Volume 18 · Issue 07 · 2026

Type 2 diabetes mellitus (T2DM) has a high prevalence in China. Disease-specific cohorts represent a cornerstone of real-world research and precision medicine, yet they currently face challenges including insufficient follow-up data, poor multi-center collaboration, and data security and privacy concerns. Taking the practice of establishing the T2DM-specific cohort at Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine as an example, this paper systematically proposes three key construction strategies. Firstly, establishing an intelligent, multi-modal active follow-up system to improve long-term follow-up adherence. Secondly, formulating unified standard datasets and closed-loop quality control to break down barriers in multi-center collaboration. Thirdly, constructing a full life-cycle protection system featuring data desensitization, encryption, and dual-review and dual-control to safeguard privacy. In the future, cross-regional and multi-center standardized construction should be promoted, and artificial intelligence and big data should be integrated to create an integrated paradigm for comprehensive diabetes governance, providing data and decision-making support for chronic disease prevention and control.

In rodents, glucagon-like peptide-1 receptor agonists (GLP-1RA) have been shown to increase the risk of thyroid parafollicular cell malignancies in a dose-dependent manner, thus raising concerns about whether GLP-1RA treatment increases the risk of thyroid cancer. In recent years, analyses based on clinical trials and real-world studies have been published. The current evidence does not support a causal relationship between GLP-1RA and human thyroid cancer. Basic research further indicates that GLP-1RA exhibits significant species-specific and cell type-specific differences in its effects on thyroid parafollicular cells and follicular cells. However, given the risks observed in rodents, GLP-1RA is still prohibited for patients with a personal or family history of medullary thyroid carcinoma, as well as patients with type 2 multiple endocrine neoplasia syndrome. This article comprehensively summarizes the clinical and non-clinical research progress on the relationship between GLP-1RA and thyroid cancer, presents the controversies surrounding this topic and the obtained evidence, and aims to inform the rational clinical use and safety evaluation of these agents.

Polypharmacy is highly prevalent and often unavoidable among older adults with type 2 diabetes mellitus (T2DM), making drug-drug interactions (DDI) a key concern for medication safety. Dipeptidyl peptidase-4 inhibitors (DPP-4i), represent one of the first-line treatment options for older adults with T2DM, and the recent approval of several new DPP-4i has broadened the therapeutic choices available to patients. However, most DPP-4is are subject to metabolism by cytochrome P450 (CYP450) enzymes or transport by P-glycoprotein (P-gp), placing them at risk for clinically relevant DDI with commonly co-prescribed medications. To further improve medication safety in older adults with T2DM, the Diabetes Committee of the Chinese Association of Geriatric Health Care developed the Expert Consensus on the Safety Management of DPP-4i Polypharmacy in Older Adults with Type 2 Diabetes. The consensus outlines seven core clinical recommendations addressing pharmacokinetic interactions mediated by metabolic enzymes and drug transporters in the context of DPP-4i-based polypharmacy. These recommendations provide a practical framework for clinicians to recognize, avoid, and mitigate the risks of DDI during combination therapy.

To compare the efficacy and safety of lidocaine medicated plaster with placebo cataplasms treatment in subjects with diabetic peripheral neuropathic pain (DPNP).

This was a multicenter, randomized, double-blind, placebo-controlled, phase Ⅲ clinical trial. Between January 7, 2022 and November 30, 2023, subjects with type 1 or type 2 diabetes complicated by DPNP were enrolled at 19 clinical centers across China. According to a 1∶1 ratio using block randomization, eligible subjects were randomly assigned to either the lidocaine medicated plaster group (containing lidocaine 700 mg, area 14 cm×10 cm, adhesive mass 14 g) or the placebo group (medicated plaster without lidocaine). Subjects in both groups applied the plaster once daily for no more than 12 hours each time, over a treatment period of 12 weeks. Subjects were assessed at the 12-week visit, and the primary efficacy endpoint [change from baseline in average daily pain score (ADPS)], secondary efficacy endpoints [ADPS response rate (proportions of subjects with a relative reduction in ADPS of ≥30% and ≥50% from baseline), changes from baseline in visual analogue scale (VAS) score and efficacy index of clinician′s global impression of change (CGIC)], as well as safety indicators (adverse events and adverse reactions) were recorded. Efficacy analyses were performed using the full analysis set (FAS), while safety analyses were performed using the safety set (SS). The mixed model for repeated measures was used to analyze the changes in ADPS after treatment from baseline. The least squares mean (LSM) difference and its 95%CI were calculated. Analysis of covariance (ANCOVA) was used for intergroup comparison.

A total of 236 subjects were enrolled. Among them, 118 subjects were in the lidocaine medicated plaster group, and 118 subjects were in the placebo group. There were 236 subjects in the FAS group (118 in the lidocaine medicated plaster group and 118 in the placebo group), and 236 subjects in the SS group (118 in the lidocaine medicated plaster group and 118 in the placebo group). At week 12, the change in ADPS from baseline in the lidocaine medicated plaster group was significantly superior to that in the placebo group (-1.81±1.56 vs. -1.41±1.46, t=-2.06, P=0.040), with difference of -0.42 (95%CI -0.80--0.05). At week 12, the ADPS response rate (the proportion of subjects achieving a ≥30% or ≥50% reduction in ADPS from baseline) in the lidocaine medicated plaster group was significantly higher than that in the placebo group [50.00% (59/118) vs. 32.20% (38/118), χ²=7.72, P=0.006; 27.97% (33/118) vs. 16.95% (20/118), χ²=4.11, P=0.043]. In addition, at week 12, the improvements in pain VAS scores and the CGIC efficacy index from baseline were significantly greater in the lidocaine medicated plaster group than in the placebo group (both P<0.05). There was no statistically significant difference in the incidence rates of adverse events or adverse reactions between the two groups (both P>0.05).

Lidocaine medicated plaster demonstrates significantly superior efficacy compared with placebo in patients with DPNP, with adverse reactions similar to placebo.

To investigate the association between joint trajectories of body mass index (BMI) and waist circumference (WC) and the risk of cardiovascular disease (CVD) among elderly patients with type 2 diabetes mellitus.

This retrospective cohort study included 24 529 type 2 diabetes mellitus patients aged ≥60 years from four districts in Nanjing, China, who received standardized management under the National Basic Public Health Service Program and completed ≥3 health examinations between 2018 and 2023, with 2018 as the baseline. Latent growth mixture modeling (LGMM) was used to identify joint BMI and WC trajectories. Incident CVD, coronary heart disease (CHD), and stroke events were recorded during follow-up from 2019 to 2023. Multivariable logistic regression models were applied to evaluate the associations between joint trajectories and CVD risk, with stratified analyses performed by sex, age, and lifestyle factors.

Among the 24 529 participants [mean age (68.4±5.5) years; 8 784 men and 15 745 women], two distinct trajectory groups were identified based on model selection criteria: a stable trajectory (n=21 970, 89.57%) and an inverted U-shaped trajectory (n=2 559, 10.43%). After adjusting for potential confounders, compared with the stable trajectory group, the inverted U-shaped group had significantly increased risks of CVD (OR=1.13, 95%CI 1.03-1.27), CHD (OR=1.23, 95%CI 1.05-1.44), and stroke (OR=1.05, 95%CI 1.01-1.19) (all P<0.05). Stratified analyses indicated that the inverted U-shaped trajectory was associated with CVD in men, smokers, drinkers, and patients with normal WC (all P<0.05).

An inverted U-shaped joint trajectory of BMI and WC increased the risk of CVD among elderly patients with type 2 diabetes mellitus, particularly in men, smokers, drinkers, and those with normal WC.

To investigate the associations of skeletal muscle index (SMI), skeletal muscle density (SMD), fat mass index (FMI) and other body composition measurement with postprandial glycemic regulatory capacity in patients with type 2 diabetes mellitus (T2DM).

This was a cross-sectional study. Consecutive patients with T2DM who were hospitalized in the Department of Endocrinology, Affiliated Hospital of Jining Medical University, from January 1, 2017 to December 31, 2021, and who underwent both abdominal CT and a steamed-bread meal test were enrolled. Data on age, sex, height, and body weight were collected. Body mass index (BMI) was calculated from height and weight. Axial CT images at the third lumbar vertebra level were analyzed using Slice-O-Matic software to obtain SMI, SMD, and FMI. The trapezoidal rule was used to calculate the postprandial areas under the glucose concentration-time curve (AUC-G) and the C-peptide concentration-time curve (AUC-C). Patients were divided into a normal group and a sarcopenia according to whether sarcopenia was diagnosed. Spearman correlation analysis was used to assess the correlations of body composition parameters with AUC-G and AUC-C, and multivariate linear regression analysis was then performed to identify factors influencing AUC-G and AUC-C.

A total of 763 T2DM patients were enrolled, with a mean age of 53.8±11.4 years, and 510 males (66.84%). Among them, 553 were in the normal group and 210 in the sarcopenia group. Compared with the normal group, patients in the sarcopenia group had lower BMI, SMI, FMI, SMD, and AUC-C, and higher AUC-G (all P<0.05). Spearman correlation analysis showed that AUC-G (r=-0.295, P<0.001), SMD (r=-0.174, P<0.001), and FMI (r=-0.129, P<0.001) were negatively correlated with SMI; FMI (r=0.316, P<0.001) and SMI (r=0.208, P<0.001) were positively correlated with AUC-C. Multivariate linear regression analysis revealed that SMD (β=-0.143, 95%CI -0.263 to -0.023) and BMI (β=-0.781, 95%CI -1.032 to -0.530) were independently associated with AUC-G, whereas FMI (β=0.045, 95%CI 0.034 to 0.056) was independently associated with AUC-C.

Higher skeletal muscle mass in T2DM patients is associated with lower postprandial blood glucose levels; whereas adipose tissue may induce insulin resistance and lead to a compensatory increase in postprandial insulin secretion.

To investigate the correlation between anthropometric indices and bone mineral density (BMD) and the associated influencing factors in patients with type 2 diabetes mellitus (T2DM).

This cross-sectional study enrolled 623 patients with T2DM who were hospitalized in the Department of Endocrinology and Metabolism, Affiliated Hospital of Jiangsu University, from July 2017 to May 2024. Anthropometric and biochemical parameters were collected. The waist-to-height-to-weight index (WHWI) was calculated, and all subjects underwent dual-energy X-ray absorptiometry (DXA) bone densitometry. Based on the BMD results, the subjects were divided into a normal bone mass group (n=303), a reduced bone mass group (n=186), and an osteoporosis group (n=134). Spearman correlation analysis was used to evaluate the correlation between anthropometric indices and bone mineral density at different sites. A multivariate logistic regression model was used to analyze the association between anthropometric indices and osteoporosis in T2DM patients. Receiver operating characteristic (ROC) curves were used to analyze the predictive efficacy of single anthropometric indices and the combination of WHWI with sex and age for osteoporosis in patients with type 2 diabetes mellitus. The area under the curve (AUC), optimal cut-off value, sensitivity and specificity were calculated.

The age of the 623 patients with T2DM was 62 (53, 70) years, including 320 males and 303 females. Compared with the normal bone mass group and osteopenia group, WHWI was significantly higher in the osteoporosis group (P<0.05). Sex (OR=4.402, 95%CI 1.755-11.042), age (OR=1.071, 95%CI 1.042-1.100), and WHWI (OR=2.383, 95%CI 1.495-3.799) were associated factors for osteoporosis in T2DM patients. WHWI was negatively correlated with BMD values at the lumbar spine, femoral neck, Ward′s triangle, greater trochanter, femoral shaft, and total hip in patients with T2DM (r=-0.606--0.459, all P<0.05). The area under the ROC curve (AUC) of WHWI for predicting osteoporosis in T2DM patients was 0.838 (95%CI 0.807-0.867), with an optimal cut-off value of 0.89, sensitivity of 0.776 and specificity of 0.793. The AUC of WHWI combined with sex and age reached 0.865 (95%CI 0.836-0.891), with an optimal cut-off value of 0.297, sensitivity of 0.784 and specificity of 0.834; the predictive efficiency of the combined model was significantly better than that of WHWI alone (P=0.031).

WHWI is higher in patients with T2DM combined with osteoporosis. WHWI combined with sex and age has good predictive value for osteoporosis.

To explore the clinical characteristics and influencing factors of abnormal glucose metabolism in obese children and adolescents.

A retrospective analysis was performed on the demographic data, serum biochemical indicators, oral glucose tolerance test (OGTT) and insulin release test results of 244 children and adolescents with simple obesity who were admitted to the Department of Pediatrics of Henan Provincial People′s Hospital from January 2018 to August 2023. According to the blood glucose levels during OGTT, the subjects were divided into normal glucose tolerance (NGT) group, prediabetes mellitus (PDM) group and type 2 diabetes mellitus (T2DM) group. Clinical characteristics were compared among the three groups. Multivariate logistic regression analysis was conducted with abnormal glucose metabolism as the dependent variable. All participants were further divided into three subgroups based on the tertiles of triglyceride (TG), and the influencing factors for abnormal glucose metabolism in obese children and adolescents were analyzed.

A total of 244 children and adolescents were enrolled, with a mean age of (13.2±2.8) years, including 167 males and 77 females. The proportions of NGT, PDM and T2DM were 43.03% (105/244), 43.85% (107/244) and 13.12% (32/244), respectively. Fasting insulin levels were within the normal range in all three groups. Insulin levels at 180 minutes decreased compared with their respective peak values but did not return to the fasting levels. After OGTT, the insulin peak in the PDM group was delayed to 60 minutes [149.0 (94.3, 242.1) μU/ml], and the insulin level at 120 minutes was 142.8 (83.4, 240.8) μU/ml, which was significantly higher than that in the NGT and T2DM groups (all P<0.05). The insulin peak in the T2DM group appeared at 120 minutes [91.4 (26.9, 214.6) μU/ml]. The homeostasis model assessment-insulin resistance (HOMA-IR) index was higher in the PDM group than in the NGT group [4.8 (3.5, 7.1) vs. 4.4 (3.2, 5.9), P<0.05], while no significant difference was observed between PDM and T2DM groups, as well as between NGT and T2DM groups (all P>0.05). With the progression of glucose metabolic disorders, the homeostasis model assessment of β-cell function (HOMA-β) gradually decreased [249.5 (170.3, 466.7) vs. 210.9 (150.9, 348.2) vs. 130.2 (69.6, 231.8)], with significant differences among the three groups (all P<0.05). The levels of TG were higher and high-density lipoprotein cholesterol (HDL-C) were lower in PDM and T2DM groups than those in NGT group (all P<0.05), whereas no significant differences were found between PDM and T2DM groups (all P>0.05). Logistic regression analysis showed that TG (OR=5.089, 95%CI 2.748-9.426) and uric acid (OR=1.003, 95%CI 1.000-1.007) were independent risk factors for abnormal glucose metabolism. When stratified by TG tertiles, the 60-min blood glucose [8.1 (7.0, 9.4) vs. 8.9 (7.7, 10.7) vs. 9.6 (8.4, 10.9) mmol/L] and 120-min blood glucose [7.1 (6.3, 8.0) vs. 7.3 (6.4, 8.4) vs. 8.3 (7.7, 10.3) mmol/L] increased gradually with elevated TG tertiles (all P<0.05). HOMA-IR showed an upward trend, while HOMA-β and area under the curve for insulin (AUC_INS) presented a downward trend, though no significant differences were detected among subgroups (all P>0.05). The blood glucose curve in the second and third TG tertile subgroups was similar to that in the PDM group, and the insulin curve in the first and second TG tertile subgroups was consistent with that in the NGT group.

Insulin resistance exists even in obese children and adolescents with normal glucose tolerance. Elevated TG level can serve as a predictive indicator for abnormal glucose metabolism in this population.

Atypical Werner syndrome is a rare hereditary progeria syndrome, exceptLMNAIn addition to genes, other pathogenic gene profiles are still expanding. This paper reports a case of a 24-year-old male with a premature facial appearance, prominent manifestation of early onset diabetes, combined with various endocrine and metabolic disorders such as hyperlipidemia, thyroid nodules, hypogonadism and osteoporosis. Whole exon sequencing detectedPCNTGene compound heterozygous variation: c.4291G>A (p.A1431T) and c.5555T>C (p.M1852T),VEGFAThere was a compound heterozygous frameshift variant in the gene: c.19_22dup (p.T8Rfs*78), which was diagnosed as atypical Werner syndrome. On the basis of conventional hypoglycemic, lipid-lowering and anti-osteoporosis treatments, idebenone was combined to improve metabolism. In addition, microwave ablation was used to treat thyroid nodules. After 1 year of follow-up, all metabolic indexes of the patient were significantly relieved, and the thyroid nodules were significantly smaller than before. This case willPCNTGenetic variation is associated with atypical Werner syndrome and suggests that it may be a key factor leading to early onset diabetes, and also provides clinical reference for integrated management strategies of such patients with combined multisystem involvement.

The diagnosis and treatment of a patient with mitochondrial diabetes mellitus (MDM) in the Department of Endocrinology of Chuiyangliu Hospital affiliated to Tsinghua University was reported. The patient was a 57-year-old male who was admitted to the hospital on Nov. 5, 2025 mainly due to "finding elevated blood sugar for 10 years, intermittent gibberish for 1 year, and poor blood sugar control for 1 month". The patient was misdiagnosed as type 2 diabetes for 10 years. Later, due to the symptoms of central nervous system, combined with the characteristics of hearing loss and maternal inheritance, the patient was diagnosed as type 2 diabetes by genetic testing.MT-TL1Gene m.3243A>MDM due to G mutation. After three pre-meal insulin aspart combined with bedtime insulin glargine treatment, blood glucose was stable and discharged. MDM is often misdiagnosed as type 1 or type 2 diabetes due to its complex and diverse clinical manifestations. It is hoped that through reporting this patient, clinicians' understanding of MDM can be improved and misdiagnoses can be reduced.

This paper reports the diagnosis and treatment of a patient with adult type 3 diabetes mellitus (MODY3) with adolescent onset in the Department of Endocrinology, Zhu Xianyi Memorial Hospital, Tianjin Medical University. The patient was a 19-year-old woman with elevated blood glucose at the age of 15, a family history of third-generation diabetes, negative glutamate decarboxylase antibodies and islet cell antibodies, elevated insulin autoantibodies (27.12 U/ml), and genetic testing suggested hepatocyte nuclear factor 1 α (HNF1A) c. 460A>C (Met154Leu) heterozygous mutation, diagnosed as MODY3, with significant improvement in blood glucose after adjusting the hypoglycemic regimen to glimepiride (2 mg early and 1 mg late). Pedigree verification found that her mother carried c.460A>C (p.Met154Leu) and c.866C>T (p. Pro289Leu) double mutation, low-dose sulfonylurea (glimepiride 2 mg, once/d) treatment was not effective, and the blood glucose was significantly improved after adding glucokinase agonist (dopliaictin 75 mg, twice/d). Clinically, for diabetic patients with strong family genetic background and atypical clinical symptoms, genetic testing should be carried out in time to identify single-gene diabetes early. Furthermore, combined glucokinase activators may be a potential therapeutic option when sulfonylureas are not effective, but further research is still needed to validate.

Diabetic foot is the number one cause of amputation and high medical costs in diabetic patients. Traditional diagnosis and treatment rely on physician experience and manual evaluation, which has problems such as strong subjectivity, insufficient standardization and difficulty in early identification. With the rapid development of artificial intelligence technology, machine learning has shown broad prospects in diabetic foot screening, diagnosis, prognosis prediction and individualized management. This paper systematically expounds the research progress of machine learning in the field of diagnosis and treatment of diabetic foot in the past five years, summarizes its application results in image recognition, risk prediction, intelligent monitoring and remote management, and provides reference for accurate prevention and treatment of diabetic foot.

Metabolic reprogramming in immune cells triggered by metabolic disorders associated with type 2 diabetes mellitus (T2DM) is a key mechanism leading to impairment of immune system function. This paper summarizes the mechanism of immune senescence induced by T2DM and focuses on the central role of T cell senescence in immune senescence. Taking intracellular glucose metabolism, lipid metabolism, amino acid metabolism and bile acid metabolism as clues, the characteristics and key regulatory pathways of T cell metabolic reprogramming in T2DM were clarified. This paper expounds the current therapeutic targets and intervention strategies for T2DM-related T cell senescence, and looks forward to the future research directions, in order to provide new ideas and methods for the treatment of immune damage caused by T2DM.

Exosomal microRNA (miRNA) plays a multi-dimensional regulatory role in the pathogenesis of diabetic nephropathy (DN), and is widely involved in key pathological links such as immune inflammation, fibrosis, apoptosis and oxidative stress. As a natural carrier of intercellular communication, exosomal miRNA has the significant advantages of stable presence in bodily fluids, high tissue specificity and close correlation with disease progression. It exhibits superior sensitivity and specificity to traditional biomarkers in early diagnosis and disease assessment of DN. In addition, intervention strategies targeting exosomal miRNAs also provide potential new directions for the precision treatment of DN. In this paper, the biological characteristics of exosomal miRNA and its functional evidence in the development of DN were systematically combed, in order to provide theoretical basis and research direction for clinical diagnosis and targeted intervention of DN.

As a low-cost, non-compulsory and easy-to-operate intervention, boosting strategies provide a brand-new way of thinking for diabetes management. Based on the dual-process theory, this paper summarizes the boosting strategies in the management of drug adherence, exercise management, health behavior development and economic effect evaluation of diabetes mellitus; At the same time, the existing research is discussed in four aspects: design strategy, research cycle, clinical translation and ethical boundary, aiming at providing a reference for building an accurate and efficient diabetes management plan.