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*

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

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

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

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

BACKGROUND/AIMS: This multicenter, open-labeled, randomized trial was performed to compare the effects of rosuvastatin 10 mg and atorvastatin 10 mg on lipid and glycemic control in Korean patients with nondiabetic metabolic syndrome. METHODS: In total, 351 patients who met the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria for metabolic syndrome with low-density lipoprotein cholesterol (LDL-C) levels > or = 130 mg/dL were randomized to receive either rosuvastatin 10 mg (n = 173) or atorvastatin 10 mg (n = 178) for over 6 weeks. RESULTS: After 6 weeks of treatment, greater reductions in total cholesterol (- 35.94 +/- 11.38 vs. - 30.07 +/- 10.46%, p < 0.001), LDL-C (48.04 +/- 14.45 vs. 39.52 +/- 14.42%, p < 0.001), non-high-density lipoprotein cholesterol (- 42.93 +/- 13.15 vs. - 35.52 +/- 11.76%, p < 0.001), and apolipoprotein-B (- 38.7 +/- 18.85 vs. - 32.57 +/- 17.56%, p = 0.002) levels were observed in the rosuvastatin group as compared to the atorvastatin group. Overall, the percentage of patients attaining the NCEP ATP III goal was higher with rosuvastatin as compared to atorvastatin (87.64 vs. 69.88%, p < 0.001). Changes in glucose and insulin levels, and homeostasis model assessment of insulin resistance index were not significantly different between the two groups. The safety and tolerability of the two agents were similar. CONCLUSIONS: Rosuvastatin 10 mg was more effective than atorvastatin 10 mg in achieving NCEP ATP III LDL-C goals in patients with nondiabetic metabolic syndrome, especially in those with lower NCEP ATP III target level goals.
Blood Glucose/metabolism ; Cholesterol, LDL/blood ; Female ; Fluorobenzenes/*administration & dosage ; Hemoglobin A, Glycosylated/metabolism ; Heptanoic Acids/*administration & dosage ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/*administration & dosage ; Hypercholesterolemia/blood/complications/*drug therapy ; Hyperglycemia/blood/complications/*drug therapy ; Insulin/blood ; Male ; Metabolic Syndrome X/blood/complications/*drug therapy ; Middle Aged ; Pyrimidines/*administration & dosage ; Pyrroles/*administration & dosage ; Sulfonamides/*administration & dosage ; Treatment Outcome

OBJECTIVETo investigate the effect of panax quinquefolius saponin(PQS) on blood glucose, blood lipid and insulin sensitivity in patients of coronary heart disease (CHD) with blood glucose abnormality (BGA).

METHODSEighty-four patients of CHD with BGA, namely CHD patients with impaired fasting glucose (IFG), or impaired glucose tolerance (IGT), or type 2 diabetes mellitus (T2DM), were randomly assigned to the PQS group (43 cases) and the control group (41 cases), all were treated with routine Western medicine, but to patients in the PQS group PQS was given orally for 4 successive weeks in addition. Levels of fasting plasma glucose (FPG), fasting insulin (FINS), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) were detected both before and after treatment, and insulin sensitive index (ISI) as well as the insulin resistance index and function of beta cells of homostasis model (Homa-IR and Homa-beta) were calculated accordingly.

RESULTSAfter treatment, FPG decreased predominantly in both groups (P < 0.01), and the decrement in the PQS group showed a greater trend (25.80 +/- 12.72) % vs (20.89 +/- 12.17) %, but with no statistical significance; no obvious change in levels of FINS, ISI and Homa-IR was found in two groups (P > 0.05). Homa-beta value, which showed insignificantly difference before treatment, increased markedly in the PQS group after treatment from 3.48 +/- 0.76 to 4.19 +/- 0.79 (P < 0.01), which was higher obviously than the unchanged value of Homa-beta in the control group (3.82 +/- 0.77, P < 0.05). There was also decreasing of TC and LDL-C levels after treatment in the PQS group (P < 0.05), and the TC level in the PQS group (1.17 +/- 0.54) mmol/L was significantly lower than that in the control group [(1.42 +/- 0.49) mmol/L, P < 0.05) after treatment.

CONCLUSIONCompared with using it alone, routine Western medicine treatment, by combining with PQS showed superiority in lowering FPG, could significantly decrease the levels of TC and LDL-C, and might improve the beta-cell function in patients of CHD with BGA. It showed no effect on insulin sensitivity of patients, in spite of in combining or not with PQS.

Aged ; Antihypertensive Agents ; therapeutic use ; Cholesterol ; blood ; Cholesterol, LDL ; blood ; Coronary Disease ; blood ; complications ; drug therapy ; Drug Therapy, Combination ; Female ; Ginsenosides ; therapeutic use ; Humans ; Hyperglycemia ; blood ; complications ; drug therapy ; Hypoglycemic Agents ; therapeutic use ; Insulin Resistance ; Male ; Middle Aged ; Phytotherapy ; Saponins ; therapeutic use ; Treatment Outcome

OBJECTIVETo investigate the effects of the treatment of supplementing qi, nourishing yin, and promoting blood flow (SQNYPBF) on the serum levels of CRP, TNF-alpha, IL-1 and IL-6, as well as the expression of HLA-DR in the peripheral monocytes in septic patients suffering from stress-induced hyperglycemia.

METHODSIn the prospective randomized controlled study, eighty-five stress-induced hyperglycemia patients with sepsis were randomly assigned to the experimental group (45 cases) and the control group (40 cases). On the basis of routine therapies, including anti-infection, nutrition support, and the glucose control with insulin pump, patients in the experimental group additionally received the treatment of SQNYPBF (They were intravenously dripped with Shenmai Injection and Sulfotanshinone Sodium Injection, once daily, for 7 successive days). The serum levels of CRP, TNF-alpha, IL-1, and IL-6 and the HLA-DR expression of the peripheral monocytes were detected using ELISA before treatment and on the 8th day of the treatment. The total dose and the duration of insulin used, the morbidity of hypoglycemia, the APACHE II scores, and the mortality within 28-day hospitalization were compared between the two groups.

RESULTSThe total dose of insulin used, the duration of insulin used, the morbidity of hypoglycemia, the APACHE II score on the 8th day of treatment, and the mortality within 28-day hospitalization significantly decreased in the experimental group, when compared with the control group (P < 0.05, P < 0.01). There was no difference in the expression of HLA-DR, the serum levels of CRP, TNF-alpha, IL-1, or IL-6 before treatment between the two groups (P > 0.05). After treatment the serum levels of CRP, TNF-alpha, IL-1, and IL-6 significantly decreased (P < 0.05) and the expression of HLA-DR significantly increased in the two groups (P < 0.05). Better effects were shown in the experimental group (P < 0.05, P < 0.01).

CONCLUSIONSQNYPBF combined intensive insulin therapy could better improve the sepsis patients' immunity, decrease the plasma glucose level and duration, increase their survival rate, and improve their prognosis.

APACHE ; Aged ; C-Reactive Protein ; analysis ; Female ; HLA-DR Antigens ; metabolism ; Humans ; Hyperglycemia ; drug therapy ; etiology ; Interleukin-1 ; blood ; Interleukin-6 ; blood ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Oxidative Stress ; Prospective Studies ; Sepsis ; complications ; drug therapy ; metabolism ; Tumor Necrosis Factor-alpha ; blood