Effects of prediabetes and diabetes on left ventricular and coronary microvascular functions

Background

Coronary flow reserve (CFR) provides independent prognostic information in diabetic patients with known or suspected coronary artery disease. However, there have been no substantial data to evaluate CFR in prediabetics. Accordingly, we aimed to evaluate CFR in subjects with prediabetes using second harmonic transthoracic Doppler echocardiography.

Methods and Results

We measured CFR of 65 subjects with prediabetes, 45 patients with overt type 2 diabetes, and 43 sex and age matched normoglycemic healthy subjects with normal glucose tolerance. Ages, gender, existence of hypertension or hypercholesterolemia, smoking status were similar among the groups. CFR was significantly lower in diabetics (2.15 ± 0.39) than in prediabetics (2.39 ± 0.45) and controls (2.75 ± 0.35); in addition, it was significantly lower in prediabetics than controls. Only 2 (5%) of control subjects had abnormal CFR (< 2) but 11 (17%) prediabetic subjects and 19 (42%) diabetic patients had abnormal CFR. We found that only age (β = − 0.31, P < 0.01) and presence of the diabetes (β = − 0.57, P < 0.01) were significant predictors of lower CFR in a multivariable model that adjusted for other variables. CFR was significantly and inversely correlated with age (r = − 0.15, P = 0.04), fasting glucose level (r = − 0.27, P = 0.001), postprandial glucose level (r = 0.43, P < 0.001), hemoglobin A1C level (r = − 0.34, P < 0.001), LDL cholesterol level (r = 0.22, P = 0.009), mitral A velocity (r = − 0.27, P = 0.001) and Tei index (r = − 0.19, P = 0.02), whereas mitral E/A ratio, mitral Em (r = 0.18, P = 0.02), mitral Em/Am ratio (r = 0.23, P = 0.004) were significantly and positively correlated with CFR.

Conclusion

CFR is impaired in subjects with prediabetics, but this impairment is not as severe as that in diabetics.     

A short message service (SMS) intervention to prevent diabetes in Chinese professional drivers with pre-diabetes: A pilot single-blinded randomized controlled trial

Aim

To determine the efficacy of delivering short-message service (SMS) to provide diabetes-related information in reducing the risk of developing diabetes in Chinese professional drivers with pre-diabetes.

Methods

A pilot single-blinded randomized controlled trial was conducted in Hong Kong between 05/2009 and 04/2012. Professional drivers with impaired glucose tolerance (IGT) were randomly allocated to either a SMS group receiving messages comprising knowledge and lifestyle modification on diabetes or to a control group with usual care. Primary outcomes were the incidence rate of diabetes mellitus over 12 and 24 months period.

Results

Fifty-four, out of 104 professional drivers recruited, were randomly allocated to intervention group. Fewer subjects developed diabetes at 12 months in intervention group (5.56%) compared to control group (16.00%). Relative risk (RR) of diabetes onset was 0.35 (95%CI: 0.10–1.24) and the number needed to treat (NNT) for preventing one diabetes was 9.57. At 24 months, RR increased to 0.62 (95%CI: 0.24–1.61) with a NNT of 10.58. Logistic regression showed a significant odds ratio of 0.04 (P = 0.021) for intervention group compared to control group at 12-month follow-up for completers and a non-significant odds ratio of 0.34 (P = 0.303) at 24-month follow-up.

Conclusions

The SMS program proved to have potential to reduce the risk of developing diabetes at 12 months but additional measures should be integrated to prevent or delay disease progression.     

理中化痰丸联合多潘立酮治疗糖尿病胃轻瘫随机平行对照研究

[目的]观察理中化痰丸联合多潘立酮治疗糖尿病胃轻瘫疗效。[方法]使用随机平行对照方法,将76例门诊及住院患者按就诊顺序编号法随机分为两组。对照组38例多潘立酮10mg/次,3次/d,饭后30min口服。治疗组38例理中化痰丸(党参、石菖蒲、生姜、法半夏、茯苓各15g,干姜、炒白术各18g,砂仁12g,炙甘草9g,大枣6g),1剂/d,水煎200mL,饭后2h口服;症状消失后,1剂/d,隔日1次;多潘立酮治疗同对照组。连续治疗30d为1疗程。观测临床症状、FPG、2hPG、HbA1c、复发率、不良反应。治疗1疗程,判定疗效。[结果]治疗组显效17例,有效18例,无效3例,总有效率92.11%。对照组显效11例,有效16例,无效11例,总有效率71.05%。治疗组疗效优于对照组(P0.05)。FPG、2hPG及HbA1c两组均有改善(P0.05),治疗组改善优于对照组(P0.05)。[结论]理中化痰丸联合多潘立酮治疗糖尿病胃轻瘫方面效果显著,值得推广。     

中青年血清胆红素轻度增高者胆红素与血糖、血脂及血压的关系

目的观察中青年血清胆红素轻度增高者血糖、血脂及血压水平。方法中青年男女556人,高胆红素组296人,对照组260人。测定两组研究对象血清总胆红素、直接胆红素、空腹血糖、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇及血压并对数据进行分析。结果男性胆红素高于女性,差异有统计学意义（P〈0．01）。高胆红素组空腹血糖低于对照组,男性二组差异有统计学意义（P〈0．01）,女性二组差异无统计学意义（P〉0．05）。高胆红素组收缩压低于对照组,但差异无统计学意义（P〉0．05）,舒张压高于对照组,且差异有统计学意义（P〈0．05）。高胆红素组男性总胆固醇、甘油三酯高于对照组,高及低密度脂蛋白胆固醇低于对照组,其中高密度脂蛋白胆固醇与对照组差异有统计学意义（P〈0．05）。高胆红素组女性总胆固醇、甘油三酯、高与低密度脂蛋白胆固醇均高于对照组,但差异无统计学意义（P〉0．05）。空腹血糖与男性总胆红素、直及间接胆红素和女性直接胆红素负相关。舒张压与男性总胆红素及直接胆红素和女性总胆红素及间接胆红素正相关;收缩压与男性胆红素不相关,与女性直接胆红素负相关。男性低密度脂蛋白胆固醇、女性总胆固醇、腰围与直接胆红素负相关。男性腰围与总胆红素、间接胆红素正相关。结论胆红素不同形式对空腹血糖均有影响,中青年阶段空腹血糖随着胆红素的增高而降低。胆红素对中青年男女舒张压的维持有一定作用,对收缩压的影响有性别差异,女性胆红素较高者,舒张压较低。中青年男女在高胆红素水平时有较少的心脑血管危险因素。     

Nocturnal hyperglycaemia in type 2 diabetes with sleep apnoea syndrome

The prevalence of Gestational Diabetes Mellitus (GDM) diagnosed by WHO criterion (2-hPG ≥ 7.8 mmol/L) was 13.4%. By International Association of Diabetes and Pregnancy Study Groups criteria of FPG ≥ 5.1 mmol/L, prevalence of GDM was 3.2%. FPG may not be suitable for diagnosis of GDM in Asian Indians due to high insulin resistance in addition to pregnancy hormonal effect.     

Guanosine triphosphate cyclohydrolase in Plasmodium falciparum and other Plasmodium species

GTP cyclohydrolase (EC 3.5.4.16), the first enzyme in the pteridine pathway leading to the de novo formation of folic acid, has been identified and isolated from the human malaria parasite, Plasmodium falciparum. The enzyme was purified 200-fold by high performance size-exclusion chromatography on a TSK-G-3000 SW protein column. The molecular weight was estimated at 300 000. Optimal enzyme activity was observed at pH 8.0 and 42 degrees C. The Km for GTP was 54.6 microM. Products of the enzyme reaction were identified as the carbon-8 of GTP and D-erythro-dihydroneopterin triphosphate. ATP was a competitive inhibitor (Ki = 600 microM) of the enzyme. Activity of the enzyme was Mg2+-independent, whereas Mn2+, Cu2+ and Hg2+ (5 mM) were inhibitory. GTP cyclohydrolase activity was also identified in a murine parasite, Plasmodium berghei, and a simian parasite, Plasmodium knowlesi. Activity of the enzyme in P. knowlesi, an intrinsically synchronous quotidian parasite, was found to be dependent on the stage of parasite development.     

孕7～15周空腹血糖水平和血脂水平诊断GDM发生的价值

目的:探讨孕7～15周空腹血浆葡萄糖水平和血脂水平对妊娠期糖尿病(gestational diabetes mellitus,GDM)发生的临床预测价值.方法:回顾性分析2012年5月至2016年12月来我院行常规产前检查的1480例孕妇的临床资料.根据75 g口服葡萄糖耐量试验(OGTT).结果:将孕妇分为GDM组(152例)和对照组(1328例),通过单因素及多因素分析GDM发生的危险因素,绘制独立危险因素的ROC曲线,计算AUC,判断各指标在GDM诊断中的预测效果.结果:GDM组的年龄(30.78±3.28)、BMI(22.55±2.87)、孕次(2.12±1.08)和FPG水平(4.98±0.37)、TG水平(1.51±0.68)、TC水平(4.71±0.76)、LDL-C水平(2.12±0.49)均高于对照组,差异有统计学意义(均P<0.05),HDL-C水平(1.99±0.35)低于对照组,差异也有统计学意义(P<0.05);年龄大、BMI高、孕次多、FPG及TG高是独立危险因素,差异有统计学意义(均P<0.05).ROC曲线分析显示BMI、FPG、TG的AUC分别为0.811、0.792、0.729.结论:年龄大、BMI高、孕次多、FPG及TG高是GDM发生的独立危险因素,诊断价值BMI>FPG>TG,通过对这指标的评估可帮助临床医生预测GDM的高危孕妇,有利于指导临床医生对孕妇进行更好的管理,降低GDM的发生率.