Objective To explore the correlation between overweight, obesity and incidence of type 2 diabetes mellitus (T2DM). Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 3, 2012), CNKI, VIP, CBM and WanFang Data were searched from inception to May, 2012 to collect the cohort studies on the correlation between overweight, obesity and incidence of T2DM. The studies were screened according to the inclusion and exclusion criteria by two researchers independently, the quality was evaluated, the data were extracted, and then meta-analysis was performed using RevMan 5.1 and Stata 11.0 software. Results A total of 8 studies involving 101 864 participants were included. The results of meta-analysis showed that, compared with the normal weight population, the onset risk of T2DM was obviously higher in the overweight (RR=2.59, 95%CI 2.11 to 3.19, Plt;0.000 01), and obese (RR=6.28, 95%CI 4.99 to 7.91, Plt;0.000 01) populations. In the subgroup analysis, the onset risk of T2DM was higher in the western obese population (RR=6.91, 95%CI 5.59 to 8.56) than the eastern obese population (RR=4.19, 95%CI 2.93 to 5.99). Based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE), the quality of the included studies on T2DM developed by overweight and obesity was low and medium respectively. Conclusion Overweight and obesity can increase the onset risk of T2DM which is higher in the female and western obese populations than the male and eastern obese populations respectively.
Objective To evaluate the effects of saxagliptin on β cell function of type 2 diabetic patients. Methods The Cochrane Library, PubMed, EMbase, CBM, VIP, and CNKI were searched from their establishment to November, 2011, for relevant randomized controlled trials on the effects of saxagliptin on β cell function in type 2 diabetic patients. Language was limited to Chinese and English only. Two reviewers independently screened the literature according to the inclusion and exclusion criteria, extracted the data, and evaluated and cross-checked the methodological quality. Then meta-analysis was conducted using RevMan 5.0 software. Results Five RCTs were included. The results of meta-analysis showed that: HOMA-B was significantly increased in the saxagliptin (or saxagliptin plus routine treatment) 2.5 mg, 5 mg, and 10 mg groups (MD=8.03, 95%CI 4.57 to 11.48, Plt;0.000 01; MD=7.50, 95%CI 4.27 to 10.73, Plt;0.000 01; MD=17.45, 95%CI 13.93 to 20.97, Plt;0.000 01); HOMA-IR was similar between saxagliptin 2.5 or 10 mg group, and control group (MD= –0.05, 95%CI –0.18 to 0.08, P=0.47; MD= –0.18, 95%CI –0.60 to 0.24, P=0.4). Conclusion Current evidence shows that saxagliptin is effective in improving β cell function and insulin resistance. Due to short follow-up and small sample size, this conclusion has to be further proved by more high-quality RCTs.
Objective To investigate the current situation of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) in Sichuan province, and to analyze the influencing factors of SMBG, so as to provide evidence for improving the level of SMBG. Methods By the convenience sampling method, 410 patients with T2DM for more than 1 year were selected from 17 hospitals and community health service centers in 7 cities across Sichuan province, and their SMBG was investigated with a questionnaire. Results Among 410 eligible patients, the average frequency of SMBG was 7.3 times per month. There were 268 patients (65.4%) performed SMBG less than 4 times per month, 94 (22.9%) performed 4-15 times per month, 29 (7.1%) performed 6-29 times per month, and 19 (4.6%) performed over 30 times per month. Just 234 patients (57.1%) monitored the HbA1c in the past 6 months. FPG, 2-hour PPG and HbA1c were negatively correlated with the frequency of SMBG. The influencing factors of SMBG were insulin treatment and education. Conlusion The SMBG status in D2TM patients is relatively poor in Sichuan province, and the compliance of SMBG is expected to be improved by enhancing diabetic education.
Objective To assess the effects and safety of sitagliptin combined with metformin in treating type 2 diabetes mellitus. Methods The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM were searched to collect the randomized controlled trials (RCTs) on sitagliptin combined with metformin in treating Type 2 diabetes mellitus (T2DM) from inception to November, 2012. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results 7 RCTs involving 2 917 patients were included. The results of meta-analysis showed that, compared with metformin alone, sitagliptin combined with metformin effectively improved HbA1c levels (WMD= –0.62%, 95%CI –0.76 to –0.47, Plt;0.000 1) and fasting plasma glucose levels (WMD= –0.7 mmol/L, 95%CI –1.03 to –0.37, Plt;0.000 01), and increased insulin sensitivity and β-cell function. But there was no significant difference between the two groups in the incidences of gastrointestinal reactions and hypoglycemia. Conclusion Compared with using metformin alone, sitagliptin combined with metformin can improve glycemic control, enhance insulin sensitivity and better β-cell function more effectively and both have a similar effect on weight lose, but there is no significant difference he incidences of gastrointestinal reactions and hypoglycemia. The above conclusion should be verified by more large-scale high-quality studies in future due to the limitations of the methodological quality and sample size of the included studies.
Objective To systematically review the effectiveness of empowerment education in patients with type 2 diabetes. Methods Databases including The Cochrane Library (Issue 12, 2012), PubMed, Ovid, EMbase, Web of Science, CNKI, WanFang Data, VIP, CBM, digital journals of the Chinese Medical Association and Google Scholar were electronically searched for the randomized controlled trials (RCTs) on empowerment education in patients with type 2 diabetes from inception to January 2013. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.2 software. Results A total of seven RCTs involving 749 Type 2 diabetic patients were finally included. The results of meta-analysis showed that, compared with the control group, the empowerment education group was better in decreasing HbA1c levels, with a significant difference (MD= –0.27, 95%CI –0.51 to –0.03, P=0.03), but no significant difference was found between the two groups in improving body mass index (BMI) (MD= 0.25, 95%CI –1.07 to 1.57, P=0.71). Conclusion The program of empowerment education could improve HbA1c levels of diabetic patients, patients’ knowledge and illness attitudes on diabetes mellitus, but its influence on patients’ BMI, LDL and self-efficacy is still unclear.
Objective To assess the effectiveness of intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer. Methods We electronically searched CENTRAL (Issue 1, 2013), PubMed (1978-2013), EMbase (1978-2013), VIP (1989-2013) and WanFang Data (1980-2013), hand-searched correlated proceedings and retrieved the references of included studies, for the randomized controlled trials on intensive versus routine education on diabetes mellitus for preventing diabetic foot ulcer all over the world. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. Results Twelve trials involving 1 841 patients were finally included. The results of meta-analysis showed that: a) the incidence of diabetic foot ulcer in the intensive education group was lower than the routine group, with a significant difference (RR=0.51, 95%CI 0.30 to 0.84, P=0.008); b) two groups were alike in the amputation rate, with no significant difference (OR=0.54, 95%CI 0.17 to 1.67, P=0.28); and c) the score of knowledge on diabetes mellitus was higher in the intensive education group than in the routine education group, with a significant difference (MD=7.32, 95%CI 3.57 to 11.06, P=0.000 1). Conclusion Current evidence shows that: compared with routine education, intensive education could reduce the incidence of diabetic foot ulcer effectively. However, the above conclusion should be verified by conducting more high quality studies.
Due to the complexity of etiology and a lot of complication of diabetes mllitus, the reliable conclusion of studies of etiology and treatment of diabtets mellitus should rely on randomized controlled trial and systematic review. Alongside the development of meta-analysis, systematic reviewes have provided many beneficial information, including gene mutation and diabetes mellitus, evaluation of risk factors, diagnostic test and treatment of diabets mellitus.
Objective To explore the effect and mechanism of sleeve gastrectomy （SG） for type 2 diabetes mellitus （T2DM） in Goto-Kakizaki （GK） rats. Methods Thirteen male GK rats at 12 weeks of age were randomly divided into SG group （n=7） and sham operation group （SO group， n=6）， receiving SG surgery and sham operation respectively.Body weight， food intake in 24hours， fasting plasma glucose， plasma glucagon-like peptide-1 （GLP-1）， and plasma Ghrelin of rats in 2 groups were measured or tested before operation， 1， 4， 10， and 26 weeks after operation. In 10 weeks after operation， fecal energy content of rats in 2 groups was tested， in addition， oral glucose tolerance test （OGTT） and insulin tolerance test （ITT） were performed to investigate the glucose tolerance and insulin sensitivity. Results ①Body weight：there were no significant difference on body weight between the 2 groups （P＞0.05）. Compared with time point of before operation， the body weight of both 2 groups decreased in 1 week after operation （P＜0.01）， but increased in 10 weeks and 26 weeks （P＜0.01）. ②Food intake in 24 hours：compared with SO group， the food intake of SG group were lower in 4 weeks and 10 weeks after operation （P＜0.05）. Compared with time point of before operation， the food intake of SG group were lower in 1， 4， and 10 weeks after operation （P＜0.05）， but lower only in 1 week in SO group （P＜0.05）. ③Value of fasting glucose：compared with SO group， the value of fasting glucose in SG group were lower after operation （P＜0.01）. Compared with time point of before operation， the value of fasting glucose of SG group were lower after operation （P＜0.01）， but decreased in 1 week only in SO group （P＜0.01）. ④Level of serum GLP-1：compared with SO group， the levels of serum GLP-1 in SG group were higher in 4， 10， and 26 weeks after operation （P＜0.05）. Compared with time point of before operation， the levels of serum GLP-1 in SG group were higher in 4， 10， and 26 weeks after operation （P＜0.05）， but levels of serum GLP-1 in SO group didn’t change significantly （P＞0.05）. ⑤Level of serum Ghrelin：compared with SO group， the levels of serum Ghrelin in SG group were lower at alltime points after operation （P＜0.01）. Compared with time point of before operation， the levels of serum Ghrelin in SGgroup were lower at all time points after operation （P＜0.001）， but levels of serum Ghrelin in SO group didn’t change significantly （P＞0.05）. ⑥Areas under curves （AUC）：the AUC of OGTT and ITT test in SG group were both lower than those of SO group （P＜0.01）. Conclusion SG surgery can induce the level of fasting plasma glucose， and canimprove glucose tolerance and insulin sensitivity with significant changes of levels of plasma GLP-1 and Ghrelin， sugg-esting that SG surgery may be a potential strategy to treat patient with T2DM but without obesity or insulin resistance.
Objectives To summarize the regulation of glucagon-like peptide-1（GLP-1） level by metabolism of gastrointestinal nutrients. Methods Domestic and international publications online involving regulation of GLP-1 level by metabolism of gastrointestinal nutrients in recent years were collected and reviewed. Results GLP-1 influenced insulin secretion and sensitivity， and played a leading role in recovery of glucose metabolism. Metabolism of gastrointestinal nutrients regulated GLP-1 level. Studies had shown that GLP-1 was a candidate mediator of the effects of gastric bypass （GBP） for type 2 diabetes mellitus（T2DM）. Conclusions It plays an important role in anti-T2DM effects of GBP that metabolism of gastrointestinal nutrients regulated GLP-1 level. The corresponding studies can provide a novel clinical field to treat T2DM.
Objective To investigate the short term and long term effects of laparoscopic gastric bypass on obesity related type 2 diabetes. Methods Twenty obese patients with type 2 diabetes underwent laparoscopic gastric bypass between Nov. 2009 and Feb. 2012 were identified in the computer database of West China Hospital of Sichuan University. All patients had short term follow-up of less than 1 year and among them 11 were with long term follow-up of 1 year or more. Body weight， body mass index （BMI）， blood glucose， glycosylated hemoglobin （HbA1c）， homeostasis model assessment of insulin resistance-insulin resistance （HOMA-IR）， blood pressure， and blood lipids were examined. Short term （＜1 year） and long term （≥1 year） remission rates of diabetes were calculated and factors which might have effects on the remission of diabetes were analyzed. Results Of patients with short term follow-up，body weight， fasting plasma glucose （FPG）， 2h plasma glucose （2hPG）， HbA1c， and HOMA-IR were reduced significantly. Among them， 18 of 20 patients （90.0%） reached the glucose and medication standards of complete remission and partial remission， 9 patients were defined as completely remitted （9/20， 45.0%）. Those accompanied with hypertension and （or） hyperlipemia were all improved clinically. The duration of diabetes， fasting and 2 h C peptide were found to be related to short term diabetes remission. Patients with long term follow-up of 1 year or more were observed to have significant reductions in body weight， FPG， 2hPG， HbA1c， and HOMA-IR as well. Hypertension and hyperlipidemia were all well controlled. The remission rate of diabetes reached 9/11 （81.8%）and those who were defined as completely remitted took a proportion of 6/11 （54.5%）. In these patients， those who did not reach the standards of complete remission had longer duration of diabetes and higher FPG when compared with those who did. No severe adverse event was found during the follow-up in either group. Most patients investigated were satisfied with the surgery.Conclusion Laparoscopic gastric bypass is effective and safe on short term and long term treatment of obesity related type 2 diabetes.