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Diabetes and heart failure: time for a new approach 糖尿病和心力衰竭:是时候采用新方法了
Pub Date : 2019-08-27 DOI: 10.15406/jdmdc.2019.06.00186
Renato Kaufman
1. Young LH, Wackers FJ, Chyun DA, et al. Cardiac outcomes after screening for asymptomatic coronary artery disease in patients with type 2 diabetes: the DIAD study: a randomized controlled trial. JAMA. 2009;301(15):1547–1555. 2. Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation. 2011;124(23):574–651.
1. Young LH, Wackers FJ, Chyun DA,等。2型糖尿病患者无症状冠状动脉疾病筛查后的心脏预后:DIAD研究:一项随机对照试验《美国医学协会杂志》上。2009; 301(15): 1547 - 1555。2. Levine GN, Bates ER, Blankenship JC,等。2011 ACCF/AHA/SCAI经皮冠状动脉介入治疗指南:美国心脏病学会基金会/美国心脏协会实践指南工作组和心血管血管造影与介入学会的报告。循环。2011;124(23):574 - 651。
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引用次数: 0
A case of subacute thyroiditis associated with complete occlusion of right coronary artery 亚急性甲状腺炎伴右冠状动脉完全闭塞1例
Pub Date : 2019-07-30 DOI: 10.15406/JDMDC.2019.06.00183
A. Nakanishi, Jouji Shunto, Reiko Shunto, M. Sata, H. Bando
Case presentation: A case is a 72-year-old male, and developed fever, sore throat and immigrating neck pain, without shortness of breath (SOB). He showed pulse 96/min, Temp 38.8C, BP 146/90mmHg, respiration and SpO2 normal. Physicals were slight tenderness in thyroid, and laboratory data revealed free T3/T4 10.7pg/mL/5.4ng/dL. He was diagnosed as subacute thyroiditis. ECG showed incomplete right bundle block branch (RBBB) and Holter ECG showed pulse rate 70-144/min and the average was 95.8/min for 24 hours. HbA1c increased from 6.4% to 7.4% for 6 weeks. For the treatment, prednisolone 20mg/day was started and reduced gradually, and thyroid function was normalized. Consecutively, he developed chest discomfort and oppression with unremarkable ECG changes and chest CT showed only the calcification of coronary arteries. Coronary angiography showed occlusion of the right proximal coronary artery (RCA, #2:100%), left anterior descending (LAD, #6:75%, #7:90%). Coronary angioplasty was operated immediately. By placing a drug-eluting stent, RCA was re-opened successfully. His symptoms disappeared, and clinical course was improved.Discussion: Subacute thyroiditis may bring hyperthyroidism and tachycardia, increased metabolism for circulatory system. Then, subacute thyroiditis would give burden and stress for coronary heart function. It is suggested that hyperthyroidism would aggravate the coronary stenosis. We have to consider such complex pathophysiology for the diseased states in the clinical medical practice.
病例介绍:1例72岁男性,出现发热、喉咙痛、移动性颈痛,无呼吸急促。脉搏96次/分,体温38.8℃,血压146/90mmHg,呼吸和SpO2正常。体格检查显示甲状腺轻度压痛,实验室数据显示游离T3/T4 10.7pg/mL/5.4ng/dL。他被诊断为亚急性甲状腺炎。心电图显示右束传导阻滞分支(RBBB)不完全,动态心电图显示脉搏率70 ~ 144次/min, 24小时平均95.8次/min。6周后,HbA1c从6.4%上升到7.4%。治疗时,开始使用强的松龙20mg/天,逐渐减量,甲状腺功能恢复正常。连续出现胸部不适和压迫,心电图无明显改变,胸部CT仅显示冠状动脉钙化。冠状动脉造影显示右冠状动脉近端闭塞(RCA, #2:100%),左前降支闭塞(LAD, #6:75%, #7:90%)。立即行冠状动脉成形术。通过放置药物洗脱支架,RCA被成功地重新打开。患者症状消失,临床病程改善。讨论:亚急性甲状腺炎可引起甲状腺功能亢进和心动过速,循环系统代谢增加。亚急性甲状腺炎会给冠状动脉功能带来负担和压力。提示甲亢会加重冠状动脉狭窄。在临床医学实践中,我们必须考虑到这种复杂的病理生理。
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引用次数: 1
The artificial pancreas: Incremental improvements towards an automated closed-loop insulin delivery system in type 1 diabetes 人工胰腺:1型糖尿病患者自动闭环胰岛素输送系统的渐进式改进
Pub Date : 2019-04-15 DOI: 10.15406/jdmdc.2019.06.00182
Martina S Burn, Sabrina C Burn, P. Burn
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引用次数: 0
Thyroid hormone abnormalities in euthyroid type 2 diabetes mellitus with chronic kidney disease in Saudi community based hospital 沙特社区医院甲状腺功能正常的2型糖尿病合并慢性肾病患者甲状腺激素异常
Pub Date : 2019-04-02 DOI: 10.15406/jdmdc.2019.06.00180
Khalid S Aljabri, Ibrahim M Alnasser, Samia A Bokhari, Muneera A Alshareef, Patan M Khan, Abdulla M Mallosho, Hesham M Abu Elsaoud, Mohammad M Jalal, Rania F Safwat, Rehab El Boraie, Nawaf K Aljabri, Bandari K Aljabri, Arwa Y Alsuraihi MS, Amjad I Hawsawi
Background and objective: The interactions between kidney and thyroid functions are known for years. The present retrospective study was conducted to find out the thyroid hormone abnormalities in patients with chronic kidney disease (CKD) and type 2 diabetes mellitus (T2DM) in Saudi community based hospital. Design: We analyzed retrospectively 872 participants with T2DM whom are between the age 20 to 96 years. All patients were from the population of the Primary health centre at King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia. All data were collected on the basis of a review of electronic medical data. Participants were defined as having T2DM according to self-report, clinical reports, use of antidiabetic agents and HbA1c (≥6.5). HbA1c was expressed as percentage. High performance liquid chromatography was used. Serums FT4 were estimated by radioimmunoassay and Serum TSH was estimated by Immunoradiometric assey. All patients in the present study fulfilled the revised National Kidney Foundation criteria for the diagnosis of CKD. The total numbers of cohort were separated on basis of age values into four groups: <40 years, 40-49 years, 50-59 years and ≥60 years. Results: 872 subjects with T2DM were included. There were 273 (31.3%) male and 557 (68.7%) were female with mean age 54.5±13.0. The mean HbA1c, TSH and FT4 value were 8.1±2.2, 2.0±1.1 mIU/l and 15.8±2.8 pmol/l respectively. Among cases of T2DM and CKD, there were 239 (61.9 %) female and 147 (38.1 %) were male with female to male ration 1.6:1.0, p<0.0001. Patients with CKD were significantly older than patients without CKD, 57.3±2.9 vs. 52.3 ±12.6 respectively, p<0.0001. Patients with CKD were significantly have higher HbA1c than patients without CKD, 8.7±2.3 vs. 7.7±2.1 respectively, p<0.0001. Patients with CKD were significantly have higher TSH than patients without CKD, 2.1±1.0 vs. 1.9±1.1 respectively, p=0.001. Patients with CKD were significantly have lower FT4 than patients without CKD, 15.5±2.8 vs. 16.1±2.9 respectively, p=0.03. Patients with CKD have higher TSH than patients without CKD across all age groups. Patients with CKD have lower FT4 than patients without CKD across all age groups except patients older than 60years. Conclusion: We conclude that despite the limitations of this hospital-based retrospective study, high TSH and low FT4 levels are highly prevalent in cohort of Saudis with CKD and T2DM. The majority of our patients in our finding were predominantly females. These two observations remain to be validated by population-based studies. In the absence of registry data, larger cooperative studies involving diverse population samples from multiple centers could help to provide further information on the true thyroid hormone abnormalities.
背景和目的:肾脏和甲状腺功能之间的相互作用多年来一直为人所知。本研究旨在回顾性研究沙特社区医院慢性肾脏疾病(CKD)合并2型糖尿病(T2DM)患者的甲状腺激素异常情况。设计:我们回顾性分析了872名年龄在20至96岁之间的T2DM患者。所有患者均来自沙特阿拉伯吉达法赫德国王武装部队医院初级保健中心的居民。所有数据都是在审查电子医疗数据的基础上收集的。参与者根据自我报告、临床报告、抗糖尿病药物的使用和HbA1c(≥6.5)定义为T2DM。HbA1c以百分比表示。采用高效液相色谱法。用放射免疫法测定血清FT4,用免疫放射测定法测定血清TSH。本研究中所有患者均符合修订后的国家肾脏基金会CKD诊断标准。根据年龄值将队列总人数分为<40岁、40-49岁、50-59岁和≥60岁4组。结果:纳入T2DM患者872例。男性273例(31.3%),女性557例(68.7%),平均年龄54.5±13.0岁。HbA1c、TSH和FT4的平均值分别为8.1±2.2、2.0±1.1 mIU/l和15.8±2.8 pmol/l。T2DM合并CKD患者中,女性239例(61.9%),男性147例(38.1%),男女比例为1.6:1.0,p<0.0001。CKD患者年龄明显大于无CKD患者,分别为57.3±2.9比52.3±12.6,p<0.0001。CKD患者HbA1c显著高于非CKD患者,分别为8.7±2.3比7.7±2.1,p<0.0001。慢性肾病患者TSH水平明显高于非慢性肾病患者,分别为2.1±1.0比1.9±1.1,p=0.001。CKD患者FT4明显低于非CKD患者,分别为15.5±2.8比16.1±2.9,p=0.03。在所有年龄组中,慢性肾病患者的TSH均高于非慢性肾病患者。除60岁以上患者外,所有年龄组CKD患者的FT4均低于非CKD患者。结论:我们得出结论,尽管这项以医院为基础的回顾性研究存在局限性,但高TSH和低FT4水平在CKD和T2DM的沙特队列中非常普遍。在我们的研究中,大多数患者以女性为主。这两个观察结果仍有待以人群为基础的研究来验证。在缺乏登记数据的情况下,涉及多个中心不同人群样本的大型合作研究可以帮助提供关于甲状腺激素异常的进一步信息。
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引用次数: 0
Analysis of hypoglycemic episodes in diabetics in Africans 非洲糖尿病患者低血糖发作分析
Pub Date : 2019-03-28 DOI: 10.15406/jdmdc.2019.06.00179
A. Ademolu
Hypoglycemia as a management complication of diabetes mellitus is a worldwide experience.1 Though concerted efforts have been made by endocrinologist, health workers and patients to reduce hypoglycemic episodes yet its occurrence and recurrence despite these efforts cannot be overemphasized. The glycemic thresholds for symptoms of hypoglycemia (among other responses) shift to lower plasma glucose concentrations after recent antecedent hypoglycemia,2‒5 and to higher plasma glucose concentrations in patients with poorly controlled diabetes and infrequent hypoglycemia.6
低血糖作为糖尿病的并发症是一种世界性的经验虽然内分泌学家、卫生工作者和患者共同努力减少低血糖发作,但尽管这些努力,它的发生和复发怎么强调也不为过。低血糖症状的血糖阈值(在其他反应中)转变为近期既往低血糖后较低的血浆葡萄糖浓度2-5,以及糖尿病控制不良和罕见低血糖患者较高的血浆葡萄糖浓度6
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引用次数: 0
Pharmacologically relevant drug interactions of α glucosidase inhibitors α葡萄糖苷酶抑制剂的药理学相关药物相互作用
Pub Date : 2019-03-13 DOI: 10.15406/jdmdc.2019.06.00178
Naina Mohamed Pakkir Maideen
The α-glucosidase inhibitors are antidiabetic agents suppressing the postprandial hyperglycemia and they include Acarbose, Miglitol and Voglibose. These drugs could be used alone or as add-on therapy to treat patients with type 2 diabetes taking other antidiabetic drugs. The gastrointestinal motility is increased by the administration of Acarbose, which may lead to decreased absorption of Digoxin and Metronidazole. The glucose lowering effects of antidiabetic drugs such as Metformin, Glibenclamide, Rosiglitazone, Vildagliptin and Dapagliflozin might be enhanced by the coadministration of α-glucosidase inhibitors, though there were reports of little or no alterations in the pharmacokinetics properties of them.
α-葡萄糖苷酶抑制剂是抑制餐后高血糖的降糖药物,包括阿卡波糖、米格列醇和伏格糖。这些药物可以单独使用,也可以作为附加疗法治疗正在服用其他抗糖尿病药物的2型糖尿病患者。阿卡波糖可增加胃肠蠕动,使地高辛和甲硝唑的吸收减少。二甲双胍、格列脲、罗格列酮、维格列汀和达格列净等降糖药物与α-葡萄糖苷酶抑制剂联合使用可能会增强降糖效果,但有报道称这些药物的药代动力学性质几乎没有变化。
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引用次数: 4
Daily improvement of blood glucose profile by continuous glucose monitoring (CGM) 通过连续血糖监测(CGM)改善每日血糖状况
Pub Date : 2019-03-07 DOI: 10.15406/JDMDC.2019.06.00177
H. Bando, Y. Kato, S. Kanazawa, Mayumi Tanaka, E. Sueki, H. Kanagawa, T. Kawata, A. Kawahito, A. Aihara
Background: The problem of glucose variability has been in focus for type 1 diabetes mellitus (T1DM) on insulin treatment. Daily profile of blood glucose was studied on Continuous Glucose Monitoring (CGM) using Free Style Libre. Case presentation and results: Patient is 54 year-old T1DM female, with HbA1c 7.8%. The blood glucose variability was measured by Free Style Libre. Insulin therapy included multiple daily insulin injection (MDI) of Insulin Glargin and Aspart. The result revealed unstable blood glucose profile in day 1 and 2. After that, the level and fluctuation of blood glucose gradually decreased from day 3 to 14. Average blood glucose in a day was 174mg/dL, 159mg/dL, 138mg/dL, 125mg/dL and 110mg/dL, in day 2, 4, 7, 9, 11, respectively. There was a discrepancy of HbA1c between 7.8% by laboratory measurement and 6.3% presumed value by Free Style Libre. Discussion and Conclusion: Free Style Libre showed satisfactory results as CGM. There was lower HbA1c value by presumed calculation, which would be possibly due to every 15minutes measurement and difficulty in checking abrupt glucose surges. CGM application would probably bring diabetic subjects behavioral change of life style, leading to better diabetic control. These results would become reference data in CGM study for future research.
背景:胰岛素治疗对1型糖尿病(T1DM)的血糖变异性问题一直是关注的焦点。采用Free Style Libre连续血糖监测仪(CGM)研究每日血糖变化。病例介绍和结果:患者54岁,T1DM女性,HbA1c 7.8%。采用Free Style Libre测量血糖变异性。胰岛素治疗包括每日多次胰岛素注射(MDI)甘精胰岛素和阿斯帕特。结果显示第1天和第2天血糖不稳定。之后,从第3天到第14天,血糖水平和波动逐渐降低。第2天、第4天、第7天、第9天、第11天的日均血糖分别为174mg/dL、159mg/dL、138mg/dL、125mg/dL和110mg/dL。HbA1c在实验室测量值7.8%与Free Style Libre推测值6.3%之间存在差异。讨论与结论:自由式自由泳作为CGM具有满意的效果。假定计算HbA1c值较低,这可能是由于每15分钟测量一次,难以检查突然的血糖激增。CGM的应用可能会带来糖尿病患者生活方式的行为改变,从而更好地控制糖尿病。这些结果为今后的CGM研究提供了参考数据。
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引用次数: 2
Where are we in the management of type 2 DM? 2型糖尿病的治疗进展如何?
Pub Date : 2019-02-25 DOI: 10.15406/jdmdc.2019.06.00176
Mohamed Hassan Hatahet
Efficacy a) Oral medications tend to be less effective in lowering HbA1c (< 1% reduction). b) Insulin and GLP1 RA reduce HbA1c more, alone or in combination. c) Basal insulin and GLP1 RA are similar in reducing HbA1c when used as 1st injectable. d) Adding an oral medication looks reasonable when HbA1c is still between 7-8%. e) Adding one of the injectable when HbA1c is 8% or above is the most reasonable to a patient on oral medication. f) Adding two or more oral medications can bring high HbA1c to goal.
a)口服药物降低HbA1c的效果较差(< 1%)。b)胰岛素和GLP1 RA单独或联合使用更能降低HbA1c。c)第一次注射时,基础胰岛素和GLP1 RA在降低HbA1c方面相似。d)当HbA1c仍在7-8%之间时,添加口服药物似乎是合理的。e)口服用药患者在HbA1c为8%及以上时加用其中一种注射剂最为合理。f)加用两种或两种以上口服药物可使高HbA1c达到目标。
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引用次数: 0
Single and combinatorial herbal formulations reversed hyperglycemia and dyslipidemia in diabetic rats 单一和组合草药制剂逆转糖尿病大鼠的高血糖和血脂异常
Pub Date : 2019-02-12 DOI: 10.15406/jdmdc.2019.06.00175
C. Chikezie, Okey, A. Ojiako, A. Angela, Emejulu, PAUL CHIDOKA CHIKEZIE
Acanthus montanus (Nees) T. Anderson is widespread in Africa, the Balkans, Romania, Greece and Eastern Mediterranean and belongs to the family of Acantheceae. The leaves are dark green and measure about 30 cm long. Common names of A. montanus are mountain thistle or Devil’s fig or Bear’s Breech. The leaf extracts of A. montanus have been previously reported to exhibit analgesics, antipyretic, antimicrobial, anti-inflammatory and immunological properties.1
山棘属棘科,广泛分布于非洲、巴尔干半岛、罗马尼亚、希腊和地中海东部。叶子是深绿色的,长约30厘米。山楂的常见名称是山蓟或魔鬼无花果或熊臀。山楂叶提取物已被报道具有镇痛、解热、抗菌、抗炎和免疫等特性
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引用次数: 0
Cognitive dysfunction in diabetes mellitus 糖尿病的认知功能障碍
Pub Date : 2019-02-07 DOI: 10.15406/jdmdc.2019.06.00174
Raman Pg
{"title":"Cognitive dysfunction in diabetes mellitus","authors":"Raman Pg","doi":"10.15406/jdmdc.2019.06.00174","DOIUrl":"https://doi.org/10.15406/jdmdc.2019.06.00174","url":null,"abstract":"","PeriodicalId":92240,"journal":{"name":"Journal of diabetes, metabolic disorders & control","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85960740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of diabetes, metabolic disorders & control
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