Volume 17 · Issue 08 · 2025

The recently released CREATE study is a 20-week, prospective, single-arm, open-label, non-interventional study that included 878 Chinese adult patients with type 2 diabetes mellitus (T2DM) who had previously received oral hypoglycemic drugs (OAD), other insulin or glucagon-like peptide-1 receptor agonist hypoglycemic therapy, and initiated or switched their treatment regimen to insulin deguspart double (IDegAsp), the results showed that the mean glycosylated hemoglobin (HbA_1c) decreased by 1.27% (95% CI-1.36% to-1.19%,P<0.000 1), fasting blood glucose decreased 1.61 mmol/L (95% CI-1.81~ -1.41 mmol/L,P<0.000 1), the trend of OAD alone, basal insulin or premixed insulin with/without OAD switching was consistent across subgroups. The total patient preference and diabetes treatment satisfaction questionnaire score increased from (26.4 ± 7.1) points at baseline to (31.6 ± 4.9) points at the end of the study. The rate of non-severe and nocturnal non-severe hypoglycemia episodes was significantly reduced (non-severe hypoglycemia episode ratio 0.37, 95% CI 0.24-0.59,P<0.000 1； Night nonsevere hypoglycemia episode rate ratio 0.45, 95% CI 0.21-0.94,P=0.032 6) and there were no significant or unexpected tolerability, safety concerns. It can be seen that in the actual diagnosis and treatment of Chinese adult T2DM patients, enabling or switching to IDegAsp can improve blood sugar control, reduce the risk of hypoglycemia, and provide an effective treatment path for patients with poor blood sugar control or treatment indolence. The CREATE study fills a data gap in the clinical efficacy and safety of IDegAsp in real-world Chinese adult patients with T2DM.

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease involving multiple pathophysiological mechanisms. As the course of the disease progresses, it is often difficult to maintain the blood glucose standard with single or double drug therapy, and the combination of three or more drugs is usually needed. The oral triple regimen based on metformin, dipeptidyl peptidase IV inhibitor (DPP-4i), and sodium-glucose cotransporter 2 inhibitor (SGLT2i) covers the multiple pathological defects of T2DM through a complementary mechanism, which can improve a variety of metabolic indicators and is applicable to a wide range of people. In recent years, with the continuous update of evidence-based evidence related to the triple regimen of metformin + DPP-4i + SGLT2i, in order to further optimize the management of T2DM, the Diabetology Professional Committee of the Chinese Research Hospital Association took the lead to initiate the 2021 edition of the "Chinese Expert Consensus on the Triple Optimization of Oral Hypoglycemic Drugs for Adult Type 2 Diabetes Patients (Metformin + Dipeptidyl Peptidase 4 Inhibitor + Sodium-Glucose Co-Transporter 2 Inhibitor)", followed the principles of clinical guideline formulation, adopted the Delphi method and the expert consensus meeting method, focused on key clinical issues, synthesized the existing evidence-based evidence and clinical practice in China, and formed 11 recommendations on the clinical application of the triple regimen of metformin + DPP-4i + SGLT2i, and summarized the safety, contraindications, application in special populations and other precautions of the regimen, aiming to provide reference and guidance for endocrinologists to standardize the application of the triple regimen of metformin + DPP-4i + SGLT2i.

The prevalence rate of overweight/obesity in China has exceeded 50%, and it is gradually increasing. Obesity-related comorbidities and chronic diseases seriously affect people's health. Weight management in overweight/obese patients is important for controlling obesity comorbidities and reducing chronic diseases. Incretin-based weight-loss drugs have a potent weight-loss effect, while improving various metabolic disorders and obesity-related organ dysfunction, and no serious side effects have been found. More and more overweight/obese patients will be treated with these drugs. In order to further standardize the clinical use of incretin-based weight loss drugs, the Endocrinology and Metabolism Physicians Branch of Chinese Medical Doctors Association and the Obesity Diagnosis and Treatment Alliance of Endocrinology and Metabolism Department organized experts in the field of endocrinology to formulate the "Expert Consensus on Clinical Application of Increatin-based Weight Loss Drugs (2025 Edition)" based on a large amount of evidence-based medical evidence, which includes the types of incretin drugs, indications, initial treatment, maintenance treatment, weight loss goals, benefits of obesity comorbidities, precautions for use in special populations and safety, etc., to provide reference for clinicians in endocrinology and metabolism departments and related disciplines who use these drugs.

Skin complications associated with insulin pump therapy in children with type 1 diabetes include lipoplasia, lipoatrophy, contact dermatitis, infection, scarring and pigmentation. At present, there is a lack of relevant guidance on prevention and nursing norms in clinical practice. Standardized nursing operation details play an important role in preventing and reducing skin complications associated with insulin pump therapy. In order to better guide medical staff to understand related skin complications and give standardized prevention and treatment, the Pediatric Endocrinology (Diabetes) Subgroup of Pediatric Nursing Alliance of National Children's Medical Center, the Endocrinology Genetics and Metabolism Group of Pediatrics Branch of Chinese Medical Association, and the Insulin Pumper Training Working Group of Diabetes Education and Management Branch of China Health Promotion and Education Association jointly organized and invited experts in related fields in China. Based on large sample data analysis, evidence summary and expert meetings, the consensus was formed. The consensus mainly includes the overview and definition of skin complications, high-risk factors, preventive measures, treatment methods and health education, etc., aiming to provide comprehensive guidance on the prevention and management knowledge of skin complications related to insulin pump therapy for pediatric diabetes treatment practitioners, and help children with type 1 diabetes to achieve long-term skin protection and sustained benefits of blood sugar management.

To investigate the association between the number of components of metabolic syndrome (MetS) in patients with type 2 diabetes mellitus (T2DM) and the risk of diabetic kidney disease (DKD).

This was a retrospective cohort study. Patients with T2DM who had no DKD at baseline and were managed individually at six centers of Li′s United Clinic in Taiwan, China from January 1, 2002, to December 31, 2018, were selected as the subjects. Baseline data, including blood pressure, fasting glucose (FPG), triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), were collected. Participants underwent four annual health check-ups, and their DKD status was reassessed annually during the follow-up period. The outcome event was DKD, and the study was terminated on December 31, 2018. MetS components included obesity, hyperglycemia, hypertension, hypertriglyceridemia, low HDL cholesterol and hypercholesterolemia. T2DM patients were divided into five groups based on the number of MetS components at baseline: Q₁ (T2DM alone), Q₂ (T2DM+1 MetS component), Q₃ (T2DM+2 MetS components), Q₄ (T2DM+3 MetS components), and Q₅ (T2DM+4 MetS components). The Cox regression model was used to analyze the relationship between T2DM combined with related MetS components and the risk of DKD occurrence, as well as the relationship between the number of different MetS components combined in T2DM patients and the risk of DKD onset.

A total of 2 096 T2DM patients were included in the study. Among them, Q₁ group had 371 cases, Q₂ group had 746 cases, Q₃ group had 609 cases, Q₄ group had 294 cases, and Q₅ group had 76 cases. After a follow-up period of (4.18±1.81) years, a total of 512 patients developed DKD. Cox proportional hazard regression analysis revealed that, after adjusting for multiple confounding factors, obese T2DM patients had a 1.64 times higher risk of developing DKD compared to non-obese T2DM patients (HR=1.64, 95%CI 1.34-2.01, P<0.001). Hypertensive T2DM patients had a 1.33 times higher risk (HR=1.33, 95%CI 1.08-1.63, P=0.007), and hypertriglyceridemic T2DM patients had a 1.28 times higher risk (HR=1.28, 95%CI 1.04-1.58, P=0.019). Compared to the Q₁ group, the risk of developing DKD in T2DM patients in the Q₃ to Q₅ groups were 1.56 times (HR=1.56, 95%CI 1.15-2.12, P=0.004), 1.78 times (HR=1.78, 95%CI 1.26-2.51, P=0.001) and 2.88 times (HR=2.88, 95%CI 1.79-4.64, P<0.001), respectively.

The increase in the number of MetS components was associated with an increased risk of DKD.

To investigate the alterations in the expression of the dopamine receptor D2 (DRD2) in pancreatic β-cells during the progression of type 2 diabetes mellitus (T2DM).

Pancreatic samples were obtained from 9 non-diabetic, 8 pre-diabetes, and 9 T2DM organ donors. The changes of DRD2 expression were assessed by immunofluorescence staining for DRD2 and insulin. The relative gene expression differences of DRD2 in the islets of non-diabetic and T2DM patients were detected by real-time quantitative polymerase chain reaction (RT-qPCR). Furthermore, the correlation between DRD2 expression levels and glycated hemoglobin A_1c (HbA_1c), body mass index and blood fat were evaluated by using simple linear regression analysis to identify potential factors influencing DRD2 expression.

Immunofluorescence staining of human pancreatic tissues revealed that DRD2 was predominantly localized in the cytoplasm of pancreatic β-cells. Compared with non-diabetic individuals, the proportion of DRD2⁺INS⁺ cells in the islets of donors with pre-diabetes and T2DM were significantly decreased (P<0.01). The RT-qPCR result showed that compared with non-diabetic donors, the relative gene expression level of DRD2 in the islets of T2DM patients was decreased (P<0.01). The proportion of DRD2⁺INS⁺ cells in the islets was negatively correlated with the HbA_1c level (r=-0.600, P<0.01), but not with the level of lipid or body mass index (all P>0.05).

The expression level of DRD2 in human islet β cells is downregulated during the process of T2DM.

To investigate the effects and potential mechanisms of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) on advanced glycation end products (AGE)-induced mitochondrial dysfunction in human aortic endothelial cells (HAEC).

HAEC were divided into the following groups: control group, AGE group, AGE+GLP-1 group, AGE+GIP group, AGE+GIP+GLP-1 group, and additional groups treated with negative control small interfering RNA (siRNA) or forkhead box O1 (FOXO1) siRNA in the presence or absence of AGE. Each group had three replicates. After 48 hours of culture, mitochondrial morphology was observed using transmission electron microscopy and super-resolution microscopy. Reactive oxygen species (ROS) levels were detected and mitochondrial membrane potential (ΔΨm) was assessed using flow cytometry assay. The protein levels of dynamin^-related protein 1 (Drp1), mitochondrial fission protein 1 (Fis1), optic atrophy protein (Opa1), mitofusin1/2 (Mfn1/2), phosphatidylinositol 3-hydroxy kinase (PI3K), Ser-ine threonine kinas (AKT), phosphorylated Ser-ine threonine kinas at Ser-473 (p-AKT), and FOXO1 were detected by Western blotting. Group comparisons were conducted using one-way ANOVA and t-tests.

Compared to the control group, the AGE group exhibited abnormal mitochondrial morphology, increased ROS, decreased ΔΨm, downregulated expression of mitochondrial fusion proteins (Opa1, Mfn1/2), upregulated expression of mitochondrial fission proteins (Drp1, Fis1) (P<0.05), increased PI3K expression (P<0.05), increased p-AKT expression (P<0.01), and elevated FOXO1 expression (P<0.05). Compared to the AGE group, treatment with GIP or GLP-1 significantly improved AGE-induced mitochondrial morphological abnormalities, reduced ROS levels, increased ΔΨm, upregulated Opa1 and Mfn1/2 expression (P<0.05), downregulated Drp1 and Fis1 expression (P<0.05), decreased PI3K expression (P<0.05), decreased p-AKT levels (P<0.05), and reduced FOXO1 expression (P<0.05). Additionally, compared to the AGE+negative control siRNA group, the AGE+FOXO1 siRNA group showed decreased p-AKT levels (P<0.05).

Both GIP and GLP-1 can reduce AGE-induced mitochondrial dysfunction in HAEC, and their mechanism may be related to the regulation of the PI3K/AKT/FOXO1 signaling pathway.

To screen for immune-related characteristic genes of diabetic foot ulcer (DFU) using a combination of transcriptome and single-cell analysis, and then to verify the results in an animal model.

The expression matrix datasets were searched from the Gene Expression Omnibus (GEO) database. Four transcriptome datasets (GSE68183, GSE37265, GSE80178, GSE83286) containing DFU and normal tissue samples and one single-cell dataset (GSE165816) were downloaded. The transcriptome data GSE68183 and GSE37265 were combined to form a training set, while the GSE80178 and GSE83286 were combined to form a validation set. Immunity-related differentially expressed genes were obtained through differential analysis and weighted gene co-expression network analysis (WGCNA). The immune-related differentially expressed genes were screened using the random forest (RF) algorithm, the least absolute shrinkage and selection operator (LASSO) algorithm, and the support vector machine-recursive feature elimination (SVM-RFE) algorithm to obtain characteristic genes. A diagnostic nomogram was constructed using the characteristic genes as parameters. The nomogram′s diagnostic efficacy was verified by the calibration curves and the receiver operating characteristic (ROC) curves for both the training set and the validation set. The area under the ROC curve (AUC) was also calculated. The CIBERSORT algorithm was applied to analyze the immune infiltration in DFU. The accuracy of the screened characteristic genes was further confirmed by single-cell analysis technology. Twelve adult healthy male Sprague-Dawley (SD) rats of clean grade (8 weeks old, weighing 180-200 g) were collected. According to the method of the random number table, the rats were divided into the DFU group (fed with a high-sucrose and high-fat diet continuously for 10 weeks, and a full-thickness skin wound with a diameter of 1.0 cm was created) and the control group (raised under normal conditions without creating a wound model). The relative expression of mRNA and proteins of the characteristic genes was determined by real-time quantitative PCR (qPCR) and Western blotting, respectively. The independent samples t-test, Mann-Whitney U test, and Chi-square test were used for inter-group comparisons.

A total of 80 immune-related differentially expressed genes were screened out through differential gene analysis and WGCNA analysis. Two characteristic genes of DFU, suppressors of cytokine signaling 3 (SOCS3) and chemokine ligand 18 (CCL18), were screened out by the three algorithms of RF, LASSO, and SVM-RFE. A diagnostic nomogram was constructed with characteristic genes as parameters. The results of the calibration curve showed that the C-indices of the training set and the validation set were 0.982 and 1.000, respectively. The results of the ROC curve showed that in the training set, the AUC of SOCS3 and CCL18 were 0.973 and 0.929 respectively, while in the validation set, the AUC of SOCS3 and CCL18 were both 0.972. CIBERSORT analysis showed that the infiltration degrees of M1 macrophages and neutrophils in DFU samples in the training set and the validation set were significantly higher than those in normal samples, while the infiltration degrees of CD8⁺T cells and resting mast cells in DFU samples were significantly lower than those in normal samples (P<0.05). Single-cell analysis further confirmed the results of transcriptome analysis. It was found that the expression levels of the characteristic genes in DFU samples were all higher than those in normal samples. CCL18 was predominantly expressed in macrophages of DFU samples, while SOCS3 was mainly expressed in fibroblasts, stromal cells, and macrophages of DFU samples. The results of Western blotting showed that the expression levels of the characteristic genes in rats of the DFU group were higher than those in the normal group, which was consistent with the trends of the results obtained from the previous transcriptome and single-cell analyses.

In this study, two immune-related characteristic genes, SOCS3 and CCL18, in DFU were screened out, and the two characteristic genes were verified by single-cell analysis technology and animal experiments.

To compare the impact of metabolic surgery performed during adolescence versus adulthood on cardiovascular disease (CVD) risk in patients with childhood-or adolescent-onset obesity.

This retrospective cohort study consecutively included patients with childhood-or adolescent-onset obesity who underwent metabolic surgery at Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University between January 2018 and January 2022. Regular follow-up was conducted, with the primary outcome being CVD events. The study endpoint was January 2023. Baseline and 1-year follow-up data were collected, including blood pressure, body weight, height, fasting insulin (FINS), fasting plasma glucose (FPG), and the body mass index (BMI) and the homeostasis model assessment of insulin resistance (HOMA-IR) were also calculated. The 30-year risk of both major and total CVD events (including two models: Model 1 does not include BMI, whereas Model 2 does) was estimated using the Framingham risk score. The proportion of patients whose risk returned to the normal range was calculated. Additionally, 1-year postoperative remission of hypertension was assessed. Patients were grouped based on age at the time of surgery: adolescent surgery group (≤19 years) and adult surgery group (>19 years). Between-group comparisons were performed using independent sample t-tests, Mann-Whitney U tests, or χ²/Fisher′s exact tests. The comparison of relevant indicators within the group at baseline and 1 year after surgery was conducted using paired t-test, Wilcoxon rank test or McNemar test. For repeated quantitative measures, analysis of covariance (ANCOVA) was applied with baseline adjustment. Multivariate logistic regression was used to evaluate the association between the surgical timing and the normalization of major and total CVD risk at 1 year postoperatively.

A total of 102 patients were included, with 33 in the adolescent surgery group and 69 in the adult surgery group. At 1 year post-surgery, both groups exhibited significant reductions in major and total CVD risk scores compared with the baseline. Compared with the adult group, the adolescent group showed significantly lower major and total CVD risk values and a higher proportion of patients whose risk returned to the normal range (all P<0.05). Multivariate logistic regression showed that adolescents had a 5.21-fold (95%CI 1.78-15.26, P=0.006; Model 1) and 2.67-fold (95%CI 1.07-6.66, P=0.041; Model 2) greater likelihood of major CVD risk normalization than adults. For total CVD risk, the corresponding odds were 2.59 (95%CI 1.03-6.52, P=0.044; Model 1) and 2.90 (95%CI 1.23-6.83, P=0.021; Model 2). One year postoperatively, the adolescent group also showed a greater reduction in diastolic blood pressure, smaller decreases in FINS and HOMA-IR, and a higher hypertension remission rate (all P<0.05).

In patients with childhood- or adolescent-onset obesity, undergoing metabolic surgery during adolescence is associated with a greater likelihood of reducing long-term CVD risk compared with surgery performed in adulthood.

To evaluate the predictive value of the atherogenic index of plasma (AIP) and how it interacts with blood pressure to affect the risk of type 2 diabetes mellitus (T2DM).

A retrospective cohort study was conducted using data from the NAGALA cohort. Participants were aged 18—79 years and were enrolled between May 1994 and December 2016. Baseline data collected included age, sex, weight, height, Body mass index (BMI), waist circumference, blood pressure, alcohol consumption, smoking status, physical activity, fatty liver, hypertension, diabetes, alanine aminotransferase (ALT), aspartate aminotransferase, total cholesterol (TC), high-density lipoprotein cholesterol, triglycerides, fasting plasma glucose, and glycated hemoglobin A_1c. AIP was calculated. The incidence of T2DM was the primary outcome. Participants were divided into quartiles according to baseline AIP values or hypertensive and normotensive subgroups based on hypertension status. Multivariable Cox proportional hazards models and Kaplan-Meier survival analysis were used to examine the association between AIP and incident T2DM in the overall population and subgroups stratified by age, sex, and BMI. The receiver operating characteristic (ROC) curve was used to analyzed the value of AIP in predicting the risk of T2DM. Both multiplicative and additive interactions between AIP and blood pressure were evaluated.

A total of 15 453 participants were included, with a mean age of (43.71±8.90) years. During a median follow-up of 5.39 years, 373 individuals (2.41%) developed T2DM. The number of participants in each AIP quartile was 3 865 cases (Q₁ group: AIP≤ -1.20), 3 863 cases (Q₂ group: -1.20 <AIP≤ -0.68), 3 863 cases (Q₃ group: -0.68 <AIP≤ -0.10), and 3 863 cases (Q₄ group: AIP>-0.10), respectively. The incidence of T2DM was significantly higher in the highest AIP group (Q₄ group: 222 cases, 5.75%) compared to the lowest group (Q₁ group: 22 cases, 0.57%) (P<0.001). Each 1-unit increase in AIP was associated with a 174.9% higher risk of T2DM (HR=2.749, 95%CI 2.428-3.111, P<0.001). After adjustment for sex, age, BMI, systolic blood pressure, ALT, and TC, AIP remained an independent predictor, with a 79.0% increased risk (HR=1.790, 95%CI 1.529-2.095, P<0.001). Kaplan-Meier analysis showed a progressive increase in T2DM risk across AIP quartiles (P for trend<0.001), with consistent associations observed in all age, sex, and BMI subgroups. The receiver operating characteristic (ROC) analysis indicated that an AIP cut-off value of 0.345 provided the optimal prediction for 10-year T2DM risk, with a sensitivity of 0.701 and specificity of 0.644. A significant multiplicative interaction between AIP and blood pressure on T2DM risk was observed, while no additive interaction was found. For each 1-unit increase in AIP, the risk of T2DM increased by 74.8% in the hypertensive subgroup (962 CASES)(P<0.05) and by 78.0% in the normotensive subgroup (14 491 cases). Among participants with normal blood pressure, those in Q₄ group had a 2.114-fold higher risk of T2DM compared to those in Q₁ group (95%CI 1.274-3.509, P<0.001), with a significant dose-response relationship (P for trend<0.001).

Elevated AIP is a strong predictor of incident T2DM in the Asian population. A significant multiplicative interaction exists between AIP and blood pressure, indicating that individuals with normal blood pressure and high AIP are at particularly elevated risk and should receive enhanced preventive attention.

Against the backdrop of a climbing global prevalence of diabetes, non-endocrinology hospitalized patients with diabetes have exploded. In view of the problems existing in the current information-based blood glucose management, such as single information collection, insufficient platform port intercommunication, lagging collaboration mode and overburden of specialists, the Second Xiangya Hospital of Central South University innovatively built the "3I mode" of blood glucose management in the whole hospital, that is, taking insulin pump therapy as the core, integrating the internet of things information platform (internet of things), and establishing an integration of nurse-physician collaboration led by full-time insulin pumpers. This model can effectively control the blood glucose level of non-endocrinology hospitalized patients, reduce the incidence of complications and shorten the hospitalization cycle; Reduce the pressure of endocrinology diagnosis and treatment, and expand the career path of diabetes specialist nurses; At the same time, it will improve the efficacy and satisfaction of blood glucose management of non-specialist medical staff. This innovative scheme provides a practical paradigm for in-hospital blood glucose management in China.

Three cases of forkhead transcription factor p3 (Foxp3Clinical phenotype, genotype characteristics and diagnosis and treatment of infants with X-linked polyendocrine adenopathy enteropathy with immune disorder syndrome (IPEX) caused by gene mutation, so as to improve clinicians' clinical understanding of this disease. Three children were male, aged 56 d, 34 d, and 3 months 15 d, one was born less than gestational age (birth weight 1 987 g), all three had eczema-like dermatitis, diarrhea, growth retardation and hypothyroidism (one positive for thyroglobulin antibodies), and two early-onset neonatal diabetes complicated with diabetic ketoacidosis (one positive for glutamate decarboxylase antibodies). WES sequencing and family verification diagnosed IPEX (Foxp3c. 1150G>A, p. Ala384Thr;Foxp3c. 1010 G>A, p. Arg337 Gln andFoxp3c. 748-750del, p. Lys250del). The above suggests that children with clinical manifestations of early-onset neonatal diabetes mellitus and other multi-glandular autoimmune diseases, eczema, intractable diarrhea, immunodeficiency, etc. should consider IPEX, WES detection for early diagnosis, immunosuppressant therapy and hematopoietic stem cell transplantation as possible effective treatment methods.

A 15-year-old male patient, who was misdiagnosed as type 1 diabetes mellitus at the age of 9, complicated with hepatomegaly, short stature and developmental retardation, was treated with insulin (insulin detemir 10 U before going to bed at night and insulin aspart 6 U before three meals) for a long time, during which the diagnosis and treatment of diabetic ketoacidosis occurred many times. The patient was diagnosed with inward rectifying potassium channel subfamily J member 11 by genetic testing in April 2024 (KCNJ11) gene mutation (c.601C>T, p.Arg201Cys) caused by adolescent-onset adult-type diabetes mellitus (MODY) 13 and switched to sulfonylureas [glibenclamide (3.75 mg, 3 times/d), glimepiride (2.00 mg, 1 time/d)] instead of insulin therapy. After changing the treatment regimen, the patient's blood glucose control improved significantly and the hepatomegaly was in remission. This article is intended to alert clinicians by reporting on this patientKCNJ11MODY13 caused by gene mutation is easily misdiagnosed as type 1 diabetes, and early genetic testing and sulfonylurea treatment can significantly improve the prognosis of patients.

A case of paroxysmal hypoglycemia caused by excessive secretion of insulin-like growth factor 2 (IGF2) from giant lobular breast tumor was reported, in order to provide reference for the diagnosis and treatment of similar patients in clinic. This case is a 52-year-old woman who was admitted to hospital with the main complaint of "sudden disorder of consciousness for 8 h". Physical examination showed a huge mass in the left breast. At the time of admission, the blood sugar at the fingertip was so low that it was undetectable. The serum insulin and C-peptide levels were significantly reduced at the onset of perfect hypoglycemia, excluding hypoglycemia caused by endogenous hyperinsulinemia. Therefore, the patient's left breast mass was punctured and pathological biopsy was taken to consider the left breast phyloid tumor, and left unilateral mastectomy was performed. After tumor resection, the patient's hypoglycemia did not repeat, and the postoperative IGF2 concentration decreased significantly (from 1 728.6 pg/ml to 416.5 pg/ml). Patients with recurrent hypoglycemia and significantly reduced serum insulin levels in clinic should consider the possibility of hypoglycemia caused by non-islet cell tumors.

Brutuximab (BV) is a CD30-directed antibody-drug conjugate used to treat relapsed or refractory classical Hodgkin's lymphoma and systemic anaplastic large cell lymphoma. According to literature reports, there are many adverse drug reactions in BV, among which the adverse drug reactions related to endocrine system account for 3.28%, but there are few reports in China that BV treatment leads to uncontrolled blood sugar. This paper reports a case of insulin resistance and uncontrolled blood glucose in a patient with mixed cell classical Hodgkin's lymphoma complicated with type 2 diabetes mellitus after BV treatment, which aims to provide some inspiration and reference for hematologists and endocrinologists in diagnosing and treating this kind of patients. The patient was a 72-year-old male who was admitted to the hospital due to "dry mouth for more than 10 years and out of control blood glucose for 2 days". He received the first BV + AVD (doxorubicin, vinandesine, and dacarbazine) anti-lymphoma treatment 8 days before admission. At that time, fasting blood glucose was 8~9 mmol/L. 2 days ago, random intravenous glucose was found to be 27.8 mmol/L and fingertip blood ketone was 0.6 mmol/L. After admission, insulin combined with oral drugs to reduce blood glucose, and the insulin dosage reached 1.53 U · kg^-1• d^-1(Total dose 88.6 U, including 60.0 U by intravenous infusion and 28.6 U by subcutaneous injection), the insulin dose was rapidly reduced after 8 days, and the patient's insulin was reduced to 25 U/d at discharge (insulin degluck 16 U, 1 dose/night + insulin aspart 3 U, 3 times/day), and the insulin dose was reduced to insulin degluck 10 U, 1 dose/night after 2 weeks. Dynamic changes of the cytokines interleukin (IL) -5, IL-6, IL-8, and tumor necrosis factor-alpha in patients' serum were monitored during treatment, suggesting that the changes in cytokines may be related to insulin resistance after BV treatment.

Masquelet induction membrane technique, also known as antibiotic bone cement induction membrane technique, has been widely used in diabetic foot ulcer (DFU) wounds, and its combined treatment methods are varied, all of which have achieved satisfactory clinical results. This article reviews, summarizes and analyzes the existing literature, expounds the wound formation of diabetic foot, the mechanism of Masquelet induction membrane technology to promote wound healing, and the application progress of Masquelet induction membrane technology supplemented with other treatment methods in DFU, in order to provide many references for the treatment of diabetic foot.

Optical coherence tomography angiography (OCTA) is an emerging non-invasive ophthalmic imaging technology. Through real-time imaging of retinal choroidal vessels, it can be used to observe the progression of diabetic retinopathy (DR), choroidal neovascularization and other diseases. Because of its advantages of non-invasive, high-resolution, rapid imaging and layered display in clinical examination, it has been widely used in the diagnosis, treatment and follow-up of ophthalmic diseases. This article reviews the application of OCTA in the diagnosis and treatment of DR.

Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are the most critical hyperglycemic states in type 1 diabetes and type 2 diabetes. Early diagnosis and management of DKA and HHS is essential to improve the prognosis of patients with diabetes. The 2024 edition of the Expert Consensus on Adult Hyperglycemic Crisis Management provides important guidance recommendations for better management of hyperglycemic emergencies. This article will introduce and review the epidemiology, pathogenesis, diagnostic criteria, recommended treatment, complications during treatment, management of special populations, prevention, summary and prospect of hyperglycemic crisis in adults, so as to help clinicians to deal with this kind of crisis more standardized.