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Application of Arterial Stiffness and Ankle Brachial Index in Evaluating Peripheral Arteriosclerosis in Elderly Patients with Type 2 Diabetes

目的　了解老年2型糖尿病动脉僵硬度与踝臂指数（ABI）对评价外周动脉硬化的价值。 方法　2010年1月－3月，应用超声、回声跟踪技术和动脉硬化检测仪检测80例老年2型糖尿病患者（观察组）和40例正常老年人（对照组）的颈总动脉内中膜厚度（IMT）、僵硬系数（β）、脉搏波传导速度（PWVβ）、ABI及动脉斑块情况。 结果　与对照组比较，观察组患者的IMT增厚、β增高、PWVβ增快、ABI降低及动脉斑块发生率增多，差异均具有统计学意义（P＜0.001）。 结论　老年2型糖尿病可导致IMT增厚、动脉僵硬度增高、PWVβ增快、ABI降低及更易发生动脉粥样硬化斑块，这些参数可以预测外周动脉粥样硬化的程度，利用彩色多普勒超声诊断仪和动脉硬化检测仪可以较容易得到这些参数，是评价外周动脉粥样硬化病变一种简便、易行，有临床实际意义的方法和手段。

Advances in Research of MicroRNA in The Pathogenesis of Type 2 Diabetes

Objective　To summarize the relationship of diabetes and its complications with microRNA. Methods　Domestic and international researches were collected by searching to summarize the role of microRNA in diabetes and its complications. Results　MicroRNA could affect the secretion of insulin and interfer metabolism of gulcose in fat cells， muscle cells， and liver cells， which resulting in insulin resistance. At the same time， the microRNA also played an role in damage of vascular endothelial cells and myocardial cell in diabetes. Conclusion　MicroRNA acts an important role in the process of diabetes and its complications.

Turn Bariatric Surgery into the Conventional Treatment of Type 2 Diabetes： What Kind of Clinical System We Need?

2型糖尿病肥胖患者口服降糖药失效启用胰岛素治疗方案的探讨

【摘要】　目的　探讨2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗方案的选择。　方法　选择2009年1月-2010年12月间40例口服降糖药失效的2型糖尿病肥胖患者，随机分为两组，每组20例。A组原口服药不变，睡前联用长效胰岛素（商品名:来得时）治疗，B组停用口服药，于早晚餐前使用预混胰岛素（商品名：诺和灵30R），治疗共3个月，分别于治疗前后观察空腹血糖、餐后2 h血糖、糖化血红蛋白、血脂、血压、体质量指数的变化，记录低血糖发生次数，并填写问卷调查表，评估患者对治疗方案的满意度和接受度。　结果　两个组治疗后空腹血糖、餐后2 h血糖、糖化血红蛋白均较治疗前明显下降（Plt;0.01），而血脂、血压变化不大；但B组体质量指数有轻微升高（Pgt;0.05），且每日胰岛素用量较A组更大（Plt;0.01），低血糖反应更多（Plt;0.05），满意度和接受度不如A组高（Pgt;0.05）。　结论　对2型糖尿病肥胖患者在口服降糖药继发失效的情况下启用胰岛素治疗，选用口服降糖药联合基础胰岛素的治疗方案具有作用佳、安全性好，体重增加不明显，患者依从性更高的特点。【Abstract】　Objective　To investigate the selection of insulin therapy for obese patients with type 2 diabetes mellitus (T2DM) after the failure of oral antihyperglycemic drugs.　Methods　Forty obese T2DM subjects who failed the therapy of oral antihyperglycemic drugs between January 2009 and December 2010 were divided into 2 groups randomly. Patients in group A (n=20) continued using oral antihyperglycemic agents while long-acting insulin (Lantus) was added at bedtime; Patients in group B (n=20) used premixed insulin (Novolin 30R) injection before breakfast and supper instead of the oral drugs. The treatment lasted for 3 months for both groups. Fasting plasma glucose (FPG), blood glucose 2 hours after breakfast (2hPG), glycated hemoglobin (HbA1c), serum lipids, blood pressure, and body mass index (BMI) were examined before and after the trial respectively. We evaluated the satisfaction and acceptance level in all subjects who underwent the treatment with questionnaires.　Results　FPG, 2hPG, HbA1c after the treatment were significantly lower than those before the treatment in both two groups (Plt;0.01), while serum lipids and blood pressure showed no significant differences. Patients in group B had slightly higher BMI (Pgt;0.05) after the treatment. Compared with patients in group A, they needed a larger insulin dosage (Plt;0.01), had higher hypoglycemia frequency (Plt;0.05) and lower satisfaction and acceptance level (Pgt;0.05).　Conclusion　For obese patients with T2DM who have failed the therapy of oral antihyperglycemic drugs, combined oral antihyperglycemic drugs with basic insulin has better effects, security, and compliance, and less weight gain.

Study on the correlation between the time within the glucose target range, the level of glycosylated hemoglobin and the risk of diabetic retinopathy

ObjectiveTo observe and analyze the correlation between time within target glucose range (TIR) and hemoglobin A1c (HbA1c) and the risk of diabetic retinopathy (DR). MethodsA retrospective clinical study. From March 2020 to August 2021, 91 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in Department of Endocrinology and Metabolic Diseases, Affiliated Hospital of Weifang Medical University, were included in the study. All patients underwent Oburg's no-dilatation ultra-wide-angle laser scan ophthalmoscopy, HbA1c and continuous glucose monitoring (CGM) examinations. According to the examination results and combined with the clinical diagnostic criteria of DR, the patients were divided into non-DR (NDR) group and DR group, with 50 and 41 cases respectively. The retrospective CGM system was used to monitor the subcutaneous interstitial fluid glucose for 7 to 14 consecutive days, and the TIR was calculated. Binary logistic regression was used to analyze the correlation between TIR, HbAlc and DR in patients with T2DM0. At the same time, a new indicator was generated, the predicted probability value (PRE_1), which was generated to represent the combined indicator of TIR and HbA1c in predicting the occurrence of DR. The receiver operating characteristic curve (ROC curve) was used to analyze the value of TIR, HbAlc and PRE_1 in predicting the occurrence of DR. ResultsThe TIR of patients in the NDR group and DR group were (81.58±15.51)% and (67.27±22.09)%, respectively, and HbA1c were (8.03±2.16)% and (9.01±2.01)%, respectively. The differences in TIR and HbA1c between the two groups of patients were statistically significant (t=3.501,－2.208; P=0.001, 0.030). The results of binary logistic regression analysis showed that TIR, HbA1c and DR were significantly correlated (odds ratio=0.960, 1.254; P=0.002, 0.036). ROC curve analysis results showed that the area under the ROC curve (AUC) of TIR, HbA1c and PRE_1 predicting the risk of DR were 0.704, 0.668, and 0.707, respectively [95% confidence interval (CI) 0.597-0.812, P=0.001; 95%CI 0.558-0.778, P=0.006; 95%CI 0.602-0.798, P=0.001]. There was no statistically significant difference between TIR, HbA1c and PRE_1 predicting the AUC of DR risk (P>0.05). The linear equation between HbAlc and TIR was HbAlc (%) = 11.37－0.04×TIR (%). ConclusionsTIR and HbA1c are both related to DR and can predict the risk of DR. The combined use of the two does not improve the predictive value of DR. There is a linear correlation between TIR and HbAlc.

The Efficacy and Safety of the Combination of Metformin with Glargine in Type 2 Diabetic Subjects

摘要:目的:了解甘精胰岛素联合二甲双胍治疗对口服降糖药血糖控制不理想的2型糖尿病患者的疗效和安全性。方法:对30例口服降糖药血糖控制不理想的2型糖尿病患者给与甘精胰岛素联合二甲双胍治疗,共12周。治疗前后测身高、体重、空腹血糖(FPG)、餐后2小时血糖(PPG)以及糖化血红蛋白(HbA1c)水平。了解治疗期间低血糖发生情况。结果:治疗后的FPG、PPG以及HbA1c水平明显下降,分别下降了303mmol/L、510mmol/L和198%,差异有统计学意义(Plt;005)。治疗后5330%的患者HbA1c水平lt;70%。治疗前HbA1c水平≥70%lt;90%的患者,治疗后706%的患者HbA1c水平lt;70%,治疗前HbA1c水平≥90%的患者,治疗后307%的患者HbA1c水平lt;70%,两者的HbA1c达标率有明显差异(Plt;005)。治疗前后体重及BMI无明显差异(Pgt;005)。30例患者中仅发生两次轻微低血糖。结论:甘精胰岛素联合二甲双胍治疗对口服降糖药治疗血糖控制不理想的2型糖尿病患者是安全有效的,尤其是对HbA1c水平lt;90%的患者,血糖控制更好,达标率更高。

Regulation of Glucagon-Like Peptide-1 Level by Metabolism of Gastrointestinal Nutrients

Objectives　To summarize the regulation of glucagon-like peptide-1（GLP-1） level by metabolism of gastrointestinal nutrients. Methods　Domestic and international publications online involving regulation of GLP-1 level by metabolism of gastrointestinal nutrients in recent years were collected and reviewed. Results　GLP-1 influenced insulin secretion and sensitivity， and played a leading role in recovery of glucose metabolism. Metabolism of gastrointestinal nutrients regulated GLP-1 level. Studies had shown that GLP-1 was a candidate mediator of the effects of gastric bypass （GBP） for type 2 diabetes mellitus（T2DM）. Conclusions　It plays an important role in anti-T2DM effects of GBP that metabolism of gastrointestinal nutrients regulated GLP-1 level. The corresponding studies can provide a novel clinical field to treat T2DM.

Study on the Relationship between Serum Visfatin and Eldly Type 2 Diabetes Mellitus withMacrovascular Lesion

目的:探讨visfatin与老年2型糖尿病及其大血管并发症和相关代谢指标的关系。方法:将66例老年糖尿病患者分为合并大血管病变组（MCV）35例和非大血管病变组（nMCV）31例，并选64例健康人做对照。采取酶联免疫测定法（ELISA）测定空腹血清visfatin浓度；并测定各组的空腹血糖、胰岛素、血压和血脂水平；用胰岛素抵抗指数（HOMAIR）HOMAIR评价胰岛素抵抗，分析各指标间的相关性及与大血管并发症的相关性。结果:①老年2型糖尿病组血清visfatin浓度高于正常对照组，差异有统计学意义（Plt;0.01）。但正常对照组与2型糖尿病组中nMCV组比较，visfatin浓度差异无统计学意义（Pgt;0.05）。②老年2型糖尿病组中大血管病变组（MCV）血清visfatin浓度明显高于非大血管病变组（nMCV），差异有统计学意义（Plt;0.01）。③相关分析显示，老年2型糖尿病组血清visfatin浓度与腰围（WC）、甘油三酯（TG）均呈显著正相关，与性别、年龄、HOMAIR呈正相关。进一步以visfatin为应变量，以年龄、性别、BMI、WC、收缩压（SBP）、舒张压（DBP）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、空腹血糖（FPG）、空腹胰岛素（FINS）、HOMAIR为自变量进行多元逐步回归分析，TG、WC和年龄是血清visfatin独立相关因素。④在老年T2DM组，以有无大血管并发症为应变量（Y=1，n=0），各指标为自变量，进行logistic回归分析，visfatin进入回归方程。结论:血清visfatin与2型糖尿病的发病不相关，但在老年2型糖尿病中与其大血管并发症有关。

Biphasic Insulin Aspart 30 Given Three Times Daily for Type 2 Diabetes: A Systematic Review

Objective　To assess the effectiveness and safety of biphasic insulin aspart 30 given three times a day in the management of type 2 diabetes. Methods　Such databases as CENTRAL, MEDLINE, PubMed and CNKI were searched on computer; additionally, the relevant conference proceedings from associations like American Diabetes Association, and the references of all selected literatures were also hand-searched. The randomized controlled trials (RCTs) on biphasic insulin aspart 30 given three times a day in treating type 2 diabetes were screened according to inclusive and exclusive criteria, without concerning the limitation of languages and blind methods. After data extraction and quality evaluation, Meta-analysis was performed by using RevMan 4.2 software. Results　Ten trials involving 1 415 patients were included. The sub-group analysis showed that compared with the group of given biphasic insulin aspart 30 twice a day (the bid group), the group of given biphasic insulin aspart 30 three times a day (the tid group) was superior in decreasing HbAlc (Plt;0.000 01). Compared with the group of thrice preprandial injection of Novolin R plus one injection of Novolin N at bedtime (the qid group), Meta-analysis showed that, a) As to the average fasting glucose levels: the tid group was not superior to the qid group (P=0.65); b) As to the average 2-hour postprandial glucose levels: the tid group was superior to the qid group (P=0.0003); c) As to the therapeutic time: the tid group was not superior to the qid group (P=0.38); d) As to the insulin doses: the tid group was superior to the qid group (P=0.000 1); e) As to the insulin costs: the tid group was inferior to the qid group (P=0.02); and e) As to the incidence of hypoglycaemia: the tid group was superior to the qid group (P=0.000 2). Compared with the oral antidiabetic drugs, the results of Meta-analyses showed: the tid group was superior in decreasing HbAlc (P=0.001). Conclusion　The limited current evidence shows that biphasic insulin aspart 30 given three times a day, as a simple insulin intensified scheme, is safe and effective for type 2 diabetes, and is worth recommending in clinic. However, all these findings should be further confirmed with more large sample and well-designed RCTs.

Evidence-Based Treatment for an Newly Diagnosed Type 2 Diabetes Mellitus in Elderly Patient

Objective　Methods of evidence-based medicine were used to make an individulized treatment plan concerning newly diagnosed type 2 diabetes mellitus in elderly patients. Method　After clinical problems were put forward, evidence was collected from third issue, 2003, Cochrane Library, Medline (PubMed 1990.1-2003.2) and http:// sumsearch.uthscsa.edu/ searchform4.htm according to the search strategy. Subject words were: diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro-and macro-vascular complications; sulphonylureas; insulin ; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis；systmatic review. Results　A total of 112 RCTs, and 24 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusions　The treatment efficacy in newly diagnosed type 2 diabetes mellitus in the elderly has been improved by determining an individulized treatment plan according to evidence-based methods.