Practical diabetes international : the journal for diabetes care teams worldwide最新文献

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The Association of British Clinical Diabetologists: recommendations following suspension of rosiglitazone (Avandia) 英国临床糖尿病学家协会:罗格列酮(文迪雅)停药后的建议

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-11-01 DOI: 10.1002/PDI.1525

N. Goenka, A. Roberts, S. Rowles, B. Ryder, P. Winocour

For all new prescriptions of thiazolidinediones, pioglitazone must be used Patients already taking rosiglitazone should have a medication review in order to consider alternative therapy Replacement therapy should be tailored according to the clinical needs of the individual patient and should be in line with existing NICE guidance when possible. Those patients whose glycaemic control requires consideration of alternatives to sulphonylureas and metformin should have an assessment of cardiovascular risk status, heart failure, osteoporosis fracture risk, weight, hepatic and renal function, hypoglycaemia and pancreatitis risk Patients already taking rosiglitazone who do not wish to change to alternative therapy should be advised that it is not possible to continue rosiglitazone as this therapy has been suspended and will be withdrawn Prior evidence of heart failure or impairment of left ventricular function remains a strict contraindication for the use of any thiazolidinediones. Osteoporosis and previous fracture may also be considered a contraindication to a thiazolidinedione

对于所有新开的噻唑烷二酮类药物，必须使用吡格列酮。已经服用罗格列酮的患者应进行药物审查，以考虑替代疗法。替代疗法应根据患者个体的临床需要量身定制，并在可能的情况下应符合现有的NICE指南。那些血糖控制需要考虑替代磺脲类药物和二甲双胍的患者应评估心血管风险状况、心力衰竭、骨质疏松骨折风险、体重、肝肾功能。已经服用罗格列酮但不希望改用替代疗法的患者应被告知，不能继续服用罗格列酮，因为该疗法已被暂停并将被撤销。先前有心衰或左心室功能损害的证据仍然是使用任何噻唑烷二酮类药物的严格禁忌症。骨质疏松症和既往骨折也被认为是噻唑烷二酮的禁忌症

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引用次数: 1

How not to die from diabetes in a mountain hut 如何在山间小屋中不死于糖尿病

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-11-01 DOI: 10.1002/PDI.1533

M. Lean

引用次数: 0

Statins should be routinely prescribed in all adults with diabetes 他汀类药物应作为所有成人糖尿病患者的常规处方

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-11-01 DOI: 10.1002/PDI.1534

R. Drummond, M. Lyall, J. McKnight

引用次数: 5

Handbook of Diabetes. By Rudy Bilous and Richard Donnelly. 4th Edition Published by Wiley‐Blackwell 2010 Price: 248 pages ISBN: 978 1 4051 8409 0 糖尿病手册。作者:Rudy Bilous和Richard Donnelly，第4版Wiley‐Blackwell出版2010年价格:248页ISBN: 978 1451 84090

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-10-01 DOI: 10.1002/PDI.1520

A. Begg

引用次数: 0

The Association of British Clinical Diabetologists (ABCD) nationwide exenatide audit 英国临床糖尿病学家协会(ABCD)在全国范围内审核艾塞那肽

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-10-01 DOI: 10.1002/PDI.1522

R. Ryder, K. Thong, M. Cull, AP Mills, C. Walton, P. Winocour

In December 2008, to accelerate understanding of a new agent, the Association of British Clinical Diabetologists (ABCD) launched a nationwide audit on the use of exenatide in clinical practice. A password-protected online questionnaire for collection of anonymised patient data was established and diabetes specialists in the UK were given persistent encouragement to submit data on their exenatide-treated patients. Baseline and latest HbA1c, weight, body mass index (BMI), waist circumference, blood pressure and lipids were compared and adverse events related to exenatide were quantified. A total of 315 contributors from 126 centres submitted data on 6717 patients (54.9% male) – mean baseline age was 54.9 years, HbA1c 9.47% (80mmol/mol), weight 113.8kg, BMI 39.8kg/m2. Of these, 4551 and 4385 had dated baseline and latest HbA1c and weight respectively. Mean (±SE) HbA1c fell by 0.73±0.03% (p<0.001) and weight by 5.9±0.1kg (p<0.001) at a median (range) of 26.1(6.6–164.1) and 26.0(6.6–159.0) weeks respectively. The following parameters also showed significant falls (p<0.001): BMI 2.2±0.1kg/m2, waist circumference 5.1±0.3cm, systolic blood pressure 3.6±0.6mmHg, total cholesterol 0.16±0.03mmol/L and HDL cholesterol 0.03±0.01mmol/L. Triglycerides decreased by 0.14±0.06mmol/L (p=0.009). The change in diastolic blood pressure was not statistically significant. In all, 23.7% of patients reported gastrointestinal side effects with 7.2% having to stop exenatide permanently. Hypoglycaemia rates were 3.3% before and 5.6% after exenatide use (p<0.001). After scrutiny, one case of pancreatitis and four cases of renal failure occurring in patients on exenatide had no obvious alternate cause. All other reported side effects had <1% incidence. The rate of exenatide discontinuation was 19.9% throughout the span of the audit, most commonly due to gastrointestinal side effects (36.1%) and lack of glycaemic or weight benefit (33.8%). This large scale audit confirmed the effectiveness of exenatide in clinical use and highlighted rare associated adverse events. Importantly, we have successfully demonstrated a novel approach by a national specialist society to independently monitor the efficacy and safety of a new treatment. Copyright © 2010 John Wiley & Sons. Practical Diabetes Int 2010; 27(8): 352–357

2008年12月，为了加速人们对一种新药的了解，英国临床糖尿病学家协会(ABCD)对艾塞那肽在临床实践中的使用进行了全国性的审计。建立了一份有密码保护的匿名患者数据收集在线问卷，并不断鼓励英国的糖尿病专家提交他们使用艾塞那肽治疗的患者的数据。比较基线和最新的HbA1c、体重、体重指数(BMI)、腰围、血压和血脂，并量化与艾塞那肽相关的不良事件。来自126个中心的315名参与者提交了6717例患者(54.9%为男性)的数据，平均基线年龄为54.9岁，HbA1c为9.47% (80mmol/mol)，体重113.8kg, BMI为39.8kg/m2。其中4551例和4385例分别有基线和最新HbA1c和体重。平均(±SE) HbA1c下降0.73±0.03% (p<0.001)，体重下降5.9±0.1kg (p<0.001)，中位(范围)分别为26.1(6.6-164.1)周和26.0(6.6-159.0)周。BMI(2.2±0.1kg/m2)、腰围(5.1±0.3cm)、收缩压(3.6±0.6mmHg)、总胆固醇(0.16±0.03mmol/L)、高密度脂蛋白(HDL)胆固醇(0.03±0.01mmol/L)均有显著下降(p<0.001)。甘油三酯降低0.14±0.06mmol/L (p=0.009)。舒张压变化无统计学意义。总的来说，23.7%的患者报告了胃肠道副作用，7.2%的患者必须永久停用艾塞那肽。使用艾塞那肽前和后低血糖率分别为3.3%和5.6% (p<0.001)。经审查，1例胰腺炎和4例肾衰竭发生在患者艾塞那肽没有明显的替代原因。所有其他报告的副作用发生率均<1%。在整个审计期间，艾塞那肽停药率为19.9%，最常见的原因是胃肠道副作用(36.1%)和缺乏血糖或体重改善(33.8%)。这项大规模的审计证实了艾塞那肽在临床使用中的有效性，并强调了罕见的相关不良事件。重要的是，我们已经成功地展示了一种由国家专家协会独立监测新疗法的有效性和安全性的新方法。版权所有©2010 John Wiley & Sons。实用糖尿病杂志2010;27日(8):352 - 357

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引用次数: 37

Bilateral cataracts as the presenting feature of type 1 diabetes 双侧白内障是1型糖尿病的表现特征

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-10-01 DOI: 10.1002/PDI.1515

M. Macleod, L. McLaren, G. Jones

334 Pract Diab Int October 2010 Vol. 27 No. 8 Copyright © 2010 John Wiley & Sons Case report Our patient, a 29-year-old female nursing student from Zimbabwe, described a six-month history of gradual deterioration in her eyesight. She had attended the optician on several occasions in that time and was reassured there was no abnormality. Her eyesight continued to deteriorate and she attended her GP who diagnosed bilateral cataracts. She was referred for urgent surgery but, in the interim, lost her eyesight completely and attended eye casualty. On examination she had snowflake cataracts bilaterally (Figure 1) and was admitted for urgent surgery. During pre-operative assessment she was found to have a random blood glucose of 26mmol/L and urinary glucose of 3+ and ketones of 2+. On further questioning, the patient described osmotic symptoms (polyuria and polydipsia) and recurrent candidal infection over a timescale similar to that of the visual loss. She had also lost approximately 30kg in weight over the previous year but had attributed this to a diet she had been on. She denied lethargy or any other symptoms on systemic enquiry. She had no significant past medical history, no family history of diabetes or cataract, and was not on any regular medication. She was transferred to the acute medical receiving ward. Venous bicarbonate was 16 and arterial blood gas measurement revealed a mild metabolic acidosis. HbA1c was 18.2% (175mmol/mol) confirming prolonged hyperglycaemia. She was commenced on an insulin sliding scale and then converted to subcutaneous insulin. This was administered by nursing staff because of her visual impairment. Urgent cataract surgery was carried out on the left eye and eyesight was restored. She was discharged home on a basal bolus regimen and further surgery was arranged for the right eye.

334 practice Diab 2010年10月第27卷第8期版权©2010 John Wiley & Sons病例报告我们的患者是一名来自津巴布韦的29岁女护理专业学生，她描述了六个月来视力逐渐恶化的历史。在那段时间里，她去了几次验光师那里，并被保证没有异常。她的视力继续恶化，她去看了全科医生，诊断为双侧白内障。她被转介进行紧急手术，但在此期间，她完全失去了视力，并被送往眼科医院。经检查，她发现双侧雪花型白内障(图1)，并接受了紧急手术。术前评估发现患者随机血糖26mmol/L，尿糖3+，酮2+。进一步询问后，患者描述了渗透性症状(多尿和烦渴)和反复念珠菌感染，时间范围与视力丧失相似。在过去的一年里，她的体重也减少了大约30公斤，但她把这归因于她一直在节食。经全身检查，她否认有昏睡或任何其他症状。她没有明显的既往病史，没有糖尿病或白内障家族史，也没有任何常规药物治疗。她被转到急症病房。静脉碳酸氢盐16，动脉血气测量显示轻度代谢性酸中毒。HbA1c为18.2% (175mmol/mol)，证实长期高血糖。她开始使用胰岛素滑动刻度，然后转为皮下胰岛素。由于她的视力受损，这是由护理人员进行的。对左眼进行了紧急白内障手术，视力恢复。出院后，她接受了基础治疗方案，并为右眼安排了进一步的手术。

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引用次数: 0

More than meets the eye: the ACCORD trial and use of statin‐fibrate combination in type 2 diabetes mellitus 超过满足眼睛:ACCORD试验和使用他汀类药物-贝特联合治疗2型糖尿病

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-10-01 DOI: 10.1002/PDI.1511

G. Watts, F. Karpe

powerful predictor of cardiovascular disease (CVD) in type 2 diabetes, with low-density lipoprotein (LDL) being the most atherogenic lipoprotein. Accordingly, the first priority of lipid-regulating treatment is to lower the plasma concentration of LDL-cholesterol. This is efficaciously achieved with a statin, as evidenced by several excellent clinical endpoint trials.1 While the importance of correcting hyperglycaemia is well established, the significance of dyslipidaemia and its treatment for preventing progression of diabetic microangiopathy, particularly retinopathy, remains undefined.

2型糖尿病患者心血管疾病(CVD)的有力预测因子，低密度脂蛋白(LDL)是最易致动脉粥样硬化的脂蛋白。因此，调脂治疗的首要任务是降低血浆ldl -胆固醇浓度。几个优秀的临床终点试验证明，他汀类药物可以有效地实现这一目标虽然纠正高血糖的重要性已经确立，但血脂异常及其治疗对预防糖尿病微血管病变(特别是视网膜病变)进展的意义仍不明确。

引用次数: 0

Exenatide-induced hypomagnesaemia causing seizures 艾塞那肽引起的低镁血症引起癫痫发作

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-10-01 DOI: 10.1002/pdi.1513

John W Foote Consultant Physician, M. K. C. Physician

引用次数: 1

Postpartum oral glucose tolerance testing: a justifiable step towards diabetes prevention 产后口服葡萄糖耐量测试:预防糖尿病的合理步骤

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-10-01 DOI: 10.1002/PDI.1514

S. Meltzer

引用次数: 1

NICE challenge on postnatal reclassification of glucose tolerance in women previously diagnosed with gestational diabetes mellitus NICE对先前诊断为妊娠期糖尿病的妇女出生后糖耐量重新分类的挑战

Practical diabetes international : the journal for diabetes care teams worldwide

Pub Date : 2010-10-01 DOI: 10.1002/PDI.1521

S. Mehmet, S. Fincher, S. Ibrahim

Women with a history of gestational diabetes mellitus (GDM) are at increased risk of developing diabetes. National Institute for Health and Clinical Excellence guidelines (July 2008) recommend the use of fasting plasma glucose (FPG) but not an oral glucose tolerance test (OGTT) at the six-week postnatal check. Our data analysis aims to challenge this recommendation. Retrospective data were obtained for 95 women with GDM who delivered at Queen Mary's Hospital, Sidcup, UK (2003–2008). The results of the FPG concentration were assessed in relation to the two-hour glucose value. Of the 95 OGTTs, the two-hour glucose value revealed that seven had diabetes and 19 had impaired glucose tolerance (IGT). However, 12 women had IGT and one had diabetes with a normal FPG (<6.0mmol/L). The sensitivity and specificity of using FPG for the diagnosis of postnatal diabetes are 85.7% and 87.5%, respectively. In our population, using a six-week postnatal FPG is unsatisfactory for evaluating the glucose tolerance of women with previous GDM as it would result in failure to diagnose 63.2% of those with IGT and a smaller proportion of those with diabetes. It is established that lifestyle changes can reduce the incidence of diabetes in individuals with IGT. For this reason, the OGTT remains the preferred option for the postnatal follow up of women with previous GDM in our hospital. Copyright © 2010 John Wiley & Sons.

有妊娠期糖尿病(GDM)病史的妇女患糖尿病的风险增加。国家健康和临床卓越研究所指南(2008年7月)建议在产后6周检查时使用空腹血糖(FPG)，而不是口服葡萄糖耐量试验(OGTT)。我们的数据分析旨在挑战这一建议。回顾性分析了2003-2008年在英国Sidcup玛丽皇后医院分娩的95名GDM妇女的资料。将FPG浓度与两小时血糖值的关系进行评估。在95名ogtt患者中，两小时血糖值显示7名患有糖尿病，19名葡萄糖耐量(IGT)受损。然而，12名女性患有IGT, 1名患有糖尿病，FPG正常(<6.0mmol/L)。FPG诊断产后糖尿病的敏感性和特异性分别为85.7%和87.5%。在我们的人群中，使用产后6周FPG来评估既往GDM女性的糖耐量是不满意的，因为它会导致63.2%的IGT患者和较小比例的糖尿病患者诊断失败。生活方式的改变可以降低IGT患者的糖尿病发病率。因此，OGTT仍是我院既往GDM妇女产后随访的首选方法。版权所有©2010 John Wiley & Sons。

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