Objective To explore the effects on quality of life (QOL), the targeted rates of metabolic parameters and cost-effectiveness in newly diagnosed type 2 diabetic patients who underwent multifactorial intensive intervention. Methods One hundred and twenty seven cases in an intensive intervention and 125 cases in a conventional intervention group were investigated by using the SF-36 questionnaire. The comparison of QOL and the targeted rates of metabolic parameters between the two groups were made. We assessed the influence factors of QOL by stepwise regression analysis and evaluated the efficiency by pharmacoeconomic cost-effectiveness analysis. Results The targeted rates of blood glucose, blood lipid and blood pressure with intensive policies were significantly higher than those with conventional policy (P＜0.05). The intensive group’s role limitations due to physical problems (RP), general health (GH), vitality (VT), role limitation due to emotional problems (RE) and total scores after 6 months intervention were significantly higher than those of baseline (P＜0.05). The vitality scores and health transition (HT) of the intensive group were better than those of the conventional group after 6 months intervention. But the QOL scores of the conventional group were not improved after intervention. The difference of QOL’s total scores after intervention was related to that of HbA1c. The total cost-effectiveness rate of blood glucose, blood lipid, blood pressure control and the total cost-effectiveness rate of QOL with intensive policy were higher than those with the conventional policy. Conclusions Quality of life and the targeted rates of blood glucose, blood lipid and blood pressure in newly diagnosed type 2 diabetic patients with multifactorial intensive intervention policy are better and more economic than those with conventional policy.
ObjectiveTo observe the lipid metabolism characteristics of type 2 diabetes mellitus (T2DM) patients with different levels of blood glucose control and preliminarily analyze their relationship with diabetic retinopathy (DR). MethodsA retrospective clinical study. From January 2019 to January 2024, 232 T2DM patients who underwent fundus examination in Department of Ophthalmology of Yichang Central People’s Hospital were included in the study. Based on the glycated hemoglobin A1c (HbA1c) test results, patients were divided into blood glucose standard group and blood glucose non standard group, with 100 and 132 cases respectively. Based on the results of fundus fluorescein angiography, patients were divided into non DR (NDR) group and DR group, with 89 and 143 cases, respectively. 100 healthy individuals who underwent physical examinations during the same period were selected as the control group. The thickness of peripapillary retinal nerve fiber layer (pRNFL) around the optic disc, the blood flow density of radial peripapillary capillaries (RPC) around the optic disc, and the thickness of ganglion cell complex (GCC) in the upper and lower parts of the optic disc and macular area were measured by optical coherence tomography angiography instrument. Fully automated biochemical analyzer was used to detect serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and HbA1c. After adjusting for confounding factors, multiple linear regression model was used to analyze the correlation between HbA1c and blood lipids. Multiple logistic regression analysis was conducted to investigate the correlation between TG, HDL-C, and the occurrence of DR. ResultsCompared with the control group, both the blood glucose standard group and the blood glucose non standard group had higher levels of HbA1c (F=8.115), TC (F=4.373), TG (F=20.220), and LDL-C (F=12.271), and lower levels of HDL-C (F=6.349), with statistically significant differences (P＜0.05). Compared with the blood glucose standard group, patients in the blood glucose non standard group had higher levels of serum HbA1c (t=3.531), TC (t=2.561), TG (t=6.418), LDL-C (t=7.880), and lower levels of HDL-C (t=5.152), with statistically significant differences (P＜0.05). Correlation analysis showed that HbA1c was positively correlated with TC, TG, and LDL-C (P＜0.05), and negatively correlated with HDL-C (P＜0.05). Multiple logistic regression analysis showed that TG, LDL-C, and HDL-C were independent risk factors for the occurrence of DR (Ptrend＜0.05). Compared with the NDR group, the DR group had thinner GCC and pRNFL thickness in the upper part of the optic disc, and lower overall and RPC blood flow density in the upper part of the optic disc, with statistically significant differences (t=4.964, 2.406, 2.685, 2.404; P＜0.05). Correlation analysis results showed that TG, LDL-C, HDL-C, HbA1c were correlated with GCC thickness, pRNFL thickness, and RPC blood flow density (P＜0.05). ConclusionsThe higher the blood glucose level in T2DM patients, the more likely they are to experience dyslipidemia. TG, LDL-C, and HDL-C are independent risk factors for the occurrence of DR. Abnormal blood lipids and blood glucose levels in T2DM patients can affect retinal nerves, blood vessels, and function.
ObjectiveTo explore the effect of type 2 diabetes mellitus (T2DM) on the vascular endothelial function of patients with heart failure with mid-range ejection fraction (HFmrEF), and the impact of endothelial function damage on the long-term prognosis of HFmrEF. Metohds87 patients with T2DM and heart failure with mid-range ejection fraction (T2DM-HFmrEF), 98 patients with HFmrEF alone, and 70 healthy control who had been hospitalized at the department of cardiology of the First Affiliated Hospital of Xinjiang Medical University from December 2018 to January 2020 were included. The levels of serum TNF-α, IL-6, vWF, eNOs and E-selectin were determined by enzyme-linked immunosorbent assay. The oxidative stress and vascular endothelial function related indicators of the 3 groups were analyzed. The primary endpoint (all-cause death, exacerbation of heart failure and rehospitalization, or exacerbation of heart failure) and secondary endpoint events (non-fatal myocardial infarction, stable and unstable angina pectoris, or stroke) were followed up for 1 year after discharge.ResultsThe levels of TNF-α, IL-6, vWF, and E-selectin in the HFmrEF combined with diabetes group were higher than those in the HFmrEF without diabetes group (P<0.05). Multivariate Cox regression analysis showed that BNP (HR=1.001, P=0.036), eNOs (HR=1.04, P<0.001), and IL-6 (HR=1.002, P<0.001) were related to the primary end point of all patients with HFmrEF. Glycated hemoglobin (HR=1.37, P=0.046), E-selectin (HR=1.01, P=0.003), vWF (HR=1.02, P=0.017), and IL-6 (HR=1.006, P=0.005) were related to the secondary end point of all patients with HFmrEF. The results of subgroup analyze showed that E-selectin (HR=1.014, P=0.012) and IL-6 (HR=1.008, P=0.007) were related to the secondary endpoint events in the HFmrEF combined with diabetes group, but were not related to the secondary end point events of the non-diabetic group (P>0.05).ConclusionsOxidative stress and vascular endothelial function damage may be involved in the pathogenesis of T2DM-HFmrEF. Serum IL-6 and E-selectin levels are related to the endpoint events in T2DM-HFmrEF patients.
ObjectiveTo systematically review the efficacy of interactive message management on patients with type 2 diabetes mellitus (T2DM).MethodsCNKI, VIP, WanFang Data, Web of Science, PubMed and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of T2DM with interactive message intervention from inception to May 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Revman5.3 software.ResultsA total of 17 RCTs involving 1 827 patients were included. Results of meta-analyses showed that compared with routine management, interactive message combined with routine management was associated with improvement of glycosylated hemoglobin, fasting blood glucose, body mass index, systolic blood pressure, and total cholesterol in T2DM patients. However, diastolic blood pressure, triglyceride, low-density lipoprotein, or high-density lipoprotein were not improved. ConclusionsThe current evidence shows that interactive message combined with routine management can significantly reduce blood glucose level, body mass index, systolic blood pressure and total cholesterol in T2DM patients. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
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.
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.
Objective To study the mechanism of gastric bypass operation on treatment of type 2 diabetes mellitus, recognize the etiology and pathogenesy of the disease and frame therapy strategy for type 2 diabetes mellitus. Methods The literatures about gastric bypass operation on treatment of type 2 diabetes mellitus, including clinical cases reports and evidence-based studies were reviewed. Results Gastrointestinal bypass operation was regarded as an effective treatment for type 2 diabetes mellitus. There were three hypotheses of therapy mechanism: early delivery of nutrients to the distal intestine, exclusion of the proximal intestine and incretin/anti-incretin. Conclusion Gastrointestinal bypass operation is now considering as an effective treatment, there is still a lack of basic experimental studies to clarify the mechanism.
Objective To assess the efficacy and safety of glimepiride for type 2 diabetes mellitus (T2DM). Methods We searched the literature from PubMed, Ovid (All EBM Reviews), CNKI, Wanfang, VIP, CBM and other databases. Evaluating the quality of the study according to Cochrane systematic reviews, Meta-analysis was performed for the results of homogeneous studies by The Cochrane Collaboration’s software RevMan 5.0, and the heterogeneous data conducted a descriptive qualitative analysis. Results Six RCTs included in the analysis and Meta-analysis was not performed due to the insufficient data (for the median or standard deviation). Six RCTs are multi-center, randomized, double-blind, placebo-controlled trials. The results showed that glimepiride groups to reduce glycosylated hemoglobin, lower fasting and postprandial blood glucose, postprandial plasma insulin enhance the efficacy were statistically significant differences (Plt;0.05) compared to placebo groups. Four studies informed the impact of fasting plasma insulin (FI) and 3 studies showed that the glimepiride groups improving the fasting plasma insulin (FI) were statistically significant differences (Plt;0.05), but 1 study showed the two groups had no significant difference (Pgt;0.05). All studies showed minor adverse reactions of glimepiride. Conclusion Glimepiride can reduce the glycosylated hemoglobin, lower the fasting and postprandial blood glucose, improve fasting and postprandial plasma insulin for type 2 diabetes patients, and have minor adverse reactions. In a word, glimepiride is an effective and security sulfonylureas drug.
ObjectiveTo understand the status of Roux-en-Y gastric bypass (RYGB) surgery for treating type 2 diabetes mellitus, and to summarize its effectiveness and existing problems.
MethodThe related literatures which discussed the treatment for type 2 diabetes mellitus by RYGB were reviewed and analyzed.
ResultsThe therapeutic effect of RYGB for type 2 diabetes mellitus with obesity was tentatively confirmed.But the underlying mechanism was unclear.And there was no standard length of exclusion of the Roux loop and biliopancreatic loop.Postoperative long-term effect was unknown.Whether RYGB was suitable for non-obese type 2 diabetes mellitus that needed further to be rese-arched.
ConclusionsThe mechanism of RYGB surgery in treatment for type 2 diabetes mellitus is complex.With the progress of basic and clinical research, the improvement of surgical technique, the elucidation of the mechanism, the affirmation of the long-term effect, and there are more benefits in patients with type 2 diabetes mellitus.
ObjectiveTo study effect of expression levels of serum inflammatory factors and insulin receptor substrate(IRS)-1/2 in visceral adipose tissue after Roux-en-Y gastric bypass(RYGB) on type 2 diabetes mellitus(T2DM) rats, and explore possible mechanism in treatment of T2DM.
MethodsThe T2DM rats models were established, which were divided into 3 groups by intervention: T2MD-RYGB group(n=14), T2MD-sham operation(T2MD-SO) group(n=10), and T2MD group(n=10), and 10 normal rats were selected as control group. The rats of the T2MD-RYGB group were received the RYGB, and of the T2MD-SO group were received transection and reanastomosis of the gastroin-testinal tract. The fasting plasma glucose(FPG), fasting insulin(FINS), C-reaction protein(CRP), tumor necrosis factor-α(TNF-α), free fatty acid(FFA), homestasis model assessment for insulin resistance(HOMA-IR), adipose tissue insulin resistance(Adipo-IR) were tested respectively before operation and on week 1, 4, 8 after operation(synchronous detec-tion of rats with or without surgical intervention). The IRS-1 and IRS-2 protein contents of the rat epididymal adipose tissue were tested on week 8 after operation.
ResultsThe FPG, FINS, CRP, TNF-α, FFA levels, and HOMA-IR, Adipo-IR indexes in the T2DM rats were significantly higher than those in the normal rats(P < 0.05) before operation, the above indicators on week 4, 8 after operation were significantly lower than those before operation in the T2MD-RYGB group(P < 0.05). The differences of changes among the other groups were not statistically significant(P > 0.05). The IRS-1 and IRS-2 protein expressions in the adipose tissue of the rats were significantly increased in the T2MD-RYGB group as compared with these indicators in the T2MD group and T2MD-SO group(P < 0.05), but which were significantly lower than those in the control group(P < 0.05).
ConclusionsRYGB could increase IRS-1/2 expression levels in adipose tissue, which could enhance insulin sensitivity, decrease serum inflammatory factors levels, and improve insulin resistance ultimately. This might be one of the mechanisms in treatment of T2DM.
