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.
ObjectiveTo explore the risk factors for accompanying depression in patients with community type Ⅱ diabetes and to construct their risk prediction model. MethodsA total of 269 patients with type Ⅱ diabetes accompanied with depression and 217 patients with simple type Ⅱ diabetes from three community health service centers in two streets of Pingshan District, Shenzhen from October 2021 to April 2022 were included. The risk factors were analyzed and screened out, and a logistic regression risk prediction model was constructed. The goodness of fit and prediction ability of the model were tested by the Hosmer-Lemeshow test and the receiver operating characteristic (ROC) curve. Finally, the model was verified. ResultsLogistic regression analysis showed that smoking, diabetes complications, physical function, psychological dimension, medical coping for face, and medical coping for avoidance were independent risk factors for depressive disorder in patients with type Ⅱ diabetes. Modeling group Hosmer-Lemeshow test P=0.345, the area under the ROC curve was 0.987, sensitivity was 95.2% and specificity was 98.6%. The area under the ROC curve was 0.945, sensitivity was 89.8%, specificity was 84.8%, and accuracy was 86.8%, showing the model predictive value. ConclusionThe risk prediction model of type Ⅱ diabetes patients with depressive disorder constructed in this study has good predictive and discriminating ability.
Objective To perform a meta-analysis and investigate the correlation between angiotensin-I converting enzyme gene insertion (I), deletion (D) polymorphism and type 2 diabetic nephropathy, assessing the bias of small sample size study and heterogeneity between studies. Methods MEDLINE, EBSCO, EMbase, PubMed, CHKD, CNKI, CBM, VIP and WanFang Data were searched (from January 1994 to March 18th 2011) for relevant case-control studies. Two reviewers independently identified the literature according to inclusion and exclusion criteria. Also references of the included literature were retrieved. Then data were extracted and assessed by the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using RevMan 5.0.0 software. Results A total of 61 studies comprising 9 979 cases and 7 252 control subjects were included. There was b evidence of heterogeneity (Plt;0.05, I2=60%) and a random effect model was employed to summarize the data. Results of meta-analysis showed that T2DM patients with II genotype had lower incidences of DN than those with DD+DI genotype (OR=0.65, 95%CI 0.57 to 0.74). The results of subgroup meta-analysis showed that Chinese, Japanese and Brazilians patients with II genotype had lower incidences of DN. However, there were no relation among Caucasus, Middle-East, Indian, Mexican, Korean, and Malaysian patients. Conclusion As for T2DM patients, their angiotensin-I converting enzyme gene insertion (I), deletion (D) polymorphism relates to DN. T2DM patients with II genotype have lower incidences of DN. But the difference of this relation varies with ethnicity.
ObjectiveTo systematically evaluate the changes in placental protein expressions in gestational diabetes mellitus (GDM) and their correlations with maternal insulin resistance (IR). Methods PubMed, Cochrane Library, Scopus, Web of Science, Embase, China National Knowledge Infrastructure, VIP database, Wanfang Database and CBMdisc were searched for case-control studies published from January 2009 to November 2021, which reported the placental protein expressions in GDM and their correlations with IR. Two researchers independently reviewed the literature, extracted data and evaluated the literature quality. RevMan 5.4 software was used for meta-analysis, and descriptive analysis was performed on data that cannot be combined. ResultsA total of 19 studies were included, comprising 2 012 patients. The results of meta-analysis showed that: the expression level of retinol binding protein 4 (RBP4) [standard mean difference=2.11, 95% confidence interval (CI) (1.64, 2.58), P<0.000 01] and the positive rate of protein tyrosine phosphatase-1B (PTP1B) [relative risk (RR)=1.56, 95%CI (1.29, 1.88), P<0.000 01] were up-regulated, and the positive rate of insulin receptor substrate 1 (IRS-1) [RR=0.69, 95%CI (0.60, 0.78), P<0.000 01] was down-regulated. The protein expression levels of RBP4 (P<0.000 01) and PTP1B (P<0.000 01) were positively correlated with homeostasis model assessment of insulin resistance (HOMA-IR), while the protein expression levels of IRS-1 (P<0.000 01) and APN (P=0.002) were negatively correlated with HOMA-IR, and glucose transporter 4 (GLUT 4) was not correlated with HOMA-IR (P=0.79). Descriptive analysis found that the expression levels or positive rates of adipocytokines (leptin, resistin), oxidative stress markers (xanthione oxidase, malondialdehyde, 8-isoprostaglandin),inflammatory factors (tumor necrosis factor α, Toll-like receptor 4, Galectin-3, Galectin-2, migration inhibitory factor),fetuin-A, forkhead box transcription factor 1, forkhead box transcription factor 3a and estrogen receptor α in GDM placenta were up-regulated and all were positively correlated with HOMA-IR. The expression levels or positive rates of insulin signaling pathway proteins [phosphoinositide 3-kinase (PI3K), protein kinases B (AKT), phospho-protein kinases B (p-AKT), GLUT 4] were down-regulated, PI3K and AKT were negatively correlatedwith HOMA-IR, while p-Akt had no correlation with HOMA-IR. ConclusionsThe dysregulation of placental protein expressions may mediate maternal IR exacerbation, thus promote the occurrence and development of GDM and other pregnancy complications. The causal relationship and regulatory mechanism are still unclear, which need to be further studied.
ObjectiveTo systematically review the efficacy of interactive message management on patients with type 2 diabetes mellitus (T2DM).MethodsCNKI, VIP, WanFang Data, Web of Science, PubMed and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of T2DM with interactive message intervention from inception to May 2021. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed by using Revman5.3 software.ResultsA total of 17 RCTs involving 1 827 patients were included. Results of meta-analyses showed that compared with routine management, interactive message combined with routine management was associated with improvement of glycosylated hemoglobin, fasting blood glucose, body mass index, systolic blood pressure, and total cholesterol in T2DM patients. However, diastolic blood pressure, triglyceride, low-density lipoprotein, or high-density lipoprotein were not improved. ConclusionsThe current evidence shows that interactive message combined with routine management can significantly reduce blood glucose level, body mass index, systolic blood pressure and total cholesterol in T2DM patients. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to verify the above conclusions.
ObjectiveTo evaluate the perioperative, short- and mid-term results of total artery bypass grafting and saphenous vein bypass grafting in three-vessel coronary heart disease patients complicated with diabetes.MethodsRetrospective analysis was performed on 46 patients (a TAR group) including 36 males and 10 females with an average age of 65.1±11.3 years who underwent total artery bypass grafting in Renji Hospital affiliated to Shanghai Jiao Tong University Medical College from 2005 to 2014. A total of 46 patients with age and gender matched admitted during the same period were selected as a control group (NCR group), in which left internal mammary artery and great saphenous vein were used as grafting vessels. Preoperative, perioperative, and postoperative (1 year and 5 years) data of the two groups were analyzed.ResultsIn terms of perioperative data, the TAR group was inferior to the NCR group in operation time, postoperative 24 h drainage volume and postoperative 24 h blood transfusion volume. However, there was no difference between the two groups in terms of perioperative mortality, ICU stay, etc. One year after surgery, there was no difference in angina pectoris recurrence, recurrent myocardial infarction or grafting vessel patency rate between the two groups. Five years after the operation, the TAR group was superior to the NCR group in angina recurrence, myocardial infarction, and grafting vessels patency rate.ConclusionFor patients with three-vessel coronary heart disease complicated with diabetes, total arterial bypass grafting can achieve better mid-term effect, although it can prolong the operation time and increase the amount of drainage and blood transfusion 24 h after operation.
Objective To study the therapeutic effect of Roux-en-Y gastric bypass （RYGB） on type 2 diabetes mellitus （T2DM） rats and explore the possible mechanism of vaspin in RYGB on T2DM. Methods Twenty SD rats with T2DM and 20 age- and sex-matched normal SD rats were randomly divided into 4 groups according to the random digits table：T2DM-RYGB group， T2DM-sham operation （SO） group，RYGB group，and SO group，10 rats in each group. Fasting plasma glucose （FPG） level，serum insulin （INS） level，vaspin level，and homeostasis model of insulin resistance （HOMA-IR） were determined before operation and on week 4，8 after operation，respectively．At the same time，the correlation between vaspin and the indicators （FPG，INS，or HOMA-IR） was analyzed．Results Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not significantly different between the T2DM-RYGB group and T2DM-SO group （P＞0.05） or between the RYGB group and SO group （P＞0.05），but the FPG level，INS level，vaspin level，and HOMA-IR in the T2DM-RYGB group and T2DM-SO group were significantly higher than those in the RYGB group （P＜0.05） and SO group （P＜0.05），respectively. On week 4 after operation，the FPG level，INS level，vaspin level，and HOMA-IR decreased in the T2DM-RYGB group，except for the FPG level，the other indexes had no significant differences as compared with the values before operation. On week 8 after operation，the FPG level，INS level，vaspin level，and HOMA-IR further decreased in the T2DM-RYGB group，there were significant differences of these indicators between before operation and on week 8 after operation. Compared the indicators after operation with before operation，the FPG level，INS level，vaspin level，and HOMA-IR were not statistically significant （P＞0.05） in the T2DM-SO group，RYGB group，or SO group. The changes in serum vaspin level correlated positively with those in INS and HOMA-IR before operaion and on week 4，8 after operaion in the T2DM-RYGB group and T2DM SO group rats （P＜0.05），respectively. Conclusions RYGB surgery has a therapeutic effect on T2DM rats，and serum vaspin level decreases and insulin resistance is improved after RYGB surgery，which may be one of the mechanisms of the treatment for T2DM.
ObjectiveTo investigate the effect of the remnant stomach after gastric bypass (GB) surgery on the weight loss and glucose metabolism in rats with obese and type 2 diabetes mellitus (T2DM).MethodsHigh fat feeding for one month combined with intraperitoneal injection of low-dose streptozotocin was used to induce obese rats with T2DM. Twenty-four rats with obese and type T2DM successfully established were randomly divided into resectional gastric bypass (R-GB) group, GB surgery (GB group), and sham operation (SO) group, eight rats in each group. The weight loss and anti-diabetic effect of the R-GB and GB were compared. Body weight, food intake, and fasting blood glucose (FBG) were measured at week 1 before operation and week 1–8 after the operation. Oral glucose tolerance test (OGTT) and insulin tolerance test (ITT) were performed using tail venous blood at week 1 before operation and on week 8 after operation (at 0, 30, 60, 90, and 120 min). The levels of serum glucagon like peptide-1 (GLP-1), gastrin, insulin, and glucagon at week 1 before operation and at week 8 after operation were detected, meanwhile the homeostasis model assessment insulin resistance (HOMA-IR) index was calculated.Results① The body weight and food intake of the rats in the R-GB group and GB group were lower than those in the SO group after operation (P<0.05) and which were lower than before operation (P<0.05), but the differences were not significant between the R-GB group and GB group after operation (P>0.05). ② The levels of FBG in the R-GB group only at week 1–4 after operation were lower than those before operation (P<0.05), while which in the GB group at week 1–8 after operation were lower than those before operation and were lower than in the SO group (P<0.05), but which in the R-GB group only at week 2–4 after operation were lower than in the SO group and which were higher than that in the GB group from 3 to 8 weeks after operation (P<0.05). ③ The area under receiver operating characteristic curves (AUCs) of blood glucoses of OGTT and ITT and HOMA-IR index at week 8 after operation were lower than those before operation (P<0.05) in the GB group and which were lower than those the other two groups (P<0.05). ④ The AUC of gastrin level at week 8 after operation was lower than that before operation in the R-GB group and which lower than that in the other two groups (P<0.05). The AUC values of insulin and glucagon levels at week 8 after operation were lower than those before operation in the GB group and which lower than those in the other two groups (P<0.05). The AUC of GLP-1 level at week 8 after operation was higher than that before operation in the GB group and which higher than that in the other two groups (P<0.05).ConclusionsGB could remarkably improve glucose metabolism and weight loss in obese rat with T2DM. Gastric remnant gastrectomy following GB has a remarkable anti-diabetic effect, but it doesn’t effect on weight loss.
ObjectiveTo systematically review the clinical and genetic features of permanent neonatal diabetes mellitus (PNDM) case reports. MethodsThe PubMed, Embase, Scopus, SinoMed, Web of Science, CINAHL, Medrxiv, VIP, CNKI and WanFang Data databases were electronically searched to collect PNDM case reports from inception to June 2023. Two reviewers independently screened literature, extracted data and assessed the reporting quality of the included studies. Descriptive analysis was performed. ResultsA total of 105 case reports were finally included. Typical clinical manifestations of PNDM were early onset of persistent hyperglycemia, developmental delay and low birth weight. The results of genetic testing showed that mutations in the KCNJ11, INS, EIF2AK3, GCK, ABCC8, PTF1A, GATA6, IER3IP1, SLC19A2, NEUROG3, PDX1, and 6q24 genes were closely associated with the development of PNDM. In addition, there may be different clinical manifestations and prognosis of PNDM in different genotypes. ConclusionThis study reveales the clinical characteristics and genetic pattern of PNDM, and provides a direction for further research on the mechanism of PNDM.
ObjectiveTo systematically review the detection rate of cognitive impairment in Chinese patients with type 2 diabetes mellitus (T2DM).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were searched to collect studies on the detection rate of cognitive impairment in Chinese patients with T2DM from inception to January 20th, 2021. Two reviewers independently screened literature, extracted data and evaluated the risk of bias of included studies. Meta-analysis was then performed using Stata 12.0 software.ResultsA total of 27 studies involving 7 920 cases were included. Meta-analysis results showed that the total detection rate of cognitive impairment in Chinese patients with T2DM was 43.2% (95%CI 36.9% to 49.6%). The results of subgroup analysis showed that in T2DM patients, the detection rate of cognitive impairment in males was 42.4% (95%CI 34.4% to 50.4%), and that in females was 48.2% (95%CI 40.9% to 55.6%). The detection rate of cognitive impairment was 25.4% (95%CI 14.7% to 36.0%) in patients under the age of 60 years, and 47.0% (95%CI 30.0% to 64.0%) in patients aged 60 years or above. The detection rate of cognitive impairment among those with primary school education level or below was 67.1% (95%CI 48.9% to 85.3%). The detection rate of cognitive impairment was 37.1% (95%CI 27.3% to 46.8%) among those with education level of junior high school or above. The detection rate of cognitive impairment in patients with disease duration less than 10 years was 28.4% (95%CI 16.0% to 40.9%) and that in patients with disease duration more than 10 years was 50.6% (95%CI 33.2% to 68.0%). The detection rate of cognitive impairment in married individuals was 45.6% (95%CI 35.8% to 55.4%) and that in singles was 68.1% (95%CI 57.5% to 78.7%). The detection rate of cognitive impairment in smokers was 38.9% (95%CI 30.7% to 47.2%) and in non-smokers was 40.9% (95%CI 32.1% to 49.6%). The detection rate of cognitive impairment in drinkers was 35.6% (95%CI 27.3% to 44.0%) and that in non-drinkers was 41.8% (95%CI 32.2% to 51.4%).ConclusionsThe detection rate of cognitive impairment in Chinese patients with T2DM is high. Due to the quantity and quality of included studies, more high-quality studies are needed to verify the above conclusions.