摘要:目的:了解糖尿病患者胰岛素泵强化治疗的护理特点并观察其疗效。方法:对158例糖尿病胰岛素泵治疗的患者进行心理、技术等综合护理。结果:158例患者用胰岛素泵强化治疗后血糖控制良好,生活质量明显提高。结论:胰岛素泵在强化治疗糖尿病方面提供了前所未有的安全、可靠、方便及灵活性,是强化治疗的最佳手段。综合护理是胰岛素泵强化治疗的保障。Abstract: Objective: To understand the insulin pump treatment of diabetes care characteristics and observe the effect. Methods: 158 patients with diabetes insulin pump therapy in patients with psychological, technology and other comprehensive care. Results: 158 patients were treated with insulin pump therapy a good blood sugar control and quality of life improved markedly. Conclusion: The diabetic insulin pump in intensive therapy has provided an unprecedented security, reliability, convenience and flexibility, is to strengthen the best means of treatment. Integrated care is the protection of insulin pump therapy.
Objective?To compare the effect of continuous subcutaneous insulin infusion (CSII) with that of multiple daily insulin injections (MDI) in the patients with newly-diagnosed type 2 diabetes, and to provide evidence for clinical treatment. Methods?We searched MEDLINE and Chinese Science and Technology Full-text Database up to Dec. 2009 to identify randomized controlled trials (RCTs) that had been conducted with patients with newly diagnosed type 2 diabetes mellitus. The selection of studies, data extraction and assessment of methodological quality were performed independently by two reviewers. Meta-analyses were performed using RevMan 5.0.23 software. The following outcomes were assessed: glycaemic control, insulin requirements, HOMA-IR, HOMA-β, hypoglycaemia and diabetic remission after follow-up. Results?Eight RCTs involving 597 newly-diagnosed type 2 diabetic patients were included. The methodological quality of the most studies was lower. The funnel plot comparing insulin requirement of CSII therapy with that of MDI therapy showed asymmetry, indicating that there was publication bias. The results of meta-analyses showed that: CSII had the same effect on improving fasting blood glucose (WMD= –0.21, 95%CI –0.42 to 0.00, P=0.05) and postprandial blood glucose (WMD= –0.24, 95CI% –0.57 to 0.08, P=0.14) as MDI in newly-diagnosed type 2 diabetes. CSII therapy took 2.74 days fewer than MDI therapy (WMD= –2.74, 95CI% –3.33 to –2.16, Plt;0.000 01) and needed lower insulin requirements (reducing 7.78 units per day) (WMD= –7.78, 95CI% –9.25 to –6.31, Plt;0.000 01) to get target glucose control. The rate of hypoglycaemia of CSII therapy decreased 69% (OR= 0.31, 95%CI 0.12 to 0.80, P=0.01) compared with that of MDI. The rate of diabetes remission after short-term intensive insulin therapy increased 46% (OR=1.46, 95%CI 1.01 to 2.10, P=0.04) in CSII therapy compared with that in MDI therapy. Conclusion?In newly-diagnosed type 2 diabetes, CSII therapy is better than MDI therapy. But because of the low quality of the included studies, the conclusion should be combined with patients and physicians’ experience, advantages and disadvantages in the clinical application.
Objective To detect the difference of the light sensitivity in the central visual field between normal people and type Ⅱ diabetic patients without diabetic retinopathy, and evaluate the effect of perimetric examination in early diagnosis of diabetic retinopathy. Methods The light sensitivity at the 80 locations in the central field was measured by Dicon field analyzer (model TKS-4000) in 76 normal eyes of 44 normal volunteers aged from 45 to 72 years and 75 eyes of 40 type Ⅱ diabetic patients without retinopathy aged from 46 to 71 years. Results For the diabetic patients without diabetic retinopathy, the light sensitivity of locations decreased by 4-8 dB,and there were some decreased light sensitivity areas. The mean light sensitivity of three zones of the central field had significant reduction in the diabetic patients as compared with the control group(Plt;0.001). Conclusion The retinal neurosensory function of diabetic patients is damaged in some degrees before diabetic retinopathy occured, and no relationship is found between the decrease of retinal light sensitivity and localized blood-retinal barrier leakage. It is suggested that examination of central field with computerized perimetry has certain clinical significance in early diagnosis of diabetic retinopathy. (Chin J Ocul Fundus Dis, 2002, 18: 218-220)
Exercise is vital for diabetics to improve their blood glucose level. However, the quantitative relationship between exercise modes (including types, intensity, time, etc.) and the blood glucose is still not clear. In order to answer these questions, this paper established a blood glucose metabolic model based on ordinary differential equation method. Furthermore, a silico method was adopted to study the effects of different aerobic exercise intensities (light, moderate and vigorous) on blood glucose and optimal strategies of insulin infusion for type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). Additionally, the universality of proposed model and insulin infusion strategies was verified based on 1 000 virtual diabetes patients’ simulation. The experimental results showed that: (1) Vigorous-intensity aerobic exercise may result in hypoglycemia (< 3.89 mmol/L), which was so harmful to health that diabetics should avoid. Compared with moderate-intensity exercise, the light-intensity aerobic exercise intuitively lowered blood glucose slowly and caused a relative long high-blood-glucose (> 6.11 mmol/L) period, however, its overall blood glucose risk index (BGRI) was lower. (2) Insulin dosage of the optimized strategies decreased by 50% and 84% for T1DM and T2DM when they did moderate intensity exercise. As for light intensity exercise, the dosage of insulin was almost the same as they didn’t do exercise, but BGRI decreased significantly. (3) The simulations of 1 000 virtual diabetic patients manifested that the proposed model and the insulin infusion strategies had good universality. The results of this study can not only help to improve the quantitative understanding about the effects of aerobic exercise on blood glucose of diabetic patients, but also contribute to the regulation and management of blood glucose in exercise mode.
Objective To construct, validate and evaluate a nomogram prediction model based on triglyceride-glucose index for predicting the risk of type 2 diabetes mellitus (T2DM) in patients with obstructive sleep apnea (OSA). Methods A total of 414 patients diagnosed with OSA who were hospitalized in the Second Affiliated Hospital of Kunming Medical University from July 2013 to July 2023 were retrospectively analyzed. They were randomly divided into training set (n=289) and validation set (n=125) at a ratio of 7:3 using R software. In the training set, univariate logistic regression, best subsets regression (BSR) and multivariate Logistic regression were used to determine the independent predictors of OSA combined with T2DM and construct a nomogram. The area under the receiver operating characteristic curve (AUC), calibration curve, Hosmer-Lemeshow goodness of fit test, decision curve analysis (DCA) and clinical impact curve (CIC) were used to evaluate the discrimination, calibration and clinical applicability of the nomogram prediction model. Finally, the internal validation of the nomogram prediction model was carried out on the validation set. Results In the training set, the results of univariate logistic regression, BSR and multivariate logistic regression analysis showed that hypertension (OR=2.413, 95%CI 1.276-4.563, P=0.007), apnea hypopnea index (OR=1.034, 95%CI 1.014-1.053, P=0.001), triglyceride-glucose index( OR=12.065, 95%CI 5.735-25.379, P<0.001), triglyceride/high density lipoprotein cholesterol (OR=0.736, 95%CI 0.634-0.855, P<0.001) were independent predictors of T2DM in OSA patients. A nomogram prediction model was constructed based on the above four predictors. In the training set and validation set, the AUC, sensitivity, and specificity of the nomogram prediction model for predicting the risk of T2DM in OSA patients were 0.820 (95%CI 0.771-0.869), 75.7%, 75.9% and 0.778 (95%CI 0.696-0.861), 74.5%, 73.0%, respectively, indicating that the nomogram had good discrimination. The calibration curve showed that the nomogram had a good calibration for predicting T2DM in OSA patients. DCA and CIC also showed that the nomogram prediction model had certain clinical utility. Conclusions A simple, fast and effective nomogram prediction model with good discrimination, calibration and clinical applicability was successfully constructed, validated and evaluated. It can be used to predict the risk of T2DM in OSA patients and help clinicians to identify patients with high risk of T2DM in OSA patients.
Objective To investigate the relationship between dyslipidemia and diabetic retinopathy in non-insulin-dependent diabetes mellitus（NIDDM） patients． Methods In 55 health controls，60 NIDDM patients with DR and 75 NIDDM patients without DR，the plasma total cholesterol（TC），triglycerides（TG），high-density lipoprotein（HDL）and HDL subfractions，fasting plasma glucose（FPG），fasting plasma insulin（FINS）and glycosylated hemogolbin（HbA 1C）were measured，and the plasma lowdensity lipoprotein （LDL） and very lowdensity lipoprotein（VLDL）were caculated． Results In NIDDM patients with DR，the TC，LDL，FPG，HbA 1C and duration of NIDDM were higher or longer than those in NIDDM patients without DR．Moreover，the TC，LDL，FPG、FINS、HbA 1C and dutation of NIDDM were increased or lengthened in NIDDM patients with proliferative DR as compared with those with backgroud DR．The correlation analysis showed the severity of DR was positively correlated with TC，LDL，HbA 1C and duration of NIDDM． Conclusion Dyslipidemia may play some role in the onset and development of DR． (Chin J Ocul Fundus Dis,1998,14:21-23)
Objective To assess the effectiveness and safety of biphasic insulin aspart 30 given three times a day in the management of type 2 diabetes. Methods Such databases as CENTRAL, MEDLINE, PubMed and CNKI were searched on computer; additionally, the relevant conference proceedings from associations like American Diabetes Association, and the references of all selected literatures were also hand-searched. The randomized controlled trials (RCTs) on biphasic insulin aspart 30 given three times a day in treating type 2 diabetes were screened according to inclusive and exclusive criteria, without concerning the limitation of languages and blind methods. After data extraction and quality evaluation, Meta-analysis was performed by using RevMan 4.2 software. Results Ten trials involving 1 415 patients were included. The sub-group analysis showed that compared with the group of given biphasic insulin aspart 30 twice a day (the bid group), the group of given biphasic insulin aspart 30 three times a day (the tid group) was superior in decreasing HbAlc (Plt;0.000 01). Compared with the group of thrice preprandial injection of Novolin R plus one injection of Novolin N at bedtime (the qid group), Meta-analysis showed that, a) As to the average fasting glucose levels: the tid group was not superior to the qid group (P=0.65); b) As to the average 2-hour postprandial glucose levels: the tid group was superior to the qid group (P=0.0003); c) As to the therapeutic time: the tid group was not superior to the qid group (P=0.38); d) As to the insulin doses: the tid group was superior to the qid group (P=0.000 1); e) As to the insulin costs: the tid group was inferior to the qid group (P=0.02); and e) As to the incidence of hypoglycaemia: the tid group was superior to the qid group (P=0.000 2). Compared with the oral antidiabetic drugs, the results of Meta-analyses showed: the tid group was superior in decreasing HbAlc (P=0.001). Conclusion The limited current evidence shows that biphasic insulin aspart 30 given three times a day, as a simple insulin intensified scheme, is safe and effective for type 2 diabetes, and is worth recommending in clinic. However, all these findings should be further confirmed with more large sample and well-designed RCTs.
ObjectiveTo evaluate the relationship between some clinical laboratory tests, such as levels of fasting insulin (FINS), triglyceride (TG) and total cholesterol (TC), and benign prostatic hyperplasia (BPH). MethodsA total of 146 male patients were included in this study. All the subjects were from the clinic of West China Hospital and Sichuan Cancer Hospital from January 2012 to July 2013. Serum FINS, TG, TC and prostate specific antigen (PSA) were tested, respectively. Prostate volume (PV) was measured by ultrasound. ResultsFINS, PAS and annual prostate growth rate increased significantly in the large PV group compared with the small PV group (P<0.01). There was no significant association of PV with body mass index and other laboratory tests like serum TC and TG. PV and annual prostate growth rate increased significantly in the group of high FINS level compared with the group of low FINS level (P<0.01). PV was positively correlated with FINS (r=0.159, P<0.05); and annual prostate growth rate was positively correlated with FINS (r=0.201, P<0.05). ConclusionHyperinsulinism may play an important role in the pathogenesis of BPA.
ObjectiveTo systematically review the efficacy and safety of premixed insulin lispro versus insulin glargine for type 2 diabetes mellitus (T2DM). MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 3, 2013), PubMed, EMbase, ClinicalTrials.gov, CBM, CNKI and WanFang Data were searched up to October 2013 for randomized controlled trials (RCTs) about the clinical efficacy and safety of premixed insulin lispro versus insulin glargine for T2DM. Two reviewers independently screened literature according to the exclusion and inclusion criteria, extracted data, and assessed methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.2 software. ResultsA total of 13 RCTs involving 4 557 patients were included. The results of meta-analysis showed that:compared to insulin glargine, premixed insulin lispro was more effective in reducing levels of HbA1c (parallel trials:WMD=-0.18, 95%CI-0.33 to-0.02, P=0.03; cross-over trials:WMD=-0.38, 95%CI-0.52 to-0.24, P < 0.000 01). However, insulin glargine was more effective in reducing levels of FPG (parallel trials:WMD=0.82, 95%CI 0.65 to 0.99, P < 0.000 01; cross-over trials:WMD=0.64, 95%CI 0.26 to 1.02, P=0.000 9), weight gain (parallel trials:WMD=0.93, 95%CI 0.31 to 1.56, P=0.003; cross-over trials:WMD=0.74, 95%CI 0.19 to 1.29, P=0.009), and decreased the incidence of hypoglycemia (parallel trials:OR=1.26, 95%CI 1.10 to 1.45, P=0.000 6; cross-over trials:OR=2.24, 95%CI 1.45 to 3.46, P=0.000 3). ConclusionFor T2DM patients, premixed insulin lispro and insulin glargine have different advantages in clinical efficacy and safety. Doctors should select appropriate insulin treatment according to patients' health conditions.
Objective To study the interferencing and anti-tumor effects of lentiviral vector of siRNA targeting IGF1R and EGFR gene of the liver cancer cell. Methods The complementary DNA containing both sense and antisense Oligo DNA of the targeting sequence was designed, synthesized and connected to the pLVTHM vector, named pLVTHM-IGF1R, into whom the EGFR-siRNA expression frame containing H1 promotor synthesized by RT-PCR was cloned to generate pLVTHM-IGF1R-EGFR-siRNA. The 293T cells were cotransfected by 3 plasmids of pLVTHM-IGF1R-EGFR-siRNA, psPAX2 and pMD2G to enclose LVTHM-IGF1R-EGFR-siRNA, which was amplified in large amount and purified by caesium chloride density gradient centrifugation for measurement of virus titer. SMMC7721 cells infected by LVTHM-IGF1R-EGFR-siRNA were infection group, the untreated SMMC7721 cells and blank vector plasmid LVTHM were two control groups (SMMC7721 cell group and blank vector group). The effect of LVTHM-IGF1R-EGFR-siRNA on IGF1R and EGFR expressions of SMMC7721 cells were detected by RT-PCR and Western blot. The antitumor potential of LVTHM-IGF1R-EGFR-siRNA to SMMC7721 cells was evaluated by Cell Counting Kit-8 assay for cell growth and TUNEL for apoptosis respectively. Results LVTHM-IGF1R-EGFR-siRNA was constructed successfully. Functional pfu titers of LVTHM-IGF1R-EGFR-siRNA was 4.58×109 pfu/ml. Protein and mRNA expression of IGF1R and EGFR of infection group were less than those of blank vector group and SMMC7721 cell group （P＜0.05）, LVTHM-IGF1R-EGFR-siRNA was more effective to inhibit the proliferation and promote apoptosis of SMMC7721 cells （P＜0.05）. Conclusion LVTHM-IGF1R-EGFR-siRNA expressing IGF1R-EGFR-siRNA can inhibit the expression of IGF1R and EGFR, and may be used for further investigation of gene therapy of liver cancer.