Objectives To assess the effects of alpha-glucosidase inhibitors in patients with type 2 diabetes mellitus. Method We searched The Cochrane Library, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, reference lists of reviews on the topic of alpha-glucosidase inhibitors and we contacted experts and manufacturers for additional trials. Date of most recent search: December 2003 (Current Contents) and April 2003 (other databases). Randomised controlled trials of at least 12 weeks duration comparing alpha-glucosidase inhibitor monotherapy in patients with type 2 diabetes with any other intervention and that included at least one of the following outcomes: mortality, morbidity, quality of life, glycemic control, lipids, insulin levels, body weight, adverse events. Two reviewers read all abstracts, assessed quality and extracted data independently. Discrepancies were resolved by consensus or by the judgement of a third reviewer. A statistician checked all extracted data entrance in the database. We attempted to contact all authors for data clarification. Results We included 41 trials (8130 participants), 30 investigated acarbose, seven miglitol, one trial voglibose and three trials compared different alpha-glucosidase inhibitors. Study duration was 24 weeks in most cases and only two studies lasted amply longer than one year. We found only few data on mortality, morbidity and quality of life. Acarbose had a clear effect on glycemic control compared to placebo: glycated haemoglobin –0.77% (95% confidence interval –0.90 to –0.64), fasting blood glucose –1.1 mmol/L (95% confidence interval –1.4 to –0.9), post-load blood glucose –2.32 mmol/L (95% confidence interval –2.73 to –1.92). The effect on glycated haemoglobin by acarbose was not dose-dependent. We found a decreasing effect on post-load insulin and no clinically relevant effects on lipids or body weight. Adverse effects were mostly of gastro-intestinal origin and dose dependent. Compared to sulphonylurea, acarbose decreased fasting and post-load insulin levels by –24.8 pmol/L (95% confidence interval –43.3 to –6.3) and –133.2 pmol/L (95% confidence interval –184.5 to –81.8) respectively and acarbose caused more adverse effects. Conclusions It remains unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes. Conversely, they have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. These effects are less sure when alpha-glucosidase inhibitors are used for a longer duration. Acarbose dosages higher than 50 mg TID offer no additional effect on glycated haemoglobin but more adverse effects instead. Compared to sulphonylurea, alpha-glucosidase inhibitors lower fasting and post-load insulin levels and have an inferior profile regarding glycemic control and adverse effects.
Objective To assess the influence of different digestive tract reconstruction on the blood glucose of gastric antral cancer patients with type 2 diabetes. Methods The clinical data of 51 cases of gastric antral cancer with type 2 diabetes treated radical surgery in this hospital from January 2006 to January 2012 were analyzed retrospectively. The patients were divided into three groups according to the different digestive tract reconstruction methods：BillrothⅠ anastomosis group （n=14）， BillrothⅡ anastomosis group （n=28）， and Roux-en-Y anastomosis group （n=9）. The indexes were analyzed and compared among three groups：① The levels of fast blood glucose （FBG） and 2h postprandial blood glucose （PG2h） were detected before operation and on 1 month and 6 months after the operation；② The level of glycated hemoglobin （HbA1c） was detected before operation and 6 months after the operation；③ The diabetes control was observed. Results The FBG and PG2h levels in the BillrothⅠ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those detected before the operation （P＞0.05）. The FBG and PG2h levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group detected on 1 month and 6 months after the operation were significantly lower than those before the operation respectively （P＜0.05）. The FBG and PG2h levels in the BillrothⅡ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those in the Roux-en-Y anastomosis group respectively （P＞0.05）， but which were markedly lower than those in the BillrothⅠ anastomosis group， the differences were statistically significant （P＜0.05）. The HbA1c levels in the BillrothⅠ anastomosis group detected before the operation and on 6 months after the operation were not statistically different from each other （P＞0.05）. The HbA1c levels in the BillrothⅡ anastomosis group and Roux-en-Y anastomosis group detected on 6 months after the operation were markedly lower than those before the operation and the difference was statistically significant （P＜0.05）. On 6 months after the operation， the HbA1c levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group were markedly lower than those in the BillrothⅠ anastomosis group and the differences were statistically significant （P＜0.05）；the HbA1c level was not statistically different between the BillrothⅡ anastomosis group and the Roux-en-Y anastomosis group （P＞0.05）. The total curative effects in the BillrothⅡ anastomosis and Roux-en-Y anastomosis groups were significantly better than those in the BillrothⅠ anastomosis group （P＜0.05）. Conclusion According to our limited clinical data， BillrothⅡ anastomosis and Roux-en-Y anastomosis for gastric antral cancer patients with type 2 diabetes may be the best surgical approach.
The cognitive impairment of type 2 diabetes patients caused by long-term metabolic disorders has been the current focus of attention. In order to find the related electroencephalogram (EEG) characteristics to the mild cognitive impairment (MCI) of diabetes patients, this study analyses the EEG synchronization with the method of multi-channel synchronization analysis--S estimator based on phase synchronization. The results showed that the S estimator values in each frequency band of diabetes patients with MCI were almost lower than that of control group. Especially, the S estimator values decreased significantly in the delta and alpha band, which indicated the EEG synchronization decrease. The MoCA scores and S value had a significant positive correlation in alpha band.
Objective To systematically review the prevalence, clinical characteristics, and prognosis of fulminant type 1 diabetes mellitus (F1DM) in China. Methods The CNKI, WanFang Data, CBM and PubMed databases were searched to collect Chinese F1MD case reports from January 1, 2000 to March 30, 2022. Data analysis was performed using Stata 16.0 software and RevMan 5.3 software. Results A total of 874 cases were included in 233 papers, involving 410 males (46.91%) and 464 females (53.09%). The age of onset was 29.32±1.09 years and the course of disease was 3.74±0.63 days. The BMI was 21.18±0.52 kg/m2, HbA1c was 6.58%±0.08%, the level of fasting C-peptide was 0.04±0.010 ng/mL, level of C-peptide 2 h after meal was 0.09±0.020 ng/mL, the level of blood glucose at the doctor’s office was 34.72±2.89 mmol/L, and the level of arterial blood gas pH was 7.09±0.015. Among them, 734 patients had diabetic ketoacidosis (84.55%), 496 patients had infection of the upper respiratory or digestive tract before onset (56.75%), 4 patients died (0.46%), 78 patients were GADA positive, 11 patients were ICA positive, 13 patients were IAA positive, and 109 were pregnant patients (90 fetal deaths, 82.57%). Conclusion Chinese F1DM is a special but common subtype of diabetes. Its characteristics include a relatively young age of onset, devastating islet damage, and rapid progression, and it is often accompanied by severe metabolic disorders, complications, and grim prognosis. Clinicians should pay more attention to F1DM.
Objective To analyze the citation classics articles， and approach the research development history and the research direction in the future about surgical treatment for type 2 diabetes. Methods The most frequently cited articles had published in Social Sciences Citation Index database by the end of October 30， 2012 were retrieved. The 50 most frequently cited articles were selected. Articles were evaluated for several characteristics， including number of citations， publication time， country of origin， institution， journal， publication type of article， and authorship. Results The most frequently cited article received 1 751 citations and the least frequently cited article received 73 citations， with a mean of 242.76 citations per article. These citation classics were published in 18 high-impact journals， led by Annals of Surgery and Obesity Research as 10 papers. Of the 50 articles， 18 articles were clinical observational study， 20 articles concerned basic science， 10 articles were review articles， and 2 articles were commentary. These citation classics were published from 1990 to 2009， most of them （40） from 2000 to 2009. Three institutions produced 2 top-cited articles， including Medical College of Virginia， Monash University， and East Carolina University. These articles originated from 14 countries， the top was USA （22 articles）. Two persons authored 3 published papers （Cummings DE and Rubino F）. Conclusion Most “citation classics” in research about surgery for type 2 diabetes are observational studies published in high-impact journals by US-based authors after 1990.
Objective To compare the blood glucose level and associated hypoglycemia risks by using insulin Glargine or human NPH both combined with Glipizide GITS in the treatment of type 2 diabetic patients. Methods Fifty-six cases with inadequate glycemia control by sulfonylurea and/or other oral agents were randomized in two groups (3∶1). In the Glarine group, 42 patients were given Clipizide GITS 5 mg every morning and injection of Glargine at bedtime daily, while 14 patients in the NPH group were given Clipizide GITS 5 mg every morning and injection of NPH at bedtime daily. The dosage of insulin was adjusted by FBG level, seeking a target of FBG＜6.7 mmol/L, and the treatment lasted for 12 weeks. The blood glucose level and incidence of hypoglycemia were observed. The daily dosages of Glargine and NPH were recorded to analyze their relations between FBG and BMI at the beginning of the trial. Results Mean of FBG and daily glucose profile were similar in the 2 groups, but the incidence of hypoglycemia in the Glargine group was significantly lower than that in the NPH group (3 cases in the Glargine group, 7.1%, 5 cases in the NPH group, 35.7%, χ2=7.0, P =0.008). Mean daily dosages of glargine at the end point were closely related to FBG and BMI at baseline. Conclusions Bedtime injection of Glargine combined with Glipizide GITs can achieve target blood glucose control and is safer than NPH. This simple “one pill-one injection” regimen may help us achieve recommended blood glucose control targets with better patients’ compliance.
Objective To investigate the association of the polymorphism of resistin gene SNP-420C/G and type 2 diabetes (T2DM) among the Chinese Han population. Methods Such databases as CNKI, WanFang database, VIP, SinoMed, and PubMed were electronically searched from January 2001 to July 2010 to collect case-control studies on polymorphism of resistin gene SNP-420C/G and T2DM among the Chinese Han population. The quality of the included studies was evaluated and the data was extracted. RevMan 4.2 software was used for meta-analyses. Results A total of five case-control studies were identified, involving 709 cases in the T2DM group and 572 cases in the control group. The results of meta-analysis showed that the Chinese Han population with CC genotypes of SNP-420 had no higher risks to T2DM (OR=1.02, 95%CI 0.81 to 1.29), and the Chinese Han population with GG genotypes of SNP-420 still had no higher risks to T2DM (OR=1.34, 95%CI 0.95 to 1.90). Conclusion Current evidence suggests that there is no association between the polymorphism of resistin gene SNP-420C/G and risk to T2DM among the Chinese Han population.
Objective To study the mechanism of gastric bypass operation on treatment of type 2 diabetes mellitus, recognize the etiology and pathogenesy of the disease and frame therapy strategy for type 2 diabetes mellitus. Methods The literatures about gastric bypass operation on treatment of type 2 diabetes mellitus, including clinical cases reports and evidence-based studies were reviewed. Results Gastrointestinal bypass operation was regarded as an effective treatment for type 2 diabetes mellitus. There were three hypotheses of therapy mechanism: early delivery of nutrients to the distal intestine, exclusion of the proximal intestine and incretin/anti-incretin. Conclusion Gastrointestinal bypass operation is now considering as an effective treatment, there is still a lack of basic experimental studies to clarify the mechanism.
Objective To explore the effects on quality of life (QOL), the targeted rates of metabolic parameters and cost-effectiveness in newly diagnosed type 2 diabetic patients who underwent multifactorial intensive intervention. Methods One hundred and twenty seven cases in an intensive intervention and 125 cases in a conventional intervention group were investigated by using the SF-36 questionnaire. The comparison of QOL and the targeted rates of metabolic parameters between the two groups were made. We assessed the influence factors of QOL by stepwise regression analysis and evaluated the efficiency by pharmacoeconomic cost-effectiveness analysis. Results The targeted rates of blood glucose, blood lipid and blood pressure with intensive policies were significantly higher than those with conventional policy (P＜0.05). The intensive group’s role limitations due to physical problems (RP), general health (GH), vitality (VT), role limitation due to emotional problems (RE) and total scores after 6 months intervention were significantly higher than those of baseline (P＜0.05). The vitality scores and health transition (HT) of the intensive group were better than those of the conventional group after 6 months intervention. But the QOL scores of the conventional group were not improved after intervention. The difference of QOL’s total scores after intervention was related to that of HbA1c. The total cost-effectiveness rate of blood glucose, blood lipid, blood pressure control and the total cost-effectiveness rate of QOL with intensive policy were higher than those with the conventional policy. Conclusions Quality of life and the targeted rates of blood glucose, blood lipid and blood pressure in newly diagnosed type 2 diabetic patients with multifactorial intensive intervention policy are better and more economic than those with conventional policy.
Objective To guide blood glucose management during pregnancy and reduce the incidence of long-term complications of the fetus by exploring the long-term growth condition of offspring of pregnant women with gestational diabetes mellitus. Methods A total of 180 cases full-term newborns of pregnant women with gestational diabetes mellitus from December 25th, 2011 to December 25th, 2012 were selected as the diabetes group. Another 200 newborns of pregnant women without any complications were randomly collected as the control group. Birth weight, gestational age, sex, blood glucose, and 24-, 48-, 72- and 120-hour transcutaneous bilirubin value after the birth of the newborns were recorded; weight, height, body mass index (BMI), triglycerides, total cholesterol, high density lipoprotein (HDL), low density lipoprotein, blood pressure and fasting plasma glucose quota between the two groups were contrasted when the children were three years old. Results There were no significant difference in the birth weight, gestational age and sex between the diabetic and the control group. The blood glucose levels of the newborns in the diabetic group was significantly lower than that in the control group (P<0.05). The 24-, 48-, 72- and 120-hour transcutaneous bilirubin values of the newborns in the diabetic group were significantly higher than those of the control group (P<0.05). The weight, height and BMI of the three years old offspring in the diabetic group were significantly higher than those in the control group (P<0.05). There were no significant difference in triglycerides, total cholesterol, HDL, Low density lipoprotein, fasting plasma glucose quota, and systolic blood pressure between the diabetic group and the control group (P>0.05), but the diastolic blood pressure in the diabetic group was much higher than that in the control group (P<0.05). Conclusion The impact of gestational diabetes mellitus on offspring of pregnant women was not only in the fetus and newborn period, but also in the future, which should be timely intervened.