四种糖尿病防治指南的比较与分析

<中国糖尿病防治指南>的制定对我国糖尿病防治事业来说是具有里程碑式的意义.我国终于有了自己的糖尿病防治指南.现今各国糖尿病学界不同组织几乎制定了各自的防治指南.对来自国际糖尿病联盟、美国糖尿病学会、亚洲-太平洋地区2型糖尿病政策组以及中华医学会糖尿病学分会等组织所制定的糖尿病防治指南,在出版形式、内容和适用性以及代表性等不同的侧面进行了比较.总体情况看国际糖尿病联盟按不同资源水平制定了不同的防治标准,判定标准明确,适用性较广,但指南的直观可读性较差;美国糖尿病学会的指南以内容丰富、全面著称,适用于较高层次的专业工作者,但稍欠可推广性;亚州-太平洋2型糖尿病政策组的指南简明、易懂,可读性佳,比较适合东南亚人群;<中国糖尿病防治指南>内容全面、精简概括,符合中国国情.     

美国医院社会责任管理实践及启示

通过对美国两个政府机构(美国国内税收署、老人医疗保险和穷人医疗救助服务中心)以及四个医疗行业组织(美国医院协会、美国基督健康协会、美国非营利医院联盟组织、美国医疗保健财务管理协会)发布的医院社会责任标准/指南进行了梳理和比较分析,介绍了美国联邦层面的标准/指南之间的内在联系。达成的共识是将慈善医疗、经过经济情况调查的政府医疗保健项目的未补偿成本定义为社会责任,而在将坏账、老人医疗保险的未补偿成本定义为社会责任方面存在分歧。提出我国医院社会责任不仅需考虑慈善医疗、未补偿的医疗成本以及对公众的责任,更要根据国情来制定相关标准。     

从不同高血压防治指南的比较看高血压治疗策略的变化

为减少因高血压造成的各种心血管事件,世界不同地区制定或修订了适合自己的高血压防治指南.通过对JNC7、ESH/ESC及2004年中国高血压防治指南的比较及分析,以便能更全面、正确地理解和发展我国新的高血压指南,并将该指南灵活运用于实际工作.     

从不同高血压防治指南的比较看高血压治疗策略的变化

为减少因高血压造成的各种心血管事件,世界不同地区制定或修订了适合自己的高血压防治指南。通过对JNC7、ESH/ESC及2004年中国高血压防治指南的比较及分析,以便能更全面、正确地理解和发展我国新的高血压指南,并将该指南灵活运用于实际工作。     

第二十届长城国际心脏病学会议、ACC论坛：2009心脏病学进展

走过十九年的曲折历程,在探索与发展中,2009年10月9-13日,由长城国际心脏病学会 议组委会、美国心脏病学学院（ACC）、亚太心脏联盟（APHA）、美国心律学会（HRS）、日本循环器学会（JCS）、欧洲高血压学会（ESH）、中华医学会心血管专业委员会和中国医师协会心血管内科医师分会等多个国内外重要学术组织或机构联合主办的长成国际心脏病学会议（GW-ICC）,     

将糖化血红蛋白控制在7.0%以下是否更安全

2008年一项针对2型糖尿病强化血糖控制对心血管病变研究(ACCORD)发现,对于病程在10年左右,30%存在心血管疾病的2型糖尿病人群,利用现有手段努力实现血糖"正常化",即糖化血红蛋白(AIC)<6.0%并没有减少糖尿病全因死亡.人们开始重新思考对2型糖尿病是否还需要强调强化血糖控制、血糖控制的目标多少为宜.中华医学会糖尿病学分会也在今年重新修订了其<中国2型糖尿病防治指南>的AIC控制目标,AIC目标由原来的6.5%提高到7.0%.那么这一改变对2型糖尿病患者来讲到底有多大意义呢?ACCORD强化降糖治疗终止后的随访研究发现强化组患者在血糖控制目标与标准治疗组相似的情况下,全因死亡串并没有随之减少.因此,需要重新检视2型糖尿病防治策略.     

第二十届长城国际心脏病学会议、ACC论坛：2009心脏病学进展

走过十九年的曲折历程，在探索与发展中，2009年10月9-13日，由长城国际心脏病学会议组委会、美国心脏病学学院（ACC）、亚太心脏联盟（APHA）、美国心律学会（HRS）、日本循环器学会（JCS）、欧洲高血压学会（ESH）、     

将糖化血红蛋白控制在7．0％以下是否更安全

2008年一项针对2型糖尿痛强化血糖控制对心血管病变研究（ACCORD）发现,对于病程在10年左右,30％存在心血管疾病的2型糖尿病人群,利用现有手段努力实现血糖“正常化”,即糖化血红蛋白（A1C）〈6．0％并没有减少糖尿病全因死亡。人们开始重新思考对2型糖尿病是否还需要强调强化血糖控制、血糖控制的目标多少为宜。中华医学会糖尿病学分会也在今年重新修订了其《中国2型糖尿病防治指南》的A1C控制目标,A1C目标由原来的6．5％提高到7．0％。那么这一改变对2型糖尿病患者来讲到底有多大意义呢？ACCORD强化降糖治疗终止后的随访研究发现强化组患者在血糖控制目标与标准治疗组相似的情况下,全因死亡率并没有随之减少。因此,需要重新检视2型糖尿病防治策略。     

糖尿病防治的策略转变——从关注糖化血红蛋白到着眼心血管事件

通过对2型糖尿病心血管终点事件的观察,更多的临床证据提示,糖尿病的治疗目标应该以减少心血管事件为主。糖尿病防治从策略上发生了两个转变,即以血糖为中心转向以防治心血管事件为中心的多危险因素综合防治策略;以糖化血红蛋白检测作为血糖评价的金标准转向以血糖量、质、时程控制的全面评价策略。     

心肺复苏新观点在临床技能培训中的应用

心肺复苏是急救医学的重要组成部分,也是医学生临床技能培训的重点内容.因此,该技术培训的先进性尤为重要. 2005年由美国心脏学会(american heart association,AHA)和国际急救与复苏联合会(international liaison committee on resuscitation,ILCOR)举办的"2005年心肺复苏和心血管病急诊科学治疗建议国际会议"(以下简称"2005国际会议")在美国达拉斯举行[1].会议完成了心肺复苏(cardiopulmonary resuscitation,CPR)和心血管病急诊领域国际学术界所期待的5年一度的指南修订.此后,复苏学的研究热点集中于新指南的相关变动[2].为使学生掌握最新的操作流程与方法,我们将以往制定的心肺复苏操作培训流程(初级复苏)进行了及时的修改与完善.     

Physical activity and psychological well-being in children with Type 1 diabetes

Physical activity and psychological well-being contribute to positive lifestyle and well-being in youngsters who have Type 1 diabetes. The aims of this study were to objectively assess the physical activity levels of children with Type 1 diabetes, and investigate associations between physical activity levels, psychological well-being and HbA(1c). Thirty-six children, mean age 12.8 years, participated in the investigation. Physical activity was assessed using heart rate monitoring over four days. Children further completed the Diabetes Quality of Life for Youths Questionnaire, the Physical Self-Perception Profile for Children and the Self-Efficacy for Diabetes Scale. Routine outpatient HbA(1c) measurements were recorded. There were no significant associations between psychological well-being and physical activity, or HbA(1c) and physical activity, thus suggesting physical activity does not directly relate to psychological well-being in children with Type 1 diabetes. It may be that the effect of physical activity differs from that in children without Type 1 diabetes because of the place of physical activity within diabetes management and the need to balance this with insulin dosage and dietary intake to maintain blood glucose levels.     

Psychological Support for Children with Diabetes: Are the Guidelines Being Met?

The significant role of psychosocial factors in the management of type 1 diabetes in youth has been well documented. The International Society for Pediatric and Adolescent Diabetes (ISPAD) therefore published the Clinical Practice Consensus Guidelines for psychological care of young patients. However, it is unclear if and how these guidelines are being implemented. A questionnaire was created to assess implementation of the guidelines and directed to physicians through the ISPAD listserve via a web-based survey. One hundred fifty-five participants from 47 countries completed the survey. Ninety-six percent of respondents reported that they work in a team with other professionals, and 95 % of teams discuss psychological difficulties associated with diabetes management. Seventy-two percent of respondents reported having “easy access” to a mental health specialist (MHS). In 56 % of practice settings, the MHS is considered to be part of the team; 43 % participate in routine clinic visits and 26 % see all patients. Seventy percent screen for psychological problems and 57 % assess family functioning. Psychosocial or behavioral interventions addressing psychosocial and regimen adherence difficulties are offered by 79 % of teams. Psychological care is available for many children with diabetes worldwide. Yet, nearly 30 % of teams do not have access to a MHS. More training in the recognition of psychosocial problems and counseling skills is warranted. More advocacy is needed to increase availability and utilization of psychological services in routine diabetes care.     

The Impact of Managing School-aged Children’s Diabetes: The Role of Child Behavior Problems and Parental Discipline Strategies

Models of diabetes management in children emphasize family relationships, particularly parent–child interactions. In adolescents, parental involvement in disease-specific management relates to better health and adherence. However, information about parental involvement in disease management for young children is limited and mixed. This study investigated behavior problems of school-aged children with Type 1 Diabetes Mellitus (T1DM) in association with parent discipline strategies and parents’ perceptions of (1) time spent managing diabetes and (2) the impact their child’s diabetes has on their discipline strategies. Parents of children ages 5–12 with T1DM completed standardized measures of child misbehavior, parent discipline strategies, and responded to questions regarding perceived time spent managing diabetes, and perceived impact of diabetes on ability to discipline. Results showed child mealtime misbehavior was common and associated with overreactive parental discipline. Further, overreactive discipline was also associated with reports of less time spent managing child’s illness. Child misbehavior was positively associated with parents’ perceived amount of time spent managing diabetes and with the impact of child diabetes on discipline. Findings suggest the importance of considering parent discipline strategies and child misbehavior when working with young children with diabetes.     

胰岛再生治疗的前景

胰岛β细胞数量减少和功能障碍是糖尿病的根本原因,现有的治疗手段主要以维持正常血糖水平为主要目的,尚无有效恢复受损胰岛功能的治愈性治疗手段。胰岛再生治疗将是一种可以恢复受损胰岛功能、改变糖尿病自然病程的崭新治疗手段。目前现有的噻唑烷二酮、肠促胰岛素及类似物、二肽基肽酶-4抑制剂等治疗,虽然不是一类新的胰岛再生药物,但其具有一定的促进胰岛再生、改善胰岛功能的作用。体外诱导β细胞再生也将为胰岛移植提供新的来源,为治愈糖尿病带来曙光。     

Self-Reported Psychological Well-Being and Disease-Related Strains among Adults with Diabetes

The study was designed to describe self-reported psychological well-being among adults with Type 1 and Type 2 diabetes and to explore associations of psychological well-being with disease-related strains, such as self-reported long-term complications, frequency of hypoglycaemia and disablement or sick-leave. A sample comprising 534 Norwegian adults with Type 1 and Type 2 diabetes aged 25-70 years participated in the study. Psychological well-being was assessed using three different scales; the WHO (Ten) Well-Being Index, the Short Zung Depression Rating Scale and four items from the anxiety sub-scale of the Hopkins Symptom Checklist. Findings indicate that adults with both types of diabetes reported relatively poor psychological well-being. There was a tendency for younger persons to report the worst psychological well-being. For symptoms of anxiety this tendency was most evident among people with Type 2 diabetes. People being disabled due to diabetes reported relatively markedly impaired psychological well-being, whereas self-reported diabetes-related complications and the number of episodes with hypoglycaemia were weakly associated with psychological well-being. Findings may indicate that healthcare practitioners should pay more attention to the psychological needs of people with diabetes. This applies especially to younger people with Type 2 diabetes.     

Illness perception clusters and relationship quality are associated with diabetes distress in adults with Type 2 diabetes

This report aims to augment what is already known about emotional distress in Type 2 diabetes, by assessing the predictive value of illness perception clusters and relationship quality on four subcategories of Diabetes Distress.162 individuals with Type 2 diabetes responded to a postal questionnaire assessing demographics, depression, diabetes distress, illness perceptions and relationship quality. Long-term blood glucose was retrieved from participants’ General Practitioner. Three illness perception clusters emerged from the data, capturing three subgroups of participants sharing similar illness perception schemas. Regression analyses were performed across each diabetes distress subscale, with demographics, illness perception clusters, and relationship variables entered into three blocks. Covariates explained 51.1% of the variance in emotional burden, 41% of the variance in regimen-related distress, 20% of the variance in interpersonal distress, and 8.6% of the variance in physician-related distress. Cluster membership was strongly associated with emotional burden, regimen-related distress, and to a lesser degree interpersonal distress, but was not associated with physician-related distress. Relationship quality most strongly predicted regimen-related distress. Illness perception schemas and interpersonal issues influence emotional adjustment in diabetes. This study provides direction for the content of a novel approach to identifying and reducing diabetes distress in people with Type 2 diabetes.     

Adherence, body mass index, and depression in adults with type 2 diabetes: the mediational role of diabetes symptoms and self-efficacy.

OBJECTIVE: Evidence indicates that depression is linked to the development and worsening of diabetes, but the mechanisms underlying this link are not well understood. The authors examined the hypothesis that diabetes-related symptoms mediate the effect of both behavioral adherence and body mass index (BMI) on depression. In addition, they examined whether a prior finding that self-efficacy mediates the effect of behavioral adherence and BMI on depression would replicate with a larger sample size (W. P. Sacco, K. J. Wells, C. A. Vaughan, A. Friedman, S. Perez, & R. Morales, 2005). Also, the relative contributions of diabetes-related symptoms and self-efficacy to depression were evaluated. DESIGN AND PARTICIPANTS: Cross-sectional design involving adults diagnosed with Type 2 diabetes (N = 99). MAIN OUTCOME MEASURES: The primary outcome measure was depression (Patient Health Questionnaire: Nine Symptom Depression Checklist). Predictors of depression were diet and exercise adherence (Summary of Diabetes Self-Care Activities Questionnaire), diet and exercise self-efficacy (Multidimensional Diabetes Questionnaire), diabetes symptoms (Diabetes Symptom Checklist), and BMI (based on height and weight data from medical records). RESULTS: Path and mediation analyses indicated that adherence and BMI each contributed to depression indirectly, via their effects on self-efficacy and diabetes-related medical symptoms. CONCLUSION: Results provide evidence consistent with two independent pathways by which BMI and adherence could increase depression in people with Type 2 diabetes. The first pathway indicates that the effects of higher BMI and poor adherence on depression are mediated by lower self-efficacy perceptions. The second pathway indicates that the effect of higher BMI on depression is mediated by increased diabetes symptoms.     

The Diabetes Family Behavior Checklist: A Psychometric Evaluation

The Diabetes Family Behavior Checklist (DFBC) assesses supportive and non-supportive parental behavior specific to diabetes management via parent and child reports. The DFBC was administered to 133 children with type 1 diabetes (T1D) and their caregivers. Subsequent analysis verified the two-factor structure of the DFBC corresponding to positive and negative support behaviors. Internal consistency was high for DFBC scores. Moderate to strong correlations with other measures of diabetes-specific familial behaviors, adherence, and metabolic control support the validity of the DFBC. Clinical application of the DFBC is discussed.     

Type 2 Diabetes Mellitus and Cognitive Performance in a Population-Based Sample of the Oldest Old: Impact of Comorbid Dementia

We examined the relationship between type 2 diabetes mellitus and cognitive function in a population-based sample of very old people. The sample comprised 338 persons, aged 80-93 years (mean age 83.5 years), of whom 70 persons had type 2 diabetes mellitus. Measures of cognitive functioning included tests of perceptual speed, visuo-spatial ability, inductive reasoning, short-term memory, semantic memory, episodic memory, and the Mini-Mental State Examination. Regression analyses showed that type 2 diabetes mellitus duration was related to test performance across all cognitive domains, with the exception of short-term memory, such that longer duration was associated with lower test performance. When cases with dementia were excluded from the sample, further analyses showed that diabetes duration was not associated with cognitive test performance. This indicates that diabetes is not related to lower cognitive function in the general population of non-demented old people. Diabetes, however, increases the risk for cerebrovascular incidents, like stroke, that may contribute to vascular dementia.     

Depressive symptomatology and coronary heart disease in Type I diabetes mellitus: a study of possible mechanisms.

Recent evidence has suggested that depressive symptomatology is a risk factor for the development of coronary heart disease (CHD) in patients with diabetes mellitus, although little is understood about mechanisms that may explain this association. The Pittsburgh Epidemiology of Diabetes Complications (EDC) Study is a natural history study of 658 men and women with childhood-onset Type I diabetes. Participants from the EDC Study who reported the fewest depressive symptoms on the Beck Depression Inventory at baseline examination were least likely to develop CHD over 10 years. Differences in insulin resistance, autonomic dysregulation, inflammation, smoking, and complications associated with Type I diabetes appear to help explain this relationship. Future research should clarify causal pathways between depressive symptomatology, behavioral and physiological processes, and CHD.