Résumé
In order to evaluate the efficacy and side effects of the non-insulin antidiabetes medications as an adjunct treatment in type 1 diabetes mellitus (T1DM), we conducted systematic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials published between the date of inception and March 2020 to produce a systematic review and meta-analysis. Overall, 57 studies were included. Compared with placebo, antidiabetes agents in adjunct to insulin treatment resulted in significant reduction in glycosylated hemoglobin (weighted mean difference [WMD], –0.30%; 95% confidence interval [CI], –0.34 to –0.25%; P<0.01) and body weight (WMD, –2.15 kg; 95% CI, –2.77 to –1.53 kg; P<0.01), and required a significantly lower dosage of insulin (WMD, –5.17 unit/day; 95% CI, –6.77 to –3.57 unit/day; P<0.01). Compared with placebo, antidiabetes agents in adjunct to insulin treatment increased the risk of hypoglycemia (relative risk [RR], 1.04; 95% CI, 1.01 to 1.08; P=0.02) and gastrointestinal side effects (RR, 1.99; 95% CI, 1.61 to 2.46; P<0.01) in patients with T1DM. Compared with placebo, the use of non-insulin antidiabetes agents in addition to insulin could lead to glycemic improvement, weight control and lower insulin dosage, while they might be associated with increased risks of hypoglycemia and gastrointestinal side effects in patients with T1DM.
Résumé
In order to evaluate the efficacy and side effects of the non-insulin antidiabetes medications as an adjunct treatment in type 1 diabetes mellitus (T1DM), we conducted systematic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials published between the date of inception and March 2020 to produce a systematic review and meta-analysis. Overall, 57 studies were included. Compared with placebo, antidiabetes agents in adjunct to insulin treatment resulted in significant reduction in glycosylated hemoglobin (weighted mean difference [WMD], –0.30%; 95% confidence interval [CI], –0.34 to –0.25%; P<0.01) and body weight (WMD, –2.15 kg; 95% CI, –2.77 to –1.53 kg; P<0.01), and required a significantly lower dosage of insulin (WMD, –5.17 unit/day; 95% CI, –6.77 to –3.57 unit/day; P<0.01). Compared with placebo, antidiabetes agents in adjunct to insulin treatment increased the risk of hypoglycemia (relative risk [RR], 1.04; 95% CI, 1.01 to 1.08; P=0.02) and gastrointestinal side effects (RR, 1.99; 95% CI, 1.61 to 2.46; P<0.01) in patients with T1DM. Compared with placebo, the use of non-insulin antidiabetes agents in addition to insulin could lead to glycemic improvement, weight control and lower insulin dosage, while they might be associated with increased risks of hypoglycemia and gastrointestinal side effects in patients with T1DM.
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Objective:To explore the associations of urinary retinol binding protein (RBP) and β 2-microglobulin (β 2-MG) with urinary albumin to creatinine ratio (UACR) and renal function in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods:A total of 1 030 Chinese patients with T2DM were included in this study. The subjects were divided into the UACR normal group (<30 mg/g), microalbuminuria group (30-300 mg/g) and macroalbuminuria group (>300 mg/g). Patients with normal UACR were further divided into two groups according to the estimated glomerular filtration rate (eGFR): the eGFR low group (<90 ml·min -1·1.73m -2) and the normal eGFR group (≥90 ml·min -1·1.73m -2). Urine RBP and β 2-MG levels among the groups were compared. Multiple linear regression analyses were applied to evaluate risk factors of urine RBP and β 2-MG. Results:In all patients ( n=1 030), urine RBP and β 2-MG increased gradually with the increase of UACR across the three groups, the proportions of abnormal urine RBP (>0.7 mg/L) and β 2-MG (>370 μg/L) in these groups were 3.8%, 8.5%, 39.0% ( P<0.001), and 12.9%, 26.7%, 46.8% ( P<0.001), respectively. In the UACR normal group ( n=788), 12.2% of the patients were with eGFR<90 ml·min -1·1.73m -2. The proportion of abnormal β 2-MG (>370 μg/L) was higher in the eGFR low group than that in the eGFR normal group (29.2% vs. 10.7%, P<0.001). Multivariate linear stepwise regression analyses were performed using natural logarithm of urine RBP or β 2-MG as dependent variable, and showed that urine RBP was independently associated with UACR ( β=0.0005, P<0.001), serum creatinine ( β=0.006, P<0.001) and glycosylated hemoglobin A1c ( β=0.050, P=0.001), and β 2-MG was independently correlated with UACR ( β=0.000 4, P<0.001), serum creatinine ( β=0.011, P<0.001), systolic blood pressure ( β=0.005, P=0.031) and fasting blood-glucose ( β=0.027, P=0.046). Conclusions:Urine RBP and β 2-MG are positively associated with high UACR and impaired renal function in T2DM patients, and these changes could occur before UACR and eGFR turned out to be abnormal. It is recommended that urine RBP and β 2-MG be detected as early as possible to identify diabetic kidney disease in patients with normal UACR and eGFR.
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Objective To observe the clinical effect on sleep improvement about acupoint application in treating the chronic insomnia of Liver-stagnation and Spleen-deficiency Syndrome.Methods A total of 68 patients with chronic insomnia with Liver-stagnation and Spleen-deficiency Syndrome were randomly and blindly divided into treatment group and control group by registration order. In the treatment process, 1 was eliminated and 33 were completed in the treatment group, 2 were eliminated and 32 were completed in the control group. The treatment group underwentAn Mian Tietherapy half an hour before bed and the control group underwent placebo therapy in the same way of treatment group. Two groups were treated for 40 days and followed-up visit six months. The change of Pittsburgh Sleep Quality (PSQI), Index Insomnia Severity Index (ISI) and TCM Syndromes Scale were detected.Results The clinical total effective rate of treatment group was 72.7% and the control group was 9.4%, and the difference was statistically significant (χ2=46.977,P<0.01). The PSQI scores after treatment (7.55 ± 1.52vs. 13.90 ± 2.44,t=148.165), and follow up 1 month (8.97 ± 2.51vs. 13.17 ± 2.79,t=37.926) in the treatment group were significantly lower than those in the control group (P<0.01). The ISI scores after treatment (7.03 ± 3.37vs. 20.89 ± 4.40,t=73.75), and follow up 1 month (9.81 ± 3.16vs. 19.41 ± 3.66,t=40.79) in the observation group were significantly lower than those in the control group (P<0.01). The TCM Syndromes Scale scores after treatment (2.05 ± 1.09vs. 6.98 ± 1.23,t=17.116), and follow up 1 month (4.06 ± 1.59vs. 6.83 ± 0.91,t=68.055) and follow up 6 month (5.12 ± 1.84vs. 7.19 ± 1.07,t=27.716) in the observation group were significantly lower than those in the control group (P<0.01).Conclusions Acupoint application could obviously change the sleep quality and Chinese medicine symptom in chronic insomnia of Liver-stagnation and Spleen-deficiency Syndrome.
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Objective: To observe the effects of acupuncture on synovial pathology, synovial mast cell degranulation and tryptase expression and to investigate the relationship between the functions of mast cells and effects of acupuncture on early adjuvant arthritis in rats. Methods: Forty-six male Wistar rats were randomly divided into normal control group (n=16), untreated group (n=15) and acupuncture group (n=15). Adjuvant arthritis was induced by injection of 0.1 mL Freund's complete adjuvant in right hind limb footpad. Normal control group and untreated group received no acupuncture treatment, while rats in the acupuncture group were treated with sterilized disposable stainless steel needles inserted perpendicularly as deep as 2 to 3 mm at Xuanzhong (GB39), 6 mm at Shenshu (BL23) and 7 mm at Zusanli (ST36) for eight times (15 min each time) every two days. Setting the modeling day as the 0 day of the experiment, the body weight and paw volume of the rats were measured every three days from the 0 day. In the end, synovial tissues of the right hind ankles were sampled and made into paraffin sections. Then they were firstly stained with hematoxylin-eosin for observing synovial pathology to evaluate the effects of acupuncture on adjuvant arthritis, then stained with toluidine blue for observing the number and degranulation ratio of synovial mast cells and finally detected by immunohistochemical staining method to investigate the expression of tryptase in synovium. Results: Compared with the untreated group, the body weight of rats in the acpuncture group was increased significantly (P<0.05), while the paw volume decreased obviously (P<0.01). Hematoxylin-eosin staining showed that acupuncture significantly inhibited inflammatory cell infiltration, synovial cell hyperplasia, and synovial fibroplasia in synovium of rats with adjuvant arthritis as compared with the untreated group (P<0.05). Toluidine blue staining showed that acupuncture could significantly diminish the numbers of total and degranulated mast cells in rats with adjuvant arthritis (P<0.01), which were significantly higher in the untreated group than in the normal control group (P<0.01). Showing by immunohistochemical staining, the expression of tryptase in synovium in the acupuncture group was decreased as compared with the untreated group (P<0.01). Analyzed by Spearman's bivariate correlation, the number of mast cells and degranulation ratio of mast cells were positively correlated with the pathological scores (r=0.837, P<0.01; r=0.634, P<0.01). Conclusion: Acupuncture can improve pathological condition of inflammatory synovium in rats with early adjuvant arthritis by inhibiting the function of synovial mast cells, which may play an important underlying role in the immunoregulation of acupuncture on adjuvant arthritis.
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To investigate the mechanism of electroacupuncturein treating chronic fatigue syndrome(CFS) in term of the neuro-endocrine system by observing the regulative effect of EA on hypothalamic-pituitary-adrenal index (HPA index) and corticotropin releasing hormone mRNA (CRH mRNA) in CFS model rats. Methods: The rats were randomly divided into control group, model group, and electroacupuncture group. Model and electroacupuncture groups were forced to swim in cold water to make CFS model, while rats in electroacupuncture group were treated with electroacupuncture treatment at the same time. Electroacupuncture group was given at Baihui(GV 20) and Zusanli(ST 36). Evaluation of the model was processed according to the behavior changes of the rats. Hypothalamic, pituitary, and adrenal were weighted to calculate HPA index. CRH mRNA in hypothalamic was measured by fluorescence quantitative polymerase chain reaction (FQPCR). Results: The model rats had behavior changes,and both physical and mental fatigue was observed. HPA index raised and expression of CRH mRNA in hypothalamus increased in CFS rats. After electroacupuncture treatment, the physical and mental fatigue was improved, and the hypothalamic index and CRH mRNA decreased significantly, while the pituitary and adrenal index only had little decrease. Conclusion: Cold water swim press could mimic the pathogenesis and make similar manifestations in rats with the common clinical symptoms. CFS has close relationship with increase of HPA index and CRH mRNA expression. Electroacupuncture can regulate the function of HPA axis to deal with CFS.