Volume 03 · Issue 01 · 2011

We all often encounter this question-how can clinicians balance scientific research with their busy work? Let's talk about some of our experiences and experiences.

Blood glucose monitoring is an important part of diabetes management, and its results are helpful to evaluate the degree of glucose metabolism disorder in diabetic patients, formulate reasonable hypoglycemic regimen, reflect the effect of hypoglycemic treatment and guide the adjustment of treatment regimen. With the progress of science and technology, blood glucose monitoring technology has also developed rapidly, which makes blood glucose monitoring more and more accurate, comprehensive, convenient and less painful. At present, clinical blood glucose monitoring methods include self-blood glucose monitoring (SMBG) by blood glucose meter, dynamic blood glucose monitoring (CGM) for continuous blood glucose monitoring for 3 days, glycosylated serum albumin (GA) reflecting the mean blood glucose level of 2 to 3 weeks and glycosylated hemoglobin (HbA1c) measurement of the mean blood glucose level of 2 to 3 months. Among them, patients undergoing SMBG is the basic form of blood glucose monitoring, HbA1c is the gold standard reflecting the long-term blood glucose control level, and CGM and GA are effective supplements to the above monitoring methods.

As early as the first half of the 20th century, it was found that goat beans may be used to treat diabetes, and their rich guanidines and related molecules are active ingredients that can exert biological effects. Werner and Bell first synthesized metformin at Trinity College, Dublin, Ireland in 1921^[1,2]。 It was later reported that the use of this compound in animal models with fever had a biological effect of lowering blood sugar^[2]。 Slotta and Tschesche reported the synthesis of nine biguanides with large structural variations, among which 1,1-dimethylbiguanide had the strongest hypoglycemic effect^[3]。 Hesse and Taubmann^[4]A more comprehensive study of the biological effects of a range of alkyl-substituted biguanides, and pharmacological tests in dogs and rabbits, again found that metformin had the strongest hypoglycemic effect in these animals. Jean Sterne, a clinician in Paris, France, is regarded as a key figure in the discovery of metformin as an oral antidiabetic drug. He cooperated with pharmacist Denis Duval to discover the potential of metformin in the treatment of diabetes in 1957 and named it LA6023 (glucophage, which means "glucophagus"). A large number of clinical studies followed, and the history of using metformin in the treatment of diabetes began^[5]。

In China, type 2 diabetes is the main diabetic patient, especially with the improvement of living standards, the prevalence of type 2 diabetes has increased from 1% in the 1980s^[1]Increased to 9.7 percent in 2007/2008^[2]。 The huge number of patients poses a severe challenge to medical staff in the field of diabetes, and how to deal with diabetes has become an urgent problem to be solved.

To investigate the current use of aspirin for primary and secondary prevention of cardiovascular diseases (CVD) in some areas of China.

Nine thousands of patients from a research of the change of prevalence of diabetes mellitus (DM) and metabolism syndrome (MS) from June 2007 to May 2008 were investigated in some areas of China (Hunan province, Guangdong province, Sichuan province and Liaoning province). The questions mainly focused on the use rate, dosage and frequency of aspirin. The treatment standard of primary prevention in overall population was based on the recommendation of the use of aspirin in people at high coronary and stroke risk > 10% risk per 10 years in American Heart Association (AHA) Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update. For the treatment standard in DM and hypertension subgroup, the relevant recommendations of the American Diabetes Association (ADA) 2010 Standards of Medical Care in Diabetes and 2007 Guidelines for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) was followed respectively.

A total of 7186 questionnaires were available for statistical analysis. Of them, 233 cases were established CVD patients. Among all patients, 14.09% of them used aspirin for primary prevention and 26.61% used for secondary prevention. In DM subgroup, 32.47% of the patients used aspirin for primary prevention of CVD and 51.16% used for secondary prevention; in hypertension subgroup, 19.93% patients used aspirin for primary prevention of CVD and 29.52% for secondary prevention. On frequency, 87.67% of the patients took aspirin once daily, 10.35% took irregularly, and 1.98% took every other day. Over half of the responders (50.25%) had not taken the optimal dose, the doses were often much lower than minimum optimal recommended in the guidelines.

Aspirin is underused in primary and secondary prevention of CVD in cases at risk in China. In the cases using aspirin, the drug is not used according to the guidelines, and 50.25% of the patients used a dosage <75 mg. Therefore, the use of aspirin for primary and secondary prevention of CVD should be further improved and standardized.

To evaluate the efficacy and safety of biphasic insulin aspart 30(BIAsp 30) in the inadequately controlled Chinese patients with type 2 diabetes.

Easy Start Study (ESS) was a multi-centre, open-labeled and self-control observational study. From September 2008 to June 2009, a total of 621 insulin-naïve patients (pharmacotherapy-naïve patients or patients exposed to oral antidiabetic drugs only) participated in the study. The efficacy and safety of BIAsp 30 once-daily for 12-week were assessed in these patients. Baseline factors potentially impact treatment efficacy were investigated too.

Baseline demographic characteristics of the 621 patients were summarized as follows: mean age (56±11) years, mean duration of diabetes (4.4±4.2 )years, mean body mass index(BMI) (25.5±2.9)kg/m^2; baseline glycosylated hemoglobin(HbA1c) 8.5%±1.2%. The initial and final doses of BIAsp 30 was (0.16±0.05)U/kg and (0.20±0.07)U/kg, respectively. After 12-week of treatment, HbA1c decreased by 1.8%±1.1% on average, and 30.8% of patients achieved a HbA1c<6.5% and 65.5% of patients achieved a HbA1c<7.0%. The fasting and postprandial plasma glucose improved significantly and the mean value of 8-point plasma glucose decreased by (3.8±2.3)mmol/L. The percentage of patients achieving HbA1c target decreased along with the increase of baseline HbA1c level and the duration of diabetes. No difference of glycaemic control was observed between the groups of pre-breakfast and pre-dinner injection. The rate of minor hypoglycaemia was 1.83 events per patient per year. Only one case of major hypoglycaemia (nocturnal) was reported. There was no significant body-weight gain before and after treatment. No adverse event reported as related to study drugs was observed.

For the insulin naïve patients, BIAsp 30 once-daily, as insulin initiation, could improve glycaemic control without compromising safety and convenience, especially for the patients with lower HbA1c level and shorter duration of diabetes.

To investigate the relationship between obstructive sleep apnea syndrome (OSAS) and metabolic syndrome (MS) in snoring people in government employees.

A total of 546 snoring official participants received physical examination in Jiangsu Province Geriatrics Hospital from October 2007 to April 2009, were brought into the research with cluster sampling. Questionnaire survey was performed firstly. All participants were divided into 2 groups according to Epworth sleepiness scale (ESS): normal group(group Ⅰ): ESS<9 and abnormal group (group Ⅱ): ESS≥9. The first 175 participants received polysomnography (PSG) test. Linear regression analysis and multivariate Logistic regression analysis were used for statistics.

(1)The median of ESS was 5(0-20). Of all 546 participants, 398 (72.9%) were in group Ⅰand 148 (27.1%) were in group Ⅱ. (2)Linear regression analysis showed: constituent ratio of MS=0.1433+ 0.0337×ESS(r²=0.7414, P=0.000), the constituent ratio of MS increased 3.37% when ESS scores increased 1. There was statistical significance difference in constituent ratio of MS between the two groups(χ²=4.605, P=0.032). (3)175 participants received PSG test and the apnea hypopnea index (AHI) was 0.3-90.0/h. The median of AHI was 34.2/h. Pearson correlation analysis showed ESS was linearly correlated with AHI (r=0.721, P=0.000). In all of the participants, there were 50 definite OSAS patients (AHI≥5/h+ ESS≥9), 118 high risk of OSAS participants (AHI≥5/h+ ESS<9), and 7 exclusion OSAS participants(AHI<5/h). Correlation analysis between AHI and HOMA-IR showed that the mean value of HOMA-IR in definite OSAS group was significantly higher than that of in the other two groups(P<0.01 andP<0.05, respectively). (4)Multivariate Logistic regression analysis showed that the major factors affecting MS were body mass index (OR=2.303, P=0.000), AHI(OR=1.083, P=0.004) and mean SpO₂ (OR=0.443, P=0.039).

The government employees with OSAS have higher risk of MS and more serious insulin resistance and need treatment early.

To evaluate the relationship between high sensitive C-reactive protein (hs-CRP) and albuminuria in type 2 diabetic patients in Shanghai downtown.

Data were obtained from a cross-sectional study undertaken to evaluate the prevalence of diabetic complications in Chinese patients with type 2 diabetes, aged over 30 years and living in downtown Shanghai. There were 1039 cases enrolled in the study, and 574 participants had measured hs-CRP and 54 patients with hs-CRP levels greater than 10 mg/L were excluded. Finally 515 patients were analyzed based on albuminuria data integrity.

(1) The hs-CRP levels were significantly correlated with age, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, serum cholesterol, serum triglyceride and albuminuria (correlation coefficient: 0.142, 0.305, 0.243, 0.225, 0.264, 0.126, 0.105 and 0.168 respectively, all P<0.05). (2) The percentage of normoalbuminuria decreased gradually, and the percentage of microalbuminuria and macroalbuminuria increased gradually following the increase of hs-CRP (χ²=18.31, P<0.01). (3) The hs-CRP levels in microalbuminuria and macroalbuminuria groups were significantly higher than that in normoalbuminuria (microalbuminuria vs normoalbuminuria, χ²=12.36, P<0.01; macroalbuminuria vs normoalbuminuria χ²=9.61, P<0.01), however, no significance on hs-CRP levels was shown between microalbuminuria and macroalbuminuria groups (χ²=1.24, P>0.05). (4) Microalbuminuria was independently associated with systolic blood pressure (β coefficient, 0.035;P<0.01), hs-CRP (β coefficient, 0.110;P<0.05) and HbA1c (β coefficient, 0.246;P<0.01) by stepwise Logistic regression analysis adjusting for age, gender and components of metabolic syndrome.

Chronic subclinical inflammation might play a role in early renal damage in population-based patients diagnosed with type 2 diabetes.

To analyze the risk factors of the elderly people with type 2 diabetes mellitus (T2DM) in Bazhong city in Sichuan province.

A total of 2414 participants ≥60 years old were selected from 7 communities in Bazhong city by cluster random sampling. Questionnaires were used among them which was related T2DM knowledge and practice, body check and laboratory examination. Non-conditional Logistic regression analysis was used for data analysis.

(1) The total prevalence of 2414 participants with type 2 diabetes was 10.4%(252/2414). Among them, the female prevalence was 12.5%(158/1261) while the male was 8.2%(94/1153). The prevalence of type 2 diabetes in urban elderly(18.2%) was higher than that in the rural(8.7%), the difference showed statistical significance(χ² value was 12.34, 34.12 respectively, all P<0.05). (2) Low income(OR=1.640), family history of diabetes(OR=2.777), high blood lipids(OR=3.190) was the risk factors for T2DM among the ≥ 60-year-old with type 2 diabetes in Bazhong city(P<0.05).

Genetic factors, low-income and blood lipid abnormalities history were closely related to elderly people with type 2 diabetes. Targeted interventions are necessary to reduce and prevent the occurrence of diabetes.

To investigate the predictive effects of perspiration-nerve examination on diabetic automomic neuropathy (DAN) in patients with type 2 diabetes mellitus (T2DM).

A total of 164 T2DM outpatients and inpatients were recruited from August 2008 to December 2009 (male 88, female 76, aged 41 to 70 years, mean (56±11) years). They were divided into non-DAN symptom group (n=98) and DAN symptom positive group (n=66) according to neuropathy symptoms evaluation form, and also divided into cardiovascular reflex test (CRT) positive group (n=92) and CRT negative group (n=72). Another 40 healthy individuals were served as controls. The positive rate of these two assessment methods was calculated. All patients and healthy adult volunteers underwent perspiration-nerve test and Ou Minuo plaster color changing time test. Student'st test and Chi-square test were used for statistic analysis.

DAN symptom positive rate in 164 T2DM patients was 40.2% (66/164), the positive rate of cardiovascular reflex test was 43.9% (72/164), and the perspiration-nerve test had the positive rate of 45.1%(74/164). There was no significant difference between positive rate in perspiration-nerve test, DAN symptom test and cardiovascular reflex test (χ² values were 3.12 and 1.22, both P> 0.05). The positive rate of cardiovascular reflex test in patients with positive DAN symptoms was 63.6%(42/66), significantly higher than in patients with negative DAN symptoms (30.6% (30/98); χ² =17.46, P<0.01). And the positive rate of perspiration-nerve test in patients with positive DAN symptoms was 90.9% (60/66), significantly higher than in patients with negative DAN symptoms (14.3% (14/98); χ²=93.51, P<0.01). In DAN symptom positive group, Ou Minuo plaster color changing time of the left and right foot was (18±6) and (18±6) min, significantly longer than that in the non-DAN symptom group (t values were 22.848 and 23.694, both P<0.01). In cardiovascular reflex test positive group, the positive rate of perspiration-nerve test was 94.4% (68/72), significantly higher than that in the cardiovascular reflex test negative group (6.5% (6/92); χ²=126.09, P<0.01). In the cardiovascular reflex test positive group, Ou Minuo plaster color changing time of the left and right foot was (21±6) and (22±6) min, significantly longer than that in the cardiovascular reflex test negative group (t values were 36.841 and 36.126, both P<0.01). Ou Minuo plaster color changing time was positively related to cardiovascular reflex test (r=0.67, P<0.01), and was negatively related with heart rate difference per minute with deep breathing (r=- 0.46), Valsalva index (r=-0.38) and 30/15 ratio (r=-0.32) (all P<0.01).

DAN in patients with T2DM could be detected early by using perspiration-nerve function evaluation.

To establish a young rat model of nonalcoholic fatty liver disease (NAFLD) and insulin resistance induced by abundant fat feeding. To investigate the mechanism of insulin resistance and the impact of metformin intervention on fatty liver young rat.

Sixty male Sprague-Dawley (SD) rats of 3 weeks old were divided into 3 groups according to random number table: control group, high fat group and metformin group (high fat plus metformin), 20 rats in each group. Feed control group with normal calorie diet for 5 weeks while high fat group and metformin group high calorie diet. At the same time, metformin group received an oral metformin suspension (0.25 g·kg^-1·d^-1) while N and HF groups normal saline. At the end of Week 5, 12 rats were randomly selected from each group for the technique of hyperinsulinemic euglycemic clamp to evaluate the insulin sensitivity while other 8 rats were executed for histological sections to observe the profiles of hepatic pathologic morphology and fat deposition. Perform Quantitative PCR (polymerase chain reaction) to analyze the hepatic expressions of sterol regulatory element binding protein-1 (SREBP-1) , insulin receptor (IR) and insulin-like growth factor-1(IGF-1)mRNAs in 6 rats which randomly selected from other 8 rats in each group. Histological grade was examined by Rank Sum test. SREBP-1, IR, IGF-1 and glucose infusion rate(GIR)were analyzed by one-way ANOVA.

After a 5 weeks: (1) Weight: control group ((316±17)g), high fat group((202±21)g), metformin group ((171±19)g), pairwise comparisons of the data in the three groups were significantly different (P<0.01). (2) Pathological result: the rat livers in high fat group presented a typical NAFLD pathological alteration. (3) The GIR level of high fat group, control group and metformin group were ((6.51±1.52), (11.57±1.97), (13.08±2.33) mg·kg^-1·min^-1)). (4) As compared with those in control group, the hepatic expression of SREBP-1 mRNA were higher in high fat group ((0.85±0.10)vs.(1.67±0.28), P<0.05)) while IR mRNA ((1.16±0.22)vs. (0.56±0.22),P<0.01)) and IGF-1 mRNA ((0.87±0.14) vs. (0.26±0.14),P<0.01)) were lower. There was no difference between the data in high fat group and metformin group(P>0.05).

A 5-week abundant fat feeding may induce NAFLD and systemic insulin resistance in young SD rat. Metformin intervention can significantly improve the insulin sensitivity, and its effect of weight reduction is irrespective of whether there is overweight or not.

To investigate the influence factors of expansion and differentiation of human pancreatic stem cells into insulin-producing cells.

Human pancreatic stem cells were obtained from induced abortive fetal pancreatic islets. The pancreatic stem cells were expanded in defined inducing-medium for 15 passengers in vivo. The nestin-positive cells and ATP-binding-cassette-superfamily-G2(ABCG2) positive cells in expanded cells were detected by flow cytometer and immunohistochemistry. Expanded pancreatic stem cells were then induced to form islet-like cell clusters (ICCs). Insulin secretion from ICCs was tested by glucose stimulatory insulin secretion (GSIS). Influence of glucose and hepatocyte growth factor on insulin producing ability of ICCs was investigated during pancreatic stem cells differentiation into insulin-producing-cells. Insulin secretion from ICCs that differentiated from 1×10⁵ expanded cells was used to estimate the efficiency of pancreatic stem cells differentiation.

Nestin-positive cells and ABCG2-positive cells were expanded to 27.9 and 37.8 times when isolated pancreatic stem cells were cultured for 15 passengers. The expanded cells formed ICCs at 15 days in vitro. When hepatocyte growth factor concentration in culture medium was 0, 5, 10, and 15 μg/L, when stimulated with 5.6 mmol/L glucose, insulin secretion from ICCs was 5.00, 12.93, 14.91 and 11.23 μU, respectively. When stimulated with 25.0 mmol/L glucose, insulin secretion was 19.91, 35.53, 47.43 and 23.33 μU, respectively. When glucose concentration in basic culture medium was 0, 2.8, 5.6 and 11.2 mmol/L, insulin secretion was 9.07, 14.21, 6.91 and 3.53 μU, respectively, while stimulated with 5.6 mmol/L glucose. While stimulated with 25.0 mmol/L glucose, insulin secretion was 26.64, 48.97, 37.63 and 34.20 μU.

Nestin positive cells and ABCG2 positive cells in can be expanded in vitro. Expanded pancreatic stem cells could retain the ability of differentiation into insulin-producing cells and formation of ICCs. A proportionate hepatocyte growth factor and glucose concentration in inductive medium would be in favor of formation of ICCs and insulin secretion during differentiation of pancreatic stem cells into insulin-producing cells.

To observe the effects of various concentrations of glucose on hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) expressed by endothelial progenitor cells (EPCs), and investigate the possible mechanism of hypoxia in the generation and development of diabetic peripheral vascular disease.

Different concentrations of glucose were added to the culture system of EPCs collected from the blood of healthy volunteers. According to the concentrations of glucose, the EPCs were divided into three groups Group A ([Glu]=5 mmol/L), B ([Glu]=10 mmol/L) and C ([Glu]=33 mmol/L), which were cultured separately in the normal (21% oxygen) and low oxygen environment (1% oxygen) in each group. The level of mRNA of HIF-1α and VEGF expressed by EPCs was detected by RT-PCR assays, and the expression of HIF-1α protein was measured by Western blot, and the level of VEGF secretion was measured by ELISA. ANOVA analysis was used for data statistics.

(1)The HIF-1α mRNA expression in hypoxic group(A=1.25±0.34, B=1.35±0.26, C=0.75± 0.22, respectively) was enhanced significantly in normoxic group(A=1.03±0.25, B=1.21±0.28, C=0.61±0.17, respectively), (group A: t=1.96, P=0.03; group B: t=2.11; P=0.03; group C: t=1.89, P=0.04 respectively). Under the same oxygen concentrations, the mRNA expression level of HIF-1α in group B was significantly higher than those in group A and group C (hypoxic group F=23.54, P=0.000; normoxic group F=29.46, P=0.000). (2)The protein expression levels of VEGF in hypoxic group and normoxic group were no statistical significance(t=0.933, 1.258, 1.001, respectively and all P>0.05)under the same glucose concentrations. Under hypoxia condition, the protein expression levels of VEGF among group A, group B and group C(A=2953±237, B=2473± 205, C=1768±195, respectively)were statistical significance (F=137.43, P=0.000). The protein expression level of VEGF among group A, B and C was 2868±247, 2377±197, 1844±203, respectively under normoxic condition ( F=97.96, P=0.000).

High level of glucose has toxicity to EPCs in the hypoxia environment, and attenuates the expression of HIF-1α and VEGF of EPCs, which might play an important role in the pathogenesis of diabetic peripheral vascular disease.

To investigate the effect of age on pancreatic islet regeneration and to explore the underlying mechanisms and the relationship between aging and diabetes.

Three month old (body weight, (16.7±1.9) g, n=12), 6 month old (body weight, (25.4±2.3) g, n=12)and 12 month old (body weight, (28.5±3.0) g, n=12) inbred C57B6 mice (SPF grade) were underwent partial (65%-70%) pancreatectomy (PPx), and the proliferating cells were labeled by BrdU in drinking water. Mice of each group were sarcrificed on 1, 2 and 4 weeks respectively. By measuring fasting blood glucose level, IVGTT and also immunohistological analyses, to observe the PPx-induced metabolic changes and islet regeneration as well as islet apoptosis event. Data were analyzed in 2-way ANOVA by Graphpad Prism 5.0 software, and P values were calculated.

For 3 month old mice, islet regeneration rates, after PPx for 1, 2 and 4 weeks were 15.1%±10.0%、25.5%±8.1%、45.7%±14.6% respectively. For 6 month old mice, islet regeneration rates were 23.9%±8.7%, 28.3%±7.6% and 27.2%±5.7%, and for 12 month old mice, islet regeneration rates were 4.4%±6.9%, 6.1%±5.8% and 5.1%±7.0%. Analyzed by 2-way ANOVA (Graphpad Prism 5.0 software), it was showed that recovering time had obvious impact on β cell regeneration ( P<0.0001), and also aging (P<0.05). The interaction of recovering time and aging had obvious impact (P<0.05). For apoptosis study, the apoptotic cells of 3 month old mice account for 2.7%±2.4%, 3.7%±3.4%, 3.1%±3.6% of total cells (1, 2 and 4 weeks respectively). But for 12 month old mice, the data were 5.6%±1.4%, 5.8%±4.3%, 6.7%±2.6%, respectively. Three month old mice had less apoptotic cells compared with those of 12 month old mice (P<0.05 ).

With aging, pancreatic islets clearly tend to lose their regenerative potential and become more susceptible to apoptosis. This could be one of the leading reasons that old people tend to have diabetes compared with younger ones.

When diabetes is first diagnosed, patients often deny and escape the disease due to changes in living habits and worries about the future, accompanied by anxiety, anger, fear, loss and other emotions, or indifferent and indifferent attitudes. About 30% of patients can develop adjustment disorder within 1 month after diagnosis^[1]。 After that, most patients still improperly adjust, coupled with the influence of various factors, can progress to other psychological disorders or even mental disorders, such as depression, anxiety, eating disorders, alcoholism, nicotine dependence, etc^[2,3]。 These negative emotions and psychological disorders vary depending on the progression of the disease and the change of treatment intensity, which seriously affects the normal treatment and quality of life of diabetic patients^[4]。 Therefore, it is very important to pay attention to the psychological obstacles in the process of diabetes patients and carry out targeted psychotherapy.

Islet β-cell-specific autoreactive T lymphocytes can be found in both type 1 diabetic patients and healthy individuals, and are usually controlled by the immune regulatory system, including regulatory T lymphocytes. Once the balance of autoimmune tolerance against islet antigens is disrupted, these autoreactive T lymphocytes specifically destroy islet beta cells. This hidden self-destruction can last undetected for many years, until 80% of pancreatic islet β cells are destroyed and the body cannot self-compensate, clinical symptoms will appear and it is difficult to cure^[1]。 This autoimmune injury process is initiated by the interaction of genetic, environmental and other factors, which leads to immune imbalance between regulatory T lymphocytes and autoimmune effector T lymphocytes, thus causing disease^[2]。 Studies have shown that clearing regulatory T lymphocytes with immunosuppressive effects can cause a variety of serious autoimmune reactions such as type 1 diabetes^[3]。 The onset of type 1 diabetes is not only associated with autoimmune effector T lymphocytes, but also with absence of number and functional defects of regulatory T lymphocytes. This article reviews the literature published in recent years and systematically summarizes the pathophysiological changes involving regulatory T lymphocytes in the pathogenesis of type 1 diabetes and its recent advances in the treatment of type 1 diabetes.

Yang Guoqing (Department of Endocrinology, General Hospital of the People's Liberation Army): A 21-year-old female patient. He was admitted to our hospital on September 28, 2008 due to "polydipsia and polyuria for more than 6 years and visual acuity decrease for 1 year". The patient suddenly developed polydipsia, polyuria and polyphagia in 2002, without obvious weight loss. Local hospital examination: fasting blood glucose (FBG) 18 mmol/L, 2 h postprandial blood glucose (PBG) 20 mmol/L, urine ketone body positive, diagnosed as "type 1 diabetes", given protamin biosynthetic human insulin injection (premixed 30R) 10 U/morning and 12 U/evening treatment, monitored blood glucose: FBG 10 mmol/L, PBG 13 mmol/L, due to poor blood glucose control, metformin 1.0 g/day was added. In 2007, he developed blurred vision, decreased vision and gradually worsened, and planned to be admitted to hospital for eye surgery. Menstrual history: Menarche at 16 years old, 3-6 days/30-60 days, last menstruation: 12 September 2008. The first aunt of the family suffered from diabetes and died of diabetes at the age of 30. The parents and the first sister are in good health. Physical examination at admission: pulse rate: 64 beats/min, blood pressure: 140/100 mm Hg (1 mm Hg =0.133 kPa). Height: 150 cm, weight: 43.5 kg, body mass index (BMI): 19.3 kg/m², Waist: 64.0 cm, Hip: 78.0 cm. The skin of the whole body was dry, with hyperplasia of vellus hair, spotty pigmentation in both lower limbs, and no acanthoid changes were seen. Vision: right eye: preocular index, left eye: preocular manual. The thyroid gland is swollen in second degree, tough in texture, and nodules with a diameter of 2 cm can be palpable. No abnormalities were found in the rest of the physical examination. Laboratory tests showed hypoalbuminemia, dyslipidemia, massive proteinuria, and poor blood sugar control; Insulin autoantibody (IAA), islet cell antibody (ICA) and serum glutamate decarboxylase antibody (GADA) were all negative. Diagnostic considerations at admission were: type 2 diabetes; diabetic nephropathy, diabetic retinopathy; Hypertensive disease; Hypoalbuminemia. Intensive insulin therapy was given after admission, insulin aspart (before three meals) + insulin glargine (before bed), and the total insulin dose was increased from 40 U/d to 60 U/d and 80 U/d. Due to poor blood sugar control, oral hypoglycemic drugs, including metformin, acarbose and repaglinide, were added successively. However, blood glucose control is poor, especially postprandial blood glucose. In order to measure serum insulin levels, insulin and oral hypoglycemic drugs are stopped. The blood glucose profile during drug withdrawal is shown inFigure 1。

Treatments for diabetes are constantly updated, offering hope to patients and challenging traditional treatment options. Among them, the treatment based on the mechanism of action of incretin has been widely and deeply studied in the treatment of type 2 diabetes in recent years, and has been gradually applied to clinical practice, which may bring new dawn to solve some problems in the treatment of type 2 diabetes. This article will mainly introduce the problems faced by traditional oral hypoglycemic drugs in the treatment of type 2 diabetes, the mechanism of action of incretin and the biological characteristics of dipeptidyl peptidase 4 (DPP-4), as well as the treatment of type 2 diabetes based on incretin.

"The Second International Forum on Blood Glucose Monitoring and the Founding Meeting of Blood Glucose Monitoring Group of Diabetes Branch of Chinese Medical Association" was held in Shanghai on December 10th, 2010. The meeting was sponsored by Diabetes Branch of Chinese Medical Association and undertaken by the Sixth People's Hospital affiliated to Shanghai Jiaotong University. The conference was first opened by Professor Yan Shijie, Executive Vice President and Secretary General of Shanghai Medical Association, and Professor Ji Linong, Chairman of Diabetes Branch of Chinese Medical Association. Subsequently, Mr. Yang Wei of the Organization and Management Department of the Chinese Medical Association announced the formal establishment of the blood glucose monitoring group of the Diabetes Branch of the Chinese Medical Association, with Professor Jia Weiping as the group leader, Professor Li Hong and Professor Li Yanbing as the deputy group leaders.

It has been found that adult patients with type 2 diabetes have abnormalities in the central nervous system, and it is not clear whether diabetes itself can adversely affect brain function and structure. Adolescent patients with type 2 diabetes are not likely to develop dominant vascular disease until many years later, therefore, this study hopes to provide a preliminary answer to the above questions by observational evaluation of this particular group.

In recent years, the incidence of type 1 diabetes has increased year by year, and most of them are autoimmune diseases. This study aimed to evaluate islet function and morphological alterations in patients with type 1 diabetes with a course of ≥50 years.

Islet β cells expressed insulin receptor and insulin signaling pathway proteins simultaneously. However, the effect of exogenous insulin on insulin secretion after blood glucose stimulation in humans is not fully elucidated. The purpose of this study was to investigate whether insulin can regulate pancreatic islet β cell function in healthy people.

Recently, it has been suggested that symptomatic hypoglycemia and associated disturbances of consciousness, syncope, epilepsy or seizures are complications after gastric bypass surgery, but the incidence of these complications has not been reported. This study aimed to observe the incidence of severe hypoglycemia and its associated symptoms after gastric bypass surgery.

Bariatric surgery is increasingly recognized as an effective means of steady weight loss and control of type 2 diabetes and its complications. Should it be early in diabetes or body mass index<35 kg/m²When surgery is performed, a long-term randomized controlled study is required to understand its mechanism of improving glycemic control and potential complications.

Previous clinical decisions are basically based on practice or experience, not on the review of existing studies, and there is no theoretical basis or evidence related to the advantages and disadvantages of treatment, which leads to problems such as misuse, abuse and waste of medical services. For this reason, many doctors are confused about how to better treat diseases. The advent of clinical guidelines has greatly reduced the occurrence of such problems.