Volume 16 · Issue 12 · 2024

This paper analyzes the harm of type 2 diabetes and obesity, and interprets the results and clinical significance of the Early study on the treatment model of newly diagnosed overweight/obese type 2 diabetes, so as to promote the Early diagnosis and treatment of overweight/obese type 2 diabetes, and provide more evidence-based evidence for the role of dietary intervention in Early blood glucose and weight management in Chinese patients with type 2 diabetes.

Pancreatic islets play an important role in maintaining blood glucose homeostasis and substance metabolism. In recent years, the mechanical properties and mechanical biological response mechanism of pancreatic islets have attracted much attention. A large number of research results show that they are involved in the occurrence and development of diabetes and other diseases, and are expected to become a new target for diabetes diagnosis and treatment. In view of this, by summarizing the relevant research at home and abroad, this paper puts forward and systematically explains the concept of "islet strength medicine" for the first time. This paper expounds the multi-scale mechanical characteristics of islets and their influence on the biological function of islets from four aspects: islet biomechanics, islet force biology, islet force diagnostics and islet force therapy, sorts out potential related action targets and force biomarkers, and focuses on their potential applications in the diagnosis and treatment of diabetes, providing new perspectives and new methods for diabetes diagnosis and treatment strategies.

There are many causes of lower limb ulcers in diabetic patients, and the most common cause is lower limb arterial disease caused by atherosclerosis. Takayasu arteritis is a rare systemic vasculitis, which can also cause lower limb ischemia and cause ulcers. When patients with lower limb ulcers have diabetic lower limb arterial disease and Takayasu arteritis at the same time, it is easy to miss the diagnosis of Takayasu arteritis, so clinical diagnosis is extremely challenging. The choice of drug therapy and revascularization in Takayasu inflammatory ulcer is different from that in atherosclerotic peripheral artery disease. Therefore, the differentiation of lower limb ulcers caused by different etiologies in diabetic patients directly determines the effectiveness of treatment and the prognosis of patients. This paper puts forward the diagnosis and treatment of lower limb ulcer in diabetic patients. First, evaluate the number, location and characteristics of the wound, and make a preliminary judgment of the cause; Second, evaluate blood supply, further investigate the cause and understand the extent of blood vessels involved through imaging examination; Third, the diagnosis of Takayasu arteritis is confirmed by serum autoimmune antibody detection and tissue biopsy. It is recommended that clinicians follow the above steps to diagnose and treat patients with diabetes complicated with lower limb ulcers, so as to avoid missing the diagnosis of rare causes such as Takayasu arteritis that may lead to lower limb ulcers.

Diabetes mellitus is a chronic metabolic disease, which can cause cardiovascular, cerebrovascular, kidney and other system damage. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1RA) are novel hypoglycemic drugs that have been shown to improve cardiovascular and renal outcomes in patients with type 2 diabetes mellitus (T2DM) and have a lower risk of hypoglycemia. This article reviews the benefits and potential risks of the combination of SGLT2i and GLP-1RA in the treatment of elderly patients with T2DM.

With the rapid growth of the number of diabetic patients in China and the increase of older mothers after the further liberalization of fertility policy, the number of gestational diabetes mellitus (GDM) is increasing year by year, which seriously threatens the health of mothers and children. It is urgent to standardize the management of GDM pregnant women and their offspring. The Diabetology Professional Committee of the Chinese Society of Research Hospitals organized experts in the fields of endocrinology and metabolism, obstetrics and gynecology, pediatrics, nutrition science and other fields to co-write the Guidelines for the Co-management of Mothers and Children with Gestational Diabetes in China (2024 Edition). The guide consists of six chapters, including the significance of co-management of GDM mother and child, GDM diagnosis and screening, GDM management plan for pregnant women, and GDM management plan for pregnant women and offspring. This guide emphasizes the importance and necessity of co-management of pregnant women with GDM and their offspring, and elaborates specific strategies for monitoring and management of pregnant women with GDM and their offspring. The promulgation of this guideline will help to guide and help clinicians to carry out all-round and life-cycle standardized management of GDM pregnant women and their offspring, aiming to further improve the near-and long-term health of mothers and children.

Insulin autoimmune syndrome (IAS) is a rare autoimmune disease characterized by spontaneous hypoglycemia. The incidence rate is higher in East Asian populations. If the diagnosis and treatment are not timely, it can cause adverse clinical outcomes and even life-threatening due to repeated hypoglycemia or fluctuations in high and low blood sugar. However, there is still a lack of guidelines or norms for IAS to guide clinical practice. In view of this, this consensus combines the latest research progress at home and abroad and clinical practice experience in China, and systematically summarizes the epidemiology, triggers, pathogenesis, clinical manifestations, diagnosis, differential diagnosis, treatment and prognosis of IAS, in order to promote the standardization and standardization of clinical diagnosis and treatment of this disease.

To investigate the relationship between serum cholinesterase (ChE) levels and peripheral nerve function in patients with type 2 diabetes mellitus (T2DM).

This was a cross-sectional study. T2DM patients were recruited for this study at the Department of Endocrinology of Nantong First People′s Hospital between January 2021 and December 2023. The height and weight of the subjects were collected to calculate body mass index (BMI); fasting glucose and insulin levels were measured to calculate homeostasis model assessment of insulin resistance (HOMA-IR); glycated hemoglobin A_1c (HbA_1c) and ChE levels were measured; and peripheral nerve function parameters, including the latency, amplitude and conduction velocity of the peripheral nerves (median nerve, ulnar nerve, common peroneal nerve, superficial peroneal nerve, tibial nerve and sural nerve) of the extremities were evaluated. The composite Z-scores of latency, amplitude and conduction velocity of the peripheral nerve were calculated. All subjects were divided into four subgroups according to the quartiles of serum ChE levels: group Q₁ (range of ChE, 3 690-7 680 U/L), group Q₂ (range of ChE, 7 690-9 020 U/L), group Q₃ (range of ChE, 9 030-10 350 U/L), and group Q₄ (range of ChE, 10 360-16 110 U/L). One-way analysis of variance with linear polynomial contrasts, the Jonckheere-Terpstra test, or the chi-squared test with linear-by-linear association was used to analyze the trend of clinical data as quartiles of serum ChE levels increased. Pearson′s correlation analysis was used to analyze the relationship between ChE and relevant clinical variables, and multivariate linear regression analysis was used to analyze whether ChE was an independent factor for peripheral nerve function (latency, amplitude and conduction velocity).

A total of 659 T2DM patients were recruited, with 165 patients in group Q₁, 166 patients in group Q₂, 164 patients in group Q₃ and 164 patients in group Q₄. From Q₁, Q₂, Q₃ to Q₄ of the ChE, the composite Z-scores of nerve latency gradually decreased (F=20.402, P for trend<0.001), while the composite Z-scores of nerve amplitude and conduction velocity increased gradually (F=78.929 and 49.018, respectively; all P for trend<0.001). Pearson′s correlation analysis revealed that the serum ChE levels were negatively correlated with the composite Z-scores of nerve latency (r=-0.190, P<0.001) and were positively correlated with the composite Z-scores of nerve amplitude and conduction velocity (r=0.318 and 0.278, respectively; all P<0.001). After adjusting for BMI, HOMA-IR, HbA_1c and other clinical variables via multivariate linear regression analysis, increased serum ChE levels were independently associated with decreased composite Z-scores of nerve latency (β=-0.093, t=-2.166, P=0.031) and increased composite Z-scores of nerve amplitude (β=0.210, t=4.963, P<0.001) and conduction velocity (β=0.152, t=3.508, P<0.001).

Increased serum ChE levels were associated with decreased nerve latency and increased nerve amplitude and conduction velocity in patients with T2DM.

To investigate the prevalence of impaired awareness of hypoglycemia (IAH) in patients with type 2 diabetes mellitus (T2DM) and to explore the factors influencing IAH using different assessment methods.

From June to December 2023, a convenience sampling method was used to select 352 patients with T2DM from Department of Endocrinology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology. Tools such as general information questionnaires, Gold score, Clarke questionnaire, and Pedersen questionnaire were used for assessment. Influencing factors were screened by univariate and correlation analyses, followed by binary logistic regression analysis to identify independent factors of IAH. Patients were stratified according to baseline characteristics such as disease duration, age, and insulin use, and differences between assessment tools were evaluated using the Kruskal-Wallis H test.

The incidence of IAH was 33.0% (116/352), 24.1% (85/352), and 41.5% (146/352) in T2DM patients assessed according to Gold score, Clarke questionnaire and Pedersen questionnaire, respectively, with different results. Gold scores were highly correlated with both Clarke questionnaire and Pedersen questionnaire scores (r=0.485, P<0.001; r=0.571, P<0.001), and Clarke scores were highly correlated with Pedersen scores (r=0.699, P<0.001).The results of binary logistic regression analysis showed that, using the Gold score as an example, duration of insulin use (OR=1.05, 95%CI 1.01-1.10), level of hypoglycemia fear (OR=1.04, 95%CI 1.01-1.07), living alone (OR=4.04, 95%CI 1.27-12.90) and hypoglycemia occurring more than 5 times per year (OR=1.39, 95%CI 1.17-2.88) were the influencing factors of IAH. Duration of insulin use and higher levels of hypoglycaemia fear were also associated with an increased risk of IAH when assessed using the Clarke questionnaire, with their OR value (95%CI) of 1.07 (1.02-1.13) and 1.06 (1.03-1.09) respectively. However, when the number of diabetic complications was 1, it appeared to reduce the risk of IAH (OR=0.32, 95%CI 0.11-0.94). When assessed with the Pedersen questionnaire, increased duration of insulin use (OR=1.07, 95%CI 1.02-1.11) and hypoglycaemia fear (OR=1.07, 95%CI 1.04-1.10) were associated with an increased risk of IAH. In subgroup-specific analyses, only the Gold score showed significant differences in duration of diseases and insulin use (H=12.42, P=0.002; Z=-3.64, P<0.001).

IAH in patients with T2DM is influenced by many factors. Although there are differences among the three assessment tools, they show good consistency, especially in patients with long duration of disease and insulin use, where the Gold score has certain advantages.

To investigate the relationship between triglyceride-glucose (TyG) index, which is a validated indicator of insulin resistance (IR), and mild cognitive impairment (MCI) in type 2 diabetes mellitus (T2DM).

This was a cross-sectional study. Patients with T2DM who were hospitalized in the Department of Endocrinology, General Hospital of Eastern Theater Command, the Affiliated hospital of Nanjing University Medical School from January 2016 to January 2022 were enrolled. The age, sex, blood pressure, height and weight of the subjects were collected, and the body mass index (BMI) was calculated. The serum uric acid, glycated hemoglobin A_1c, (HbA_1c) fasting plasma glucose (FPG), triglyceride (TG) and triglyceride-glucose (TyG) index were collected, and the Montreal cognitive assessment (MoCA) score was evaluated. According to MoCA score, the subjects were divided into MCI group (MoCA total score<26) and non-MCI group (MoCA total score≥26). Two independent samples t test, Mann-Whitney U test and χ² test were used to compare between groups. Spearman correlation analysis was used to analyze the correlation between MoCA score and other indicators. Binary logistic regression analysis was used to analyze the influencing factors of cognitive impairment, and the interaction term between BMI and TyG index was established to verify its significance level. The receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to evaluate the predictive ability of TyG index and traditional risk factors for diabetic MCI.

A total of 333 T2DM patients were enrolled, including 200 patients with MCI and 133 patients without MCI. Compared with the non-MCI group, FPG and TyG index were increased, and serum uric acid level was decreased in the MCI group (P<0.05). Correlation analysis results showed that TyG index was negatively correlated with MoCA score (r=-0.200, P<0.05). Binary logistic regression analysis showed that after adjusting for all confounding factors, TyG index still had a positive effect on MCI in T2DM patients (OR=1.880, 95%CI 1.327-2.664, P<0.001). Especially in T2DM patients aged ≥30 and <60 years, with a BMI of <24.0 kg/m², the increase of TyG index was associated with a higher risk of MCI (OR=3.317, 95%CI 1.515-7.263, P=0.003). The results of interaction analysis showed that there was an interaction effect between BMI and TyG index, which affected the occurrence of MCI in T2DM patients (OR=0.917, 95%CI 0.843-0.999, P<0.05). The results of ROC curve showed that the combined TyG index and traditional risk factors (age, sex, BMI, hypertension, HbA_1c) had a higher predictive ability for MCI than the traditional risk factors alone (AUC=0.626, 95%CI 0.565-0.688, P<0.05).

TyG index is associated with MCI in T2DM patients, and TyG index in combination with traditional risk factors has a higher predictive value for MCI in T2DM patients.

To investigate the correlation of long non-coding RNA (lncRNA) growth arrest-specific transcript 5 (GAS5) and cadherin-11 (Cad-11) expression levels in peripheral blood with the risk of osteoporotic vertebral compression fracture (OVCF) in postmenopausal patients with type 2 diabetes mellitus (T2DM).

A total of 133 postmenopausal T2DM patients who visited the Department of Endocrinology and enrolled in the National Standardised Metabolic Disease Management Centre and were hospitalised in the Department of Spine Surgery of the First Affiliated Hospital of Baotou Medical College of Inner Mongolia University of Science and Technology from February to November 2023 were selected and divided into non-osteoporosis (NOP) group (63 cases), osteoporosis (OP) group (31 cases) and OVCF group (39 cases). The weights, body mass index (BMI), and other general data and biochemical indexes of the patients were collected, and visceral fat area (VFA) and subcutaneous fat area (SFA) were measured by bioelectrical impedance method, and the ratio of visceral fat area to subcutaneous fat area (VSR) was calculated. The bone mineral density (BMD) of lumbar spine (L_1-4) and the corresponding T-value were measured by dual-energy X-ray absorptiometry, and the expression of lncRNA GAS5 and Cad-11 in peripheral blood was detected by quantitative reverse transcription-polymerase chain reaction. One-way analysis of variance(ANOVA), Kruskal-Wallis H test, and χ² test were used for comparison between multiple groups, and LSD-t test and Mann-Whitney U test were used for two-by-two comparison between two groups. Multivariate logistic regression analysis was used to analyze the influencing factors of OVCF in postmenopausal T2DM patients.

Compared with the NOP group, VFA was increased and L_1-4 BMD was decreased in the OVCF group, and BMI, SFA, and body weight were decreased and VSR was increased in the OVCF group compared with the NOP and OP groups (P<0.05). LncRNA GAS5 expression levels were sequentially increased in the NOP, OP, and OVCF groups, and Cad-11 was sequentially decreased in the three groups (P<0.05). Multivariate Logistic regression analysis showed that lncRNA GAS5 (OR=4.696, 95%CI 1.149-19.187), Cad-11 (OR=0.180, 95%CI 0.047-0.686), and BMI (OR=0.065, 95%CI 0.011-0.372) were the factors of OVCF in postmenopausal T2DM.

High expression of lncRNA GAS5 and low expression of Cad-11 in peripheral blood of postmenopausal T2DM patients correlate with the risk of developing OVCF.

To investigate the characteristics and trends of early-onset type 2 diabetes mellitus (T2DM) incidence in Tianjin from 2006 to 2022 and to provide a scientific basis for prevention and control.

This was a cross-sectional study. The incidence data of T2DM in people under 40 years of age in 2006—2022 were obtained and analyzed from the Tianjin population-based incidence surveillance system collected by the Tianjin Centre for Disease Control and Prevention (CDC). Diffences in early-onset T2DM by age, sex and region were compared. Standardized incidence rates were calculated using the China′s 5th population census in 2000. The Joinpoint regression model was used to analyze the temporal trend, the Cochran-Armitage test was used to determine the significance of the age trend, and the Pearson chi-squared test was used to compare the differences between groups.

From 2006 to 2022, a total of 29, 977 new cases of T2DM in people under 40 years were reported in Tianjin. The early-onset T2DM crude incidence rate ranged from 12.21/100 000 to 55.09/100 000, while the adjusted incidence rate ranged from 11.49/100 000 to 48.04/100 000, with 2015 as the nodal year, showing an increasing trend from 2006 to 2015 with an annual percentage change (APC) of 15.19% (t=8.206, P<0.001), and a stable trend was observed from 2015 to 2022 (APC=3.00%, t=1.897, P=0.082). The incidence rate of early-onset T2DM increased with age, with the highest rate in the 30-39 age group (P<0.001). The highest average annual increase was observed in the 20-29 age group, with an average annual percentage change (AAPC) of 15.07% (t=11.638, P<0.001). The adjusted incidence of early-onset T2DM for both males and females was noded at 2015, with an increasing trend from 2006 to 2015 (APC _male=15.65%, APC _female=14.29%, both P<0.001), and stable trend from 2015 to 2022 (both P>0.05), The adjusted rate in males has been higher than females from 2006 to 2022 (all P<0.05). Regarding the regional analysis, the adjusted incidence rate of early onset T2DM in urban area from 2006 to 2012 showed an increasing trend (t=4.887, P<0.001) with an APC of 18.77%, and was stable from 2012 to 2022 (APC=1.95%, t=1.823, P=0.093). For rural residents, there was an increasing trend from 2006 to 2015 (t=7.364, P<0.001), with an APC of 18.46%, and a slower increasing trend from 2015 to 2022 (APC=4.32%, t=2.225, P=0.046). The adjusted rate in rural areas has been higher than urban areas from 2014 to 2022 (all P<0.05). The analysis of early-onset T2DM patients in Tianjin from 2006 to 2022 showed that the early-onset T2DM patients aged 30-39 years old with comorbidities had the highest proportion compared to other age groups (χ²=72.744, P<0.001), males were higher than females (χ²=168.260, P<0.001), and urban residents were higher than that rural residents (χ²=14.056, P<0.001). Ketoacidosis and neuropathy were the most common acute and chronic complications, respectively.

The incidence of early-onset T2DM in Tianjin is generally increasing from 2006 to 2022. The population aged over 20 years old, males and in rural areas were the key groups for prevention and control.

To investigate the effect of celastrol on non-alcoholic fatty liver disease (NAFLD) in diabetic mice and its preliminary mechanism.

(1) A total of 10 male db/db mice were divided into two groups: model (db/db) group and celastrol (Cel) group by using a random number table, with 5 mice in each group. Five male db/m mice of the same age were used as the blank (db/m) group. Celastrol was injected intraperitoneally into Cel group for 21 days, and an equal volume of saline was injected intraperitoneally into the db/m and db/db groups. Body weight and food intake were recorded, and glucose and insulin tolerance tests were performed. The levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), fasting insulin, triglycerides (TG), and total cholesterol (TC) in plasma were measured by enzyme-linked immunosorbent assay computational homeostasis modeling to assess insulin resistance (HOMA-IR) indices. Real-time polymerase chain reaction (PCR) and Western blotting were used to detect the mRNA and protein levels of sirtuin1 (SIRT1), peroxisome proliferator-activated receptor γ coactivator-1α (PGC-1α) and carnitine palmityltransferase 1A (CPT1A) in the liver. (2) Human hepatoma cell line HepG2 cells were stimulated with palmitic acid to establish a model of hepatic steatosis. Steatosis hepatocytes were divided into model (PA) group and celastrol (Cel) groups, and normal hepatocytes were used as the blank (Con) group. The optimal dosage of celastrol for cell intervention was clarified by CCK8 assay. Then 1 μmol/L celastrol was used for 24 hours. At the end of the culture, the level of TG in hepatocytes was detected, and real-time PCR and Western blotting were used to detect the mRNA and protein expression of SIRT1, PGC-1α, and CPT1A. Group comparisons were performed using t-test or one-way analysis of variance (ANOVA).

(1) Compared with db/m group, the body weight, food intake, fat content, fasting blood glucose, and HOMA-IR were significantly increased in db/db group (P<0.05); compared with db/db group, the body weight, food intake, fat content, fasting blood glucose, and HOMA-IR were significantly decreased in Cel group (P<0.05). (2) Compared with db/m group, mice in db/db group showed a significant increase in plasma and liver TG and TC levels (P<0.05), and a significant increase in plasma IL-1β, IL-6, and TNF-α levels (P<0.05). Compared with db/db group, mice in Cel group showed significant decrease in plasma and liver TG and TC levels (P<0.05), and significant decrease in plasma IL-1β, IL-6, and TNF-α levels (P<0.05). (3) Compared with db/m group, the mRNA and protein levels of SIRT1, PGC-1α and CPT1A in the liver of db/db group were significantly decreased (P<0.05), and the acetylation level of PGC-1α was increased. Compared with db/db group, the mRNA and protein levels of SIRT1, PGC-1α, and CPT1A in the liver of Cel group were significantly increased (P<0.05), and the acetylation level of PGC-1α was decreased. (4) Compared with Con group, the TG level of hepatocytes in PA group were significantly increased (P<0.05). Compared with PA group, the TG level of hepatocytes in Cel group was significantly decreased (P<0.05). (5) Compared with Con group, the levels of SIRT1, PGC-1α, CPT1A mRNA and protein in hepatocytes of PA group were significantly decreased (P<0.05). Compared with PA group, SIRT1, PGC-1α, CPT1A mRNA and protein levels in hepatocytes of Cel group were significantly increased (P<0.05).

Celastrol may improve glycolipid metabolism in db/db mice, increase fatty acid oxidation, reduce hepatic TG accumulation, and reverse liver injury in NAFLD via SIRT1/PGC-1α/CPT1A pathway.

To investigate the effects of liraglutide on insulin resistance in the skeletal muscle of ob/ob mice, and to explore the correlation between the expression of sestrin2/adenosine monophosphate-activated protein kinase (Sesn2/AMPK), autophagy factors and insulin resistance.

Thirty male 7-week-old ob/ob mice were randomly divided into three groups: ob/ob mice group (Ob group, n=10), high-fat diet group (Ob+HFD group, n=10), and liraglutide group (Ob+HFD+Lir group, n=10). In addition, 10 male C57BL/6J mice were used as the normal control group (NC group). Mice in the NC, Ob, and Ob+HFD groups were injected intraperitoneally with normal saline, while mice in the Ob+HFD+Lir group were injected intraperitoneally with liraglutide injection at a dose of 400 μg·kg^-1·d^-1. After one week of adaptive feeding, the intervention lasted for 5 weeks. Mouse body weight was measured, oral glucose tolerance test (OGTT) was performed, transmission electron microscopy was used to observe the morphology of gastrocnemius muscle and the number of autophagosomes, and Western blotting was used to detect the expression of Sesn2, AMPK, phosphorylated AMPK (p-AMPK), sequestosome 1 (P62), microtubule-associated protein 1 light chain 3Ⅰ (LC3Ⅰ), microtubule-associated protein 1 light chain 3Ⅱ (LC3Ⅱ), protein kinase B (AKT), phosphorylated AKT (p-AKT), and glucose transporter 4 (GLUT4) proteins in mouse gastrocnemius muscle tissue. One-way analysis of variance (ANOVA) was used to compare between groups.

Compared with the NC group, the body weight and the area under the curve (AUC) of the time-blood glucose curve during OGTT increased in the Ob and Ob+HFD groups. Compared with the Ob group, the body weight and AUC increased in the Ob+HFD group. Compared with the Ob+HFD group, the body weight and AUC decreased in the Ob+HFD+Lir group, with statistically significant differences [NC group AUC (1 196.0±136.5) mmol·L^-1·min^-1, Ob group AUC (1 573.0±117.4) mmol·L^-1·min^-1, Ob+HFD group AUC (1 781.0±193.6) mmol·L^-1·min^-1, Ob+HFD+Lir group AUC (1 312.0±140.8) mmol·L^-1·min^-1, P<0.05]. Compared with the NC group, the number of autophagosomes in the gastrocnemius muscle tissue of the Ob and Ob+HFD groups decreased, and muscle tissue damage, cytoplasmic edema, local fragmentation of myofibrils, and uneven muscle filament thickness were observed by transmission electron microscopy. Compared with the Ob group, the number of autophagosomes in the gastrocnemius muscle tissue of the Ob+HFD group further decreased, muscle tissue damage was more obvious, cytoplasmic edema, disorganized arrangement of myofibrils, and swelling of organelles were observed. In the Ob+HFD+Lir group, the number of autophagosomes in the gastrocnemius muscle increased, muscle tissue damage was less severe, the cytoplasm was slightly lighter and more pale, organelles were slightly swollen, and a small amount of myofibril fragmentation was observed, with statistically significant differences (P<0.05). Compared with the NC group, the expression of Sesn2 and GLUT4 proteins in the gastrocnemius muscle of the Ob and Ob+HFD groups decreased, the ratios of p-AMPK/AMPK, LC3Ⅱ/LC3Ⅰ, and p-AKT/AKT decreased, and the expression of P62 protein increased. Compared with the Ob group, the changes in the Ob+HFD group were more significant. Liraglutide intervention reversed the abnormal expression and ratios of the above proteins, with statistically significant differences (all P<0.05).

Liraglutide may alleviate insulin resistance in the skeletal muscle of ob/ob mice, which could be associated with the Sesn2/AMPK pathway and autophagy.

A case of von Hippel-Lindau (VHL) syndrome complicated with hepatocyte nuclear factor 1 α (HNF1A) Diagnosis and treatment of mutant patients. The patient had previous hyperglycemia with pancreatic cyst and renal cyst, and was diagnosed with VHL syndrome by genetic test and related examinationHNF1AMutations. This article focuses on reviewing the whole process from initial onset to definite diagnosis of this patient, and analyzes and discusses the clinical characteristics and possible mechanisms of abnormal glucose metabolism in this patient, in order to provide reference for the diagnosis and treatment of this kind of disease.

The diagnosis and treatment of a patient with refractory diabetic gastroparesis (DGP) was reported. The patient was a 33-year-old woman diagnosed with type 1 diabetes mellitus (T1DM) at the age of 14, complicated by diabetic nephropathy, and dependent on insulin therapy after onset. 10 months ago, I began to have nausea and vomiting after eating, accompanied by early satiety, belching, and occasionally severe abdominal cramps. Gastric emptying scintigraphy confirmed the presence of a significant delay in solid gastric emptying, confirming the diagnosis of DGP. Intensive hypoglycemic regimen, dietary adjustment and drug treatment were given, but the curative effect was not good. The symptoms were relieved after CT-guided visceral nerve destruction. At present, there is no definite treatment for DGP. Through the report of this patient, we hope to provide some experience and basis for the future research and treatment of DGP.

Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrine and metabolic diseases, characterized by irregular menstruation, hyperandrogenism or Kaohsiung manifestations, and polycystic variations of the ovaries. Insulin resistance (IR) plays a central role in the pathogenesis of PCOS, and the hyperinsulinemia caused by it stimulates ovarian overproduction of androgens. About half of PCOS patients are accompanied by overweight or obesity. Obesity can cause and aggravate IR and hyperandrogenemia in PCOS patients. Together, the three form a vicious circle and lead to the progression of PCOS. Lifestyle intervention is the first-line treatment for PCOS patients, and diet intervention is the cornerstone of PCOS management. Different dietary patterns, such as low-carbohydrate diet, ketogenic diet, intermittent fasting, etc., may have different effects on body weight and insulin sensitivity in patients with PCOS. However, there are relatively few current studies on dietary interventions for PCOS. This paper summarizes the influence of different dietary patterns on body weight and insulin sensitivity in PCOS patients, in order to provide reference for clinical practice of dietary intervention in PCOS patients.

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) has become a new type of hypoglycemic drug. The drug has a unique hypoglycemic mechanism: it mainly reduces the function of sodium-glucose cotransporter 2 in renal proximal convoluted tubular epithelial cells. Reabsorption of glucose and sodium ions. Follow-up evidence-based medical evidence shows that SGLT2i has a cardiorenal protective effect independent of the hypoglycemic effect, which further expands its clinical indications and has become the first-line drug for chronic kidney disease and heart failure. This paper introduces the main biological information and function of SGLT2i target genes, pharmacological mechanism and possible problems after long-term use, as well as the chemical composition, molecular structure and metabolic kinetic parameters of SGLT2i currently on the market, and discusses the prospect of clinical application of SGLT2i.