angiography (FFA). Blood pressure, fasting and postprandial blood sugar, glycosylated haemoglobin（HbA1c）, total serum cholesterol, triglyceride, creatinine, and albumin excretion rate were measured.ResultsThe morbidity rate of type 2 DR was 27.8%（761/2739）, and the morbidity rate of PDR was 4.2%（114/2 739） occupying 15% of the patients with DR. The duration, fasting blood sugar, glycosylated haemoglobin, blood pressure and albumin excretion rate were much higher than those in the control（P＜0.01, glycosylated haemoglobin P＜0.05）. The independent risk factors of PDR were duration of the disease （r=0.15, P＜0.01） and albumin excretion rate （r=0.08, P＜0.05）. The risk factors of PDR were albumin excretion rate and fasting blood sugar (r=0.13, P＜0.05) in patients with longer duration(≥5 years). The morbidity rate of PDR was 2.3%, 5.9% and 12.4% in patients with duration less than 5 years, 5 to 10 years and over 10 years groups, respectively. The morbidity of PDR of the patients in normal albuminuria, microalbuminuria and overt albuminuria group was 2.1%、5.3% and 18.8% respectively.ConclusionsType 2 diabetes accompanied with PDR is relative to the duration of the diabetes, albumin excretion rate, fasting blood sugar, blood pressure, and glycosylated haemoglobin, in which the duration of the disease, albuminuria and fasting blood sugar are the risk factors of occurance of PDR. (Chin J Ocul Fundus Dis, 2003,19:338-340)
摘要:目的:探討2型糖尿病合并糖尿病足患者與胰島素抵抗的關系。方法:205例2型糖尿病患伴糖尿病足患者作為觀察組,無足部病變的糖尿病患者作為對照組,觀察其體重指數、空腹血糖、胰島素、血脂等指標,兩組間進行比較并相關性分析、多元回歸分析。胰島素抵抗指數(HOMAIR)=FPG×FIns/22.5。結果:糖尿病足患者的HOMAIR顯著高于無糖尿病的患者(Plt;0.05)。多元回歸分析顯示糖尿病病程、LDL及BMI是影響2型糖尿病足患者胰島素抵抗的主要危險因素。結論:糖尿病足患者存在著更嚴重的胰島素抵抗。Abstract: Objective: To discuss the relationship between diabetes and pedopathy of type II diabetes and insulin resistance. Methods:The diabetes type II patients were divided into group A (combined with pedopathy) and group B (without pedopathy). The blood glucose and insulin of empty stomach, BMI,Alc and lipid were detected. The insulin resistance index (HOMAIR) was calculated and compared between two groups. Results:The HOMAIR was higher in group A than that in group B (Plt;0.05).The duration of disease,LDL and BMI was positive related with diabetes pedopathy. Conclusion:The insulin resistance was more worse in pedopathy of Type II diabetes.
Diabetes and its complications pose a serious threat to human life and health. It has become a public health problem of wide concern worldwide. Currently, diabetes is mainly treated with insulin injection in clinic. However, manual insulin injection still has many shortcomings. In recent years, with the deepening of research, it has been found that an automated insulin delivery system (AID), which combines a continuous glucose monitoring device with an insulin pump, can significantly improve the effectiveness of diabetes treatment and reduce the incidence of complications in patients. This paper firstly introduces the composition of the AID system and its working principle, and then details the development history and current status of the related technologies from the aspects of continuous glucose monitoring technology, insulin pumps and the development of closed-loop control algorithms, etc. Finally, this paper looks forward to the application prospect and future development of AID system in the field of diabetes treatment, providing theoretical reference for further research.
Objective To evaluate the efficacy of glucose-insul in-potassium (GIK) in patients with acute myocardialinfarction (AMI). Methods Both foreign language databases including The Cochrane Library (issue 4, 2007), PubMed, EMBASE and Chinese databases involving CBM, VIP and CJFD were searched to identify randomized controlled trials (RCTs) that reported the effect of GIK on the heart function (left ventricular ejection fraction LVEF, ST changes, left ventricular remodel ing) of patients with AMI. Two reviewers assessed the qual ity of each trial and extracted data independently. The Cochrane Collaboration’s RevMan 4.2.10 software was used for statistical analysis. Results Five RCTs were included, all of which came from abroad. The methodological qual ity of the included studies was good. The basel ine data of each trial were comparable. Meta-analyses showed that no significant difference was observed in the improvement of LVEF between the GIK group and the control group (WMD=1.87, 95%CI -0.32 to 4.06, P =0.09), whereas GIK was more beneficial in decreasing ST (OR=1.92, 95%CI 1.25 to 2.96,P =0.003) and preventing left ventricular remodel ing (OR=0.08, 95%CI 0.01 to 0.68, P=0.02). Conclusion Based on the above evidence, although GIK may, to some extent, be beneficial for both ST decreasing and long-term prognoses in patients with AMI, it can not yet be concluded that GIK can improve the heart function of those patients. Therefore, it is imperative to design and implement further stricter, large-scale RCTs, so as to accurately identify the therapeutic effect of GIK solution in patients with myocardial infarction.
Objective Through studying a diabetic patient accompanied with pancreatic cancer by means of evidence-based clinical practice, to find out the relationship between diabetes mellitus and cancer and whether the long-acting insulin glargine increases the risk of cancer or not, which is regarded as a disputable hot issue at present. Methods Such databases as The Cochrane Library (Issue 3, 2010), OVID-EBM Reviews (1991 to Sept. 2010), MEDLINE (1950 to Sept. 2010) and CNKI (2000 to Sept. 2010) were retrieved to collect high quality clinical evidence, and the best therapy was formulated in accordance with the willingness of patients themselves. Results Eight randomized controlled trials (RCTs), four meta-analyses and one RCT meta-analysis were included. The evidence indicated that: a) Diabetes mellitus was kind of related to the occurrence of malignancies; b) There was no evidence at present showing the relationship between long-acting insulin glargine and cancer; c) Strictly controlling of blood sugar did not increase the risk of tumorigenesis, but hyperglycemia causing cancer was proofless; and d) Whether the diabetic patient with cancer should stop taking long-acting insulin glargine or not should require suggestions from specialists rather than patients themselves. Conclusion No evidence at present shows that tumorigenesis is related to diabetes mellitus, long-acting insulin glargine and strict controlling of blood sugar. It is necessary to require more evidence to decide whether the therapy should be adjusted or not for the diabetic patient with cancer who is in the process of glargine therapy.
ObjectiveTo summarize the research progress of correlation between pancreatic cancer and diabetes mellitus.MethodsRecent studies on the association between pancreatic cancer and diabetes mellitus were extensively reviewed, and relevant research results on the association between pancreatic cancer and diabetes mellitus were reviewed.ResultsPancreatic cancer had a particular association with diabetes. Patients with pancreatic cancer may develop new diabetes or worsen existing diabetes mellitus. About 50% of patients with pancreatic cancer had diabetes mellitus before diagnosis, suggesting a “dual causal relationship” between pancreatic cancer and diabetes mellitus. Long-term type 2 diabetes mellitus (T2DM) was one of the high risk factors for the occurrence and development of pancreatic cancer. T2DM may also increase the risk of pancreatic cancer due to hyperinsulinemia, adipokine, and other factors. Pancreatic cancer was one of the cause of diabetes mellitus at the same time, but its mechanism was not yet known, also needed to get a lot of information to understand the impact of long-term diabetes mellitus on the development of pancreatic cancer, as well as the reason of pancreatic cancer related to diabetes mellitus mechanism.ConclusionThe clear relationship between pancreatic cancer and diabetes mellitus has not been proved, and further research is needed to clarify the relationship between them.
ObjectiveTo compare the efficacy of sitagliptin plus glargine insulin versus repaglinide plus glargine insulin in the treatment of Type-2 diabetes mellitus (T2DM). MethodsA total of 140 T2DM patients who were inadequately controlled by oral anti-diabetic agents from January 2011 to December 2012 were divided into sitagliptin plus glargine insulin group (observation group) or repaglinide plus glargine insulin group (control group). The duration of treatment was 12 weeks. Fasting blood glucose (FBG), 2h plasma glucose (2hPG), glycated haemoglobin (HbA1c), body max index (BMI) and dose of insulin as well as hypoglycemia events were recorded and analyzed. ResultsAfter treatment, FBG, 2hPG, and HbA1c were significantly decreased in both groups (P<0.05). HbA1c targeting rate was 88.3% in the observation group and 87.8% in the control group. Compared with the control group, the observation group used 12.1% less dosage of insulin, and had decreased BMI and low incidence of hypoglycemia. ConclusionSitagliptin plus glargine insulin can effectively control blood glucose and body weight with low incidence of hypoglycemia and much less insulin dosage under the same HbA1c targeting rate. Sitagliptin plus glargine insulin is a good combination therapy for the treatment of T2DM.
ObjectiveTo investigate the protective effect of exogenous insulin on relative adrenal insufficiency (RAI) in rats with severe acute pancreatitis (SAP).MethodsEighty SPF SD rats were randomly divided into 5 groups (n=16): sham operation (SO) group, SAP group, low-dose insulin intervention (low-dose) group (0.05 U/100 g body weight), medium-dose insulin intervention (medium-dose) group (0.1 U/100 g body weight), and high-dose insulin intervention (high-dose) group (0.2 U/100 g body weight). The five groups were randomly divided into two subgroups: cosyntropin stimulation test (CST) subgroup and non-CST subgroup. SAP model was established by retrograde injection of 5% sodium taurocholate into biliopancreatic duct. The rats were sacrificed 3 hours after the establishment of SAP model. The levels of amylase (AMY), alanine aminotransferase (ALT), aspartate aminotransferase (AST), urea (Ur) and creatinine (Cr) were detected by automatic biochemical analyzer. The serum levels of tumor necrosis factor-α (TNF-α) and corticosterone (Cor) were detected by ELISA kit. The pathological changes of pancreas and adrenal gland were observed under light microscope. The lipid content of adrenal gland was observed by oil red O staining.ResultsCompared with the SO group, the serum levels of Amy, ALT, AST, Ur, Cr, TNF-α and Cor in the SAP group were significantly increased (P<0.05), typical pathological damages occurred in pancreas and adrenal gland, and pathological scores were significantly increased (P<0.05). Compared with the SAP group, the levels of AMY, ALT, AST, Ur, Cr, TNF-α and Cor in the low-dose group were not significantly changed (P>0.05); the levels of AMY, ALT, AST, Ur, Cr and TNF-α in the medium-dose group and the high-dose group were significantly decreased (P<0.05), and Cor levels were significantly increased (P<0.05). Compared with the low-dose group, AMY, ALT, AST, Cr, TNF-α in the medium-dose group and the high-dose group were significantly decreased (P<0.05), Cor level were significantly increased (P<0.05), Ur level had no significant change. There were no significant difference in AMY, ALT, AST, Ur, Cr, TNF-α and Cor levels between the medium-dose group and the high-dose group (P>0.05). After CST intervention, there were no significant change in serum Cor levels in the SAP group and the low-dose group (P>0.05), but the serum Cor levels in the SO group, the medium-dose group and the high-dose group were significantly increased (P<0.05).ConclusionAppropriate dose of exogenous insulin can improve SAP related adrenal injury and RAI, but the specific mechanism still needs further study.
ObjectiveTo observe and compare the cytological and biological differences between human normal and degenerated nucleus pulposus (NP), and to investigate the repair effect of insulin-like growth factor 1 (IFG-1) and platelet derived growth factor (PDGF) on human degenerated NP.MethodsHuman degenerative and normal NP tissues were obtained from operative patients, a portion of which were processed into tissue sections and HE staining was performed to observe the morphological changes of nucleus pulposus cells (NPCs) before and after degeneration of NP. Immunohistochemistry staining was used to determine the expression levels of collagen type Ⅰ, collagen type Ⅱ, B-cell lymphoma 2 (Bcl-2), Bcl-2 associated X (Bax) proteins. Another portion of tissues were isolated and cultured and NPCs morphology was observed under inverted microscope. Western blot analysis was used to detect collagen type Ⅱ protein expression. Then, the gene transfection experiments were launched, including 4 groups, with group A designed as degenerated NPCs only, and groups B, C, and D of degenerated NPCs transfected with IGF-1 gene lentiviral particles, PDGF gene lentiviral particles, and lentiviral particles carrying IGF-1 and PDGF double genes, respectively. At 21 days after transfection, the cell morphology of each group was observed under inverted microscope, the positive rates of IGF-1 and PDGF of each group were measured by flow cytometry, and the expression of collagen type Ⅱ protein was detected by using immunohistochemistry staining and Western blot.ResultsHE staining showed that there were a large number of notochordal cells and a small number of chondrocytes in the central NP tissue of normal group, while the NPCs in degeneration group were significantly reduced, and a large proportion of fibrocartilage tissues were found in NP tissue. Immunohistochemistry staining showed that the percentages of collagen type Ⅰ and Bax protein-positive cells in degeneration group were significantly higher than those of normal group, while the percentages of collagen type Ⅱ and Bcl-2 protein-positive cells were significantly lower than those of normal group (P<0.05). Western blot showed that the relative expression level of collagen type Ⅱ protein in degeneration group was significantly lower than that in normal group (t=65.493, P=0.000). At 21 days after gene transfection, compared with group A, the cell viability of groups B, C, and D increased and the morphology became more regular. Flow cytometry showed that the percentages of IGF-1-positive cells in groups B and D were significantly higher than that in group A, and the percentages of PDGF-positive cells in groups C and D were significantly higher than that in group A (P<0.05). Immunohistochemistry staining showed that the positive stainings of collagen type Ⅱ in groups A, B, C, and D was (±), (+), (+), and (++), respectively. Western blot showed that the relative expression of collagen type Ⅱ protein in groups A, B, C, and D increased by degrees, and the differences between groups were significant (P<0.05).ConclusionBoth IGF-1 and PDGF can reverse the degeneration of intervertebral discs NPCs and they have synergistic effects, providing experimental basis for its application in clinical treatment approaches for degenerative disc disease.
ObjectiveTo systematically review the efficacy and safety of premixed insulin lispro versus insulin glargine for type 2 diabetes mellitus (T2DM). MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 3, 2013), PubMed, EMbase, ClinicalTrials.gov, CBM, CNKI and WanFang Data were searched up to October 2013 for randomized controlled trials (RCTs) about the clinical efficacy and safety of premixed insulin lispro versus insulin glargine for T2DM. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data, and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs involving 4 557 patients were included. The results of meta-analysis showed that:compared to insulin glargine, premixed insulin lispro was more effective in reducing levels of HbA1c (parallel trials:WMD=-0.18, 95%CI-0.33 to-0.02, P=0.03; cross-over trials:WMD=-0.38, 95%CI-0.52 to-0.24, P < 0.000 01). However, insulin glargine was more effective in reducing levels of FPG (parallel trials:WMD=0.82, 95%CI 0.65 to 0.99, P < 0.000 01; cross-over trials:WMD=0.64, 95%CI 0.26 to 1.02, P=0.000 9), weight gain (parallel trials:WMD=0.93, 95%CI 0.31 to 1.56, P=0.003; cross-over trials:WMD=0.74, 95%CI 0.19 to 1.29, P=0.009), and decreased the incidence of hypoglycemia (parallel trials:OR=1.26, 95%CI 1.10 to 1.45, P=0.000 6; cross-over trials:OR=2.24, 95%CI 1.45 to 3.46, P=0.000 3). ConclusionFor T2DM patients, premixed insulin lispro and insulin glargine have different advantages in clinical efficacy and safety. Doctors should select appropriate insulin treatment according to patients' health conditions.