Volume 04 · Issue 02 · 2012

The onset of diabetes is hidden, the course of the disease is long, and the complications are serious, which brings a huge burden to the family, society and medical security system. Because diabetes is a chronic disease, and high caloric intake and long-term sedentary lifestyle play a decisive role in its occurrence and development, lifestyle interventions are recommended as the basic treatment modality throughout diabetes treatment in various authoritative diabetes guidelines^[1,2]。 We know that diabetics are the very group that has serious lifestyle problems. Therefore, how to make patients who don't know much about nutrition learn to calculate calories and rationally distribute nutrients through diabetes education is a problem faced by clinicians. A nationwide survey of diabetes education conducted in 2010 by the Diabetes Education and Management Group of the Diabetes Division of the Chinese Medical Association (CDS) found that 80% of patients said they had received diabetes education^[3]But blood sugar control is still not ideal. It can be seen that even if patients receive diabetes-related knowledge education and participate in learning, it does not mean that they can do it according to management requirements, and some inherent bad living habits are difficult to change. This is not unrelated to how and how long people with diabetes are educated. In addition, proper medication and insulin injection techniques in diabetes medication and self-glucose monitoring necessary for good glycemic control all require knowledge transfer or technical guidance.

The latest data shows that the number of diabetic patients in China has reached 92.4 million^[1]The situation of diabetes prevention and treatment is extremely severe. Diabetes education plays a key role in the prevention and treatment of diabetes, but health education is effective only if it causes behavior change^[2]。 Diabetes education in China started late, and there is still a lack of recognized and effective education model^[3]。 Surveillance, another aspect of the "five carriages" of integrated diabetes management, is equally important for diabetes management. However, education and monitoring themselves cannot directly change metabolic indicators, and they must be promoted through lifestyle adjustment and rational use of drugs. This paper summarizes the research of several diabetes education models and tools at home and abroad, as well as the behavior change by blood glucose monitoring.

At present, the prevalence of diabetes is increasing year by year. The latest research results show that among adults over 20 years old in China, the prevalence rate of diabetes is 9.7%^[1]At present, it has become the country with the largest number of diabetic patients in the world. According to the survey in 2003, about 1/3 of diabetic patients in China have various acute and chronic complications every year due to lack of knowledge and failure to take active treatment measures^[2]。 In 2010, a national survey by the Diabetes Education and Management Group of the Diabetes Branch of the Chinese Medical Association (CDS) showed that although nearly 80% of patients with type 2 diabetes had received health education, the overall blood sugar control was still poor. Therefore, it is urgent to vigorously carry out diabetes health education.

To study the relationship between the prehypertension and disorders of glucose and lipid metabolism among the community residents in Chengdu area.

A cross-sectional population-based survey for chronic diseases in Chengdu was performed from April to November in 2008. Using cluster random sampling method, three communities were selected in Chengdu area. All the participants completed a detailed questionnaire and underwent anthropometric measurements. A total of 1486 normotensive subjects and 1636 prehypertensive subjects among the 5123 individuals aged 40 years and above were included in this study. The glucose and lipid metabolism profiles in normotensive group and prehypertension group were determined and compared. The relation between prehypertension and other related clinicopathological factors was also investigated. Chi-squared tests for categorical variables, t-tests for continuous variables and logistic regression analysis for related risk factors were performed in this study.

The total prevalence of prehypertension among the community residents aged 40 years and over in Chengdu area was 31.93%, the standard prevalence was 32.70%, it was 35.56% in male and 29.69% in female. The prevalence of isolated impaired fasting glucose, isolated impaired glucose tolerance, impaired fasting glucose combined impaired glucose tolerance and diabetes were 3.42%/2.22%, 18.46%/14.47%, 2.69%/1.55% and 15.71%/8.41% in prehypertensive/ normotensive subjects respectively; there were significant differences in all the above-mentioned four parameters between the two groups(χ²=4.064, 8.978, 4.833, 38.613, respectively; all P<0.05). The prevalence of hypercholesterolemia, hypertriglyceridemia, high low density lipoprotein-cholesterol (LDL-C) and low high density lipoprotein-cholesterol (HDL-C) were 5.38%/3.30%, 17.11%/9.62%, 2.69%/1.68% and 11.74%/6.93% in prehypertensive/normotensive subjects respectively; there were significant differences in all the above-mentioned four parameters between the two groups (χ²=8.041, 37.313, 4.219, 21.009, all P<0.05). Logistic regression analysis showed that age, gender, body mass index, waist to hip ratio, elevated postprandial blood glucose, elevated triglycerides, total cholesterol and HDL-C were correlated with prehypertension(OR=1.03, 0.60, 1.10, 6.92, 1.04, 1.10, 1.19, 0.68, all P<0.05). Female and elevated HDL-C were negatively correlated with prehypertension (allP<0.05). Age and gender were nonmodifiable factors.

Prehypertension is highly prevalent among middle-aged and elderly in the communities in Chengdu area. The prehypertensive subjects are more susceptible to diabetes and dyslipidemia.

To observe the changes of serum advanced glycosylation end products(AGEs) in newly diagnosed type 2 diabetes, and to explore the relationship with insulin resistance and β-cell first-phase secretion function.

A total of 56 patients with newly diagnosed type 2 diabetes(diabetes group) were included from the Affiliated Hospital of Qingdao University Medical College from January 2010 to June 2011, according to WHO diagnostic criteria of type 2 diabetes mellitus (1999). The mean age was (40±7) years, including 45 male and 11 female. Thirty-eight healthy people including 30 men and 8 women who visited our clinic for medical check-up were regarded as the normal control group, and the mean age was (38±7) years. All subjects were given AGEs, fasting blood glucose(FBG), blood lipids and concurrent L-arginine stimulation test, etc. The Pearson correlation coefficients were calculated to assess the strength of the correlations of random pairs of parameters. Multiple stepwise regression analysis was performed to determine association between multiple factors. Binary logistic regression analysis was conducted to determine risk factors.

Serum AGEs levels were significantly increased in diabetes group((4.68±0.61)ng/L) as compared to normal control group ((2.88±0.20) ng/L), there was significant difference between the two groups(t=-9.276, P<0.01). AGEs had positive correlation with FBG and homeostasis model assessment-insulin resistance(HOMA-IR)(r= 0.787, 0.857, all P<0.01)and negative correlation with the insulin secretion peak and homeostasis model assessment β(HOMA-β) (r=-0.392, -0.378, P<0.01). Multiple stepwise regression analysis was performed and the results indicated that the insulin secretion peak showed significant negative correlations with AGEs and systolic blood pressure(SBP)(standardβ value was -0.384, -0.296 respectively, all P<0.05), and significant positive correlations with body mass index(BMI)(P<0.05) after adjustment for age, sex, blood lipids, glycated hemoglobin(HbA1c). Logistic regression analysis of risk factors for insulin resistance indicated AGEs (OR=1.166, P<0.05) and BMI (OR=1.471, P<0.01) were major unique risk factors.

AGEs levels were significantly increased in newly diagnosed type 2 diabetes and may be related to insulin resistance and β-cell first-phase secretion function.

To investigate the relationship among mean amplitude of glycemic excursions(MAGE), inflammatory factors (C-reactive protein(CRP), tumor necrosis factor-α(TNF-α), interleukin-6(IL-b)) and prognosis in critically ill patients in Intensive Care Unit (ICU).

The study included 60 subjects(38 male subjects and 22 female subjects, mean age was 55 years, 2 subjects withdrew) , and they were admitted to ICU between January 2010 and January 2011, with acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) scores over 10, stress hyperglycemia, non-diabetic history and glycated hemoglobin(HbA1c) between 4% and 6%. The subjects were taken monitor MAGE by continuous glucose monitoring system (CGMS) for 12 hours after admission, and measured serum levels of CRP, TNF-α and IL-6, and the prognosis was observed 28 days later. Analyze the relationship among MAGE, inflammatory factors and APACHE Ⅱ scores.The data was compared between the two groups by using t test.

Pearson correlation analysis showed that 24 hours after admission MAGE correlated closely with CRP, TNF-α, IL-6 and APACHE Ⅱ (r=0.622, 0.505, 0.509, 0.597; P<0.01). Multivariate linear regression analysis suggested MAGE and IL-6 played more important roles in APACHE Ⅱ scores (P<0.05). Compared with survivors, subjects who died at the end of our study had much higher levels of MAGE and APACHE Ⅱ (P<0.01). Logistic regression analysis indicated that MAGE correlated with patients' motality (OR=4.401, 95%CI: 2.185-6.618, P<0.05).

MAGE is closely associated with serum inflammatory factors and critically ill patients' condition; (2)MAGE was an independent predictor in the prognosis of patients in ICU.

To explore the effect of tissue inhibitor of metalloproteinase 1 (TIMP-1) on the biological behaviors of rat dermal fibroblast with high matrix metalloproteinase 9 (MMP-9), in order to provide an experimental basis for looking for a new way to treat diabetic foot.

The cell model of skin fibroblast was established by using dermal fibroblast cell line CRL-1213 from SD rats with high expression of MMP-9 by high glucose (22.0 mmol/L) + high homocysteine (100 μmol/L) co-culture. Exogenous TIMP-1 was used to inhibite the activity of MMP-9. Realtime PCR and ELISA were used to detect the expression of MMP-9 mRNA and protein. Gelatin zymography was used to detect the activity of MMP-9. Flow cytometry was used to detect cell proliferation. CCK-8 was used to detect cell viability. ELISA assay was used to detect collagen (hydroxyproline) secretion. Scratch test was used to evaluate horizontal migration of cells. Transwell method was used to evaluate vertical migration of cells. ANOVA was used for data analysis.

The expression difference of MMP-9 mRNA and protein between TIMP-1 group and high MMP-9 group had no statistically significant (P>0.05). But the activity of MMP-9 protein in TIMP-1 group was lower than that in high MMP-9 group (1.47±0.13 vs 0.43±0.13,t=12.495, P<0.01). Compared with control group, the proportion of S phase cells [(9.31±0.24)% vs (6.54±0.29)%], proliferation index [(13.8±0.5)% vs (11.3±0.6)%], cell viability (1.76±0.13 vs 1.35±0.12), collagen (hydroxyproline) secretion [(1126±63) vs (353±61) μg/L], 6 h horizontal migration rate [(38.7±2.6)% vs (21.3±2.1)%] and the number of vertical migration cells (91±4 vs 71±4) in high MMP-9 group were decreased(t=16.433, 7.328, 5.113, 19.847, 11.529 and 8.124 repectively, all P<0.05). After interfered by TIMP-1, the proportion of S phase cells [(6.54±0.29)% vs (7.75±0.27)%], proliferation index [(11.3±0.6)% vs (12.5±0.5)%], cell viability (1.35±0.12 vs 1.64±0.14), collagen (hydroxyproline) secretion [(353±61) vs (829±59)μg/L], horizontal migration rate [(21.3±2.1)% vs (31.5 ± 2.7)%] and the number of vertical migration cells (71±4 vs 85±4) were increased compared with those in high MMP-9 group(t=6.881, 3.292, 3.615, 12.590, 6.644 and 6.015 respectively, all P<0.05).

The biological behaviors of skin fibroblasts with high expression of MMP-9 is inhibited. The inhibited effect can be decreased by exogenous TIMP-1.

To conduct a meta-analysis of randomized-controlled trials in order to assess the effects of regular physical activity on glycemic and lipid control in Chinese type 2 diabetic patients.

All randomized controlled trials (RCTs) that evaluated the effects of physical activity intervention (duration≥3 months) in Chinese type 2 diabetic patients in China BioMedical literature on disc (CBMdisc) (1978 to February 2011), Chinese Science and Technology Academic Journal (Chongqing VIP) (1989 to February 2011), Wanfang data (1982 to February 2011), China Journals Full text Database (CJFD) (1994 to February 2011), and Papers on Academic Conference of China (1998 to February 2011) were retrieved. And also the reference lists of all articles collected were checked to ensure that no relevant suitable studies were missed. The articles concerning comparisons between regular physical activity combined with usual treatments and usual treatments combined with irregular physical activity or alone were included. The trials were selected and assessed by two authors independently. Continuous data were calculated as mean differences (MD). Random-effects model and fixed-effects model were used to perform meta-analysis for with and without heterogeneity respectively.

Only twenty papers containing 23 RCTs were available for pooling involving 1444 participants. Compared with the control, the physical activity intervention significantly improved glycemic control as indicated by a decrease in glycated haemoglobin A1c (HbA1c) levels of 1.18% (weighted MD(WMD)=-1.18, 95% confidence interval (CI) -1.67 to -0.69; P<0.01). And there was a reduction in triglycerides (TG) and total cholesterol (TC) levels by 0.27 mmol/L (-0.27, 95%CI: -0.36 to -0.19) and 0.78 mmol/L (WMD=-0.78, 95%CI: -0.88 to -0.68) respectively with physical activity intervention. Also high-density lipoprotein cholesterol (HDL-C) increased by 0.17 mmol/L (WMD=0.17, 95%CI: 0.12 to 0.23) and low-density lipoprotein cholesterol (LDL-C) decreased by 0.48 mmol/L (WMD=-0.48, 95%CI: -0.64 to -0.32).

The results suggest that regular physical activity decreases HbA1c, TG, TC and LDL-C and increases HDL-C in Chinese type 2 diabetic patients, additional high quality of randomized-controlled trials are needed on these topics.

To evaluate the long-term economic and clinical outcomes of type 2 diabetes patient education in China.

A validated computer simulation model of type 2 diabetes (the CORE Diabetes Model) was used to make projections of long-term economic and clinical outcomes for people with type 2 diabetes in China who received or did not receive diabetes related education. The simulation compared two cohorts of people with diabetes - one cohort received education (intervention group, n=568) and another cohort did not (control group, n=620). The two groups were match controlled. The base case cohort characteristics were based on the subgroup of type 2 diabetes patients from the 1998-2006 Diabcare-China surveys. Projections were made over a 50-year time horizon to capture the costs of long-term complications. The mean HbA1c was 7.6%±1.6%, duration of diabetes was (3.2±5.6) years, mean age was (55±11) years, 591 males and 597 females.

Patients who received diabetes education(intervention group) reduced their relative lifetime risk of many serious complications, including end-stage renal disease (45.5%), late stage eye disease (30.9%) and myocardial infarction (9.2%). Furthermore, undiscounted life expectancy was increased by 1.1 years, quality adjusted life year (QALY) was increased by 0.76 years and total lifetime costs increased by RMB 5183 yuan per person. The incremental cost-effectiveness ratio (ICER) was RMB 6784 yuan per QALY gained for patients in intervention group versus those in control group.

Patient education for type 2 diabetes patients increases life expectancy and reduces the incidence of major and minor complications, and it is a very cost-effective intervention.

To improve compliance of patients with type 2 diabetes mellitus with a new education mode involving the patients' family members.

Set up a diabetes education mode joined by the doctors (manager, M), the patients' family members(urger, U), the patients (self-manager, S)and the nurses (teacher, T)(MUST). The improvement of compliance in 180 patients treated from June to July 2010 was evaluated with modified Deborah's diabetes knowledge and self-management skills self-evaluate table. The patients were divided block-randomly into intervention group and control group(90 patients in each group). There were 47 males and 43 females in intervention group with a mean age of (52±12)yrs and a disease-course of (10±3) yrs; there were 46 males and 44 females in control group with a mean age of (52±12)yrs and a disease-course of (11±4) yrs. The patients in intervention group were educated with MUST mode for 1 year, and meanwhile the patients in control group were educated in traditional education system. The compliance change of patients was compared between the two groups. Thet test was used in paired- or indipendent-samples analysis and χ ² test in counting variable.

The good compliance in intervention group at the end of observation improved more than 1 time compared with that at the beginning (75.6% vs 34.4%, P<0.01). This improvement was observed at the point of the 3rd month(67.8%,P<0.01) and kept in this high level to the end of the observation. From the 3rd month on, the good compliance in intervention group at each point of observation were statistically higher than those in control group (allP<0.01). Diet and exercise were the barriers to compliance improvement in control group according to the analysis of the five sub-items of compliance. Advisable exercise intensity(OR=2.555, P=0.000), advisable use of insulin(OR=4.812, P=0.002), low-salt and low-fat diet (OR=5.028, P=0.029), advisable blood sugar monitoring frequency (OR=20.656, P=0.000) and advisable exercise frequency (OR=6.560, P=0.001) were the most 5 single items affected to compliance improvement in two groups.

The urger role of the family members of the type 2 diabetic patients is most important in the MUST educational system for these patient to improve the compliance reliably.

To compare the efficacy and safety of insulin glargine vs additional oral antidiabetic drug (OAD) combined with one basic OAD in patients with poorly controlled type 2 diabetes mellitus (T2DM).

A total of 387 patients (mean age 54 years) with T2DM who were inadequately controlled with one kind of sulfonylureas (SU) or metformin for at least 3 months were eligible for enrollment from 12 centres of China from June 2006 to December 2007. All the patients were randomized to receive insulin glargine (Group A, n=193) or an additional OAD (Group B, n=194) for 24 weeks. The changes in glycated haemoglobin (HbA1c) level, blood glucose parameters, and C-peptide level and incidence of hypoglycemia were assessed and compared between the two groups at 24 weeks. Student'st test was used for data analysis.

A total of 375 patients were included in the final analysis (186 in Group A and 189 in Group B). After 24-week treatment, the reduction of HbA1c from baseline was 1.5% in Group A and 1.3% in Group B (t=-7802.0, -6983.5, both P<0.01), and the reduction was comparable between the two groups (Z=-1.3914, P=0.1641). The reduction of HbA1c from baseline to 24 weeks in the subgroup of insulin glargine≥0.2 U·kg^-1·d^-1 (n=114) was significantly larger than that of Group B ((1.6±1.2)% vs (1.3±1.3)%, Z=-1.9962, P=0.0459). The reduction of fasting plasma glucose (FPG) and 2-h plasma glucose (2-h PG) from baseline to 24 weeks in Group A was significantly larger than that in Group B (Z=-5.5516, -3.9158, both P<0.01). The changes of 0 or 2-h C-peptide level from baseline to 24 weeks were significantly different between the two groups(Z=-5.3894, -2.7775, both P<0.01). The incidence of hypoglycemia was comparable between the two groups.

These findings show that additional treatment with insulin glargine or another OAD could contribute to effective control of blood glucose, and insulin glargine may boast stronger effectiveness when the dosage is titrated sufficiently.

Resveratrol is a natural polyphenol compound existing in plants, existing in common medicinal plants, such as Cassia, Veratrum, Polygonum cuspidatum, etc. It was first discovered in fruits and plants, especially in grapes and wines, and has wide biological activities and great clinical application potential^[1]。 Most early studies on resveratrol mainly focused on its cardiovascular protection and anti-tumor. Later, it was found that it has the effects of enhancing cell viability, antioxidant scavenging free radicals, improving insulin resistance, and anti-inflammatory effects. At present, relevant studies have proved that resveratrol also plays a role in diabetes. This paper reviews the biological properties of resveratrol and its improvement of oxidative stress in early diabetic nephropathy.

Diabetic foot disease is a disease in which the tissue below the ankle is destroyed in diabetic patients due to diabetic vascular disease and/or neuropathy and infection^[1], the most common form is foot ulcer. According to foreign scholars, about 80% of diabetic patients are amputated due to worsening of foot ulcers^[2,3]。 Among the patients with diabetic foot ulcer in China, about 70% of patients are co-infected. Infection is the main cause of amputation and even death in diabetic patients^[2]。

A recent study suggests that low-density lipoprotein (LDL) glycated by pyruvaldehyde (MG) is associated with an increased risk of atherosclerosis. LDL is glycosylated by MG to form small and dense LDL, which can explain why diabetic patients have an increased risk of cardiovascular disease and why metformin has a cardiovascular protective effect.

In a cross-sectional study to evaluate the relationship between insulin resistance and islet beta cell function and body mass index (BMI) in normal glucose tolerance patients, 2931 subjects aged 20 to 79 years from Fujian Province were screened by the researchers from July 2007 to May 2008 using a multi-layer sampling method for questionnaire, physical examination and laboratory examination. Insulin sensitivity was estimated using the steady-state model insulin resistance index (HOMA – IR), insulin secretion level was assessed using the steady-state model islet beta cell function index (HOMA – β), and the proportion of insulin increment (Δ I) for 30 min by oral glucose tolerance test₃₀/Δ G₃₀) to quantify pancreatic islet beta cell function. Calculate Δ I₃₀/Δ G₃₀Ratio to HOMA – IR to assess the relationship between islet beta cell function and insulin resistance. BMI was assessed with multiple logistic regression analysis and with insulin resistance and islet beta cell function with multiple linear regression and analysis of variance. The results showed that the age-and sex-related prevalence of overweight and obesity was 23.04% (27.44% men and 18.40% women) and 2.65% (2.75% men and 2.55% women), respectively. After adjusting for covariates, BMI became an independent risk factor for overweight or obesity. HOMA – IR, HOMA – β, and Δ I in the normal body weight, super-recombination, and obese groups₃₀/Δ G₃₀There are significant differences. BMI was associated with HOMA – IR, HOMA – β, and Δ I in multiple linear regression analyses₃₀/Δ G₃₀Significantly correlated.

Male patients are more likely to die from coronary artery disease than women. There is evidence that testosterone has a protective effect against cardiovascular disease in men. However, little has been reported about the role of estrogen in male coronary artery disease.

Results from a meta-analysis of randomized controlled studies on the effects of intensive hypoglycemic therapy on cardiovascular events and microvascular complications in adults with type 2 diabetes showed that intensive hypoglycemic therapy did not significantly affect all-cause death in patients (HR＝1.04，99%CI0.91 to 1.19) and cardiovascular death (HR=1.11, 99% CI 0.86-1.43); Intensive hypoglycemic therapy and nonfatal myocardial infarction (HR＝0.85，99%CI0.74-0.96) and microalbuminuria (HR＝0.90，99%CI0.85~0.96) is related to the reduction of the risk of occurrence; In addition, intensive hypoglycemic therapy increases the risk of developing severe hypoglycemia by more than 2 times (HR＝2.33，99%CI1.62-3.36). In 5 years, one case of myocardial infarction can be avoided for every 117 to 150 patients treated, one case of microalbuminuria can be avoided for every 32 to 142 patients treated, and one severe hypoglycemia can occur for every 15 to 52 patients treated. Analysis of trials with Jadad scores>3 found that intensive hypoglycemic therapy was not significantly associated with a reduced risk of death, but increased the risk of congestive heart failure by 47%.

Supplementation of trace elements is considered as one of the measures to prevent and treat diabetes. A recent study shows that serum magnesium ion concentration may be related to the occurrence of macrovascular complications in type 2 diabetes. In addition to traditional treatment, appropriate magnesium supplementation may help prevent complications for diabetic patients.

In an article published inAtherosclerosisIn the above study, the researchers included 2,949 subjects aged 20 to 94 years in Fujian Province, China, and assessed the risk of cardiovascular disease of the subjects with the help of abnormal electrocardiogram (MA-ECG) and microalbuminuria indicated by Minnesota code.

Current studies have found that albuminuria, decreased glomerular filtration rate (GFR), and retinopathy are associated with macrovascular events in patients with type 2 diabetes. One article published inAtherosclerosisThe aim of the above review is to investigate whether this association can be generalized to any microvascular complication of diabetes.