Neutral protamine hagedorn/regular insulin in the treatment of inpatient hyperglycemia: Comparison of 3 basal-bolus regimens

AIM To compare the safety and efficacy or 3 basal-bolus regimens of neutral protamine hagedorn(NPH)/regular insulin in the management of inpatient hyperglycemia.METHODS We randomized 105 patients with blood glucose levelsbetween 140 and 400 mg/dL to a basal-bolus regimen of NPH insulin given once(n = 30), twice(n = 40) or three times(n = 35) daily, in addition to pre-meal regular insulin. Major outcomes included were differences in glycemic control, frequency of hypoglycemia and total insulin dose.RESULTS NPH insulin given in a once-daily regimen was associated with better glycemic control(58.3%) compared to twice daily(42.4%) and three times daily(48.9) regimens(P = 0.031). The frequency of hypoglycemia was similar between the three groups(2.0%, 0.7% and 1.2%, P = 0.21). The mean insulin dose at discharge was 0.48 ± 0.14 U/kg in the once-daily group compared to 0.69 ± 0.28 in the twice-daily, and 0.65 ± 0.20 in the three times daily regimens(P < 0.001).CONCLUSION NPH insulin administered in a once-daily regimen resulted in improvement in glycemic control with similar rates of hypoglycemia compared to a twice-daily and a three times-daily regimen. Further studies are needed to evaluate whether this regimen could be implemented in all hospitalized patients with hyperglycemia.

代谢综合征与阿尔茨海默病的相关性及机制研究进展

近期研究发现代谢综合征(MetS)患者有认知功能下降甚至向痴呆进展的趋势,而阿尔茨海默病(AD)是痴呆最重要的分型。本文回顾总结既往研究中MetS导致的认知功能障碍与AD发病的相关性,指出有较多证据支持MetS作为整体及其组分中的高血压、高血糖是AD的危险因素,而胰岛素抵抗、神经慢性炎症、脂肪因子紊乱等在发病过程中起到重要作用,因尚缺乏可有效延缓或逆转AD病理进展的治疗方案,期待以相对可治MetS为干预靶标,为早期防治AD综合策略的制订提供科学证据。

A Potential Role for GLUT4 in Predicting Sepsis in Critically Ill Children

Background: This study investigated serum Glucose transporter (GLUT) 4 levels and examined the relationship between serum GLUT4 levels and sepsis in critically ill children. Methods: This was a retrospective study of 77 critically ill children and 33 non-diabetic healthy children (controls) who were admitted between 07/2015 and 05/2016. Patient data, clinical information, and blood samples were collected on admission, alongside a large number of laboratory parameters that were routinely assessed. Critically ill patients were divided into sepsis and non-sepsis/systemic inflammatory response syndrome (SIRS). Serum GLUT4 was measured using western blotting and enzyme-linked immunosorbent assays. Insulin resistance indexes, clinical data, laboratory parameters, and inflammatory cytokines were assessed. Results: GLUT4 serum levels were higher in critically ill children than in healthy children (90.5 vs. 30.3 μg/L, P 0.05). Compared to healthy children, hyperglycemic patients (n = 48) had elevated GLUT4 serum levels (30.3 vs. 103.7 g/L, P Conclusions: GLUT4 serum levels might be significantly increased in critically ill children compared with healthy children, particularly those in septic shock. Serum GLUT4 could predict disease severity.

New insights into insulin: The anti-inflammatory effect and its clinical relevance

Hyperglycemia, a commonly exhibited metabolic disorder in critically ill patients, activates the body's inflammatory defense mechanism, causing the waterfall release of numerous inflammatory mediators and cytokines, and eventually leads to organ damage. As the only glucose-lowering hormone in the body, insulin not only alleviates the detrimental effects of hyperglycemia through its metabolic regulation, but also directly modulates inflammatory mediators and acts upon immune cells to enhance immunocompetence. In this sense, hyperglycemia is pro-inflammatory whereas insulin is anti-inflammatory. Therefore, during the past 50 years, insulin has not only been used in the treatment of diabetes, but has also been put into practical use in dealing with cardiovascular diseases and critical illnesses. This review summarizes the recent advances regarding the anti-inflammatory effects of insulin in both basic research and clinical trials, with the hope of aiding in the design of further experimental research and promoting effective insulin administration in clinical practice.

Steroid hyperglycemia: Prevalence, early detection and therapeutic recommendations: A narrative review

Steroids are drugs that have been used extensively in a variety of conditions. Although widely prescribed for their anti-inflammatory and immunosuppressive properties, glucocorticoids have several side effects, being hyperglycemia one of the most common and representative. In the present review, we discuss the main epidemiologic characteristics associated with steroid use, with emphasis on the identification of high risk populations. Additionally we present the pathophysiology of corticosteroid induced hyperglycemia as well as the pharmacokinetics and pharmacodynamics associated with steroid use. We propose a treatment strategy based on previous reports and the understanding of the mechanism of action of both, the different types of glucocorticoids and the treatment options, in both the ambulatory and the hospital setting. Finally, we present some of the recent scientific advances as well as some options for future use of glucocorticoids.

Clinical Outcomes Associated with Use of Subcutaneous Sliding Scale Insulin Compared to Other Insulin Regimens in Hospitalized Patients

Background: Hyperglycemia in hospitalized patients is managed through one of the following approaches: sliding scale insulin (SSI) alone;SSI plus long-acting insulin and basal-bolus insulin (BBI). The optimal insulin treatment regimen is still debated. Objectives: To evaluate the clinical outcomes associated with the use of SSI compared to other regimens. Setting: The general medical wards in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Methods: Medical charts for adult patients admitted between October 2014-December 2015 with type 2 diabetes or uncontrolled hyperglycemia with insulin treatment were reviewed. Data from capillary blood glucose were measured daily for the first 5 days of hospitalization and recorded. Demographics and blood glucose levels were compared by group using one-way ANOVA or Chi-square test. The number of hyperglycemic/hypoglycemic episodes was analyzed using the Kruskal-Wallis test. Results: A total of 240 patients were included. The three insulin regimen groups were not statistically different in terms of the number of days with episodes of hyper- or hypoglycemia (p > 0.05). However, a significantly bigger change from baseline (improvement) in random blood glucose (RBG) levels was observed in BBI and SSI plus glargine patients compared to SSI (p = 0.014). Conclusion: Our study showed no significant difference in the number of days with episodes of hyper- or hypoglycemia for SSI vs. other insulin regimens. However, SSI patients had less improvement in their RBG levels compared to other insulin regimen groups. Further studies with a larger sample size are needed to confirm these findings.

Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlled studies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased boththe incidence ofinfection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a closed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.

Insulin Release from the Beta Cells in Acatalasemic Mice Is Highly Susceptible to Alloxan-Induced Oxidative Stress

Background: Catalase deficiency (acatalasemia) is sensitive to alloxan, and the administration to acatalasemic mice develops hyperglycemia under mild conditions. However, the mechanism is still poorly understood. Methods: Alloxan was used to induce the oxidative stress and intraperitoneally administered to acatalasemic and normal mice. The blood samples of these mice after 1, 3, 5 and 7 days were examined. The pancreatic islets 7 days after alloxan administration were isolated, and the insulin released under 3 mM and 20 mM glucose was examined. Results: After alloxan administration, increase of oxidative markers in blood and pancreatic apoptosis in acatalasemic mice were observed immediately. Insulin in blood was lowered after 3 days, and the insulin in acatalasemic mice was lower than that in normal mice. Hyperglycemia in the acatalasemic mice was observed after 3 days. The pancreatic islets after 7 days were isolated. A reduction of the insulin released from the islets under glucose stimulation was observed. The stimulation indexes of the normal and acatalasemic mice were 1.4 ± 0.6 and 0.7 ± 0.3, respectively. Conclusions: Alloxan induced a deterioration of glucose-dependent insulin secretion ability from the islets, and the deterioration mostly contributed to hyperglycemia, rather than apoptosis.

Jamun (Syzygium cumini) seed and fruit extract attenuate hyperglycemia in diabetic rats

Objective: To evaluate the potential of both jamun(Syzyguim cumini) seed and fruit extracts against hyperglycemia.Methods: Male Sprague Dawley rats were used to evaluate hypoglycemic potential of jamun extracts. Purposely, jamun fruit and seed's ethanolic extracts based diets were provided to normal and high sucrose diet induced hyperglycemic/diabetic rats for sixty days. The serum glucose and insulin levels were monitored at monthly intervals to evaluate hypoglycemic effect of jamun extracts.Results: The results of instant research depicted that both seed and fruit extracts reduce the blood glucose level significantly and also regulate the insulin levels in hyperglycemic rats. It was noted that jamun fruit extract attenuated serum glucose levels to 5.35% and 12.29% in normal and hyperglycemic rats, respectively;while insulin levels were improved by 2.82% and 6.19% correspondingly. Whereas, jamun seed extract reduced glucose to 7.04% & 14.36% and showed 3.56% & 7.24% higher insulin levels in normal & hyperglycemic rats, respectively.Conclusions: The present research revealed that both jamun fruit and seeds have potent prophylactic role against hyperglycemia. In this respect, diet based regimen may be tailored using jamun fruit/seed and their extracts to alleviate hyperglycemia.

高血压脑出血术后应激性高血糖胰岛素控制方案的治疗效果

目的 探讨高血压脑出血术后发生应激性高血糖患者实施胰岛素控制方案的临床效果。方法 选取2021年1月至2022年3月淮南市第一人民医院神经外科收治的高血压脑出血患者,并在进行开颅去骨瓣减压加血肿清除术之后发生了应激性高血糖的64例患者为研究对象,按照住院号的奇偶分实验和对照组各32例,对照组患者予以常规胰岛素强化治疗,实验组实施胰岛素控制方案治疗,以患者血糖控制在7.8~9.9 mmol/L为目标,观察2组患者术后治疗的效果差异。结果 2种方案治疗后,实验组血糖达到目标值时间短于对照组,实验组应用胰岛素总量较少、实验组低血糖和高渗糖救援发生率明显较对照组低、实验组并发症率低于对照组(均P<0.05)。结论 高血压脑出血术后应激性高血糖予以胰岛素控制方案治疗可有效稳定患者血糖水平,缩短控制血糖至目标水平的时间、降低不良反应和并发症发生率,可促进患者康复,有推广价值。

长效胰岛素类似物的安全性回顾:从成人2型糖尿病到妊娠期高血糖

长效胰岛素类似物进入中国市场已有20年,临床应用中得到普遍认可且积累了长足的经验。以德谷胰岛素和甘精胰岛素U300为代表的新型超长效胰岛素也先后进入中国市场,在起效时间、峰值时间、作用持续时间上,更接近生理性基础胰岛素分泌模式,变异性更低,低血糖风险更小,安全性更高。EXPECT研究证实了德谷胰岛素妊娠期应用的疗效和安全性,最新版说明书已做出修订,指出“如果临床需要,可以考虑在妊娠期间使用德谷胰岛素进行治疗”。因此,本文将从临床研究、指南角度,对比分析四种长效胰岛素类似物的特点,解析德谷胰岛素与多个长效胰岛素类似物在临床应用的安全性,尤其是妊娠期高血糖使用德谷胰岛素的安全性。

2型糖尿病增加帕金森病风险相关机制研究进展

2型糖尿病与帕金森病的发生发展密切相关,其中高血糖导致的神经毒性和脑组织胰岛素抵抗发挥重要作用,但具体机制尚不明确。慢性血糖升高可能通过促进氧化应激、神经炎症、晚期糖基化终末产物和内源性神经毒素形成,导致黑质多巴胺能神经元损伤,而胰岛素抵抗通过多种途径参与其中。本文对2型糖尿病增加帕金森病风险的作用机制进行综述,为2型糖尿病患者的帕金森病预防与治疗提供指导。

新损伤严重度评分联合乳酸及甘油三酯葡萄糖指数对非糖尿病多发伤患者72h病死率的预测价值

目的探究新损伤严重度评分(new injury severity score,NISS)联合乳酸(lactic,Lac)及甘油三酯葡萄糖指数(triglyceride glucose index,TyG)对非糖尿病多发伤患者72h病死率的预测价值。方法回顾性分析2019年11月—2021年11月安徽医科大学第二附属医院急诊外科收治非糖尿病多发伤患者资料147例,收集患者一般资料、NISS和入院24h内初始Lac、甘油三脂、空腹血糖,并计算TyG值,按照入院72h救治结果不同分为存活组(94例)和死亡组(53例)。应用SPSS26.0统计软件对各指标进行组间比较,采用受试者工作(receiver operating characteristic,ROC)曲线预测上述指标在评估病情严重程度中的灵敏度与特异度。结果147例患者72h内死亡53例,病死率36.1%(95%CI0.28~0.45),两组患者性别、年龄、体质量指数组间比较差异无统计学意义(P>0.05),存活组与死亡组患者NISS、Lac、TyG三者比较差异有统计学意义(P<0.05)。ROC示NISS、Lac、TyG及联合检测的ROC曲线下面积分别为0.705、0.684、0.720和0.834。结论NISS、Lac及TyG三者联合较单用三项指标对非糖尿病多发伤患者72h病死率预测价值较高,具有一定的临床应用价值。

糖尿病与衰老的相关性及机制研究进展

糖尿病是全世界患病人数较多的慢性疾病之一,严重的糖尿病并发症一直是困扰临床的难题。糖尿病及其并发症的发生机制复杂,且很多机制尚未阐明。近年来,研究发现糖尿病和衰老在发生机制上存在许多交联之处。本文通过文献回顾,总结分析二者的相互作用机制,并加以综述,旨在对今后相关临床与基础研究提供指导。

短期胰岛素泵强化治疗在重症病毒性肺炎合并应激性高血糖治疗中的疗效观察

目的 探讨短期胰岛素泵强化治疗在重症病毒性肺炎合并应激性高血糖中的临床疗效。方法 选择我科2018年9月~2021年9月期间收治的重症病毒性肺炎合并应激性高血糖患者53例作为研究对象,分为短期静脉胰岛素泵强化治疗组和短期皮下胰岛素泵对照组,观察两组血糖达标时间、低血糖发生率、低钾发生率、继发感染率、多脏器衰竭发生率、APACHEⅡ评分、机械通气时间、死亡率、住院时间等指标的变化。结果 治疗组和对照组均能有效降低血糖,与对照组相比,治疗组血糖达标时间更短(P<0.05),显著降低重症病毒性肺炎的APACHEⅡ评分(P<0.05)、多脏器衰竭发生率(P<0.05)、继发感染率(P<0.05)和总住院时间(P<0.05),而在机械通气时间、死亡率以及并发症发生率方面两组无明显差别(P>0.05)。结论 短期静脉胰岛素泵强化治疗方案可以快速平稳地控制应激性高血糖,改善患者APACHEⅡ评分,降低多脏器衰竭及继发感染发生率,降低总住院时间,且操作方便,临床上值得推荐。

糖尿病对肺癌的影响及其机制研究进展

肺癌是我国常见的恶性肿瘤,其发病率和死亡率高,严重影响人民健康。糖尿病是肺癌患者的常见合并疾病,其对肺癌的发生进展有诸多影响,包括明显增加肺癌患病风险、增加肺癌放疗后放射性肺炎的发生率以及对肺癌预后可能产生影响。然而,目前关于糖尿病对肺癌作用的机制尚未完全明确,可能包括胰岛素抵抗、高血糖症、慢性炎症以及糖尿病并发症对治疗的影响。不同糖尿病患者之间血糖控制情况不同,因此选取定量的实验室指标来进一步划分患者是未来研究糖尿病对肿瘤影响的可行方向。

脑卒中肠内营养应激性高血糖的管理现状

脑卒中患者常伴有意识障碍、吞咽障碍,给予肠内营养对避免营养不良、改善预后具有重要意义。应激性高血糖是急性期常见并发症,对患者预后不利。肠内营养会对血糖产生影响,本文就相关问题进行文献检索,对肠内营养与血糖的关系、肠内营养的管理、高血糖的管理以及中医护理技术辅助降糖进行综述。

非糖尿病患者肠外营养期间血糖控制及胰岛素应用的现状与进展

高血糖(HG)是住院患者肠外营养(PN)期间常见的并发症,与高感染率等并发症和死亡风险相关,通常需要胰岛素治疗。目前国际上对于非糖尿病(NDM)患者PN时是否常规应用胰岛素预防HG、使用胰岛素的最佳途径及剂量、方案存在诸多争议。本研究通过检索相关文献并总结提出NDM患者PN时胰岛素应用的优化策略。

小叶苦丁提取物通过上调Nrf2/INS蛋白质水平表达降低小鼠高血糖

近年来,高血糖的患病率不断增加,患者身体损伤严重。与常规西药相比,天然产物不良反应少,可延缓高血糖并发症。小叶苦丁是一种珍贵的天然产品资源,含有多种对人体有益的成分。本研究旨在研究不同剂量的小叶苦丁提取物对高血糖小鼠血糖代谢的调节作用。本研究采用脂多糖加链脲佐菌素诱导小鼠高血糖模型,小叶苦丁提取物以低、中、高(5g·kg^(-1)·d-1,10g·kg^(-1)·d-1,15g·kg^(-1)·d-1)3个剂量灌胃给药,连续7周。每周于固定时间采集小鼠尾静脉血测定小鼠空腹血糖值。给药7周后,按规定取每只小鼠的血清和脏器,测定血清中甘油三酯(TG)、胆固醇(CHO)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、糖化血清蛋白(GSP)、胰高血糖素样肽-1(GLP-1)、空腹胰岛素(FINS)和胰高血糖素(GC)含量水平。结果显示,模型组小鼠血糖值、各项血清生化指标与正常组小鼠均具有显著性差异(P<0.01或P<0.05),高血糖症状明显。小叶苦丁提取物低、中、高剂量组HDL-C、FINS含量显著高于模型组(P<0.01),TG、CHO、LDL-C含量减少,血糖值显著降低,与模型组相比具有极显著性差异(P<0.01)。中、高剂量组GSP含量较模型组显著降低(P<0.01或P<0.05)。小鼠胰腺组织的H&E染色结果显示,高血糖小鼠在灌胃小叶苦丁提取物后,胰岛细胞形态有所改善;免疫组织化学法观察胰腺组织胰岛素、核因子E2相关因子2蛋白质水平的表达,并采用免疫印迹实验(WB)和实时荧光定量(RT-qPCR)验证。结果表明,胰岛素(INS)、核因子E2相关因子2(Nrf2)蛋白质表达水平上调,其中高剂量组效果最佳(P<0.01)。以上结果提示,小叶苦丁提取物能够降低高血糖小鼠的血糖值,对其胰岛细胞损伤具有改善作用,能够改善高血糖小鼠症状,为临床治疗高血糖提供了新参考。