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Abstract:There is more higher prevalence of diabetes in the elderly population and some clinical characteristics in these elderly patients, such as insidious onset of diabetes accompanied with different diseases and/or diabetic complications. These patients usually take more kinds of drugs, sometimes forget taking drugs and are easily complicated with cardiovascular and other events after severe hyperglycemia or hypoglycemia. Actually there is big variance in these elderly patients on their health, medical care, economic level and the ability of self-care. It is most important to carry out the individualized treatment and to put the safety first in controlling blood glucose and multi-cardiovascular risk factors. The earlier screening and diagnosis of diabetes, scientific, effective and safe treatment are the principles in the management of hyperglycemia in these patients. The target of controlling blood glucose level is not as strict as that in younger diabetic patients based on their basic health condition, diabetic complications, and their quality of life, etc.

Abstract:Objective To investigate the relationship between ankle-brachial index (ABI) and diabetic peripheral neuropathy (DPN) in patients with type 2 diabetes mellitus(T2DM). Methods ABI was determined in 427 patients with T2DM by Doppler ultrasound, and the patients were divided into group A (ABI≥0.9) and group B (ABI＜0.9). The sensory nerve conduction velocity (NCV), latent period and amplitude of posterior tibial nerve in all patients with T2DM were determined by electromyography. These indexes were compared between the two groups, and their relationships were analyzed by linear correlation analysis and multiple linear regression. Results There were 115 patients with ABI＜0.9 in group B, accounting for 26.9%. The nerve conduction velocity [left NCV: (30±8) vs (32±7) m/s, right NCV: (29±6) vs (33±7) m/s, P＜0.01] and amplitude [left amplitude: (10±12) vs (15±16) mV, right amplitude: (9±7) vs (14±13) mV, P＜0.01] of posterior tibial nerve were lower in group B than in group A, and the latent period [left latent period: (8.2±2.0) vs (7.4±1.4) ms, right latent period: (8.3±1.7) vs (7.4±1.3) ms, P＜0.01] of posterior tibial nerve were higher in group B than in group A. ABI was negatively correlated with latent period and positively correlated with amplitude of posterior tibial nerve in T2DM patients. After adjustment with a series of confounding factors such as age, course of disease, body mass index (BMI), systolic blood pressure, total cholesterol, low density lipoprotein cholesterol (LDL-C), serum creatinine, NCV and amplitude, multivariate analysis results demonstrated that ABI was associated with age, LDL-C, NCV and BMI. Conclusions In patients with T2DM, peripheral artery disease is a potentially important influencing factor for diabetic peripheral neuropathy.

Abstract:Objective To investigate the association of type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD) with adipocytokines. Methods One hundred subjects from our medical examination center were included in the study. The control group comprised 47 subjects(group A) and the NAFLD group comprised 53 subjects (group B). One hundred and forty inpatients with T2DM were divided into two groups according to the abdominal ultrasound. Seventy-nine patients had T2DM(group C) and 61 patients had T2DM and NAFLD (group D). All the participants were subjected to measurement of liver function, lipids, blood glucose, insulin, C reactive protein (CRP), uric acid, adiponecin(APN) and tumor necrosis factor-α (TNF-α). Results The body mass, body mass index (BMI), waist circumference, levels of lipids, insulin, HOMA-IR, transaminase and uric acid in group B were significantly higher than those in group A(P＜0.01). β-cell function was significantly lower in group B than in group A(P＜0.01). The levels of fasting insulin, cholesterol, triglycerides(TG), uric acid, alanine aminotransferase (ALT) and γ-glutamyltransferase (GGT) in group B were significantly higher than those in group C(P＜0.01). The body mass, waist circumference, levels of fasting insulin, TG, HOMA-IR, ALT and GGT in group D were significantly higher than those in group C(P＜0.01). The blood pressure and levels of HOMA-IR in group D were higher than those in group B(P＜0.01). The APN levels in group B, C and D were significantly lower (P＜0.01), and TNF-α levels were significantly higher than those in group A(P＜0.01). The APN levels of group D were lower (P＜0.01), and TNF-α levels were higher than those in group B and C (P＜0.01). The logistic regression analysis showed that TG and TNF-α were independent risk factors for NAFLD. The APN was negatively associated with HOMA-IR, TG, waist circumference, TNF-α. And TNF-α was positively associated with fasting insulin, HOMA-IR, negatively associated with APN. Conclusions The adipocytokines probably play a role in the pathophysiology of T2DM and NAFLD, and the restoration of the adipocytokines has some clinical significance.

Abstract:Objective To investigate the prevalence of diabetic retinopathy (DR) and its risk factors in type 2 diabetes mellitus (T2DM) inpatients of Shanghai region. Methods A total of 2454 T2DM inpatients were included. Clinical data were collected and the levels of DR were assessed with non-mydriatic retinal photographs according to the Diabetic Retinopathy Disease Severity Scale. The prevalence of DR and its risk factors were analyzed using trend analysis and logistic stepwise regression analysis. Results The prevalence of DR in T2DM inpatients was 32.7%. With the increment of age, diabetes duration and HbA1c levels, the prevalence of DR increased consequently (P＜0.05). The risk factors of retinopathy in T2DM patients included diabetes duration (OR＝1.107, 95% CI 1.089-1.125, P＜0.0001), glycated hemoglobin (OR＝1.071, 95% CI 1.024-1.119, P＝0.0026) and systolic blood pressure levels (OR＝1.016, 95% CI 1.010-1.022, P＜0.0001). The age of T2MD onset was also associated with DR(OR＝0.991, 95% CI＝0.981～1.000, P＝0.0556). Conclusions The prevalence of DR is relatively high in T2DM inpatients. Duration of T2DM, status of glycemic control and hypertension are independent risk factors for T2DM patients.

Abstract:Objective To identify the risk factors for the occurrence and development of diabetic foot(DF) in patients with type 2 diabetes mellitus, and to study the influence of blood glucose fluctuation on DF. Methods Clinical data of 192 patients with non-DF and 575 patients with DF were analyzed. According to the severity of DF, 575 DF patients were further divided into Wagner 1~2, Wagner 3, and Wagner 4~5 subgroups. According to whether amputation was performed or not, 575 patients with DF were further divided into DF with amputation and without amputation groups. The analysis factors included biochemical indicators, standard of blood glucose (SDBG), coefficient of variation(CV) of fasting plasma glucose(CV-FPG), large amplitude of glycemic excursions(LAGE). Results Compared with NDF group, the age, diabetic course, serum creatinine, blood uric acid, hyper-sensitivity C reaction protein(hsCRP), Alb/Cr, SDBG, CV-FPG, and LAGE were higher, and total protein, serum albumin, total cholesterol, triglyceride and low density lipoprotein cholesterol were lower in DF group. The difference was statistically significant in hsCRP, SDBG, CV-FPG between the two groups(P＜0.05). Compared with NDF group, the DF with amputation group had significantly increased SDBG, CV-FPG and LAGE(P＜0. 05). Among which, SDBG was also significantly different between DF with amputation and without amputation groups(P＜0.05). Logistic regression analysis showed that hsCRP, Alb/Cr, serum albumin, SDBG and CV-FPG were the independent risk factors for diabetic foot; and that SDBG was the independent risk factor for amputation in DF patients. Conclusion The fluctuations in hsCRP, Alb/Cr, serum albumin, SDBG, CV-FPG are closely related to the development of DF.

Abstract:Objective To determine the risk factors of diabetic foot amputation from the view of nutrition so as to provide clinical basis for treatment and prevention of diabetic foot amputation. Methods Totally 311 patients with diabetes were enrolled, and were divided into amputation group, non-amputation group, and no diabetic foot group. Clinical characteristics, clinical examination results and nutrition related indicators were retrospectively analyzed. The continuous data were examined with t test, and discrete data with chi-square test. The factors with statistical difference screened from univariate analysis underwent multivariate logistic analysis. Results The incidence of amputation was 27.97% (87/311). Among which, there were 7 cases under 55 years old(8.05%; 7/87) and 80 cases over 55 years old (91.95%; 80/87); 20 cases with disease course less than 5 years (22.99%; 20/87), 11 cases with disease course ranging from 5～10 years (12.64%; 11/87), 56 cases with disease course longer than 5 years (64.37%; 56/87). There were significant differences in age and disease course between amputation group and non-amputation group (P＜0.01). The independent risk factors of amputation for diabetic foot included age, diabetes course, serum albumin, hemoglobin, glycated hemoglobin and high-sensitivity C-reactive protein. Conclusion Patients with diabetic foot amputation suffers poor nutrition. We recommend to strengthen the nutrition support for these patients, so as to enhance ulcer healing and reduce amputation risk.

Abstract:Objective To investigate the correlationship between education level and cardiac risk factors in Chinese patients with type 2 diabetes mellitus(T2DM). Methods The diabetic patients, who underwent diabetic complication assessment and had clinical data for cardiac risk factors screening were enrolled. The subjects were divided into 4 groups according to their education level. The controlling state of cardiac risk factors was compared between 4 groups. Results Totally 9921 patients entered the study. The diabetic patients carrying more than two cardiac risk factors (patients with metabolic syndrome) accounted for 57.3%. With the elevation of education level, the proportion of female patients increased; the blood pressure, heart rate, fasting plasma glucose(FPG), 2-hour postprandial glucose, HbA1c, HOMA-insulin resistance, total cholesterol(TC), high density lipoprotein cholesterol(HDL-C), low density lipoprotein cholesterol(LDL-C), and urine albumin/creatinine ratio decreased; uric acid increased; the qualifying rate for control of TC, HDL-C, blood pressure, FPG, waist circumference and HbA1c increased gradually; prevalence of MS decreased. Conclusions The T2DM patients with low education level have lower qualifying rate of cardiac risk factors and carry more cardiac risk factors.

Abstract:Objective To determine the CT angiographic characteristics of coronary artery of diabetic patients in different age groups and to discuss the appropriate time for them to undergo coronary computed tomography angiography(CCTA). Methods A retrospective analysis was performed on the coronary CT angiographic characteristics of 1876 diabetic patients suspected of coronary heart disease (CHD). These patients were divided into＜60 years group (878 cases) and≥60 years group(998 cases). The coronary stenosis and calcification score were compared between the two age groups after stratification by hypertension, dyslipidemia, obesity and smoking. Results There were significant differences between the two groups in the prevalence of coronary stenosis (32.11% vs 24.39%, P＜0.05) and the prevalence of multivessel lesions (23.25% vs 14.01%, P＜0.05). After stratification by obesity, smoking, and dyslipidemia, the statistical analysis showed that there were more patients who had severe or/and moderate coronary stenosis, multi-vessel lesions and higher calcium score in≥60 years group than in＜60 years group(P＜0.05). Conclusions For diabetic patients with multiple coronary risk factors and aged≥60 years, early screening for coronary artery disease is recommended. CCTA is a simple and noninvasive method for this task.

Abstract:Objective To observe effect of beraprost sodium(BPS) on inflammatory factors in type 2 diabetic mellitus(T2DM) rats. Methods Thirty SD rats were randomly divided into control group, T2DM group, BPS treatment group. High-fat diet-fed was performed in DM and BPS rats to set T2DM model, and BPS of 0.6mg/(kg·d) was given to BPS rats. After 8 weeks, there were 6 rats left in each group, and the levels of interleukin-6(IL-6), tumor necrosis factorα(TNF-α), myeloperoxidase(MPO) and high sensitive-C reactive protein(hs-CRP) were determined in all groups. Results After 8 weeks of treatment, the levels of IL-6, TNF-α, MPO and hs-CRP were higher in T2DM rats than in control rats. In BPS rats, the levels of IL-6, TNF-α, MPO and hs-CRP were significantly lower than those in T2DM rats. Conclusion Beraprost sodium can significantly reduce the levels of inflammatory cytokines and alleviate the inflammation damage.

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Abstract:Peripheral artery disease (PAD) is more common, severe and more aggravated in the patients with diabetes mellitus. The conservative treatment of PAD should take into consideration two aspects: control of cardiovascular risk factors, and symptomatic treatment of intermitent claudication. Pentoxifylline, cilostazo, Sarpogrelate, and prostaglandins E can alleviate the peripheral ischemic symptoms, increase walking distance and improve the quality of life.

Abstract:Objective The importance of pharmacogenetic algorithms in warfarin dose prediction has drawn more attention. However, their performance has still been influenced by race and multiple clinical factors including warfarin dosage. The aim of this study was to evaluate the relationship of warfarin dosage with polymorphisms of CYP2C9*3, VKORC1-1639 A/G and CYP4F2*3, and the accuracy of pharmacogenetic algorithms. Methods We detected the polymorphisms of CYP2C9*3,VKORC1-1639 A/G and CYP4F2*3 in a cohort of Chinese patients (n＝282) under low intensity warfarin anticoagulation with target international normalized ratio (INR) ranging from 1.6 to 2.5, and evaluated the relationship between warfarin dosage and these polymorphisms. Then, the patients were stratified to 3 groups according to the dose range: higher dose group (≥4.5 mg/d), intermediate dose group (1.5～4.5 mg/d), and lower dose group (≤1.5 mg/d). We evaluated the performances of 8 eligible pharmacogenetic algorithms in different dose range. The performance of each algorithm was evaluated by calculating the percentage of patients whose predicted dose fell within 20% of their actual therapeutic dose (percentage within 20%), and the mean absolute error (MAE) between each predicted dose and actual stable dose. Results In the entire cohort, warfarin doses differed significantly across genotypes for CYP2C9*3 (P＜0.001), VKORC1-1639 A/G (P＜0.001), and CYP4F2*3 (P＝0.025). The algorithms from Caucasian and racially mixed populations tended to perform better in higher dose group, and algorithms from Asian populations performed better in intermediate dose group. None of the algorithms performed well in lower dose group. Conclusions Polymorphisms of CYP2C9*3, VKORC1-1639 A/G and CYP4F2*3 associate with stable warfarin dose in Chinese patients. No eligible pharmacogenetic algorithm could perform satisfactorily for all dosing range in the Chinese patients.

Abstract:Objective To study the role of heart rate(HR) variation in predicting the development of heart failure(HF). Methods According to the standard of HF staging system from the American Cardiology College (ACC)/the American Heart Association (AHA), four groups of the subjects were involved in the study: the normal control group (70 cases), HF high risk group(70 cases), cardiac function compensatory group(70 cases) and HF group (32 cases). All subjects underwent the 6-minute walk test. HR before and after the exercise was compared, and the walking distance was recorded. The HR variation and the 6-minute walk distance were compared between different groups. The relationship of HR with the 6-minute walk distance was analyzed. Results The resting HR was higher in cardiac function compensatory group and HF group than in normal control group and HF high risk group (P＜0.05). HR immediately after exercise had no statistical difference between the four groups (P＞0.05). The HR variation degree and 6-min walk distance displayed decreasing tendencies with the gradual development of HF (P＜0.05). The resting HR and the 6-minute walk distance was negatively correlated (r＝-0.311, P＜0.01). HR variation degree and the 6-minute walk distance was positively correlated (r＝0.386, P＜0.01). Conclusions The increase of the resting HR, the reduction of the HR variation degree after exercise and the decrease of the 6-minute walk distance could be used to predict the cardiac function compensatory period and development of HF.

Abstract:Objective To discuss the curative effect of zoledronic acid on severe osteoporosis in the elderly. Methods Totally 120 patients were randomly divided into treatment group(n=60, mean age: 67.6 years) receiving Caltrate D and Alpha D3 plus zoledronic acid treatment for 24 weeks, and the control group(n=60, mean age: 66.4 years) receiving Caltrate D and Alpha D3 treatment only. Bone pain of patients in two groups before and two weeks after treatment was assessed and bone mineral density(BMD) of hip and lumbar vertebrae was examined before and 12 months after treatment. In addition, calcium, phosphorus and alkaline phosphatase(AKP) in plasma were also assessed and adverse events were observed. Results After excluding the 3 drop-out cases, bone pain was alleviated faster in treatment group(n=57) than in control group(n=53), and improvement of BMD in treatment group was also significantly better than that in control group(P＜0.05). AKP was decreased significantly in treatment group[(95.2±11.2) vs (147.3±16.1)IU/L; P＜0.05], while kept no change in control group after treatment. There were no significant differences in the levels of plasma calcium and phosphorus in both groups between pre- and post- treatment(P＞0.05). Conclusion Zoledronic acid can significantly relieve pain and other symptoms, and improve BMD in patients with severe osteoporosis.

Abstract:Objective To study the effect of age on iodinated contrast induced acute kidney injury (CI-AKI) in male rats. Methods According to the age category, 36 healthy SD male rats were divided into three age groups (n=12/group), including 4 months, 12 months and 24 months group, and then each age group were randomly divided into control group and contrast media(CM) group(n = 6). After 24 h water deprivation, all three CM groups were intravascularly injected with 76% diatrizoate (10 ml/kg) through a caudal vein. The other three control groups were injected with equal volumes of saline in parallel. Urine creatinine (UCr), enzyme activity of urine N-acetyl-beta-D-glucosaminidase(UNAG), serum creatinine (SCr), creatinine clearance rate (Ccr), malondialdehyde (MDA) level and angiotensin-converting enzyme(ACE) activity were determined. The rats were sacrificed after 48 h. Then pathological changes of the right kidney tissue and the expression of Sp1 protein in the renal tissue were examined. Results At 48 h after CM administration, 24 months rats showed a significant increase in SCr by＞25% from baseline (P＜0.01) and a decline in Ccr (P＜0.05); the levels of ACE and MDA in renal tissues and scores of tubular injury were also increased (P＜0.01); the expression of Sp1 protein in renal tissue was significantly upregulated (P＜0.05). At 24 h after CM administration, the enzyme activity of UNAG was significantly higher(P＜0.001). In 12 months rats with CM injection, the level of SCr was increased by <25% from baseline(P＜0.05). There was an increasing trend but no significant statistic difference in levels of MDA and ACE in renal tissue, scores of tubular injury, and expression of Sp1 protein between control group and CM group of 12 months rats. There was no difference between control group and CM group of 4 months rats in all above parameters (P>0.05). Conclusion Aging is a risk factor for CI-AKI in rat. Oxidative stress, ACE, and transcription factor Sp1 play a role in nephrotoxcity induced by iodinated contrast media in the aging male rats.

Abstract:Objective To explore the possible mechanisms of protective effect of simvastatin on acute pulmonary embolism(APE) in rat. Methods Seventy-two male Sprague-Dawley rats were randomly divided into sham-operation group, pulmonary thromboembolism(PTE) group and statins intervention group(n = 24 in each group). Right ventricular systolic pressure(RVSP) and mean pulmonary arterial pressure (mPAP) were measured by right heart catheter at 2 h, 6 h, 24 h after induction of PTE. Blood gas analysis was processed and immunohistochemical analysis was performed to study the changes of endothelial nitric oxide synthase leNOS in pulmonary vascellum at 6 h following induction of PTE. ELISA kits were used to evaluate the level of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) in plasma. Results MPAP and RVSP at each time point was increased in the PTE group compared with sham-operation group(P＜0.01) and decreased in the statins intervention group compared with PTE group significantly(P＜0.05). Compared with PTE group, PaO2 in statins intervention group was increased significantly 6 h after induction of PTE(P＜0.05). Compared with sham-operation group, eNOS protein expression in PTE group at 6h after induction was decreased significantly(P＜0.01). Compared with PTE group, it increased significantly in statin group(P＜0.05). Compared with sham-operation group, the plasma levels of IL-6 and TNF-α at each time point in the PTE group were increased slightly(P＞0.05), while decreased slightly with simavastatin pretreatment(P＞0.05). Conclusion Pretreatment with simavastatin decreases RVSP and mPAP, and improves hypoxemia and endothelial function in the rats with PTE, while has no effect on IL-6 and TNF-α.

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Abstract:Although majority clinical trials of antiplatelet therapy in patients with acute coronary syndrome(ACS) showed significant benefits, but in elderly patients, especially ≥75 years, the outcomes mostly were less effective, the bleeding risk increased. This review will discuss briefly the pathobiology of hemostasis, thrombosis and hemorrhage due to aging, and the changes of vascular repair and integrity, and the clinical benefit and bleeding risk of antiplatelet therapy in elderly patients with ACS in recent clinical trials.