Effects of insulin aspart and metformin on gestational diabetes mellitus and inflammatory markers

BACKGROUND Gestational diabetes mellitus(GDM)refers to hyperglycemia caused by insulin resistance or insufficient insulin secretion during pregnancy.Patients with GDM have a high risk of pregnancy complications,which can adversely affect both maternal and fetal health.Therefore,early diagnosis,treatment and monitoring of GDM are essential.In recent years,a new treatment scheme represented by insulin aspart combined with metformin has received increasing attention.AIM To explore the effects of insulin aspart combined with metformin on patients with GDM and inflammatory markers.METHODS From April 2020 to September 2022,124 patients with GDM in Sanya Women and Children’s Hospital Managed by Shanghai Children’s Medical Center were collected and analyzed retrospectively.The control group(CG)comprised 62 patients treated with insulin aspart alone,and 62 patients treated with insulin aspart and metformin formed the observation group(OG).Before and after treatment,improvement of blood-glucose-related indexes[fasting blood glucose(FBG),2-h postprandial glucose(2h PG)and hemoglobin A1c(HbA1c)],serum related factor[serum homocysteine(Hcy)],serum inflammatory cytokines[tumor necrosis factor(TNF)-α,interleukin(IL)-6 and C-reactive protein(CRP)]were compared between the two groups.The clinical efficacy,adverse pregnancy outcomes and incidence of pregnancy complications were compared between the two groups.RESULTS After treatment,the levels of FBG,2h PG,HbA1c,Hcy,TNF-α,IL-6 and CRP in both groups were significantly decreased(P<0.05),and the levels of FBG,2h PG,HbA1c,Hcy,TNF-α,IL-6 and CRP in the OG were lower than in the CG(P<0.05).The total clinical effectiveness in the OG was higher than that in the CG(P<0.05).The total incidence of adverse pregnancy outcomes and complications in the OG was significantly lower than in the CG(P<0.05).CONCLUSION Insulin aspart combined with metformin are effective for treatment of GDM,which can reduce blood-glucoserelated indexes,Hcy and serum inflammatory cytokines,and risk of adverse pregnancy outcomes and complications.

Association of Interleukin-6-174G/C Polymorphism with the Risk of Diabetic Nephropathy in Type 2 Diabetes:A Meta-analysis

Previous studies reported the association between interleukin-6(IL-6)-174G/C gene polymorphism and the risk of diabetic nephropathy in type 2 diabetes mellitus(T2DN).However,the results remain controversial.In the present study,we conducted a meta-analysis to further examine this relationship between IL-6-174G/C gene polymorphism and T2DN.Three databases(PubMed,SinoMed and ISI Web of Science)were used to search clinical case-control studies about IL-6-174G/C polymorphism and T2DN published until Apr.14,2018.Fixed-or random-effects n lodels were used to calculate the effect sizes of odds ratio(OR)and 95%confide nee intervals(95%CI).Moreover,subgroup analysis was performed in tenns of the excretion rate of albuminuria.All the statistical analyses were con ducted using Stata 12.0.A total of 11 case-control studies were included in this study,involving 1203 cases of T2DN and 1571 cases of T2DM without DN.Metaanalysis showed that there was an association between IL-6-174G/C polymorphism and increased risk of T2DN under the allelic and recessive genetic models(G vs.C:OR=1.10,95%CI 1.03-1」&P=0.006;GG vs.CC+GC:OR=1.11,95%CI 1.02-1.21,P=0.016).In the subgroup analysis by albuminuria,a significant association of IL-6-174G/C polymorphism with risk of T2DN was noted in the microalbuminuria group under the recessive model(OR=1.54,95%CI 1.02-2.32,P=0.038).In conclusion,this meta-analysis suggests that IL-6-174G/C gene polymorphism is associated with the risk of T2DN.

2型糖尿病并高脂血症患者血清IL-6、血浆纤维蛋白原水平分析

目的：测定糖尿病并高脂血症患者血清白细胞介素（IL－6）和血浆纤维蛋白原（Fg）水平。方法：应用酶标免疫分析法测定19例2型糖尿病并高脂血症患者和36例健康查作者血清IL－6水平，应用比浊法测定对例2型糖尿病并高脂血症患者和22例健康查作者血浆Fg水平。结果：糖尿病并高脂血症患者血清IL－6水平和血浆Fg水平均明显高于各自健康对照组（P＜0．01）。结论：2型糖尿病并高脂血症患者IL－6和Fg水平均明显升高。

亚临床炎症与2型糖尿病及其血管并发症关系的研究

为探讨亚临床炎症与 2型糖尿病及其血管并发症的关系 ,对 40例糖尿病并血管病变者、2 0例糖尿病无并发症者和 2 0例查体健康者血清白介素 6(IL 6)、肿瘤坏死因子 α(TNF α)、C反应蛋白 (CRP)、纤维蛋白原(FIB)进行测定。结果显示 ,糖尿病并血管病变者和糖尿病无并发症者血清CRP、IL 6、TNF α和FIB水平均明显高于健康人 (P <0 0 5 ) ,且合并血管病变者上述各项指标明显高于无并发症者 (P <0 0 5 )。CRP与IL 6、TNF α、FIB之间呈正相关 (P <0 0 5 ) ;CRP尚与体重指数 (BMI)、胰岛素 (INS)、餐后血糖 (PBG)、糖化血红蛋白 (HbA1c)、胆固醇 (CH)、甘油三酯 (TG)及高密度脂蛋白 (HDL)相关 (P <0 0 5 )。提示亚临床炎症参与糖尿病及其血管并发症的发生 ,与脂代谢紊乱、胰岛素抵抗及糖耐量异常关系密切 ,CRP、IL 6、TNF α。

辛伐他汀对2型糖尿病合并高脂血症患者血浆纤维蛋白原水平的影响

目的:测定2型糖尿病合并高脂血症患者血浆纤维蛋白原(Fg)水平,并观察辛伐他汀(Sim)对其影响.方法:应用比浊法测定21例2型糖尿病合并高脂血症患者(观察组)和22例健康查体者(NC组)血浆Fg水平.观察组中8例患者用Sim(5mg,qn,po)治疗,治疗4wk后观察Sim对Fg和血胆固醇(TC)及血甘油三酯(TG)的影响.结果:21例患者血浆Fg水平均显著高于NC组(P<0.01).8例患者经过Sim 4 wk治疗后,血浆Fg水平由(2.70±0.66)g/L下降至(2.44±0,51)g/L(P<0.05),TC由(6.37±0.87)mmol/L降至(5.60±0.71)mmol/L(P<0.05),TG下降无显著差异(P>0.05).结论:糖尿病合并高脂血症患者体内Fg水平明显升高,Sim能降低其血浆Fg水平.

丹蛭降糖胶囊对2型糖尿病合并高脂血症患者纤维蛋白原水平的影响

目的 进一步观察丹蛭降糖胶囊对2型糖尿病合并高脂血症患者纤维蛋白原水平的影响。方法 采用丹蛭降糖胶囊对32例2型糖尿病患者的纤维蛋白原水平学指标进行了治疗前后的观察测定。结果 丹蛭降糖胶囊不仅可显著改善2型糖尿病患者的血糖、血脂等,还可显著改善患者血浆纤维蛋白原水平。结论 提示丹蛭降糖胶囊可以改善机体的纤维蛋白原水平,防止并发症的发生和发展。

艾塞那肽联合胰岛素治疗对 2 型糖尿病患者炎性标志物的影响

背景在成年人中有1/12的患者死亡可归因于糖尿病。糖尿病患者血脂、炎性因子明显高于非糖尿病患者。且高血脂、高血糖、高炎性因子水平往往增加心血管疾病风险。目的探讨艾塞那肽联合胰岛素治疗血糖控制不佳的2型糖尿病患者对纤维蛋白原(FIB)、超敏C反应蛋白(hs-CRP)、白介素6(IL-6)及肿瘤坏死因子α(TNF-α)的影响。方法选取2016年6月-2018年6月在徐州医科大学附属医院内分泌科住院或门诊治疗的2型糖尿病患者193例为研究对象。将研究对象随机分为艾塞那肽组(n=98)和胰岛素组(n=95)。所有患者继续以往的饮食、运动及口服药物。艾塞那肽组加用艾塞那肽同时胰岛素剂量暂减30%,以后根据血糖水平调节胰岛素剂量。胰岛素组根据血糖水平单纯调节胰岛素剂量。治疗6个月后比较两组降糖效果及FIB、hs-CRP、IL-6、TNF-α的变化。同时采用多元逐步线性回归分析炎性标志物的影响因素。结果两组治疗后空腹血糖(FPG)、餐后2 h血糖(2 hPG)、胰岛素抵抗指数(HOMA-IR)、糖化血红蛋白(HbA1c)、三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、hs-CRP、IL-6及TNF-α均较治疗前降低,差异有统计学意义(P<0.05);治疗后艾塞那肽组HOMA-IR、hs-CRP、IL-6及TNF-α低于胰岛素组,差异有统计学意义(P<0.05)。艾塞那肽组治疗后体质量、体质指数(BMI)、腰围(WC)及胰岛素日用量较治疗前降低,差异有统计学意义(P<0.05);FIB治疗后与治疗前比较,差异无统计学意义(P>0.05)。胰岛素组治疗后体质量、BMI、WC及胰岛素日用量较治疗前增高,差异有统计学意义(P<0.05);FIB与治疗前比较,差异无统计学意义(P>0.05)。无论是在艾塞那肽组,还是在胰岛素组,△FIB与△WC、△体质量、△BMI、△HOMA-IR呈正相关(r=0.269~0.423,P<0.05),△hs-CRP与△WC及△HOMA-IR呈正相关(r=0.223~0.515,P<0.05),△IL-6和△TNF-α与△WC呈正相关(r=0.215~0.379,P<0.05)。多元逐步线性回归分析显示,在艾塞那肽组和胰岛素组,△BMI及△HOMA-IR是△FIB的影响因素,△WC是△hs-CRP、△IL-6及△TNF-α的影响因素(P<0.05)。结论艾塞那肽联合胰岛素治疗2型糖尿病降糖效果与胰岛素加量相当,但可减低患者体质量、BMI、WC,减少胰岛素用量,改善胰岛素抵抗,减轻亚临床炎性指标。

hs-CRP、IL-6和纤维蛋白原与AECOPD合并T2DM患者病情程度的相关性

目的研究超敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)和纤维蛋白原与慢性阻塞性肺疾病急性加重(AECOPD)合并2型糖尿病(T2DM)患者病情程度的相关性。方法本研究为病例对照研究。采用非随机抽样法收集2020年6月至2022年6月上海市奉贤区中心医院呼吸科收治的AECOPD患者161例,按照入院诊断是否合并T2DM分为单纯AECOPD组104例和合并T2DM组57例。收集患者的一般临床资料和入院时检验指标数据。采用酶联免疫吸附试验测定患者血清IL-6水平。采用Pearson法分析患者hs-CRP、IL-6和纤维蛋白原水平与患者动脉血氧分压(PaO_(2))、动脉血二氧化碳分压、空腹血糖、糖化血红蛋白、住院天数及住院费用的相关性。采用二元logistic回归分析影响合并T2DM组患者预后的危险因素。结果与单纯AECOPD组比较,合并T2DM组患者hs-CRP[117.50(68.54,147.95)mg/L比91.27(50.50,122.20)mg/L)]、IL-6[(132.43±45.00)ng/L比(90.40±42.03)ng/L)]和纤维蛋白原[(4.31±1.60)g/L比(3.76±1.40)g/L)]水平均升高(t值分别为2.50、5.80、2.23,均P<0.05)。单纯AECOPD组患者hs-CRP水平与PaO_(2)呈负相关(r=-0.22,P=0.023),纤维蛋白原水平与糖化血红蛋白呈正相关(r=0.20,P=0.047);合并T2DM组患者hs-CRP、IL-6和纤维蛋白原水平与PaO_(2)均呈负相关(均P<0.05),与住院天数和住院费用均呈正相关(均P<0.05)。年龄和hs-CRP为合并T2DM组患者预后不良的危险因素(OR值分别为1.11和1.01,均P<0.05)。结论hs-CRP、IL-6和纤维蛋白原水平可以反映AECOPD合并T2DM患者病情严重程度和预后情况,从而为制定针对性治疗方案提供参考。