Recently, a debate has been raised regarding the place and the role of sulfonylureas (SU) amongst the armamentarium of drugs available for treatment of hyperglycemia in subjects with type 2 diabetes mellitus. With the...Recently, a debate has been raised regarding the place and the role of sulfonylureas (SU) amongst the armamentarium of drugs available for treatment of hyperglycemia in subjects with type 2 diabetes mellitus. With the advent of new drugs, SUs are being relegated and denigrated by some authorities contrary to present recommendations by various organizations e.g. American Diabetes Association, European Association for the Study of Diabetes and International Diabetes Federation. In this article, the advantages of SUs over the new agents in terms of their well established and proven better efficacy as well as their short term and long term (over 50 years) safety based on extensive literature data are documented. Moreover, lower costs of SUs render them to be far more cost effective when compared to new agents and therefore make them affordable in many regions of the world. Additionally, SUs are probably the initial drugs of choice in lean subjects with prediabetes and type 2 diabetes because they are the most effective secretogogues and major pathophysiologic mechanism of altered glucose metabolism in lean subjects is the decline in insulin secretion and not rising insulin resistance. Furthermore, SUs are also the most cost effective 2nd line agents in obese subjects with type 2 diabetes on lapse of glycemic control while receiving metformin. Finally, with progression of the disorder, the most cost effective combination of 2 oral agents in conjunction with basal insulin remains to be metformin and SUs. Many studies have documented a significantly greater extra pancreatic effect of glimepiride in comparison to other SUs probably because of its unique property in enhancing insulin sensitivity in conjunction with its ability to stimulate both 1st and 2nd phase insulin secretion. These characteristics may contribute to its greater efficacy with lesser hypoglycemia when compared with other SUs. Lack of hypoglycemic effect of metabolites of glimepiride may also be responsible for lesser hypoglycaemia. Moreover, metabolism of glimepiride performed partially by the liver and partially by the kidneys may render it suitable and adaptable to be administered safely in subjects with hepatic or renal dysfunctional as well as elderly. Finally, the documentation of its pleiotropic effects in lowering of cardiovascular surrogate markers, improving thrombotic milleau by reducing platelet aggregation factors along with improvement in glycemic control and its preferential binding to SU receptors on the pancreatic beta cells rather than myocardium may be responsible for providing better cardiovascular outcomes in comparison to other SUS and thus make it a better choice amongst SUs in subjects with or without presence of cardiovascular disease. Additionally, once daily administration because of lasting efficacy for 24 hours based on its half life is likely to enhance compliance on the part of patients and assist in attaining and maintaining desirable glycemic control. Therefore, SUs still deserve to be major players in management of hyperglycemia in subjects with type 2 diabetes mellitus and glimepiride may be the best choice amongst SUs because of its long term record regarding efficacy and safety in diverge population of subjects with type 2 diabetes mellitus.展开更多
【目的】探讨老年糖尿病合并膝关节骨性关节炎行单髁置换术(UKA)后胫骨后倾角(posterior tibial slope,PTS)变化对患者关节活动功能的影响。【方法】回顾性分析2020年6月至2022年6月在本院接受UKA的96例老年糖尿病合并膝关节骨性关节炎...【目的】探讨老年糖尿病合并膝关节骨性关节炎行单髁置换术(UKA)后胫骨后倾角(posterior tibial slope,PTS)变化对患者关节活动功能的影响。【方法】回顾性分析2020年6月至2022年6月在本院接受UKA的96例老年糖尿病合并膝关节骨性关节炎患者的临床资料,计算手术前后PTS的变化值(△PTS),根据△PTS分为PTS减小组(△PTS<-2.5°,n=36)和PTS微减组(-2.5°≤△PTS<0°,n=42)及PTS增大组(△PTS≥0°,n=18)。所有患者术后均至少随访12个月,比较各组患者术后膝关节活动度(range of motion,ROM)、膝关节主动活动时所能达到的最大屈曲角度(max flexion degree,MFD)、膝关节协会临床评分(Knee Society Clinical Score,KSS-C)、膝关节协会功能评分(Knee Society Functional Score,KSS-F),并记录术后并发症的发生情况;采用Pearson相关性分析△PTS与术后ROM、MFD、KSS-C、KSS-F的相关性。【结果】PTS减小组患者术后ROM、MFD、KSS-C、KSS-F均高于PTS微减组及PTS增大组(P<0.05)。△PTS与ROM、MFD、KSS-C、KSS-F呈负相关(P<0.05)。各组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。【结论】对于老年糖尿病合并膝关节骨性关节炎患者,UKA术后PTS适当减小可显著改善患者膝关节功能,提高患者生活质量。展开更多
Technological innovation plays an important role in the dynamics of economic growth and in promoting the welfare of the general population. In support of this hypothesis, an empirical study was carried out to assess t...Technological innovation plays an important role in the dynamics of economic growth and in promoting the welfare of the general population. In support of this hypothesis, an empirical study was carried out to assess the spatial distribution of insulin and supplies （glucometers） for the control of diabetes in patients registered in the Public Healthcare System in Salvador, Bahia, from 1998 to 2012. In order to achieve this objective, we applied a combination of data collection strategies, including spatial analysis and discrete choice model estimation. The study proposed to answer the following question： What factors affect access to the supplies required to control diabetes in insulin-dependent patients？ To this end, we assessed the spatial distribution of diabetic patients in Salvador who had received glucometers. The hypothesis asserted that social, economic and geographical factors determine access to the supplies （glucometers） used to control diabetes. Exploratory Spatial Data Analysis （ESDA） was therefore performed using the Global Spatial Autocorrelation Index in order to analyze the spatial distribution of glucometers. We then performed econometric estimations and analyzed the results. The final results initially demonstrated that there were major inconsistencies in the distribution of glucometers; i.e. purely random factors largely determined the probability of obtaining this device. Individual characteristics were not decisive factors in the probability of obtaining a glucometer, which were insteadrelated to type of diabetes and recommended treatment.展开更多
[目的]分析糖尿病（DM）对原发性肝细胞癌（HCC）手术治疗的影响.[方法]对2003年1月至2009年10月本院收治的186例HCC手术治疗进行回顾性分析,DM合并HCC组52例（DM组）,HCC组134例（非DM组）.[结果]①DM组患者的年龄、入院时空腹血糖、...[目的]分析糖尿病（DM）对原发性肝细胞癌（HCC）手术治疗的影响.[方法]对2003年1月至2009年10月本院收治的186例HCC手术治疗进行回顾性分析,DM合并HCC组52例（DM组）,HCC组134例（非DM组）.[结果]①DM组患者的年龄、入院时空腹血糖、术前准备时间、术后拆线时间、平均住院时间均高于非DM组（P〈0.05）.但两组间肿瘤大小及肝功能水平无统计学差异.②与非DM组相比,DM组患者术后并发症发生率（18/52,34.6%vs14/134,10.4%）明显增高（P〈0.05）,更易出现胸腔积液、胆瘘、膈下感染、切口感染、术后死亡（P〈0.05）.③.DM组中,与无并发症出现的患者相比,有并发症者术前血糖（7.7±1.2 vs 6.8±0.7）及术后7 d的血糖水平（7.8±1.6 vs 6.9±0.9）均较高,年龄大（52±9.1 vs 47±7.9）,肝硬化发生率（12/18,66.7%vs17/34,50.0%）高（P〈0.05）.[结论]HCC合并糖尿病患者手术前后血糖控制极为重要,根据患者的具体情况充分个体化地及时合理调整胰岛素用量是防止术后并发症产生的关键.展开更多
文摘Recently, a debate has been raised regarding the place and the role of sulfonylureas (SU) amongst the armamentarium of drugs available for treatment of hyperglycemia in subjects with type 2 diabetes mellitus. With the advent of new drugs, SUs are being relegated and denigrated by some authorities contrary to present recommendations by various organizations e.g. American Diabetes Association, European Association for the Study of Diabetes and International Diabetes Federation. In this article, the advantages of SUs over the new agents in terms of their well established and proven better efficacy as well as their short term and long term (over 50 years) safety based on extensive literature data are documented. Moreover, lower costs of SUs render them to be far more cost effective when compared to new agents and therefore make them affordable in many regions of the world. Additionally, SUs are probably the initial drugs of choice in lean subjects with prediabetes and type 2 diabetes because they are the most effective secretogogues and major pathophysiologic mechanism of altered glucose metabolism in lean subjects is the decline in insulin secretion and not rising insulin resistance. Furthermore, SUs are also the most cost effective 2nd line agents in obese subjects with type 2 diabetes on lapse of glycemic control while receiving metformin. Finally, with progression of the disorder, the most cost effective combination of 2 oral agents in conjunction with basal insulin remains to be metformin and SUs. Many studies have documented a significantly greater extra pancreatic effect of glimepiride in comparison to other SUs probably because of its unique property in enhancing insulin sensitivity in conjunction with its ability to stimulate both 1st and 2nd phase insulin secretion. These characteristics may contribute to its greater efficacy with lesser hypoglycemia when compared with other SUs. Lack of hypoglycemic effect of metabolites of glimepiride may also be responsible for lesser hypoglycaemia. Moreover, metabolism of glimepiride performed partially by the liver and partially by the kidneys may render it suitable and adaptable to be administered safely in subjects with hepatic or renal dysfunctional as well as elderly. Finally, the documentation of its pleiotropic effects in lowering of cardiovascular surrogate markers, improving thrombotic milleau by reducing platelet aggregation factors along with improvement in glycemic control and its preferential binding to SU receptors on the pancreatic beta cells rather than myocardium may be responsible for providing better cardiovascular outcomes in comparison to other SUS and thus make it a better choice amongst SUs in subjects with or without presence of cardiovascular disease. Additionally, once daily administration because of lasting efficacy for 24 hours based on its half life is likely to enhance compliance on the part of patients and assist in attaining and maintaining desirable glycemic control. Therefore, SUs still deserve to be major players in management of hyperglycemia in subjects with type 2 diabetes mellitus and glimepiride may be the best choice amongst SUs because of its long term record regarding efficacy and safety in diverge population of subjects with type 2 diabetes mellitus.
文摘【目的】探讨老年糖尿病合并膝关节骨性关节炎行单髁置换术(UKA)后胫骨后倾角(posterior tibial slope,PTS)变化对患者关节活动功能的影响。【方法】回顾性分析2020年6月至2022年6月在本院接受UKA的96例老年糖尿病合并膝关节骨性关节炎患者的临床资料,计算手术前后PTS的变化值(△PTS),根据△PTS分为PTS减小组(△PTS<-2.5°,n=36)和PTS微减组(-2.5°≤△PTS<0°,n=42)及PTS增大组(△PTS≥0°,n=18)。所有患者术后均至少随访12个月,比较各组患者术后膝关节活动度(range of motion,ROM)、膝关节主动活动时所能达到的最大屈曲角度(max flexion degree,MFD)、膝关节协会临床评分(Knee Society Clinical Score,KSS-C)、膝关节协会功能评分(Knee Society Functional Score,KSS-F),并记录术后并发症的发生情况;采用Pearson相关性分析△PTS与术后ROM、MFD、KSS-C、KSS-F的相关性。【结果】PTS减小组患者术后ROM、MFD、KSS-C、KSS-F均高于PTS微减组及PTS增大组(P<0.05)。△PTS与ROM、MFD、KSS-C、KSS-F呈负相关(P<0.05)。各组患者术后并发症发生率比较,差异无统计学意义(P>0.05)。【结论】对于老年糖尿病合并膝关节骨性关节炎患者,UKA术后PTS适当减小可显著改善患者膝关节功能,提高患者生活质量。
文摘Technological innovation plays an important role in the dynamics of economic growth and in promoting the welfare of the general population. In support of this hypothesis, an empirical study was carried out to assess the spatial distribution of insulin and supplies （glucometers） for the control of diabetes in patients registered in the Public Healthcare System in Salvador, Bahia, from 1998 to 2012. In order to achieve this objective, we applied a combination of data collection strategies, including spatial analysis and discrete choice model estimation. The study proposed to answer the following question： What factors affect access to the supplies required to control diabetes in insulin-dependent patients？ To this end, we assessed the spatial distribution of diabetic patients in Salvador who had received glucometers. The hypothesis asserted that social, economic and geographical factors determine access to the supplies （glucometers） used to control diabetes. Exploratory Spatial Data Analysis （ESDA） was therefore performed using the Global Spatial Autocorrelation Index in order to analyze the spatial distribution of glucometers. We then performed econometric estimations and analyzed the results. The final results initially demonstrated that there were major inconsistencies in the distribution of glucometers; i.e. purely random factors largely determined the probability of obtaining this device. Individual characteristics were not decisive factors in the probability of obtaining a glucometer, which were insteadrelated to type of diabetes and recommended treatment.
文摘[目的]分析糖尿病（DM）对原发性肝细胞癌（HCC）手术治疗的影响.[方法]对2003年1月至2009年10月本院收治的186例HCC手术治疗进行回顾性分析,DM合并HCC组52例（DM组）,HCC组134例（非DM组）.[结果]①DM组患者的年龄、入院时空腹血糖、术前准备时间、术后拆线时间、平均住院时间均高于非DM组（P〈0.05）.但两组间肿瘤大小及肝功能水平无统计学差异.②与非DM组相比,DM组患者术后并发症发生率（18/52,34.6%vs14/134,10.4%）明显增高（P〈0.05）,更易出现胸腔积液、胆瘘、膈下感染、切口感染、术后死亡（P〈0.05）.③.DM组中,与无并发症出现的患者相比,有并发症者术前血糖（7.7±1.2 vs 6.8±0.7）及术后7 d的血糖水平（7.8±1.6 vs 6.9±0.9）均较高,年龄大（52±9.1 vs 47±7.9）,肝硬化发生率（12/18,66.7%vs17/34,50.0%）高（P〈0.05）.[结论]HCC合并糖尿病患者手术前后血糖控制极为重要,根据患者的具体情况充分个体化地及时合理调整胰岛素用量是防止术后并发症产生的关键.
