2型糖尿病患者中医辨证分型与听力损害的相关分析

目的:观察不同中医证型2型糖尿病患者听力损害程度、范围、表现,纯音测听和血液流变学指标变化,并与健康人对照。方法:①选择2003-07/2005-08在解放军第三○三医院内分泌科门诊就诊或住院治疗的2型糖尿病患者81例,男55例,女26例。选择同期在本院进行健康体检的健康者55名为对照组,男36名,女19名。均对检测指标知情同意。②参照1993年卫生部《中药新药临床研究指导原则》关于“治疗消渴病(糖尿病)的临床研究指导原则”所确定的辨证标准,并结合临床实际,初步拟设阴虚热盛证(n=29)、气阴两虚证(n=22)、阴阳两虚证(n=30)3个证型。③使用MedseOB822听力计进行纯音听阈检查,耳聋程度判定标准选择4级方法:轻度聋(纯音听力损失10～30dB),中度聋(纯音听力损失31～60dB),重度聋(纯音听力损失61～90dB),极重度聋(纯音听力损失>90dB)。听力减退的判定标准:言语频率(包括语音频率、4kHz和8kHz频率)平均听力损失≥10dB。④采用北京产LBY-N6A自清洗旋转式黏度计检测血液流变学指标(全血高、低切黏度,血浆比黏度,红细胞压积,全血还原黏度和K值方程)。结果:2型糖尿病患者81例和健康体检者55名均进入结果分析。①阴虚热盛证、气阴两虚证、阴阳两虚证2型糖尿病患者听力减退患病率明显高于对照组(50.0%,56.8%,51.7%,23.6%,P<0.05);平均听阈值明显高于对照组[(29.76±8.08),(33.76±9.50),(32.63±10.19),(26.52±5.01)dB,P<0.05]。阴虚热盛证患者的平均听阈值明显低于气阴两虚证和阴阳两虚证患者(P<0.05)。不同中医证型2型糖尿病患者与对照组的听力损害发病表现(突发聋和渐进聋)及损伤范围(单侧聋和双侧聋)和损害程度无明显区别(P>0.05)。②对照组语音频率、4kHz和8kHz频率双侧纯音测听指标均明显低于不同中医证型2型糖尿病患者(除外阴虚热盛证患者左侧和气阴两虚证患者右侧4kHz频率纯音测听结果,P<0.05),同时阴虚热盛证患者的语音频率、4kHz和8kHz频率双侧纯音测听指标均明显低于气阴两虚证和阴阳两虚证患者(除外气阴两虚证患者左侧和阴阳两虚证患者右侧4kHz频率纯音测听结果,P<0.05)。③对照组血液流变学指标均明显低于不同中医证型2型糖尿病患者(除外阴虚热盛证患者红细胞压积和全血还原黏度,P<0.05);阴虚热盛证患者血液流变学指标明显低于气阴两虚证和阴阳两虚证患者(除外气阴两虚证患者全血低切黏度和阴阳两虚证患者血浆比黏度,P<0.05)。结论:①2型糖尿病患者并发听力损害患病率明显高于健康者,但听力损害范围、表现及程度与健康者无明显区别。②阴虚热盛证2型糖尿病患者听力损害程度和血液流变学指标异常程度轻于其他2种证型。     

中医证型与2型糖尿病患者胰岛素抵抗及B细胞功能的关系

目的:观察中医证型与2型糖尿病患者胰岛素抵抗、B细胞功能的关系。方法:选取2012年至2014年7月苏州市中医医院内分泌科确诊的2型糖尿病住院病人98例,分析其胰岛素抵抗、B细胞功能和中医证型:阴虚热盛证、痰湿困脾证、气阴两虚证、阴阳两虚证的关系。结果:四种证型的空腹胰岛素、空腹C肽在各组间无统计学差异(P0.05)。但空腹胰岛素值以痰湿困脾证最高,气阴两虚证次之,阴阳两虚证最低;空腹C肽以气阴两虚证最高,阴虚热盛证次之,阴阳两虚证最低。四种证型的HOMA-IR、ISI、HOMA-β在各组间无统计学差异(P0.05)。但HOMA-IR在痰湿困脾证最大,其余按阴虚热盛证→气阴两虚证→阴阳两虚证的顺序逐渐增大;按阴虚热盛证→痰湿困脾证→气阴两虚证→阴阳两虚证顺序的ISI依次减低;HOMA-β值在痰湿困脾证最大,其余按阴虚热盛证→气阴两虚证→阴阳两虚证排序逐渐减小。结论:2型糖尿病患者的中医证型及病机与胰岛素抵抗、胰岛β细胞分泌功能的损害程度相关。阴虚热盛证、痰湿困脾证以胰岛素抵抗为主;气阴两虚证、阴阳两虚证以胰岛β细胞功能降低为主。苏州地区2型糖尿病患者的中医证型以痰湿困脾证为主,并贯穿病程始终。提示:痰湿困脾可能是苏州地区糖尿病的重要病因病机。     

不同中医证型2型糖尿病患者骨密度及骨代谢改变

背景：2型糖尿病患者骨密度易出现异常改变，但规律尚未明确。目的：从中医证型角度探讨2型糖尿病患者骨密度和骨代谢改变的病理生理特征。设计：病例一对照，对比观察。单位：解放军广州军区广州总医院内分泌科。对象：选择2003—04／2004-04解放军广州军区广州总医院内分泌科住院2型糖尿病患者103例，男55例，女48例。按中医证型将患者分为3组：阴虚热盛证组32例、气阴两虚证组36例、阴阳两虚证组35例。选择同期本院健康体者30人为对照组，男16人，女14人。纳人对象均对实验目的知情同意。方法：①采用双能X线吸收骨矿含量测定仪测定各组对象第14腰椎正位和总体髋部及左侧髋部股骨颈的骨密度。②采用放射免疫法测定血清骨钙素。③采用比色法测定血清抗酒石酸酸性磷酸酶水平。④计量和计数资料差异比较分别采用g检验和x^2检验。主要观察指标：①各组对象第1～4腰椎和总体髋部及左侧髋部股骨颈骨密度。②各组对象骨质疏松患病率比较。⑧各组对象血清骨钙素和抗酒石酸酸性磷酸酶水平比较。结果：2型糖尿病患者103例和健康体检者30人均进人结果分析。①第1-4腰椎和总体髋部及髋部股骨颈骨密度：阴虚热盛证组、气阴两虚证组、对照组均明显高于阴阳两虚证组（P〈0．05-4）．01）。②骨质疏松发生率：阴虚热盛证组、气阴两虚证组、对照组明显低于阴阳两虚证组[34％（11／32）,42％（15／36]，33％（10／30），71％（25／35），P〈0．01]。③血清骨钙素水平：阴虚热盛证组和气阴两虚证组明显高于阴阳两虚证组（P〈0．01），低于对照组（P〈0．05）。④血清抗酒石酸酸性磷酸酶水平：各组差异不明显（P〉0．05）。结论：①阴阳两虚证2型糖尿病患者骨量和骨形成明显低于健康人和阴虚热盛证和气阴两虚证患者，骨质巯松发生率明显高于健康人和其他2个证型患者。②阴虚热盛证、气阴两虚证2型糖尿病患者骨量、骨形成接近健康人。     

虚证原发性高血压患者左心室收缩功能变化的超声研究

目的：探讨虚证原发性高血压患者左心室收缩功能变化的特异性。方法：９８例临床确诊高血压病患者按中医辨证标准分为阴虚阳亢证３０例,气阴两虚证３８例,阴阳两虚证３０例,应用二维超声心动图技术测量左心室收缩功能指标。结果：阴虚阳亢证组左心室收缩功能指标左室短轴缩短分数（ＦＳ）、射血分数（ＥＦ）、心肌收缩性显著高于正常对照组（Ｐ＜０．０５和Ｐ＜０．０１）;气阴两虚证组和阴阳两虚证组ＦＳ、ＥＦ、心肌收缩性、左室射血时间（ＬＶＥＴ）显著低于正常对照组（Ｐ均＜０．０１）,射血前期时间（ＰＥＰ）、ＰＥＰ／ＬＶＥＴ显著高于正常对照组（Ｐ均＜０．０１）;虚证各组间比较：各项指标差异均显著,其中ＦＳ、ＥＦ、ＬＶＥＴ和心肌收缩性呈下降趋势（阴阳两虚证组＜气阴两虚证组＜阴虚阳亢证组）;ＰＥＰ、ＰＥＰ／ＬＶＥＴ呈升高趋势（阴阳两虚证组＞气阴两虚证组＞阴虚阳亢证组）。结论：阴虚阳亢证高血压病患者心肌收缩功能亢进,气阴两虚证患者心肌收缩功能储备减退,阴阳两虚证患者心肌收缩功能明显下降     

不同中医证型2型糖尿病患者骨密度及骨代谢改变

背景2型糖尿病患者骨密度易出现异常改变,但规律尚未明确.目的从中医证型角度探讨2型糖尿病患者骨密度和骨代谢改变的病理生理特征. 设计病例-对照,对比观察.单位解放军广州军区广州总医院内分泌科.对象选择2003-04/2004-04解放军广州军区广州总医院内分泌科住院2型糖尿病患者103例,男55例,女48例.按中医证型将患者分为3组阴虚热盛证组32例、气阴两虚证组36例、阴阳两虚证组35例.选择同期本院健康体者30人为对照组,男16人,女14人.纳入对象均对实验目的知情同意.方法①采用双能X线吸收骨矿含量测定仪测定各组对象第1～4腰椎正位和总体髋部及左侧髋部股骨颈的骨密度.②采用放射免疫法测定血清骨钙素.③采用比色法测定血清抗酒石酸酸性磷酸酶水平.④计量和计数资料差异比较分别采用q检验和x2检验.主要观察指标①各组对象第1～4腰椎和总体髋部及左侧髋部股骨颈骨密度.②各组对象骨质疏松患病率比较.③各组对象血清骨钙素和抗酒石酸酸性磷酸酶水平比较.结果2型糖尿病患者103例和健康体检者30人均进入结果分析.①第1～4腰椎和总体髋部及髋部股骨颈骨密度阴虚热盛证组、气阴两虚证组、对照组均明显高于阴阳两虚证组(P＜0.05～0.01).②骨质疏松发生率阴虚热盛证组、气阴两虚证组、对照组明显低于阴阳两虚证组[34%(11/32),42%(15/36),33%(10/30),71%(25/35),P＜0.01].③血清骨钙素水平阴虚热盛证组和气阴两虚证组明显高于阴阳两虚证组(P＜0.01),低于对照组(P＜0.05).④血清抗酒石酸酸性磷酸酶水平各组差异不明显(P＞0.05).结论①阴阳两虚证2型糖尿病患者骨量和骨形成明显低于健康人和阴虚热盛证和气阴两虚证患者,骨质疏松发生率明显高于健康人和其他2个证型患者.②阴虚热盛证、气阴两虚证2型糖尿病患者骨量、骨形成接近健康人.     

突发性耳聋患者中医辨证分型与纯音测听指标的对照

目的：对突发性耳聋患者中医辨证分型与纯音测听指标进行对照，分析二者的关系及规律性。 方法：选择2002-10／2005-10在沈阳医学院附属沈州医院门诊就诊和住院治疗的突发聋患者192例，入选病例均在治疗开始前由资深中医师进行辨证诊断，根据患者的病史和症状，以及舌象、临床表现，初步拟设风热侵袭型、肝火上扰型、痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型等6个基本证型。并接受了纯音听阈检查，纯音听阈检查使用Medse OB822听力计，采用上升法检查气、骨导纯音听阈。以4级分类法为标准：①轻度聋：纯音听力损失10～30dB；②中度聋：纯音听力损失31-60dB；③重度聋：纯音听力损失61-90dB；④极重度聋：纯音听力损失〉90dB。听力损失损失图形按7种图形划分：①高频听力损失型。②低频听力损失型。③中频听力损失型。④碟型、平坦听力损失型。⑤岛状听力损失型。⑥高、低频听力损失型。⑦全频听力损失型。听力学检查时间为治疗前1周内。对不同中医证型突发聋患者纯音测听各项指标作一比较，进行归纳分析。 结果：突发聋患者192例最终全部进入结果分析。①突发聋患者192例中，风热侵袭型47例，肝火上扰型28例，痰火蕴结型25例，肾精亏损型11例，脾胃虚弱型14例，气滞血瘀型67例。②与总体样本纯音测听指标比较中，痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型患者患耳多数纯音测听指标均明显高于总体样本，而风热侵袭型和肝火上扰型患者多数指标明显低于总体样本（P均〈0．05～0．01）。③各组间比较中，痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型患者的双侧语音频率、8kHz频率多数测听指标均明显高于风热侵袭型和肝火上扰型患者，另有脾胃虚弱型双侧和气滞血瘀型患者的左侧4kHz频率明显高于后两者（P均〈0．05-0．01）。④各证型突发聋患者听力损失程度比较中，风热侵袭型中轻度聋和中度聋较多见，而肝火上扰型则以中度聋居多数，痰火蕴结型、肾精亏损型、脾胃虚弱型和气滞血瘀型患者均以重度聋、极重度聋听力损失为主。⑤各证型患者听力损伤图形比较中，风热侵袭型和肝火上扰型损伤图形以高频听力损失型和碟型、平坦听力损失型为主，而痰火蕴结型仅以碟型、平坦听力损失型为多，气滞血瘀型以高频听力损失型、碟型平坦听力损失型和中频听力损失型为主要分布，肾精亏损型和脾胃虚弱型患者则以岛状听力损失型和全频听力损失型为主要代表。 结论：各种中医证型突发聋患者听力损失程度、纯音听阈指标和听力损伤图形表现不一，痰火蕴结、肾精亏损、脾胃虚弱和气滞血瘀型患者听力损失程度较重，对各证型患者进行辨证施治有可能改善病情。     

2型糖尿病患者抑郁、焦虑情绪评分与中医症候的关系

目的 进行2型糖尿病思者的中医症候与抑邵、焦虑情绪评分调查，研究其规律性。方法 167例2型糖尿病患者在治疗前1周内分别接受了中医师辨证和Zung编制的抑郁自评量表(SDS)和焦虑自评量表(SAS)评估。结果 167例2型糖尿病患者中医证型分布如下：肺胃热盛证31例(18．6％)、气阴两虚证43例(25．7％)、肝肾阴虚证25例(14．9％)、阴阳俱虚证9例(5．4％)、血瘀气滞证19例(11．4％)、脾胃气阴两虚证11例(6．6％)、湿邪阻滞证16例(9．6％)、肝郁化热证13例(7．8％)。在2型糖尿病患者中医证型与抑郁、焦虑情绪评分结果比较中，气阴两虚证、肝肾阴虚证和阴阳俱虚证SAS评分和SDS评分均明显高于肺胃热盛证、血瘀气滞证、脾胃气阴两虚证、湿邪阻滞证和肝郁化热证患者相同项评分(P均&;lt;0．01～0．05)。结论 2型糖尿病中气阴两虚、肝肾阴虚和阴阳俱虚的中医症候患者的抑郁、焦虑情绪评分较高。     

2型糖尿病患者抑郁、焦虑情绪评分与中医症候的关系

目的进行2型糖尿病患者的中医症候与抑郁、焦虑情绪评分调查,研究其规律性。方法167例2型糖尿病患者在治疗前1周内分别接受了中医师辨证和Zung编制的抑郁自评量表(SDS)和焦虑自评量表(SAS)评估。结果167例2型糖尿病患者中医证型分布如下:肺胃热盛证31例(18.6%)、气阴两虚证43例(25.7%)、肝肾阴虚证25例(14.9%)、阴阳俱虚证9例(5.4%)、血瘀气滞证19例(11.4%)、脾胃气阴两虚证11例(6.6%)、湿邪阻滞证16例(9.6%)、肝郁化热证13例(7.8%)。在2型糖尿病患者中医证型与抑郁、焦虑情绪评分结果比较中,气阴两虚证、肝肾阴虚证和阴阳俱虚证SAS评分和SDS评分均明显高于肺胃热盛证、血瘀气滞证、脾胃气阴两虚证、湿邪阻滞证和肝郁化热证患者相同项评分(P均<0.01～0.05)。结论2型糖尿病中气阴两虚、肝肾阴虚和阴阳俱虚的中医症候患者的抑郁、焦虑情绪评分较高。     

中医药治疗糖尿病近况(上)

糖尿病是一种慢性进行性内分泌代谢紊乱疾病,属祖国医学的消渴病范畴。近十余年来采用中医药辨治,取得了较大进展,现综述如下。一、辨证施治1.据阴阳盛衰分型施治:传统观点认为糖尿病的基本病理是阴津亏耗,燥热偏盛,阴虚为本,燥热为标,病程迁延阴损及阳致气阴两虚或阴阳两虚,故临床可分为阴虚型、气阴两虚型和阴阳两虚型三个类型。张云如等治疗328例成人糖尿病,分为阴虚热盛,气阴两虚及阴阳两虚三型。认为阴虚燥热型多见于病之初期,治宜清热养阴;气阴两     

不同中医证型高血压患者的心血管危险因素分层、高血压分期、分级及血脂等指标变化特征

目的：不同中医证型的高血压患者的代谢紊乱程度也并不完全一致，观察心血管危险因素分层、高血压分期、分级，血脂和血流变学指标在不同中医证型高血压患者间的差异。方法：选择2003-01／2005-01在沈阳医学院沈州医院心内科门诊就诊或住院治疗的原发性高血压患者395例，男228例，女167例。参照1993年卫生部中药新药临床研究指导原则关于治疗高血压的临床研究指导原则所确定的辨证标准将患者分为4种证型。肝火亢盛证54例，男35例，女19例；阴虚阳亢证177例，男101例，女76例；痰湿壅盛证62例，男37例，女25例；阴阳两虚证102例，男62例，女40例。均自愿参加。①用每个证型所有患者总高血压期数、级数、层数与该证型例数之比表示高血压患者平均危险分层、级别、分期情况。②采用氧化酶法测高血压患者血清总胆固醇及三酰甘油；用化学修饰酶法测高密度脂蛋白胆固醇和低密度脂蛋白胆固醇。③采用自清洗旋转式黏度计检测高血压患者全血黏度(高、低切)、血浆比黏度、红细胞压积、全血还原黏度和K值方程。用τ检验进行组间显著性测定。结果：按意向处理分析，进入结果分析原发性高血压患者395例。①各证型高血压患者平均高血压分期、分级和心血管危险因素分层：痰湿壅盛证高血压患者平均高血压分层与阴阳两虚证相近[(1．33&;#177;1．08)，(1.31&;#177;0．94)层／例．P&;gt;0．05]，平均高血压分期和分级明显高于阴阳两虚证[(1．57&;#177;0．89)期／例，(2.37&;#177;0．91)级／例；(1．52&;#177;0．90)期／例，(2．27&;#177;0．86)级／例，P&;lt;0．05]。肝火亢盛证、阴虚阳亢证高血压患者的平均高血压分期、分级和分层明显高于阴阳两虚证[(1．88&;#177;0．76)期／例，(2．59&;#177;0．80)级／例，(1．51&;#177;0．89)层／例；(1．63&;#177;0．84)期／例，(2．76&;#177;1．01)级／例，(1．39&;#177;0．94)层／例，P&;lt;0．05～0．01]。②各证型高血压患者空腹血脂浓度：肝火亢盛证低密度脂蛋白胆固醇与高密度脂蛋白胆固醇之比明显高于阴阳两虚证(P&;lt;0．05)。肝火亢盛证、阴虚阳亢证、痰湿壅盛证总胆固醇、三酰甘油、低密度脂蛋白胆固醇浓度和总胆固醇与高密度脂蛋白胆固醇之比明显高于阴阳两虚证(P&;lt;0．05～0．01)；高密度脂蛋白胆固醇浓度明显低于阴阳两虚证(P&;lt;0．05～0．01)。③高血压患者血液流变学指标：除阴虚阳亢证全血还原黏度和痰湿壅盛证血浆比黏度、红细胞压积与阴阳两虚证相近外(P&;gt;0．05)。肝火亢盛证、阴虚阳亢证和痰湿壅盛证全血高切黏度、全血低切黏度、血浆比黏度、红细胞压积、伞血还原黏度和K值方程明显高于阴阳两虚证(P&;lt;0．05～0．01)。结论：①肝火亢盛证、阴虚阳亢证和痰湿壅盛证高血压患者较阴阳两虚证有更高的发生动脉硬化危险性和更多心血管危险因素，高血压患病程度更重，有更多的合并症。②肝火亢盛证、阴虚阳亢证和痰湿壅盛证高血压患者较阴阳两虚证更易发生血脂紊乱和血流变学异常。     

Lipid disorders in type 1 and type 2 diabetes

Atherosclerotic cardiovascular disease is the most important cause of morbidity and mortality in diabetic subjects. Abnormalities in circulating lipids and lipoproteins are considered to be important risk factors for cardiovascular disease because they occur with increased frequency in diabetic individuals. Because reversal of these abnormalities carries the potential for preventing or ameliorating cardiovascular disease, their identification and management with other cardiovascular disease risk factors deserve equal importance to the management of hyperglycemia and frequently are complementary to it.     

Angina pectoris in type A and type B cardiac patients

The type A behavior pattern is characterized by excessive competitive drive, a sense of time urgency, enhanced aggressiveness, hostility and a persistent desire for recognition. Type A behaviour is widely recognized as a risk factor in coronary heart disease. This study investigated whether type As and Bs differ in their experience of pain and pain coping efforts. A group of type A (n = 35) and a group of type B (n = 19) cardiac disease patients served as subjects. All subjects underwent diagnostic treadmill testing and were compared on a variety of pain measures. There were no differences between type As and Bs in age, sex, presence of state or trait anxiety or severity of cardiac disease. Type A patients, however, were much more likely than type Bs to be classified on the New York Heart Association (NYHA) functional angina scale as having more severe pain and functional limitation. Type As were also less likely to use pain coping strategies to deal with their pain. Those who assess pain and functional impairment in cardiac patients using the NYHA scale should be aware that type A personality characteristics may affect their assessments. Type A patients who tend to make little use of pain coping strategies may benefit from systematic training in pain control methods. Additional research is needed to examine whether type A-B differences in pain and pain coping strategies may affect risks of coronary morbidity and mortality.     

Spectrum of proteinuria in type I and type II diabetes

We prospectively investigated the evolution of proteinuria in 52 type I diabetics over 7.8 +/- 0.3 (mean +/- SE) yr and in 61 type II diabetics over 6.4 +/- 0.3 yr. Measurements of renal protein clearance were performed serially, and the time course of proteinuria was classified in each subject based on a threshold albumin clearance of 11 nl/s, equivalent to a urinary albumin excretion rate of 30 micrograms/min. The classification based on this threshold yielded four distinct patterns of albuminuria: minimal, intermittent, progressing, and established. These patterns occurred in both type I and type II diabetics independently of the duration of follow-up. This study has identified a pattern of intermittent microalbuminuria that is also associated with transient elevations of transferrin and IgG clearances. The relationship of clinical and biochemical parameters to proteinuria patterns was evaluated. No relationship was detected between proteinuria patterns and glycemic control in either type I or type II diabetics. In type I but not type II diabetics, established proteinuria was associated with higher systolic blood pressure and decreased creatinine clearance. The phase of intermittent proteinuria detected in this study may represent a reversible stage in the development of diabetic nephropathy, but the factors that trigger the transition to progressing proteinuria remain obscure.     

Basal C-peptide in the discrimination of type I from type II diabetes

Basal serum C-peptide concentrations in diabetic patients showed two groups. Diabetic patients with low C-peptide levels (less than or equal to 0.16 nmol/L) have clinical characteristics of type I diabetes, and all were on insulin therapy. With long duration of diabetes, an increasing proportion had undetectable C-peptide. Diabetic patients with high C-peptide levels (greater than 0.16 nmol/L) resemble type II diabetes. In this group 30% were on insulin therapy but duration of known disease was not associated with any decline in the high basal C-peptide levels. The small proportion of diabetic patients with basal serum C-peptide in the range of 0.17-0.32 nmol/L have indeterminate status.     

Conjunctival flora in patients with type 1 or type 2 diabetes mellitus

Patients with diabetes mellitus (DM) are prone to infection because glucose in the skin, urine, mucous membranes, and tears promotes growth of microorganisms. Conjunctival flora develops soon after birth, and some saprophytic conjunctival flora play a pathogenic role when immune function is compromised, which can lead to serious infection. DM is one condition that may compromise immune status. In lacrimal function tests of DM patients, a decrease in breakup time (BUT) of lacrimal film and a decrease in Schirmer’s test results were seen. In the present study, conjunctival flora in patients with DM was compared with that in controls with regard to type and duration of diabetes and results of lacrimal function tests. Seventeen patients with type 1 DM (n=34 eyes), 66 patients with type 2 DM (n=132 eyes), and 50 control subjects (n=100 eyes) were included. The control group consisted of age-matched patients with no ophthalmologic problems other than refractive error. Clycosylated hemoglobin values were measured with highpressure liquid chromatography with the Hi-AUTOA1c analyzer (Kyoto Daiichi Kagatu Co., Ltd., Kyoto, Japan). Type and duration of diabetes and demographic data were recorded, and routine ophthalmologic examinations were performed; the BUT of lacrimal film was determined, and the results of Schirmer’s test were assessed. Microbiologic sampling was performed twice for both eyes with sterile cotton swabs. One sample was incubated in 2 mL of brain-heart infusion broth agar; the other was incubated for the presence of fungi in Sabouraud dextrose agar. Colony morphology, hemolysis, and Cram’s stain, as well as catalase, oxidase, and coagulase tests were performed. No growth was observed in 12 of 1 7 patients (35.4%) with type 1 DM, 28 of 66 patients (21.2%) with type 2 DM, and 25 of 50 control subjects (50%).Staphylococcus epidermidis (11.79%) andStaphylococcus aureus (11.7%) were the most frequently isolated organisms in the type 1 DM group, and Sepidermidis (24.2%) and Saureus (21.2%) were the predominant organisms in the type 2 DM group. In control subjects, Sepidermidis (22%), Saureus (12%), andCorynebacterium spp (10%) were the most frequently isolated organisms, and the number of eyes with growth of Saureus was significantly higher in the type 2 DM group than in the other groups (P<.01). Patients with diabetes are more prone to postoperative endophthalmitis than are nondiabetics, and preoperative application of antiseptic or antimicrobial agents to the conjunctiva may not sterilize the area. Impaired integrity of the posterior capsule may also increase the risk of endophthalmitis. Postoperative endophthalmitis is usually associated with gram-positive organisms (75%–80%); gram-negative organisms (15%–29%) and fungi (3%–13%) account for a smaller number of cases. A high rate of resistance to penicillin, ampicillin, and tetracycline was observed in Saureus isolates, although resistance to vancomycin was absent, rendering this molecule the most effective therapeutic option. In this study, Sepidermidis and Saureus were the 2 most frequently isolated organisms in patients with DM. It is concluded that the conjunctival flora in diabetic subjects differs from that in nondiabetic subjects. This should be considered preoperatively and postoperatively, and prophylactic and postoperative treatment should be administered accordingly to diabetic patients.     

Pramlintide in the treatment of type 1 and type 2 diabetes mellitus

BACKGROUND: Amylin is a 37-amino acid peptide neurohormone that is cosecreted with insulin from the pancreatic beta cells in response to meals. It lowers serum glucose by decreasing glucagon release, slowing gastric emptying, and decreasing food intake. Pramlintide, a synthetic amylin analogue, is approved by the US Food and Drug Administration for use with mealtime insulin in patients with type 1 diabetes and patients with type 2 diabetes who are using mealtime insulin only or the combination of insulin and metformin and/or a sulfonylurea. OBJECTIVE: This article reviews the available literature on pramlintide with respect to its mechanism of action, pharmacokinetics and pharmacodynamics, clinical efficacy in type 1 and type 2 diabetes, safety and tolerability, dosing, contraindications, and drug interactions. METHODS: MEDLINE (1966-April 2005), Iowa Drug Information Service (1966-April 2005), and International Pharmaceutical Abstracts (1970-April 2005) were searched for clinical trials and therapeutic reviews published in the English language. The search terms were pramlintide and amylin. The bibliographies of identified articles were reviewed for additional references. All relevant studies were included in the review. RESULTS: Six studies, ranging in duration from 4 to 52 weeks, examined the effect of administering pramlintide with premeal insulin in patients with type 1 diabetes. In these trials, pramlintide 120 to 270 microg/d reduced glycosylated hemoglobin (HbA(1c)) by 0.1 % to 0.67%, 1-hour postprandial glucose (PPG) by 4.4 to 7 mmol/L, and 2-hour PPG by 3.6 to 4.8 mmol/L. Five studies, also ranging from 4 to 52 weeks' duration, examined the effect of administering premeal pramlintide in patients with type 2 diabetes. In these trials, pramlintide 90 to 450 microg/d reduced HbA(1c) by 0.3% to 0.62%, 1-hour PPG by 4.8 mmol/L, and 2-hour PPG by 3.4 mmol/L. The principal adverse events reported in clinical trials were nausea and hypoglycemia. The incidence of hypoglycemia in the first 4 weeks of therapy was 2 to 4 times greater with pramlintide compared with placebo; thus, the manufacturer recommends reducing the dose of premeal insulin by 50% when starting pramlintide. Close monitoring of blood glucose levels is recommended when initiating pramlintide therapy. CONCLUSIONS: Use of pramlintide in addition to insulin in patients with type 1 and type 2 diabetes was associated with modest reductions in HbA(1c). The primary adverse effects of pramlintide therapy were nausea and hypoglycemia.