Serum tumor markers expression(CA199,CA242,and CEA)and its clinical implications in type 2 diabetes mellitus

BACKGROUND Glucose and lipid metabolic disorder in patients with type 2 diabetes mellitus(T2DM)is associated with the levels of serum tumor markers of the digestive tract,such as cancer antigen(CA)199.Therefore,tumor markers in T2DM are important.AIM To evaluate the expression of serum tumor markers[CA199,CA242,and carcinoembryonic antigen(CEA)]and the clinical implications of the expression in T2DM.METHODS For this observational study conducted at Hefei BOE Hospital,China,we enrolled 82 patients with first-onset T2DM and 51 controls between April 2019 and December 2020.Levels of fasting blood glucose(FBG),tumor markers(CA199,CEA,and CA242),glycosylated hemoglobin(HbA1c),etc.were measured and group index levels were compared.Moreover,FBG and HbA1c levels were correlated with tumor marker levels.Tumor markers were tested for diagnostic accuracy in patients with>9%HbA1c using the receiver operating curve(ROC)curve.RESULTS The T2DM group had high serum FBG,HbA1c,CA199,and CEA levels(P<0.05).A comparative analysis of the two groups based on HbA1c levels(Group A:HbA1c≤9%;Group B:HbA1c>9%)revealed significant differences in CEA and CA199 levels(P<0.05).The areas under the ROC curve for CEA and CA199 were 0.853 and 0.809,respectively.CA199,CEA,and CA242 levels positively correlated with HbA1c(r=0.308,0.426,and 0.551,respectively)and FBG levels(r=0.236,0.231,and 0.298,respectively).CONCLUSION As compared to controls,serum CEA and CA199 levels were higher in patients with T2DM.HbA1c and FBG levels correlated with CA199,CEA,and CA242 levels.Patients with poorly controlled blood sugar must be screened for tumor markers.

Correlation between cerebral neurotransmitters levels by proton magnetic resonance spectroscopy and HbA1c in patients with type 2 diabetes

BACKGROUND Cognitive dysfunction is the main manifestation of central neuropathy.Although cognitive impairments tend to be overlooked in patients with diabetes mellitus(DM),there is a growing body of evidence linking DM to cognitive dysfunction.Hyperglycemia is closely related to neurological abnormalities,while often disregarded in clinical practice.Changes in cerebral neurotransmitter levels are associated with a variety of neurological abnormalities and may be closely related to blood glucose control in patients with type 2 DM(T2DM).AIM To evaluate the concentrations of cerebral neurotransmitters in T2DM patients exhibiting different hemoglobin A1c(HbA1c)levels.METHODS A total of 130 T2DM patients were enrolled at the Department of Endocrinology of Shanghai East Hospital.The participants were divided into four groups according to their HbA1c levels using the interquartile method,namely Q1(<7.875%),Q2(7.875%-9.050%),Q3(9.050%-11.200%)and Q4(≥11.200%).Clinical data were collected and measured,including age,height,weight,neck/waist/hip circumferences,blood pressure,comorbidities,duration of DM,and biochemical indicators.Meanwhile,neurotransmitters in the left hippocampus and left brainstem area were detected by proton magnetic resonance spectroscopy.RESULTS The HbA1c level was significantly associated with urinary microalbumin(mALB),triglyceride,low-density lipoprotein cholesterol(LDL-C),homeostasis model assessment of insulin resistance(HOMA-IR),and beta cell function(HOMA-β),N-acetylaspartate/creatine(NAA/Cr),and NAA/choline(NAA/Cho).Spearman correlation analysis showed that mALB,LDL-C,HOMA-IR and NAA/Cr in the left brainstem area were positively correlated with the level of HbA1c(P<0.05),whereas HOMA-βwas negatively correlated with the HbA1c level(P<0.05).Ordered multiple logistic regression analysis showed that NAA/Cho[Odds ratio(OR):1.608,95%confidence interval(95%CI):1.004-2.578,P<0.05],LDL-C(OR:1.627,95%CI:1.119-2.370,P<0.05),and HOMA-IR(OR:1.107,95%CI:1.031-1.188,P<0.01)were independent predictors of poor glycemic control.CONCLUSION The cerebral neurotransmitter concentrations in the left brainstem area in patients with T2DM are closely related to glycemic control,which may be the basis for the changes in cognitive function in diabetic patients.

The Ability of Baseline Triglycerides and Total Cholesterol Concentrations to Predict Incidence of Type 2 Diabetes Mellitus in Chinese Men and Women:A Longitudinal Study in Qingdao, China

Objectives The purpose of this study was to assess the association between triglycerides(TG),total cholesterol(TC)at baseline,and type 2 diabetes mellitus(T2DM)incidence in a general Chinese population.Further,it aimed to evaluate the ability of TG and TC to predict T2DM incidence.Methods Qingdao Diabetes Prevention Program participants recruited between 2006 and 2009 were followed up in 2012–2015.TG,TC,and T2DM status were measured.Cox proportional hazards models were used to estimate the association between TG,TC,and T2DM incidence.The receiver operating characteristic(ROC)curve was used to evaluate the ability of TG and TC to identify T2DM participants.Results The incidence of T2DM significantly increased with TG in women and TC in both men and women(Ptrend<0.05).Univariate Cox regression indicated that higher TG{borderline high TG[hazards ratio(HR):2.05;95%confidence interval(CI):1.40,3.00]and hypertriglyceridemia[HR:2.64;95%CI:1.68,4.15]}and TC[hypercholesterolemia(HR:2.05;95%CI:1.43,2.95)]were significantly associated with increased risk of T2DM incidence in women but not in men.Multivariate Cox regression showed that hypertriglyceridemia in women(HR:1.78,95%CI:1.07,2.97),borderline high TC in men(HR:1.61,95%CI:1.04,2.48),and hypercholesterolemia in women(HR:1.68,95%CI:1.81,2.61)had a higher significant risk of T2DM incidence.The optimal cutoff values of TG were>1.15 and>1.23 mmol/L in men and women,respectively.For TC,they were>5.17 and>5.77 mmol/L in men and women,respectively.The area under the ROCs of TG and TC were 0.54(0.51–0.57)and 0.55(0.52–0.58),respectively,in men,and 0.60(0.58–0.62)and 0.59(0.56–0.61),respectively,in women.Conclusion Elevated TG and TC were risk factors for T2DM incidence.However,no predictive capacity was found for both factors to identify T2DM incidence in Chinese men and women.Hence,TG and TC levels in both Chinese men and women might be used for decreasing the incidence of T2DM but no clinical predictive capacity for T2DM.

Association between admission hemoglobin level and prognosis in patients with type 2 diabetes mellitus

BACKGROUND Anaemia is common in patients with chronic kidney disease(CKD)and is a major risk factor that contributes to mortality in such patients.Type 2 diabetes mellitus(T2DM)is one of the leading causes of CKD.The association between admission hemoglobin levels and renal damage in patients with T2DM remains unclear.AIM To evaluate the relationship between admission hemoglobin levels and prognosis in patients with T2DM.METHODS We performed a retrospective analysis of 265 consecutive patients presenting with T2DM between 2011 and 2015.The composite endpoint was end-stage renal disease or a 50%reduction in the estimated glomerular filtration rate.RESULTS In multivariable-adjusted Cox proportional hazards models(adjusting for demographic factors,traditional risk factors,lipids),the adjusted hazard ratios(HRs)for the highest and middle tertiles compared to the lowest tertile of hemoglobin were 0.82(95%CI:0.11-6.26,P=0.8457)and 0.28(95%CI:0.09-0.85,P=0.0246),respectively.However,after further adjustment for glycaemia control,hemoglobin was positively related to the risk of the composite endpoint(HR:1.05,95%CI:0.14-8.09,P=0.9602)when the highest tertile was compared to the lowest tertile of hemoglobin.We found a U-shaped relationship between hemoglobin levels and the composite endpoint.The curve tended to reach the lowest level at an optimal hemoglobin level.CONCLUSION Among patients with T2DM,a U-shaped relationship was observed between hemoglobin levels and renal damage.A lower admission hemoglobin level(hemoglobin<13.3 g/dL)is an independent predictor of renal damage.

Admission hemoglobin level and prognosis of type 2 diabetes mellitus and possible confounding factors:Correspondence

This letter to editor discusses on the publication on admission hemoglobin level and prognosis of type 2 diabetes mellitus.A comment on published article is raised.The specific confounding conditions on the hemoglobin level are mentioned.Concerns on clinal application are raised and discussed.

A Study of Correlation of Serum Chromium Level with Glycosylated Haemoglobin (HbA1c), Total Cholesterol and Triglycerides, among Type 2 Diabetes Patients

Background: Diabetes mellitus is a common disease and it is a major cause of morbidity;several studies indicate that diabetes is a likely under reported cause of death. Chromium’s is important trace element to control diabetes mellitus and metabolism of carbohydrate, lipid and protein. Objective: The purpose of this study was to understand the relationship between serum chromium, with HbA1c, Total cholesterol and Triglycerides among type 2 diabetes patients among diabetic patients. Methodology: This is cross-sectional study done in Jabber Abu Ezz Centre for treatment and care of diabetics in Khartoum—Sudan. Four hundred subjects were enrolled in this study;one hundred subjects were normal healthy as control group, and three hundred subjects diabetic patient type 2 as test group;demographic and biochemical data were collected;serum chromium, Glycosylated Haemoglobin (HbA1c), Total cholesterol Triglycerides, were determined by using NYCOCARD READER II, spectrophotometer (Biosystem 310) and spectrophotometer 210-VGP. Result: In this study there is significant parameters level means of FBS HbA1c, Total Cholesterol, Triglycerides and Chromium of the test groups when compared with healthy control groups subjects (P = 0.001, 0.018, 0.01, 0.011, 0.004), respectively. Significant negative correlation is between FBS, HbA1c, Total Cholesterol, Triglycerides and Chromium (r = ?0.555, P value = 0.003), (r = ?0.668, P value = 0.002), (r = ?0.335, P value = 0.004) and (r = ?0.774, P value = 0.002) respectively. Conclusion: There was significant correlation between serum Chromium level with fasting blood sugaer, Glycosylated Haemoglobin (HbA1c), Total cholesterol and Triglycerides among type 2 diabetes patients.

Therapeutic potential of human embryonic stem cells in type 2 diabetes mellitus

AIM:To evaluate the safety and efficacy of human embryonic stem cells(h ESCs)for the management of type 2 diabetes mellitus(T2DM).METHODS:Patients with a previous history of diabetes and its associated complications were enrolled and injected with hE SC lines as per the defined protocol.The patients were assessed using Nutech functional score(NFS),a numeric scoring scale to evaluate the patients for 11 diagnostic parameters.Patients were evaluated at baseline and at the end of treatment period 1(T1).All the parameters were graded on the NFS scale from 1to 5.Highest possible grade(HPG)of 5 was considered as the grade of best improvement.RESULTS:Overall,94.8%of the patients showed improvement by at least one grade of NFS at the end of T1.For all the 11 parameters evaluated,54%of patients achieved HPG after treatment.The four essential parameters(improvement in glycated hemoglobin(HbA 1c)and insulin level,and fall in number of other oral hypoglycemic drugs with and without insulin)are presented in detail.For Hb A1c,72.6%of patients at the end of T1 met the World Health Organization cut off value,i.e.,6.5%of HbA 1c.For insulin level,65.9%of patients at the end of T1 were able to achieve HPG.After treatment,the improvement was seen in 16.3%of patients who required no more than two medications along with insulin.Similarly,21.5%of patients were improved as their dosage regimen for using oral drugs was reduced to 1-2 from 5.CONCLUSION:hE SC therapy is beneficial in patients with diabetes and helps in reducing their dependence on insulin and other medicines.

Comparison of different gastric bypass procedures in gastric carcinoma patients with type 2 diabetes mellitus

AIM:To determine the effect of different Roux-en-Y gastric bypass procedures in gastric carcinoma patients with type 2 diabetes mellitus.METHODS:A retrospective analysis of the clinical data of 54 patients with gastric cancer and type 2 diabetes mellitus treated in the Department of General Surgery from January 2006 to June 2013 was conducted.The patients underwent gastrectomy using different Rouxen-Y gastric bypass procedures(traditional,n=26;modified,n=28).Fasting plasma glucose(FPG),two hour postprandial blood glucose(2 h PBG)and hemoglobin A1c(Hb A1c)were analyzed before surgery(0 mo)and 1,3 and 6 mo after surgery.RESULTS:FPG and 2 h PBG levels were significantlydecreased 1 mo after surgery in the traditional Rouxen-Y gastric bypass group(FPG 7.5±1.3 vs 10.7±1.2,P<0.05)(2 h PBG 10.2±1.8 vs 13.8±3.2,P<0.05).FPG and 2 h PBG levels were significantly decreased after surgery in the modified Roux-en-Y gastric bypass group(FPG 6.9±1.2 vs 10.5±1.1,6.5±1.3 vs 10.5±1.1,6.4±1.2 vs 10.5±1.1,P<0.05)(2 h PBG9.9±2.2 vs 14.1±2.9,9.2±2.4 vs 14.1±2.9,8.9±2.6 vs 14.1±2.9,P<0.05).Compared with the levels before surgery,Hb A1c levels were significantly decreased 3 and 6 mo after surgery(7.2±1.1 vs 10.5±1.1,5.5±1.1 vs 10.5±1.1,P<0.05).Significant differences between the two groups regarding FPG,2 h PBG and Hb A1c concentration were observed 3 and 6mo after surgery(FPG 10.1±1.5 vs 6.5±1.3,10.3±1.4 vs 6.4±1.2,P<0.05)(2 h PBG 13.1±2.8 vs 9.2±2.4,13.6±3.1 vs 8.9±2.6,P<0.05)(Hb A1c 10.1±1.4 vs 7.2±1.1,10.5±1.3 vs 5.5±1.1,P<0.05).CONCLUSION:Modified Roux-en-Y gastric bypass can improve glucose metabolism in type 2 diabetic patients with gastric cancer.

Prevalence of nonalcoholic fatty liver disease and its association with age in patients with type 2 diabetes mellitus

BACKGROUND Type 2 diabetes mellitus(T2DM)is a risk factor for nonalcoholic fatty liver disease(NAFLD).AIM To determine the prevalence and clinical correlates of NAFLD in a large cohort of patients with T2DM.METHODS Four hundred thirty-seven participants with T2DM who consulted at Meijo Hospital from April 2019 to September 2020 and underwent computed tomography(CT)were assessed.The mean age was 74±13 years,and 269 were men.Hepatic attenuation minus splenic attenuation(CTL−S)less than 1 Hounsfield unit was considered fatty liver.NAFLD was defined as fatty liver in the absence of significant alcohol consumption and hepatitis virus infection.A multiple logistic regression was used to assess the independent factors associated with NAFLD.RESULTS NAFLD was identified in 25.2%of the participants.Young age(odds ratio[OR]=−0.945;95%confidence interval[CI]:0.922–0.969),higher hemoglobin levels(OR=1.501,95%CI:1.278–1.764),lower high-density lipoprotein(HDL)cholesterol levels(OR=0.971,95%CI:0.953–0.989),and the absence of dialysis(OR=0.109,95%CI:0.014–0.856)were independent predictors of NAFLD.CONCLUSION NAFLD was detected with CT in 25.2%of the participants.NAFLD was associated with younger age,higher hemoglobin levels,lower HDL cholesterol levels,and an absence of dialysis.

Acetylsalicylic Acid Administered in Patients with Type 2 Diabetes Mellitus and Its Effect on the Antioxidant Enzyme System

Type 2 diabetes mellitus and its complications are associated with oxidative stress and the depletion of antioxidant defenses. The influence of acetylsalicylic acid on reversing the decrease in antioxidants, insulin resistance, glucose homeostasis, and inflammatory cascade can help prevent diabetes complications. Purpose: The aim of the study was to evaluate the effect of acetylsalicylic acid on the antioxidant enzymatic system in patients with diabetes. Methods: A randomized, double-blind, placebo-controlled clinical trial was carried out in 21 patients of both sexes with Type 2 diabetes for less than five years at the time of diagnosis, without pharmacological treatment, and randomly selected. Acetylsalicylic acid (300 mg) was administered orally for three months to the study group (n = 11) compared to the placebo control group (n = 10). Before and after the intervention, anthropometric and metabolic measurements were taken, fasting plasma glucose, glycated hemoglobin A1c, lipid profile panel, glutathione peroxidase, superoxide dismutase, catalase, and antioxidant capacity/activity were determined;values are presented as mean ± standard deviation. Intra- and intergroup differences were tested by Wilcoxon signed rank and Mann-Whitney U test, respectively;p-value ≤ 0.05 was considered statistically significant. Results: The acetylsalicylic acid group showed a decrease in weight (85.6 ± 19.3 vs. 84.1 ± 19.0 kg p = 0.01), cholesterol (205.9 ± 16.6 vs. 186.0 ± 23.2 mg/dL p = 0.02), and glycated hemoglobin A1c (7.8% ± 0.9% vs. 7.0% ± 0.7% p = 0.02). The placebo group exhibited reduction in weight (76.1 ± 14.9 vs. 74.9 ± 15.0 kg p = 0.04), glycated hemoglobin A1c (6.9% ± 0.6% vs. 6.2% ± 0.4% p = 0.004), and total antioxidant capacity (4.1 ± 0.5 vs. 4.8 ± 0.3 mmol/L p = 0.002). Conclusion: The administration of acetylsalicylic acid did not modify the antioxidant enzyme system.

Vitamin D and Its Association with Glycemic Status in Bangladeshi Adults with Newly Detected Type 2 Diabetes Mellitus

Background: Very limited data are available regarding the association of vitamin D with glycemic status among adults with newly detected type 2 diabetes mellitus (T2DM) in Bangladesh. Objectives: To determine vitamin D status and its association with glycemic status in Bangladeshi adults with newly detected T2DM. Materials and Methods: This cross-sectional study was carried out in 102 newly detected T2DM diagnosed on the basis of the American Diabetes Association 2017 criteria (age: 42.95 ± 10.68 yrs.;m/f: 44/58) and equal number of age and sex matched controls (age: 40.43 ± 11.04 years) recruited consecutively from the Department of Endocrinology, BSMMU to measure serum vitamin D by high performance liquid chromatography method. Results: Both vitamin D deficiency (<20 ng/ml) (87.3% vs. 74.5%, p < 0.03) and severe vitamin D deficiency (<10 ng/ml) (56.2% vs. 26.3%, p < 0.001) were significantly higher in people with T2DM than control population. The mean level of 25(OH)D was significantly lower in adults with T2DM than control population (12.41 ± 6.85 ng/ml vs. 15.74 ± 6.25 ng/ml, p < 0.001). A significant inverse correlation was observed between vitamin D & HbA1c (r = -0.249, p = 0.011) in patients with T2DM. HbA1c was linearly associated with vitamin D (β = -0.26, p = 0.009) and severe vitamin D deficiency by binary (OR = 1.37, p = 0.003) and multinomial logistic regression (HbA1c ≥ 10%: OR = 4.25, p = 0.04) in people with T2DM after adjustment for age and BMI. Conclusions: Severe vitamin D deficiency was positively associated with T2DM and inversely associated with HbA1c in patients with newly detected T2DM.

Analysis on blood glucose excursions in well-controlled patients with type 2 diabetes mellitus

Objective:To probe glycemic excursions in type 2 diabetic patients whose hemoglobin A1c(HbA1c) was kept ≤6.0%.Methods:Totally 36 cases with type 2 diabetes(T2DM) with HbA1c≤6.0% and 30 cases with normal glucose tolerance(NGT) from December 2005 to December 2007 in our department were subjected prospectively.Continuous glucose monitoring system(CGMS) was employed to record their continuous blood glucose level for 3 d.The blood glucose profiles including the mean blood glucose(MBG),standard differentiation(SD),mean amplitude of glycemic excursions(MAGE) and absolute means of daily differences(MODD) were analyzed.Results:T2DM group had obviously postprandial hyperglycemia,in about 2 h after meal,especially after breakfast.Fifty-two hypoglycemic episodes occurred during the monitoring period in T2DM groups,of which 73.1%(38 episodes) were absence of symptomatic hypoglycemia with the lowest value of blood glucose only 2.0 mmol/L.And 20 episodes took place during the day hours,while 32 episodes observed during the night hours.Compared with NGT groups,SD,MAGE and MODD were all significantly higher in T2DM groups.MBG was significantly correlated with HbA1c in T2DM groups,but SD,MAGE,NGE and MODD were all independent of HbA1c.MAGE was independent of MODD.Conclusion:The amplitude of glycemic excursions is higher in normol-controlled T2DM groups than the NGT groups.Thus ideally glycemic control is not only to make HbA1c reach standard,but also to lessen glycemic excursions and reduce hypoglycemia episodes.

Therapeutic effects of acupuncture on blood glucose level among patients with type-2 diabetes mellitus: A randomized clinical trial

Objective:To compare the therapeutic effects of acupuncture with sham acupuncture on levels of fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c) among patients with type-2 diabetes mellitus (T2DM) under treatment with metformin.Method:Eighty participants with T2DM were allocated randomly to treatment (n =40) and control (n =40) groups.In addition to metformin therapy,patients in the acupuncture group received acupoint stimulation with even manipulation at 15 acupoints,and needles were retained for 20 minutes.The sham-acupuncture group was treated with very small needles inserted at a very shallow depth (3-5 mm) without manipulation at non-acupoints 1 cm around the actual acupuncture points.Both groups were treated for 14 sessions during 10 weeks of treatment.The FPG level was measured before treatment as well as after 1,2,4,6 and 12 weeks of treatment.The HbA1c percentage was assessed once before treatment and once 12 weeks after treatment initiation.Results:Levels of FPG and HbA1c in both groups were reduced significantly in comparison with baseline measurements (both P <.01).However,acupuncture treatment led to a significant reduction in the FPG level as compared with sham acupuncture after 4 weeks or 10 sessions of treatment [mean difference (MD) =10.18,95% confidence interval (CI) =1.74 to 18.6,P =.019],after 6 weeks or 12 sessions of treatment (MD =10.53,95% CI =2.22 to 18.83,P =.014) and after 12-week follow-up (MD =8.8,95% Cl =0.66 to 16.94,P =.034).Acupuncture treatment reduced the HbA1c level significantly in comparison with that in the shamacupuncture group (MD =0.27,95%Cl =0.08 to 0.47,P =.007).Conclusion:Our study revealed that acupuncture (as a type of Chinese therapy) combined with metformin (as a conventional hypoglycemic medication) had a greater effect on glycemic control than that elicited in the placebo control group.Consequently,acupuncture could be used as adjuvant therapy among patients with T2DM.

2型糖尿病患者糖化血红蛋白与血清炎症指标、免疫球蛋白水平的相关性研究

目的 探究2型糖尿病患者糖化血红蛋白水平与血清炎症指标、免疫球蛋白水平的相关性。方法 选择2022年1—9月期间到福州市第二医院就诊的50例2型糖尿病患者作为研究对象,均进行糖化血红蛋白、炎症指标、免疫球蛋白检测。同时根据患者糖化血红蛋白水平分为A组(糖化血红蛋白<7.5%,n=15)、B组(糖化血红蛋白7.5%~9.0%,n=20)、C组(糖化血红蛋白>9.0%,n=15),比较各组检测结果,并分析炎症指标、免疫球蛋白与糖化血红蛋白水平的相关性。结果 C组的超敏C反应蛋白(Hypersensitive C-reactive Protein, hsCRP)、白介素-6(Interleukin-6, IL-6)、肿瘤坏死因子-α(Tumor Necrosis Factor-α, TNF-α)、免疫球蛋白A(Immunoglobulin A, IgA)水平显著高于B组、A组,差异有统计学意义(P均<0.05)。C组免疫球蛋白G(Immunoglobulin G, IgG)水平明显低于B组、A组,差异有统计学意义(P均<0.05)。B组的hs-CRP、IL-6、TNF-α、IgA水平明显高于A组,IgG水平明显低于A组,差异有统计学意义(P均<0.05)。Pearson相关系数分析显示,hs-CRP、IL-6、TNF-α、IgA与糖尿病患者糖化血红蛋白水平呈正相关性,IgG与糖化血红蛋白水平呈负相关(P<0.05),而免疫球蛋白M(Immunoglobulin M, IgM)水平与糖化血红蛋白水平无相关性(P>0.05)。结论 2型糖尿病患者存在hs-CRP、IL-6、TNF-α及IgA、IgG异常,与糖化血红蛋白水平呈明显相关性,因此对于糖化血红蛋白异常升高者,需密切监测上述炎症、免疫球蛋白指标,便于临床及早发现患者机体异常,及时干预。

新诊断2型糖尿病合并非酒精性脂肪肝发生的影响因素分析

目的分析新诊断2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)发生的影响因素。方法收集2019至2020年在我院内分泌科住院的166例新诊断为T2DM患者作为研究对象,根据腹部B超检查结果,参照相关诊断标准将其分为T2DM合并NAFLD组(113例)和单纯T2DM组(53例)。收集所有患者的一般资料,包括性别、年龄、体重、体质指数(BMI)、收缩压(SBP)及舒张压(DBP);检测两组患者的生化指标,包括糖化血红蛋白(HbA1c)、空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及低密度脂蛋白胆固醇(LDL-C)水平。采用多因素Logistic回归分析探讨T2DM合并NAFLD发生的影响因素。结果两组患者的年龄、SBP及DBP比较,差异无统计学意义(P>0.05);两组患者的性别比较,差异具有统计学意义(P<0.05);T2DM合并NAFLD组的体重、BMI大于单纯T2DM组,差异具有统计学意义(P<0.05)。两组患者的FBG、TC及HDL-C水平比较,差异无统计学意义(P>0.05);T2DM合并NAFLD组的HbA1c、LDL-C水平低于单纯T2DM组,差异具有统计学意义(P<0.05);T2DM组合并NAFLD组的TG水平高于单纯T2DM组(P<0.05)。多因素Logistic回归分析结果显示,性别、体重、HbA1c及TG是T2DM合并NAFLD发生的影响因素(P<0.05)。结论性别、体重、HbA1c及TG是新诊断T2DM合并NAFLD发生的影响因素,临床应针对女性、肥胖、低HbA1c及高TG水平患者开展筛查,进一步预防及干预T2NM合并NAFLD发生,并针对影响因素开展相关措施。

不同强度训练方式对2型糖尿病超重或肥胖者体成分及糖代谢影响的Meta分析

目的:系统评价高强度间歇训练(high-intensity interval training,HIIT)与中等强度持续性训练(moderate-intensity continuous training,MICT)对2型糖尿病超重或肥胖患者体成分、糖代谢相关指标干预效果,对比两种运动方式的改善效果,为2型糖尿病超重或肥胖患者运动处方的制定提供参考依据。方法:检索The Cochrane Library、PubMed、EMbase、Web of Science、中国知网、中国生物医学文献数据库(CBM)、万方及美国临床试验注册中心数据库,搜集HIIT与MICT对2型糖尿病超重或肥胖患者体成分和糖代谢相关指标干预效果比较的随机对照试验,检索时间为各数据库建库至2022年6月。由2名研究者对所纳入的研究进行筛选、质量评价和数据提取,采用RevMan 5.4软件对结局指标进行Meta分析。结果:①共纳入13项随机对照试验,包括371例患者,所纳入研究整体质量较高。②HIIT组与MICT组对体成分改善效果无显著性差异(体质量:WMD=2.44,95%CI:-3.01-7.89,P>0.05;体质量指数:WMD=0.28,95%CI:-1.21-1.77,P>0.05;腰围:WMD=2.16,95%CI:-2.04-6.35,P>0.05;体脂百分比:WMD=0.47,95%CI:-2.11-3.05,P>0.05);③两组体质量与体质量指数指标“训练周期≥12周”亚组“训练频率≤3次/周”亚组差异有显著性意义(训练周期≥12周亚组:WMD=4.25,95%CI:0.90-7.59,P=0.01;WMD=2.71,95%CI:1.92-3.51,P<0.00001;训练频率≤3次/周亚组:WMD=5.14,95%CI:1.7-8.57,P=0.003;WMD=1.67,95%CI:0.66-2.67,P=0.001);④敏感性分析结果显示,HIIT组与MICT组体脂百分比指标差异有显著性意义(WMD=2.17,95%CI:1.20-3.14,P<0.0001),两组对糖代谢改善效果无显著性差异(空腹血糖:WMD=0.31,95%CI:-0.17-0.79,P>0.05;糖化血红蛋白:WMD=0.01,95%CI:-0.19-0.20,P>0.05;胰岛素抵抗指数:WMD=-0.14,95%CI:-0.71-0.42,P>0.05);⑤亚组分析结果显示,空腹血糖指标在“训练频率≤3次/周”亚组分析中差异有显著性意义(WMD=0.92,95%CI:0.25-1.60,P=0.007);糖化血红蛋白在“训练频率>3次/周”亚组分析中差异有显著性意义(WMD=-0.2,95%CI:-0.3至-0.1,P<0.0001)。结论:①整体而言,HIIT与MICT对改善2型糖尿病超重或肥胖患者体质量、体质量指数、腰围及体脂百分比等体成分和空腹血糖、糖化血红蛋白及胰岛素抵抗指数等糖代谢指标无显著差异;②当训练周期≥12周、训练频率≤3次/周时,MICT对体质量以及体质量指数的改善效果具有一定优势。

血清HbA1c、LAG-3与2型糖尿病患者合并甲状腺结节的相关性

目的探究血清糖化血红蛋白(HbA1c)、淋巴细胞活化基因-3(LAG-3)与2型糖尿病(T2DM)患者合并甲状腺结节的相关性。方法纳入河北医科大学第三医院2021年7月至2022年7月收治的T2DM合并甲状腺结节患者120例,设为研究组;同期选取单纯T2DM患者(无甲状腺结节)100例作为对照组。根据甲状腺结节的病理学检查结果将研究组分为良性结节组(85例)和恶性结节组(35例)。采用酶联免疫吸附试验检测所有研究对象血清LAG-3水平;全自动糖化血红蛋白分析仪检测所有研究对象HbA1c水平。采用Spearman法分析T2DM合并甲状腺结节患者血清中HbA1c、LAG-3与甲状腺影像报告与数据系统(TI-RADS)评分的相关性。采用多因素Logistic回归分析T2DM合并甲状腺结节的影响因素。采用受试者工作特征(ROC)曲线分析HbA1c、LAG-3水平对T2DM合并甲状腺结节的诊断价值。结果与对照组比较,研究组HbA1c水平升高(P<0.05),LAG-3水平降低(P<0.05)。与良性结节组比较,恶性结节组血清中LAG-3水平降低(P<0.05),HbA1c水平升高(P<0.05)。Spearman法分析结果显示,T2DM合并甲状腺结节患者HbA1c水平与TI-RADS评分呈正相关(r=0.378,P<0.001);血清LAG-3水平与TI-RADS评分呈负相关(r=-0.472,P<0.001)。多因素Logistic回归分析结果显示,HbA1c是T2DM患者发生甲状腺结节的危险因素(P<0.05),LAG-3是T2DM患者发生甲状腺结节的保护因素(P<0.05)。HbA1c、LAG-3联合诊断T2DM合并甲状腺结节优于二者单独诊断(Z二者联合-HbA1c=2.542,P=0.011;Z二者联合-LAG-3=3.098,P=0.002)。结论T2DM合并甲状腺结节患者血清LAG-3水平明显降低,HbA1c水平明显升高,二者与甲状腺结节的恶性程度有关。

Role of serum β2-microglobulin, glycosylated hemoglobin, and vascular endothelial growth factor levels in diabetic nephropathy

BACKGROUND Diabetic nephropathy(DN)is a common complication of type 1 and type 2 diabetes that can lead to kidney damage and high blood pressure.Increasing evidence support the important roles of microproteins and cytokines,such asβ2-microglobulin(β2-MG),glycosylated hemoglobin(HbA1c),and vascular endothelial growth factor(VEGF),in the pathogenesis of this disease.In this study,we identified novel therapeutic options for this disease.AIM To analyze the guiding significance ofβ2-MG,HbA1c,and VEGF levels in patients with DN.METHODS A total of 107 patients with type 2 diabetes mellitus complicated with nephropathy and treated in our hospital from May 2018 to February 2021 were included in the study.Additionally,107 healthy individuals and 107 patients with simple diabetes mellitus were selected as the control groups.Changes inβ2-MG,HbA1c,and VEGF levels in the three groups as well as the different proteinuria exhibited by the three groups were examined.RESULTS Changes inβ2-MG,HbA1c,and VEGF levels in the disease,healthy,and simple diabetes groups were significantly different(P<0.05).The expression of these factors from high to low were evaluated in different groups by pairwise comparison.In the disease group,high to low changes inβ2-MG,HbA1c,and VEGF levels were noted in the massive proteinuria,microproteinuria,and normal urinary protein groups,respectively.Changes in these factors were positively correlated with disease progression.CONCLUSION The expression of serumβ2-MG,HbA1c,and VEGF was closely correlated with DN progression,and disease progression could be evaluated by these factors.

甘油三酯-葡萄糖指数对2型糖尿病患者发生NAFLD的预测价值

目的探究甘油三酯-葡萄糖指数(TyG)对2型糖尿病(T2DM)患者发生非酒精性脂肪肝(NAFLD)的预测价值。方法选取T2DM患者306例,根据患者TyG四分位数分为Q1组(n=78)、Q2组(n=55)、Q3组(n=89)和Q4组(n=84),比较患者一般资料和生化指标。随访2年后进行肝脏彩超检查,比较各组NAFLD发生情况,分析T2DM患者发生NAFLD的危险因素,以及TyG对发生NAFLD的预测价值。结果由Q1组至Q4组,患者血清高密度脂蛋白胆固醇逐渐降低,血压、空腹血糖、谷草转氨酶、谷丙转氨酶、谷氨酰转肽酶、尿酸、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、糖化血红蛋白、TyG和NAFLD发生率逐渐升高(P<0.05)。Logistic回归分析显示,TyG越高NAFLD发病风险越高(P<0.05)。TyG对T2DM患者发生NAFLD具有良好的预测价值(P<0.05)。结论TyG可有效预测T2DM患者发生NAFLD,适宜在临床推广应用。

昆明市2社区2型糖尿病慢病管理患者服药依从性对病情控制的影响

目的分析昆明市2社区2型糖尿病(type 2 diabetes,T2DM)慢病管理患者服药依从性对病情控制的影响。方法选取2021年12月至2022年7月昆明市官渡、小板桥2个社区纳入慢病管理的2型糖尿病患者138例,完善基本信息采集、糖化血红蛋白(HbAlc)等相关检查,进行Morisliy服药依从性量表(8-item Morisky medication adherence scale,MMAS-8)问卷调查,分析服药依从性高(A组)、中(B组)、低(C组)3组的HbAlc等指标水平,并进行统计学分析。结果A组病例数占22.5%,B组占44.9%,C组占32.6%。2组间的尿白蛋白肌酐比(UACR)、HbA1c、血肌酐差异有统计学意义(P<0.05)。A组患者UACR、HbAlc、血肌酐水平低于B组、C组患者,UACR、HbAlc、血肌酐与用药依从率存在相关性,呈负相关(P<0.05)。结论昆明市官渡社区、小板桥2社区2型糖尿病慢病管理患者服药依从性高的患者比例仅为22.5%。依从性越高,患者UACR、HbAlc、血肌酐水平越低,两者之间存在相关性,提示应将服药的依从性作为社区糖尿病慢病管理中重点之一,并应加强对患者服药依从性的干预。