As more and more studies suggest that type 2 diabetes mellitus (T2DM) is closely related to male hypogonadism, people begin to pay more attention to the role of testosterone in the development of T2DM and the effect and safety of testosterone supplementary therapy. There is some controversy in randomized controlled studies and meta-analyses about the effects of testosterone supplementation on the blood glucose level, androgen deficiency symptoms, and cardiovascular diseases. This review focuses on the diagnosis of hypogonadism in T2DM males, differences in the therapeutic effects and safety of testosterone replacement among different studies, and rational use of testosterone supplementation for T2DM patients.
Androgens ; deficiency ; Blood Glucose ; Cardiovascular Diseases ; etiology ; Diabetes Mellitus, Type 2 ; etiology ; Hormone Replacement Therapy ; Humans ; Hypogonadism ; complications ; diagnosis ; drug therapy ; Male ; Meta-Analysis as Topic ; Randomized Controlled Trials as Topic ; Testosterone ; physiology ; therapeutic use

Sleep has important effects on physical and mental health, and sleep disorders are associated with increased mortality and morbidity. This study was conducted to evaluate the relationship between sleep duration or sleep quality and the risk of type 2 diabetes. The FACTS (FAmily CohorT Study in primary care) was established to investigate the relations between familial environment and health which was conducted at 22 family medicine outpatient clinics in general hospitals. Total 563 patients without diabetes who received > or =1 year follow-up examination were included in the analysis. We used the Pittsburgh Sleep Quality Index to determine sleep quality, and a score of > or =5 was considered to define poor sleep quality. Patients taking oral hypoglycemic agents, having a fasting glucose level of >126 mg/dL, or diagnosed with diabetes by physicians were classified as having diabetes. The median follow-up period was 2.5 years. Poor sleep quality was associated with a higher risk of diabetes after adjusting for age, sex, body mass index, income, physical activity, and family history of diabetes (relative risk=2.64; 95% confidence interval, 1.03-6.78). As a risk factor for the development of diabetes, poor sleep quality may independently increase the incidence of diabetes.
Aged ; Blood Glucose/analysis ; Body Mass Index ; Cohort Studies ; Demography ; Diabetes Mellitus, Type 2/complications/*diagnosis/drug therapy ; Female ; Follow-Up Studies ; Humans ; Hypoglycemic Agents/therapeutic use ; Male ; Middle Aged ; Obesity/complications ; Primary Health Care ; Risk Factors ; *Sleep ; Surveys and Questionnaires

BACKGROUND: Glycated albumin (GA) is a better marker of short-term glycemic control than glycated hemoglobin (A1c). Dyslipidemia is the main cause of cardiovascular complications in diabetes mellitus (DM). Studies on the correlation of GA with lipid indices are sparse. We investigated the diagnostic utility of GA for DM and its relationship with serum lipid profiles compared with that of A1c. METHODS: The GA enzymatic method was used to determine the diagnostic utility of GA for DM by using samples from 163 normal subjects (group 1) and 102 patients newly diagnosed with type 2 DM (T2DM; group 2). To analyze the lipid profiles, 263 patients with T2DM receiving treatment (group 3) were recruited. RESULTS: GA correlated with A1c (r=0.934, P<0.0001). Linear regression analysis indicated that GA levels were about 2.48 folds those of A1c. In the ROC analysis for GA to diagnose DM, the areas under the curve (0.988, 95% confidence interval 0.972-1.004) was excellent. HDL levels were significantly lower in groups 2 and 3. In group 1, positive correlations were observed between A1c and triglyceride (TG), total cholesterol (TC), LDL, TG/HDL, TC/HDL, and LDL/HDL levels. A negative correlation was observed between HDL and A1c levels. In group 3, HDL levels (P=0.0124 and P=0.0141, respectively) were significantly higher and LDL levels tended to be lower, not statistically significant, in the well-controlled group categorized using the A1c and GA cut-off values. CONCLUSIONS: GA is a potential diagnostic tool for DM. Compared with A1c, GA seems less relevant to dyslipidemia.
Adult ; Area Under Curve ; Blood Glucose/analysis ; Cholesterol, HDL/blood ; Cholesterol, LDL/blood ; Chromatography, High Pressure Liquid ; Diabetes Mellitus, Type 2/complications/*diagnosis/drug therapy ; Female ; Humans ; Hyperlipidemias/complications/*diagnosis ; Hypoglycemic Agents/therapeutic use ; Linear Models ; Lipids/blood ; Male ; Middle Aged ; ROC Curve ; Serum Albumin/*analysis

BACKGROUND/AIMS: To investigate abnormalities in blood electrolyte levels during severe hypoglycemia in Korean patients with type 2 diabetes mellitus (T2DM) in a clinical setting. METHODS: Blood electrolyte levels in adult T2DM patients during severe hypoglycemia were collected from January 1, 2008 to December 31, 2012. Patients who maintained normal serum creatinine and blood urea nitrogen levels were utilized in the study. Severe hypoglycemia was defined as a condition requiring medical assistance, such as administering carbohydrates when serum glucose levels less than 70 mg/dL were observed, in conjunction with other symptoms of hypoglycemia. RESULTS: A total of 1,068 patients who visited the emergency room with severe hypoglycemia were screened, of which 219 patients were included in this study. The incidence of abnormal levels for any electrolyte was 47%. Hypokalemia (< 3.5 mmol/L) was the most common type of electrolyte disturbance observed at 21.9%. A decrease in serum potassium levels was associated with decreases in blood glucose levels (r = 0.151, p = 0.025). During severe hypoglycemia, median blood glucose levels, incidence of tachycardia (> 100 beats per minute) and severe hypertension (> or = 180/120 mmHg) were 30 mg/dL (range, 14 to 62) and 35 mg/dL (range, 10 to 69; p = 0.04), 18.8% and 7.2% (p = 0.02), and 20.8% and 10.2% (p = 0.05) in the hypokalemia and normokalemia groups, respectively. CONCLUSIONS: During severe hypoglycemia, hypokalemia occurred in 21.9% of T2DM patients and was associated with tachycardia and severe hypertension. Therefore, the results suggest that severe hypoglycemia may increase cardiovascular events in T2DM.
Aged ; Aged, 80 and over ; Biomarkers/blood ; Blood Glucose/drug effects/*metabolism ; Diabetes Mellitus, Type 2/blood/diagnosis/drug therapy/*epidemiology ; Emergency Service, Hospital ; Female ; Humans ; Hypertension/chemically induced/epidemiology ; Hypoglycemia/blood/chemically induced/diagnosis/*epidemiology/therapy ; Hypoglycemic Agents/adverse effects ; Hypokalemia/blood/chemically induced/diagnosis/*epidemiology ; Male ; Middle Aged ; Potassium/*blood ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index ; Tachycardia/chemically induced/epidemiology ; *Water-Electrolyte Balance/drug effects

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

We evaluated the prevalence of vitamin B12 deficiency and associated factors in type 2 diabetes patients using metformin. A total of 799 type 2 diabetes patients using metformin was enrolled. Vitamin B12 and folate levels were quantified by chemiluminescent enzyme immunoassay. Vitamin B12 deficiency was defined as vitamin B12 < or = 300 pg/mL without folate deficiency (folate > 4 ng/mL). The prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes patients was 9.5% (n = 76), and the mean vitamin B12 level was 662.5 +/- 246.7 pg/mL. Vitamin B12 deficient patients had longer duration of metformin use (P < 0.001) and higher daily metformin dose (P < 0.001) than non-deficient patients. Compared with daily metformin dose of < or = 1,000 mg, the adjusted odds ratio for 1,000-2,000 mg, and > or = 2,000 mg were 2.52 (95% CI, 1.27-4.99, P = 0.008) and 3.80 (95% CI, 1.82-7.92, P < 0.001). Compared with metformin use of < 4 yr, the adjusted odds ratios for 4-10 yr, and > or = 10 yr were 4.65 (95% CI, 2.36-9.16, P < 0.001) and 9.21 (95% CI, 3.38-25.11, P < 0.001), respectively. In conclusion, our study indicates that patients with type 2 diabetes treated with metformin should be screened for vitamin B12 deficiency, especially at higher dosages (> 1,000 mg) and longer durations (> or = 4 yr) of treatment.
Aged ; Area Under Curve ; Diabetes Mellitus, Type 2/complications/diagnosis/*drug therapy ; Female ; Folic Acid/blood ; Humans ; Hypoglycemic Agents/adverse effects/*therapeutic use ; Immunoassay ; Male ; Metformin/adverse effects/*therapeutic use ; Middle Aged ; Odds Ratio ; Patients ; Prevalence ; ROC Curve ; Time Factors ; Vitamin B 12/blood ; Vitamin B 12 Deficiency/diagnosis/epidemiology/*etiology

We describe herein a case of life-threatening hypoglycemia due to spurious elevation of glucose concentration during the administration of ascorbic acid in a type 2 diabetic patient. A 31-year-old female was admitted for proliferative diabetic retinopathy treatment and prescribed high dose ascorbic acid. During hospitalization, she suddenly lost her consciousness and her glucose concentration was 291 mg/dL, measured using self-monitoring blood glucose (SMBG) device, while venous blood glucose concentration was 12 mg/dL. After intravenous injection of 50% glucose solution, the patient became alert. We reasoned that glucose measurement by SMBG device was interfered by ascorbic acid. Physicians should be aware of this interference; high dose ascorbic acid may cause spurious elevation of glucose concentration when measuring with SMBG devices.
Adult ; Ascorbic Acid/administration & dosage/adverse effects/contraindications/*therapeutic use ; Blood Glucose ; Blood Glucose Self-Monitoring/instrumentation/standards ; Diabetes Mellitus, Type 2/blood/drug therapy ; Female ; Humans ; Hypoglycemia/*diagnosis ; Renal Dialysis

OBJECTIVETo explore the therapeutic effect and the hemorrheology change of berberine in new diagnosed patients with type 2 diabetes combining nonalcoholic fatty liver disease.

METHODSixty patients, in our department from March 2009 to March 2010, with type 2 diabetes and nonalcoholic fatty liver disease were randomly divided into two groups. One group was given berberine, another group was given Xuezhikang, both for 12 weeks. The indicators, include B-ultrasound of liver, triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), alanine aminotransferase (ALT), aspertate aminotransferase (AST), hemorrheology, were detected before and after treatment.

RESULTAfter treatment by berberine, B-ultrasound of liver were better than before, the effective rate was 70%, vs 73.3% after treatment by Xuezhikang. ALT, AST, TC, TG, LDL-L, hemorrheology (including the whole blood viscosity, whole blood viscosity, high cutting reduction of whole blood viscosity, plasma cutting reductive low viscosity, blood sedimentation, RBC deposited, fibrinogen) were significantly lower than before, however, HDL-L significantly increased (P<0.05). The therapeutic effect of xuezhikang was the same as berberine. The distance between the indicators of the two groups was no different.

CONCLUSIONBerberine can obviously improve the conditions of new diagnostic T2DM patients with nonalcoholic liver lesions, effectively reduce hemorrheology indicators, and has good application prospect.

Adult ; Alanine Transaminase ; blood ; Berberine ; therapeutic use ; Diabetes Mellitus, Type 2 ; blood ; diagnosis ; drug therapy ; Drugs, Chinese Herbal ; therapeutic use ; Fatty Liver ; blood ; diagnosis ; drug therapy ; Female ; Humans ; Lipoproteins, HDL ; blood ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; Treatment Outcome ; Triglycerides ; blood

OBJECTIVE: To explore the effect of Euonymus alatus on the blood glucose and hemorheology in rat model of Type 2 diabetes mellitus with blood stagnation (DMBS). METHODS: High fat diet with streptozocin was used to establish the rat model of Type 2 diabetes mellitus, followed by the prednisolone and adrenaline muscle injection to obtain DMBS. DMBS rats were divided into a DMBS group (treated with saline gavage), an Euonymus alatus group (treated with Euonymus alatus gavage), and a glybenzoylamide group (treated with glybenzoylamide gavage).A blank group was treated with saline gavage. The experiment lasted 4 weeks, followed by the evaluation of rats' behavior, and detection of fasting blood glucose and hemorheology. RESULTS: Compared with DMBS rats, the symptoms of polydipsia and diuresis in Euonymus alatus rats were improved, with increased body weight (P<0.05), better fur and mental state, increased resistance for being caught, and reduced tongue stagnation. Compared with DMBS group, though body weight increased, resistance for being caught decreased in the glybenzoylamide group with bad fur and mental state,and tongue stagnation. As to the fasting blood glucose, there was significant difference between the Euonymus alatus group and the DMBS group (P<0.05). As to the hemorheology, including whole blood viscosity (shear rates 1,5,50, and 100 s(-1)), plasma viscosity, and hematocrit, the Euonymus alatus rats had a better efficacy than DMBS rats and glybenzoylamide rats (P<0.05 or P<0.01). CONCLUSION Euonymus alatus can reduce the fasting blood glucose of DMBS and improve blood stagnation.
Animals ; Blood Glucose ; analysis ; Blood Viscosity ; drug effects ; Diabetes Mellitus, Experimental ; blood ; drug therapy ; Diabetes Mellitus, Type 2 ; blood ; drug therapy ; Diagnosis, Differential ; Drugs, Chinese Herbal ; pharmacology ; Euonymus ; chemistry ; Hemorheology ; drug effects ; Male ; Medicine, Chinese Traditional ; Random Allocation ; Rats ; Rats, Sprague-Dawley

BACKGROUND/AIMS: Based on the results of well designed clinical studies, intensive insulin therapy has been established to improve glycemic control in newly diagnosed diabetes. However, discrepancies exist between the findings of clinical trials and experiences in general practice. Furthermore, the efficacy of an early insulin therapy (EIT) - commonly used in general practice - on long-term glycemic control has not been established. Therefore, we evaluated the effects of EIT on pancreatic beta-cell function and glycemic control using insulin-based methods widely employed in general practice. METHODS: We performed a retrospective cohort study that initially involved reviewing patients' medical records. Following a thorough review, 61 patients who received either biphasic or prandial EIT at the time of diagnosis were enrolled. We then evaluated changes in beta-cell function and glycemic control during a 48-month follow-up period. RESULTS: Mean HbA1c decreased significantly as a result of EIT from 10.7 +/- 1.8% to 6.2 +/- 1.1% (p < 0.001). On average, 2.6 months was required to achieve an HbA1c value < 7%. EIT significantly improved the insulinogenic index. Glycemic control was well maintained for 48 months. More than 70% of patients were able to maintain glycemic control following lifestyle modifications or treatment with oral antidiabetic drugs. No significant differences were identified between patients receiving biphasic EIT and prandial EIT in terms of glycemic control or pancreatic beta-cell function. CONCLUSIONS: Our results suggest that regardless of the method of delivery, EIT significantly improves beta-cell function and facilitates long-term glycemic control in patients with newly diagnosed type 2 diabetes mellitus.
Administration, Oral ; Adult ; Blood Glucose/metabolism ; Cohort Studies ; Diabetes Mellitus, Type 2/blood/diagnosis/*drug therapy/*physiopathology ; Female ; Hemoglobin A, Glycosylated/metabolism ; Humans ; Hypoglycemic Agents/administration & dosage ; Insulin/administration & dosage/*therapeutic use ; Insulin Resistance ; Insulin-Secreting Cells/*drug effects/*physiology ; Male ; Middle Aged ; Retrospective Studies