胰岛细胞移植治疗1型糖尿病现状与未来

自2000年加拿大Edmonton报道了7例1型糖尿痛患者施行胰岛细胞移植术成功以来,越来越多的人把注意力投向了胰岛细胞移植的领域。然而,临床移植工作的成功开展还面临两大困难,一方面现有的胰岛细胞来源已经远远不能满足临床移植的需要,另一方面,现有免疫抑制方案造成了很多副作用。近年来,科技工作者正在探索新的途径,寻找新的胰岛来源。特别是包括体外重编程干细胞（iPS）、调节性T细胞和脐血干细胞在内的多种新技术的研究工作取得了许多进展,将为我们提供更多的选择,有可能成为今后的发展方向。本文就胰岛细胞移植治疗1型糖尿病的现状与未来展望进行简要的综述。     

噻唑烷二酮类药物在1型糖尿病治疗中的价值

噻唑烷二酮类药物（TZD）已在2型糖尿病中广泛应用。鉴于TZD具有增加胰岛素敏感性、抗炎症、调节免疫等作用,对它在1型糖尿病中的应用价值亦有探讨,这有助于指导实践和进一步研究。     

Plasma BDNF is reduced among middle-aged and elderly women with impaired insulin function: Evidence of a compensatory mechanism

Brain-derived neurotrophic factor (BDNF) plays a regulatory role in neuronal differentiation and synaptic plasticity and has been linked to glucose regulation and cognition. Associations among plasma BDNF, cognition, and insulin function were explored. Forty-one participants with impaired insulin function (IIF), ranging from insulin resistance to type 2 diabetes mellitus (T2DM), were matched with 41 healthy controls on gender, age, education, and IQ. Participants received complete medical, neurological, psychiatric, and neuropsychological evaluations. IIF individuals had significantly lower plasma BDNF levels than controls, particularly females, and higher BDNF levels were associated with poorer explicit memory in IIF females, suggesting that higher levels within this group may reflect the body’s efforts to respond to damage. After accounting for age, education, and HbA1c, BDNF significantly predicted 13.1–23.5% of the variance in explicit memory in IIF women. These findings suggest that BDNF elevations within diseased groups may not always be a marker of health.     

用比较治疗学的观点谈早期2型糖尿病的胰岛素强化治疗

现在越来越多的证据显示短期胰岛素强化治疗可以使血糖接近正常,并明显改善胰岛β细胞功能,但是也有专家认为这种胰岛素治疗的代价比能带来的好处更多。本文运用比较治疗学的观点就这一问题进行了探讨,并强调了胰岛素强化治疗在早期2型糖尿病治疗中的重要意义。     

TNF-α和IL-6基因多态性与妊娠期糖尿病的相关研究

为探讨TNF-α和IL-6基因多态性在妊娠期糖尿病中的分布及其相关性,对照性检测了糖尿病及正常孕妇TNF-α和IL-6的基因型。结果显示：TNF-α的基因多态性与妊娠期糖尿病相关;TNF-α和IL-6基因多态性在妊娠期糖尿病中有协同作用,基因型之间的相互作用可能决定了妊娠期糖尿病的遗传易感性。     

从“扁鹊自责”谈我国糖尿病防治现状及对策

全球糖尿病发病率日益增多。我国糖尿病诊断率及治疗达标率低,并发症发生率高、进展快,治疗现状令人担忧。减轻体重干预糖耐量受损,是决定疾病转归的关键环节、生活方式及药物干预均可降低糖尿病发生率。只有重视普及糖尿病相关知识,提高专业队伍素质,针对高危人群重点筛查及干预,早期发现糖尿病及综合治疗,才有可能减少糖尿病发病率及致残、致死率。     

Self-reported Diabetes Prevalence and Risk factors in South Africa: Results from the World Health Survey

Using the data from the South African World Health Survey (WHS), the current study aims to assess the self-reported prevalence of diabetes and associated risk factors by socio-economic characteristics in South Africa. A population-based survey of 2314 participants (1116 men and 1236 women) was conducted in South Africa in 2003. Results indicate an overall self-reported diabetes prevalence of 9.1%, 7.1% for men and 10.8% for women. In terms of diabetes risk factors, high rates of overweight or obesity (58.4%), physical inactivity (55.2%), less than 5 servings of fruits and vegetables in a day (69.3%), and medium or high stress levels (63.3%) were found; 18.4% were smoking daily and 7.3% were risky drinkers. Univariate regression analyses found that from the six different risk factors none apart from having high stress were associated with the occurrence of diabetes. Greater age was associated with obesity and inversely associated with insufficient consumption of fruits and vegetables. Daily smoking and being physically inactive were inversely associated with risky drinking. Low socioeconomic background was associated with unhealthy diet, physical inactivity and stress.     

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.     

Illness perceptions and self-care behaviours in the first years of living with type 2 diabetes; does the presence of complications matter?

Objective: To assess illness perceptions, self-care behaviours and their relationship in recently diagnosed type 2 diabetes mellitus (T2DM) patients with and without diabetes-related complications.

Design: Cross-sectional survey among 192 recently diagnosed T2DM patients of whom 23% reported the presence of diabetes-related complications. Illness perceptions and self-care were assessed by the Revised Illness Perception Questionnaire (IPQ-R) and the revised Summary of Diabetes Self-Care Activities (SDSCA) measure.

Results: Generally, participating patients perceived T2DM as a chronic, but relatively controllable condition with minor consequences. In the presence of complications, however, T2DM was perceived as more unpredictable with more (serious) consequences and less controllable by self-care or medical treatment. Furthermore, engagement in exercise and foot care was reported more often by patients with complications. Self-care was related to certain illness perception dimensions, and interactions between perceptions and complications were found.

Conclusion: T2DM patients in the first years of their illness are often recommended to make lifestyle changes in the absence of noticeable diabetes-related symptoms or complaints. As many T2DM patients do not seem to perceive their condition to be serious and postpone lifestyle changes until diabetes-related complications appear, a major challenge for professionals is to convince asymptomatic patients of the importance of self-care.     

Social relationships,stressful life events,and self-reported physical health: Genetic and environmental influences

Abstract

This study investigates how the associations between self-reported health, stressful life events, and social relationships are mediated by genetic and environmental influences and how much of the variance in health is in common with variation in these psychosocial factors. The analyses are based on questionnaire data from 576 pairs of twins reared apart and twins reared together. The data revealed that for men environmental influences were solely important for variation in the psychosocial measures and were the primary mediators of the relationship with health. For women, on the other hand, a substantial portion of the variance in the psychosocial factors was due to genetic influences and these influences also contributed to the bulk of the correlations with health. The gender differences for the relationships and their mediation indicate that what should be regarded as a psychosocial factor of importance for health might differ between genders.