Volume 07 · Issue 03 · 2015

Diabetes is an outbreak trend all over the world. The latest epidemiological evidence suggests that the overall prevalence of diabetes among Chinese adults has risen rapidly from 9.7% in 2007 to 11.6% in 2010^[1,2]。 Among the diagnosed diabetic population, the vast majority of diabetic patients do not exercise enough, and only 25.8% of patients receive regular diabetes treatment; Only 39.7% of patients receiving regular treatment had their blood glucose controlled at ideal levels^[2]。 Diabetes mellitus is progressing rapidly, and its microvascular and macrovascular complications are seriously threatening human health. Because type 2 diabetes (T2DM) accounts for 90% to 95% of the total incidence of diabetes^[3]Therefore, the prevention and treatment of diabetes, especially T2DM, has increasingly become an important public health problem in China.

According to the latest research results of the Chinese Medical Association and the Chinese Center for Disease Control and Prevention, the incidence of adult diabetes in China is as high as 11.6%^[1]The number of diabetic patients has ranked first in the world. The control of diabetes is not the diagnosis and treatment of the disease in the traditional sense but the systematic management. The Guidelines for the Prevention and Treatment of Type 2 Diabetes in China point out that every diabetic patient should receive diabetes education once diagnosed. In order to ensure the quality of health education, every integrated diabetes management unit should have at least one specially trained diabetes educator^[2]The quality of educators determines the effectiveness of health education to a certain extent. Therefore, the training and management of diabetes educators is particularly important.

To investigate the correlation of different levels of exercise on metabolic control and chronic complications in patients with type 2 diabetes in China.

A total of 5 961 patients with type 2 diabetes were selected from 50 representative centers across China for this survey during April to July in 2010. Patients were divided into three groups according their compliance to exercise: full (2 096), partial (2 398) and poor (1 466) compliance. Analysis of variance and Chi-square test were used to test the differences of measurement data and counts data among the three groups, respectively, and Logistic regression models was used to analyze the interdependency between exercise and patients with hypoglycemia.

Fasting blood glucose, 2 h postprandial blood glucose, HbA_1c, total cholesterol, triglycerides, body mass index, systolic blood pressure, diastolic blood pressure of patients in the full compliance group were significantly lower than those of partial and poor compliance group (numerical comparison are as follows (7.7±2.8) vs (8.2±2.9) vs (8.6±3.5) mmol/L, (10.8±4.2) vs (11.7±4.4) vs 12.2±4.8) mmol/L, HbA_1c (8.0±2.1) vs (8.3±2.2) vs (8.7±2.3) %, (4.8±1.3) vs (4.9±1.5) vs (4.8±1.4) mmol/L, (1.9±1.6) vs (2.1±1.7) vs (2.3±2.0) mmol/L, (24.1±3.7) vs (24.6±4.0) vs (24.8±4.7) kg/m², (129±16) vs (130±17) vs (132±18) mmHg, (78±10) vs (79± 10) vs (80± 11) mmHg, 1 mmHg=0.133 kPa, F=3.658-37.799, P<0.05) . The morbidity of diabetic peripheral vascular disease, diabetic nephropathy, diabetic peripheral neuropathy, diabetic retinopathy and diabetic foot of patients in the full compliance group were less than poor compliance group (numerical comparison are as follows (12.51% vs 15.96%) , (12.56% vs 18.69%) , (24.50% vs 29.33%) , (28.84% vs 33.63%) , (4.11% vs 9.14%) , χ²=8.580, 25.547, 10.715, 9.629, 47.724, P<0.05) .

Patients with regular exercise has better glycemic control, blood pressure, lipid and body mass index. Furthermore, the prevalence of diabetic complications is lower.

To investigate the comprehensivework of diabetes educators who had the certifications of Chinese Medical Association-Chinese Center for Disease Control-Johnson & Johnson Diabetes Institute (JJDI) and the satisfaction of manager.

Cross-sectional investigating method was used in this study. Educators who had finished the training in JJDI from 2008 to 2014 and their managers were involved. The diabetes educators were required to fill in the questionnaire for diabetes educator and the managers were required to fill in the questionnaire for education leader on line. The data was analysis by SPSS 17.0. Data between groups were analyzedby chi-square test. Measurement data were analyzed by t test.

The satisfaction for curriculum before and after 2010 hasn't statistical differences, however the satisfaction of practice curriculumhas declined- trend.About 64.5% (89/138) students thought that their capacity was improved after training. Compared with the result of 2010, the time that the students spent to educate the inpatients with diabetes were increase form (23±16) hours per month to (36±29) hours per month (t=-2.334, P<0.05), the time that they spent to educate the outpatient with diabetes were increase form (14± 12) hours per month to (32 ± 26) hours per month (t=- 2.194, P<0.029). Exceptimplement the education workflowand training the other nurses, the work that the systematic education (80.8%vs 92.2%, χ ²=19.766, P<0.001) , recording the education of patients (54.6%vs 80.3%, χ ²=51.384, P<0.001) and evaluation the education (50.8%vs 88.9%, χ ²=107.729, P<0.001) had improved obviously. The main difficulties between 2010 and 2014 were that they had no enough time to educate patients (78.1%vs 50.9%, χ ²=60.365, P<0.001) and had no full-time diabetes educator in their department (72.3%vs15.9%, χ ²=188.310, P<0.001). The percentage of above data in 2014 decreased compared with in 2010. For managers, 23.4% (123/525) of them were unsatisfied with the work of research carried by these educators.

The content and time spent on diabetes education were improved from 2010. In the future, we should manage and evaluate the practice bases, give the educator full-time education job, train on nursing research and improve the comprehensivequality of educators.

To evaluate the oxidative status under different blood glucose levels, and study the relationship between body phagocyte-like nicotinamide adenine dinucleotide phosphate oxidase (Nox) with oxidative stress and pancreatic β-cell function.

According to the fasting blood-glucose and oral glucose tolerance test, 84 individuals who participated physical exam were divided into 3 groups: normal glucose tolerance group (NGT, n=26, FPG<6.1 mmol/L and OGTT 2 hPG<7.8 mmol/L), impaired glucose regulation group (IGR,n=27, FPG between 6.1-7.0 mmol/L and OGTT 2 hPG<7.8 mmol/L)or FPG<6.1 mmol/L and OGTT 2 h PG between 7.8-11.1 mmol/L, or FPG between 6.1-7.0 mmol/L and OGTT 2 h PG between 7.8-11.1 mmol/L, and diabetes mellitus group (n=31, FPG≥7.0 mmol/L, and/or OGTT 2 hPG≥ 11.1 mmol/L).Nox, 8-hydroxy-2′-deoxyguanosine (8-OHdG), superoxide dismutase (SOD), malondialdehyde (MDA) was measured. The islet beta cell function index (HBCI)was calculated by each recognized formula. Variance analysis was used to analysis between multiple groups, and independent samples t testto comparetwo groups. Pearson′s correlation Multivariate regression analysis were performed between HBCI which was corrected by insulin resistance and other variable.

With the increase of blood glucose, the level of Nox in DMgroup was higher than IGR group.HBCI was decreased ((143.3±22.1)vs (118.0±21.8)U/L, (12.4 ± 2.3)vs (31.1 ± 7.7), t=2.156, 5.621, respectively, all P<0.05). Nox in DM group was significantly higher than NGT, group. HBCI was significantly decreased ((143.3±22.1)vs (97.2±19.9)U/L, 12.4±2.3 vs 105.2±21.3,t=4.460, 4.111, respectively, all P<0.05) . The further multiple regression analysis indicated that only Nox was independent factor on HBCI (r=-0.572, β=-1.088, R₂=0.455, P<0.001).

Nox maybe an ideal index in reflecting the oxidative status in the body. Oxidative stress derived from Nox is closely tied to pancreatic β-cell function.

To explore the relationship between serum level of 25-hydroxyvitamin D₃ (25- [OH]D₃) at first trimester of pregnancy and gestational diabetes mellitus (GDM).

The prospective case-control study involved 1 768 women who took antenatal care at Guangdong Women and Children Hospital from June 2011 to March 2013. All subjects were enroled at 6-13 weeks of gestation and blood sample was taken to measure glucolipid metabolic index and 25-[OH]D₃ levels. At 24- 28 weeks of gestation, all subjects took 75 g oral glucose tolerance test (OGTT) . The subjects were divided into GDM group (n=350, maternal age (29±5) years) and control group (n=1 418, maternal age (29±4) years) according to results of OGTT and fasting blood glucose (FBG) , and then 25-[OH] D₃ levels and glucolipid metabolic index between the two groups were compared. Data was analyzed by using independent t test, Pearson correlation, logistic regression.

The progestational body mass index (BMI) of GDM patients was significantly higher ((22.6±3.1 vs 20.5±2.1) kg/m², t=5.913, P<0.05) as compared with the controls.There was no significant difference of maternal age between the two groups (t=0.342, P>0.05).Among women who developed GDM, maternal serum 25-[OH] D₃ concentrations at first trimester of pregnancy were significantly lower than the controls ((23.8±3.3 vs 37.8±12.8) nmol/L, t=17.936, P<0.05); The serum 25-[OH] D₃ levels were significantly and negatively correlated with HOMA-IR (r=–0.867, P<0.05), TG (r=–0.133, P<0.05), progestational BMI (r=-0.244, P<0.05); Women who were classified as being deficient for vitamin D had a 1.669- fold increased subsequent risk of GDM, as compared with vitamin D sufficient women after adjustment for progestational BMI, TG, LDL-C, FBG, HOMA-IR (adjustedOR:1.669; 95%CI: 1.460-1.912, P<0.05);The receiver operating characteristic curve (ROC) analysis showed that the sensitivity was 85.9% and the specificity was 83.7% in predicting GDM at point of 28.2 nmol/L of serum 25-[OH] D₃ concentration.

The serum 25-[OH] D₃ concentrations at first trimester of pregnancy were significantly decreased in women who were subsequently developed GDM. Maternal vitamin D deficiency at first trimester of pregnancy is associated with an elevated risk for GDM.

To investigate the clinical risk factors of type 2 diabetes mellitus (T2DM)combined with hepatic fibrosis.

Totally 112 patients with T2DM from Department of Endocrinology, the First Affiliated Hospital of Xinjiang Medical University from April to September in 2013 were enrolled in our study. Male patients were 69, female patients were 43, age was 53±1, the average of duration of T2DM was 4 year (1- 10 year). They were divided into 2 groups, according to the fibroscan measured, T2DM combined with hepatic fibrosis group (liver hardness value ≥6.65 kPa, group A, case group, n=44); T2DM without hepatic fibrosis (liver hardness value<6.65 kPa, group B, control group,n=68). The gender, age, ethnic, disease history, laboratory examination (liver enzyme)and ultrasound were collected and analyzed with univariate analysis and multivariate analysis.

(1)Patients of case group had a significantly higher ratio of having hypertension history (52.3%), fatty liver (90.9%), rate of poor blood glucose control (70.5%), body mass index (BMI) ((28.49 ± 0.16)kg/m²), alanine aminotransferase (ALT) (20.04 (14.75-47.40)U/L), aspartate aminotransferase (AST) (26.70 (17.10~36.91)U/L)than those in control group (26.5%, 69.1%, 50.0%, 26.32±0.39, 16.30 (13.63-20.40), 19.25 (14.50-27.68), χ ²=7.664, 7.316, 4.589; t=- 3.121, Z=- 2.121, - 2.821; P<0.05 all above). White blood cell count (6.58 ± 0.25), neutrophile count (3.75 ± 0.18), mean corpuscular volume (MCV) (87.51 ± 0.59)in case group were significantly lower than those in control group (7.54±0.25, 4.47±0.19, 89.74±0.49) (t=2.740, 2.789, 2.876; P<0.01 all above) . (2)Multivaiate logistic regression analysis showed that hypertension history, fatty liver, increased AST, decreased white blood cell count and decreased MCV were the independent risk factors of T2DM combined with hepatic fibrosis (OR=3.576, 3.850, 1.110, 0.669, 0.808, P<0.05 all above).

Hypertension history, fatty liver, increased AST, decreased white blood cell count and decreased MCV were the related risk factors of T2DM combined with hepatic fibrosis. This study provides a theoretical basis to early screen patients with hepatic fibrosis in T2DM.

To investigate the effects of pioglitazone on expressions of serum amyloid A (SAA) protein, retinol binding protein 4 (RBP4) and hepar resistin- like molecules α (RELMs/FIZZ1) of insulin-resistant (IR) rats induced by diets.

Taking the completely randomized method, a total of 30 male Wistar rats were divided into 2 groups: control group (n=10, fed with normal diet) and model group (n=20, fed with high sugar high fat diet). Eight weeks later, the indexes of insulin resistance was assessed to confirm that models were successfully established. The 20 well-established IR rat models were divided into 2 groups with random number table:IR and pioglitazone group. The three groups were continually fed with the same diet as before, while the rats in pioglitazone group were administerd with a daily 20 mg/kg of pioglitazone for eight weeks in addition. At the end of sixteen weeks, blood samples were collected for measuring the levels of triglyceride (TG) , total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) , fasting glucose (FPG) , SAA, fasting insulin (FINS) and the body weight were measured. And the liver FIZZ1 mRNA was measured. The homeostasis model assessment index of IR (HOMA-IR) was calculated. Difference of measurement data was compared with single factor analysis of variance.

The levels of body weight, FBG, FINS, HOMA-IR, TC, TG, LDL-C, SAA, RBP4 and FIZZ1 mRNA in IR group were all significantly higher than those in control group (t=-20.666 to-3.681, allP<0.01), while the level of HDL-C was much lower (t=8.950, P<0.01). After the intervention of pioglitazone, the level of FBG, FINS, HOMA-IR, TC, LDL-C, SAA, FIZZ1 mRNA and RBP4 decreased significantly (t=3.756-11.648, all P<0.01), and the level of HDL-C increased much (t=-1.464, P>0.05). In a bivariate analysis, the level of SAA, RBP4 and FIZZ1 mRNA were correlated with body weight, FBG, FINS, HOMA-IR, TC, TG, LDL-C positively (r=0.384-0.876, all P<0.05)and HDL-C negatively (r=-0.460 - -0.620, all P<0.01). FIZZ1 and SAA were correlated with RBP4 positively (r=0.750, 0.682, both P<0.01).

FIZZ1, SAA and RBP4 is related to IR closely. Pioglitazone improves IR by down-regulating the level of SAA, RBP4 and FIZZ1 mRNA.

To explore the relationship of 8-epi-prostaglandin F2alpha (8- isoPGF2α) and C242T gene polymorphism in the p22phoxsubunit of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase with T2DM patients with macroangiopathy in Hebei Province Han population.

A total of 215 T2DM patients (105 macroangiopathy patients and 110 pure T2DM patients, from inpatient inthird hospital of Hebei Medical Universitybetween July 2012 and July 2013)and 100 healthy individuals in control group were enrolled in this study. Body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), ankle brachial index (ABI)were measured and calculated.Fasting blood glucose (FBG), total cholesterol (TC), circulating triglycerides (TG), low density lipoprotein cholesterol (LDL- C) and high density lipoprotein cholesterol (HDL- C) were measured by automatic biochemical analyzer and hemoglobin A₁c (HbA_1c) was tested by SIEMENS DCA 2000 Analyzer. Serum 8-isoPGF2α was measured by enzyme linked immunosorbent assay.C242T genotype of p22phox subunitwas typed by polymerase chain reaction-restriction fragment length polymorphism. Statistical analysis were performed by using analysis of variance, correlation analysisand logistic stepwise regression analysis.

8-isoPGF2α in T2DM patients with macroangiopathy group ((49±24)ng/L) was higher than that in pure T2DM group ((33±13)ng/L,t=-5.856, P<0.05)and control group ((28±13)ng/L,t=-7.780, P<0.05).8-iso-PGF2α was positively correlated with SBP, DBP, BMI, TC, TG, LDL- C, FBG and HbA1c (r=0.247, 0.269, 0.201, 0.134, 0.177, 0.233, 0.255, 0.226 respectively, all P<0.05), and was negatively correlated with ABI and HDL-C (r=-0.382, -0.195respectively, both P<0.05).In T2DM macroangiopathy group, the frequency of allele T and CT+TT genotype was significantly higher than that in pure T2DM group (χ²=6.67, 4.08 respectively, both P<0.05)and control group (χ²=14.01, 10.81, bothP<0.05).The morbidity of macroangiopathy in CT+TT genotype group was higher than that in CC genotype (χ²=10.06, P<0.01) . Multiple regression analysis showed that BMI, LDL- C and circulating 8- iso- PGF2α level were the independent risk factors of T2DM macroangiopathy (β=0.913, 2.787, 0.835).

In T2DM group, the level of oxidative stress increases, especially in T2DM macroangiopathy group.There seems no correlation between P22phox subunit C242T gene polymorphism and liability of T2DM macroangiopathy.

To investigate the renoprotective effects of pentoxifylline (PTX)in rats with diabetes mellitus (DM)based on its mechanism of anti-oxidative stress.

A total of 50 clean and healthy male SD rats were randomly divided into 5 groups with random number table: normal control group, DM group, high-dose PTX (PTXh)group, low-dose PTX (PTXl)group and benazepril (Ben)group. DM rat models were established with streptozotocin. Urinary protein excretion, serum cystatin C (CysC), superoxide dismutase (SOD)and malondialdehyde (MDA)in renal homogenate were assayed with biochemical analyzer. Renal nitrotyrosine was detected by immunohistochemistry and oxidative carbonyl protein (OCP)by oxyblot immunoblotting. Renal morphology was examined with Masson staining. Rats in all groups were administrated with gastric perfusion once a day for 12 consecutive weeks: control and DM groups with water, PTXl group with 30 mg/ (kg·d)of PTX, PTXh group with 50 mg/ (kg·d)of PTX and Ben group with 3 mg/ (kg·d)of benazepril. Variance analysis was used to compare the data difference between groups.

Compared with that in control group, renal SOD levels in DM, PTXl and Ben groups decreased remarkably (F=4.687, P<0.05), and renal SOD was significantly higher in PTXh group when compared with that in DM rats ((87±9)vs (121±27) U/L, t=3.64, P<0.05). Compared with in control group, renal MDA levels in all other groups were elevated significantly (F=9.803, P<0.05); Compared with that in DM group, MDA levels in PTXh, PTXl and Ben groups decreased strikingly (t=-2.59, -2.59, -2.49, allP<0.05). It showed dominant pathological damages and increased expression of nitrotyrosine (NT)in cytoplasma of mesangial cells in rats in the DM group. In contrast, the PTXh group showed alleviated pathological damages and decreased NT expression, while the PTXl and Ben groups exhibited moderate improvements of the renal damage. Compared with that in control group, the expression of OCP in renal cortex in DM, PTXl and Ben groups increased significantly (t=9.43, 2.51 and 2.34, allP<0.05)while it in PTXh group restored to near control level (t=1.834, P>0.05).

PTX is proved to be renoprotective in diabetic rats, which may be associated with its anti-oxidative stress mechanism.

This study is to investigate the changes of serum anti-aging protein Klotho levels and its correlation with other serum indexes in type 2 diabetes mellitus (T2DM)patients at different stages of diabetic kidney disease (DN). A total of 462 cases with T2DM were divided into three groups according to the level of urinary albumin to creatinine ratio (UACR): normoal buminuric group (group N, UACR<30 mg/g,n=180), microalbuminuric group (group M, UACR 30-300 mg/g, n=158), and macro-albuminuric group (group L, UACR>300 mg/g,n=124), while 160 healthy volunteers age-matched were selected as the normal control (NC)group, 78 males and 82 females, age (51 ± 6)yrs. The levels of serum soluble-Klotho (sKlotho), neutrophil gelatinase-associated lipocalin (NGAL), 8- isoprostane prostaglandin F2α (8-iso-PGF2α), monocyte chemotactic protein-1 (MCP-1), tumor necrosis factor-α (TNF-α)and transforming growth factor-β 1 (TGF-β1)were determined by a quantitative sandwich enzyme-linked immuno sorbent assay (ELISA)in all the cases and 160 subjects of control (group NC). Multiple regression analysis was used to analyze the relationship between the various indexes of serum and urinary albumin. The results showed as following: (1)Compared with group NC, the levels of serum sKlotho in group N was obviously decreased (377.2 (359.5-394.9) ng/L vs 246.1 (236.1-256.2)ng/L,P<0.05), especially in group L (90.1 (83.1-97.0)ng/L). (2)The serum sKlotho levels were significantly negative in correlation with NGAL and UACR levels (r=-0.491, -0.732, bothP<0.05), but positively correlated with estimated glomerular filtration rate (eGFR,r=0.344, P<0.05). The levels of serum sKlotho was negatively correlated to the levels of serum 8-Iso-PGF2α, MCP-1, TNF-α, TGF-β1 (r=-0.437, -0.358, -0.422, -0.461, all P<0.05). The results suggest that the serum levels of Klotho may become new biological maker proteins of early diagnosing DN in T2DM. The mechanisms may be involved in oxidative stress related to inflammation and renal fibrosis.

Diabetes education plays an important role in helping patients manage themselves. In order to improve patients' self-management ability and quality of life, different forms of diabetes education have been explored in various countries^[1,2]。 Among them, the structured management project is advocated by the National Institute for Clinical Excellence (NICE) in the UK. This article introduces and comments on the contents and effects of the structured management of diabetes in Britain.

Diabetes is one of the most common diseases that seriously endanger human health, among which type 2 diabetes (T2DM) patients account for 90% to 95%. It is estimated that by 2025, the number of T2DM patients in the world will reach about 300 million. Exercise therapy is one of the most important prevention and treatment methods of diabetes, especially suitable for the prevention and treatment of T2DM patients. It has the advantages of easy operation, less environmental restriction, low cost and few side effects. In recent years, there have been many studies on the mechanism of action of exercise therapy in the prevention and treatment of T2DM and its complications. The results of these studies are summarized as follows.

The prevalence of obesity is increasing with the development of socioeconomy and the change of lifestyle. A 2014 survey by the Institute of Health Metrics and Evaluation at the University of Washington found that the number of obese people has been increasing in the past 30 years^[1]At present, about 1/3 of adults and 1/4 of children in the world are overweight, and the number of obese people is as high as 671 million. Obesity can cause a series of chronic metabolic diseases. In my country's REACTION study, Bi et al.^[2]The study found that the prevalence of diabetes, hypertension and cardiovascular disease among obese people is much higher than that of normal weight people. At present, obesity has become a global disease affecting human health.

Type 1 diabetes is a metabolic disease that causes progressive destruction of pancreatic islet β cells due to various causes, resulting in absolute insulin deficiency and elevated blood sugar. It is classified into two subtypes: autoimmune (1A) and idiopathic (1B). fulminant type 1 diabetes mellitus (FT1DM) was developed in 2000 by Japanese scholars Imagawa et al.^[1]It is proposed for the first time that it is temporarily included in the category of idiopathic type 1 diabetes because no clear etiology and autoimmune evidence have been found. It has acute onset, rapid progression, diverse clinical manifestations, and is easily misdiagnosed. Once the treatment is delayed, the prognosis is poor. Pregnancy is a risk factor for FT1DM, and a national survey in Japan found that almost all T1DM onset during pregnancy belonged to FT1DM. We recently treated a patient with FT1DM after miscarriage, which is presented below.

As the course of T2DM progresses, most patients need to initiate insulin therapy. Insulin itself promotes anabolism and has a potential weight gain effect, so it is more clinically necessary to strike a balance between blood sugar control and weight gain.