Volume 11 · Issue 02 · 2019

In order to further reduce the amputation rate of diabetic foot (DF), the prevention, diagnosis and treatment of DF in China must be standardized according to the Chinese Diabetic Foot Prevention and Treatment Guidelines. In the popularization and application of the guidelines, we should adhere to: (1) the concept of "prevention is greater than cure" for diabetic foot; (2) The concept of "multidisciplinary collaboration" in diabetic foot; (3) The concept of timely referral/two-way referral; (4) Make full use of existing technology to implement seamless docking of diabetic foot management. On this basis, finally explore a set of diabetic foot prevention and treatment system suitable for China's national conditions, so that the cause of diabetic foot in China can reach a new level.

2019 will mark the 10th anniversary of the founding of the Chinese Journal of Diabetes. The continuous progress of Chinese Journal of Diabetes is the common achievement of successive editors, editorial boards, contributing scholars and editorial departments. This article will review the main progress made in the field of diabetes in China over the past 10 years, and will be summarized in nine parts. The fourth part of this publication is a brief description of new technologies for diabetes monitoring and treatment, the fifth part is the concept and practice of individualized precision medicine for diabetes, covering large-scale clinical research carried out or participated in in my country, and the sixth part is the change and exploration of diabetes management model. It is emphasized that there is still a lack of objective evaluation index and comprehensive evaluation system in the individualized management of diabetes in China, and more research support is needed.

Recently, the Diabetes Branch of the Chinese Medical Association, together with the Infectious Diseases Branch and Tissue Repair and Regeneration Branch of the Chinese Medical Association, formulated the Guidelines for the Prevention and Treatment of Diabetic Foot in China (2019 Edition), which is based on the best clinical evidence and combined with expert experience. The diagnosis and treatment process is formulated. It mainly includes three sections: epidemiological data of diabetic foot and early screening and prevention; Standardized diagnosis and treatment process of diabetic neuropathy/lower limb vascular disease/diabetic foot infection; Systemic nutrition, psychological state and progress in the treatment of traditional Chinese medicine. This guide refers to a large number of domestic and foreign research advances, and for the first time elaborates in detail from all aspects of diabetic foot prevention and treatment. This paper makes a brief analysis of the guide and recommends it.

Diabetic foot is one of the main causes of disability and death of diabetic patients. Based on the principle of "Chinese practice, Chinese evidence and Chinese guidelines", the Diabetology Branch of Chinese Medical Association, together with the Infectious Diseases Branch of Chinese Medical Association, the Tissue Repair and Regeneration Branch and other multidisciplinary experts in related fields, jointly formulated this clinical guideline suitable for the current situation of diabetic foot in China, aiming at standardizing the prevention, diagnosis and treatment of diabetic foot in China. This guideline has the following features: (1) highlighting clinical practicality; (2) Chinese evidence fully incorporated in the field of diabetic foot; (3) Pay attention to early screening and management, emphasizing that prevention of diabetic foot is better than treatment; (4) Emphasize the importance of standardized and comprehensive management; (5) Emphasize the multidisciplinary collaborative diagnosis and treatment of diabetic foot. In addition, with reference to the requirements of the 2017 version of China's Type 2 Diabetes Prevention and Treatment Guidelines, key points and evidence levels have been added, and the evidence levels are divided into three levels: A, B and C according to evidence quality, clinical significance, universality and applicability. Grade A: Evidence based on multiple randomized clinical trials or meta-analyses. Grade B: Evidence based on a single randomized clinical trial or multiple non-randomized controlled studies. Grade C: Expert consensus opinion only and/or based on results from small-scale studies, retrospective studies, and registered studies.

To evaluate the effect of smoking and smoking cessation on transcutaneous oxygen pressure (TcPO₂) of low extremity in man with type 2 diabetics.

120 men with type 2 diabetes (aged≥18 years) were recruited from the Endocrinology Department, Zhongda Hospital, Southeast University. Based on the smoking status, they were assigned to three groups: current-smoking (CS, n=40); quit-smoking (QS, n=40) and non-smoking (NS, n=40). General clinical data of all subjects were recorded and assessed. TcPO₂ at the dorsum of foot and chest was monitored before and after five-minute treadmill exercise. Analysis of variance (ANOVA) and Generalized Estimating Equations (GEE) were performed to analyze the effect of smoking/smoking-cessation on TcPO₂ before and after exercise respectively.

In resting-state (t=0 min), the TcPO₂ on dorsal foot in CS was significantly decreased compared with NS ((36.12±10.25) vs (55.46±7.32) mmHg, 1 mmHg=0.133 kPa, F=1.145, P=0.011) and QS (41.05±11.23, F=2.221, P=0.023). Instead, TcPO₂ on the chest and bilateral perfusion index were undifferentiated among the three groups (F=1.125, P=0.424). After a five-minute treadmill exercise, TcPO₂ on the chest showed an upward trend in all three groups with no significant difference (Wald χ ²=3.212, P=0.549). The partial regression coefficient B of TcPO₂ at dorsum of foot decreased significantly in CS (B=-46.823) and QS (B=-38.267) and the difference was statistically significant compared with NS (Wald χ ²=8.263, 6.078 and all P<0.05) in spite of no difference between the CS and QS (Wald χ ²=0.512, P>0.05).

Smoking can induce a decline in TcPO₂ in man with type 2 diabetics. To an extent, smoking cessation only ameliorates the decrease of TcPO₂ in the lower extremities.

To observed the effects of saxagliptin and metformin monotherapy on bone metabolism and body fat distribution in patients with newly diagnosed type 2 diabetes.

Sixty patients with newly diagnosed T2DM who visited endocrinology outpatient department of our hospital from October 2016 to June 2017 were randomly divided into the saxagliptin treatment group (Sax, n=30) and the metformin treatment group (Met, n=30) for a 24-week treatment. At the baseline and 24 weeks after treatment, general information, glycometabolism and lipid metabolism index, Inflammation index, bone metabolism index (25(OH)D₃, β-CTx, OC, tPINP), BMD (L1-L4, FN) and Body Fat Distribution (Fat%, VAT. Area, A/G, FMI) were measured. Paired t was used to compare pre-and post treatment effect within group. Difference between groups was analyzed using independent samples t test, and the non-normal distribution data was tested with rank sum test.

After 24 weeks of intervention, body mass index (BMI), body weight, waist circumference, fasting plasma glucose (FPG), glycosylated hemoglobin (HbA_1c), insulin resistance index (HOMA-IR), total Cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), hypersensitive C-reactive white (hs-CRP), VAT.Area, Fat%, A/G, and FMI were all significantly decreased (Met group: t=2.1-8.3; Sax group: t=1.9-6.9; all P<0.05). Islet cell secretion index (HOMA-β), OC, 25 (OH) D₃ increased significantly [Met group: HOMA-β: 51.29(34.66) vs 36.16(37.20), OC: (17.27±4.86) vs (14.16±4.12) ng/ml, 25(OH)D₃: (18.89±6.06) vs (14.64±5.74) ng/ml, t=-1.6,-5.6,-8.2; Sax group: HOMA-β: 54.40(29.36) vs 50.78(42.64), OC: (17.93±3.81) vs (14.30±3.77) ng/ml, 25(OH)D₃: (19.01±6.17) vs (14.13±5.06) ng/ml, t=-0.5,-7.8,-8.0, all P<0.05]; the left femoral neck BMD of the Sax group increased earlier [(0.81±0.09) vs (0.79±0.09) g/cm², t=-2.7, P<0.05]. The VAT. Area and FMI of the Met group were significantly lower than those of the Sax group [VAT.Area: (81.14±19.11) vs (92.62±22.84); FMI:6.33±1.48 vs 6.78±1.34, t=-1.9,-1.2, P<0.05].

Both metformin and saxagliptin could increase OC and 25(OH)D₃ levels, promote bone formation and improve body fat distribution in patients with T2DM. Saxagliptin could increase femoral neck bone mineral density in patients with newly diagnosed T2DM. While metformin have a better effect on the improvement of visceral fat area and fat mass index.

To investigate the metabolic changes induced by cerium oxide (CeO₂) nanoparticles in ulcerous wound tissues of diabetic GK rats using non-target metabolomics.

Twenty male GK rats with 8-10-week age and (256±3) g weight were randomly divided into normal saline group (10 rats) and CeO₂ nanoparticles group (10 rats). Two skin lesions with a diameter of 8 mm deep to the muscle layer were created symmetrically on both sides of the spine of the dorsal scapulae of the rats. The wounds were administered with saline or CeO₂ nanoparticles daily for 7 days, and the rats were sacrificed on day 7 for HE staining and metabolomics analysis. Liquid chromatography-mass spectrometry was used to detect the changes of metabolites in rat wound tissues, and differential metabolites were screened by principal component analysis and orthogonal partial least squares discriminant analysis.

Compared with the normal saline group, the HE staining in the rats of CeO₂ nanoparticles group had fewer inflammatory cells and more regular fibroblasts. A total of 15 different metabolites and 6 metabolic pathways that were significantly interfered with the experimental conditions were screened, including purine metabolism, glycine, serine and threonine metabolism, arachidonic acid metabolism, biosynthesis of unsaturated fatty acids, pantothenate and CoA biosynthesis and citrate cycle.

Nano-cerium oxide can significantly improve the wound healing by regulating glucose, lipid and amino acid metabolism of the metabolic network in GK rat wounds, and up-regulating the signaling pathways of anti-inflammatory and anti-oxidative stress.

To investigate the effect of microRNA (miR)-324-3p on the apoptosis of human renal tubular epithelial cells (HK-2) induced by high glucose.

HK-2 cells were cultured in different environment, and divided into low glucose group, high glucose group, hyperosmolar group, high glucose with miR-324-3p mimic group, hyperosmolar with miR-324-3p mimic group, miR-324-3p mimic group with different concentration, and negative control group. The apoptosis of HK-2 cells were detected by flow cytometry with Annexin Ⅴ-FITC/PI double dye. The expression of miR-324-3p was detected by real-time polymerase chain reaction. The expression of Bcl-2, Bax and cleaved caspase-3 protein level were evaluated by Western blot. Data were analyzed with t test for two groups, one-way ANOVA for multiple groups.

The expression of miR-324-3p was increased in high glucose group compared with that in low glucose group (2.33±0.27 vs 1.00±0.33, t=5.40, P<0.01). The expression of cleaved caspase-3 protein level was gradually increased with the increase of miR-324-3p mimic concentration (F=177.01, all P<0.05). Compared with the high glucose group, Bcl-2 expression was down-regulated in the high glucose with miR-324-3p mimic group (0.38±0.01 vs 0.40±0.00, t=-3.19, P<0.05), and the expression of Bax and cleaved caspase-3 were both increased (1.80±0.04 vs 1.68±0.03, t=4.32, P<0.05; 0.91±0.01 vs 0.66±0.01, t=29.75, P<0.01, respectively), and Bcl-2/Bax ratio was also decreased (0.21±0.00 vs 0.24±0.00, t=-11.20, P<0.01).

The expression of miR-324-3p is significantly up-regulated in HK-2 cells cultured by high glucose. MiR-324-3p increases cleaved caspase-3 protein level to promote HK-2 cell apoptosis possibly through down-regulating the ratio of Bcl-2/Bax.

congenital hyperinsulinism (CHI) is a group of diseases characterized by the spontaneous excessive secretion of insulin by β cells of pancreatic islets, excluding secondary factors such as insulinoma, iatrogenic hyperinsulinemia or dumping syndrome, and leading to persistent hypoglycemia. It is also the main cause of hypoglycemia in newborns and infants^[1]。 Thirteen gene mutations have been found to be associated with the occurrence of CHI^[2]However, the genetic mechanism is still unknown in about half of patients with congenital hyperinsulinemia. Short-chain 3-hydroxylamino-CoA dehydrogenase hyperinsulinism (SCHAD-HI): Caused by mutations in the HADH gene encoding short-chain 3-hydroxyyacyl-CoA dehydrogenase (SCHAD), it is a rare type of congenital hyperinsulinemia^[3]。 This type of mutation is mostly autosomal recessive inheritance, with different clinical manifestations in children, and most of them are effective for diazoxide treatment^[4]。 In this paper, a case of SCHAD-HI was reported in clinic, and its clinical characteristics and genetic characteristics were described in detail, so as to improve clinicians' understanding of SCHAD-HI.

Genetic and environmental factors play an important role in embryonic development and the progression of metabolic diseases. More and more studies have shown that epigenetic regulation of gene expression may affect pancreatic embryonic development and the pathogenesis of diabetes. This review mainly introduces the differentiation of pancreatic islets during embryonic development and the regulatory effects of epigenetic mechanisms on the genes related to pancreatic islet development.

Glycosylated hemoglobin (HbA_1c) is an important index to assess the level of blood sugar control in diabetic patients, but it has certain limitations. With the development of continuous glucose monitoring (CGM) technology, new indexes such as glucose time within target range (TIR) have attracted gradual attention in recent years. The latest research evidence shows that there is a good correlation between TIR and diabetic microvascular complications, and affirms its importance in clinical trial evaluation and treatment plan development. With the accumulation of more evidence-based evidence and the advancement of CGM research and development, TIR is expected to surpass HbA in the future_1cIt has become one of the important indicators of blood sugar control and management.

In 1937, Shu-Hsien Wang published the first relatively large scale retrospective case analysis of diabetes in China with the title "Diabetes Mellitus: An Analysis of 347 Cases (Chinese Inpatients) " on the Chinese Medical Journal. Following the brief review of the first part of the essay, the second part which mainly focused on the treatment (especially the insulin treatment) and prognosis of diabetes at that time was discussed in this paper.