Objectives To assess the effects of alpha-glucosidase inhibitors in patients with type 2 diabetes mellitus. Method We searched The Cochrane Library, MEDLINE, EMBASE, Current Contents, LILACS, databases of ongoing trials, reference lists of reviews on the topic of alpha-glucosidase inhibitors and we contacted experts and manufacturers for additional trials. Date of most recent search: December 2003 (Current Contents) and April 2003 (other databases). Randomised controlled trials of at least 12 weeks duration comparing alpha-glucosidase inhibitor monotherapy in patients with type 2 diabetes with any other intervention and that included at least one of the following outcomes: mortality, morbidity, quality of life, glycemic control, lipids, insulin levels, body weight, adverse events. Two reviewers read all abstracts, assessed quality and extracted data independently. Discrepancies were resolved by consensus or by the judgement of a third reviewer. A statistician checked all extracted data entrance in the database. We attempted to contact all authors for data clarification. Results We included 41 trials (8130 participants), 30 investigated acarbose, seven miglitol, one trial voglibose and three trials compared different alpha-glucosidase inhibitors. Study duration was 24 weeks in most cases and only two studies lasted amply longer than one year. We found only few data on mortality, morbidity and quality of life. Acarbose had a clear effect on glycemic control compared to placebo: glycated haemoglobin –0.77% (95% confidence interval –0.90 to –0.64), fasting blood glucose –1.1 mmol/L (95% confidence interval –1.4 to –0.9), post-load blood glucose –2.32 mmol/L (95% confidence interval –2.73 to –1.92). The effect on glycated haemoglobin by acarbose was not dose-dependent. We found a decreasing effect on post-load insulin and no clinically relevant effects on lipids or body weight. Adverse effects were mostly of gastro-intestinal origin and dose dependent. Compared to sulphonylurea, acarbose decreased fasting and post-load insulin levels by –24.8 pmol/L (95% confidence interval –43.3 to –6.3) and –133.2 pmol/L (95% confidence interval –184.5 to –81.8) respectively and acarbose caused more adverse effects. Conclusions It remains unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes. Conversely, they have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. These effects are less sure when alpha-glucosidase inhibitors are used for a longer duration. Acarbose dosages higher than 50 mg TID offer no additional effect on glycated haemoglobin but more adverse effects instead. Compared to sulphonylurea, alpha-glucosidase inhibitors lower fasting and post-load insulin levels and have an inferior profile regarding glycemic control and adverse effects.
ObjectiveTo systematically review the correlation between type 2 diabetes mellitus (T2DM) and the risk of kidney cancer. MethodsPubMed, EMbase, Web of Science, CBM, VIP and CNKI databases were electronically searched to collect cohort studies on the association between T2DM and kidney cancer from inception to August 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis then performed by using Stata 15.0 software. ResultsA total of 17 cohort studies involving 2 003 165 T2DM patients were included. The results of meta-analysis showed that patients with T2DM had a higher kidney cancer risk than controls (RR=1.51, 95%CI 1.39 to 1.64, P<0.001). Subgroup analysis showed that the incidence of kidney cancer in T2DM patients was higher in different gender, region, population, follow-up time, diabetes assessment method and other subgroups. ConclusionsCurrent evidence shows that T2DM is a risk factor for kidney cancer.
Objective To assess the influence of different digestive tract reconstruction on the blood glucose of gastric antral cancer patients with type 2 diabetes. Methods The clinical data of 51 cases of gastric antral cancer with type 2 diabetes treated radical surgery in this hospital from January 2006 to January 2012 were analyzed retrospectively. The patients were divided into three groups according to the different digestive tract reconstruction methods：BillrothⅠ anastomosis group （n=14）， BillrothⅡ anastomosis group （n=28）， and Roux-en-Y anastomosis group （n=9）. The indexes were analyzed and compared among three groups：① The levels of fast blood glucose （FBG） and 2h postprandial blood glucose （PG2h） were detected before operation and on 1 month and 6 months after the operation；② The level of glycated hemoglobin （HbA1c） was detected before operation and 6 months after the operation；③ The diabetes control was observed. Results The FBG and PG2h levels in the BillrothⅠ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those detected before the operation （P＞0.05）. The FBG and PG2h levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group detected on 1 month and 6 months after the operation were significantly lower than those before the operation respectively （P＜0.05）. The FBG and PG2h levels in the BillrothⅡ anastomosis group detected on 1 month and 6 months after the operation were not statistically different from those in the Roux-en-Y anastomosis group respectively （P＞0.05）， but which were markedly lower than those in the BillrothⅠ anastomosis group， the differences were statistically significant （P＜0.05）. The HbA1c levels in the BillrothⅠ anastomosis group detected before the operation and on 6 months after the operation were not statistically different from each other （P＞0.05）. The HbA1c levels in the BillrothⅡ anastomosis group and Roux-en-Y anastomosis group detected on 6 months after the operation were markedly lower than those before the operation and the difference was statistically significant （P＜0.05）. On 6 months after the operation， the HbA1c levels in the BillrothⅡanastomosis group and Roux-en-Y anastomosis group were markedly lower than those in the BillrothⅠ anastomosis group and the differences were statistically significant （P＜0.05）；the HbA1c level was not statistically different between the BillrothⅡ anastomosis group and the Roux-en-Y anastomosis group （P＞0.05）. The total curative effects in the BillrothⅡ anastomosis and Roux-en-Y anastomosis groups were significantly better than those in the BillrothⅠ anastomosis group （P＜0.05）. Conclusion According to our limited clinical data， BillrothⅡ anastomosis and Roux-en-Y anastomosis for gastric antral cancer patients with type 2 diabetes may be the best surgical approach.
ObjectiveTo observe the influence and interaction of duodenal jejunal bypass (DJB) and hepatic branch of vagus on glucose metabolism, and fasting serum glucagon like peptide-1 (GLP-1), peptide YY (PYY) in non-obese rat with type 2 diabetes mellitus (T2DM). MethodsForty non-obese Wistar rats (GK) with T2DM were randomly divided into four groups: sham operation group (SO group), sham operation plus hepatic branch of vagus resection (HBVR) group (SO+HBVR group), DJB group, and DJB+ HBVR group. The changes of preoperative and postoperative body weight, fasting blood glucose level, fasting serum insulin level, fasting serum GLP-1 and PYY contents among four groups were observed. ResultsIn the DJB group, the postoperative body weight and fasting blood glucose level were decreased significantly (P < 0.05) and the fasting insulin level, fasting serum GLP-1 and PYY contents were increased significantly (P < 0.05) as compared with the preoperative corresponding values in the same group, and it was found that the hepatic branch of vagus could more lastingly maintain postoperative lower body weight (P < 0.05), improve the level of insulin (P < 0.05), increase the fasting serum GLP-1 and PYY contents (P < 0.05) as compared with the DJB+HBVR group. ConclusionDJB could improve glucose metabolism effect of GK rats, the hepatic branch of vagus might play a role in it, too.
Objective To evaluate the efficacy and safety of saxagliptin in type 2 diabetes patients. Methods The following databases as The Cochrane Library (Issue 2, 2011), PubMed (1978 to May 2011), EMbase (1974 to May 2011), CNKI (1978 to May 2011), VIP (1989 to May 2011) and CBM (1978 to May 2011) were searched. The quality of included randomized controlled trials (RCTs) was assessed according to the Cochrane Collaboration system review, and then meta-analysis was performed using RevMan 5.0. Results A total of 7 RCTs were included. The results of meta-analyses showed that HbA1c was significantly reduced in the saxagliptin group than that in placebo group (MD= –0.69, 95%CI –0.78 to –0.60, Plt;0.000 01). There was no significant difference in the incident rate of adverse reaction between two groups (RR=1.02, 95%CI 0.98 to 1.06, P=0.26). Conclusion Saxagliptin is effective and safe for type 2 diabetes. But its long-term efficacy and safety still need to be confirmed by performing more high quality, large sample RCTs with long-term follow-up.
ObjectiveTo understand the role of metformin on reducing incidence of type 2 diabetes mellitus (T2MD) patients complicated with liver cancer. MethodThe related literatures of metformin treated patients with T2MD complicated with liver cancer at home and abroad in recent years were reviewed. ResultsA large number of epidemiological and clinical data showed that the metformin might prevent the occurrence of the T2MD patients complicated with liver cancer, its mechanism was mainly inhibited the proliferation of hepatoma cells through the ATM-LKB1-AMPK-mTOR pathway, PI3K/Akt/mTOR pathway, or miRNA. The current controversy was the authenticity of the data, the influencing factors included the aging problem and characteristics of metformin user. The prospective study design rigorous remained to be clarified. ConclusionMetformin could reduce the incidence of T2MD patients complicated with liver cancer, and could inhibit the growth of liver cancer cells, which provides a new way of thinking for the comprehensive treatment of liver cancer.
Objective To analyze the citation classics articles， and approach the research development history and the research direction in the future about surgical treatment for type 2 diabetes. Methods The most frequently cited articles had published in Social Sciences Citation Index database by the end of October 30， 2012 were retrieved. The 50 most frequently cited articles were selected. Articles were evaluated for several characteristics， including number of citations， publication time， country of origin， institution， journal， publication type of article， and authorship. Results The most frequently cited article received 1 751 citations and the least frequently cited article received 73 citations， with a mean of 242.76 citations per article. These citation classics were published in 18 high-impact journals， led by Annals of Surgery and Obesity Research as 10 papers. Of the 50 articles， 18 articles were clinical observational study， 20 articles concerned basic science， 10 articles were review articles， and 2 articles were commentary. These citation classics were published from 1990 to 2009， most of them （40） from 2000 to 2009. Three institutions produced 2 top-cited articles， including Medical College of Virginia， Monash University， and East Carolina University. These articles originated from 14 countries， the top was USA （22 articles）. Two persons authored 3 published papers （Cummings DE and Rubino F）. Conclusion Most “citation classics” in research about surgery for type 2 diabetes are observational studies published in high-impact journals by US-based authors after 1990.
Objective To compare the blood glucose level and associated hypoglycemia risks by using insulin Glargine or human NPH both combined with Glipizide GITS in the treatment of type 2 diabetic patients. Methods Fifty-six cases with inadequate glycemia control by sulfonylurea and/or other oral agents were randomized in two groups (3∶1). In the Glarine group, 42 patients were given Clipizide GITS 5 mg every morning and injection of Glargine at bedtime daily, while 14 patients in the NPH group were given Clipizide GITS 5 mg every morning and injection of NPH at bedtime daily. The dosage of insulin was adjusted by FBG level, seeking a target of FBG＜6.7 mmol/L, and the treatment lasted for 12 weeks. The blood glucose level and incidence of hypoglycemia were observed. The daily dosages of Glargine and NPH were recorded to analyze their relations between FBG and BMI at the beginning of the trial. Results Mean of FBG and daily glucose profile were similar in the 2 groups, but the incidence of hypoglycemia in the Glargine group was significantly lower than that in the NPH group (3 cases in the Glargine group, 7.1%, 5 cases in the NPH group, 35.7%, χ2=7.0, P =0.008). Mean daily dosages of glargine at the end point were closely related to FBG and BMI at baseline. Conclusions Bedtime injection of Glargine combined with Glipizide GITs can achieve target blood glucose control and is safer than NPH. This simple “one pill-one injection” regimen may help us achieve recommended blood glucose control targets with better patients’ compliance.
Objective To investigate the association of the polymorphism of resistin gene SNP-420C/G and type 2 diabetes (T2DM) among the Chinese Han population. Methods Such databases as CNKI, WanFang database, VIP, SinoMed, and PubMed were electronically searched from January 2001 to July 2010 to collect case-control studies on polymorphism of resistin gene SNP-420C/G and T2DM among the Chinese Han population. The quality of the included studies was evaluated and the data was extracted. RevMan 4.2 software was used for meta-analyses. Results A total of five case-control studies were identified, involving 709 cases in the T2DM group and 572 cases in the control group. The results of meta-analysis showed that the Chinese Han population with CC genotypes of SNP-420 had no higher risks to T2DM (OR=1.02, 95%CI 0.81 to 1.29), and the Chinese Han population with GG genotypes of SNP-420 still had no higher risks to T2DM (OR=1.34, 95%CI 0.95 to 1.90). Conclusion Current evidence suggests that there is no association between the polymorphism of resistin gene SNP-420C/G and risk to T2DM among the Chinese Han population.
ObjectiveTo systematically review the effect of intermittent fasting on type 2 diabetes mellitus. MethodsThe CNKI, WanFang Data, VIP, CBM, PubMed, Web of Science, The Cochrane Library and EMbase databases were electronically searched to collect randomized controlled trials (RCTs) on intermittent fasting intervention in the treatment of type 2 diabetes mellitus from inception to April 2022. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias of the included studies. The RevMan 5.4 software and Stata 17.0 software were used for meta-analysis. ResultsA total of 17 RCTs comprising 1 428 patients with type 2 diabetes mellitus were included. The results of meta-analysis showed that intermittent fasting improved body weight (WMD=−2.84, 95%CI −3.79 to −1.88, P<0.05), body mass index (BMI) (WMD=−1.07, 95%CI −1.52 to −0.61, P<0.05), glycosylated hemoglobin levels (SMD=−0.78, 95%CI −1.19 to −0.38, P<0.05), and fasting glucose levels (SMD=−0.65, 95%CI −1.01 to −0.3, P<0.05). ConclusionThe current evidence suggests that intermittent fasting improves body weight, BMI, glycated hemoglobin, and fasting blood glucose levels in patients with type 2 diabetes. Due to the limited quantity and quality of the included studies, more high-quality studies are needed to verify the above conclusion.