Effects of Chinese Patent Drug Zishen Pills in Treatment of Elderly Patients with Impaired Glucose Tolerance(IGT)

[Objectives]To evaluate the efficacy of Zishen Pills(ZSP),a Chinese patent drug,in the treatment of elderly patients with impaired glucose tolerance(IGT)and its effects on the prevention of diabetes mellitus(DM).[Methods]Thirty-five IGT patients were randomized to receive 10 g of ZSP three times daily(ZSP group,n=24)or no drug intervention(control group,n=11)for 12 weeks.Oral glucose tolerance test,glycated hemoglobin A1c(HbA1c),body mass index,blood lipids levels,fasting insulin,and insulin resistance calculated using homeostatic model assessment(HOMA-IR)of all the patients were observed and compared before and after the treatment.[Results]Thirty participants completed the trial(20 in ZSP group and 10 in the control group).There were statistically significant decreases in plasma triglycerides(TG),fasting blood-glucose(FBG),2-h plasma glucose(2-h PG),HbA1c,and HOMA-IR in ZSP group compared with the control group after 12 weeks of treatment(P<0.05 or P<0.01).After 12 weeks of treatment,2(20.0%)patients returned to normal blood glucose,and 2(20.0%)patients turned into DM in control group,while in the ZSP group,9(45.0%)patients returned to normal blood glucose and 1(5.0%)patient turned into DM.[Conclusions]ZSP effectively improved glucose control,increased the conversion of IGT to normal glucose,and improved the insulin resistance in elderly patients with IGT.This Chinese patent drug may have a clinical value for IGT.

Microbiome and metabolome dysbiosis analysis in impaired glucose tolerance for the prediction of progression to diabetes mellitus

Gut microbiota and circulating metabolite dysbiosis predate important pathological changes in glucose metabolic disorders;however,comprehensive studies on impaired glucose tolerance(IGT),a diabetes mellitus(DM)precursor,are lacking.Here,we perform metagenomic sequencing and metabolomics on 47 pairs of individuals with IGT and newly diagnosed DM and 46 controls with normal glucose tolerance(NGT);patients with IGT are followed up after 4 years for progression to DM.Analysis of baseline data reveals significant differences in gut microbiota and serum metabolites among the IGT,DM,and NGT groups.In addition,13 types of gut microbiota and 17 types of circulating metabolites showed significant differences at baseline before IGT progressed to DM,including higher levels of Eggerthella unclassified,Coprobacillus unclassified,Clostridium ramosum,L-valine,L-norleucine,and L-isoleucine,and lower levels of Eubacterium eligens,Bacteroides faecis,Lachnospiraceae bacterium 3_1_46FAA,Alistipes senegalensis,Megaspaera elsdenii,Clostridium perfringens,α-linolenic acid,10E,12Z-octadecadienoic acid,and dodecanoic acid.A random forest model based on differential intestinal microbiota and circulating metabolites can predict the progression from IGT to DM(AUC=0.87).These results suggest that microbiome and metabolome dysbiosis occur in individuals with IGT and have important predictive values and potential for intervention in preventing IGT from progressing to DM.

Oral glucose tolerance test in diabetes,the old method revisited

The oral glucose tolerance test(OGTT)has been widely used both in clinics and in basic research for a long time.It is applied to diagnose impaired glucose tolerance and/or type 2 diabetes mellitus in individuals.Additionally,it has been employed in research to investigate glucose utilization and insulin sensitivity in animals.The main aim of each was quite different,and the details are also somewhat varied.However,the time or duration of the OGTT was the same,using the 2-h post-glucose load glycemia in both,following the suggestions of the American Diabetes Association.Recently,the use of 30-min or 1-h post-glucose load glycemia in clinical practice has been recommended by several studies.In this review article,we describe this new view and suggest perspectives for the OGTT.Additionally,quantification of the glucose curve in basic research is also discussed.Unlike in clinical practice,the incremental area under the curve is not suitable for use in the studies involving animals receiving repeated treatments or chronic treatment.We discuss the potential mechanisms in detail.Moreover,variations between bench and bedside in the application of the OGTT are introduced.Finally,the newly identified method for the OGTT must achieve a recommendation from the American Diabetes Association or another official unit soon.In conclusion,we summarize the recent reports regarding the OGTT and add some of our own perspectives,including machine learning and others.

Scleredema Diabeticorum in a Patient with the Normal Range of the Hemoglobin A1c Level and Impaired Glucose Tolerance

Scleredema diabeticorum is an uncommon skin disorder showing a diffuse, symmetrical, and non-pitting persistent in-duration developing initially on the nape. It usually occurs in patients with poorly controlled or insulin-resistant diabetes mellitus. We present a 57-year-old woman with scleredema diabeticorum with hemoglobin A1c 6.1% (normal, 4.7% - 6.2%) and impaired glucose tolerance. Alcian blue staining at pH 7.0 illustrated deposits of acid mucopolysaccharides between the collagen bundles in the reticular dermis, but the staining at pH 1.5 did not show the deposits. This case indicates that scleredema diabeticorum may be an early indicator of undiagnosed diabetes mellitus in some cases, and that impaired glucose tolerance test should be performed for individuals with scleredema even though the hemoglobin A1c level is within the normal range.

Prevalences of Diabetes and Hypertension and Their Relationship in Community Population of Jiangsu Province

To determine the prevalences of non-insulin-dependent-diabetes mellitus (NIDDM),impaired glucose tolerance (IGT) and hypertension on urban and rural communities of Jiangsu province,8734 subjects sampled from six areas of Jiangsu were investigated. Blood glucose of 2 h after oral administration of 75 g glucose (2 h BG) was measured. WHO criteria were used for the diagnosis of NIDDMand IGT. Meanwhile epidemiological data were collected. Blood pressure, height, weight, waist and hip girths were measured. The crude prevalence was found to be 5. 82% (men 4.62%,woman 6. 69%) for NIDDM, 5. 87% (men 5. 30%, women 6. 29% ) for IGT and 14. 72% (men 16. 50%, women 13. 43 % ) for hypertension in the population obove 20 years of age. Age-adjusted prevalence was 4. 63% for NIDDM, 5. 07 % for IGT and 11. 19% for hypertension. Age increase (>40 years), obesity (BMI≥27) and central fat distribution (WHR≥0.88) were the risk factors for both diabetes and hypertension. The subjects≥40 years of age and obesity were the high risk population of NIDDM, IGT and hypertension. They were the target population for theprevention and treatment of diabetes and hypertension in the community level. High prevalences of NIDDM,IGT and hypertension were observed in the community population in Jiangsu province. To reinforce the prevention and treatment of these disorders in the province is imperative.

老年人群糖尿病和IGT患病率及其影响因素

目的:了解重庆市老年人群糖尿病(DM)和糖耐量低减(IGT)的患病情况及其主要患病风险因素,为城市社区人群制定适宜的预防和干预措施提供科学依据。方法:采用整群分层抽样方法,对60岁以上1 791例自然人群进行了横断面调查。结果:DM患病率14.45%,IGT患病率21.70%,随着年龄增加,DM和IGT患病率亦逐渐升高。超重者(BMI≥25)DM和IGT患病率为17.51%和28.02%,肥胖者(BMI≥30)DM和IGT患病率为21.43%和37.14%,按腰臀比(WHR)划分,向心性肥胖者DM和IGT患病率为17.45%和25.09%。影响DM患病风险的因素主要有:DM家族史、BMI、WHR、高收缩压、高甘油三酯。结论:在社区人群中,倡导健康合理的膳食习惯、控制血压、体重是降低糖尿病发生的重要措施,老年人是DM防治工作的主要对象。

深圳市DM、IGT患病率与性别、年龄和文化程度的关系

目的 探讨深圳市糖尿病 (DM)、糖耐量减低 (IGT)患病率与性别、年龄及文化程度的关系。方法 对 2 0岁以上的 82 0 0例行糖尿病流行病学调查。结果 1DM患病率为 4.2 3% ,其中男性 3.5 6 % ,女性 4.6 5 % ;IGT为 11.94% ,其中男性 10 .19% ,女性 13.0 1%。 2 DM在 5 9岁以前和 IGT在 49岁以前 ,其患病率随年龄增加呈倍数增长。 3低文化程度 (初中以下 )者 DM、IGT患病率明显高于高文化程度 (高中以上 )者。 4绝经后 DM、IGT患病率明显高于绝经前。 5有生育巨大儿史的女性 DM、IGT患病率较无生育巨大儿史的女性高。结论 深圳市女性 DM、IGT患病率高于男性 ,且随年龄增大而增高。DM治疗的重点在 5 0岁以后 ;而 IGT的干预重点在 49岁以前。应重视女性和低文化程度人群的糖尿病教育。更年期前后的内分泌改变可能促进了 DM、IGT的发生。有生育巨大儿的女性是 DM。

二甲双胍对IGT的干预治疗疗效观察

近年来糖尿病（ＤＭ）和糖耐量减低（ＩＧＴ）患病率有逐年增高的趋势，研究发现几乎所有的ＤＭ患者在发生ＤＭ之前，均经过ＩＧＴ阶段。本文通过对３２例ＩＧＴ者随机分为二甲双胍治疗组及非药物干预治疗组比较分析，结果提示，二甲双胍治疗组比非药物干预治疗组ＤＭ发生率明显减少，而ＩＧＴ向糖耐量正常（ＮＧＴ）人转化者则明显增多，这可能是二甲双胍具有不刺激胰岛β细胞分泌胰岛素，且能预防和减轻胰岛素抵抗，减轻高胰岛素血症之特点，进而能针对ＩＧＴ的基本缺陷——胰岛素抵抗和胰岛素分泌异常进行干预治疗，结果可纠正ＩＧＴ患者的糖代谢紊乱，防止ＩＧＴ向ＤＭ转化，同时又能使ＩＧＴ向糖耐量正常（ＮＧＴ）人转化。因此，用二甲双胍对ＩＧＴ的干预治疗对提高ＩＧＴ人群的生活质量，减少ＤＭ的发病率具有重要的意义。

餐后有氧联合抗阻运动对糖耐量减低(IGT)人群干预效果研究

目的:观察规律性餐后有氧联合抗阻运动干预对糖耐量减低(impaired glucose tolerance,IGT)人群的血糖、血脂与胰岛素敏感性的影响。方法:选取60例糖耐量减低(IGT)受试者,年龄42~58岁,随机分为餐后运动干预组与餐前运动干预组,分别在晚餐后与晚餐前1 h进行12周有氧联合抗阻运动干预(50 min/次,3次/周),比较2组空腹血糖、餐后血糖、糖化血红蛋白、血脂和胰岛素敏感性相关指标。结果:组内比较餐后干预组与餐前干预组受试者的空腹血糖、餐后血糖、糖化血红蛋白与运动前相比均降低;餐后运动干预组与餐前组相比,餐后2 h血糖明显降低(P<0.05);餐后运动干预组与餐前组相比,胰岛素敏感性相关指标及血脂指标胆固醇、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇均明显改善,差异有显著性。结论:12周餐后有氧联合抗阻运动干预,有效改善糖耐量减低人群的血糖、血脂与胰岛素敏感性,餐后血糖降低效果显著;运动方式与运动时间点的选择在IGT人群运动干预中同样重要。本研究可为进一步提高IGT人群运动干预的效率提供科学依据。

营养干预对IGT人群糖脂代谢及胰岛素抵抗的临床研究

目的:通过营养干预的手段观察其对糖耐量减低(IGT)人群糖脂代谢及胰岛素水平的影响。方法:通过流调,以服糖耐量试验(OGTT)筛查IGT患者,随机分为对照组和干预组,干预组通过营养师进行善食调查,营养教育,饮食评价指导总计1.5年,对照组不进行任何指导教育。两组于试验前后检查空腹血糖(FPG),餐后2小时血糖(2hpG),胰岛素(Ins)水平及胰岛素抵抗指数(HOMA-IR)等。结果:饮食干预组体质指数(BMI),FPG、Ins及HomA-IR等较对照组明显下降(P<0.01)仅2人转为糖尿病(DM),对照组试验前后各项指标无显著变化,有6人转为DM,两组经t检验,DM的患病率有统计学意义(P<0.05)。结论:营养干预对改善IGT患者的糖脂代谢,胰岛素抵抗有重要作用。

糖耐量低减患者(IGT)视网膜病变分析

作者等应用检眼镜,眼底彩色照相和荧光血管造影检查482例 IGT 和220例正常糖耐量试验健康人的眼底,主要发现视网膜微血管病变和 RPE 病变。IGT 的视网膜微血管瘤和黄斑旁毛细血管扩张有一定的临床意义,高血压可能是促进 IGT 形成视网膜微血管瘤的危险因素。

疗养军事飞行人员糖代谢现状调查分析

目的 调查疗养军事飞行人员的血糖代谢现状,分析其糖代谢异常的发病特点,为飞行人员的糖尿病(diabetes mellitus,DM)航卫保障提供科学依据。方法 随机抽取2021-01/2023-09月于某中心疗养的军事飞行人员共2591例,行口服葡萄糖耐量试验,测定其空腹血糖(fasting plasma glucose,FPG)、餐后2 h血葡萄糖(2 h postprandial blood glucose,2 hPG)和糖化血红蛋白(glycosylated hemoglobin,HbA_(1)c),统计DM、糖尿病前期(pre-diabetes mellitus,PDM)的患病率,比较不同年龄段(年龄<30岁、30岁≤年龄<40岁、40岁≤年龄<50岁、年龄≥50岁)、不同飞行时间(飞行时间<1000 h、1000 h≤飞行时间<3000 h、3000≤飞行时间<5000 h、飞行时间≥5000 h)、不同勤务类别(空勤、战勤)、不同机种(歼击机、轰炸机、直升机、运输机、其他)飞行人员血糖代谢情况。结果 2591例军事飞行人员中,诊断为PDM 286例(11.04%),诊断为DM 49例(1.89%),血糖正常2256例(87.07%)。在286例PDM患者中,空腹血糖受损(impaired fasting glucose,IFG)、糖耐量减低(impaired glucose tolerance,IGT)、IFG合并IGT及单纯5.7%≤HbA_(1C)≤6.4%者的检出率分别为1.93%、2.82%、2.01%、4.28%。军事飞行人员DM或PDM患病率及FPG、2 hPG、HbA_(1C)水平随年龄增大而增加(P均<0.01),随飞行时间增长而增加(P均<0.01),不同勤务类别、不同机种DM或PDM患病率及FPG、2 hPG、HbA_(1C)水平差异均无统计学意义(P均>0.05)。结论 军事飞行人员血糖代谢问题突出,潜在DM患病风险高,飞行人员DM或PDM患病率及FPG、2hPG、HbA_(1C)水平随年龄及飞行时间增加而增加,而与勤务类别和机种关系不大,应加强飞行人员DM防控措施。

IFG患者的糖尿病和IGT的患病率

目的 :探讨空腹糖耐量异常 (IFG)患者的归属 ,其糖尿病和糖耐量异常的患病率。方法 :对 5 2例IFG病人进行口服葡萄糖耐量试验。结果 :①糖尿病组 :2 5例 ,占 48.1% ;②糖耐量减低组 (IGT) :2 2例 ,占 42 .3% ;③正常组 :5例 ,占 9.6 %。结果显示 :IFG患者仍有较高的糖尿病发病率。结论 :IFG患者应作口服葡萄糖耐量试验(OGTT)检查 ,不能单纯以空腹血糖诊断糖尿病。

平糖降脂方联合生活方式干预治疗糖耐量减低(IGT)的临床观察

目的观察平糖降脂方联合生活方式干预对糖耐量减低(IGT)的近期临床疗效。方法将85例IGT患者随机分为对照组42例与治疗组43例。对照组患者单纯应用饮食及运动方案治疗;治疗组患者在对照组治疗基础上加用中药平糖降脂方治疗。观察两组患者治疗后的临床疗效、血糖水平[空腹血糖(FPG)、餐后2h血糖(2hPG)]及血脂[总胆固醇(TC)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)]情况。结果对照组总有效率为30.9%,治疗组为87.8%,两组比较有显著性差异(P<0.01)。治疗组患者治疗后FPG、2hPG、TC、TG、LDL-C均有明显下降,与对照组比较,有显著性差异(P<0.01)。结论平糖降脂方联合生活方式干预治疗IGT患者具有良好疗效,值得推广。

IGT和糖尿病视网膜病变关系的研究进展

糖耐量低减(i mpaired glucose tolerance,IGT)是介于正常和糖尿病之间的中间状态,其所致的糖尿病视网膜病变越来越受到人们的关注。本文主要叙述了IGT患者糖尿病视网膜病变的发病率,从高血糖、胰岛素抵抗和高胰岛素血症、游离脂肪酸和脂肪细胞因子释放增多这几个方面阐述了IGT时糖尿病视网膜病变的发病机理,强调对IGT患者进行早期干预的重要性。

伴IGT的STEMI患者行PCI前后血清MIP-1α的变化及阿卡波糖的干预价值

目的探讨伴糖耐量降低（IGT）的ST段抬高型急性心肌梗死（STEMI）患者行经皮冠状动脉介入治疗（PCI）前后血清巨噬细胞炎症蛋白1α（MIP—1α）的变化及阿卡波糖对其干预价值。方法选择拟行PCI的STEMI患者160例，设为A组。依据是否合并IGT，再将分入A，组（伴IGT者）和A2组（不伴IGT者），随机将A，组等分人A1a组和A1b组；选取健康志愿者30例，设为B组。A组行标准PCI术，A1a组自PCI后另予阿卡波糖治疗，连续6个月。A组于PCI前（T0）、PCI后24h（T1）、PCI后6个月（T2）；B组于体检当日，采用双抗体夹心酶联免疫吸附试验（ELISA）测定血清MIP—1α水平。A1组、A2组均于T0时间点，A1组另于T2时间点，行超声心动图检查了解左心室结构和功能。结果A组中，伴IGT的STEMI患者构成比为71．25％。T0时间点，A组血清MIP-1α水平显著高于B组（t=7．37，P〈0．01），A1组高于A2组（t=4．63，P〈0．05）；T1时间点，A组血清MIP—1α水平均升高（t-3．65—4．77，P〈0．05），A1组高于A2组水平（t=5．21，P〈0．05）；T2时间点，A组血清MIP—1α均显著降低（t=6．13—7．62，P〈0．01），且A1a组血清MIP—1α低于A1b组（t=4．06，P〈0．05）。T2时点，A1a组、A1组的LVD、LVMI减小，LVEF增大（t=3．67—6．21，P〈0．05或P〈0．01），A1b组的LVMI减小，LVEF增大（tLVMI=3．53，tLVEF=3．85，P〈0．05）；且A1a组LVD、LVMI数值低于A1b组，LVEF数值高于A1b组（t=3．40～4．12，P〈0．05）。结论伴IGT的STEMI患者血清MIP-1α水平显著高于健康人群，行PCI术后呈一过性升高，其后逐渐降低。对伴IGT的STEMI患者予以阿卡波糖干预治疗，能进一步降低血清MIP-1α水平，缓解机体炎症反应程度，改善左心室结构和功能，这对于伴IGT的STEMI患者临床诊疗具有一定的借鉴意义和参考价值。

Liver Enzymes Concentrations Are Closely Related to Pre-diabetes:Findings of the Shanghai Diabetes Study Ⅱ (SHDS Ⅱ)

Objective To investigate the relationship of liver enzymes with hyperglycemia in a large population in Shanghai and identify the association between liver enzymes and insulin resistance. Methods A total of 3 756 participants were enrolled. Each participant underwent an oral glucose tolerance test and completed a questionnaire. Anthropometric indices were recorded and serum samples were collected for measurement. Results Liver enzymes concentrations were independently associated with i-IGT, iFG＋IGT, and diabetes. With the increase of ALT and GGT concentrations, ORs for i-IGT, IFG＋tGT, and diabetes increased gradually. By comparing patients in the highest quartile of GGT concentrations or ALT concentrations with those in the lowest quartile （Q1）, ORs for iqGT, IFG＋IGT, or diabetes was significant after adjustment. Both ALT and GGT concentrations were linearly correlated with HOMA-IR and independently associated with HOMA-IR [ALT OR （95% Cl）： 2.56 （1.51-4.34） P=0.00; GGT OR （95% CI）： 2.66 （1.53-4.65） P=0.00]. Conclusion Serum ALT and GGT concentrations were closely related to pre-diabetes and diabetes in the Shanghai population and positively associated with insulin resistance.

Type 2 diabetes after gestational diabetes: The influence of changing diagnostic criteria

A previous diagnosis of gestational diabetes(GDM)carries a lifetime risk of progression to type 2 diabetes of up to 60%.Identification of those women at higher risk of progression to diabetes allows the timely introduction of measures to delay or prevent diabetes onset.However,there is a large degree of variability in the literature with regard to the proportion of women with a history of GDM who go on to develop diabetes.Heterogeneity between cohorts with regard to diagnostic criteria used,duration of follow-up,and the characteristics of the study population limit the ability to make meaningful comparisons across studies.As the new International Association for Diabetes in Pregnancy Study Group criteria are increasingly adopted worldwide,the prevalence of GDM is set to increase by two-to three-fold.Here,we review the literature to examine the evolution of diagnostic criteria for GDM,the implications of changing criteria on the proportion of women with previous GDM progressing to diabetes,and how the use of different diagnostic criteria may influence the development of appropriate follow-up strategies.

Treatment of prediabetes

Progression of normal glucose tolerance(NGT) to overt diabetes is mediated by a transition state called impaired glucose tolerance(IGT). Beta cell dysfunction and insulin resistance are the main defects in type 2 diabetes mellitus(type 2 DM) and even normoglycemic IGT patients manifest these defects. Beta cell dysfunction and insulin resistance also contribute to the progression of IGT to type 2 DM. Improving insulin sensitivity and/or preserving functions of beta-cells can be a rational way to normalize the GT and to control transition of IGT to type 2 DM. Loosing weight, for example, improves whole body insulin sensitivity and preserves beta-cell function and its inhibitory effect on progression of IGT to type 2 DM had been proven. But interventions aiming weight loss usually not applicable in real life. Pharmacotherapy is another option to gain better insulin sensitivity and to maintain beta-cell function. In this review, two potential treatment options(lifestyle modification and pharmacologic agents) that limits the IGT-type 2 DM conversion in prediabetic subjects are discussed.

Prediabetes diagnosis and treatment: A review

Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. While, the diagnostic criteria of prediabetes are not uniform across various international professional organizations, it remains a state of high risk for developing diabetes with yearly conversion rate of 5%-10%. Observational evidence suggests as association between prediabetes and complications of diabetes such early nephropathy, small fiber neuropathy, early retinopathy and risk of macrovascular disease. Several studies have shown efficacy of lifestyle interventions with regards to diabetes prevention with a relative risk reduction of 40%-70% in adults with prediabetes. While there is increasing evidence to prove the efficacy of pharmacotherapy in prevention of diabetes in adults with prediabetes, pharmaceutical treatment options other than metformin are associated with adverse effects that limit their use for prediabetes. There are no reports of systematic evaluation of health outcomes related to prediabetes in children. The effects of pharmacotherapy of prediabetes on growth and pubertal development in children remains unknown. Secondary intervention with pharmacotherapy with metformin is advocated for high-risk individuals but criteria for such consideration benefit of early intervention, long term cost effectiveness of such interventions and the end point of therapy remain unclear. Pharmacotherapy must be used with caution in children with prediabetes. Prediabetes is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It is considered to be an at risk state, with high chances of developing diabetes. While, prediabetes is commonly an asymptomatic condition, there is always presence of prediabetes before the onset of diabetes. The elevation of blood sugar is a continuum and hence prediabetes can not be considered an entirely benign condition. This aim of this review is to describe the challenges associated with diagnosis of prediabetes, the possible adverse medical outcomes associated with prediabetes and the treatment options and rationale for their use in context of prediabetes.