手术治疗2型糖尿病的利弊

外科手术治疗重度肥胖由来已久。近年来观察发现,同样的手术对糖尿病预防率和"治愈率"非常理想。目前我国这方面的工作如火如荼。今年世界糖尿病联盟专门在纽约开会,宣布将外科手术治疗肥胖、糖尿病作为糖尿病防治的手段之一。本文简述了外科手术发展史、手术治疗的疗效及并发症。辩证看待手术治疗2型糖尿病,正确把握手术适应证和熟练掌握手术操作至关重要,我们仍然需要正视外科手术治疗2型糖尿病所存在的一些问题,如是否具备手术指征、可能出现一定的并发症、术后未必能够完全治愈等等,不宜盲目推广。关于其是否能够完全颠覆糖尿病的传统治疗模式,现在就下结论还为时尚早,尤其是现在糖尿病的内科治疗新方法层出不穷,尚需要进行大规模的临床研究来对各种内外科疗法进行评估和对照。

张家口地区40岁以上人群2型糖尿病易患因素分析

目的:研究张家口地区2型糖尿病患者的易患因素,为糖尿病的病因、发病机制、预防的研究提供依据。方法:采用抽样分层横断面现场调查方法对张家口地区40岁以上人群进行问卷调查,并进行口服75g葡萄糖耐量实验。结果:张家口地区40岁以上人群T2DM的患病率为5.86%,糖耐量减低(IGT)患病率为10.43%。T2DM患病率与糖尿病家族史、肥胖、受教育程度、高血压密切相关,与性别、职业、吸烟无显著相关。结论:多种因素参与了T2DM的发生。

2型糖尿病合并冠心病与尿微量白蛋白的关系

2型糖尿病（diabetes mellitus type2,T2DM）患者中非特异性冠状动脉硬化性心脏病（coronary heart disease,CHD）的发生率高达40%-50%。尿微量白蛋白（Microalbuminuria,MA）是糖尿病肾病（DN）一个重要临床表现,然而近几年来研究表明MA与T2DM合并CHD有着明显的相关性,MA本身就是一种内皮损伤为特征的血管病变的临床表现。但是MA的产生和T2DM合并CHD的病理机制都十分复杂,所以尚不能把MA作为CHD的诊断和评价的主要指标,而其又确在某种程度上反映着CHD的病情,所以可以将其看作一个参考指标结合其它指标综合对CHD作出评价。

社区家庭随诊对新诊断老年2型糖尿病患者预后和生活质量的影响

将我院诊治的135例新发老年2型糖尿病患者随机分为观察组(n=67)和对照组(n=68),观察组在常规治疗同时接受定期家庭随诊,而对照组仅接受常规治疗。随诊期限为12个月。记录两组患者糖尿病控制效果,利用EQ-5D简易自评量表评价患者生活质量,同时检测血糖、血脂和糖化血红蛋白等指标变化,比较两组间的差异。结果随诊12个月后,观察组血糖控制达标率明显高于对照组(91.27%vs 78.62%,P<0.05),低血糖发生率低于对照组(6.82%vs 18.07%,P<0.05),两组未见明显心脑血管并发症;观察组平均血糖、血脂和糖化血红蛋白水平明显低于对照组(P<0.05)。此外,家庭随访组老年糖尿病患者生活质量明显高于对照组(89.56±7.1 vs 70.81±5.30,P<0.05)。

吡格列酮治疗2型糖尿病的疗效及其对胰岛素敏感性的影响

目的探讨吡格列酮治疗2型糖尿病的疗效及其对胰岛素敏感性的影响。方法选择2008年3月～2011年2月在我院门诊就诊的2型糖尿病患者175例作为研究对象。随机将其分为治疗组和对照组。两组患者均予以饮食干预、运动疗法和磺脲类药物。对照组加用二甲双胍缓释片0.5g/d,qd口服。治疗组在对照组基础上应用吡格列酮30mg/d,bid口服。两组疗程均为12周,评价疗效。结果治疗组总有效率91.11%,对照组总有效率80.00%,两组总有效率比较差异有统计学意义(P<0.05);治疗组可显著降低空腹、餐后2h血糖及胰岛素抵抗指数,胰岛素敏感指数较治疗前亦明显上升,对照组和治疗前比较均有统计学意义(P<0.05或P<0.01)。结论吡格列酮能够在增加胰岛素敏感性和纠正血糖的同时,使炎症因子C反应蛋白的水平降低,临床疗效肯定。

老年2型糖尿病患者高同型半胱氨酸血症与胰岛素抵抗相关研究

目的:探讨老年2型糖尿病患者同型半胱氨酸(Hcy)与胰岛素抵抗的相关性,分析高同型半胱氨酸血症(HHcy)的影响因素。方法:选取30例老年体检者作为健康对照组,同时选取符合入选标准的86例老年2型糖尿病患者按照体重指数分为正常体重组、超重组和肥胖组。留取血、尿测定Hcy及生化指标,计算体重指数(BMI)、稳态模型胰岛素抵抗指数(HOMA-IR)。结果:1.各组血浆Hcy水平依次升高,F=20.134,P=0.000。2.各组间HOMA-IR、BMI、FPG、FINS、HbA1c、TC、TG、HDL-c、LDL-c、尿Alb/Cr、BUN、收缩压(SBP)、病程有统计学差异,P<0.05。Cr、舒张压(DBP)无差别,P>0.05。3.相关分析表明Hcy与HOMA-IR、BMI、FPG、HbA1c、TC、TG、HDL-c、LDL-c、尿Alb/Cr、Cr、SBP、DBP、病程成显著正相关,P<0.05;与BUN、FINS无相关性,P>0.05。进一步多元线性逐步回归分析显示仅HOMA-IR、BMI、SBP、TC、尿Alb/Cr、Cr、FPG与血浆Hcy水平独立相关。结论:1.随着胰岛素抵抗的加重,血浆Hcy水平逐渐升高。老年2型糖尿病患者血浆Hcy水平升高与胰岛素抵抗有关。2.老年2型糖尿病患者HOMA-IR、BMI、SBP、TC、尿Alb/Cr、Cr、FPG是影响血浆Hcy水平的独立相关因素。

Effects of needling at Sanyinjiao(SP6)acupuncture point on blood glucose levels and cardiovascular functions in patients with type 2 diabetes mellitus:a randomized placebo-controlled study

Objective To determine the effect of needling at Sanyinjiao(SP6)on random blood glucose(RBG)levels and cardiovascular function in patients with type 2 diabetes mellitus(T2DM).Methods In this randomized placebo-controlled study,T2DM patients(aged 35-65 years)were recruited from the Government Yoga and Naturopathy Medical College and Hospital,Chennai,India,between January 5,2022 and March 15,2023.Participants were randomly as-signed to either acupuncture group or sham acupuncture group.The acupuncture group re-ceived bilateral needling at Sanyinjiao(SP6)while sham acupuncture group received needling at a non-acupuncture point[1.5 cun lateral to Sanyinjiao(SP6)]for 30 min.Primary outcome was RBG,and secondary outcomes included systolic blood pressure(SBP),diastolic blood pressure(DBP),pulse rate(PR),pulse pressure(PP),mean arterial pressure(MAP),rate pressure product(RPP),and double product(Do-P).All parameters were assessed imme-diately before and after intervention.Results A total of 100 patients with T2DM were enrolled in the study,and blinded to acupuncture group(n=50)and sham acupuncture group(n=50).Intergroup analysis showed that significant reductions in RBG(P<0.001),SBP(P=0.035),DBP(P=0.008),and MAP(P=0.009)were found in acupuncture group compared with sham acupuncture group.Within-group analysis showed significant reductions in RBG(P<0.001),SBP(P<0.001),DBP(P=0.008),PP(P=0.023),MAP(P<0.001),RPP(P<0.001),and Do-P(P=0.002)in acupunc-ture group,whereas sham acupuncture group showed a significant decrease in PR(P=0.023)only in the post-test assessment compared with pre-test assessment.Conclusion A period of 30 min of needling at the Sanyinjiao(SP6)acupuncture point re-duces RBG and promotes cardiovascular function in patients with T2DM as compared with needling at non-acupuncture points.Sanyinjiao(SP6)acupuncture may offer an immediate,non-pharmacological intervention to strengthen glycemic control management and cardio-vascular health in T2DM patients.

甘精胰岛素联合阿卡波糖在糖尿病围手术期应用的疗效和安全性评价

目的:探讨甘精胰岛素联合阿卡波糖在糖尿病围手术期治疗中的疗效及安全性。方法:32例围手术期糖尿病患者分为甘精胰岛素联合阿卡波糖组18例和每日多次胰岛素治疗组(MSII)14例,观察患者治疗期间血糖变化及术后并发症情况。结果:32例患者血糖均明显降低(P<0.05),两组间血糖下降水平比较无统计学差异(P>0.05),甘精胰岛素联合阿卡波糖组低血糖发生率明显低于MSII组,伤口愈合均良好。结论:在2型糖尿病患者围手术期中应用甘精胰岛素联合阿卡波糖能安全、有效地控制血糖,使患者顺利渡过围手术期。

Abnormal Change in Body Weight and Non-Fasting Blood Glucose Levels of Mouse Strain C57BL/6J in Generating Type 2 Diabetes Model

The commercially available inbred obesity-prone C57BL/6J （B6） and outbred stock ICR mice （3-week old） purchased from a breeder of Beijing were weaned onto high-fat diet （HFD）, HFD-3% fructose water （HFDF） and standard rodent chow, respectively. After exposure to the diets for six weeks, HFD and HFDF fed mice were injected intraperitoneally with streptozotocin （STZ, 100mg/kg body weight） and kept on the same diet for next four weeks. Body weight was recorded weekly. Non-fasting blood glucose levels of HFD and HFDF fed mice were measured before and after STZ injections. The body weight of HFD-fed and HFDF-fed B6 mice were significantly lower than that of the control, but body weight of HFD-fed and HFDF-fed ICR mice were significantly higher than that of the control. After injection of STZ, blood glucose levels were above the stardardized criterion （11 mmol/L） for the diabetes mouse model in both HFD and HFDF fed ICR mice, but reverse in B6 mice. The type 2 diabetes model was generated successfully in ICR but not in B6 mice, regardless of whether fructose was supplied. The current results indicated that ICR mouse is still a useful and economical strain for HFD-induced/STZ-treated type 2 diabetes model, and that some variation may occur in the genetic composition among B6 mice bred by different breeders.

内皮素和一氧化氮检测对糖尿病血管内皮功能的评价作用

目的探讨血浆内皮素(ET)和血清一氧化氮(NO)检测对初诊糖尿病血管内皮功能的评价作用。方法分别采用放射免疫法和硝酸还原酶法对初诊的2型糖尿病(T2DM)患者39例和正常对照组40例血浆中的ET和血清中NO进行检测,同时运用彩色多普勒超声仪检测DM患者内皮依赖性舒张功能(FMD),对二者相关进行分析。结果初诊的T2DM患者血浆ET为(61.42±17.66)ng/l,显著高于正常对照组的(44.35±15.27)ng/l(P<0.001),而血清NO为(58.37±14.70)μmol/l,明显低于正常对照组的(69.20±18.15)μmol/l(P<0.01),而且DM患者的血浆ET水平和FMD呈显著的负相关关系(r=-0.62,P<0.001)。

Yi-Qi-Zeng-Min-Tang,a Chinese medicine,ameliorates insulin resistance in type 2 diabetic rats

AIM:To investigate the effects of the Chinese herbal decoction,Yi-Qi-Zeng-Min-Tang(YQZMT),on insulin resistance in type 2 diabetic rats.METHODS:Sprague-Dawley rats were divided into two dietary regiments by feeding either normal pellet diet(NPD) or high fat diet(HFD).Four weeks later,the HFD-fed rats were injected intraperitoneally with lowdose streptozotocin(STZ).Rats with non-fasting blood glucose level ≥ 16.67 mmol/L were considered type 2 diabetic and further divided into five subgroups:the type 2 diabetes model group,low-dose,medium-doseand high-dose YQZMT groups,and rosiglitazone group.Age-matched NPD-fed rats served as controls.YQZMT or rosiglitazone were administered for 8 wk.Intraperitoneal glucose and insulin tolerance tests were performed before and after the treatment to measure the glucose tolerance and insulin sensitivity.Serum levels of biochemical parameters,adipocytokines,such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),as well as free fatty acids(FFAs),were also analyzed.RESULTS:There was significant elevation of insulin resistance and serum levels of fasting glucose(12.82 ± 1.08 mmol/L vs 3.60 ± 0.31 mmol/L,P < 0.01),insulin(7197.36 ± 253.89 pg/mL vs 4820.49 ± 326.89 pg/mL,P < 0.01),total cholesterol(TC)(8.40 ± 0.49 mmol/L vs 2.14 ± 0.06 mmol/L,P < 0.01),triglyceride(2.24 ± 0.12 mmol/L vs 0.78 ± 0.05 mmol/L,P < 0.01),low-density lipoprotein cholesterol(LDL-c)(7.84 ± 0.51 mmol/L vs 0.72 ± 0.04 mmol/L,P < 0.01) and decrease in high-density lipoprotein cholesterol(HDL-c)(0.57 ± 0.03 mmol/L vs 1.27 ± 0.03 mmol/L,P < 0.01) in the low-dose STZ and high-fat diet induced type 2 diabetic group when compared with the control group.Administration of YQZMT induced dose-and timedependent changes in insulin resistance,glucose and lipid profile,and reduced levels of FFA,TNF-α and IL-6 in the type 2 diabetic rats.After the treatment,compared with the diabetic group,the insulin resistance was ameliorated in the high-dose YQZMT(2.82 g/100 g per day) group,with a significant reduction in serum glucose(12.16 ± 1.00 mmol/L vs 17.65 ± 2.22 mmol/L,P < 0.01),homeostasis model assessment of basal insulin resistance(22.68 ± 2.37 vs 38.79 ± 9.02,P < 0.05),triglyceride(0.87 ± 0.15 mmol/L vs 1.99 ± 0.26 mmol/L,P < 0.01),TC(3.31 ± 0.52 mmol/L vs 6.50 ± 1.04 mmol/L,P < 0.01) and LDL-c(2.47 ± 0.50 mmol/L vs 6.00 ± 1.07 mmol/L,P < 0.01),and a signif icant increase in HDL-c(0.84 ± 0.08 mmol/L vs 0.50 ± 0.03 mmol/L,P < 0.01).But the body weight was not changed signif icantly.CONCLUSION:YQZMT,which ameliorates insulin resistance and does not cause increase in body weight,may be a suitable therapeutic adjunct for the treatment of type 2 diabetes.

Nicotinamide overload may play a role in the development of type 2 diabetes

AIM： To investigate whether nicotinamide overload plays a role in type 2 diabetes. METHODS： Nicotinamide metabolic patterns of 14 diabetic and 14 non-diabetic subjects were compared using HPLC. Cumulative effects of nicotinamide and N^1-methylnicotinamide on glucose metabolism, plasma HzO2 levels and tissue nicotinamide adenine dinucleotide （NAD） contents of adult Sprague-Dawley rats were observed. The role of human sweat glands and rat skin in nicotinamide metabolism was investigated using sauna and burn injury, respectively. RESULTS： Diabetic subjects had significantly higher plasma N^1-methylnicotinamide levels 5 h after a 100-mg nicotinamide load than the non-diabetic subjects （0.89 ± 0.13 μmol/L vs 0.6 ± 0.13 μmol/L, P 〈 0.001）. Cumulative doses of nicotinamide （2 g/kg） significantly increased rat plasma Nl-methylnicotinamide concentrations associated with severe insulin resistance, which was mimicked by Nl-methy-Inicotinamide. Moreover, cumulative exposure to N^1- methylnicotinamide （2 g/kg） markedly reduced rat muscle and liver NAD contents and erythrocyte NAD/ NADH ratio, and increased plasma H2O2 levels. Decrease in NAD/NADH ratio and increase in H2O2 generation were also observed in human erythrocytes after exposure to N^1-methylnicotinamide in vitro. Sweating eliminated excessive nicotinamide （5.3-fold increase in sweat nicotinamide concentration 1 h after a 100-mg nicotinamide load）. Skin damage or aldehyde oxidase inhibition with tamoxifen or olanzapine, both being notorious for impairing glucose tolerance, delayed N^1- methylnicotinamide clearance. CONCLUSION： These findings suggest that nicotinamide overload, which induced an increase in plasma N^1- methylnicotinamide, associated with oxidative stress and insulin resistance, plays a role in type 2 diabetes.

Predictors of diabetes self-management among type 2 diabetics in Indonesia:Application theory of the health promotion model

Objective:This study aimed to identify factors predicting diabetes self-management among adults with type 2 diabetes mellitus in Malang City,East Java,Indonesia.Methods:A cross-sectional design was used in this study.Participants were selected from five primary health centers in Malang City,East Java,Indonesia using the multistage sampling method.A total of 127 adults with type 2 diabetes mellitus were recruited.Data were collected by questionnaires which were the general diabetes knowledge,the Beliefs of Treatment Effectiveness,the Diabetes Distress Scale,the Self-efficacy for Diabetes Scale,the brief Chronic Illness Resources Survey,the Situational Questionnaire and the Summary of Diabetes Self-care Activities.A self-administered questionnaire was used to collect the data.Multiple linear regression with stepwise method was used toanalyze the data.Results:The scores of seven questionnaires(i.e,diabetes knowledge,perceived benefit of diabetes self-management,diabetes distress,perceived self-efficacy,social support,situational influence,and diabetes self-management)were 13.75±3.59,34.9±4.89,3.03±0.86,3.60±0.53,27.79±5.56,3.27±0.58,3.81±1.08,respectively.The significant predictors of diabetes self-management were treatment,perceived self-efficacy,and situational influences.These variables explained 20.8%(adjusted R^(2)=0.208)of the variance in diabetes self-management among adults with type 2 diabetes mellitus in Malang City.Conclusion:Diabetes self-management among adults with type 2 diabetes mellitus could be improved by enhancing their perceived self-efficacy to achieve their self-management behavior,such as having a healthy diet,exercising regularly,actively monitoring blood glucose level,taking medication and foot care,and providing support to promote good situational influence.

Roles of adipocyte derived hormone adiponectin and resistin in insulin resistance of type 2 diabetes

AIM： To detect plasma levels of new adipocyte derived hormone adiponectin and resistin in type 2 diabetes patients and to explore their potential roles in insulin resistance in type 2 diabetes. METHODS： According to the body mass index （BMI）, 60 type 2 diabetes patients were divided into two groups, one group was non-obese diabetes patients with BMI 〈 25Kg/M^2 （30 cases） and the other group was obese diabetes patients with BMI 〉25Kg/M^2 （30 cases）. There were 28 healthy persons in the control group. EUSA technique was employed to determine the plasma adiponectin and resistin concentrations. The fasting blood glucose, insulin and blood lipid were detected respectively by electrocheminescence immunoassay and immunoturbidimetric assay. Insulin resistance index and insulin sensitive index were calculated by the homeostasis model assessment （HOMO）. RESULTS： The levels of plasma adiponectin were decreased significantly in diabetes group compared to that in control group （non-obese： 8.58±0.86, obese： 6.22±1.34 vs 10.53±1.47 P〈0.05）; moreover, adiponectin concentration in obese diabetes group was significantly decreased compared to that in non-obese diabetes group （6.22±1.34 vs 8.58±0.86, P〈 0.05）. The levels of plasma resistin were increased significantly in diabetes group compared to that in control group （obese： 18.64 ± 4.65, non-obese： 24.05±9.07 vs 14.16±5.25, P〈0.05,P〈0.05）; furthermore, the levels of resistin in obese diabetes group were increased significantly compared to that in non-obese diabetes group （P〈 0.05）. Plasma adiponectin was correlated negatively with BMI, blood glucose, insulin resistance index and triglyceride （respectively, r=-0.55, P〈0.01; r=-0.51, P〈0.05; r=-0.52, P〈 0.05： r=-0.39, P〈 0.05）, while it was positively correlated with insulin sensitive index （r=0.45, P〈0.05）. Conversely, plasma resistin correlated positively with BMI, blood glucose, triglyceride and insulin resistance index （respectively, r=0.40, P〈 0.05; r= 0.52, P〈0.05; r= 0.46, P〈 0.01; r= 0.27, P〈 0.05）, and negatively correlated with insulin sensitive index （r=-0.32, P〈 0.05）. CONCLUSION： Plasma adiponectin and resistin are associatecl with the disorder of metabolism of glucose and lipid in diabetes. The relationship between these hormone and insulin sensitivity suggests that they may take part in the development of insulin resistance of type 2 diabetes.

Association of C(-106)T Polymorphism in Aldose Reductase Gene with Diabetic Retinopathy in Chinese Patients with Type 2 Diabetes Mellitus

Objective To identify the possible association between C（-106）T polymorphism of the aldose reductase （ALR） gene and diabetic retinopathy （DR） in a cohort of Chinese patients with type 2 diabetes mellitus （T2DM）. Methods From November 2009 to September 2010, patients with T2DM were recruited and assigned to DR group or diabetic without retinopathy （DWR） group according to the duration of diabetes and the grading of 7-field fundus color photographs of both eyes. Genotypes of the C（-106）T polymorphism （rs759853） in ALR gene were analyzed using the MassARRAY genotyping system and an association study was performed. Results A total of 268 T2DM patients （129 in the DR group and 139 in the DWR group） were included in this study. No statistically significant differences were observed between the 2 groups in the age of diabetes onset （P=0.10） and gender （P=0.78）. The success rate of genotyping for the study subjects was 99.6% （267/268）, with one case of failure in the DR group. The frequencies of the T allele in the C（-106）T polymorphism were 16.0% （41/256） in the DR group and 19.4% （54/278） in the DWR group （P=0.36）. There was no signit^cant difference in the C（-106）T genotypes between the 2 groups （P=0.40）. Compared with the wild-type genotype, odds ratio （OR） for the risk of DR was 0.7 （95% CI, 0.38-1.3） for the heterozygous CT genotype and 0.76 （95% CI, 0.18-3.25） for the homozygous TT genotype. The risk of DR was positively associated with microalbuminuria （OR=4.61; 95% CI, 2.34-9.05） and insulin therapy （OR=3.43; 95% CI, 1.94-6.09）. Conclusions Microalbuminuria and insulin therapy are associated with the risk of DR in Chinese patients with T2DM. C（-106）T polymorphism of the ALR gene may not be significantly associated with DR in Chinese patients with T2DM.

Relationship between hepatitis C virus infection and type 2 diabetes mellitus:Meta-analysis

AIM:To investigate the association between hepatitis C infection and type 2 diabetes mellitus.METHODS:Observational studies assessing the relationship between hepatitis C infection and type 2 diabetes mellitus were identified via electronic and hand searches.Studies published between 1988 to March 2011 were screened,according to the inclusion criteria set for the present analysis.Authors performed separate analyses for the comparisons between hepatitis C virus(HCV) infected and not infected,and HCV infected and hepatitis B virus infected.The included studies were further subgrouped according to the study design.Heterogenity was assessed using I2 statistics.The summary odds ratios with their corresponding 95% CIs were calculated based on a random-effects model.The included studies were subgrouped according to the study design.To assess any factor that could potentially affect the outcome,results were further stratified by age group(proportion of ≥ 40 years),gender(proportion of male gender),body mass index(BMI)(pro-portion of BMI ≥ 27),and family history of diabetes(i.e.,self reported).For stability of results,a sensitivity analysis was conducted including only prospective studies.RESULTS:Combining the electronic database and hand searches,a total of 35 observational studies(in 31 articles) were identified for the final analysis.Based on random-effects model,17 studies(n = 286 084) compared hepatitis C-infected patients with those who were uninfected [summary odds ratio(OR):1.68,95% CI:1.15-2.45].Of these 17 studies,7 were both a cross-sectional design(41.2%) and cohort design(41.2%),while 3 were case-control studies(17.6%).Nineteen studies(n = 51 156) compared hepatitis C-infected participants with hepatitis B-infected(summary OR:1.92,95% CI:1.41-2.62).Of these 19 studies,4(21.1%),6(31.6%) and 9(47.4%) were cross-sectional,cohort and case-control studies,respectively.A sensitivity analysis with 3 prospective studies indicated that hepatitis C-infected patients had a higher risk of developing type 2 diabetes compared with uninfected controls(summary odds ratio:1.41,95% CI:1.17-1.7;I2 = 0%).Among hepatitis C-infected patients,male patients(OR:1.26,95% CI:1.03-1.54) with age over 40 years(summary OR:7.39,95% CI:3.82-9.38) had an increased frequency of type 2 diabetes.Some caution must be taken in the interpretation of these results because there may be unmeasured confounding factors which may introduce bias.CONCLUSION:The findings support the association between hepatitis C infection and type 2 diabetes mellitus.The direction of association remains to be determined,however.Prospective studies with adequate sample sizes are recommended.

Interventions for self-management of type 2 diabetes:An integrative review

Background:Type 2 diabetes mellitus has been identified as one of the most challenging chronic illnesses to manage.Since the management of diabetes is mainly accomplished by patients and families,selfmanagement has become the mainstay of diabetes care.However,a significant proportion of patients fail to engage in adequate self-management.A priority research question is how do interventions affect the self-management behaviors of persons with Type 2 diabetes?Purpose/Objectives:The purpose of this integrative review is to provide a summary and critique of interventions that support diabetes self-management in the patient with TypeⅡdiabetes mellitus.Design:An integrative review design,with a comprehensive methodological approach of reviews,allowing inclusion of experimental and non-experimental studies.Procedures:A comprehensive search was conducted via Ebscohost using databases of Academic Search Complete,CINAHL,Health Source:Nursing/Academic Edition,MEDLINE,PsycArtiCLES,and PsycInfo.The final number of papers used for this review were:motivational interviewing(6),peer support/coaching(10),problem solving therapy(3),technology-based interventions(30),lifestyle modification programs(7),patient education(11),mindfulness(3),and cognitive behavioral therapy(5).Results:Studies were examined from seventeen countries including a broad range of cultures and ethnicities.While interventions have shown mixed results in all interventional categories,many studies do support small to modest improvements in physiologic,behavioral,and psychological outcome measures.Considerable heterogeneity of interventions exists.The most commonly reported physiologic measure was HbA1c level.Outcome measures were collected mostly at 6 and 12 months.Duration of most research was limited to one year.Conclusions:Research exploring the impact of interventions for self-management has made major contributions to the care of persons with type 2 diabetes,from offering suggestions for improving care,to stimulating new questions for research.However,implications for clinical practice remain inconclusive,and limitations in existing research suggest caution in interpreting results of studies.

Effects of Fuscoporia obliqua on Postprandial Glucose Excursion and Endothelial Dysfunction in Type 2 Diabetic Patients

Postprandial hyperglycemia has been reported to elicit endothelial dysfunction and provoke future cardiovascular complications. A reduction of postprandial blood glucose levels by the glucosidase inhibitor Fuscoporia obliqua was associated with a risk reduction of cardiovascular complications, but the effects of Fuscoporia obliqua on endothelial function have never been elucidated. This study is aimed to assess the efficacy of Fuscoporia obliqua on postprandial metabolic parameters and endothelial function in type 2 diabetic patients. Postprandial peak glucose (14.47±1.27 vs. 8.50±0.53 mmol/liter), plasma glucose excursion (PPGE), and change in the area under the curve (AUC) glucose after a single loading of test meal (total 450 kcal; protein 15.3%; fat 32.3%; carbohydrate 51.4%) were significantly higher in the diet-treated type 2 diabetic patients (n=14) than the age-and sex-matched controls (n=12). The peak forearm blood flow response and total reactive hyperemic flow (flow debt repayment) during reactive hyperemia, indices of resistance artery endothelial function on strain-gauge plethysmography, were unchanged before and after meal loading in the controls. But those of the diabetics were significantly decreased 120 and 240 min after the test meal. A prior administration of Fuscoporia obliqua decreased postprandial peak glucose, PPGE, and AUC glucose. The peak forearm blood flow and flow debt repayment were inversely well correlated with peak glucose, PPGE, and AUC glucose, but not with AUC insulin or the other lipid parameters. Even a single loading of the test meal was shown to impair the endothelial function in type 2 diabetic patients, and the postprandial endothelial dysfunction was improved by a prior use of Fuscoporia obliqua. Fuscoporia obliqua might reduce macrovascular complication by avoiding endothelial injury in postprandial hyperglycemic status.

Hepatitis C virus and type 2 diabetes

This review focuses on the relationship between hepatitis C virus(HCV) infection and glucose metabolism derangements.Cross-sectional and longitudinal studies have shown that the chronic HCV infection is associated with an increased risk of developing insulin resistance(IR) and type 2 diabetes(T2D).The direct effect of HCV on the insulin signaling has been analyzed in experimental models.Although currently available data should be considered as preliminary,HCV seems to affect glucose metabolism via mechanisms that involve cellular pathways that have been implicated in the host innate immune response.IR and T2D not only accelerate the histological and clinical progression of chronic hepatitis C,but also reduce the early and sustained virological response to interferon-alpha-based therapy.Thus,a detailed knowledge of the mechanisms underlying the HCV-associated glucose metabolism derangements is warranted,in order to improve the clinical management of chronic hepatitis C patients.