Comparison of Glucose Control by Added Liraglutide to Only Insulin Infusion in Diabetic Patient Undergoing Cardiac Surgery: A Preliminary Randomized?Controlled Trial

Background: Liraglutide, glucagon-like peptide-1 (GLP-1) receptor agonist, has been investigated for safety and effectiveness for blood glucose (BG) control in a surgical setting. However, there are only a few studies specific to cardiac surgery patients. Aims: To primarily compare perioperative 1) BG and 2) glycemic variability (GV) between added liraglutide and only insulin infusion in diabetes mellitus (DM) patients undergoing cardiac surgery. Setting and Design: A randomized control trial was conducted in DM patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Inclusion criteria were age 20� years and DM Type 2. Material and Methods: The recruited patients were randomly assigned to Group 1 (added liraglutide with insulin infusion) and Group 2 (insulin infusion). Insulin infusion was based on institutional protocol. Point of care testing (POCT) glucose was used for the adjustment of insulin and BG analysis. Continuous glucose monitor (CGM) was for GV analysis (using Standard deviation: SD). Statistics: t?test, Chi?square or Fisher?exact test, or Mann朩hitney U test. Results: Finally, 60 patients were in our study (Group 1 = 32 vs Group 2 = 28). Perioperative mean BG levels of Group 1 were significantly lower than Group 2 with a mean difference of 15.9 mg/dL. Nine patients (18.7% vs 10.7%, P = 0.384) had BG of 60� with mean BGs (109.1 vs 147.9, P = 0.001) in the morning. Thirteen patients (9.4% vs 35.7%, P = 0.025) had BG >180 mg/dL at the 1st operative hour. SDs were increasing, but lower SD of Group 1 were observed at the postoperative period. Mean of SDs at postoperative day 2 were 23.65 vs 32.79 mg/dL, P = 0.018. Conclusions: Liraglutide added with insulin infusion can attenuate perioperative BG and is beneficial in the aspect of lowering GV together with BG at the postoperative period in DM patients. Liraglutide can be applied in cardiac surgery but a rearrangement of time and dosage should be further investigated.

Respostas agudas da glicose sanguínea no segundo dia da recuperação do exercício resistido de moderada vs. alta intensidade em mulheres com diabetes tipo 2 / Acute blood glucose responses on the second day of recovery from moderate vs. high intensity resistance exercise in women with type 2 diabetes

O exercício resistido (ER) pode reduzir a glicose no sangue em pessoas com diabetes tipo 2 (DM2). No entanto, é necessária maior clareza quanto à intensidade do ER e ao tempo necessário para essa resposta aguda. Portanto, o objetivo deste estudo foi comparar as respostas agudas de glicose no sangue no segundo dia de recuperação do ER moderada versus de alta intensidade em mulheres com DM2. Doze mulheres com DM2 (55,2 ± 4,0 anos; 70,1 ± 11,4 kg; e 155,7 ± 3,3 cm) realizaram duas sessões experimentais com sete dias de intervalo em ordem aleatória. Para a sessão 1: ER40% do teste de uma repetição máxima (1RM) e sessão 2: ER80%1RM, com 16 e 8 repetições para cada série, respectivamente, em 7 exercícios com 3 circuitos durante 40min. A glicemia foi monitorada por 35h (primeiro dia: 24h e segundo dia: 11h) a cada 5 minutos após cada sessão experimental pelo Sistema de Monitoramento Contínuo de Glicose (modelo Guardian REAL-Time). O teste t de Student não mostrou diferença significativa na glicemia do segundo dia (11h) após as sessões de ER40%1RM vs. RE80%1RM [respectivamente, 161,3 ± 62,3 mg.dL-1 vs. 157,2 ± 41,9 mg.dL-1; t (11) = 0,259; p = 0,800]. A ANOVA two-way para medidas repetidas mostrou que as respostas de glicose no sangue a cada hora durante a recuperação no segundo dia não mostraram diferenças significativas entre as sessões de ER [F (1,731; 19,039) = 0,688; p = 0,734]. Concluímos que as respostas glicêmicas agudas no segundo dia da recuperação do ER de intensidade moderada e alta não diferiram entre as mulheres com DM2.

Resistance exercise (RE) can lower blood glucose in people with type 2 diabetes (T2D). However, greater clarity is needed regarding the RE intensity and time required for this acute response. Therefore, the aim of this study was to compare acute blood glucose responses on the second day of recovery from moderate vs. high-intensity RE in women with T2D. Twelve women with T2D (55.2 ± 4.0 years; 70.1 ± 11.4 kg; and 155.7 ± 3.3 cm) performed two experimental sessions seven days apart in a randomized order. For session 1: RE40% of one-repetition maximum test (1RM) and session 2: RE80%1RM, with 16 and 8 repetitions for each set, respectively, in 7 exercises with 3 circuits during 40min. Blood glucose was monitored for over 35h (first day: 24h and second day: 11h) every 5 minutes after each experimental session by the Continuous Glucose Monitoring System (Guardian REAL-Time model). Student's t-test showed no significant difference in blood glucose on the second day (11h) after RE40%1RM vs. RE80%1RM sessions [respectively, 161.3 ± 62.3 mg.dL-1 vs. 157.2 ± 41.9 mg.dL-1; t (11) = 0.259; p = 0.800]. Two-way ANOVA for repeated measures showed that blood glucose responses every hour during recovery on the second day showed no significant differences between RE sessions [F (1.731, 19.039) = 0.688; p = 0.734]. We concluded that the acute blood glucose responses on the second day of moderate and high intensity RE did not differ among women with T2D.

Effect evaluation of “healthy eating plate” based dietary management for diabetic inpatients / 预防医学

Objective@#To evaluate the effect of "healthy eating plate" based dietary management on diabetic inpatients.@*Methods@#The patients with type 2 diabetes mellitus (T2DM) admitted to Daishan First People's Hospital from November 2019 to November 2020 were selected and randomly divided into two groups. The intervention group was given "healthy eating plate" based dietary management, while the control group was given routine dietary management. Demographic data and physical examination results were collected. Fasting blood glucose (FPG), glycosylated hemoglobin (HbA1c), triglyceride (TG) and total cholesterol (TC) were detected at admission, discharge and 3 months after discharge, and compared between the two groups by covariance and generalized estimating equation. @*Results@#here were 52 patients aged (55.83±9.67) years in the intervention group, with 29 (55.77%) males and 23 (44.23%) females. There were 53 patients aged (57.54±11.09) years in the control group, with 32 (60.38%) males and 21 (39.62%) females. There were no significant differences in FPG, HbA1c, TG and TC levels between two groups at discharge (P>0.05). The level of HbA1c in the intervention group was significantly lower than that in the control group at 3 months after discharge (P<0.05); there were no significant differences in FPG, TG and TC levels (P>0.05).@*Conclusion @#The "healthy eating plate" based dietary management can better control the blood glucose of diabetic patients, and can help maintain the dietary treatment. It is worthy of promotion in diabetic patients.

Desarrollo y Simulación de un Algoritmo de Control Automatizado para Insulinoterapia de Urgencias Hiperglucémicas en Diabetes / Development and Simulation of an Automated Control Algorithm for Insulin Therapy of Hyperglycemic Emergencies in Diabetes

Resumen El presente trabajo describe el desarrollo y simulación de un algoritmo para el control automático de la infusión de insulina en el manejo glucémico de pacientes con cetoacidosis diabética (CAD) y estado hiperosmolar hiperglucémico (EHH). Se programó un algoritmo que calcula la insulina necesaria para lograr un descenso glucémico de 50 mg/dL/h hasta llegar a glucemias de 250 mg/dL, para posteriormente mantenerlas en 220 mg/dL hasta la remisión de la patología. La simulación del software se realizó haciendo uso de registros glucémicos de 10 pacientes con CAD manejados en el Hospital Juárez de México. Los resultados de la simulación mostraron una incidencia 6 veces menor de hipoglucemias, así como un 33.7% menos de insulina necesaria dentro del tratamiento, sin diferencias entre los descensos medios de glucosa por hora de las mediciones reales y simuladas. Este software propone un uso innovador de los llamados páncreas artificiales al aplicarlos en urgencias hiperglucémicas, implementando además el uso de la sensibilidad a la insulina como variable para el funcionamiento de los mismos. Los resultados demuestran que el algoritmo podría ser capaz de lograr un manejo glucémico apegado a las guías de tratamiento, generando un menor gasto de insulina y evitando hipoglucemias durante la terapéutica, con una posible aplicación en dispositivos biomédicos autónomos.

Abstract This paper describes the development and simulation of an algorithm for the automatic control of insulin infusion, in the glycemic management of patients with diabetic ketoacidosis (CAD) and hyperglycemic hyperosmolar state (EHH). An algorithm was programmed to calculate the requirement insulin for a glycemic decrease of 50 mg/dL/h until reach 250 mg/dL in blood glucose levels, and thus maintaining it at 220 mg/dL until the pathology remission. The software simulation was performed using glycemic records of 10 patients with CAD managed in the Hospital Juárez de México. The results of the simulation showed a lower incidence of hypoglycemia, as well as a lower insulin requirement within the treatment, without differences in the average glucose decreases per hour between real and simulated measurements. This software proposes an innovative use of the artificial pancreas in hyperglycemic emergencies, and also implementing the use of insulin sensitivity as a variable for their function. The results show that the algorithm could be able to achieve glycemic management attached to the treatment guidelines, generating lower insulin expenditure and avoiding hypoglycemia during therapy, with a possible application in autonomous biomedical devices.

Impact of an inpatient multidisciplinary glucose control management program

ABSTRACT Objective: Glycemic control has been increasingly recognized as a critical element in inpatient care, but optimal management of blood glucose in the hospital setting remains challenging. The aims of this study were to describe and evaluate the impact of the implementation of an inpatient multidisciplinary glucose control management program on glucose control in hospitalized patients. Materials and methods: Retrospective analysis of medical records and glucose monitoring data obtained by point- of-care testing (POCT) in hospitalized patients before (May 2014) and after (June 2015 and May 2017) the implementation of the program. Results: We analyzed 6888, 7290, and 7669 POCTs from 389, 545, and 475 patients in May 2014, June 2015, and May 2017, respectively. Hyperglycemia (≥ 180 mg/ dL) occurred in 23.5%, 19.6%, and 19.3% POCTs in May 2014, June 2015, and May/2017, respectively (p < 0.001), while severe hyperglycemia (≥ 300 mg/dL) was observed in 2.5%, 2.2%, and 1.8% of them, respectively (p = 0.003). Hyperglycemia (≥ 180 mg/dL) reduced significantly from May 2014 to June 2015 (16.3%, p < 0.001) and from May 2014 to May 2017 (178%, p < 0.001). No significant changes occurred in hypoglycemic parameters. Conclusions: The implementation of an inpatient multidisciplinary glucose control management program led to significant reductions in hyperglycemic events. The key elements for this achievement were the development of institutional inpatient glycemic control protocols, establishment of a multidisciplinary team, and continuing educational programs for hospital personnel. Altogether, these actions resulted in improvements in care processes, patient safety, and clinical outcomes of hospitalized patients.

Understanding of type 1 diabetes mellitus: what we know and where we go / 소아과

The incidence of type 1 diabetes mellitus (T1DM) in children and adolescents is increasing worldwide. Combined effects of genetic and environmental factors cause T1DM, which make it difficult to predict whether an individual will inherit the disease. Due to the level of self-care necessary in T1DM maintenance, it is crucial for pediatric settings to support achieving optimal glucose control, especially when adolescents are beginning to take more responsibility for their own health. Innovative insulin delivery systems, such as continuous subcutaneous insulin infusion (CSII), and noninvasive glucose monitoring systems, such as continuous glucose monitoring (CGM), allow patients with T1DM to achieve a normal and flexible lifestyle. However, there are still challenges in achieving optimal glucose control despite advanced technology in T1DM administration. In this article, disease prediction and current management of T1DM are reviewed with special emphasis on biomarkers of pancreatic β-cell stress, CSII, glucose monitoring, and several other adjunctive therapies.

Research Progress on Non-Drug Treatment for Blood Glucose Control of Type 2 Diabetes Mellitus / 中国结合医学杂志

Type 2 diabetes mellitus (T2DM) is one of the common endocrinology diseases that greatly affects the health care sector and economy. Application of hypoglycemic drugs has its own drawbacks and the use of non-drug therapy on treating T2DM has drawn much attention recently. This paper reviewed the research development of the non-pharmacological interventions on T2DM in recent years, including dietary therapy, exercise therapy, psychotherapy, acupuncture and moxibustion therapies and so on. The authors mentioned the problems in the research of non-drug treatment for blood glucose control of T2DM and put forward new ideas for the research in the future. Further well-designed trials with large sample size and long-term follow-up are needed to confirm current conclusions.

Effect of omni-directional health education on self management level and blood glucose control in type 2 diabetic patients / 中国中西医结合急救杂志

Objective To explore the effect of omni-directional health education on self-management level and blood glucose control in patients with type 2 diabetes mellitus. Methods A total of 100 diabetic patients admitted to the department of neurology of Taizhou Central Hospital from January to December 2016 were randomly divided into an observation group and a control group, 50 cases in each group. All patients were given conventional medication according to their systemic conditions, the control group used conventional nursing care, while the observation group was supplemented with omni-directional health education (including diet control therapy, exercise therapy, blood glucose control, hypoglycemic drug use and observation, foot care, blood glucose self monitoring) on the basis of routine nursing;the course of treatment was 2 weeks in the two groups. The differences in self-management level and the effect of blood glucose control were compared between the two groups. Results On the return visits, the self-management scores were significantly higher in both groups than those before education (the control group was 35.2±9.2 vs. 30.1±5.2, the observation group was 78.6±11.5 vs. 29.8±5.4, all P < 0.05), fasting blood glucose [FBG (mmol/L): the control group was 8.8±2.5 vs. 14.8±2.9, the observation group was 6.1±1.6 vs. 15.1±2.7, both P < 0.05) and 2 hours postprandial blood glucose [2 h PBG (mmol/L): the control group was 12.5±3.4 vs. 22.5±3.8, the observation group was 9.1±2.2 vs. 21.9±3.6) were obviously lower than those before education (all P < 0.05), the degrees of improvement of the observation group were more significant than those of the control group [self management score: 78.6±11.5 vs. 35.2±9.2, FBG (mmol/L): 6.1±1.6 vs. 8.8±2.5, 2 hours PBG (mmol/L): 9.1±2.2 vs. 12.5±3.4, all P < 0.05]. Conclusion Omni-directional health education can improve the self-management level of diabetic patients, and the patient's blood glucose control is relatively better.

The effect of two different glycemic management protocols on postoperative cognitive dysfunction in coronary artery bypass surgery / Efeito de dois protocolos de controle glicêmico diferentes sobre a disfunção cognitiva após cirurgia de revascularização do miocárdio

Abstract Introduction: Postoperative cognitive dysfunction (POCD) is an adverse outcome of surgery that is more common after open heart procedures. The aim of this study is to investigate the role of tightly controlled blood glucose levels during coronary artery surgery on early and late cognitive decline. Methods: 40 patients older than 50 years undergoing elective coronary surgery were randomized into two groups. In the "Tight Control" group (GI), the glycemia was maintained between 80 and 120 mg dL-1 while in the "Liberal" group (GII), it ranged between 80-180 mg dL-1. A neuropsychological test battery was performed three times: baseline before surgery and follow-up first and 12th weeks, postoperatively. POCD was defined as a drop of one standard deviation from baseline on two or more tests. Results: At the postoperative first week, neurocognitive tests showed that 10 patients in the GI and 11 patients in GII had POCD. The incidence of early POCD was similar between groups. However the late assessment revealed that cognitive dysfunction persisted in five patients in the GII whereas none was rated as cognitively impaired in GI (p = 0.047). Conclusion: We suggest that tight perioperative glycemic control in coronary surgery may play a role in preventing persistent cognitive impairment.

Resumo Introdução: A disfunção cognitiva pós-operatória (DCPO) é um resultado adverso cirúrgico que é mais comum após cirurgias cardíacas abertas. O objetivo deste estudo foi investigar o papel dos níveis de glicose no sangue rigorosamente controlados durante a cirurgia coronariana no declínio cognitivo precoce e tardio. Métodos: Foram randomizados em dois grupos 40 pacientes acima de 50 anos e submetidos à cirurgia coronariana eletiva. No grupo "controle rigoroso" (GI), a glicemia foi mantida entre 80-120 mg.dL-1; enquanto no grupo "liberal" (GII), variou entre 80-180 mg.dL-1. A bateria de testes neuropsicológicos foi feita três vezes: fase basal, antes da cirurgia e na primeira e 12ª semana de acompanhamento no pós-operatório. DCPO foi definida como uma queda de um desvio padrão da fase basal em dois ou mais testes. Resultados: Na primeira semana de pós-operatório, os testes neurocognitivos mostraram que 10 pacientes no GI e 11 pacientes no GII apresentaram DCPO. A incidência de DCPO precoce foi semelhante entre os grupos. No entanto, a avaliação tardia revelou que a disfunção cognitiva persistiu em cinco pacientes no GII, enquanto nenhum paciente foi classificado como cognitivamente prejudicado no GI (p = 0,047). Conclusão: Sugerimos que o controle glicêmico rigoroso no perioperatório de cirurgia coronariana pode desempenhar um papel na prevenção da deterioração cognitiva persistente.

Studies Progress Of Comprehensive Treatment Of Diabetic Peripheral Neuropathy / 中国药师

Diabetic peripheral neuropathy( DPN) is one of the most common chronic complications and the disabling one, which is related to chronic hyperglycemia and microvascular changes. Currently, the treatments of diabetic peripheral neuropathy contains glu-cose control,pain management,etiological treatment,prevention and remove risk factors. So we make a review on the progress on the treatment of DPN by now , providing a scientific basis to a advanced and effective program.

The effect of accurate control over blood glucose on immunity in patients with stroke-associated infection / 中华急诊医学杂志

Objective To investigate the correlation between blood glucose and stroke-associated infection (SAI) as well as the effect of accurate control over blood glucose on T-lymphocytes.Methods Stroke patients with stress hyperglycemia (random blood glucose ≥ 11.1 mmol/L) were divided into thc accurate control of blood glucose group (A) and the control group (C).The blood glucose was accurately controlled within 5.56-8.33 mmol/L in the group A and ＜ 11.10 mmol/L in the group C by infusion of regular insulin.The NIHSS and APACHE Ⅱ evaluation were performed at day 0,3 and 7 after admission,T-lymphocytes were measured by flow cytometry and the rate of stroke-associated infection was recorded.Results A total of 325 patients were enrolled in the present study.The patients in the group A had lower incidence of stroke-associated infection (51.8％ vs.64.0％,P =0.027) and lower incidence of hypoglycemia (2 vs.25,P ＜ 0.05).Lower level of average blood glucose [(7.00 ± 0.85) mmol/L vs.(8.97 ±1.68) mmoL/L,P ＜0.05] and lower blood sugar variability (12.1％ vs.18.7％,P ＜0.05) were found in the patients of group A compared with the group C.The patients in the group A at day 7 after admission showed higher counts of CD8 +,CD4 +and CD4 +/CD8 + [(0.42 ±0.13) × 109L-1vs.(0.34 ±0.12) ×109L-1,(0.50±0.13) ×109L-1vs.(0.39±0.17) ×109L-1and (1.36±0.14) vs.(1.14 ± 0.15) respectively,all P ＜ 0.05].Logistic regression analysis showed that blood glucose and CD4 + count were independent risk factors of stroke-associated infection.The AUCs of CD4 + and CD8 + for predicting stroke-associated infection were 0.814 and 0.724,respectively.The AUC (0.890) of a combination of CD4 + and CD8 + was significantly higher than that of CD4 + or CD8 + alone in predicting strokeassociated infection.Conclusions Accurate control over blood glucose decreases the fluctuation of the blood glucose level and the incidence of hypoglycemia.It improves the immunity associated with T lymphocyte,decreases the incidence of stroke-associated infection and thus improves prognosis of those patients.

Effects of Pharmaceutical Care on Blood Glucose Control and Medication Compliance in Patients with Dia-betes Mellitus / 中国药房

OBJECTIVE:To explore the effects of pharmaceutical care on blood glucose control and medication compliance in patients with diabetes mellitus. METHODS:Nighty-two discharged patients with diabetes mellitus in our hospital from Apr. to Sept. 2015 were divided into intervention group and control group by random number table method,with 46 cases in each group. Both groups were given Chlorpropamide tablets+Metformin glibenclamide tablets(Ⅰ)for 3 months;intervention group additionally re-ceived pharmaceutical care as medication education,telephone follow-up,etc. The levels of glycosylated hemoglobin and blood glu-cose,medication compliance were compared between 2 groups before and after treatment. RESULTS:Before treatment,there was no statistical significance in the levels of glycosylated hemoglobin and blood glucose,or medication compliance between 2 groups (P>0.05). After treatment,the levels of glycosylated hemoglobin and blood glucose in 2 groups were significantly decreased,and the intervention group was significantly lower than control group;the effects of blood glucose control in patients younger than 60 years old were better than in patients older than 60 years old,with statistical significance(P<0.05). After one month of treatment, the proportion of good medication compliance were increased significantly in 2 groups,and the intervention group was significantly higher than control group. After 3 months of treatment,the proportion of good medication compliance in 2 groups were significant-ly higher than before treatment,and 1 month after treatment,while the intervention group was significantly higher than control group. The improvement of medication compliance in patients younger than 60 years old was better than in patients older than 60 years old,with statistical significance (P<0.05). CONCLUSIONS:Pharmaceutical care contributes to blood glucose control and improves the medication compliance,especially for those younger than 60 years old.

Effects of lifestyle intervention on glucose control in people with type 2 diabetes / 上海交通大学学报（医学版）

Lifestyle intervention is basic and background treatment for people with type 2 diabetes.Effective lifestyle intervention contributes to better glucose control and delay of diabetic complications.Dietary and exercise interventions as well as lifestyle advice are major components of lifestyle intervention.Dietary intervention focuses on restriction of total caloric intake and balanced nutritional composition,while exercise intervention focuses on exercise mode,frequency,intensity,timing,and duration.This review introduced several lifestyle intervention measures including exercise and dietary interventions as well as lifestyle advice,and discussed their effects on glucose control in people with type 2 diabetes.

A three-year follow-up on patients with T2DM on drug therapy in Shihezi communities / 实用医学杂志

Objective To explore the changes of the constituent ratio of hypoglycemic scheme and clinical outcomes of patients with type 2 diabetes mellitus(T2DM)in recent three years in Shihezi. Methods The cluster random sampling methods were used to select 300 patients with T2DM who met the standards in November 2012 from 13 communities in Shihezi. The datasets including general demographic information ,treatment and clinical outcomes were collected by following them up for three years. Results From 2012 to 2015,the proportion of pa-tients with oral drugs decreased from 63.5％ to 51％ while increased from 30.8％ to 41.8％ with insulin treatment. For the patients with insulin treatment ,the rate of patients on single drug therapy declined significantly (χ2 =8.77,P<0.05),while significantly increased on insulin combined with oral drug(χ2=-10.27,P<0.01). The incidence of adverse effects increases from 16.8％ to 24.5％. As compared with 2012,blood sugar levels and con-trol rate had no obvious changes in 2015;namely,according to the standard(1),the control rate of blood glucose in 2015 was 41.2％,decreasing 4.0％as compared with 2012,while according to the standard(2),it increasd by 1.4％ from 2012 to 2015(52.9％). The rate of diabetic complications significantly increased from 2012 to 2015. Conclusions Oral drugs are mainly used in the treatment of T2DM in Shihezi communities,whereas the rate of insulin use elevates. The blood glucose control rate,medication safety,and ability to lower the rate of diabetic com-plications need to be improved in T2DM patients in Shihezi communities.

A three-year follow-up on patients with T2DM on drug therapy in Shihezi communities / 实用医学杂志

Objective To explore the changes of the constituent ratio of hypoglycemic scheme and clinical outcomes of patients with type 2 diabetes mellitus(T2DM)in recent three years in Shihezi. Methods The cluster random sampling methods were used to select 300 patients with T2DM who met the standards in November 2012 from 13 communities in Shihezi. The datasets including general demographic information ,treatment and clinical outcomes were collected by following them up for three years. Results From 2012 to 2015,the proportion of pa-tients with oral drugs decreased from 63.5％ to 51％ while increased from 30.8％ to 41.8％ with insulin treatment. For the patients with insulin treatment ,the rate of patients on single drug therapy declined significantly (χ2 =8.77,P<0.05),while significantly increased on insulin combined with oral drug(χ2=-10.27,P<0.01). The incidence of adverse effects increases from 16.8％ to 24.5％. As compared with 2012,blood sugar levels and con-trol rate had no obvious changes in 2015;namely,according to the standard(1),the control rate of blood glucose in 2015 was 41.2％,decreasing 4.0％as compared with 2012,while according to the standard(2),it increasd by 1.4％ from 2012 to 2015(52.9％). The rate of diabetic complications significantly increased from 2012 to 2015. Conclusions Oral drugs are mainly used in the treatment of T2DM in Shihezi communities,whereas the rate of insulin use elevates. The blood glucose control rate,medication safety,and ability to lower the rate of diabetic com-plications need to be improved in T2DM patients in Shihezi communities.

A glucose-centric perspective of hyperglycemia.

Digestion of food in the intestines converts the compacted storage carbohydrates, starch and glycogen, to glucose. After each meal, a flux of glucose (>200 g) passes through the blood pool (4-6 g) in a short period of 2 h, keeping its concentration ideally in the range of 80-120 mg/100 mL. Tissue-specific glucose transporters (GLUTs) aid in the distribution of glucose to all tissues. The balance glucose after meeting the immediate energy needs is converted into glycogen and stored in liver (up to 100 g) and skeletal muscle (up to 300 g) for later use. High blood glucose gives the signal for increased release of insulin from pancreas. Insulin binds to insulin receptor on the plasma membrane and activates its autophosphorylation. This initiates the post-insulin-receptor signal cascade that accelerates synthesis of glycogen and triglyceride. Parallel control by phos-dephos and redox regulation of proteins exists for some of these steps. A major action of insulin is to inhibit gluconeogensis in the liver decreasing glucose output into blood. Cases with failed control of blood glucose have alarmingly increased since 1960 coinciding with changed life-styles and large scale food processing. Many of these turned out to be resistant to insulin, usually accompanied by dysfunctional glycogen storage. Glucose has an extended stay in blood at 8 mM and above and then indiscriminately adds on to surface protein-amino groups. Fructose in common sugar is 10-fold more active. This random glycation process interferes with the functions of many proteins (e.g., hemoglobin, eye lens proteins) and causes progressive damage to heart, kidneys, eyes and nerves. Some compounds are known to act as insulin mimics. Vanadium-peroxide complexes act at post-receptor level but are toxic. The fungus-derived 2,5-dihydroxybenzoquinone derivative is the first one known to act on the insulin receptor. The safe herbal products in use for centuries for glucose control have multiple active principles and targets. Some are effective in slowing formation of glucose in intestines by inhibiting α–glucosidases (e.g., salacia/saptarangi). Knowledge gained from French lilac on active guanidine group helped developing Metformin (1,1-dimethylbiguanide) one of the popular drugs in use. One strategy of keeping sugar content in diets in check is to use artificial sweeteners with no calories, no glucose or fructose and no effect on blood glucose (e.g., steviol, erythrytol). However, the three commonly used non-caloric artificial sweeteners, saccharin, sucralose and aspartame later developed glucose intolerance, the very condition they are expected to evade. Ideal way of keeping blood glucose under 6 mM and HbA1c, the glycation marker of hemoglobin, under 7% in blood is to correct the defects in signals that allow glucose flow into glycogen, still a difficult task with drugs and diets.

Effect of vitamin D supplementation on insulin resistance and blood glucose in people who are obese or people with abnormal glucose metabolism:A meta-analysis / 中华内分泌代谢杂志

Objective To systematically review the evidence for the effect of vitamin D supplementation on insulin resistance and blood glucose in people who are obese or people with abnormal glucose metabolism. Methods We searched databases including Pubmed, Elsevier, Web of Science, and WANFANG Database etc. for randomized controlled trials comparing vitamin D or analogues with placebo. We extracted data on insulin resistance and blood glucose, including homeostasis model assessment of insulin resistance( HOMA-IR), fasting blood glucose, HbA1C (% ). A1l data were analyzed using Review Manager 5. 0. Results Nine studies involving 867 participants were included. The results of meta-analysis showed that: ( 1 ) For people who are obese and with abnormal glucose metabolism, meta-analysis showed a small improvement in HOMA-IR(SMD -0. 34,95% CI -0. 61 to -0. 06, P<0. 05) and a small effect on fasting glucose (SMD -0. 41 mmol/ L, 95% CI -0. 68 to -0. 15, P<0. 05),while such effects were not seen in people who are obese but with normal blood glucose. (2) No serious adverse events were associated with the administration of vitamin D. Conclusion vitamin D supplementation may be benefit for improving insulin resistance and fasting blood glucose in people who are obese and with abnormal glucose metabolism, but has no effect on obese people with normal blood glucose.

In-depth Medical Nutrition Therapy for a Woman with Diabetes: From Pregnancy to Delivery

Diabetes in pregnancy is associated with higher rates of miscarriage, pre-eclampsia, preterm labor, and fetal malformation. To prevent these obstetric and perinatal complications, women with diabetes have to control levels of blood sugar, both prior to and during pregnancy. Thus, individualized medical nutrition therapy for each stage of pregnancy is essential. We provided in-depth medical nutrition therapy to a 38-year-old pregnant woman with diabetes at all stages of pregnancy up to delivery. She underwent radiation therapy after surgery for breast cancer and was diagnosed with diabetes. At the time of diagnosis, her glycated hemoglobin level was 8.3% and she was planning her pregnancy. She started taking an oral hypoglycemic agent and received education regarding the management of diabetes and preconception care. She became pregnant while maintaining a glycated hemoglobin level of less than 6%. We provided education program for diabetes management during the pregnancy, together with insulin therapy. She experienced weight loss and ketones were detected; furthermore, she was taking in less than the recommended amount of foods for the regulation of blood sugar levels. By giving emotional support, we continued the counseling and achieved not only glycemic control but also instilled an appreciation of the importance of appropriate weight gain and coping with difficulties. Through careful diabetes management, the woman had a successful outcome for her pregnancy, other than entering preterm labor at 34 weeks. This study implicated that the important things in medical nutrition therapy for pregnant women with diabetes are frequent follow-up care and emotional approach through the pregnancy process.

Management of Diabetes in Liver Cirrhosis / 임상당뇨병

Diabetes mellitus (DM) is common in patients with liver cirrhosis, indicating a bidirectional relationship between DM and liver cirrhosis. Type 2 DM is a risk factor for development and progression of chronic liver disease including liver cirrhosis, and DM may occur as a complication of liver cirrhosis. Hyperglycemia and hyperinsulinemia have profibrogenic properties on hepatic stellate cells, and contribute to liver damage by promoting inflammation and fibrosis through an increase in mitochodrial oxidative stress mediated by adipokines. The presence of DM in patients with liver cirrhosis is not only related to the poor survival rate but also associated with major complications of cirrhosis. This suggests that optimal management of DM could be beneficial in patients with liver cirrhosis. However, the management of DM in patients with liver cirrhosis is complex because of impaired liver function and of the potential hepatotoxicity of oral hypoglycemic agents. We review the clinical implications and the therapeutic management of DM in patients with liver cirrhosis.

The impact of management program for children with diabetes in China on the glycemic control of type 1 diabetic mellitus children and factors associated with glycemic control / 中华实用儿科临床杂志

Objective To compare the glycemic control of different management approaches in type 1 diabetic mellitus (T1 DM) children,and to evaluate the influence factors associated with glycemic control.Methods This survey included 68 T1DM children from January 2012 to December 2014 in the Affiliated Hospital of Qingdao University of more than 1 year management.Hemoglobin A1c (HbA1c) levels were detected to assess glycemic control.Twenty-three T1DM children who participated in the World Diabetes Foundation(WDF) management program (group A) were compared with 45 T1DM children who were managed by themselves (group B).The clinical data were analyzed to explore the correlations with glycemic control.Results The HbA1c of 68 children was (8.86 ± 2.00)％,and only 21 cases (30.9％) had optimal HbAlc (HbAlc ＜ 7.5％).The level of HbA1 c of group A (7.60 ± 1.57)％ was significantly lower than that of group B[(9.40 ± 1.91) ％] (t =-4.045,P =0.001).Group A had less fluctuation in blood glucose than group B,which the duration more than 3 years.Duration (F =2.277,P =0.004),frequency of self-monitoring blood glucose (F =9.375,P =0.001),diabetic education (F =3.276,P =0.002),and diabetic diet (t =-2.046,P =0.025) were associated with glycemic control.Conclusions The glycemic control of T1 DM children at the Affiliated Hospital of Qingdao University was at the medium level,most of them haven't reached the target levels.The WDF management program could significantly and continuously monitor the glycemic level.Diabetic education and more frequent self-monitoring blood glucose and diabetic diet are associated with better glycemic control.