Recognition of fasting or overall hyperglycaemia when starting insulin treatment in patients with type 2 diabetes in general practice

OBJECTIVE: The efficacy of various regimens of initial insulin treatment in poorly controlled type 2 diabetes was compared with regard to diurnal glucose variation. DESIGN: Randomized controlled trial. Setting. Insulin therapy initiated on hospital wards, follow-up as outpatients for 12 months. SUBJECTS: Fifty-two type 2 diabetic patients (HbA1c >7.5%, mean 9.8%) on maximal oral therapy. Interventions. Insulin only (IO), bedtime insulin with sulphonylurea (glipizide) (IS), or bedtime insulin with metformin (IM). MAIN OUTCOME MEASURES: HbA1c and body weight. RESULTS: HbA1c decreased on average by 1.8, 1.0 and 1.5 percentage points in the IO, IS, and IM groups, respectively (p always <0.025). Body weight increased, most in the IO patients (+6.2 kg), least in the IM patients (+3.4 kg). Analysing all treatment groups combined, a similar HbA1c reduction was observed in patients with overall hyperglycaemia (low fasting plasma glucose/HbA1c ratio) and in patients with fasting hyperglycaemia (high fasting plasma glucose/HbA1c ratio). Within the overall hyperglycaemia group, the IS and IM patients had smaller decreases in HbA1c (-1.5 and -1.3 percentage points, respectively) than the IO patients (-2.7 percentage points). On the other hand, within the fasting hyperglycaemia group HbA1c reductions were -1.2, -0.8 and -1.5 percentage points, in the IO, IS, and IM groups, respectively. CONCLUSION: Not all poorly controlled type 2 diabetic patients should automatically be treated with an oral agent and bedtime insulin. Two daily insulin injections is a valid choice, particularly if the patient has overall hyperglycaemia.     

Tracheal Fibroxanthoma in a Child

Abstract

Exenatide (exendin-4) is a 39-amino acid peptide belonging to the glucagon-like peptide-1 (GLP-1) receptor agonist class that has been demonstrated to improve glycemic control in patients with type 2 diabetes mellitus. Exenatide can be injected twice daily (ExBID) before meals or once weekly (ExQW) when encompassed within dissolvable poly-(D,L -lactide-co-glycolide) microspheres. The primary difference between these formulations is the plasma concentration of exenatide over time, with the long-acting form providing continuous delivery. Clinical trials have examined the similarities and differences in the efficacy and safety/tolerability outcomes of these formulations. In 2 clinical studies spanning 24 and 30 weeks, significant (P < 0.05) reductions from baseline were observed in fasting plasma glucose (ExBID, ?12 and ?25 mg/dL; ExQW, ?35 and ?41 mg/dL), postprandial glucose (ExBID, ?124 mg/dL; ExQW, ?95 mg/dL), and glycated hemoglobin (HbA1) (ExBID, ?0.9% and ?1.5%; ExQW, ?1.6% and ?1.9%). Reductions in body weight from baseline were significant and similar with both treatments (ExBID, ?1.4 and ?3.6 kg; ExQW, ?2.3 and ?3.7 kg). Reductions in systolic blood pressure from baseline were observed with both formulations, particularly in patients who were hypertensive at baseline. Beneficial improvements in lipid profiles were small and fluctuated in significance. Patients reported greater treatment satisfaction with ExQW compared with ExBID dosing. Gastrointestinal adverse events were commonly observed with both formulations but were less frequent with ExQW. These events were of mild-to-moderate intensity and rarely led to discontinuation. Real-world data for ExBID demonstrated decreases in HbA_1c, fasting plasma glucose, and body weight that were consistent with clinical trial results. Cases of pancreatitis or renal impairment have been reported in patients treated with ExBID, although no causal relationship with treatment has been shown. This review describes the similarities and differences between exenatide delivered as a twice-daily or as a once-weekly injection to provide a better understanding of the clinical effects and potential clinical uses of each.     

Effects of a cinnamon extract on plasma glucose, HbA, and serum lipids in diabetes mellitus type 2

BACKGROUND: According to previous studies, cinnamon may have a positive effect on the glycaemic control and the lipid profile in patients with diabetes mellitus type 2. The aim of this trial was to determine whether an aqueous cinnamon purified extract improves glycated haemoglobin A1c (HbA1c), fasting plasma glucose, total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triacylglycerol concentrations in patients with type 2 diabetes. METHODS: A total of 79 patients with diagnosed diabetes mellitus type 2 not on insulin therapy but treated with oral antidiabetics or diet were randomly assigned to take either a cinnamon extract or a placebo capsule three times a day for 4 months in a double-blind study. The amount of aqueous cinnamon extract corresponded to 3 g of cinnamon powder per day. RESULTS: The mean absolute and percentage differences between the pre- and post-intervention fasting plasma glucose level of the cinnamon and placebo groups were significantly different. There was a significantly higher reduction in the cinnamon group (10.3%) than in the placebo group (3.4%). No significant intragroup or intergroup differences were observed regarding HbA1c, lipid profiles or differences between the pre- and postintervention levels of these variables. The decrease in plasma glucose correlated significantly with the baseline concentrations, indicating that subjects with a higher initial plasma glucose level may benefit more from cinnamon intake. No adverse effects were observed. CONCLUSIONS: The cinnamon extract seems to have a moderate effect in reducing fasting plasma glucose concentrations in diabetic patients with poor glycaemic control.     

A follow-up study of the occurrence and consequences of HbA1c measurements in an unselected cohort of non-pharmacologically treated patients with Type 2 diabetes

Objectives

To describe the occurrence of HbA1c measurements among non-pharmacologically treated diabetes patients, and to evaluate whether poor blood glucose regulation (HbA1c >8%) prompted intensification of treatment.

Method

Data from the National Health Service Registry, the Regional Laboratory Database and the Danish National Hospital Registry were collected from 2002 to 2004 to identify and describe all Type 2 diabetic patients above 40 years of age in a background population of nearly 660 000 citizens in Aarhus County, corresponding to 12% of the total Danish population.

Results

A total of 1989 had at least one HbA1c measurement, whereas 484 (20%) had no HbA1c measurement at all in 2003. Most patients had an HbA1c of less than 8%, and for 820 (41%) HbA1c was less than 6.5%, but for 316 (16%) patients, the first HbA1c measurement in 2003 was above 8%. After 6 months, patients with HbA1c above 8% had a higher probability of initiating pharmacological treatment (M; 0.64; 95% CI 0.58–0.70) (F; 0.68; 95% CI 0.58–0.77) than patients with HbA1c below 8% (M; 0.12; 95% CI 0.10–0.14) (F; 0.11; 95% CI 0.09–0.14).

Conclusion

This study indicates that poor blood glucose regulation (HbA1c >8%) prompted a shift from non-pharmacological treatment to pharmacological treatment for most patients. However, a substantial group of patients are either not monitored on a regular basis or, if monitored, their elevated measurements of HbA1c do not prompt initiation of pharmacological treatment.     

HbA1c对糖调节受损和2型糖尿病的诊断价值

摘要：目的：评估糖化血红蛋白（HbA1c）不同cut off值诊断2型糖尿病（T2DM）的效能,初步探讨美国糖尿病协会（ADA）推荐的HbA1c诊断T2DM及T2DM前期标准对中国人的适用性。 方法：招募接受口服葡萄糖耐量（OGTT）试验且试验前未诊治为T2DM的志愿者338例,用高效液相色谱法检测HbA1c;以WHO标准诊断糖调节受损（IGR）、糖耐量正常和T2DM;用受试者工作特征（ROC）曲线分析不同 cut off值HbA1c诊断IGR和T2DM的效能。 结果：HbA1c在诊断T2DM时,ROC曲线下面积（AUC^ROC）为0.954,最佳cut off值为6.0%,敏感性为92.5%,特异性为86.0%;当HbA1c为6.5%时,敏感性为64.8%,特异性为96.7%;当HbA1c为5.6%时,诊断T2DM阴性预测值为100.0%;HbA1c诊断IGR的AUC^ROC为0.653。 结论: HbA1c用于IGR的诊断效能不高;HbA1c诊断T2DM最佳cut off值为6.0%,此界值诊断敏感性较FPG高,但特异性较差;ADA推荐用于T2DM诊断的cut off值6.5%主要考虑到诊断的特异性,该诊断标准适用于中国人群。     

不同比例抗阻-有氧联合训练对2型糖尿病患者降糖作用的观察

目的观察不同比例抗阻-有氧联合训练对2型糖尿病患者降糖的作用,为2型糖尿病患者训练提供最佳方案。方法将42例2型糖尿病患者平均分为高抗-有氧联合训练组16例(A组)、低抗-有氧联合训练组16例(B组)、空白对照组10例(C组)。三组患者均予相同的降糖、降脂等基础治疗,疗程均为8周。在训练前后分别进行口服葡萄糖耐量试验评价空腹血糖(FBG)、餐后两小时血糖(2h PBG)、糖化血红蛋白(Hb A1c)水平及胰岛素敏感性(ISI)等指标。结果三组患者治疗前各项指标比较差异无统计学意义(P0.05)。疗程结束后,A、B两组患者的FBG、2h PBG、Hb A1c及ISI水平较C组均出现好转,差异有统计学意义(P0.05);与A组相比,B组患者在改善FBG、2h PBG、Hb A1c及ISI水平方面更加显著(P0.05)。结论高抗-有氧联合训练及低抗-有氧联合训练都可以有效改善2型糖尿病患者的血糖水平和胰岛素敏感性的作用,但低抗-有氧联合训练对于改善胰岛素敏感性治疗效果要优于高抗-有氧联合训练。     

超敏肌钙蛋白I检测在糖尿病心肌损伤早期诊断中的价值

目的探讨超敏肌钙蛋白I(hs-cTnI)在糖尿病心肌损伤早期诊断中的临床价值。方法选取240例2型糖尿病(T2DM)组及40例健康对照组,检测2组研究对象的糖化血红蛋白(HbA1c)、天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)及hs-cTnI水平。结果 T2DM组血清hs-cTnI水平显著高于健康对照组(P0.05),血清AST、CK及CK-MB水平与健康对照组比较,差异无统计学意义(P0.05);HbA1c≥6.5%组hs-cTnI水平及升高率显著高于HBA1c≤6.4%组(P0.05),AST、CK、CK-MB水平及升高率在2组间差异无统计学意义(P0.05);T2DM组HbA1c与血清hs-cTnI呈正相关(r=0.471,P0.05)。结论 hs-cTnI诊断T2DM患者早期心肌损伤具有重要的临床价值,且hs-cTnI与HbA1c呈正相关,值得临床关注。     

2型糖尿病患者糖化白蛋白/糖化血红蛋白比值与动态血糖参数的相关性分析

目的 探讨糖化白蛋白/糖化血红蛋白比值（GA/HbA1c）与2型糖尿病（T2DM）患者动态血糖参数间的相关性。方法筛选2020年1月至2021年12月期间首次就诊于复旦大学附属中山医院内分泌科的T2DM患者。收集其一般临床资料,包括患者的血压、体重指数、生化指标、空腹血糖(FBG)、空腹C肽、精氨酸激发后的C肽,HbA1c、GA等。每例患者入院后佩戴扫描式血糖监测仪,截取每例患者入院后第3到5天的72小时的血糖结果,以此计算平均血糖、平均血糖波动幅度(MAGE)、最高及最低血糖差（△BG）,以及血糖在目标范围的时间（TIR）、血糖高于目标范围时间（TAR）、血糖低于目标范围时间（TBR）。采用SPSS17.0统计学软件进行数据分析。结果共100例T2DM患者入选,其中男58例,女42例。以GA/HbA1c比值三分位数分组。随GA/HbA1c比值升高,激发后C肽值呈逐渐降低趋势(P趋势<0.05),MAGE、FBG、△BG呈逐步升高趋势(P趋势<0.05)。Pearson相关分析/Spearman秩相关分析显示,GA/HbA1c比值与空腹C肽、激发后C肽水和TIR平呈负相关(P<0.01),与FBG、MAGE、△BG呈正相关(P<0.05)。与并发症个数无相关性。多元线性回归分析显示,GA/HbA1c比值与MAGE、△BG、TIR 独立相关(P<0.05)。Logistic回归分析显示,GA/HbA1c比值与TIR（OR=6.990,95% CI 2.179~22.423,P<0.01）是否达标独立相关。结论GA/HbA1c比值与T2DM患者的残余胰岛β细胞功能相关,与血糖波动参数MAGE、△BG、TIR独立相关。该比值是评估胰岛功能、监测血糖波动及考察血糖达标的敏感指标。     

糖化血红蛋白检测的临床循证

目的了解3 269例本实验室接收标本的糖化血红蛋白(HbA1c)检测结果的频数分布;并对62例糖尿病患者同一天检测HbA1c,空腹血糖(Fib)及餐后2 h血糖(2 hPBG),探讨其相关性,进一步明确糖化血红蛋白在糖尿病治疗上的监测价值。方法 BIO-RAD VARIANTⅡ糖化血红蛋白分析仪,采用高效液相色谱法测定标本的糖化血红蛋白含量;BECKMAN LX20自动生化分析仪及配套试剂,葡萄糖氧化酶电极法检测标本中的葡萄糖含量。结果 3 269例HbA1c结果的频数分布P50对应的HbA1c含量为6.5%。位于正常范围内的HbA1c4.0%~6.0%有961例,占总人数29.5%;HbA1c在6.0%~8.0%控制范围内有1 611例;HbA1c含量大于8.0%以上,属糖尿病患者血糖控制未达到标准有697例,占总人数21.3%。同一天HbA1c与餐后2 hPBG的相关性更密切。结论本院临床医生能较合理利用该检测项目,来本院接受治疗的糖尿病患者HbA1c大都控制在较好的水平。     

Insulin secretion and sensitivity as determinants of HbA1c in type 2 diabetes

BACKGROUND: Defects in insulin secretion and sensitivity, two major determinants of glycaemic control, can occur and progress or not in parallel. The present study was designed to compare the respective roles of both determinants on HbA1c, in type 2 diabetic patients, according to whether or not residual beta-cell function was stimulated with insulin secretagogues. MATERIALS AND METHODS: Insulin secretion and insulin sensitivity were both estimated using the homeostasis model assessment (HOMA). HbA1c, insulin sensitivity (HOMA2%S) and insulin secretion (HOMA2%B) were determined in 289 noninsulin-using type 2 diabetic patients who were further divided into two groups according to treatment: metformin alone (group I, n = 57) or metformin and glyburide (group II, n = 232). The patients of both groups were further divided into three subsets in order to test the dependence of HbA1c on HOMA2%B and HOMA2%S. RESULTS: In group I mean HbA1c were greater (8.4%) in patients with HOMA2%B < 50% than in the two subsets with HOMA2%B > or = 50%: 7.2 and 6.8% (P = 0.0013). In group II mean values of stimulated-insulin secretion (HOMA2%B) were lesser (40.7 and 30.1%) in the two subsets of patients with HbA1c > or = 8% than in patients with HbA1c < 8%: 55.1% (P < 0.0001). By contrast, we found no differences in both groups with HOMA2%S. A stepwise multiple regression showed that HOMA2%B contributed to HbA1c more than HOMA2%S both in groups I (33.5% vs. 23.4%) and II (22.7% vs. 8%). CONCLUSIONS: Although the role of insulin sensitivity is not negligible, insulin secretion appears to be the major determinant of diabetic control in overt type 2 diabetic patients who are treated with metformin alone or with a two-drug therapy combining metformin and glyburide.     

不同时间的低碳水化合物饮食干预对2型糖尿病患者糖化血红蛋白影响的Meta分析

目的 探索不同时间的低碳水化合物饮食(LCD)干预对2型糖尿病(T2DM)患者糖化血红蛋白(HbA1c)的影响。 方法 检索MEDLINE、PubMed、OVID、中国知网、维普、万方等数据库,收集LCD干预对T2DM患者HbA1c影响的随机对照试验,用RevMan5.3软件进行统计分析。 结果 共纳入文献8篇。LCD干预3个月( Z=2.28, P<0.05)和6个月( Z=14.99, P<0.01)时降低HbA1c的效果优于其他糖尿病饮食,但1年( Z=0.65 , P=0.51)和2年( Z=1.62, P=0.10)时差异无统计学意义。 结论 LCD短期降糖效果优于其他糖尿病饮食,长期两者效果相似,是适合T2DM患者的治疗性饮食。     

糖化血红蛋白与活化部分凝血活酶时间的相关性研究

目的 研究糖化血红蛋白(HbA1c)与活化部分凝血活酶时间的相关性,评价2型糖尿病的凝血功能.方法 收集符合标准的病例200例,HbA1c<6.2% 121例,HbA1c>6.2% 79例,分别进行凝血酶原时间(PT)、部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)项目的 测试.结果 组内比较:HbA1c <6.2%组,FIB升高差异有统计学意义(P<0.01),说明控制较好的糖尿病患者多伴有FIB升高;HbA1c >6.2 g/L组,APTT缩短,FIB升高差异有统计学意义(P<0.01);说明控制较差的患者常伴有APTT缩短,FIB升高.两组间APTT缩短差异有统计学意义,说明APTT缩短与HbA1c呈正相关.结论 APTT可作为2型糖尿病凝血功能的评价指标.     

个性化FITT运动方案对2型糖尿病患者HbA1c的影响

目的：明确个性化FITT运动方案对2型糖尿病患者HbA1c的影响。方法：将研究对象随机分为对照组与干预组,对照组予以常规运动指导,干预组制定个性化运动方案,分别收集两组患者入院时及出院三个月后的HbA1c值,比较其糖代谢水平和相关指标的变化。结果：干预组的HbA1c较三个月前有了显著降低,平均降低3.17%。实验组与对照组同期HbA1c变化相比有差异,实验组与对照组三个月后的HbA1c平均相差1.84%。结论：个性化的运动方案较之常规运动指导对控制患者的糖化血红蛋白、降低血糖有着更好的效果。