Correlation of GA/HbA1c ratio with carotid atherosclerosis in type 2 diabetes / 实用医学杂志

Objective To investigate the association between the glycated albumin to glycated hemoglobin (GA/A1c) ratio and carotid plaque. Methods Type 2 diabetic (T2DM) patients in endocrine inpatient department of Sichuan Provincial People′s Hospital were chosen whose clinical data were collected. Results Of the recruited 154 T2DM patients , GA/HbA1c ratio was negatively correlated with BMI , blood uric acid and was positively correlated with age, HCY, FBG, PBG, left carotid IMT and right carotid IMT. In terms of carotid plaque, GA, GA/HbA1c ratio and HCY were higher in carotid plaque positive patients than those without carotid plaque. The results of logistic regression analysis showed that GA/HbA1c ratio was significantly associated with the presence of carotid plaque (P=0.008). Conclusions GA/HbA1c ratio was positively correlated with the presence of carotid artery IMT in T2DM This suggests that GA/HbA1c ratio will serve as a useful clinical marker for predicting diabetic cardiovascular complications.

Comparison between recombinant human parathyroid hormone (1-34) and elcatonin in treatment of primary osteoporosis

Objective:To evaluate the efficacy and safety of rhPTH(1-34)vs. elcatonin.Methods:Sixty patients with primaryOP were randomly divided into two groups according to the ratio of3:1. rhPTH(1-34) group(PTH group) was treated with subcutaneous injection of rhPTH(1-34)20 μg daily for18 months, and the elcatonin group(CT group) was treated with intramuscular injection of elcatonin20U weekly for12 months.Bone mineral density(BMD) of the lumbar spine2-4(L2-4) and femoral neck, serum calcium and phosphorus, urinary calcium, serum bone specific alkaline phosphatase(BSAP), and urinary c-terminal telopeptides of type Ⅰ collagen/creatinine(uCTX-Ⅰ/Cr) were tested at baseline, and6,12, and18 months after treatment.Results:InPTH group, BMD ofL2-4 at6,12, and18 months,BDM of femoral neck at18 month,BSAP at6 and12 months and uCTX-Ⅰ/Cr at6,12 and18 months were all significantly raised.InCT group,BMD ofL2-4at 12 month and that of femoral neck at12 and18 months were significantly elevated, whileBSAP was significantly decreased at12 and18 months, and no significant difference onCTX-Ⅰ/Cr was observed.WhenBMD growth and growth rate between two groups were compared,PTH group had better improvement inL2-4BMD and growth rate thanCT group at6,12, and18 months.BMD growth and growth rate of femoral neck at12 month and its growth at18 month inCT group were higher than inPTH group, but there was no significant difference between two groups regarding the growth rates at18 month.Besides, there were no significant differences regarding the rates of adverse reactions between two groups.Conclusions: rhPTH(1-34), is safe and effective in the treatment of primaryOP.It is superior to elcatonin in improving vertebralBMD at onset time, growth rate and growth range, but inferior to elcatonin atBMD of femoral neck.

Efficacy of parathyroid hormone (1-34) and elcatonin in postmenopausal women with osteoporosis：A randomized and controlled trial for 18 months / 中华内分泌代谢杂志

Objective Recombinant human parathyroid hormone(1-34) [ rhPTH(1-34)] is the unique anabolic substance acting on the skeleton. The efficacy and safety of long-term administration of rhPTH(1-34) in Chinese postmenopausal women have not been evaluated. This study compared the clinical efficacy and safety of rhPTH(1-34) with elcatonin for treating postmenopausal women with osteoporosis in 11 urban areas of China. Methods A total of453 postmenopausal women with osteoporosis were enrolled in an 18-month, multi-center, randomized, controlled study. They were randomized to receive either rhPTH(1-34) 20 μg(200 U) daily for 18 months, or elcatonin 20 U weekly for 12 months. Lumbar spine ( L1-4) and femoral neck bone mineral density (BMD), fracture rate, back pain as well as biochemical markers of bone turnover ( serum bone-specific alkaline phosphatase was measured by radioimmunoassay; C-telopeptide/ creatinine ( CTX/ Cr) measured by quantitative sandwich enzyme-linked immunosorbent assay) at 6, 12, and 18 months. Adverse events were recorded. Results rhPTH(1-34) increased lumbar BMD more significantly than that did by elcatonin at 6 months( M6), 12 months (M12), and 18 months(M18; 4. 3% vs 1. 94% , 6. 8% vs 2. 72% , 9. 51% vs 2. 86% , P<0. 01). There was only a small but significant increase of femoral neck BMD at M18(2. 64% , P<0. 01) in rhPTH(1-34) groups. There were greater increases in bone turnover markers in the rhPTH(1-34) group than in the elcatonin group at M6, M12, and M18[serum bone-specific alkaline phosphatase(BSAP) 93. 67% vs -3. 56% , 117. 78% vs -4. 12% , 49. 24% vs-5. 81% , P<0. 01; urinary CTX/ Cr 250% vs -29. 5% , 330% vs -41. 4% , 273 % vs -10. 6% , P<0. 01]. rhPTH (1-34) showed similar effect of pain relief as elcatonin. The incidence of clinical fractures was 5. 36% (6 / 112) in elcatonin group and 3. 23% ( 11 / 341 ) in rhPTH ( 1-34 ) group ( P = 0. 303 ). Both treatments were well tolerated. Hypercaluria(9. 38% ) and hypercalcemia(7. 04% ) in rhPTH(1-34) group was transient and caused no clinical symptoms. Pruritus(8. 21% vs 2. 68, P=0. 044) and redness of injection site(4. 40% vs 0, P=0. 024) were more frequent in rhPTH(1-34). Nausea / vomiting(16. 07% vs 6. 16% , P = 0. 001) and hot flushes(7. 14% vs 0. 59% , P<0. 001) were more common in elcatonin group. Conclusion rhPTH(1-34) treatment was associated with greater increases in lumbar spine BMD and bone formation markers. It could increase femoral BMD after 18 months treatment. rhPTH(1-34) could ameliorate back pain effectively. The results of the present study indicate that rhPTH(1-34) is an effective, and safe agent in treating postmenopausal women with osteoporosis.

Biphasic insulin aspart 30 improved glycemic control in Chinese patients with type 2 diabetes poorly controlled on oral glucose-lowering drugs: a subgroup analysis of the A₁chieve study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The effectiveness and safety of initiating biphasic insulin aspart 30 in patients who were poorly controlled on oral glucose-lowering drugs were studied in randomized controlled trials, while results from clinical practice remain limited. This subgroup analysis was to provide such findings from a large-scale non-interventional study.</p><p><b>METHODS</b>A1chieve was a multinational, prospective, open-label, non-interventional, 24-week study in patients with type 2 diabetes initiating insulin analogues in 28 countries across Asia, Africa, Europe, and Latin America. After physician had taken the decision to use this insulin, any patient with type 2 diabetes who was not treated with or who had started the study insulin within 4 weeks before inclusion was eligible. Patients were treated with study insulin alone or in combination with oral glucose-lowering drugs. Data on adverse drug reactions, hypoglycemia and glycemic control were collected at baseline, week 12 and 24. This is a report of a Chinese subgroup analysis from the A1chieve study.</p><p><b>RESULTS</b>Totally, 4 100 patients constituted this subgroup. No serious adverse drug reactions were reported. Rates of total, major, nocturnal hypoglycemic events (events/patient per year) were 1.47, 0.10, 0.31 at baseline and 1.35, 0.00, 0.22 at week 24, respectively. Glycemic control was improved as measured by hemoglobin A1c (mean 9.3% to 7.0%, reduction -2.3%), fasting plasma glucose (mean 10.2 to 6.8 mmol/L, reduction -3.5 mmol/L) and postprandial plasma glucose (mean 14.4 to 8.8 mmol/L, reduction -5.6 mmol/L), all P < 0.001. Change in mean body weight was +0.3 kg (P < 0.001).</p><p><b>CONCLUSION</b>In this subgroup analysis of the A1chieve study, biphasic insulin aspart 30 improved glycemic control with low risk of hypoglycemia.</p>

An initial study of left intra-ventricular diastolic fluid dynamics in pre-diabetics using vector flow mapping / 中华超声影像学杂志

Objective To evaluate left intra-ventricular diastolic blood flow patterns and fluid dynamics in pre diabetics using vector flow mapping(VFM),and to explore the value of left intra-ventricular hydromechanics characteristics assessment of intracardiac flow by VFM with more sensitive indexes.Methods Forty four patients with type 2 diabetes,twenty-eight pre-diabetes patients and thirty-three normal volunteers underwent VFM to determine the left ventricular(LV) diastolic blood flow patterns and fluid dynamics.The two-dimensional color Doppler flow images data were acquired in standerd apical fourchamber view during 3 complete cardiac cycles.These images were analyzed using a dedicated off-line workstation.At different level (mitral annulus,papillary muscl and apex level),the diastole blood flow parameters of LV including flow velocity and volume,velocity gradients (△V),pressure gradients (△P),diastole flow volume,vortex intensity ( Ⅵ),vortex area ( VA),vortex radius (VA) were derived.Thedifferences of the above parameters were compared among the three groups.The correlationship between diastolic function parameters and LV hydromechanics indexes were analyzed.Results ① Compared to normal group and pre-diabetics group,the LV diastolic function parameters E/A and e/a in diabetics group were lower( P ＜0.01),with no differences for E/e( P ＞0.05).There were no significant diffrences of these indices between diabetics group and pre-diabetics group( P ＞0.05).②)Compared to normal group,the intraventricular peak flow velocity at basal level,△V and △P in diabetics group and pre-diabetics group were lower( P ＜0.01),but there were no significant differences of these indices between diabetics group and prediabetics group( P ＞ 0.05).③Compared to normal group,the diastolic positive volume at basal level in diabetics group and pre-diabetics group was lower ( P ＜0.01 ),but there was no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).④ Compared to the normal group,the Ⅵ in diabetics and pre-diabetics group was decreased,but there were no significant differences ofthese indices between diabetics group and pre-diabetics group( P ＞0.05).The VA and VR in diabetics and pre-diabetics group were increased,but there were no significant differences of these indices between diabetics group and pre-diabetics group ( P ＞ 0.05).⑤ There were no correlationship between diastolic function parameters and LV hydromechanics indexes.Conclusions There is the same LV diastolic blood flow patterns and fluid dynamics existed in pre-diabetics as diabetics.VFM could be used as a new methods to demonstrate the early left intra-ventricular fluid dynamics damages in pre-diabetics patients.

Significance of islet auto-antibodies and ?-cell function in patients with ketosis-prone diabetes / 中国糖尿病杂志

Objective To investigate the clinical characteristics of islet auto-antibodies and ?-cell function in patients with ketosis-prone diabetes(KPD). Methods A total of 78 patients with KPD were divided into four categorical groups based on the presence or absence of auto-antibodies (A+ or A-) and of ?-cell functional reserve(?+ ?-):A+?+(group 1,n=13),A-?-(group 2,n=18),A-?+(group 3,n=28),A+?-(group 4,n=19).Islet auto-antibodies,including glutamic acid decarboxylase antibody(GAD-Ab),islet cell antibody(ICA)and insulin autoantibody(IAA) were measured. The clinical characteristics,biochemical parameters and serum peptide were compared among four groups. Results Compared with group 1,2 and 4,group 3 showed the oldest age at onset,and higher levels of BMI,hypertension,serum triglyceride,cholesterol,fasting and postprandial C-peptide. Patients in group 2 had the youngest age at onset,the lowest level of serum C peptide. The phenotypes of patients in group 1 and group 4 were intermediate between group 2 and group 3. Conclusions About 39.7% of patients with KPD have positive islet auto-antibodies. Patients with KPD show significantly different levels of ?-cell function,clinical characteristics and biochemical parameters,which may need different therapeutic strategies.