Objective To determine the clinical efficacy of probucol in patients with diabetic macular edema (DME) and elevated serum lipids after focal/grid laser photocoagulation. Methods A prospective randomized controlled study included 48 type 2 diabetic patients with DME and dyslipidemia which were randomly divided into three groups. For patients with bilateral disease only the more severe eye was included. All patients were subjected to strict metabolic and blood pressure control during enrollment. All cases received macular laser photocoagulation. Besides, sixteen patients in group A were treated with probucol, 16 members in group B with atorvastatin and 16 members in group C were not treated with any lipid-lowering therapy for about three months. The outcome measurements were status of macular edema and hard exudates, visual acuity, foveal thickness, serum lipids and urine 8-hydroxydeoxyguanosine (8-OHdG) during the three months. Results The study included 20 men and 28 women with noninsulin dependent diabetes mellitus who could achieve good metabolic and blood pressure control within three months of inclusion in the study. Thirteen of 16 patients in group A, twelve of 16 patients in group B and five of 16 patients in group C showed reduction in hard exudates. Regression of macular edema was seen in twelve patients in group A, 11 in group B and eight in group C (χ2=2.368,P＞0.05). The difference of foveal thickness in group A, B and C was statistically significant (t=4.929, 4.669; P=0.000). Nine patients in group A, eight in group B and six in group C showed improving of visual acuity (χ2=1.169,P＞0.05). Three months after treatment, triglycerides (TG) (t=7.954, 6.832; P＜0.05), total cholesterol (TC) (t=6.643, 5.368; P＜0.05) and low-density lipoprotein cholesterol (LDLC) (t=3.279, 3.835; P＜0.05) decreased in group A and group B but not in group C, and high-density lipoprotein cholesterol showed no significant difference in the three groups. 8-OHdG decreased gradually during the first and third month in group A and group B but not in group C. In the first month post treatment, 8-OHdG showed no difference between group A and group B. In the third month, the 8-OHdG was lower in group A than group B, and the difference was statistically significant (t=2.947,P＜0.05). ConclusionsIn type 2 diabetes patients with DME and dyslipidemia, oral probucol can reduce the severity of hard exudates and macular edema, improve the visual acuity, and inhibit the levels of TG, TC, LDLC and 5-OHdG. The effect of probucol was similar to atorvastatin. Probucol could be an adjunct treatment of those patients.
Objective To investigate the safety and efficiency of a blood glucose control method in diabetic patients with gastrointestinal neoplasm who were subjected to postoperative early enteral nutrition (EEN). Methods Thirty-seven diabetic patients with gastrointestinal neoplasm received enteral nutriment——Glucerna SR through nasojejunal tubes 24 hours after operation. The blood glucose level was safely controlled through injecting insulin intravenously and subcutaneously. Meanwhile, any change of blood and urine glucose level was monitored and the indexes representing the levels of nutrition, biochemistry and immunity were measured before the implementation of EN, 5 d and 8 d of EN after operation, respectively. Results All the patients were able to bear EEN and there was no severe complications occurred. Significant increase of serum levels of albumin, prealbumin and transferrin were observed after EEN support （P＜0.05）, as well as the serum levels of IgG， IgA and IgM （P＜0.01）. However, body weight， HGB and the serum levels of ALT and TBIL showed no significant changes （Pgt;0.05）. There were 81.1%（30/37） of patients whose blood glucose levels were controlled steadily within the range of (7.8±1.1) mmol/L. Conclusion Injecting insulin intravenously and subcutaneously after operation may be a safe and effective method to control blood glucose level. And the postoperative implementation of EEN can be considered as the first choice of nutrition support for diabetic patients with gastrointestinal neoplasm.
Objective To evaluate and select essential medicine for diabetes mellitus based on the burden of disease. Methods By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence. Results (1) Six guidelines were included, three of which were evidence-based and published from 2006 to 2011. (2) Five recommended medicines were included according to recommendations and evidence of WHOEML (2011), NEML (2009), CNF (2010) and other guidelines. They were metformin, glibenclamide, glipizide, rosiglitazone and pioglitazone. Domestic evidence of the first three drugs was evaluated. (3) The first three have been marketed with the specifications and dosage forms corresponding to guidelines in China. The FBG cost-effectiveness ratios of metformin with different dosage forms as immediate release compressed tablet, enteric-coated tablet and sustained release capsule were 3.37, 3.76 and 3.50 respectively. 2-hour BG cost-effectiveness ratios of metformin were 3.74, 4.00 and 3.71 respectively. The cost-effectiveness ratio of glibenclamide and glimepiride were 11.23 and 13.81 respectively. Conclusion We offer a recommendation for: (1) Metformin (immediate release tablet/capsule for oral use, 0.25 g), contraindicated in patients with renal insufficiency. (2) Glibenclamide (tablet, 2.5 mg; capsule, 1.75 mg) and glipizide (tablet, 2.5 or 5mg; dispersible tablet, 5 mg), contraindicated in children, women during pregnancy or lactation, patients in the perioperative period of major operation, patients after total pancreatectomy, and patients allergic or adversely reacted to sulfa drug. (3) Evidence-based and standardized primary healthcare guidelines as well as clinical and pharmacoeconomic studies on diabetes mellitus (large-scale, multi-centre, randomized and double-blinded) are needed to produce high-quality local evidence.
Diabetic kidney disease (DKD) is a major complication of diabetes mellitus. One third of patients with advanced diabetes mellitus can develop to uremia, which seriously endangers people’s health. In recent years, with the improvement of people’s living standards and the increasing incidence of diabetes, it has become the main cause of end stage renal disease in China. Over the past two decades, the understanding of diagnosis and treatment of DKD has been improved, such as putting forward the new concept of normoalbuminuric DKD and developing a variety of new anti-diabetic drugs. However, at present, the basic strategies of DKD treatment are still lifestyle modification, glucose control, blood pressure control and lipid control.
Autophagy is a lysosome dependent, conservative material degradation process, which exists in all eukaryotic cells and plays import roles in many pathophysiology process. Erectile dysfunction (ED) is a common male disease with multiple etiology. In recent years, more and more evidences have demonstrated that autophagy has a close relation to ED, therefore, we combine previous study to classify ED by hypoxia, aging, diabetes and other causes, and review the advances of autophagy in ED.
ObjectiveTo investigate the clinical symptom and risk factors of diabetic seizures. MethodsThe clinical data of 44 patients with diabetes related seizures were analyzed with the clinical classification, blood glucose, Na+, Plasma Osmotic Pressure, HbA1c, EEG, brain MR, and the antiepileptic drugs. Results① Diabetic hyperglycemia (DH) related seizures: among the 28 patients, 17 cases were male patients, 11 cases were female patients. The mean age was 51.3 years old. Simple partial seizure without secondary generalized seizures (12/28, 42.8%) was the most common, 8 patients (8/28, 28.6%) showed complex partial seizure, 8 patients (8/28, 28.6%) showed no obvious focal origin generalized tonic-closure seizures. Patients with poor glycemic control (HbA1c > 9%) had significantly higher risk of generalized seizures (46.7% vs. 7.7 %, P < 0.05) (P < 0.05). ② Diabetic ketoa-cidosis or hypertonic state associated seizures: among the 7 patients, 6 cases were male patients, 1case was female patients. The mean age was 45.7 years old, 2 patients (2/7, 28.6%) had generalized tonic-clonic seizure, 2 patients (2/7, 28.6%) showed status epilepticus, 2 patients (2/7, 28.6%) showed local motor seizure, 1 patient (1/7, 14.2%) showed Jackson seizure. ③ Diabetic hypoglycemia related seizures: among the 9 patients, 7 cases were male patients, 2 cases were female patients. The mean age was 45.3 years old.5 patients showed generalized tonic-clonic seizure (5/9, 55.6%), 3 patients had complex partial seizure (3/9, 33.3%), 1 patients had generalized tonic-closure seizures (1/9, 11.1%). ConclusionSimple partial seizure is the most common in patients with diabetic hyperglycemia related seizures; so as to diabetic hypoglycemia and keto-acidosis, generalized seizures are relatively common. HbA1c can be an important risk factor of seizures for patients with hyperglycemia.
【Abstract】ObjectiveTo investigate the effects of cholecystokinin （CCK） on diabetes mellitus with cholecystolithiasis. MethodsRelevant literatures of recent years were reviewed. ResultsCCK exists widely in human body．On the one hand, CCK enhances cholecystolithiasis by causing diabetes. On the other hand, its pathological changes can also lead to cholecystolithiasis. Besides, it is possibility that the CCKrelated gene abnormality is the common cause of diabetes and cholecystolithiasis. ConclusionCCK plays an important role in diabetes mellitus complicated with cholecystolithiasis. However, there is much yet to be known about CCK．
Objective To observe the serum betatrophin levels in patients with type 2 diabetes mellitus (T2DM) and to explore the role of betatrophin in the pathogenesis of diabetic retinopathy (DR). Methods A total of 59 patients with T2DM (DM group) and 14 healthy controls (NC group) were enrolled in the study. Vision, slit lamp microscope, indirect ophthalmoscope, fluorescein fundus angiography were performed on all the subjects. According to the results of the examination combined with the international DR clinical staging criteria, the patients were divided into no DR (Non-DR) group, non-proliferative DR (NPDR) group, and proliferative DR (PDR) group, with 30, 20 and 9 patients in each, respectively. The fasting blood glucose (FPG), insulin (FIN), C-peptide, glycated hemoglobin (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein (HDL-C), low-density lipid Protein (LDL-C) levels were detected. The level of betatrophin in serum was determined by enzyme-linked immunosorbent assay. The correlation between betatrophin and other indicators was analyzed by Spearman correlation. The influencing factors of PDR were analyzed by logistic regression. Results Compared with subjects in the NC group, the level of FPG (F=-4.316, P＜0.001), FIN (F=2.142, P=0.001), HbA1c (F=-5.726, P＜0.001), TC (t=3.609, P=0.010), LDL-C (t=0.000, P=0.003), and betatrophin (F=-2.263, P=0.024) were significantly increased and HDL-C level (F=-3.924, P＜0.001) was decreases in the DM group. The difference of TG level between two groups was not statistically significant (F= -1.422, P=0.155). Compared with the Non-DR group and the NPDR group, the serum C-peptide (F=7.818, P=0.020) and betatrophin levels (F=12.141, P=0.002) were significantly increased in the PDR group. Spearman correlation analysis showed that the levels of betatrophin in the DM group was positively correlated to TC (r=0.304, P=0.019). The serum levels of betatrophin was positively correlated to body mass index in the Non-DR group (r=0.513, P=0.004). Furthermore, in the PDR group, a significant positive correlation was observed between the serum betatrophin levels and diastolic blood pressure (r=0.685, P=0.042). Logistic regression analysis showed that the duration of diabetes, serum C-peptide and betatrophin levels were risk factors for PDR. After controlling for the duration and serum C-peptide, the PDR risk for betatrophin levels great than or equal to 1.0 ng/ml was 12 times as much as betatrophin levels less than 1.0 ng/ml in T2DM patients. Conclusions The serum betatrophin content of patients with T2DM is abnormal. Betatrophin may be involved in the occurrence and development of PDR.