Volume 14 · Issue 04 · 2022

Immune checkpoint inhibitors (ICPi) have attracted widespread attention as a new way of tumor immunotherapy. Immune-related adverse reactions cannot be ignored, and endocrine glands are common involvement targets. Patients with concomitant autoimmune diseases, such as autoimmune endocrine diseases, are generally excluded from clinical trials due to concerns about potential adverse reactions and expected efficacy. With the increasing incidence of autoimmune diseases worldwide, the widespread clinical application of ICPi has become a new problem in clinical practice for the safety and efficacy of patients with autoimmune diseases. Clinicians inevitably encounter this problem in clinical practice. Necessary attention and participation is an important step to make better clinical decisions.

Glucokinase gene (GCK) Diabetes due to glucokinase dysfunction due to inactivating mutations is a common type of monogenic diabetes mellitus (MDM), i.e.GCK-MDM, commonly referred to as adolescent-onset adult-type diabetes mellitus (MODY) type 2, or MODY2 orGCK-MODY.GCK-MDM is distinguished from other types of diabetes by its glucose profile, lipid profile, risk of chronic complications associated with diabetes, and therefore its management protocol is different, in addition, special management strategies are required at specific stages of the life cycle (e.g., during pregnancy). Due to clinician and patient concernsGCK-Insufficient understanding of MDM leads to a high rate of misdiagnosis and mistreatment. This expert consensus is based on domestic and foreignGCK-Research results of MDM, agreement on its diagnosis, treatment, follow-up, evaluation and prevention of complications and comorbidities, and relevant recommendations.

Diabetes self-management education and support (DSMES) is an important link to improve the severe situation of diabetes prevention and control in China. Primary medical institutions are the main battlefield of DSMES, and primary medical workers are the main force in implementing DSMES. In order to effectively carry out DSMES in primary medical institutions, an expert group formed by the Diabetology Professional Committee of Chinese Research Hospital Society and Shenzhen Diabetes Prevention and Treatment Center compiled the Expert Consensus on Self-management Education and Support of Adult Type 2 Diabetes Patients in Primary Medical Institutions. The consensus elaborates on the core meaning, responsibility objectives, main contents, implementation methods, implementation opportunities and quality assessment of DSMES in six aspects, and puts forward a systematic knowledge list, standardized processes and paths and quality assessment methods, aiming at promoting and standardizing the development of DSMES at the grass-roots level, improving the management and education of patients with type 2 diabetes and their health status, and reducing diabetes-related medical expenses.

Diabetic Charcot foot is a serious and potentially disabling disease that affects the foot and ankle joints. Diabetic neuropathy is the most common cause of Charcot foot, but it is easy to be confused with other diseases, and it is difficult to diagnose and treat early, which easily leads to joint deformity and even amputation. This article reviews the progress of diagnosis and treatment of diabetic Charcot foot, in order to improve the understanding and diagnosis and treatment level of this disease.

We aimed to explore the relationship between the change amplitude of glycemic and metabolic syndrome after glucose load in normal glucose tolerance (NGT) people.

According to the World Health Organization diabetes diagnostic criteria, a total of 22 302 NGT subjects with complete data were screened from the China National Diabetes and Metabolic Disorders Study (CNDMDS) from 2007 to 2008. The absolute difference between 2 h post-load glucose (2hPG) and fasting plasma glucose (FPG) during oral glucose tolerance test (OGTT) was used to reflect the change amplitude of glycemic, and compare the differences of metabolic indices and the prevalence of metabolic syndrome between different change amplitude. As a part of CNDMDS, 3 247 subjects completed the baseline survey from 2007 to 2008 in Shaanxi Province, in the retrospective cohort to 2016 and 2017, a total of 678 NGT subjects with complete data were included in the confirmatory analysis. According to the cut-off point of the change amplitude of glycemic related to metabolic diseases from the receiver operating characteristic curve (ROC) in the cross-sectional analysis, subjects were divided into two groups to compare the incidence risk of diabetes after 9 years of follow-up. The t test, analysis of variance and chi-square test were used to compare the differences in clinical characteristics and metabolic indices among different groups, and Logistic regression analysis was used to evaluate the influence of different groups on the prevalence of MS and the incidence of diabetes.

We divided the change amplitude of glycemic after glucose load of 22 302 subjects into quartiles, among which the change amplitude were as follows: Q1 group (<0.45 mmol/L, 5 593 subjects), Q2 group (0.45 to 0.93 mmol/L, 5 603 subjects), Q3 group (0.94 to 1.60 mmol/L, 5 636 subjects), Q4 group (>1.60 mmol/L, 5 470 subjects); the body mass index (BMI), waist circumference, blood pressure, total cholesterol, triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were increased significantly with the increasement of the change amplitude of glycemic, while high-density lipoprotein cholesterol (HDL-C) decreased significantly, the prevalence of metabolic syndrome (MS) and the proportion of subjects with middle or high risk for developing coronary heart disease in 10 years [Framingham risk score (FRS) ≥10%] were increased significantly. Logistic regression analysis showed that the large change amplitude of glycemic after glucose load was a risk factor for MS. Use MS and FRS ≥10% as the outcome variables, the change amplitude of glycemic as the independent variable, the cut-off point of the change amplitude of glycemic both were 1.09. Among 678 NGT subjects in the retrospective cohort, the incidence of diabetes in the group with small change amplitude of glycemic (the change amplitude of glycemic ≤1.09 mmol/L) and large change amplitude of glycemic (the change amplitude of glycemic >1.09 mmol/L) were 7.2% (28/388) and 13.1% (38/290), respectively, the difference was statistically significant (P=0.011). Logistic regression analysis showed that the change amplitude of glycemic after glucose load >1.09 mmol/L was a risk factor for diabetes, after adjusting for age, gender, BMI, smoking, drinking, exercise and family history of diabetes, the risk ratio was 1.829 (95%CI 1.079 to 3.101, P=0.025).

In NGT people, the large change amplitude of glycemic after glucose load was a risk factor for metabolic diseases and could predict the occurrence of diabetes.

To investigate the effects of empagliflozin on blood pressure variability (BPV) and left ventricular mass index (LVMI) in patients with type 2 diabetes mellitus (T2DM) and hypertension.

This was a prospective parallel control study. A total of 90 patients who were hospitalized in the Department of Endocrinology, the Second Affiliated Hospital of Anhui Medical University from October 2020 to April 2021 were recruited. They all had used one or more hypoglycemic agents with poor blood glucose, and hypertension control were basically stable. Study subjects were divided into the control group and empaglliflozin group by random number table. The control group regulated the original dose of hypoglycemic agents or added others (sodium-glucose cotransporter 2 receptor inhibitors and glucagon-like peptide-1 receptor agonists were excepted), the empagliflozin group maintained the original hypoglycemic scheme and added empagliflozin (10 mg per day) for 48 weeks of continuous observation. Before and after treatment, clinical data such as body mass index (BMI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were collected; fasting blood glucose (FPG), 2-hour postprandial blood glucose (2hPG), glycated hemoglobin A_1c (HbA_1c), and serum lipid were detected. 24hDBP, daytime SBP (dSBP), daytime DBP (dDBP) and 24hSBP standard deviation (24hSBPSD) were monitored by a 24-h ambulate blood pressure monitor. Left ventricular inner diameter (LVDd) and ventricular septal thickness (IVS) were measured by echocardiography, and LVMI was calculated. The adverse reactions during therapy were observed. The differences among the groups were compared using t test, χ² test, and nonparametric test.

Among the 90 patients, 2 patients in the empagliflozin group withdrew from the study due to economic factors, 3 patients were lost to follow-up, 5 patients in the control group were lost to follow-up, and 40 patients in each group successfully completed the follow-up observation. There was no difference in age, sex, BMI, duration of diabetes, LVMI and BPV between the two groups at baseline. After 48 weeks of treatment, there were statistically significant decreased in empagliflozin group in FPG, HbA_1c, BMI, LVMI, 24hSBP, 24hDBP, dSBP, dDBP [(5.78±0.84) vs. (7.96±1.45) mmol/L, (6.30±0.72)% vs. (9.06±1.76)%, (24.39±2.52) vs. (26.97±2.71) kg/m², (80.80±10.78) vs. (92.96±11.19) g/m², (125±7) vs. (132±12) mmHg (1 mmHg=0.133 kPa), (78±11) vs. (81±10) mmHg, (123±7) vs. (131±11) mmHg, (79±12) vs. (83±10) mmHg, respectively], and the proportion of dipper blood pressure increased [4 cases (10.0%) vs. 14 cases (35.0%)], the differences were statistically significant (all P<0.05). And compared with the control group, BMI, DBP, HbA_1c, FPG, 2hPG, triglycerides, total cholesterol, low-density lipoprotein-cholesterol, LVDd, IVS, dSBP, 24hSBPSD in the empagliflozin group were significantly decreased after treatment, and the differences were statistically significant (all P<0.05). There was no significant difference in adverse reactions between the two groups (P>0.05).

In patients with T2DM combined with hypertension, empagliflozin can significantly improve the circadian rhythm, and significantly reduce the LVMI, blood pressure, BMI, blood glucose and lipid, without increasing adverse reactions such as hypoglycemia.

To study the effect of dapagliflozin on the composition of the gut microbiota and the function of β-cells in newly diagnosed type 2 diabetes mellitus (T2DM).

A total of 52 newly diagnosed T2DM patients who were hospitalized in Yancheng Tinghu District People Hospital from December 2018 to September 2019 were enrolled, and 20 healthy people from the physical examination center were selected as the control group. In hospital, patients with T2DM were given intensive insulin therapy based on the guidance of specialist nurses and diabetic diet, which stopped insulin therapy one week after the blood glucose reached the target. T2DM patients were divided into two groups according to a random number table method: dapagliflozin group (dose of 10 mg, once per day) and metformin group (dose of 0.5 to 1.0 g, twice per day). The two groups were both treated for 12 weeks. The general data of the two groups of patients were collected and various indexes before and 12 weeks after treatment were recorded, including body mass index (BMI), waist circumference, uric acid, glycated hemoglobin A_1c (HbA_1c), triglycerides (TG), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), fasting blood glucose (FPG), 2 h postprandial blood glucose (2hPG), homeostasis model assessment of insulin resistance (HOMA-IR) and beta-cell function (HOMA-β), and so on. The feces samples of the two groups of the patients in both groups were collected before intervention and at 12 weeks after intervention. 16SrDNA sequencing to detect changes in gut microbiota composition were evaluated. The t test was used for the comparison between the two groups. The comparison of each index between groups using an analysis of one-way analysis of variances or Kruskal-Wallis test. Spearman correlation analysis was used to analyze the correlation between differential gut microbiota and clinical parameters of T2DM.

There were 26 cases in dapagliflozin group, 26 cases in metformin group. Compared to metformin group after 12 weeks treatment, the BMI, LDL-C, HOMA-IR level was significantly reduced, while the levels of HDL-C and HOMA-β were increased by dapagliflozin treatment, the differences were statistically significant (all P<0.05). Fecal samples were successfully collected from 13 patients in metformin group, 11 patients in dagaglipin group and 20 patients in normal control group, respectively. The alpha diversity was significantly increased in metformin group and dapagliflozin group; for a comparison of two group, dapagliflozin treatment decreased the relative abundance of Enterobacteriaceae, Flavonifractor and increased abundance of Faecalibacterium and Prevotellaceae compared to metformin group. Blautia positively correlated with the levels of FPG, 2hPG, and HbA_1c (r=0.41, 0.41, 0.43, respectively, all P<0.01), Faecalibacterium negatively correlated with the levels of FPG, 2hPG, and HbA_1c (r=-0.36, -0.34, -0.46, respectively, all P<0.01), Erysipelotrichaceae positively correlated with the levels of FPG, 2hPG, and HbA_1c (r=0.44, 0.46, 0.46, all P<0.01).

In newly diagnosed T2DM patients, dapagliflozin group was superior to metformin group in reducing body weight, increasing pancreatic β-cell function, and improving insulin resistance. Gut microbiome composition was significantly altered in T2DM patients by both groups after 12 weeks treatment, however, there were differences in the composition structure and abundance level of gut microbiota after metformin and dapagliflozin treatments.

To investigate the prevalence and influencing factors of diabetes in people (≥60 years old) in Anning City, Yunnan Province.

This was a cross-sectional study (from September 2019 to January 2020) using multi-stage stratified group sampling with 9 447 people (≥60 years old) from 57 villages in Anning City. The data of individual′s information were recorded, such as age, nation, local economic development level, height, weight, body mass index (BMI), fasting plasma glucose (FPG), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol(LDL-C), then the detection rate of the dyslipidemia was calculated. All participants were divided into diabetic group (FPG≥7.0 mmol/L or previously diagnosed diabetes), impaired fasting glucose group (6.1 mmol/L≤FPG<7.0 mmol/L), and normal glucose group (FPG<6.1 mmol/L) based on their glucose metabolic status. Analysis of variances, Kruskal-Wallis H test, chi-square test or Cochran-Armitage trend test were used to compare the indicators within the groups, with the multivariate logistic regression model was adopted to analyze the influencing factors of diabetes.

A total of 9 447 individuals were included. Among them, 1 630 cases in diabetic group, 1 267 cases in impaired fasting glucose group, and 6 550 cases in normal glucose group. The prevalence of diabetes was 17.25% (1 630/9 447). The prevalence of diabetes in the Han nationality was significantly higher than that in the minorities, and the rate in high economic level area was significantly higher than that in middle economic level area (P<0.05). Multi-level logistic regression analysis suggested that there was a cross interaction between the different levels of economic development, and ethnic minorities on the prevalence of diabetes in the elderly(≥60 years old, OR=0.307,95%CI 0.190-0.494,P<0.001), dyslipidemia (OR=1.822, 95%CI 1.612-4.687, P=0.042), overweight (OR=2.749, 95%CI 1.099-3.023, P=0.004), age (OR=1.562, 95%CI 0.705-1.977, P=0.032) were all risk factors for diabetes.

The prevalence of diabetes in people aged 60 years and above in Anning city of Yunnan is 17.25%. Moreover, the level of economic development and ethnic minorities have cross-layer interaction on the prevalence of diabetes in people aged 60 years old and above. The main risk factors for diabetes include dyslipidemia, overweight and age.

To investigate the effect of myeloid-derived growth factor (MYDGF) on browning of white adipose tissue in obese mice.

Male C57BL/6J wild-type (WT) mice and MYDGF knockout (KO) mice fed a high fat diet for 12 weeks were divided into WT-GFP group, WT-MYDGF group, KO-GFP group, and KO-MYDGF group according to AAV (adeno-associated viral)-MYDGF or AAV-GFP (green fluorescent protein) intervention. WT mice fed a normal chow diet were used as a control group. The body weight and heat production during the light and dark of mice in each group were detected. The epididymal white adipose tissue (eWAT), the inguinal white adipose tissue (iWAT) and the interscapular brown adipose tissue (iBAT) were isolated and weighed. The morphology of adipocytes was observed by hematoxylin and eosin (HE) staining. The expression of browning-related genes [uncoupling protein 1 (UCP1), peroxisome proliferator-activated receptor γ (PPARγ), peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α), PRD1-BF1-RIZ1 homologous domain containing 16 (PRDM16)] were detected by immunohistochemistry and the real-time polymerase chain reaction (RT-PCR), the vessels of adipose tissues were detected by immunofluorescence staining in subcutaneous adipose tissue. According to the results of MTT experiment, 3T3-L1 preadipocytes treated with 100 ng/ml recombinant MYDGF (rMYDGF) for 24 h were selected as experimental group (rMYDGF), and cells treated with 0 ng/ml rMYDGF for 24 h were selected as control group (Vehicle). The mRNA and protein expression levels of UCP1, PPARγ, PGC-1α and PRDM16 were detected by RT-PCR and western blot. Independent-samples t test was used for comparison between two groups.

A total of 30 mice were enrolled, including 6 mice in each of the control group, WT-GFP group, WT-MYDGF group, KO-GFP group and KO-MYDGF group. After 12 weeks of intervention, the body weight of WT-MYDGF group and KO-MYDGF group decreased compared with WT-GFP group and KO-GFP group, while heat production during the light and dark increased, the mRNA expression of UCP1, PPARγ, PGC-1α, PRDM16 and the number of blood vessels increased (P<0.05). The volume and cell size of eWAT and iWAT decreased in mice supplemented with MYDGF. The weight of eWAT and iWAT decreased in WT-MYDGF group compared with WT-GFP group (P<0.05), and the weight of eWAT decreased in KO-MYDGF group compared with KO-GFP group (P<0.05). In vitro, the mRNA and protein expression of browning-related genes UCP1, PPARγ, PGC-1α and PRDM16 increased in 3T3-L1 adipocytes of rMYDGF group compared with Vehicle group (P<0.05).

MYDGF promotes browning of white adipose tissue in obese mice.

To explore the effects of electroacupuncture on apoptosis of interstitial cells of Cajal (ICC) in rats with diabetic gastroparesis.

Thirty-two SD rats were divided into normal control (NC) group, model group, electroacupuncture group and metoclopramide group, with 8 in each group. The blood glucose was measured by a blood glucose meter. The gastric emptying rate and small intestine propulsion rate were measured by intragastric phenol red method. The primary culture of antral ICC was extracted, the protein expression of B-cell lymphoma protein 2 (Bcl-2), B-cell lymphoma-2-interacting protein (Beclin1), Caspase-3 were detected by Western blot, and the apoptosis rate was observed by flow cytometry. One-way analysis of variance (ANOVA) was used for the index comparisons among the 4 groups, and LSD was used for index comparisons between every 2 groups.

Compared with NC group, the blood glucose was statistically increased, the gastric emptying rate and small intestine propulsion rate were statistically decreased, the protein expression of Bcl-2, Beclin1 and Caspase-3 of ICC and the apoptosis rate of ICC were statistically increased (all P<0.05) in model group, electroacupuncture group and metoclopramide group. Compared with model group, the blood glucose in electroacupuncture and metoclopramide group were statistically decreased, the gastric emptying rate and small intestine propulsion rate were statistically increased, the protein expression of Caspase-3 of ICC and the apoptosis rate of ICC were statistically decreased (all P<0.05). The protein expression of Bcl-2, Beclin1 of ICC in electroacupuncture group statistically increased compared with model group (P<0.01). Compared with metoclopramide group, the protein expression of Bcl-2 and Beclin1 of ICC were statistically increased, and the protein expression of Caspase-3 and the apoptosis rate of ICC in electroacupuncture group were statistically decreased (all P<0.05).

Electroacupuncture may inhibit the apoptosis of the gastric antrum ICC by regulating the expression of the apoptosis-related factors Bcl-2, Beclin1 and Caspase-3.

The practice of the hierarchical diagnosis and treatment referral system for diabetes is an important measure to integrate the respective advantages and synergies of community doctors and specialists, ensure that patients enjoy high-quality medical services, and the treatment is homogenized and safe. In order to further optimize the allocation of urban medical resources, build a perfect graded diagnosis and treatment system, improve the quality of medical service, and standardize the clinical diagnosis and treatment behavior, this paper summarizes the practical experience of graded diagnosis and treatment and referral system of diabetes in Shenzhen, in order to provide reference for the construction of graded diagnosis and treatment service system of diabetes in other areas.

Three patients with hypopituitarism and sudden hyperosmolarity and hyperglycemia after craniopharyngioma surgery admitted to the Department of Endocrinology and Metabolism of Tianjin Medical University General Hospital were retrospectively analyzed. The pathogenesis process, serological results, treatment and follow-up of 3 patients were retrospectively analyzed, and the literature of 7 similar cases was reviewed. Three patients with hypopituitary function after craniopharyngioma operation had no family history of diabetes and preoperative diabetes history. They had sudden hyperosmolar hyperglycemia after operation, and were complicated with hyperlipidemia and non-alcoholic fatty liver disease. After insulin and oral drug treatment, blood glucose control was acceptable. In clinical work, attention should be paid to monitoring the blood glucose level of patients with hypopituitary function after craniopharyngioma operation, so as to avoid acute complications such as diabetic ketoacidosis and hyperosmolar hyperglycemia.

This article retrospectively summarizes the clinical data of a patient with 17q12 deletion syndrome admitted to the PLA General Hospital in February 2021, and reviews the relevant literature. The patient was a 35-year-old male. Medium size, low blood potassium and magnesium repeatedly checked; The 75 g oral glucose tolerance test showed an increase in blood glucose of more than 11.1 mmol/L after glucose administration. Ultrasound revealed left kidney cyst. The whole exome sequencing assay was 46, XN, del (17q12). seq [GRCh37/hg19] (34587257-36104957) ×1, a deletion of approximately 1.52 Mb was detected in the 17q12 segment, which is associated with "renal cysts and diabetic syndrome" in the BGI160 database. 17q12 deletion syndrome is characterized by adolescent-onset adult-type diabetes type 5 (MODY5) in combination with kidney structural or functional abnormalities and neuropsychiatric or neurodevelopmental disorders. However, the frequent overlap between hepatocyte nuclear factor 1 β (HNF1 β) mutations and 17q12 deletion syndrome in clinic is often overlooked. While the entire HNF1 β deletion is the most common cause of MODY5, all patients suspected of MODY5 should be examined for common clinical features of 17q12 deletion syndrome. It is recommended that for patients with hypokalemia and hypomagnesemia, attention should be paid to the evaluation of blood sugar and blood pressure. When multiple phenotypes occur in clinic, the possibility of hereditary diseases should be considered. When whole exon assay fails to lock the lesion, the possibility of fragment deletion should be considered.

A case of adolescent occult autoimmune diabetes mellitus (LADY) in a patient with anorexia nervosa was reported after using olanzapine. The patient was a 12-year-old girl who was hospitalized with the main complaint of "weight loss for more than 1 year and blood sugar increase for more than 2 months". Various diabetic autoantibodies such as anti-islet cell antibody, tyrosine phosphatase antibody and glutamate decarboxylase antibody were detected as high titer positive, and human leukocyte antigen typing suggested that she was adolescent occult autoimmune diabetes. After intensive insulin therapy and withdrawal of olanzapine, metformin treatment alone has steadily controlled blood glucose for more than half a year. Eating disorders and autoimmune diabetes have a common genetic susceptibility. During treatment with atypical antipsychotics such as olanzapine, blood glucose changes should be closely monitored, especially for some diabetic autoimmune antibody-positive or autoimmune diabetes patients with high-risk genotypes, they should be alert to the occurrence of diabetes.

This article reports the clinical data of two patients with diabetes, insulin resistance, acanthosis nigricans, retinitis pigmentosa, hyperlipidemia, liver and kidney function impairment, and whole exon gene sequencing. The results showed that two patients carriedALMS1Compound heterozygous mutations of genes c.2179dupT and c.10825C>T, c.2433dupA and c.11042dupT, combined with clinical symptoms, were diagnosed as Alström syndrome. At present, the main clinical symptoms of 84 patients with Alström syndrome in China have been reported as obesity or overweight, visual impairment, hearing impairment, and type 2 diabetes. In this paper, c.2433dupA and c.11042dupT were new pathogenic mutation sites in two patients with Alström syndrome, and hypokalemia and pancreatitis were uncommon.ALMS1The gene mutations were focused on the 8th and 16th exons.

Mauriac syndrome is a rare diabetic complication caused by poor glycemic control of diabetes, also known as diabetic pseudodwarf. This article reports a male patient with Mauriac syndrome, who was characterized by abdominal distension as the first feature before puberty. Blood glucose fluctuated greatly before diagnosis, and auxiliary examination showed hepatomegaly, significantly elevated transaminases and hypercholesterolemia. Initially, genetic metabolic disease was suspected, but after active hypoglycemic treatment, symptomatic treatment and whole exon gene testing to rule out related diseases caused by causative gene mutations, Mauriac syndrome was finally diagnosed. With the increasing awareness of glycemic control in diabetes mellitus and the popularization of insulin use, Mauriac syndrome is relatively rare. There are constant reports of this syndrome abroad, but only a few cases were reported in China at the beginning of the 21st century and all of them were adolescent female patients. Now, a preadolescent male patient admitted to the People's Hospital of Xinjiang Uygur Autonomous Region is reported, in order to improve clinicians' understanding of Mauriac syndrome.

Blood glucose fluctuation is one of the hotspots in diabetes research. In recent years, its evaluation methods and evaluation parameters have been continuously enriched. However, at present, most parameters still only focus on the amplitude of short-term blood glucose fluctuation, but do not reflect the regularity of blood glucose changes in time scale. Therefore, it is one of the directions of everyone's interest to find parameters that can synthesize the amplitude of blood glucose fluctuation and the changes in time series. The correlation between short-term and long-term blood glucose fluctuations and chronic complications of diabetes mellitus has been supported by more clinical evidence, while the research on the basic mechanism is still being improved. Besides oxidative stress and chronic inflammation, abnormal blood glucose fluctuations also lead to vascular damage through epigenetic changes. In addition, with the continuous emergence of new hypoglycemic drugs, their improvement degree on abnormal blood sugar fluctuations has also received attention, in order to further delay the occurrence and development of chronic complications of diabetes.

Diabetic cardiomyopathy is an important cause of heart failure and even death in diabetic patients, and autophagy dysregulation in its pathogenesis is gradually attracting people's attention. Glycogen autophagy, as a selective autophagy, plays an important role in maintaining glucose homeostasis in the heart, skeletal muscle and liver. Glycogen autophagy is regulated by a variety of signaling pathways, and its dysregulation will cause glycogen accumulation, which is the cause of Pompe disease in infants. Glycogen autophagy also reduces the sensitivity of cardiomyocytes to insulin through the forkhead transcription factor O1 signaling pathway, aggravating the damage of diabetic cardiomyopathy. This paper reviews the occurrence of glycogen autophagy and its research progress in diabetic cardiomyopathy. Targeting glycogen autophagy may provide a new strategy for the treatment of the disease.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy, and the development of this disease can cause serious adverse effects on mother and child health. There is evidence that in the pathogenesis of GDM, the inflammatory response of placental tissue, which is mainly manifested by inflammatory cell aggregation and inflammatory factor secretion, plays a crucial role. In recent years, many studies have revealed the aberrant expression of non-coding RNA in GDM and its relationship with inflammation-related mechanisms, as well as the potential implications as novel biomarkers to assist in early clinical diagnosis of GDM. This paper summarizes the latest research on the involvement of non-coding RNA in the regulation of inflammatory mechanisms related to GDM, in order to provide new ideas for the diagnosis and treatment of GDM.

Telemedicine technology promotes the close integration of information technology and medical service industry, and has a wide range of applications. It can assist clinical medical staff to monitor and manage diabetic foot patients and reduce the occurrence of adverse events. This article reviews the concept of telemedicine, the application forms and effects of telemedicine technology in diabetic foot patients at home and abroad, the existing problems and suggestions, in order to provide reference and basis for the popularization and application of telemedicine technology in diabetic foot patients management.

Gestational diabetic ketoacidosis (DKA) is a critical emergency in pregnancy, which seriously threatens the life of mother and child. However, there is a lack of large-scale systematic research, and its understanding is generally insufficient. This paper introduces the epidemiology, pathophysiological mechanism, triggers, clinical manifestations, diagnosis and treatment of DKA in pregnancy, expounds the difference between DKA in pregnancy and DKA in non-pregnancy, and its influence on fetus, and analyzes the characteristics of DKA in pregnancy from multiple aspects.

Continuous glucose monitoring technology (CGM) provides continuous, comprehensive, and reliable blood glucose information throughout the day to understand the trends and characteristics of blood glucose fluctuations. Glycemic control is improved when diabetics use CGM during home isolation. Application of CGM in isolation wards can reduce the risk of occupational exposure. Application of CGM is beneficial for enhancing diabetes management for patients and clinicians during quarantine.