Objective To investigate effect of metabolic surgery on type 2 diabetes mellitus (T2DM) patients with body mass index (BMI) 27.5–32.5 kg/m2. Methods The clinical data of 43 T2DM patients with BMI 27.5–32.5 kg/m2 underwent metabolic surgery from October 2014 to October 2016 in the Third Xiangya Hospital of Central South University were analyzed retrospectively. The related indexes such as BMI, blood glucose level, blood lipid level were analyzed before and after metabolic surgery. Results All the patients underwent metabolic surgery successfully. Among them, 35 cases underwent laparoscopic gastric bypass surgery while 8 cases underwent laparoscopic sleeve gastrectomy without related complications after operation. Compared with preoperative indexes, the BMI, fasting blood glucose, HbA1c, triglyceride, and total cholesterol on the postoperative different time were all significantly decreased (P<0.05) except for the HbA1c on the postoperative 1-week, the high density lipoprotein level on the postoperative 12-month was significantly increased (P<0.05). The OGTT 30, 60, and 120 min blood glucose levels on the postoperative 1-week and 3-month, and 60 and 120 min blood glucose levels on the postoperative 6-month and 12-month were all significantly decreased (P<0.05). The OGTT-IRT 60 min insulin level on the postoperative 3-month and the 30 min insulin levels on the postoperative 6- and 12-month were all significantly increased (P<0.05). The levels of OGTT-CRT 30 and 60 min C peptide on the postoperative 6-month and the level of 30 min C peptide on the postoperative 12-month were all significantly increased (P<0.05). Conclusions Metabolic surgery is effective in treatment of T2DM patients with BMI 27.5–32.5 kg/m2, and levels of blood glucose and blood lipids can be improved significantly. Synthesis and release of insulin by islet cells can be ameliorated.
Objectives To systematically analyze the effect of high-intensity and low-intensity resistance training on glycosylated hemoglobin (HbA1c) in elderly patients with type 2 diabetes. Methods PubMed, EBSCO, Cochrane Library, Web of science, Wanfang, Chinese National Knowledge Infrastructure and Chongqing VIP were searched to collect randomized controlled trials of resistance training intervention in elderly patients with type 2 diabetes. The search time limit was from the establishment of the database to August 28, 2021, and the RevMan 5.3 and Stata 15.0 software were used for meta-analysis. Results A total of 415 patients in 8 articles were included in this study. A subgroup analysis based on control measures showed that compared with the resistance training group, the HbA1c level effect value of the non- training group was weighted mean difference (WMD) = ?0.54% [95% confidence interval (CI) (?1.06%, ?0.03%), P=0.04)], the HbA1c level effect value of the flexibility training group was WMD=?0.47% [95%CI (?1.05%, 0.12%), P=0.12], the HbA1c level effect value of the aerobic training group was WMD=?0.10% [95%CI (?0.71%, 0.51%), P=0.75]. Subgroup analysis of resistance strength showed that compared with the flexibility or non-resistance training group, both high-intensity [WMD=?0.99%, 95%CI (?1.16%, ?0.81%), P<0.00001] and low- and medium-intensity resistance training [WMD=?0.29%, 95%CI (?0.58%, ?0.01%), P=0.05] can reduce HbA1c. Compared with the high-intensity resistance training, the HbA1c level effect value of the low- and medium-intensity resistance training was WMD=0.03% [95%CI (?0.33%, 0.39%), P=0.88]. Compared with the low- and medium-intensity resistance training, the HbA1c level effect value of the low- and medium-intensity aerobic training was WMD=?0.10% [95%CI (?0.71%, 0.51%), P=0.75]. Among all the included studies, only the high-intensity resistance training group reported multiple adverse events.ConclusionsCurrent evidence suggests that elderly patients with type 2 diabetes are more suitable to choose low-to-medium-intensity resistance training to control HbA1c. It is recommended that elderly patients with type 2 diabetes take 60% to 75% of the maximum muscle strength of medium-intensity resistance training.
Objective To assess the improvement of different resistance training regimens on blood lipid metabolism and insulin resistance in patients with type 2 diabetes mellitus (T2DM). Methods PubMed, ProQuest, Embase, Web of Science, China National Knowledge Infrastructure, Wanfang, and VIP databases were searched to collect randomized controlled trials of resistance training intervention to improve blood lipids and insulin resistance in patients with T2DM. The search time range was from the establishment of the databases to May 2023. Two reviewers assessed the risk of bias of the included studies using the Physiotherapy Evidence Database scale, and performed a network meta-analysis of the extracted data using Stata 16.0 software. Results In the end, 24 articles were included, and a total of 983 participants were enrolled. The result of network meta-analysis showed that high-frequency and moderate-intensity resistance exercise significantly improved the levels of insulin resistance [standardized mean difference=?1.71, 95% confidence interval (CI) (?2.75, ?0.67)], triglycerides [weighted mean difference (WMD)=?0.27 mmol/L, 95%CI (?0.51, ?0.04) mmol/L], and total cholesterol [WMD=?0.16 mmol/L, 95%CI (?0.20, ?0.12) mmol/L], but had no significant effect on improving the level of high-density lipoprotein [WMD=0.05 mmol/L, 95%CI (?0.02, 0.11) mmol/L] or low-density lipoprotein [WMD=?0.20 mmol/L, 95%CI (?0.42, 0.03) mmol/L]. The results of cumulative probability ranking showed that high-frequency and moderate-intensity resistance exercise was the best in improving insulin resistance, triglycerides, high-density lipoprotein and low-density lipoprotein levels. Conclusion Based on current evidence, high-frequency and moderate-intensity resistance exercise may be the best resistance exercise regimen to improve insulin resistance and lipid metabolism in patients with T2DM.
Objective To investigate and analyze the incidence and clinical characteristics of malnutrition in patients with tuberculosis and type 2 diabetes. Methods four hundred patients with tuberculosis and type 2 diabetes were diagnosed in the tuberculosis Department of West China Hospital of Sichuan University from June 1, 2018 to April 30, 2023. The incidence and clinical characteristics of malnutrition were analyzed using the nutritional risk Screening 2002 score and the Global Malnutrition Leadership Initiative criteria. Results 170 patients (42.5%) were malnourished. In malnourished patients, 78 cases (45.9%) had fever, 132 cases (77.6%) had cough, 44 cases (25.9%) had hemoptysis, and 36 cases (21.2%) had night sweating. Compared with the non-malnourished patients, the difference was statistically significant (P<0.05). Lymphocyte count was (1.0±0.5)×109/L, albumin was (31.4±20.5)g/L; CD3 count 792.7±205.0, CD4 count 535.4±15.0, CD8 count 429.5±123.0, CD3%: 65.5%±11.1%, CD4%: 39.1%±9.6%, CD8%: 19.1%±9.6%, CD4/CD8: 1.3±0.2, which were significantly lower than those in the group without malnutrition. Pulmonary cavity occurred in 44 cases (25.9%), lesions in 2 - 4 lung fields in 76 cases (44.7%) and lesions in ≥5 lung fields in 52 cases (30.6%), all of which were significantly higher than those in the non-malnutrition group. The above differences were statistically significant.Conclusion We should pay more attention to the screening of malnutrition in patients with tuberculosis and type 2 diabetes. Patients with malnutrition have more obvious clinical symptoms, lower immunity, and more serious imaging lesions.
摘要:目的: 觀察格列美脲對2型糖尿病患者心血管的保護作用并探討其可能的機制。 方法 :112例T2DM患者隨機分為格列美脲組(格列美脲+二甲雙胍)和對照組(格列本脲+二甲雙胍),觀察治療前后兩者空腹及餐后兩小時血糖(FBG,2hPBG)、糖化血紅蛋白(HbA1c)、空腹胰島素(FINS)、HOMA模型胰島素抵抗指數(HOMAIR)、甘油三脂(TG)、總膽固醇(TC)、高密度脂蛋白膽固醇(HDLC)、低密度脂蛋白膽固醇(LDLC)、同型半胱氨酸(HCY)、血漿脂聯素的變化。 結果 :兩組患者的TC、LDLC、TG、FBG、2hPBG都較治療前降低,連續服用6個月以上格列美脲的T2DM患者其血漿HCY、HOMAIR、血糖水平明顯下降,血漿脂聯素水平明顯升高,與對照組相比差異有統計學意義(〖WTBX〗P lt;005)。 結論 :格列美脲能降低多項心血管危險因子水平,對血脂、HCY和動脈粥樣硬化都有良性調節作用,其作用基礎可能與改善胰島素抵抗,增加血漿脂聯素相關。Abstract: Objective: To observe the protective effects and to explore mechanisms of glimepiride on cardiovascular system of Type 2 Diabetes Mellitus. Methods : 112 patients with type 2 diabetes mellitus were randomly divided into treatment group (glimepiride combined with metformin) and control group (glibenclamide combined with metformin). The fasting blood glucose (FBG), 2hPBG, hemoglobin A1c (HbA1c), FINS, HOMAIR, blood lipid (TC, TG, LDLC and HDLC), HCY (homocysteine) and adiponectin were detected before and after treatment. Results : In all cases, the level of TC、LDLC、TG、FBG、2hPBG were decreased after treated with glimepiride or glibenclamide combined with metformin for 6 monthes. Moreover, the level of HCY, HOMAIR and blood glucose were decreased and the level of adiponectin was increased significantly than that of in control group (Plt;005). Conclusion : Glimepiride showed the effective on decreasing the risk factor of cardiovascular system disease with regulation of blood lipid, HCY, and improve the atherosclerosis. The effective of glimepiride on cardiovascular system was relation to improved the insulin resistance and increase the adiponectin.
ObjectiveTo compare effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy (SADI-S) and single anastomosis sleeve ileal (SASI) bypass on weight loss and glucose regulating as well as difference in micronutrient deficiency in obese rats with type 2 diabetes mellitus. MethodsThirty-six Spraque-Dawley rats fed with high fat diet combined with intraperitoneal injection of low-dose streptozotocin (35 mg/kg) for 1 month were used to induce obese rats with type 2 diabetes mellitus, then were randomly averagely divided into 3 groups: SADI-S group, SASI group, and sham operation (SO) group. Eight rats from numbered rats of each group were randomly selected to carry out experimental observation. The rats’ body weight, food intake, and fasting blood glucose (FBG) were measured from before operation to postoperative 1–6 months. Meanwhile blood was collected before surgery, as well as at month 1 and 6 after surgery for oral glucose tolerance testing (OGTT) and insulin resistance testing (ITT). Serum glucagon-like peptide (GLP-1), hemoglobin, and albumin levels, as well as vitamin B12, calcium, and ferrum concentrations were measured before surgery as well as at month 1 and 6 after surgery. Results① The body weight, food intake (except 5–6 months), and FBG level in the SADI-S group and SASI group were lower than the SO group (P<0.05) from 1- to6-month after operation, and all obviously decreased at month 1 after operation (P<0.05), but there was no statistical differences between the SADI-S group and SASI group (P>0.05). ② The postoperative OGTT and ITT blood glucose levels in the SADI-S group and SASI group were lower than those in the SO group (P<0.05) and were lower than those in the preoperative levels (P<0.05), and the SADI-S group had a lower OGTT blood glucose level than the SASI group at month 6 after operation (P<0.05). ③ The GLP-1 levels of the SADI-S group and SASI group were higher than that of the SO group (P<0.05), and higher than before operation at month 6 after operation (P<0.05) , but there was no statistical difference was found between the SADI-S group and SASI group after operation (P>0.05). ④ The postoperative albumin levels of the SADI-S group and SASI groups= were lower than of the SO group (P<0.05) and were lower than before operation, and albumin level of the SADI-S group was lower than of the SASI group at postoperative month 6 (P<0.05); while the hemoglobin had no statistical differences among the 3 groups (P>0.05). ⑤ The ferrum concentration of the SADI-S group was lower than that of the SASI group and SO group at 1 month after operation (all P<0.05), while it increased slightly at month 6 after operation and had no statistical difference between the SADI-S group and SASI group (P>0.05); the calcium concentrations of the SADI-S group and SASI group only at 6 month after operation were lower than those of the SO group (P<0.05), and were lower as compared with before operation (P<0.05) , but no statistical difference was found between the SADI-S group and SASI group (P>0.05); the vitamin B12 had no statistical differences among the 3 groups (P>0.05). ConclusionsFor obese rats with type 2 diabetes mellitus, SADI-S and SASI have similar weight loss effect. Long-term glucose reduction of SADI-S shows a advantage than SASI, but influence of postoperative micronutrients of SASI is inferior to SASI.
A lot of evidence-based medical evidence has shown that laparoscopic Roux-en-Y gastric bypass (LRYGB) is a durable and effective method for obesity and diabetes, and can significantly improve a series of obesity-related metabolic complications. This guideline provides a detailed description of the main operating steps and technical points of the symmetric three-port LRYGB, including posture layout, trocar position selection, liver suspension, gauze exposure, production of small gastric sacs, gastrojejunal anastomosis and production of biliary pancreatic branches, entero-enteric side to side anastomosis, closure of gastrointestinal anastomosis and mesenteric hiatus, greater omentum coverage, and closure of incisions. The purpose is to standardize the operating process of the symmetrical three hole method of LRYGB, providing standardized surgical operation references for clinical doctors in the field of obesity metabolic surgery.
ObjectiveTo observe expressions of E3 ubiquitin ligase—mitsugmin53 (MG53) protein, MG53 mRNA, and insulin receptor substrate 1 (IRS-1) mRNA in skeletal muscle of non-obese type 2 diabetic mellitus (T2DM) rats after gastric bypass operation (GBP), and to investigate possible mechanism of GBP in improving insulin resistance.MethodsTwenty-four healthy male GK rats were randomly divided into diabetic operation group, diabetic sham operation group, and diabetic control group, 8 rats in each group; besides, 8 male Wistar rats were served as normal control group. The expressions of MG53 protein in skeletal muscle tissue were detected by using Western blot method on week8 after operation. The mRNA levels of IRS-1 and MG53 in skeletal muscles tissue were measured by RT-PCR methods on week 8 after operation.Results① The expressions of MG53 protein and MG53 mRNA in the diabetic sham operation group and diabetic control group were significantly higher than those in the diabetic operation group and the normal control group on week 8 after operation (P<0.05), respectively, which had no significant differences between the diabetic operation group and the normal control group (P>0.05), and between the diabetic sham operation group and the diabetic control group (P>0.05) on week 8 after surgery. ② Compared with the normal control group, the expression of IRS-1 mRNA was significantly decreased in the diabetic operation group, the diabetic sham operation group, and the diabetic control group (P<0.05), while there were no significant differences between the diabetic operation group, diabetic sham operation group, and the diabetic control group on week 8 after operation (P>0.05).ConclusionExpression of E3 ubiquitin ligase—MG53 protein in skeletal muscle tissue in T2DM rats following GBP is decreased, thus reduces the IRS-1 ubiquitin-degradation, increase the expression of IRS-1 protein in insulin signaling pathway of skeletal muscle tissue, and improve insulin resistance of skeletal muscle.
Objective To demonstrate the efficacy, tolerability, and safety of domestic Acarbose tablet compared with Glucobay (Acarbose tablet produced by Bayer company) in patients with type 2 diabetic patients. Method A multicenter randomized controlled parallel-group comparison study was conducted. 177 Chinese type 2 diabetic patients were recruited from 4 clinical centers. The patients were divided randomly into domestic Acarbose tablet (A group) or Glucoby (B group) treatment group. The trial consisted of a 2-4 weeks equilibrated period followed by an 8 week course of treatment. Results 165 patients have finished the trial (81 in A group and 84 in B group). After 4 weeks of treatment, the mean of fasting blood glucose (FBG) in A and B group were reduced 1.61 and 2.08 mmol/L respectively, and mean of postprandial blood glucose (PBG) lowered 5.06 and 5.09mmol/L respectively. After 8 weeks of treatment, the mean of FBG were reduced 1.95 and 2.62mmol/L respectively, and mean of PBG lowered 4.88 and 5.98 mmol/L, respectively, and mean of HbA1c were lowered 1.13% and 1.20% respectively in A and B group. The differences in reduction of FBG, PBG, and HbA1c between A and B group were no statistic significance. The serum triglyceride levels and BMI were decreased significantly in both A, B groups. 3 patients who drinking wine during trial on A group had asymptomatic elevations in serum transaminases that normalized in 2 weeks after stopped drinking and Acarbose withdrawal. Flatulence was the most common side effect. Conclusions In this multicenter study, domestic Acarbose tablet 50 mg t.i.d. was an effective, safe, and generally well-tolerated therapy as similar as Glucobay in type 2 diabetic patients.
摘要:目的: 總結2型糖尿病患者陰莖勃起功能障礙(ED)的相關危險因素及臨床治療評價。 方法 :分析收集兩家醫院120例住院及門診2型糖尿病男性患者的性功能狀況、年齡、糖尿病病程、血壓、糖化血紅蛋白、血脂、吸煙與否等指標,以及接受真空負壓吸引聯合萬艾可治療的79名患者追蹤3個月的療效評分。 結果 :男性2型糖尿患者中ED的患病率為658%,多因素回歸分析顯示患者年齡、糖尿病病程、糖化血紅蛋白與ED的發生獨立相關,而血壓、血脂等因素〖WTBX〗P >005,無顯著性差異。接受真空負壓吸引聯合萬艾可治療的79例ED患者其有效率達到759%。 結論 :男性2型糖尿病患者中ED是常見的合并癥,患病率隨年齡、糖尿病病程、糖化血紅蛋白的增加而增加。真空負壓吸引聯合萬艾可治療糖尿病合并ED療效可靠。Abstract: Objective: Make a conclusion on related ED risk factors and clinic therapy evaluation in 120 Type 2 male diabetic mellitus. Methods : Analyze and collect 120 cases in two hospitals regarding sexual function,age,diabetes course,blood pressure,HbA1c,bolldfat, smokingcondition,etc;follow up 79 cases for 3months and evaluate therapy as a result of vacuum subpressure absorption associated with viagra (sildenafil) therapy. Results : The ED rate in Type 2 male diabetic is 658%;the multifactorial regression analysis shows that occurrence of ED is respectively related with age,diabetes course,HbA1c;there isn’t obvious discrdpancy in blood pressure,blood fat,etc(P >005); the effective rate of vacuum subpressure absorption associated with Viagra (sildenafil) therapy in 79 cases is759%. Conclusion : It’s common complications to get ED among the Type 2 male Diabetics and the case rate goes up with the increase of age,diabetes course, HbA1c;it’s reliable to take therapy of vacuum subpressure absorption associated with Viagra.