Volume 17 · Issue 01 · 2025

Metabolic disease, cardiovascular disease (CVD), and chronic kidney disease (CKD) often coexist, and to recognize the complex relationship between diseases, in 2023 the American Heart Society first proposed the concept of cardiovascular-renal-metabolic (CKM) syndrome, which is characterized by metabolic risk factors, pathophysiological interactions between CVD, and CKD, leading to increased multiple organ dysfunction and adverse cardiovascular outcomes. The core role of the liver in metabolism has been gradually revealed. Metabolism-related fatty liver disease (MASLD) is the liver component of metabolic syndrome, and the pathological mechanisms are widely overlapping. Patients with MASLD have a greater risk of developing CVD and CKD. Therefore, from the perspective of endocrinologists and hepatologists, this paper proposes the concept of metabolism-related hepatocardiorenal syndrome (MALCKS), and believes that MALCKS can more accurately describe the functional damage caused by metabolic abnormalities to vital organs in the whole body. By sorting out the connotation of CKM syndrome and its relationship with MASLD, the relationship mechanism between MASLD and metabolic syndrome and cardiorenal related diseases was expounded, and it was believed that MASLD was related to the occurrence of circulatory system, kidney and endocrine and metabolic related diseases. The concept of CKM was expanded, and multidisciplinary management under the framework of MALCKS was advocated to improve the prognosis of patients.

In March 2024, the International Diabetes Federation released the International Diabetes Federation's Position Statement on the Diagnosis of Prediabetes and Type 2 Diabetes with Blood Glucose at 1 Hour Post-Load (referred to as the Position Statement), proposing recommendations for the use of plasma glucose at 1 h post-load (1hPG) for the diagnosis of intermediate hyperglycemia (IH) and type 2 diabetes (T2DM). The position statement collects and summarizes the diagnostic evidence of 1hPG for IH and T2DM after 75 g oral glucose tolerance test (OGTT) for more than 40 years, and formally proposes that 1hPG can be used as a new standard for the diagnosis of glucose metabolism abnormalities. This article combs and interprets the key points of the position statement, in order to provide reference for early diagnosis and intervention of diabetes. The content covers the value of 1hPG in predicting progression to T2DM, identifying 1hPG cutpoints with T2DM risk, the prevalence of 1hPG ≥8.6 mmol/L after loading, the evidence that 1hPG ≥8.6 mmol/L precedes impaired glucose tolerance (IGT) and T2DM, the predictive value of complications related to abnormal glucose metabolism, the use value of 1hPG in special populations, and the cutoff value of 1hPG in diagnosing T2DM.

With the important progress made in diabetes research at home and abroad, new methods and technologies for diagnosis and treatment are constantly coming out, and relevant clinical research evidence continues to be abundant. The Diabetes Branch of Chinese Medical Association organized experts to revise the original guidelines and formed the Guidelines for the Prevention and Treatment of Diabetes in China (2024 Edition), which aims to deliver important progress in time and guide clinical practice. This guide consists of 20 chapters, covering the epidemiology, diagnosis and classification, tertiary prevention, screening and evaluation, education and management of diabetes in China, comprehensive control objectives of type 2 diabetes and treatment pathways for hyperglycemia, medical nutrition therapy, exercise therapy, drug therapy for hyperglycemia, weight management of patients with type 2 diabetes, diabetes-related technologies, acute complications, management of cardiovascular diseases and risk factors, chronic complications of diabetes, childhood and adolescent diabetes, type 1 diabetes, hypoglycemia, special cases of diabetes, metabolic syndrome, and prevention and treatment of diabetes with traditional Chinese medicine. The release of this guideline will help guide and help clinicians to standardize and comprehensively manage diabetic patients, promote the improvement and progress of the industry, and improve patients' quality of life and clinical outcomes.

To investigate whether there was a correlation between serum cholinesterase (ChE) levels and bone mineral density in middle-aged to elderly patients with type 2 diabetes mellitus (T2DM).

This was a cross-sectional study. Middle-aged to elderly T2DM patients (males ≥55 years old and postmenopausal females) were recruited for this study at the Department of Endocrinology of Nantong First People′s Hospital between December 2020 and December 2023. The height and weight of the subjects were collected to calculate their body mass index (BMI); serum ChE levels, albumin, fasting C-peptide, hemoglobin, glycated hemoglobin A_1c (HbA_1c) and bone turnover biomarkers (BTM), including osteocalcin, β-crosslaps (β-CTX) and total procollagen-1 N-terminal peptide (P1NP), were measured; the bone mineral density of various regions was assessed by dual-energy X-ray absorptiometry (DXA) in all subjects, including the lumbar, femoral neck, hip, and whole body. All subjects were divided into two subgroups according to the median serum ChE level (8.20 kU/L): the low-level ChE group (range of ChE, 3.72-8.20 kU/L) and the high-level ChE group (range of ChE, 8.21-15.38 kU/L). The two-sample independent t-test, the Mann-Whitney U test, or the chi-squared test was used to analyze the differences between the two subgroups; Pearson′s correlation analysis was used to analyze the relationship between ChE and related clinical variables; and multivariate linear regression analysis was used to analyze whether ChE was an independent factor for bone mineral density in various regions of the body.

A total of 668 middle-aged to elderly T2DM patients were included, with 335 patients in the low-level ChE group and 333 patients in the high-level ChE group. Compared to the low-level ChE group, the high-level ChE group had greater lumbar, femoral neck, hip and whole-body bone mineral density (P<0.01). Pearson′s correlation analysis revealed that the serum ChE levels were positively correlated with the lumbar, femoral neck, hip and whole-body bone mineral density (r=0.182, 0.271, 0.289 and 0.165, respectively; P<0.001). After adjusting for BMI, albumin, fasting C-peptide, hemoglobin, HbA_1c, BTM (osteocalcin, β-CTX and P1NP) and other clinical variables via multivariate linear regression analysis, increased serum ChE levels were still independently associated with increased lumbar bone mineral density (β=0.146, t=3.077, P=0.003), femoral neck bone mineral density (β=0.186, t=4.409, P<0.001), hip bone mineral density (β=0.171, t=4.104, P<0.001) and whole-body bone mineral density (β=0.116, t=2.738, P=0.006) in middle-aged to elderly patients with T2DM.

The serum ChE levels are positively associated with bone mineral density and represent an independent influencing factor for the increase in bone mineral density in middle-aged to elderly patients with T2DM.

To investigate the relationship between serum uric acid (SUA) to serum creatinine (Scr) ratio (SUA/Scr) and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

This was a cross-sectional study. A total of 434 T2DM patients were enrolled in the ophthalmology and endocrinology departments of Nanjing Drum Tower Hospital from December 2021 to December 2023, and divided into the T2DM group (231 cases) and DR group (203 cases) according to the photographic results. The DR group was further divided into non-proliferative diabetic retinopathy (NPDR) group (122 cases) and proliferative diabetic retinopathy (PDR) group (81 cases). SUA and Scr levels were measured in all patients, and SUA/Scr was calculated. T2DM patients were divided into low SUA/Scr group (SUA/Scr<4.37, 146 cases), medium SUA/Scr group (SUA/Scr 4.37-5.46, 146 cases) and high SUA/Scr group (SUA/Scr>5.46, 142 cases) according to the SUA/Scr tripartite. The logistic regression model was used to examine the association of SUA/Scr with DR and its severity. The diagnostic value of SUA/Scr and SUA in predicting DR was evaluated using the area under the receiver operating characteristics (ROC) curve (AUC).

The SUA/Scr levels in the PDR group were significantly higher than those in the NPDR group and T2DM group (6.54±1.55 vs. 5.54±1.32 vs. 4.36±0.98, P<0.01). Multivariate logistic regression analysis showed that SUA/Scr was an influencing factor for NPDR(OR=4.046, 95%CI 2.450-6.680, P<0.05) and PDR (OR=4.253, 95%CI 1.429-7.363, P<0.05). SUA/Scr levels tended to be higher in the T2DM group than in the control group, although the difference did not reach statistical significance. With the increase of SUA/Scr levels, the incidence of NPDR [18.5% (27/146) vs. 22.6% (33/146) vs. 43.7% (62/142), P<0.05] and PDR [1.4% (2/146) vs. 13.7% (20/146) vs. 41.5% (59/142), P<0.05] gradually increased. ROC curve analysis showed that the area under ROC curve of SUA/Scr was larger than that of SUA. When the cut-off value of SUA/Scr was 5.01, the sensitivity for diagnosing DR was 74.9% and the specificity was 76.6%.

SUA/Scr is an important influencing factor for the occurrence and development of DR, and may be used as an effective tool to identify the risk of DR in T2DM patients.

To investigate the factors that contribute to the glucose metabolism in patients with Gitelman syndrome (GS).

This was a case-control study. GS patients and non-functioning adrenal incidentaloma (NFAI) patients hospitalized at the Department of Endocrinology of the First Medical Center in Chinese PLA General Hospital from January 2013 to September 2023 were recruited. Fasting blood insulin, fasting plasma glucose, plasma potassium, plasma magnesium, height, and weight of these patients were collected, and an oral glucose tolerance test (OGTT) was performed. Body mass index (BMI), area under the curve of glucose (AUC_glu), area under the curve of insulin (AUC_ins), homeostasis model assessment of insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), Matsuda insulin sensitivity index (ISI), homeostasis model assessment β cell function (HOMA-β) and insulin secretion-sensitivity index-2 (ISSI-2) were calculated. GS individuals were assigned to normal and abnormal glucose metabolism groups based on OGTT results. Two independent samples t-test, Mann-Whitney U-test, or χ2-test were used for comparisons between groups. Logistic regression model was used to analyze the risk factors for impaired glucose metabolism and insulin resistance (IR) in GS patients.

A total of 44 patients with GS and 60 patients with NFAI were included in the study. Compared with NFAI patients, higher prevalence of impaired glucose metabolism [25.00% (15/60) vs. 63.64% (28/44), χ2=15.625, P<0.001], higher AUC_glu [14.77 (13.22,16.79) vs. 16.63 (14.53,20.50) mmol·h/L, Z=3.017, P=0.003] and AUC_ins [107.28(73.62,161.57) vs. 156.55 (111.76,234.50) mU·h/L, Z=3.296, P=0.001] were present in GS patients. Compared with NFAI patients, patients with GS showed higher HOMA-IR [1.64 (1.27, 2.32) vs. 2.84 (1.89, 4.19),Z=4.257, P<0.001], lower QUICKI [0.35 (0.34, 0.37) vs. 0.33 (0.31, 0.35), Z=-4.257, P<0.001] and lower Matsuda ISI [94.57 (62.39, 113.54) vs. 46.55 (33.39, 83.98), Z=-4.514, P<0.001]. Compared with NFAI patients, HOMA-β[119.83 (79.81, 166.15) vs. 157.62 (110.25, 252.38), Z=3.007, P=0.003] was significantly higher and ISSI-2 [674.10 (509.47, 842.03) vs. 588.38 (335.11, 699.66), Z=-2.704, P=0.007]was significantly lower in GS patients. According to logistic regression model, plasma magnesium (OR=0.62,95%CI 0.40-0.98, P=0.042) and plasma potassium (OR=0.90,95%CI 0.80-0.99,P=0.046) were identified as independent influential factors for impaired glucose metabolism, while BMI (OR=1.61,95%CI 1.09-2.37,P=0.016) and plasma magnesium (OR=0.68,95%CI 0.46-0.99,P=0.045) were identified as independent influential factors for IR in GS patients.

GS patients had a higher risk of impaired glucose metabolism, with hypokalemia and hypomagnesemia playing important roles.

To investigate the metabolic risk factors for comorbid low muscle mass in patients with type 2 diabetes mellitus (T2DM) and to establish a nomogram model for predicting the risk of low muscle mass in T2DM.

This was a cross-sectional study. A total of 450 patients with T2DM who were hospitalized in the Department of Endocrinology, Second Affiliated Hospital of Air Force Medical University from January to December 2022 were selected. The general information and laboratory indicators of the patients were collected, including age, sex, height, weight, duration of disease, blood pressure, comorbidities, treatment, fasting plasma glucose, fasting C-peptide, glycated hemoglobin A_1c (HbA_1c), total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), uric acid, and creatinine; the body mass index (BMI) was calculated utilizing height and weight, while the homeostatic model assessment for insulin resistance [HOMA-IR (CP)] was calculated using fasting plasma glucose and fasting C-peptide. Bioelectrical impedance analysis method was used to determine the appendicular skeletal muscle mass of patients and to calculate the subsequent appendicular skeletal muscle index. Logistic regression analysis was used to explore the influencing factors of low muscle mass in T2DM patients, and metabolic indicies were applied to construct a nomogram model for predicting the risk of prevalence of low muscle content in T2DM patients. Bootstrapping was applied to internally validate the nomogram, where its efficacy was assessed using the area under the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow test and decision curve analysis.

A total of 450 patients were enrolled, including 299 males and 151 females, with an average age of 57.00 (48.00, 64.00) years, an average disease duration of 8.00 (2.00, 15.00) years, and an average HbA_1c of 8.40% (7.00%, 10.30%). After adjusting for sex, duration of illness and HbA_1c, the multivariable logistic regression analysis showed that age, LDL-C, and HOMA-IR (CP), BMI were the influencing factors for T2DM patients with low muscle mass (OR=1.061, 95%CI 1.020-1.104; OR=1.547, 95%CI 1.026-2.334; OR=1.279, 95%CI 1.022-1.602; OR=0.474, 95%CI 0.386-0.582). The area under the ROC curve was 0.920 (95%CI 0.887-0.954). The Hosmer-Lemeshow test showed that the model was accurate and well-fitted, and the prediction results were close to the actual clinical decision curve, suggesting that the model has clinical benefits.

The nomogram model established by combining age, BMI, LDL-C and HOMA-IR (CP) can be used to predict the risk of prevalence of low muscle mass in T2DM.

This paper draws on the development experience and advanced ideas of diabetes education and management at home and abroad, combined with the current situation of self-management education and support for type 1 diabetes patients in China, establishes full-time posts of type 1 diabetes teachers, and clarifies the admission conditions, post responsibilities, work systems and training forms of type 1 diabetes teachers training schools. Through comprehensive assessment and joint decision-making, the structured education method of diabetes will be popularized, so as to improve the level of type 1 diabetes care and health education in China. This article introduces the establishment and practice of full-time posts of type 1 diabetes teachers in detail, aiming at providing reference for effective training and use of type 1 diabetes teachers.

Four cases of young onset, negative islet autoantibodies, and genetic tests indicated the presence of glucokinase (GCK) Gene heterozygous mutation, but the clinical manifestations and clinical diagnosis and treatment of diabetes cases are different, suggesting that for young onset diabetic patients, it is necessary to interpret their genetic test reports in combination with their clinical characteristics to clarify the diabetes classification and guide further individualized treatment.

Retrospective analysis of a case of pregnancy complication in Hainan Hospital affiliated to Hainan Medical UniversityWRNDiagnostic and therapeutic process of patients with Werner syndrome whose genetic mutation manifests as diabetes mellitus. The proband was a 26-year-old woman who saw the doctor for "finding elevated blood sugar for 6 months and 2 weeks of pregnancy". The patient was diabetic complicated with pregnancy, and the clinical manifestations were special premature aging face, thin body, malnutrition, accompanied by hyperinsulinemia and hypertriglyceridemia. Genetic testing found that the subject carriedWRNThe mutant gene, i.e. M1: c.1105C>T: p.R369*, confirmed Werner syndrome. The proband had poor blood glucose control after intensive therapy with insulin alone. After combining with metformin 0.5 g (3 times/d), the blood glucose control gradually stabilized. Six months later, a boy was delivered prematurely, and the newborn's blood glucose was normal at initial screening.

Islet autoantibodies (IABs) are specific biomarkers of type 1 diabetes mellitus (T1DM). Although multiple IAb positivity has been widely used in the clinical diagnosis and risk prediction of T1DM, the clinical significance of single IAb positivity is still controversial. This paper comprehensively analyzes the incidence of single IAb positivity in different studies and its potential value in the prediction and diagnosis of T1DM, and summarizes the methods to improve the clinical value of single IAb positivity, aiming to provide a new perspective for the application of IAb in clinical practice.