Volume 17 · Issue 02 · 2025

Glucagon (GCG) is a polypeptide hormone secreted by islet alpha cells and composed of 29 amino acids. It plays an important role in glucose metabolism homeostasis and maintains normal blood glucose levels together with insulin. One of the main physiological effects of GCG is to act directly on the liver, and induce the increase of liver glucose output by increasing liver glycogenolysis, gluconeogenesis and inhibiting liver glycogen synthesis. The pathogenesis of diabetes "double hormone theory" believes that not only insulin deficiency leads to insufficient glucose utilization, but GCG excess is also one of the causes of diabetes. GCG also plays an important role in energy metabolism, and has attracted great attention as an important target of several metabolic diseases. The biggest confusion faced by GCG laboratory testing is the lack of highly specific testing means and the difficulty of ensuring the stability of GCG blood samples. With the iteration of technology, GCG accurate detection has been able to meet clinical needs and will play an increasingly important role in the diagnosis and treatment of metabolic diseases.

Diabetic nephropathy (DKD) is the main cause of chronic kidney disease and end-stage kidney disease, and how to prevent and treat it more effectively is crucial. In recent years, with the deepening understanding of the role of inflammation and fibrosis in the pathogenesis and progression mechanism of DKD, it is particularly important to deepen the prevention and control theory of DKD around inflammation and fibrosis, which are the key links in the progression of renal lesions. One protection and double antibody is a prevention and treatment idea put forward for the research progress of the incidence of DKD, in which "one protection" refers to protecting the kidney and kidney, removing or reducing the internal and external risk factors of kidney injury, including blood sugar, blood pressure, blood lipids and other internal kidney injury causes and metabolic indicators. Control, and avoid the secondary blow of external injury-promoting factors such as nephrotoxic drugs; "Double antibody" refers to anti-inflammatory and anti-fibrotic, targeting DKD inflammatory and fibrotic targets, aiming to block the pathophysiological process of kidney deterioration, delay or even reverse the progression of kidney disease, and reduce the occurrence of end-stage kidney disease. This article fully expounds the importance and future application prospect of "one guarantee and double antibody" in the prevention and treatment of DKD from the relevant risk factors and pathogenesis of DKD, relevant evidence-based evidence and other dimensions, in order to promote the construction of the theoretical system of DKD prevention and treatment and guide the future clinical treatment innovation.

In recent years, the number of diabetic patients has increased by a blowout. Poor blood glucose control of hospitalized diabetic patients in non-endocrine and metabolism departments can lead to a variety of acute and chronic complications of diabetes, increase the disability rate, mortality rate and waste of medical resources. Under the traditional model, the blood glucose management of these patients faces great challenges. In the era of smart medical care, how to realize "the same disease, the same hospital, the same treatment", so that inpatients in non-endocrine and metabolism departments can enjoy the same medical resources, and manage the blood sugar of inpatients in a standardized and orderly manner, it is necessary to build an integrated blood sugar management in the whole hospital. The top-level design can realize multi-departmental collaborative management, reduce unnecessary risks, and finally achieve the goal of promoting patient recovery, improving patient quality of life and satisfaction, and reducing medical expenses.

Type 1 diabetes mellitus (T1DM) is an autoimmune disease. Currently, patients are mainly treated with intensive insulin, but cannot mimic endogenous insulin secretion. Islet transplantation provides an effective treatment for patients with T1DM, but it has not been widely used in clinical practice due to the lack of high-quality donor pancreas. Stem cell-induced differentiation of islet cell transplantation provides a new possibility for the treatment of T1DM. September 2024,CellThe journal reported the first clinical study in the world of autologous human chemically reprogrammed pluripotent stem cell-derived islet cell transplantation for the treatment of T1DM. The first subject recovered endogenous insulin secretion after receiving human chemically reprogrammed pluripotent stem cell-derived islet cell transplantation and disengaged from exogenous insulin therapy. The results preliminarily confirm that islet cells derived from human chemically reprogrammed pluripotent stem cells are safe and effective in the treatment of T1DM, and are expected to be a brand-new method for the treatment of T1DM. This article will interpret the results of this study and explore its clinical significance.

Sodium-glucose cotransporter 2 inhibitor (SGLT2i) is a new class of oral hypoglycemic drugs. It can reduce blood sugar by inhibiting the reabsorption of glucose by the proximal convoluted tubules of the kidney, increasing urinary sugar excretion, and also lowering body weight, blood pressure, uric acid and other metabolic effects, with significant heart and kidney benefits. At the same time, the safety of SGLT2i medication is also the focus of clinicians. Therefore, it is necessary to comprehensively balance the hypoglycemic and cardiorenal benefits and medication risks of SGLT2i in clinic, and choose the best individualized treatment decision for patients.

To investigate the association between advanced glycation end products (AGE) and kidney disorder among patients with type 2 diabetes mellitus (T2DM).

This was designed as a cross-sectional study. Study subjects were selected from patients with T2DM who were hospitalized in the Department of Endocrinology and Metabolism, Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from May 2017 to April 2024. Age, sex and serum creatinine were collected and estimated glomerular filtration rate (eGFR) was calculated; urinary albumin and urinary creatinine were collected and the urinary albumin-to-creatinine ratio (UACR) was calculated; height and weight were collected and body mass index (BMI) was calculated; diabetes duration, smoking status, alcohol consumption, systolic blood pressure, triglyceride (TG), total cholesterol (TC), glycated hemoglobin A_1c (HbA_1c), hypoglycemic therapy, anti-hypotensive therapy and lipid-regulating therapy were collected. AGE accumulation was detected and the patients were divided into Q₁ group (AGE≤71.7), Q₂ group (71.7<AGE≤77.7), Q₃ group (77.7<AGE≤86.7) and Q₄ group (AGE>86.7) according to the quartile cut-off points of skin AGE levels. UACR≥30 mg/g was defined as higher UACR, eGFR<60 ml·min^-1·(1.73 m²)^-1 was defined as lower eGFR. Binary logistic regression analysis was performed to assess the associations of skin AGE with higher UACR and lower eGFR. Based on the binary logistic regression model, the C-statistics of the two models before and after the addition of skin AGE were calculated respectively.

A total of 2 169 patients with T2DM were included in this study. Seven hundred and twenty-three (33.3%) participants had a higher UACR and 224 (10.3%) participants had a lower eGFR. Binary logistic regression analysis revealed that after adjusting for age, sex, diabetes duration, alcohol consumption, drinking status, BMI, systolic blood pressure, TG, TC, HbA_1c and medication prescription, the Q₄ group had a 51% increased risk of higher UACR (OR=1.51, 95%CI 1.16-1.96) and a 52% increased risk of lower eGFR (OR=1.52, 95%CI 1.05-2.21) compared to Q₁ group. In addition, when skin AGE was included in a predictive model that included HbA_1c and other variables, the C statistic for predicting higher UACR improved from 0.725 (95%CI 0.703-0.748) to 0.730 (95%CI 0.708-0.752) (P=0.036).

Higher skin AGE was significantly associated with an increased risk of kidney disorder in patients with T2DM.

To explore the effect of liraglutide on anxiety and depression in patients with type 2 diabetes mellitus (T2DM).

This study was a randomized controlled trial. A total of 150 outpatients and inpatients with T2DM who demonstrated substandard glycemic control on oral metformin monotherapy in Heilongjiang Provincial Hospital from January 2023 to June 2023 were enrolled as study subjects. They were divided into liraglutide-treated and basal insulin-treated groups in a 1∶1 ratio according to the random number method of sampling, there were 75 patients in each group. Both groups took metformin orally at a dose of 500 mg three times a day, adjusted according to the blood glucose values of patients for 6 months respectively. The age, sex, height, weight, family history of diabetes, smoking and drinking history, duration of diabetes within the two groups were recorded and the body mass index (BMI) was calculated. Systolic blood pressure, diastolic blood pressure, fasting plasma glucose (FPG), glycated hemoglobin A_1c (HbA_1c), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were measured at baseline and 6 months after treatment. In addition, the Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) of patients were assessed before and after medication. Independent samples t-test or chi-square test were used for intergroup comparisons, and paired t-test was used for intragroup comparisons. Then, Pearson correlation analysis was used to analyze the correlation between HAMA, HAMD, and clinical data. Binary logistic regression analysis was used to explore the risk factors for post-treatment anxiety and depression.

After 6 months of treatment, compared to the basal insulin group, the HAMA scores [(4.39±1.26) and (5.72±1.43) points, respectively], HAMD scores [(4.71±2.13) and (5.61±2.30) points, respectively], fasting serum IL-6 [(4.78±1.76) and (5.35±1.70) pg/ml, respectively] and TNF-α [(12.44±2.54) and (13.58±2.94) pg/ml, respectively] of the liraglutide group were significantly reduced (all P<0.05). Pearson analysis revealed that, at the 6-month research endpoint, HAMA scores of patients were positively correlated with baseline and post-treatment BMI, post-treatment HbA_1c, baseline IL-6, baseline HAMA scores, and post-treatment HAMD scores (r=0.319, 0.232, 0.294, 0.246, 0.563, 0.250, respectively, all P<0.05). HAMD scores of patients were positively correlated with disease duration, baseline and post-treatment BMI, baseline and post-treatment FPG, baseline TNF-α, baseline and post-treatment HAMA scores and baseline HAMD scores (r=0.291, 0.372, 0.233, 0.621, 0.342, 0.283, 0.403, 0.722, 0.250, respectively, all P<0.05). Multivariate logistic regression analysis revealed that duration, BMI, HbA_1c, FPG, IL-6, and TNF-α were the risk factors for anxiety in T2DM patients (OR=1.108, 1.234, 1.756, 1.385, 1.551 and 1.359, respectively; all P<0.05), while liraglutide was a protective factor for anxiety in T2DM patients (OR=0.219, P<0.05); duration, BMI, HbA_1c, FPG, and TNF-α were risk factors for depression in T2DM patients (OR=1.070, 1.177, 1.600, 1.291 and 1.203, respectively, all P<0.05), while liraglutide was a protective factor for depression in T2DM patients (OR=0.302, P<0.05).

Liraglutide can significantly improve depression and anxiety scores in patients with T2DM.

To investigate the correlation between retinopathy and mild cognitive impairment (MCI) and brain imaging changes in patients with type 2 diabetes mellitus (T2DM).

This was a cross-sectional study. Patients with T2DM who visited the Endocrinology Department of Nanjing Drum Tower Hospital from January 2019 to December 2023 were selected as the study subjects. Clinical data and fundus photographic examination data were collected, and cognitive assessment and 3.0T head functional magnetic resonance imaging (MRI) were performed. The results of the cognitive function assessment were used to determine whether the subjects had MCI. A repeatable set of neuropsychological state measurements was used to assess delayed memory and processing speed. According to the results of fundus photography, T2DM patients were divided into diabetic retinopathy (DR) group and non-diabetic retinopathy (NDR) group. Two independent sample t test and chi-square test were used to compare the combined MCI ratio and cognitive function between the two groups. Logistic regression analysis was used to analyze whether DR was an influential factor for MCI in T2DM patients. Based on the results of the head magnetic resonance imaging, freesurfer 7.1.0 software was used to extract the volume of the right hippocampus, DPABI software was used to calculate the functional connectivity between the right hippocampus and the default mode network and the visual network, and covariance one-way analysis of variance (ANOVA) was used to analyze the differences in brain structure and function between the two groups.

A total of 196 patients with T2DM were included in this study. There were 49 cases in the DR group and 147 cases in the NDR group. Compared with the NDR group, the proportion of MCI in the DR group was higher, the score of delayed memory was lower, and the processing speed was longer (all P<0.05). Logistic regression analysis showed that DR was the influential factor in the occurrence of MCI in T2DM patients (OR=2.065, 95%CI 1.011-4.220, P=0.047). The results of head MRI showed that the right hippocampal atrophy in DR patients was higher than that in NDR patients (P<0.05). In DR patients, functional connections between the right hippocampus and the default mode network were enhanced, while functional connections between the right hippocampus and the visual network were impaired (all P<0.05).

Compared with NDR patients, T2DM patients with DR had a higher risk of MCI and more severe cognitive impairment. The right hippocampus of DR patients had reduced volume, abnormal synchronization of local functional activity and impaired functional connectivity with multiple brain regions.

To explore the real world model of hypoglycemic treatment for post-chronic pancreatitis diabetes mellitus (PPDM-C).

This was a cross-sectional study. Patients with PPDM-C who visited the Gastroenterology Department of First Affiliated Hospital of Naval Medical University from January 2018 to March 2023 were collected and screened. Data on sex, current glycemic control treatment prescriptions, and glycated hemoglobin (HbA_1c) levels at admission were collected. Patients were divided into four groups based on their glycemic control treatment prescriptions at the time of their admission: untreated group, oral hypoglycemic medication-only group, insulin-only group, and combined insulin and oral medication group. Poor glycemic control was defined as HbA_1c>7%, and good glycemic control as HbA_1c≤7%. One-way analysis of variance or χ² test were used for comparison between groups.

A total of 386 PPDM-C patients were included in the study. Among them, there were 103 cases (26.7%) in the untreated group, 135 cases (35.0%) in the oral hypoglycemic medication-only group, 107 cases (27.7%) in the insulin-only group, and 41 cases (10.6%) in the insulin combined with oral medication group. Within the 386 PPDM-C patients, 314 (81.3%) were male, and 224 patients (58.0%) had poor glycemic control. Among the 103 untreated PPDM-C patients, 68.0% (70/103) had poor glycemic control. Analysis of glycemic control in the study subjects showed that the proportion of patients with good glycemic control in the oral hypoglycemic medication-only group [59.3% (80/135)] was higher than in the untreated group [32.0% (33/103)], insulin-only group [32.7% (35/107)], and combined insulin and oral medication group [34.1% (14/41)] (all P<0.05).

In the real world, glycemic control in patients with PPDM-C is not ideal, treatment is not standardized, and there is no unified prescription pattern for glycemic control treatment.

To investigate the awareness, screening status and knowledge requirements of healthcare workers on diabetes mellitus related cognitive impairment.

From September 2022 to August 2023, a multi-center cross-sectional online survey was conducted through phased sampling to investigate the awareness, screening status and knowledge requirements of diabetes related cognitive impairments among medical staff from hospitals across China. The t-test of two independent samples and the chi-squared test were used for comparison between the two groups.

A total of 508 questionnaires were collected from 16 provinces in China, 81.7% (415/508) from 75 tertiary hospitals and 18.3% (93/508) from 47 secondary and community hospitals. Participants were mainly from the department of endocrinology [77.4% (393/508)], of which 70.9% (360/508) were doctors and 73.4% (373/508) had worked for 6 years or more. The survey showed that knowledge about cognitive impairment of diabetes were insufficient among healthcare professionals; 40.2% (204/508) were not familiar, 45.3% (230/508) were moderately familiar, and only 14.5% (74/508) were very familiar. Over half of the participants were not familiar with cognitive screening guidelines or literature for diabetic patients [57.7% (293/508)], 31.3% (159/508) were moderately familiar, while only 11.0% (56/508) were very familiar. Over half of the healthcare professionals had misunderstandings about some of the objective knowledge. Only 34.6% (176/508) of the medical staff put cognitive screening into routine clinical practices for diabetic patients, which was higher in tertiary hospitals than in secondary and community hospitals, but the difference was not statistically significant [35.4% (147/415) vs. 31.2% (29/93), χ²=0.60, P>0.05]. Nursing staffs were more likely to put cognitive screening into clinical practices for diabetic patients [41.9% (62/148) vs. 31.7% (114/360), χ²=4.84, P<0.05]. Common reasons for hindering cognitive screening were lack of knowledge [85.6% (435/508)], insufficient time [75.4% (383/508)], and the time-consuming nature of screening tools [59.1% (300/508)]. The majority of the medical staff agreed that it was necessary to conduct cognitive screening in diabetic patients regularly [95.3% (484/508)]; 98.2% (499/416) wished to learn about relevant knowledge and believed that training for healthcare workers was needed.

Currently, most healthcare workers engaged in diabetes mellitus management generally lack awareness of diabetes mellitus related cognitive impairment, and the rate of cognitive screening is low. However, attitudes towards cognitive screening and knowledge requirements are positive.

To investigate the protective effect and mechanism of celastrol on palmitic acid-induced human podocyte injury.

Normal human podocytes were cultured and evenly divided into a control group, a palmtic acid group and different dosage groups of celastrol. Cell counting kit-8 assay was used to detect the effect of different concentrations of celastrol extract on the proliferation inhibition rate of podocytes. Changes in the cytoskeleton of podocytes were observed by phalloidin staining. Lipid droplet deposition in podocytes was detected by Oil red O staining. The protein expression levels of podocin, membrane-associated guanylate kinase inverted-2 (MAGI2), microtubule-associated protein 1 light chain 3β (LC3B), silent mating type information regulation 2 homolog-1 (SIRT1), phosphorylate adenosine 5′-monophosphate activated protein kinase α (p-AMPKα), phosphorylate mammalian target of rapamycin (p-mTOR), sterol regulatory element binding proteins (SREBP) and adipose differentiation related protein (ADRP) in podocyte were detected by Western blotting. Immunofluorescence staining was used to detect the formation of LC3B punctate aggregates. Independent samples t-test was used for comparison between two groups, and one-way analysis of variance (ANOVA) was used for comparison between multiple groups.

Compared with the control group, the protein expressions of podocin and MAGI2 decreased (P<0.05) in the palmitic acid group; changes in the cytoskeleton remodeling of podocytes were obvious, F-actin stress fibers decreased; red lipid droplets were increased in podocytes, the positive area of Oil red O accounted for about 50% of the total area, and lipid droplet deposition in podocytes increased significantly; the protein expression levels of SREBP1, SREBP2, ADRP and p-mTOR increased (P<0.05), while p-AMPKα, SIRT1 and LC3B decreased (P<0.05). LC3B green fluorescent dot aggregates decreased in podocytes, the average fluorescence intensity decreased and the autophagy level decreased. All of these changes were significantly reversed after the intervention with celastrol (P<0.05).

Celastrol could alleviate palmitic acid-induced podocyte damage and lipid deposition, possibly through activation of the SIRT1/AMPK signaling pathway and the induction of autophagy.

To investigate the efficacy and safety of an open-source hybrid closed-loop artificial pancreatic system in the treatment of hospitalized adults with type 1 diabetes mellitus (T1DM).

It was a prospective, single-center, single-arm exploratory study. Inpatients with T1DM admitted from June to August 2023 in the Department of Endocrinology of Xiantao First People's Hospital were selected as the research subjects, and treated with open-source hybrid closed-loop artificial pancreatic system for 5-7 days. After treatment, the time glucose was within the target range (TIR, i.e., the percentage of time when the 24-h glucose level was 3.9-10.0 mmol/L), the time glucose was above the target range (TAR, where TAR0 refers to the percentage of time when the 24-h glucose level was>10.0 mmol/L, TAR1 refers to the percentage of time when the 24-h glucose level was 10.1-13.9 mmol/L, and TAR2 refers to the percentage of time when the 24-h glucose level was>13.9 mmol/L), and the time glucose was below the target range (TBR, where TBR0 refers to the 24-h glucose level<3.9 mmol/L time, TBR1 refers to the percentage of 24-h glucose levels of 3.0~3.9 mmol/L time, TBR2 refers to 24-h glucose levels<3.0 mmol/L time as a percentage), mean glucose (MG) and glucose coefficient of variation (CV). The changes of diurnal TIR, TAR, TBR, MG and CV were analyzed and compared on day 1 and day 4 of treatment and during the whole treatment period. Two independent samples were usedtTesting, paired samplestTest, Mann-WhitneyUTest or Wilcoxon test for comparison between groups.

A total of 10 hospitalized patients with T1DM were included. After 5 to 7 days of treatment, the TIR of patients with T1DM was (62.85 ± 29.25) %; In the hyperglycemia classification, TAR0 was 27.0% (9.5%, 57.5%), TAR1 was (24.74±8.77) %, and TAR2 was 8.22% (2.54%, 20.13%); In the hypoglycemia classification, TBR0 was 0.79% (0, 2.22%), TBR1 was 0.32% (0, 2.09%), and TBR2 was 0 (0, 0.27%); MG was 8.74 (7.80, 11.02) mmol/L and CV was 0.32 ± 0.04. Both TBR0 and TBR1 decreased in patients with T1DM on Day 4 of treatment compared to Day 1 of treatment (ZValues were 2.303 and 2.037, respectively, bothP<0.05）。 Throughout the treatment period, nocturnal TIR increased by 17.78% compared to daytime (95% CI 9.20% to 23.26%,P=0.001), nocturnal TAR0 decreased by 17.99% compared with daytime (95% CI 9.67% to 26.31%,P<0.001）； Night MG decreased by 1.29 mmol/L compared with daytime (95% CI 0.51-2.08 mmol/L,P<0.001）。

An open-source hybrid closed-loop artificial pancreatic system can improve TIR and reduce hypoglycemic time in the treatment of patients with T1DM.

Insulin receptor (INSR) Gene heterozygous mutations often lead to severe insulin resistance and hyperglycemia, and hypoglycemia as the first and prominent symptom is rare. This article reports a case of a prepubertal girl with hypoglycemic convulsions. Postprandial hyperglycemia, acanthosis nigricans, hirsutism, and polycystic ovarian changes were found. Considering the possibility of insulin resistance syndrome type A (TAIRS), after diet and exercise management and oral metformin drug treatment, blood sugar control was satisfactory and hypoglycemia did not occur again. Genetic test results suggest simultaneous presenceINSRC. 3745G>T: p. V1249F heterozygous mutation and ATP-binding cassette subfamily C member 8 (ABCC8) c.2263C>T: p.R755W heterozygous mutation, the former has not been reported yet, further predicted by family investigation and validation, bioinformatics software, consideringINSRc.3745G>T: p.V1249F is a potentially pathogenic mutation, whereasABCC8The pathogenic significance of gene mutation in the development of hypoglycemia in patients is unknown. Therefore, TAIRS should be considered in the differential diagnosis of childhood hypoglycemia, and the interpretation of gene mutations should be closely integrated with clinical phenotype and carefully attributed.

One case of insulin receptor was reported (INSR) Diagnosis and treatment of patients with type A insulin resistance syndrome (TAIRS) with missense heterozygous mutations in the gene. The patient was an adolescent female who saw the doctor for "primary amenorrhea". The relevant examination results suggested the presence of severe insulin resistance, hyperandrogenemia and polycystic ovary syndrome. High-throughput gene sequencing suggested the presence of INSR: c.3328G>T (p.Asp1110Tyr) mutation, which has not been reported in previous literature. Combined with the clinical manifestations and examination results of the patient, TAIRS was considered, and menstrual cramps occurred after 4 months of treatment with pioglitazone and metformin combined with spironolactone. In this paper, the clinical characteristics, diagnosis and treatment of TAIRS were analyzed and discussed, so as to broaden the thinking of clinical workers on the diagnosis and treatment of this kind of severe insulin resistance disease.

Pairing Box 4 (PAX4) gene mutations have been linked to type 1 diabetes, type 2 diabetes, and adolescent-onset adult diabetes mellitus (MODY). In order to further improve the understanding of diabetes mellitus caused by this gene variant, a case of diabetes mellitus was reportedPAX4Early onset diabetes patients caused by gene heterozygous mutations and a literature review summary. The patient had severe diabetic nephropathy and diabetic retinopathy, massive proteinuria and renal insufficiency, negative insulin autoantibody test, and islet function tested during hospitalization. Genetic analysis detected a G>A mutation in exon c.386 of chromosome 7 at locus 127254586 (NM_001366110.1) in the patient and his eldest son, resulting in a mutation of amino acid 129 from arginine to glutamine (p.Arg129Gln). Therefore, for diabetic patients with strong family genetic background, we should be alert to the possibility of single-gene diabetes, and timely conduct necessary genetic testing, and genetic diagnosis may have important guiding significance for treatment plan and prognosis.

Diabetic cardiomyopathy (DCM) is a serious complication caused by diabetes. Recently, a large number of studies have proved that ferroptosis is an important mechanism of DCM, among which nuclear factor E2-related factor 2 (Nrf2) -mediated ferroptosis has gradually become a research hotspot. This article reviews the progress of Nrf2-mediated ferroptosis and the mechanism of related pathways in the development of DCM, in order to provide a new perspective for basic research and clinical treatment of DCM.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy that increases the risk of adverse maternal and infant pregnancy outcomes. At present, the diagnosis time of GDM at home and abroad is in the middle and third trimester of pregnancy, at this time, the early damage of GDM to the fetus is irreversible. Therefore, the early prediction of GDM has become a hot topic in global academic circles. As an emerging artificial intelligence science, machine learning (ML) has been gradually applied to the early prediction field of GDM by analyzing clinical data, finding out the correlation between variables and constructing prediction models. Based on this, this article will summarize the establishment, verification and application performance of GDM prediction model based on ML, so as to provide physicians with clinical diagnosis and treatment experience, and also provide reference for clinical application of ML.

The proprotein converting enzyme subtilisin 9 (PCSK9) is regarded as an important target for lowering blood lipids and treating atherosclerotic cardiovascular disease (ASCVD). There are currently multiple treatment strategies for PCSK9. Due to the association between diabetes and increased risk of ASCVD, the role of PCSK9 and its inhibitors in diabetes, as well as the effect of hypoglycemic drugs on PCSK9, have also attracted much attention, but the conclusions of relevant studies show large differences. While the results of current epidemiological, preclinical and clinical trials show a positive correlation between plasma PCSK9 levels and glycemic parameters and risk of type 2 diabetes, genetic studies have shown the opposite results. Overall, the effect of PCSK9 inhibitors on glycemic control indicators, as well as the long-term safety on islet beta cell function, remain unclear. This article reviews the important research on the correlation between PCSK9 and diabetes in recent years, in order to provide reference for related basic research and clinical research.