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1.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 50(1): 77-82, 2019 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-31037909

RESUMO

OBJECTIVE: To compare the predictive value of different measures of obesity for metabolic syndrome (MetS) in adult Yi and Han nationality population. METHODS: A total of 3 492 urban and rural residents in Chengdu and Liangshan Yi Autonomous Prefecture participated in this study. Demographic and laboratory data were collected. Spearman correlation analysis was used to investigate the relationship between different obesity measurement indexes and MetS. Receiver operating characteristic (ROC) curve was used to compare the predictive value between different obesity measurement indexes. RESULTS: Spearman correlation analysis showed that MetS was related to body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), lipid accumulation index (LAP) and visceral adiposity index (VAI). The ROC curve showed that the LAP had the highest predictive value for MetS in both Yi and Han male adults, area under the curves (AUCs) >0.90; whereas WHR had the lowest predictive value. WHtR had high predictive value for MetS in both Yi and Han female adults (AUCs >0.88), VAI had the worst predictive value. CONCLUSION: Among different measures of obesity, LAP may have the optimal predictive value for MetS in male adults as do WHtR in female adults either in Yi or Han nationality. These findings should be confirmed through the measure of visceral fat volume and prospective study.


Assuntos
Síndrome Metabólica , Adulto , Índice de Massa Corporal , Estudos Transversais , Grupos Étnicos , Feminino , Humanos , Masculino , Obesidade , Estudos Prospectivos , Curva ROC , Fatores de Risco , Circunferência da Cintura , Relação Cintura-Quadril
2.
Adv Ther ; 36(6): 1485-1496, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31004325

RESUMO

INTRODUCTION: China has the largest number of diabetic patients in the world. In the past 2 decades, the prevalence of diabetes in China has increased dramatically, and the current status of diabetes control in the diabetic population is not satisfactory. Although insulin is currently recognized in diabetes treatment guidelines as the therapeutic option for patients not adequately controlled by diet/exercise and oral agents, the proportion of patients with type 2 diabetes using insulin is still very low, and the time when insulin therapy is initiated is relatively late. In using insulin injections, concerns about the complexity of the treatment regimen, a fear of needles, and other psychological barriers can affect insulin treatment, impacting on patient compliance and potentially resulting in a poor treatment response. Another type of insulin injection device that has become available recently, the needle-free injector, is now being used in clinical practice because of its unique features and patients' injection experiences. The aims of this study are to investigate the efficacy and safety of the needle-free injector-based insulin treatment in blood glucose control in patients with type 2 diabetes, as compared with a conventional needle-based insulin treatment, and to evaluate patient satisfaction with the different insulin delivery methods. METHODS AND PLANNED OUTCOMES: A prospective, multicenter, randomized, open-label, parallel-group clinical trial was designed and implemented in China. A total of 420 patients with type 2 diabetes from ten research centers will be enrolled in the study. The primary efficacy endpoint is the change in the glycosylated hemoglobin (HbA1c) level from baseline to after 16 weeks of treatment after randomization. Secondary efficacy endpoints include measurements of blood glucose concentrations, the rate of achieving the target HbA1c level of less than 7%, patients' quality-of-life (as determined by the SF-36 questionnaire), the insulin dose administered, compliance with insulin therapy, and patients' satisfaction with their injection device. ETHICS AND DISSEMINATION: The study was approved by the Independent Ethics Committee (IEC) of Peking University Peoples Hospital and was conducted in accordance with the moral, ethical, and scientific principles of the declaration of Helsinki and the provisions of good clinical practice (GCP) in China. Written informed consent will be obtained from all participants before any study-related procedures are implemented. It is hoped that the study will provide evidence for the clinical application of the needle-free injector by providing data on its efficacy and safety, as compared with a conventional insulin pen, in the Chinese type 2 diabetes population. When available, the results will be published in an international peer-reviewed journal. TRIAL REGISTRATION: ClinicalTrials.gov Identifier, NCT03243903. Registration date, August 9, 2017. FUNDING: Beijing QS Medical Technology Co., Ltd.

3.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 48(1): 81-85, 2017 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-28612564

RESUMO

OBJECTIVES: To investigate the relationship between serum 25-hydroxyvitamin D3 [25(OH)D3 ] concentration and glucose metabolism. METHODS: This cross-sectional survey recruited 668 participants, and the demographic and clinical characteristics of the participants were obtained from questionnaires. Physical examination and blood biochemical examination were performed, then the participants were divided into three groups as normal glucose tolerant (NGT) group, impaired glucose regulation(IGR) group, and diabetes mellitus (DM) group. RESULTS: There was no statistical significant difference in serum 25(OH)D3 concentration among the three groups ( P>0.05). With comparison of different serum 25(OH) D3 concentration, there was no statistical significant difference in the incidence of DM and IGR, FPG, 2 h BG, HOMA-IR, ISI-composite, HOMA-ß or ΔI30/ΔG30 ( P>0.05). Serum 25(OH)D3 concentration was not associated with DM, IGR, FPG, 2 h BG, HOMA-IR, ISI-composite, HOMA-ß or ΔI30/ΔG30 ( P>0.05). CONCLUSIONS: No relationship between serum 25(OH)D3 concentration and glucose metabolism is comfirmed.


Assuntos
Calcifediol/sangue , Diabetes Mellitus Tipo 2/sangue , Glucose/metabolismo , Resistência à Insulina , Glicemia/análise , Estudos Transversais , Teste de Tolerância a Glucose , Humanos
4.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 48(3): 418-421, 2017 May.
Artigo em Chinês | MEDLINE | ID: mdl-28616917

RESUMO

OBJECTIVES: To investigate the feasibility of using human-specific insulin radioimmunoassay (Ins-RIA) kit to measure the concentrations of serum insulin in minipigs. METHODS: The Serum samples (219) of Bama minipigs were collected. The concentrations of serum insulin in Bama minipigs were measured by Ins-RIA kit and porcine-specific insulin enzyme linked immunosorbent assay (Ins-ELISA) kit, respectively. The linear regression analysis was undertaken in a randomly selected 175 samples (80% of total samples) to establish predictive equations between the concentrations of serum insulin measured by Ins-ELISA and the concentrations of serum insulin measured by Ins-RIA. The equations were then cross-validated in the remaining 44 samples (20% of total samples) that had not been included in the regression analysis. RESULTS: Measured insulin concentration was lower with the Ins-ELISA than that with the Ins-RIA [(15.32±15.50) µIU/mL vs. (32.31±21.74) µIU/mL, respectively, P<0.000 1]; The final predictive equation for the Ins-ELISA (µIU/mL) was equal to -7.29+0.70 × Ins-RIA(µIU/mL) ( R2=0.94). The differences between the predicted values and the actual measured values were 17.18%. CONCLUSIONS: Insulin values in Bama minipigs obtained from the Ins-ELISA and Ins-RIA are not equivalent and differ significantly. However, the insulin concentration by Ins-ELISA can be well estimated by Ins-RIA.

5.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 48(3): 441-445, 2017 May.
Artigo em Chinês | MEDLINE | ID: mdl-28616922

RESUMO

OBJECTIVES: To compare the clinical characteristics and prevalence of chronic complications in type 2 diabetes mellitus (T2DM) patients with various degrees of obstructive sleep apnea syndrome (OSAS). METHODS: A total of 170 patients with T2DM and OSAS were enrolled in this study. These participants were divided into three groups with low, medium and high apnea-hypopnea index (AHI), respectively. The demographic characteristics, biochemical indicators and chronic complications of the patients in the three groups were compared. Multivariate Logistic regression analysis was performed to determine the associations between chronic complications and OSAS. RESULTS: The patients with severe OSAS had higher waist circumference (P=0.045), higher BMI (P=0.069), higher prevalence of diabetic peripheral neuropathy (DPN), and higher prevalence of diabetic retinopathy (DR) than the patients with mild-moderate OSAS. Similar levels of macrovascular complications were found in the three groups (P>0.05). The logistic regression analyses showed that DPN (OR=1.024, 95%CI 1.002-1.046) and chronic kidney disease (OR=1.026, 95%CI 1.004-1.049) were independent predictors of AHI, adjusting for the lowest oxygen saturation, gender, age, diabetic duration, family history of diabetes, BMI, and HbA1c. Other microvascular and macrovascular complications were not predictors of AHI. CONCLUSIONS: Patients with T2DM and severe OSAS have a higher risk of DPN and DR. Particular attention should be paid to T2DM patients with severe OSAS to prevent complications.

6.
J Clin Lipidol ; 10(1): 150-60, 2016 Jan-Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26892132

RESUMO

OBJECTIVE: The aim of this study was to assess the levels of serum lipid and awareness, treatment, and control of dyslipidemia in type 2 diabetes mellitus (T2DM) patients from top-ranked endocrinology clinics in large cities of China. MATERIALS AND METHODS: A cross-sectional study in a representative sample of 4807 Chinese adults 40 to 75 years of age was conducted during 2010 to 2011 at 20 endocrinology clinics in top-ranked hospitals covering most of the major cities of China. Serum lipid levels were measured, and treatment of dyslipidemia was recorded and assessed. RESULTS: In the present study, the prevalence of dyslipidemia was 67.1% in T2DM subjects. Among those with dyslipidemia, the proportion of awareness and treatment was 68.7% and 55.9%. Among participants with lipid-lowering therapy, 686 subjects achieved the low-density lipoprotein cholesterol (LDL-C) control less than 2.60 mmol/L, with the rate being 39.4%. In those patients with previous cardiovascular disease, the percentage of participants who achieved LDL-C goal (1.80 mmol/L) was 15.3%. CONCLUSION: The prevalence of dyslipidemia is high, and the awareness, treatment, and control of dyslipidemia are relatively low in Chinese T2DM patients. This calls for the awareness and intervention of dyslipidemia in these patients.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Dislipidemias/complicações , Dislipidemias/epidemiologia , Endocrinologia , Adulto , China/epidemiologia , Cidades/epidemiologia , Estudos Transversais , Dislipidemias/sangue , Dislipidemias/terapia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco
7.
J Antimicrob Chemother ; 71(6): 1688-96, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-26888908

RESUMO

OBJECTIVES: Few randomized controlled studies have compared antibiotic regimens against diabetic foot infections (DFIs) in Chinese patients. We evaluated the efficacy and safety of ertapenem versus piperacillin/tazobactam for the treatment of DFIs in Chinese patients. METHODS: Patients with moderate to severe DFIs requiring parenteral antibiotics were randomized in a 1 : 1 ratio to receive ertapenem (1.0 g once daily) or piperacillin/tazobactam (4.5 g every 8 h) by 30 min intravenous (iv) infusions for ≥5 days. The primary outcome was favourable clinical response at discontinuation of iv therapy (DCIV). An evaluable-patient population was identified for primary analysis of non-inferiority at -15%. Safety was assessed. ClinicalTrials.gov: NCT01370616. RESULTS: Of 565 patients randomized, 443 patients (ertapenem = 219 and piperacillin/tazobactam = 224) were clinically evaluable for primary analysis. In the clinically evaluable population, the proportions of patients with favourable clinical response at DCIV were 93.6% (205/219) and 97.3% (218/224) in the ertapenem and piperacillin/tazobactam groups, respectively (difference: -3.8%, 95% CI: -8.3%, 0.0%). Ertapenem had a significantly lower favourable clinical response rate (91.5% versus 97.2%, 95% CI for difference: -12.1%, -0.3%) at DCIV in severe DFI patients. In the modified ITT population, 88.8% (237/267) and 90.6% (241/266) of patients in the ertapenem and piperacillin/tazobactam groups, respectively, had favourable clinical responses at DCIV (difference: -1.9%, 95% CI: -7.3%, 3.3%). Microbiological eradications of causative pathogens and adverse events were similar between treatment groups. CONCLUSIONS: Treatment with ertapenem was non-inferior to piperacillin/tazobactam in Chinese patients with DFIs. Ertapenem treatment resulted in a markedly lower rate of clinical resolution in severe DFIs.


Assuntos
Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Pé Diabético/complicações , Ácido Penicilânico/análogos & derivados , Inibidores de beta-Lactamases/uso terapêutico , beta-Lactamas/uso terapêutico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , China , Método Duplo-Cego , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Ertapenem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácido Penicilânico/efeitos adversos , Ácido Penicilânico/uso terapêutico , Piperacilina/efeitos adversos , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Resultado do Tratamento , Adulto Jovem , Inibidores de beta-Lactamases/efeitos adversos , beta-Lactamas/efeitos adversos
8.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 47(5): 790-795, 2016 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-28598101

RESUMO

OBJECTIVES: To compare the pancreatic ß-cell functions of Han people between those with normal glucose tolerance (NGT),prediabetes (PD),and newly-diagnosed type 2 diabetes mellitus (NDDM), and to evaluate the value of the continuous glucose monitoring system (CGMS) in determining ß-cell functions. METHODS: A total of 169 volunteers of Han people (20-75 years old, 72 male and 97 female) without diagnosed diabetes were given 75-g oral glucose tolerance test (OGTT) and insulin release tests. The body mass index (BMI) of the participants ranged from 18.5 to 28.0 kg/m².They were categorized into NGT (n=87), PD (n=52) and NDDM (n=30) groupsaccording to the World Health Organization (WHO) 1999 criteria.Blood samples were taken to test triglyceride(TG),total cholesterol (TC),and glycosylated hemoglobin A1c (HbA1c). The participants were also given a 72 h continuous glucose monitoring. The ß-cell functions were calculated using the OGTT and insulin release test results, which included homeostasis model assessment insulin resistance (HOMA-IR),homeostasis model assessment ß-cell function (HOMA-B),basic secretion, early phase secretion, and second phase secretion. The area under the curve of glucose (AUC-G) was estimated through the CGMS.A multivariate stepwise regression model was developed to identify predictors of ß-cell functions. RESULTS: Significant differences in age,BMI,HOMA-IR,HOMA-B,AUC-G, basic secretion, early phase secretion and second phase secretion were found between the NGT and PD groups (P<0.05) and between the NGT and NDDM groups (P<0.05). Differences in AUC-G and basic secretion and early phase secretion were found between the PD and NDDM groups (P<0.05),but not in age, BMI, HOMA-IR, HOMA-B, and second phase secretion.The multivariate stepwise regression analysis showed that HOMA-B (standardized partical regression coefficient ß=-0.244,P=0.001), basic secretion (ß=-0.355,P<0.001), and HbA1c (ß=0.638,P<0.001) contributed significantly to the AUC-G. CONCLUSIONS: ß-cell functions decline in those with prediabetes, which appears first at the second phase secretion. Changes in ß-cell secretion functions are more obvious than in insulin resistance during the progression from PD to NDDM.AUC-G can be a better indicator of impaired ß-cellfunctions.


Assuntos
Glicemia/análise , Células Secretoras de Insulina/citologia , Adulto , Idoso , Automonitorização da Glicemia , Índice de Massa Corporal , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Teste de Tolerância a Glucose , Humanos , Insulina , Resistência à Insulina , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/fisiopatologia , Adulto Jovem
10.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 45(4): 623-7, 2014 Jul.
Artigo em Chinês | MEDLINE | ID: mdl-25286688

RESUMO

OBJECTIVE: To identify the characteristics of glucose profiles in patients with insulinoma using continuous glucose monitoring system (CGMS). METHODS: Six patients with insulinoma (All of the patients were diagnosed after operations with pathological tests) admitted to the Department of Endocrinology and Metabolism, West China Hospital of Sichuan University from October 2009 to November 2011 were recruited for this study (group A). They were compared with 71 patients with normal glucose tolerance (NGT) (group B) and 3 patients with responsive hypoglycemia (group C). All of the participants received 75 g oral glucose tolerance tests (OGTT), insulin release tests, and 72 h CGM. Glucose fluctuations and hypoglycemia risks were assessed by the following parameters obtained from CGMS: mean blood glucose (MBG) and standard deviation (SD), mean amplitude of glycemic excursion (MAGE), mean daily differences (MODD), low glucose index (LBGI), glycaemic Risk Assessment Diabetes Equation (GRADE) and M-value. RESULTS: Group A had significantly lower levels of HbA1c, fasting blood glucose, and 2 h-BG than group B (P < 0.05). Compared with Group B, Group A had lower levels of 72 h-MBG (P < 0.001) and higher levels of LBGI, M-value, GRADE, SD and MODD (P < 0.05). The insulinoma patients had 27 occasions of hypoglycemia (glucose < 2.8 mmol/L), more likely in early morning, at a fasting state or preprandial periods. Such events were rare in the control groups (2 occasions in Group B and one occasion in Group C). CONCLUSION: Insulinoma patients present a greater level of glucose fluctuations and frequent hypoglycemia. Hypoglycemia risk detected by CGM is helpful for differentiating diagnosis of insulinoma.


Assuntos
Glicemia/análise , Insulinoma/diagnóstico , Estudos de Casos e Controles , China , Diagnóstico Diferencial , Intolerância à Glucose , Teste de Tolerância a Glucose , Humanos , Monitorização Fisiológica , Neoplasias Pancreáticas
11.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 45(1): 74-8, 2014 Jan.
Artigo em Chinês | MEDLINE | ID: mdl-24527587

RESUMO

OBJECTIVE: To estimate the prevalence of hypertension and to identify factors associated with the prevention and control of hypertension in Chinese Yi populations. METHODS: A cross-sectional study was conducted in Liangshan Yi Autonomous Prefecture of Sichuan province. Random cluster sampling method was adopted to recruit participants. A total of 1 255 Yi people who were 20 years or older from one urban district and three rural villages participated in this study. Demographic and medical and laboratory data were collected from July to September 2007. The prevalence of hypertension and levels of awareness and control of hypertension were calculated and compared between genders and urban and rural residencies. RESULTS: The age-standardized prevalence of hypertension reached 17.3% in the Chinese Yi populations. Urban residents had a significantly higher level of prevalence of hypertension than that of rural residents (25.9% vs. 8.9%, P < 0.001). Among the hypertensive patients, 2.8% were aware of their high blood pressure, 26.1% were taking antihypertensive medications, and 8.8% had their blood pressures controlled (< 140/90 mm Hg). Urban residents had significantly higher levels of awareness (35%) and endorsement of treatment (31.1%) than their rural counterparts (13.6% for awareness and 10.6% for treatment, P < 0.001). For those living in urban areas, higher prevalence of hypertension was associated with older age, being a woman, having higher annual income (> or = yen 10,000), overweight/obesity and higher levels of total cholesterol. Older age and high levels of total cholesterol were also found to be associated with increased risk of hypertension in the rural residents. CONCLUSION: Hypertension is prevalent in Yi populations. The awareness and control of hypertension in Yi populations is poor. Public health interventions are needed.


Assuntos
Anti-Hipertensivos/uso terapêutico , Hipertensão/epidemiologia , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Colesterol/sangue , Estudos Transversais , Feminino , Humanos , Hipertensão/prevenção & controle , Renda , Masculino , Obesidade , Sobrepeso , Prevalência , População Rural , População Urbana
12.
Zhonghua Yi Xue Za Zhi ; 93(18): 1401-6, 2013 May 14.
Artigo em Chinês | MEDLINE | ID: mdl-24025505

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of vitamin D (VD) for patients with type 2 diabetes mellitus. METHODS: Randomized controlled trials (RCT) were identified from CBM (1978.1-2012.9), CNKI (1979.1-2012.9), Pubmed (1950.1-2012.9), EMbase (1970.1-2012.9) and Cochrane library (issue 4, 2012). Publications of the RCT on the treatment of type 2 diabetes mellitus with VD were included and analyzed according to the criteria of Cochrane handbook. RESULTS: Six RCT involving 328 patients were included. Meta-analysis indicated that VD caused a reduction in glycosylated hemoglobin A 1c (HbA 1c) (P = 0.05) but not in fasting plasma glucose (FPG), homeostasis model assessment index of insulin resistance (HOMA-IR) and failed to improve quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment index of ß cell function (HOMA-ß) (P > 0.05). As reported in a trial, the side effect of VD was hypercalcemia. CONCLUSION: VD may have positive effects on patients with type 2 diabetes mellitus. However, the evidence is weak due to the general low methodological quality. Thus we have not made a reliable conclusion about the effects of VD for type 2 diabetes mellitus at the moment. Further larger, randomized, double-blind, placebo-controlled and multicenter trials are warranted.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Vitamina D/uso terapêutico , Glicemia , Humanos , Resistência à Insulina , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
13.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 728-33, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230749

RESUMO

Diabetic peripheral artery disease and diabetic foot ulcers are leading causes of hospitalization, for patients with diabetes mellitus, and also are the most important causes of amputation of the lower extremity in those patients, which contribute to the increased mortality and cardiovascular death. The incidence of diabetic peripheral artery disease and diabetic foot ulcers shows increasing trend. Diabetic peripheral artery disease and diabetic foot ulcers can be successfully treated only by the multidisciplinary foot-care services which provide more comprehensive and integrated care as compared to ordinary medical team or single specialist. Multidisciplinary foot-care services are provided by the team consist of: diabetologist, diabetes nurse, vascular surgeon, general surgeon, orthopedist, orthopaedic surgeon, podiatrist and orthotist, interventional radiologist and a radiology coordinator, microbiologist, psychologist, educators, shoemaker and rehabilitation team. Contrary to developed countries, multidisciplinary foot-care team has not been constructed in most centres in China. Diabetic education, appropriate foot care, early detection of risk factors of foot ulcers and early intervention are key components in the overall management of diabetic foot disorders and have assumed important roles in programs focused on amputation prevention. Prompt and aggressive treatments of diabetic peripheral artery disease and diabetic foot ulcers can often prevent an exacerbation of the problem and the potential need for amputation, which include correction of biomechanical abnormalities, infection control, serial debridement of ulcers, peripheral revascularization and wound coverage, etc. It is very important to construct a multidisciplinary diabetic foot care team to more effectively improve the survival and prognosis of patients with diabetic peripheral artery disease and diabetic foot ulcers with comprehensive treatments.


Assuntos
Angiopatias Diabéticas/terapia , Pé Diabético/terapia , Relações Interprofissionais , Doença Arterial Periférica/terapia , Angiopatias Diabéticas/prevenção & controle , Pé Diabético/prevenção & controle , Humanos , Doença Arterial Periférica/prevenção & controle
14.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 734-8, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230750

RESUMO

OBJECTIVE: To investigate the relationship between blood glucose fluctuations and carotid intima-media thickness (CIMT) in type 2 diabetic patients. METHODS: 64 patients with type 2 diabetes mellitus (T2DM) in the Department of Endocrinology and Metabolism, West China Hospital from July 2009 to March 2012 were recruited in this study. The CIMT were measured bilaterally with high-resolution ultrasonography. The glucose excursions were assessed by the following parameters obtained from the continuous glucose monitoring system (CGMS) for 72 h: mean blood glucose (MBG) and its standard deviation (SD), mean amplitude of glycemic excursion (MAGE), mean of daily differences (MODD). Glycosylated hemoglobin (HbAlc), triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-c), and low-density lipoprotein cholesterol (LDL-c) of the participants were also determined. According to the levels of CIMT, 64 diabetic patients were classified into two groups: diabetes mellitus without atherosclerosis (A group, n = 37) and diabetes mellitus with atherosclerosis (B group, n = 27). The relationship between the parameters of glycaemic variability and CIMT was examined. RESULTS: (1) There were no differences between A group and B group with regard to gender composition, course of diabetes, body mass index (BMI), diabetic chronic complications, family history of diabetes, smoking, alcohol drinking, diastolic blood pressure (DBP), TG, TC, HDL-c, SD and MAGE (P > 0.05). A group had younger age and lower levels of systolic blood pressure (SBP), LN(LDL-c) and LN (MODD) than B group (P < 0.05). (2) Pearson correlation analyses showed that CIMT was positively correlated with age (r = 0.370, P = 0.005), LN (LDL-c) (r = 0.325, P = 0.009), SD (r = 0.251, P = 0.045) and LN (MODD) (r = 0.346, P = 0.005). (3) Age, smoking, LN (LDL-c) and LN (MODD) were identified as predictors for CIMT in the multiple linear regression analysis. CONCLUSION: Glucose excursions may contribute to the development of atherosclerosis in patients with type 2 diabetes, which is independent from HbA1c levels.


Assuntos
Aterosclerose/complicações , Glicemia/análise , Espessura Intima-Media Carotídea/estatística & dados numéricos , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Artéria Carótida Primitiva/patologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Pessoa de Meia-Idade
15.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 743-6, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230752

RESUMO

OBJECTIVE: To investigate angiographical characteristics of carotid, vertebral, subclavian, and renal arteries in the type 2 diabetic patients with lower extremities peripheral arterial disease (LEPAD). METHODS: There were 104 type 2 diabetic patients with LEPAD recruited in this study, who received digital subtract arteriography (DSA). Ankle-brachial index (ABI) assessment was also performed in 50 participants. Dependent upon the stenosis degree of vertebral artery, subclavian artery and renal artery measured by DSA, the patients were divided into normal group (stenosis < or = 50%) or pathological group(stenosis > 50% or blocked lesions). The angiographic features of carotid, vertebral, subclavian, and renal arteries were analyzed and the relationship between arterial stenosis and ABI was explored. RESULTS: DSA results of 104 patients showed that the most common lesion in the arteries was plaque. The stenosis degrees of 51%-74% and 75%-99% were most commonly observed in renal artery, with incidence of 22.1% and 5.8%, respectively. Arterial occlusion was most commonly observed in vertebral artery, with incidence of 27.9%. The patients with stenosis or occlusion of arteries had lower ABI (P = 0.000), and the patients with stenosis or occlusion of vertebral and renal arteries also had lower ABI (P = 0.003 and 0.02, respectively), compared with those without stenosis. ABI < 0.9 indicated higher risk of stenosis or occlusion of vertebral and renal arteries (P = 0.008 and 0.047 respectively). Between the patients with subclavian arterial stenosis and those without this artery stenosis, there was no statistical significant difference observed in ABI level. CONCLUSION: Type 2 diabetic patients with LEPAD can affect multiple arteries, showing plaque formation, multi-segmental stenosis and occlusion of arteries. The patients with ABI < 0.9 have higher risk of multiple arterial stenosis or occlusion lesions.


Assuntos
Angiografia Digital , Artérias Carótidas/diagnóstico por imagem , Diabetes Mellitus Tipo 2/complicações , Doença Arterial Periférica/etiologia , Artéria Renal/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/diagnóstico por imagem , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Artéria Subclávia/diagnóstico por imagem
16.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 739-42, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230751

RESUMO

OBJECTIVE: To identify the ultrasound image characteristics of lower limb arteries in diabetic feet. METHODS: 189 patients with diabetic feet were recruited in this study. 375 lower limbs of the patients were classified into grade I-IV according to their Fontaine classifications and accepted Color Doppler Ultrasound examinations. Of the 375 lower limbs, 210 were classified as level I, 46 as level II, 43 as level III and 76 as level IV. The degree of artery stenosis was categorized into < or = 50% reduction in diameter, 51%-99% reduction in diameter and complete occlusion. The lesion characteristics of common femoral arteries, superficial femoral arteries, popliteal arteries, anterior tibial arteries, posterior tibial arteries, peroneal arteries and dorsalis pedis arteries were analyzed. The ultrasound scores of lower limbs arterial diseases were compared in the patients with different levels of Fontaine classifications. RESULTS: The incidence of plagues in lower extremities arteries was 97.60% (366/375). Most plaques (97.60%, 366/375) were distributed in crus arteries and the majority of plaques (59.47%, 223/375) were serious. The incidence of PAD was 63.73% (239/375). Crus vasculars involvement was more serious. The levels of Fontaine classifications of the lower limb arteries were associated with ultrasound vascular disease severity scores. The higher grade had higher scores. The lower limbs with at least one occlusive blood vessel in the patients with Fontaine grade I reached 30%. CONCLUSION: The Ultrasound image is an important screening tool for PAD in diabetic feet. It can estimate the type of plaques, the seriousness of artery diseases and the location of lesions. Because up to 30% diabetic feet with Fontaine I classifications have at least one occlusive blood vessel, the clinical manifestations do not provide enough evidence for the diagnosis of PAD.


Assuntos
Artérias/diagnóstico por imagem , Pé Diabético/diagnóstico por imagem , Extremidade Inferior/irrigação sanguínea , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Artéria Femoral/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagem , Artérias da Tíbia/diagnóstico por imagem , Ultrassonografia Doppler em Cores
17.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 747-51, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230753

RESUMO

OBJECTIVE: To document the effectiveness and patient experience of surgical treatment for diabetic lower limb arterial occlusion. METHODS: Out of 290 diabetic patients with lower limb arterial occlusion, 69 received by-pass operation because of severe stenosis below the abdominal aorta and severe ulcers in feet from April 2004 to April 2011. We reviewed the experience and outcome of the 69 diabetic patients who underwent surgical operations on lower limb arterial occlusion. RESULTS: 100% initial surgical success was achieved. The morbidity (excluding death) was 12.3% +/- 4.1% and 15.7% +/- 5.1% at 1 year and 3 years after operations, respectively. Five (7.2%) death cases were recorded, which resulted in a survival rate of 94.2% +/- 2.8% and 92.0% +/- 3.5% at 1 year and 3 years after operations, respectively. About 90.6% +/- 3.6% and 87.2% +/- 4.9% of patients had graft patency 1 year and 3 years after operations, respectively; and 6. 5% + 3. 1% had amputations. Four (5. 8%) patients developed graft thrombosis, in which 2 (2.9%) had amputations because of recurrence of thrombosis after thrombectomy. Two (2.9%) patients had amputations because of graft infection accompanied with graft resection operations. One (1.4%) patient received repeated arterialized operation on great saphenous vein because of popliteal artery occlusion, and obtained a good outcome within two years. One (1.4%) patient developed stomas false aneurysm, but the excision of the false aneurysm resulted in a good outcome in four years. CONCLUSION: Detailed pre-operation assessment, optimal selection of surgical procedure and perioperative management can help improve the outcome of diabetes and decrease amputation rate in patients with diabetic lower limb arterial occlusion.


Assuntos
Arteriopatias Oclusivas/cirurgia , Pé Diabético/cirurgia , Extremidade Inferior/irrigação sanguínea , Veia Safena/transplante , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Arteriopatias Oclusivas/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
18.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 752-6, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230754

RESUMO

OBJECTIVE: To identify the optimal protocol of MR contrast imaging in diabetic foot. METHODS: 20 patients with diabetic feet were enrolled and examined with 3D FLASH-MRA, 3D VIBE-WE, 2D SE-FS, 2D TSE-FS and 2D FLASH-FS at a 1.5T MR scanner for vascular changes in feet. Their effectiveness in displaying blood vessels, venous aliasing and articular cartilage, as well as the signal-to-noise ratio (SNR) and contrast ratio (CR) of plantar skins calcaneus, flexor digitorum brevis, dorsal artery, and talocalcaneal joint cartilage in diabetic feet were compared. RESULTS: (1) 3D FLASH-MRA was better in displaying blood vessels and venous aliasing than the others (P < 0.05); (2) 3D VIBE-WE was better in displaying articular cartilage than 2D SE-FS, 2D TSE-FS and 2D FLASH-FS (P < 0.05); (3) 3D VIBE-WE had higher SNR and CR of plantar skins, dorsal artery, talocalcaneal joint cartilage, calcaneus, and flexor digitorum brevis than the others (P < 0.05). CONCLUSION: 3D VIBE-WE is the preferred sequence for T1 weighted imaging with contrast in diabetic feet. It can also serve as the supplemental sequence of 3D FLASH-MRA in MR angiography.


Assuntos
Pé Diabético/diagnóstico , Aumento da Imagem/métodos , Imagem por Ressonância Magnética/métodos , Idoso , Meios de Contraste , Pé Diabético/patologia , Feminino , Humanos , Imagem Tridimensional/métodos , Masculino , Pessoa de Meia-Idade
19.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 757-61, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230755

RESUMO

OBJECTIVE: To investigate the dynamic changes of matrix metalloproteinase-1,-9 (MMP-1, MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1 ) in the refractory diabetic dermal ulcers treated with autologous platelet-rich gel (APG). METHODS: 86 patients with nonhealing diabetic dermal ulcers were randomly assigned to two groups treated with standard procedures and APG (standard care plus topic application of autologous platelet-rich gel). The granulation tissues were collected at d0, d3, d6, d9, and d15 in patients in the APG group and at d0, d6, d15 in patients in the standard care group. The areas of ulcers were measured. The protein levels of MMP-1, MMP-9 and TIMP-1 in the tissues were determined with ELISA. The ratio of MMP-9/TIMP-1 and its relationship with the areas of ulcers were examined. RESULTS: The areas of ulcers of patients in the APG group decreased significantely (vs. do, P < 0.05). The concentrations of MMP-1 in the granulation tissues of patients treated with APG fluctuated and reached the lowest level at d15 (vs. d6, P < 0.05). The concentrations of MMP-9 in the patients treated with AGP decreased from d3 to d15, but without statistical significance compared with d0 (P > 0.05). The concentrations of TIMP-1 in the patients treated with AGP increased from d3 and reached the peak at d6 (P < 0.05). The ratio of MMP-9/TIMP-1 at both d6 and d15 decreased significantly compared with d0 (P < 0.05) in the patients treated with AGP. The areas of ulcers in the patients with standard care decreased significantly at d15 (vs. d6, P < 0.05). The concentrations of MMP-1 reached the peak at d6 (P < 0.05) and then decreased in the patients with standard care but was still higher than the patients treated with APG (P < 0.05). The concentrations of MMP-9 decreased significantly at d15 compared with d0 in the patients treated with standard care (P < 0.05), but the change of TIMP-1 was not significant. The ratio of MMP-9/TIMP-1 in the patients with standard care decreased at d15 compared with the d0 (P < 0.05). The ratio of MMP-9/TIMP-1 was positively correlated with the areas of ulcers (r = 0.353, P < 0.05). CONCLUSION: Topical application of APG might redress the proteolytic imbalance of refractory diabetic dermal ulcers by decreasing the concentration of MMPs and increasing that of TIMPs in granulation tissues. The ratio of MMP-9/TIMP-1 is a predictor of poor healing of refractory diabetic dermal ulcers.


Assuntos
Colagenases/metabolismo , Complicações do Diabetes/terapia , Pé Diabético/terapia , Plasma Rico em Plaquetas , Úlcera Cutânea/terapia , Adulto , Idoso , Complicações do Diabetes/metabolismo , Pé Diabético/metabolismo , Feminino , Géis , Tecido de Granulação/metabolismo , Humanos , Masculino , Metaloproteinase 1 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Pessoa de Meia-Idade , Transfusão de Plaquetas/métodos , Úlcera Cutânea/etiologia , Úlcera Cutânea/metabolismo , Inibidor Tecidual de Metaloproteinase-1/metabolismo , Cicatrização
20.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 43(5): 762-5, 2012 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-23230756

RESUMO

OBJECTIVE: To evaluate the potential financial benefit of topical application of autologous platelet-rich gel (APG) in treating diabetic refractory cutaneous ulcers. METHODS: A single-center prospective randomized controlled trial was undertaken, with 117 patients with proven diabetic refractory cutaneous ulcers participating in the study. The patients who gave informed consents were randomly assigned into standard care group (n = 58) or standard care plus topical application of APG treatment group (n = 59). The outcome of healing and the medical expenditur and length of stay in the patients were compared between the two groups. RESULTS: The APG-treated group had better healing outcomes than the standard-treated group. The APG-treated group had 84.750 (50/59) complete healing and 98.31% improvement, higher than the 68.97% (40/58) and 75.86%, respectively, in the standard-treated group (P = 0.026). The median length for healing in the APG-treated patients was 36 days, shorter than the 45 days in the standard-treated patients (P = 0.012). The total medical expenditure and length of stay in hospitals were not significantly different between APG-treated patients [yen 38223 (23070-57398); 57 (41-94) days] and standard-treated patients [yen 35070 (24436-53649); 58 (31.75-58.50) days) (P = 0.455 and 0.301 respectively). Spendings on items such as medicine, artificial treatment, materials, interventional operation, surgical procedures, laboratory tests and other auxiliary examination, accommodations, meals, nursing care and debridement and dressing change were similar between the two groups (P > 0.05). CONCLUSION: There is an advantage for the topical application of APG on diabetic refractory cutaneous ulcers in terms of the healing outcomes. APG is a cost-effective choice for patients with diabetic refractory cutaneous ulcers.


Assuntos
Complicações do Diabetes/terapia , Pé Diabético/economia , Hospitalização/estatística & dados numéricos , Plasma Rico em Plaquetas , Úlcera Cutânea/economia , Administração Cutânea , Adulto , Idoso , Complicações do Diabetes/metabolismo , Pé Diabético/metabolismo , Pé Diabético/terapia , Feminino , Géis/economia , Custos Hospitalares , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Transfusão de Plaquetas/métodos , Plasma Rico em Plaquetas/fisiologia , Estudos Prospectivos , Úlcera Cutânea/etiologia , Úlcera Cutânea/terapia , Cicatrização
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