Volume 15 · Issue 10 · 2023

Diabetes mellitus is a major risk factor for chronic kidney disease (CKD). Fineridone, a novel nonsteroidal mineralocorticoid receptor antagonist, has been shown to have clear renal and cardiovascular protective effects in diabetic patients with CKD. Long-term use can significantly reduce urinary albumin/creatinine ratio (UACR) levels, and has little effect on blood potassium. In order to help the clinical application of feneridone more rational and standardized, based on the existing research evidence and combined with clinical practice experience, the expert group formed the "Chinese Expert Consensus on the Application of Feneridone in Patients with Diabetes Complicated with Chronic Kidney Disease (2023 Edition)" after many discussions, explaining its mechanism of action and pharmacological properties, evidence-based medical evidence, suitable populations, specific usage and precautions, and forming 27 recommendations, aiming to provide reference for the rational clinical use of this drug.

To investigate the efficacy of beraprost sodium in improving balance function in patients with diabetic peripheral neuropathy (DPN).

DPN patients attending the Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University from July 2021 to September 2022 were selected and allocated to the study group (15 cases) and the control group (14 cases) for 12 weeks of treatment using the random number table method. The study group received 40 μg oral beraprost sodium (3 times per day)+500 μg methylcobalamin tablets (3 times per day), and the control group received only 500 μg oral methylcobalamin tablets (3 times per day). General information of the patients was collected, nerve conduction velocity was measured and severity was graded using the Toronto Clinical Neuropathy Score (TCSS); balance function was assessed by recording the Berg Balance Scale score (BBS), the total length of the trajectory of the plantar center of pressure sway (LNG), the area of the trajectory envelope graphic (SSKG), and the length of the trajectory per unit of time (LNG/T); and vestibular function was assessed by recording the P1 and N1 waves latency, amplitude, and asymmetry ratio of the cervical VEMP and ocular VEMP examination. The changes in the above indices before and after the intervention were observed and compared using a t test, paired t test, non-parametric rank sum test, or paired rank sum test.

The baseline data of the study and control groups were balanced. The BBS of the study group was 55.00 (54.00, 56.00) points after the intervention, which was higher than the 54.00 (53.00, 55.00) points after the intervention in the control group, and the difference was statistically significant (P=0.011). In the intensive closed-eye Romberg test, the LNG of the study group before the intervention was (1 825.30±735.57) mm, and after the intervention was (1 329.55±582.34) mm, which was a decrease from the pre-intervention period, and the difference was statistically significant (P=0.035). LNG/T in the study group was (74.26±20.65) mm/s before the intervention and (63.99±15.75) mm/s after the intervention, a decrease from the pre-intervention period with a statistically significant difference (P=0.005). The differences in LNG and LNG/T before and after the intervention in the control group were not statistically significant (P>0.05). For cervical VEMP, the differences in P1 latency and N1 latency before and after intervention were statistically significant in the study group and decreased after intervention compared with before intervention (P<0.05); for ocular VEMP, the amplitude of the study group was higher in the study group than that of the control group (3.90±1.58) μV after intervention compared to that of the control group (2.16±0.46) μV. The difference was statistically significant (P=0.007). The TCSS score of the study group was (8.73±2.05) before the intervention and (7.07±2.34) after the intervention, which decreased from the pre-intervention, and the difference was statistically significant (P=0.002); the difference between the pre- and post-intervention in the control group was not statistically significant (P=0.177). The MCV of the median, ulnar, tibial, and common peroneal nerves increased after the intervention in the study group compared with the pre-intervention period, and the difference was not yet statistically significant (P>0.05).

Beraprost sodium may improve balance function and neurological symptoms in patients with DPN, and its mechanism may be related to vestibular nerve conduction function, inner ear microcirculation, and improvement of DPN.

To investigate the metabolic adaptation of normal pregnancy and the pathogenesis of gestational diabetes mellitus (GDM) from the first to the third trimester.

This was a case-control study. A total of 1 471 pregnant women who visited at the Department of Obstetrics of Peking University First Hospital in the first trimester from September 2017 to June 2018. Those with complete serum samples in the first, second and third trimester and who delivered in the hospital were taken as research objects. They were divided into a GDM group and a normal control group according to their glucose metabolism status. Fasting plasma glucose (FPG) and fasting insulin (FINS) in first, second and third trimester were detected, and 75 g oral glucose tolerance test (OGTT) was performed at 24 weeks and later to explore metabolic adaptation in pregnancy and the pathogenesis of GDM. Homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were calculated. T-test and Mann-Whitney U test were used to compare between groups.

A total of 510 subjects were included in the study. There were 260 cases in GDM group and 250 cases in normal control group. In terms of blood glucose, FPG, 1 h-postprandial plasma glucose (1hPG) and 2 h-postprandial plasma glucose (2hPG) of 75g OGTT in GDM group were significantly higher than those in control group [5.14 (4.80, 5.34) vs 4.63 (4.43, 4.84), 9.56 (8.17, 10.48) vs 7.64 (6.57, 8.63), 8.05 (6.88, 9.08) vs 6.46 (5.82, 7.22) mmol/L,P<0.001]. The level of FPG in both GDM and normal control groups decreased gradually with gestational age (FPG of different trimesters were all P<0.017), but the level of FPG in GDM group was significantly higher than that in control group from first to third trimester[5.27 (4.99, 5.55) vs 5.10 (4.87, 5.30), 5.14 (4.80, 5.34) vs 4.63 (4.43, 4.84),4.77 (4.52, 5.08) vs 4.48 (4.31, 4.70) mmol/L, P<0.001]. In terms of insulin resistance and dynamic changes in islet beta cell function, all FINS levels, HOMA-IR and HOMA-β increased gradually from the first to the third trimester, peaking in the third trimester, whether GDM or normal control group. FINS in the second trimester and HOMA-IR from the first to the third trimester in GDM group were higher than those in control group (all P<0.05), whereas HOMA-β in the second and the third trimesters were lower than those in control group (all P<0.001).

Physiological insulin resistance occurs in normal pregnancy, and beta cells compensate to maintain normal blood glucose. However, there was more severe insulin resistance and higher FPG in GDM group from the first trimester, and beta cell insufficiency in the second and third trimesters. It is suggested that although GDM is diagnosed in second trimester and later, its pathological and physiological abnormalities are already present in the first trimester.

To investigate the risk factors for gestational diabetes mellitus (GDM), and to analyze the relationship between gestational hyperglycemia, including pregestational diabetes mellitus (PGDM) and GDM, and adverse pregnancy outcomes.

A retrospective historical cohort study was used. Birth registration data from Songjiang District, Shanghai between 2013 and 2020 and the clinical disease diagnosis data from medical institutions between 2011 and 2020 were collected. Household registration, maternal age, educational level, parity, abortion times, gestational age, delivery mode, gestational hypertension, polycystic ovary syndrome (PCOS), PGDM and GDM were collected. Birth weight and birth defects were also collected. According to the diagnostic criteria of PGDM and GDM, parturients were divided into PGDM group, GDM group and normal glucose metabolism population (control group). Chi-square test and analysis of variance were used to compare the statistical difference among the three groups. Multivariate logistic regression model was used to analyze the association between maternal fertility characteristics and GDM, and multi-level logistic model analysis was used to analyze the association between PGDM, GDM and adverse pregnancy outcomes.

A total of 116 041 parturients were included, and 104 379 were in the control group. There were 11 662 (10.05%) with gestational hyperglycemia, including 1 055 (0.91%) of PGDM and 10 607 (9.14%) with GDM. Multivariate logistic regression analysis showed that Shanghai residents (OR=1.39, 95%CI 1.32-1.46), abortion history (OR_{1 time}=1.11, 95%CI 1.06-1.17; OR_{≥3 times}=1.17, 95%CI 1.07-1.27), and PCOS (OR=2.24, 95%CI 1.92-2.60) were associated with a higher risk of GDM, but the risk of GDM was lower in multipara than in primipara (OR=0.84, 95%CI 0.80-0.88). After adjusting for maternal household registration, age, educational level, parity, abortion times, previous abortion history, gestational hypertension and PCOS, the risk of cesarean section (OR=1.08, 95%CI 1.03-1.13), macrosomia (OR=1.35, 95%CI 1.24-1.47), and birth defects (OR=2.20,95%CI 1.97-2.45) was higher among GDM patients. The risk of cesarean section (OR=1.36, 95%CI 1.18-1.56), preterm delivery (OR=1.76, 95%CI 1.43-2.15), macrosomia (OR=2.33, 95%CI 1.90-2.85) and birth defects (OR=2.44, 95%CI 1.82-3.26) was higher among PGDM patients, and even higher than that among GDM patients.

The prevalence of gestational hyperglycemia in Shanghai was 10.05%. Shanghai nationality, abortion history and PCOS are the risk factors for GDM, and patients with PGDM and GDM have an increased risk of adverse pregnancy outcomes.

To investigate the associations between individual and combined diabetic risk factors and diabetes mellitus in the population aged over 40 years in Zhengzhou city, Henan province.

This study was based on the Chinese Cardiometabolic Disease and Cancer Cohort (4C) study, a resident population aged ≥40 years with complete information at baseline during October 2011 to May 2012, who were invited to an in-person visit between August 2014 and December 2015. Waist circumference, blood pressure and other metabolic indicators such as blood glucose, blood lipids were measured. The participants were from Henan Branch Center of 4C study. The t-test, nonparametric test and χ² test were used to compare the baseline data between subjects of different sexes. Cox proportional hazards models were used to analyze the risk factors of diabetes mellitus.

A total of 3 028 participants (952 men and 2 076 women) were included in the study. Compared with participants without prediabetes, hypertension and central obesity, participants with prediabetes only (HR=4.16, 95%CI 2.58-6.71, P<0.05) or hypertension only (HR=2.25, 95%CI 1.15-4.42, P<0.05) had a significantly higher risk of diabetes, whereas participants with central obesity only (HR=1.27, 95%CI 0.70-2.32, P>0.05) did not have a significantly higher risk of diabetes mellitus. When analyzed collectively, participants with prediabetes plus hypertension (HR=5.33, 95%CI 2.95-9.62, P<0.05), prediabetes plus central obesity (HR=4.86, 95%CI 2.94-8.03, P<0.05), and hypertension plus central obesity (HR=3.70, 95%CI 1.95-7.00, P<0.05) had a significantly higher risk of diabetes. Moreover, participants with the combination of prediabetes, hypertension and central obesity exhibited the highest risk for diabetes mellitus (HR=7.76, 95%CI 4.49-13.44, P<0.05).

Prediabetes, hypertension and central obesity showed additive associations with the risk of diabetes in middle-aged and older adults in Henan.

To investigate the correlation between different obesity indices and the incidence of hyperuricemia (HUA) and hypertension in patients with type 2 diabetes mellitus (T2DM) older than 50 years old.

As a cross-sectional study, the subjects were chosen from a prospective study on the epidemiology of lower extremity arterial disease in Chinese patients with T2DM from June 2016 to January 2017. The height, weight, waist circumference (WC) (traditional obesity index), hip circumference, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) of the subjects were collected. Three traditional obesity indices [body mass index (BMI), waist hip ratio (WHR), and waist height ratio (WHtR)], as well as five new obesity indices [visceral fat index (VAI), body roundness index (BRI), a body shape index (ABSI), lipid accumulation index (LAP), and relative fat mass (RFM)], were calculated. Logistic regression analysis was used to analyze the correlation between different obesity indices and the occurrence of HUA and hypertension. The area under the receiver operating characteristic curve (AUC) was used to compare the value of different obesity indices in predicting HUA and hypertension.

A total of 6 646 patients with T2DM were finally included in the study. There were 964 cases in HUA group and 5 682 cases in non-HUA group. There were 4 388 cases in the hypertension group and 2 258 cases in the non-hypertension group. Multivariate logistic regression results showed that after adjusting for confounding factors, except for the new obesity index ABSI, other obesity indices [four traditional obesity indices (WC, BMI, WHR, WHtR) and four new obesity indices (VAI, BRI, LAP, RFM)] were positively correlated with the occurrence of HUA (P<0.05). The AUC of male VAI and LAP for predicting HUA were 0.654 and 0.651, respectively, while the AUC of female VAI and LAP for predicting HUA were both 0.671, which were higher than the traditional indices. In men, the nine obesity indices were all positively associated with the occurrence of hypertension (P<0.05), and the AUC (0.643) of ABSI was the highest. In women, except for VAI and ABSI, the seven obesity indices were positively correlated with hypertension (P<0.05), and the AUC (0.620) of BMI was the highest.

In T2DM patients over the age of 50, BMI, WC, WHR, WHtR, VAI, BRI, LAP, RFM were all positively correlated with the occurrence of HUA. The new obesity indices VAI and LAP had certain advantages over traditional indices in HUA risk screening and population health intervention. In men, nine obesity indices were positively correlated with the occurrence of hypertension. Compared with traditional indices, ABSI had certain advantages in the monitoring and intervention of hypertension in this population. In women, except VAI and ABSI, 7 obesity indices were positively correlated with hypertension.

To investigate the association between different dietary patterns and diabetic kidney disease (DKD) in patients with type 2 diabetes mellitus (T2DM) in Shanxi province.

This study was based on the Chinese Chronic Disease and Risk Factor Surveillance System. A multi-stage stratified sampling method was used to randomly select two districts (Xinghualing District, Taiyuan City, and Yuci District, Jinzhong City) and two counties (Huguan County, Changzhi City, and Jiang County, Yuncheng City) in the chronic disease surveillance sites in Shanxi Province from June to August 2019. A total of 1 332 patients with T2DM who met the nadir criteria and had complete data for this study were selected. Independent sample t-test, rank sum test and χ² test were used to compare between groups. Dietary patterns were constructed using factor analysis and binary logistic regression analysis was used to analyze the relationship between dietary pattern scores and urine microalbumin/creatinine (UACR) and estimated glomerular filtration rate (eGFR) levels.

The prevalence of DKD in Shanxi province was 21.9% (292/1 332), 18.4% (153/833) and 27.9% (139/499) in urban and rural areas, respectively. The intake of coarse grains, potatoes, legumes, and eggs was higher in rural areas than in urban areas, whereas the intake of refined grains, vegetables, fruits, dairy products, livestock, aquatic products, and nuts was lower in rural areas (P<0.05). Six dietary patterns were constructed, namely “animal protein”,“coarse grains，plant protein”,“nuts and fruits”,“refined grains，vegetables”,“dairy products” and “added sugar”. The magnitudes of the factor contributions were 15.4%, 10.0%, 8.3%, 8.1%, 7.6% and 7.2%, respectively, explaining 56.5% of the total variance. After adjustment for the age, duration of diabetes, residential area, educational level, occupation, annual per capita household income and expenditure, smoking status, alcohol consumption, weekly physical activity energy expenditure, exercise intensity, daily sleep duration, BMI, waist circumference, systolic and diastolic blood pressure, and fasting plasma glucose, glycated hemoglobin A_1c, total cholesterol, triglyceride, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid levels, binary logistic regression analysis showed a 50.5% reduction in the risk of albuminuria in patients in the highest quartile of the “nuts and fruits” diet compared with those in the lowest quartile (OR=0.495, 95%CI 0.320-0.765, P<0.05). Patients in the top quartile of the “added sugar” diet had a 2.969-fold increased risk of reduced eGFR (OR=3.692, 95%CI 1.240-10.997, P<0.05).

In patients with T2DM in Shanxi province, “nuts and fruits” diets reduce the risk of albuminuria, whereas “added sugar” diets increase the risk of reduced eGFR.

To explore the association between metformin use and the risk of Parkinson′s disease (PD) in patients with type 2 diabetes mellitus (T2DM) in Yinzhou District, Ningbo City.

This was a retrospective cohort study and T2DM patients were recruited from the Yinzhou Regional Health Care Database as research subjects. This study adopted an active drug control and new drug user design, with sulfonylurea drugs as the control, in which a cohort of new users of metformin or sulfonylureas after January 1, 2009 was assembled. Inverse probability of treatment weighting (IPTW) was used to control for the baseline confounding factors, and the Cox regression model was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between Met use and incidence of PD.

A total of 79 111 patients with T2DM were included. The cohort included 41 116 new users of metformin and 37 995 new users of sulfonylureas. During the follow-up period, there were 799 incident cases of PD occurred, 471 were in the sulfonylurea group and 328 were in the metformin group. The incidence rates were 186.7 per 100 000 person-years (471/252 326)and 147.7 per 100 000 person-years (328/222 011), respectively. Compared with sulfonylureas, the crude analysis without adjusting any confounding showed that there was a significant negative association between the use of metformin and the incidence of PD, with an HR of 0.80 (95%CI 0.70-0.93). After adjusting for potential confounders with IPTW, metformin was not significantly associated with the risk of PD (HR=0.88, 95%CI 0.76-1.01). The results of the subgroup and sensitivity analyses were generally consistent with those of the primary analysis.

There is no significant association between the use of metformin and the risk of PD in T2DM patients in Yinzhou District, Ningbo City.

To analyze the clinical characteristics of patients with programmed death receptor 1 (PD-1) inhibitor associated with type 1 diabetes mellitus (T1DM).

Clinical data from 5 patients with T1DM induced by PD-1 inhibitor who were hospitalized at the Department of Endocrinology of Beijing Shunyi Hospital from May 2020 to December 2022 were analyzed. General clinical data and laboratory examination results were collected. The blood glucose monitoring results of 4 patients with new-onset diabetes were followed during PD-1 inhibitor treatment and before the onset of T1DM. The diagnosis and treatment plan during hospitalization, monitoring of the prognosis, and follow-up blood glucose and C-peptide results after discharge were recorded.

There were 5 patients, 4 men and 1 woman, with a median age of 63 (53 to 71) years, including 4 patients with fulminant T1DM. Four patients presented with diabetic ketoacidosis (DKA) for the first time. The median time from first PD-1 inhibitor treatment to the onset of T1DM was 232 (82 to 288) days, and the median number of cycles was 10 (2 to 14). Three out of five patients developed DKA without blood glucose monitoring at 44, 40, and 65 days after discontinuing PD-1 inhibitor treatment, respectively. At diagnosis of T1DM, the median blood glucose was 28.83 (25.16 to 43.24) mmol/L, glycosylated hemoglobin was 8.5% (6.8% to 9.7%), fasting C-peptide was<0.02 (<0.02 to 0.37) ng/ml, 2 h C-peptide was 0.06 (<0.02 to 0.68) ng/ml, and urine ketone body showed positive (++ to +++). Islet-autoantibodies were positive in two patients, and thyroid-related antibodies were positive in two patients. Four patients with new-onset diabetes completed a total of 26 treatment cycles, including 21 cycles in which pre-treatment fasting blood glucose was measured, and the median blood glucose was 5.72 (5.09 to 6.97) mmol/L. Fasting blood glucose was measured within 7 days after 9 treatment cycles, with a median blood glucose of 7.22 (5.88 to 8.95) mmol/L. All patients with T1DM were successfully treated with a hospital stay of 10 to 19 days. After discharge, 1 patient received insulin pump therapy, while the other 4 patients received basal plus meal insulin therapy, with the insulin doses ranging from 0.53 to 0.77 U/kg per day for all patients. Four patients reexamined C-peptide which decreased to the lower limit of detection between 36 and 49 days after discharge. All 5 patients adhered to the discharge hypoglycemic regimen to control blood glucose, which fluctuated between 6 and 13 mmol/L.

PD-1 inhibitors can cause T1DM, predominantly presenting as fulminant T1DM. DKA is often the first manifestation and can occur even after discontinuation of PD-1 treatment, as the destruction of pancreatic β-cells appears to be irreversible and requires insulin therapy. Therefore, continuous blood glucose monitoring is required during PD-1 inhibitor treatment and after discontinuation of treatment for early identification and timely intervention.

Diabetic mastopathy is a rare benign breast disease, with clinical and imaging manifestations similar to breast cancer, which is easy to be misdiagnosed. Two patients with diabetic mastopathy admitted to Tianjin Medical University General Hospital were reported in this paper. Case 1 is a 47-year-old premenopausal patient with type 1 diabetes. He has been using insulin for 30 years and has poor blood sugar control for a long time. This time, he went to the doctor mainly because "bilateral breast masses were found for 6 years". Both breast ultrasound and mammography indicated that bilateral breast glands occupied space. Finally, puncture biopsy was performed and diabetic mastopathy was diagnosed. Case 2 is a 60-year-old postmenopausal patient with type 2 diabetes. He was treated with insulin for 2 years and had poor blood sugar control for a long time. This time, he went to the doctor mainly because of "the left breast mass was found for 2 months". Breast ultrasound and mammography showed that the left breast occupied space. Finally, he underwent puncture biopsy and was diagnosed with diabetic mastopathy. None of the two patients underwent surgical treatment and were followed up. This article reports the clinical diagnosis and treatment of two patients with diabetic breast disease, in order to improve clinicians' understanding of the disease and avoid excessive surgery.

One case of solute transport family 2 member 2 gene (SLC2A2) Diagnosis and treatment of patients with severe insulin resistance caused by heterozygous mutations. The patient was a 12-year-old and 6-month-old boy who was admitted to the hospital with the main complaint of "progressive blackening of multiple skin folds throughout the body for 2 years". The fasting insulin was 150.10 mU/L, and the insulin was>1 000.00 mU/L 2 hours after meal, accompanied by overweight and fatty liver. Whole exon gene sequencing was used to detect the peripheral blood DNA of patients and verified by Sanger sequencing, and it was found that itsSLC2A2There was a heterozygous nonsense mutation of c.1093C>T p.Arg365Ter in the region of exon 9 of the gene, and this site was normal in both parents. The patient wasde novoMutations. It is suggested that for patients with severe insulin resistance, in addition to the genes related to insulin receptor pathway, lipodystrophy and syndrome, the genes related to glucose transport should also be considered. The patient is currently using lifestyle intervention and oral metformin to alleviate disease progression.

One case of ATP-sensitive potassium channel was reported (K_ATP) Diagnosis and treatment of adult diabetes mellitus (MODY) patients with adolescent onset caused by gene mutation. The patient was a 24-year-old woman, and her health examination accidentally found elevated blood glucose, urine glucose (+ + + +) and urine protein (+ + +). The patient was sensitive to sulfonylurea therapy and clinically suspected MODY. Patients and their parents were performed by whole-exome high-throughput sequencingKCNJ11gene mutation site screening and functional prediction analysis using bioinformatics protein functional prediction software found that patients and their fathers carriedKCNJ11(NM_000525.3) c.11G>A (p.Arg4His) heterozygous mutation. The patient was treated with low-dose sulfonylureas, and the blood glucose was well controlled at follow-up. His father's hyperglycemia was well controlled through diet control and regular exercise. Combined with the diagnosis and treatment experience of patients and related literature reports, it is suggested that the clinical diagnosis of MODY should be strengthened to differentiate from atypical type 1 diabetes (T1DM) and type 2 diabetes (T2DM) in order to improve the quality of life of patients.

The diagnosis and treatment of a patient with mitochondrial diabetes mellitus (MDM) was reported. The patient was admitted to the hospital with the main complaint of "finding elevated blood sugar for 16 years, accompanied by hearing loss in both ears for 3 years". According to the characteristics of early onset age, diabetes, neurological deafness and genetic test results, the patient was diagnosed as a mitochondrial gene point mutation (3243A>G) caused by MDM. Combined with the diagnosis and treatment of patients, this paper discusses the clinical characteristics, diagnosis and treatment points of MDM, in order to improve the clinical understanding of this disease.

Anaplastic lymphoma kinase (ALK) inhibitors are the leading drugs in the treatment of non-small cell lung cancer, and hyperglycemia is one of its adverse reactions. This kind of hyperglycemia occurs due to the action of ALK inhibitors on insulin receptors and insulin-like growth factor-1 receptors, which affect the process of blood sugar regulation. For hyperglycemia caused by ALK inhibitors, clinicians can target hypoglycemic drugs or suspend ALK inhibitors and add more effective hypoglycemic measures to make the patient's antitumor treatment proceed smoothly. This article mainly introduces the relationship between ALK inhibitors and hyperglycemia, its mechanism and coping strategies, in order to provide help for clinical diagnosis and treatment.

In recent years, with the progress of the research related to islet cell plasticity, the resulting endogenous beta cell regeneration therapy has attracted increasing attention of researchers. Endogenous beta cell regeneration is mainly through self-replication of beta cells, redifferentiation of dedifferentiated beta cells, transdifferentiation of mature somatic cells, and differentiation of islet stem cells. This article will briefly introduce the mode and related mechanism of islet beta cell regeneration.

Obesity is one of the biggest health problems worldwide. In recent years, increasing attention has been paid to new strategies for the treatment of obesity. Obesity is closely related to excessive fat accumulation and abnormal fat distribution. Mammalian adipose tissue is divided into two categories: white adipose tissue (responsible for storing energy) and brown adipose tissue (responsible for generating heat). During the browning of adipose tissue, white adipose tissue can be transformed into beige adipose tissue with heat-producing ability, making it an important target for obesity treatment. In this paper, the related mechanisms of adipose tissue browning and its research progress in non-drug and drug weight loss in recent years are reviewed.

Urinary metabolomics has become one of the research methods for the mechanism and early diagnosis of many diseases by analyzing small molecule metabolites of terminal metabolites. A variety of metabolic diseases are closely related to urine examination. In recent years, the study of metabolic diseases using urine metabolomics has made great progress. In this paper, the technical methods of urine metabolomics are briefly introduced, and the research progress of biomarkers of metabolic diseases such as obesity, hyperuricemia, diabetes mellitus, hyperlipidemia and non-alcoholic fatty liver disease is reviewed.

Diabetes is a common and frequently occurring disease, which seriously threatens human health. Diabetic cardiomyopathy is a serious complication of diabetes, which is characterized by cardiomyocyte hypertrophy and apoptosis, myocardial interstitial fibrosis and diastolic dysfunction, and ultimately leads to heart failure, which is easily overlooked in clinical practice. Hippo signaling pathway is one of the important signaling pathways that regulate cell proliferation, apoptosis and influence extracellular matrix remodeling. Interfering with the expression of Hippo signaling pathway-related protein and further inhibiting cardiomyocyte apoptosis and myocardial interstitial fibrosis may be a new target for the prevention and treatment of diabetic cardiomyopathy.

Type 1 diabetes mellitus (T1DM) is a disease of autoimmune-mediated beta cell destruction. Despite some advances in insulin formulations and infusion devices, there is still a lack of methods to effectively compensate for lost beta cell function in T1DM. Islet cell replacement therapy appears to be an ideal therapy. The induction of pluripotent stem cells to differentiate into mature islet organoids can theoretically achieve sufficient and stable endogenous insulin replacement, which makes the cure of T1DM possible. At present, stem cell-derived insulin-secreting cells (SC-IPC) have entered the clinic and achieved certain clinical efficacy. However, SC-IPC still has many difficulties such as cell survival and immune rejection. This paper briefly expounds the technical development and clinical trials of SC-IPC, and further discusses the potential schemes to improve its efficacy, as well as the controversies and shortcomings of SC-IPC.

Gitelman syndrome (GS) is caused bySLC12A3An autosomal recessive renal tubular disease caused by genetic mutations, characterized by hypokalemic metabolic alkalosis, hypomagnesemia and hypocalciuria. In recent years, more and more studies have shown that GS patients can be complicated with abnormal glucose metabolism, and the mechanism is still unclear. It is mainly considered to be related to insulin resistance or insulin secretion disorder caused by hypokalemia, hypomagnesemia and hyperaldosterone status. Hypomagnesemia may play a key role in the development of insulin resistance. This article summarizes the prevalence, mechanism and treatment of GS with abnormal glucose metabolism, in order to arouse the attention of endocrinologists to GS with abnormal glucose metabolism, and improve the quality of life of patients with GS with abnormal glucose metabolism.

Evidence-based nursing practice requires nursing staff to combine current best scientific evidence with clinical nursing experience while considering patient values and preferences to make clinical decisions. According to the "6S" evidence resource pyramid of evidence-based medicine, evidence summary is a kind of advanced scientific evidence at the same level as evidence-based practice guidelines. In the era when evidence-based practice guidelines are scarce, it has become the main basis for clinical evidence use. In recent years, the number of evidence summary papers published has gradually increased, but in the field of diabetes nursing, there is a large gap in evidence summary papers. This paper integrates the process and writing standards of producing evidence summary between the evidence-based health care center of Joanna Briggs Institute (JBI) in Australia and the evidence-based nursing cooperative center of JBI in Fudan University, summarizes the suggestions for producing evidence summary in the field of diabetes care, and combs the key points of report writing, so as to provide reference for more and higher quality evidence summary research in the field of diabetes care.