Objective To assess the effectiveness of bariatric surgery for obese type 2 diabetes mellitus (T2DM) in Mainland China. Methods Such databases as the Cochrane Central Register of Controlled Trials (Issue 2, 2012), MEDLINE (1990 to February 2012), EMbase (1990 to February 2012), CBM (1990 to February 2012), CNKI (1990 to February 2012), WanFang Data (1999 to February 2012) and VIP (1996 to February 2012) were searched, and the references of the included literature were also retrieved. The studies were screened according to the predefined inclusion and exclusion criteria, the data were extracted, the quality was evaluated, and then the meta-analysis was performed using RevMan 5.2 software. Results A total of 6 controlled before-and-after studies involving 100 patients were included. The overall quality of all literature was as low as grade C. The results of meta-analysis showed that the following indexes after operation obviously decreased than before: 1-month postoperative fasting plasma glucose (MD= –2.27, 95%CI ?4.12 to ?0.42, P=0.02), 6-month postoperative fasting plasma glucose (MD= ?2.73, 95%CI ?2.91 to 2.56, Plt;0.000 01), and 6-month postoperative glycated hemoglobin (SMD= ?1.97, 95%CI ?2.98 to ?0.96, P=0.000 1), and the differences were statistically significant. The sensitivity analysis indicated the results of meta-analysis were credible and stable, but the funnel-plot analysis displayed publication bias might exist in the included studies. Conclusion Current studies show that bariatric surgery is effective for obese T2DM patients in mainland China. However, due to small sample size and low methodological quality of the included studies, its effect has to be proved by high quality, large sample, and long follow-up studies.
Objective To systematically evaluate the correlation between type 2 diabetes mellitus (T2DM) in Chinese population and K121Q polymorphism in exon-4 of plasma cell glycoprotrin-1 (PC-1) gene. Methods The following databases such as CNKI, VIP, CBM, PubMed, EMbase, The Cochrane Library (Issue 3, 2012) and WanFang Data were searched to collect case-control studies on the correlation between T2DM and K121Q polymorphism in exon-4 of PC-1 gene. The retrieval time was from 1980 to 2012. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data and assessed the quality. Then the meta-analysis was conducted by using RevMan 5.0 and Stata 12.0 software, and the publication bias was analyzed by means of Egger’s linear regression. Results A total of 11 studies involving 1 637 T2DM patients and 1 730 healthy volunteers were included. The results of meta-analyses showed that, for Chinese population, the risk of T2DM was higher in those with K/Q genotype than K/K genotype (OR=1.84, 95%CI 1.19 to 2.85, P=0.006), in Q/Q+K/Q genotype than K/K genotype (OR=1.92, 95%CI 1.18 to 3.14, P=0.009), and also in allele Q than allele K (OR=1.83, 95%CI 1.16 to 2.89, P=0.010). Conclusion The K121Q polymorphism in exon-4 of PC-1 gene in Chinese population is significantly associated with T2DM. For the quantity and quality limitation of the included studies, this conclusion has to be further proved by more studies.
Objective To investigate the association between costs of hospitalized patients with diabetes mellitus and their complications in the West China Hospital of Sichuan University, so as to provide baseline data for further research. Methods We extracted the hospitalization case data of hospitalized patients with diabetes mellitus who were discharged from the department of endocrinology and metabolism, or discharged after being transferred to other departments for treatment from January 2011 to December 2012, using the hospital information system (HIS) of the West China Hospital of Sichuan University. The data included baseline of hospital patients, discharge diagnosis, hospitalization costs, and if their medical insurance had been registered in hospital. Then, we classified the diseases according to ICD-10 based on discharge diagnosis, coped the data using Excel 2010 software, and conducted statistical analysis using SPSS 13.0. Results a) In 2011, acute and chronic diabetes complication in diabetes inpatients were 11.9% (166/1 396) and 67.1% (930/1 396), respectively. Most of them had peripheral neuropathy and peripheral vascular disease. b) The most frequently-occurred complications were hypertension, followed by dyslipidemia, and osteoporosis. c) The median hospital stay was 13 days (7 to 9 days), and the median total cost of hospital/person-time was 6 578.88 yuan (4 186.93 to 10 953.89 yuan). d) The total cost and duration of hospitalization increased along with the increasing number of the chronic complications of diabetes. e) The diabetic foot patients were 255 person-times, the median duration of hospitalization was 18 days (13 to 29 days), and the median total cost of hospital/person-time was 16 672.19 yuan (10 903.93 to 28 530.37 yuan). Diabetes patients with foot complication had higher total costs and longer duration of hospitalization than those without foot complication. Conclusion Diabetes mellitus is one of the most important diseases in the department of endocrinology and metabolism, which is heavy disease burden. The costs of hospitalization and chronic complications are closely associated. Among these complications, diabetic foot is the heaviest disease burden.
Objective To systematically review the methodological quality of guidelines concerning pharmacological intervention for complicated hypertension. Methods The databases and relevant guideline websites such as MEDLINE, EMbase, CBM, WangFang Data, National Guideline Clearinghouse (NGC), Guidelines International Network (GIN), National Institute for Health and Clinical Excellence (NICE) and Clinical Practice Guideline Network (CPGN) were searched to collect the clinical guidelines concerning pharmacological intervention for complicated hypertension. By adopting the Appraisal of Guidelines for Research and Evaluation (AGREE), the methodological quality of guidelines was assessed. Meanwhile the similarities, differences and features of drug recommendation in guidelines for different areas and diseases were analyzed by means of analogy comparison.Results A total of 21 guidelines concerning pharmacological intervention for complicated hypertension were included. The number of guidelines concerning hypertension complicated with coronary heart disease (CHD), stroke, diabetes mellitus (DM) and kidney disease (KD) was 5, 5, 7 and 4, respectively. The publication year ranged from 2000 to 2011. According to the AGREE instrument, 19 and 2 guidelines were graded as Level B and C, respectively. The overall guidelines got low average scores in the domain of “Stakeholder involvement” and “Applicability”, including 9 evidence-based guidelines. There were totally 4 and 3 classes in terms of the level of evidence and recommendation, respectively; moreover, 10 and 6 expression forms were adopted in the level of evidence and recommendation, respectively. For hypertension with angina pectoris, -blocker (BB) and calcium channel blocker (CCB) were recommended unanimously. For hypertension with myocardial infarction, angiotensin converting enzyme inhibitor (ACEI) and BB were recommended unanimously. For hypertension with heart failure, ACEI, angiotensin-receptor blocker (ARB) and BB were recommended unanimously. For hypertension with later stage of post-stroke, 76.47% guidelines recommended diuretic (D) and ACEI. For hypertension with acute stroke, recommendations were mainly based on the guidelines developed by American Heart Association/American Stroke Association (AHA/ASA). For hypertension with DM or KD, the guidelines basically recommended that systolic/diastolic pressure should be controlled in the range of less than 130/80 mmHg. For hypertension with DM, ACEI were recommended unanimously, followed by D and CCB. For hypertension with KD, ACEI/ARB was recommended, while 3 of the 5 guidelines recommending CCB were from Asian. Conclusion The overall methodological qualities of complicated hypertension guidelines differs, with high proportion of evidence-based guidelines. The classification criteria of the levels of evidence and recommendation are still suboptimal. For hypertension with CHD, DM, KD and later stage of stroke, results from high quality clinical evidence are consistent, and the recommendations are basically unanimous, with no regional and quality difference. But in some clinical researches beyond reaching a consensus at present, the recommendation discrepancy exists, and there still remains controversy for hypertension with acute stroke.
Objective To explore the situation and causes of misdiagnosed hypoglycemia in China so as to develop some strategies for reducing misdiagnosis.Methods We searched CBMdisc, CMCC, CJFD and VIP (Jan. 1994-Dec. 2003). All the publisled studies about the misdiagnosis of hypoglycemia were collected to analyse their classifications and causes.Results A total of 172 studies involving 1 478 patients met the inclusion criteria. The studies were either case reports or clinical reviews. The 1 478 cases were misdiagnosed as 31 sorts of diseases, mainly including stroke (71.18%), transient ischemia attack (4.87%), epilepsy (4.13%) and hepatic coma (2.64%) . The causes of misdiagnosis could be classified into 14 categories, including complex manifestations of hypoglycemia (29.07%), lack of knowledge of hypoglycemic encephalopathy (16.44%), insufficient medical history collection (10.21%) and interference of compound diseases (9.86%) etc..Conclusions The misdiagnosis of hypoglycemia is mainly caused by the poor professional skills of doctors or their lack of responsibility, and poor patient management, especially when hypoglycemia are manifested by brain disability.
Objective To investigate the effect of constitutively active Akt1 gene on rat engrafted islets in apoptosis and revascularization, and to explore potential method of gene therapy in the islet transplantation. Methods Rat islet which was transfected constitutively actived Akt1 gene via adenovirus vector using MOI=500. Thirty-six streptozotocin induced diabetic Wistar rats were divided into 3 groups complete randomly: Adv-CA-Akt1 group, Adv-LacZ group and simple transplantation group. Blood glucose and insulin were determined after operation. TUNEL was used to detect the apoptotic islet cells. HE and immunohistochemical staining of insulin were used to evaluate the histology of the islet grafts. The microvessel density (MVD) was determined by CD31 immunohistochemical staining. Results The fasting glucose level in Adv-CA-Akt1 group restored to normal 2 days after transplantation. However, in Adv-LacZ group and simple transplantation group, it reduced but still kept being hyperglycemia. And the serum insulin level was higher than other two groups ( P ＜ 0.05). Compared to simple transplantation group and Adv-LacZ group, apoptotic rate decreased 25% in Adv-CA-Akt1 group, a large number of islet grafts were seen under the capsule of the kidney, which were positively stained by insulin antibody. In the other two groups, the islet groups mass were lighter, and few positively stained by insulin antibody. MVD showed lighter positive endothelial cells stained by CD31 antibody in the other two groups than Adv-CA-Akt1 group ( P ＜ 0.05). Conclusion Constitutively activate Akt1 gene can prolong graft survival during early posttransplant period, and can accelerate the revascularization of islet grafts effectively.
Objective To investigate pathogenesy and therapeutic prospect of diabetes mellitus accompanied lower limb vascular lesion. Methods Relevant literatures of recent years were reviewed. Results Diabetes mellitus is one of the main risk factor causing peripheral artery disease. The site of vascular lesion often occur in major blood vessel and micrangium. The arterial sclerosis and decreased blood supply in microcirculation are important factors of lower limb ischemia. Lower limb ischemia in patients with diabetes mellitus is a common complication. Medical treatment and surgical treatment are the methods to improve symptoms of the complication. Conclusion Surgical therapy is an effective method for the treatment of diabetes mellitus accompanied lower limb vascular lesion.
Abstract： Objective To evaluate clinical outcomes of endoscopic vein harvesting （EVH）for coronary artery bypass grafting（CABG） in diabetic patients. Methods In this prospective non-randomized control study, patients with type 2 diabetes who underwent CABG from December 2010 to Febuary 2012 in West China Hospital were enrolled. Based on different vein graft harvesting technique, these patients were divided into two groups: an EVH group and a conventional vein harvesting（CVH）group. Perioperative complications were compared between the two groups. Interventional or CT coronary angiogram was used to evaluate bypass graft patency during follow-up. Results A total of 51 patients with type 2 diabetes were enrolled in this study with 24 patients in the EVH group and 27 patients in the CVH group. There was no statistical difference in age, weight, and comorbidities between the two groups. There was no statistical difference in cardiopulmonary bypass time and aortic cross-clamping time between the two groups （67.2±9.8 min versus 68.3±14.5 min, P＞0.05; 62.4±11.3 min versus 65.2±10.3 min, P＞ 0.05）. The vein graft harvesting time （35.6±6.4 min versus 45.2±11.4 min, P＜ 0.05）and rate of delayed leg wound healing（0.0% with 0/24 versus 18.5% with 5/27, P＜0.05） of the EVH group were significantly shorter or lower than those of CVH group.There was no statistical difference in major postoperative complications with respect to venous graft failure rate and chest pain during short term follow-up（9.1 months in the CVH group and 9.4 months in the EVH group） between the two groups. Conclusion EVH is a safe, effective, minimally invasive and quick vein graft harvesting technique for CABG in diabetic patients.
Abstract： Objective To study the difference of gene expression profile of bone marrow mesenchymal stem cells （MSCs） cultured in vitro from coronary heart disease patient with or without diabetes mellitus by Affymetrix Gene array. Methods One male patient at age of 53 years with coronary heart disease and diabetes mellitus was included in this study with the diagnosis of coronary heart disease and type 2 diabetes mellitus. Another male patient at age of 51 years with coronary heart disease without diabetes mellitus was also included in this study with the diagnosis of coronary heart disease. MSCs of the two patients were isolated and purified by the methods of density gradient centrifugation with lymphocyte separation medium for human and adherent filtration. The MSCs expression profile of cytokines and signal transduction genes were examined by Affymetrix gene array. Results There were 27 functional protein genes expression in the patient with coronary heart disease and diabetes mellitus relating to cell apoptosis, cytokine, and signal transduction. Among them, the expression of 13 functional genes, including TNFRSF10B, TNFRSF21, NGF, CAV2, ITGA8, TNS1, ITGA2, AKT3, MBP, MAP2, INHBA, FST, PLA2G5, increased significantly in the patient with coronary heart disease and diabetes mellitus. However, the expression level of 14 genes, including EPR1, BIRC5, HELLS, BCL2, HGF, CASP1, SEPP1, ITGA9, MAP2K6, RUNX3, TGFBR2, RUNX2, CTNNB1, CDC42, decreased significantly. Conclusion The gene expression profile of bone marrow MSCs from coronary heart disease patient with diabetes mellitus is significantly different from the patient with coronary heart disease patient without diabetes mellitus.
Objective To explore the impact of diabetes on coronary artery bypass grafting （CABG） in clinical representations, operative morbidity and mortality in this hospital. Methods Data was collected as a part of prospective registry of CABG through Sep. 2001 to Jul. 2003. Four hundreds and eighty-two patients were recruited. They were divided into diabetic group （n= 135） and non-diabetic group （n=347） depended on if the patients with diabetes or not. All patients were treated with insulin for hyperglycemia. Clinical representations, operative morbidity and mortality in this hospital between two groups were compared by using chi-square tests, t tests and logistic regression. Results Re-exploration in diabetic group was higher than that in non-diabetic group （4.4% vs. 0. 9%; x2= 6. 769, P = 0. 009）. There was no significant difference in the operative morbidity and mortality in hospital between two groups. Multi-variance logistic regression showed that the lower left ventricular ejection fraction （〈 0. 40,OR 15.96）, re-exploration （OR 32. 77） and re-intubation （OR 124.17） were the predictors of perioperative mortality in hospital. Conclusions There are no significant difference in the operative mortality and complication between patients with diabetes and patients with non-diabetes. Strict glucose control in perioperative period would reduce hospital mortality and morbidity.