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1、糖尿病新进展.糖尿病热点回顾提纲改善胰岛微环境治疗糖尿病糖尿病冠心病患者治疗性激素与糖尿病含糖饮料与糖尿病糖尿病与肿瘤改善胰岛微环境治疗糖尿病胰岛β细胞代谢胰腺来源于胚胎时期胰腺背段和腹部胚芽胰岛β细胞质量动力学变化受代谢因素的影响，通过其新生或再生、凋亡或坏死保持动态平衡成年胰岛正常β细胞是缓慢更新的组织，大鼠增生率3%左右，其目的对抗β细胞的正常丧失、体重的增加和胰岛素抵抗的功能性负担胰岛β细胞质量动力学变化受代谢因素的影响，通过其新生或再生、凋亡或坏死保持动态平衡，而当凋亡占优势时,β细胞急剧减少,功能缺陷,导致2型糖尿病的发生。阻止β细胞破坏、促进β细胞再生长是治
2、疗糖尿病的重要措施。胰岛微环境葡萄糖毒性血管内皮细胞功能紊乱炎症因子胰岛β细胞凋亡脂代谢紊乱氧化应激(线粒体、内质网）胰淀粉素恢复β细胞数量改善胰岛素抵抗：噻唑烷二酮、二甲双胍调脂、降压早期胰岛素治疗抗氧化应激GLP-1及类似物PDX-1干细胞移植其它移植骨髓干细胞移植来源于骨髓的干细胞在患者胰岛微环境中可促进内源性β细胞团的再生Case1男,46,病史4年,BMI25.6其母有DM口服药胰岛素格化止0.5tid，拜唐苹50mgtid,文迪亚4mgqdR4u4u4u，来得时12u格化止0.25tid，拜唐苹50mgtid,文迪亚4mgqd来得时12u拜唐苹50mgtid,
3、文迪亚4mgqd来得时14u拜唐苹50mgtid,文迪亚4mgqd来得时10u拜唐苹50mgbid,文迪亚4mgqd来得时10u文迪亚4mgqd停文迪亚4mgqd停C-PeptideLevelsandInsulinIndependence FollowingAutologousNonmyeloablativeHematopoieticStemCellTransplantation inNewlyDiagnosedType1DiabetesMellitusJAMA.2009;301(15):1573-1579糖尿病冠心病患者治疗ARandomizedTrialofThera
4、piesforType2Diabetes andCoronaryArteryDiseaseFirsthypothesiswasthatpromptrevascularization(eithersurgicalorcatheter-based)wouldreducelong-termratesofdeathandcardiovascularevents,ascomparedwithmedicaltherapyalone.Secondhypothesiswasthatastrategyofinsulinsensitization(withatargetlevelforgly
5、catedhemoglobinoflessthan7.0%)wouldreducelong-termratesofdeathandcardiovascularevents,ascomparedwithastrategyofinsulinprovisionNEnglJMed2009;360:2503-15.性激素与糖尿病SexHormone–BindingGlobulinand RiskofType2DiabetesinWomenandMenHormone–bindingglobulin(SHBG)wasthoughttobethebindingofcirculatingh
6、ormonesSHBGmaydirectlymediatecell-surfacesignaling,cellulardeliverymaintenanceofglucosehomeostasis.StudyPopulationTheWomen’sHealthStudy,begunin1993,isarandomized,double-blind,placebo-controlled,2-by-2factorialstudyoflow-doseaspirinandvitaminEfortheprimarypreventionofcardiovasculardiseasea
7、ndcancerin39,876femalehealthprofessionalsintheUnitedStateswho,atenrollment,were45yearsofageorolderanddidnothavediabetes,Duringa10-yearfollow-upperiodConclusionsLowcirculatinglevelsofsexhormone–bindingglobulinareastrongpredictoroftheriskoftype2diabetesinwomenandmen.T
