1型糖尿病免疫调节治疗：愿望与现实

1型糖尿病动物模型干预研究显示有效阻断口细胞自身免疫性损伤可阻止或逆转新发生的糖尿病。已完成的临床免疫调节干预研究的结果并不令人满意,目前有数百项Ⅰ、Ⅱ期临床阶段的干预试验研究在招募或进行中。早期临床试验发现长期服用T细胞抑制剂环孢素A可提高新诊断1型糖尿病的缓解率,但是由于担心其长期服用所致的肾毒性等不良反应,终止了其在1型糖尿病治疗中的进一步应用。目前针对1型糖尿病免疫调节治疗主要集中在抗原特异性（胰岛素、谷氨酸脱羧酶65）、抗原非特异性（抗淋巴细胞单克隆抗体）免疫调节治疗和促进β细胞新生等措施方面,这三大类措施的联合应用有可能实现更有效的干预效果和较低的毒副作用。目前针对1型糖尿病的三级预防临床研究的现实意义较一、二级预防研究更大,可在较短时间内、花费更少的资金和精力获得更有效的干预措施,而这些试验的成功更加有利于一、二级1型糖尿病的预防。寻找更准确的1型糖尿病发病预测和评价干预效果的方法是成功探索1型糖尿病干预手段的关键之处。     

Evaluation of a Family Systems Intervention for Managing Pediatric Chronic Illness: Mastering Each New Direction (MEND)

Family systems play a crucial, albeit complex, role in pediatric chronic illness. Unfortunately, very few psychosocial interventions are available to help these stressed families navigate the developmental steps of chronic illness. A new intervention (MEND) addresses the needs of these families and applies to a broad range of chronic illnesses. This article presents this family systems intervention as well as includes preliminary program evaluation data on 22 families that graduated from the program. Results show consistently strong effects across an array of psychosocial measures. Conclusions from this preliminary study suggest that families entering MEND present with high levels of stress due to the child's chronic illness, but after MEND, the level of stress and other functioning measures are comparable to those seen in healthy families, suggesting that the program offers a significant benefit to families with pediatric chronic illness.     

α-硫辛酸对2型糖尿病肾病血浆Hcy和血清Cys水平的影响

观察α-硫辛酸治疗2型糖尿病肾病（DN）的临床疗效。将62例DNⅣ期患者随机分为2组（对照组和试验组）,在常规治疗基础上对照组应用银杏提取物20ml、试验组应用α-硫辛酸300mg,分别加入250ml生理盐水每日一次滴注,共2周。观察治疗前后两组血浆同型半胱氨酸（Hcy）、血清胱抑素（Cys）等及一般临床资料水平的变化...     

2型糖尿病与骨代谢标志物相关性分析

探讨骨代谢标志物与2型糖尿病的相关性。收集2型糖尿病患者50例为糖尿病（T2DM ）组,非糖尿病患者17例为对照组,检测所有研究对象的血清骨代谢标志物、空腹血糖（FBG）、糖化血红蛋白（HbA1c）。与对照组相比,T2DM 组血清25-羟维生素D3（25-OH VitD3）、骨钙素（BGP）、总Ⅰ型胶原氨基端延长肽（TPINP）水平明显下降,β胶原特殊序列（β-CTx）水平升高;血清25-OH VitD3与 HbA1c呈负相关,BGP与 FBG呈负相关,TPINP与 FBG和 HbA1c呈负相关,β-CTx与FBG、HbA1c呈正相关。提示2型糖尿病与骨代谢标志物存在一定的相关性。     

Ethnic differences in illness perceptions,self-efficacy and diabetes self-care

This study assessed differences between Europeans, South Asians and Pacific Islanders in illness perceptions, self-efficacy, self-care, metabolic control and retinopathy in diabetes. We also evaluated the role of illness perceptions and self-efficacy in diabetes self-care and metabolic control within each group. A total of 86 Europeans, 86 South Asians, and 87 Pacific Islanders with type-2 diabetes completed self-report measures of illness perceptions, self-efficacy and self-care. Metabolic control and retinopathy data were collected from patient records. Results showed that Pacific Islanders and South Asians held shorter illness timeline perceptions compared to Europeans. Relative to both the other groups, Pacific Islanders also had elevated scores on three illness perceptions subscales: consequences, identity and emotional representations. They had lower medication-specific self-efficacy as well as poorer medication self-care, metabolic control and retinopathy. In all three groups, self-efficacy was fairly consistently related to self-care, but not to metabolic control. Illness perceptions were less consistently related to self-care, but were associated with metabolic control.     

The relationship of diabetes knowledge to regimen compliance and metabolic control during pregnancy

Abstract

The relationship of diabetes knowledge to regimen compliance and metabolic control was examined in a sample of pregnant women with preexisting insulin-dependent and noninsulin-dependent diabetes mellitus (N = 27) and women who developed gestational diabetes during pregnancy (N = 45). Subjects completed self-report measures of diabetes knowledge and compliance with their diabetic regimen and blood glucose levels were monitored. Knowledge was positively, although modestly, related to dietary compliance, compliance with insulin administration and insulin reaction management recommendations, as well as fasting blood glucose levels. Findings suggest that among pregnant women, efforts to increase knowledge of diabetes specific to pregnancy may result in some improvement in selected aspects of the diabetic regimen.     

Illness representations predict adherence in adolescents and young adults with type 1 diabetes

Objective: Most adolescents and young adults (AYAs) with type 1 diabetes struggle with diabetes self-management and exhibit suboptimal glycemic control. This study examined two models of association between illness representations, a modifiable predictor of suboptimal outcomes, and adherence and glycemic control in AYAs with type 1 diabetes.

Design and main outcome measures: Ninety-nine AYAs (ages 15–20?years) completed measures of illness representations and adherence at two visits. Blood glucose monitoring frequency and haemoglobin A1c were obtained via chart review. Relationships were examined using structural equation modelling.

Results: Illness representations accounted for a significant proportion of the variance in blood glucose monitoring frequency (ΔR^2?=?.23, p?<?.01) and adherence to emergency precautions at Time 1 (ΔR^2?=?.07, p?=?.03). Illness representations also accounted for significant variance in blood glucose monitoring frequency (ΔR^2?=?.08, p?=?.01), adherence to recommendations for insulin and food (ΔR²?=?.08, p?=?.02) and exercise (ΔR^2?=?.10, p?<?.01), and adherence to emergency precautions (ΔR^2?=?.16, p?<?.01) at Time 2.

Conclusion: Illness representations are salient predictors of adherence in this population. Interventions targeting adherence promotion and glycemic control in AYAs with type 1 diabetes may be enhanced by efforts to modify illness representations.     

Associations between type of treatment and illness-specific locus of control in type 1 diabetes patients

Abstract

This study examined differences in diabetes-specific locus of control beliefs of 82 insulin-treated Type I diabetes patients undergoing either conventional therapy (CT), intensified conventional therapy (ICT) or continuous subcutaneous insulin infusion (CSII). Compared to CT with its adherence to a strict regimen, ICT and CSII allow a much greater flexibility in timing of meals and daily activities. On the other hand, such flexibility requires a much more active role of the patient. The hypotheses of higher internality and lower powerful others locus of control beliefs in ICT and CSII patients than in CT patients could be supported for powerful others locus of control only. A one-year follow-up replicated this finding. Furthermore, high powerful others locus of control was associated with low diabetes-related knowledge and poor glycaemic control. The relevance of the patients' experience with the respective treatment is examined in view of the results and implications for studies on the feasibility of diabetes regimens are discussed.     

Exploring patient perspectives of prediabetes and diabetes severity: a qualitative study

Abstract

Objective: This qualitative study sought to identify and describe patients’ variant perceptions of disease severity after receiving a type 2 diabetes (T2DM) or prediabetes (preDM) diagnosis.

Design: Researchers interviewed 29 patients from two US medical centers to ascertain perceptions of severity. We used the constant comparative method from a grounded theory approach to identify themes from patients’ perspectives that inform their disease severity. This approach was used to help translate research to practice and ultimately identify intervention strategies informed by authentic experiences of preDM and T2DM patients.

Results: Perceptions of disease severity fell into two groups: high and low severity. Patients diagnosed with T2DM and preDM emerged in both groups and were comparative in terms of sample size, gender, and ethnic diversity. Several factors contributed to patients’ beliefs, including what they were told about the disease, observations from experiences within their own social network, and information from formal diabetes classes and their own research. The two perspectives diverged when patients described how their belief was informed by three thematic properties or personal factors: (i) fears; (ii) clinician communication; and (iii) social comparisons.

Conclusions: Beliefs about severity are influenced by patients’ fears, interactions with clinicians, and experiences within their social networks. These findings show that when interacting with patients with T2DM or preDM, clinicians should elicit patient perceptions of disease severity so they may then tailor the discussion to address these perceptions and help patients grasp the severity of these conditions.