Objectives To assess the effects of alpha-glucosidase inhibitors in patients with type 2 diabetes mellitus. Method We searched The Cochrane Library, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, reference lists of reviews on the topic of alpha-glucosidase inhibitors and we contacted experts and manufacturers for additional trials. Date of most recent search: December 2003 (Current Contents) and April 2003 (other databases). Randomised controlled trials of at least 12 weeks duration comparing alpha-glucosidase inhibitor monotherapy in patients with type 2 diabetes with any other intervention and that included at least one of the following outcomes: mortality, morbidity, quality of life, glycemic control, lipids, insulin levels, body weight, adverse events. Two reviewers read all abstracts, assessed quality and extracted data independently. Discrepancies were resolved by consensus or by the judgement of a third reviewer. A statistician checked all extracted data entrance in the database. We attempted to contact all authors for data clarification. Results We included 41 trials (8130 participants), 30 investigated acarbose, seven miglitol, one trial voglibose and three trials compared different alpha-glucosidase inhibitors. Study duration was 24 weeks in most cases and only two studies lasted amply longer than one year. We found only few data on mortality, morbidity and quality of life. Acarbose had a clear effect on glycemic control compared to placebo: glycated haemoglobin –0.77% (95% confidence interval –0.90 to –0.64), fasting blood glucose –1.1 mmol/L (95% confidence interval –1.4 to –0.9), post-load blood glucose –2.32 mmol/L (95% confidence interval –2.73 to –1.92). The effect on glycated haemoglobin by acarbose was not dose-dependent. We found a decreasing effect on post-load insulin and no clinically relevant effects on lipids or body weight. Adverse effects were mostly of gastro-intestinal origin and dose dependent. Compared to sulphonylurea, acarbose decreased fasting and post-load insulin levels by –24.8 pmol/L (95% confidence interval –43.3 to –6.3) and –133.2 pmol/L (95% confidence interval –184.5 to –81.8) respectively and acarbose caused more adverse effects. Conclusions It remains unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes. Conversely, they have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. These effects are less sure when alpha-glucosidase inhibitors are used for a longer duration. Acarbose dosages higher than 50 mg TID offer no additional effect on glycated haemoglobin but more adverse effects instead. Compared to sulphonylurea, alpha-glucosidase inhibitors lower fasting and post-load insulin levels and have an inferior profile regarding glycemic control and adverse effects.
The incidence of obesity and type 2 diabetes mellitus (T2DM) in adolescents has been rapidly increasing over the past two decades due to dramatic changes in dietary structure and physical activity. The incidence of diabetic retinopathy (DR), a serious vision-threatening complication of diabetes, is also increasing yearly in the adolescent population with T2DM. Due to the insidious onset of retinal diseases in the early stages, regular screening is important for the timely diagnosis of DR. However, there are still problems such as low attention of the population and insufficient screening rate. In the future, we should strengthen the health education of the adolescent population and optimize the control of risk factors such as blood glucose and blood pressure. At the same time, appropriate screening strategies should be actively developed, and the use of telemedicine and emerging technologies should be promoted for early detection of treatable lesions to improve patient prognosis.
摘要:目的:比较不同人群踝肱指数（ABI）的测量值,探讨糖尿病大血管病变的多发性及相关性 。方法: 对2007年2月至2009年5月间在本院住院的49名经冠状动脉造影和/或心肌损伤三项及心电图临床证实心肌梗死的糖尿病患者,及50名经冠状动脉造影和/或心肌损伤三项及心电图临床证实无冠脉病变的糖尿病患者,并另选取50名无糖尿病及冠心病的对照50人共149例行下肢检查,分析各组ABI的特点。结果: 三组间ABI比较均有差异,两两比较有统计学差异(Plt;0.05),且糖尿病并冠心病患者的ABI值较对照组明显下降,两组ABI值比较有统计学差异(Plt;0.01)。 结论: 糖尿病合并冠心病与糖尿病足的发病有相关一致性,ABI降低最明显。Abstract: Objective: To explore the multiplicity and correlation of macroangiopathy in type 2 diabetes,we compared the ankle brachial index(ABI) in different populations. Methods: We analyzed the ankle brachial index(ABI) of lower extremity of 149 people in our hospital from February,2007 to May, 2009:A group,49 diabetes with myocardial infarction diagnosed by coronary angiography and / or myocardial damage check and ECG.B group,50 diabetes without myocardial infarction diagnosed by the same methods. Control group, 50 people without diabetes or coronary heart disease. Results: There were significant differences among three groups, respectively (Plt;0.05). And there was decreased ankle brachial index(ABI)in diabetes with coronary heart disease compared with the control group, with significant difference(Plt;0.01). Conclusion: There was a relation between diabetes with coronary heart disease and the incidence of diabetic foot, with obvious reduction of ankle brachial index(ABI)
ObjectiveTo investigate whether transplantation of islet cells combined with bone marrow mesenchymal stem cell (BMSCs) of the pancreatic subcapsular promoting revascularization of pancreatic islets in rats, so as to reduce the loss of islet cells after transplantation and improve the success rate of islet cell transplantation. MethodsThe model of diabetic rat was established. The BMSCs and islet cells were cultured and identified, then the simple islet cells, simple BMSCs, and combination of islet cells and BMSCs were injected into the pancreatic subcapsular of the islet cell group, BMSCs group, and combination group, respectively. In addition, the same amount of normal saline was injected into the same site as the control group. There were 10 rats in each group. The changes of blood glucose and serum insulin in different time point were detected in each group. The mRNA expressions of angiogenesis factors such as hypoxia inducible factor-1α (HIF-1α), stromal cell derived factor 1α (SDF1α), vascular endothelial growth factor (VEGF), and basic fibroblast growth factor 2 (FGF2) were determined by real-time quantitative PCR. Results① The blood glucose levels of the islet cell group and combination group were lower than those of the control group and the BMSCs group within 15 d after surgery (P<0.05) and decreased to the normal level, which of the combination group could still maintain the normal level until on day 29 (P<0.05), but which of the islet cell group began to increase on day 15 after surgery and was similar to that in the BMSCs group (P>0.05). ② Compared with the control group and the BMSCs group, the insulin levels were higher in the islet cell group and combination group on day 1, 3, 7, 15, and 29 after surgery (P<0.05), especially in the combination group. ③ The expression levels of HIF-1α, SDF1α, VEGF, and FGF2 mRNAs in the combination group were higher than those the other three groups, and the differences were statistically significant (P<0.05). ConclusionsIslet cell transplantation of pancreatic subcapsular could decrease blood glucose level in diabetic rats. Hypoglycemic effect of single islet cell transplantation gradually weakens on day 15 d after surgery. After BMSCs combined with islet cells transplantation, the glycemic effect of rat is stable for a longer time. Expressions of angiogenesis factors of BMSCs combined with islet cells transplantation rat are high, which combined with pathological sections suggests that BMSCs could promote vascular recanalization of islet transplantation.
We assayed the levels of free radical and scavenger in the blood and lens of streptozotocin-in-duced diabetic SD rats, and found that the levels of lipoperoxide(LPO),MDA were higher than that of normal SD rats, and the total superoxygen dismutase (T-SOD), Cu-Zn-SOD) were lower that that of normal rats ( P lt;0.01 ). Simultaneous injection of streptozotocin and large dose of SOD could no avoid the occurence of diabetes mllitus, but did improve the metabolism of free radical in blood and lens. Hence, we think that large dose of SOD might be effective in preventing to development of diabetic cataract which is related to deterioration of free radical metabolism. （Chin J Ocul Fundus Dis,1994,10:25-27）
Objective To assess the effects and safety of sitagliptin combined with metformin in treating type 2 diabetes mellitus. Methods The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM were searched to collect the randomized controlled trials (RCTs) on sitagliptin combined with metformin in treating Type 2 diabetes mellitus (T2DM) from inception to November, 2012. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results 7 RCTs involving 2 917 patients were included. The results of meta-analysis showed that, compared with metformin alone, sitagliptin combined with metformin effectively improved HbA1c levels (WMD= –0.62%, 95%CI –0.76 to –0.47, Plt;0.000 1) and fasting plasma glucose levels (WMD= –0.7 mmol/L, 95%CI –1.03 to –0.37, Plt;0.000 01), and increased insulin sensitivity and β-cell function. But there was no significant difference between the two groups in the incidences of gastrointestinal reactions and hypoglycemia. Conclusion Compared with using metformin alone, sitagliptin combined with metformin can improve glycemic control, enhance insulin sensitivity and better β-cell function more effectively and both have a similar effect on weight lose, but there is no significant difference he incidences of gastrointestinal reactions and hypoglycemia. The above conclusion should be verified by more large-scale high-quality studies in future due to the limitations of the methodological quality and sample size of the included studies.
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.
ObjectiveTo systematically review the efficacy of Roux-en-Y gastric bypass for obesity and its comorbidities. MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 11, 2013), CBM, CNKI, VIP and WanFang Data, etc. were electronically searched from inception to November 2013, for including all studies on Roux-en-Y gastric bypass for obesity and its comorbidities. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. And then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 25 before and after self-control studies involving 2 966 cases with overweight or obesity were included. The results of meta-analysis showed that:after Roux-en-Y gastric bypass operation, the patients had significant reduction in BMI (MD=-16.40, 95%CI-17.42 to-15.38, P < 0.000 01), type 2 diabetes mellitus prevalence (RR=0.23, 95%CI 0.17 to 0.31, P < 0.000 01), and hypertension prevalence (RR=0.34, 95%CI 0.26 to 0.43, P < 0.000 01); besides, fasting glucose, blood pressure and serum lipid levels obviously decreased (P < 0.000 01). ConclusionRoux-en-Y gastric bypass for obesity patients is effective in reducing weight loss, type 2 diabetes mellitus incidence and cardiovascular disease incidence. Due to the limitation of the design of the included studies, the conclusion needs to be verified by further conducting high quality randomized controlled trials with large sample-size.
ObjectiveTo systematically review the independent physical risk factors associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus. MethodsWe searched MEDLINE, EMbase, CBM, CNKI and VIP for all studies about the independent physical risk factors associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus up to December 2012. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 11 studies involving 12 957 patients with type 2 diabetes were included. Of these 11 studies, 9 were cross-sectional studies, two were cohort studies, and one was case-control study. The results showed that:the main physical factors associated with DKD were:duration of diabetes (OR=1.11, 95%CI 1.05 to 1.18), waist circumference (OR=1.02, 95%CI 1.00 to 1.04), fasting glucose (OR=1.11, 95%CI 1.07 to 1.16), glycosylated hemoglobin (OR=1.20, 95%CI 1.06 to 1.36), systolic blood pressure (OR=1.03, 95%CI 1.02 to 1.05), diastolic blood pressure (OR=2.41, 95%CI 1.15 to 4.64), triglycerides (OR=1.24, 95%CI 1.02 to 1.51), high-density lipoprotein (OR=0.558, 95%CI 0.369 to 0.844), blood uric acid (OR=1.005, 95%CI 1.002 to 1.009), blood urea nitrogen (OR=1.58, 95%CI 1.37 to 1.82), past history of kidney disease (OR=3.26, 95%CI 1.20 to 8.87) and family history of kidney disease (OR=1.83, 95%CI 1.29 to 2.60). ConclusionCurrent evidence shows that multiple physical factors were associated with the development of type 2 diabetic kidney disease. However, due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the conclusion.
ObjectiveTo discuss the characteristics of coronary artery disease in patients with type 2 diabetes using coronary angiography of Dual Source CT. MethodsWe collected the clinical data of patients who underwent coronary angiography of Dual Source CT between December 2010 and November 2012 in Sichuan Provincial People's Hospital and Sichuan Orthopedic Hospital. A total of 302 patients (74 with type 2 diabetes, and 228 with no diabetes) were examined with CT coronary angiography. All images were comprehensively assessed. Types of plaques and luminal narrowing were evaluated. ResultsPatients with type 2 diabetes had more plaques (P<0.05), especially mixed plaques and non-calcified plaques, than non-diabetic patients (P<0.05). The proportions of calcified plaque, mixed plaques, non-calcified plaque in patients with type 2 diabetes were 29.1%, 41.1%, 29.8%, respectively. The proportions of calcified plaque, mixed plaques, non-calcified plaque in patients with nondiabetic patients were 39.7%, 36.0%, 24.3%, respectively. The difference of the composition between diabetes and nondiabetic was significant (P<0.05). There were more mild, moderate and severe narrowing in type 2 diabetic patients than those in non-diabetic patients (P<0.05). ConclusionCoronary angiography of CT depicts a high plaque burden in patients with type 2 diabetes mellitus (mixed plaque is the most common type), which may cause stenosis easily.