上海孕妇糖尿病率逾世界水平

上海市1996年糖尿病筛选检查发现，妊娠糖尿病的发病率为2％。而不久前对本市11家医院2700多名产妇的调查显示，这一比例已超过5％。而世界平均比例只有3％左右。据上海市第一人民医院产科主任徐先明介绍，由于胎盘分泌的激素能抵消部分胰岛素，因此妇女很容易在怀孕期间出现糖尿病。该医院对产妇情况的跟踪表明，2003年该院1000例孕妇中，有100例妊娠糖尿病患者；而去年的1300例孕妇中，有150例患者，比例上升了1．54％。

基层医务人员引导糖尿病人自我管理,是治疗成功的关键

糖尿病（DM）已成为世界性的流行性疾病,经济发展的速度远远超过患者对健康知识水平的提高,与知晓率不成比列的增长,是导致糖尿病高发的原因之一。例如据相关资料统计,克拉玛依市民人均收入略低于上海市民,但克市糖尿病率明显高于上海市民。

对2型糖尿病患者实施心理护理的效果评价

目的评价对2型糖尿病患者实施心理护理的效果。方法选取2013年1月~2014年1月我院收治的84例2型糖尿病患者作为研究对象,全部入选患者按照随机数字表法分为干预组和对照组各42例。对照组患者行常规护理,包括定期监测血糖、饮食指导、服药指导、运动指导等。干预组在对照组的基础上着重实施心理护理干预,比较两组患者的血糖控制效果、糖尿病知识掌握情况。结果干预组患者血糖控制有效率为92.85%,显著高于对照组的76.19%,差异有统计学意义（P〈0.05）。干预组患者糖尿病知识掌握率达97.61%,显著高于对照组的73.81%,差异有统计学意义（P〈0.05）。结论对2型糖尿病患者实施心理护理可以有效控制血糖,提高患者对糖尿病知识的掌握程度,从而使患者积极配合治疗及护理。

血清尿酸与2型糖尿病肾病的相关性分析

目的分析2型糖尿病肾病的危险因素,并探讨血清尿酸与糖尿病肾病的相关性。方法选取2016年1月至2018年3月新疆医科大学第一附属医院收治的并明确诊断为糖尿病肾病患者463例,收集详细的人口学资料、BMI、血脂、血肌酐、糖化血红蛋白、肾小球滤过率,通过Pearson相关性分析、多元线性回归探讨糖尿病肾病的危险因素,并研究分析血清尿酸与肾小球滤过率的关系。结果463例糖尿病肾病患者中,男性占71.92%,平均年龄55.70岁,平均糖化血红蛋白8.58%,男性和女性间年龄、BMI、总胆固醇及低密度脂蛋白差异无统计学意义;依据尿酸不同水平分组,发现三组人群甘油三酯、高密度脂蛋白、血肌酐、尿素、糖化血红蛋白、eGFR等指标差异有统计学意义。Pearson相关性分析发现血尿酸与估算的肾小球滤过率呈负相关(r=-0.475,P<0.01),在多元线性回归中通过逐步回归法构建回归方程发现,血尿酸每增加一个标准差,eGFR下降0.036 ml/(min×1.73 m^(2))(P=0.009)。结论随着血尿酸水平的增高,eGFR值逐渐下降(r=-0.429,P<0.01),血尿酸是2型糖尿病肾病患者肾小球滤过率下降的独立危险因素。

临床合理用药指导对2型糖尿病患者用药依从性的作用分析

目的探讨对2型糖尿病患者给予临床合理用药指导干预后对其用药依从性等的影响。方法选取2018年1月—2020年12月收治的80例2型糖尿病患者进行干预研究。随机分为常规组(采用常规指导方法展开疾病干预)和研究组(采用临床合理用药指导方法展开疾病干预),各40例。比较两组患者用药总依从率、空腹血糖、餐后2 h血糖水平以及糖尿病知识总掌握率。结果研究组用药总依从率(95.00%)高于常规组(72.50%),差异有统计学意义(P<0.05)。干预前,两组空腹血糖、餐后2 h血糖水平差异无统计学意义(P>0.05);干预后,研究组空腹血糖(6.03±0.19)mmol/L、餐后2 h血糖水平(8.79±1.11)mmol/L均低于常规组(6.99±0.23)、(11.42±1.82)mmol/L,差异有统计学意义(P<0.05)。研究组糖尿病知识总掌握率(97.50%)高于常规组(75.00%),差异有统计学意义(P<0.05)。结论临床合理用药指导方式有效应用后,可显著提高患者用药依从性以及糖尿病知识掌握情况,有效降低血糖水平,促进2型糖尿病患者总体预后水平提升。

雷公藤多甙治疗糖尿病肾病疗效观察

目的：观察雷公藤多甙治疗2型糖尿病。肾病Ⅳ期临床疗效。方法：选取我科2006年5月-2010年5月住院2型糖尿病肾病Ⅳ期患者58例，随机分为对照组30例和治疗组28例。两组均常规饮食控制及应用降糖药物治疗，治疗组加用雷公藤多甙片20mg／次，3次／日，口服，连续应用6个月。所有病例治疗前后行24h尿微量白蛋白排泄率（UAER）、血浆白蛋白（Alb）、血肌肝（Scr）、尿素氮（BUN）、内生肌酐清除率Ccr等检查。结果：治疗组在治疗后24h尿微量白蛋白排泄率（UAER）、血浆白蛋白（Alb）、血肌肝（Set）、尿素氮（BUN）、内生肌酐清除率Ccr均较治疗前有明显改善。与治疗前及与对照组比较差异有显著性（P〈0．05），没有明显副作用。结论：雷公藤多甙治疗2型糖尿病肾病Ⅳ期是安全有效的方法，值得临床推广应用。

低热量饮食对短病程超重或肥胖T2DM患者糖脂相关指标的影响

目的 探讨低热量饮食(LCD)对短病程超重或肥胖2型糖尿病(T2DM)患者糖脂相关指标的影响。方法选取病程5年内超重或肥胖T2DM患者62例,随机分为LCD组、对照组各31例。两组均给予二甲双胍联合短期胰岛素泵强化治疗,并进行中等强度体育运动,由营养科医师和DM专科医生共同制定食谱,LCD组总热量1 000~1 200 kCal/d,对照组总热量1 400~1 800 kCal/d。干预前及干预第26周检测两组糖化血红蛋白(HbA1c)、空腹血糖(FPG)、空腹C肽、餐后2 h血糖(2 h PG)、TC、TG、LDL-C、HDL-C,计算BMI、胰岛素抵抗指数(HOMA-IR)、胰岛功能指数(HOMA-ISLET);用多频率生物电阻抗法测内脏脂肪面积;计算血糖缓解率、达标率及低血糖发生率。结果 干预后,两组血糖相关指标均较干预前改善(P均<0.05),且LCD组FPG、2 h PG、内脏脂肪面积、HOMA-ISLET均优于对照组(P均<0.05)。干预前后两组组间体质量及血脂比较差异无统计学意义(P均>0.05);干预后,LCD组体质量、TG、TC、LDL-C、HDL-C均较干预前改善(P均<0.05),对照组体质量、TG、TC、LDL-C均较干预前改善(P均<0.05)。LCD组血糖缓解率高于对照组(P<0.05),两组血糖达标率、低血糖发生率比较差异无统计学意义(P均>0.05)。结论 LCD可显著降低短病程超重或肥胖2型糖尿病患者血糖及内脏脂肪含量,改善胰岛功能,提高血糖缓解率。

养老院16例低血糖患者管理体会

随着糖尿病率的上升,尤其是老年人和长疗程使用药物的患者,在一生中几乎均可能发生低血糖[1]。低血糖一旦发生,如果诊治不及时,则预后严重,有时可危及生命。针对我院长期收治的老年糖尿病患者,通过对其中16例发生低血糖患者展开分析、探讨,并进行科学有效的整改措施,经过6个月的努力使我院老年糖尿病患者的低血糖发生率显著降低。现总结如下：1临床资料统计2013年我院糖尿病低血糖上报表16份,其中男性5例,女性11例,年龄65~90岁;糖尿病史3个月~25年。上半年低血糖发生14例,

EFFECTS OF VITAMIN D RECEPTOR GENE POLYMORPHISMS ON SUSCEPTIBILITY TO TYPE 1 DIABETES MELLITUS

Objective To investigate the influence of vitamin D receptor （VDR） gene polymorphisms on susceptibility to type 1 diabetes mellitus （T1DM） in the Chinese Han population. Method One hundred and thirty-six Chinese Han people, including 54 T1DM patients and 82 unrelated healthy subjects as control were genotyped by polymerase chain reaction-restriction fragment length polymorphism for three restriction sites in the VDR gene, which were ApaI, TaqI, and BamL Results The frequency of B allele of BsmI site in VDR gene was significantly higher in T1DM patients than in healthy subjects （ P = 0. 033 ） while no difference was found between the two groups in the distribution of ApaI and TaqI polymorphisms. Conclusion The BsmI polymorphism of VDR gene may be associated with the susceptibihty to T1DM in the Chinese Han population of Beijing.

2011 update on esophageal achalasia

There have been some breakthroughs in the diagnosis and treatment of esophageal achalasia in the past few years.First,the introduction of high-resolution manometry with pressure topography plotting as a new diagnostic tool has made it possible to classify achalasia into three subtypes.The most favorable outcome is predicted for patients receiving treatment for type Ⅱ achalasia (achalasia with compression).Patients with typeⅠ(classic achalasia) and type Ⅲ achalasia (spastic achalasia) experience a less favorable outcome.Second,the first multicenter randomized controlled trial published by the European Achalasia Trial group reported 2-year follow-up results indicating that laparoscopic Heller myotomy was not superior to endoscopic pneumatic dilation (PD).Although the follow-up period was not long enough to reach a convincing conclusion,it merits the continued use of PD as a generally available technique in gastroenterology.Third,the novelendoscopic technique peroral endoscopic myotomy is a promising option for treating achalasia,but it requires increased experience and cautious evaluation.Despite all this good news,the bottom line is a real break-through from the basic studies to identify the actual cause of achalasia that may impede treatment success is still anticipated.

Diabetes but not insulin is associated with higher colon cancer mortality

AIM： To evaluate whether diabetic patients had a higher risk of colon cancer mortality and its associated risk factors. METHODS： The sex-specific crude and age-standard- ized （to the 2000 World Health Organization popula- tion） mortality rates of colon cancer in the Taiwan Residents general population were first calculated from 1995 to 2006. The trends were evaluated by linear regression. A total of 113 347 diabetic men and 131 573 diabetic women aged ~〉 25 years at recruitment from 1995 to 1998 were followed up until the end of 2006. Age/sex- specific colon cancer mortality rate ratios were cal- culated comparing the mortality rates of the diabetic patients with the average mortality rates of the general population within 12 years （1995-2006）. A sub-cohort of diabetic patients （42 260 men and 49 405 women） was interviewed using a baseline questionnaire and Cox＇s regression was used to evaluate the risk factors for colon cancer mortality in these diabetic patients.RESULTS： The crude and age-standardized trends of colon cancer mortality from 1995 to 2006 increased significantly for both sexes in the general population. A total of 641 diabetic men and 573 diabetic women died of colon cancer, with a mortality rate of 74.4 and 54.3 per 100 000 person-years, respectively. Mortality rate ratios [95% confidence intervals （CIs）] showed a significantly higher risk of mortality from colon can- cer for the diabetic patients compared to the general population, with the magnitude increasing with de- creasing age： 1.65 （1.40-1.95）, 2.01 （1.78-2.27）, 2.75 （2.36-3.21） and 5.69 （4.65-6.96） for /〉 75, 65-74, 55-64 and 25-54 years old, respectively, for men; and 1.46 （1.24-1.72）, 2.09 （1.84-2.38）, 2.67 （2.27-3.14） and 3.05 （2.29-4.06）, respectively, for women. Among the sub-cohort of diabetic patients who had been in- terviewed with the baseline questionnaire, including information on age, sex, diabetes duration, diabe- tes type, body mass index, smoking, insulin use and area of residence, age and smoking were significantly predictive for colon cancer mortality, with respec- tive adjusted hazard ratios （HRs） （95% CIs） of 1.077 （1.066-1.088） and 1.384 （1.068-1.792）. Diabetes dura- tion became a significant factor when those who died of colon cancer within 5 years of diabetes diagnosis were excluded to minimize the possible contamination of diabetes caused by incipient colon cancer, with an adjusted hazard ratio of 1.021 （1.007-1.034）. Sex, dia- betes type, insulin use, body mass index and area of residence were not significant predictors for colon can- cer mortality in the diabetic patients. Although insulin use was categorized into subgroups of duration of use （non-users and users 〈 5 years, 5-9 years and i〉 10 years）, none of the HRs for colon cancer mortality was significant with regards to different durations of insulin use. CONCLUSION： Colon cancer mortality is increasing in Taiwan. A higher risk is observed in diabetic patients. Smoking, but not insulin use, is a modifiable risk factor.

EFFECT OF CAPTOPRIL ON RENAL HEMODYNAMICS AND RENAL PROSTAGLANDINS IN EARLY TYPE Ⅱ DIABETIC PATIENTS WITH NORMO-OR MICROALBUMINURIA

In this study,we investigated the effect of captopril(CPT) on glomerular filtration rate(GFR),effective renal plasma flow(ERPF),filtration fraction(FF),urinary albumin excretion(UAE) and daily urinary excretion of thromboxane B2(TXB2) and 6-keto-prostaglandin F1a(6-keto-PGFla) in 29 normotensive non-insulin-dependent diabetes(NIDDM) patients without clinically discernible nephropathy.Before treatment,urinary excretion 6-keto-PGF1a was significantly increased(P<0.05) in 29 NIDDM patients compared with 25 health subjects matched for age and sex.The values of GFR and FF were significantly higher(P<0.01 and P<0.005,respectively) in NIDDM than in normal volunters,whereas ERPF was comparable in both groups.Meanwhile we observed that UAE of early NIDDM was increased before treatment.After CPT treatment,GFR,FF,UAE and urinary excretion of 6-keto-PGFla were significantly reduce(all P<0.005) compared with those of NIDDM before treatment. These data indicated that CPT is effective in lowering glomerular filtration pressure and ameliorating microalbuminuria in the normotensive early NIDDM.

A meta-analysis of Wendan decoction in the treatment of diabetic gastroparesis

Objective To evaluate the clinical efficacy and safety of Wendan decoction in the treatment of diabetic gastroparesis (DGP). Methods PubMed, MEDLINE, The Cochrane Library, Embase, China Biology Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP) and Wanfang databases were searched and eligible randomized controlled clinical trials (RCTs) were included. The quality of the RCTs was evaluated by the Cochrane risk of bias assessment tool, and data analysis were performed with Review Manager 5.3. Results A total of 7 studies were included, including 533 patients. Meta analysis results showed that the effective rate of Wendan decoction in the treatment of diabetic gastroparesis was better than that of the control group [RR=1.30, 95%CI (1.20, 1.40), P<0.001], and the improvement of fasting blood glucose (FBG) was better than that of western medicine [MD =-0.43, 95%CI (-0.91,-0.01), P=0.05]. The recurrence rate in the TCM treatment group was lower than that in the western medicine group[RR = 0.29, 95%CI (0.13, 0.62), P=0.002]. Conclusion Compared with western medicine, Wendan decoction has better curative effect on DGP and can reduce its recurrence rate. However, due to the low quality of the included literatures and the possibility of bias, large-scale and high-quality RCTs are still needed for further confirmation.

针对性健康教育对糖尿病合并痛风患者的效果

目的 观察糖尿病合并痛风患者实施针对性健康教育的临床效果以及价值,探究糖尿病合并痛风患者有效的健康教育方法。方法 选取2022年1月—2023年1月天津医科大学朱宪彝纪念医院收治的糖尿病合并痛风患者88例为研究对象,随机分为对照组和观察组各44组。对照组患者开展常规护理,观察组患者在对照组的基础上开展针对性健康教育。观察两组糖尿病疾病知识掌握率、痛风疾病知识掌握率、治疗依从率、干预前后糖尿病患者生存质量特异性量表(DSQL)评分及护理满意率。结果 观察组糖尿病疾病知识掌握率、痛风疾病知识掌握率、治疗依从率均高于对照组,差异均有统计学意义(P<0.05)。干预后,两组DSQL各项评分均明显改善,而观察组DSQL各项评分均明显优于对照组,差异均有统计学意义(P<0.05)。观察组护理满意率为95.45%,高于对照组的79.55%,差异有统计学意义(χ^(2)=5.090 9,P<0.05)。结论 糖尿病合并痛风患者实施针对性健康教育的临床效果较好,可有效提升糖尿病疾病知识掌握率、痛风疾病知识掌握率、治疗依从率,改善患者生活质量,患者满意率高,值得临床推广应用。

应用心理治疗技术对糖尿病患者进行情绪管理

我国糖尿病率呈逐年上升的趋势，目前面临着全新的问题：我国现有9200万糖尿病患者，成为世界上糖尿病患者最多的国家。据世界卫生组织（WHO）公布的最新统计资料显示；目前发展中国家糖尿病患者总数已占全球糖尿患者总数的71%。而糖尿病的患病率、病死率以及对健康的总体危害程度很高。

月经初潮年龄与代谢综合征及其组分的关联

月经初潮年龄较早与儿童肥胖、成年期肥胖、心血管疾病及2型糖尿病率和病死率密切相关。代谢综合征（metabolic syndrome,MS）及其组分能够识别2型糖尿病和心血管疾病高危人群。

Clinical Effects of Acupuncture for Diabetic Peripheral Neuropathy

Objective:To observe the clinical effects of acupuncture for diabetic peripheral neuropathy.Methods:Totally 65 patients were randomly divided into a treatment group of 32 cases and a control group of 33 cases. On the basis of conventional treatment of diabetes,acupuncture was used in the treatment group,and inositol was orally administered in the control group.During a 3-month treatment,changes in the symptoms were observed.Results:In the treatment group,16 cases were markedly relieved,12 cases improved,and 4 cases failed,with a total effective rate of 87.5%.In the control group,7 cases were markedly relieved,14 cases improved and 12 cases failed,with a total effective rate of 63.6%.There was a significant difference in the total effective rate between the 2 groups(P<0.05) .Conclusion:Acupuncture may show good effects for diabetic peripheral neuropathy.