ObjectiveTo study the correlation of postoperative cognitive dysfunction (POCD) with type-2 diabetes and glycosylated hemoglobin (HbA1c) levels in elderly patients. MethodsA total of 140 elderly patients who were going to undergo non-cardiothoracic surgery in our hospital between January 2011 and February 2013 were included in this study.ASA classification was between I and Ⅲ.There were 78 males and 62 females,aged between 65 and 86 years old.Group A had 70 patients with diabetes,while group B had another 70 corresponding patients without diabetes.One day before surgery and a week after surgery,Mini-mental State Examination (MMSE) and Montreal Cognitive Functioning Scale (MoCA) were used to test patients'cognitive function,and the incidence of POCD was compared between the two groups.Group A patients,according to HbA1c levels,were divided into group AH (HbA1c>7.5%) and group AL (HbA1c<7.5%).And we compared the relationship between group AL and group B,and the relationship between group AH and group B. ResultsThe incidence of POCD in group A was significantly higher than that in group B (P<0.05).Group AH had a significantly higher incidence of POCD than group AL (P<0.05).No significant difference was found in fasting plasma glucose among the groups. ConclusionElderly diabetic patients with poor glycemic control is a risk factor for POCD occurrence,but fasting glucose as a predictor of POCD is not as good as HbA1C.
ObjectiveTo study the effect of combined treatment using pancreatic kinionogenase enteric-coated tab and mecobalamin injection on diabetic peripheral neuropathy (DPN) patients. MethodsWe collected 84 subjects with DPN who received treatment from January 2012 to December 2012 in our hospital, and we randomly divided them into treatment group (42 subjects, using pancreatic kinionogenase enteric-coated tab and methylcobalamin injection) and control group (42 subjects, using mecobalamine only). Subjects in the treatment group were given oral pancreatic kininogenase at 120 unit/times and 3 times/day, and methylcobalamin intravenous injection at 1 mg/day for 14 days. Subjects in the control group were only given methylcobalamin intravenous injection at 1 mg/day for 14 days. ResultsIn the treatment group, 22 subjects showed excellent, 19 subjects effective and 1 subject ineffective outcome. In the control group, 8 subjects showed excellent, 22 effective and 12 ineffective outcome. The difference between the two groups is statistically significant (P<0.01). Compared with no treatment, the nerve conduction velocity in both the two groups has been improved. The improvement in the treatment group is significantly better than that of the control group (P<0.01), and all of them had no obvious adverse reaction during the treatment. ConclusionThe combined treatment using pancreatic kinionogenase enteric-coated tab and methylcobalamin injection on DPN is better than using methylcobalamin only.
ObjectiveTo compare the efficacy of sitagliptin plus glargine insulin versus repaglinide plus glargine insulin in the treatment of Type-2 diabetes mellitus (T2DM). MethodsA total of 140 T2DM patients who were inadequately controlled by oral anti-diabetic agents from January 2011 to December 2012 were divided into sitagliptin plus glargine insulin group (observation group) or repaglinide plus glargine insulin group (control group). The duration of treatment was 12 weeks. Fasting blood glucose (FBG), 2h plasma glucose (2hPG), glycated haemoglobin (HbA1c), body max index (BMI) and dose of insulin as well as hypoglycemia events were recorded and analyzed. ResultsAfter treatment, FBG, 2hPG, and HbA1c were significantly decreased in both groups (P<0.05). HbA1c targeting rate was 88.3% in the observation group and 87.8% in the control group. Compared with the control group, the observation group used 12.1% less dosage of insulin, and had decreased BMI and low incidence of hypoglycemia. ConclusionSitagliptin plus glargine insulin can effectively control blood glucose and body weight with low incidence of hypoglycemia and much less insulin dosage under the same HbA1c targeting rate. Sitagliptin plus glargine insulin is a good combination therapy for the treatment of T2DM.
ObjectiveTo systematically evaluate the safety of dipeptidyl peptidase-4 (DPP-4) inhibitors on the risk of cardiovascular events in type 2 diabetes mellitus (T2DM) patients. MethodsDatabases such as the Cochrane Library, PubMed, Elsevier ScienceDirect and EMbase were searched to collect randomized controlled trials (RCTs) about DPP-4 inhibitors for T2DM patients from inception to February 2014. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan5.2 software. ResultsA total of 20 RCTs involving 10 402 patients were included. The results of meta-analysis showed that:there were no significant differences between the DPP-4 inhibitors group and the control group in the cardiovascular adverse events (RR=0.86, 95%CI 0.62 to 1.20, P=0.38) and acute coronary syndrome (RR=0.66, 95%CI 0.37 to 1.17, P=0.15). Subgroup analyses by type of liptins and durations showed there were lower risks of adverse cardiovascular events in the DPP-4 inhibitors group of the sitagliptin subgroup (RR=0.49, 95%CI 0.29 to 0.82, P=0.007) and the duration of ≥52 weeks subgroup (RR=0.62, 95%CI 0.39 to 0.97, P=0.04). No significant difference was found between the two groups in hypertension events (RR=1.09, 95%CI 0.84 to 1.40, P=0.52). ConclusionThe DPP-4 inhibitors are relatively safe. In the long-term treatment of T2DM, the sitagliptin could not only effectively control the level of blood sugar but also might obtain benefits in cardiovascular aspects.
ObjectiveTo research the change and significance of Ghrelin and Visfatin in plasma after Roux-en-Y gastric bypass surgery (RYGB) in type-2 diabetes (T2DM) rats. MethodsThirty healthy Sprague Dawley (SD) rats (8 weeks) were divided into T2DM group (n=22) and blank control group (CSO group, n=8). Then rats of T2DM group were fed with high calorie and high sugar diet for 6 weeks, following by one dose of streptozotocin via intraperitioneal injection. Finally, there were 18 T2DM rats were successfully established. Then those 18 T2DM rats were divided into two groups:RYGB group (n=10) and sham operation group (DSO group, n=8). Rats of RYGB underwent RYGB, rats of DSO group and CSO group underwent sham operation. Levels of fasting serum glucose (FBG), fasting serum insulin (FINS), Ghrelin, and Visfatin of rats in 3 groups were detected by enzyme-linked immunoassay (EIA) before and 4 weeks after operation, and calculating the lee index and insulin sensitivity index (ISI). ResultsIn RYGB group, compared with before operation, the body weight, lee index, levels of FBG, FINS, and Visfatin decreased after 4 weeks after operation (P < 0.050), but level of ISI and Ghrelin increased (P < 0.050), while there was no significant difference in body weight, body length, lee index, ISI, levels of FBG, FINS, Ghrelin, and Visfatin in DSO and CSO group before and 4 weeks after operation (P > 0.050). In addition, there was statistical difference among the 3 groups in difference before and after operation of Ghrelin and Visfatin, the difference before and after operation of Ghrelin and Visfatin was larger than those of DSO group and CSO group (P < 0.050), but the difference was not significant differed between DSO group and CSO group (P > 0.050). ConclusionsThe increase of plasma Ghrelin and the decrease of Visfatin play important role in the mechanism after RYGB in treatment of T2DM rats.