published_or_final_version / Anatomy / Doctoral / Doctor of Philosophy

The increasing prevalence causes great burden to global health. Although there is not yet an agreement on the effect of SMBG for non-insulin-treating type 2 DM patients in comprehensive management, some guidelines recommended all diabetes patients should conduct SMBG. This literature review of 5 meta-analyses and 13 randomized controlled clinical trials assessed the effectiveness of SMBG in glucose control (HbA1c), detection of hypoglycemia, non-glycemic outcomes and potential influence factors(duration of diabetes, baseline HaB1c level, SMBG frequency, SMBG duration, co-interventions) of SMBG efficacy on type 2 diabetes patients not using insulin. The method of this literature review is through a comprehensive electronic literature search of Ovid MEDLINE, EMBASE, the Cochrane Library and China Journals Full-text Database. Both English and Chinese language literatures were reviewed. All meta-analysis and randomized controlled trials of type 2 diabetes non-insulin-using patients taking SMBG to improve the glycemic control and other outcomes were included. In these studies, absolute HbA1c reduction, recognized episodes of hypoglycemia, wellbeing, QALY, DALY, complication morbidity, mortality were used as outcome measures if available. A score list based on the PRISMA Statement was used to evaluate the quality of meta-analyses. 5 meta-analysis all reported a statistical significant but clinical modest-moderate difference in HbA1c reduction between SMBG and non-SMBG group, a new published randomized controlled trial with small cohort enrolled in none of the meta- analyses did not support this conclusion. Evidence showed frequency of SMBG did not influence the efficacy of SMBG, co-interventions as education/consultation, regimen change played a positive roll on SMBG efficacy. Whether baseline HbA1c, duration of diabetes or SMBG itself have an effect on SMBG efficacy was still unknown. There is inadequate evidence of SMBG efficacy of detection of hypoglycemia of patient-oriented outcomes. No eligible Chinese article was defined to enroll in this review. This review did not support to suggest all type 2 diabetes patients not using insulin to conduct SMBG at the frequency the guidelines recommended. Carefully designed and longer-term trials are needed to obtain evidence that is more robust. Further investigation would provide more evidence of the characteristics of potential influence factors, which may help to define the specific population or optimal mode that guarantee the greatest efficacy of SMBG. / published_or_final_version / Public Health / Master / Master of Public Health

Objective：Low vitamin D has been implicated in the development of type 2 diabetes. However, whether vitamin D continues to have a clinically significant effect in existing diabetes is unclear. The objective of this study was to examine the association of serum vitamin D with glycemic control in established type 2 diabetes. Methods: This was a retrospective analysis of medical records. Characteristics of 487 patients with type 2 diabetes were stratified by vitamin D status and serum glycosylated hemoglobin (HbA1c). Vitamin D deficiency among the subjects was studied. The relationship between vitamin D and glycemic control was explored by multiple linear regression, multivariate analysis of variance (MANOVA) and chi-square test. Patients were stratified into overweight and non-overweight group based on body mass index (BMI), and the association of serum vitamin D concentration with glycemic control was evaluated in each group. Insulin resistance and C-peptide as mediators between vitamin D and HbA1c was tested. The impact of vitamin D on cholesterol metabolism was also assessed. Results: (1) Vitamin D deficiency was highly prevalent, accounting for 88.3% of the study sample. (2) Serum vitamin D levels were significantly inversely associated with serum HbA1c. This correlation was stronger in overweight group than in non-overweight group. There was no significant relationship between serum vitamin D levels and fasting plasma glucose (FPG). HbA1c was significantly lower in vitamin D insufficiency group than in vitamin D severe deficiency group. (3) Insulin resistance partially mediated the association between vitamin D and HbA1c. (4) No significant association of Vitamin D with low density lipoprotein (LDL) or high density lipoprotein (HDL) was found in this study. Conclusions: There was an inverse association between serum vitamin D levels and HbA1c. The inverse correlation of serum vitamin D level and HbA1c was stronger in overweight group than in non-overweight group, which indicates patients with obesity might benefit more from vitamin D supplementation. / published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Biochemistry / Master / Master of Philosophy

published_or_final_version / Biochemistry / Master / Master of Philosophy

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In this thesis, we study time-dependent empirical processes, which extend the classical empirical processes to have a time parameter; for example the empirical process for a sequence of independent stochastic processes {Yi : i ∈ N}: (1) ν_n(t, y) = n^(−1/2 )Sigma[1_(Y i(t)¬<=y) – P(Yi(t) <= y)] from i=1 to n, t ∈ E, y ∈ R. In the case of independent identically distributed samples (that is {Yi(t) : i ∈ N} are iid), Kuelbs et al. (2013) proved a Central Limit Theorem for ν_n(t, y) for a large class of stochastic processes. In Chapter 3, we give a sufficient condition for the weak convergence of the weighted empirical process for iid samples from a uniform process: (2) α_n(t, y) := n^(−1/2 )Sigma[w(y)(1_(X (t)<=y) – y)] from i=1 to n, t ∈ E, y ∈ [0, 1] where {X (t), X1(t), X2(t), • • • } are independent and identically distributed uniform processes (for each t ∈ E, X (t) is uniform on (0, 1)) and w(x) is a “weight” function satisfying some regularity properties. Then we give an example when X (t) := Ft(Bt) : t ∈ E = [1, 2], where Bt is a Brownian motion and Ft is the distribution function of Bt. In Chapter 4, we investigate the weak convergence of the empirical processes for non-iid samples. We consider the weak convergence of the empirical process: (3) β_n(t, y) := n^(−1/2 )Sigma[(1_(Y (t)<=y) – Fi(t,y))] from i=1 to n, t ∈ E ⊂ R, y ∈ R where {Yi(t) : i ∈ N} are independent processes and Fi(t, y) is the distribution function of Yi(t). We also prove that the covariance function of the empirical process for non-iid samples indexed by a uniformly bounded class of functions necessarily uniformly converges to the covariance function of the limiting Gaussian process for a CLT.

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