Volume 01 · Issue 05 · 2009

Since entering the 21st century, diabetes has spread rapidly all over the world, bringing great burden to human society. Chinese people are susceptible to diabetes. With the aggravation of social aging, the improvement of living standards and the increase of obese people caused by bad lifestyle, the situation of diabetes prevention and treatment in China is becoming increasingly severe. Since the first epidemiological survey of diabetes in China was carried out in 1980, the prevalence of diabetes has increased from less than 1% at that time to about 10% at present, becoming the third most serious threat to human health after tumors and cardiovascular diseases. Chronic disease. Faced with huge challenges, China's diabetology community has made fruitful progress in epidemiological investigation, basic research and clinical treatment of diabetes in recent decades. At the same time, it has vigorously carried out diabetes health education, strengthened early prevention of diabetes, and minimized all kinds of harms caused by diabetes and its complications through early detection, early screening, early diagnosis and effective intervention.

In October 2009, our great motherland celebrated its 60th anniversary. 60 years, glory days in the blink of an eye; In the past 60 years, the land of China has become a mulberry field. 60 years of pursuit and exploration, spring breeze and autumn rain walked together; 60 years of abundance and brilliance, spring and autumn fruit together witness. Looking back at the road, every step forward is full of hardships and hardships. This is true of the country, and so is the progress of medical science.

Diabetes mellitus in children and adolescents is a common endocrine disease in pediatrics. In the past 60 years, great progress has been made in the diagnosis and treatment level, diabetes education and long-term management of children and adolescents in China, and the self-affirmation awareness and quality of life of diabetic children have been continuously improved. Among them, the gradual improvement and systematization of diabetes management enables children with diabetes to obtain early diagnosis and regular treatment, reduces the occurrence of acute and long-term complications, reduces the mortality and disability rate of childhood diabetes, and lays a foundation for the further development of diabetes diagnosis and treatment.

In recent years, epidemiological investigations show that the prevalence of diabetes among adults in China has reached 10% or more in large and medium-sized cities, and exceeds 5% in rural areas. Impaired glucose tolerance is also very common. Due to the very high proportion of abnormal blood sugar in the background population, hospitalized patients, especially critically ill patients, are often accompanied by hyperglycemia.

To constitute a crowd of multiple familial type 2 diabetes mellitus(T2DM) and to observe the effects of several risk factors of hypertension, lipid metabolic disorder, obesity and insulin resist.

According to American Diabetes Association criteria of diabetes, pedigrees with two or over two T2DM patients were chosen and all people were diagnosed by OGTT.Eight hundred and sixty–five persons from 182 pedigrees with two or more T2DM patients were analyzed after the type 1 diabetes mellitus, maturity onset diabetes of the young(MODY) and mitochondrial gene mutation pedigrees were excluded.The survey includes tests of blood glucose, insulin, C–peptide, lipids, etc.

The prevalence of T2DM and impared glucose regulation impaired glucose regulation(IGR) was 59.88%, the prevalence of T2DM was 45.43%, including 94 T2DM and 102 IGR newly discovered, the prevalence of T2DM and IGR in the diabetes family was significant higher than those in the common populations. The systolic pressure, diastolic pressure blood lipid, BMI, HOMA–IR in diabetic group were obviously higher than those in IGR group or normal group.

There is significant familial aggregation in T2DM.The history of hypertension and hyperlipidemia and obesity are the risk factors of T2DM or IGR patients.Insulin resistance exists before the attack of diabetes mellitus.

To understand the prevalence of diabetic retinopathy (DR) and its risk factors.

The cluster multistage sampling was conducted in a total of 2276 patients with type 2 diabetes living in the urban area of Benxi who received mydriasis funduscopy or fundus fluorescein angiography. The clinical data were collected. Grouping was based on different risk factors and other complications. Statistical analysis was carried with SPSS 13.0 software.

The prevalence of DR was 31.81%. DR was increased with age(χ²=25.037, P<0.05), and reached up to 37.37% in the patients over 65 years old. DR was also increased with the duration of diabetes(χ²=109.873, P<0.05), and reached up to 53.81% in the patients with disease over 20 years. Smoking, hypertension, hyperlipidemia, diabetes family medical history, hyperuricemia, HbA1c≥8%, and combinant coronary heart disease or diabetic polyneuropathy (DPN) could increase the prevalence of DR. The tea consumption decreased the prevalence (χ²=9.977, P<0.05) and the severity (χ²=7.267, P<0.05) of DR.

Old age, longer duration of diabetes, smoking, hypertension, hyperlipidemia, diabetes family medical history, hyperuricemia, HbA1c≥8%, and combinant coronary heart disease or DPN may be the risk factors of DR. Tea consumption may delay the development of DR.

To observe the efficacy and safety of insulin aspart in intensive insulin therapy of hyperglycemia in medical critically ill patients.

A total of 186 medical critically ill patients with fasting blood glucose (10.8±2.3)mmol/L were divided into multiple daily insulin(MDI) group(n=90) and continous subcutaneous insulin infusion (CSII) group(n=96), both groups were divided into insulin aspart subgroup and human regular insulin subgroup randomly.Bonus dosage was offered by insulin aspart or human regular insulin in MDI group, base dosage was offered by Glagine.Bonus and base dosage were offered by insulin aspart or human regular insuline in CSII group.The dosage of insulin was adjusted according to multi–points blood glucose levels. The course of intensive insulin therapy was 7 days with blood glucose levels 4.4~8.3 mmol/L, and it was changed to regular insulin therapy after 7 days with blood glucose levels 4.4~11.1 mmol/L. Average blood glucose level, blood glucose standard deviation, the equation of the highest and the lowest blood glucose level in one day, percentage of total hypoglycemia and serious hypoglycemia, average insulin dosage, decline of blood CRP level and APACHEⅡ during 7 days, and mortality during twenty eight days were observed.

(1) There were no statistical significance in difference on lab items before intensive insulin therapy in both subgroups. (2)Compared to human regular insulin subgroup, insulin aspart subgroup was lower in average blood glucose level. MDI group: (6.17±1.32) mmol/L vs (7.6±1.6) mmol/L; CSII group: (6.0±1.2) mmol/L vs (7.4±2.5) mmol/L, P<0.05 respectively. Standard deviation MDI group: (1.54±0.27)mmol/L vs (1.92±0.38) mmol/L; CSII group: (1.24±0.27)mmol/L vs (1.83±0.45) mmol/L, respectively(P<0.05). The equation MDI group: (3.0±0.5)mmol/L vs (3.9±1.1) mmol/L; CSII group: (3.1±0.6) mmol/L vs (3.9±1.0) mmol/L, respectively(P<0.05). CSII group were lower in seventh day of intensive insulin therapy; average insulin dosage was less (MDI group: (38±3)U/d vs (42±4)U/d; CSII group: (37±4)U/d vs (40±6)U/d,P<0.05 respectively), percentage of total hypoglycemia (MDI group: 17.4% vs 27.3%; CSII group: 8.0% vs 17.4%,P<0.05 respectively) and serious hypoglycemia (MDI group: 4.3% vs 15.9%; CSII group: 2.0% vs 6.5%,P<0.05 respectively) was lower during seven days, decline of blood CRP level during seven days was more obvious (MDI group: (44.8±1.6) mg/L vs (27.8±1.2) mg/L; CSII group: (57.7±2.4)mg/L vs (36.7±1.2)mg/L,P<0.05 respectively), decline of APACHE Ⅱduring seven days was more obvious (MDI group: (7.5±2.1) score vs (4.3±1.1) score; CSII group: (8.4±1.3) score vs (6.1±1.5) score,P<0.05 respectively); mortality was not different in statistical during twenty eight days (MDI group: 13.0% vs 13.6%; CSII group: 6.0% vs 6.5%,P>0.05 respectively).

Insulin aspart can better control average blood glucose and its variability, lower the percentage of hypoglycemia, save insulin dosage and relieve inflammation than human regular insulin in treating hyperglycemia of medical critically ill patients.

To evaluate autonomic nervous function of type 2 diabetes mellitus with lower extremity neuropathy.

Clinical and laboratory data of 117 type 2 diabetes mellitus (T2DM) patients and 50 healthy controls in Metabolism Hospital of Tianjin Medical University were analyzed between January 2008 and March 2009 and divided into 58 type 2 diabetes mellitus with lower extremity neuropathy (T2DM 1 group) , and 59 type 2 diabetes mellitus without lower extremity neuropathy (T2DM 2 group). Heart rate variability(HRV) analysis and its circadian rhythm(CR) were determined from 24–hour Holter recording. Body mass index(BMI), systolic blood pressure(SBP), diastolic blood pressure(DBP), triglyceride(TG), total cholesterol(TC), high–density lipoprotein–cholesterol(HDL–C), low–density lipoprotein–cholesterol(LDL–C), fasting blood sugar(FBS), postprandial 2 h blood sugar(2 h PBS), glycated hemoglobin A–1c(HbA1c), fasting insulin(FINS), HOMA–IR, valsalva movement response index, 30/15 ratio, the difference in respiration, were measured. ANOVA, χ ² test, and rank sum test were used for data analysis.

(1) Timing domain parameter of HRV , standard deviation of all normal R–R intervals(SDNN)(F=94.702, P<0.01), standard deviation of the average normal R–R intervals for 5–minute segments(SDANN)(F=77.786, P<0.01), mean of the standard deviation of all normal R–R intervals for 5–minute segments (SDNNIDX)(F=55.422, P<0.01), root mean square successive difference ( rMSSD)(F=56.175, P<0.01), of differences between adjacent normal R–R intervals >50ms, (pNN50)(F=49.110, P<0.01)were significantly decreased in group T2DM 1 and T2DM 2. (2) Timing domain parameter of HRV in healthy controls , rMSSD, pNN50 was decreased in daytime((31±15) ms, 4%(0~45%), respectively)and increased in nighttime(35(14~107)ms, (11.5%(0~54%), respectively), (t=4.629, 5.007, P<0.01), respectively), but SDNN was increased in daytime ((113±20)ms) and decreased in nighttime((104±25)ms) (t=2.472, P=0.013). CR of HRV , SDNN ((81±16) , (77±19))ms, (t=1.952, P=0.051) was changed in T2DM 1 . CR of HRV, SDNN((64±15), (64±20))ms, (t=0.155, P=0.877), rMSSD((21±19), (22±21))ms, (t=1.103, P=0.270), pNN50 1%(0~30%), 1%(0~28%), (t=1.328, P=0.184) were disappeared in T2DM.

Impaired and serious impaired vegetative nervous function in type 2 diabetes mellitus without and with lower extremity neuropathy. CR of HRV is a useful parameter in assessing autonomic nervous function of type 2 diabetes mellitus without and with lower extremity neuropathy.

To compare the plasma endogenous secrection receptor for advanced glycation end products (esRAGE) level between normal subjects and type 2 diabetes mellitus (T2DM) patients, and to investigate whether the esRAGE is associated with diabetic peripheral neuropathy in T2DM patients.

A total of 24 cases of normal subjects and 61 cases of T2DM patients were involved in the study, and then the patients were divided into two groups, that was, patients with diabetic peripheral neuropathy (DPN) group and without diabetic peripheral neuropathy (non–DPN) group. Plasma esRAGE was measured with Enzyme linked immunosorbent assay (ELISA). Myoelectricity evoked potential equipment was applied to detect nerve conduction studies. Blood pressure, body mass index, fasting plasma glucose, HbA1c, and plasma lipids level were measured as well. Student t test and nonparametric statistics were applied to analysis data between two groups and the related factors of DPN were investigated with logistic regression analysis.

The plasma esRAGE level did not show significant difference between normal subjects and T2DM patients ((0.28±0.13) μg/L vs (0.25±0.15) μg/L, P>0.05). However there was significant different between DPN group and non–DPN group in patients ((0.21±0.14) μg/L vs (0.33±0.13) μg/L,P<0.05). The logistic regression analysis showed DPN was associated with age, HbA1c, and esRAGE in T2DM patients.

The plasma esRAGE level has not significant difference between T2DM patients and normal subjects. The plasma esRAGE level is a protective factor for DPN , on the contrary age and HbA1c are risk factors for DPN in T2DM patients.

To explore the renoprotective effect of reduced glutathione on streptozotocin–induced diabetic rats and its possible mitochondrial mechanism in the kidneys.

After the diabetic rat models were induced by intraperitoneal injection of streptozotocin (STZ), the diabetic rats were randomly divided into non–treated group (DM), and reduced glutathione–treated group (DM+ GSH). The normal non–diabetic rats were served as the control group (NC). Eight weeks later, the excretion of urinary albumin excrection rate(UAER), serum creatinine(SCr) and serum urea nitrogen(BUN) were detected. Morphological changes of the kidney were observed by optics microscope. The levels of malondialdehyde (MDA)and the activity of superoxide dismutase (SOD) in serum and renal cortex were detected. Meanwhile, kidney mitochondrial membrane potential and mitochondrial swelling were measured between the different groups.

Compared with the NC group, the excretion of UAER, SCr and BUN were significantly increased (all P<0.05), and pathological changes of diabetic nephropathy occured in the DM group.The levels of MDA in serum (μmol/L) and renal cortex(μmol/g) were significantly elevated (5.59±1.028 vs 2.97±0.77, 4.80±0.83 vs 2.98±0.75, allP<0.01), and the activity of SOD in serum(U/ml) and renal cortex(U/mg) was significantly reduced in the DM group(89.13±22.73 vs 124.1±9.27, 46.05±10.24 vs 89.89±17.62, allP<0.01). The kidney mitochondrial membrane potential was significantly decreased(495.79±124.71 vs 965.77±246.48,P<0.05), and mitochondrial swelling was weaken in the DM group.Compared with the DM group, the excretion of UAER, SCr and BUN were significantly decreased (allP<0.05), and above abnormal pathological changes were improved in the DM+ GSH group.The levels of MDA in serum (μmol/L) and renal cortex(μmol/g)were significantly reduced (4.15±0.59 vs 5.59±1.03, 3.39±0.61 vs 4.80±0.83, allP<0.05), and the activity of SOD in serum(U/ml) and renal cortex(U/mg) was significantly elevated in the DM+ GSH group (112.92±8.93 vs 89. 13±22.73, 83.15±16.75 vs 46.05±10.24, allP<0.05). The kidney mitochondrial membrane potential was significantly elevated (715.97±188.65 vs 495.79±124.71,P<0.05)and mitochondrial swelling was reinforced.

Reduced glutathione could ameliorate the function of mitochondria in the kidneys of STZ–induced diabetic rats to show nephroprotective effect.

To investigate the effect of peroxisome proliferators–activated receptor α ligand (fenofibrate) on free fatty acid–induced impairment in islet microvascular endothelial cells.

Islet microvascular endothelial cell line, MS–1 cells, was co–incubated with PPAR–α ligand fenofibrate and palmitate. MTT viability assay and flow cytometry were used to analyze the effect of fenofibrate on FFA–induced impairment of islet microvascular endothelial cells. The concentrations for NO, SOD and MDA in the culture solution were tested by ultraviolet spectrophotometry.

MS–1 growth rates of the control group, FFA group and fenofibrate intervention group were (100.0±0.7)%, (16.2±0.8)% and (26.8±0.8)% respectively, and the difference was statistically significant (P<0.001); MS–1 apoptotic rates of the three groups were (4.80±2.07)%, (26.31±1.78)% and (19.20±1.90)% respectively, and the difference was statistically significant (P<0.001); NO concentrations were (6.61±0.65), (2.48±0.62), (4.11±0.33)μmol/L respectively, and the difference was statistically significant (P<0.001); SOD level of each group was (20.29±1.10), (15.10±0.40) and (16.46±0.73) U/ml respectively, and the difference was statistically significant (P<0.001); MDA levels were (4.44±0.98), (8.26±0.85) and (5.56±0.91)μmol/L respectively, and the difference was statistically significant (P<0.001).

FFA can mediate distinctive lipotoxicity and oxidative stress to islet microvascular endothelial cells, and application of PPAR–α ligands may be valuable in protecting islet microvascular endothelial cells from FFA cytotoxicity.

To study the association of proteasome subunit alpha type 6 (PSMA6) gene –8C/G polymorphism with obesity and insulin resistance in diabetic patients of Dongxiang Nationality.

The genotypes of –8C/G variant in PSMA6 gene were determined by polymerase chain reaction–restriction fragment length polymorphisms assay in 117 patients with type 2 diabetes mellitus and 144 individuals with normal glucose tolerance (NGT) from March 2006 to March 2008. According to body mass index (BMI) or insulin resistance index (HOMA–IR), the patients in the type 2 diabetes mellitus group and NGT group were assigned into the obesity subgroup and normal body weight subgroup or insulin resistance subgroup and non–insulin resistance subgroup, respectively. Meanwhile, the fasting insulin and glucose levels were measured via radioimmunoassay.

The genotype or allele frequencies of –8C/G variant in PSMA6 gene of type 2 diabetes mellitus group was significantly different from that of the NGT group (χ²=5.805, P=0.016), either between patients with obesity and normal body weight subjects (χ²=11.584, P=0.001), or between patients with insulin resistance and non–insulin resistance subjects (χ²=4.506, P=0.034). Moreover, the frequency of CG+ GG genotype and allele C of insulin resistance subjects was significantly higher than that of the non–insulin resistance subjects in the NGT group(χ²=6.265, P=0.012; χ ²=4.572, P=0.033).

The PSMA6 –8C/G polymorphism is associated with diabetes and insulin resistance and closely related to obesity in people of Dongxiang Nationality.

To investigated the role of miRNA–375 and V1 in the free fatty acids (FFAs) mediated β cell apoptosis(lipoapoptosis).

We transfected mouse β–cell line NIT–1 with miRNA–375 or antisense oligonuleotide(2'–O–me–375) to enhance or specifically inhibit miRNA–375 function, then investigated the change in the percentage of apoptotic cells upon one type of long–chain–FFA palmitate challenge (500 μmol/L for 48 h) using Hochest 33342 and terminal deoxynucleotidyl transferase–mediated deoxyuridine triphosphate nick end–labeling (TUNEL) staining, V1 protein level using Western blotting.

Overexpression of miRNA–375 was associated with enhanced pancreatic β–cell lipoapoptosis (Hochest 33342 stained apoptotic cells: from (14.85±3.22)% to (26.96±8.29)%; TUNEL positive cells: from(13.68±3.73)% to (22.7±9.14)%, P<0.001). In contrast, inhibition of endogenous miRNA–375 function by 2'–O–me–375 suppressed the lipoapoptosis(Hochest 33342 stained apoptotic cells: from (14.85±3.22)% to (5.23±2.27)%; TUNEL positive cells: from (13.68±3.73)% to (4.82±2.27)%,P<0.001). Meanwhile the protein level of V1 was inversely correlated with the percentage of palmitate–induced apoptotic NIT–1 cell.

miRNA–375 is a regulator of lipoapoptosis of mouse pancreatic β cell, and down–regulation of V1 by miRNA–375 may be involved.

Blood glucose level is a direct reflection of islet β cell function, and islet β cell function defect is the main mechanism of hyperglycemia in type 2 diabetes mellitus. Only when islet β cell function defect is insufficient to maintain glucose metabolism homeostasis can cause clinical hyperglycemia manifestations. Hyperglycemic status severely affects islet beta cell function. Hyperglycemia acts in two ways, chronic persistent hyperglycemia and chronic fluctuating hyperglycemia. Glycosylated hemoglobin (HbA1c) reflects long-term glycemic control levels but does not reflect the magnitude of blood glucose fluctuations, and even if HbA1c levels are similar, the magnitude of blood glucose fluctuations may differ significantly. The increase of blood glucose fluctuation is a sign of aggravation of glucose metabolism disorder, and it is also a manifestation of gradual decline of pancreatic islet β cell function. Studies have shown that type 2 diabetes not only increases blood glucose levels, but also significantly increases blood glucose fluctuations^[1]。 In this study, HbA1c reflected the blood glucose control level of type 2 diabetes mellitus, and CGMS monitored the blood glucose fluctuation to observe the blood glucose homeostasis, and explored the influence of blood glucose stability on the function of pancreatic islet β cells, so as to control the blood glucose level (quantity) and pay attention to the blood glucose fluctuation (quality), so as to protect the function of pancreatic islet β cells and provide certain basis for clinical treatment.

Diabetes has become one of the diseases with the highest incidence and the most serious threat to human health in the world. In recent years, the incidence of diabetes has been increasing, and the incidence is becoming younger. Therefore, the prevention and treatment of diabetes mellitus has become a hot spot in medical research at present. Due to the disorder of insulin production or the inability of insulin to fully exert its physiological role, diabetic patients cause glucose metabolism disorders, resulting in macrovascular and microvascular diseases, which in turn lead to a series of complications (including atherosclerosis, ischemic necrosis of limbs, retinopathy and renal failure). Although insulin therapy can improve the glucose metabolism disorder in patients to some extent, this method cannot effectively prevent or reverse the vascular disease and its complications caused by diabetes. Pancreas or islet transplantation is an effective method for treating diabetes mellitus. Recent studies have shown that pancreas or islet transplantation can not only correct glucose metabolism disorders, but also effectively prevent or reverse vascular lesions and their complications caused by diabetes mellitus. These findings clearly suggest that pancreatic or islet transplantation is an insulin replacement therapy, and preventing or reversing vascular lesions in diabetes may become a new evaluation index for pancreatic or islet transplantation in the treatment of diabetes. This paper will summarize the research progress in this area.

Fat is an important energy storage tissue in human body, and the disorder of lipid metabolism in adipose tissue is closely related to hypertriglyceridemia, type 2 diabetes and obesity. Fat metabolism genes in adipose tissue regulate the balance of adipogenesis and decomposition. In the past, lipogenic genes have been studied, but the knowledge of lipolytic genes is limited to hormone-sensitive lipase (HSL). With the birth of HSL knockout mice in 2000^[1]It was found that there was no obesity or only diglyceride deposition, indicating that there should be more important enzymes controlling the hydrolysis of fat. In 2004, Zimmermann^[2]A new lipolytic gene, adipose triglyceride lipase (ATGL), was discovered. This paper reviews the recent research of this gene.

Diabetic foot disease refers to foot infections, ulcers, and/or deep tissue destruction associated with regional neurological abnormalities and distal peripheral vascular lesions of the lower extremities that occur in diabetic patients. Diabetic foot disease is a serious chronic complication of diabetes. All layers of tissue from the skin of the foot to bones and joints can be involved. In severe cases, local or total foot gangrene can occur, requiring amputation. Amputation can seriously affect the quality of life of patients and increase the risk of contralateral amputation. Diabetic foot disease can be delayed, or it can develop rapidly. In a short time, the condition will turn for the worse, and in severe cases, it can lead to disability or even death. Diabetic foot disease is more common in elderly diabetic patients, especially those with multiple diabetic complications^[1]。

The main pathogenesis of type 2 diabetes mellitus (T2DM) is islet hypofunction and insulin resistance. The decrease of the number of beta cells in pancreatic islets is one of the reasons for the defect of insulin secretion in pancreatic islets. Promoting β cell regeneration to increase the number of β cells and protect the islet function of patients has become a hot spot in the treatment of T2DM. This article will summarize the relationship between beta cell neogenesis and T2DM.

On August 14 – 16, 2009, the 6th Asia-Pacific Conference on Diabetic Foot and Limb Diseases and the 5th National Conference on Diabetic Foot and Lower Limb Vascular Diseases were grandly held in Beijing. Professor Robert G. Frykberg and Professor Benjamin A. Lipsky from the United States gave a detailed and in-depth explanation on diabetic foot disease co-infection.

Multiple studies have confirmed that intensive hypoglycemic therapy in patients with type 2 diabetes can slow the progression of microvascular lesions, but its effect on macrovascular lesions remains uncertain. Recently, both the ADVANCE and ACCORD studies confirmed that intensive hypoglycemic therapy did not significantly reduce the incidence of cardiovascular events, and the ACCORD study was forced to terminate early due to the significantly higher mortality in the intensive hypoglycemic therapy group. Therefore, scholars designed the Veterans Diabetes Controlled Study (VADT) to explore the effect of intensive hypoglycemic therapy on the incidence of cardiovascular events in patients with type 2 diabetes.

Type 2 diabetes is more prevalent in people with ethnic genetic backgrounds. This study assessed differences in the incidence of diabetes among Caucasians, Japanese Americans, and native Hawaiians by analyzing population data from the Hawaiian region in the Multi-Ethnic Cohort Study (MEC).

Studies have shown that with the prolongation of diabetes, the amount of pancreatic islet beta cells in patients decreases progressively, and many preparations can promote the regeneration of pancreatic islet beta cells. However, most studies on the effects of these agents on islet beta cell numbers have been conducted in vitro or in rodent models, making it difficult to directly apply the results to humans. To this end, Juris J. Meier et al. conducted a study to explore whether the islet β cell area can be evaluated by measuring the human insulin secretion function.

Epidemiological studies have shown that short stature is associated with metabolic diseases, hypertension and cardiovascular diseases, but its relationship with microvascular complications of diabetes is unclear. To this end, Wadén et al. analyzed data from the Finnish Diabetic Nephropathy Study (FinnDiane) and the Diabetes Control and Complications Trial (DCCT). A total of 3968 adult patients with type 1 diabetes, mean age (37.8±11.5) years, duration of diabetes (23.0±12.0) years, age of onset of diabetes (14.8±8.5) years, mean height (177.3±7.0) cm, were enrolled in the FinnDiane study,<18-year-olds accounted for 67.4%. A total of 1246 adult patients with mean age (28.7±5.7) years, duration of diabetes (5.8±4.3) years, age of onset (22.9±7.2) years, and mean height (178.7±7.1) cm were included in the DCCT study,<18-year-olds accounted for 25.6%. The results showed that patients in the lowest quartile of height in the FinnDiane study had a significantly increased risk of developing diabetic nephropathy than other patients (OR＝1.71，95%CI1.44 to 2.02,P<0.001), the risk of laser treatment for retinopathy is also significantly increased (OR＝1.66, 95%CI1.43 to 1.93,P<0.001)。 Similarly, patients in the lowest quartile of height in the DCCT study had grade 4 to 6 diabetic nephropathy (HR＝2.70，95%CI1.59 to 4.59,P<0.001) and the risk of proliferative retinopathy (HR＝2.06，95%CI1.15 to 3.71,P=0.016) both increased. Researchers believe that the correlation between body size and microvascular complications in adults with type 1 diabetes may be related to the following reasons: (1) premature development of diabetes in childhood; (2) "Common soil" hypothesis, that is, there are factors that contribute to both short stature and diabetes complications. In conclusion, the study suggests a higher incidence of microvascular complications in short-statured adults with type 1 diabetes, and understanding their specific mechanisms may be useful in developing relevant prevention strategies. – – Translated from Adult stature and diabetes complications in patients with type 1 diabetes: the FinnDiane Study and the Diabetes Control and Complications Trial. Diabetes, 2009, 58: 1914 – 1920.

Years ago, it was recognized that a previous meal of food could affect blood sugar levels at the next meal. However, intravenous and oral glucose tolerance tests did not show a second meal in patients with type 2 diabetes. To this end, the researchers designed the present study to determine whether there is a second meal phenomenon in patients with type 2 diabetes.

Previous studies have confirmed that intensive hypoglycemic therapy can lead to a decrease in blood sugar and glycosylated hemoglobin levels, significantly reducing the risk of diabetic complications. This paper will systematically expound the composition, measurement methods, individual differences and influencing factors of glycosylated hemoglobin, discuss the limitation of mean blood glucose replacing glycosylated hemoglobin, and explore the best clinical indicators of blood glucose control.

The latest research by Utzschneider et al. shows that the insulin secretion/insulin sensitivity index (IS/IR) calculated based on plasma glucose and insulin concentrations in oral glucose tolerance tests IS negatively correlated with multiple blood-taken intravenous glucose tolerance tests. This index IS a common method to assess pancreatic islet β cell function and insulin resistance, and can predict the future risk of type 2 diabetes in Japanese Americans.

Diabetes mellitus is one of the risk factors for mild cognitive dysfunction, vascular dementia, and Addison's disease. However, the relationship between the degree of blood glucose increase and cognitive function status is still unclear. To this end, the researchers carried out the ACCORD-MIND study on the basis of the ACCORD randomized controlled trial (a total of 10 251 diabetic patients with glycosylated hemoglobin>7.5% and cardiovascular risk factors were included to observe whether controlling blood sugar, blood pressure and blood lipids within the normal range can significantly reduce the incidence of cardiovascular events in patients with type 2 diabetes) to observe whether relevant interventions can slow down the occurrence of cognitive dysfunction and brain structural changes in 2,977 patients. The researchers used four cognitive function assessment methods, namely DSST, MMSE, RAVLT and Stroop Test, to observe the relationship between cognitive function scores, glycated hemoglobin and fasting blood glucose after adjusting for age and other factors.