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Objective To evaluate efficacy and safety of acarbose compared with metformin as add-on therapy in patients with type 2 diabetes mellitus inadequately controlled with insulin. Methods This was a randomized, open-labeled, and parallel group study. Ninety-one type 2 diabetic patients ( HbA1C7.5%-11.0%) who were suboptimally controlled despite receiving twice daily injection of insulin (30-60 U/d for at least 8 weeks) were enrolled. They were randomly assigned 1 ∶ 1 ∶ 1 to continuation of insulin, insulin with acarbose (Ins+Aca), and insulin with metformin (Ins+Met) groups to insulin treatment. The levels of HbA1C, oral glucose tolerance test, blood lipids etc were measured at baseline and 12 weeks, and adverse events were recorded. Results The mean HbA1C levelsdecreasedfrom(7.9±0.4)%atbaselineto(7.0±0.3)%atweek12(P＜0.01)intheIns+Acagroupand(7.8 ±0.2)%to(7.0±0.3)%in the Ins+Met group(P＜0.01), while no significant change in HbA1Cin the insulin alone group. Adding acarbose to insulin resulted in similar reductions in HbA1Crelative to metformin (P＝0.431). The achievement rate of HbA1Cbelow 7.0%at week 12 was the same(both 70%) between the Ins+Aca group and the Ins+Met group. Insulin combined with acarbose in improving blood glucose fluctuation effect was more significant than that incombinationwithmetformin(P＜0.01),withstandarddeviation(SD)ofbloodglucose[(1.1±0.5vs2.7±0.6) mmol/L, P＜0.01], postprandial blood glucose fluctuations [(0.5 ± 0.7 vs 2.8 ± 0.4) mmol/L, P＜0.01], the maximumbloodglucosefluctuations[(2.8±0.7vs4.6±0.6)mmol/L,P＜0.01].Theweightlossoccurredinboththe Ins+AcaandtheIns+Metgroups[-(0.5±0.8vs1.0±0.4)kg].Therewasnosignificantchangesinbloodpressure and lipid profile. Hypoglycemic episodes were comparable in all groups. No serious adverse event was noted in any group. Conclusions Adding acarbose or metformin to insulin therapy could achieve improvements in glycemic control with similar reductions in HbA1Clevels and weight, when comparing with insulin treatment alone. Add-on acarbose to insulin therapy may exist more effectively on glucose fluctuation than that of add-on metformin, which may have important clinical implications in those patients with postprandial hyperglycemia, large blood glucose fluctuation, and intolerance to metformin.
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The knowledge of endocrine metabolic diseases represented by type 2 diabetes mellitus is highly specialized, complicated, and has many clinical guidelines. In this context, team based learning teaching combined with case teaching based on evidence-based medicine was applied in the actual class teaching. The class was divided into several groups and the students were encouraged to discuss and study from each other with the guidance of teachers. Consequently, students' learning interests and spirit of team-work were greatly enhanced, the way of thinking using evidence-based medicine and their ability to solve the practical clinical problems were also improved.
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ObjectiveTo evaluate the safety and efficacy of 30 mg pioglitazone hydrochloride combined with sulphonyurea in the treatment of type 2 diabetic patients.MethodsA randomized, double blind, placebo-controlled, parallel group, multicenter study was performed.A total of 236 patients, who had fasting plasma glucose(FPG) 7.5-13.0 mmol/L and glycosylated hemoglobin A1c(HbA1 c) 7.0％ -12.0％,treated with stable dosage of a sulphonyurea for at least 30 days previously, were randomized to receive placebo or pioglitazone 30 mg once daily for 16 weeks.The sulphonyurea and dosage remained unchanged.ResultsThe patients who had been treated with pioglitazone 30 mg showed significant decrease than that in the placebo group on the average from baseline in FPG [(1.48 ±2.08) mmol/L vs (-0.17 ± 1.92)mmol/L, P＜0.05], and in HbAlc [(0.92 ±0.10)％ vs (0.28 ±0.11)％, P＜0.05].Since fasting plasma insulin (Flns) levels decreased (0.24 ±0.04) mU/L and (0.09 ±0.04) mU/L in the two groups.The homeostatic model assessment insulin resistant (HOMA-IR) decreased 1.42 ± 2.90 and 0.46 ± 3.53 in two groups.The triglyceride level was decreased 0.36 mmol/L and 0.14 mmol/L, and the HDL-C level increased 0.17 mmol/L and 0.05 mmol/L in two groups.There were significant differences in two groups (all P ＜ 0.05).ConclusionsThe 16-week clinical study demonstrated that pioglitazone hydrochloride with a dosage of 30mg daily, could significantly improve the blood glucose control and enhance the insulin sensitivity, lower triglyceride and raise HDL-C level as an additional therapy to a stable-dose sulphonyurea in Chinese type 2 diabetic patients previously poorly controlled by single sulphonyurea therapy, and furthermore had good safety and compliance.
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0.05)in sex,age and volume of lesions.Over a course of treatment the average volume of thyroid adenomas of each group significantly(P
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Student as standard patient(SSP) was defined as student receiving relative medical training,who was willing to act as a human analogue as a patient and could be used as not only a patient but also a teacher in clinic practice.The results indicates that the using of SSP in the clinical teaching of endocrinology could promote the students'level in practice and in the meanwhile,it could be useful to testing the learning result.
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Objective:To study the differentially expressed genes associated with lipid metabolism in adipose tissues of patients with insulin resistant(IR) type 2 diabetes mellitus(T2DM),in an effort to explore the mechanism of IR.Methods: mRNA from the omental adipose tissues of T2DM patients(n=5) and normal controls(n=5) were reversely transcribed into cDNAs with the incorporation of fluorescent dUTP(cy-5 or cy-3) to prepare hybridization probes.The mixed probes were hybridized with a cDNA microarray containing the target genes.The results were scanned and subjected to computer analysis to search for the difference between the gene spectrum of T2DM patients and normal controls.The differentially expressed gene,FOXC2,was verified by Northern blot.Results: Eighty-two differentially expressed genes were identified between these 2 groups,with 10 associated with lipid metabolism,including 5 upregulated ones and 5 downregulated ones.Northern blotting confirmed that the expression of FOXC2 mRNA was increased in IR group,which was in accordance with the result of cDNA microarray analysis.Conclusion: The pathogenesis of IR is related with lipid metabolism and the FOXC2 gene may be a candidate gene of(IR. )