Outpatient insulin use in type 2 diabetes mellitus and acute respiratory distress syndrome outcomes:A retrospective cohort study

BACKGROUND The impact of type 2 diabetes mellitus(T2DM)on acute respiratory distress syndrome(ARDS)is debatable.T2DM was suspected to reduce the risk and complications of ARDS.However,during coronavirus disease 2019(COVID-19),T2DM predisposed patients to ARDS,especially those who were on insulin at home.AIMTo evaluate the impact of outpatient insulin use in T2DM patients on non-COVID-19 ARDS outcomes.METHODS We conducted a retrospective cohort analysis using the Nationwide Inpatient Sample database.Adult patients diagnosed with ARDS were stratified into insulin-dependent diabetes mellitus(DM)(IDDM)and non-insulindependent DM(NIDDM)groups.After applying exclusion criteria and matching over 20 variables,we compared cohorts for mortality,duration of mechanical ventilation,incidence of acute kidney injury(AKI),length of stay(LOS),hospitalization costs,and other clinical outcomes.RESULTS Following 1:1 propensity score matching,the analysis included 274 patients in each group.Notably,no statistically significant differences emerged between the IDDM and NIDDM groups in terms of mortality rates(32.8%vs 31.0%,P=0.520),median hospital LOS(10 d,P=0.537),requirement for mechanical ventilation,incidence rates of sepsis,pneumonia or AKI,median total hospitalization costs,or patient disposition upon discharge.CONCLUSION Compared to alternative anti-diabetic medications,outpatient insulin treatment does not appear to exert an independent influence on in-hospital morbidity or mortality in diabetic patients with non-COVID-19 ARDS.

Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: Current perspectives

Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.

Study of Angiotensin Converting Enzyme Gene Polymorphism in Egyptian Type 2 Diabetes Mellitus with Diabetic Kidney Disease

Objective: Diabetic kidney disease DKD (Diabetic nephropathy DN) is considered one of the chronic micro vascular complications of diabetes mellitus and considered the commonest cause leading to chronic renal failure and chronic renal dialysis. Genetic susceptibility has been implicated in DKD. The angiotensin converting enzyme (ACE) is one of the key roles in the renin angiotensin system cascade by converting angiotensin I to angiotensin II which plays a key role in regulation of blood pressure as well as electrolytes and fluid balance. This study addressed the association of (ACE) gene polymorphisms with DN in Egyptian (T2DM) patients. Methods: Our research comprised of 75 cases of T2DM with diabetic kidney disease, 100 cases of T2DM without DKD and 94 healthy volunteers. Different genotypes of ACE gene were determined by SSP-PCR analysis. Results: Gene polymorphism of ACE (DD, ID, II) in diabetic patient with DKD is 44%, 52%, 4% respectively and for T2DM individuals without DKD is 23%, 72%, 5% respectively. (DD) had significant higher frequencies in T2DM patients with DKD compared to those without DKD (p < 0.005) and (ID) had significant higher frequencies in T2DM without DKD (p < 0.0001). These results indicated that there is an association between ACE gene polymorphisms and susceptibility of diabetic patients to be affected by diabetic kidney disease. Conclusion: From our results, we can conclude that genotype of ACE in Egypt DD is the genotype of cases diabetic kidney disease. So the presence of D allele has a significant relation with diabetic kidney disease. Our data confirm the role of ACE in its relationship with diabetic kidney disease in Egyptian type 2 diabetic patients.

Enhancement maximum slope of increase of magnetic resonance angiography in patients with diabetes lower extremity arterial disease and its correlation with endothelial injury and oxidative stress

Objective:To study the enhancement maximum slope of increase of magnetic resonance angiography in patients with diabetes lower extremity arterial disease and its correlation with endothelial injury and oxidative stress.Methods: Patients with diabetes lower extremity arterial disease accepting 3D-CEMRA examination in our hospital between May 2013 and December 2015 were selected as the pathology group, and the enhancement maximum slope of increase was measured;healthy volunteers receiving physical examination in our hospital during the same period were selected as control group, and serum levels of endothelial oxidative stress injury-related molecules of two groups of subjects were determined.Results:The enhancement maximum slope of increase of the lesion-side anterior tibial artery, posterior tibial artery, peroneal artery and dorsalis pedis artery of pathology group were significantly lower than those of the unaffected-side;serum CyPA, ERK1, ERK2, Akt, JAK, HO-1 and CO content of pathology group were significantly higher than those of control group and negatively correlated with the enhancement maximum slope of increase of lower extremity while Prdx6, SOD, CAT, GSH-Px, eNOS and NO content were significantly lower than those of control group and positively correlated with the enhancement maximum slope of increase of lower extremity.Conclusion: The enhancement maximum slope of increase of magnetic resonance angiography significantly reduces in patients with diabetes lower extremity arterial disease and is closely related to oxidative stress-induced endothelial injury as well as eNOS/NO and HO-1/CO system function change.

Diabetic patients with chronic kidney disease: Non-invasive assessment of cardiovascular risk

The prevalence and burden of diabetes mellitus and chronic kidney disease on global health and socioeconomic development is already heavy and still rising.Diabetes mellitus by itself is linked to adverse cardiovascular events,and the presence of concomitant chronic kidney disease further amplifies cardiovascular risk.The culmination of traditional(male gender,smoking,advanced age,obesity,arterial hypertension and dyslipidemia)and non-traditional risk factors(anemia,inflammation,proteinuria,volume overload,mineral metabolism abnormalities,oxidative stress,etc.)contributes to advanced atherosclerosis and increased cardiovascular risk.To decrease the morbidity and mortality of these patients due to cardiovascular causes,timely and efficient cardiovascular risk assessment is of huge importance.Cardiovascular risk assessment can be based on laboratory parameters,imaging techniques,arterial stiffness parameters,ankle-brachial index and 24 h blood pressure measurements.Newer methods include epigenetic markers,soluble adhesion molecules,cytokines and markers of oxidative stress.In this review,the authors present several non-invasive methods of cardiovascular risk assessment in patients with diabetes mellitus and chronic kidney disease.

Treatment with NADPH oxidase inhibitor apocynin alleviates diabetic neuropathic pain in rats

Increased reactive oxygen species by the activation of NADPH oxidase（NOX） contributes to the development of diabetic complications.Apocynin,a NOX inhibitor,increases sciatic nerve conductance and blood flow in diabetic rats.We investigated potential protective effect of apocynin in rat diabetic neuropathy and its precise mechanism of action at molecular level.Rat models of streptozotocin-induced diabetes were treated with apocynin（30 and 100 mg/kg per day,intragastrically） for 4 weeks.Mechanical hyperalgesia and allodynia were determined weekly using analgesimeter and dynamic plantar aesthesiometer.Western blot analysis and histochemistry/immunohistochemistry were performed in the lumbar spinal cord and sciatic nerve respectively.Streptozotocin injection reduced pain threshold in analgesimeter,but not in aesthesiometer.Apocynin treatment increased pain threshold dose-dependently.Western blot analysis showed an increase in catalase and NOX-p47 phox protein expression in the spinal cord.However,protein expressions of neuronal and inducible nitric oxide synthase（n NOS,i NOS）,superoxide dismutase,glutathion peroxidase,nitrotyrosine,tumor necrosis factor-α,interleukin-6,interleukin-1β,aldose reductase,cyclooxygenase-2 or MAC-1（marker for increased microgliosis） in the spinal cord remained unchanged.Western blot analysis results also demonstrated that apocynin decreased NOX-p47 phox expression at both doses and catalase expression at 100 mg/kg per day.Histochemistry of diabetic sciatic nerve revealed marked degeneration.n NOS and i NOS immunoreactivities were increased,while S-100 immunoreactivity（Schwann cell marker） was decreased in sciatic nerve.Apocynin treatment reversed these changes dose-dependently.In conclusion,decreased pain threshold of diabetic rats was accompanied by increased NOX and catalase expression in the spinal cord and increased degeneration in the sciatic nerve characterized by increased NOS expression and Schwann cell loss.Apocynin treatment attenuates neuropathic pain by decelerating the increased oxidative stress-mediated pathogenesis in diabetic rats.

胰高糖素样肽1受体激动剂与钠-葡萄糖共转运蛋白2抑制剂治疗2型糖尿病伴肾损害结局比较的Meta分析

目的评价胰高糖素样肽1(glucagon-like peptide-1,GLP-1)受体激动剂与钠-葡萄糖共转运蛋白2(sodium-glucose cotransporter protein-2,SGLT-2)抑制剂治疗2型糖尿病伴肾损害的疗效。方法以“diabetes mellitus complicated with kidney injury”“GLP-1 receptor agonist”“SGLT-2 inhibitor”“Randomized control”“糖尿病合并肾损伤”“GLP-1受体激动剂”“SGLT-2抑制剂”“随机对照”等为关键词对中国知网、维普、万方、Web of Science、PubMed、Embase等数据库进行检索分析,检索时限从建库到2022年1月间公开发表的随机对照试验,采用RevMan 5.3软件进行Meta分析。结果共检索到2146篇GLP-1受体激动剂与SGLT-2抑制剂的疗效和临床结局的文章,经筛选最终8篇纳入本次研究。与对照相比,GLP-1受体激动剂、SGLT-2抑制剂在降低糖化血红蛋白方面更具有优势(MD=-0.36,95%CI:-0.52~-0.19,P<0.05);GLP-1受体激动剂与SGLT-2抑制剂能够更好地提升估算肾小球滤过率水平(MD=0.28,95%CI:0.08~0.48,P=0.005);GLP-1受体激动剂与SGLT-2抑制剂均能够更好地降低患者尿白蛋白/肌酐比值(MD=-1.37,95%CI:-1.55~-1.20,P<0.05);GLP-1受体激动剂与SGLT-2抑制剂在治疗不同肾损害程度时,不良反应的差异无统计学意义(P>0.05)。结论GLP-1受体激动剂与SGLT-2抑制剂在治疗糖尿病合并肾损害中均具有一定价值。

糖尿病酮症酸中毒或高渗性高血糖状态致横纹肌溶解临床分析

目的探讨糖尿病酮症酸中毒(DKA)或高渗性高血糖状态(HHS)导致横纹肌溶解(RM)的临床特点、治疗及预后。方法对该院2010年1月至2014年11月收治的30例RM患者的临床资料进行回顾性分析。结果 30例RM患者中(18例为DKA,12例为HHS)10例出现急性肾损伤(AKI组)。AKI组患者血清肌酸激酶、血肌红蛋白、急性生理和慢性健康评分Ⅱ较非AKI组明显增高,差异有统计学意义(P<0.05)。经过补液、胰岛素治疗、维持水电解质酸碱平衡、抗感染、血液净化等综合治疗,26例患者存活,4例患者死于多器官功能衰竭。AKI组患者的住院时间[(24.3±3.4)d]与非AKI组[(12.5±1.5)d]比较,差异有统计学意义(P<0.05),而两组患者28 d病死率比较,差异无统计学意义(P>0.05)。结论DKA或HHS导致的RM在临床上少见,血清肌酸激酶和血生化检测可提高诊断率。加强对RM的认识,做到早诊断、早治疗,可有效提高治愈率,改善预后,避免严重并发症发生。

生化检验指标在糖尿病早期肾损伤诊断中的临床分析

目的讨论生化检验指标在糖尿病早期肾损伤诊断中的临床应用效果。方法将本院2018年3月-2019年3月收治的糖尿病者46例当作研究组,将同期来院进行常规体检者46例当作对照组,两组均接受生化指标检验,比对诊断结果。结果研究组UTP、ACR、hsCRP、CysC、HbAlc生化指标水平高于对照组,P <0.05。结论生化指标检验方法在糖尿病早期肾损伤诊断中效果确切,值得深入研究。

桑寄生醇提物改善2型糖尿病模型小鼠血糖水平及其肝肾并发症的作用及机制研究

目的:研究桑寄生醇提物改善2型糖尿病(T2DM)模型小鼠血糖水平及其肝肾并发症的作用及机制。方法:通过高糖高脂饲料喂养结合腹腔注射链脲佐菌素的方法建立小鼠T2DM模型。将T2DM模型小鼠60只随机分为模型对照组(生理盐水)、阳性对照组[二甲双胍,150 mg/(kg·d)]和桑寄生醇提物高、中、低剂量组[30、15、7.5 g/(kg·d),以生药量计],每组12只;另设正常小鼠12只为空白对照组(生理盐水)。连续给予小鼠相应药液或生理盐水28 d后,检测其血清中空腹血糖(FBG)、空腹胰岛素(FINS)、白细胞介素2(IL-2)、IL-4、IL-12、γ干扰素(IFN-γ)、血肌酐(Scr)、尿素氮(BUN)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)的水平,收集其24 h尿液并检测尿肌酐(Ucr)水平,并计算胰岛素敏感指数(ISI)和胰岛素抵抗指数(HOMA-IR);采用苏木精-伊红染色法,观察肝细胞病理学变化;检测肝组织中Bcl-2、Bax水平,以及肾组织中Toll样受体4(TLR4)、核因子κB亚基p65亲和肽(NF-κB p65)水平。结果:与空白对照组比较,模型对照组小鼠的血清FBG、FINS、IL-4、ALT、AST、BUN、Scr水平及HOMA-IR值均显著升高,Ucr、IL-2、IL-12、IFN-γ水平及ISI值均显著降低(P<0.01);肝组织细胞表现出明显病理变化;肝组织中Bcl-2水平及Bcl-2/Bax比值均显著降低,Bax水平显著升高(P<0.01);肾组织中TLR4、NF-κB p65水平均显著升高(P<0.01)。与模型对照组比较,桑寄生醇提物各剂量组的肝组织病理学变化明显减轻;除桑寄生醇提物低剂量组血清中IFN-γ水平和肾组织中NF-κB p65水平无显著差异外,上述其余各指标均显著改善(P<0.01或P<0.05)。结论:桑寄生醇提物具有改善T2DM模型小鼠高血糖水平及肝肾并发症、保护肝肾功能的作用;其机制可能与提高免疫功能、上调抗凋亡相关因子、下调促凋亡及促炎相关因子的表达,从而维持肝细胞功能状态、减轻肾细胞受损程度有关。

糖尿病下肢动脉病变患者磁共振血管造影的强化最大上升斜率评估及其与内皮损伤、氧化应激的相关性

目的:研究糖尿病下肢动脉病变患者磁共振血管造影的强化最大上升斜率评估及其与与内皮损伤、氧化应激的相关性。方法:选择2013年5月~2105年12月期间在广东省东莞市道滘医院接受3DCEMRA检查的糖尿病下肢动脉病变患者作为病理组,测定强化最大上升斜率;选择同期在广东省东莞市道滘医院体检的健康志愿者作为对照组,测定两组受试者血清中内皮氧化应激损伤相关分子的含量。结果:病理组患者病变侧胫前动脉、胫后动脉、腓动脉、足背动脉的强化最大上升斜率均显著低于健康侧;病理组患者血清中CyPA、ERK1、ERK2、Akt、JAK、HO-1、CO的含量显著高于对照组且与下肢动脉强化最大上升斜率呈负相关,Prdx6、SOD、CAT、GSH-Px、eNOS、NO含量显著低于对照组且与下肢动脉强化最大上升斜率呈正相关。结论:糖尿病下肢动脉病变患者磁共振血管造影的强化最大上升斜率显著降低且与氧化应激所致内皮损伤、eNOS/NO及HO-1/CO系统功能改变密切相关。

胱抑素C与超敏C-反应蛋白在糖尿病肾病早期诊断中的应用

目的探讨2型糖尿病(T2DM)患者血清Cysc和hs-CRP的水平对诊断糖尿病早期肾损害的价值。方法T2DM患者根据其肾功能分为肾功能正常组和肾功能异常组,各30例,同时选择30例健康者为对照组。比较各组血清CysC以及hs-CRP水平。结果T2DM患者CysC以及hs-CRP水平均高于对照组(P<0.05),肾功能异常组患者的CysC以及hs-CRP水平也明显高于肾功能正常组(P<0.05);在T2DM患者中,血清CysC与hs-CRP呈正相关(r=0.39)。结论CysC和hs-CRP作为诊断糖尿病早期肾损害的敏感指标,联合检测更具价值。

Angiogenin gene polymorphism A risk factor for diabetic peripheral neuropathy in the northern Chinese Han population?

Angiogenin is associated with the pathogenesis of diabetic peripheral neuropathy. Here, we se- quenced the coding region of the angiogenin gene in genomic DNA from 207 patients with type 2 diabetes mellitus （129 diabetic peripheral neuropathy patients and 78 diabetic non-neuropathy pa- tients） and 268 healthy controls. All subjects were from the Han population of northern China. No mutations were found. We then compared the genotype and allele frequencies of the angiogenin synonymous single nucleotide polymorphism rs11701 between the diabetic peripheral neuropathy patients and controls, and between the diabetic neuropathy and non-neuropathy patients, using a case-control design. We detected no statistically significant genetic associations. Angiogenin may not be associated with genetic susceptibility to diabetic peripheral neuropathy in the Han population of northern China.

Rhabdomyolysis and Acute Pancreatitis in Diabetic Ketoacidosis: A Case Report and Review of Literature

Diabetic ketoacidosis (DKA) is a life-threatening complication in patients with Type 1 or Type II. Diabetes Mellitus resulting in fluid shifts, electrolytes imbalance and acid-base disorders, can lead to multi-organ Failure. The Pancreas and skeletal muscles are not commonly affected in DKA. We present a case of 41-year-old female who was initially admitted in intensive care unit for treatment of Diabetic ketoacidosis, and was treated appropriately later she complained of abdominal pain and generalized myalgia. Hospital course was complicated with Acute pancreatitis and Rhabdomyolysis. Serum electrolytes were significant for hypo-phosphatemia. Workup for myositis and acute pancreatitis were negative. The exact etiology is unknown, but it is proposed in many literature articles that serum hyper-osmolarity and/or electrolyte abnormalities can be the culprits in triggering the complications.

早产儿脑损伤早期相关高危因素分析

目的分析早产儿产前、产中及产后各因素对神经系统预后的影响。方法回顾性分析该院新生儿重症监护病房(NICU)2014年12月-2016年6月住院的患儿,其中选择符合诊断标准的早产儿脑损伤病例45例作为实验组,50例无脑损伤早产儿为对照组,收集并分析所有病例的相关危险因素。结果分别比较两组间产前及产时各因素的差异,其中母亲患有绒毛膜羊膜炎的患儿比较差异有统计学意义(χ~2=6.521,P<0.05),而母亲患妊娠期高血压疾病、妊娠期糖尿病的早产儿以及分娩方式(剖宫产)的比较,差异无统计学意义(χ~2=3.790、0.176、0.657,均P>0.05);分别比较两组间产后各因素的差异,其中患有败血症(χ~2=4.679)以及低血糖(t=-2.73)的患儿比较差异有统计学意义(均P<0.05),且两组间正压通气时间和5 min Apgar评分的比较差异有统计学意义(t=2.21、5.52,均P<0.05),而患儿入院体温的比较,差异无统计学意义(t=-1.67,P>0.05)。结论其母患绒毛膜羊膜炎,患儿患败血症、低血糖以及Apgar评分低,机械通气时间长都是早产儿脑损伤的早期危险因素。

达格列净抑制2型糖尿病小鼠心血管及肾脏并发症的研究

目的:探讨达格列净对2型糖尿病小鼠心、肾的保护作用。方法:选取24只6周龄的雄性2型糖尿病模型(C57BLKS/J-leprdb/leprdb,db/db)小鼠,随机等分成达格列净投药组和对照组,另选取同周龄雄性非糖尿病的(C57BLKS/J-leprdb/+,db/m)小鼠12只作为正常组。检测小鼠血糖后,从第7周开始对投药组小鼠进行为期10周的达格列净用药,其余小鼠给予同等计量生理盐水,期间定期监测血糖、血压、尿糖以及各项代谢相关指标。投药结束后分离心脏及肾脏组织,组织切片进行染色观察。结果:与对照组相比,投药组达格列净用药后第1周血糖值显著降低(P<0.01),用药9周后糖耐量测试结果显示血糖值几乎接近正常小鼠组水平,但各组间血压值无明显差异,心肌间质纤维化、炎性细胞浸润、氧化应激水平明显下降,同时肾小球硬化、炎性细胞浸润和氧化应激程度明显得到改善。结论:达格列净用药不仅能显著降低2型糖尿病模型小鼠血糖,还能有效抑制糖尿病引起的心血管及肾损害。

胱抑素C与糖化血红蛋白联合检测在糖尿病肾病早期诊断中的临床价值

目的探讨2型糖尿病（T2DM）患者血清胱抑素C（CysC）与糖化血红蛋白（HbAlC）水平对诊断糖尿病早期肾损害的价值。方法将80例T2DM患者根据其肾功能分为肾功能正常组和肾功能异常组，各40例，同时选择40例健康者为对照组。比较各组血清胱抑素C与糖化血红蛋白水平。结果T2DM患者CysC与HbAlc水平均高于对照组（P〈0．05），肾功能异常组患者的CysC与HbAlc水平也明显高于肾功能正常组（P〈0．05）；在T2DM患者中，CysC与HbAIc呈正相关（r=0．39）。结论CysC与HbAlc作为诊断糖尿病早期肾损害的敏感指标，联合检测更具临床价值。