Objectives To assess the effects of alpha-glucosidase inhibitors in patients with type 2 diabetes mellitus. Method We searched The Cochrane Library, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, reference lists of reviews on the topic of alpha-glucosidase inhibitors and we contacted experts and manufacturers for additional trials. Date of most recent search: December 2003 (Current Contents) and April 2003 (other databases). Randomised controlled trials of at least 12 weeks duration comparing alpha-glucosidase inhibitor monotherapy in patients with type 2 diabetes with any other intervention and that included at least one of the following outcomes: mortality, morbidity, quality of life, glycemic control, lipids, insulin levels, body weight, adverse events. Two reviewers read all abstracts, assessed quality and extracted data independently. Discrepancies were resolved by consensus or by the judgement of a third reviewer. A statistician checked all extracted data entrance in the database. We attempted to contact all authors for data clarification. Results We included 41 trials (8130 participants), 30 investigated acarbose, seven miglitol, one trial voglibose and three trials compared different alpha-glucosidase inhibitors. Study duration was 24 weeks in most cases and only two studies lasted amply longer than one year. We found only few data on mortality, morbidity and quality of life. Acarbose had a clear effect on glycemic control compared to placebo: glycated haemoglobin –0.77% (95% confidence interval –0.90 to –0.64), fasting blood glucose –1.1 mmol/L (95% confidence interval –1.4 to –0.9), post-load blood glucose –2.32 mmol/L (95% confidence interval –2.73 to –1.92). The effect on glycated haemoglobin by acarbose was not dose-dependent. We found a decreasing effect on post-load insulin and no clinically relevant effects on lipids or body weight. Adverse effects were mostly of gastro-intestinal origin and dose dependent. Compared to sulphonylurea, acarbose decreased fasting and post-load insulin levels by –24.8 pmol/L (95% confidence interval –43.3 to –6.3) and –133.2 pmol/L (95% confidence interval –184.5 to –81.8) respectively and acarbose caused more adverse effects. Conclusions It remains unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes. Conversely, they have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. These effects are less sure when alpha-glucosidase inhibitors are used for a longer duration. Acarbose dosages higher than 50 mg TID offer no additional effect on glycated haemoglobin but more adverse effects instead. Compared to sulphonylurea, alpha-glucosidase inhibitors lower fasting and post-load insulin levels and have an inferior profile regarding glycemic control and adverse effects.
The incidence of obesity and type 2 diabetes mellitus (T2DM) in adolescents has been rapidly increasing over the past two decades due to dramatic changes in dietary structure and physical activity. The incidence of diabetic retinopathy (DR), a serious vision-threatening complication of diabetes, is also increasing yearly in the adolescent population with T2DM. Due to the insidious onset of retinal diseases in the early stages, regular screening is important for the timely diagnosis of DR. However, there are still problems such as low attention of the population and insufficient screening rate. In the future, we should strengthen the health education of the adolescent population and optimize the control of risk factors such as blood glucose and blood pressure. At the same time, appropriate screening strategies should be actively developed, and the use of telemedicine and emerging technologies should be promoted for early detection of treatable lesions to improve patient prognosis.
Objective To assess the effects and safety of sitagliptin combined with metformin in treating type 2 diabetes mellitus. Methods The Cochrane Library, PubMed, EMbase, CNKI, WanFang Data, VIP and CBM were searched to collect the randomized controlled trials (RCTs) on sitagliptin combined with metformin in treating Type 2 diabetes mellitus (T2DM) from inception to November, 2012. References of included studies were also retrieved. Two reviewers independently screened studies according to exclusion and inclusion criteria, extracted data, and assessed the methodological quality. Then, meta-analysis was performed using RevMan 5.1 software. Results 7 RCTs involving 2 917 patients were included. The results of meta-analysis showed that, compared with metformin alone, sitagliptin combined with metformin effectively improved HbA1c levels (WMD= –0.62%, 95%CI –0.76 to –0.47, Plt;0.000 1) and fasting plasma glucose levels (WMD= –0.7 mmol/L, 95%CI –1.03 to –0.37, Plt;0.000 01), and increased insulin sensitivity and β-cell function. But there was no significant difference between the two groups in the incidences of gastrointestinal reactions and hypoglycemia. Conclusion Compared with using metformin alone, sitagliptin combined with metformin can improve glycemic control, enhance insulin sensitivity and better β-cell function more effectively and both have a similar effect on weight lose, but there is no significant difference he incidences of gastrointestinal reactions and hypoglycemia. The above conclusion should be verified by more large-scale high-quality studies in future due to the limitations of the methodological quality and sample size of the included studies.
Objective To evaluate the effectiveness of diabetic patient education on glycemic control for diabeties. Methods Fifty cases of type 2 diabetic patients with educational interventions from the Diabetic Educational Center of West China Hospital and 50 type 2 diabetic patients without educational intervention were selected randomly. All the patients completed the same questionnaire. The data were analyzed by SPSS 10.0. Results The age of patients in educational group was older and the duration of sickness was longer than those in the control group, but their blood glucoses were better controlled. Conclusions Diabetic patient education is important to improve their glycemic control and decrease the risks and deterioration of diabetic chronic complications.
Objective Methods of evidence-based medicine were used to make an individulized treatment plan concerning newly diagnosed type 2 diabetes mellitus in elderly patients. Method After clinical problems were put forward, evidence was collected from third issue, 2003, Cochrane Library, Medline (PubMed 1990.1-2003.2) and http:// sumsearch.uthscsa.edu/ searchform4.htm according to the search strategy. Subject words were: diabetes mellitus non-insulin-dependent; self-monitor of blood glucose; micro-and macro-vascular complications; sulphonylureas; insulin ; aspirin; metformin; acarbose; self-monitor of blood glucose; older patient; hypertension management; Lipid management; RCT; human; meta-analysis；systmatic review. Results A total of 112 RCTs, and 24 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data. After one year follow-up, the plan was proved optimal. Conclusions The treatment efficacy in newly diagnosed type 2 diabetes mellitus in the elderly has been improved by determining an individulized treatment plan according to evidence-based methods.
ObjectiveTo systematically review the efficacy of Roux-en-Y gastric bypass for obesity and its comorbidities. MethodsSuch databases as PubMed, EMbase, The Cochrane Library (Issue 11, 2013), CBM, CNKI, VIP and WanFang Data, etc. were electronically searched from inception to November 2013, for including all studies on Roux-en-Y gastric bypass for obesity and its comorbidities. According to inclusion and exclusion criteria, two reviewers independently screened literature, extracted data, and evaluated methodological quality of included studies. And then meta-analysis was performed using RevMan 5.3 software. ResultsA total of 25 before and after self-control studies involving 2 966 cases with overweight or obesity were included. The results of meta-analysis showed that:after Roux-en-Y gastric bypass operation, the patients had significant reduction in BMI (MD=-16.40, 95%CI-17.42 to-15.38, P < 0.000 01), type 2 diabetes mellitus prevalence (RR=0.23, 95%CI 0.17 to 0.31, P < 0.000 01), and hypertension prevalence (RR=0.34, 95%CI 0.26 to 0.43, P < 0.000 01); besides, fasting glucose, blood pressure and serum lipid levels obviously decreased (P < 0.000 01). ConclusionRoux-en-Y gastric bypass for obesity patients is effective in reducing weight loss, type 2 diabetes mellitus incidence and cardiovascular disease incidence. Due to the limitation of the design of the included studies, the conclusion needs to be verified by further conducting high quality randomized controlled trials with large sample-size.
ObjectiveTo systematically review the independent physical risk factors associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus. MethodsWe searched MEDLINE, EMbase, CBM, CNKI and VIP for all studies about the independent physical risk factors associated with diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus up to December 2012. Two reviewers independently screened studies according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Then meta-analysis was conducted using RevMan 5.2 software. ResultsA total of 11 studies involving 12 957 patients with type 2 diabetes were included. Of these 11 studies, 9 were cross-sectional studies, two were cohort studies, and one was case-control study. The results showed that:the main physical factors associated with DKD were:duration of diabetes (OR=1.11, 95%CI 1.05 to 1.18), waist circumference (OR=1.02, 95%CI 1.00 to 1.04), fasting glucose (OR=1.11, 95%CI 1.07 to 1.16), glycosylated hemoglobin (OR=1.20, 95%CI 1.06 to 1.36), systolic blood pressure (OR=1.03, 95%CI 1.02 to 1.05), diastolic blood pressure (OR=2.41, 95%CI 1.15 to 4.64), triglycerides (OR=1.24, 95%CI 1.02 to 1.51), high-density lipoprotein (OR=0.558, 95%CI 0.369 to 0.844), blood uric acid (OR=1.005, 95%CI 1.002 to 1.009), blood urea nitrogen (OR=1.58, 95%CI 1.37 to 1.82), past history of kidney disease (OR=3.26, 95%CI 1.20 to 8.87) and family history of kidney disease (OR=1.83, 95%CI 1.29 to 2.60). ConclusionCurrent evidence shows that multiple physical factors were associated with the development of type 2 diabetic kidney disease. However, due to the limited quantity and quality of the included studies, more high quality studies are needed to verify the conclusion.
ObjectiveTo discuss the characteristics of coronary artery disease in patients with type 2 diabetes using coronary angiography of Dual Source CT. MethodsWe collected the clinical data of patients who underwent coronary angiography of Dual Source CT between December 2010 and November 2012 in Sichuan Provincial People's Hospital and Sichuan Orthopedic Hospital. A total of 302 patients (74 with type 2 diabetes, and 228 with no diabetes) were examined with CT coronary angiography. All images were comprehensively assessed. Types of plaques and luminal narrowing were evaluated. ResultsPatients with type 2 diabetes had more plaques (P<0.05), especially mixed plaques and non-calcified plaques, than non-diabetic patients (P<0.05). The proportions of calcified plaque, mixed plaques, non-calcified plaque in patients with type 2 diabetes were 29.1%, 41.1%, 29.8%, respectively. The proportions of calcified plaque, mixed plaques, non-calcified plaque in patients with nondiabetic patients were 39.7%, 36.0%, 24.3%, respectively. The difference of the composition between diabetes and nondiabetic was significant (P<0.05). There were more mild, moderate and severe narrowing in type 2 diabetic patients than those in non-diabetic patients (P<0.05). ConclusionCoronary angiography of CT depicts a high plaque burden in patients with type 2 diabetes mellitus (mixed plaque is the most common type), which may cause stenosis easily.
ObjectiveTo observe the lipid metabolism characteristics of type 2 diabetes mellitus (T2DM) patients with different levels of blood glucose control and preliminarily analyze their relationship with diabetic retinopathy (DR). MethodsA retrospective clinical study. From January 2019 to January 2024, 232 T2DM patients who underwent fundus examination in Department of Ophthalmology of Yichang Central People’s Hospital were included in the study. Based on the glycated hemoglobin A1c (HbA1c) test results, patients were divided into blood glucose standard group and blood glucose non standard group, with 100 and 132 cases respectively. Based on the results of fundus fluorescein angiography, patients were divided into non DR (NDR) group and DR group, with 89 and 143 cases, respectively. 100 healthy individuals who underwent physical examinations during the same period were selected as the control group. The thickness of peripapillary retinal nerve fiber layer (pRNFL) around the optic disc, the blood flow density of radial peripapillary capillaries (RPC) around the optic disc, and the thickness of ganglion cell complex (GCC) in the upper and lower parts of the optic disc and macular area were measured by optical coherence tomography angiography instrument. Fully automated biochemical analyzer was used to detect serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and HbA1c. After adjusting for confounding factors, multiple linear regression model was used to analyze the correlation between HbA1c and blood lipids. Multiple logistic regression analysis was conducted to investigate the correlation between TG, HDL-C, and the occurrence of DR. ResultsCompared with the control group, both the blood glucose standard group and the blood glucose non standard group had higher levels of HbA1c (F=8.115), TC (F=4.373), TG (F=20.220), and LDL-C (F=12.271), and lower levels of HDL-C (F=6.349), with statistically significant differences (P＜0.05). Compared with the blood glucose standard group, patients in the blood glucose non standard group had higher levels of serum HbA1c (t=3.531), TC (t=2.561), TG (t=6.418), LDL-C (t=7.880), and lower levels of HDL-C (t=5.152), with statistically significant differences (P＜0.05). Correlation analysis showed that HbA1c was positively correlated with TC, TG, and LDL-C (P＜0.05), and negatively correlated with HDL-C (P＜0.05). Multiple logistic regression analysis showed that TG, LDL-C, and HDL-C were independent risk factors for the occurrence of DR (Ptrend＜0.05). Compared with the NDR group, the DR group had thinner GCC and pRNFL thickness in the upper part of the optic disc, and lower overall and RPC blood flow density in the upper part of the optic disc, with statistically significant differences (t=4.964, 2.406, 2.685, 2.404; P＜0.05). Correlation analysis results showed that TG, LDL-C, HDL-C, HbA1c were correlated with GCC thickness, pRNFL thickness, and RPC blood flow density (P＜0.05). ConclusionsThe higher the blood glucose level in T2DM patients, the more likely they are to experience dyslipidemia. TG, LDL-C, and HDL-C are independent risk factors for the occurrence of DR. Abnormal blood lipids and blood glucose levels in T2DM patients can affect retinal nerves, blood vessels, and function.
Objective To investigate the current situation of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) in Sichuan province, and to analyze the influencing factors of SMBG, so as to provide evidence for improving the level of SMBG. Methods By the convenience sampling method, 410 patients with T2DM for more than 1 year were selected from 17 hospitals and community health service centers in 7 cities across Sichuan province, and their SMBG was investigated with a questionnaire. Results Among 410 eligible patients, the average frequency of SMBG was 7.3 times per month. There were 268 patients (65.4%) performed SMBG less than 4 times per month, 94 (22.9%) performed 4-15 times per month, 29 (7.1%) performed 6-29 times per month, and 19 (4.6%) performed over 30 times per month. Just 234 patients (57.1%) monitored the HbA1c in the past 6 months. FPG, 2-hour PPG and HbA1c were negatively correlated with the frequency of SMBG. The influencing factors of SMBG were insulin treatment and education. Conlusion The SMBG status in D2TM patients is relatively poor in Sichuan province, and the compliance of SMBG is expected to be improved by enhancing diabetic education.