目的 探讨长病程2型糖尿病（T2DM）患者体质指数（BMI）与胰岛β细胞功能间的相关关系。方法 选取2023年12月—2024年3月于承德市中心医院内分泌风湿免疫科住院的260例长病程（病程≥10年）T2DM患者作为研究对象，依据BMI将其分成正常组、超重组和肥胖组，比较三组间一般资料、检验学指标及检查的差异，分析胰岛β细胞功能与各指标间的相关性。结果 三组研究对象在空腹静脉血糖（FPG）、空腹C肽（FCP）、胰岛素抵抗指数（HOMA-IR）、尿酸（UA）、甘油三酯（TG）等上差异有统计学意义（P＜0.05），在胰岛β细胞功能指数（HOMA-β）比较差异无统计学意义（P＞0.05）；肥胖组的FPG、FCP、HOMA-IR、UA、TG均高于正常组（P＜0.05），超重组的UA、TG均高于正常组（P＜0.05），肥胖组的FPG、HOMA-IR、UA高于超重组（P＜0.05），Spearman相关分析结果显示HOMA-β与体质量指数（BMI）无相关性（r=0.046，P=0.461），HOMA-β与UA（r=0.226，P＜0.001）、TG（r=0.148，P=0.017）呈正相关，HOMA-IR与BMI（r=0.279，P＜0.001）与、UA相关（r=0.284，P＜0.001）及TG（r=0.349，P＜0.001）呈正相关，多元线性回归分析显示UA是HOMA-β的影响因素（P＜0.05），BMI、UA、TG是HOMA-IR的影响因素（P＜0.05）。结论 长病程的T2DM患者，其胰岛素抵抗水平随着BMI的增加逐渐升高，而胰岛β细胞功能指数与BMI的相关性不显著。同时，UA和TG也是长病程T2DM患者胰岛β细胞功能的影响因素。
Objective To explore the correlation between body mass index（BMI）and islet β cell function in patients with long course type 2 diabetes mellitus（T2DM）．Methods A total of 260 patients with T2DM with a long course of disease（course≥10 years）admitted to the Department of Endocrinology and Rheumatology of Chengde Central Hospital from December 2023 to March 2024 were selected as the study objects，and were divided into normal group，overweight group and obese group according to BMI．Comparison among the three groups in general data，inspection index and and the difference of the islet β cell function were performed，and the correlation among the indexes was analyzed．Results There were statistically significant differences in fasting plasma glucose（FPG），fasting C peptide（FCP），homeostasis model assessment-insulin resistance（HOMA-IR），uric acid（UA）and triglycerides（TG）among the three groups（P＜0.05），but no statistically significant differences in homeostatic model assessment of β-cell function（HOMA-β）（P＞0.05）．The levels of FPG，FCP，HOMA-IR，UA and TG in the obese group were higher than those in the normal group（P＜0.05）；the levels of UA and TG in the overweight group were higher than those inthe normal group（P＜0.05）；the levels of FPG，HOMA-IR and UA in the obese group were higher than those in the overweight group（P＜0.05）．Spearman correlation analysis showed that HOMA-β was not correlated with BMI（r=0.046，P=0.461），but was positively correlated with UA and TG（r=0.226，P＜0.001；r=0.148，P=0.017），HOMA-IR was positively correlated with BMI，UA and TG（r=0.279，P＜0.001；r=0.284，P＜0.001；r=0.349，P＜0.001）．Multiple linear regression analysis showed that UA was the influencing factor of HOMA-β（P＜0.05），BMI，UA and TG were the influencing factors of HOMA-IR（P＜0.05）．Conclusions In T2DM patients with long disease course，the level of insulin resistance increased gradually with the increase of BMI，but the correlation between β-cell function index and BMI was not significant．At the same time，UA and TG are also factors affecting the function of islet β cells in patients with long-course T2DM．
目的 探讨高龄妊娠期糖尿病（GDM）产妇糖耐量的特点及其与妊娠结局的关系。方法 选择2020年1月1日—2024年12月31日在广州市第一人民医院规律产检并分娩的高龄产妇727例，包括高龄初产妇226例（GDM 78例）和高龄经产妇501例（GDM 131例），按照75 g OGTT血糖异常项数进行分组：一项血糖异常产妇为GDM I组（高龄初产妇38例，高龄经产妇68例）；两项血糖异常产妇为GDM Ⅱ组（高龄初产妇26例，高龄经产妇51例）；三项血糖异常产妇为GDM Ⅲ组（高龄初产妇14例，高龄经产妇12例）；75 g OGTT正常高龄产妇为对照组。收集研究对象一般资料、75g OGTT血糖及相关妊娠结局进行分析比较。结果 高龄初产妇GDM发生率（34.51%）较高龄经产妇GDM发生率（26.15%）高，差异具有统计学意义（P=0.021）；高龄初产妇GDM Ⅲ型宫内感染（28.57%）、产后出血（14.29%）发生率最高，差异具有统计学意义（P=0.037、0.039）；高龄初产妇GDM I型早产（23.68%）发生率最高，差异具有统计学意义（P=0.013）。高龄初产妇及经产妇GDM Ⅱ型的羊水过多、甲状腺功能减退、宫内感染、早产发生率均呈上升趋势。结论 高龄妊娠糖尿病产妇随OGTT血糖异常项增多出现不良妊娠结局风险升高，其中高龄初产妇的早产、宫内感染及产后出血的发生率更高，因此，针对高龄初产妇，应更加注重孕期血糖及健康管理，以减少不良妊娠结局的发生。
Objective To analyze glucose tolerance characteristics in elderly pregnant women with gestational diabetes mellitus（GDM）and relationship with pregnancy outcomes．Methods From January 1，2020，and December 31，2024，727 elderly pregnant women who underwent routine prenatal examinations and delivered in Guangzhou First People’s Hospital were recruit．Among them，226 were elderly primiparas and 501 were elderly multiparas．GDM was diagnosed in 78 elderly primiparas and 131 elderly multiparas．Based on the results of the 75 g oral glucose tolerance test（OGTT），GDM cases were classified as follows：GDM I（one abnormal glucose value；38 elderly primiparas，68 elderly multiparas），GDM II（two abnormal values；26 elderly primiparas，51 elderly multiparas），and GDM Ⅲ（three abnormal values；14 elderly primiparas，12 elderly multiparas）．Elderly pregnant women with normal OGTT results served as the control group．General clinical data and pregnancy outcomes were collected．The prevalence and characteristics of GDM in elderly primiparas and multiparas were analyzed．Results The incidence of GDM was significantly higher in elderly primiparas than in elderly multiparas（P=0.021）．The incidence of intrauterine infection and postpartum hemorrhage was highest in elderly primiparas with GDM Ⅲ（P=0.037，0.039）．The incidence of preterm birth was highest in elderly primiparas with GDM I（P=0.013）．The incidence of polyhydramnios，hypothyroidism，intrauterine infection，and preterm birth showed an increasing trend in both elderly primiparas and multiparas with GDM II．Conclusions Elderly primiparas with more severe glucose tolerance abnormalities are at a higher risk of adverse pregnancy outcomes．Enhanced blood glucose monitoring and comprehensive health management during pregnancy are crucial for reducing the incidence of adverse outcomes in this population．
随着糖尿病发病率不断攀升，人们逐渐聚焦于糖尿病合并骨质疏松。围绕此疾病，国内外学者开展了广泛而深入的研究，临床实践聚焦于两点：糖尿病的精准治疗和骨质疏松的有效干预。在确保血糖稳定的基础上，致力于抑制骨吸收、促进骨形成。在此治疗理念指导下，临床医生应当更加全面了解血糖管理与抗骨质疏松药物的作用机制并合理应用，更大程度改善患者的临床症状及预后。然而，药物作用机制复杂，联合应用存在潜在药物相互作用问题。未来研究方向包括探索更安全有效的联合治疗方案，更加精确化地治疗以提高临床疗效。文章分析了降糖药物及抗骨质疏松药物对疾病的疗效，并展望未来的研究方向，旨在为临床实践提供更为深刻与全面的指导。
As the incidence of diabetes mellitus continues to rise，people are also gradually focusing on diabetes mellitus combined with osteoporosis，which puts patients at a higher risk of fragility fracture．Scholars at home and abroad have conducted extensive and in-depth research around this condition，and clinical practice has focused on two points：first，the precise treatment of diabetes，and second，the effective intervention of osteoporosis．On the basis of ensuring blood glucose stabilization，we are committed to inhibiting bone resorption and promoting bone formation．Under the guidance of this therapeutic concept，we should have a more comprehensive understanding of the mechanism of action of blood glucose management and anti-osteoporosis drugs and apply them rationally，aiming to improve the clinical symptoms and prognosis of patients to a greater extent through dual intervention．However，the mechanism of action of different drugs is complex，and there are potential drug-drug interactions and safety issues associated with their combined use．Future research directions should include exploring safer and more effective combination therapies，developing novel drugs，and more precise and individualized treatments to improve clinical efficacy．This article analyzes the efficacy of glucose-lowering drugs and anti-osteoporosis drugs on the disease and looks forward to future research directions，aiming to provide more profound and comprehensive guidance for clinical practice．
目的 探讨2型糖尿病（T2DM）睡眠障碍患者使用经颅微电流刺激（CES）联合自我穴位按摩干预的效果。方法 使用随机数表法将南昌大学第二附属医院2022年6月—2023年1月收治的T2DM合并睡眠障碍患者100例分为两组，每组各50例。对照组采用CES干预，基于此，观察组加用自我穴位按摩，比较两组临床疗效、睡眠质量及血糖水平。结果 与对照组干预总有效率80.00%（40/50）比较，观察组干预总有效率96.00%（48/50）更高（χ 2 =6.061，P=0.014）；两组干预后匹兹堡睡眠质量指数（PSQI）中入睡时间、睡眠效率、催眠药物、睡眠障碍、睡眠时间、主观睡眠质量、日间功能障碍及总分均降低，且观察组［（0.95±0.28）分、（1.05±0.24）分、（0.55±0.14）分、（0.67±0.20）分、（0.92±0.21）分、（0.82±0.20）分、（0.65±0.18）分、（5.61±1.10）分］均低于对照组［（1.42±0.33）分、（1.30±0.33）分、（1.40±0.26）分、（1.14±0.27）分、（1.31±0.30）分、（1.32±0.37）分、（1.22±0.27）分、（9.11±1.26）分］（t=7.679、4.332、20.354、9.891、7.531、8.406、12.421、14.797，均P＜0.001）；两组干预后餐后2 h血糖（2 hPG）、糖化血红蛋白（HbA1c）及空腹血糖（FBG）水平均降低，且观察组2 hPG［（6.14±0.68）mmol/L］、HbA1c［（3.45±0.37）%］、FBG［（5.52±0.48）mmol/L］低于对照组［（7.12±1.25）mmol/L、（4.30±0.34）%、（6.58±0.67）mmol/L］（t=4.870、11.961、9.094，均P＜0.001）。结论 对T2DM合并睡眠障碍患者使用CES联合自我穴位按摩干预效果满意，可有效提高患者的睡眠质量，调节血糖水平。
目的 分析共同照护模式联合回授法健康教育在2型糖尿病患者中的应用效果。方法 将2023年1月—2023年12月广州市第一人民医院收治 的114例2型糖尿病患者作为此次研究对象，分为研究组（n=57）和对照组（n=57），对照组患者给予常规护理结合健康教育，研究组患者给予共同照护模式联合回授法健康教育，评估两组在培训前及培训后1、3个月的血糖控制情况及糖尿病患者自我管理行为量表（SDSCA）等指标。结果 培训1、3个月后，两组患者的空腹血糖、餐后2 h血糖、糖化血红蛋白均低于培训前，且研究组空腹血糖、餐后2 h血糖、糖化血红蛋白水平均低于对照组（P＜0.05）。培训1、3个月后，两组患者的糖尿病患者SDSCA评分高于培训前，且研究组各项评分高于对照组（P＜0.05）。重复测量方差分析表明随着时间的推移，患者的血糖控制状况随着不同护理培训策略而得到改善。结论 使用共同照护模式联合回授法健康教育对2型糖尿病患者可以更显著改善血糖控制水平、提高自我管理效能。
Objective To analyze the effect of co-care mode and feedback health education on patients with type 2 diabetes．Methods From January 2023 to December 2023，114 patients with type 2 diabetes admitted to Guangzhou First People’s Hospital were divided into two groups：experimental group（n=57）and control group（n=57）．Patients in control group were given routine nursing combined with health education．Patients in study group were given co-care and feedback health education．Before intervention and 1，3 months after intervention，patients’ blood glucose control and diabetic self-management behavior scale（SDSCA）were evaluated．Results After 1 and 3 months of intervention，the fasting blood glucose，2-hour blood glucose and HbA1c of the two groups were significantly lower than those before intervention，and the fasting blood glucose，2-hour blood glucose and HbA1c of the experimental group were significantly lower than those of the control group（P＜0.05）．After 1 month and 3 months of intervention，the SDSCA scores of diabetic patients in both groups were higher than those before intervention，and the scores of study group were higher than those of control group（P＜0.05）．Repeated measures analysis of variance indicating that glycemic control improved significantly over time with different nursing training strategies．Conclusions Co-care mode and feedback health education can significantly improve blood glucose control and self-management efficiency in patients with type 2 diabetes．
