知识宣教辅助饮食指导对老年T2DM患者的影响

为了探讨饮食指导联合知识宣教对老年T2DM患者血糖波动的影响,本研究选取在本院治疗的136例老年T2DM患者并随机分组,对照组患者给予常规护理,试验组患者实施知识宣教辅助饮食指导。通过观察比较比较两组患者血糖达标时间、血糖波动次数、平均血糖漂移幅度、空腹血糖、餐后2 h血糖、糖化血红蛋白和血脂水平差异,本研究发现治疗后试验组患者血糖达标时间为(19.06±2.70) h、血糖波动次数为(2.01±0.94)次/d、平均血糖漂移幅度为(3.12±1.04) mmol/L,较对照组均明显改善(p<0.05);试验组患者空腹血糖为(6.01±0.18) mmol/L、餐后2 h血糖(8.31±0.32) mmol/L、糖化血红蛋白(6.39±0.65)%,明显低于对照组(p<0.05);试验组患者LDL-C为(2.49±0.02) mmol/L、TG为(1.12±0.02) mmol/L同对照组比较明显下降(p<0.05)。研究表明,针对老年T2DM患者给予饮食指导联合知识宣教可控制患者血糖和血脂水平,避免血糖波动,值得推广应用。     

Ethnic differences in body composition and obesity related risk factors: study in Chinese and white males living in China

The purpose of this cross-sectional observational study was to identify ethnic differences in body composition and obesity-related risk factors between Chinese and white males living in China. 115 Chinese and 114 white male pilots aged 28-63 years were recruited. Fasting body weight, height and blood pressure were measured following standard procedures. Whole-body and segmental body composition were measured using an 8-contact electrode bioimpedance analysis (BIA) system. Fasting serum glucose, fasting plasma total cholesterol (TC), high-density lipoprotein (HDL) cholesterol, and triglycerides (TG) were assessed using automatic biochemistry analyzer. After adjusting for age and body mass index (BMI), Chinese males had significantly higher percentage of body fat (PBF) both with respect to whole body (Chinese: 23.7%±0.2% vs. Whites: 22.4%±0.2%) and the trunk area (Chinese: 25.0%±0.3% vs. Whites: 23.2%±0.3%) compared to their white counterparts. At all BMIs, Chinese males had significantly higher fasting glucose levels (Chinese: 5.7±1.0 mmol/L vs. Whites: 5.2±1.0 mmol/L) but lower high-density lipoprotein levels (Chinese: 0.8±1.0 mmol/L vs. Whites: 1.0±1.0 mmol/L) than white males. In addition, a marginally significantly higher diastolic blood pressure was found among Chinese men than that among white men (Chinese: 80±1.0 mmHg vs. Whites: 77±1.0 mmHg). Chinese males had more body fat and a greater degree of central fat deposition pattern than that seen in white males in the present study. Furthermore, data on blood pressure, fasting glucose and blood lipids suggest that Chinese men may be more prone to obesity-related risk factors than white men.     

Influence of oral contraceptives on changes of the carbohydrate metabolism

Serum glucose and serum insulin levels were measured during oral glucose tolerance tests in 100 women, 20-39 years of age, who used the OC (oral contraceptive) preparation Stediril and in a control group of 96 women of the same age group. Significantly lower fasting serum glucose levels were observed after 6 months of OC use. Significant decreases in glucose tolerance were observed among OC users who had taken OCs for longer than 6 months. The blood glucose levels were elevated significantly in this group 60 and 120 minutes after the beginning of the test. No correlation could be found between age and changes in glucose tolerance. No significant differences in fasting serum insulin levels were found in either group. A significant increase in serum insulin levels was observed among women who had used OCs longer than 6 months; this increase was apparent only 120 minutes after the beginning of the test. These changes in glucose tolerance were found to be reversible. Glucose tolerance tests should be preformed once a year on OC users, more often if an abnormality in glucose metabolism, e.g. latent diabetes, is present.     

Resolving the sources of plasma glucose excursions following a glucose tolerance test in the rat with deuterated water and [U-13C]glucose

Sources of plasma glucose excursions (PGE) following a glucose tolerance test enriched with [U-(13)C]glucose and deuterated water were directly resolved by (13)C and (2)H Nuclear Magnetic Resonance spectroscopy analysis of plasma glucose and water enrichments in rat. Plasma water (2)H-enrichment attained isotopic steady-state within 2-4 minutes following the load. The fraction of PGE derived from endogenous sources was determined from the ratio of plasma glucose position 2 and plasma water (2)H-enrichments. The fractional gluconeogenic contributions to PGE were obtained from plasma glucose positions 2 and 5 (2)H-positional enrichment ratios and load contributions were estimated from plasma [U-(13)C]glucose enrichments. At 15 minutes, the load contributed 26±5% of PGE while 14±2% originated from gluconeogenesis in healthy control rats. Between 15 and 120 minutes, the load contribution fell whereas the gluconeogenic contribution remained constant. High-fat fed animals had significant higher 120-minute blood glucose (173±6 mg/dL vs. 139±10 mg/dL, p<0.05) and gluconeogenic contributions to PGE (59±5 mg/dL vs. 38±3 mg/dL, p<0.01) relative to standard chow-fed controls. In summary, the endogenous and load components of PGE can be resolved during a glucose tolerance test and these measurements revealed that plasma glucose synthesis via gluconeogenesis remained active during the period immediately following a glucose load. In rats that were placed on high-fat diet, the development of glucose intolerance was associated with a significantly higher gluconeogenic contribution to plasma glucose levels after the load.     

GK糖尿病大鼠生物学特性观察

目的了解2型糖尿病模型GK大鼠生长曲线、主要脏器重量、糖代谢等生物学特性,评价GK大鼠葡萄糖刺激的胰岛素分泌能力。方法采用51只雄性GK大鼠及15只年龄性别匹配的Wistar大鼠作为研究对象。测定13周龄GK、Wistar大鼠空腹血糖、23周龄GK大鼠空腹及随机血糖。随访GK及Wistar大鼠生长曲线,34～46周龄期间血糖、糖化血红蛋白。46周龄时行腹腔葡萄糖耐量实验（IPGTT）,计算相关参数评价β细胞葡萄糖刺激的胰岛素分泌能力;之后处死大鼠,脏器称重。比较GK及Wistar大鼠间上述各指标差异。结果13周龄GK大鼠空腹血糖4．74±0．41mmol／L,对照Wistar大鼠1．85±0．44mmol／L（P〈0．001）。23周龄GK大鼠空腹血糖7．88±1．96mmol／L,随机血糖9．91±3．52～13．46±4．13mmol／L。7～20及34～45周龄期间GK大鼠体重高于对照Wistar大鼠（P〈0．05）,46周龄时无显著性差异。34～45周龄期间GK大鼠空腹血糖、进食后血糖、HbAlc均高于对照Wistar大鼠（P〈0．05）。IPGTT曲线下面积分析示GK大鼠胰岛素曲线下面积（AUCi）、葡萄糖曲线下面积（AUCg）高于对照Wistar大鼠,胰岛素与葡萄糖曲线下面积比值（AUCi／AUCg）低于对照Wistar大鼠,差异均有显著性（P〈0．05）。GK大鼠肾脏重量高于对照Wistar大鼠（P〈0．05）,余主要脏器重量差异无显著性。结论GK大鼠空腹血糖、进食后血糖、HbAlc水平升高,葡萄糖刺激的胰岛素分泌能力（GSIS）减退,葡萄糖刺激后胰岛素分泌早期相消失,晚期相代偿性增加,具有2型糖尿病特点;体重、血糖等生物学特性稳定。     

Inhibitory effect of CuSO₄ on α-glucosidase activity in ddY mice

We investigated the effects of divalent alkaline earth and first-row transition metal and zinc ions on α-glucosidase activity in vitro and in vivo. CuSO? and ZnSO? exhibited a high α-glucosidase inhibitory effect in vitro. The IC(50) values of CuSO? were 0.77 ± 0.01 (substrate; maltose) and 0.78 ± 0.01 (substrate; sucrose), and those of ZnSO? were 5.49 ± 0.14 (substrate; maltose) and 4.70 ± 0.06 (substrate; sucrose) for yeast α-glucosidase. On the basis of Lineweaver-Burk plots, both CuSO? and ZnSO? exhibited different modes of inhibition against α-glucosidase. Subsequently, oral glucose and sucrose tolerance tests (OGTT and OSTT) were performed on non-diabetic ddY mice to examine the effect of the metal ions on their blood glucose levels. As a result of single oral administration of CuSO? in non-diabetic ddY mice, a significant and potent lowering of the blood glycemic response toward disaccharide, sucrose, ingestion was observed at 45 min after doses of 0.08 and 0.24 mmol kg(-1) body weight. In contrast, the CuSO? administration showed no suppression of the elevation of blood glucose levels in mice after a monosaccharide, glucose, administration. These results indicate that CuSO? suppresses disaccharide digestion by inhibiting α-glucosidase activity in the epithelium of the small intestine, suggesting that antidiabetic Cu complexes with some ligands have a similar action mechanism to that of α-glucosidase inhibitor, acarbose, currently used for clinical purposes.     

IGF-Ⅰ和 MGF 长期基因治疗对小鼠血糖代谢的影响

为研究IGF-Ⅰ和MGF长期基因治疗对哺乳动物血糖代谢的生理影响,首先构建了包含MGF和IGF-Ⅰ全长编码基因的真核表达载体,然后使用活体基因导入仪将其导入小鼠的左侧股四头肌,每2周一次共导入3次,首次导入15周后进行糖耐量测定实验。实验证实IGF-Ⅰ的长期持续表达会导致小鼠的糖代谢能力降低,血糖最高值可达到12.07±1.35mmol/L比对照(10.15±0.87mmol/L)和MGF组(10.58±0.61mmol/L)有显著性的升高(P<0.05),MGF单独存在情况下在糖代谢方面则没有上述作用,但是IGF-Ⅰ和MGF共同导入的小鼠的血糖调节能力更明显减弱,其最高值(16.30±2.69mmol/L)明显高于其它3组(P<0.001)。因此推测与胰岛素进行拮抗作用的主要是IGF-Ⅰ的N段序列,而产生与糖代谢相关功能的则为暴露的IGF-ⅠC段序列;另一种可能是MGF促进了肌肉细胞对外源DNA的吸收和表达因此其可以作为基因导入的佐剂。     

Evaluating the glucose tolerance test in mice

The objective of this study was to determine the optimal conditions under which to assess glucose tolerance in chow- and high-fat-fed C57BL/6J mice. Mice were fed either chow or high-fat diet for 8 wk. Variables tested were fasting duration (0-, 3-, 6-, and 24-h and overnight fasting), route of administration (intraperitoneal vs. oral) load of glucose given (2, 1, or 0.5 g/kg and fixed 50-mg dose), and state of consciousness. Basal glucose concentrations were increased in high-fat- compared with chow-fed mice following 6 h of fasting (9.1 +/- 0.3 vs. 7.9 +/- 0.4 mmol/l P = 0.01). Glucose tolerance was most different and therefore significant (P = 0.001) in high-fat-fed mice after 6 h of fasting (1,973 +/- 96 vs. 1,248 +/- 83 mmol.l(-1).120 min(-1)). The difference in glucose tolerance was greater following an OGTT (142%), in contrast to an IPGTT, with a 127% difference between high fat and chow. We also found that administering 2 g/kg of glucose resulted in a greater level of significance (P = 0.0008) in glucose intolerance in high-fat- compared with chow-fed mice. A fixed dose of 50 mg glucose regardless of body weight was enough to show glucose intolerance in high-fat- vs. chow-fed mice. Finally, high-fat-fed mice showed glucose intolerance compared with their chow-fed counterparts whether they were tested under conscious or anesthetized conditions. We conclude that 2 g/kg glucose administered orally following 6 h of fasting is best to assess glucose tolerance in mice under these conditions.     

Inclusion of Plasma Lipid Species Improves Classification of Individuals at Risk of Type 2 Diabetes

Background

A significant proportion of individuals with diabetes or impaired glucose tolerance have fasting plasma glucose less than 6.1 mmol/L and so are not identified with fasting plasma glucose measurements. In this study, we sought to evaluate the utility of plasma lipids to improve on fasting plasma glucose and other standard risk factors for the identification of type 2 diabetes or those at increased risk (impaired glucose tolerance).

Methods and Findings

Our diabetes risk classification model was trained and cross-validated on a cohort 76 individuals with undiagnosed diabetes or impaired glucose tolerance and 170 gender and body mass index matched individuals with normal glucose tolerance, all with fasting plasma glucose less than 6.1 mmol/L. The inclusion of 21 individual plasma lipid species to triglycerides and HbA1c as predictors in the diabetes risk classification model resulted in a statistically significant gain in area under the receiver operator characteristic curve of 0.049 (p<0.001) and a net reclassification improvement of 10.5% (p<0.001). The gain in area under the curve and net reclassification improvement were subsequently validated on a separate cohort of 485 subjects.

Conclusions

Plasma lipid species can improve the performance of classification models based on standard lipid and non-lipid risk factors.     

Effect of Dahi containing Lactococcus lactis on the progression of diabetes induced by a high-fructose diet in rats

The antidiabetic effect of dahi was observed on high-fructose-induced diabetic rats. The fasting blood glucose, glycosylated haemoglobin, insulin, free fatty acids and triglyceride levels of the dahi fed group animals were significantly lower than those of the control group (p<0.05). The imparity of the glucose tolerance test was also delayed by one week in the dahi-fed animals.     

High serum fasting peptide YY (3-36) is associated with obesity-associated insulin resistance and type 2 diabetes

We studied whether serum fasting levels of active form of peptide YY (PYY), PYY(3-36), are associated with obesity and related phenotypes. The study population consisted of 428 patients with coronary artery disease and diagnosed type 2 diabetes and 440 patients with coronary artery disease but without evidence of diabetes from the ARTEMIS study. The patients were recruited from the consecutive series of patients undergoing coronary angiography in the Oulu University Hospital. The patients without diabetes underwent a 2-hour oral glucose tolerance test. PYY(3-36) levels were analyzed by human PYY(3-36) specific radioimmunoassay. Result suggested that when PYY(3-36) tertiles were considered, high serum fasting PYY(3-36) concentration was associated with high body mass index, waist circumference, hemoglobin A1c, fasting blood glucose, leptin, triglyceride (p for all p ≤ 0.001), serum insulin (p=0.013) and with a low high-density lipoprotein cholesterol (p=0.004) concentrations in the analyses adjusted for age, sex and study group. The link high PYY(3-36)-high insulin level was evident in subjects with normal glucose tolerance (p<0.05). The prevalence of diabetes was 72%, 46% and 30% in the highest, medium and lowest PYY(3-36) tertile (p<0.001). The PYY(3-36) concentrations (after adjustment for age, sex and body mass index) were higher in type 2 diabetics compared to subjects with impaired fasting glucose, impaired glucose tolerance and normal glucose tolerance (p<0.001 for trend). In conclusion, fasting PYY(3-36) concentrations in type 2 diabetic subjects are high. Although high PYY(3-36) is strongly linked to obesity and associated insulin resistance, the relation between PYY(3-36) and type 2 diabetes is independent of body fatness.     

定期血糖监测对糖尿病患者血糖控制及生活方式的影响

目的:探讨定期血糖监测对糖尿病血糖控制及生活方式的影响。方法:随机抽取我中心2010-2011年度确诊的老年2型糖尿病患者110例,随机分为干预组和对照组,每组各55例;2组均接受正规降糖药物治疗及生活方式指导,干预组每周进行一次血糖监测,每3个月测一次糖化血红蛋白,对照组按患者意愿测定血糖指标,通过12个月的观察,研究两组患者在血糖控制及生活方式上的差异。结果:干预组患者空腹血糖(FPG)由定期监测血糖前的(7.26±1.36)mmol/L降至(6.68±1.10)mmol/L;餐后2小时血糖(2HPG)由定期监测血糖前的(12.34±2.29)mmol/L降至(11.09±1.98)mmol/L;糖化血红蛋白由监测前的(7.99±1.61)%降至(6.60±0.87)%;差异具有显著性(P<0.05);生活方式亦有明显改善,差异具有显著性(P<0.05);而对照组的改变不如干预组。结论:通过定期血糖监测可以有效地控制血糖、糖化血红蛋白,促使老年2型糖尿病患者改变不良生活方式。     

Use of Glucose,Insulin, and C‐Reactive Protein to Determine Need for Glucose Tolerance Testing

Objective: Glucose intolerance has been shown to be a better predictor of morbidity and mortality than impaired fasting glucose. However, glucose tolerance tests are inconvenient and expensive. This study evaluated the relative frequencies of glucose intolerance and impaired fasting glucose and sought to determine if 2‐hour glucose could be predicted from simple demographic and laboratory data in an obese population. Research Methods and Procedures: Eighty‐nine obese subjects (median BMI 35 kg/m², range 30 to 40 kg/m²) underwent glucose tolerance testing. Using step‐wise linear and logistic regression analysis, fasting glucose, high‐sensitivity C‐reactive protein (hsCRP), fasting insulin, high‐density lipoprotein cholesterol, triglycerides, weight, height, BMI, waist circumference, hip circumference, waist‐to‐hip ratio, sex, and age were assessed as predictors of glucose intolerance. Results: Impaired glucose tolerance was more prevalent (27%) than impaired fasting glucose (5.6%). Only fasting glucose and hsCRP were significant (p < 0.05) independent predictors of impaired 2‐hour glucose (>140 mg/dL). A fasting glucose ≥ 100 mg/dL or an hsCRP > 0.32 mg/dL (upper quartile of the normal range) detected 81% (sensitivity) of obese subjects with impaired glucose tolerance; however, specificity was poor (46%). Fasting insulin ≥ 6 μU/mL had better sensitivity (92%) but poorer specificity (30%). Discussion: Impaired glucose tolerance is more common than impaired fasting glucose in an obese population. Possible strategies to avoid doing glucose tolerance tests in all obese patients would be to do glucose tolerance testing only in those whose fasting glucose is ≥ 100 mg/dL or whose hsCRP exceeds 0.32 mg/dL or those whose fasting insulin is ≥ 6 μU/mL.     

Adaptation of hepatic gluconeogenesis and ketogenesis to altered supply of substrates during late pregnancy in the rat

The relative importance of the main glucogenic and ketogenic substrates, and interactions between fatty acids availability and ketogenesis have been investigated in virgin or 21 day pregnant rats. Fed pregnant rats displayed elevated lactatemia and the production of lactate by portal-drained viscera was markedly reduced. In contrast, the production of alanine and propionate from digestion was almost similar in fed pregnant and virgin rats. The release of glucose by the liver in fed animals was higher in pregnant rats, and lactate was the main glucogenic substrate taken up whereas alanine uptake was reduced. The hepatic utilization of propionate was not different between the two groups of fed animals. Hepatic gluconeogenesis and lactate extraction were enhanced by starvation; the contribution of lactate to glucose release remained higher in pregnant than in virgin rats, whereas the contribution of alanine was lower, owing to its decreased availability in afferent blood. There was a large uptake of intestinally-derived acetate in fed rates, and a slight release, parallel to ketogenesis, was observed in starved pregnant rats. Free fatty acids were elevated and efficiently taken up by the liver in fed pregnant rats, but without any noticeable ketogenesis. Hepatic ketogenesis was enhanced in starved animals, with marked hyperketonaemia in pregnant rats. However, in those animals, the hepatic release of ketone bodies was not proportional to ketonaemia and was almost similar to the release in starved virgin rats.     

Effects of fasting on hematologic and clinical chemical values in cynomolgus monkeys (Macaca fascicularis)

Background Fasting is an important pre‐analytical factor that may affect clinical pathology parameters in toxicological and pharmacological studies. Little information is available on how fasting affects clinical pathology parameters in cynomolgus monkeys (Macaca fascicularis).The aim of this study was to evaluate the influence of fasting on clinical pathology parameters in healthy adult cynomolgus monkeys. Methods Five female and six male cynomolgus monkeys were fasted for 0, 8, 16, and 24 hours. Changes in body weight (BW), core hematologic, and serum clinical chemical parameters were evaluated. Results The BW significantly decreased after 24 hours of fasting. Significant decreases in red blood cell count, hemoglobin, hematocrit, and mean corpuscular volume and increases in mean cell hemoglobin and mean cell hemoglobin concentration were observed at 16 hours in males. In females, increasing the duration of fasting caused a significant time‐dependent increase in platelets. Blood urea nitrogen showed significant decreases in female and male monkeys after fasting. Alkaline phosphatase increased in females after fasting. Aspartate transaminase significantly increased both in females and males at 8 hours. In females, alanine transaminase and lactate dehydrogenase significantly increased at 8 hours. Albumin significantly decreased in males 24 hours, but increased in females 16 hours after fasting. Serum glucose and triglyceride were not affected by fasting. Serum calcium decreased and inorganic phosphorus increased in males after fasting. Conclusion These results suggested that clinical pathology data would vary after fasting. The decision to feed or fast before blood collection for clinical pathology tests should be made based on careful consideration.     

Seven days of aerobic exercise training improves conduit artery blood flow following glucose ingestion in patients with type 2 diabetes

The vasodilatory effects of insulin account for up to 40% of insulin-mediated glucose disposal; however, insulin-stimulated vasodilation is impaired in individuals with type 2 diabetes, limiting perfusion and delivery of glucose and insulin to target tissues. To determine whether exercise training improves conduit artery blood flow following glucose ingestion, a stimulus for increasing circulating insulin, we assessed femoral blood flow (FBF; Doppler ultrasound) during an oral glucose tolerance test (OGTT; 75 g glucose) in 11 overweight or obese (body mass index, 34 ± 1 kg/m2), sedentary (peak oxygen consumption, 23 ± 1 ml·kg?1·min?1) individuals (53 ± 2 yr) with non-insulin-dependent type 2 diabetes (HbA1c, 6.63 ± 0.18%) before and after 7 days of supervised treadmill and cycling exercise (60 min/day, 60-75% heart rate reserve). Fasting glucose, insulin, and FBF were not significantly different after 7 days of exercise, nor were glucose or insulin responses to the OGTT. However, estimates of whole body insulin sensitivity (Matsuda insulin sensitivity index) increased (P < 0.05). Before exercise training, FBF did not change significantly during the OGTT (1 ± 7, -7 ± 5, 0 ± 6, and 0 ± 5% of fasting FBF at 75, 90, 105, and 120 min, respectively). In contrast, after exercise training, FBF increased by 33 ± 9, 39 ± 14, 34 ± 7, and 48 ± 18% above fasting levels at 75, 90, 105, and 120 min, respectively (P < 0.05 vs. corresponding preexercise time points). Additionally, postprandial glucose responses to a standardized breakfast meal consumed under "free-living" conditions decreased during the final 3 days of exercise (P < 0.05). In conclusion, 7 days of aerobic exercise training improves conduit artery blood flow during an OGTT in individuals with type 2 diabetes.     

中老年食蟹猴群体自发型糖尿病的筛选

筛选440只中老年偏胖食蟹猴群体中自发糖尿病个体,并探讨食蟹猴群体中糖尿病粗筛的方法。以调查基础血糖值为基础,推断疑似糖尿病血糖值,后经OGTT(口服糖耐量)和尿检结果验证该血糖值是否准确。结果显示中老年偏胖食蟹猴群体血糖值为(3.88±0.98)mmol/L,其中56只食蟹猴血糖值大于5.0mmol/L,被初步定为糖尿病个体。这些个体全部糖耐量异常,且36只(69.23%)出现尿糖阳性,证明血糖值大于5.0mmol/L可作为本群体食蟹猴糖尿病的粗筛标准。由于针对中老年偏胖食蟹猴群体,患病率为12.72%(56/440),高于我国糖尿病患病率(9.7%)。虽然该实验的糖尿病血糖指标并不适用于所有食蟹猴群体,但是该筛选的流程简单快捷,对动物损伤小,可适用于大群体糖尿病的筛选。     

Glucose tolerance in patients with cystic fibrosis: five year prospective study.

OBJECTIVES--To study prevalence and incidence of diabetes mellitus in patients with cystic fibrosis. DESIGN--Five year prospective study with annual oral glucose tolerance tests. SETTING--CF Center Copenhagen, Denmark. SUBJECTS--191 patients with cystic fibrosis aged above 2 years. MAIN OUTCOME MEASURES--Glucose tolerance, plasma glucose concentrations after fasting and after glucose loading, and haemoglobin A1c levels. RESULTS--Prevalence of diabetes increased from 11% (n = 21) to 24% (n = 46) during study, with annual age dependent incidence of 4-9%. Diabetes was diagnosed at median age of 21 (range 3-40). At diagnosis of diabetes, symptoms of hyperglycaemia were present in 33% of patients, fasting hyperglycaemia (> or = 7.8 mmol/l) was seen in 16%, and increased haemoglobin A1c levels (> 6.4%) were seen in 16%. Impaired glucose tolerance implied higher risk for development of diabetes than normal glucose tolerance (odds ratio 5.6). In 58% of cases with impaired glucose tolerance, however, glucose tolerance was normal at next annual test. Normal glucose tolerance was found in only 37% of patients at all five tests. Within this group of patients, median plasma glucose concentrations after fasting and after glucose loading and haemoglobin A1c levels increased by 6-8% during study. CONCLUSIONS--Prevalence and incidence of diabetes in cystic fibrosis patients was high and increased with age. Since hyperglycaemic symptoms, fasting hyperglycaemia, and increased levels of glycated haemoglobin did not reliably identify diabetes mellitus, we recommend annual oral glucose tolerance tests in all cystic fibrosis patients aged over 10 years.     

Serum level of advanced glycation end-products (AGEs) is an independent determinant of plasminogen activator inhibitor-1 (PAI-1) in nondiabetic general population.

Glucose can react nonenzymatically with amino groups of proteins to form senescent macroprotein derivatives termed advanced glycation end-products (AGEs). Recently, AGEs have been shown to play an important role in atherosclerosis even in nondiabetic subjects. However, the molecular mechanism underlying this is not fully understood. We have now investigated whether serum AGE level was an independent determinant of plasminogen activator inhibitor-1 (PAI-1), a major physiological inhibitor of fibrinolysis, in nondiabetic general population. One-hundred and eighty-six nondiabetic Japanese subjects underwent a complete history and physical examination, determination of blood chemistries, PAI-1, and AGEs. Uni- and multivariate analyses were applied for the determinants of PAI-1 levels. The average PAI-1 levels were 29.7+/-23.8 ng/ml in males and 21.8+/-17.1 ng/ml in females, respectively. Univariate regression analysis showed that PAI-1 levels were associated with age (inversely, p=0.003), male (p=0.003), body mass index (BMI) (p<0.001), HDL-cholesterol (inversely, p<0.001), triglycerides (p<0.001), fasting plasma glucose (p<0.001), insulin (p<0.001), uric acids (p<0.001), AGEs (p=0.037), and alcohol intake (p<0.001). By the use of multiple regression analyses, BMI (p<0.001), male (p=0.003), fasting plasma glucose (p=0.005), age (inversely, p=0.017), and AGEs (p=0.034) remained significant. The present study is the first demonstration that serum AGE level was one of the independent determinants of PAI-1 in nondiabetic general population. The AGE-associated thrombogenic abnormality may be involved in atherogenesis in nondiabetic subjects.     

二甲双胍对多囊卵巢综合征肥胖型患者LH和FSH的影响

目的：探讨二甲双胍对多囊卵巢综合征肥胖型患者血清中胰岛素、LH和FSH水平的影响。方法：将84例PCOS肥胖型患者随机分成44例对照组（克罗米芬）和40例观察组（二甲双胍）,采用放射免疫法测定黄体生成素（LH）和卵泡刺激素（FSH）的水平,分别于服药前（0分钟）和服后60、120分钟经前臂静脉采血,测血糖浓度及血清胰岛素水平。结果：对照组患者治疗前0min、60min及120min的血糖OGTT分别为（4．57±0．25）mmol／L、（8．38±7．05）mmol/L（7.21±0．12）mmol／L。治疗后0min、60min及120min的血糖OGTT无明显变化。观察组患者治疗前0min、60min及120min的血糖OGTT分别为（4．11±0．31）mmol／L、（8．23±6．57）mmol／L及（7．25±0．13）mmol／L,治疗后0min、60min及120min的血糖0GTT明显降低。对照组患者治疗前血清中胰岛素为（47．32±9．52）U／ml,治疗后为（42．25±7．65）U／ml,治疗前后无明显差异。观察组患者治疗前血清中胰岛素为（46．41±6．11）U／ml,治疗后血清胰岛素水平明显降低。对照组患者治疗后血清中LH为（17．22±2．14）mU／ml,FSH为（1．24±0．33）mU／ml,而与对照组相比,观察组患者血清中的LH明显降低,而FSH水平升高。结论：二甲双胍导致多囊卵巢综合征患者血清中胰岛素水平降低,从而减轻了胰岛素对LH的刺激作用,使LH水平下降,FSH升高,进而改善机体的激素紊乱,最终达到治疗PCOS的目的。