Volume 01 · Issue 03 · 2009

Type 2 diabetes has historically been regarded as a medical disease, and commonly used treatments include controlling diet, strengthening exercise, taking oral drugs, and using insulin to control blood sugar, blood pressure, and blood lipids. However, due to the complicated pathogenesis, the treatment cannot be aimed at the etiology and pathogenesis, and it is difficult for the above-mentioned medical treatment to ensure that the blood sugar, blood pressure and blood lipid of patients return to normal levels for a long time^[1]Therefore, various diabetic complications inevitably occur, and a decrease in pancreatic islet β cell function, an increase in blood sugar, an increase in hypoglycemia due to heavy use of insulin, an increase in body mass, and the like gradually occur. Only 3% ~7% of the whole diabetic population have blood sugar, blood pressure and blood lipids that reach the recommended treatment goals^[2]。 Domestic research data show that only 11.5% of patients have blood glucose control standard (glycosylated hemoglobin<6.5%)； The compliance rate of blood pressure (whether systolic or diastolic) is about 40%; The compliance rate of serum total cholesterol was only 25.6%, the compliance rate of low density lipoprotein cholesterol was about 40%, and the compliance rate of high density lipoprotein cholesterol was the highest, 71.5%. Because of the high requirements of pancreatic transplantation and islet cell transplantation, it is not universally carried out at present. Therefore, a new therapeutic measure is needed to ensure that blood sugar, blood pressure and blood lipids are up to standard.

At present, there are more than 170 million diabetic patients worldwide, of which about 90% are type 2 diabetic patients. The main measures used to treat diabetes include diet control, exercise, oral hypoglycemic drugs or the use of insulin, etc. However, due to poor compliance of patients, it is difficult to control blood sugar at normal levels. In recent years, by analyzing the effect of obese patients undergoing bariatric surgery abroad, it was found that not only the body weight of patients decreased significantly after surgery, but also the complicated type 2 diabetes was unexpectedly improved or even cured. It is now believed that bariatric surgery can obstruct the intake of food by physical or mechanical means, reduce the absorption area of digestive tract to obstruct the mixing of food and digestive juice, and correct the disorder of gastrointestinal hormone secretion to achieve the effect of weight loss and blood sugar level reduction. At present, commonly used surgical methods include laparoscopic adjustable gastric banding (LAGB) and laparoscopic gastric bypass (GBP), etc. This article intends to explain the risks and countermeasures of bariatric surgery in the treatment of type 2 diabetes.

The incidence of obesity has increased significantly over the past two decades. The World Health Organization estimates that there are more than 1 billion overweight people worldwide, of which 300 million are obese. According to this trend, the number of overweight people worldwide will reach 1.5 billion by 2015^[1]。 Patients with morbid obesity are often accompanied by obesity-related complications such as hypertension, type 2 diabetes, hyperlipidemia, gastroesophageal reflux disease, degenerative osteoarthropathy, and coronary heart disease. Obesity and its complications spend a considerable amount of medical resources. Although non-surgical treatments for obesity, such as diet control, exercise, and drugs, can reduce body mass by 5% to 10% in a short time, the effect for long-term weight loss is not ideal, so surgical treatment of obesity is becoming more and more important. At present, how to make reasonable use of limited health care resources, reduce the medical expenses of obesity and related complications, and meet the basic medical security needs of nationals, has attracted increasing attention of governments and scholars. In recent years, the international health economics research on bariatric surgery has gradually increased, which is described as follows.

To understand the efficacy and safety of sufficient dose of metformin either plus gliquidone or plus acarbose for the treatment of type 2 diabetes mellitus.

One hundred and forty patients with type 2 diabetes who were inadequately controlled with previous therapy were randomized to receive sustained–release metformin(1500 mg/d) in combination with either gliquidone(start with 30 mg, bid) or acarbose(start with 50 mg, bid) for 14 weeks. The anthropometric parameters, fasting blood glucose levels, lipid profiles, HbA1c and post–challenge glucose and insulin responses were measured at baseline and at the end of treatment.

After 14 weeks treatment, the level of the glycated hemoglobin A1c (HbA1c) in the 2 group were both decreased than before(metformin+ gliquidone group with (7.4±1.1)%, metformin+ acarbose group with (7.8±1.1)%). The level of HbA1c decreased significantly more in metformin plus gliquidone group(1.7%) than in metformin plus acarbose group(0.9%), P=0.0001. The rate of HbA1c<6.5% was 25.71% in metformin plus gliquidone group, compared to 12.86% in metformin plus acarbose group(P=0.054). The insulin resistance index(HOMA–IR) and the beta–cell function index (HOMA–β) improved significantly in both groups, but no difference was observed between the two groups.

As compared to metformin plus acarbose, the combined therapy with metformin plus gliquidone more significantly improved glycemic control and was well tolerated among inadequately controlled patients with type 2 diabetes.

To evaluate the efficacy of laparoscopic adjustable gastric banding (LAGB) in improving or resolving morbid obesity with type 2 diabetes (T2DM).

From October 2006 to December 2008, 15 morbidly obese patients with type 2 diabetes underwent LAGB. The body mass index (BMI), fasting (FBG) and postprandial blood glucose(PBG), medication for diabetes was assessed preoperatively and 1, 3, 6, 12 and 24 months after LAGB. The glycosylated serum protein (GSP) and serum insulin were measured at set intervals during a 12–month period after surgery.

All the 15 patients lost weight, with BMI decreased from (41±7) kg/m² before LAGB to (31±6) and (28±5) kg/m² post–operative 12 and 24 month (t value was 2.104、3.862, respectively, P<0.05 and P<0.01). Compared to before the operation, the FBG level((11.2±1.4) mmol/L)were decreased significantly at 6th month, 12th and 24th month ((7.5±1.3) , (6.2±1.4) , (5.9±1.4) mmol/L) after LAGB (t value was 2.044, 2.416 and 2.473, all P<0.05). And the PBG level from (16.6±1.7) mmol/L (before the operation) decreased to (10.1±2.1) mmol/L (6th month), (7.7±2.6) mmol/L(12th month) and (7.4±2.3) mmol/L( 24th month, t value was 2.062, 3.073 and 3.084, all P<0.05). At 6th and 12th month after LAGB, the levels of GSP and serum insulin were decreased significantly. 8 cases stopped any medication at 24th month after surgery.

This clinical observational study suggests that LAGB is effective in inducing loss of weight and remission of T2DM.

To study the effects of pioglitazone intervention on urine albumin/creatine ratio in non–diabetic subjects with hypertriglyceridemia and its potential protective effects on cardiovascular disease.

In this prospective randomized placebo–controlled trial, 88 non–diabetic subjects with hypertriglyceridemia were selected from the Physical Examination Center of the First Hospital of Huairou District or Endocrinology Department of Beijing China–Japan Friendship Hospital during February and November 2005. The participants were randomly assigned to 3 groups: placebo (n=35), diet and exercise education plus placebo (n=27) , or diet and exercise education plus 15 mg/d pioglitazone (n=26) for 24 months. Before and during the intervention, plasma FFA, triglyceride (TG), blood glucose (BG) and urine albumin/creatine ratio were measured. One–way analysis of variance was used for data analysis.

A total of 67 subjects completed this 2–year study. There was no significant difference in fasting FFA, TG, and BG among the three groups at baseline. At the end of the second year, there were still no difference in BG among the three groups, but compared with the placebo control group, FFA in the pioglitazone group were significantly lower (0.30 and 0.43 mmol/L, t=–0.18, P<0.05). FFA decreased much greater in the pioglitazone group than that in the placebo control group (–0.246 and–0.003,t=–0.24, P≤0.01). There was no significant difference in urine albumin/creatine ratio among the three groups at baseline. At the end of the second year, compared with the placebo control group, urine albumin/creatine ratio was lower in the pioglitazone group (0.31 and 2.28 g/mol, P<0.01).

The data show that urine albumin / creatine ratio in non–diabetic subjects with hypertriglyceridemia increased year by year, which could be prevented by the use of pioglitazone.

To observe the association between educational level and individualized diabetic education and glucose control in diabetic patients.

A total of 8887 sets of type 2 diabetic patients' information were collected from the diabetes information management system from January 2004 to December 2008. According to their educational level, the participants were divided into 3 groups: college group (n=2968), high school group (n=2156), and primary school group (n=3763). Of those patients, 2034 received diabetic education or individualized consultation for several times, the other 6853 subjects never received any diabetic education. The effect of education level and diabetic education on glucose control in diabetic patients was observed. Systolic pressure, fasting plasma glucose, HbA1c, serum insulin, C–peptide, serum lipid profile and body mass index were measured. One–way analysis of variances, t test, and Chi–square test were used for data analysis.

The participants with higher education level experienced more optimal glucose control (χ²=24.71, P<0.01). The glucose control was significantly better in the college group than in the high school group or primary school group. There was also significant difference in glucose control situation between the patients received individualized diabetic education several times and those never did (χ²=15.52, P<0.01). Patients without individualized diabetic education had significantly higher body mass index, HbA1c, and postprandial plasma glucose levels than those with such education.

Education level and individualized diabetic education may have important effects on glucose control, diabetic complication prevention, and quality of life improvement.

To explore the relationship between the incidence of carotid arterial diseases and related factors in elderly diabetes patients.

Two hundred sixty elderly diabetic patients were included in diabetes group and 206 elderly healthy volunteers were included in control group. The age, gender, diabetic duration, fasting plasma glucose(FPG), postprandial glucose(PPG), glycosylated hemoglobin(HbA1c), total cholesterol(TC), total triglyceride(TG), high density lipoprotein cholesterol (HDL–C), low–density lipoprotein cholesterol (LDL–C), very low–density lipoprotein (VLDL), apolipoprotein A₁(ApoA₁), apolipoprotein B(ApoB), blood pressure (BP), body mass index(BMI), C–reactive protein(CRP) of the two groups were measured. All patients were examined by color Doppler ultrasonography. The relationship between the incidence of carotid arterial diseases and related factors was analyzed by Logistic regressive model.

(1) The intima–media thickness(IMT) became thickened in 241 cases (92.6%) in diabetes group and 43 cases (20.8%) in control group. The difference between two groups was statistically significant(χ²=249.06, P<0.01). The prevalence rates of carotid plaque were 81.3% (212 cases) in diabetes group and 20.3% in control group (42 cases)(χ²=173.32, P<0.01). The incidences of carotid arteries stenosis were 34.2% (89 cases) in diabetes group and 0.01% (3 cases)in control group(χ²=77.92, P<0.01). (2) The levels of FPG, PPG, TC, TG, LDL–C, ApoB and CRP were significantly higher in diabetes group than those in control group (t=16.99, 15.82, 15.92, 6.43, 10.84, 3.69, 17.09; all P<0.05), but the levels of HDL–C and ApoA were significantly lower in diabetes group than those in control group (t=4.54, 37.74; both P<0.05). Compared with diabetes patients without carotid arterial diseases, the levels of HbA1c, TG, LDL–C and ApoB were increased in diabetes patients with carotid artery lesion (t=3.02, 3.26, 3.79, 9.06, 2.50; all P<0.01). (3) Logistic regression showed that age, gender, diabetic duration, LDL–C, HDL–C, TG, SBP and CRP were the independent risk factors for carotid arterial diseases in elderly diabetes patients(OR=1.063, 1.925, 1.081, 1.039, 0.138, 1.865, 5.145, 5.663; all P<0.05).

Carotid arterial diseases in elderly type 2 diabetes patients are resulted from many factors.Earlier intervention and controlling these factors will have clinic significance for prevention and treatment of type 2 diabetes.

To evaluate the correlation of serum lipoprotein(a) (Lp(a)) with diabetic nephropathy in hospitalized type 2 diabetes mellitus.

Lipid profile, blood glucose, serum creatinine and urinary albumin excretion rate (UAER) were measured in 1238 hospitalized type 2 diabetic patients from January 2007 to November 2008. The blood pressure, body weight and diabetes duration were recorded. Glomerular filtration rate (GFR) was estimated by the simplified MDRD equation. t test and multiple stepwise regression were used for data analysis.

There was no significant difference in serum Lp(a) level among different age group(F=1.144, P>0.05). Serum Lp(a) level of macroalbuminuria group was significantly higher than that of nomoalbuminuria or microalbuminuria group(F=4.113, P<0.05). The cohort was divided into four groups by the quartile of serum Lp(a). It was demonstrated that UAER was increased with serum Lp(a) level while GFR decreased (F=7.877 or 4.479, P<0.01). Lp(a) showed positive correlations with total cholesterol, low–density lipoprotein cholesterol (LDL–C) and UAER (r=0.152, 0.169, and 0.18, P<0.01) and a negative correlation with GFR (r=–0.061, P<0.01). Systolic pressure, Lp(a), LDL–C, GFR, and age were independent risk factors for UAER according to multiple stepwise regression analysis.

Serum Lp(a) level might be associated with the onset and progression of diabetic nephropathy regardless of age, diabetic duration and glycemic control.

To investigate the effects of sulodexide on 24–h urinary albumin excretion rate (UAER) and the mRNA or protein expression of transforming growth factor–β1 (TGF–β1) in diabetic rats induced by streptozotocin.

Thirty–three healthy eight–week–old male Sprague Dawley (SD) rats were randomly divided into the normal control group (n=11), diabetic group (n=11), and sulodexide intervention group (n=11). The last two groups were injected with streptozotocin (65 mg/kg) at abdominal cavity while the normal control rats were injected with saline after 10 hours' fasting. When fasting blood glucose was >16.7 mmol/L for 72 h, the rats were confirmed to be patterned successfully. Nine rats in the diabetic group and 10 rats in the sulodexide group entered the study. The dose of sulodexide was 10 mg·kg^–1·d^–1, and the other two groups were administrated with comparative normal saline for 12 weeks. Overnight urine was collected to assess 24–h UAER after 12 weeks' treatment, and the renal sections were handed by immunohistochemical staining and the expression of TGF–β1 mRNA was detected by RT–PCR. One–way analysis of variances and SNK or LSD test were used for data analysis.

24–h UAER were average 363 μg/min in the diabetes control group, 151 μg/min in the sulodexide intervention group, and 26 μg/min in the normal control group ( F=93.93, P<0.01). The expression of TGF–β1 mRNA were 3.11±0.84 in the diabetic group, 0.99±0.27 in the sulodexide intervention group, and 0.44±0.13 in the normal control group (F=80.43, P<0.01). The expression of TGF–β1 protein was most obvious in the endochylema of the renal tubule epithelium cells in diabetic rats, which was attenuated markedly by sulodexide.

Sulodexide may play an important role in renoprotection by decreasing UAER and down–regulating the expression of TGF–β1 mRNA and protein of the renal tissues in diabetic rats.

To study the effects of high blood glucose on expression of oncostatin M (OSM) in macrophages and the association of OSM with proliferation of human aortic smooth muscle cells.

Monocytic cell line THP–1 was incubated with PMA to induce macrophages. The human macrophage cell line–derived cytokines influenced by hyperglycemia (15 mmol/L) were screened by human cytokine antibody array, which was further confirmed by Western blot and ELISA. RT–PCR was used to determine the expression of OSM receptors GP130–OSMRβ and GP130–LIFR in human aortic endothelial cells, smooth muscle cells and macrophages. The effects of OSM on proliferation of human aortic smooth muscle cell was assessed using the XTT assay. One–way analysis of variances was used for data analysis.

Incubation with PMA induced mature macrophages. Human cytokine antibody array showed that high blood glucose up–regulated the expression of OSM in macrophages, which was further confirmed by Western blot and ELISA. The expression of GP130–OSMRβ and GP130–LIFR was found in human aortic endothelial cells, smooth muscle cells and macrophages. XTT assay showed that OSM promoted proliferation of human aortic smooth muscle cells. Compared with 0 μg/L OSM (OD=0.468±0.032), the proliferation of human aortic smooth muscle cells was significantly increased in 5, 10, 20 μg/L OSM (OD=0.503±0.026, 0.520±0.027, 0.513±0.026, respectively) (F=10.40, P<0.05)

High blood glucose could increase the expression and secretion of OSM in macrophages. OSM may promote the proliferation of human aortic smooth muscle cells by binding with its receptors, which partly involves in the development of diabetic macroangiopathy.

Diabetic retinopathy is a common chronic microvascular complication in diabetic patients, which is the main cause of blindness and visual impairment in diabetic patients. It has become a public health problem that threatens the quality of life of diabetic patients in China. For middle-aged diabetic patients, early diagnosis and treatment of chronic complications has its unique significance. However, there are no reports of retinopathy in middle-aged type 2 diabetic patients in China. We retrospectively analyzed the clinical data of middle-aged diabetic patients admitted to the Department of Endocrinology of our hospital from July 2002 to September 2008, aiming to understand the characteristics and influencing factors of retinopathy in middle-aged type 2 diabetic patients, and provide theoretical basis for effective clinical prevention, control and delay of diabetic retinopathy.

Diabetic peripheral vascular disease (PAD) is the main cause of diabetic foot and amputation, and its prevalence can reach 15%^[1]。 The traditional treatment of diabetic foot is based on active control of blood sugar and infection, local dressing change, improvement of whole body microcirculation, anticoagulation, plaque stabilization, hyperbaric oxygen therapy, barotherapy, etc. Amputation will be considered for patients with severe foot gangrene^[2,3]。 At present, it has been reported at home and abroad that percutaneous endovascular interventional surgery has good curative effect on diabetic lower limb vascular disease and diabetic foot^[4,5,6]。 Therefore, we selected 298 patients with type 2 diabetes mellitus combined with lower extremity vascular stenosis and occlusive disease, and divided them into interventional treatment group and traditional treatment group to compare the efficacy.

At present, there is evidence that surgical treatment can achieve lasting weight loss and diabetes remission in 50% to 85% of severely obese people, and significantly reduce patient mortality^[1]。 Among many surgical bariatric procedures, Roux-en-Y gastric bypass (RYGB) is one of the preferred treatments for severe obesity due to its long-term stable weight loss and improvement of insulin resistance. Because RYGB operation significantly reduces gastric volume, and the short hunger state before and after operation plays a role in controlling blood sugar, some scholars have previously believed that postoperative gastric volume reduction is one of the reasons for the improvement of diabetes. However, later studies found that after duodenal bypass with preserving gastric volume, diabetic obese patients only showed a short decrease in food intake. After a certain period of time, their food intake completely recovered or even exceeded that before operation, but these patients' blood sugar can still be well controlled and can remain normal for a long time^[2]。 Weight loss after surgery in obese patients has also been thought to be the cause of diabetes control. However, studies have shown that RYGB can cure diabetes within 1 to 2 weeks after surgery, while significant weight loss takes several months^[3]。 Therefore, it is considered that diet reduction and body mass decrease after RYGB are not the main reasons for blood sugar control and diabetes remission. So, by what mechanisms does RYGB alleviate type 2 diabetes? This paper expounds its possible mechanism from the following aspects.

As one of the important methods of diabetes management, blood glucose monitoring is of great significance to the diagnosis, treatment and prognosis of the disease, and has been paid more and more attention by medical staff and patients. As a common instrument for blood glucose monitoring, portable blood glucose meter is convenient to carry and simple to operate, and can accurately and truly reflect the blood glucose level of patients. However, in clinical work, some factors affect the accuracy of blood glucose monitoring results to varying degrees. Below, these influencing factors are briefly introduced from the two aspects of the blood glucose meter itself and the user.

The defect of islet β cell function is one of the important pathophysiological mechanisms in the development of diabetes. At present, there are many methods to assess the function of pancreatic islet beta cells, including detection of insulin pulse-like secretion pattern and stimulation test of pancreatic islet beta cell secretion (glucose stimulation test and non-glucose stimulation test). Each method has its own advantages and disadvantages, and should learn from each other's strengths and weaknesses in clinical application and be applied reasonably.

This article focuses on the central content of the special presentation of the 69th American Diabetes Association (ADA) Congress, especially the latest achievements in basic research on diabetes and the latest advances in its clinical application.

The 69th Annual Meeting of the American Diabetes Society had a special report on "Cancer and Diabetes". Three speakers presented from three aspects: epidemiology, the relationship between insulin resistance and cancer, and the relationship between hypoglycemic therapy and cancer.

At the 69th Annual Meeting of the American Diabetes Association (ADA) in New Orleans, a series of reports once again pushed the study of the relationship between diabetes and cardiovascular disease to a new climax, including: Evaluating the effects of rosiglitazone on cardiac endpoints and glycemic control in diabetes (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes, RECORD) The results of the study and the Bypass Angioplasty Revascularization Investigation in Type 2 Diabetics (BARI2D) study were published; Further analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the Veterans Affairs Diabetes Trial (VADT); Current thematic forums on cardiovascular risk assessment and management of diabetes mellitus and research on intervening cardiovascular risk factors in prediabetes, among others.

The 69th Annual Meeting of the American Diabetes Association (ADA) conducted a special discussion on ambulatory blood glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII). The main research progress is briefly summarized below.

At the 69th Annual Meeting of the American Diabetes Society (ADA), Professor Robert from the Center for Endocrinology and Metabolism at the University of California, San Diego, led a symposium on "New Therapies for Type 2 Diabetes". Four scholars from around the world reported their findings.

For a long time, the diagnosis of diabetes mainly depends on fasting plasma glucose or oral glucose tolerance test. However, this traditional diagnostic method will face challenges. At the 69th Annual Meeting of the American Diabetes Society (ADA), an international expert committee composed of ADA, International Diabetes Federation (IDF) and European Association for Diabetes Research (EASD) jointly recommended that glycated hemoglobin HbA1c be used as a new method of diabetes diagnosis, which aroused great repercussions and became one of the hot spots of this annual meeting.

According to a 2008 report by Thomson Reuters Technologies Group^[1]In the 10 years from January 1, 1998 to June 30, 2008, there were 554,478 papers included in the Science Citation Index (SCI) in China, ranking fifth in the world; It was cited 2,495,294 times, ranking 10th in the world; The average number of articles cited was 4.5 times, ranking 11th in the world. In addition, the 10 disciplines with the highest international visibility in China do not include clinical medicine (pharmacology ranks 8th), which is extremely disproportionate to the status of a huge country with a population of 1.3 billion and rich clinical resources. China's clinical medical research field is one of the most promising scientific research fields for major original innovation. As an editor of medical journals, I often feel sad and worried when I see that valuable clinical data have not been properly summarized and analyzed, and some shoddy medical papers and medical journals are filled with my vision. In this paper, combined with the practice of medical journal editing, the following views are put forward and discussed with domestic medical scientific researchers.

Defective insulin secretion and insulin resistance are the main pathogenesis of type 2 diabetes. During the course of type 2 diabetes, chronic persistent hyperglycemia promotes the decline of pancreatic islet beta cell function. Previous studies have found that blood sugar fluctuation plays a more important role in initiating oxidative stress response and promoting diabetic complications than chronic persistent hyperglycemia. However, the relationship between blood glucose fluctuations and islet beta cell function in type 2 diabetes remains unknown.

Patients with type 2 diabetes are at high risk for cardiovascular events. Previous studies have shown that increasing insulin sensitivity can improve the outcome of cardiovascular events more effectively than increasing insulin secretion, and coronary revascularization can significantly reduce the incidence of myocardial infarction and mortality in patients with acute coronary syndrome. However, the efficacy of these therapeutic measures in diabetic patients with myocardial ischemia has not been established. Therefore, researchers conducted a study on the effectiveness of revascularization therapy and insulin sensitizer therapy in reducing cardiovascular events and mortality in patients with type 2 diabetes and coronary heart disease.

The high incidence of atherosclerosis in diabetic patients leads to a continuous increase in coronary heart disease (CHD, myocardial infarction and death). Currently, there are two types of treatment strategies for diabetic cardiovascular events, one is pharmacological therapy (lifestyle intervention, glycemic control and active secondary prevention), and the other is cardiac catheter-based interventional therapy and revascularization surgery.

Glucagon-like polypeptide-1 is secreted by intestinal L cells, which can delay gastric emptying, regulate feeding, and have the function of stimulating insulin secretion and inhibiting glucagon secretion in a glucose concentration-dependent manner. However, glucagon-like polypeptide-1 can be rapidly degraded by dipeptidyl peptidase-4. Liraglutide is an analogue of human glucagon-like polypeptide-1. The arginine at position 34 is replaced by lysine, and the palmitic acid side chain at position C-16 is connected to the glutamyl group. Its structural change can delay the absorption of the drug through subcutaneous tissue, and reversibly bind to protein, delaying the degradation rate by dipeptidyl peptidase-4. The researchers compared the efficacy and safety of liraglutide and the glucagon-like polypeptide-1 receptor agonist exenatide.

Peroxisome proliferator-activated receptor (PPAR) agonists have attracted much attention due to their cardiovascular side effects. (PPAR) -α agonists can significantly improve blood lipid levels in patients with type 2 diabetes, while (PPAR) -γ agonists have been widely used for glycemic control therapy in patients with type 2 diabetes. However, the problems of fluid retention, weight gain and congestive heart failure caused by drug therapy are gradually emerging. (PPAR) -α/γ dual agonist deglitzar can effectively control blood sugar, improve blood lipid levels, and minimize related side effects such as weight gain and edema during treatment. To this end, Robert et al. conducted a study on the efficacy and safety of alogliza in the treatment of type 2 diabetes.

Adiponectin has anti-inflammatory and insulin sensitizing effects, and can predict the risk of type 2 diabetes. However, it is not clear whether the protective effect of this factor on type 2 diabetes is consistent among different populations and its dose-effect relationship. A recently published systematic review and meta-analysis attempted to answer this question.

Statins have a clear effect in the secondary prevention of coronary heart disease, which can reduce all-cause mortality and recurrence of cardiovascular disease in patients with coronary heart disease. However, it is inconclusive whether it is beneficial for people without coronary artery disease but with cardiovascular risk factors, and whether its efficacy differs between gender, age, and between diabetic and non-diabetic patients.