利拉鲁肽与甘精胰岛素治疗初诊2型糖尿病的疗效及安全性比较

试验以对比利拉鲁肽与甘精胰岛素分别联合二甲双胍对初诊为2型糖尿病患者血糖控制效果及其安全性为目的.将60例初诊为2型糖尿病患者随机分为两组,予以利拉鲁肽(1.2u/d)及甘精胰岛素(0.3u/kg·d)分别联合二甲双胍(1g,Bid)治疗8周,比较治疗前后的血糖、糖化血红蛋白等指标.结果显示两组治疗后血糖、糖化血红蛋白均明显减低(P＜0.05);利拉鲁肽组低血糖发生率明显低于甘精胰岛素组(P＜0.05);而该组治疗后体重及收缩压下降,与胰岛素组有明显差异(P＜0.05).故对糖尿病患者,利拉鲁肽与甘精胰岛素同样有效控制血糖,而利拉鲁肽能够明显降低体重及收缩压,并且低血糖发生率更低.     

甘精胰岛素注射时段对2型糖尿病患者空腹血糖的影响

比较甘精胰岛素在不同时段注射对2型糖尿病患者空腹血糖的影响。最终选择89例2型糖尿病患者随机分为两组接受甘精胰岛素早餐前（A组,n=46）和夜间睡前（B组,n=43）注射治疗,观察两组患者空腹血糖的变化。结果显示,所有患者使用甘精胰岛素治疗以后,空腹血糖水平较治疗前均有明显下降,具有统计学差异（P均〈0.001）。但B...     

甘精胰岛素注射时段对2型糖尿病患者空腹血糖的影响

比较甘精胰岛素在不同时段注射对2型糖尿痛患者空腹血糖的影响.最终选择89例2型糖尿病患者随机分为两组接受甘精胰岛素早餐前(A组,n=46)和夜间睡前(B组,n=43)注射治疗,观察两组患者空腹血糖的变化.结果显示,所有患者使用甘精胰岛素治疗以后,空腹血糖水平较治疗前均有明显下降,具有统计学差异(P均<0.001).但B组的空腹血糖水平下降幅度更为明显,两者相比具有统计学差异(P<0.001).故在相同剂量的情况下,夜间睡前注射甘精胰岛素较晨间注射具有更强的降糖幅度,效果更好.     

阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖糖尿病短期疗效

观察阿卡波糖、二甲双胍联合胰岛素类似物治疗肥胖2型糖尿病的短期疗效。将60例符合标准患者随机分为观察组和对照组各30例,均给予重组甘精胰岛素联合赖脯胰岛素强化治疗控制血糖,观察组同时给予阿卡波糖及二甲双胍口服,出院时进行疗效评价。观察组血糖达标时间、胰岛素用量少于对照组,餐时胰岛素停用比例大于对照组,差异有统计学意义（P＜0．05）;两组患者出院时体重较入院时均有所下降,观察组较对照组体重变化更明显（P＜0．01）。阿卡波糖、二甲双胍联合胰岛素类似物治疗方案,可作为初诊肥胖2型糖尿病治疗的理想方法之一。     

2型糖尿病胰岛素治疗探讨

过去,人们(包括医护人员)对2型糖尿病的胰岛素治疗存在许多误区.通过糖尿病的流行病学,2型糖尿病的发病机制,早期胰岛素治疗对2型糖尿病的意义,及胰岛素的种类、剂型,和使用方法(包括补充疗法和替代疗法),以及2型糖尿病的治疗现状,来阐述胰岛素治疗对2型糖尿病的必要性.     

2型糖尿病胰岛素治疗探讨

过去,人们(包括医护人员)对2型糖尿病的胰岛素治疗存在许多误区。通过糖尿病的流行病学,2型糖尿病的发病机制,早期胰岛素治疗对2型糖尿病的意义,及胰岛素的种类、剂型,和使用方法(包括补充疗法和替代疗法),以及2型糖尿病的治疗现状,来阐述胰岛素治疗对2型糖尿病的必要性。     

糖尿病的免疫抑制治疗

淡化糖尿病的分型为我们提供了一个全新的思维空间.即传统的1型和至少部分2型糖尿病可能都是一种自身免疫性疾病,而目前流行的炎症学说可能是对认可免疫损伤是糖尿病发病理论的一个过渡,我们应该重新审视糖尿病的早期治疗和研究其慢性并发症的发病机理.我们则采用小剂量、长时间的治疗理念,早期接受这种免疫治疗的患者出现低血糖的症状,遂减少胰岛素的剂量;再次出现低血糖,我们就继续减少胰岛素的荆量.结果,有部分患者完全摆脱了胰岛素.我们对糖尿病的再认识是建立在对多脏器活检的基础之上.我们的活检结果表明,糖尿病肾病存在着免疫损伤.糖尿病眼底病变是使患者致盲的主要病因,糖尿病患者的眼底病变是一种自身免疫损伤的结果.我们尝试用小剂量的免疫抑制剂环孢茵素A(25 mg bid)治疗糖尿病眼底出血,取得了不错的疗效,也证实糖屎病眼底病变是一种血管炎,与自身免疫痛变有关.其他的器官还包括垂体、大脑的血管、糖尿痛足、冠心痛、皮肤的病变和肌肉活检的免疫组化也均有证据表明,免疫损伤是导致多种慢性并发症的罪魁祸首,是一种多器官免疫损伤的结果无论是1型糖尿痛,还是2型糖尿病,肌细胞表面或多或少均有免疫复合物沉积.这些免疫复合物的存在势必会影响胰岛素与肌肉细胞表面的胰岛素受体结合,即胰岛素抵抗的存在.为此,我们在临床上广泛采用了免疫抑制治疗的理念治疗糖尿病.应用小剂量胰岛素和小剂量环孢素A治疗早期发现的糖尿病取得了不错的疗效.唯一担心的副作用发生在肝脏,即部分糖尿病患者会出现总胆红索升高,而也有一部分患者总胆红素不升高.     

心理性胰岛素抵抗及应对策略

糖尿病易导致严重的慢性并发症,已成为影响人们生活质量的一种常见疾病.早期应用胰岛素是使2型糖尿病患者血糖得到良好控制、减少并发症发生的有效手段.但许多患者不愿接受或延迟胰岛素治疗.本文旨在探讨胰岛素应用过程中患者及医护人员存在的心理障碍,即心理性胰岛素抵抗,并进一步阐述其应对策略.     

从2型糖尿病的发病机制谈糖尿病治疗的新策略

2型糖尿病的发病机制主要为胰岛素抵抗与胰岛β细胞分泌功能受损,二者相互依存、相互作用。2型糖尿病的治疗应以减轻胰岛素的抵抗和保护胰岛β细胞为主,以生活方式干预加二甲双胍作为基础治疗,根据不同个体在不同阶段所侧重的不同发病机制,采用联合、综合管理。     

运用比较治疗学的方法促进T2DM胰岛素治疗决策的最优化

2型糖尿病(T2DM)为内分泌科常见疾病,胰岛素是最主要的治疗药物之一,但胰岛素治疗方法诸多,各种方案的疗效参差不齐.为了促进2型糖尿病治疗决策的最优化,本文通过利用检索国内报道的相关文献,对文献中2型糖尿病的胰岛素治疗方法进行归纳总结,并且运用比较治疗学的研究方法进行比较分析,旨在寻求最有效的治疗方案.     

Experimentation with Group Techniques with Ego-Disturbed Mothers

Abstract

Psycho–educational groups (PEGs) have been shown to be a particularly effective form of treatment for patients classified under the rubric of severely and persistently mentally ill (SPMI). However, recent surveys suggest that certain professionals, such as nurses and clinical psychologists, called on to conduct these groups may have limited to no training. This study tested three methods (self–instructional, workshop, and workshop plus clinical supervision) designed to provide on-the-job training to practicing clinicians. Specifically, training was based on two manuals; one that operationalized the basic knowledge and skills needed to run an effective PEG and the second being a commonly used PEG program for symptom management targeted at SPMI patients. Eight nurses from four adult units at a state psychiatric hospital initially received self–instructional or workshop training and then conducted a 12–session symptom management PEG composed of four to five SPMI patients (e.g., schizophrenia, schizoaffective or major depression disorders). In a second wave of additional training, nurses received workshop training or clinical supervision and then conducted a second PEG. Differences between training methods were assessed by nurse– and patient–completed measures that tapped the knowledge and skills emphasized in the symptom management and PEG (nurses only) manuals. Results indicated limited support for the superiority of the workshop method on the nurse measures alone. Implications for training working professionals in group treatments and assessing outcomes with chronic SPMI patients are discussed.     

Factors associated with respite care use by families with a child with disabilities

This paper reviews the literature on respite care utilization, describes a respite care program in Arkansas, and reports on a study of utilization initiated by the Arkansas Division of Mental Health Services (DMHS). Among the 89 families qualifying for respite services, 70 consented to participate, and 66 were surveyed in a phone interview. Users (n=54) and non-users (n=12) were compared relative to a variety of staff, child, geographic, and budget differences. Also, respite use was examined relative, to the aforementioned variables based on level of use, (i.e., none, low, moderate, high). There were no differences in use according to age, the number of family members, family income, or needs of the child. A larger percentage of non-use and low use of respite care was evident among those families receiving Tax Equity Fiscal Responsibility Act (TEFRA) benefits. There were no significant differences between races related to perceived barriers to care. Differences in expectations/experiences with respite care among rural and urban groups were limited with rural respondents expressing, concern about travel/distance issues. Overall, the program as a whole received positive ratings by parents, and no clear factors were found to be related to non-use in the small sample (n=12) who did not take advantage of respite services.     

Go/no‐go procedure with compound stimuli with children with autism

The go/no‐go with compound stimuli is an alternative to matching‐to‐sample to produce conditional and emergent relations in adults. The aim of this study was to evaluate the effectiveness of this procedure with two children diagnosed with autism. We trained and tested participants to respond to conditional relations among arbitrary stimuli using the go/no‐go procedure. Both learned all the trained conditional relations without developing response bias or responding to no‐go trials. Participants demonstrated performance consistent with symmetry, but not equivalence.     

Working with families of adults with anorexia nervosa

The aim of this paper is to describe working with the carers (families) of adults with anorexia nervosa (AN), which is different from working with families of younger adolescents. The main difference is in the area of rights and responsibilities of both parties. Moreover, as AN in adults is often a chronic condition, the treatment goal may not focus on recovery, but instead on improvement in quality of life. Thus the spectrum of nature and degree of parental involvement in the treatment of adults with AN is much broader than in children and adolescents. Our framework for intervention is based on a clear model of carer distress, from which targets for intervention follow. The paper outlines some of the core components of this work.     

Using Relaxation Techniques with Individuals and with Groups

The use of biofeedback, meditation, deep breathing relaxation, and imagery relaxation with individuals and with groups is described. The physical and mental well-being of people depends on learning ways to relax. Relaxation techniques reduce high levels of stress by facilitating the mind to switch from dwelling on day-to-day concerns to instead dwcll on relaxing themes. The body always responds to thinking processes; when the mind switches from dwellir~g on distressing thoughts to relaxing thoughts, the body becomes more relaxed.     

The Therapeutic Process with Children with Learning Disorders

Abstract

Clinicians who work with children and adolescents with learning disorders must be aware of the relationship between the learning disorder and the psychopathology the children present. This article offers a conceptual framework, based on psychoanalytic self psychology, to understand the modifications that are necessary in the treatment of this population. The author suggests that, in contrast to other approaches, it is not possible to conceptualize the treatment of these children as having a beginning, a middle, and an end. Rather, the therapeutic process is open-ended and conceived as occurring during a series of moments. The moments may be categorized as concordant, complementary, or disjunctive. During concordant moments a holding environment is created; during complementary moments the transference and countertransference is addressed; and during disjunctive moments the ruptures that inevitably occur during treatment are dealt with.     

Group intervention with children of parents with aids

This paper describes a format for group intervention with children of parents with AIDS. Therapeutic factors specific to group work with these children and special issues regarding AIDS are discussed. The stages of development of such groups are outlined, with particular attention paid to themes of grief and loss. Suggestions for future work in this area are given.