糖尿病性脂肪肝的诊治

糖尿病主要分为1型糖尿病和2型糖尿病，其中2型糖尿病容易引起脂肪肝，而1型糖尿病较少引起脂肪肝。为什么2型糖尿病容易引起脂肪肝而1型糖尿病不易引起呢？研究发现，肥胖是脂肪肝形成的主要原因。90％的2型糖尿病患者为肥胖，所以，2型糖尿病易发生脂肪肝。血糖升高不是糖尿病导致脂肪肝形成的主要机制，     

浅谈糖尿病的防治

2型糖尿病的发病呈家族聚集性，是与遗传密切相关的疾病。2型糖尿病家系中，非糖尿病的一级亲属是2型糖尿病发病的高危人群，那么就家庭而言，糖尿病的防治显得尤为重要。     

酮症起病的糖尿病

酮症起病是1型糖尿病的常见现象,而能够长期不依赖于胰岛素治疗是2型糖尿病的特点,兼有这两种特征的糖尿病患者,可能是独立于1型或2型糖尿病之外的一种新的糖尿病类型。     

糖尿病危险度测算器——一种检出漏诊的糖尿病和糖尿病前期的简便工具

2型糖尿病（T2DM）患病率的全球增长和糖尿病心血管并发症的增加,给各国人民带来健康和经济上的巨大负担,使预防2型糖尿病成为重要的卫生保健问题。早期发现2型糖尿病的危险人群进行重点预防,是降低2型糖尿病和减少糖尿病并发症的关键。为此各国普遍开展糖尿病预防教育和人群筛查,但收效有限,特别是对广大人群通过测血糖进行筛查还存在不少困难。     

儿童糖尿病的预警信号

过去,一提起儿童糖尿病,多是指1型糖尿病,而2型糖尿病似乎只有成人才会得。但报道称,在日本的儿童糖尿病中,2型糖尿病占80％。远远高于1型糖尿病。尽管我国目前尚缺乏这方面的统计资料,但临床上儿童2型糖尿病日益增多却是不争的事实。     

认识2型糖尿病

2型糖尿病因 1．遗传因素：和1型糖尿病类似，2型糖尿病也有家族发病的特点。因此很可能与基因遗传有关。这种遗传特性2型糖尿病比1型糖尿病更为明显。     

糖尿病与减肥手术

许多患者咨询,称听说减肥手术可以减轻2型糖尿病的症状。那么这个手术对1型糖尿病有效吗?肥胖的人更容易患上2型糖尿病。肥胖者和已经患有2型糖尿病的人发现,如果他们减肥,要控制他们的糖尿病很容易。肥胖和2型糖尿病之间的联系很紧密,减肥手术可以大幅度地减肥。所以,没有必要为手术对2型糖尿病的风险降低而感到惊讶。     

1型糖尿病与2型糖尿病血脂对照分析

目的：观察1型糖尿病和2型糖尿病血脂代谢特征。方法：比较两型糖尿病病人血脂代谢与空腹血糖、年龄、体重的关系。结果：①不论是1型糖尿病还是2型糖尿病，均以TG升高为主，TG值明显高于正常人；②两种类型糖尿病。空度血糖控制不好的病人血脂异常的患病率均较高；③1型糖尿病病人年龄与血脂无相关性；2型糖尿病病人年龄越大，血脂异常患病率越高；④1型糖尿病病人体重指数与血脂异常患病率不相关，2型糖尿病病人体重指数越大，血脂异常患病率越高。结论：1型糖尿病和2型糖尿病的血脂异常与空腹血糖、年龄及体重指数具有不同的相关性。     

高血压与糖尿病

1　流行病学特点流行病学研究证实 ,在糖尿病人群中高血压的发生率显著高于普通人群。据荷兰ＬｏｕｉｓＶｅｒｓｃｈｏｏｒ报道 ,约 40 %～ 5 0 %的糖尿病患者有高血压 ,而非糖尿病人群为 2 0 %。75岁以上的糖尿病患者高血压发生率可高达 6 0 % ,当糖尿病合并广泛肾损害时几乎 10 0 %有高血压。但 1型与 2型糖尿病患者原发性高血压的发生率不尽相同 ,2型糖尿病患者原发性高血压的发生率是非糖尿病人群的 2～ 3倍 ,而1型糖尿病患者原发性高血压的发生率与普遍人群相似 ,但当 1型糖尿病发生糖尿病肾病时易引起继发性高血压。2　 2型糖尿病高血…     

糖尿病酮症酸中毒不是1型糖尿病的专利

糖尿病酮症酸中毒（DKA）是一种十分凶险的糖尿病急性并发症,一旦救治不及时,很容易导致昏迷或死亡。DKA在1型糖尿病患者中较为常见,而且是儿童和青少年1型糖尿病患者的头号杀手,但这并不意味着它不会侵犯2型糖尿病患者。据统计,OKA患者中约有三分之一为2型糖尿病患者。甚至有些人是在发生糖尿病酮症酸中毒而人院后才发现自己原来早已得了糖尿病。因此,识别DKA的症状和预防其发生至关重要。     

Clinical characteristics,types and complications of diabetics with young age at the onset (14–25 years)

AimsTo determine the distribution, clinical features and complications of the different types of diabetes in young age. Methods: The records of children and adolescents with age at the onset of DM (14–25 years) between January 2017 and August 2018, were reviewed. Clinical and laboratory characteristics of the patients at diagnosis and type of diabetes were recorded. Results: Out of 80 patients (48 males, 32 females), 53 had type 1 DM (66.2%) and 27 had type 2 DM (33.8%). Mean age at the onset of diabetes was 19.75 ± 4.01 years for type 1 DM and 21.37 ± 3.08 years for type 2 DM. Family history of DM was more common in type 2 DM (62.9% of parents, p = 0.000389). Mean BMI in type 2 DM (25.03 ± 5.88 kg/m2) was higher than in type 1 DM (p = 0.009). Osmotic symptoms were more common in type 1 DM (73.06%, p = 0.00151). Conclusion: Osmotic symptoms and ketosis were more common in young age type 1 DM. Family history of DM was more common in parents of type 2 DM.     

Frequency of severe hypoglycaemia in type 1 and type 2 diabetes during conventional insulin therapy.

To determine the frequency of severe hypoglycaemia during conventional insulin therapy in juvenile-onset and adult-onset type 1 and in type 2 diabetes mellitus (DM), we retrospectively analysed the medical records of 165 Turkish diabetic patients who have been treated with conventional insulin. Patients were divided into 3 subgroups with respect to the type of diabetes: 33 had juvenile-onset Type 1 DM, 18 had adult-onset type 1 DM, and 114 had type 2 DM. The diabetic subgroups were found to be comparable with regard to mean frequency of severe hypoglycaemia (juvenile-onset type 1 DM: 0.20 episode x patient(-1) x year-1, adult-onset type 1 DM: 0.10 episode x patient(-1) x year(-1), type 2 DM: 0.15 episode x patient(-1) x year(-1)). Frequency of severe hypoglycaemia necessitating in-hospital treatment was 0.05 episode x patient(-1) x year(-1) for all diabetic subgroups. The data clearly indicate that the extent of the problem of severe hypoglycaemia during conventional insulin therapy in type 2 DM is comparable with both juvenile and adult-onset forms of type 1 DM in Turkish diabetic population.     

Subcutaneous microdialysis before and after an oral glucose tolerance test: a method to determine insulin resistance in the subcutaneous adipose tissue in diabetes mellitus

AIMS: Subcutaneous microdialysis has been used for continuous glucose monitoring in patients with diabetes mellitus (DM) to facilitate tight regulation of blood glucose levels. The aims of this study were therefore to investigate (i) the relationship between capillary and interstitial glucose in patients with type 1 or 2 DM and healthy subjects and (ii) the feasibility of using microdialysis to assess local insulin sensitivity in adipose tissue. METHODS: Using subcutaneous microdialysis, interstitial glucose, lactate, pyruvate and glycerol were determined as measures of glucose and lipid metabolism in adipose tissue, before and after an oral glucose tolerance test (OGTT) in 14 patients and seven controls. The results were correlated to whole-body insulin sensitivity and insulin sensitivity in liver estimated from the levels of insulin-like growth factor-binding protein 1 (IGFBP-1). RESULTS: Capillary and interstitial glucose correlated before and after OGTT in healthy subjects and in type 1 DM but not in type 2 DM. In fasting state, the glycerol levels were higher in both type 1 and type 2 DM compared with controls. After the OGTT, the insulin levels were sufficient to suppress lipolysis in type 1 but not in type 2 DM. The glucose/lactate ratio was higher at fasting in type 1 DM and after OGTT in type 1 and 2 DM. In type 1 DM, basal interstitial glycerol levels correlated to whole-body glucose utilization. In type 2 DM, correlations were found between the basal glycerol levels and whole-body insulin sensitivity and between glucose/lactate and per cent decrease in IGFBP-1 levels 120 min after OGTT. CONCLUSION: Capillary and interstitial glucose correlated before and after OGTT in healthy subjects and patients with type 1 DM. Correlations were also found between insulin sensitivity in whole body and in adipose tissue in both type 1 and type 2 DM and between insulin sensitivity in subcutaneous adipose tissue and liver in type 2 DM. This study shows that microdialysis technique can be used to study in vivo insulin sensitivity in adipose tissue over time and may be useful in the evaluation of, for example, the effects of new drugs on insulin sensitivity.     

The prevalence of fibromyalgia syndrome in a group of patients with diabetes mellitus

We have studied the prevalence of fibromyalgia syndrome (FMS) in patients with type 1 and type 2 diabetes mellitus (DM). Relationship with disease control of DM and the presence of FMS was also evaluated. We have studied 93 consecutive patients with DM (85 with type 2 DM and 8 patients with type 1 DM) followed in Diabetes Center. Single researcher took the history and did physical examination including manual tender point examination according to Manual Tender Point Survey instructions. For the diagnosis of FMS, 1990 American College of Rheumatology Classification Criteria for FMS was used. We measured patients’ fasting blood sugar levels and HbA1c levels around the same time period. Patients were excluded from the study if they had any other serious disease, and if there was any history of drug use that interferes with the symptoms of FMS. Patients with rheumatoid arthritis (RA) were accepted as controls. FMS was found in 18% of patients with DM type 2 (no patients with FMS in type 1 DM group), in 34% of patients with RA. Female patients with DM type 2 had significantly higher FMS rates. Mean fasting blood sugar levels and mean HbA1c levels were not significantly different between type 2 DM patients with FMS and DM patients without FMS. In RA group, in RA patients without FMS, the use of steroids was significantly higher. We have found an increased prevalence rate of FMS in patients with DM type 2 and RA. There was no correlation between the prevalence rate of FMS and good DM disease control.     

Pancreatic volume in type 1 und type 2 diabetes mellitus

We measured pancreatic volume (PV) using helical computed tomography (CT) in 26 patients with type 1 diabetes mellitus (DM), 29 patients with type 2 DM, and 22 healthy individuals. We also evaluated the relationship between PV and the body surface area (BSA), established the pancreatic volume index (PVI) by dividing PV by BSA to correct PV for the body build, and examined its relationships with the duration of illness, serum C-peptide immunoreactivity level (CPR), and serum immunoreactive trypsin level (IRT). BSA and PV were correlated significantly (p<0.0001, r=0.645) in healthy individuals, and they were correlated also in the diabetic patients, (p=0.0023, r=0.563 in type 1 DM; p=0.0346, r=0.392 in type 2 DM). PV was significantly smaller in the type 1 DM group than in the healthy group and type 2 DM group (p<0.001 for both). PVI was also significantly smaller in the type 1 DM group than in the healthy group and type 2 DM group p<0.001 for both). PVI and IRT were significantly correlated in both DM groups (p<0.0001, r=0.732 in type 1 DM; p=0.0469, r=0.731 in type 2 DM). PVI was not correlated with the duration of illness or CPR. Helical CT was useful for the measurement of the pancreatic volume, and the pancreatic volume was reduced particularly in the patients with type 1 DM. A strong correlation was observed between PV and exocrine pancreatic function in type 1 DM, but the correlation between PV and exocrine pancreatic function was weak in type 2 DM. Received: February 2001 / Accepted in revised form: July 2001     

Consequences of asymptomatic bacteriuria in women with diabetes mellitus

BACKGROUND: Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) more often than women without DM. It is unknown, however, what the consequences of ASB are in these women. OBJECTIVE: To compare women with DM with and without ASB for the development of symptomatic urinary tract infections (UTIs), renal function, and secondary complications of DM during an 18-month follow-up period. METHODS: In this multicenter study we monitored women with DM with and without ASB for the development of symptomatic UTIs, renal function, and secondary complications (ie, retinopathy, neuropathy, microvascular, or macrovascular diseases). Data on the first 18-month follow-up period are presented. RESULTS: At least 1 uncontaminated urine culture was available from 636 women (258 with type 1 DM and 378 with type 2 DM). The prevalence of ASB at baseline was 26% (21% for those with type 1 DM and 29% for those with type 2 DM). Follow-up results were available for 589 (93%) of the 636 women. Of these 589 women, 115 (20%) (14% with type 1 DM and 23% with type 2 DM) developed a symptomatic UTI. Women with type 2 DM and ASB at baseline had an increased risk of developing a UTI during the 18-month follow-up (19% without ASB vs 34% with ASB, P =.006). In contrast, there was no difference in the incidence of symptomatic UTI between women with type 1 DM and ASB and those without ASB (12% with ASB vs 15% without ASB). However, women with type 1 DM and ASB had a tendency to have a faster decline in renal function than those without ASB (relative increase in serum creatinine level 4.6% vs 1.5%, P = 0.2). CONCLUSION: Women with type 2 DM and ASB have an increased risk of developing a symptomatic UTI than those without ASB.     

Management of diabetes mellitus and patients' attitude towards the disease: Data from a nationwide study in Greece

AimTo examine management of diabetes mellitus (DM) and patients' attitude towards DM in a random sample of the adult Greek population.Methodss: We selected a random sample of adults with self-reported DM (n = 1002) from a population-based nationwide study using the effective random sampling technique. Collection of data was performed through phone interviews.ResultsPrevalence of type 1 DM was 3.5% and of type 2 DM 96.5%. Prevalence of type 1 DM declined while of type 2 DM increased with age. No gender or residency differences were found between type 1 and type 2 DM. A total of 72.0% of subjects with type 2 DM were treated with oral antidiabetic drugs (OAD), 11.5% were treated with insulin and 7.1% were treated with both OAD and insulin. Internists specialized in DM were mainly doctors who started insulin treatment. Almost half of insulin naive subjects were skeptical towards insulin initiation and their main concern was the needle punch.ConclusionsIn a random nationwide sample of the adult population in Greece the majority of subjects with self-reported DM had type 2 DM. Most patients with type 2 were treated with OAD. Almost half of insulin naive subjects were skeptical towards insulin initiation.     

Comparison of nucleotide sequence of p2C region in diabetogenic and non-diabetogenic Coxsacie virus B5 isolates

Enteroviruses are environmental triggers in the pathogenesis of type 1 diabetes mellitus (DM). A sequence of six identical amino acids (PEVKEK) is shared by the 2C protein of Coxsackie virus B and the glutamic acid decarboxylase (GAD) molecules. Between 1995 and 2002, we investigated 22 Coxsackie virus B5 (CVB5) isolates from southern Taiwan. Four of these isolates were obtained from four new-onset type 1 DM patients with diabetic ketoacidosis. We compared a 300 nucleotide sequence in the 2C protein gene (p2C) in 24 CVB5 isolates (4 diabetogenic, 18 non-diabetogenic and 2 prototype). We found 0.3-10% nucleotide differences. In the four isolates from type 1 DM patients, there was only 2.4-3.4% nucleotide difference, and there was only 1.7-7.1% nucleotide difference between type 1 DM isolates and non-diabetogenic isolates. Comparison of the nucleotide sequence between prototype virus and 22 CVB5 isolates revealed 18.4-24.1% difference. Twenty-one CVB5 isolates from type 1 DM and non-type 1 DM patients contained the PEVKEK sequence, as shown by the p2C nucleotide sequence. Our data showed that the viral p2C sequence with homology with GAD is highly conserved in CVB5 isolates. There was no difference between diabetogenic and non-diabetogenic CVB5 isolates. All four type 1 DM patients had at least one of the genetic susceptibility alleles HLA-DR, DQA1, DQB1. Other genetic and autoimmune factors such as HLA genetic susceptibility and GAD may also play important roles in the pathogenesis in type 1 DM.     

糖原合成酶基因M416V多态性与2型糖尿病的相关性

目的 探讨糖原合成酶，即Glycogen Synthase(GS)基因M416V多态性与2型糖尿病(T2DM)的相关性。方法 利用聚合酶链式反应限制性片段长度多态性(PCRRFLP)技术分析252例T2DM患者、196例非DM对照者GS基因第10外显子第416号位点上由蛋氨酸(Methionine)置换成缬氨酸(Valine)的变异，即M416V。结果 (1)T2DM组的GS基因M416V的Val等位基因频率为10．3％，对照组的Val等位基因频率为6．4％；T2DM组中的Val等位基因频率显著高于对照组，P-0．037。(2)在T2DM组中，具有GS基因Val等位基因者的BMI值明显高于无Val等位基因者(P-0、024)，具有GS基因Val等位基因者的2hPG值明显高于无Val等位：基因者(P-0．005)。结论 GS基因416位点上的Val等位基因与T2DM的发病有一定的相关性，并且它可能参与胰岛素抵抗(肥胖、高血压、高血脂等)的发生。