Purpose　To review evidence-based management of nephropathy in patients with type 2 diabetes.Data sources　A literature search (MEDLINE 1966 to 2000) was performed using the key word “diabetic nephropathy". Relevant book chapters were also reviewed.Study selection　Well-controlled, prospective landmark studies and expert review articles on diabetic nephropathy were selected.Data extraction　Data and conclusions from the selected articles that provide solid evidence to the optimal management of diabetic nephropathy were extracted and interpreted in light of our clinical research experience with many thousands of Hong Kong Chinese patients.Results　Hypertension, long diabetes duration, poor glycaemic control and central obesity are the most important risk factors. Microalbuminuria is a practical marker to predict overt nephropathy in type 2 diabetic patients. Risk factor modification, renal function monitoring and combined therapies are the current integrated approaches to manage patients with diabetic kidney disease. Optimal glycaemic control is the mainstay of treatment but effective antihypertensive therapy is also key to delaying the progression of diabetic nephropathy. Angiotensin-converting enzyme inhibitors and angiotensin Ⅱ receptor antagonists have important renoprotective actions independent of their blood pressure lowering actions. Conclusions　Diabetic nephropathy is the leading cause of end-stage renal disease worldwide. Monitoring renal function and screening for microalbuminuria will allow the identification of patients with nephropathy at a very early stage for intervention. Tight glycaemic control and aggressive antihypertensive treatment as well as the use of renin-angiotensin system inhibitors should substantially delay the progression of nephropathy.

2型糖尿病病程演变与生存质量关系探讨

Objective To discuss the relation between the course of type 2 diabetes (2 DM) and blood sugar, body mass index (BMI), insulin resistance (INS), and the secretion function of insulin, and the effects of these factors to the quality of life. Methods The 233 patients were divided into 5 groups. They were normal sugar tolerance (A) group, impaired sugar tolerance (B) group, the course of DM less than 5 years(C) group, the course of DM between 5～ 9 years(D) group, and the course of DM more than 10 years (E)group. To measure the blood sugar, BMI, the area under the INS Curve, INS active index (IAI), INS secretion index (IS) were calculated to analyze their effects in the course of type 2 DM. Results From group A to group E, FPG, 1 hour PG, 2 hour PG, and the area of blood sugar were much higher with the course of DM, and increased progressively. IAI was much lower with the course of DM, and descended progressively.Conclusion In the course of 2 DM, the level of blood sugar rose progressively and the progressive impairment of INS and the secretion function of insulin had important effects in this term.

一种坎格列净工艺杂质的制备分离与结构鉴定

(S)-1-氯乙酰基-2-氰基吡咯烷的合成

Effects of resistant exercise on regulating the gutmicrobiota related to glucose control in mice with type 2 diabetes

Objective:To explore the effect of resistant exercise on improvement of gut microbiota regulating glucose control in mice with type 2 diabetes.Methods:Male mice with type 2 diabetes aged 8 weeks were randomly assigned to control group,aerobic training (AT)group and resistant training (RT) group.One month after the intervention,the blood glucose was measured and the feces were collected to detect gut microbiota by using 16S rRNA high-throughput sequencing method.Results:The higher proportion and abundance of Firmicutesbacteria and lower proportion and abundance of Bacteroidetesbacteria were found in AT group.The number and abundance of Akkermansia muciniphila in feces of RT group were significantly higher than those of AT and control groups.Lower level of blood glucose was observed in RT group relating to control group.Conclusion:Resistant exercise to improve gut microbiota is expected to be a new method for the prevention and treatment of type 2 diabetes.