Management status of type 2 diabetes mellitus in tertiary hospitals in Beijing： gap between guideline and reality

Background Diabetes has become one of the most common chronic diseases and the third leading cause of death in China. Many programs have been initiated at national and local levels to address the illness. However, the effect of these programs in daily outpatient clinics is still unclear. The objective of this study was to investigate the management status of type 2 diabetes mellitus （T2DM） and factors associated with it in diabetes clinics of tertiary hospitals in Beijing. Methods A cross-sectional survey was conducted in six tertiary hospitals in Beijing. Control criteria were defined based on 2007 China guideline for type 2 diabetes （CGT2D）. Results A sample of 1151 patients, age （60.8±9.2） years, and with a median disease duration of 7.3 years was included. The hemoglobin Alc （HbAlc） mean level was （7.15±1.50）%, the percentage of patients achieving the targets for HbAlc was 37.8%, blood pressure 65.6%, triglyceride （TG） 48.8%, high-density lipoprotein （HDL） 59.2%, low-density lipoprotein （LDL） 34.0%, and total cholesterol （TC） 42.0%. The factors independently associated with glycemic control were diabetes duration （odds ratio （OR） = 0.95; 95% confidence interval （CI）： 0.919-0.982, P 〈0.01）, body mass index （BMI） （OR=0.914, 95% CI： 0.854-0.979, P=0.01） and smoking （OR=0.391, 95% Ch 0.197-0.778, P〈0.01）. The factors independently associated with blood pressure control were BMI （OR=0.915, 95% Ch 0.872-0.960, P 〈0.01） and male gender （OR=0.624, 95% CI： 0.457-0.852, P 〈0.01）. The factor independently associated with LDL control was education level （OR=1.429, 95% Ch 1.078-1.896, P=0.013）. Conclusions The management status of T2DM patients in tertiary hospitals in Beijing has improved remarkably. However, there is still room for further improvement to reach the guideline target. Long diabetes duration, high BMI, smoking, male gender and low education level were independently associated with poor metabolic control.

HLA-DQ, DR allele polymorphism of type 1 diabetes in the Chinese population： a meta-analysis

Background Type 1 diabetes （TID） is a multifactorial disease. This article aims to evaluate the relationship between allele polymorphism of HLA-DQ, DR and TID in the Chinese population. Methods The odds ratios （ORs） of HLA-DQ, DR allele distributions in patients with T1D were analyzed against healthy controls. All the relevant studies in Pubmed and CNKI were identified, and poor qualified studies were excluded. The meta-analysis software REVMAN 4.2 was applied for investigating heterogeneity among individual studies and for summarizing all the studies. The publication bias were also evaluated. Results DQA1＊0301, DQA1＊0501, DQB1＊0201, DQB1＊0302 were the susceptible alleles （all P 〈0.05） in the Chinese population, their merger ORs 2.40, 3.15, 3.66, and 2.67 respectively. DQA1＊0103, DQA1＊0201, DQA1＊0401, DQB1＊0301, DQB1＊0402, DQB1 ＊0501, DQB1＊0503, DQB1＊0601 and DQB1＊0602 were the protective alleles （P 〈0.05）, their merger ORs were 0.11, 0.45, 0.30, 0.38, 0.23, 0.37, 0.25, 0.48, and 0.30 respectively. In serum level, DR3, DR4, DR9 alleles were the susceptible alleles （all P 〈0.05） and their merger ORs were 5.58, 1.53, 1.66, 29.78, and 6.65 respectively. HLA-DR2, DR5, and DR7 alleles were the protective alleles （all P 〈0.05） and their merger ORs were 0.39, 0.51, and 0.50. In genetic type level, DRB1＊04, DRB1＊0301, DRB1＊0901 were the susceptible alleles （all P 〈0.05） and their merger ORs were 2.19, 6.43, 1.31, 3.83, and 8.08. DRBI＊07, DRBI＊08, DRB1＊12, DRB1＊13, DRB1＊14, DRB1＊16, DRBI＊0406 alleles were the protective alleles （all P 〈0.05） and their merger ORswere 0.44, 0.27, 0.45, 0.13, 0.19, 0.40, and 0.27 respectively. Conclusions In the Chinese population, some HLA-DQ, DR alleles are relevant to T1D which are not totally the same as non-Chinese populations.

2型糖尿病患者个体化血糖控制目标和药物治疗

"有效管理糖尿病全球合作组织"(下称"糖尿病全球合作组织")成立的宗旨是为临床提供实用指南以改善糖尿病患者的预后,制定并修改相关策略以改善T2DM患者血糖控制情况。糖尿病全球合作组织提倡对糖尿病患者实行个体化治疗方案,明确需要特殊考虑T2DM患者亚组人群。这篇文章基于此前发表的文献,扩大了实用指南的范围,包括有并发症的新诊断T2DM患者和妊娠期糖尿病(GDM)患者。良好血糖控制是T2DM管理的基石,在预防或延缓糖尿病并发症的发生、发展过程中发挥重要作用。个体化治疗目标和安全及时的血糖达标治疗方案至关重要。另外,还需制定更全面的护理计划以降低心血管风险和改善患者预后。

Effects of Chinese medicine Tongxinluo on hyperglycemia and beta-cell damage in streptozotocin-induced diabetic rats

Background Oxidative stress has been implicated in the onset and progression of diabetes. Tongxinluo is a traditional Chinese medicine with potent antioxidant properties. The aim of this study was to test the hypothesis that pretreatment with Tongxinluo has similar effects as melatonin on preventing hyperglycemia and beta-cell damage in a rat model of streptozotocin （STZ）-induced diabetes. Methods Forty male Sprague Dawley rats were randomly assigned to four groups （n=10 each）： normal control （NC） group; STZ group （70 mg/kg, i.p.）; Tongxinluo （1.0 g-kg-^-d-1） pretreated （TXL＋STZ） group and melatonin （200 iJg-kg-~.d-1） pretreated （MLT＋STZ） group. Tongxinluo and melatonin were administered by gavage beginning 8 days before STZ injection and continuing until the end of the study （15 days after STZ administration）. Blood glucose levels and body weights, malondialdehyde （MDA）, and reduced glutathione （GSH） levels were measured, and immunofluorescence studies were performed in all of the groups. Results Pretreatment with Tongxinluo, as with melatonin, attenuated severe hyperglycemia and weight loss induced by STZ.. In pancreatic homogenates, MDA levels were significantly lower and GSH levels were significantly higher in Tongxinluo pretreated group and in melatonin pretreated group than those in STZ group. Values of insulin staining were significantly improved in Tongxinluo pretreated group and in melatonin pretreated group as compared with those in STZ group. Conclusions Tongxinluo, as melatonin, prevented hyperglycemia and beta-cell destruction induced by STZ in rats through reducing oxidative stress in pancreatic tissues. Tongxinluo may provide an alternative therapy for the prevention and treatment of diabetes.

Replication of association study between type 2 diabetes mellitus and IGF2BP2 in Han Chinese population

Background The association between IGF2BP2 and type 2 diabetes mellitus （T2DM） has been repeatedly confirmed among different ethnic populations. However, in several genome-wide association studies （GWAS） from the Chinese Han population, the gene IGF2BP2 has not been replicated. The results of relevant studies for the association between IGF2BP2 and T2DM showed controversy in Chinese Han population. It is necessary to systematically evaluate the contribution of common variants in IGF2BP2 to T2DM in Chinese Han population.

Determinants for inadequate glycaemic control in Chinese patients with mild-to-moderate type 2 diabetes on oral antidiabetic drugs alone

Background Prevalence of inadequate glycaemic control among patients with type 2 diabetes mellitus （T2DM） remains high. We assessed glycaemic control in the real-life practice among people with T2DM in metropolises in China who were treated with oral antidiabetic drugs （OAD） alone and to determine factors associated with inadequate glycaemic control in this population. Methods An observational, cross-sectional multicentre study was conducted in 16 metropolitan medical centers. People with T2DM who had been followed-up before the index visit which occurred from January to September 2007 were included in the study. All subjects were 〉30 years of age at the time of T2DM diagnosis and had received monotherapy or combination therapy of OAD for at least 6 months. Demographic and clinical data were collected from medical records. The main study outcome was the inadequate glucose control rate, which was calculated by the proportion of patients with haemoglobin Alc （HbAlc） 〉6.5% detected on the index visit. Results In this cohort of 455 patients with T2DM whose mean age was 60.6 years and mean disease duration was 6.1 years, 45.5% had inadequate glycaemic control. The mean （SD） HbA1c was 6.7% （1.3）. Multivariate Logistic regression showed that physical inactivity, disease duration 〉10 years, body mass index （BMI） ≥24 kg/m2, low homeostasis model assessment of β-cell function （HOMA-13） index, less frequency of medical visit and hypertriglyceridaemia were independent determinants of inadequate glycaemic control. Higher incidence of self-reported hypoglycemia experience （47.1% vs. 34.8%, P=0.008） and more fear of hypoglycemia quantified by Worry subscale of the Hypoglycaemia Fear Survey （HFS） II were happened in subjects with good glycemic control. Conclusion Approximately one half of these outpatients with T2DM from the metropolitan medical centers in China had inadequate glycaemic control treated with OAD alone, which raises the need for more effective educational and therapeutic approaches on management of hypertriglycemia, enhancing physical exercise and weight control, and at the same time. Iowerina the hvooalvcemic risk and diminishina the hvooalvcemic fear of oatients.

Multicenter clinical study on the efficacy and safety of inhalable insulin aerosol in the treatment of type 2 diabetes

Background A new inhalable insulin aerosol （Inh-lns） was developed in China. The aim of this multicenter clinical study was to evaluate the efficacy and safety of this new Inh-lns as a treatment of type 2 diabetes. Regular porcine insulin （RI） was used as a control. Methods This study is a prospective, randomized, open-label, parallel-group multicenter clinical trial in which 253 qualified patients with type 2 diabetes received the insulin Glargine daily at bedtime plus either a pre-meal Inh-lns or a pre-meal subcutaneous RI for 12 weeks. HbAlc, fasting plasma glucose （FPG）, the 1-hour-postprandial blood glucose （1hPBG） and the 2-hour-postprandial blood glucose （2hPBG） were measured. Events were monitored for adverse effects. Results After 12 weeks, the HbAlc decreased significantly from baseline in both treatment groups, with no significant difference between the two regimens. In the Inh-lns group, FPG, both lhPBG and 2hPBG significantly declined from baseline after the 8th- and 12th-weeks of treatment. The reduced values of FPG or 1hPBG between the two groups showed a more significant hypoglycemic effect with the Inh-lns than the RI. After 12 weeks, the pulmonary carbon monoxide diffusing capacity （DLco） was significantly lower in Inh-lns group than in the RI. The main side effects of Inh-lns were coughing, excessive sputum, and hypoglycemia. Conclusions Inh-lns was effective in decreasing HbAlc like the RI. It was better in lowering the FPG and the lhPBG than the RI. Its main side effects were coughing, excessive sputum, and hypoglycemia. Also, Inh-lns slightly impaired DLco.

Efficacy and safety of insulin treatment in type 2 diabetes using a new index called glucose safety control index

Objective To recommend an index named glucose safety control index （GSCI） to evaluate the efficacy and safety for insulin regimens. Data sources We searched databases for primary studies published in English. The main search concepts were type 2 diabetes, insulin treatment, premixed insulin, premixed insulin analogs, basal inuslin, basal inuslin analogs, bolus insulin, bolus insulin analogs, safety and efficacy.