AIM:To identify factors associated with adherence to annual eye examinations among adults with diabetes mellitus(DM)in Malaysia METHODS:Data from community-dwelling adults aged≥18y with known DM,defined as those who ...AIM:To identify factors associated with adherence to annual eye examinations among adults with diabetes mellitus(DM)in Malaysia METHODS:Data from community-dwelling adults aged≥18y with known DM,defined as those who had previously been informed by a doctor or assistant medical officer of their diagnosis were analyzed using the National Health and Morbidity Survey 2023,a population-based crosssectional survey conducted using a two-stage stratified random sampling design.Locally validated questionnaire on diabetic eye screening was administered through faceto-face interviews from July until September 2023.Adults with known DM were asked three key questions about eye examinations:whether their eyes had been examined using clinical tools(illustrated with images of a direct ophthalmoscope,slit lamp or fundus camera),the timing of their last eye examination(if applicable),and whether they had been referred to an ophthalmology clinic for DM-related complications,serving as a proxy for diabetic retinopathy(DR)referrals.Complex sample analysis,incorporating sample weights and the study’s design,were used to describe respondents’baseline characteristics by urban or rural localities.Multivariable binary logistic regression with adjusted odds ratio(aOR)and 95%confidence interval(CI)was performed.RESULTS:Among 1554 adults with known DM in Malaysia,58.8%had never undergone an eye examination and only 29.5%complied with the recommended annual eye check-ups.Additionally,25.8%of DM patients were referred to an ophthalmology clinic for DR.Referral to ophthalmology clinic for DR(aOR=4.63,95%CI:3.27,6.55),insulin use(aOR=1.93,95%CI:1.37,2.72),secondary education(aOR=1.71,95%CI:1.03,2.85)and DM duration≥10y(aOR=1.48,95%CI:1.02,2.16)were associated with higher odds of annual eye examinations.Chinese(aOR=0.50,95%CI:0.29,0.87)and Indian(aOR=0.47,95%CI:0.29,0.78)ethnicities had lower odds of undergoing annual eye examinations compared to Malay ethnicity.Similarly,those with a monthly household income of≥RM10000(aOR=0.45,95%CI:0.21,0.95)were less likely to get their eyes examined yearly.CONCLUSION:Fewer than one-third of adults with DM in Malaysia adhere to the recommended annual eye examinations,with lower compliance observed among Chinese or Indian ethnicities and those with higher household incomes.Targeted educational campaigns for Chinese,Indian,and higher-income adults with DM may encourage regular eye exams and reduce preventable vision loss from DR in Malaysia.展开更多
Background: Diabetes mellitus (DM) is a disease characterized by hyperglycemia due to (a) insulin-insufficiency (type I DM), or (b) impaired glucose cell-entry (insulin resistance) due to the downregulation of insulin...Background: Diabetes mellitus (DM) is a disease characterized by hyperglycemia due to (a) insulin-insufficiency (type I DM), or (b) impaired glucose cell-entry (insulin resistance) due to the downregulation of insulin cell receptors (type II DM). Type I DM usually presents with florid manifestations contrary to a slowly-progressive type II. Patients and methods: Over the past 10 years, we encountered 9 obese patients with controlled insulin-requiring type II DM for years, at a dose of 62 ± 5 units/day, who developed sudden and severe insulin resistance (IR) that required 210 ± 25 units daily. All patients had very high levels of anti-Glutamic Acid Decarboxylase (GAD) antibodies. Despite a lack of previous testing for anti-GAD antibodies, they were treated, with Cyclosporin A (Cy), as an autoimmune disorder superimposed on their type II MD. Initially all patients were treated with 100 mg, of Cy, twice daily aiming at an initial trough level of 100 - 150 ng/ml. Three months later, the dose was reduced to 50 mg twice daily for a total of 2 years. Results: Amelioration of IR was achieved by 1 month with a reduction of daily insulin requirement to 123 ± 16 units that further decreased to 76 ± 11 by the end of the 3rd month. Such improvement persisted for 2 years and >1 year after Cy discontinuation. Moreover, a decline in insulin requirements was associated with a parallel decrease in anti-GAD antibody levels and an increase in C-peptide insulin without kidney disease. Conclusion: Anti-GAD antibodies can induce acute IR in type II DM, and this phenomenon can be treated safely and effectively with Cy.展开更多
BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scen...BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scenario to decide whether to do a biopsy or not.Since non-diabetic kidney diseases(NDKD)are common,and some patients may have NDKD superimposed on diabetic kidney diseases(DKD),therefore,kidney biopsy may be warranted to rule out NDKD.AIM To determine the prevalence of NDKD,DKD,or mixed lesions,identify predictors of NDKD,and investigate renal and patient survival,as well as factors associated with these outcomes.METHODS This retrospective observational study was conducted on patients with biopsyproven NDKD,DKD,and mixed lesions(having both NDKD and DKD).Binary logistic regression models were constructed to identify predictors of NDKD.Kaplan-Meier survival analysis was performed to compare time to kidney failure and patient survival across the three histological groups.Multivariable Cox proportional hazards regression was used to identify clinical and pathological factors associated with kidney failure and all-cause mortality.RESULTS A total of 103 biopsies were analyzed.Sixty-four(62.1%)had NDKD alone or mixed lesions.The most common NDKD pathologies were interstitial nephritis in 12(29.2%),focal segmental glomerulosclerosis in 10(24.4%),and immune complex–mediated glomerulonephritis in five(12.2%)patients.Compared to DKD,NDKD was associated with significantly lower odds of proteinuria>3.5 g/day[odds ratio(OR),0.02;P=0.0015],retinopathy(OR=0.04;P=0.0067),and diabetes duration≥10 years(OR=0.01;P=0.0002).However,NDKD had higher odds of anemia(Hemoglobin<12 g/dL;OR=9.56;P=0.0107)and creatinine levels>180μmol/L(OR=18.68;P=0.0063).Kaplan-Meier analysis showed significant differences in renal survival(log-rank P=0.0033).Patients with NDKD have the best outcomes,while those with DKD have the worst.In a multivariable Cox regression analysis,increasing age,creatinine,arteriosclerosis,and severe interstitial fibrosis and tubular atrophy were independently associated with kidney failure.At the same time,the use of renin angiotensin system blockers was protective(hazard ratio=0.43,P=0.02).Kaplan-Meier curves for patient survival also differed significantly(log-rank P=0.018);patients in the mixed group showed the highest mortality,while those with NDKD showed the lowest.Mortality was independently associated with older age,hypoalbuminemia,diabetic retinopathy,arteriosclerosis,and higher creatinine.CONCLUSION NDKD and mixed lesions are frequent in diabetic patients.These histological lesions carry distinct prognostic implications.Clinical features such as a shorter diabetes duration,absence of retinopathy,anemia,and elevated creatinine levels suggest NDKD and warrant biopsy.NDKD had better renal and patient survival rates,while mixed lesions had the worst outcomes.Older age,hypoalbuminemia,retinopathy,arteriosclerosis,and elevated creatinine were key predictors of mortality.展开更多
BACKGROUND L-arginine(L-Arg)is one of the most widely used amino acids in dietary and pharmacological products.However,the evidence on its usefulness and dose limitations,especially in diabetics is still controversial...BACKGROUND L-arginine(L-Arg)is one of the most widely used amino acids in dietary and pharmacological products.However,the evidence on its usefulness and dose limitations,especially in diabetics is still controversial.AIM To investigate the effects of chronic administration of different doses of L-Arg on the cardiac muscle of type 2 diabetic rats.METHODS Of 96 male rats were divided into 8 groups as follows(n=12):Control,0.5 g/kg L-Arg,1 g/kg L-Arg,1.5 g/kg L-Arg,diabetic,diabetic+0.5 g/kg L-Arg,diabetic+1 g/kg L-Arg,and diabetic+1.5 g/kg L-Arg;whereas L-Arg was orally administered for 3 months to all treated groups.RESULTS L-Arg produced a moderate upregulation of blood glucose levels to normal rats,but when given to diabetics a significant upregulation was observed,associated with increased nitric oxide,inflammatory cytokines,and malonaldehyde levels in diabetic rats treated with 1 g/kg L-Arg and 1.5 g/kg L-Arg.A substantial decrease in the antioxidant capacity,superoxide dismutase,catalase,glutathione peroxidase,reduced glutathione concentrations,and Nrf-2 tissue depletion were observed at 1 g/kg and 1.5 g/kg L-Arg diabetic treated groups,associated with myocardial injury,fibrosis,α-smooth muscle actin upregulation,and disruption of desmin cardiac myofilaments,and these effects were not noticeable at normal treated groups.On the other hand,L-Arg could significantly improve the lipid profile of diabetic rats and decrease their body weights.CONCLUSION L-Arg dose of 1 g/kg or more can exacerbates the diabetes injurious effects on the myocardium,while 0.5 g/kg dose can improve the lipid profile and decrease the body weight.展开更多
NARCOTREND index （NI） is based on studies ofnormal human brain electrical data. It uses anordinary electrode to collect and analysis brainelectrical signals immediately at any positionof the head, to display the sta...NARCOTREND index （NI） is based on studies ofnormal human brain electrical data. It uses anordinary electrode to collect and analysis brainelectrical signals immediately at any positionof the head, to display the state of consciousness and depthof anesthesia of patients on the touch screen afterautomatic analysis and classification, so as to guide doseadjustment of anesthetics. NI may make the consciousnessand depth of anesthesia monitoring safe, simple, accurate,and economic. It is important that NI is more accurate thanclassical electroencephalographic variables.^1 Weber et al2believed that the NI was an objective and true index in theevaluation of propofol sedation in children.展开更多
Diabetics is one of the world’s most common diseases which are caused by continued high levels of blood sugar.The risk of diabetics can be lowered if the diabetic is found at the early stage.In recent days,several ma...Diabetics is one of the world’s most common diseases which are caused by continued high levels of blood sugar.The risk of diabetics can be lowered if the diabetic is found at the early stage.In recent days,several machine learning models were developed to predict the diabetic presence at an early stage.In this paper,we propose an embedded-based machine learning model that combines the split-vote method and instance duplication to leverage an imbalanced dataset called PIMA Indian to increase the prediction of diabetics.The proposed method uses both the concept of over-sampling and under-sampling along with model weighting to increase the performance of classification.Different measures such as Accuracy,Precision,Recall,and F1-Score are used to evaluate the model.The results we obtained using K-Nearest Neighbor(kNN),Naïve Bayes(NB),Support Vector Machines(SVM),Random Forest(RF),Logistic Regression(LR),and Decision Trees(DT)were 89.32%,91.44%,95.78%,89.3%,81.76%,and 80.38%respectively.The SVM model is more efficient than other models which are 21.38%more than exiting machine learning-based works.展开更多
Diabetes is one of the four major non-communicable diseases,and appointed by the world health organization as the seventh leading cause of death worldwide.The scientists have turned over every rock in the corners of m...Diabetes is one of the four major non-communicable diseases,and appointed by the world health organization as the seventh leading cause of death worldwide.The scientists have turned over every rock in the corners of medical sciences in order to come up with better understanding and hence more effective treatments of diabetes.The continuous research on the subject has elucidated the role of immune disorders and inflammation as definitive factors in the trajectory of diabetes,assuring that blood glucose adjustments would result in a relief in the systemic stress leading to minimizing inflammation.On a parallel basis,microbial infections usually take advantage of immunity disorders and propagate creating a pro-inflammatory environment,all of which can be reversed by antimicrobial treatment.Standing at the crossroads between diabetes,immunity and infection,we aim in this review at projecting the interplay between immunity and diabetes,shedding the light on the overlapping playgrounds for the activity of some antimicrobial and anti-diabetic agents.Furthermore,we focused on the antidiabetic drugs that can confer antimicrobial or anti-virulence activities.展开更多
Introduction: To describe the epidemiologic profile, clinical and paraclinical of diabetics presenting microalbuminuria at Marc Sankale center. Patients and methods: We have done cross-sectional and retrospective stud...Introduction: To describe the epidemiologic profile, clinical and paraclinical of diabetics presenting microalbuminuria at Marc Sankale center. Patients and methods: We have done cross-sectional and retrospective study in a descriptive and analytic view or way. It happened within 6 months. Diabetic patients who performed the nycthemeral urinary albumin dose and mentioned in the file were included. The last study is considered as a positive one from 30 to 299mg/24h: Microalbuminuria. The creatinine has been noted and the clearing of the creatinine is calculated through the formula of Cockcroft and Gault. The statistical analysis of data has been done thanks to software such as excel 2013 and SPSS VER 18.0. Results: 221 patients have been noted with 70% women and 30% men. The age varied between 30 years and 85 years with an average of 56, 62 against 9.97 years. Sixty three (63) patients have microalbuminuria (29%);creatinine has been regularized to 25 patients with 14.8% of cases. Among the microalbuminuria patients having completed the creatinine, 32 patients (42.7%) and 16 (21.3%) are respectively in a state of chronical renal failure, light and moderated. Conclusion: The microalbuminuria is frequent to diabetics. But in our series a starting renal insufficiency could precede that microalbuminuria.展开更多
GUO Sai-shan was born on October 24, 1938, in Putian Fujian Province, 1960 graduated in Shanghai First Medical College （now Shanghai Medical University）. At present, she is the Professor of Peking Union Medical Coll...GUO Sai-shan was born on October 24, 1938, in Putian Fujian Province, 1960 graduated in Shanghai First Medical College （now Shanghai Medical University）. At present, she is the Professor of Peking Union Medical College. Chief Doctor,Post-doctorate Tutor, in 1991 to 2002 she was appointed as Director of Department of Traditional Chinese Medicine （TOM）;展开更多
Zinc plays a critical role in a variety of cell functions and elicits the fact that both its deficiency and excess may demonstrate deleterious situation. It has been proposed that zinc is required for multiple steps i...Zinc plays a critical role in a variety of cell functions and elicits the fact that both its deficiency and excess may demonstrate deleterious situation. It has been proposed that zinc is required for multiple steps in insulin synthesis and release. This study investigated the relationship of zinc and glucose in diabetics. Using serum samples of diabetic patients whose glucose concentrations were above the threshold (10.0 mmol/l), spectroscopic methods were used to determine the concentration of glucose and zinc. Results obtained showed a negative correlation between level of glucose and zinc. Data were analyzed using student’s t-test with the aid of Graph Pad Prism (R) version 6.01 with a p value of <0.05 considered statistically significant. We concluded that reduced concentration of zinc observed in the study could be an uncommon factor to hyperglycemia and impose risk factor to diabetics. Its evaluation along with glucose levels is highly recommended in management of diabetic patients.展开更多
Objectives:The objective of this study is to assess the handgrip strength(HGS)in patients with type 2 diabetes,compare it with nondiabetes age-matched individuals,and assess the correlation between diabetic status and...Objectives:The objective of this study is to assess the handgrip strength(HGS)in patients with type 2 diabetes,compare it with nondiabetes age-matched individuals,and assess the correlation between diabetic status and HGS among diabetic patients.Materials and Methods:A community-based cross-sectional study was conducted in rural Mysore,India,for 4 months.Fifty-eight clinically diagnosed type 2 diabetics and 58 nondiabetics participated in the study.The handheld dynamometer was used to test the HGS of all subjects in their dominant hand.Independent t-test was used to analyze the differences in HGS between patients with and without diabetes.Results:The mean dynamometer reading among diabetics was 19.08±7.51,whereas that in nondiabetics was 27.474±13.11.There was a significant difference in HGSs between diabetics and nondiabetics(P<0.01).Conclusion:Decreased muscle strength and quality in the upper extremities are associated with type 2 diabetes and can lead to functional and physical limitations.Diabetic patients’HGS should be evaluated promptly to identify any disabilities and plan for appropriate therapy.展开更多
Background: To evaluate if the risk for developing atrial fibrillation after lung surgery is higher for diabetics than non-diabetic patients and whether diabetic status prolongs the length of in-hospital stay. Objecti...Background: To evaluate if the risk for developing atrial fibrillation after lung surgery is higher for diabetics than non-diabetic patients and whether diabetic status prolongs the length of in-hospital stay. Objective: To compare the outcome of amiodarone prophylaxis in diabetics and non-diabetics. Design: Subgroup analysis within a randomized, controlled, double-blinded trial. Results: Development of atrial fibrillation was equally frequent among diabetics (18.2%) and non-diabetics (20.5%) (p = 1.00). Atrial fibrillation occurred in 7.1% of prophylactic diabetics and in 9.3% of prophylactic non-diabetics, while 37.5% non-prophylactic diabetics and 31.3% non-prophylactic non-diabetics experienced atrial fibrillation (p = 0.31). Prophylactic amiodarone was equally effective in diabetics as in non-diabetics with a relative risk of 3.5 (1.8 - 67.0) and the number need to treat of 4.4 (3.3 - 8.3) (p = 0.31). The length of in-hospital stay for diabetics was equal to non-diabetics with an average stay of 7.1 versus 8 days at Aarhus University Hospital (p = 0.61) with similar stays at intermediary and intensive care unit as well as total in-hospital stay of 8.9 versus 10 days (p = 0.60). Conclusions: Diabetics have the same risk of atrial fibrillation and the same benefits from prophylactic amiodarone as non-diabetics after surgery for lung cancer. Furthermore, diabetics have the same length of stay as non-diabetics. No severe adverse effects were found in either group.展开更多
AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of...AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms. METHODS： In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn （at least 1/wk）, regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance. RESULTS： The average duration of diabetes were 12 ± 9.2 years and the average HbAlc level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 Ibs. and 32 ± 7.2 kg/m^2. Forty percent （61/150） patients reported having at least one of the symptoms of GERD and thirty percent （45/150） reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy （58.7% vs 32.7%, P 〈 0.01）. The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy （43.5% vs 24%; 10.9% vs 4.8% and 17.8% vs 6.7% respectively, P 〈 0.05）. CONCLUSION： The prevalence of GERD symptoms in type 2 DM is higher than in the general population. Our data suggest that DM neuropathy may be an important associated factor for developing GERD symptoms.展开更多
AIM:To investigate whether Helicobacter pylori(H.pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy.METHODS:The databases of Pub Med,Cochrane Library,Chi...AIM:To investigate whether Helicobacter pylori(H.pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy.METHODS:The databases of Pub Med,Cochrane Library,Chinese Bio Medicine Web Base and Chinese Science and Technology Journals were searched from inception to June 2014.Studies examining the association between H.pylori infection and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion.Meta-analyses were conducted using the Review Manager software version 5.2.The outcome measures are presented as weighed mean differences(WMDs) with 95% confidence intervals(CIs).Statistical heterogeneity was assessed by the Cochran Q test and the I2 statistic.RESULTS:A total of 21 relevant publications were identified.A meta-analysis of 11 studies with 513 patients with diabetes mellitus(DM) showed significantly lower glycosylated hemoglobin(Hb A1c) levels in the H.pylori-negative than H.pylori-positive DM participants(WMD = 0.43,95%CI:0.07-0.79;P = 0.02).In children and adolescents with type 1 DM(T1DM),there was a positive association between H.pylori infection and Hb A1 c level(WMD = 0.35,95%CI:0.05-0.64;P = 0.02),but there was no difference in those with type 2 DM(T2DM,WMD = 0.51,95%CI:-0.63-1.65;P = 0.38).A meta-analysis of six studies with 325 T2 DM participants showed a significant difference in the fasting plasma glucose levels between H.pylori-positive and H.pylori-negative participants(WMD = 1.20,95%CI:0.17-2.23;P = 0.02).Eradication of H.pylori did not improve glycemic control in the T2 DM participants in a threemonth follow-up period(Hb A1 c decrease:WMD =-0.03,95%CI =-0.14-0.08;P = 0.57;fasting plasma glucose decrease:WMD =-0.06,95%CI:-0.36-0.23;P = 0.68).Glycemic control was significantly better in T1 DM participants who were not reinfected than in those who were reinfected(Hb A1c:WMD = 0.72,95%CI:0.32-1.13:P = 0.00).CONCLUSION:H.pylori infection is associated with poorer glycemic control in T1 DM patients,but eradication may not improve glycemic control in DM in a short-term follow-up period.展开更多
Background There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease （CAD） in patients with diabetes mellitus. We determined the relationship between five conventional ...Background There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease （CAD） in patients with diabetes mellitus. We determined the relationship between five conventional lipid ratios and the extent of coronary artery lesions in Chinese Type 2 diabetics with stable angina pectoris （SAP）. Methods A prospective cohort study within 373 type 2 diabetic patients diag- nosed with stable CAD by coronary angiography was performed. All patients were classified into three groups according to the tertiles of Gensini scores （GS, low group 〈 8 points n = 143; intermediate group 8-28 points, n = 109; high group 〉 28 points, n = 121）. Association between the ratios of apolipoprotein （apo） B and apoA-1, total cholesterol and high density lipoprotein cholesterol （TC/HDL-C）, triglycerides and HDL-C （TG/HDL-C）, low density lipoprotein cholesterol and HDL-C （LDL-C/HDL-C）, Non-HDL-C/HDL-C and GS were evaluated using the receivers operating characteristic （ROC） curves and multivariate logistic regression models. Results The ratio of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C, and Non-HDL-C/HDL-C were correlated with Gensini scores. Area under the ROC curves for predicting high Gensini scores in the ratios of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C and Non-HDL-C/HDL-C were 0.62, 0.60, 0.59 and 0.60, respec- tively （P 〈 0.005 for all）. According to multivariate logistic regression analysis after adjusted with demographic characteristic and other lipid parameters, the ratio of apoB/apoA-1 is qualified as an independent discriminator for the severity of CAD. However, after fiu-ther adjusting different baseline variables, such as left ventricular ejective fraction, hemoglobin Alc, leukocytes count and serum creatinine, none of the above lipid ratios remained. Conclusions Compared with other lipid parameters, the ratio of apoB/apoA-1 appears to be more significantly correlated with the extent of coronary artery lesions in Chinese diabetics, but it was not an independent predictor in these settings.展开更多
Objective:To evaluate the effects of the modified Linggui Zhugan Decoction(加味苓桂术甘汤) combined with short-term very low calorie diets(VLCDs) on glycemic control in newly diagnosed type 2 diabetes mellitus(T2DM) p...Objective:To evaluate the effects of the modified Linggui Zhugan Decoction(加味苓桂术甘汤) combined with short-term very low calorie diets(VLCDs) on glycemic control in newly diagnosed type 2 diabetes mellitus(T2DM) patients.Methods:A total of 20 subjects with newly diagnosed T2DM were treated with the modified Linggui Zhugan Decoction(one-month administration) combined with short-term VLCDs(5 days),and 3-months follow-up.A standard 75-g oral-glucose-tolerance test(OGTT) indexes fasting plasma glucose(FPG),post-prandial 0.5 h and 2 h plasma glucose(P0.5hPG,P2hPG),glycated hemoglobin A1C(GHbA1C),body weight,body mass index(BMI),insulin function,insulin resistance index,incidence of hypoglycemia,and the liver and renal functions were evaluated before and after treatment.Correlations of BMI with insulin function and insulin resistance were also assessed.Results:After the treatment,the patients' plasma glucose decreased steadily,FPG decreased from 5.8±0.9 mmol/L at pre-treatment to 5.0±0.6 mmol/L at 3-months follow-up(P<0.05),and P2hPG decreased from 11.7±3.8 mmol/L at pre-treatment to 6.9±0.9 mmol/L at 3-months follow-up(P<0.01).The level of GHbA1C declined from(6.47±1.24)% at pre-treatment to(6.14±0.99)% at 3-months follow-up(P<0.01).Body weight and BMI also declined significantly.Insulin resistance index was improved obviously and no event of hypoglycemia occurred.Part of the patients companied with fatty liver had a transient increase in hepatic transaminase during the treatment,but it turned to normal after the treatment.Conclusions:The modified Linggui Zhugan Decoction combined with short-term VLCDs can be safely implemented for steady glycemic control in newly diagnosed T2DM patients.展开更多
AIM： To assess the incidence of and risk factors for gallstone disease （GSD） among type 2 diabetics in Kinmen, Taiwan. METHODS： A screening program for GSD was performed by two specialists who employed real-time a...AIM： To assess the incidence of and risk factors for gallstone disease （GSD） among type 2 diabetics in Kinmen, Taiwan. METHODS： A screening program for GSD was performed by two specialists who employed real-time abdominal ultrasound to examine the abdominal region after patients had fasted for at least eight hours. Screening, which was conducted in 2001, involved 848 patients diagnosed with type 2 diabetes. After exclusion of 63 subjects with prevalent GSD, 377 participants without GSD were invited in 2002 for a second round of screening. A total of 281 （74.5%） subjects were re-examined. RESULTS： Among the 281 type 2 diabetics who had no GSD at the first screening, 10 had developed GSD by 2002. The incidence was 3.56% per year （95%CI： 1.78% per year-6.24% per year）. Using a Cox regression model, age （RR = 1.07, 95% CI： 1.00-1.14）, waist circumference （RR = 1.12, 95% CI： 1.01-1.29）, and ALT （RR = 1.13, 95%CI： 1.01-1.26） appeared to be significantly correlated with development of GSD. CONCLUSION： Older age is a known risk factor for the development of GSD. Our study shows that greater waist circumference and elevated ALT levels are also associated with the development of GSD among type 2 diabetics in Kinmen.展开更多
AIM:To explore the related risk factors for diabetic retinopathy(DR)in type 2 diabetes with insulin therapy.METHODS:We studied the relationships among blood glucose,serum C-peptide,plasma insulin,beta-cell function an...AIM:To explore the related risk factors for diabetic retinopathy(DR)in type 2 diabetes with insulin therapy.METHODS:We studied the relationships among blood glucose,serum C-peptide,plasma insulin,beta-cell function and the development of DR.Beta-cell function was assessed by a modified homeostasis model assessment(modified HOMA)which was gained by using C-peptide to replace insulin in the homeostasis model assessment(HOMA)of beta-cell function.We also studied the relationships between modified HOMA index and serum C-peptide response to 100 g tasteless steamed bread to determine the accuracy of modified HOMA.RESULTS:Our study group consisted of 170 type 2diabetic inpatients with DR(age:58.35±13.87y,mean±SD)and 205 type 2 diabetic inpatients with no DR(NDR)(age:65.52±11.59y).DR patients had higher age,longer diabetic duration,higher hypertension grade,higher postprandial plasma glucose,higher fluctuation level of plasma glucose,lower body mass index(BMI),lower postprandial serum insulin and C-peptide,lower fluctuation level of serum insulin and C-peptide(P【0.05).In our logistic regression model,duration of diabetes,hypertension grade,fasting plasma insulin and glycosylated hemoglobin(HbA1C)were significantly associated with the presence of DR after adjustment for confounding factors(P【0.05).CONCLUSION:Our results suggested although modified HOMA showed significant correlation to the occurrence of DR on Spearman’s rank-correlationanalysis,logistic regression showed no significant association between these two variables after adjustment for relevant confounding factors(such as age,sex,duration of diabetes,BMI,hypertension grade,HbA1C,plasma insulin).Duration of diabetes,hypertension grade,fasting plasma insulin and HbA1C were independently associated with the development of DR in Chinese type 2 diabetics.展开更多
AIM:To evaluate the rates of retinopathy without diabetes and diabetic retinopathy(DR),associated with some markers of oxidative stress,antioxidants and cardiometabolic risk factors.METHODS:We determined the prevalenc...AIM:To evaluate the rates of retinopathy without diabetes and diabetic retinopathy(DR),associated with some markers of oxidative stress,antioxidants and cardiometabolic risk factors.METHODS:We determined the prevalence of DR in 150type 2 diabetes mellitus(T2DM)patients,that of retinopathy in 50 non diabetics,the levels of body mass index(BMI),waist circumference(WC),blood pressure,lipids,8-isoprostane,8-hydroxydeoxyguanosine(8-oHdG),gamma-glutamyl transferase(GGT),oxidized low density lipoprotein(LDL)(OxLDL),thiobarbituric acid reacting substances(TBARS),reduced glutathione(GSH),superoxide dismutase(SOD),uric acid,creatinine,albumin,total antioxidant status(TAOS),zinc,selenium,magnesium,vitamin C,vitamin D,vitamin E,glucose,apolipoprotein B(ApoB).RESULTS:The prevalences of DR at 53y and Rtp at62y were 44%(n=66)and 10%(n=5),respectively.Thehighest levels of 8-isoprostane,8-OHdG,TBARS,SOD,and OxLDL were in DR.The lowest levels of vitamin D,vitamin C,TAOS,and vitamin E were in DR.In the casecontrol study discriminant analysis,the levels of vitamin C,vitamin D,ApoB,8-OHdG,creatinine,Zn,vitamin E,and WC distinguished significantly non-diabetics without DR(controls),T2DM patients without DR and T2DM patients with DR.CONCLUSION:Anticipation of DR onset is significantly associated with the exageration of oxidative stress biomarkers or decrease of antioxidants in African type 2diabetics.Prevention of oxidative stress and abdominal obesity is needed.Supplementation in vitamin C,D,and E should be recommended as complement therapies of T2DM.展开更多
文摘AIM:To identify factors associated with adherence to annual eye examinations among adults with diabetes mellitus(DM)in Malaysia METHODS:Data from community-dwelling adults aged≥18y with known DM,defined as those who had previously been informed by a doctor or assistant medical officer of their diagnosis were analyzed using the National Health and Morbidity Survey 2023,a population-based crosssectional survey conducted using a two-stage stratified random sampling design.Locally validated questionnaire on diabetic eye screening was administered through faceto-face interviews from July until September 2023.Adults with known DM were asked three key questions about eye examinations:whether their eyes had been examined using clinical tools(illustrated with images of a direct ophthalmoscope,slit lamp or fundus camera),the timing of their last eye examination(if applicable),and whether they had been referred to an ophthalmology clinic for DM-related complications,serving as a proxy for diabetic retinopathy(DR)referrals.Complex sample analysis,incorporating sample weights and the study’s design,were used to describe respondents’baseline characteristics by urban or rural localities.Multivariable binary logistic regression with adjusted odds ratio(aOR)and 95%confidence interval(CI)was performed.RESULTS:Among 1554 adults with known DM in Malaysia,58.8%had never undergone an eye examination and only 29.5%complied with the recommended annual eye check-ups.Additionally,25.8%of DM patients were referred to an ophthalmology clinic for DR.Referral to ophthalmology clinic for DR(aOR=4.63,95%CI:3.27,6.55),insulin use(aOR=1.93,95%CI:1.37,2.72),secondary education(aOR=1.71,95%CI:1.03,2.85)and DM duration≥10y(aOR=1.48,95%CI:1.02,2.16)were associated with higher odds of annual eye examinations.Chinese(aOR=0.50,95%CI:0.29,0.87)and Indian(aOR=0.47,95%CI:0.29,0.78)ethnicities had lower odds of undergoing annual eye examinations compared to Malay ethnicity.Similarly,those with a monthly household income of≥RM10000(aOR=0.45,95%CI:0.21,0.95)were less likely to get their eyes examined yearly.CONCLUSION:Fewer than one-third of adults with DM in Malaysia adhere to the recommended annual eye examinations,with lower compliance observed among Chinese or Indian ethnicities and those with higher household incomes.Targeted educational campaigns for Chinese,Indian,and higher-income adults with DM may encourage regular eye exams and reduce preventable vision loss from DR in Malaysia.
文摘Background: Diabetes mellitus (DM) is a disease characterized by hyperglycemia due to (a) insulin-insufficiency (type I DM), or (b) impaired glucose cell-entry (insulin resistance) due to the downregulation of insulin cell receptors (type II DM). Type I DM usually presents with florid manifestations contrary to a slowly-progressive type II. Patients and methods: Over the past 10 years, we encountered 9 obese patients with controlled insulin-requiring type II DM for years, at a dose of 62 ± 5 units/day, who developed sudden and severe insulin resistance (IR) that required 210 ± 25 units daily. All patients had very high levels of anti-Glutamic Acid Decarboxylase (GAD) antibodies. Despite a lack of previous testing for anti-GAD antibodies, they were treated, with Cyclosporin A (Cy), as an autoimmune disorder superimposed on their type II MD. Initially all patients were treated with 100 mg, of Cy, twice daily aiming at an initial trough level of 100 - 150 ng/ml. Three months later, the dose was reduced to 50 mg twice daily for a total of 2 years. Results: Amelioration of IR was achieved by 1 month with a reduction of daily insulin requirement to 123 ± 16 units that further decreased to 76 ± 11 by the end of the 3rd month. Such improvement persisted for 2 years and >1 year after Cy discontinuation. Moreover, a decline in insulin requirements was associated with a parallel decrease in anti-GAD antibody levels and an increase in C-peptide insulin without kidney disease. Conclusion: Anti-GAD antibodies can induce acute IR in type II DM, and this phenomenon can be treated safely and effectively with Cy.
文摘BACKGROUND Diabetic patients with atypical presentation are often challenging in terms of diagnosis and management.Kidney biopsy is not routinely done in diabetics,and clinicians are always in a dilemma in such a scenario to decide whether to do a biopsy or not.Since non-diabetic kidney diseases(NDKD)are common,and some patients may have NDKD superimposed on diabetic kidney diseases(DKD),therefore,kidney biopsy may be warranted to rule out NDKD.AIM To determine the prevalence of NDKD,DKD,or mixed lesions,identify predictors of NDKD,and investigate renal and patient survival,as well as factors associated with these outcomes.METHODS This retrospective observational study was conducted on patients with biopsyproven NDKD,DKD,and mixed lesions(having both NDKD and DKD).Binary logistic regression models were constructed to identify predictors of NDKD.Kaplan-Meier survival analysis was performed to compare time to kidney failure and patient survival across the three histological groups.Multivariable Cox proportional hazards regression was used to identify clinical and pathological factors associated with kidney failure and all-cause mortality.RESULTS A total of 103 biopsies were analyzed.Sixty-four(62.1%)had NDKD alone or mixed lesions.The most common NDKD pathologies were interstitial nephritis in 12(29.2%),focal segmental glomerulosclerosis in 10(24.4%),and immune complex–mediated glomerulonephritis in five(12.2%)patients.Compared to DKD,NDKD was associated with significantly lower odds of proteinuria>3.5 g/day[odds ratio(OR),0.02;P=0.0015],retinopathy(OR=0.04;P=0.0067),and diabetes duration≥10 years(OR=0.01;P=0.0002).However,NDKD had higher odds of anemia(Hemoglobin<12 g/dL;OR=9.56;P=0.0107)and creatinine levels>180μmol/L(OR=18.68;P=0.0063).Kaplan-Meier analysis showed significant differences in renal survival(log-rank P=0.0033).Patients with NDKD have the best outcomes,while those with DKD have the worst.In a multivariable Cox regression analysis,increasing age,creatinine,arteriosclerosis,and severe interstitial fibrosis and tubular atrophy were independently associated with kidney failure.At the same time,the use of renin angiotensin system blockers was protective(hazard ratio=0.43,P=0.02).Kaplan-Meier curves for patient survival also differed significantly(log-rank P=0.018);patients in the mixed group showed the highest mortality,while those with NDKD showed the lowest.Mortality was independently associated with older age,hypoalbuminemia,diabetic retinopathy,arteriosclerosis,and higher creatinine.CONCLUSION NDKD and mixed lesions are frequent in diabetic patients.These histological lesions carry distinct prognostic implications.Clinical features such as a shorter diabetes duration,absence of retinopathy,anemia,and elevated creatinine levels suggest NDKD and warrant biopsy.NDKD had better renal and patient survival rates,while mixed lesions had the worst outcomes.Older age,hypoalbuminemia,retinopathy,arteriosclerosis,and elevated creatinine were key predictors of mortality.
基金The Deputyship for Research and Innovation, Ministry of Education in Saudi Arabia, No. IF2/PSAU/2022/03/23339.
文摘BACKGROUND L-arginine(L-Arg)is one of the most widely used amino acids in dietary and pharmacological products.However,the evidence on its usefulness and dose limitations,especially in diabetics is still controversial.AIM To investigate the effects of chronic administration of different doses of L-Arg on the cardiac muscle of type 2 diabetic rats.METHODS Of 96 male rats were divided into 8 groups as follows(n=12):Control,0.5 g/kg L-Arg,1 g/kg L-Arg,1.5 g/kg L-Arg,diabetic,diabetic+0.5 g/kg L-Arg,diabetic+1 g/kg L-Arg,and diabetic+1.5 g/kg L-Arg;whereas L-Arg was orally administered for 3 months to all treated groups.RESULTS L-Arg produced a moderate upregulation of blood glucose levels to normal rats,but when given to diabetics a significant upregulation was observed,associated with increased nitric oxide,inflammatory cytokines,and malonaldehyde levels in diabetic rats treated with 1 g/kg L-Arg and 1.5 g/kg L-Arg.A substantial decrease in the antioxidant capacity,superoxide dismutase,catalase,glutathione peroxidase,reduced glutathione concentrations,and Nrf-2 tissue depletion were observed at 1 g/kg and 1.5 g/kg L-Arg diabetic treated groups,associated with myocardial injury,fibrosis,α-smooth muscle actin upregulation,and disruption of desmin cardiac myofilaments,and these effects were not noticeable at normal treated groups.On the other hand,L-Arg could significantly improve the lipid profile of diabetic rats and decrease their body weights.CONCLUSION L-Arg dose of 1 g/kg or more can exacerbates the diabetes injurious effects on the myocardium,while 0.5 g/kg dose can improve the lipid profile and decrease the body weight.
文摘NARCOTREND index （NI） is based on studies ofnormal human brain electrical data. It uses anordinary electrode to collect and analysis brainelectrical signals immediately at any positionof the head, to display the state of consciousness and depthof anesthesia of patients on the touch screen afterautomatic analysis and classification, so as to guide doseadjustment of anesthetics. NI may make the consciousnessand depth of anesthesia monitoring safe, simple, accurate,and economic. It is important that NI is more accurate thanclassical electroencephalographic variables.^1 Weber et al2believed that the NI was an objective and true index in theevaluation of propofol sedation in children.
文摘Diabetics is one of the world’s most common diseases which are caused by continued high levels of blood sugar.The risk of diabetics can be lowered if the diabetic is found at the early stage.In recent days,several machine learning models were developed to predict the diabetic presence at an early stage.In this paper,we propose an embedded-based machine learning model that combines the split-vote method and instance duplication to leverage an imbalanced dataset called PIMA Indian to increase the prediction of diabetics.The proposed method uses both the concept of over-sampling and under-sampling along with model weighting to increase the performance of classification.Different measures such as Accuracy,Precision,Recall,and F1-Score are used to evaluate the model.The results we obtained using K-Nearest Neighbor(kNN),Naïve Bayes(NB),Support Vector Machines(SVM),Random Forest(RF),Logistic Regression(LR),and Decision Trees(DT)were 89.32%,91.44%,95.78%,89.3%,81.76%,and 80.38%respectively.The SVM model is more efficient than other models which are 21.38%more than exiting machine learning-based works.
文摘Diabetes is one of the four major non-communicable diseases,and appointed by the world health organization as the seventh leading cause of death worldwide.The scientists have turned over every rock in the corners of medical sciences in order to come up with better understanding and hence more effective treatments of diabetes.The continuous research on the subject has elucidated the role of immune disorders and inflammation as definitive factors in the trajectory of diabetes,assuring that blood glucose adjustments would result in a relief in the systemic stress leading to minimizing inflammation.On a parallel basis,microbial infections usually take advantage of immunity disorders and propagate creating a pro-inflammatory environment,all of which can be reversed by antimicrobial treatment.Standing at the crossroads between diabetes,immunity and infection,we aim in this review at projecting the interplay between immunity and diabetes,shedding the light on the overlapping playgrounds for the activity of some antimicrobial and anti-diabetic agents.Furthermore,we focused on the antidiabetic drugs that can confer antimicrobial or anti-virulence activities.
文摘Introduction: To describe the epidemiologic profile, clinical and paraclinical of diabetics presenting microalbuminuria at Marc Sankale center. Patients and methods: We have done cross-sectional and retrospective study in a descriptive and analytic view or way. It happened within 6 months. Diabetic patients who performed the nycthemeral urinary albumin dose and mentioned in the file were included. The last study is considered as a positive one from 30 to 299mg/24h: Microalbuminuria. The creatinine has been noted and the clearing of the creatinine is calculated through the formula of Cockcroft and Gault. The statistical analysis of data has been done thanks to software such as excel 2013 and SPSS VER 18.0. Results: 221 patients have been noted with 70% women and 30% men. The age varied between 30 years and 85 years with an average of 56, 62 against 9.97 years. Sixty three (63) patients have microalbuminuria (29%);creatinine has been regularized to 25 patients with 14.8% of cases. Among the microalbuminuria patients having completed the creatinine, 32 patients (42.7%) and 16 (21.3%) are respectively in a state of chronical renal failure, light and moderated. Conclusion: The microalbuminuria is frequent to diabetics. But in our series a starting renal insufficiency could precede that microalbuminuria.
文摘GUO Sai-shan was born on October 24, 1938, in Putian Fujian Province, 1960 graduated in Shanghai First Medical College （now Shanghai Medical University）. At present, she is the Professor of Peking Union Medical College. Chief Doctor,Post-doctorate Tutor, in 1991 to 2002 she was appointed as Director of Department of Traditional Chinese Medicine （TOM）;
文摘Zinc plays a critical role in a variety of cell functions and elicits the fact that both its deficiency and excess may demonstrate deleterious situation. It has been proposed that zinc is required for multiple steps in insulin synthesis and release. This study investigated the relationship of zinc and glucose in diabetics. Using serum samples of diabetic patients whose glucose concentrations were above the threshold (10.0 mmol/l), spectroscopic methods were used to determine the concentration of glucose and zinc. Results obtained showed a negative correlation between level of glucose and zinc. Data were analyzed using student’s t-test with the aid of Graph Pad Prism (R) version 6.01 with a p value of <0.05 considered statistically significant. We concluded that reduced concentration of zinc observed in the study could be an uncommon factor to hyperglycemia and impose risk factor to diabetics. Its evaluation along with glucose levels is highly recommended in management of diabetic patients.
文摘Objectives:The objective of this study is to assess the handgrip strength(HGS)in patients with type 2 diabetes,compare it with nondiabetes age-matched individuals,and assess the correlation between diabetic status and HGS among diabetic patients.Materials and Methods:A community-based cross-sectional study was conducted in rural Mysore,India,for 4 months.Fifty-eight clinically diagnosed type 2 diabetics and 58 nondiabetics participated in the study.The handheld dynamometer was used to test the HGS of all subjects in their dominant hand.Independent t-test was used to analyze the differences in HGS between patients with and without diabetes.Results:The mean dynamometer reading among diabetics was 19.08±7.51,whereas that in nondiabetics was 27.474±13.11.There was a significant difference in HGSs between diabetics and nondiabetics(P<0.01).Conclusion:Decreased muscle strength and quality in the upper extremities are associated with type 2 diabetes and can lead to functional and physical limitations.Diabetic patients’HGS should be evaluated promptly to identify any disabilities and plan for appropriate therapy.
文摘Background: To evaluate if the risk for developing atrial fibrillation after lung surgery is higher for diabetics than non-diabetic patients and whether diabetic status prolongs the length of in-hospital stay. Objective: To compare the outcome of amiodarone prophylaxis in diabetics and non-diabetics. Design: Subgroup analysis within a randomized, controlled, double-blinded trial. Results: Development of atrial fibrillation was equally frequent among diabetics (18.2%) and non-diabetics (20.5%) (p = 1.00). Atrial fibrillation occurred in 7.1% of prophylactic diabetics and in 9.3% of prophylactic non-diabetics, while 37.5% non-prophylactic diabetics and 31.3% non-prophylactic non-diabetics experienced atrial fibrillation (p = 0.31). Prophylactic amiodarone was equally effective in diabetics as in non-diabetics with a relative risk of 3.5 (1.8 - 67.0) and the number need to treat of 4.4 (3.3 - 8.3) (p = 0.31). The length of in-hospital stay for diabetics was equal to non-diabetics with an average stay of 7.1 versus 8 days at Aarhus University Hospital (p = 0.61) with similar stays at intermediary and intensive care unit as well as total in-hospital stay of 8.9 versus 10 days (p = 0.60). Conclusions: Diabetics have the same risk of atrial fibrillation and the same benefits from prophylactic amiodarone as non-diabetics after surgery for lung cancer. Furthermore, diabetics have the same length of stay as non-diabetics. No severe adverse effects were found in either group.
文摘AIM： To analyze the prevalence of gastroesophageal reflux disease （GERD） related symptoms in patients with diabetes mellitus （DM） and to find out the relationship between diabetic neuropathy and the prevalence of GERD symptoms. METHODS： In this prospective questionnaire study, 150 consecutive type 2 diabetic patients attending the endocrine clinic were enrolled. A junior physician helped the patients to understand the questions. Patients were asked about the presence of five most frequent symptoms of GERD that included heartburn （at least 1/wk）, regurgitation, chest pain, hoarseness of voice and chronic cough. Patients with past medical history of angina, COPD, asthma, cough due to ACEI or preexisting GERD prior to onset of diabetes and apparent psychiatric disorders were excluded from the survey. We further divided the patients into two groups based on presence or absence of peripheral neuropathy. Out of 150 patients, 46 had neuropathy, whereas 104 patients did not have neuropathy. Data are expressed as mean ± SD, and number of patients in each category and percentage of total patients in that group. Normal distributions between groups were compared with Student t test and the prevalence rates between groups were compared with Chi-square tests for significance. RESULTS： The average duration of diabetes were 12 ± 9.2 years and the average HbAlc level of this group was 7.7% ± 2.0%. The mean weight and BMI were 198 ± 54 Ibs. and 32 ± 7.2 kg/m^2. Forty percent （61/150） patients reported having at least one of the symptoms of GERD and thirty percent （45/150） reported having heartburn at least once a week. The prevalence of GERD symptoms is higher in patients with neuropathy than patients without neuropathy （58.7% vs 32.7%, P 〈 0.01）. The prevalence of heartburn, chest pain and chronic cough are also higher in patients with neuropathy than in patients without neuropathy （43.5% vs 24%; 10.9% vs 4.8% and 17.8% vs 6.7% respectively, P 〈 0.05）. CONCLUSION： The prevalence of GERD symptoms in type 2 DM is higher than in the general population. Our data suggest that DM neuropathy may be an important associated factor for developing GERD symptoms.
文摘AIM:To investigate whether Helicobacter pylori(H.pylori) infection is associated with glycemic control and whether hyperglycemia is modified by eradication therapy.METHODS:The databases of Pub Med,Cochrane Library,Chinese Bio Medicine Web Base and Chinese Science and Technology Journals were searched from inception to June 2014.Studies examining the association between H.pylori infection and glycemic control and/or the effect of eradication treatment on glycemic control in diabetic humans were eligible for inclusion.Meta-analyses were conducted using the Review Manager software version 5.2.The outcome measures are presented as weighed mean differences(WMDs) with 95% confidence intervals(CIs).Statistical heterogeneity was assessed by the Cochran Q test and the I2 statistic.RESULTS:A total of 21 relevant publications were identified.A meta-analysis of 11 studies with 513 patients with diabetes mellitus(DM) showed significantly lower glycosylated hemoglobin(Hb A1c) levels in the H.pylori-negative than H.pylori-positive DM participants(WMD = 0.43,95%CI:0.07-0.79;P = 0.02).In children and adolescents with type 1 DM(T1DM),there was a positive association between H.pylori infection and Hb A1 c level(WMD = 0.35,95%CI:0.05-0.64;P = 0.02),but there was no difference in those with type 2 DM(T2DM,WMD = 0.51,95%CI:-0.63-1.65;P = 0.38).A meta-analysis of six studies with 325 T2 DM participants showed a significant difference in the fasting plasma glucose levels between H.pylori-positive and H.pylori-negative participants(WMD = 1.20,95%CI:0.17-2.23;P = 0.02).Eradication of H.pylori did not improve glycemic control in the T2 DM participants in a threemonth follow-up period(Hb A1 c decrease:WMD =-0.03,95%CI =-0.14-0.08;P = 0.57;fasting plasma glucose decrease:WMD =-0.06,95%CI:-0.36-0.23;P = 0.68).Glycemic control was significantly better in T1 DM participants who were not reinfected than in those who were reinfected(Hb A1c:WMD = 0.72,95%CI:0.32-1.13:P = 0.00).CONCLUSION:H.pylori infection is associated with poorer glycemic control in T1 DM patients,but eradication may not improve glycemic control in DM in a short-term follow-up period.
文摘Background There is a paucity of data about the best lipid ratio predicting the severity of coronary artery disease （CAD） in patients with diabetes mellitus. We determined the relationship between five conventional lipid ratios and the extent of coronary artery lesions in Chinese Type 2 diabetics with stable angina pectoris （SAP）. Methods A prospective cohort study within 373 type 2 diabetic patients diag- nosed with stable CAD by coronary angiography was performed. All patients were classified into three groups according to the tertiles of Gensini scores （GS, low group 〈 8 points n = 143; intermediate group 8-28 points, n = 109; high group 〉 28 points, n = 121）. Association between the ratios of apolipoprotein （apo） B and apoA-1, total cholesterol and high density lipoprotein cholesterol （TC/HDL-C）, triglycerides and HDL-C （TG/HDL-C）, low density lipoprotein cholesterol and HDL-C （LDL-C/HDL-C）, Non-HDL-C/HDL-C and GS were evaluated using the receivers operating characteristic （ROC） curves and multivariate logistic regression models. Results The ratio of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C, and Non-HDL-C/HDL-C were correlated with Gensini scores. Area under the ROC curves for predicting high Gensini scores in the ratios of apoB/apoA-1, TC/HDL-C, LDL-C/HDL-C and Non-HDL-C/HDL-C were 0.62, 0.60, 0.59 and 0.60, respec- tively （P 〈 0.005 for all）. According to multivariate logistic regression analysis after adjusted with demographic characteristic and other lipid parameters, the ratio of apoB/apoA-1 is qualified as an independent discriminator for the severity of CAD. However, after fiu-ther adjusting different baseline variables, such as left ventricular ejective fraction, hemoglobin Alc, leukocytes count and serum creatinine, none of the above lipid ratios remained. Conclusions Compared with other lipid parameters, the ratio of apoB/apoA-1 appears to be more significantly correlated with the extent of coronary artery lesions in Chinese diabetics, but it was not an independent predictor in these settings.
基金supported by International Science and Technology Cooperation Program of Guangdong Province (No. 2009B050700022)
文摘Objective:To evaluate the effects of the modified Linggui Zhugan Decoction(加味苓桂术甘汤) combined with short-term very low calorie diets(VLCDs) on glycemic control in newly diagnosed type 2 diabetes mellitus(T2DM) patients.Methods:A total of 20 subjects with newly diagnosed T2DM were treated with the modified Linggui Zhugan Decoction(one-month administration) combined with short-term VLCDs(5 days),and 3-months follow-up.A standard 75-g oral-glucose-tolerance test(OGTT) indexes fasting plasma glucose(FPG),post-prandial 0.5 h and 2 h plasma glucose(P0.5hPG,P2hPG),glycated hemoglobin A1C(GHbA1C),body weight,body mass index(BMI),insulin function,insulin resistance index,incidence of hypoglycemia,and the liver and renal functions were evaluated before and after treatment.Correlations of BMI with insulin function and insulin resistance were also assessed.Results:After the treatment,the patients' plasma glucose decreased steadily,FPG decreased from 5.8±0.9 mmol/L at pre-treatment to 5.0±0.6 mmol/L at 3-months follow-up(P<0.05),and P2hPG decreased from 11.7±3.8 mmol/L at pre-treatment to 6.9±0.9 mmol/L at 3-months follow-up(P<0.01).The level of GHbA1C declined from(6.47±1.24)% at pre-treatment to(6.14±0.99)% at 3-months follow-up(P<0.01).Body weight and BMI also declined significantly.Insulin resistance index was improved obviously and no event of hypoglycemia occurred.Part of the patients companied with fatty liver had a transient increase in hepatic transaminase during the treatment,but it turned to normal after the treatment.Conclusions:The modified Linggui Zhugan Decoction combined with short-term VLCDs can be safely implemented for steady glycemic control in newly diagnosed T2DM patients.
基金Supported by the grants from the Cheng Hsin Rehabilitation Medical Center, No. 93-25
文摘AIM： To assess the incidence of and risk factors for gallstone disease （GSD） among type 2 diabetics in Kinmen, Taiwan. METHODS： A screening program for GSD was performed by two specialists who employed real-time abdominal ultrasound to examine the abdominal region after patients had fasted for at least eight hours. Screening, which was conducted in 2001, involved 848 patients diagnosed with type 2 diabetes. After exclusion of 63 subjects with prevalent GSD, 377 participants without GSD were invited in 2002 for a second round of screening. A total of 281 （74.5%） subjects were re-examined. RESULTS： Among the 281 type 2 diabetics who had no GSD at the first screening, 10 had developed GSD by 2002. The incidence was 3.56% per year （95%CI： 1.78% per year-6.24% per year）. Using a Cox regression model, age （RR = 1.07, 95% CI： 1.00-1.14）, waist circumference （RR = 1.12, 95% CI： 1.01-1.29）, and ALT （RR = 1.13, 95%CI： 1.01-1.26） appeared to be significantly correlated with development of GSD. CONCLUSION： Older age is a known risk factor for the development of GSD. Our study shows that greater waist circumference and elevated ALT levels are also associated with the development of GSD among type 2 diabetics in Kinmen.
文摘AIM:To explore the related risk factors for diabetic retinopathy(DR)in type 2 diabetes with insulin therapy.METHODS:We studied the relationships among blood glucose,serum C-peptide,plasma insulin,beta-cell function and the development of DR.Beta-cell function was assessed by a modified homeostasis model assessment(modified HOMA)which was gained by using C-peptide to replace insulin in the homeostasis model assessment(HOMA)of beta-cell function.We also studied the relationships between modified HOMA index and serum C-peptide response to 100 g tasteless steamed bread to determine the accuracy of modified HOMA.RESULTS:Our study group consisted of 170 type 2diabetic inpatients with DR(age:58.35±13.87y,mean±SD)and 205 type 2 diabetic inpatients with no DR(NDR)(age:65.52±11.59y).DR patients had higher age,longer diabetic duration,higher hypertension grade,higher postprandial plasma glucose,higher fluctuation level of plasma glucose,lower body mass index(BMI),lower postprandial serum insulin and C-peptide,lower fluctuation level of serum insulin and C-peptide(P【0.05).In our logistic regression model,duration of diabetes,hypertension grade,fasting plasma insulin and glycosylated hemoglobin(HbA1C)were significantly associated with the presence of DR after adjustment for confounding factors(P【0.05).CONCLUSION:Our results suggested although modified HOMA showed significant correlation to the occurrence of DR on Spearman’s rank-correlationanalysis,logistic regression showed no significant association between these two variables after adjustment for relevant confounding factors(such as age,sex,duration of diabetes,BMI,hypertension grade,HbA1C,plasma insulin).Duration of diabetes,hypertension grade,fasting plasma insulin and HbA1C were independently associated with the development of DR in Chinese type 2 diabetics.
文摘AIM:To evaluate the rates of retinopathy without diabetes and diabetic retinopathy(DR),associated with some markers of oxidative stress,antioxidants and cardiometabolic risk factors.METHODS:We determined the prevalence of DR in 150type 2 diabetes mellitus(T2DM)patients,that of retinopathy in 50 non diabetics,the levels of body mass index(BMI),waist circumference(WC),blood pressure,lipids,8-isoprostane,8-hydroxydeoxyguanosine(8-oHdG),gamma-glutamyl transferase(GGT),oxidized low density lipoprotein(LDL)(OxLDL),thiobarbituric acid reacting substances(TBARS),reduced glutathione(GSH),superoxide dismutase(SOD),uric acid,creatinine,albumin,total antioxidant status(TAOS),zinc,selenium,magnesium,vitamin C,vitamin D,vitamin E,glucose,apolipoprotein B(ApoB).RESULTS:The prevalences of DR at 53y and Rtp at62y were 44%(n=66)and 10%(n=5),respectively.Thehighest levels of 8-isoprostane,8-OHdG,TBARS,SOD,and OxLDL were in DR.The lowest levels of vitamin D,vitamin C,TAOS,and vitamin E were in DR.In the casecontrol study discriminant analysis,the levels of vitamin C,vitamin D,ApoB,8-OHdG,creatinine,Zn,vitamin E,and WC distinguished significantly non-diabetics without DR(controls),T2DM patients without DR and T2DM patients with DR.CONCLUSION:Anticipation of DR onset is significantly associated with the exageration of oxidative stress biomarkers or decrease of antioxidants in African type 2diabetics.Prevention of oxidative stress and abdominal obesity is needed.Supplementation in vitamin C,D,and E should be recommended as complement therapies of T2DM.
