Blood Glucose ; analysis ; Diabetes Complications ; prevention & control ; Diabetes Mellitus, Type 2 ; blood ; therapy ; Humans ; Risk Factors

Diabetes mellitus is common in our increasingly affluent and ageing population. Although it is an old friend of practising family physicians, there is a need to be familiar with and up to date about the disease. As patients become more informed and receptive to current medical information, family physicians also need to stay current. This article highlights the evidences that have shaped our current treatment targets for type 2 diabetes mellitus.
Diabetes Mellitus, Type 1 ; blood ; therapy ; Diabetes Mellitus, Type 2 ; blood ; therapy ; Family Practice ; methods ; Glycated Hemoglobin A ; metabolism ; Humans ; Physicians, Family

OBJECTIVETo observe the effect of Jianpi Wenshen Decoction (JWD) on serum gastrin, plasma motilin and somatostatin in patients of diabetic diarrhea (DD).

METHODSPatients with DD were randomly divided into two groups, the JWD group and the control group treated with Loperamide (LPA). Besides, a normal control group was set up. Changes of serum gastrin, plasma motilin and somatostatin were observed.

RESULTSBefore treatment, the levels of gastrin and motilin in both groups were higher and somatostatin lower than those in the normal control group. After 1 month treatment, levels of the three indices were restored in both group approaching the normal range with insignificance as compared with those in the normal control group (P > 0.05). Level of plasma motilin and serum gastrin showed an increasing trend along with the therapeutic effect elevation, while level of somatostatin showed a decreasing trend.

CONCLUSIONJWD could promote the recovery of the impaired function of vegetative nerve system in DD patients. At the same time, serum gastrin, plasma motilin and somatostatin may be taken as the indexes for evaluating the efficacy in treating DD.

Adult ; Aged ; Diabetes Mellitus, Type 1 ; complications ; Diabetes Mellitus, Type 2 ; blood ; complications ; drug therapy ; Diarrhea ; blood ; drug therapy ; etiology ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Gastrins ; blood ; Humans ; Male ; Middle Aged ; Motilin ; blood ; Phytotherapy ; Somatostatin ; blood

Although various basal-bolus insulin therapy (BBIT) protocols have been used in the clinical environment, safer and more effective BBIT protocols are required for glucose control in hospitalized patients with type 2 diabetes (T2D). Modeling approaches could provide an evaluation environment for developing the optimal BBIT protocol prior to clinical trials at low cost and without risk of danger. In this study, an in-silico model was proposed to evaluate subcutaneous BBIT protocols in hospitalized patients with T2D. The proposed model was validated by comparing the BBIT protocol and sliding-scale insulin therapy (SSIT) protocol. The model was utilized for in-silico trials to compare the protocols of adjusting basal-insulin dose (BBIT1) versus adjusting total-daily-insulin dose (BBIT2). The model was also used to evaluate two different initial total-daily-insulin doses for various levels of renal function. The BBIT outcomes were superior to those of SSIT, which is consistent with earlier studies. BBIT2 also outperformed BBIT1, producing a decreased daily mean glucose level and longer time-in-target-range. Moreover, with a standard dose, the overall daily mean glucose levels reached the target range faster than with a reduced-dose for all degrees of renal function. The in-silico studies demonstrated several significant findings, including that the adjustment of total-daily-insulin dose is more effective than changes to basal-insulin dose alone. This research represents a first step toward the eventual development of an advanced model for evaluating various BBIT protocols.
Blood Glucose/analysis ; Diabetes Mellitus, Type 2/*drug therapy ; Hospitalization ; Humans ; Hypoglycemic Agents/*therapeutic use ; Insulin/*therapeutic use ; Models, Theoretical

Berberine (BBR) is a type of alkaloids isolated from Coptidis Rhizoma and Phellodendri Chinensis Cortex and has been used to treat bacterial gastroenteritis, diarrhea and other digestive diseases for more than 1 000 years. According to recent studies, berberine has been found to have multiple pharmacological activities, including lowering blood glucose and lipid, anti-inflammation, antioxidation, relieving type 2 diabetic nephropathy (DN), diabetic cardiovascular disease, diabetic peripheral neuropathy ( DPN) and other complications. In this article, the authors summarized the literature reports about the effects of BBR in lowering blood glucose and preventing and treating the above type 2 diabetes and its complications, in order to provide reference to further studies and promotion of BBR's application.
Animals ; Berberine ; administration & dosage ; Blood Glucose ; metabolism ; Diabetes Complications ; drug therapy ; metabolism ; Diabetes Mellitus, Type 2 ; drug therapy ; metabolism ; Drugs, Chinese Herbal ; administration & dosage ; Humans

OBJECTIVETo evaluate the efficacy and the relevant effect factors of acupuncture for type 2 diabetes mellitus (T2DM) in females.

METHODSOf 83 female patients of T2DM, 49 cases were deficiency of kidney yin syndrome and 34 cases were yin and yang deficiency syndrome. Acupuncture was adopted and the acupoints were selected according to the syndrome differentiation. In kidney yin deficiency syndrome, Taixi (KI 3), Shenmen (HT 7), Taichong (LR 3) and Sanyinjiao (SP 6), etc. were selected. In yin and yang deficiency syndrome, Shenshu (BL 23), Pishu (BL 20), Yishu (Extra) and Jingmen (GB 25), etc. were selected. In 3 courses of treatment, the changes in fasting plasma glucose (FPG), fasting insulin (FINS), insulin sensitivity index (ISI), insulin resistace index (Homa-IR), index of islet beta-cell function (Homa-beta), total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) were compared before and after treatment between the two groups. The relationship of the efficacy was analyzed in terms of the syndrome differentiation, age, duration of sickness, obesity and hereditary factors.

RESULTSAfter the treatment, the levels of FPG, FINS, Homa-IR, TC, TG and LDL-C were reduced obviously (all P < 0.01) and the levels of ISI, Homa-beta and HDL-C were increased apparently (all P < 0.01). The total clinical effective rate was 80.7% (67/83), in which, that of kidney yin deficiency syndrome was 83.7% (41/49) and that of yin and yang deficiency syndrome was 76.5% (26/34). The efficacy was not different significantly between the two syndromes. But, the younger the age was, the better the efficacy was.

CONCLUSIONAcupuncture positively regulates the glucose and lipid metabolism in the patients of T2DM. This therapy improves insulin resistance, enhances the body sensitivity to insulin and improves insulin beta-cell function. The efficacy is related to the patient's age.

Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Blood Glucose ; metabolism ; Cholesterol ; blood ; Diabetes Mellitus, Type 2 ; metabolism ; therapy ; Female ; Humans ; Middle Aged ; Treatment Outcome ; Triglycerides ; blood ; Young Adult

BACKGROUNDThis prospective, randomized, controlled study was designed to investigate the effects of a diabetes specific formula (Diason low energy: 313.8 kJ/100 ml), compared with a standard formula, on insulin sensitivity, serum C peptide, serum lipids and free fatty acid (FFA) in type 2 diabetics.

METHODSIn total of 71 type 2 diabetics completed the study. Enteral formulas were given orally as the sole source of nutrition to the subjects for 6 days. Venous blood samples (0.5, 1, 2, 3 hours) were collected at day-7 after a 75 g oral glucose tolerance test (OGTT), day 1 after a standard test meal (1673.6 kJ) and after 6 days of either the test diabetes specific formula or a standard formula. Plasma glucose, serum insulin, C peptide and lipids were measured.

RESULTSAfter the intervention period, the diabetes specific formula resulted in a significantly lower postprandial rise in blood glucose concentrations at 0.5 hour (P < 0.05) and 1 hour (P < 0.01); significantly lower peak height of plasma glucose (P = 0.05); significantly lower plasma insulin concentrations at 0.5 hour (P < 0.01), 1 hour (P < 0.01) and 2 hours (P < 0.01); and a significantly lower plasma insulin peak compared to controls; both OGTT and a standard test meal (P < 0.05). The glucose and insulin area under the curve after the diabetes specific formula compared to the standard formula were significantly lower. The C peptide level was lower after 6 days of both nutrition formulas compare to 75 g OGTT, but not different from the standard mixed meal. Both formulas were well tolerated.

CONCLUSIONSIn summary the diabetes specific formula with a relatively high monounsaturated fatty acid and high multi fiber proportion significantly improved glycemic control. On top of this, the insulin sensitivity (HOMA-IS) was significantly improved and may therefore directly improve the impact on long term complications. The disease specific formula should therefore be the preferred option to be used by diabetic and hyperglycemic patients in need of nutritional support.

C-Peptide ; blood ; Diabetes Mellitus, Type 2 ; blood ; diet therapy ; Diet, Diabetic ; Fatty Acids, Nonesterified ; blood ; Humans ; Insulin ; secretion ; Lipids ; blood ; Middle Aged ; Prospective Studies

This study is to evaluate the therapeutic effect of fibroblast growth factor 21 (FGF21) on type 2 diabetic mice model and to provide mechanistic insights into its therapeutic effect. Type 2 diabetic animal model was established with high calorie fat diet and low dose streptozotocin (STZ) injection. Mice were then randomized into 5 groups: model control, FGF21 0.25 and 0.05 μmol x kg(-1) x d(-1) groups, insulin treatment group. Ten age-matched normal KM mouse administered with saline were used as normal controls. Serum glucose, insulin, lipid products and the change of serum and liver tissue inflammation factor levels between five groups of mouse were determined. The results showed that blood glucose, insulin, free fatty acids (FFAs), triglycerides, and inflammatory factor average FGF-21 of type 2 diabetes model group and normal control group were significantly higher (P < 0.01), while compared with insulin group, no difference was significant. Average blood glucose, insulin, blood lipid and inflammatory factor of FGF-21 treatment group compared with type 2 diabetes group was significantly lower (P < 0.01) and insulin group has no difference with the model control group. The results of OGTT and HOMA-IR showed that insulin resistance state was significantly relieved in a dose-dependent manner. Thus, this study demonstrates that FGF-21 significantly remits type 2 diabetic mice model's insulin resistance state and participates in the regulation of inflammatory factor levels and type 2 diabetes metabolic disorders.
Animals ; Blood Glucose ; Diabetes Mellitus, Experimental ; drug therapy ; Diabetes Mellitus, Type 2 ; drug therapy ; Diet, High-Fat ; Fatty Acids, Nonesterified ; blood ; Fibroblast Growth Factors ; pharmacology ; Insulin ; blood ; Insulin Resistance ; Mice ; Streptozocin ; Triglycerides ; blood

PURPOSETo review evidence-based management of nephropathy in patients with type 2 diabetes.

DATA SOURCESA literature search (MEDLINE 1966 to 2000) was performed using the key word "diabetic nephropathy". Relevant book chapters were also reviewed.

STUDY SELECTIONWell-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.

DATA EXTRACTIONData and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.

RESULTSHypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions.

CONCLUSIONSDiabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.

Albuminuria ; diagnosis ; therapy ; Blood Glucose ; analysis ; Diabetes Mellitus, Type 2 ; complications ; Diabetic Nephropathies ; epidemiology ; therapy ; Dietary Proteins ; administration & dosage ; Humans ; Hyperlipidemias ; therapy ; Hypertension ; therapy

BACKGROUNDSubcutaneous absorption is accelerated by the monomeric conformation of insulin Aspart, which provides good glycemic control with a lower risk of hypoglycemia and less body weight increase. In the present study we investigated the efficacy and safety of a rapid-acting human insulin analogue (insulin Aspart) delivered with continuous subcutaneous insulin infusion (CSII) into Chinese diabetic patients.

METHODSA total of 21 patients with type 1 or type 2 diabetes were recruited for the 2-way cross-over, open-labeled trial, and then randomized to Group A (n = 10, treated with insulin Aspart) or Group B (n = 11, treated with Novolin R). Insulin Aspart and Novolin R were administered by CSII. Capillary glucose concentrations were measured at 8 time points, pre-prandial and postprandial, bedtime (10 pm), midnight (2 am) every day during the treatment.

RESULTSThe average capillary glucose profiles for the day were much better controlled in Group A than in Group B (P < 0.01). The blood glucose levels were particularly better controlled in Group A than in Group B at pre-breakfast ((6.72 +/- 1.24) mmol/L vs (7.84 +/- 1.58) mmol/L, P = 0.014), post-breakfast ((8.96 +/- 2.41) mmol/L vs (11.70 +/- 3.11) mmol/L, P = 0.0028), post-supper ((8.15 +/- 2.10) mmol/L vs (10.07 +/- 2.36) mmol/L, P = 0.008), bed time ((7.73 +/- 1.72) mmol/L vs (9.39 +/- 2.05) mmol/L, P = 0.007) and midnight ((6.32 +/- 1.16) mmol/L vs (7.48 +/- 1.36) mmol/L, P = 0.0049). There was no significant difference in the frequency of hypoglycemic episodes between the two groups.

CONCLUSIONInsulin Aspart results in better control of blood glucose levels than regular human insulin (Novolin R) in diabetic patients during delivery by CSII.

Adult ; Aged ; Blood Glucose ; analysis ; Cross-Over Studies ; Diabetes Mellitus, Type 1 ; drug therapy ; Diabetes Mellitus, Type 2 ; drug therapy ; Female ; Humans ; Hypoglycemic Agents ; administration & dosage ; Insulin ; administration & dosage ; analogs & derivatives ; Insulin Aspart ; Insulin Infusion Systems ; Male ; Middle Aged