吡格列酮二甲双胍复方制剂临床应用专家建议

不同作用机制的口服降糖药联合治疗2型糖尿病在临床应用中已十分广泛,其中二甲双胍联合吡格列酮是中华医学会糖尿病学分会、美国糖尿病协会等国内外指南推荐的首选治疗方案之一。吡格列酮二甲双胍片作为二者的固定复方制剂,具有经济方便的优点,同时提高了患者的用药依从性。临床应用时可根据患者的具体情况单独使用吡格列酮二甲双胍片,或与其他多种口服降糖药联合用药。为提高临床医生对此类单片复方制剂的认识,促进基层治疗的合理用药,根据现有的循证证据,制定了《吡格列酮二甲双胍复方制剂临床应用专家建议》,分别从临床地位、作用机制、疗效、安全、推荐人群和特殊人群等方面进行阐述。

糖尿病患者骨折风险管理中国专家共识

1型和2型糖尿病患者的骨质量受损,骨折风险升高。由于糖尿病患者的骨密度不一定下降,而且各种糖尿病治疗有可能对骨骼产生影响,因而给临床上如何管理糖尿病患者的骨折风险带来了挑战。中华医学会骨质疏松和骨矿盐疾病分会、中华医学会内分泌学分会、中华医学会糖尿病学分会和中国医师协会内分泌代谢科医师分会共同组织专家,在充分汇总复习文献的基础上,就如何在糖尿病患者中评估骨折风险、实施骨质疏松防治、合理使用各类降糖药物等问题达成共识。

一种新型的超宽带板间垂直互连电路

随着集成电路密度的提高,板间互连结构成为不可忽视的一项重要技术。设计了一种基于HTCC工艺的新型超宽带板间互连电路,利用微波传输技术以及电磁仿真软件分析了信号的传输性能,表现了该结构的可行性。与BGA结构和毛纽扣结构进行仿真对比,表明其性能优于毛纽扣,且与BGA相当。优化后的互连电路在DC-30 GHz内信号的插入损耗小于0.35 dB,回波损耗优于15 dB,具有良好的传输性能。应用该互连电路的接收前端模块体积缩小40%。

基层应用胰高糖素样肽-1受体激动剂治疗2型糖尿病的指导建议

胰高糖素样肽-1受体激动剂(GLP-1RA)被证实对血糖、体重和心、肾均有益,越来越广泛地应用于临床,并被指南推荐为治疗2型糖尿病(T2DM)合并动脉粥样硬化性心脏病(ASCVD)患者的优选用药。文章针对基层医生使用GLP-1RA临床实践的主要问题,以问答的形式提供简明扼要的指导建议,旨在为基层医生规范使用该类药物提供参考,更好地帮助改善患者结局。

茶多酚调节STAT3/miR-126/端粒信号通路活性延缓高糖诱导的人肾小球系膜细胞衰老

探讨茶多酚(tea polyphenols,TP)在体外高糖环境下延缓人肾小球系膜细胞(human glomerular mesangial cells,HGMCs)衰老的作用及可能的机制。在体外培养HGMCs,分为正常组(normal group,N,5.5 mmol·L^-1葡萄糖)、甘露醇组(mannitol group,MNT,5.5 mmol·L^-1葡萄糖+24.5 mmol·L^-1甘露醇)、高糖组(high dose of D-glucose group,HG,30 mmol·L^-1葡萄糖)、低剂量TP组(low dose of TP group,L-TP,30 mmol·L^-1葡萄糖+5 mg·L^-1 TP)及高剂量TP组(high dose of TP group,H-TP,30 mmol·L^-1葡萄糖+20 mg·L^-1 TP),分别在37℃,5%CO2条件下培养,干预72 h后,首先观察TP对HGMCs形态的影响;其次,检测细胞周期、衰老相关半乳糖苷酶(senescence-associated-β-galactosidase,SA-β-gal)染色阳性率、端粒长度;最后,检测p53-p21-Rb信号通路中关键信号分子p53,p21,Rb的蛋白表达水平及p-STAT3,miR-126的表达水平。结果表明,高糖能诱导HGMCs衰老,不仅表现为细胞周期阻滞于G1期、SA-β-gal染色阳性率升高、端粒长度缩短,还表现为p53,p21,Rb蛋白表达水平升高和p53-p21-Rb信号通路激活。L-TP能延缓HGMCs衰老,不仅表现为HGMCs细胞周期G1期阻滞的改善、SA-β-gal染色阳性率的下降、端粒长度的延长,还表现为p53,p21,Rb蛋白表达水平的下降,端粒-p53-p21-Rb信号通路活性的抑制。此外,高糖诱导HGMCs p-STAT3表达水平上调、miR-126表达水平下调,而L-TP可使这些变化得到改善。总之,高糖能激活端粒-p53-p21-Rb信号通路而诱导HGMCs衰老;L-TP能调节STAT3/miR-126表达水平,抑制端粒-p53-p21-Rb信号通路活性而延缓高糖诱导的HGMCs衰老。这些发现为临床上防治糖尿病肾病相关的肾脏细胞衰老提供了有效的干预措施。

Thrice-daily biphasic insulin aspart 30 may be another therapeutic option for Chinese patients with type 2 diabetes inadequately controlled with oral antidiabetic agents

In subjects with type 2 diabetes inadequately controlled with oral antidiabetic agents （OADs）, insulin therapy is usually started to improve glycaemic control after failure of diet, exercise and OADs.1 Although there is no standard way to introduce insulin treatment, premixed formulations are a popular option. They offer an alternative to basal-bolus therapy and provide basal and prandial coverage with a single injection. Indeed, Koivisto et al2 in 1999 reported that 39% of patients with type 2 diabetes worldwide used premixed insulin as part of their therapeutic regimen, The modern premixed insulins, such as biphasic insulin aspart 30 （BIAsp 30） are most frequently prescribed twice-daily （BID） in clinical practice. However,

Inadequate glycaemic control and antidiabetic therapy among inpatients with type 2 diabetes in Guangdong Province of China

Background Diabetes mellitus has become epidemic in recent years in China. We investigated the prevalence of hyperglycaemia and inadequate glycaemic control among type 2 diabetic inpatients from ten university teaching hospitals in Guangdong Province, China. Methods Inadequate glycaemic control in diabetic patients was defined as HbA1c 〉 6.5%. Therapeutic regimens included no-intervention, lifestyle only, oral antiglycemic agents （OA）, insulin plus OA （insulin＋OA）, or insulin only. Antidiabetic managements included monotherapy, double therapy, triple or quadruple therapy. Results Among 493 diabetic inpatients with known history, 75% had HbA1c ≥ 6.5%. inadequate glucose control rates were more frequently seen in patients on insulin＋OA regimen （97%） ,than on OA regimen （71%） （P 〈0.001）, and more frequent in patients on combination therapy （81%-96%） than monotherapy （7,5%） （P 〈0.0,5）. Patients on insulin differed significantly from patients on OA by mean HbA1c, glycemic control rate, diabetes duration, microvascular complications, and BMI （P 〈0.01）. Conclusions This study showed that glycaemic control of type 2 diabetic patients deteriorated for patients who received insulin and initiation time of insulin was usually delayed, it is up to clinicians to move from the traditional stepwise therapy to a more active and early combination antidiabetic therapy to provide better glucose control.

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.

Cardiovascular effects and mechanisms of sodium-glucose cotransporter-2 inhibitors

Sodium-glucose cotransporter-2 inhibitors(SGLT2 inhibitors)are a new type of drug for the treatment of diabetes,and they have been proven to have a good hypoglycemic effect.Several lines of clinical evidence have shown that SGLT2 inhibitors can significantly reduce the risks of atherosclerosis,hospitalization for heart failure,cardiovascular death,and all-cause mortality and delay the progression of chronic kidney disease.Because of the protective effects of SGLT2 inhibitors on the heart and kidney,they are being studied for the treatment of heart failure and chronic kidney disease in patients without diabetes.Therefore,it is necessary for cardiologists,patients with diabetes,and nephrologists to fully understand this type of drug.In this review,we summarize the following three aspects of SGLT2 inhibitors:the recent clinical evidence of their cardiovascular benefits,their mechanisms of action,and their safety.