从《黄帝内经》“气”的理论探讨糖尿病病机

研读《黄帝内经》中"气"学理论,探讨西医学概念糖尿病的发生病机。《黄帝内经》认为:人是禀天地之气所生,而脏腑之气又受四时之气、阴阳之气影响。若其影响致气机失调而受损,则影响情志,影响精微物质的吸收,影响精气布散,故而引起消渴,即西医学概念之糖尿病。利用传统的中医理论探讨了《黄帝内经》中"气"学理论对糖尿病病机的影响,在临床上为糖尿病的中医药治疗提供了参考思路。

Chronic hepatitis C virus infection and post-liver transplantation diabetes mellitus

Patients with chronic hepatitis C virus （HCV） infection have a significantly increased prevalence of type 2 diabetes mellitus compared to controls or HBV-infected patients. Moreover, the incidence rate of post-liver transplantation diabetes mellitus （PTDM） also appears to be higher among patients wibh HCM infection. PTDM is often assodated with direct viral infection, autoimmune disorders, and immunosuppressive regimen. Activation of tumor necrosis factor-α may be the link between HCV infection and diabetes. In this article, we reviewed the epidemiologic association between HCV infection and PTDM, highlighting the most recent pathophysiologic insights into the mechanisms underlying this association.

Is adiponectin level a predictor of nonalcoholic fatty liver disease in nondiabetic male patients?

AIM: To study the levels of adiponectin in nondiabetic patients with nonalcoholic fatty liver disease (NAFLD) in comparison with control group.METHODS: Thirty-five patients who had elevated serum aminotransferase levels with bright liver and 34 healthy volunteers without liver disease were evaluated. Age,gender and body mass index (BMI) were recorded. Fasting plasma glucose, insulin, adiponectin, proinsulin and lipid profile were measured. A standard oral glucose tolerance test (OGTT) with insulin response was performed and the index of insulin resistance was calculated according to the homeostasis model assessment (HOMA) method.RESULTS: According to the OGTT results, none of the participants had diabetes. Serum adiponectin levels were statistically significantly lower in patients with NAFLD than in control group (8.14±3.4 μg/mL vs12.4±9.4 μg/mL,respectively, P＜0.01). A statistically significant correlation was found between adiponectin and BMI (r: -0.33, P＜0.01),HOMA (r: -0.26, P＜0.05), proinsulin (r: -0.32, P＜0.01),AST (r: -0.25, P＜0.05), ALT (r: -0.26, P＜0.05) or GGT (r: -0.22, P＜0.05). In multiple regression analysis models,adiponectin levels were the only predictor of NAFLD in males, whereas in female group it was the BMI.CONCLUSION: Low adiponectin level might be a predictor of NAFLD especially in male nondiabetics.

Is diabetes a causal agent for colorectal cancer? Pathophysiological and molecular mechanisms

The possible relationship between diabetes mellitus (DM) and colorectal cancer (CRC), concerning pathophysiological and molecular mechanisms is highlighted in this review. The most recent and complete articles and developments in this particular field were thoroughly reviewed. Common risk factors, such as obesity, sedentary lifestyle, and Western diet between DM and CRC, led to the theory that DM might be a causal agent for CRC development. Various studies have connected type 2 DM and CRC, either proximal or distal, in both sexes. Additionally, chronic insulin treatment has been linked with increased colorectal tumor risk among type 2 diabetic patients. Interestingly, elevated hemoglobin A1c has been proven to be an independent predictor of aggressive clinical behavior in CRC patients. These mechanisms include the insulin-like growth factor-hyperinsulinemia theory and the participation of oncogenic intracellular signaling pathways. Furthermore, it has been proposed that Cox-2 inhibitors might have a role in decreasing the incidence of CRC. Finally, the use of statins to reduce the risk for colon cancer in patients with diabetes has remained controversial. Diabetic patients over 50 should receive counseling regarding their elevated risk for CRC, and screening colonoscopy should be recommended before initiating insulin therapy. However, there are no current guidelines, and this strategy is not yet applicable to some countries, as the corresponding risk would not allow screening colonoscopy to be adopted. There is strong evidence to indicate that DM is a causal agent for CRC development. This conclusion provides new impetus for re-evaluating CRC screening worldwide.

HOMA-ESTIMATED INSULIN RESISTANCE IN NONDIABETIC INDIVIDUALS

Objective To assess the relationship between HOMA-estimated insulin resistance and risk fac-tors of cardiovascular disease in the general population. Methods 268 eligible subjects of Pudong ShangGan community, aged 45-80 years, volunteered to participate in this cross-sectional survey. Fasting insulin was measured by means of a radioimmunoassay. Results Anthropometric parameters ,fasting blood glucose and insulin, increased in a linear fashion across quartiles of HOMA-IR after adjustment for age and sex. HOMA-IR was significantly associated with measures of anthropometry (BMI,r = 0. 30; waist circumference, r =0. 35; and waist-to-hip ratio,r =0.21), fasting (glucose,r =0. 41; insulin,r=0. 71), and cardiovascular risk factors ( cholesterol, r = 0. 23; triglyceride,r = 0. 31; systolic blood pressure,r= 0. 25; and diastolic blood pressure, r = 0. 20; all P < 0. 0001). In logistic regression analysis, odds ratios indicate that individuals with obesity ( high levels of BMI and waist circumference) were more than 4 times likely to have elevated HOMA-IR. With increase of log triglycerides, the risk of having elevated HOMA-IR increased more than 2. 4 times. For increase in systolic and diastolic blood pressure, the likelihood of having elevated HOMA-IR increased >1. 8 times. Conclusion HOMA-IR was significantly and independently associated with risk factors of cardiovascular disease in this study.

Incretin-based therapies for type 2 diabetes with nonalcoholic fatty liver disease: a systematic review and meta-analysis

We conducted a systematic review and meta-analysis of randomized controlled trials（RCTs） to determine the effectiveness and safety of incretin-based therapies（IBTs） for the treatment of type 2 diabetes（T2DM） with nonalcoholic fatty liver disease（NAFLD）. Electronic databases such as the Cochrane library, EMbase, Pub Med, and three Chinese databases were searched for RCTs that compared IBTs with other treatments or placebo for T2 DM with NAFLD. Two reviewers independently assessed the risk of bias, extracted, and analyzed the data. A meta-analysis was performed using Revman 5.2. Publication bias was evaluated. Seven RCTs involving 532 patients were ultimately included. The results of meta-analysis（random-effects model） revealed that IBTs had a significant reduction in serum ALT（WMD –12.30, 95% CI –17.53~–7.06） and BMI（WMD –2.64, 95% CI –4.35~–0.94）. However, there was no significant difference in other outcomes including Hb A1 c, AST, TC, TG and HOMA-RA. IBTs were well tolerated by patients but the evidence was limited. The significant decrease in hepatic biochemical markers following treatment with IBTs, as well as improvements in BMI, suggested that IBTs may be an effective option for T2 DM with NAFLD.

Metabolic memory: mechanisms and implications for diabetic vasculopathies

In the past decades,a persistent progression of diabetic vascular complications despite reversal of hyperglycemia has been observed in both experimental and clinical studies.This durable effect of prior hyperglycemia on the initiation and progression of diabetic vasculopathies was defined as"metabolic memory".Subsequently,enhanced glycation of cellular proteins and lipids,sustained oxidative stress,and prolonged inflammation were demonstrated to mediate this phenomenon.Recently,emerging evidence strongly suggests that epigenetic modifications may account for the molecular and phenotypic changes associated with hyperglycemic memory.In this review,we presented an overview on the discovery of metabolic memory,the recent progress in its molecular mechanisms,and the future implications related to its fundamental research and clinical application.

Considerations on Syndrome Differentiation and Acupuncture Treatment of Diabetic Peripheral Neuropathy

To give the considerations on the syndrome differentiation and acupuncture treatment of diabetic peripheral neuropathy, generalize its pathogenesis and summarize treatment rules, this paper reviews and analyzed 52 articles on acupuncture treatment in recent years. It is believed that diabetic peripheral neuropathy is rooted from qi-yin deficiency and presented with blood stasis and collateral obstruction; many organs are affected, the liver, kidney, spleen and stomach in particular; the treatment principle concentrates on unblocking collaterals and regulating organs＇, treatment centers on limb acupoints, Back-Shu point and Front-Mu point; acupuncture treatment should be adopted early as possible and its clinical efficacy is rather good.

Effect of curcumin on rats/mice with diabetic nephropathy: a systematic review and Meta-analysis of randomized controlled trials

OBJECTIVE: To assess the renal protective effects of curcumin administration ondiabetic rats/mice.METHODS: Databases were searched electronically and conference papers searched manually for search terms to find relevant studies. Articles were assessed independently by two reviewers. Review Manager 5.1 was used fordata analysis.RESULTS: Fourteen randomized controlled experiments were included. Meta-analysis demonstrated that blood sugar levels and kidney weight to body weight ratios in the model group were higher than those in the normal group, and the curcumin group had significantly lower mesangial area to glomerular area ratios compared with the model group, and also lower levels of urinary protein,blood urea nitrogen and serum creatinine.CONCLUSION: Curcumin shows protective effects on the kidneys of rats/mice with diabetes.