Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp) control in patients with hypertension and several studies also showed the efficacy of ...Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp) control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic w'. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, 〈 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, 〉 140 mmHg, and by their hemoglobin Alc (HbAlc) level: tight control, 〈 6.5%; usual control, 6.5%-7.5%; or uncontrolled, 〉 7.5%, respectively. Results The mean CIMT was 8.20 ±0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 ram). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ±0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03) but not between glycemic control categories (8.20± 0.10 mm, 8.1 ±0.08 mm, and 8.40 ± 0.14 ram, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR=1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI) 1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.展开更多
Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study ...Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects 〉 65 years old (n = 465) with a follow-up 〉 3 years. Low-density lipoprotein cholesterol (LDL-C), blood pressure (BP) and glycated hemoglobin (HbAlc) goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society (ESC/EAS), European Society of Hypertension (ESH)/ESC and European Association for the Study of Diabetes (EASD) guidelines. Results The LDL-C targets were attained by 27~,4, 48% and 62% of very high, high and moderate risk patients, respectively. Those receiving statin + ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy (48% vs. 33%, P 〈 0.05). Of the diabetic sub- jects, 71% had BP 〈 140/85 mmHg, while 78% of those without diabetes had BP 〈 140/90 mmHg. A higher proportion of the non-diabetic individuals (86%) had BP 〈 150/90 mmHg. Also, a higher proportion of those with diabetes had HbAlc 〈 8% rather than 〈 7% (88% and 47%, respectively). Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbAlc levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar- gets could be more easily achieved in this population.展开更多
Background The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was...Background The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was to assess the level of under-pharmacy and poly-pbarmacy and its prognostic impact in elderly patients with metabolic syndrome. Methods Retrospective chart-review at a tertiary medical center, of 324 patients greater than 65 years of age who met the International Diabetes Foundation criteria for metabolic syndrome diagnosis [Body Mass Index (BMI) 〉 30 kg/m2, diagnosis of type 2 diabetes, hypertension, and dyslipidemia]. Results There were 60 (18.5%) patients in the low (〈 5) medication burden group, 159 (49.1%) in the medium (〉 5 and 〈 10) medication burden group, and 105 (32.4%) in the high (〉 10) medication burden group. At baseline, the groups differed only by systolic blood pressure. At two years follow-up, the medium group had significantly better improvement in high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), HbAlc, and systolic blood pressure compared to the low medication burden group and significantly better improvement in triglycerides, Haemoglobin Alc (HbAlc) and systolic blood pressure compared to the high medication group. Decrease in HDL-C was the only variable associated with strokes. High medication burden predicted hospitalization burden. The number of anti-hypertensives, history of tobacco use, low and high medication burdens and decrease in HDL-C were all associated with death. Conclusions Both poly-pharmacy and under-pharmacy are associated with a decreased therapeutic benefit among patients with metabolic syndrome in terms of important laboratory measurements as well as clinical outcomes such as myocardial infarctions, hospitalization, and death.展开更多
Objective:To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c(HbA1c) was kept ≤6.0%.Methods:Totally 36 cases with type 2 diabetes(T2DM) with HbA1c≤6.0% and 30 cases with normal glucose tole...Objective:To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c(HbA1c) was kept ≤6.0%.Methods:Totally 36 cases with type 2 diabetes(T2DM) with HbA1c≤6.0% and 30 cases with normal glucose tolerance(NGT) from December 2005 to December 2007 in our department were subjected prospectively.Continuous glucose monitoring system(CGMS) was employed to record their continuous blood glucose level for 3 d.The blood glucose profiles including the mean blood glucose(MBG),standard differentiation(SD),mean amplitude of glycemic excursions(MAGE) and absolute means of daily differences(MODD) were analyzed.Results:T2DM group had obviously postprandial hyperglycemia,in about 2 h after meal,especially after breakfast.Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups,of which 73.1%(38 episodes) were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L.And 20 episodes took place during the day hours,while 32 episodes observed during the night hours.Compared with NGT groups,SD,MAGE and MODD were all significantly higher in T2DM groups.MBG was significantly correlated with HbA1c in T2DM groups,but SD,MAGE,NGE and MODD were all independent of HbA1c.MAGE was independent of MODD.Conclusion:The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups.Thus ideally glycemic control is not only to make HbA1c reach standard,but also to lessen glycemic excursions and reduce hypoglycemia episodes.展开更多
Type 2 diabetes (T2D) is common in the elderly and more than half of the people with diabetes are over 65 years old. Elderly diabetic patients have a higher frequency of hypertension, coronary artery disease and chr...Type 2 diabetes (T2D) is common in the elderly and more than half of the people with diabetes are over 65 years old. Elderly diabetic patients have a higher frequency of hypertension, coronary artery disease and chronic kidney disease than non-diabetic elderly patients and the risk of these complications increases with patient age, duration of the dia- betes and glycated hemoglobin values. Besides the known classical factors of renal disease progression,展开更多
GHB (γ-hydroxybutyrate) is becoming popular recreational drugs. As a result of its strong sedative and amnesiac effects, GHB has been implicated in a number of DFSA cases. The natural presence of GHB in the human b...GHB (γ-hydroxybutyrate) is becoming popular recreational drugs. As a result of its strong sedative and amnesiac effects, GHB has been implicated in a number of DFSA cases. The natural presence of GHB in the human body and its rapid elimination after ingestion make it difficult to detect and to evaluate its roles in suspected GHB-facilitated assaults. The paper describes an analytical method for the determination of GHB in urine using LC-MS/MS. Samples were acidified by ammonium chloride solution and extracted with ethyl acetate, and then the extracts were analysed by LC-MS/MS. The limit of detection was 0.05 p.g/mL (S/N = 3). The intra- and inter-day precision was within 10.0% at three concentrations. The methods were found to be sensitive, accurate, rapid and suitable for the forensic toxicology to test GHB in real cases.展开更多
The glycation of hemoglobin is catalyzed by buffer phosphate and arsenate. The catalytic constant (kB) for aqueous arsenate is two-fold larger than for aqueous phosphate. The catalytic constant (ks) of phosphate i...The glycation of hemoglobin is catalyzed by buffer phosphate and arsenate. The catalytic constant (kB) for aqueous arsenate is two-fold larger than for aqueous phosphate. The catalytic constant (ks) of phosphate in sorbitol mixtures increase from (1.67 ± 0.11) × 10-10 s-1·M-1 to (5.78 ± 0.39) × 10-10 s-1·M-1 and the catalytic constant is enhanced 3.5 times, relative to that in water; the catalytic constant (kB) of arsenate in sorbitol mixtures increase from (2.98±0.07)× 10-10 s-1·M-1 to (6.62 ± 0.53) × 10-10 s-1·M-1 and the catalytic constant is enhanced 2 times, relative to that in water. The spontaneous rate constants are independent of sorbitol concentration for phosphate and arsenate. The catalytic power of phosphate and arsenate in sorbitol are the same. Desolvation of strongly hydrated species such as HPO42 and HAsO42 should make a contribution to the energy cost of the formation of anion-hemoglobin complexes and can be a possible explanation for higher catalytic potential of HAsO42 in water. The same catalytic constant (ksB) for phosphate and arsenate in sorbitol indicates that the same catalyst base group on the hemoglobin molecule may be involved in the abstraction of proton in the Amadori rearrangement.展开更多
To assess the efficacy of pharmacist lead insulin management in improvement of HbAlc. Patients were referred to the LMttS (Licking Memorial Health Systems) Outpatient Medication Therapy Insulin Clinic by their physi...To assess the efficacy of pharmacist lead insulin management in improvement of HbAlc. Patients were referred to the LMttS (Licking Memorial Health Systems) Outpatient Medication Therapy Insulin Clinic by their physician during the time periods of July 2012 through March 2013 and August 2014 through December 2014. Physician authorization permitted pharmacists to provide clinical monitoring in order to evaluate and adjust insulin, GLP-I agonist and amylin mimetic doses by adhering to approved dosing guidelines and policy and procedures. Hemoglobin Atc values were obtained from the patients electronic medical records. Patients achieved an average decrease in HbAlc of 0.8 percentage points over a mean of 83 days. Pharmacist insulin management is an innovative pharmacy service through which clinical pharmacists can have an impact on patients' HbAtc.展开更多
As a new oral hypoglycemic agent, saxagliptin belongs to the class of dipeptidyl peptidase-4 (DPP-4) inhibitors. However, it remains inconclusive whether saxagliptin is associated with increased risk of adverse even...As a new oral hypoglycemic agent, saxagliptin belongs to the class of dipeptidyl peptidase-4 (DPP-4) inhibitors. However, it remains inconclusive whether saxagliptin is associated with increased risk of adverse events (AE) and efficacy as add-on treatment. Therefore, we performed an up-to-date meta-analysis to compare the efficacy and safety of saxagliptin with placebo and other oral hypoglycemic agents in adult patients with type 2 diabetes mellitus (T2DM). Randomized clinical trials (RCTs) comparing saxagliptin with comparators were retrieved by selecting articles from Pubmed, Embase, Cochrane Library and Clinical Trials Registry Platform up to Oct. 2013. Weighted mean difference (WMD) was used to analyze the effect of hypoglycemic agents on HbAlc, weight and fasting plasma glucose (FPG). While the patients who achieved HbAlc〈7.0% and had AE were analyzed as relative risks (RR). A total of 18 articles from 16 RCTs and one clinic trial from the WHO International Clinical Trials Registry Platform met the included criterion. Clinically significant decrease from baseline HbAlc compared with placebo was certified for 2.5 mg/day saxagliptin (WMD = -0.45%, 95% CI, -0.48% to -0.42%) and 5 mg/d saxagliptin (WMD = -0.52%, 95% CI, -0.60% to -0.44%). Saxagliptin as add-on therapy was superior to thiazolidinediones, up-titrated glyburide, up-titrated metformin or metformin monotherapy in achieving HbA1c〈7.0%. Treatment with saxagliptin had negligible effect on weight, and it was considered weight neutral. Saxagliptin treatment did not increase the risk of hypoglycemia (RR = 1.28, 95% CI 0.72 to 2.27, P = 0.40) and serious adverse experiences (RR = 1.25, 95% CI 0.94 to 1.66, P = 0.13). No statistically significant differences were observed between saxagliptin and comparators in terms of the risk of infections. The present study showed that saxagliptin was effective in improving glycaemic control in T2DM with a low risk of hypoglycaemia and incidence of infections in either monotherapy or add-on treatment. This founding should be further certified by large-sample size and good-designed RCT.展开更多
The leaves of Aquilaria sinensis(Lour.) Gilg have been used in folk medicine for the treatment of diabetes in Guangdong Province,China.In this study,effects of ethanol extract of Aquilaria sinensis leaves on hypergl...The leaves of Aquilaria sinensis(Lour.) Gilg have been used in folk medicine for the treatment of diabetes in Guangdong Province,China.In this study,effects of ethanol extract of Aquilaria sinensis leaves on hyperglycemia were investigated in diabetic db/db mice.After 4 weeks of administration,the 95%ethanol(EtOH) extract of Aquilaria sinensis leaves (AE),especially at high dose level(600 mg/kg),activated AMP-activated protein kinase(AMPK),resulting in reduced fasting blood glucose and glycosylated hemoglobin levels in db/db mice.In addition,the oral glucose tolerance test(OGTT test) showed that AE could remarkably improve insulin resistance.Compared to Thiazolinediones(TZDs),no weight gain was observed after AE administration,which is a severe side effect of TZDs.The data suggested that AE could act as an activator of AMPK,and might be used as an alternative to TZDs in the management of obesity-related diabetes.展开更多
OBJECTIVE: To provide clinical evidence in support of Dahuang Huanglian Xiexin decoction(DHXD) to treat type 2 diabetes mellitus(T2DM) and to introduce a new treatment option for clinicians.METHODS: Retrospective anal...OBJECTIVE: To provide clinical evidence in support of Dahuang Huanglian Xiexin decoction(DHXD) to treat type 2 diabetes mellitus(T2DM) and to introduce a new treatment option for clinicians.METHODS: Retrospective analysis was used to evaluate DHXD for the treatment of T2DM by analyzing clinical records of 183 cases. Patients with T2DM who met the inclusion criteria between January 1,2013 and January 1, 2014 were enrolled. The effects of the treatment were evaluated by the changes in fasting blood-glucose(FBG), postprandial blood sugar(PBG), hemoglobin A1c(Hb Alc), blood lipid profiles and body mass index(BMI) at 1, 2, 3 and 6 months. The changes in main symptoms were alsoevaluated. The dosage of Huanglian(Rhizoma Coptidis) and related factors were analyzed.RESULTS: There was a significant improvement in mean Hb A1C at 3 and 6 months after DHXD treatment compared with the baseline level(P < 0.01).There were also significant improvements in FBG,PBG, blood lipid series and BMI. DHXD also improved the main symptoms of stomach and intestine excessive heat syndrome in patients with obese T2DM. Huanglian(Rhizoma Coptidis) was the most frequently used in 678 clinical visits, the dosage of Huanglian(Rhizoma Coptidis) was related to age, BMI, DM duration, the level of blood glucose,and use of Western hypoglycemic drugs.CONCLUSION: This study suggests that DHXD could decrease blood glucose and improve T2DM symptoms and reduce body weight. The use of DHXD may indicate a new optional treatment for T2 DM.展开更多
Objective: To observe the therapeutic effect of different dosages of Gegen Qin Lian Decoction (葛根芩连汤) on type 2 diabetic patients. Methods: Fifty-four type 2 diabetic patients from low dosage group (20 cases), me...Objective: To observe the therapeutic effect of different dosages of Gegen Qin Lian Decoction (葛根芩连汤) on type 2 diabetic patients. Methods: Fifty-four type 2 diabetic patients from low dosage group (20 cases), medium dosage group (19 cases) and high dosage group (15 cases) were treated with different dosage of Gegen Qin Lian Decoction for 12 weeks. Fasting blood-glucose (FBG), postprandial blood sugar (PBG) and Hemoglobin A1c (HbAlc) were determined before and after treatment. Results: With the increase of dosage, the overall effective rate of glycaemic control increased, and FBG, PBG, HbAlc decreased. The overall effective rate of blood glucose control of high dosage, medium dosage and low dosage group were 80%, 47%, 30% respectively, and there were significant differences between high dosage group and low dosage group. The decrease of FBG, PBG and HbAlc of high dosage showed significant differences from low dosage too. These data was analyzed by trend χ2 test and covariance analysis. Conclusion: The result indicated that different dosage of Gegen Qin Lian Decoction has dose-effect relationship in reducing HbAlc and FBG.展开更多
Type 1 diabetes mellitus is heterogeneous in many facets. The patients suffered from type 1 diabetes present several levels of islet function as well as variable number and type of islet-specific autoantibodies. This ...Type 1 diabetes mellitus is heterogeneous in many facets. The patients suffered from type 1 diabetes present several levels of islet function as well as variable number and type of islet-specific autoantibodies. This study was to investigate prevalence and heterogeneity of the islet autoantibodies and clinical phenotypes of type 1 diabetes mellitus; and also discussed the process of islet failure and its risk factors in Chinese type 1 diabetic patients. A total of 1,291 type 1 diabetic patients were enrolled in this study. Demographic information was collected. Laboratory tests including mixed-meal tolerance test, human leukocyte antigen alleles, hemoglobin A1 c, lipids, thyroid function and islet autoantibodies were conducted. The frequency of islet-specific autoantibody in newly diagnosed T1 DM patients(duration shorter than half year) was 73% in East China. According to binary logistic regressions, autoantibody positivity, longer duration and lower Body Mass Index were the risk factors of islet failure. As the disease developed, autoantibodies against glutamic acid decarboxylase declined as well as the other two autoantibodies against zinc transporter 8 and islet antigen 2. The decrease of autoantibodies was positively correlated with aggressive beta cell destruction. Autoantibodies can facilitate the identification of classic T1 DM from other subtypes and predict the progression of islet failure. As there were obvious heterogeneity in autoantibodies and clinical manifestation in different phenotypes of the disease, we should take more factors into consideration when identifying type 1 diabetes mellitus.展开更多
Objective: Decompensated chronic hyperglycemia often leads to late microvascular complications such as retinopathy, diabetic foot syndrome, and diabetic kidney disease. The aim of this study was to determine the conc...Objective: Decompensated chronic hyperglycemia often leads to late microvascular complications such as retinopathy, diabetic foot syndrome, and diabetic kidney disease. The aim of this study was to determine the concentration of vascular endothelial growth factor A (VEGF-A) and its receptors in patients with well-controlled diabetes. Methods: The study was conducted on 31 patients with well-controlled type 2 diabetes without microor macroangiopathy. Thirty healthy volunteers were enrolled in a control group. Serum concentrations of VEGF-A, VEGF receptors 1 and 2 (VEGFR1 and VEGFR2), fasting glucose, and lipid profiles were measured, and the plasma concentration of glycated hemoglobin (HbAlc) was determined. Results: No significant differences were observed between the concentration of VEGF-A, VEGFR1 or VEGFR2 in the subject group and that in the control group. Positive correlations were noted between the levels of VEGF-A, VEGFR2, and triglyceride, and there was a negative correlation between the levels of VEGFR2 and high-density lipoprotein (HDL)-cholesterel in the study group. Conclusions: The concentrations of VEGF-A and its receptors 1 and 2 in patients with well-controlled diabetes are comparable to those of healthy individuals, which may indicate that appropriate control of glucose levels delays the occurrence of vascular complications. A negative correlation between VEGFR2 and HDL-cholesterol levels, and positive correlations between VEGF-A, VEGFR2, and triglyceride levels, suggest that lipid abnormalities occurring in diabetes may be involved in the modulation of angiogenesis.展开更多
OBJECTIVE: To explore the laws governing the distribution ofTraditional Chinese Medicine (TCM) syndrome elements (SEs) of senile diabetes (SD) and their relationship to relevant factors. METHODS: An investigation of p...OBJECTIVE: To explore the laws governing the distribution ofTraditional Chinese Medicine (TCM) syndrome elements (SEs) of senile diabetes (SD) and their relationship to relevant factors. METHODS: An investigation of patients who met the inclusion criteria was conducted by trained doctors, using case report forms. All related data were collected, including body mass index, glycated hemoglobin, illness course, complications, symptoms, and tongue and pulse manifestation. The SEs of each patient were judged by three qualified associate chief physicians independently. RESULTS: The main SEs of SD are Yin deficiency, Qi deficiency, blood stasis, and phlegm turbidity. Yindeficiency, Qi deficiency, blood stasis, and phlegm turbidity are most commonly seen among 4-SE combinations. Yang deficiency is typically related to illness course and BMI, phlegm turbidity to hypertension and hyperlipidemia, excessive heat to diabetic microangiopathy, and blood stasis to illness course and diabetic macroangiopathy. CONCLUSION: SD pathogenesis has a deficiency in origin and excess in superficiality. Deficiency syndrome mainly manifests as deficiency of both Qi and Yin, and concurrently in Yang deficiency. Excess syndrome is characterized by blood stasis and phlegm turbidity. SEs analysis provides a basis for the prevention and treatment of SD with TCM and lays the foundation for objectively evaluating multicentric clinical research for SD inTCM.展开更多
OBJECTIVE: Sui Zheng Shi Liang strategy (regulating prescription dosage with different syndromes) is an important part of syndrome differentiation and treatment in Traditional Chinese Medicine (TCM). Questionnaires we...OBJECTIVE: Sui Zheng Shi Liang strategy (regulating prescription dosage with different syndromes) is an important part of syndrome differentiation and treatment in Traditional Chinese Medicine (TCM). Questionnaires were given to doctors and patients to study the essential factors (indicators and timing) of Sui Zheng Shi Liang strategy in the treatment process of type 2 diabetes (T2DM). METHODS: Two questionnaires were designed for diabetes patients and their doctors. The questionnaires included the most important indicators for determining the patient's condition, the ability of TCM in treating T2DM, the length of time it takes for TCM to be effective, and when to adjust the prescription dosage.The frequency of answers was calculated, summarized, and analyzed after the survey. RESULTS: Twenty questionnaires from doctors and 90 questionnaires from patients were included in the analysis. Doctors and patients recognized thatTCM could decrease blood glucose, improve syndromes, and delay complications. Doctors were mainly concerned about glycosylated hemoglobin, while the patients were concerned about fasting plasma glucose for determining whether treatment was effective. Doctors also paid attention to changes in blood sugar and syndromes 2 weeks after medication was given as the indication to adjust the prescription dosage, while patients were concerned about these factors in 4 weeks.The prescription should be regulated when there are side effects or the medication is ineffective. CONCLUSION: The essential factor in the treatment process of T2DM in Sui Zheng Shi Liang strategy is that if fasting blood glucose level did not decrease after 4 weeks of treatment, the Chinese medicine prescription should be adjusted.展开更多
基金Acknowledgment This research was supported in part by the National Natural Science Foundation of China (81072355), Beijing Medical Scientific Development Foundation (2007-2039), Ministry of Science and Technology of China (2009BAI 86B01).
文摘Backgroud Numerous studies have confirmed the effectiveness of slowing the progression of atherosclerosis by blood pressure (Bp) control in patients with hypertension and several studies also showed the efficacy of intensive glycemic control in decreasing progression of carotid intima-media thickness (CIMT) in patients with type 1 and type 2 diabetes. However, few studies have compared the relative importance of glycemic w'. Bp control in patients with diabetes and hypertension. We aimed to investigate the association between Bp and glycemic control and subclinical carotid atherosclerosis in older patients with hypertension and type 2 diabetes. Methods In a cross-sectional study, B-mode high-resolution ultrasonography of the carotid artery was performed in 670 subjects (508 males and 162 females) aged 60 years or over who had self-reported hypertension and diabetes but no history of coronary heart disease or stroke. Subjects were categorized by their systolic blood pressure: tight control, 〈 130 mmHg; usual control, 130-139 mmHg; or uncontrolled, 〉 140 mmHg, and by their hemoglobin Alc (HbAlc) level: tight control, 〈 6.5%; usual control, 6.5%-7.5%; or uncontrolled, 〉 7.5%, respectively. Results The mean CIMT was 8.20 ±0.11 mm, and carotid plaque was found in 52.5% (352/670) subjects. Overall, 62.1% of the subjects had subclinical carotid atherosclerosis, defined as having either carotid plaque or elevated CIMT (≥ 1.1 ram). The mean CIMT was significantly different between Bp control categories (7.60 ± 0.09 mm, 7.90 ±0.08 mm, and 8.60 ± 0.12 mm, respectively, P = 0.03) but not between glycemic control categories (8.20± 0.10 mm, 8.1 ±0.08 mm, and 8.40 ± 0.14 ram, respectively, P = 0.13) using ANCOVA analysis. Multivariable logistic regression adjusting for potential confounding factors showed that usual or uncontrolled Bp control were associated with having carotid plaque (OR = 1.08 and OR=1.42, respectively), or elevated CIMT [Odd ratio (OR) = 1.17, 95% confidence interval (CI) 1.04-2.24, and OR = 1.54, 95% CI 1.36-2.96, respectively compared to tight Bp control; but did not show glycemic control as independent predictor of either having carotid plaque or elevated CIMT. Conclusions In older patients with hypertension and diabetes, blood pressure control, but not glycemic control is associated with subclinical carotid atherosclerosis.
文摘Objective To examine target attainment of lipid-lowering, antihypenensive and antidiabetic treatment in the elderly in a specialist set- ting of a University Hospital in Greece. Methods This was a retrospective study including consecutive subjects 〉 65 years old (n = 465) with a follow-up 〉 3 years. Low-density lipoprotein cholesterol (LDL-C), blood pressure (BP) and glycated hemoglobin (HbAlc) goal achievement were recorded according to European Society of Cardiology/European Atherosclerosis Society (ESC/EAS), European Society of Hypertension (ESH)/ESC and European Association for the Study of Diabetes (EASD) guidelines. Results The LDL-C targets were attained by 27~,4, 48% and 62% of very high, high and moderate risk patients, respectively. Those receiving statin + ezetimibe achieved higher rates of LDL-C goal achievement compared with those receiving statin monotherapy (48% vs. 33%, P 〈 0.05). Of the diabetic sub- jects, 71% had BP 〈 140/85 mmHg, while 78% of those without diabetes had BP 〈 140/90 mmHg. A higher proportion of the non-diabetic individuals (86%) had BP 〈 150/90 mmHg. Also, a higher proportion of those with diabetes had HbAlc 〈 8% rather than 〈 7% (88% and 47%, respectively). Of note, almost one out of three non-diabetic individuals and one out of ten diabetic individuals had achieved all three treatment targets. Conclusions Even in a specialist setting of a University Hospital, a high proportion of the elderly remain at suboptimal LDL-C, BP and HbAlc levels. The use of drug combinations could improve multifactorial treatment target attainment, while less strict tar- gets could be more easily achieved in this population.
文摘Background The diagnosis of metabolic syndrome indicates a clustering of metabolic imbalances which in sum have been recognized as a major predictor of cardiovascular and all-cause mortality. The aim of this study was to assess the level of under-pharmacy and poly-pbarmacy and its prognostic impact in elderly patients with metabolic syndrome. Methods Retrospective chart-review at a tertiary medical center, of 324 patients greater than 65 years of age who met the International Diabetes Foundation criteria for metabolic syndrome diagnosis [Body Mass Index (BMI) 〉 30 kg/m2, diagnosis of type 2 diabetes, hypertension, and dyslipidemia]. Results There were 60 (18.5%) patients in the low (〈 5) medication burden group, 159 (49.1%) in the medium (〉 5 and 〈 10) medication burden group, and 105 (32.4%) in the high (〉 10) medication burden group. At baseline, the groups differed only by systolic blood pressure. At two years follow-up, the medium group had significantly better improvement in high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), HbAlc, and systolic blood pressure compared to the low medication burden group and significantly better improvement in triglycerides, Haemoglobin Alc (HbAlc) and systolic blood pressure compared to the high medication group. Decrease in HDL-C was the only variable associated with strokes. High medication burden predicted hospitalization burden. The number of anti-hypertensives, history of tobacco use, low and high medication burdens and decrease in HDL-C were all associated with death. Conclusions Both poly-pharmacy and under-pharmacy are associated with a decreased therapeutic benefit among patients with metabolic syndrome in terms of important laboratory measurements as well as clinical outcomes such as myocardial infarctions, hospitalization, and death.
基金Supported by the National "Eleventh Five-year Plan" for Major Scientific and Technological Research (2006BAI02B08)
文摘Objective:To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c(HbA1c) was kept ≤6.0%.Methods:Totally 36 cases with type 2 diabetes(T2DM) with HbA1c≤6.0% and 30 cases with normal glucose tolerance(NGT) from December 2005 to December 2007 in our department were subjected prospectively.Continuous glucose monitoring system(CGMS) was employed to record their continuous blood glucose level for 3 d.The blood glucose profiles including the mean blood glucose(MBG),standard differentiation(SD),mean amplitude of glycemic excursions(MAGE) and absolute means of daily differences(MODD) were analyzed.Results:T2DM group had obviously postprandial hyperglycemia,in about 2 h after meal,especially after breakfast.Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups,of which 73.1%(38 episodes) were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L.And 20 episodes took place during the day hours,while 32 episodes observed during the night hours.Compared with NGT groups,SD,MAGE and MODD were all significantly higher in T2DM groups.MBG was significantly correlated with HbA1c in T2DM groups,but SD,MAGE,NGE and MODD were all independent of HbA1c.MAGE was independent of MODD.Conclusion:The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups.Thus ideally glycemic control is not only to make HbA1c reach standard,but also to lessen glycemic excursions and reduce hypoglycemia episodes.
文摘Type 2 diabetes (T2D) is common in the elderly and more than half of the people with diabetes are over 65 years old. Elderly diabetic patients have a higher frequency of hypertension, coronary artery disease and chronic kidney disease than non-diabetic elderly patients and the risk of these complications increases with patient age, duration of the dia- betes and glycated hemoglobin values. Besides the known classical factors of renal disease progression,
文摘GHB (γ-hydroxybutyrate) is becoming popular recreational drugs. As a result of its strong sedative and amnesiac effects, GHB has been implicated in a number of DFSA cases. The natural presence of GHB in the human body and its rapid elimination after ingestion make it difficult to detect and to evaluate its roles in suspected GHB-facilitated assaults. The paper describes an analytical method for the determination of GHB in urine using LC-MS/MS. Samples were acidified by ammonium chloride solution and extracted with ethyl acetate, and then the extracts were analysed by LC-MS/MS. The limit of detection was 0.05 p.g/mL (S/N = 3). The intra- and inter-day precision was within 10.0% at three concentrations. The methods were found to be sensitive, accurate, rapid and suitable for the forensic toxicology to test GHB in real cases.
文摘The glycation of hemoglobin is catalyzed by buffer phosphate and arsenate. The catalytic constant (kB) for aqueous arsenate is two-fold larger than for aqueous phosphate. The catalytic constant (ks) of phosphate in sorbitol mixtures increase from (1.67 ± 0.11) × 10-10 s-1·M-1 to (5.78 ± 0.39) × 10-10 s-1·M-1 and the catalytic constant is enhanced 3.5 times, relative to that in water; the catalytic constant (kB) of arsenate in sorbitol mixtures increase from (2.98±0.07)× 10-10 s-1·M-1 to (6.62 ± 0.53) × 10-10 s-1·M-1 and the catalytic constant is enhanced 2 times, relative to that in water. The spontaneous rate constants are independent of sorbitol concentration for phosphate and arsenate. The catalytic power of phosphate and arsenate in sorbitol are the same. Desolvation of strongly hydrated species such as HPO42 and HAsO42 should make a contribution to the energy cost of the formation of anion-hemoglobin complexes and can be a possible explanation for higher catalytic potential of HAsO42 in water. The same catalytic constant (ksB) for phosphate and arsenate in sorbitol indicates that the same catalyst base group on the hemoglobin molecule may be involved in the abstraction of proton in the Amadori rearrangement.
文摘To assess the efficacy of pharmacist lead insulin management in improvement of HbAlc. Patients were referred to the LMttS (Licking Memorial Health Systems) Outpatient Medication Therapy Insulin Clinic by their physician during the time periods of July 2012 through March 2013 and August 2014 through December 2014. Physician authorization permitted pharmacists to provide clinical monitoring in order to evaluate and adjust insulin, GLP-I agonist and amylin mimetic doses by adhering to approved dosing guidelines and policy and procedures. Hemoglobin Atc values were obtained from the patients electronic medical records. Patients achieved an average decrease in HbAlc of 0.8 percentage points over a mean of 83 days. Pharmacist insulin management is an innovative pharmacy service through which clinical pharmacists can have an impact on patients' HbAtc.
基金Xinjiang Medical University Scientific Research and Innovation Foundation(Grant No.XYDCX2014117)
文摘As a new oral hypoglycemic agent, saxagliptin belongs to the class of dipeptidyl peptidase-4 (DPP-4) inhibitors. However, it remains inconclusive whether saxagliptin is associated with increased risk of adverse events (AE) and efficacy as add-on treatment. Therefore, we performed an up-to-date meta-analysis to compare the efficacy and safety of saxagliptin with placebo and other oral hypoglycemic agents in adult patients with type 2 diabetes mellitus (T2DM). Randomized clinical trials (RCTs) comparing saxagliptin with comparators were retrieved by selecting articles from Pubmed, Embase, Cochrane Library and Clinical Trials Registry Platform up to Oct. 2013. Weighted mean difference (WMD) was used to analyze the effect of hypoglycemic agents on HbAlc, weight and fasting plasma glucose (FPG). While the patients who achieved HbAlc〈7.0% and had AE were analyzed as relative risks (RR). A total of 18 articles from 16 RCTs and one clinic trial from the WHO International Clinical Trials Registry Platform met the included criterion. Clinically significant decrease from baseline HbAlc compared with placebo was certified for 2.5 mg/day saxagliptin (WMD = -0.45%, 95% CI, -0.48% to -0.42%) and 5 mg/d saxagliptin (WMD = -0.52%, 95% CI, -0.60% to -0.44%). Saxagliptin as add-on therapy was superior to thiazolidinediones, up-titrated glyburide, up-titrated metformin or metformin monotherapy in achieving HbA1c〈7.0%. Treatment with saxagliptin had negligible effect on weight, and it was considered weight neutral. Saxagliptin treatment did not increase the risk of hypoglycemia (RR = 1.28, 95% CI 0.72 to 2.27, P = 0.40) and serious adverse experiences (RR = 1.25, 95% CI 0.94 to 1.66, P = 0.13). No statistically significant differences were observed between saxagliptin and comparators in terms of the risk of infections. The present study showed that saxagliptin was effective in improving glycaemic control in T2DM with a low risk of hypoglycaemia and incidence of infections in either monotherapy or add-on treatment. This founding should be further certified by large-sample size and good-designed RCT.
基金New-Century Talent Program,Ministry of Educating of China(Grant No.985-2-102-113)National Key Technology R&D Program"New Drug Innovation"of China(Grant No.2009ZX09311-004,2012ZX09301-002-002-002)
文摘The leaves of Aquilaria sinensis(Lour.) Gilg have been used in folk medicine for the treatment of diabetes in Guangdong Province,China.In this study,effects of ethanol extract of Aquilaria sinensis leaves on hyperglycemia were investigated in diabetic db/db mice.After 4 weeks of administration,the 95%ethanol(EtOH) extract of Aquilaria sinensis leaves (AE),especially at high dose level(600 mg/kg),activated AMP-activated protein kinase(AMPK),resulting in reduced fasting blood glucose and glycosylated hemoglobin levels in db/db mice.In addition,the oral glucose tolerance test(OGTT test) showed that AE could remarkably improve insulin resistance.Compared to Thiazolinediones(TZDs),no weight gain was observed after AE administration,which is a severe side effect of TZDs.The data suggested that AE could act as an activator of AMPK,and might be used as an alternative to TZDs in the management of obesity-related diabetes.
基金the National Basic Research Program of China(Study of Dose-effect Relationship of Classical Prescription,973 Program,No.2010CB530601)
文摘OBJECTIVE: To provide clinical evidence in support of Dahuang Huanglian Xiexin decoction(DHXD) to treat type 2 diabetes mellitus(T2DM) and to introduce a new treatment option for clinicians.METHODS: Retrospective analysis was used to evaluate DHXD for the treatment of T2DM by analyzing clinical records of 183 cases. Patients with T2DM who met the inclusion criteria between January 1,2013 and January 1, 2014 were enrolled. The effects of the treatment were evaluated by the changes in fasting blood-glucose(FBG), postprandial blood sugar(PBG), hemoglobin A1c(Hb Alc), blood lipid profiles and body mass index(BMI) at 1, 2, 3 and 6 months. The changes in main symptoms were alsoevaluated. The dosage of Huanglian(Rhizoma Coptidis) and related factors were analyzed.RESULTS: There was a significant improvement in mean Hb A1C at 3 and 6 months after DHXD treatment compared with the baseline level(P < 0.01).There were also significant improvements in FBG,PBG, blood lipid series and BMI. DHXD also improved the main symptoms of stomach and intestine excessive heat syndrome in patients with obese T2DM. Huanglian(Rhizoma Coptidis) was the most frequently used in 678 clinical visits, the dosage of Huanglian(Rhizoma Coptidis) was related to age, BMI, DM duration, the level of blood glucose,and use of Western hypoglycemic drugs.CONCLUSION: This study suggests that DHXD could decrease blood glucose and improve T2DM symptoms and reduce body weight. The use of DHXD may indicate a new optional treatment for T2 DM.
基金supported by a grant from the National Basic Research Program (973 Program, No.2010CB530601)
文摘Objective: To observe the therapeutic effect of different dosages of Gegen Qin Lian Decoction (葛根芩连汤) on type 2 diabetic patients. Methods: Fifty-four type 2 diabetic patients from low dosage group (20 cases), medium dosage group (19 cases) and high dosage group (15 cases) were treated with different dosage of Gegen Qin Lian Decoction for 12 weeks. Fasting blood-glucose (FBG), postprandial blood sugar (PBG) and Hemoglobin A1c (HbAlc) were determined before and after treatment. Results: With the increase of dosage, the overall effective rate of glycaemic control increased, and FBG, PBG, HbAlc decreased. The overall effective rate of blood glucose control of high dosage, medium dosage and low dosage group were 80%, 47%, 30% respectively, and there were significant differences between high dosage group and low dosage group. The decrease of FBG, PBG and HbAlc of high dosage showed significant differences from low dosage too. These data was analyzed by trend χ2 test and covariance analysis. Conclusion: The result indicated that different dosage of Gegen Qin Lian Decoction has dose-effect relationship in reducing HbAlc and FBG.
基金supported by the National Natural Science Foundation of China(81270897,81300668,81370939,81400813,81400808,81530026,81370922)the Jiangsu Provincial Special Program of Medical Science(BL2012026)the Project Funded by the Priority Academic Program Development of Jiangsu Higher Education Institutions support this study
文摘Type 1 diabetes mellitus is heterogeneous in many facets. The patients suffered from type 1 diabetes present several levels of islet function as well as variable number and type of islet-specific autoantibodies. This study was to investigate prevalence and heterogeneity of the islet autoantibodies and clinical phenotypes of type 1 diabetes mellitus; and also discussed the process of islet failure and its risk factors in Chinese type 1 diabetic patients. A total of 1,291 type 1 diabetic patients were enrolled in this study. Demographic information was collected. Laboratory tests including mixed-meal tolerance test, human leukocyte antigen alleles, hemoglobin A1 c, lipids, thyroid function and islet autoantibodies were conducted. The frequency of islet-specific autoantibody in newly diagnosed T1 DM patients(duration shorter than half year) was 73% in East China. According to binary logistic regressions, autoantibody positivity, longer duration and lower Body Mass Index were the risk factors of islet failure. As the disease developed, autoantibodies against glutamic acid decarboxylase declined as well as the other two autoantibodies against zinc transporter 8 and islet antigen 2. The decrease of autoantibodies was positively correlated with aggressive beta cell destruction. Autoantibodies can facilitate the identification of classic T1 DM from other subtypes and predict the progression of islet failure. As there were obvious heterogeneity in autoantibodies and clinical manifestation in different phenotypes of the disease, we should take more factors into consideration when identifying type 1 diabetes mellitus.
基金Project supported by the Collegium Medicum in Bydgoszcz,Nicolaus Copernicus University in Toruń,Poland
文摘Objective: Decompensated chronic hyperglycemia often leads to late microvascular complications such as retinopathy, diabetic foot syndrome, and diabetic kidney disease. The aim of this study was to determine the concentration of vascular endothelial growth factor A (VEGF-A) and its receptors in patients with well-controlled diabetes. Methods: The study was conducted on 31 patients with well-controlled type 2 diabetes without microor macroangiopathy. Thirty healthy volunteers were enrolled in a control group. Serum concentrations of VEGF-A, VEGF receptors 1 and 2 (VEGFR1 and VEGFR2), fasting glucose, and lipid profiles were measured, and the plasma concentration of glycated hemoglobin (HbAlc) was determined. Results: No significant differences were observed between the concentration of VEGF-A, VEGFR1 or VEGFR2 in the subject group and that in the control group. Positive correlations were noted between the levels of VEGF-A, VEGFR2, and triglyceride, and there was a negative correlation between the levels of VEGFR2 and high-density lipoprotein (HDL)-cholesterel in the study group. Conclusions: The concentrations of VEGF-A and its receptors 1 and 2 in patients with well-controlled diabetes are comparable to those of healthy individuals, which may indicate that appropriate control of glucose levels delays the occurrence of vascular complications. A negative correlation between VEGFR2 and HDL-cholesterol levels, and positive correlations between VEGF-A, VEGFR2, and triglyceride levels, suggest that lipid abnormalities occurring in diabetes may be involved in the modulation of angiogenesis.
基金Supported by The Special Scientific Research Program of State Administration of Traditional Chinese Medicine: Methodological Evaluation of Treating Type 2 Diabetes with Syndrome Differentiation Methods Based on Three Stages In TCM(No. 06-07LP42)
文摘OBJECTIVE: To explore the laws governing the distribution ofTraditional Chinese Medicine (TCM) syndrome elements (SEs) of senile diabetes (SD) and their relationship to relevant factors. METHODS: An investigation of patients who met the inclusion criteria was conducted by trained doctors, using case report forms. All related data were collected, including body mass index, glycated hemoglobin, illness course, complications, symptoms, and tongue and pulse manifestation. The SEs of each patient were judged by three qualified associate chief physicians independently. RESULTS: The main SEs of SD are Yin deficiency, Qi deficiency, blood stasis, and phlegm turbidity. Yindeficiency, Qi deficiency, blood stasis, and phlegm turbidity are most commonly seen among 4-SE combinations. Yang deficiency is typically related to illness course and BMI, phlegm turbidity to hypertension and hyperlipidemia, excessive heat to diabetic microangiopathy, and blood stasis to illness course and diabetic macroangiopathy. CONCLUSION: SD pathogenesis has a deficiency in origin and excess in superficiality. Deficiency syndrome mainly manifests as deficiency of both Qi and Yin, and concurrently in Yang deficiency. Excess syndrome is characterized by blood stasis and phlegm turbidity. SEs analysis provides a basis for the prevention and treatment of SD with TCM and lays the foundation for objectively evaluating multicentric clinical research for SD inTCM.
基金Supported by the National Basic Research Program (973Program, No. 2010CB530601)the National Natural Science Fund (No. 81274000)
文摘OBJECTIVE: Sui Zheng Shi Liang strategy (regulating prescription dosage with different syndromes) is an important part of syndrome differentiation and treatment in Traditional Chinese Medicine (TCM). Questionnaires were given to doctors and patients to study the essential factors (indicators and timing) of Sui Zheng Shi Liang strategy in the treatment process of type 2 diabetes (T2DM). METHODS: Two questionnaires were designed for diabetes patients and their doctors. The questionnaires included the most important indicators for determining the patient's condition, the ability of TCM in treating T2DM, the length of time it takes for TCM to be effective, and when to adjust the prescription dosage.The frequency of answers was calculated, summarized, and analyzed after the survey. RESULTS: Twenty questionnaires from doctors and 90 questionnaires from patients were included in the analysis. Doctors and patients recognized thatTCM could decrease blood glucose, improve syndromes, and delay complications. Doctors were mainly concerned about glycosylated hemoglobin, while the patients were concerned about fasting plasma glucose for determining whether treatment was effective. Doctors also paid attention to changes in blood sugar and syndromes 2 weeks after medication was given as the indication to adjust the prescription dosage, while patients were concerned about these factors in 4 weeks.The prescription should be regulated when there are side effects or the medication is ineffective. CONCLUSION: The essential factor in the treatment process of T2DM in Sui Zheng Shi Liang strategy is that if fasting blood glucose level did not decrease after 4 weeks of treatment, the Chinese medicine prescription should be adjusted.