Volume 18 · Issue 01 · 2026

Euglycemic diabetic ketoacidosis (euDKA) is a diabetic emergency that often presents insidiously in clinical settings. Its core feature is ketoacidosis, and its clinical manifestations are similar to those of conventional diabetic ketoacidosis (DKA), including symptoms of metabolic acidosis such as Kussmaul respirations, nausea, vomiting, and altered mental status. The key distinguishing feature is that patients with euDKA have blood glucose levels lower than those with typical DKA, ranging from normal to mildly elevated. This frequently leads to clinical oversight, potentially resulting in severe consequences or even life-threatening situations. This article reviewed the epidemiology, pathophysiology, common predisposing factors, clinical management, monitoring, and prevention of euDKA. It aims to enhance the early recognition capabilities of healthcare professionals regarding euDKA, with the goal of reducing its incidence and mortality through preventive measures and standardized treatment. Multidisciplinary collaboration and standardized medication management strategies, particularly regarding drug discontinuation, are key to prevention.

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

This was a cross-sectional study. Middle-aged to elderly patients with T2DM (males ≥55 years old and postmenopausal females) were collected through convenience sampling from the Outpatient Department of Endocrinology of Nantong First People′s Hospital between August 2023 and April 2025. Data on height, weight, alanine aminotransferase (ALT), triglyceride (TG), total cholesterol (TC), fasting C-peptide, 25-hydroxyvitamin D [25(OH)D], glycated hemoglobin A_1c (HbA_1c), serum ChE levels, fat mass parameters (limb fat mass and total fat mass), and muscle mass parameters (limb muscle mass and total muscle mass) were measured. Body mass index (BMI) was calculated based on the recorded height and weight, and appendicular skeletal muscle index (ASMI) was calculated based on the limb muscle mass and height. All subjects were divided into three subgroups according to the tertiles of serum ChE level: T₁ group (range of ChE, 3.68-8.11 kU/L), T₂ group (range of ChE, 8.12-9.51 kU/L), and T₃ group (range of ChE, 9.52-15.88 kU/L). One-way analysis of variance (ANOVA) with linear polynomial contrasts, the Jonckheere-Terpstra test, and the chi-square test with linear-by-linear associations were applied to assess trends in clinical data as the tertiles of ChE increased. Pearson′s correlation analysis was used to analyze the relationships between the serum ChE levels and body composition (fat and muscle mass parameters), and multivariate linear regression analysis was used to analyze whether the serum ChE levels were an independent factor in the fat and muscle mass parameters.

A total of 1 103 middle-aged to elderly patients with T2DM were enrolled, with 368 patients in T₁ group, 369 patients in T₂ group and 366 patients in T₃ group. From T₁, T₂ to T₃ group, limb fat mass, total fat mass, limb muscle mass, total muscle mass, and ASMI were progressively increased (P for trend<0.001). Pearson′s correlation analysis revealed that the serum ChE levels were positively correlated with limb fat mass (r=0.166, P<0.001), total fat mass (r=0.259, P<0.001), limb muscle mass (r=0.308, P<0.001), total muscle mass(r=0.291, P<0.001), and ASMI (r=0.329, P<0.001). Furthermore, after adjusting for BMI, ALT, TG, TC, fasting C-peptide, 25(OH)D, HbA_1c and other clinical covariates via multivariable linear regression analysis, increased serum ChE levels were associated with increased limb muscle mass (β=0.110, t=6.129, P<0.001), total muscle mass (β=0.088, t=5.001, P<0.001) and ASMI (β=0.132, t=7.216, P<0.001) in patients with T2DM.

Serum ChE levels were positively associated with skeletal muscle mass parameters in middle-aged to elderly patients with T2DM. The elevation of serum ChE may represent an independent factor associated with increased skeletal muscle mass in this population.

To examine the associations between age at obesity onset and body mass index (BMI) variability with the risk of type 2 diabetes mellitus (T2DM) and all-cause mortality.

This prospective cohort study was conducted using data from the China Health and Nutrition Survey (CHNS) from 1991 to 2015. Adults without diabetes at baseline, with complete data and at least two health assessments, were included in this study. The data such as age, sex, education, residential region, smoking, alcohol consumption, systolic and diastolic blood pressure, hypertension status, use of antihypertensive and antidiabetic medications, and baseline BMI were collected. Cox regression was applied to examine the associations between age at obesity onset and the risks of T2DM and all-cause mortality. BMI variability was assessed using variability independent of the mean (VIM), and Cox regression was applied to estimate HR and 95%CI for outcomes across VIM quartiles.

A total of 10 703 participants were included, with a mean age of (41.31±14.37) years, and 52.9% (5 665/10 703) were female. Over an average follow-up of 15 years, 1 678 incident cases of obesity were identified. After adjusting for age, sex, education, residential region, smoking, alcohol consumption, systolic and diastolic blood pressure, hypertension status, use of antihypertensive and antidiabetic medications, and baseline BMI, individuals with obesity onset before 40 years had the highest risks of T2DM and all-cause mortality, with HR (95%CI) of 3.35 (1.38-8.14) and 5.68 (1.11-29.02), respectively. The risks declined with increasing age at obesity onset. During follow-up, 626 cases of T2DM and 833 all-cause deaths occurred. Based on VIM quartiles, participants were classified as Q₁ group (VIM 0-1.40, 2 697 cases), Q₂ group (VIM 1.41-2.15, 2 662 cases), Q₃ group (VIM 2.16-3.10, 2 689 cases), and Q₄ group (VIM 3.11-14.03, 2 655 cases). After multivariable adjustment, higher quartiles of VIM (Q₄ group) were associated with increasing risks of T2DM and all-cause mortality. Participants in the highest quartile had significantly greater risks of T2DM (HR=1.59, 95%CI 1.26-2.02) and all-cause mortality (HR=1.44, 95%CI 1.17-1.77)(both P<0.05). When VIM was analyzed as a continuous variable, each one standard deviation increase in VIM was associated with higher risks of T2DM (HR=1.17, 95%CI 1.09-1.26) and all-cause mortality (HR=1.11, 95%CI 1.04-1.18)(both P<0.05). Sensitivity analyses using alternative variability metrics yielded consistent results.

An early age at obesity onset and greater BMI variability were independently associated with increased risk of T2DM and all-cause mortality.

To analyse the global burden of type 2 diabetes mellitus (T2DM) among individuals aged 15-34 years (early-onset) over 1990—2021 by location, sex, and age and to project the trends through 2040 based on the latest open data from the global burden of disease (GBD) in 2021 study.

This was a cross-sectional study. Data on age-standardised incidence, mortality, and disability-adjusted life year (DALY) rates of T2DM among individuals aged 15-34 years were obtained from GBD 2021 study. The average annual percent change (AAPC) was calculated, and the projected trends of the burden of T2DM for 2021-2040 were determined. Stratified analyses were conducted by age, sex and region. The population aged 15-34 years was divided into four age groups at 5-year intervals: 15-19 years old, 20-24 years old, 25-29 years old and 30-34 years old. Based on the social development index (SDI), countries included in the study were classified into five levels: low (SDI<0.466), moderately low (SDI 0.466-0.619), medium (SDI 0.620-0.712), moderately high (SDI 0.713-0.810), and high SDI (SDI>0.810).

Over 1990-2021, the global age-standardised incidence, mortality and DALY rates of T2DM among individuals aged 15-34 years increased from 99.01/100 000 (95%CI 67.35/100 000-134.76/100 000), 0.53/100 000 (95%CI 0.47/100 000-0.58/100 000) and 87.64/100 000 (95%CI 66.54/100 000-114.44/100 000) in 1990 to 205.64/100 000 (95%CI 148.57/100 000-267.69/100 000), 0.61/100 000 (95%CI 0.53/100 000-0.69/100 000) and 161.46/100 000 (95%CI 115.72/100 000-218.95/100 000) in 2021, respectively. Furthermore, the incidence rate in males was higher than in females in the same age group (222.39/100 000 vs. 188.39/100 000, respectively) in 2021. In 2021, among all age subgroups, individuals aged 30-34 years had the highest incidence and DALY rates (242.39/100 000 and 297.48/100 000, respectively). Countries with a high SDI demonstrated the largest average annual percent increase in age standardised incidence (AAPC=3.16%, P<0.05). Furthermore, the age standardised incidence rate of T2DM among individuals aged 15-34 years is projected to increase from 205.64/100 000 in 2021 to 239.11/100 000 in 2040.

Over 1990—2021, the global age standardised incidence and DALY rates of T2DM in individuals aged 15-34 years increased significantly, particularly in countries with a high SDI. Within the same age group, males were more likely to be affected by T2DM than females. Compared with individuals aged under 30 years, those aged 30-34 years experienced a greater disease burden. Moreover, the prevalence of T2DM among young people is projected to continue increasing in the future.

To assess the inter-laboratory variability and consistency of C-peptide detection in China.

The study consisted of two parts. Part 1 integrated data from 3 645 laboratories in the first 2024 "endocrine routine external quality assessment (EQA) program". Reagents used by each laboratory were collected, and laboratories were grouped according to reagent type. The coefficient of variation (CV) of C-peptide measurements within each reagent group was calculated, and laboratory performance was assessed based on the deviation of their C-peptide results from the group-specific target value. Part 2 involved a national trueness verification survey comprising 94 laboratories. Samples were reference materials prepared from fresh mixed human serum at five C-peptide concentration levels from Endocrine Laboratory of Beijing Hospital: CP-1 (C-peptide <0.50 nmol/L), CP-2 (0.50 nmol/L≤C-peptide<1.50 nmol/L), CP-3 (1.50 nmol/L≤C-peptide<2.00 nmol/L), CP-4 (2.00 nmol/L≤C-peptide<3.00 nmol/L), and CP-5 (C-peptide≥3.00 nmol/L), with values assigned by a candidate reference method using isotope dilution liquid chromatography-tandem mass spectrometry. Based on data from the routine EQA, the six major C-peptide detection systems in China were identified as Roche electrochemiluminescence system (Switzerland), Mindray chemiluminescence system (Shenzhen, China), Snibe chemiluminescence system (Shenzhen, China), Abbott chemiluminescence system (USA), Siemens chemiluminescence system (Germany), Beckman chemiluminescence system (USA). The within-and between-laboratory CV, as well as the within-and between-system CV for C-peptide, were collected to evaluate the comparability and trueness of results across these systems.

In the routine EQA program, the Roche system accounted for the highest proportion [31.66% (1 154/3 645)]. The within-reagent group CV ranged from 1.28% to 8.26%, and the overall pass rate was 98.1% (3 576/3 645). The trueness verification survey showed that within-laboratory CV ranged from 0.28% to 11.07%, while between-laboratory CV ranged from 13.57% to 21.81%. For the six major systems, within-system CV ranged from 3.67% to 11.74%, and between-system CV ranged from 20.14% to 32.28%. Compared to the target values, the C-peptide measurements across the six systems showed varying degrees of bias at different concentration levels, with the median bias rang of -10.13% to 91.14%.

Currently, a wide variety of C-peptide detection systems are used in China, and the comparability and trueness of results among different systems are poor.

To explore the healing effect and underlying molecular mechanism of nano-curcumin in a diabetic rats ulcer model.

Curcumin was encapsulated in chitosan via ionic crosslinking to synthesize nano-curcumin, which was subsequently characterized using scanning electron microscopy (SEM) and zeta potential analyzer. Forty-eight specific pathogen-free Sprague-Dawley (SD) rats were randomly allocated into 8 groups using a random number table (n=6 per group): the control group, diabetes group, positive control group, chitosan group, curcumin 4 group, curcumin 8 group, nano-curcumin 4 group and nano-curcumin 8 group. The ulcer model was prepared by high-fat diet and streptozotocin to establish a diabetic wound model. Positive drugs, chitosan, different concentrations of curcumin, and different concentrations of nano-curcumin were added to the ulcer of rats, and the ulcer map was observed and collected. The wound healing rates of each group on 7 d and 14 d were analyzed. The fluorescence expression of terminal deoxynucleotidyl transferase mediated dUTP nick-end labeling (TUNEL), Platelet endothelial cell adhesion molecule-1 (CD31), B-cell lymphoma-2 (Bcl-2), Bcl-2 associated X (BAX) were detected by immunofluorescence. Human umbilical vein endothelial cells (HUVEC) were used to verify the potential mechanism of nano-curcumin promoting diabetic ulcer healing. The cell experiment was divided into 6 groups: normal group, control group, model group, curcumin group, nano-curcumin group and chitosan group. Immunofluorescence and flow cytometry were used to detect the levels of apoptosis [propidium iodide (PI)] and oxidative stress [reactive oxygen species (ROS)] in different groups. The repeated measurement data were analyzed by generalized estimation equation. One-way analysis of variance or Kruskal-Wallis H rank sum test was used for comparison between groups. Tukey, Dunnett ′s T₃ or Bonferroni method were used for post hoc test.

Under the scanning electron microscope, the curcumin nanoparticles were found to be uniform in size, with an average polymer dispersity index (PDI) of 0.390. The curcumin release rate was found to reach 98% at 24 h. In animal experiments, on the 7th day, compared with the normal group (74.3%±4.9%), the ulcer healing rate of the diabetic group was significantly delayed (50.9%±4.5%, P<0.05). Compared with the diabetic group (50.9%±4.5%), the ulcer healing rate of the nano-curcumin 4 group (healing rate 71.8%±0.7%) and the nano-curcumin 8 group (healing rate 81.8%±1.7%) was significantly accelerated (P<0.05), and the nano-curcumin group had achieved re-epithelialization at 14 days. Compared with the normal group, the expression of TUNEL and BAX in the diabetic group increased, and the expression of Bcl-2 and CD31 decreased (all P<0.05). Following the intervention of nano-curcumin, the above indexes all changed in reverse. In cell experiments, immunofluorescence and flow cytometry showed that the expression of PI and ROS in the model group was higher than that in the normal group (P<0.05). However, the expression of PI and ROS in the curcumin, nano-curcumin and chitosan treatment groups was lower than that in the model group (P<0.05).

Nano-curcumin was successfully synthesized and rapidly released curcumin in vitro. In diabetic rats, nano-curcumin attenuated excessive oxidative stress and inhibited endothelial apoptosis, thereby accelerating ulcer healing. These results indicate that nano-curcumin may serve as a promising therapeutic strategy for improving diabetic wound outcomes.

To explore the clinical characteristics and adverse maternal and neonatal outcomes between pregnant women with overt diabetes mellitus (ODM) and gestational diabetes mellitus (GDM), and to investigate their influencing factors.

This retrospective cohort study included pregnant women with hyperglycemia who were treated at the First Affiliated Hospital to Nanjing Medical University from September 2022 to September 2023. Age, pre-pregnancy body mass index (BMI), gestational age at delivery, family history of diabetes, history of adverse pregnancy outcomes, history of hypertensive disorders in pregnancy, cesarean delivery,systolic blood pressure, diastolic blood pressure, 75 g oral glucose tolerance test (OGTT) results, and neonatal adverse outcomes [macrosomia, admission to neonatal intensive care unit (NICU)] were collected. According to the type of diabetes mellitus, pregnant women were divided into ODM group and GDM group. Two independent samples t-tests, Mann-Whitney U test, or χ² test were used to compare between groups. Multivariate logistic regression analysis and restricted cubic spline were used to analyze factors associated with macrosomia, neonatal NICU admission, and cesarean delivery.

A total of 670 pregnant women with hyperglycemia were included, of whom 124 were classified into the ODM group and 546 into the GDM group. Compared to the GDM group, the ODM group showed significantly higher proportions of advanced maternal age, pre-pregnancy BMI, systolic blood pressure, diastolic blood pressure, and blood glucose levels at all OGTT time points. Risks of gestational hypertension, cesarean delivery, macrosomia, and neonatal NICU admission were significantly higher in the ODM group (all P<0.05). Multivariate logistic regression showed the gestational week at delivery (OR=1.840, 95%CI 1.386-2.443), pre-pregnancy BMI (OR=1.092, 95%CI 1.014-1.175), and fasting plasma glucose (OR=1.973, 95%CI 1.252-3.109) were risk factors for macrosomia (all P<0.05). History of adverse pregnancy (OR=1.890, 95%CI 1.023-3.493), OGTT 1 h blood glucose (OR=1.288, 95%CI 1.041-1.593), and OGTT 2 h blood glucose (OR=1.238, 95%CI 1.022-1.501) were predictors for neonatal NICU admission (all P<0.05). Maternal age (OR=1.071, 95%CI 1.024-1.121), gestational hypertension (OR=2.377, 95%CI 1.353-4.176), fasting plasma glucose (OR=1.739, 95%CI 1.246-2.428), and family history of diabetes (OR=1.871, 95%CI 1.105-3.169) were risk factors for cesarean delivery (all P<0.05). The restricted cubic spline model revealed that when fasting blood glucose exceeded 5.02 mmol/L, the risks of macrosomia and cesarean delivery gradually increased. Furthermore, when OGTT 1 h blood glucose exceeded 10.13 mmol/L or OGTT 2 h blood glucose exceeded 8.87 mmol/L, the risk of NICU admission increased.

Pregnant women with ODM exhibit more severe metabolic disturbances and significantly higher risks of adverse maternal and neonatal outcomes compared to those with GDM. There is a need for active emphasis on multidimensional glycemic control in ODM management. Implementation of tailored interventions should be guided by the predictive effects of OGTT time-specific glucose on adverse outcomes.

Type 1 diabetes mellitus (T1DM) is a common immune metabolic disease, characterized by autoimmune destruction of pancreatic islet β cell function, and its prevalence is increasing year by year. The incidence of T1DM is significantly related to heredity. Genetic risk score (GRS) is an effective tool to assess the correlation between disease and heredity. It has important application value in the field of T1DM prevention and treatment, and can be used for screening, disease prediction and typing diagnosis of high-risk groups of T1DM. A variety of T1DM-GRS models have been constructed and their effectiveness has been confirmed by related studies. This paper mainly introduces the application progress of GRS in T1DM related fields and discusses the limitation and prospect of its clinical application.

A case of intermittent olfactory abnormalities in a type 2 diabetic patient after use of semaglutide is reported. The patient was a 55-year-old male who complained of "finding elevated blood sugar for 3 years" and was admitted to hospital for diabetic blood sugar control and complication screening. Physical examination found blood pressure 166/95 mmHg (1 mmHg =0.133 kPa) and body mass index 26.3 kg/m²。 Laboratory tests showed fasting blood glucose 7.69 mmol/L, 2 h postprandial blood glucose 13.36 mmol/L and glycated hemoglobin 6.5%; C-peptide and insulin release test indicated insulin resistance; Alanine aminotransferase was 108.1 U/L, aspartate aminotransferase was 60.8 U/L, and there were no abnormalities in the remaining liver and renal function indexes. HDL cholesterol 0.91 mmol/L, LDL cholesterol 3.05 mmol/L, triglyceride 1.52 mmol/L; Abdominal ultrasound showed fatty liver and gallbladder polyps. Previous hypertension, chronic hepatitis B virus and hypertrophic cardiomyopathy. For the first time, semaglutide 0.25 mg was used once a week to reduce glucose. Intermittent olfactory hallucinations (musty smell) occurred after 1 week, and the drug was discontinued after 1 month of administration. After discontinuation, the abnormal olfactory symptoms disappeared within 1 week; Symptoms recurred the next day after reuse of semaglutide, accompanied by constipation and gastrointestinal discomfort. Combined with the correlation of medication time and positive re-challenge test, a score of 7 on the Naranjo probability scale suggested that semaglutide was "probably" related to abnormal sense of smell, and there was no organic disease in the relevant rhinological examination, so semaglutide-induced abnormal sense of smell was considered. Continuous use of semaglutide 0.25 mg once a week, close observation for 2 weeks, the above symptoms gradually relieved; After 4 weeks, the sense of smell returned to normal and the symptoms of gastrointestinal discomfort disappeared. During this period, the patient's blood glucose was maintained within the target range, and no hypoglycemic therapeutic drugs were adjusted. This case suggests that clinical attention should be paid to the rare neurological adverse reactions of glucagon-like peptide-1 receptor agonists, especially the abnormal sense of smell. During the medication, we should closely monitor and be alert to the recurrence of symptoms when repeated medication.

Diabetes-related cognitive dysfunction (DCD) is a common complication of elderly diabetic patients, which seriously impairs the quality of life and social function of patients. Studies have found that chronic low-grade inflammation is prevalent in diabetic patients, and its development process is often accompanied by cognitive decline. As a characteristic of chronic inflammation in diabetes mellitus, inflammatory aging may be related to neuroinflammatory response and amyloid deposition, and plays an important role in the occurrence and development of diabetic cognitive dysfunction. Inflammatory aging is the result of neuroinflammation and accelerated apoptosis of neurons caused by degeneration of the immune system and accumulation of senescent cells. At present, the treatment methods for DCD mainly include anti-inflammatory therapy, islet amyloid peptide (IAPP) targeted intervention and stem cell therapy. These interventions have proposed response plans for different aspects such as chronic inflammation, immune aging and nerve damage caused by diabetes, and have potential therapeutic effects. However, some of the above intervention methods are in the initial exploration stage of basic research, and some are in the experimental verification stage with animals as models. They have not yet been widely applied in clinical application. In the future, it is still necessary to further verify their safety and effectiveness, and explore their synergistic effect under the mechanism of inflammatory aging, which provides more theoretical basis and treatment methods for the clinical treatment of DCD.

Mitochondria-associated endoplasmic reticulum membrane (MAM), a highly dynamic membrane structure connecting mitochondria and the endoplasmic reticulum, provides a physical platform for signal transduction and material exchange between organelles. MAM-mediated Ca²⁺Homeostasis, mitophagy, lipid metabolism, mitochondrial dynamics, endoplasmic reticulum stress (ERS) and glucose metabolism are the core pathogenesis of diabetic microvascular disease. This article focuses on the structure and biological function of MAM, as well as the role and mechanism of MAM in diabetic microvascular disease, in order to explore new targets for the clinical prevention and treatment of diabetic microvascular disease.