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This type of newly diagnosed type 2 diabetes patients can benefit from short-term intensive treatment

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In the traditional treatment of patients with type 2 diabetes, a step-by-step treatment strategy is adopted, and the blood glucose level is used as the basis for the adjustment of the plan. Among the targets for the control of type 2 diabetes mentioned in the China Type 2 Diabetes Prevention Guide (2017 Edition), fasting blood glucose should be 4.4-7.0mmolL, non-fasting blood glucose was <10.0 mmol / L, and glycated hemoglobin was <7%.Glycemic control goals need to be formulated individually, and vary according to the patient's age, complications, and comorbidities.The lifestyle intervention in the hyperglycemia treatment path runs through, and then step-by-step treatment from monotherapy → dual therapy → triple therapy → multiple injections of insulin. When the blood glucose control is not up to standard (glycated hemoglobin ≥7.0%), the next stepOne step treatment.At present, the traditional treatment strategy is mainly to meet the blood glucose standard, and does not take into account the β-cell function of newly diagnosed type 2 diabetes patients. In fact, some patients with newly diagnosed type 2 diabetes do not perform step-down glucose therapy and directly give short-term intensive insulin therapy.Allow patients to achieve drug-free response with long-term benefits.The β cell function of newly diagnosed type 2 diabetes has recently been published in the China 4C study. It is concluded that the pathophysiological basis for the increase in diabetes in China is an increase in insulin resistance based on impaired islet function.β-cell dysfunction is divided into two parts, one is the deficiency of insulin secretion, the other is the abnormal insulin secretion pattern and the change of proinsulin.Defects in first-phase insulin secretion in newly diagnosed type 2 diabetes are common.The first-phase insulin secretion is also known as the acute insulin release response. In normal people, the first-phase insulin secretion peaks 2-4 minutes after intravenous glucose injection, and disappears after 6-10 minutes. If the sugar load persists, the first insulinIt is secreted in two phases until glucose is cleared.The acute insulin secretion phase (AIR) in the intravenous glucose tolerance test and the calculation of the area under the insulin curve (AUC) in IVGTT can all reflect islet β-cell function.The study found that severely impaired islet β-cell function in patients with newly diagnosed type 2 diabetes is mainly manifested in the absence of AIR and a significant decrease in insulin AUC, a significant decrease in β-cell function index (Homa β), and a decrease in insulin secretion quality.Among them, islet β-cell function is impaired and progressive failure occurs with the progression of type 2 diabetes.Traditional treatment regimen PK early intensive therapy A large number of studies have shown that progressive islet β-cell function is a decisive factor for the occurrence and development of type 2 diabetes. At present, the traditional treatment plan uses stepwise treatment, which cannot block the progressive failure of β-cell function.As the islet function of patients with type 2 diabetes weakens year by year, the treatment plan also transitions from a single drug to a multi-drug combination, oral hypoglycemic drugs are initiated, and then combined with hypoglycemic drugs or insulin injections with different mechanisms of action.This traditional treatment strategy focuses on achieving the standard of treatment, does not remove reversible factors, and does not pay attention to β-cell protection. The goal is often to achieve the standard, and with the increase in the number of drugs, it will increase the difficulty of doctors' decision-making and make patients graduallyLose confidence in blood sugar control.In actual clinical cases, the decline of β-cells occurs earlier than expected. Studies have shown that mild hyperglycemia causes significant impairment of β-cell function.Strict control of early long-term blood glucose is beneficial to long-term protection of β-cell function.As early as possible, short-term glucose intensive therapy can effectively reverse type 2 diabetes. Related research conducted by Professor Weng Jianping and Professor Li Yanbing showed that 382 patients with newly diagnosed type 2 diabetes were included. Compared with the oral hypoglycemic regimen, short-term intensive insulin therapy was used (CSII / MDI), the islet β-cell function was significantly improved, and it was better maintained for 1 year, and the remission rate was significantly higher than that of the oral drug group after 1 year.Which newly diagnosed type 2 DM patients are suitable for short-term intensive insulin therapy. Glucose toxicity exists in the case of high glucose. This situation requires short-term intensive insulin therapy to improve the condition in a short time.When newly diagnosed type 2 diabetes patients have HbA1c> 9.0% or FPG> 11.1mmol / L with obvious symptoms of hyperglycemia, it is recommended to start short-term intensive insulin therapy.The shorter the course of the disease, the lower the HbA1c and FPG at the time of diagnosis. After a short period of intensive insulin therapy, better islet function improvement can often be obtained, and a higher proportion of patients can obtain clinical remission.After so many years of research and clinical practice, the Department of Endocrinology, the First Affiliated Hospital of Sun Yat-sen University, after short-term intensive insulin therapy based on the baseline glycosylation of 10.1% to 11.6% of newly diagnosed type 2 diabetes, can achieve a 1-year remission rate of more than 50%.The 2-year remission rate is about 42%. The arginine stimulation test can find the recovery of first-phase insulin secretion. In short, short-term intensive insulin therapy can significantly restore islet β-cell function and improve insulin sensitivity.At the 2018 ADA Conference, Professor Li Yanbing’s team reported China’s gratifying results. Short-term insulin pump intensive treatment in 95 newly diagnosed and untreated patients with type 2 diabetes (average saccharification is 11.2%) can relieve 1 year.The rate reached 58.9%.Regarding the administration of insulin doses, Professor Li Yanbing’s team formulated a formula based on experience, as follows: Daily Total Estimation Formula = 0.35 * weight (kg) + 2.05 * FPG (mmol / L) + 4.24 * TG (mmol / L) +0.55 * waist (cm) -49.1, can be started at 80% of the calculated dose to avoid hypoglycemia. Patients usually reach their blood glucose level within 1-2 days.The ratio of basal and meal insulin is set according to about 4: 6 (not given according to the 1: 1 ratio of European and American populations). Insulin pump applications generally require the insulin dose to be set in stages, but it is relatively new for islet function.For patients with type 2 diabetes, you can do it without segmentation. On the first day of compliance, reduce the insulin consumption from 10 pm to 3 am the next day, and reduce it by about 10% -20%.Meal insulin distribution was based on: 30%, 35%, and 35%.In addition, patients who have been diagnosed with T2DM (have a certain course of disease) and are receiving hypoglycemic drugs. Due to the significant increase in blood glucose or large blood glucose fluctuations, short-term insulin intensive therapy can also be used to correct hyperglycemia or severe blood glucose fluctuations.This includes: ① the maximum tolerated dose of 2 oral hypoglycemic agents combined for more than 3 months, HbA1c> 9.0%; ② using basal insulin or premixed insulin 2 times a day, and undergoing sufficient dose adjustment for 3People with poor blood glucose control (HbA1c> 7.0%) or recurrent hypoglycemia after more than one month.In short, short-term intensive insulin pump therapy can quickly achieve the standard of blood glucose in patients with type 2 diabetes, significantly recover islet function, delay disease progression, and simplify treatment options.At the same time that patients achieved drug-free remission, no significant complications were found during long-term follow-up, which means that intensive short-range insulin pump therapy can benefit patients in the short and long term.For those patients with newly diagnosed diabetes with high blood glucose, timely intensive insulin therapy is used to relieve the patients’ high glucose toxicity and benefit from lowering glucose.The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party..

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Metformin-the gospel for patients with moderate to severe acne?

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Dermatologists usually prescribe oral antibiotics combined with isotretinoin to treat acne vulgaris, but the side effects of traditional treatment options have received more and more attention, so it is necessary to find alternative treatment options.Studies have shown that acne production may be related to mTORC1 drive, and the effect of metformin on mTORC1 activity has been confirmed.Therefore, researchers have speculated that metformin may be used as an adjuvant treatment for improving acne, and research has been carried out in this way.Study Design This study was a randomized, open-label, prospective study with the main purpose of assessing the safety and effectiveness of metformin 850 mg per day in combination with topical peroxybenzoyl and tetracycline.The study subjects were adults (18-40 years) with moderate to severe facial acne from the University of Malaysia Medical Centre.Enrollment requirements: Participants’ overall assessment (IGA) score ≥ 3 points (0-5 points), at least 20 inflammatory lesions on the face or ≥ 30 non-inflammatory lesions, and no more than 5 except the outer part of the noseNodular lesions.Exclusion criteria: This study excluded participants with congenital, explosive acne, or secondary acne, as well as those who were pregnant, breastfeeding, were using topical anti-acne preparations, had a chemical peel, and had systemic acne treatment.By.Patients were randomly divided into groups, in which the treatment group received benzoyl peroxide (2.5%, once daily) + tetracycline capsules (250 mg, twice daily) + metformin (850 mg, once daily), and the other group received only the first twoDrugs for 12 weeks.Researchers evaluated participants at baseline, 6 weeks of medication, and 12 weeks of medication.The primary efficacy endpoint was the percentage change in the number of inflammation, non-inflammatory, and total skin lesions from baseline at 12 weeks.The secondary efficacy study endpoint was improvement in the IGA score [Treatment Success Rate: IGA score of 0 (clear) or 1 (nearly clear), or the percentage of participants who improved by 2 levels from the baseline to the 12th week with a CADI score].At each follow-up, the researchers evaluated participants for adverse events and tolerability, and used the insulin resistance homeostasis model (HOMA-IR) to assess participants’ insulin resistance status.The criteria for underweight are BMI <18.5kg / m ^ 2, normal weight BMI18.5-22.9 kg / m ^ 2, overweight BMI 23-25 ​​kg / m ^ 2, and obesity> 25kg / m ^ 2.In addition, the efficacy of metformin in different BMI participants was evaluated in a subgroup analysis.The study results were screened and a total of 84 participants were included. They were randomly divided into the metformin treatment group (n = 42) and the control group (n = 42). The baseline characteristics of the two groups were similar.1. Metformin brings higher treatment success rate In terms of improvement in the amount of non-inflammatory damage, at the 12th week, the metformin group was better than the control group (44.9% vs. 37.4%), but did not reach a significant difference (P= 0.445). In terms of improvement in the number of inflammatory lesions, at the 12th week, the metformin group performed better (83.1% vs. 75.6%), but did not reach a significant difference (P = 0.064).Treatment success rate: At 12 weeks, the treatment success rate of the metformin group was significantly better than that of the control group (66.7% vs. 43.2%, P <0.05).2. The treatment benefit has little to do with obesity. The researchers performed a subgroup analysis of the efficacy of the underweight and overweight / obese people in the metformin group, and found that the treatment success rate, the CADI score improved, and the number of skin lesions improved.No significant difference.3. Metformin has significant effects on body weight and blood glucose: At 12 weeks, BMI in the metformin group was significantly reduced by 0.26 ± 0.72 kg / m ^ 2 (P <0.05), and the control group increased without decreasing.Fasting blood glucose: At 12 weeks, the fasting blood glucose level in the metformin group decreased significantly by 0.15 ± 0.62 mmol / L (P <0.05), while the control group increased without decreasing.4. Safety Among subjects receiving metformin treatment, hypoglycemia did not occur, but 13 people (31.7%) developed gastrointestinal symptoms, including nausea, vomiting, abdominal discomfort and bloating, but within a tolerable rangeWithin two weeks, the duration did not exceed 2 weeks, and no serious adverse events occurred.Limitations of the study The limitations of this study include: 1. The results may be more valuable if metformin is used without other anti-acne drugs; 2. The sample size is small when analyzing the BMI subgroup; 3. Facial acne scarsThe type, size, and severity may have an effect on the CADI score; 4. No confounding factors such as diet, sedentary, stress, and sleep were intervened.This article summarizes for the first time this study evaluated the efficacy of metformin as an adjuvant therapy for acne among participants of different genders, insulin resistance status, and BMI levels.The results showed that in terms of treatment success rate, the metformin group (combined with local peroxybenzoyl + oral tetracycline) was significantly higher than the control group (local peroxybenzoyl + oral tetracycline, 66.7% vs. 43.2%, P = 0.04)And this benefit has little to do with whether the participants are obese.The main adverse reactions (31.7%) in the metformin group were still gastrointestinal symptoms, but they were all tolerable and disappeared within 2 weeks.Researchers believe that this study provides strong data to support metformin as an adjuvant for acne, but further research is needed in the future.I would like to remind you that although this study gives promising results, patients with acne must follow the doctor's advice and do not take medicine on their own.The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party..

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22,000 Chinese people study: Sleep less than 6 hours a day, more likely to become fat!

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[1] Obesity: Lai bed makes sense: I’m not lazy, I lose weight in bed!Does Key Point sleep thin or fat?Recent studies from China have analyzed the relationship between adult sleep time and obesity.This prospective study enrolled nearly 22,000 Chinese adults, collected participants’ self-reported daily sleep time, and measured the weight of these participants.At the beginning of the study, participants had an average sleep time of 7.5 hours.After a follow-up of 8.0 years, participants who slept for less than 6 hours were found to have a significantly increased risk of weight gain of 5 kg or more by 13% (HR 1.13, 95% CI 1.02-1.29), and this increased risk was found in those who did not exercise.It was more pronounced in the population, and too short a bedtime was also associated with a 13% increase in the risk of central obesity (HR1.13, 95% CI 1.00-1.28).Researchers point out that people who sleep short have an increased risk of developing weight gain and central obesity compared to people who sleep seven hours a day.Therefore, I am not lying in bed in the morning, I am losing weight!Although you don’t get fat after too much sleep, previous research has also proven that too much sleep increases the risk of stroke … how so hard to sleep![2] JAMA Netw Open: Children ca n’t blame moms for their fatness, and their dads have to carry them!Key Point Although a large number of studies have confirmed that maternal obesity can lead to epigenetic changes in offspring and increase the child’s risk of obesity in the future, this pot can not all allow mothers to carry back … except that the father’s obesity of children has not been fully studied beforeImpact.A recent cohort study from the United States involving 2,128 live births analyzed the child’s BMI change from birth to adolescence and the relationship between epigenetic markers and parental BMI.The study analyzed the corresponding data of 428 groups of parents and offspring.The results showed that the father’s BMI ≥25 kg / m2 was related to the child’s birth weight gain (P = 0.004).Nine umbilical cord blood DNA methylation CpG loci were independently related to the father’s BMI (p <0.05), but not to the mother's BMI, suggesting that the father's BMI also had an independent effect on the epigenetics of the offspring.Among them, the methylation level of cg04763273 in umbilical cord blood decreased with the increase of the father's BMI, and the BMI decreased by 5% (P = 3.13x10-8) for each 1kg / m2 increase and continued to 3 and 7 years old; the father's BMIIt is also related to methylation at cg01029450 in the promoter region of the ARFGAP3 gene, which is related to lower birth weight (β = -0.0003; SD = 0.0001; P = 0.03) and higher BMI at 3 years of ageZ-scores are relevant.Researchers point out that the healthy weight of offspring is not only related to the mother, but the father should also take responsibility for it.[3] Diabetes Care: Three-pronged approach, increasing 10.8% of patients with diabetes to control standards Key Point Effective primary care is an important guarantee for the successful achievement of metabolic control goals for patients with diabetes. Recent UNITED studies have analyzed how to improve the management of diabetes at the grassroots level.In order to improve the control rate of diabetic patients.The study included 585 patients with type 2 diabetes treated with the General Care Management System (SysCM), and analyzed the proportion and factors that reached the standardized performance goal (NQF # 0729) for optimal diabetes care.It was found that if the decision-making process is shared with patients (P = 0.001), the list of tests / interventions needed to prevent / monitor diabetes is implemented (P = 0.002), and doctors remind patients to perform age-based risk assessments at the time of consultation (P = 0.002) If all three measures can be achieved, the number of patients with diabetes control will increase by 10.8%.Researchers point out that in order to improve the quality of diabetes care, these factors need to be considered when designing and delivering treatments.[4] Diabetes Care: There is a two-way relationship between severe hypoglycemia (SHE) and the risk of cardiovascular events in patients with hypoglycemia and cardiovascular disease. Key Point: Recent studies have attempted to identify this relationshipPatients at double risk.The study included 14,752 participants in the EXSCEL trial and analyzed the relationship between SHE and major cardiovascular events.It was found that SHE was rare during the study and had nothing to do with exenatide (p = 0.179), but SHE was related to the risk of all-cause death (HR1.83, 95% CI 1.38–2.42; P <0.001), heartIncreased risk of death from vascular events (HR 1.60, 95% CI 1.11-2.30; P = 0.012), increased risk of admission to heart failure (HR 2.09, 95% CI 1.37– 3.17; P = 0.001); meanwhile, non-fatal MI(HR2.02, 95% CI 1.35-3.01; P = 0.001), non-fatal stroke (HR2.30, 95% CI 1.25-4.23; P = 0.007), and admission to cardiovascular disease (HR2.00, 95% 1.39-2.90; P <0.001) and admission to heart failure (HR 3.24, 95% CI 1.98–5.30; P <0.001) were both associated with an increased risk of subsequent SHE.Researchers point out that SHE and cardiovascular events have a two-way correlation, and those with higher comorbidity scores are at higher risk for both events.[5] Thyroid: Radioactive iodine treatment does not increase overall cancer risk Key Point Radioactive iodine is an important treatment for hyperthyroidism, but when people hear radioactivity, they worry about whether this treatment will increase the risk of cancer.So is this concern necessary?Recent research from Israel has explored this issue.The study was based on 16,000 patients in the Clalit Medical Database, who were treated with radioactive iodine or antithyroid drugs, with a total follow-up time of 123,000 · years.It was found that there was no relationship between radioiodine treatment and overall cancer risk (HR 0.99, 95% CI 0.83-1.19; p = 0.91). For a single cancer species, non-radioiodine treatment was found to be non-radioactive only in univariate analysis.The relationship between Hodgkin's lymphoma risk (HR2.89, 95% CI 1.12-7.46; p = 0.03), but this association was not found in the multivariate analysis, and the absolute incidence of non-Hodgkin's lymphoma was alsoNo significant increase (2.18 / 1000 person-years, -0.38 to 4.68 / 1000 person-years).Researchers believe that radioiodine treatment for hyperthyroidism does not increase the risk of cancer, and patients with hyperthyroidism can safely receive this treatment.[6] PNAS: Voltage-gated calcium 3.1 channel or a new target for diabetes treatment Key Point Voltage-gated calcium 3.1 channel (CaV3.1) is associated with less calcium influx in healthy rat and human β cellsYes, but this channel becomes active in patients with diabetes.Recent studies have found that this may be one of the pathogenic mechanisms of diabetes.The increased expression of CaV3.1 will cause a large influx of calcium, which will damage the genomic expression of exocytosis protein in β cells, reduce the insulin secretion ability of β cells and disrupt glucose homeostasis.Recombinant adenovirus transduction up-regulates the expression of CaV3.1 channels in rat β-cells, and its insulin secretion is significantly reduced.This effect can be prevented by inhibiting the CaV3.1 channel or inhibiting calcium-dependent calcineurin.Researchers have pointed out that the pathological role of β-cell CaV3.1 channels in diabetes and its complications has long been ignored, and the findings suggest that this channel may become a new target for diabetes treatment.[7] Diabetes & Metabolism: The worse the lung function, the more likely you are to develop type 2 diabetes. Key Point Some previous studies have shown that decreased lung function is associated with an increased risk of type 2 diabetes, but this link has not been validated in East Asian populations.A recent genomic and epidemiological study from South Korea included 7,853 non-diabetic adults aged 40-69 years, based on participants' estimated forced vital capacity (% PFVC) and estimated forced expiratory volume in the first second (%PFEV1) The patients were divided into four groups with different lung functions, and the relationship between lung function and type 2 diabetes was evaluated.A total of 1403 participants were diagnosed with type 2 diabetes during a 12-year follow-up period.According to% PFVC, compared with the 1/4 with the best lung function, the risk of type 2 diabetes increased significantly in the 1/4 with the worst lung function, with a 67% increase in men (HR 1.67, 1.35-2.07), and a 77% increase in women.% (HR1.77, 95% CI 1.39-2.24); According to% PFEV1, the incidence in the poorest 1/4 of the population is 58% higher risk for men (HR1.58, 95% CI 1.28-1.95)), Women increased by 61% (HR1.61, 95% CI 1.27-2.03).Researchers believe that decreased lung function can independently predict future increases in the risk of type 2 diabetes and is not associated with obesity, smoking, and inflammation.[8] JCEM: 20-year-old hypothyroidism, the risk of thrombosis soars to 11 times in the future!Key Point patients with hypothyroidism account for about 0.3% of the population, and patients with subclinical hypothyroidism account for about 4.3%.Hypothyroidism may cause symptoms such as fatigue, muscle soreness, weight gain, and fear of cold. It may also lead to hypercoagulable blood.A recent analysis included data from 12,000 patients at the University of New Mexico Health Science Center, of which 510 had hyperthyroidism, 1405 had subclinical hypothyroidism, and 327 had hypothyroidism.The study followed 5.1 years and recorded 228 cases of thromboembolic events.Analysis showed that hypothyroidism was associated with an increased risk of thromboembolic events.Compared with people with normal thyroid function, patients with hypothyroidism at the age of 20 may have a significantly increased risk of thrombosis up to 11.14 times (OR 11.14, 95% CI 1.63-76.34), and patients with hypothyroidism at the age of 35 are 2.67 times (OR 2.67)., 95% CI 1.10-6.48), the increased risk of thrombosis was not significant in 40-year-old hypothyroidism patients (OR 1.66, 95% CI 0.83-3.31).At the same time, the risk of thromboembolism in 20-year-old patients with hyperthyroidism will increase to 7.55 times (OR 7.55, 95% CI 1.05-54.48), and men (OR 1.36, 95% CI 1.02-1.81) and smokers (OR 2.21, 95% CI 1.41-3.45).Researchers point out that patients under 35 with abnormal thyroid function may need to pay attention to their risk of thromboembolism..

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Appropriate exercise can control sugar, but don’t step on these 3 big pits!

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Can exercise help people with diabetes control blood sugar?The answer is beyond doubt.Exercise can significantly improve metabolism-related indicators, such as exercise can improve the level of glycated hemoglobin (HbA1c) in diabetic patients. This improvement effect is comparable to that of diet therapy, drug therapy, and insulin therapy [1].Other studies have shown that aerobic exercise for only 12 weeks can significantly reduce patients’ HbA1c levels, increase skeletal muscle strength, and improve motor perception [2].However, in clinical practice, patients are often encountered to exercise according to their own ideas, but they have no effect. There are even cases of hypoglycemia caused by excessive exercise. Today, we will take a look at the “pits” that are most easily stepped on by sports sugar.”!01 Don’t have to do preparation activities before exercise?wrong!According to the “Guidelines for the Treatment of Diabetes in China”, each exercise should be prepared for 5 to 10 minutes before exercise and at least 5 minutes for relaxation after exercise.The human body needs to have an adaptive process from the quiet state to the intense exercise. Fully preparing activities can not only improve the excitability of the central nervous system, but also overcome the inertia of internal organs.At the same time, the nervous system’s ability to coordinate and command muscles is improved, so that the organs can cooperate with each other, improve the working ability of sports organs, and prevent injury accidents [3].02 The greater the intensity of exercise, the better?wrong!The design of exercise requires coordination of exercise time and exercise intensity.When the intensity of exercise is large, the duration of exercise is correspondingly shortened; when the intensity is small, the duration of exercise is appropriately extended.In addition, exercise intensity should not be too large. Excessive exercise or intense exercise for a short period of time will stimulate the body’s stress response, leading to increased secretion of hormones such as catecholamines against insulin, increased blood sugar, and even induced diabetic ketoacidosis.It is not good to control diabetes [4].In order to ensure that exercise is safe and effective, exercise intensity must be controlled within the established effective range. Exercises exceeding 80% VO2max (maximum oxygen uptake) are dangerous; exercise less than 50% VO2max is harmful to the elderly and patients with heart disease.Suitable [5].For middle-aged and elderly diabetic patients, it is more suitable to exercise at an intensity of 50% to 60% VO2max due to many complications [6].In order to exercise safely, in principle, diabetic patients who are older than 40 years of age, have a disease course of more than 10 years, and have symptoms and signs of cardiovascular disease should obtain target heart rate through exercise tests [7].03 Can the exercise plan be adjusted at will?wrong!Exercise therapy is part of lifestyle intervention for diabetic patients. If the doctor determines the exercise program, it is not recommended that the patient adjust it by himself. From the current research results on exercise and diabetes, aerobic exercise and resistance training are good ways of exercise for diabetic patients.Selection, suggesting that the best exercise program for patients with type 2 diabetes is a combination of aerobic exercise and resistance training [8].Due to the differences in individual disease status and athletic ability, the sports training plan should adopt the principle of gradual (from little to many, light to heavy, rare to complex, periodic, moderate recovery), and according to the disease at different periodsAnd changes in athletic ability while adjusting the plan [8].Therefore, adjustment of exercise programs for diabetic patients is complicated and should be carried out under the guidance of a professional physician.The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party.

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Beware of missed diagnosis!

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Case sharing patient, 48 years old, 6 years history of diabetes, blood glucose level continued to rise to the hospital in the past week.At the time of the diagnosis of diabetes 6 years ago, the patient weighed 278 pounds (126 kg) and had a BMI> 30 kg / m ^ 2. At first, the doctor recommended that he treat the disease through diet control, exercise and taking metformin. After 4 months, he lost weight, Fasting blood glucose levels were reduced below 100 mg / dL (5.6 mmol / L), and metformin was subsequently discontinued.The patient’s blood glucose remained at a good level until a sudden increase in blood glucose occurred one week before the visit. The fasting blood glucose level was> 200 mg / dL (11.2 mmol / L), accompanied by polyuria and polydipsia, but his diet was good.Nausea, vomiting, or dehydration. No fever, chills, cough, stuffy nose, chest pain, abdominal pain, or difficulty urinating.With the exception of diabetes, patients were also accompanied by hypertension (taking losartan), hyperlipidemia (taking atorvastatin), and gout (taking allopurinol).Family history of diabetes: Both parents are diabetic.Initial test: blood pressure of 148 / 70mmHg, pulse rate of 100 beats / minute, weight of 273 pounds (124kg, BMI> 30kg / m ^ 2), fever symptoms, other examination results showed that the patient’s skin, head, eyes, throat, heart and lungBoth were normal and abdomen, but urine tests revealed large amounts of glucose and ketone bodies.Further testing (Table 1) showed that blood glucose levels were significantly increased (21.2mmol / L), C peptide levels were too low to be detected, serum ketone body levels were positive, and anion gap was elevated (22mmol / L), suggesting diabetic ketosisAcidosis (DKA).Blood cultures were negative.Treatment: During the hospitalization, the patient received intravenous infusion and insulin injection (6 units per hour). Within 48 hours, the anion gap returned to normal. On the seventh day, fasting c-peptide levels returned to normal 1.9ng / dL (0.8-3.2ng)./ dL).After discharge, he received insulin glargine and lispro combined therapy to remind patients to pay close attention to blood glucose levels. Over time, blood glucose levels gradually approached normal. After 6 months, insulin was stopped and switched to oral medication.Case discussion Diabetic ketoacidosis (DKA) is a severe disorder of glucose, fat and protein metabolism caused by severe insulin deficiency and inappropriate elevation of glycemic hormone.Most patients with DKA will be accompanied by symptoms such as polyuria, thirst, weight loss, etc. For patients with complete insulin deficiency, metabolic decompensation can quickly occur within 24 hours.Typical symptoms of DKA also include nausea, vomiting, abdominal pain, lethargy, deep and slow breathing with hyperventilation.On physical examination, most patients have hypotension or normal blood pressure, increased heart rate, increased breathing rate, decreased volume signs, keto-breathing (rotten apple flavor), and severe dehydration may cause patients to become unresponsive or even comatose.It is worth noting that the DKA symptoms of the patient in this case are not typical. The above-mentioned typical DKA symptoms such as nausea, vomiting, abdominal pain, dehydration, and keto-breathing did not appear. They only showed a sudden and continuous rise in blood sugar, accompanied by excessive drinking,Polyuria, DKA can be confirmed through further examination, which is more likely to be missed, reminding clinicians to pay attention.In addition, medical staff speculated that the cause of DKA in patients in this case may be related to transient suppression of β-cell function, but the underlying reason is not clear.Furthermore, the patient was diagnosed with diabetes 6 years ago, but after diet control, exercise, and short-term use of metformin, diabetes was resolved within 4 months.During this consultation, it was found that in addition to meeting the typical characteristics of type 1 diabetes, such as a sharp decrease in C-peptide levels and severe insufficient insulin secretion, it was also accompanied by typical characteristics of type 2 diabetes, such as obesity, adult onset, and family history of diabetes.From a therapeutic point of view, although patients show typical insulin dependence during ketoacidosis, but then like type 2 diabetes, β-cell function is partially retained, and blood glucose can be replaced by oral hypoglycemic drugs instead of insulin.The above characteristics are consistent with the characteristics of a special type of diabetes-ketosis-prone diabetes (also known as idiopathic type 1 diabetes, type 1B diabetes, or Flatbush diabetes). Studies have shown that these patients are often obese, reminding us againConcerns about the special type of diabetes.This article summarizes a case of DKA that is not accompanied by typical symptoms such as nausea, vomiting, ketone-like breathing, and dehydration, but only with symptoms of sudden rise in blood sugar, excessive drinking, and polyuria, which are more likely to be missed…

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When diabetes suffers from high uric acid, what is the combination of the two?

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Diabetes and hyperuricemia are common metabolic diseases in the clinic, so when diabetes suffers from hyperuricemia, how can we send medicines to lose one another and achieve a win-win situation?Diabetes and hyperuricemia are related siblings, and they can coexist and affect each other.On the one hand, diabetes can lead to an increase in serum uric acid, the possible mechanisms are as follows: (1) In the state of insulin resistance (IR), the intermediate products of the glycolysis process are transferred to 5-phosphate ribose and phosphoribosyl pyrophosphate, resulting inIncreased blood uric acid production.(2) Patients with type 2 diabetes often have hyperinsulinemia.Hyperinsulinemia can promote Na +-H + exchange in the renal proximal tubules, increase anion (including uric acid) reabsorption, and reduce uric acid excretion.(3) Type 2 diabetes and its complications increase the level of oxidative stress in the body, and uric acid is one of the main endogenous water-soluble antioxidants in the human body. In order to protect the body from harmful oxidative free radicals, blood uric acid levelsRise.(4) Patients with diabetes often have factors such as hypertension and renal arteriosclerosis. Arteriosclerosis leads to glomerular hypoxia, increased lactic acid production, and excretion due to competition with uric acid, resulting in increased blood uric acid.(5) For severe diabetic nephropathy and renal insufficiency, the effective nephron decreases, uric acid filtration from the glomerulus decreases, and the kidney’s ability to excrete uric acid weakens.On the other hand, hyperuricemia is an independent risk factor for the occurrence and development of diabetes complications. According to statistics, the incidence of microangiopathy, macrovascular disease, and neuropathy in diabetic patients with hyperuricemia is significantly higher than uric acid levels.Normal diabetics.(1) Increase the risk of diabetic nephropathy: Diabetic nephropathy is a serious complication of type 2 diabetes. Hyperuricemia not only causes uric acid crystal deposition to cause renal arterioles and chronic interstitial inflammation to aggravate kidney damage, but uric acid can directly cause kidney damage.Microvessel disease occurs in the afferent bulbous artery, leading to chronic kidneys and end-stage development of uremia, but a major cause of death in patients with diabetes.(2) Increase the risk of diabetic retinopathy: Diabetic retinopathy is a major cause of blindness and disability in diabetic patients.Increased blood uric acid can cause urate crystals to deposit on the walls of arterial blood vessels, cause vascular intimal damage, and also cause vascular smooth muscle proliferation, leading to retinal vascular disease.These can cause microcirculation disorders, which promote the occurrence of diabetic retinopathy.(3) Increasing the risk of diabetic macroangiopathy: Especially in elderly patients with type 2 diabetes, the increase in blood uric acid levels is significantly related to the occurrence and development of coronary heart disease and cerebrovascular disease.Macrovascular disease is the leading cause of death in patients with type 2 diabetes.(4) Hyperuricemia is related to hypertension in patients with type 2 diabetes: Hyperuricemia can also lead to the occurrence of hypertension and difficult to control hypertension in patients with type 2 diabetes.Because hyperuricemia can increase insulin resistance and promote the production of angiotensin II, these factors can lead to increased blood pressure.Therefore, when the type of diabetic patients with hypertension is difficult to control, blood uric acid levels need to be monitored to exclude the effect of high uric acid on blood pressure.(5) Hyperuricemia is related to other metabolic abnormalities of type 2 diabetes: Hyperuricemia is closely related to dyslipidemia, obesity, etc. Those with abnormal uric acid levels have higher levels of dyslipidemia and obesity, and with theIncreased and showed an increasing trend, so patients with type 2 diabetes and hyperuricemia are more likely to have metabolic abnormalities such as obesity, increased abdominal circumference, and increased blood lipids.The cause may be related to the increase of insulin resistance in patients with type 2 diabetes with hyperuricemia.In general, diabetes and hyperuricemia have a common pathogenesis, they are related to each other, cause and effect, and affect each other.Therefore, in the prevention and treatment of type 2 diabetes and chronic complications, we must not only pay attention to the control of blood glucose, blood pressure, blood lipids, weight, etc., but also pay attention to the risk factor of hyperuricemia and give relevant treatment in time.So when diabetes suffers from hyperuricemia, how should the medicine be used?On this issue, we divide into two angles to discuss in detail.1 Selection of uric acid lowering and anti-gout drugs ▎Uric acid lowering glucose metabolism patients with blood uric acid> 480μmol / L should immediately start uric acid lowering drug treatment.In theory, lowering blood uric acid can improve insulin resistance, increase insulin sensitivity, and protect pancreatic β-cell function, which is conducive to blood glucose control.Therefore, the currently used uric acid-lowering drugs have no adverse effect on blood sugar, but pay close attention to the adverse reactions of the drugs during use.▎Anti-gout drugs clinically hyperuricemia often causes gout, and gout attacks may be induced during uric acid lowering treatment. Therefore, the application of anti-gout drugs has to be considered during the treatment of diabetes combined with hyperuricemia.The commonly used drugs for gout attacks are: colchicine, non-steroidal anti-inflammatory drugs (NSAIDs) or glucocorticoids.Glucocorticoids may significantly increase blood sugar. Therefore, when diabetes occurs with gout, we should try to avoid using glucocorticoids.However, on the other hand, the gout treatment guidelines suggest that in order to avoid worsening renal function, gout should be used to control the onset of gout.If a diabetic patient is associated with renal insufficiency and gout at the same time, we need to consider the use of glucocorticoids as appropriate according to the patient’s blood glucose or renal function, and closely monitor changes in blood glucose and renal function during the medication.2 The choice of hypoglycemic drugs The goal of hypoglycemic treatment is not only to control blood sugar, but also to reduce the complications of diabetes and reduce the risk of death, thereby improving the long-term prognosis of patients.When diabetes encounters the special case of hyperuricemia, choose a hypoglycemic drug. In addition to paying attention to the efficacy of hypoglycemic agents, attention should also be paid to the effect of hypoglycemic drugs on uric acid. In principle, it does not affect the metabolism of uric acid and does not increase or induce it.Gout hypoglycemic drugs are preferred.The following briefly introduces the characteristics of current hypoglycemic drugs and their effects on uric acid▎α-glucosidase inhibitors: Delays the absorption of carbohydrates by inhibiting intestinal α-glucosidase activity, which is suitable for carbohydrate-basedAnd postprandial blood sugar rise.Domestically listed are acarbose, voglibose and miglitol.Among them, acarbose can reduce the increase of blood uric acid level caused by sucrose decomposition.▎thiazolidinediones (TZDs): Reduce blood glucose mainly by increasing the sensitivity of target cells to insulin action and reducing insulin resistance.There are mainly rosiglitazone and pioglitazone, which can reduce fasting and postprandial blood glucose, reduce glycated hemoglobin, and improve lipid metabolism disorders.May reduce blood uric acid levels by reducing insulin resistance and improving lipid metabolism.▎Metformin: Metformin can inhibit glycogen breakdown, promote glucose utilization, and increase the sensitivity of the body’s insulin to reduce blood sugar, while also having a weight loss effect.It is generally believed that metformin reduces weight and reduces triglycerides by suppressing appetite, increases insulin sensitivity, reduces renal tubular epithelial cell apoptosis, thereby improving renal function, promoting blood uric acid metabolism, and thereby lowering blood uric acid levels.▎SGLT2 inhibitor: By inhibiting the sodium glucose cotransporter 2 (SGLT2) activity of the renal proximal tubule reabsorbs glucose, it increases urine glucose excretion and lowers blood sugar.Studies have shown that SGLT2 inhibitors can reduce blood uric acid by 10% to 15%.Blood uric acid, like blood glucose, is also absorbed in the proximal tubules.SGLT2 inhibitors increase urinary glucose excretion and increase uric acid secretion in response to the reabsorption of glucose, resulting in increased uric acid excretion. DDP-4 inhibitors and GLP-1 receptor agonists: dipeptidyl peptidase-4Although (DPP-4) inhibitors and glucagon-like peptide-1 (GLP-1) receptor agonists have different sites of action, they are both drugs that promote insulin secretion indirectly through intestinal insulinotropin.It promotes insulin secretion in a glucose concentration-dependent manner. As the blood glucose increases, the amount of insulin secretion increases, but when the blood glucose concentration is too low, it no longer promotes insulin secretion.These two drugs can improve islet function, reduce insulin resistance, do not cause elevated blood uric acid, and even reduce serum uric acid by reducing serum insulin levels and weight.Sulfonylureas: Reduce blood sugar by stimulating islet β-cell secretion of insulin, increasing insulin levels in the body.Among them, glibenclamide, glimepiride, gliclazide and other drugs that are mainly excreted by the kidney may affect kidney function and reduce the excretion of uric acid, but the overall effect is not significant.Gliquidone has little effect on uric acid mainly through bile excretion.Glinate: It is a blood glucose regulator for meals. It can increase serum insulin concentration to reduce glucose. It is mainly metabolized by the liver and has little effect on uric acid. However, it is also believed to cause hyperinsulinemia, and insulin can promote kidney to uric acid.Reabsorption, causing an increase in blood uric acid.▎Insulin is a good medicine for treating various types of diabetes, but the drug can increase the reabsorption of uric acid and increase the blood uric acid level in the metabolic process of the body.Although hyperinsulinemia is the main cause of elevated blood uric acid levels, other studies have found that short-term intensive insulin therapy can effectively improve insulin resistance and reduce blood uric acid levels in patients with type 2 diabetes.Therefore, insulin can affect the level of blood uric acid from multiple levels. It cannot be simply said that the use of insulin must increase or decrease blood uric acid, which is closely related to the dose of insulin used by the patient and the pancreas and pancreas function of the patient..From the characteristics of the above-mentioned hypoglycemic agents, metformin, TZDs, α-glucosidase inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors can improve islet function, reduce insulin resistance, and reduce blood uric acid to some extent.Role, SGLT-2 inhibitors can directly promote the excretion of uric acid. If there is no contraindication, these types of hypoglycemic agents are preferred for patients with diabetes and hyperuricemia; insulin secretagogues (sulfonylureas and glienafil) are generallyIt is said that it has little effect on uric acid, but after all, insulin secretagogues can increase serum insulin concentration and may not be conducive to uric acid excretion, so it is not recommended; insulin can promote renal reabsorption of uric acid and adversely affect uric acid excretion, so it is useful for diabetesPatients with high uric acid are not suitable.For insulin secretagogues and exogenous insulin, if it must be used, it is best to use it in combination with metformin or insulin sensitizers, alpha glucosidase inhibitors, and reduce the amount of insulin as much as possible.In short, diabetes combined with hyperuricemia requires a combination of both and comprehensive treatment.In terms of drug selection schemes, drugs that lower blood uric acid theoretically, lowering blood uric acid can help lower blood sugar, and have no effect on blood sugar as a whole; however, some blood glucose lowering drugs may cause uric acid to increase.As far as possible, you should choose a hypoglycemic agent that is beneficial to uric acid excretion..

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How to adjust the glucose-lowering drugs for diabetes patients?

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The current guidelines for the prevention and treatment of type 2 diabetes mellitus include indications, contraindications, surgical methods, surgical risks, and postoperative management of bariatric surgery. However, there is no detailed description of drug adjustments for patients undergoing bariatric surgery.The “Expert Consensus on Perioperative Management of Weight Loss Metabolic Surgery (2019 Edition)” issued by the Professional Committee of Diabetes and Obesity Surgery of the Chinese Research Hospital Association explains the management of various combined states of weight loss surgery.What about blood sugar management during surgery?Preoperative glycemic control target weight loss is mainly to optimize patients’ metabolic indexes before surgery. For the glycemic control target, refer to the China Guidelines for the Prevention and Treatment of Type 2 Diabetes (2017 Edition). The glycated hemoglobin level is 6.5% -7.0%, and fasting blood glucose is <6.1mmol /L. Blood sugar at 2h after meal is less than 7.8mmol / L.The target value of glycated hemoglobin in patients with diabetic complications or poor glycemic control is <8.0%.Preoperative and intraoperative drug regimens should be discontinued and the glitazones, glitalides, and dipeptidyl peptidase-4 inhibitors should be discontinued and the basal insulin dose reduced to 0.3U / kg 24 hours before surgery.Metformin was discontinued on the day of surgery.On the day of surgery, blood glucose should be controlled <7.8mmol / L.When the patient's blood glucose was> 7.8mmol / L, 1U short-acting insulin was used to correct each blood glucose value exceeding 2.2mmol / L.It is recommended to use glucose, insulin, potassium combined with intravenous infusion during operation, and adjust the ratio of glucose to insulin in time according to blood glucose changes.At the same time, it is necessary to pay attention to the occurrence of hypoglycemia during the operation, and 5% glucose solution (100-125mL / h) can be infused intravenously to prevent hypoglycemia.Early treatment of postoperative drug use strategies: The principle of supplementing fluids and preventive antibacterial drugs after weight loss is the same as that of conventional gastrointestinal surgery. It is usually not necessary to add extra fat milk or amino acids, but you should pay attention to monitoring the patient’s blood glucose level.The amount of individual daily fluid replacement needs to be determined based on the patient’s weight.The patient’s renal function has been controlled, and it is recommended to resume metformin use on the third day after surgery, the dose is 850mg, 1-2 times a day.For patients after gastric bypass, metformin has increased bioavailability by 50%, so doses should be reduced.The fasting blood glucose value should be adjusted on the 7th to 10th days after the operation, and the blood glucose should be monitored at least twice a day. Among them, the fasting blood glucose target value in the early morning is 5.6-6.7mmol / L, and the target blood glucose value is 2mmol / L at 2h after the mealAvoid the use of sulfonylureas and other medications that can cause a risk of hypoglycemia.Long-term treatment: Some patients with type 2 diabetes have relieved their diabetes after weight loss, but some patients still need to use diabetes drugs. The principle of drug use for these patients follows the China Guidelines for the Prevention and Treatment of Type 2 Diabetes (2017 Edition).Blood pressure and blood lipids.Patients with postoperative blood glucose monitoring program should regularly monitor blood glucose levels after discharge.It is recommended to monitor 2-4 times a day, including early morning fasting blood glucose, to understand the regularity of blood glucose fluctuations.Regularly checking blood sugar levels can help patients build and adapt to a new lifestyle.The target of postoperative blood glucose control is 4.0-7.0mmol / L before meals, blood glucose 5.0-10.0mmol / L at 2h after meals, and glycated hemoglobin <7.0%, the incidence of long-term complications after surgery is significantly reduced.It is recommended to evaluate the glycated hemoglobin, fasting and 2 h postprandial blood glucose, insulin, and C-peptide levels within 1 year after the operation. At the same time, a glucose tolerance test (simultaneous blood glucose and insulin, CPeptide level) to clearly assess pancreatic β-cell function. If significant insulin resistance persists, metformin therapy can be used.The follow-up interval was then determined based on the patient's glucose metabolism status.It should be noted that very few patients receiving SG may have recurrent hypoglycemia after surgery. At this time, non-insulinoma pancreatic hypoglycemia syndrome, human factors, iatrogenic factors, dumping syndrome and insulinoma should be performed.Screening for other causes.How to prevent hypoglycemia after weight loss surgery should be treated in time, but it is also important to prevent blood glucose fluctuations and hypoglycemia in patients.The following points need to be noted in the postoperative diet: 1) Slow down the eating speed and eat less frequently.2) Avoid concentrated sweets to prevent dumping syndrome and severe fluctuations in blood sugar.3) Avoid eating fried and non-digestible food.4) Avoid irritating foods such as ice water, coffee, tea, and alcohol within 3 months after surgery.The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party..

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Total blood sugar control is not good, patients with type 2 diabetes can also try it

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Does T2DM patients benefit from continuous glucose monitoring?CGM is more commonly used in patients with type 1 diabetes. CGM is a monitoring technology that uses the glucose sensor to monitor the glucose concentration of subcutaneous tissue fluid and indirectly reflect the blood glucose level. The sensor continuously measures glucose and detects the inter-tissue interval every 10 seconds.Fluid, giving an average every 5 minutes, and can read 288 data per day, so CGM can provide continuous, comprehensive, and reliable all-day blood glucose information, understand the trend of blood glucose fluctuations, and find that it is not easy to be detected by traditional monitoring methodsOccult hyperglycemia and hypoglycemia.However, the benefits of CGM in patients with type 2 diabetes have not been identified, so the use of this blood glucose test is limited.A large proportion of patients with type 2 diabetes are elderly, often with complications, and multiple medication problems. CGM can personalize diabetes management. A recent study used a meta-analysis to monitor continuous blood glucose in patients with type 2 diabetes.(CGM) and self-glycemic monitoring (SMBG) were systematically reviewed.Researchers conducted a systematic literature search in Medline (PubMed). There are different levels of evidence supporting the use of CGM to reduce glycated hemoglobin (HbA1c), reduce the incidence of hypoglycemia events, and increase patient satisfaction.A meta-analysis has shown that the use of CGM in patients with type 2 diabetes is beneficial, and it can significantly reduce glycated hemoglobin compared to conventional methods of SMBG.The research methods and results were searched by grid words and keywords. Finally, 628 studies were selected. These studies included a comparison of the use of CGM and SMBG (or other conventional methods) in patients with type 2 diabetes (≥19 years).Hemoglobin was used as the result of blood glucose control, and the average baseline glycation was ≥6.5%.Exclude studies involving pregnant women and hospitalized patients.The final meta-analysis included only 5 RCT studies, of which 382 patients had type 2 diabetes that met our study criteria, and one of the studies had patients withdrawn. Therefore, the final meta-analysis included 374 patients with type 2 diabetes and 186 patients with dynamic blood glucose.Monitoring, 188 cases were the control group (SMBG group).The study lasted 3-8 months, with baseline saccharification levels ranging from 6.9% to 12%. In addition, at baseline, the cumulative average saccharification of all RCTs was 8.53%, indicating poor glycemic control.Findings: Using the RevMan 5 tool to perform a cumulative analysis of all data from five RCTs, this model resulted in very low data heterogeneity.Data from five RCT studies showed that compared with SMBG, patients with type 2 diabetes can reduce glycated hemoglobin by 0.25%, 95% CI: 0.45-0.06, P = 0.01.The difference in the combined mean HbA1c was -0.25 (-0.45, -0.06).Advantages of using CGM in T2DM patients CGM is the latest tool to control diabetes. This study conducted a meta-analysis of the use of CGM in patients with type 2 diabetes. Most studies focused on HbA1c, hypoglycemia, glucose variability, and patient satisfaction.several aspects.1. The continuous feedback mechanism of glycated hemoglobin CGM can make glycation lower: this indicator is the main observation result of most studies that study the use of CGM in type 2 diabetes.In contrast, the use of CGM can reduce saccharification. However, a Japanese study conducted in university hospitals published in 2016 concluded that the use of CGM had no significant reduction in saccharification, but compared with other studies, the Japanese study had a very large sample size.small.In this meta-analysis, analysis of the aggregated data of the five included RCT studies shows that compared with SMBG, CGM can effectively reduce the level of saccharification, with an average difference of -0.25, 95% CI: (-0.45, -0.06), p = 0.01.The cumulative average glycation of these five RCT baselines was 8.53%, which means that CGM is effective for patients with type 2 diabetes who have poor glycemic control.Discontinuation of CGM, sugar control effect is still there: intermittent use of real-time CGM (RT-CGM) for 12 weeks has been shown to effectively reduce glycation levels in patients, even if CGM is stopped after 12 weeks, researchers have found this positive effect on blood glucoseThe effect remained at 40 weeks.That is to say, the short-term use of CGM is also beneficial to patients. Through real-time feedback of glucose changes, patients can better understand how to choose food. Such a feedback mechanism can enable patients to develop a healthy lifestyle, which is very important for patients’ daily management.2. Timely detection of nocturnal hypoglycemia. In the management of diabetic patients, strict glycemic management helps prevent chronic complications. However, in the strict control of sugar, hypoglycemic events have attracted much attention.Due to concerns about the occurrence of hypoglycemia, strict control of blood glucose is limited in many cases. In elderly patients with diabetes, hospitalizations due to hypoglycemia events are more common than hyperglycemia.Long-term patients may have peripheral neuropathy leading to an increase in asymptomatic hypoglycemia (there is no corresponding warning in the body when hypoglycemia occurs). In addition, nighttime hypoglycemia is not easy to detect. Compared with SMBG, the hypoglycemic events detected by CGMs are obvious.More, therefore, dynamic blood glucose monitoring helps to detect hypoglycemia in time, especially concealed hypoglycemia or nocturnal hypoglycemia, so that patients and their families can take appropriate actions in a timely manner.Of course, some studies have found no difference in the detection of hypoglycemia between the two methods. This may be because these populations are relatively stable and have low blood glucose fluctuations, so they are not enough to detect differences between groups.3. Both the blood glucose fluctuation and the time to reach the standard HbA1c and SMBG can estimate the average glucose value, but they lack the monitoring of blood glucose fluctuation. It is observed that most of the high blood sugar occurs after meals, and most of the low blood sugar occurs at night, in the morningIf you measure your blood sugar with your fingers before meals, these poor blood glucose control conditions will be missed. In addition, because saccharification is related to the average blood glucose level and the extreme values ​​are ignored, it sometimes does not reflect the true situation of the patient. For example, there are reports that obese patients mayIncorrectly displayed low saccharification values.CGM will generate a large amount of blood glucose data, which can make up for the above shortcomings. Among them, the time to achieve standard (TIR) ​​is an important parameter to evaluate the quality of blood glucose control. The time (or number) of blood glucose in the target range accounts for the total measurement time (or number); the target rangeGenerally set to 70-180mg / dl (3.9-10mmol / L), and sometimes set to 70-140mg / dl (3.9-7.8mmol / L).The 2020ADA diabetes diagnosis and treatment specification mentions that below the target time (<3.9 and 3.0 mmol / L) and above the target time (> 10.0 mmol / L) in CGM are useful parameters for re-evaluating the treatment plan.4. Patient satisfaction This is a key factor in determining whether patients use CGM in their daily lives. Compared with saccharification (checked every three months) or finger blood test, CGM equipment is always connected to the patient’s body, each time it takes 7-14-day monitoring, however, the research report found that patients ‘compliance with CGM use was very high, which may be related to patients’ recognition of the accuracy of the equipment and the availability of data.Other studies have also confirmed the satisfaction of patients. By using CGM to effectively control patients’ energy intake, their weight has been significantly reduced, and their blood pressure has also been reduced. In addition, real-time dynamic blood glucose monitoring can timely feedback the patient’s blood glucose during diet and exercise.Change the situation and urge patients to adhere to a healthy lifestyle for a long time.However, some studies have found no significant differences in patient weight, blood pressure, and patient satisfaction.Summary At present, CGM is mainly used in patients with type 1 diabetes, but this technology is expensive and currently not widely used in patients with type 2 diabetes. For patients with type 2 diabetes who have poor glycemic control, try to make a dynamic blood glucoseMonitoring, combined with your own diet, exercise and medication, may be able to discover the characteristics of your own blood sugar, and help patients better diet and exercise, and help better control blood sugar.Of course, CGM requires regular fingertip blood glucose calibration. At the same time, researchers pointed out that the device is inaccurate when blood glucose is low, and it takes 5-20 minutes for the glucose level between blood vessels and interstitial fluid to reach equilibrium.Therefore, some people think that its detection is not reliable, especially in the case of fluctuating blood glucose delivery.In addition, the device needs to be applied to the skin, and it takes a long time, so some people will feel uncomfortable.Therefore, for the application of CGM in diabetic patients, we must see the advantages and disadvantages and take a comprehensive view..

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5 Essential Knowledge for Diabetes Exercise Therapy!

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Lifestyle management plays the most basic and important role in diabetes care. The well-known diabetes research in our country, the Daqing Research, has made a sensation in the world because lifestyle intervention can prevent diabetes for the first time, and rewritten the guidelines for diabetes prevention …”Eating people as food” is the most popular idiom in China. It is also the most important part when referring to lifestyle interventions. Patients always like to ask, “Doctor, do I have any taboos about getting diabetes?” But rarelyThe patient asked, “How should I live with diabetes?” Lifestyle interventions include not only diet therapy (also called nutrition therapy), but also exercise therapy, psychotherapy, and patient self-management.Today, we will briefly talk about what benefits diabetes exercise can bring to patients with diabetes!01 Prevention of diabetes, exercise is more effective than diet control!Exercise can increase physical fitness, reduce obesity, improve heart and lung function, and thus reduce the incidence of diabetes.Some research statistics show that less than 5% of patients with diabetes exercise regular exercise, and the incidence of type 2 diabetes in people who are physically active is significantly reduced [1].And the famous Daqing research results show that the annual incidence of diabetes patients in the exercise treatment group is significantly lower than the control group and the diet treatment group [2].02 Different sports, different effects!Studies have shown that if you perform moderate-intensity aerobic exercise (to the level of sweating) more than once a week, such as walking, jogging, cycling, etc., the incidence of type 2 diabetes will be significantly reduced.Patients with type 2 diabetes performed 50% to 60% of the maximum oxygen uptake aerobic exercise for 8 weeks, and found that the average cardiac output of the patient increased, blood pressure decreased, and resting heart rate decreased [3].In addition, 30 minutes of moderate-intensity exercise can improve the sensitivity and binding ability of insulin receptors and accelerate the use of blood glucose [4]; long-term aerobic exercise can effectively promote the increase in the number and activity of insulin receptors [5].03 Exercise can significantly improve blood sugar!If the condition allows, maintaining a regular, moderate-intensity exercise for a long time can significantly reduce fasting blood glucose and postprandial blood glucose [6].Hyperglycemia is a hallmark of diabetes, including both persistent and fluctuating hyperglycemia.A 12-week exercise regimen based on strict diet control can significantly reduce glycated hemoglobin and insulin resistance index (insulin resistance index = fasting blood glucose x fasting insulin / 22.5), and improve blood glucose fluctuations [7].04 Exercise can effectively prevent complications [8]!1. Systematic, long-term medium-intensity aerobic exercise is of great significance in preventing and treating various complications such as diabetic cardiomyopathy, cerebrovascular disease, kidney disease, and fundus disease.2. Exercise can enhance nerve conduction and thereby improve peripheral neuropathy, including diabetic foot.3. Lifestyle intervention techniques including quantitative energy expenditure exercise prescription can significantly improve glucose and lipid metabolism in patients with type 2 diabetes.05 Not all people with diabetes can exercise!The first thing to be clear is that not all patients with diabetes need / suit for exercise therapy. Like all treatment methods, exercise therapy has its indications and contraindications [9].In addition, the exercise capacity and level of the patient should be considered when formulating the exercise prescription for diabetes. Preparatory and tidying activities must be taken before and after exercise to avoid cardio-cerebral vascular accidents, musculoskeletal and joint injuries, and ensure the safety of exercise.The above content is only authorized by 39Health.com for exclusive use, please do not reprint without authorization of the copyright party.

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What are the early symptoms of diabetes?

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Diabetes is a relatively common chronic disease in life. It occupies a certain proportion in the middle-aged and elderly patients. It is not diabetes itself that ultimately kills patients, but the complications caused by diabetes.But if the blood sugar control is stabilized after the illness, you can safely spend the old age.So what are the early symptoms of diabetes?Although diabetes is a lifelong disease, if blood sugar is controlled properly, complications will not occur prematurely.This requires paying attention to the details of your life and your diet after you become ill.But how do you know if you have diabetes?Let ’s introduce what are the early symptoms of diabetes. Friends who do n’t know much about it can learn from it below.Diabetes generally does not have too obvious discomfort and clinical manifestations at an early stage, and it needs to be known by testing blood glucose. Therefore, regular periodic medical examinations will ring alarm bells for patients.Here we introduce the early symptoms of diabetes through typing.1. Type 1 Diabetes: Type 1 diabetes found during adolescence is more common, usually with more rapid onset, and there will be “three more and one less” clinical manifestations before diagnosis.That is, drink more, drink more urine, eat more and lose weight.2. Type 2 Diabetes: Type 2 diabetes is mostly adult patients, and usually develops after the age of 40. Often, it is more common in obesity and dyslipidemia.And high blood pressure can accompany it.With the continuous improvement of dietary conditions, there are not a few who are sick before the age of 40, and some patients have a family history.3, abnormal blood glucose in the early stages of diabetes: hypoglycemia may appear in the early symptoms of diabetes, such as symptoms of palpitation, nausea and cold sweat 3-5 hours after a meal, and some patients will have significantly increased blood sugar,It is also accompanied by changes in vision, skin infections, and gingivitis.Regular physical examinations can be made available in time for the early onset of diabetes, and early control of blood sugar, so as to prevent the rapid development of the disease, will also be very helpful for future treatment.

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