Volume 11 · Issue 05 · 2019

Diabetes is a major chronic disease that threatens human health, and maintaining ideal blood glucose levels can not only reduce the risk of chronic complications of diabetes, but also effectively improve clinical outcomes. Blood glucose monitoring is an important means to guide blood glucose to reach the standard, and it is also a recognized method to evaluate blood glucose control. The content of blood glucose monitoring covers point blood glucose, glycosylated hemoglobin, glycosylated albumin and continuous glucose monitoring. Mastering the characteristics of various monitoring methods, jointly applying different monitoring technologies, and complementing each other's advantages have important guiding significance for improving the blood glucose management level of diabetes. In recent years, big data and artificial intelligence have been continuously integrated into blood glucose management, and the rapid development of science and technology has made non-invasive blood glucose monitoring emerge. It is expected that new monitoring technologies will continue to emerge in the near future, which can be more convenient, intelligent and non-invasive than now, and provide scientific and reliable new tools for blood glucose management.

Blood glucose monitoring plays an important role in diabetes management. In recent years, a new scanning glucose monitoring technology (FGM) based on intertissue fluid glucose concentration monitoring and algorithm has made breakthroughs and is leading the revolution in the field of blood glucose monitoring. FGM is different from the previous continuous glucose monitoring technology in that it does not need finger blood calibration, can obtain instant glucose values by simply scanning, and can provide dynamic glucose profiles for 14 days. For the use of FGM, national diabetes associations have successively issued guidelines or consensus. In order to further standardize and rationally apply this new technology, in 2018, the Blood Glucose Monitoring Group of Diabetes Branch of Chinese Medical Association released the "Expert Consensus on Clinical Application of Scanning Glucose Monitoring Technology in China". In this paper, the accuracy evaluation, reporting related indicators, clinical benefits and map reading methods of FGM application in the Consensus are deeply interpreted, so as to help clinicians to apply FGM to carry out clinical work.

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 adapting to 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 investigate the prevalence of sarcopenia in middle aged and elderly patients with type 2 diabetes (T2DM) and clarify the associated risk factors.

From January 2016 to March 2018, 1 125 T2DM patients over 50 years old in endocrinology departments of nine hospitals in Beijing were enrolled in this study with system random sampling method. All patients, including 586 males and 539 females, were grouped into middle aged group (50-59 years), young elderly group (60-74 years) and elderly group (over 75 years) by age. Body composition was measured with bioimpedance analysis. Low muscle mass was defined as the appendicular skeletal muscle mass index below 7.18 kg/m² in men and 5.73 kg/m² in women. Low muscle strength was defined as grip strength below 29.5 kg in men and 21.2 kg in women. Sarcopenia was defined with low muscle mass coexisted with low grip strength. Chi-square test was used to compare the prevalence difference between groups. Multivariate Logistic regression was used for correlation analysis.

(1) The detection rate of low muscle mass in all participants was 14.0%(157/1 125),which was significantly higher in male than that in female(18.3% vs 9.3%, χ ²=18.867, P<0.05). (2) The detection rate of low grip strength in all participants was 36% (405/1 125), which was significantly higher in male than that in female (50.3% vs 20.4%, χ ²=109.183, P<0.05). (3) The prevalence of sarcopenia in all participants was 8.5%(96/1 125), which was significantly higher in male than that in female (12.8% vs 3.9%, χ ²=28.509, P<0.05). The prevalence of sarcopenia were 4.4%(21/475), 8.9%(49/548), 25.5%(26/102) in middle aged group, young elderly group and elderly group, respectively (χ²=47.984, P<0.05). The sarcopenic prevalence in male was obviously higher than that in female in young elderly and elderly group (χ²=9.872-16.325, all P<0.05). (4) Logistic regression analysis showed that men, aging, low body mass index (BMI) and high glycated hemoglobin A_1c (HbA_1c) were risk factors associated with sarcopenia. The risk of sarcopenia increased obviously in patients older than 75 years (OR=4.992, 95%CI: 2.448-10.179) or whose HbA_1c was over 10% (OR=3.563, 95%CI:1.526-8.322) .

The risk of low muscle mass and low muscle strength increases in aged and elderly patients with T2DM. Low BMI, aging, high HbA_1c were risk factors associated with sarcopenia in elderly patients with T2DM.

To evaluate the efficacy and safety of chiglitazarin type 2 diabetic patients with pioglitazone as control group.

A multi-center (6 hospitals), randomized, double-blind, and parallel controlled clinical trial was carried out from November 2009 to November 2010. A total of 200 patients with newly diagnosed type 2 diabetes [glycated hemoglobin A_1c (HbA_1c): 7%-10%] were randomized to take 32, 40, 48 mg chiglitazar or 30 mg pioglitazone, respectively. At baseline and the 16th week, the levels of HbA_1c, fasting plasma glucose (FPG), 2 h post prandial piasma glucose (2h-PPG), insulin and lipid profiles were measured and adverse events were observed. Analysis of variance was used for comparison between groups and paired t-test was used for intra-group comparison.

The reduction differences were statistically significant from baseline to the 16th week at doses of 32, 40, 48 mg chiglitazar or 30 mg pioglitazone groups (t=-8.16-3.58, all P<0.05), but not among these 4 groups (F=0.40-0.75, all P>0.05). The least squares mean and 95% confidence intervals of HbA_1c, FPG and 2h-PPG in the four groups were as follow respectively: HbA_1c [-1.03% (-1.30, -0.77)%, -1.22% (-1.48, -0.96)%, -1.11% (-1.37, -0.85)% and -1.18% (-1.44, -0.91)%]; FPG[-1.79 (-2.43, -1.16), -1.82 (-2.44, -1.20), -1.76 (-2.37, -1.14) and -2.01(-2.64, -1.39)] mmol/L; 2h-PPG[-2.42 (-3.37, -1.47), -2.09 (-3.01, -1.16), -2.77 (-3.70, -1.84) and -3.11 (-4.06, -2.17)] mmol/L. Significant reductions from baseline to the 16th week were observed in triglycerides dose of 40 and 48 mg chiglitazar group and in cholesterol at dose of 32 mg chiglitazar group, while a slightly significant increase in HDL-C was observed in each of these 4 groups (t=2.40-3.88, all P<0.05). Moreover, the incidences of adverse events were similar among these 4 groups (P>0.05).

Chiglitazar is noninferior to pioglitazone in hypoglycemin effects for patients with type 2 diabetes. Both drugs have similar safety and tolerance.

To explore the effect of glucagon-like peptide-1 receptor agonist (GLP-1RA) on cardiovascular risk in overweight/obese type 2 diabetic patients complicated with coronary heart disease.

A retrospective study was proceeded in 200 overweight/obese diabetic patients with coronary heart disease at Fuwai Hospital from October 2010 to October 2016. Patients were divided into GLP-1RA treatment group (n=105) and the conventional treatment group (n=95). Data of body weight,body mass index (BMI), glycated hemoglobin A_1c (HbA_1c), fasting plasma glucose (FPG) and blood lipids before and after treatment for 6 months or drug withdrawal after 30 months were analyzed. The incidence rates of recurrent cardiovascular events/the cardiovascular risks were also evaluated between these 2 groups. Kruskal-Wallis test was used to compare the continuous variables in non-normal distribution, Student-t test was used to compare the continuous variables in normal distribution,and paired t-test was used to analyze the follow-up data and baseline data. Chi-Square test was used to compare the classified variable between groups. Multivariate Logistic regression analysis was used to analyze the related risk factors of cardiovascular events.

Weight [(-5.7±4.0) vs (-1.3±2.4)kg], BMI [(-1.9±1.3) vs (-0.4±0.7)kg/m²], HbA_1c [(-1.5±1.3)% vs (-0.8±0.6)%] and low density lipoprotein cholesterol after 6-month treatment were significantly decreased in GLP-1RA treatment group than those in conventional treatment group (t=2.42-4.19, all P<0.05). After 30-month following-up, the incidence rates of cardiovascular events in GLP-1RA group were significantly lower than those in conventional treatment group [2.86%(3/105) vs 11.58%(11/95), χ ²=4.57, P<0.05]. Compared with conventional treatment group after adjustment of multiple risk factors, the risk of recurrent cardiovascular events in GLP-1RA treatment group was significantly decreased (OR:0.23, 95%CI: 0.06-0.89, P=0.04).

Short-term application of GLP-1RA could alleviate body weight, improve glycolipid metabolic disorder, and reduce the risk of recurrent cardiovascular events in overweight/obese type 2 diabetic patients with coronary heart disease.

To investigate the islet α-cell function in patients with newly-onset fulminant type 1 diabetes mellitus (FT1DM).

Newly-onset type 1 diabetes mellitus (T1DM) patients diagnosed in the First Affiliated Hospital of Nanjing Medical University from October 2017 to July 2018 were recruited and divided into FT1DM group (n=4), typical autoimmune T1DM group (n=10), and 15 healthy volunteers were as controls. When the fasting blood glucose levels were controlled lower than10 mmol/L, steamed bread meal tests (SBMT) were performed to assess the functions of α-cell and β-cell. Blood glucose, C-peptide and glucagon were tested. The incremental areas under curve of glucagon (iAUC _glucagon) and C-peptide (tAUC _c-peptide) were calculated based on SBMT. A one-way analysis of variance was used for comparison among multiple groups. The least significant difference test was used to analyze the data with homogeneity of variance, and the Games-Howell test was used to analyze the data with heterogeneity of variance.

(1) The differences of tAUC _c-peptide among three groups were statistically significant (F=98.343, P<0.001). The tAUC _c-peptide in FT1DM group was significantly lower than that in typical autoimmune T1DM group [(192.62±68.98) vs (1 535.71±199.73) pmol·L^-1·h^-1, q_crit=3.830, P<0.001] and healthy control group [(192.62±68.98) vs (6 798.80±541.40) pmol·L^-1·h^-1, q_crit=3.688, P<0.001] respectively; (2) The fasting glucagon concentration in FT1DM group was lower than that in healthy control group [(6.19±2.92) vs (7.60±0.90) pmol/L], but higher than typical autoimmune T1DM group [(4.33±0.69) pmol/L]. Compared with baseline values, the levels of glucagon in both FT1DM group and typical autoimmune T1DM group increased after SBMT. The differences in iAUC_glucagon among three groups after SBMT were significant (F=34.344, P<0.001). The iAUC _glucagon in FT1DM group was significantly higher than those in typical autoimmune T1DM group [(21.55±8.88) vs (6.72±2.92) pmol·L^-1·h^-1, t=2.987, P=0.006] and healthy control group [(-13.16±7.68) pmol·L^-1·h^-1, t=7.348, P<0.001], respectively.

Not only complete failure of islet β-cell function, but also dysfunction of islet α-cell can present in patients with FT1DM, which is charicterized by postprandial hyperglucagonemia.

To evaluate the correlation between sweating function and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM).

A total of 326 hospitalized patients with T2DM in the Department of Endocrinology, General Hospital of Eastern Theater Command from August 2017 to February 2018 were enrolled, with an average age of (54.1±12.46) years. According to the diagnostic criteria of standard cardiovascular reflex test (CARTs), the patients were divided into two groups:225 cases with CAN and 101 cases without CAN (NCAN). Clinical biochemical indexes and sweat functions were compared between two groups to evaluate the relationship between Sudoscan and CAN. Kruskal-Wallis test and t test were used for comparison between groups. Spearman correlation analysis and binary logistic regression analysis were performed.

Electrochemical skin conductance (ESC) of hand (HESC) and feet (FESC) using Sudoscan test in CAN group and NCAN group were (64.8±15.71) vs (69.98±13.75) μs and (67.46±18.64) vs (71.47±17.39) μs, respectively. There were significant differences between two groups ( Z=-2.965, P=0.003; Z=-2.196, P=0.028). Spearman correlation analysis showed that HESC and FESC were positively correlated with heart rate variability (r value: 0.142-0.172, 0.117-0.196, all P<0.05). Age, durationof disease, HESC, FESC, CAN risk and other factors were included in the stepwise regression analysis. Results showed that age, HESC and postural diastolic pressure were independent factors of CAN (β=0.062, -0.02, 0.037, allP<0.05).

Sudoscan test is an objective, simple and quantitative method which showed potential in the early screening of diabetic cardiovascular autonomic neuropathy.

Menopause is a special physiological stage for women. Ovarian function declines and estrogen secretion decreases, which marks the termination of female fertility. Perimenopause refers to the period surrounding menopause, from the onset of endocrine, biological, and clinical features associated with menopause near menopause to one year after the last menstrual period. The changes of sex hormone levels in postmenopausal women are closely related to insulin resistance and lipid metabolism disorders, which leads to various metabolic diseases in women in this period. Among them, diabetes is the most likely disease, and estrogen, estrogen/testosterone ratio disorders are the key factors of diabetes development in postmenopausal women^[1]But its mechanism is not clear. menopausal hormone therapy (MHT) mainly refers to the individualized administration of low-dose estrogen and/or progesterone drugs to women with declining ovarian function on the premise of having indications and no contraindications to improve the symptoms of perimenopausal women. However, the regulation of blood sugar by MHT in diabetic women and the risk of diabetes in healthy postmenopausal women are not yet clear. This article reviews the risk of diabetes in perimenopausal women and its possible mechanisms, the benefits and risks of MHT, and related mechanisms.

The scanning glucose monitoring (FGM) system is simple to use, stable and reliable data, and has certain advantages in blood glucose management of inpatients. Evidence-based evidence shows that FGM is not only beneficial to ward management, but also improves work efficiency and reduces medical risks to a certain extent, and brings many benefits to patients, with broad application prospects.

It′s widely rumoured that Hu Shih, one of the most well-known Chinese philosophers and essayists in Republican China, has diabetes. By going through his diary and relevant materials, the authors tried to find the truth of his disease. Furthermore, the social and medical backgrounds of such rumour was discussed. The history of diagnosis and differential diagnosis of diabetes in the early 20th century in China was a significant part of that background.