Type 2 diabetes mellitus is a progressive process. With the course of the disease progress, microvascular and macrovascular complications always happen. Thrombotic events caused by macrovascular complications, including coronary heart diseases and cerebrovascular diseases, are the main fatal factor for the patients with type 2 diabetes. Endothelial dysfunction, coagulative activation, impaired fibrinolysis, together with hyper-reactive platelets contribute to the diabetic prothrombotic state, which is strongly related to the macrovascular complications. In particular, the hyper-reactive platelets play a fundamental role among them. Type 2 diabetes is characterized by several metabolic dysfunctions such as hyperglycemia, insulin resistance and shortage, oxidative stress, systemic inflammation, obesity, and dyslipidemia. These metabolic dysfunctions work together to promote the formation of hyper-reactive platelets, which are distinctive in type 2 diabetes. The regular antiplatelet drugs, like aspirin, show limited inhibitory effect on them. Hence, studying the mechanism behind the hyper-reactive platelets could provide a brand-new view on the prevention of macrovascular complications and cardiovascular events in type 2 diabetes.
Blood Platelets ; Diabetes Mellitus, Type 2/drug therapy* ; Humans ; Hyperglycemia/complications* ; Insulin Resistance ; Obesity/complications*

OBJECTIVETo study the clinical features of neonatal diabetes mellitus (NDM).

METHODThirteen cases with NDM were seen in our department between Jul. 2004 and Sept. 2009. Their clinical features were reviewed retrospectively.

RESULTSThe average birth weight of the 13 cases was 2.30 kg. The median age at diagnosis was 2 months. The mean blood glucose at diagnosis was 22.2 mmol/L. Symptoms in 9 of 13 cases were exacerbated by infection and only 5 had typical symptoms of diabetes mellitus including polydipsia, polyuria, polyphagia and body weight loss. The common clinical findings included athrepsia, diuresis, and moderate dehydration. Ketoacidosis attacked 3 cases and 3 children had hypertriglyceridemia, meanwhile, 2 children had complications of blood clotting dysfunction and congenital cardiopathy, respectively. Autoantibody to insulin (IAA) was tested in 11 cases, all but one case was negative. Glycosylated hemoglobin was increased in 6 cases. Insulin treatment was started in all the 13 cases. The initial dose was 0.56-1.00 U/(kg × d), and the maximal dose was 1.35 U/(kg × d) depending on the variety of blood glucose. Blood glucose decreased significantly within 24 hours. Unfortunately, 1 case developed progressive blood glucose decline and recurrent hypoglycemia. Symptoms of the 3 cases who developed DKA were relieved 48 hours later, and their blood glucose was well under control. Among the 8 cases followed up, 4 had TNDM and 2 had PNDM. Unfortunately, 1 case died at the age of 3 months because insulin injection was stopped by the parents.

CONCLUSIONEarly diagnosis and prompt management may lead to favorable prognosis. Blood glucose monitoring is a valuable method to avoid misdiagnosis and NDM should be differentiated from stress hyperglycemia, iatrogenic, or other causes of hyperglycemia.

Blood Glucose ; analysis ; Diabetes Mellitus ; classification ; drug therapy ; Female ; Humans ; Hyperglycemia ; Infant ; Infant, Newborn ; Male ; Retrospective Studies

Hyperglycemia significantly increases the risk of cardiovascular disease (CVD) in diabetics. However, it has been shown by a series of large scale international studies that intensive lowering of blood glucose levels not only has very limited benefits against cardiovascular problems in patients, but may even be harmful to patients at a high risk for CVD and/or poor long-term control of blood glucose levels. Therefore, Western medicine is faced with a paradox. One way to solve this may be administration of Chinese herbal medicines that not only regulate blood glucose, blood fat levels and blood pressure, but also act on multiple targets. These medicines can eliminate cytotoxicity of high glucose through anti-inflammatory and anti-oxidant methods, regulation of cytokines and multiple signaling molecules, and maintenance of cell vitality and the cell cycle, etc. This allows hyperglycemic conditions to exist in a healthy manner, which is called "harmless hyperglycemia" Furthermore, these cardiovascular benefits go beyond lowering blood glucose levels. The mechanisms of action not only avoid cardiovascular injury caused by intensive lowering of blood glucose levels, but also decrease the cardiovascular dangers posed by hyperglycemia.
Blood Glucose ; analysis ; Cardiovascular Diseases ; prevention & control ; Diabetes Mellitus ; blood ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Humans ; Hyperglycemia ; complications ; etiology

The influence of early-stage intensive insulin therapy on the plasma levels of vascular endothelial growth factor (VEGF) and the related parameters in patients with severe trauma and the clinical implication were investigated. Sixty-four cases of severe trauma (injury severity score ≥20) with stress hyperglycemia (blood glucose >9 mmol/L) were randomly divided into intensive insulin therapy group and conventional therapy group. ELISA method, radioimmunoassay and density gradient gradation one-step process were used to determine plasma VEGF, endothelin-1 (ET-1), and the number of circulating endothelial cells (CECs) at the day of 0, 2, 3, 5 and 7 after admission. Simultaneously, the changes of CRP concentration in plasma were monitored to evaluate inflammatory response. The results showed that plasma levels of observational indexes in patients receiving early-stage intensive insulin therapy were all significantly lower than those in conventional therapy groups 2, 3, 5 and 7 days after admission [for VEGF (ng/L), 122.2±23.8 vs. 135.9±26.5, 109.6±27.3 vs. 129.0±18.4, 88.7±18.2 vs. 102.6±27.3, 54.2±26.4 vs. 85.7±35.2, P<0.05, 0.01, 0.05, 0.05 respectively; for ET-1 (ng/L), 162.8±23.5 vs. 173.7±13.2, 128.6±17.5 vs. 148.8±22.4, 96.5±14.8 vs. 125.7±14.8, 90.7±16.9 vs. 104.9±22.5, P<0.05, 0.01, 0.01, 0.01 respectively; for CRP (mg/L), 23.2±13.8 vs. 31.9±16.5, 13.6±17.3 vs. 23.5±18.4, 8.7±10.2 vs. 15.6±13.3, 5.2±9.4 vs. 10.7±11.2, all P<0.05; for CECs (/0.9 μL), 10.9±5.6 vs. 13.9±6.2, 8.5±4.9 vs. 11.3±5.3, 6.3±6.4 vs. 9.4±5.7, 4.8±7.1 vs. 7.8±4.8, all P<0.05]. It was concluded that intensive insulin therapy could antagonize the endothelium injury after trauma and reduce inflammation response quickly, which was one of important mechanisms by which intensive insulin therapy improves the prognosis of trauma patients.
Adult ; Endothelin-1 ; blood ; Female ; Humans ; Hyperglycemia ; blood ; diagnosis ; drug therapy ; Hypoglycemic Agents ; therapeutic use ; Insulin ; therapeutic use ; Male ; Reproducibility of Results ; Sensitivity and Specificity ; Treatment Outcome ; Vascular Endothelial Growth Factor A ; blood ; Wounds and Injuries ; blood ; diagnosis ; drug therapy

OBJECTIVE: To evaluate the effect of different control levels of glucose on the serum lactic acid during operation, and to investigate the relation between glucose and lactic acid to find a new way of myocardial protection. METHODS: Volunteers were divided into an experiment group(n=38) and a control group(n=33) by random sampling and double blind method. The experiment group received intensive insulin therapy and the control group received traditional therapy. The arterial blood gas samples of all the patients at different time points after the operation were harvested in the intensive care unit for blood gas analysis. The related data were collected and analyzed. RESULTS: The serum glucose level in the 2 groups decreased firstly, then increased, and recovered finally. The serum lactic acid level in the 2 groups increased firstly, decreased later, then reincreased, and recovered finally. The highest level of the serum lactic acid was found 2 hours after the operation. There were significant differences in serum glucose and lactic acid levels at 2, 12, and 24 h after the operation in the two groups (P<0.01). The other data were not significant (P>0.05). CONCLUSION The variation of serum glucose and lactic acid level at 2, 12, 24 h after the valve replacement is consistent and significant. The serum lactic acid in the serum may be decreased by controlling the blood glucose, which provides experiment basis for myocardial protection.
Adult ; Cardiopulmonary Bypass ; adverse effects ; Double-Blind Method ; Female ; Heart Valve Prosthesis Implantation ; Humans ; Hyperglycemia ; blood ; drug therapy ; prevention & control ; Insulin ; therapeutic use ; Lactic Acid ; blood ; Male ; Middle Aged ; Postoperative Complications ; drug therapy ; prevention & control ; Rheumatic Heart Disease ; blood ; surgery

INTRODUCTIONAs the effectiveness of intensive glycaemic control is unclear and recommended glycaemic targets are inconsistent, this study aimed to ascertain the prevalence of dysglycaemia among hospitalised patients with diabetes mellitus in an Asian population and evaluate the current standards of inpatient glycaemic control.

METHODSA retrospective observational study was conducted at a secondary hospital. Point-of-care blood glucose (BG) values, demographic data, medical history, glycaemic therapy and clinical characteristics were recorded. Dysglycaemia prevalence was calculated as proportions of BG-monitored days with at least one reading exceeding the cut points of 8, 10 and 15 mmol/L for hyperglycaemia, and below the cut point of 4 mmol/L for hypoglycaemia.

RESULTSAmong the 288 patients recruited, hyperglycaemia was highly prevalent (90.3%, 81.3% and 47.6% for the respective cut points), while hypoglycaemia was the least prevalent (18.8%). Dysglycaemic patients were more likely than normoglycaemic patients to have poorer glycated haemoglobin (HbA1c) levels (8.4% ± 2.6% vs. 7.3% ± 1.9%; p = 0.002 for BG > 10 mmol/L) and longer lengths of stay (10.1 ± 8.2 days vs. 6.8 ± 4.7 days; p = 0.007 for BG < 4 mmol/L). Hyperglycaemia was more prevalent in patients on more intensive treatment regimens, such as basal-bolus combination therapy and the use of both insulin and oral hypoglycaemic agents (100.0% and 96.0%, respectively; p < 0.001 for BG > 10 mmol/L).

CONCLUSIONInpatient glycaemic control is suboptimal. Factors (e.g. type of treatment regimen, discipline and baseline HbA1c) associated with greater prevalence of dysglycaemia should be given due consideration in patient management.

Aged ; Blood Glucose ; analysis ; Diabetes Mellitus ; drug therapy ; Female ; Hospitals ; Humans ; Hyperglycemia ; complications ; drug therapy ; Hypoglycemia ; complications ; drug therapy ; Hypoglycemic Agents ; therapeutic use ; Inpatients ; Insulin ; therapeutic use ; Male ; Middle Aged ; Point-of-Care Systems ; Prevalence ; Retrospective Studies ; Singapore ; Treatment Outcome

Hyperglycemia during chemotherapy occurs in approximately 10% to 30% of patients. Glucocorticoids and L-asparaginase are well known to cause acute hyperglycemia during chemotherapy. Long-term hyperglycemia is also frequently observed, especially in patients with hematologic malignancies treated with L-asparaginase-based regimens and total body irradiation. Glucocorticoid-induced hyperglycemia often develops because of increased insulin resistance, diminished insulin secretion, and exaggerated hepatic glucose output. Screening strategies for this condition include random glucose testing, hemoglobin A1c testing, oral glucose loading, and fasting plasma glucose screens. The management of hyperglycemia starts with insulin or sulfonylurea, depending on the type, dose, and delivery of the glucocorticoid formulation. Mammalian target of rapamycin (mTOR) inhibitors are associated with a high incidence of hyperglycemia, ranging from 13% to 50%. Immunotherapy, such as anti-programmed death 1 (PD-1) antibody treatment, induces hyperglycemia with a prevalence of 0.1%. The proposed mechanism of immunotherapy-induced hyperglycemia is an autoimmune process (insulitis). Withdrawal of the PD-1 inhibitor is the primary treatment for severe hyperglycemia. The efficacy of glucocorticoid therapy is not fully established and the decision to resume PD-1 inhibitor therapy depends on the severity of the hyperglycemia. Diabetic patients should achieve optimized glycemic control before initiating treatment, and glucose levels should be monitored periodically in patients initiating mTOR inhibitor or PD-1 inhibitor therapy. With regard to hyperglycemia caused by anti-cancer therapy, frequent monitoring and proper management are important for promoting the efficacy of anti-cancer therapy and improving patients' quality of life.
Blood Glucose ; Drug Therapy ; Fasting ; Glucocorticoids ; Glucose ; Hematologic Neoplasms ; Humans ; Hyperglycemia* ; Immunotherapy ; Incidence ; Insulin ; Insulin Resistance ; Mass Screening ; Prevalence ; Quality of Life ; Sirolimus ; Whole-Body Irradiation

BACKGROUNDDiabetes mellitus has become epidemic in recent years in China. We investigated the prevalence of hyperglycaemia and inadequate glycaemic control among type 2 diabetic inpatients from ten university teaching hospitals in Guangdong Province, China.

METHODSInadequate glycaemic control in diabetic patients was defined as HbA1c = 6.5%. Therapeutic regimens included no-intervention, lifestyle only, oral antiglycemic agents (OA), insulin plus OA (insulin + OA), or insulin only. Antidiabetic managements included monotherapy, double therapy, triple or quadruple therapy.

RESULTSAmong 493 diabetic inpatients with known history, 75% had HbA1c = 6.5%. Inadequate glucose control rates were more frequently seen in patients on insulin + OA regimen (97%) than on OA regimen (71%) (P < 0.001), and more frequent in patients on combination therapy (81% - 96%) than monotherapy (75%) (P < 0.05). Patients on insulin differed significantly from patients on OA by mean HbA1c, glycemic control rate, diabetes duration, microvascular complications, and BMI (P < 0.01).

CONCLUSIONSThis study showed that glycaemic control of type 2 diabetic patients deteriorated for patients who received insulin and initiation time of insulin was usually delayed. It is up to clinicians to move from the traditional stepwise therapy to a more active and early combination antidiabetic therapy to provide better glucose control.

Aged ; China ; epidemiology ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; Female ; Glycated Hemoglobin A ; analysis ; Humans ; Hyperglycemia ; epidemiology ; Hypoglycemic Agents ; administration & dosage ; Inpatients ; Male ; Middle Aged

OBJECTIVETo investigate the effect of a tight control of blood glucose by intensive insulin therapy on human sepsis, and to explore the potential mechanism of the intensive insulin therapy.

METHODSEligible patients were randomized by a blinded pharmacist to receive tight control of blood glucose by intensive insulin therapy (maintenance of blood glucose at a level between 4.4 and 6.1 mmol/L) or to receive conventional treatment (maintenance of glucose at a level between 10.0 and 11.1 mmol/L). The expression of HLA-DR on peripheral monocytes was measured in 54 patients by flow cytometry on 24 h, 3 d, 5 d, 7 d, 10 d and 14 d of intensive care in parallel with serum c-reactive protein (CRP), severity of the disease (APACHE II score, SOFA score) and clinical data collection.

RESULTSPatients receiving intensive insulin therapy were less likely to require prolonged mechanical ventilation. Tight control of blood glucose significantly reduced the number of days during which leukopenia or leukocytosis and the days with hypo- or hyperthermia (P < 0.05). Hypoglycemia occurred in 3 patients (10.7%) in the tight control of blood glucose group. There were no instance of hemodynamic deterioration or convulsions. Compared with the conventional treatment, tight control of blood glucose also increased the HLA-DR expression of peripheral monocytes, and there were significantly difference on 3 d, 5 d and 7 d (P < 0.05). Whereas it suppressed the elevated serum CRP concentrations, there was significantly difference on 7 d (P < 0.05).

CONCLUSIONSTight control of blood glucose by intensive insulin therapy expedited healing of human sepsis, and increased the HLA-DR expression of peripheral and suppressed the elevated serum CRP. So, it is necessary to use insulin to strict control the glucose levels in human sepsis.

Blood Glucose ; metabolism ; C-Reactive Protein ; metabolism ; HLA-DR Antigens ; biosynthesis ; Humans ; Hyperglycemia ; drug therapy ; etiology ; metabolism ; Hypoglycemic Agents ; therapeutic use ; Insulin ; therapeutic use ; Sepsis ; complications

OBJECTIVETo observe the effect of combination therapy of acarbose and Liuwei Nengxiao capsule (LWNXC) in improving senile postprandial hyperglycemia and insulin sensitivity.

METHODSSeventy-four patients with simple postprandial hyperglycemia were divided into the control group and the treated group, 37 in each group, who were treated with acarbose alone and the combination therapy respectively for 1 month, and the changes on 2 hrs postprandial glucose (2 hPG), blood pressure (BP), blood lipid, body mass index (BMI), insulin functional index as well as the adverse reaction of acarbose in the two groups were observed.

RESULTSAfter treatment, the levels of 2 hPG, fasting blood glucose (FBG), BMI, total cholesterol and lowdensity lipoprotein-cholesterol were improved in the treated groups more significantly than those in the control group (P < 0.05 or P < 0.01). Insulin sensitive index (ISI) and insulin resistance were improved in the two group (P < 0.05 or P < 0.01), but the improvement in the treated group was more significant than that in the control group (P < 0.01). Moreover, the adverse reactions were less in the treated group than in the control group.

CONCLUSIONThe combination therapy of acarbose and LWNXC could not only improve the postprandial hyperglycemia, but also markedly increase the insulin sensitivity, and shows obvious improving effect on parameters of blood lipid, BP and BMI. The adverse reaction could be evidently reduced by combined use with LWNXC.

Acarbose ; therapeutic use ; Aged ; Blood Glucose ; metabolism ; Capsules ; Drug Therapy, Combination ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Glycoside Hydrolase Inhibitors ; Humans ; Hyperglycemia ; drug therapy ; Hypoglycemic Agents ; therapeutic use ; Insulin Resistance ; Lipids ; blood ; Male ; Middle Aged ; Phytotherapy ; Postprandial Period