功能性消化不良的中医外治法治疗进展

功能性消化不良(FD)是临床上最常见的一种功能性胃肠病,发病率高其发病机制尚未完全明确,本文从针刺、灸法、穴位埋线、穴位注射、耳穴贴压疗法、整脊疗法、针药结合疗法综述了中医外治法治疗功能性消化不良的研究进展,基于以上研究进展,今后应进行更多的随机对照大样本临床研究,从而更好地指导临床工作。     

Risk factors for coronary heart disease in type II diabetes mellitus

Cardiovascular complications are the major cause of morbidity and mortality in diabetic patients. An attempt has been made to evaluate the risk factors for coronary heart disease in type II diabetics. In the present study the levels of fasting and postprandial plasma glucose, total cholesterol, low density lipoproteins, triglycerides were high and the levels of high density lipoproteins were low in the type II diabetics compared to controls. The markers of free radical induced injury i.e. malondialdehyde and nitrite/nitrate were high while total antioxidant status a marker for antioxidant protection against reactive oxygen species was low in diabetics compared to controls. The study therefore suggests the importance of assessing these markers of oxidative stress and antioxidant capacity along with the other routine investigations in diabetic patients for initiating antioxidant therapy in addition to primary and secondary preventive measures to mitigate the devastating consequences of diabetes leading to coronary heart disease.     

Redefinition of gestational diabetes mellitus: implications for laboratory practice in Croatia

An increasing prevalence of gestational diabetes has become a very challenging task in prenatal care worldwide. International Association of Diabetes and Pregnancy Study Groups (IADPSG) has recently issued recommendations on the diagnosis and classification of hyperglycaemia in pregnancy. These recommendations, the first to provide harmonised, evidence-based criteria for the diagnosis and classification of diabetes in pregnancy, are currently being discussed and accepted worldwide by the relevant authorities. As the acceptance of the proposed criteria has major implications for both clinical and laboratory settings, a concerted action towards necessary changes in practice has to be carefully planned and adjusted to national health-care specificities.IADPSG criteria have been strongly advocated by the Croatian Perinatology Society, resulting in a new strategy for the detection and diagnosis of hyperglycaemic disorders in pregnancy.To address the respective laboratory requirements, in April 2012, the Croatian Chamber of Medical Biochemists appointed a Working Group to provide a standardised procedure for the diagnosis of gestational diabetes, applicable to all laboratories involved in prenatal care, in both primary and specialised health-care facilities.In this paper we discuss key laboratory-related issues regarding succesful implementation of the IADPSG criteria in Croatia.     

Inverse optimal neural control of blood glucose level for type 1 diabetes mellitus patients

In this paper, inverse optimal neural control for trajectory tracking is applied to glycemic control of type 1 diabetes mellitus (T1DM) patients. The proposed control law calculates the adequate insulin delivery rate in order to prevent hyperglycemia and hypoglycemia levels in T1DM patients. Two models are used: (1) a nonlinear compartmental model in order to obtain type 1 diabetes mellitus virtual patient behavior, and (2) a neural model obtained from an on-line neural identifier, which uses a recurrent neural network, trained with the extended Kalman filter (EKF); the last one allows the applicability of an inverse optimal neural controller. The proposed algorithm is tuned to track a desired trajectory; this trajectory reproduces the glucose absorption of a healthy person. The applicability of the proposed control scheme is illustrated via simulations.     

Impaired hypothalamic-pituitary-gonadal axis function in men with diabetes mellitus

In view of association of diabetes mellitus and male infertility, present study was designed to investigate the functional status of hypothalamic pituitary gonadal (HPG) axis in diabetic men. Thirty-five diabetic men (BMI 22.24±0.21) in the age group 20–40 (30.6±4.7) years were selected. Twenty-five healthy men (BMI 23.85±0.25), in the same age group (29.5±4.8) served as control. Blood samples were collected for hormonal and biochemical estimations. Diabetic men had significantly low serum testosterone with low LH and FSH, hypercholesterolemia, hypertriglyceridemia, hypoalbuminemia and increased oxidative stress. Low serum testosterone in diabetic men was accompanied by low LH and FSH; the inability of the pituitary gland to respond appropriately to a decline in testosterone implying central effect of high serum glucose on the interaction between the nervous and endocrine system. Nutritional deficiency, increased oxidative stress and increased aromatase activity due to excessive body fat might have also contributed to low serum testosterone.     

Study of lipid peroxide and lipid profile in diabetes mellitus

The study was designed to find out the correlation between lipid peroxidation, lipoprotein levels to severity and complication of diabetes mellitus. Degree of lipid peroxidation was measured in terms of malondialdehyde (MDA) along with lipid profile and blood glucose in diabetes mellitus. It is categorised into insulin dependent diabetes mellitus (IDDM), non insulin dependent diabetes mellitus (NIDDM) and diabetes mellitus(DM) with complication. Total 112 known diabetic patients and 52 non-diabetic controls were studied. These patients were grouped as per the concentration of fasting blood glucose level i.e. controlled, poorly controlled, and uncontrolled group. There are significant increase in the lipid peroxide (MDA) and lipid profile except HDL cholesterol which is decreased, has been found in all groups as compared to controls In NIDDM group lipid peroxidation was markedly increased than IDDM group and it was higher in DM with complications. Other finding observed was that the level of lipid peroxide increased as per the increase in concentration of blood glucose. The increase lipid peroxidation in the hyperglycemic condition may be explained, as the superoxide dismutase enzyme which is antioxidant becomes inactive due the formation of superoxide radical within the cell. Maximum lipid peroxidation leads to the damage of the tissue and organs which results into complication in diabetic patients. High levels of total cholesterol appear due to increased cholesterol synthesis. The triglyceride levels changes according to the glycemic, control. The increase may be due to overproduction of VLDL-TG. It is concluded that good metabolic control of hyperglycemia will prevent in alteration in peroxidation and the lipid metabolism, which may help in good prognosis and preventing manifestation of vascular and secondary complication in diabetes mellitus.     

Small molecules hold promise for convenient diabetes treatment

An orally available "small molecules" recently identified by CAS scientists may hold the key to a more convenient treatment of the most common type of human diabetes.     

Salivary proteolytic activities in periodontitis, gingivitis and diabetes mellitus

Elastase activity was found to be significantly increased in periodontitis (0.872±0.4270 absorbance units/mg protein, mean±S. D., 1.05±0.61 units/ml saliva), gingivitis (0.772±0.416 units/mg protein, 1.515±0.952 units/ml) and diabetes (0.549±0.286 units/mg protein, 1.20±0.769 units/ml) compared to normals (0.255±0.089) units/mg protein, 0.264±0.079 units/ml). Chymotryptic activity was not found to be increased in these disease conditions over the normal level (0.284±0.096 units/mg protein). Aminopeptidase activity was elevated only in periodontitis (0.670+0.140 units/mg protein) compared to normals (0.349±0.100 units/mg protein). Trypsin-like activity was also found to be significantly raised in periodontitis compared to normals when Pro-Phe-Arg-p-nitroanilide (0.666±0.204 units/mg protein), Ile-Pro-Arg-p-nitroanilide (1.59±0.260 units/mg protein) and Pyroglu-Pro-Arg-p-nitroanilide (1.82±0.380 units/mg protein) were used as substrates. The normal values with these three substrates were respectively, 0.454±0.110, 1.04±0.231 and 1.15±0.312 units/mg protein. Total protein level in saliva was found to be significantly elevated in gingivitis (209±66.8 mg/dl) and diabetes (204±68.0) compared to normal values (107±20.7). Increase in periodontitis was marginal (127±28.3 mg/dl). Expression of proteolytic activities normalized to protein level was useful in differential diagnosis. Increase in elastase level in saliva is not a specific marker for periodontal diseases.     

Lipid peroxidation in erythrocytes of patients with type 2 diabetes mellitus

Lipid peroxidation by measurement of Thiobarbituric Acid Reactive Substances (TBARS) and antioxidant status by determining the activities of the enzymes, Catalase (Cat), Glutathione Peroxidase (GPx) and Superoxide Dismutase (SOD) and the level of Reduced Glutathione (GSH) in the erythrocytes of patients with type 2 Diabetes Mellitus were investigated. It was observed that the level of TBARS in the erythrocytes was increased by 50% showing a significant generation of free radicals in the erythrocytes of these patients. The activities of both Cat and SOD were enhanced while that of GPx was not altered. The level of GSH was also not changed.     

补阳还五汤联合糖尿病治疗仪治疗糖尿病高危足临床研究

观察补阳还五汤联合糖尿病治疗仪治疗糖尿病高危足的临床疗效。80例糖尿病足0级病变患者随机分为治疗组40例和对照组40例,在常规治疗的基础上,治疗组给予补阳还五汤联合糖尿病治疗仪治疗,对照组给予前列腺素E1治疗。疗程4周,评价疗效。结果：治疗组显效11例（27.5%）,有效23例（57.5%）,无效6例（15.0%）,总有效率85.0％;对照组显效2例（5.0%）,有效28例（70.0%）,无效10例（25.0%）,总有效率75.0％。治疗组显效率及总有效率优于对照组,差异有显著性意义（经Ridit检验,u=2.0430,P〈0.05）。补阳还五汤联合糖尿病治疗仪治疗糖尿病高危足疗效确切,值得临床推广应用。     

Evaluation of adenosine deaminase activity and lipid peroxidation levels in diabetes mellitus

There was increase in erythrocyte lipid peroxidation and adenosine deaminase (ADA) activity in red blood cells (RBC's), white blood cells (WBC's) and plasma, in 30 patients of confirmed diabetes mellitus, 10 each of insulin dependent diabetes mellitus (IDDM or type I), non-insulin dependent diabetes mellitus (NIDDM or type II) and diabetes with ketoacidosis when compared with 20 healthy individuals (controls). Glycosylated hemoglobin A1c%, plasma free fatty acid (FFA) and glycerol levels were also elevated in all the cases when compared with controls. The increase was more in diabetic ketoacidosis group. Significant positive correlations were seen between erythrocyte lipid peroxidation and ADA activities in RBC's, WBC's and plasma. It is suggested that decreased tissue adenosine levels due to increase in ADA activity, is related to the severity of hyperglycemia and lipid peroxidation in diabetes mellitus.     

Cancer in south Karnataka and its paradoxical relation to diabetes mellitus

The present work identifies a high incidence of oral cancer in south Karnataka. The primary reason for this could be due to extensive addiction to tobacco alone or tobacco and alcohol in most of these patients. The next in intensity was cancer of the breast and cervix among the cancer patients surveyed in south Karnataka. Majority of these patients had no specific addiction and the exact reason for this high incidence remains unclear. Only a small percentage of patients exhibited other types of organ related cancer. It has been reported that the incidence percentage of diabetes mellitus and cancer in India, parallel each other. However, we observed a low incidence of diabetes mellitus patients also having cancer in south Karnataka. Though the exact reason for this remains unclear an attempt has been made here to explain this phenomenon, hypothetically using information in literature, which suggests a suppression of cellular regenerative activity by sugar and sugar phosphates. Cellular regenerative activity is well known to be a prerequisite for cancer.     

RBC membrane composition in insulin dependent diabetes mellitus in context of oxidative stress

Glyco-oxidation is considered as a source of permanent, cumulative, oxidative damage to long lived proteins in ageing and in diabetes. Although RBC depends solely on glucose for energy purpose, hyperglycemic state glycosylates hemoglobin, creates oxidative stress and puts the cellular components at risk. In view of this, RBC membrane composition was analyzed in diabetic patients. The results were compared with healthy age and sex matched control groups. When RBC membrane components such as protein, sialic acid, phospholipids and cholesterol were determined in insulin dependent diabetes mellitus, a significant rise in phospholipids and cholesterol and significant fall in sialic acid and protein content was noted. RBC membrane composition showed pronounced alterations in insulin dependent diabetes mellitus. These changes were accompanied by higher levels of lipid peroxidation products like Malondialdehyde.     

Hypolipidemic effect of water extract ofFicus bengalensis in alloxan induced diabetes mellitus in rabbits

Hypolipidemic effect of the water extract of the bark ofFicus bengalensis was investigated in alloxan induced diabetes mellitus in rabbits. Treatment for one month (50 mg/kg body weight/day) brought down the level of total serum cholesterol (TC) in subdiabetic and diabetic rabbits (five in each group) from 82±11 mg% and 118±10.6 mg% to 42.7±3.1 mg% and 51.7±4.7 mg% respectively. Low density lipoprotein cholesterol and very low density lipoprotein cholesterol values came down from 34±10 mg% and 95±24 mg% to 16±3 mg% and 29±4 mg% in subdiabetic and diabetic rabbits. Triacylglycerol level before treatment was 121±21.6 mg% and 416±70 mg% in subdiabetic and diabetic rabbits. Treatment brought it down to 45±5 mg% and 81±27.5 mg%. Glycosylated hemoglobin was brought down from 2.1±0.3% to 1.5±0.1% in subdiabetic group and from 4.28±0.5% to 2±0.3% in diabetic group, indicating that treatment with water extract effectively controlled blood sugar. After treatment with water extract serum lipid values were nearly equal to those in healthy controls (normal) in subdiabetic rabbits, while in diabetic group, the values were only slightly above those of normal.     

Haemoglobin A1c-based screening for prediabetes and diabetes mellitus: a multi-center study in Croatian adult population

IntroductionBased on the hypothesis that there is a substantial rate of adults with prediabetes and undiagnosed diabetes mellitus (DM), our aim was to perform haemoglobin A1c (HbA_1c)-based screening in a cohort of Croatian adults and estimate the prevalence of prediabetes and undiagnosed DM according to American Diabetes Association criteria.Materials and methodsThis multi-center, cross-sectional study performed in six Croatian hospitals included 5527 patients aged 40 to 70 years admitted to the Emergency Department or undergoing a primary care check-up. Haemoglobin A1c was measured from leftover whole blood samples using the enzymatic method on either Alinity c or Architect c-series analyser (Abbott Laboratories, Chicago, USA). Haemoglobin A1c between 39-47 mmol/mol was classified as prediabetes, while ≥ 48 mmol/mol as undiagnosed DM.ResultsAfter exclusion of 435 patients with known DM, the final cohort included 5092 patients (median age 57; 56% males). A total of 882 (17.3%) patients had HbA_1c values between 39 and 47 mmol/mol. There were 214 (4.2%) patients with HbA_1c ≥ 48 mmol/mol. Prediabetes prevalence ranged from 14.2% to 20.5%, while undiagnosed DM from 3.3% to 7.3%, with statistically significant differences among settings (P < 0.001). Age-stratified analysis showed that prediabetes and undiagnosed DM prevalence increase with age (P < 0.001), being 25.4% and 5.8%, respectively, in patients aged 60 to 70 years.ConclusionUnderlying impairment of glucose metabolism was identified in about one in five adults, with significant number of patients with already overt DM. These results should serve as a starting point for further steps directed towards promotion of preventive measures for DM in Croatia.     

Effect of increasing duration of diabetes mellitus type 2 on glycated hemoglobin and insulin sensitivity

Non-insulin dependent diabetes mellitus (NIDDM) is the most rapidly growing chronic metabolic disorder in the world. With advancement in the age and duration of diabetes there is a gradual tendency for the level of blood sugar to rise along with a subsequent increase in the HbA1c as well as in the fasting insulin level. Whether this is an aging process or increased frequency of diabetes is still controversial. The correlation between glucose and insulin sensitivity is consistent with the idea that the degree of chronic hyperglycemia is a cause of excessive insulin resistance in type 2 diabetes, i.e. the insulin resistance which characterizes type 2 diabetes but not nondiabetic subjects matched for age, gender, family history and duration of diabetes. The study comprised a total of 76 subjects out of which 30 were normal, non-diabetic persons and the rest 46 were diabetics with different duration of time in years, after being diagnosed diabetic. Data was analyzed after dividing the subjects into four groups—Group 1 comprised of one year old diabetics, Group 2 was made up of those, who had diabetes, for the past 2–5 years, Group 3 included patients who were diabetic since more than 5 years and Group 4 included non-diabetics as the normal control group. The results obtained indicated that the HbA1c levels showed a significant increase with the duration of diabetes as well as the insulin level showed a significant correlation after adjustment for age, sex and duration of diabetes.     

Pharmacogenetics and personalized treatment of type 2 diabetes

Type 2 diabetes mellitus (T2DM) is a worldwide epidemic with considerable health and economic consequences. T2DM patients are often treated with more than one drug, including oral antidiabetic drugs (OAD) and drugs used to treat diabetic complications, such as dyslipidemia and hypertension. If genetic testing could be employed to predict treatment outcome, appropriate measures could be taken to treat T2DM more efficiently. Here we provide a review of pharmacogenetic studies focused on OAD and a role of common drug-metabolizing enzymes (DME) and drug-transporters (DT) variants in therapy outcomes. For example, genetic variations of several membrane transporters, including SLC22A1/2 and SLC47A1/2 genes, are implicated in the highly variable glycemic response to metformin, a first-line drug used to treat newly diagnosed T2DM. Furthermore, cytochrome P450 (CYP) enzymes are implicated in variation of sulphonylurea and meglitinide metabolism. Additional variants related to drug target and diabetes risk genes have been also linked to interindividual differences in the efficacy and toxicity of OAD. Thus, in addition to promoting safe and cost-effective individualized diabetes treatment, pharmacogenomics has a great potential to complement current efforts to optimize treatment of diabetes and lead towards its effective and personalized care.