Diabetes mellitus (DM) is a major global health issue, with glycated hemoglobin levels serving as the gold standard for evaluating glucose level control in DM patients. However, it has limitations in reflecting glucose oscillations (i.e. glycemic variability, GV). Increasing evidence suggests that GV is closely related to the progression of diabetes complications and patient prognosis. As people realize the importance of avoiding hypoglycemia while achieving target glycated hemoglobin levels in treatment, the clinical significance of GV becomes more obvious. This article systematically reviewed the concept and connotation of GV, summarized the latest research on its role in the complications of diabetes, and revealed the biochemical and pathophysiological abnormalities caused by excessive glycemic oscillation, aiming to provide a theoretical basis for the risk warning and early intervention of DM patients.
Humans ; Blood Glucose/metabolism* ; Diabetes Complications/physiopathology* ; Glycated Hemoglobin/metabolism* ; Hypoglycemia ; Diabetes Mellitus, Type 2/complications*

OBJECTIVE: The present study aims at determining the stability of a popular type 2 diabetes rat model induced by a high-fat diet combined with a low-dose streptozotocin injection. METHODS: Wistar rats were fed with a high-fat diet for 8 weeks followed by a one-time injection of 25 or 35 mg/kg streptozotocin to induce type 2 diabetes. Then the diabetic rats were fed with regular diet/high-fat diet for 4 weeks. Changes in biochemical parameters were monitored during the 4 weeks. RESULTS: All the rats developed more severe dyslipidemia and hepatic dysfunction after streptozotocin injection. The features of 35 mg/kg streptozotocin rats more resembled type 1 diabetes with decreased body weight and blood insulin. Rats with 25 mg/kg streptozotocin followed by normal diet feeding showed normalized blood glucose level and pancreatic structure, indicating that normal diet might help recovery from certain symptoms of type 2 diabetes. In comparison, diabetic rats fed with high-fat diet presented decreased but relatively stable blood glucose level, and this was significantly higher than that of the control group (P<0.05). CONCLUSIONS This model easily recovers with normal diet feeding. A high-fat diet is suggested as the background diet in future pharmacological studies using this model.
Animals ; Blood Glucose ; metabolism ; Diabetes Mellitus, Experimental ; blood ; etiology ; physiopathology ; Diabetes Mellitus, Type 2 ; blood ; etiology ; physiopathology ; Diet, High-Fat ; adverse effects ; Insulin ; blood ; Lipids ; blood ; Liver ; drug effects ; pathology ; physiopathology ; Male ; Malondialdehyde ; blood ; Oxidative Stress ; Rats ; Rats, Wistar ; Streptozocin ; administration & dosage ; toxicity ; Superoxide Dismutase ; blood ; Uric Acid ; blood

Nonalcoholic fatty liver disease (NAFLD) and type 2 Diabetes Mellitus (T2DM) are highly prevalent diseases and are closely associated, with NAFLD being present in the majority of T2DM patients. In Asian traditional medicine, Mori Cortex is widely used for the treatment of diabetes and hyperlipidemia. However, whether it has a therapeutic effect on T2DM associated with NAFLD is still unknown. The present study showed that the oral treatment with Mori Cortex extract (MCE; 10 g·kg·d) lowered the blood lipid levels and reversed insulin resistance (IR) in high fat-diet/streptozotocin-induced type 2 diabetes in rats. The expression levels of sterol receptor element-binding protein-1c (SREBP-1c) and carbohydrate-responsive element binding protein (ChREBP), which are involved in steatosis in NAFLD rats, were measured in the liver samples. MCE decreased the protein and mRNA expression levels of SREBP-1c and ChREBP. In conclusion, down-regulation of SREBP-1c and ChREBP might contribute to the protective effect of MCE on hepatic injury and IR in the rats with T2DM associated with NAFLD.
Alanine Transaminase ; blood ; Animals ; Aspartate Aminotransferases ; blood ; Basic Helix-Loop-Helix Leucine Zipper Transcription Factors ; genetics ; Diabetes Mellitus, Type 2 ; blood ; chemically induced ; drug therapy ; metabolism ; Diet, High-Fat ; adverse effects ; Disease Models, Animal ; Down-Regulation ; drug effects ; Insulin ; blood ; Insulin Resistance ; physiology ; Lipid Metabolism ; drug effects ; genetics ; Liver ; drug effects ; physiopathology ; Male ; Morus ; Non-alcoholic Fatty Liver Disease ; blood ; chemically induced ; drug therapy ; metabolism ; Phytotherapy ; Plant Extracts ; pharmacology ; therapeutic use ; Rats ; Rats, Sprague-Dawley ; Streptozocin

Aged ; Blood Glucose ; metabolism ; Diabetes Mellitus, Type 2 ; blood ; physiopathology ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Male ; Middle Aged ; Neuropsychological Tests

Differences in arterial stiffness between the two sides of the carotid arteries were investigated using ultrasonic radiofrequency in 88 patients with type 2 diabetes and 70 controls. The compliance coefficient (CC), pulse wave velocity (PWV), intima-media thickness (CIMT) and diameter (CCAD) of the common carotid arteries (CCAs) were measured. The ratio of the left to right CCAs was calculated to provide four indexes: CC ratio, PWV ratio, CIMT ratio and CCAD ratio. In the diabetes group, the PWV on the left side was significantly higher than that on the right side, while the CC on the left side was significantly lower than that on the right side. The bilateral CIMT was thicker and CCAD was wider, the left PWV traveled faster, and the right CC was higher in the diabetes group than in the control group. The PWV ratio between the two groups was significantly different and correlated positively with duration of diabetes and systolic blood pressure (SBP). The differences between the two sides of CCAs in patients with diabetes suggested that disease duration and SBP were important risk factors for arterial stiffness. Identifying the difference could potentially lead to the much earlier diagnosis of arteriosclerosis.
Adult ; Aged ; Blood Pressure ; Carotid Artery, Common ; diagnostic imaging ; physiopathology ; Carotid Intima-Media Thickness ; Case-Control Studies ; Diabetes Mellitus, Type 2 ; diagnostic imaging ; physiopathology ; Echocardiography ; instrumentation ; methods ; Female ; Humans ; Male ; Middle Aged ; Pulse Wave Analysis ; Risk Factors ; Ultrasonics ; Vascular Stiffness

OBJECTIVETo compare the efficacy between acupuncture at stellate ganglion combined with intravenous administration of alprostadil and simple intravenous administration of alprostadil on lower limb atherosclerosis of early diabetes mellitus.

METHODSSixty patients of lower limb atherosclerosis of early diabetes mellitus were randomly divided into an observation group and a control group, 30 cases in each one. Patients in the two groups were treated with basic treatment to control blood glucose and lipid. In addition, patients in the control group were treated with intravenous administration of alprostadil (10 µg) and sodium chloride solution (100 mL); based on this, patients in the observation group were treated with acupuncture at stellate ganglion. The treatment was given once a day; the consecutive treatment of two weeks constituted one session, and totally 4 sessions were given. The total syndrome score, glycosylated hemoglobin (HbA1c), blood flow of posterior tibial artery and dorsal artery of foot were observed before and after treatment; the clinical efficacy was compared between the two groups.

RESULTSCompared before treatment, the total syndrome score, HbA1c, blood flow of posterior tibial artery and dorsal artery of foot were significantly improved after treatment (all P < 0.05), which were more obvious in the observation group (all P < 0.05). After treatment, the total effective rate was 93.3% (28/30) in the observation group, which was significantly superior to 86.7% (26/30) in the control group (P < 0.05). CONCLUSION Acupuncture at stellate ganglion combined with intravenous administration of alprostadil achieve better effect than simple intravenous administration of alprostadil for lower limb atherosclerosis of early diabetes mellitus, which improve the clinical symptoms, regulate blood sugar and increase the blood flow of lower limb.

Acupuncture Points ; Acupuncture Therapy ; Aged ; Atherosclerosis ; etiology ; physiopathology ; therapy ; Diabetes Mellitus, Type 2 ; complications ; Female ; Humans ; Lower Extremity ; blood supply ; innervation ; physiopathology ; Male ; Middle Aged ; Stellate Ganglion ; physiopathology ; Treatment Outcome

OBJECTIVETo evaluate the long-term clinical effect of Tangyiping Granules (, TYP) on patients with impaired glucose tolerance (IGT) to achieve normal glucose tolerance (NGT) and hence preventing them from conversion to diabetes mellitus (DM).

METHODSIn total, 127 participants with IGT were randomly assigned to the control (63 cases, 3 lost to follow-up) and treatment groups (64 cases, 4 lost to follow-up) according to the random number table. The control group received lifestyle intervention alone, while the patients in the treatment group took orally 10 g of TYP twice daily in addition to lifestyle intervention for 12 weeks. The rates of patients achieving NGT or experiencing conversion to DM as main outcome measure were observed at 3, 12, and 24 months after TYP treatment. The secondary outcome measures included fasting plasma glucose (FPG), 2-h postprandial plasma glucose (2hPG), glycosylated hemoglobin (HbA1c), fasting insulin (FINS), 2-h insulin (2hINS), homeostatic model assessment of insulin resistance (HOMA-IR), blood lipid and patients' complains of Chinese medicine (CM) symptoms before and after treatment.

RESULTSA higher proportion of the treatment group achieved NGT compared with the control group after 3-, 12- and 24-month follow-up (75.00% vs. 43.33%, 58.33% vs. 35.00%, 46.67% vs. 26.67%, respectively, P<0.05). The IGT to DM conversion rate of the treatment group was significantly lower than that of the control group at the end of 24-month follow-up (16.67% vs. 31.67%, P<0.05). Before treatment, FPG, 2hPG, HbA1c, FINS, 2hINS, HOMA-IR, triglyceride (TG), total cholesterol, low- and high-density lipoprotein cholesterol levels had no statistical difference between the two groups (P>0.05). After treatment, the 2hPG, HbA1c, HOMA-IR, and TG levels of the treatment group decreased significantly compared with those of the control group (P<0.05). CM symptoms such as exhaustion, irritability, chest tightness and breathless, spontaneous sweating, constipation, and dark thick and greasy tongue were significantly improved in the treatment group as compared with the control group (P<0.05). No severe adverse events occurred.

CONCLUSIONTYP administered at the IGT stage with a disciplined lifestyle delayed IGT developing into type 2 DM.

Blood Glucose ; metabolism ; Blood Platelets ; drug effects ; metabolism ; Case-Control Studies ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; Drugs, Chinese Herbal ; pharmacology ; therapeutic use ; Erythrocytes ; drug effects ; metabolism ; Female ; Glucose Intolerance ; blood ; drug therapy ; Humans ; Insulin ; blood ; Kidney ; drug effects ; physiopathology ; Leukocytes ; drug effects ; metabolism ; Lipids ; blood ; Liver ; drug effects ; physiopathology ; Male ; Middle Aged ; Time Factors

OBJECTIVETo observe the effect and mechanism of curcumin derivative B06 on kidney from rats with hyperlipidemia and type 2 diabetes.

METHODSThirty five male SD rats were randomly divided into five groups(n = 7): the normal control group, high-fat group, high-fat + B06-treatd group, diabetic group, diabetic + B06-treated group. After fed with high-fat diet for 4 weeks, the later two groups were in- jected with streptozotocin intraperitoneally to induce type 2 diabetes mellitus. B06-treated groups were given B06 by gavage at a dosage of 0.2 mg/kg . d for 8 weeks. After the treatment, the serum creatinine, blood urea nitrogen and uric acid were detected biochemically, the morphology of kidney was observed with light and transmission electron microscopy, the expression of collagen fibers was observed with Masson staining, the protein expression of collogen IV and fibronectin in kidney were determined by Immunohistochemistry.

RESULTSIt was showed that the levels of the serum creatinine and blood urea nitrogen elevated significantly in diabetic group. In high-fat and diabetic groups, increased glomerular mesangial matrix and collagen fiber and thicken glomerular basal membrane were observed under light microscopy, swelling and fusion of foot process were found under electron microscope; increased green matrix within glomeruli was observed under Masson staining. collogen IV and fibronectin protein expression were significantly enhanced in high-fat group and diabetic group. After B06's intervention, the levels of serum creatinine and blood urea nitrogen were decreased in diabetic groups, the morphological change of kidney was obviously relieved, Collogen IV and fibronectin protein expression reduced.

CONCLUSIONCurcumin derivative B06 exerts a protective effect on kidney in type 2 diabetic rats, reduced expressions of collogen IV and fibronectin, inhibition of the accumulation of extracellular matrix and glomerular mesangial proliferation, and then prevention of renal fibrosis may be the mechanism.

Animals ; Blood Urea Nitrogen ; Collagen Type IV ; metabolism ; Creatinine ; blood ; Curcumin ; pharmacology ; Diabetes Mellitus, Experimental ; complications ; drug therapy ; Diabetes Mellitus, Type 2 ; Drugs, Chinese Herbal ; Fibronectins ; metabolism ; Kidney ; metabolism ; physiopathology ; Kidney Diseases ; drug therapy ; Male ; Rats ; Rats, Sprague-Dawley ; Streptozocin ; Uric Acid ; blood

OBJECTIVETo observe the clinical efficacy of BO's abdominal acupuncture for obese type-2 diabetes mellitus (T2DM).

METHODSSixty patients of obese T2DM were randomly divided into an acupuncture group and a medication group, 30 cases in each one. Patients in the medication group were treated with basic treatment combined with oral administration of regular antidiabetics, three weeks as one session. Patients in the acupuncture group, based on the medication group, were treated with abdominal acupuncture at Yinqiguiyuan [Zhongwan (CV 12), Xiawan (CV 10), Qihai (CV 6), Guanguan (CV 4)], Fusiguan [Huaroumen (ST 24), Wailing (TE 5)], Tianshu (ST 25), Daheng (SP 15), Qixue (KI 13), etc.; the treatment was given three times per week, 3 weeks as one session. The systolic blood pressure (SBP), diastolic blood pressure (DBP), body weight, waist circumference (WC), hip circumference, body mass index (BI) were observed before and after treatment in the two groups, and fasting plasma glucose (FPG), fasting insulin (FINS), 2-hours postprandial blood glucose by oral glucose tolerance test (OGTT) and insulin, total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), HOMA-IR of insulin resistance index were calculated and adverge events were recorded.

RESULTSCompared before the treatment, SBP, WC, body weight, BMI, FPG, OG-TT2hBG, FINS, GTT2h insulin, HOMA-IR, TC and LDL-C in the acupuncture group were all significantly reduced (all P <0. 05), while FPG, OGTT2H insulin and TG were increased in the medication group (all P<0. 05)'. The differences of reducing SBP, WC, FPG, OGTT2H insulin, HOMA-IR, TC, TG and LDL-C were statistically significant between the two groups (all P<0. 05). The total effective rate was 93. 3% (28/30) in the acupuncture group, which was significantly superior to 23. 3% (7/30) in the medication group (P<0. 01).

CONCLUSIONBO's abdominal acupuncture has obvious clinical efficacy for obese type-2 diabetes mellitus, featuring in lowering blood pressure, reducing weight, decreasing blood glucose, im- proving insulin resistance and lowering lipid, which has no adverse effects and is worthy of clinical popularization and application.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Blood Glucose ; metabolism ; Body Mass Index ; Body Weight ; Cholesterol ; blood ; Diabetes Mellitus, Type 2 ; metabolism ; physiopathology ; therapy ; Female ; Humans ; Insulin ; blood ; metabolism ; Lipoproteins, LDL ; blood ; metabolism ; Male ; Middle Aged ; Triglycerides ; blood ; Waist Circumference

Hypoglycemia is a major barrier to achieving the glycemic goal in patients with type 2 diabetes. In particular, severe hypoglycemia, which is defined as an event that requires the assistance of another person to actively administer carbohydrates, glucagon, or take other corrective actions, is a serious clinical concern in patients with diabetes. If severe hypoglycemia is not managed promptly, it can be life threatening. Hypoglycemia-associated autonomic failure (HAAF) is the main pathogenic mechanism behind severe hypoglycemia. Defective glucose counter-regulation (altered insulin secretion, glucagon secretion, and an attenuated increase in epinephrine during hypoglycemia) and a lack of awareness regarding hypoglycemia (attenuated sympathoadrenal activity) are common components of HAAF in patients with diabetes. There is considerable evidence that hypoglycemia is an independent risk factor for cardiovascular disease. In addition, hypoglycemia has a significant influence on the quality of life of patients with diabetes. To prevent hypoglycemic events, the setting of glycemic goals should be individualized, particularly in elderly individuals or patients with complicated or advanced type 2 diabetes. Patients at high-risk for the future development of severe hypoglycemia should be selected carefully, and intensive education with reinforcement should be implemented.
Autonomic Nervous System/physiopathology ; Biological Markers/blood ; Blood Glucose/*drug effects/metabolism ; Diabetes Mellitus, Type 2/blood/complications/diagnosis/*drug therapy/physiopathology ; Health Knowledge, Attitudes, Practice ; Humans ; Hypoglycemia/blood/chemically induced/epidemiology/physiopathology/*prevention & control ; Hypoglycemic Agents/*adverse effects ; Incidence ; Patient Education as Topic ; Prevalence ; Prognosis ; Risk Assessment ; Risk Factors