Objective　A recent study has shown the association between a sulfonylurea receptor gene-1 (SUR1) variant and hyperinsulinemia in normal individuals from a high diabetes risk ethnic group,supporting the hypothesis that the primary insulin hypersecretion may be an antecedent of type 2 diabetes.Methods　To test this hypothesis in Chinese population,we studied the allele and genotype distribution of the polymorphism at -3 position of intron 24 in SUR1 by PCR-RFLP technique in 206 unrelated normal glucose tolerant subjects with strong family history of type 2 diabetes (group A) and 110 normal individuals without family history of diabetes (group B).Results　The frequency of “-3c” allele and “-3cc” genotype of intron 24 in group A was significantly higher than that in group B (64% vs 54%，P=0.004 and 38% vs 24%，P=0.002 respectively).Moreover,in group A, those carrying “cc” genetype had a higher BMI (27.27±6.37 vs 24.99±3.43kg/m2，P＜0.05；27.27±6.37 vs 25.28±2.78kg/m2，P＜0.05),fasting insulin (15.52±10.72 vs 9.27±5.03U/ml,P＜0.01；15.52±10.72 vs 10.79±7.80U/ml,P＜0.05) and 2h insulin levels (76.41±54.02 vs 55.43±49.60U/ml,P＜0.01；76.41±54.02 vs 55.71±40.39, P＜0.05) as well as lower insulin sensitivity ［HOMA(Ri］: 4.00±3.09 vs 2.79±1.32, P＜0.01； 4.00±3.09 vs 2.82±2.94, P＜0.01) as compared with that in carriers of other genotypes (“ct” and “tt”).Conclusion　This study suggested the possibility that the defect in SUR1 gene might contribute to the insulin hypersecretion which might be the cause of subsequent increased body weight and decreased insulin sensitivity.

Objective　To study the predictive value of islet cell antibody (ICA),64KD protein antibody(64KDAb) and insulin auto-antibody (IAA) in the first-degree relatives of type 1 diabetics.Methods　The determination of islet autoantibody distribution in type 1 diabetes patients,first-degree relatives without diabetes and normal individuals was made.Results　The results revealed that ICA and 64KDAb positive rate in type I diabetes patients and their first-degree relatives was significantly higher than normal individuals.The positive rate of 64KDAb is higher than that of ICA and IAA. Conclusion　These results suggest that 64KDAb's sensitivity is higher than ICA and IAA's,so 64KDAb is more valuable as the marker of predicting type 1 diabetes.The combined determination of ICA,64KDAb and IAA might improve the value for predicting diabetes.

Objective　To study the changes of the four active substances endothelin(ET),calcitonin gene related peptide (CGRP),thromboxane B2(TXB2) and 6-Keto-prostaglandin F1α(6-Keto-PGF1α) in plasma when they acted on each other in the formation and development of diabetic retinopathy.Methods　Using the method of radio-immunity,the levels of ET,CGRP,TXB2,6-Keto-PGF1α in plasma were measured in four groups of patients with type 2 diabetes (group 1∶40 cases without retinopathy;group 2∶40 cases with primary retinopathy;group 3.40 cases with hyperplasia type of retinopath;group 4∶40 cases normal controls).Results　The results showed that ET increased progressively (P＜0.01) with the prolonging of the duration of DM and the worsening of retina damage、CGRP showed a decreasing tendency (P＜0.05,P＜0.01) in the advanced stage of DM retinopathy.Rectilinear regression analysis showed that the association of ET/CGRP with TXB2/6-Keto-PGF1α became closer with the worsening of deabetic retinopathy (r=0.44,P＜0.05;r=0.596,P＜0.01).Conclusion　The four active substances acted on each other in the formation and development of diabetic retinopathy.It had a significent meaning in the initial mechanism of DM,in the development of disease and in the direction of medication usage to understand their relationship.

Objective To assess the prevalence of the A to G mutation at position 3243 of the mitochondrial tRNALeu(UUR) gene in type 2 diabetes in a Chinese population. Methods We screened 716 randomly selected, unrelated patients with type 2 diabetes for the mutation with a PCR-RFLP technique. Results Three individuals with this mutation were identified, representing approximately 0. 4％ of the type 2 patients screened. Further screening of first degree relatives of these 3 patients identified another 4 affected carriers. In comparison with type 2 diabetic patients without the mutation, these 7 carriers of the mt3243 mutation had:①an earlier onset of diabetes (38. 0±10.1 yr vs 53. 4±10.0 yr, P ＜0. 001) ;②lower BMI (19.5±2.0 vs 24. 9±10. 9, P ＜0. 0001) ;and ③ lower post-challenge insulin levels (Area under the curve of insulin levels during the OGTT, 2946± 1647.2 vs 7469±6647.7, P ＜ 0. 01). In addition, we screened the same 716 patients with type 2 diabetes, as well as 181 controls with normal glucose tolerance,for a newly described mt 3316 G→A mutation. This mutation was found in 16 patients with type 2 diabetes (2.20％) and 5 controls (2.7％). Therefore, the frequency of the mutation was not different between patients and controls.Moreover, clinical characteristics such as age of onset of diabetes, BMI, and insulin levels were not different between diabetic patients with the mt3316 mutation and those without it. Concision The mt3316 G→ A mutation is a polymorphism unrelated to diabetes.

Objective To determine the causative organisms and antimicrobial susceptibility of community- and hospital-acquired pneumonia (CAP and HAP) in type 2 diabetes in Fujian Provincial Hospital. Methods The data of becteria spectrum and their drug susceptibility in patients with type 2 diabetes complicated by pulmonary infection were retrospectively analyzed in January 1995 to October 2006. Results The isolated bacteria of sputum culture of 494 cases included 73 gram-positive cocci(16.7%),139 gram negative bacilli(31.9%)and 224 fungus(51.4%).G+ cocci mainly included staphylococci,G-bacilli mainly included Klebsiella pneumoniae,Bowman immovability bacillus and Pseudomonas aeruginosa.In both CAP and HAP,fungus and G- bacilli were the dominant pathogens.The pathogenic bacteria were resistant to multi-antibiotics,and the resistant rates from HAP patients was higher than those from CAP. Of the bacterial strains isolated from blood culture,G-bacilli constituted 87.5%. Conclusions Fungus and G-bacilli were the dominant pathogens.Phlegm culture and drug sensitive test are helpful for reasonable use of antibiotics for patients with type 2 diabetes complicated by pulmonary infection in clinical practice.

Objective To discuss the significance and alteration of heart rate turbulence (HRT) of diabetics with ventricular premature beats of coronary heart disease (CHD). Methods 107 patients were chosen and divided into DM group(n=30), CHD group (n=32)and normal group(n=45).The turbulence onset(TO)and turbulence slope(TS) were calculated and analyzed. Results For the diabetics with ventricular premature beats, TO value was higher and TS value was lower than the normal group(all P<0.05).The value of TO and TS of the diabetics with ventricular premature beats were similar to those of CHD(P>0.05). Conclusions HRT can be used to estimate the integrality and stability of cardiac autonomic nerve function for the diabetics and it is an important factor for diagnosis.

Objective To investigate the variance of daily glucose profiles at different stages of glucose metabolism so as to instruct the development of rational programs of treatment. Methods The CGMS(continuous glucose monitoring sysytem)data of NGT(nomal glucose tolerance),IFG(impaired fasting glucose), IGT(impaired glucose tolerance),IFG+IGT and newly diagnosed T2DM(type 2 diabetes mellitus)were analyzed. Results There was no significant difference between NGT,IFG and IGT in the level of glucose and the degree of glycemic excursion(P>0.05).The level of glucose and the degree of glycemic excursion in IFG plus IGT were significantly higher than those in NGT, IFG and IGT(P<0.05).There was no significant difference between IFG plus IGT and T2DM in the degree of glycemic excursion(P>0.05).The level of glucose in T2DM was significantly higher than that of other groups(P<0.05). Conclusions With the aggravation of abnormality of glucose metabolism,the level of glucose becomes higher and the degree of glycemic excursion becomes more serious.Early intervention is suggested on the stage of IFG plus IGT.

Objective To establish the microtiter plate radiobinding assay (RBA) of IA-2A and to evaluate its clinical application. Methods The purified ~(35)S - IA-2 was incubated with sera for 24 hours on a 96-well V-shaped bottom plate, and then transferred to the Millipore plate coated with protein A, and counted with liquid scintillation and luminescence counters after washing. The IA-2A levels were detected in 162 patients with type 1 diabetes(T1DM),210 patients with newly diagnosed type 2 diabetes(T2DM) and 224 healthy controls to evaluate clinical application of IA-2A RBA. Results 1. The intra-coefficient of variation (CV) of the assay was 4.1%～10.0%, and the inter CV was 5.7%～12.8%. 2. The results from DASP 2005 showed that the sensitivity and specificity of the assay were 72% and 98%. The results of IA-2A from two methods of RBA and classical radioligand assay(RLA) were significantly correlated (r=0.962,P＜0.001) with a consistency of 96.5%. 3. When compared with the healthy controls, T1DM patients had higher positivity for IA-2A (22.8% vs 0.89%, χ~2=49.9,P＜0.001), but no significant difference was found in T2DM patients(2.4% vs 0.89%, χ~2=1.5,P＞0.05). 4. The consistency rate of IA-2A measurement was 100% between RBA using finger tip blood and RLA using venous blood (r=0.977,P＜0.001). Conclusions The microtiter plate RBA of IA-2A using finger tip blood has high sensitivity, specificity and reproducibility, and possesses a good clinical value.

Objective To investigate the value and limitations of ultrasound determination-evaluated brachial artery endothelial function in elderly diabetic patients. Methods High-resolution two-dimensional ultrasound was used to determine brachial artery(BA) flow-mediated vasodilation(FMD) during reactive hyperemia. Endothelial function was evaluated by FMD in 67 elderly patients with type 2 diabetes. Results In diabetes versus normal control group,the BA diameter and flow velocity showed no significant difference (P＞0.05) at basal state,but showed significant decreases (P＜0.05) after reactive hyperemia. Single-factor correlation analysis showed that FMD was in negative correlation with disease course, TG, ISI and age (r=-0.2357,-0.2215 and -0.3256, -0.2415,(all P＜0.05～0.01),and showed no correlation of FMD with BMI, TC, FBG, HbA1c, FIns. Conclusions FMD has a value in evaluating the flow-mediated endothelial dysfunction in older T2DM patients, while our analysis of the results should consider the patient's age, gender, race, disease course, blood lipids and other factors.

Objective To assess the association of cerebrovascular reserve(CVR) with diabetes(DM)、hypertensive atherosclerotic lacunar infarction(HALI),hypertension(HT) and diabetic lacunar infarction(DLI) by means of transcranial Doppler ultrasonography (TCD) with breath-holding maneuver.Methods The breath-holding index (BHI), which was the percentage increase in middle cerebral artery(MCA) blood flow velocity as index of CVR assessment,was detected during breath-holding by TCD and breath-holding technique in 30 diabetic patients,30 hypertensive atherosclerotic lacunar infarction patients,30 hypertension patients and 30 diabetic lacunar infarction patients. Results There was significant difference in the ascending rates of Vm and BHI between diabetic group and diabetic lacunar infarction group,diabete lacunar infarction group and hypertensive atherosclerotic lacunar infarction group,hypertension group and diabetic group (all P<0.05). Conclusions Diabetes can more significantly impair CVR than hypertension. Diabetic lacunar infarction can more significantly impair CVR than diabetes. Diabetic lacunar infarction can more significantly impair CVR than hypertensive atherosclerotic lacunar infarction .