Volume 14 · Issue 10 · 2022

Hyperglycemic crisis events (HCE) are common acute complications of diabetes, which seriously affect the short-term and long-term prognosis of patients. The onset of HCE is acute and the prognosis is poor. Early standardized diagnosis and treatment is very important to improve the prognosis of patients. Nevertheless, the diagnosis and treatment options proposed by the current guidelines at home and abroad are still quite different, which brings many differences to clinical work. In view of this, on the basis of comparing the current guidelines, this paper deeply discusses the inducing changes of HCE, the differences and differences in clinical diagnosis and treatment, and summarizes and forecasts the research progress of HCE.

Panvascular disease is not only a common comorbidity of type 2 diabetes mellitus (T2DM), but also the leading cause of disability and death in patients with T2DM. To promote multidisciplinary cooperation, interdisciplinary integration, and early detection of panvascular diseases in T2DM patients, a panel composed of Chinese experts in cardiovascular disease, endocrinology, nephrology, neurology, and health management led by Chinese College of Cardiovascular Physicians was established and developed this consensus based on the latest evidence-based medical research and crucial progress in the related disciplines. This consensus covers the epidemiological characteristics, pathophysiological mechanisms, multidisciplinary collaborative diagnosis and treatment, as well as risk assessment and management, and highlights the early risk assessment of panvascular disease in patients with T2DM (assess risk factors, vascular structure and function, and target organ damage at least annually). This consensus also emphasizes that managing panvascular disease in patients with T2DM requires the participation of both patients and multidisciplinary physicians and the necessity of strengthening the control of blood glucose, blood pressure, blood lipids, and antiplatelet therapy based on lifestyle interventions. The consensus will standardize the comprehensive clinical management of panvascular disease in patients with T2DM and improve patient prognosis.

The integration of sports and medicine aims to promote in-depth cooperation between the sports sector and the medical and health sector to promote health through sports. However, there is still a lack of unified standards for how to carry out and implement diabetes exercise intervention under the concept of integration of physical education and medicine. Therefore, this consensus was compiled under the organization of Diabetes and Microcirculation Professional Committee of Chinese Microcirculation Society, Education and Management Group of Diabetes Branch of Chinese Medical Association, Grassroots Endocrinology and Metabolism Group of Endocrinology Branch of Chinese Medical Association, Sports and Health Branch of Chinese Preventive Medicine Association and Sports and Medical Integration Diabetes Sports Rehabilitation Alliance, and by consulting the latest literature evidence at home and abroad. This consensus mainly includes the theoretical basis of diabetes mellitus exercise intervention, the current situation and problems of physical and medical integration diabetes mellitus exercise intervention, program formulation and intervention form, as well as the implementation process and management mode.

To explore the effects of serum uric acid (SUA) on the incidence of prediabetes mellitus (PreDM) population.

This study was a prospective cohort study. Community residents who were diagnosed with PreDM at baseline in Dalian from July to December 2011 and completed a three-year follow-up were selected as the research objects. The sex was collected. The age, weight, waist circumference, high-density lipoprotein-cholesterol (HDL-C), fasting plasma glucose (FPG), 2 h-postprandial plasma glucose (2hPG), fasting insulin (FINS), blood uric acid, glycated hemoglobin A_1c (HbA_1c) of all subjects at baseline and three years later were collected, and then the patients′ homeostasis model assessment of insulin resistance (HOMA-IR), were calculated. The subjects were divided into diabetes group and non-diabetes group according to their blood glucose level at the completion of 3 years. The subjects were divided into three groups according to the tertiles of baseline blood uric acid level. The first quartile (S1) group (SUA≤287 μmol/L), second quantile (S2) group (287 μmol/L<SUA≤342 μmol/L), third quartile (S3) group (SUA>342 μmol/L). Comparisons between the diabetic and non-diabetic groups were performed using two independent samples t-tests and chi-square. Multiple logistic regression analysis was used to analyze the relationship between SUA and incidence of diabetes in PreDM population.

A total of 1 349 subjects with PreDM attended the follow up survey, included 338 males and 1 011 females. There were 153 cases in diabetes group and 1 196 cases in non- diabetes group. Compared with the non- diabetes group, the baseline SUA level of subjects in the diabetes group increased (t=-3.83, P<0.001). The cumulative incidence of diabetes in S1, S2 and S3 groups after 3 years was 7.7% (35/454), 11.8% (53/448) and 14.5% (65/447), respectively, with statistically significant difference (χ²=10.62,P<0.01). Logistic regression analysis showed that, after adjusting for age, sex, weight, waist circumference, HDL-C, FPG, 2hPG and HOMA-IR confounding factors, the risk of diabetes in S2 and S3 groups increased to 1.472 times (95%CI 0.928-2.377) and 1.698 times (95%CI 1.047-2.752) respectively compared with S1 group.

With the increase of baseline SUA level, the cumulative incidence rate of diabetes in PreDM population increased after 3 years. Elevated SUA level might increase the risk of diabetes.

To investigate the association between the triglyceride glucose (TyG) index and the risk of incident diabetic nephropathy (DR) among patients with type 2 diabetes mellitus (T2DM).

This was a retrospective cohort study. We enrolled the patients with T2DM who underwent health check-up from January 2015 to December 2021 at Huadong Sanatorium, 1 153 patients were eligible after selection and follow-up. Investigators were stratified into four groups based on the quartiles of the baseline TyG index, including Q₁, Q₂, Q₃ and Q₄ groups. TyG of Q₁ was less than or equal to 8.77, TyG of Q₂ was from 8.78 to 9.20, TyG of Q₃ was from 9.21 to 9.69, TyG of Q₄ was more than or equal to 9.70. Cox proportional hazards regression model and restricted cubic spline (RCS) was used to evaluate the associations between TyG index and the risk of incident DR. We performed the subgroup analysis based on age, gender, and explored the interaction effects between TyG index and risk factors.

A total of 7 660.75 person-years were followed up, with a median follow-up time of 7 years. During the follow-up period, 140 cases of new DR occurred. Cox proportional hazard regression model analysis showed that after adjusting for age, gender, course of disease, smoking, alcohol consumption, exercise, high-density lipoprotein-cholesterol, systolic blood pressure, body mass index, glycated hemoglobin A_1c, the use of hypoglycemic drugs, and the use of lipid-lowering drugs, compared with TyG index Q₁ group, the HR (95%CI) of DR in Q₂, Q₃, and Q₄ groups were 3.42(1.66-7.05), 3.89(1.90-7.99), and 4.23(2.07-8.68), respectively, all trend test P<0.001. RCS analysis showed that the correlation between TyG index and DR risk was linear, but there was a segmented effect. When TyG index was less than 9.16, the HR of DR onset was 5.74 (95%CI 2.13-15.49), P=0.006; When TyG index≥9.16, its impact on DR incidence tended to be gentle, and the HR of DR incidence was 1.30 (95%CI 0.94-1.81), P=0.115.

High TyG index is strongly associated with DR. TyG index has early predictive value for DR.

To investigate the prevalence, and clinical and biochemical characteristics of Mauriac syndrome in patients with type 1 diabetes mellitus (T1DM).

This study was a case-control study. The patients with T1DM who met the inclusion and exclusion criteria in the Department of Endocrinology and Metabolic Diseases, Xinjiang Uygur Autonomous Region People′s Hospital from January 2012 to December 2020 were selected as the case group, and T1DM patients with normal transaminases were matched 1∶4 according to age and sex as the control group. The gender, age, and the number of subjects with abdominal pain, abdominal distension, vomiting, short stature, and history of recurrence of diabetic ketoacidosis (DKA) were collected, and their total cholesterol (TC) and triglyceride (TG) were determined. The glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), lactate, lactate dehydrogenase, glycated hemoglobin A_1c (HbA_1c), etc, were determined as well. The patient was examined for hepatomegaly at the same time. The t test, Mann-Whitney U test, χ² test or Fisher test were used to compare the differences of measurement data and enumeration data between groups.

A total of 286 T1DM patients were included, of which 12 were eventually diagnosed with Mauriac syndrome. Among them, there were 5 cases aged<18 years and 7 cases aged ≥18 years; 5 cases with abdominal pain, 6 cases with previous history of DKA recurrence, 3 cases with abdominal distention, 2 cases with short stature, 3 cases with vomiting, and 9 cases with imaging suggestive of hepatomegaly. Compared with the control group, the patients in the case group had more abdominal distension, hepatomegaly and recurrence of DKA, and higher HbA_1c, TC, TG, ALT, AST, lactate and lactate dehydrogenase (Ρ<0.05).

In T1DM patients with poor blood sugar control and elevated transaminase and/or hepatomegaly, the possibility of Mauriac syndrome should be alerted if the patients accompanied by elevated levels of TC, TG, lactate and lactate dehydrogenase.

To assess the correlation between retinal vessel caliber and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM).

A total of 309 T2DM patients who were hospitalized in the Department of Endocrinology of Hebei General Hospital from January to December 2021 were assigned to two groups according to urine microalbumin/creatinine ratio (UACR) and estimated glomerular filtration rate (eGFR), including non-DKD group (212 cases) and DKD group (97 cases). Height, weight, body mass index (BMI), systolic blood pressure, diastolic blood pressure, glycated hemoglobin A_1c (HbA_1c), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C), UACR and eGFR were recorded. The retinal vascular parameters (venula temporalis retinae superior and arteriola nasalis retinae superior) were measured by the automated retina image analysis system. Central retinal vein equivalent value (CRVE) was calculated. According to the quintile of the diameter level of the retinal superior temporal vein, the patients were divided into Q₁ group (<136.13 μm, 68 cases), Q₂ group (136.13-148.42 μm, 56 cases), Q₃ group (148.43-160.72 μm, 62 cases), Q₄ group (160.73-177.12 μm, 64 cases) and Q₅ group (>177.12 μm, 59 cases). The t test or Mann-Whitney U test was used for comparison between two groups, and ordered logistic regression analysis was used to evaluate the correlation between retinal vascular diameter and DKD.

There were statistically significant differences in the level of venula temporalis retinae superior [(161.87±22.47) vs. (152.93±21.98) μm], CRVE [(191.75±20.18) vs. (187.09±17.52) μm] and arteriola nasalis retinae superior [(84.62±15.09) vs. (88.15±13.94) μm] between groups (all P<0.05). Multivariate logistic regression showed that widened venula temporalis retinae superior and widened CRVE were independent influencing factors for DKD (OR=1.187, 95%CI 1.068-1.320, P=0.001; OR=1.018, 95%CI 1.002-1.034, P=0.027), logistic regression analysis showed that widened venula temporalis retinae superior was an independent influencing factor for DKD in the Q₂, Q₄ and Q₅ group (OR=5.194, 95%CI 2.025-13.326; OR=3.477, 95%CI 1.360-8.891; OR=4.895, 95%CI 1.912-12.530; P value for trend=0.007).

Widened venula temporalis retinae superior and widened CRVE were independent influencing factors for DKD in T2DM patients.

To investigate the biological role and potential mechanism of O-acetylglucosamine (O-GlcNAC) glycosylated silent information regulator 1 (SIRT1) on mediating nuclear factor-κB (NF-κB) signaling pathway and severe diabetic myocardial injury in vitro.

H9c2 cells were divided into normal glucose (NG) group, high glucose (HG, 30 mmol/L) group, HG+control small interfering RNA (HG+siNC) group, HG+OGT siRNA (HG+siOGT) group, HG+control plasmid (HG+vector) group, high glucose+OGT overexpression plasmid (HG+OGT) group to analyze the effects of O-GlCNAC transferase (OGT) on SIRT1 function (each group had 6 rewells). H9c2 cells were divided into NG group, HG group, HG+dimethyl sulfoxide (HG+DMSO) group, HG+OGT inhibitor (HG+AC-5SGLCNAC) group and HG+OGA inhibitor (HG+NButGT) group to analyze the effect of O-GlCNAc glycosylation on SIRT1 protein function (each group had 6 rewells). H9c2 cells were divided into NG group, HG group, HG+Vector group, HG+SIRT1^WT group and HG+SIRT1^S549A group to further verify and explore the specific mechanism of O-GlcNAc glycosylated modification of SIRT1 protein, with 6 rewells in each group. Western blotting was performed to detect the expression of OGT, SIRT1, O-GlcNAc glycosylation, and the NF-κB signaling pathway. The 2′,7′-dichlorofluorescein and TdT-mediated dUTP nick-end labeling (TUNEL) assay were used to examine the reactive oxygen species (ROS) and cell apoptosis level of each group. The inflammatory factor levels, included interleukin (IL)-6, IL-1β and tumor necrosis factor (TNF)-α, were tested with enzyme-linked immunosorbent assay (ELISA). The t test was used to compare the data between the two groups, and two-way analysis was used to compare the data between multiple groups.

Compared with NG groups, Western blotting results showed that SIRT1 was significantly decreased, and the OGT was increased of HG groups (P<0.001). Subsequently, compared with HG+siNC and HG+DMSO groups, O-glycosylated SIRT1 level was respectively decreased in HG+siOGT and HG+Ac-5SGlcNAc groups, and the SIRT1 protein level was increased (all P<0.05). In addition, the cellular ROS, apoptosis and inflammatory level were significantly decreased in HG+siOGT and HG+Ac-5SGlcNAc groups (P<0.05), and NF-κB signaling pathway was decreased in HG+siOGT and HG+Ac-5SGlcNAc groups (P<0.05). On the contrary, compared with HG+vectors and HG+DMSO groups, the O-GlcNAc modification level of SIRT1 protein was further increased, and the SIRT1 protein level was decreased in HG+OGT and HG+NButGT groups (P<0.05). The intracellular ROS and apoptosis levels were also significantly increased in HG+OGT and HG+NButGT groups (P<0.05). Inflammation mediated by NF-κB signaling pathway was further activated in HG+OGT and HG+NButGT groups. Compared with HG+SIRT1^WT group, the proliferation ability of H9c2 cells in HG+SIRT1^S549A group was decreased (P<0.01), the levels of ROS and apoptosis were increased (P<0.01), and the level of NF-κB signaling pathway was increased (P<0.001).

High concentration of glucose could inhibit the protein level and function of SIRT1 by increasing the O-GlcNAC glycosylation modification level of SIRT1 protein. Subsequently, O-GlCNAC glycosylated SIRT1 led to the activation of intracellular NF-κB signaling pathway, and increased the cellular inflammatory response induced by high glucose, and ultimately promoted cardiomyocyte injury.

To investigate the correlation between glycosylated hemoglobin variation index (HGI) and bone metabolic markers in patients with type 2 diabetes mellitus (T2DM).

443 patients with T2DM who were hospitalized in Jimo District People's Hospital of Qingdao from June to December 2021 were selected as the study subjects, including 202 males and 241 females. General data including age, sex, body mass index (BMI), diabetes, smoking history and drinking history were collected. Fasting blood glucose (FPG) was measured by glucose oxidase method, and glycosylated hemoglobin (HbA) was measured by high pressure liquid exchange method_1c), electrochemiluminescence method was used to detect the N-terminal midmolecular fragment of osteocalcin (N-MID), parathyroid hormone (PTH), β-collagen degradation products (β-CTX), total type I collagen amino-terminal elongating peptide (PINP), 25 (OH) vitamin D [25- (OH) D]. The bone mineral density of lumbar spine and femoral head was measured by dual-energy X-ray absorption method to judge whether the patient had osteoporosis. According to FPG and HbA_1cThe index of variation of glycosylated hemoglobin (HGI) was calculated and grouped in tertiles according to HGI values: 148 cases in low HGI group (HGI ≤ -0.944) and 148 cases in medium HGI group (-0.944<HGI<0.556) and 147 in the high HGI group (HGI ≥0.556). Bone metabolic indexes were compared between groups by Kruskal-WallisHBonferroni method and Spearman correlation analysis were used to analyze the correlation between HGI and bone metabolism indexes N-MID, PTH, PINP, β-CTX and 25- (OH) D, and multiple linear regression analysis were used to analyze the influencing factors of PTH, N-MID and β-CTX.

There were no significant differences in gender, age, BMI, and course of diabetes mellitus between the 3 groups (P>0.05）。 In female patients, patients in the high HGI group had reduced PTH levels compared to those in the low HGI group (P=0.026), patients in the middle HGI group had reduced N-MID, β-CTX levels (P=0.036, 0.047), patients in the high HGI group had reduced N-MID, β-CTX levels (P=0.001, 0.028), and the prevalence of osteoporosis was increased in patients in the medium and high HGI groups (P=0.012、0.010）。 Spearman correlation analysis showed that HGI was inversely correlated with PTH, N-MID, β-CTX (rValues were-0.144, -0.227, and-0.166, respectively, allP<0.05）。 Taking HGI as the dependent variable, after adjusting for age, BMI, and course of diabetes, multiple linear regression showed that PTH, N-MID, and β-CTX were negatively correlated with HGI in women (β values were-0.152, -0.218, and-0.154, respectively, allP<0.05）。

High levels of HGI were significantly associated with low levels of bone metabolic markers in women with T2DM. It can provide a reference for predicting the changes of bone metabolism markers in women with T2DM.

This paper reports two diabetic patients who need to be differentiated from monogenic diabetes. The patient had an early onset age, a definite third-generation genetic family history, no insulin was used to control blood sugar in the early onset, and islet function suggested acceptable C-peptide levels after basal and stimulation, and insulin autoantibodies were negative. High-throughput sequencing revealed that the carboxy ester lipase (CELThe frameshift mutation causing protein truncation of the gene is a suspected pathogenic mutation according to the guidelines of the American Society of Medical Genetics and Genomics, and it is intended to diagnose adult diabetes type 8 (MODY8) with adolescent onset. The authorCELThe characteristics of the gene and the clinical characteristics of MODY8 were analyzed in detail, and it was found that current evidence suggests that only those located inCELBase deletion mutations at the proximal end of the variable number of tandem repeats of the gene can cause MODY, while the reported two patients had base deletion mutations at the distal end of the variable number of tandem repeats and base insertion mutations at the proximal end of the variable number of tandem repeats, which are not explicitly the type of gene mutation that causes MODY8 diabetes. More importantly, the clinical manifestations of the two patients also did not meet the clinical characteristics of MODY8 diabetes, thus finally excluding the diagnosis of MODY8. This paper suggests that clinicians should not only identify single-gene diabetes such as MODY in diabetic people, but also not blindly rely on genetic test results to make diagnosis, but should carefully analyze genotypes and clinical manifestations to identify diabetes.

A newly diagnosed obese type 2 diabetes mellitus (T2DM) complicated with hypertension, coronary heart disease, fatty liver and drug-induced renal damage in the Department of Endocrinology of the First Affiliated Hospital of Harbin Medical University was reported. The diagnosis and treatment process of semaglutide combined with metformin was reported. The patient was a 40-year-old male who went to the doctor because of "polydipsia and polyuria for 1 month and aggravation for 2 days". Relevant examinations were completed and the diagnosis of T2DM was confirmed. Given semaglutide combined with metformin treatment, the patient's blood sugar, blood lipid and blood pressure were well controlled, the weight loss was obvious, the mood was stable, and the satisfaction was high. Semaglutide is a novel weekly preparation of glucagon-like peptide-1 receptor agonist, which is used for intensive hypoglycemic and weight-loss treatment in obese T2DM patients, and can benefit multiple organs.

The diagnosis and treatment of semaglutide in a patient with type 2 diabetes mellitus (T2DM) complicated with non-alcoholic fatty liver disease was reported. The patient was a 37-year-old male who saw the doctor because "blood glucose was found to be elevated for 1 year". He was previously complicated with fatty liver, abnormal liver function, and hypertrophic obstructive cardiomyopathy. Combined with laboratory tests, he was definitively diagnosed with T2DM. Considering the patient's concomitant disease and the need to reduce the frequency of medication, the original hypoglycemic regimen was changed to subcutaneous injection of semaglutide. The patient's blood sugar control was more ideal, the degree of fatty liver was reduced, the liver function returned to normal, the frequency of medication was significantly reduced compared with before, and the patient's compliance and satisfaction were improved. Studies have shown that glucagon-like peptide-1 receptor agonist (GLP-1RA) can improve the liver fat content of patients with T2DM. Semaglutide, as the latest weekly preparation of GLP-1RA, can be considered for use in patients with T2DM with fatty liver, improve blood sugar control and also improve fatty liver and liver function.

Retrospective analysis of the diagnostic and therapeutic course of a type 2 diabetic patient admitted to the Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, who gradually changed to insulin deglucin combined with semaglutide and metformin after intensive therapy with insulin pump. The patient was a 69-year-old male who was admitted to the hospital because he was "found to have elevated blood sugar for 16 years". After admission, relevant examinations were completed and the diagnosis of "type 2 diabetes" was confirmed. After admission, he was given intensive insulin pump therapy combined with drug therapy, and the scheme was gradually improved and adjusted. Finally, it was determined that insulin degluc 12 U per night combined with semaglutide 0.25 mg once a week, subcutaneous injection, blood glucose tended to be stable and controlled well. Semaglutide is a novel weekly preparation of glucagon-like peptide-1 receptor agonist, which can be used alone or in combination with other hypoglycemic drugs, opening a new era for the treatment of diabetes.

A patient with type 2 diabetes mellitus with coronary heart disease admitted to the Department of Endocrinology of the First Affiliated Hospital of Suzhou University was retrospectively analyzed and reviewed the diagnosis and treatment process of optimizing blood glucose with semaglutide and improving cardiovascular risk. The patient was a 58-year-old male who was admitted due to "finding elevated blood sugar for 15 years and poor glycemic control for 3 months". The patient had a history of "coronary stenting" 2 years ago and is now receiving oral atorvastatin for lipid-lowering treatment. The patient's hypoglycemic regimen before admission was insulin glargine combined with oral metformin, acarbose and dapagliflozin to control blood glucose. The patient's blood glucose and blood lipid were not well controlled. After admission, it was adjusted to semaglutide combined with metformin to control blood glucose, and the patient's blood glucose, blood lipids, blood pressure and weight gradually reached the standard. Semaglutide is a weekly preparation of glucagon-like peptide-1 receptor agonist, which can be applied to the treatment of adult patients with type 2 diabetes whose blood glucose is not up to standard after treatment with metformin and/or sulfonylurea drugs, and can reduce the risk of major cardiovascular adverse events in patients with type 2 diabetes and cardiovascular disease.

The diagnosis and treatment of a newly diagnosed obese type 2 diabetes mellitus complicated with polycystic ovary syndrome was reported. The patient was admitted due to "amenorrhea with weight gain for 2 years, polyuria and polydipsia for more than 1 month". After admission, all examinations were completed, and the diagnosis of type 2 diabetes complicated with polycystic ovary syndrome was confirmed. After intensive insulin pump therapy, the simplified regimen was semaglutide combined with metformin therapy. Blood glucose control reached the standard, weight loss, and menstruation returned to normal. As a new long-acting glucagon-like peptide-1 analogue, semaglutide has potent hypoglycemic benefits while having heart and kidney benefits. Due to their wide range of effects, glucagon-like peptide-1 receptor agonists may bring new treatment options for obese patients with polycystic ovary syndrome in the future.

Diabetic foot ulcer (DFU) is one of the serious chronic complications of diabetes mellitus. The healing of chronic wounds of DFU is a problem that people have paid continuous attention to and widely studied. microRNA (miRNA) is a highly conserved endogenous non-coding small RNA molecule involved in many biological processes including diabetic wound healing. MiRNAs regulate encoded proteins in humans primarily by inhibiting mRNA translation. This paper reviews the research progress of the healing mechanism of miRNA in DFU.

Diabetic nephropathy (DKD) is one of the typical microvascular complications of diabetes, and it is also the main cause of chronic kidney disease and end-stage kidney disease at present. DKD has a hidden onset and lacks sensitive early diagnosis methods. Although renal biopsy is the "gold standard" for diagnosis, it is difficult to make a large-scale general investigation because it is invasive and risky. Fundus and kidney have many similarities in anatomy, physiology and pathology. Fundus blood vessels are also the only microvessels that can be directly observed in human body. The changes of microcirculation can help predict the progression of DKD. In particular, the development of optical coherence tomography angiography (OCTA) in recent years has provided help for the quantification of fundus microcirculation. This paper reviews the application progress of OCTA quantitative analysis in DKD.

Diabetic nephropathy (DKD) is one of the microvascular complications of diabetes and is the main cause of end-stage kidney disease. The pathogenesis of DKD has environmental factors in addition to genetic susceptibility gene factors, and epigenetics has been shown to act as a bridge between genetics and environment. Epigenetic research mainly includes DNA methylation, post-translational modification of histones and non-coding RNA regulation. In recent years, the research of DNA methylation of DKD has made great progress at home and abroad, and the research of RNA methylation has attracted more and more attention. Therefore, this paper mainly reviews the current DNA methylation research of DKD, and puts forward possible diagnostic and therapeutic strategies for DKD based on DNA methylation research.

Diabetic nephropathy (DKD) refers to chronic kidney disease caused by diabetes, which is a common chronic complication of type 2 diabetes and a major cause of end-stage kidney disease (ERSD). Early intervention of DKD can alleviate and delay the progression of renal lesions. However, there are still many limitations in the diagnosis and treatment of DKD. Therefore, the early diagnosis and intervention of DKD has become a hot topic in the field of diabetes. Nickel striated protein (Metrnl) is a novel adipokine, which has physiological effects such as correcting lipid metabolism disorders, reducing inflammatory response and improving insulin resistance, and plays an important role in metabolic diseases. The role of Metrnl in DKD has also been gradually discovered. This article reviews the potential role of Metrnl in DKD, in order to provide more ideas for clinical diagnosis and treatment.