Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus

BACKGROUND In China,the prevalence of type 2 diabetes mellitus(T2DM)among diabetic patients is estimated to be between 90%-95%.Additionally,China is among the 22 countries burdened by a high number of tuberculosis cases,with approximately 4.5 million individuals affected by active tuberculosis.Notably,T2DM poses a significant risk factor for the development of tuberculosis,as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis(T2DMPTB),which has risen from 19.3%to 24.1%.It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.AIM To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis(T2DM-PTB),as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.METHODS T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group,Simple DM patients presenting to our hospital in the same period were the control group,Controls and case groups were matched 1:2 according to the principle of the same sex,age difference(±3)years and disease duration difference(±5)years,patients were investigated for general demographic characteristics,diabetes-related characteristics,body immune status,lifestyle and behavioral habits,univariate and multivariate analysis of the data using conditional logistic regression,calculate the odds ratio(OR)values and 95%CI of OR values.RESULTS A total of 315 study subjects were included in this study,including 105 subjects in the observation group and 210 subjects in the control group.Comparison of the results of both anthropometric and biochemical measures showed that the constitution index,systolic blood pressure,diastolic blood pressure and lymphocyte count were significantly lower in the case group,while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group.The results of univariate analysis showed that poor glucose control,hypoproteinemia,lymphopenia,TB contact history,high infection,smoking and alcohol consumption were positively associated with PTB in T2DM patients;married,history of hypertension,treatment of oral hypoglycemic drugs plus insulin,overweight,obesity and regular exercise were negatively associated with PTB in T2DM patients.Results of multivariate stepwise regression analysis found lymphopenia(OR=17.75,95%CI:3.40-92.74),smoking(OR=12.25,95%CI:2.53-59.37),history of TB contact(OR=6.56,95%CI:1.23-35.03)and poor glycemic control(OR=3.37,95%CI:1.11-10.25)was associated with an increased risk of developing PTB in patients with T2DM,While being overweight(OR=0.23,95%CI:0.08-0.72)and obesity(OR=0.11,95%CI:0.02-0.72)was associated with a reduced risk of developing PTB in patients with T2DM.CONCLUSION T2DM-PTB patients are prone to worse glycemic control,higher infection frequency,and a higher proportion of people smoking,drinking alcohol,and lack of exercise.Lymphopenia,smoking,history of TB exposure,poor glycemic control were independent risk factors for T2DM-PTB,and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Effects of vitamin D supplementation on glucose and lipid metabolism in patients with type 2 diabetes mellitus and risk factors for insulin resistance

BACKGROUND Type 2 diabetes mellitus(T2DM)is a chronic metabolic disease featured by insulin resistance(IR)and decreased insulin secretion.Currently,vitamin D deficiency is found in most patients with T2DM,but the relationship between vitamin D and IR in T2DM patients requires further investigation.AIM To explore the risk factors of IR and the effects of vitamin D supplementation on glucose and lipid metabolism in patients with T2DM.METHODS Clinical data of 162 T2DM patients treated in First Affiliated Hospital of Harbin Medical University between January 2019 and February 2022 were retrospectively analyzed.Based on the diagnostic criteria of IR,the patients were divided into a resistance group(n=100)and a non-resistance group(n=62).Subsequently,patients in the resistance group were subdivided to a conventional group(n=44)or a joint group(n=56)according to the treatment regimens.Logistic regression was carried out to analyze the risk factors of IR in T2DM patients.The changes in glucose and lipid metabolism indexes in T2DM patients with vitamin D deficiency were evaluated after the treatment.RESULTS Notable differences were observed in age and body mass index(BMI)between the resistance group and the non-resistance group(both P<0.05).The resistance group exhibited a lower 25-hydroxyvitamin D_(3)(25(OH)D_(3))level,as well as notably higher levels of 2-h postprandial blood glucose(2hPG),fasting blood glucose(FBG),and glycosylated hemoglobin(HbA1c)than the non-resistance group(all P<0.0001).Additionally,the resistance group demonstrated a higher triglyceride(TG)level but a lower high-density lipoprotein-cholesterol(HDL-C)level than the non-resistance group(all P<0.0001).The BMI,TG,HDL-C,25(OH)D_(3),2hPG,and HbA1c were found to be risk factors of IR.Moreover,the posttreatment changes in levels of 25(OH)D_(3),2hPG,FBG and HbA1c,as well as TG,total cholesterol,and HDL-C in the joint group were more significant than those in the conventional group(all P<0.05).CONCLUSION Patients with IR exhibit significant abnormalities in glucose and lipid metabolism parameters compared to the noninsulin resistant group.Logistic regression analysis revealed that 25(OH)D_(3)is an independent risk factor influencing IR.Supplementation of vitamin D has been shown to improve glucose and lipid metabolism in patients with IR and T2DM.

Prevalence and risk factors of diabetes mellitus among elderly patients in the Lugu community

BACKGROUND Age is a significant risk factor of diabetes mellitus(DM).With the develop of population aging,the incidence of DM remains increasing.Understanding the epidemiology of DM among elderly individuals in a certain area contributes to the DM interventions for the local elderly individuals with high risk of DM.AIM To explore the prevalence of DM among elderly individuals in the Lugu community and analyze the related risk factors to provide a valid scientific basis for the health management of elderly individuals.METHODS A total of 4816 elderly people who came to the community for physical examination were retrospectively analyzed.The prevalence of DM among the elderly was calculated.The individuals were divided into a DM group and a non-DM group according to the diagnosis of DM to compare the differences in diastolic blood pressure(DBP)and systolic blood pressure(SBP),fasting blood glucose,body mass index(BMI),waist-to-hip ratio(WHR)and incidence of hypertension(HT),coronary heart disease(CHD),and chronic kidney disease(CKD).RESULTS DM was diagnosed in 32.70%of the 4816 elderly people.The BMI of the DM group(25.16±3.35)was greater than that of the non-DM group(24.61±3.78).The WHR was 0.90±0.04 in the non-DM group and 0.90±0.03 in the DM group,with no significant difference.The left SBP and SBP in the DM group were 137.9 mmHg±11.92 mmHg and 69.95 mmHg±7.75 mmHg,respectively,while they were 126.6 mmHg±12.44 mmHg and 71.15 mmHg±12.55 mmHg,respectively,in the non-DM group.These findings indicate higher SBP and lower DBP in DM patients than in those without DM.In the DM group,1274 patients were diagnosed with HT,accounting for 80.89%.Among the 3241 non-DM patients,1743(53.78%)were hypertensive and 1498(46.22%)were nonhypertensive.The DM group had more cases of HT than did the non-DM group.There were more patients with CHD or CKD in the DM group than in the non-DM group.There were more patients who drank alcohol more frequently(≥3 times)in the DM group than in the non-DM group.CONCLUSION Older adults in the Lugu community are at a greater risk of DM.In elderly individuals,DM is closely related to high BMI and HT,CHD,and CKD.Physical examinations should be actively carried out for elderly people to determine their BMI,SBP,DBP,and other signs,and sufficient attention should be given to abnormalities in the above signs before further diagnosis.

Challenges and pitfalls of youth-onset type 2 diabetes

The incidence and prevalence of youth-onset type 2 diabetes mellitus(T2DM)are increasing.The rise in frequency and severity of childhood obesity,inclination to sedentary lifestyle,and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications.Indeed,youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM,with greater insulin resistance and more rapid deterioration of beta cell function.Therefore,intermediate complications such as microalbuminuria develop in late childhood or early adulthood,while end-stage complications develop in mid-life.Due to the lack of efficacy and safety data,several drugs available for the treatment of adults with T2DM have not been approved in youth,reducing the pharmacological treatment options.In this mini review,we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.

Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai

BACKGROUND Globally,patients with diabetes suffer from increased disease severity and mortality due to coronavirus disease 2019(COVID-19).Old age,high body mass index(BMI),comorbidities,and complications of diabetes are recognized as major risk factors for infection severity and mortality.AIM To investigate the risk and predictors of higher severity and mortality among inhospital patients with COVID-19 and type 2 diabetes(T2D)during the first wave of the pandemic in Dubai(March–September 2020).METHODS In this cross-sectional nested case-control study,a total of 1083 patients with COVID-19 were recruited.This study included 890 men and 193 women.Of these,427 had T2D and 656 were non-diabetic.The clinical,radiographic,and laboratory data of the patients with and without T2D were compared.Independent predictors of mortality in COVID-19 non-survivors were identified in patients with and without T2D.RESULTS T2D patients with COVID-19 were older and had higher BMI than those without T2D.They had higher rates of comorbidities such as hypertension,ischemic heart disease,heart failure,and more life-threatening complications.All laboratory parameters of disease severity were significantly higher than in those without T2D.Therefore,these patients had a longer hospital stay and a significantly higher mortality rate.They died from COVID-19 at a rate three times higher than patients without.Most laboratory and radiographic severity indices in non-survivors were high in patients with and without T2D.In the univariate analysis of the predictors of mortality among all COVID-19 non-survivors,significant associations were identified with old age,increased white blood cell count,lymphopenia,and elevated serum troponin levels.In multivariate analysis,only lymphopenia was identified as an independent predictor of mortality among T2D non-survivors.CONCLUSION Patients with COVID-19 and T2D were older with higher BMI,more comorbidities,higher disease severity indices,more severe proinflammatory state with cardiac involvement,and died from COVID-19 at three times the rate of patients without T2D.The identified mortality predictors will help healthcare workers prioritize the management of patients with COVID-19.

Risk factors for diabetic retinopathy in northern Chinese patients with type 2 diabetes mellitus

AIM: To investigate the prevalence and risk factors of diabetic retinopathy (DR) in northern Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective cross-sectional study was performed between May 2011 and April 2012. A total of 1100 patients (male/female, 483/617) were included in this study. DR was defined following the Early Treatment Diabetic Retinopathy Study (ETDRS) severity scale. All included patients accepted a comprehensive ophthalmic examination including retinal photographs. Logistic regression models were used to estimate odds ratios (ORs) and 95% confidence interval (CI) after adjusting for age and gender. RESULTS: Retinopathy was present in 307 patients with a prevalence of 27.9%. In univariate logistic analysis, presence of DR was associated with longer duration of diabetes (OR, 5.70; 95% CI, 2.91-12.56), higher concentration of fasting blood glucose (OR, 12.94; 95% CI, 2.40-67.71), higher level of glycosylated hemoglobin HbA1c (OR, 5.50; 95% CI, 3.78-11.97) and insulin treatment (OR, 6.99; 95%Cl, 1.39-35.12). The lifestyle of patients with T2DM including smoking, alcohol consumption and regular exercise seemed not associated with the development of DR. CONCLUSION: Our study suggests that fasting serum glucose concentration, HbA1c level, duration of diabetes and insulin treatment are potential risk factors for DR in northern Chinese patients with T2DM, while the lifestyle of included patients seems not associated with DR.

Epidemiological characteristics and risk factors of diabetic retinopathy in type 2 diabetes mellitus in Shandong Peninsula of China

AIM: To determine the epidemiological characteristics and estimate the risk factors of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM) in Shandong Peninsula of China. METHODS: The cases of T2DM admitted to Affiliated Hospital of Medical College of Qingdao University, Shandong Province, China, from January 2006 to December 2010 were retrospectively reviewed. The epidemiological characteristics of DR were estimated. The cases were divided into two groups according to degrees of retinopathy: non-DR group and DR group. Logistic regression analysis was used to study the related risk factors of DR. RESULTS: The prevalence of DR in patients with T2DM was 25.08% (834/3326). There was significant difference between the average age for men (59.08 +/- 15.43 years) and for women (62.92 +/- 18.19 years, P=0.0021). The majority of DR occurred in women (female: male ratio=1.76:1, P<0.0001). The incidence rate of DR in urban (489/834) was higher than that in rural area (345/834, P<0.0001). In 834 DR patients, the mean duration of T2DM was 8.90 +/- 4.15 years (range: 0-16 years); 440 people (52.76%) had received varying degrees of health education about prevention and primary care of DM; and 473 people (56.71%) suffered from other DM complications confirmed at the same time. In addition, the incidence rate of monocular (551/3326) and binocular retinopathy (283/3326) were statistically different (P<0.0001). Factors associated (p<0.05) with the presence of DR included old age, lower health educational level, intraocular surgery history, longer duration of T2DM, accompanying with other DM complications, no standard treatment procedure, lower body mass index (BMI) and higher fasting plasma glucose (FPG), glycated hemoglobin A(1)C (HbA(1)C), urine albumin (UA), total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C). The risk factors (P<0.05) independently associated with the presence of DR were: longer duration of T2DM, lower health educational level, higher FPG, higher UA, lower BMI and higher IC. CONCLUSION: DR is highly prevalent in the patients with T2DM in Shandong Peninsula of China. Besides blood glucose, many factors are associated with the present and development of DR.

Risk factors in patients with type 2 diabetes in Bengaluru: A retrospective study

BACKGROUND Risk factors such as hereditary, ecological, and metabolic are interrelated and contribute to the development of type 2 diabetes mellitus. Family history(FH) of diabetes mellitus, age, obesity, and physical inactivity are some of the risk factors for the development of type 2 diabetes.AIM To study various aetiological determinants and risk factors for type 2 diabetes in Bangalore, India. This retrospective study examined questionnaire from patients attending the Diabetes Clinic.METHODS Data on various parameters were obtained through a questionnaire from 533 patients on the first visit to the diabetes clinic. Data regarding various aetiological determinants and risk factors viz.: Genetic risk factor and few modifiable risk factors were collected. Chi-squared test was used for statistical analysis.RESULTS A higher incidence of type 2 diabetes in males and younger population was observed in Bangalore, India. Obesity and FH were significant risk factors for not only type 2 diabetes but also early onset of diabetes. In addition, maternal history of type 2 diabetes and consanguinity increased incidence of early onset type 2 diabetes.CONCLUSION Risk factors such as obesity and FH(maternal history of type 2 diabetes) and consanguinity may play an important role in screening of family members of type 2 diabetes patients which may lead to early intervention and reduced risk of subsequent complications. Moreover, susceptible population can be counselled for the management of the type 2 diabetes including periodic investigation of blood glucose levels and lifestyle changes.

Modifiable Behavioral Risk Factors Associated with Biological Risk Factors in Subjects at Risk of Type 2 Diabetes in Benin: PREDIBE Study

Introduction: Type 2 diabetes is a major public health problem worldwide. This study aimed at identifying modifiable behavioral risk factors associated with biological factors in people at risk of type 2 diabetes which could be targeted in the design and implementation of appropriate interventions to prevent the disease. Methods: 180 subjects at risk of type 2 diabetes (aged 15 - 60 years) were identified and selected at random during a preliminary survey conducted in two groups of villages in northeastern Benin. The study took part on August 2017. Questionnaires were administered to consenting subjects;anthropometric measurements taken and blood samples withdrawn. Blood samples were subjected to biochemical testing according to standard protocols. Results: Data was obtained from 180 subjects at risk of type 2 diabetes. The average age of the subjects was 42.76 ± 11.30 years. Multivariate analysis showed inadequate dietary intake score, low physical activity and tobacco use as behavioral factors significantly associated with high waist circumference, high blood sugar, low HDL cholesterol, high triglyceride levels and high body fat percentage. Conclusion: There is a possible association between biological and behavioral risk factors.

Assessment of Diabetes Control Level and Associated Cardiovascular Risk Factors

Introduction: Cardiovascular diseases are the leading cause of mortality in type 2 diabetics patients. Our work aimed to assess the level of control of type 2 diabetes and associated cardiovascular risk factors. Patients and study method: This was an observational cross-sectional study of type 2 diabetics patients. The parameters studied were: sociodemographic data, lifestyle, anthropometric data, levels of control of diabetes by the level of HbA1C, blood pressure measured at the office and cholesterol. Results: 326 type 2 diabetics patients were collected. The sex-ratio was 0.35. The average age of the patients was 58 ± 11 years. A physical inactivity remained present in 79 patients (24.23%), 2 patients (0.61%) continued to smoke. The prevalence of obesity was 21.16% (n = 69) or 25% of women and 10.4% of men (p = 0.01). Abdominal obesity was observed in 151 patients (46.31%), 139 of whom were female and 12 male (p = 0.001). Diabetes was sufficiently controlled in 65.34% of patients (n = 213) while cholesterolemia and hypertension were controlled in 33.44% and 8.33% of patients respectively. Conclusion: Type 2 diabetes was frequently associated with other cardiovascular risk factors. Control of diabetes and these factors was insufficient. Therapeutic education of type 2 diabetics patients needed to be improved.

A nomogram of 5-year risk of type 2 diabetes in Chinese population

Objective:The aim of this study was to analyze the risk factors of type 2 diabetes in 5 years in Chinese population,and to construct the prediction model of nomogram and verify its validity.Methods:The physical examination and follow-up data of the participants who received physical examination at 32 sites in 11 cities in China from 2010 to 2016 were collected from the Dryad digital repository database.Randomly divided into modeling group(n=22936)and validation group(n=9830).In the modeling group,the independent risk factors were determined by single factor and multi factor analysis based on Cox regression model,and the nomogram prediction model was constructed by R software.The accuracy and performance of the model were evaluated by AUC value,C-index and calibration curve.Results:The multivariate regression model suggested that fasting blood glucose,triglyceride,smoking history and drinking history were independent risk predictors of 5-year risk of type 2 diabetes in Chinese population.In the modeling group,AUC was 0.776(95%CI:0.699-0.849),and C-index was 0.783(95%CI:0.706-0.856).Similarly,in the validation group,the AUC value was 0.743(95%CI:0.665-0.824),and the C-index was 0.764(95%CI:0.667-0.846),suggesting that the model had a good discrimination ability.The 5-year adjusted risk curve of type 2 diabetes in Chinese population suggests a good consistency between the predicted value and the actual value.Conclusion:The nomogram model can predict the 5-year risk of type 2 diabetes in Chinese population intuitively and accurately.

HbA1c、LDL-C、HDL-C联合检测在2型糖尿病肾病中的诊断价值

目的:探究糖化血红蛋白(HbA1c)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)联合检测在2型糖尿病肾病中的诊断价值。方法:选取2019年1月—2021年12月南京中医药大学附属苏州市中医医院收治的120例2型糖尿病患者作为研究对象。根据患者是否发生糖尿病肾病将其分为合并肾病组(n=35)和未合并肾病组(n=85)。收集两组患者一般资料。检测两组Hb A1c、LDL-C、HDL-C。比较两组一般资料及Hb A1c、LDL-C、HDL-C水平。分析2型糖尿病肾病的危险因素。分析HbA1c、LDL-C、HDL-C对2型糖尿病肾病的诊断价值。结果:合并肾病组糖尿病病程长于未合并肾病组,吸烟史占比高于未合并肾病组,差异有统计学意义(P<0.05)。合并肾病组HbA1c、LDL-C水平均高于未合并肾病组,HDL-C水平低于未合并肾病组,差异有统计学意义(P<0.05)。logistic分析结果显示,HbA1c、LDL-C、吸烟史、糖尿病病程均是2型糖尿病患者合并糖尿病肾病的危险因素,HDL-C是保护因素(P<0.05)。HbA1c、LDL-C、HDL-C联合检测的AUC最高。结论:HbA1c、LDL-C、HDL-C联合检测应用于2型糖尿病肾病诊断中,具有较高的诊断价值,为临床对2型糖尿病肾病的早期诊断提供新思路。

基于临床资料与实验室指标构建2型糖尿病发生糖尿病肾病预测模型及价值验证

目的探究基于临床资料与实验室指标构建2型糖尿病(T2DM)发生糖尿病肾病(DN)的预测模型,并进行预测价值验证,为临床提供相关参考依据。方法选取我院2019年1月至2021年3月T2DM患者267例作为研究对象,根据《糖尿病肾病防治专家共识(2014年版)》中DN诊断标准分为单纯T2DM组(197例)与DN组(70例)。收集两组临床资料、实验室指标,构建T2DM发生DN的Logistic回归模型,评价模型的预测价值,并进行个体值预测验证。结果单因素分析,年龄、性别、BMI、动脉粥样硬化、冠心病、吸烟史、饮酒史、糖尿病家族史、FBG、2hPG、Hb、TG、Scr、BUN不是T2DM发生DN的影响因素(P>0.05);T2DM病程、高血压、HbA1c、TC、HDL-C、LDL-C、SUA是T2DM发生DN的影响因素(P<0.05);Logistic回归分析,T2DM病程、高血压、HbA1c、TC、LDL-C、SUA是T2DM发生DN的独立危险因素,HDL-C是T2DM发生DN的独立保护因素(P<0.05);ROC曲线分析,根据上述独立因素构建Logistic回归模型,该模型预测T2DM发生DN的最佳截断值Log(P)为0.489,AUC为0.830,95%CI为0.779~0.873,灵敏度为61.43%,特异性为89.34%,较各影响因素单独预测价值高。随机抽取2021年4月至2022年1月T2DM患者178例作为验证集,其中发生DN患者42例,未发生DN患者136例,该模型在验证集中预测T2DM发生DN的AUC为0.922,95%CI为0.872~0.957,灵敏度为85.71%,特异性为87.50%。结论基于T2DM病程、高血压、HbA1c、TC、LDL-C、HDL-C、SUA构建T2DM发生DN的预测模型具有可靠预测价值,能作为临床预测DN风险的重要途径。

2型糖尿病合并感染患者肺炎克雷伯菌分布及预后影响因素分析

目的:探讨2型糖尿病(T2DM)合并感染患者肺炎克雷伯菌(KP)分布及预后影响因素分析。方法:选择226例T2DM患者为研究对象,根据是否合并KP感染分为未感染组(n=170)和感染组(n=56),分析T2DM患者感染的危险因素。收集T2DM合并感染患者KP标本,记录标本来源并进行菌种鉴定和药敏试验,并对所有菌株进行多位点序列(MLST)分型,记录预后情况。结果:基础疾病、抗生素使用、侵入性操作、血清白蛋白(ALB)、糖化血红蛋白(HbA1c)、空腹血糖(FPG)为影响T2DM发生感染的危险因素(均P<0.05)。T2DM合并感染患者体内分离56株肺炎克雷伯菌,肺炎克雷伯菌在痰液中的占比最高为44.62%,其次为尿液19.64%,血液中占比16.07%,脓液中占比12.5%,其他标本占比7.14%。56株KP总耐药率最高为氨苄西林,最低为亚胺培南,痰液标本中KP对头孢呋辛、头孢哌酮、庆大霉素耐药率高于非痰液标本,非痰液标本中KP对头孢他啶高于痰液标本(均P<0.05)。56株肺炎克雷伯菌MLST分型共发现42个ST型,ST-20型、36型、65型、347型、660型各2株,分别占3.57%,23型4株占7.14%,ST-17、25、29、35、37、45、86、189、208、211、218、322、355、412、490、519、557、595、726、776、1049、1092、1103、1319、1569、1916、2059、3014、3140、3536、4023、4194、4262、4412、4857型各1株,分别占1.78%,其他ST型7株占比12.5%。56例T2DM合并KP感染患者预后良好患者52例,预后不良患者4例,预后良好率为92.86%。结论:T2DM合并感染患者KP主要分布在痰液和尿液中,基础疾病、抗生素使用、侵入性操作、ALB、HbA1c、FPG是影响KP感染发生危险因素,T2DM合并KP感染患者根据药敏结果选择用药,有利于患者预后。

2型糖尿病合并阻塞性睡眠呼吸暂停低通气综合征的列线图预测模型构建

目的 构建2型糖尿病(T2DM)合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)的列线图预测模型。方法 选取2018年9月至2020年4月自贡市第四人民医院完成多导睡眠监测的526例T2DM患者为研究对象,并按照7∶3的比例随机分为训练组和验证组。通过对T2DM患者进行单变量和多变量的logistic回归分析,本研究确定了OSAHS的风险因素,并据此构建了一个预测模型。模型的有效性通过计算受试者工作特征曲线下的面积(AUC)、使用校正曲线和决策曲线(DCA)进行评估。结果 多因素logistic分析结果显示,体重指数(OR=1.09,95%CI:1.01~1.17)、高血压病史(OR=3.80,95%CI:3.43~4.26)、血清低密度脂蛋白(OR=1.35,95%CI:1.03~1.56)及25(OH)维生素D(OR=0.94,95%CI:0.91~0.96)水平是T2DM合并OSAHS发生的独立预测因素(P <0.05)。根据上述变量建立列线图预测模型,并在训练组和验证组中预测T2DM合并OSAHS发生的AUC分别为0.742和0.789。Hosmer-Lemeshow拟合优度检验显示模型具有较好的拟合度(P> 0.05)。DCA显示预测模型能够获得净收益的风险阈值大于0.9。结论 本研究成功建立并验证了一种性能良好的列线图预测模型,有助于提高T2DM患者合并OSAHS的早期识别和筛选能力。

2型糖尿病心脏自主神经病变合并视网膜病变和肾病的临床研究

目的:探讨2型糖尿病心脏自主神经病变合并视网膜病变和肾病的患病率及危险因素。方法:选取2022年5月至2023年5月于云南省第一人民医院内分泌科住院的2型糖尿病(type 2 diabetes mellitus,T2DM)患者203例,以心血管反射试验(cardiovascular autonomic reflex tests,CARTs)结合评分判定糖尿病心脏自主神经病变(diabetic cardiac autonomic neuropathy,CAN),按照是否合并糖尿病视网膜病变(diabetic retinopathy,DR)、糖尿病肾脏病变(diabetic kidney disease,DKD)分为单纯CAN组、CAN合并DR组、CAN合并DKD组及CAN合并DR、DKD组,收集所有受试者的临床相关资料。采用SPSS 26.0软件进行统计学分析。结果:①203例T2DM患者中,CAN的患病率为58.62%,CAN合并DR、CAN合并DKD及CAN合并DR、DKD的患病率分别为10.08%、7.56%、10.92%。②在4组中年龄、糖化血红蛋白(glycosylated hemoglobin,HbA1c)、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、乳酸脱氢酶(lactate dehydrogenase,LDH)、直接胆红素(direct bilirubin,DBIL)、72 h动态血糖葡萄糖在目标范围内时间(72 hours dynamic blood glucose within the target range of time,TIR)等因素差异有统计学意义(P<0.05)。③Logistic回归分析结果:HbA1c(OR=2.948,95%CI=1.015~8.560,P=0.047)、LDH(OR=1.151,95%CI=1.035~1.280,P=0.010)为CAN合并DR、DKD发生发展的促进因素;DBIL(OR=0.057,95%CI=0.005~0.658,P=0.022)、eGFR(OR=0.700,95%CI=0.513~0.955,P=0.025)、TIR(OR=0.877,95%CI=0.775~0.992,P=0.037)、年龄(OR=0.550,95%CI=0.349~0.868,P=0.010)的水平与CAN合并DR、DKD的发生发展相关。结论:较低的eGFR、TIR、DBIL、年龄与CAN合并DR、DKD的发生呈负相关,较高的HbA1c、LDH与CAN合并DR、DKD的发生呈正相关,故在eGFR、TIR、DBIL、年龄相对偏低和(或)HbA1c、LDH相对偏高的糖尿病人群中需更注重CAN合并DR、DKD的筛查。

2型糖尿病患者并发糖尿病肾病风险的列线图预测模型与验证研究

背景糖尿病肾病(DN)是糖尿病患者常见的并发症,对其发生风险进行预测与验证,有助于提前识别高风险患者并采取干预措施,以避免或延缓肾脏疾病的进展。目的分析影响2型糖尿病(T2DM)患者并发DN的风险因素,构建T2DM患者发生DN风险的预测模型并进行验证。方法选取2016年1月—2021年6月在新疆医科大学第一附属医院住院的5810例T2DM患者为研究对象,根据是否并发DN将患者分为DN组(481例)和非DN组(5329例)。对其中481例DN患者和非DN患者依据性别、年龄(±2岁)进行1∶1病例对照匹配,将匹配后的962例T2DM患者根据2∶1比例随机分为训练组(n=641)和验证组(n=321)。收集患者的基础数据,如临床特征、实验室检查结果及其他相关数据。采用LASSO回归优化筛选变量,利用多因素Logistic回归分析建立列线图预测模型。分别采用受试者工作特征(ROC)曲线、Hosmer-Lemeshow校准曲线和决策曲线分析(DCA)评价预测模型的区分度、校准度以及预测模型的临床有效性。结果DN组与非DN组患者性别、年龄、BMI、糖尿病病程、白细胞计数、总胆固醇、三酰甘油、低密度脂蛋白胆固醇、血清肌酐、高血压、收缩压、舒张压、糖化血红蛋白载脂蛋白B、24 h尿微量总蛋白、定性尿蛋白比较,差异有统计学意义(P<0.05)。采用LASSO回归分析方法,筛选出5个与T2DM患者发生DN风险相关的预测变量,结合多因素Logistic回归分析结果显示,糖尿病病程、总胆固醇、血清肌酐、高血压、定性尿蛋白是T2DM患者并发DN的危险因素(P<0.05)。训练组DN发生风险的ROC曲线下的面积(AUC)为0.866(95%CI=0.839~0.894),验证组DN发生风险的AUC为0.849(95%CI=0.804~0.889)。Hosmer-Lemeshow校准曲线拟合度较好(训练组P=0.748;验证组P=0.986)。DCA显示当患者的阈值概率为0.15~0.95时,使用列线图预测模型预测T2DM患者发生DN风险更有益。结论本研究发现糖尿病病程、总胆固醇、血清肌酐、高血压、定性尿蛋白可能是T2DM患者并发DN的危险因素,建立了包含该5个危险因素的列线图预测模型,可用于预测T2DM患者发生DN的风险。

Clustering of Cardiovascular Risk Factors and Diabetes： A Prospective Cohort Study on the Inner Mongolian Population in China

Objective To evaluate the effect of clustering of cardiovascular risk factors（CVRFs） on type 2 diabetes mellitus（T2 DM） incidence and identify some high predictive clusters in the Inner Mongolian population in China. Methods A total of 1,884 Mongolian individuals aged 20 years or above were followed up from 2002 to 2013 and included in the final analysis. We categorized the participants into two subgroups according to the study outcome event. A Cox proportional hazards model was used to evaluate the effect of clustering of CVRFs on the incidence of T2 DM. Areas under the curve were used to compare the effect of every cluster on T2 DM and identify those having higher predictive value. Results We found 203 persons with T2 DM. Subjects with incident T2 DM tended to be older, had a higher prevalence of drinking, had higher systolic and diastolic pressures; total cholesterol, triglyceride, low-density lipoprotein cholesterol, and C-reactive protein levels; waist circumference; body mass index; and heart rate and lower HDL-C level than did those without T2 DM. The multivariable adjusted hazard ratio（95% confidence interval） of T2 DM was calculated based on comparisons with subjects with 0 CVRFs; in participants with 2 and ≥ 3 factors, the adjusted hazard ratios were 2.257（1.448, 3.518） and 3.316（2.119, 5.188）, respectively. Conclusion The clustering of CVRFs increased the risk of T2 DM. On the basis of fast heart rate, the cluster of abdominal obesity and other CVRFs had higher predictive value for T2 DM than the other three CVRF clusters.

Atherosclerotic cardiovascular disease among patients with type 2 diabetes in Basrah

AIM:To determine the frequency of atherosclerotic cardiovascular disease and its risk factors among patients with type 2 diabetes in Basrah,Iraq.METHODS:Participants in this cross-sectional study were patients who had type 2 diabetes for at least 1 year,presenting at the Al-Faiha Diabetes Endocrine and Metabolism Center in Basrah(Southern Iraq) over the period from January to December 2008.RESULTS:The series included 1079 patients(58.8% men),of whom 25.0% were smokers.The prevalence of symptomatic cardiovascular disease and hypertension was 16.0%,and 44.3% respectively.Those who were overweight or obese constituted 70.5%.Insulin was used in only 26.9% despite 56.1% having had diabetes for 6 years and more.The mean glycated hemoglobin(HbA1c) was 9.46% ± 2.0% and only 5.5% achieved the target of HbA1c of < 7%.We had 68.7% of patients with total cholesterol of ≥ 200 mg/dL,21.5% with high density lipoprotein cholesterol of < 40 mg/dL,84.1% with low density lipoprotein cholesterol of ≥ 100 mg/dL and 71.6% with triglyceride of ≥ 150 mg/dL.CONCLUSION:Among adults with type 2 diabetes mellitus,there was increased frequency of cardiovascular disease and its modifiable risk factors.This finding necessitated urgent work to modify these risk factors in a population based setting.

Relationship between lipoprotein （a） and micro/macro complications in type 2 diabetes mellitus： a forgotten target

ObjectivesIncreased 脂蛋白(a) 浆液集中似乎是一个心血管的风险因素；这没在 extracoronary 动脉粥样硬化复杂并发症被证实。我们因此希望获得更深的卓见 into&#x000a0；在脂蛋白(a) 的血浆集中和类型 2 糖尿病 mellitus 并且到的微脉管、宏脉管的复杂并发症之间的关系在这 association.MethodsThis 识别可能的差别是描述的观察代表性的研究。二 -- 有类型 2 糖尿病 mellitus 的 117 个老病人从内部药 outclinic 被包括。人体测量的数据，分析数据(象高血压的胰岛素保守，基础、饭后的肽 C， glycosylated 血红素，肾的参数，类脂化合物侧面和临床的数据，肥胖，微 -- 并且 macrovascular 复杂并发症是 collected.ResultsPatients 根据类型被组织进化的 2 糖尿病 mellitus 时间。脂蛋白(a) 的吝啬的血浆集中是 22.2 &#x000b1；17.3 mg/dL (22.1 &#x000b1；为男性的 15.9 mg/dL，和 22.1 &#x000b1；为女性的 18.4 mg/dL ) 。有高血压，冠的心疾病，脑血管的事故， microalbuminuria 和 proteinuria 的病人介绍了脂蛋白(a) 的统计上重要的增加的水平。同样，有 hyperlipoprotein (a) 的病人(&#x02265；30 mg/dL ) 脲和全部的胆固醇的介绍显著地增加的层次。在 multivariate 回归模型，脂蛋白(a) 的水平断然与冠的心疾病和糖尿病的 nephropathy 被相关(P &#x0003c；0.01 并且 P &#x0003c；0.005，分别地) 脂蛋白(a) 的血浆层次的 .ConclusionsThe 举起与冠的心疾病和 diabe tic nephropathy 的发展被联系。因此，我们认为脂蛋白(a) 的决心可以是在有类型 2 糖尿病 mellitus 的病人的脉管的复杂并发症的一个预示的标记。