Volume 15 · Issue 07 · 2023

The current comorbidity of diabetes and cardiovascular diseases is severe, and comprehensive blood glucose monitoring and management is very important to improve blood glucose control and prevent cardiovascular complications. The continuous glucose monitoring (CGM) system can provide dynamic, real-time, and multi-dimensional blood glucose information, which can help reduce blood glucose variability and reduce latent hyperhypoglycemic events, and improve prognosis. However, there is lack of evidence for the direct effect of CGM on cardiovascular complications of diabetes. This article reviews the relationship between CGM and its associated blood glucose parameters and cardiovascular outcome in diabetic patients, and discusses its clinical application prospect in diabetic patients with high cardiovascular risk.

Post-transplant diabetes mellitus (PTDM) is a common endocrine and metabolic disorder after adult solid organ transplant (SOT), affecting 10% to 40% of recipients. PTDM has been associated with increased mortality, heightened risk of infections, graft-related complications and cardiovascular diseases, all of which seriously threaten the quality of life and long-term survival of recipients. According to recent studies and the domestic healthcare system, this consensus provides a comprehensive overview of the epidemiology, risk factors, pathogenesis, screening and diagnosis, treatments, prevention strategies, cardiovascular risk factor management and microvascular complications associated with PTDM, in order to further standardize the diagnosis and treatment of PTDM. The objective is to standardize the comprehensive management of PTDM with the aim of enhancing the long-term quality of life and clinical outcomes for SOT recipients.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) play an important role in the integrated management of type 2 diabetes mellitus (T2DM). Henggliflozin has been approved for marketing in my country for single or combination treatment of adult T2DM. In order to guide the clinical standardized application of Henggliflozin, the Endocrinology and Metabolism Physician Branch of Chinese Medical Doctors Association organized experts to set up a writing group of "Expert Guidance Opinions on Clinical Application of Henggliflozin". Based on the basic and clinical research data of Henggliflozin, combined with authoritative guidelines and consensus at home and abroad and the latest research progress and application status of SGLT2i drugs, this edition of "Expert Guidance Opinions on Clinical Application of Henggliflozin" was compiled. The contents include the physical and chemical properties, key clinical evidence, clinical application scope, and precautions for use of Henggliflozin.

To explore and summarize the experience of early screening of diabetic foot disease (DFD) in community and the construction of DFD database standard.

Electronic data capture system (EDC) was established to input and collect data to build DFD database, after unifying data elements by referring to domestic and foreign guidelines in related fields under the guidance of multidisciplinary experts and standardized collation, compilation of case report forms (CRF), classification of tasks and unified pre-screening training according to the results of field research in different communities. It had to ensure that the work information from each post-assembly line was input into the EDC in real time, and at the same time, the Clinical Research Associate (CRA) conducted real-time and spot checks for quality control, and regular meetings and summary seminars provided timely feedback and revision.

In this study, the early screening indicators of DFD included 54 sub-items and 7 forms, which were divided into basic information, medical history information, physical examination, laboratory examination, auxiliary examination, living conditions and follow-up records. According to the different levels of the forms, three CRF were compiled: basic, enrolment and follow-up information form. Information from DFD database such as peripheral artery disease (PAD), loss of protective sensation (LOPS), foot deformity, history of foot ulcer, history of lower limb amputation and history of end-stage renal disease were summarized and used to classify the high risk of diabetic foot, and follow-up was carried out at different frequencies according to the classification.

The early community screening and database construction of DFD are not mature enough and the process is complicated, which needs to be standardized, adapted to local conditions, simplified and constantly updated.

To investigate the current status of diabetic retinopathy (DR) in type 2 diabetes mellitus (T2DM) in Shanxi province and to construct a predictive model for the risk of developing non-proliferative DR (NPDR) in T2DM.

Based on the Chinese Chronic Disease and its Risk Factor Surveillance System, a multi-stage stratified random sampling method was used to select 1 891 patients with diabetes mellitus in two districts and two counties in Shanxi province from June, 2019 to August, 2019 for a status survey. A total of 1 276 patients with T2DM who met the nadir criteria and had complete data for this study were selected. The general information and laboratory data were collected, including T2DM course, systolic blood pressure, glycated hemoglobin A_1c (HbA_1c), total cholesterol (TC), urinary microalbumin-creatinine ratio (UACR), serum creatinine (Scr), and estimated glomerular filtration rate (eGFR). According to the results of fundus microscopy, T2DM patients were divided into non-DR (NDR, 1 119 cases) and NPDR group (157 cases), and T2DM patients were randomly divided into training set (766 cases) and validation set (510 cases) by random number table method in a ratio of 6∶4. The multifactor logistic stepwise regression method was used to screen the model variables. The study constructed a column line graph model for the risk of developing NPDR in T2DM patients, and the predictive value, calibration and clinical utility of the model were comprehensively evaluated using subject working characteristic curves, goodness-of-fit curves and clinical decision curves.

The prevalence of NPDR among T2DM patients in Shanxi province was 12.3% (157/1 276). In the training set, compared with the NDR group, the duration of T2DM, systolic blood pressure, HbA_1c, TC, UACR and Scr in the NPDR group were elevated and eGFR was decreased, and the differences were all statistically significant (P<0.05). Binary logistic regression analysis suggested that HbA_1c≥7% (OR=3.254), systolic blood pressure≥140 mmHg (1 mmHg=0.133 kPa) (OR=1.739), UACR≥30 mg/g (OR=1.892) and elevated Scr (OR=1.015) were risk factors for T2DM with NPDR, and advanced age (OR=0.971) was a protective factor for T2DM with NPDR (all P<0.05). The area under the working characteristic curve for subjects in the training and validation sets was 0.755 (95%CI 0.700-0.806) and 0.737 (95%CI 0.670-0.801), respectively. The Hosmer-Lemeshow test showed that the model fit was good and the prediction results were close to the actual, clinical decision curve, suggesting that the model had clinical benefit.

The prevalence of NPDR among T2DM patients in Shanxi province was 12.3%. In this study, we constructed a nomogram mode to predict the risk of NPDR in T2DM patients, which has clinical significance for early screening of people at high risk of NPDR.

To analyze the changes in blood vessel and lesion area in different types of diabetic macular edema (DME).

A total of 196 patients with DME who were treated in First Hospital of Hebei Medical University from January 2018 to January 2021 were selected as the observation objects. They were divided into simple diffuse DME group [without serous retinal detachment (SRD), 126 cases] and observation group according to SRD type DME group (combined SRD, 192 cases). General data such as age, sex, duration of diabetes and creatinine were compared between the two groups. Routine eye examinations and optical coherence tomography angiography were performed in both groups. The macular foveal retinal thickness (CST), and subfoveal choroidal thickness (SFCT) of the fovea were compared between the two groups. The area of fovea avascular zone (FAZ) and the level of deep-superficial flow ratio (DSFR) were compared between the two groups. Independent sample t-test was used to compare the two groups. Multivariate logistic regression was used to analyze the influencing factors of DME patients with SRD.

Compared with the simple diffuse DME group, the CST in the SRD-type DME group [(485.63±18.63) μm vs. (405.61±25.36) μm, t=32.395, P<0.001] and SFCT levels [(295.46±51.16) μm vs. (274.16±52.98) μm, t=3.581, P<0.001] were increased, DSFR level (1.10±0.05 vs. 1.16±0.12, t=6.164, P<0.001) and FAZ area [(0.31±0.16) mm²vs. (0.38±0.12) mm², t=4.196, P<0.001] were decreased, and the differences were statistically significant. Multivariate logistic regression analysis showed that SFCT, DSFR and FAZ area were independent risk factors for DME patients with SRD (OR=1.905, P=0.005; OR=0.452, P=0.001; OR=0.658, P=0.012).

There were differences in SFCT, DSFR and FAZ area in patients with different types of DME, which were the risk factors for SRD in DME patients.

To investigate the association between body fat percentage (PBF), fat mass index (FMI) and lipid profile in the first trimester with gestational diabetes mellitus (GDM).

The retrospective analysis was performed on 1 578 pregnant women who received prenatal care in the Third Affiliated Hospital of Sun Yat-sen University from May 2020 to May 2021. All subjects were measured by bioelectrical impedance analysis in the first trimester to obtain PBF and fat mass, height and weight, and at the same time plasma fasting blood glucose (FPG), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) were measured. 75 g oral glucose tolerance test (OGTT) was conducted between 24 and 28 weeks, FPG, 1 h plasma glucose (1hPG) and 2 h plasma glucose (2hPG) were detected, and the subjects were divided into GDM group (318 cases) and control group (1 260 cases) according to OGTT results. Independent sample t-test, Mann-Whitney U and χ² test were used for comparison between groups, logistic regression model was used to analyze the association between observation index and GDM.

The prevalence of GDM was 20.15% (318/1 578). The age, BMI, PBF, FMI, FPG, TC, TG, LDL-C, 75 g OGTT-FPG, 1hPG and 2hPG, the proportion of gravidity≥3 times in the GDM group were higher than those in the control group (P<0.05). The risk of GDM in those aged≥25 years increased 183.2% (OR=2.832, 95%CI 1.414-5.672, P<0.05), BMI≥24.0 kg/m² was 123.9% (OR=2.239, 95%CI 1.674-2.997, P<0.001), and PBF≥25% was 91.2% (OR=1.912, 95%CI 1.462-2.501, P<0.001). The pregnant women were grouped according to the quartile of FMI, FPG, TC, TG, HDL-C and LDL-C (Q₁, Q₂, Q₃ and Q₄ group). The Q₄ group of FMI increased the risk of GDM by 97.7% compared with the Q₁ group (P<0.05); the Q₃ group and Q₄ group of TC increased the risk of GDM by 63.3% and 55.7% compared with the Q₁ group (P<0.05); the Q₄ group of TG increased the risk of GDM by 54.8% compared with the Q₁ group (P<0.05).

Age≥25 years, BMI≥24.0 kg/m² and PBF≥25% are closely related to the incidence of GDM. The levels of PBF, FMI, TC and TG in the first trimester can provide a reference for early prediction of GDM.

To investigate the molecular mechanism of serum complement C1q/tumor necrosis factor-related protein 13 (CTRP13) involvement in high glucose-induced filtration dysfunction in human hepatic sinusoidal endothelial cells (HLSEC).

HLSEC were cultured in vitro, lentiviral CTRP13 overexpression vector (LV-CTRP13) was constructed and infected with HLSEC, and the cells were divided into normal control (5.5 mmol/L glucose, NC), high glucose (25 mmol/L, HG), NC+LV-CTRP13, HG+LV-CTRP13, NC+empty control (LV-CON) group, HG+LV-CON group, HG+LV-CTRP13+salt-inducible kinase 1 (SIK1) inhibitor (HG-9-91-01) group, HG+LV-CON+HG-9-91-01 group, HG+LV-CTRP13+cyclic adenosine monophosphate-regulated transcriptional co-activator 2 (CRTC2) inhibitor (GW4064) group, and HG+LV-CON+GW4064 group. The mRNA and protein expression levels of CTRP13, SIK1, CRTC2, P130 Crk-related substrate (P130Cas) were detected by quantitative real-time fluorescence PCR (qRT-PCR) and Western blotting. One-way analysis of variance (ANOVA) was used for comparison between groups.

Compared with the NC group, mRNA and protein expression of CTRP13, SIK1, and P130Cas were decreased in the HG group, and mRNA and protein expression of CRTC2 were increased (P<0.05). Compared with the HG+LV-CON group, the mRNA and protein expression of CTRP13, SIK1, and P130Cas were elevated in the HG+LV-CTRP13 group, and the mRNA and protein expression of CRTC2 were decreased (P<0.05). Compared with the HG+LV-CTRP13 group, the mRNA and protein expression of CRTC2 was elevated in the HG+LV-CTRP13+HG-9-91-01 group, while the mRNA and protein expression of SIK1 and P130 Crk-associated substrate were decreased (P<0.05). Compared with the HG+LV-CTRP13 group, the mRNA and protein expression of CRTC2 was decreased in the HG+LV-CTRP13+GW4064 group, and the mRNA and protein expression of P130Cas was increased (P<0.05).

CTRP13, SIK1, CRTC2, and P130Cas are involved in high-glucose-induced HLSEC filtration dysfunction, and CTRP13 overexpression inhibits high-glucose-induced HLSEC filtration dysfunction through a mechanism mediated through the SIK1/CRTC2 pathway.

To explore the application and effect of deboned skin flap in wound repair of patients with diabetic toe gangrene.

Fifteen patients with diabetic toe gangrene admitted to Guangzhou First People's Hospital from January 2017 to December 2022 were collected, and their wounds were repaired with toe deboned flap. The inclusion criteria of patients were that they met the Wagner classification of diabetic toe gangrene grades 3 to 4, and there were different degrees of necrosis in both toes. Of the 15 patients, 13 were males and 2 were females; The age ranged from 58 to 89 years, with an average of (73.8 ± 7.1) years; The duration of diabetes mellitus was 1 to 20 years, with an average (7.7±5.9) years; The course of gangrene was 3~60 days, with an average of (18.5±18.2) days; There were 9 cases of left foot and 8 cases of right foot, of which 2 cases had gangrene in both toes; The wound extent was 1.0 cm ×1.0 cm ~3.0 cm ×2.5 cm. Preoperative preparation was carried out, flap design was performed according to the extent of toe necrosis, flap excision and wound repair were performed. After operation, the blood supply of the skin flap was closely observed, and anti-infection, anticoagulation, anti-spasm treatment and symptomatic treatment were routinely performed. The wound was changed with lipid hydrogel-oligosaccharide reticular dressing, and the sutures were removed 12~14 days after operation. Patients were followed up by telephone or routine outpatient clinic after operation to evaluate the treatment effect and adverse reactions.

All 15 cases completed the operation successfully. Necrosis of the tip of the flap occurred in one case. The necrotic tissue was cut after operation, and the wound healed by dressing change. In 2 patients, due to the large wound surface, the skin flap could not completely cover the wound surface, and another tomographic skin was taken to repair the exposed wound surface. All the other 12 patients' skin flaps survived in the first stage, and the sutures were removed 14 days after operation. After rehabilitation training, all the activities of the ankle joint of the patients basically recovered. The follow-up time was 6 to 24 months, with a median follow-up time of 12 months. The appearance of the foot and ankle was satisfactory, the flap had no contracture, good texture, did not affect the wear of shoes, and no ulcer occurred around the flap.

The toe deboned flap has little damage to the donor site, thin flap, and satisfactory appearance and function in repairing the wound adjacent to the forefoot without secondary thinning; The design and cutting are relatively simple, and the repair of diabetic toe gangrene wounds can achieve better results.

The diagnosis and treatment of a patient with type 1 diabetes complicated with glycogenic liver disease was reported. The patient was a 46-year-old woman who was admitted to the hospital with the main complaint of "polydipsia, polydipsia, weight loss for 4 months, and abdominal pain for more than 2 days". Through clinical data analysis and liver biopsy, it was in line with the characteristics of type 1 diabetes complicated with glycogenic liver disease. After admission, ketoacidosis and hyperosmolar hyperglycemia were corrected after active fluid rehydration and hypoglycemic treatment, and glycogen accumulation was improved compared with before. The patient was diagnosed with glycogenic liver disease at the age of 46 years, which is different from the age and course of common diagnosis of this disease. In this paper, the clinical characteristics and key points of diagnosis and treatment of glycogenic liver disease were discussed in combination with the diagnosis and treatment process of patients, in order to improve the clinical understanding of this disease.

Since the launch of sodium-glucose cotransporter 2 inhibitor (SGLT2i), a large amount of evidence-based evidence has confirmed that SGLT2i can bring metabolic, cardiovascular and renal benefits to patients with type 2 diabetes and even non-type 2 diabetes. Therefore, it is recommended by major guidelines at home and abroad as the preferred hypoglycemic drug for the purpose of cardiac and renal protection. However, its specific benefit mechanism has not been fully elucidated. This article mainly reviews the relationship between SGLT2i drugs and clinical benefits such as hypoglycemic efficacy, cardiorenal protection, neuroprotection and regulation of pancreatic islet function from the difference of selectivity of SGLT2i drugs to sodium-glucose cotransporter receptor, in order to provide reference for clinical workers to meet the individual needs of patients.

Post-transplantation diabetes is a common chronic complication after organ transplantation, which significantly increases the risk of organ failure, cardiovascular disease, infection and death. It is of great significance to identify and standardize the treatment in time. A large number of studies have shown that the novel hypoglycemic drug sodium-glucose cotransporter 2 inhibitor (SGLT2i) can not only effectively control blood glucose, but also have cardiovascular and renal protective effects in ordinary T2DM patients. In recent years, research reports on the effectiveness and safety of SGLT2i in the treatment of post-transplantation diabetes have increased gradually. This article will review the application progress of SGLT2i in post-transplantation diabetes.

Diabetic nephropathy (DKD) has gradually become the main cause of chronic kidney disease in China. Due to the lack of specific therapeutic measures, once a large number of proteinuria and renal insufficiency occur, it often irreversibly progresses to end-stage renal failure. How to diagnose and treat DKD early has become a research hotspot in recent years. Metabolome technology can quantitatively detect a variety of metabolites with high throughput, and then analyze the occurrence and development mechanism of diseases by analyzing metabolic pathways. Therefore, it is widely used in chronic non-communicable diseases such as diabetes, cardiovascular diseases, kidney diseases and tumors. Previous studies have found correlations between multiple metabolites and DKD, which may be potential biomarkers; At the same time, metabolites are also involved in kidney damage caused by diabetes, enriching the understanding of the pathogenesis of DKD. This article reviews the progress of metabolome in the diagnosis, treatment and pathogenesis of DKD.

Treatment-induced diabetic neuropathy (TIND) often occurs shortly after rapid correction of hyperglycemia with insulin, and patients often have a history of poor glycemic control, characterized by acute severe distal limb pain, peripheral nerve fiber damage, and autonomic dysfunction. TIND presents a unique acute neuropathic pain, which is a reversible disease. Patients' pain usually improves after treatment, but there are few reports, which hinders the timely diagnosis and effective treatment of TIND. In this paper, the mechanism, clinical manifestation, risk factors, diagnosis, treatment and prognosis of TIND were expounded to provide clinical reference.