Thyroid Disorders in Patients of Type 2 Diabetes Mellitus

The study was planned to assess the prevalence of thyroid disorders in type 2 diabetes in North Indian population and to correlate the serum insulin and glycosylated haemoglobin levels with thyroid hormones. It is a case control study. One hundred and twenty patients of type 2 diabetes were included in the study along with 117 adults of the same age group and normal glucose levels as controls. All blood samples were taken from subjects who fasted for at least 12 h before the blood collection. Glycosylated hemoglobin was determined by ion exchange chromatography and serum insulin and thyroid hormones were assessed through enzyme linked immunosorbent assay. Fasting blood glucose and glycosylated haemoglobin levels were significantly higher in diabetics showing a poor glucose control. Serum tri-iodothyronine values were significantly lower in diabetics. There was a significant correlation between glycosylated haemoglobin and thyroid hormones. There was no correlation between serum insulin and thyroid hormones.     

Adiponectin Gene Polymorphism and its Association with Type 2 Diabetes Mellitus

Mutations in different regions of adiponectin gene have been reported to be associated with obesity, atherosclerosis and type 2 diabetes mellitus. The present study was aimed to investigate the association among SNP 45 T > G of adiponectin gene and type 2 diabetes in South Indian population. 75 clinically diagnosed case of type 2 diabetes were studied and compared with 75 apparently healthy controls. The genotype frequency of SNP45 T > G in exon 2 of adiponectin gene was determined by PCR based restriction enzyme analysis using the restriction enzyme SmaI. (recognition site: CCC↓GGG). Three kind of genotypes: wild type TT (470 bp), heterozygous type TG (470 bp, 336 bp, 134 bp) and homozygote mutant type GG (336 bp, 134 bp) were studied. A positive association has been found between SNP45 T > G and type 2 diabetes in the study population (P = 0.010, OR = 3.797, 95% CI = 1.312–10.983). Therefore, SNP45T > G in adiponectin gene may be one of the risk factors for type 2 diabetes.     

2型糖尿病并发骨质疏松症相关因素的研究进展

2型糖尿病并发骨质疏松症的机制比较复杂,很多相关因素都可能促使骨质疏松症的发生,如胰岛素水平、晚期糖基化终末产物、胰岛素样生长因子、血糖代谢异常等.另外,一些治疗2型糖尿病的降糖药物也可能与骨质疏松症的发生具有一定的关系.文章主要针对2型糖尿病并发骨质疏松症的相关因素进行研究.     

Glycemic control modifies the association between microalbuminuria and c-reactive protein in Type 2 Diabetes Mellitus

Microalbuminuria and C-reactive protein reflect closely related components of the same disease process. The present study attempts to evaluate whether any association exists between C-reactive protein and microalbuminuria in Type 2 Diabetes Mellitus patients with poor and adequate glycemic control. It was observed that in diabetics with poor glycemic control, microalbuminuria showed a significant positive correlation with C-reactive protein and the prevalence of microalbuminuria was significantly more at elevated C-reactive protein levels. These parameters were not significant in subjects with adequately controlled disease. Further, there was a significant increase in levels of microalbuminuria in patients with poor glycemic control when compared to well-controlled diabetics at comparative levels of C-reactive protein. This study supports the hypothesis that endothelial dysfunction and inflammatory activity are involved in the pathogenesis of microalbuminuria and underscores the importance of glycemic control in the progression of inflammation in diabetes.     

Evaluation of Oxidative Stress in Type 2 Diabetes Mellitus and Follow-up Along with Vitamin E Supplementation

Increased oxidative stress is a widely accepted participant in the development and progression of diabetes and its complications. The present study has been undertaken to evaluate oxidative stress in type 2 diabetes mellitus and effect of vitamin E supplementation on oxidative stress. In all 120 subjects were enrolled in the present study, 40 subjects are age and sex matched controls. Test group comprised of clinically diagnosed (n = 80) type 2 diabetic patients. Biochemical parameters like serum MDA, nitric oxide, superoxide dismutase, erythrocyte reduced glutathione and platelet aggregation were analyzed in control and diabetic group. Test group is further categorized as Group I (n = 40) diabetics were treated by only hypoglycemic drugs and Group II (n = 40) diabetics were treated by hypoglycemic drugs with vitamin E supplementation. All above biochemical parameters were again reassessed after 3 months follow-up in both group and its values were compared with its respective baseline levels. The study shows, reduction of oxidative stress, improvement in antioxidant enzymes and endothelial dysfunction in group II, those were on treatment of hypoglycemic drugs along with vitamin E supplementation. Hence the present study may conclude that vitamin E supplementation along with hypoglycemic drugs may be beneficial to type 2 DM patients to minimize vascular complications.     

Association of Aberrations in One Carbon Metabolism with Intimal Medial Thickening in Patients with Type 2 Diabetes Mellitus

The present work was aimed to study the association of one carbon genetic variants, hyperhomocysteinemia and oxidative stress markers, i.e., serum nitrite, plasma malondialdehyde (MDA) and glutathione (GSH) on intimal medial thickening (IMT) in patients with type 2 diabetes mellitus (T2D). A total number of 76 subjects from ACS Medical College and Hospital, Chennai, India were included in the study, i.e., Group I (n = 42) of T2D and Group II (n = 34) of age- and sex matched healthy controls. The glycated haemoglobin was measured by ion-exchange resin method; plasma homocysteine by Enzyme Linked Immunosorbant Assay method; serum nitrite (nitric oxide, NO), plasma MDA and GSH by spectrophotometric methods; the IMT by high frequency ultrasound. The polymorphisms of one carbon genetic variants were genotyped using polymerase chain reaction-restriction fragment length polymorphism and amplified fragment length polymorphism methods. Results indicate that methyltetrahydrofolate homocysteine methyl transferase (MTR) A2756G allele was found to be protective in T2D and the other variants were not significantly associated with T2D. Glutamate carboxypeptidase II (GCP II) C1561T (r = 0.34; p = 0.05) and methylene tetrahydrofolate reductase (MTHFR) C677T (r = 0.35; 0.04) showed positive correlation with plasma homocysteine in T2D cases. In this study, MTR A2756G allele was found to be protective in T2D; GCP II C1561T and MTHFR C677T showed positive association with plasma homocysteine in T2D cases. Among all the genetic variants, MTR A2756G was found influence IMT. RFC 1 G80A and TYMS 5′-UTR 2R3R showed synergistically interact with MTR A2756G in influencing increase in IMT.     

Dyslipidemia Associated with Poor Glycemic Control in Type 2 Diabetes Mellitus and the Protective Effect of Metformin Supplementation

The nature of the dyslipidemia associated with diabetes mellitus is complex and is the major risk factor for atherosclerosis and coronary artery disease. Aim of this study was to assess the effect of glycemic control, achieved by metformin, glibenclamide and insulin, on lipid profile in type 2 diabetic patients. One hundred and sixty-five type 2 diabetes mellitus patients were classified into good glycemic control (Group I) and poor glycemic control (Group II) on the basis of their blood HbA1c values. The Group II was characterized with high serum triglyceride (190.46 ± 15.20 mg/dl), total cholesterol (175.3 ± 6.31 mg/dl) as well as high LDL-cholesterol (109.0 ± 5.88 mg/dl). Significant correlations were evident between HbA1c and dyslipidemia, particularly serum TG (r = 0.28, P < 0.05), and between HbA1c and total cholesterol (r = 0.310, P < 0.05). Better glycemic control and improved dyslipidemia were observed in patients on combination therapy of metformin plus glibenclamide.     

糖尿病与胃轻瘫的关系

介绍了糖尿病与胃轻瘫的关系。糖尿病胃轻瘫的发病机理可能与糖尿病植物神经病变、平滑肌变性、高血糖等有关。诊断胃排空时间的方法有Ｘ线监视、胃肠电分析、Ｂ型超声及核素标记的试餐（金标准）。采用促胃动力药物如胃复安、多潘立酮、西沙比利、红霉素入Ｒｅｎｚａｐｒｉｄｅ对糖尿病胃轻瘫有一定的疗效。一旦被诊断为糖尿病胃轻瘫,宜及早使用促胃动力药,可改善糖尿病胃轻瘫的大部分症状和体征。     

Association of Single Nucleotide Polymorphisms of Adiponectin Gene with Type 2 Diabetes Mellitus,and Their Influence on Cardiovascular Risk Markers

Type 2 diabetes mellitus is a genetically heterogeneous condition, characterized by insulin deficiency and/or insulin resistance. The etiology of type 2 diabetes is complex, with involvement of genetic and environmental factors. The adipose tissue protein ‘adiponectin’ is known to increase insulin sensitivity with decreased risk of type 2 diabetes mellitus. The gene for adiponectin is present on chromosome 3q27, the association of number of single nucleotide polymorphisms of adiponectin gene with type 2 diabetes and its complications have been reported. In the present study the two most common SNPs +45T/G & +276G/T, and their association with type 2 diabetes mellitus and cardiovascular markers were studied. The significant difference in genotype frequencies of +45T/G & +276G/T was found in type 2 diabetic patients and controls, with odds ratio of 1.13 & 1.26 respectively. BMI, Fasting blood glucose, fasting insulin, HOMA IR, triglyceride and VLDL cholesterol levels were increased, and HDL cholesterol level was decreased in patients carrier for +45T/G SNP than the wild type. While only decrease in the HDL cholesterol was reported in carriers for SNP +276G/T than the wild type. The logistic regression analysis revealed the positive association of SNP +45T/G with total cholesterol & LDL cholesterol. And negative association of HDL cholesterol was found with SNPs +45T/G and +276G/T. The haplotype analysis shows the alterations in means of biochemical markers in the patients having haplotype (GG) for mutant allele of SNP +45T/G and wild allele for SNP +276G/T.     

Acetylation Pharmacogenetics and Renal Function in Diabetes Mellitus Patients

Activities of human hepatic drug metabolizing enzymes N-acetyl transferase (NATS) had earlier been recognized as a cause of inter-individual variation in the metabolism of drugs. Therefore acetylation of many drugs in human exhibit genetic polymorphism. The aim of the study was to investigate if acetylator status predispose diabetic mellitus patients more to the complications of renal disease, One hundred and twenty (120) diabetics consisting of (50) Type 1 (T₁) and 70 Type 2 (T₂) diabetes mellitus patients and 100 healthy individuals as controls were classified as slow or rapid acetylator using sulphamethazine (SMZ) as an in vivo probe. The percentage acetylation, recovery of SMZ, creatinine clearance and presence of urinary albumin were determined. A significant difference (P < 0.05) was observed in the percentage of SMZ acetylated between slow and rapid acetylators in control, T₁ and T₂ subjects. The ratios of slow to rapid acetylators for T₁, T₂ and control subjects were 1:4, 3:2 and 2:3 respectively. No significant differences were observed in the percentage of SMZ recovered in the urine of slow and rapid acetylators that are diabetics. The difference in creatinine clearance of slow and rapid acetylators in T₁ and T₂ were significant (P < 0.05). 29% out of 120 (24.2%) diabetics (T₁ and T₂) exhibited albuminuria out of which 25 (86.2%) had slow acetylator status. These findings suggest that slow acetylator status in diabetes mellitus could be a predisposing factor in the development of renal complications. This underscores the need for a rapid pharmacogenetic testing and therapeutic drug monitoring in such patients. However this inference could be further validated with a larger sample size.     

56例糖尿病患者并低蛋白血症临床分析

１０４例糖尿病患者肝功能检查发现低蛋白血症５６例．男女患病率相仿，与血糖水平、尿蛋白排泄有关．提示糖尿病患者大多数存在营养不良．高血糖及糖尿病肾病是糖尿病患者并发低蛋白血症的重要因素．治疗上在积极控制血糖的同时应加强优质蛋白的补充，预防糖尿病肾病的发生．     

Assessment of Endothelial Dysfunction in Health and Disease; Using Various Parameters

Conditions like hypertension, atherosclerosis and diabetes are known to be the result of endothelial dysfunction which could begin early in the life of an individual. The markers of endothelial dysfunction studied in the present work are plasma hemoglobin, serum high sensitivity C-reactive protein (hsCRP) and plasma nitrite and nitrate. We studied the onset of endothelial dysfunction with increase in age as well as in disease condition like newly detected hypertensives and of hypertensive diabetic patients. The mean plasma hemoglobin and hsCRP values were found to increase with age. hsCRP and plasma hemoglobin levels were significantly higher in patient groups as compared to aged-matched controls. On the other hand nitrate and nitrite was significantly higher in patients who suffered from both diabetes and hypertension together and nitrate values were significantly lower in patients who suffered from hypertensive alone. Plasma hemoglobin and hsCRP are associated with endothelial dysfunction and increases both with age as well as in disease condition.     

胆囊收缩素与糖尿病合并胆囊结石的关系

目的 探讨在糖尿病合并胆囊结石的情况下胆囊收缩素可能起到的影响和作用.方法 综合近几年相关研究方面的文献并进行综述.结果 在糖尿病患者体内胆囊收缩素的水平较正常值有明显的改变,异常水平的胆囊收缩素对胆囊结石的形成起到了很大的影响作用.另外,胆囊收缩素的受体异常也可以引起胆囊结石.结论 胆囊收缩素在糖尿病合并胆囊结石的发病中产生了很大的影响.     

Vitamin D Deficiency and Insulin Resistance in Normal and Type 2 Diabetes Subjects

Vitamin D is recognized to serve a wide range of biological functions. The presence of vitamin D receptors on different tissues explains it’s diversity of actions. Reduced levels of vitamin D is associated with insulin resistance and increased diabetes risk. The study included 50 normal healthy individuals and 49 type 2 diabetes subjects. Fasting blood glucose, total cholesterol, triglycerides, HDLc, fasting insulin, parathyroid hormone, calcium, albumin and Homeostasis model for assessment of insulin resistance (HOMAIR) were measured in all the study participants. Type 2 diabetes subjects were divided into group 1 with 25 hydroxy vitamin D (25(OH)D) ≤20 ng/ml and group 2 with 25(OH)D >20 ng/ml. By the results of this study, the mean 25(OH)D level was low (20.09 ng/ml) in type 2 diabetes compared to controls (23.89 ng/ml) and the p value was 0.02. The estimated insulin resistance by HOMAIR was more in group 1 than in group 2 of diabetes with p value of 0.037. The Pearson’s correlation-coefficient was negative for 25(OH)D and insulin in type 2 diabetes (r = ?0.294), 25(OH)D was negatively correlated with HOMAIR in total subjects. Type 2 diabetes subjects had reduced levels of vitamin D than normal individuals. The insulin resistance was more in vitamin D deficiency state. Hence vitamin D has a role in glucose metabolism, deficiency can result in insulin resistance and diabetes.     

Proxidant and antioxidant status in patients of type II Diabetes Mellitus with IHD

Patients with type II Diabetes Mellitus (NIDDM) are more prone to Ischaemic Heart Disease (IHD). Although, oxygen free radicals are known to contribute to the development of IHD, conflicting reports are available regarding the antioxidant status in patients of NIDDM complicated with IHD. This study was undertaken to investigate the oxidative status in patients of NIDDM and to assess their correlation with plasma glucose, glycosylated haemoglobin and duration of diabetes. The levels of malondialdehyde were significantly increased where as levels of superoxide dismutase, Glutathione peroxidase and vitamin C were significantly decreased in diabetics without complications and non-diabetics with IHD when compared with the controls. The levels of malondialdehyde and Glutathione peroxidase were significantly increased where as levels of superoxide dismutase and vitamin C were significantly decreased in diabetics with IHD when compared with diabetics without complications and non-diabetics with IHD. The implications of the results are discussed.     

Coagulopathy is Initiated with Endothelial Dysfunction and Disrupted Fibrinolysis in Patients with COVID-19 Disease

A substantial group of patients suffer from Covid-19 (CAC) coagulopathy and are presented with thrombosis. The pathogenesis involved in CAC is not fully understood. We evaluated the hemostatic and inflammatory parameters of 51 hospitalized Covid-19 adult patients and 21 controls. The parameters analyzed were danger signal molecule (High molecular weight group box protein-1/HMGBP-1), platelet count, prothrombin time (PT), activated partial thromboplastin time (aPTT), D-dimer, fibrinogen, endothelial protein C receptor (EPCR), soluble E-selectin, soluble P-selectin, thrombomodulin, tissue plasminogen activator (TPA), plasminogen activator inhibitor-1 (PAI-1), soluble fibrin monomer complex (SFMC), platelet-derived microparticles (PDMP), β-thromboglobulin, antithrombin and protein C. The main objective of our study was to investigate which part of the hemostatic system was mostly affected at the admission of Covid-19 patients and whether these parameters could differentiate intensive care unit (ICU) and non-ICU patients. In this prospective case–control study, 51 patients ≥ 18 years who are hospitalized with the diagnosis of Covid-19 and 21 healthy control subjects were included. We divided the patients into two groups according to their medical progress, either in ICU or non-ICU group. Regarding the outcome, patients were again categorized as a survivor and non-survivor groups. Blood samples were collected from patients at admission at the time of hospitalization before the administration of any treatment for Covid-19. The analyzes of the study were made with the IBM SPSS V22 program. p < 0.05 was considered statistically significant. A total of 51 adult patients (F/M: 24/27) (13 ICU and 38 non-ICU) were included in the study cohort. The mean age of the patients was 68.1 ± 14.4 years. The control group consisted of 21 age and sex-matched healthy individuals. All of the patients were hospitalized. In a group of 13 patients, Covid-19 progressed to a severe form, and were hospitalized in ICU. We found out that the levels of fibrinogen, prothrombin time (PT), endothelial protein-C receptor (EPCR), D-dimer, soluble E-selectin, soluble P-selectin, plasminogen activator inhibitor-1 (PAI-1), and tissue plasminogen activator (TPA) were increased; whereas, the levels of soluble fibrin monomer complex (SFMC), platelet-derived microparticles (PDMP), antithrombin and protein-C were decreased in Covid-19 patients compared to the control group at hospital admission. Tissue plasminogen activator was the only marker with a significantly different median level between ICU and non-ICU groups (p < 0.001). In accordance with the previous literature, we showed that Covid-19 associated coagulopathy is distinct from sepsis-induced DIC with prominent early endothelial involvement and fibrinolytic shut-down. Reconstruction of endothelial function at early stages of infection may protect patients from progressing to ICU hospitalization. We believe that after considering the patient''s bleeding risk, early administration of LMWH therapy for Covid-19, even in an outpatient setting, may be helpful both for restoring endothelial function and anticoagulation. The intensity of anticoagulation in non-ICU and ICU Covid-19 patients should be clarified with further studies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12291-023-01118-3.     

中医药治疗2型糖尿病血脂异常的研究进展

2型糖尿病是临床上糖尿病最常见的类型,占糖尿病患者的85％,往往伴随血脂代谢异常的发生.近几年,大量的文献报道,中医药治疗2型糖尿病血脂异常能有效改善胰岛素抵抗,缓解临床症状,调控血糖和血脂水平,无明显不良反应,因此在临床治疗上值得推广应用.文章主要从中医药治疗2型糖尿病血脂异常的病因病机、辨证分型和治疗等方面进行综述...     

浅谈老年糖尿病人的家庭护理

目的：院提高老年糖尿病人家庭护理的质量和纠正病人不良的生活习惯,使其保持良好的心理状态,活动能力,促进康复治疗。方法院通过理论研究,在家庭中对老年患者进行心理护理,饮食治疗,运动疗法,用药指导,并发症的预防,随访与记录以及健康教育。结果院防止急性并发症的发生和减低慢性并发症的风险,对已经发生的并发症进行有效控制,提高患者生活质量,延长患者寿命。结论院积极有效的家庭护理得到老年患者和社会的认可,对老年糖尿病的治疗具有关键性的作用。