糖尿病与骨质疏松症

糖尿病和骨质疏松症都是常见病,尤其在老年人2型糖尿病伴发骨质疏松十分常见.本文重点介绍糖代谢异常时矿盐、骨代谢和骨密度的影响以及骨折的发生情况.糖尿病治疗药物罗格列酮与骨量丢失也做了简介.     

糖尿病与免疫

糖尿病患病率呈全球性迅速增加,其确切发病机制至今不明。现已公认1型糖尿病中的自身免疫亚型是一种T细胞介导的胰岛β细胞选择性破坏的自身免疫病。而2型糖尿病的发生则是多因素、多步骤的过程。以往公认的胰岛素抵抗和胰岛素分泌受损是2型糖尿病发病的中心环节,不能很好解释2型糖尿病中常见的临床和生化特征如:中心性肥胖、高血压、加速的动脉粥样硬化、血脂紊乱、抑郁、凝血异常等。最近一种观点认为天然免疫系统的激活和慢性低度炎症参与了2型糖尿病的发病,至少有12个研究提示循环炎症因子、急性期反应物是2型糖尿病发生的主要预测因子…     

Diabetes and Depression

Diabetes and depression occur together approximately twice as frequently as would be predicted by chance alone. Comorbid diabetes and depression are a major clinical challenge as the outcomes of both conditions are worsened by the other. Although the psychological burden of diabetes may contribute to depression, this explanation does not fully explain the relationship between these 2 conditions. Both conditions may be driven by shared underlying biological and behavioral mechanisms, such as hypothalamic-pituitary-adrenal axis activation, inflammation, sleep disturbance, inactive lifestyle, poor dietary habits, and environmental and cultural risk factors. Depression is frequently missed in people with diabetes despite effective screening tools being available. Both psychological interventions and antidepressants are effective in treating depressive symptoms in people with diabetes but have mixed effects on glycemic control. Clear care pathways involving a multidisciplinary team are needed to obtain optimal medical and psychiatric outcomes for people with comorbid diabetes and depression.     

Diabetes and exercise

This review describes (1) the metabolic and hormonal response to exercise in normal and diabetic man, and (2) the potential benefits of physical training in diabetes. Whereas in normal man plasma glucose varies little during exercise, the insulin-dependent diabetic subject may experience an increase in plasma glucose, a modest decrease or a marked decrease which can result in symptomatic hypoglycemia. Evidence is reviewed that the glycemic response depends on the ambient plasma concentration of insulin and that this may be influenced by an effect of exercise on the absorbtion of insulin from its site of injection. The response to exercise of noninsulin-dependent diabetic subjects and of diabetic subjects with autonomic neuropathy is also described. Physical training improves glucose tolerance in some noninsulin-dependent diabetic subjects and in insulin-dependent patients, it may diminish insulin requirements. It may also have a role in retarding the development of cardiovascular complications. Physical training is not totally innocuous, however, and in many patients with diabetes special precautions are required.     

吸烟与糖尿病

近来的研究表明,吸烟是糖尿病发生的独立危险因子,两者之间存在剂量反应关系,而且,吸烟还可促进糖尿病患者心血管疾病、糖尿病、肾病、肺功能损害及足部溃疡的发生.其可能的机制是烟草成分增加胰岛素抵抗,由此影响血糖控制.临床医师应重视糖尿病患者的戒烟治疗,以提高患者的生活质量,改善远期预后.     

Diabetes and Schizophrenia

People with schizophrenia have 2- to 5-fold higher risk of type 2 diabetes than the general population. The traditional risk factors for type 2 diabetes, especially obesity, poor diet, and sedentary lifestyle, are common in people with schizophrenia already early in the course of illness. People with schizophrenia also often have low socioeconomic status and income, which affects their possibilities to make healthy lifestyle choices. Antipsychotic medications increase the risk of type 2 diabetes both directly by affecting insulin sensitivity and indirectly by causing weight gain. Lifestyle modification interventions for prevention of diabetes should be an integral part of treatment of patients with schizophrenia. In the treatment of type 2 diabetes in patients with schizophrenia, communication and collaboration between medical care and psychiatric treatment providers are essential.     

Diabetes and biomarkers

Biomarkers play an integral part in conducting clinical trials and treating patients. In most instances, they help medical practitioners, researchers, and regulatory officials make well-informed, scientifically sound decisions. However, in clinical studies, there is often uncertainty in how much weight to place on biomarker results versus clinical outcomes. This uncertainty emanates from opposing goals of the drug approval process. On one hand, the process must ensure that all therapeutics tested are safe and that the benefits outweigh the risks. On the other hand, the process should allow therapies to be accessible to patients as quickly as reasonably possible. Judicious use of biomarkers in the drug development process can bring these goals into alignment. More efficient discovery and use of biomarkers in the development of antidiabetes drugs will depend on advancing our understanding of the pathogenesis of diabetes and especially its macrovascular complications.     

Hypertension and Diabetes

Co-presentation of hypertension and diabetes leads to a significantly greater increase of cardiovascular mortality than each disease separately. Hypertension appears to be not only a complication of diabetes but apparently also shares a common pathogenetic mechanism, particularly in non-insulin dependent diabetes. Recent data suggest alterations in the nocturnal decline of blood pressure in diabetics, which together with microalbuminuria, may prove to be a predictor of nephropathy and hypertension. When hypertension occurs in diabetics, it requires a vigorous therapeutic approach. Nevertheless, the presence of diabetes modifies the requirement for first line therapy, particularly with respect to potential alterations of metabolic homeostasis in order to effectively prevent cardiovascular complications.