Volume 03 · Issue 03 · 2011

Dynamic blood glucose monitoring (CGM) refers to a monitoring technology that reflects blood glucose level by monitoring glucose concentration in subcutaneous intertissue fluid through a glucose sensor, and can provide continuous and comprehensive blood glucose information. CGM techniques used in clinic can be divided into retrospective CGM system and real-time CGM system. At present, retrospective CGM system is the main one in China. The following briefly introduces the development process, applicable populations and new clinical application of CGM technology in China.

Good glycemic control can delay and/or prevent the onset of chronic complications of diabetes. However, whether for type 1 or type 2 diabetic patients, good blood sugar control is a prerequisite for the increase in the occurrence of severe hypoglycemia, and hypoglycemia becomes the biggest obstacle to achieving blood sugar control^[1,2]。 In patients with good control of glycosylated hemoglobin (HbA1c), blood glucose fluctuations, i.e., unpredictable hypoglycemia and hyperglycemia, often occur^[3]； Moreover, hypoglycemia, especially asymptomatic hypoglycemia, is common in elderly diabetic patients with a long course of disease, which to varying degrees offsets the benefits brought by good blood sugar control^[4]。 Although the results of self-monitoring of blood glucose (SMBG) are helpful to assess the degree of glucose metabolism disorder in diabetic patients, formulate hypoglycemic regimen, reflect the effect of hypoglycemic treatment and guide the adjustment of treatment regimen, SMBG only monitors point blood glucose, cannot fully reflect the whole day blood glucose profile of patients, there is a "blind spot" in monitoring, especially it cannot monitor asymptomatic hypoglycemia, and is susceptible to individual inaccurate measurement results^[5]。 The emergence of continuous glucose monitoring (CGM) technology can provide continuous, comprehensive and reliable blood glucose information throughout the day, understand the trend of blood glucose fluctuations, and detect hyperglycemia and hypoglycemia that are not easily monitored by SMBG^[6,7]Benefits for blood sugar control in diabetic patients^[8]。 However, these benefits are based on the high accuracy of dynamic blood glucose monitoring system (CGMS), so its accuracy should be considered when selecting CGMS in clinic.

Large prospective clinical studies such as the Diabetes Control and Complications Trial (DCCT) and its follow-up Diabetes Intervention and Complications Epidemiology (EDIC) study, and the British Diabetes Prospective Study (UKPDS) have clearly shown that compared with conventional treatment, intensive glycemic control can significantly reduce the incidence of chronic microvascular and macrovascular complications of diabetes^[1,2]。 Intensive insulin therapy is currently the most powerful means of blood sugar control, and the basal + meal insulin therapy mode, especially continuous subcutaneous insulin infusion (CSII) therapy, is the closest insulin intensive therapy plan to the physiological insulin mode of action. Under frequent blood glucose monitoring, intensive insulin therapy is an important part of intensive diabetes management. Not only patients with type 1 diabetes with absolute insulin deficiency need long-term intensive insulin therapy, but for newly diagnosed type 2 diabetes patients with severe blood glucose increase, short-term intensive insulin therapy can also significantly improve their pathophysiological defects, repair the damaged islet β cell function, obtain long-term stable control of blood glucose, and delay the progression of the disease^[3]。 However, despite the use of frequent self-monitoring of blood glucose (SMBG), the incidence of severe hypoglycemic events in the DCCT study was 3.3 times higher in the intensive insulin treatment group than in the conventional treatment group. The increased risk of hypoglycemic events accompanied by intensive insulin therapy often leads to resistance and fear in patients, which becomes the main obstacle to blood sugar control. Therefore, if the blood glucose can reach the standard quickly and stably under the premise of avoiding hypoglycemic events as much as possible, it is necessary to have a blood glucose monitoring system that can fully reflect the change trend of blood glucose and provide blood glucose information accurately and timely. continuous glucose monitoring system (CGMS) came into being, which plays an important role in blood glucose management of diabetic patients. Combined with the current research status at home and abroad and the author's clinical experience, this paper discusses the role of CGMS in diabetic patients receiving intensive insulin therapy.

With the continuous development of society and the change of people's lifestyle, diabetes has become an "epidemic" and spread all over the world. According to the survey conducted by the Chinese Diabetes and Metabolic Syndrome Research Group of the Diabetology Branch of the Chinese Medical Association from 2007 to 2008, the prevalence rates of diabetes in men and women over 20 years old in China have reached 10.6% and 8.8% respectively, and the overall prevalence rate has reached 9.7%, while the prevalence rate of pre-diabetes is as high as 15.5%. According to this, it can be estimated that the total number of diabetes patients in China has reached 92.4 million, and the number of pre-diabetes has reached 148 million^[1]。 The treatment of diabetes has become an urgent problem that needs our attention.

To establish the corresponding value of mean blood glucose (MBG) for a specific target of glycated hemoglobin A1C (HbA1c), and evaluate the relationship between 24 hour MBG determined by continuous glucose monitoring and HbA1c in subjects with different states of glucose tolerance.

From August 2007 to January 2010, 318 subjects who accepted oral glucose tolerance test in out-patient department and ward of Shanghai Jiao Tong University Affiliated Sixth People's Hospital were enrolled, including 115 with normal glucose regulation, 57 with impaired glucose regulation and 146 with newly diagnosed type 2 diabetes. Based on the diagnostic criteria specified in American Diabetes Association (ADA, 2003) guidelines, categories of glucose tolerance were defined as diabetes mellitus and impaired glucose regulation.Biochemical indicators were investigated in each group. Oral glucose tolerance test was performed and 2-h postchallenge glycemia (2 h PG) was also measured. MBG was measured with continuous glucose monitoring system. HbA1c was measured with high performance liquid chromatography method. The correlations among MBG, HbA1c and the other parameters monitored were analyzed. Statistical analysis was performed using one way ANOVA, Kruskal-Wallis test, Chi-square test, Spearman correlation analysis and Linear regression analysis.

(1)The levels of HbA1c and MBG in 318 subjects were (6.6±1.5)% and (7.3±2.3) mmol/L, respectively.(2)MBG was significantly correlated with HbA1c (r=0.848, P<0.01). Linear regression analysis, using MBG and HbA1c summarized by patient (n=318), produced a relationship of MBG=1.252×HbA1c-0.992 (R²=0.718, P<0.01). That is, MBG will increase 1.252 mmol/L with 1% increase of HbA1c. When HbA1c level was 6.5%, the expected value of MBG was 7.1 mmol/L. When HbA1c level was 7.0%, the expected value of MBG was 7.8 mmol/L.(3)In 146 patients newly diagnosed type 2 diabetes, the relationship between MBG and HbA1c was similar to that in total subjects (r=0.788, P<0.01), and the linear regression analysis showed a relationship of MBG=1.255×HbA1c-0.886 (R²=0.621, P<0.01). When HbA1c level was 6.5%, the expected value of MBG was 7.3 mmol/L. When HbA1c level was 7.0%, the expected value of MBG was 7.9 mmol/L.

We initially establish the corresponding value of MBG for a specific HbA1c target and provide the basis for translating HbA1c into mean blood glucose in Chinese subjects.

To evaluate efficacy, safety and effect of glycemic excursion of once-daily insulin detemir added to oral antidiabetic drugs in poorly controlled type 2 diabetes patients by continuous glucose monitoring system(CGMS) and Hyperinsulinemic-euglycemic Clamp Technique.

20 type 2 diabetes patients with poor glycemic control by oral antidiabetic drugs were added to receive once-daily bedtime insulin detemir injection. The observation lasted for three months. The parameters were measured before and after treatment included M value, AIR, MAGE, MODD by continuous glucose monitoring system(CGMS) and Hyperinsulinemic-euglycemic Clamp Technique. The parameters included BMI, TC, TG, LDL, HDL, C-P and HbA1c also were measured before and after treatment. Data analysis were performed using SPSS 16.0.

After 3 months' treatment, HbA1c, WHR, TC, LDL were significantly decreased than before, respectively((8.8±1.6)%, (7.6±1.3)%,t=4.830, P<0.001; (0.95±0.04)mmol/L, (0.94±0.04)mmol/L,t=2.317, P<0.05; (5.1±0.6) mmol/L, (4.5±0.9) mmol/L,t=3.459, P<0.01; (3.2±0.8) mmol/L, (2.6±0.8) mmol/L,t=3.822, P<0.01) M value was significantly increased than before ((3.9±2.1) mg·min^-1·kg^-1, (5.0±2.4)mg·min^-1·kg^-1,t=-2.269, P<0.05), AIR was also increased but no statistical difference. Detemir treatment also obviously reduced MAGE from (7.3 ± 2.4)mmol/L to(5.4±2.9)mmol/L, there were significances in statistics. But there was no statistical difference in MODD after treatment. After detemir treatment, the value of weight was decreased than before, but with no statistical difference.There was no serious hypoglycemia.

Once-daily insulin detemir added to oral antidiabetic drugs in poorly controlled type 2 diabetes patients could improved glycemic control, the insulin sensitivity and reduced glycemic.

To evaluate the efficacy and safety of isophane protamine biosynthetic human insulin injection in the treatment of diabetes mellitus.

A randomized, open, Novolin 50R-controlled, and multicenter clinical trial was conducted from September 2007 to August 2008. In this study, a total of 220 patients with diabetes mellitus were enrolled and were randomly divided into two groups: group A were treated with domestic drug (Yousilin 50R, n=111), group B were treated with imported drug (Novolin 50R, n=109). The fasting blood glucose(FBG), 2-hour past-meal blood glucose(PBG), blood hematoglobin A1C(HBA1c) and complications were recorded and compared between the two groups and in the same group before and after 12-week of treatment with the experimental drugs. The t test was implied in the comparison of data between the two groups.

After the 12-week of treatment, the levels of HBA1c, FBG and PBG in group A were all decreased significantly compared with baselines (from 9.3%±1.8%, (9.9±3.4) mmol/L, (16.0±4.7) mmol/L to 7.5%±1.2%, (7.6±2.1) mmol/L, (10.9±3.6) mmol/L, respectively; and t value was -11.55, -7.36, -10.12, respectively; all P<0.05), and decreased for 1.8%, 2.9 mmol/L and 5.0 mmol/L, respectively. And those indicators were all significantly declined too in group B (from 9.3%±1.7%, (9.9±3.0) mmol/L, (15.9±4.3)mmol/L to 7.8%±1.3%, (8.0±2.2) mmol/L, (11.4±3.9) mmol/L, respectively; andt value was -9.37, -6.91, -9.34, respectively; all P<0.05), and declined for 1.5%, 1.9 mmol/L and 4.5 mmol/L, respectively. The differences in reductions of HBA1c, FBG and PBG level between the two groups were all not statistically significant (F value was 4.04, 2.50 and 0.97, P value was 0.046, 0.1156 and 0.3248, respectively). The incidence of hypoglycemia in the tow groups was similar(χ²=0.36, P=0.551). No serious complications occurred in the two groups. Covariance analysis showed the two drugs had a similar efficacy on diabetes mellitus.

Yousilin 50R and Novolin 50R have similar efficacy and safety profiles in treating diabetes mellitus.

To investigate the association between the polymorphisms of the LPL gene and blood triglyceride in type 2 diabetes mellitus(DM).

152 first admission patients with Type 2 DM were chosen from the first affiliated hospital of Zhengzhou University and 145 control subjects were observed. Blood DNA samples were obtained from subjects in both groups, PCR amplification were performed on particular LPL gene fragments, restriction enzyme digestion and their products analyzed.All patients were measured TC, TG, HDL-C, LDL-C, ApoA.ApoB, FBG, HbA1c, HOMA-IR. Detected by statistical methods χ ² test whether the observed genetic equilibrium genotype. T check was used to compare the intergroup blood fat levels, the disparation of genotypic frequency and allele frequency were compared with χ ² test with the test criterion α=0.05.

LPL gene locus in the case group, Ser447Ter G allele and CG genotypes were lower than that of control group(3.3% vs 12.4%; 6.6% vs 24.8%)and there was statistical significance for all differences(all P<0.05). Both in case group and control group, CG genotype carriers' plasma TG levels were lower than that of non-carrier (respectively: 1.39±0.11 vs 1.68±0.18; 1.24±0.08 vs 1.48±0.15), and the differences have statistical significance (P<0.05). Control groups' CG genotype HDL-C were higher than CC genotype (1.46±0.06 vs 1.35±0.08;P<0.05 ). Asp9Asn and Asn291Ser variants were not found either in T2DM patients or in controls. There were no significant differences in the frequencies of LPL PvuⅡmutations either. And both groups' gene frequencies were precisely in line with the balance law Hardy-Weinberg detection.

Asp9Asn, Asn291Ser and PvuⅡpolymorphisms in the LPL gene bear no relationship with the type 2 diabetes mellitus in Han people in Henan province. However, the Ser447Ter polymorphism in the LPL gene may reduce plasma triglyceride level, which maybe a protective mutation in reduction of the incidence of type 2 diabetes mellitus.

To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency and pancreatic β-cell dysfunction in type 2 diabetes mellitus(T2DM).

From January to April 2008, 96 patients with T2DM(group A) and 35 healthy volunteers with a normal glucose tolerance (NGT) (group B) were enrolled in this study. According to the course of T2DM and symptom of heart failure, the patients in group A were divided into three groups: group A1: newly-diagnosed T2DM or course of T2DM<2 years,n=33; group A2: course of T2DM>2 years without obvious signs and symptoms of heart failure,n=32; group A3: course of T2DM>2 years with obvious clinical signs and symptoms of heart failure,n=31. The serum fasting plasma glucose (FPG), fasting insulin(FINS), true insulin(TI), proinsulin(PI) and brain natriuretic peptide(BNP) were detected in all the subjects. The ratio between early diastolic peak flow velocity and atrium peak flow velocity(E/A), the lateral wall of mitral annular movement(e/a), pulmonary venous peak systolic velocities and diastolic velocities (S/D) and left ventricular ejection fraction(LVEF) stage in all subjects were examined by echocardiogram. Variance analysis was used for data analysis among the 4 groups.

The Homa-Is decreased with the progression of T2DM (group B: 110.0±76.3, group A1: 45.0±22.7, group A2: 15.0±14.0, group A3: 5.8±2.4; F=6.34, P<0.05); it indicated that the secretary function of β-cell declined significantly with the progress of T2DM. The serum level of BNP was significantly increased accompanied the function declines of pancreatic β-cell (group B: (75±19) ng/L, group A1: (810±185) ng/L, group A2: (1060±264) ng/L, group A3: (2071±785) ng/L;F=8.89, P<0.05). The serum level of TI and PI in group A3 were all significantly lower than those in group B, A1 and A2 (allP<0.05). The values of E/A, e/a, S/D and LVEF in group A were all significantly lower than those in group B (allP<0.05).

With the functional declines of pancreatic β-cell in T2DM, the myocardial contractility and diastolic function declines, meanwhile the TI and PI secretion reduces, and these changes finally induce metabolic disorders which can aggravate heart failure.

To evaluate the effect of hyperuricemia on type2 diabetic peripheral neuropathy and analysis of the relationship between hyperuricemia and insulin resistance.

90 type2 diabetic mellitus patients with peripheral neuropathy were divided into the high uric acid (HUA) group which including 42 cases, and the normal uric acid (NUA) group which including 48 cases, the two groups were comparable. Fasting blood glucose(FBG), fasting insulin(FINS), glycosylated hemoglobin(HbA1c), micro-albumin urine(MAU) and blood fat were detected in each group, and body mass index(BMI), homeostatic model assessment of insulin resistance index (HOMA-IR) were calculated. The sensory, motor conduction velocity and amplitude of the 90 patients' dominant side limbs nerve, which including median nerve, ulnar nerve, tibial nerve and common peroneal nerve , were measured by EMG evoked potential instrument.

The FINS, HOMA-IR, MAU and TG of the patients in group HUA were higher than that in group NUA((11±6)μIU/ml, (15±7) μIU/ml; 4.2±1.2, 6.4±2.1; (76±17) mg/L, (103±10) mg/L; (1.8±1.4) mmol/L, (2.4±1.8) mmol/L;P<0.05 or <0.01). The HUA group patients' tibial nerve and common peroneal nerve's sensory conduction velocity and amplitude were lower than that in group NUA((10±3)m/s, (23.7±2.1)m/s; (12±4)m/s, (27±3) m/s; (0.34±0.09) μV, (1.1±0.5) μV; (0.32±0.07) μV, (1.1±0.4) μV;P<0.05 or <0.01). By the Spearman correlation analysis, the level of uric acid was positively correlated with FINS, HOMA-IR, MAU and BMI(r=0.296, 0.234, 0.225, 0.224, all P<0.05), and it was negatively correlated with the sensory conduction velocity and amplitude of the tibial nerve, common peroneal nerve(r=-0.232, -0.286, -0.355, -0.335, P<0.05 or <0.01). Then correct the effect of age, pathogenesis, adiposity, blood glucose and insulin resistance by partial correlation analysis, the level of uric acid was still negatively correlated with the sensory conduction velocity and amplitude of the tibial nerve, common peroneal nerve(r=-0.223, -0.240, -0.312, -0.293, P<0.05 or <0.01).

Hyperuricemia could aggravate the peripheral sensory neuropathy of type2 diabetic mellitus, and it was positively correlated with insulin resistance.

To investigate the effect of insulin treatment on adiponectin receptor 2(AdipoR2)/peroxisome proliferator-activated receptor-α(PPAR-α) signaling pathway of high-fat-fed/streptozotocin-treated diabetic rats.

High-fat-diet and streptozotocin-treated type 2 diabetic SD rats were used in our experiment. Briefly, 42 male SD rats were randomly grouped into normal controls (NC, n=12) and high-fat-fed group (n=30, 56% fat in calorie) after one week's acclimatization. The normal controls were given normal diet. The diabetic rats were induced by high-fat-diet and streptozotocin injection. The insulin group (INS,n=15) were given NPH insulin injection after the diagnosis of diabetes mellitus for 3 weeks. At the end, the rats were sacrificed and serum samples and liver tissues were collected and stored at -80 ℃. We used rat adiponectin ELISA kit to detect fasting serum adiponectin level. Realtime PCR and Western blott were performed to determine the expression of molecular effectors involved in AdipoR2/ PPAR-α pathway. ANOVA or LSD test were used for data analysis.

The expressions of serum adiponectin detected by rat adiponectin ELISA kit in NC, DM and INS groups were (0.55±0.16), (0.27±0.09) and (1.54±0.24) μg/L respectively, that was to say, lower fasting adiponectin level was found in diabetic rats than that in NC rats which could be ameliorated by insulin treatment. The expression of AdipoR2 mRNA was 0.70±0.30 and protein level was 0.72±0.12 in diabetic rats that were up-regulated compared with the controls (0.38±0.02 for mRNA and 0.49±0.05 for protein) and decreased after insulin treatment (0.27±0.09 for mRNA and 0.42±0.09 for protein). In diabetic rats, both mRNA and protein levels of hepatic PPAR-α were much lower (0.60±0.20 and 0.19±0.04, respectively) than those in the controls (2.70±1.50 and 0.43±0.18, respectively) ( P<0.05), while elevated after insulin treatment (1.30±0.40 and 0.27±0.07, respectively).

Insulin treatment can improve AdipoR2/ PPAR-α signaling pathway in high-fat-diet and streptozotocin-induced diabetic rats, which leads to increased fatty acid oxidation and perhaps the subsequent improvement of hepatic lipid accumulation.

To investigate the effects of Cordyceps sinensis cultivated by artificial fermentation on the expression of pigment epithelium-derived factor(PEDF), matrix metalloproteinase-2(MMP-2) and transforming growth factor-β₁(TGF-β₁) in the kidney of diabetic rats.

A total of 8-week-old 45 male SD rats with a weight of 180-220 g were randomly divided into three groups by randomized block design: normal group (group A, n=15), diabetic group (group B, n=15) and Cordyceps sinensis treated group (group C, n=15). The rats in group B and C were injected intraperitoneally with streptozotocin in a dose of 55 μg/g to establish the rats DM models. Three days after the animal model was established, Cordyceps sinensis was administrated intragastricly in a dose of 4 μg·g ^-1·d^-1 at certain times in group C, and the rats were given saline in the same manner in group A and B. Twelve weeks after, the kidney mass/body mass index (KI), 24-h urinary volume, 24-h urinary albumin excretion (UAE), serum creatinine (SCr), blood ureanitrogen (BUN), triacylglycerol(TG) and total cholesterol(TC) in the three groups were measured and compared. The expression of PEDF, MMP-2 and TGF-β₁ proteins and PEDF m RNA in the kidney tissue were determined by using immunohistochemistry methods and reverse transcription-polymerase chain reaction (RT-PCR) analysis in the three groups. The t test was used in the comparison between two groups and analysis of variance was used among the three groups.

The level of KI, BUN, SCr, UAE, TC and TG in group B and C were all significantly higher than those in group A (all P<0.01), and the above-mentioned indexes in group C were all significantly lower than those in group B(allP<0.01). Immunohistochemistry showed that renal PEDF, MMP-2 protein expression in group B (1.53±0.12, 1.8±0.5) and C (2.60±0.15, 3.3±0.4) were significantly lower than those in group A(3.96±0.14, 4.3±0.6), while the TGF-β₁ was higher in group B (4.60±0.15) and C(2.60±0.09) than that in group A(1.57±0.09); the expression of PEDF and MMP-2 was higher in group C than that in group B (P<0.01), while expression of TGF-β₁ decreased (P<0.01). RT-PCR analysis showed that the expression of PEDF mRNA in group B and C was 0.3±0.1 and 0.8±0.2 respectively, and was significantly lower than that in group A (1.2±0.3)(allP<0.01), and it was higher in group C than that in group B(P<0.01).

PEDF, MMP-2 and TGF-β₁ may play a role in the development of diabetic nephropathy. The kidney protection effects of Cordyceps sinensis cultivated by artificial fermentation in diabetic rats may be exerted through ameliorating renal function, regulating serum lipid and modulating the expression of PEDF, MMP-2 and TGF-β₁.

To investigate the changes of glucokinase (GK) and glucose transporter 2 (GLUT2) gene expression and insulin secretion induced by free fatty acid (FFA) in βTc6 cells.

βTc6 cells were cultured in vitro, treating with FFA (0.25, 0.5 and 1.0 mmol/L) for 24 hours, then examined GK and GLUT2 expression by real-time PCR and Western blot analysis. In addition the morphological change of βTc6 cells and the glucose stimulated insulin secretion (GSIS) were observed. Data analysis was assessed by using one-way ANOWA.

(1)After intervening with 0.25 mmol/L FFA for 24 hours, no changes were found in the morphology and GSIS of βTc6 cell. There were no changes of the expression of GK and GLUT2 mRNA and protein in βTc6 cell(all P>0.05). (2)After intervening with 0.50-1.00 mmol/L FFA for 24 hours, the accumulation of lipid droplets in βTc6 cells was found in the cells, and cells mass showed the trend of disintegration. With the increase of FFA concentration, the above phenomenon was more visible, the expression of GK and GLUT2 mRNA decreased(GK_FFA0.500.32±0.05 vs GK_Control0.80±0.12; GLUT2_FFA0.500.28±0.04 vs GLUT2_Control0.72±0.11, GK_FFA1.000.24±0.03 vs GK_FFA0.500.32±0.05; GLUT2_FFA1.000.21±0.03 vs GLUT2_FFA0.500.28±0.04, all P<0.05), and GK and GLUT2 protein reducedgradually, GSIS also decreased gradually (allP<0.05).

FFA intervention with lower concentration can not affect the survival of βTc6 cells and GSIS and the expression of GK and GLUT2. But when FFA level increases abnormally β cells will be impaired the GK and GLUT2 expression and GSIS will be inhibited.

To determine the possible effect of cyclooxygenase-2 (COX-2) -765G/C polymorphism on the risk of diabetic nephropathy (DN) in patients with type 2 diabetes mellitus (T2DM) in Kunming.

A total of 252 T2DM patients from the First Affiliated Hospital of Kunming Medical University between January and December 2008 were assigned to the free-DN group (n=100), microalbuminuria DN group (n=78) and macroalbuminuria DN group (n=74) according to 24-hour urinary albumin excretion ratio(24-h UAER) or spot urinary albumin/creatinine (UACR) ratio. The polymorphism of COX-2 gene -765G/C was detected by PCR-RFLP. The genotypes and allele frequency distributions were compared by using χ ² test. The related characteristics of investigated objects were compared by analysis of variance. Logistic regression analysis was performed to calculate correlated markers of DN risk.

In T2DM patients, -765GG genotype was significantly different between microalbuminuria DN﹢macroalbuminuria DN group and free-DN group (0.901 vs 0.810; χ ²=4.309, P<0.05). In DN patients, the levels of fasting plasma glucose (FPG) and 2-hour plasma glucose (2-h PG) of those with -765GG genotype were higher than those without ((7.9±4.0) vs (5.9±1.7) mmol/L, (12±5) vs (9±4) mmol/L, respectively;t values were 0.001 and 0.020, both P<0.05). Logistic regression analysis indicated that -765GG genotype (odds ratio (OR)=3.25; 95%confidence interval (CI): 1.336 to 7.901) was risk factor of DN.

The COX-2 gene promoter -765GG may be associated with DN in Kunming Han individuals with T2DM.

Hyperglycemia is the sign of diabetes and the main cause of chronic complications, and its adverse effects are mainly reflected in chronic persistent hyperglycemia and blood sugar fluctuations. The harm of long-term hyperglycemia to the chronic complications of diabetes has been clearly established, and recent studies have shown that blood sugar fluctuation may also be related to the occurrence and development of diabetic complications. Therefore, it may be necessary to balance the reduction of blood glucose fluctuations in order to more optimally control blood glucose when formulating a treatment regimen. The problem that needs to be solved urgently is to establish the evaluation index of blood glucose fluctuation with simple calculation and clinical significance. While many indicators are available to assess blood glucose fluctuations, there is no uniformly accepted optimal indicator to date^[1]。 mean amplitude of glycemic excursion (MAGE), as an important index to reflect blood glucose fluctuation, is attracting more and more attention with the rapid development of continuous glucose monitoring (CGM). However, the calculation method of MAGE has confused many clinicians, and its clinical value is constantly controversial. In this paper, the research progress of MAGE and blood glucose fluctuation is reviewed.

Type 1 diabetes mellitus (T1DM) is divided into 2 subtypes: autoimmune (1A) and idiopathic (1B). Among them, type 1A is a chronic autoimmune disease involving T and B lymphocytes, and the role of B cells in type 1A diabetes is more complex. At present, attention to B cells in type 1A diabetes has gone far beyond its function of secreting autoantibodies. With the continuous exploration of the role of B cells in T1DM, the research of B cells as therapeutic targets is gradually becoming a hot spot. This paper mainly discusses the dual role of B cells in type 1A diabetes mellitus by promoting and inhibiting autoimmune response.

The latest epidemiological survey of diabetes in China shows that the prevalence of diabetes among Chinese people over 20 years old is as high as 9.7%^[1]。 What is worrying is that although the prevalence of diabetes in China is high, the blood sugar compliance rate is low, and the two form a great contrast. The 2006 diabetes status survey in China showed that only 26.8% of patients had ideal blood glucose control [glycosylated hemoglobin (HbA1c) ≤6.5%]; However, 73.2% of patients failed to reach the standard of blood glucose control (HbA1c>6.5%), and 28.3% of patients with HbA1c>8%; Although there are numerous factors affecting blood glucose achievement, even among patients who have already used insulin, the rate of blood glucose achievement is only 37%^[2]However, patients' lack of mastery of insulin injection technology may be one of the important reasons.

Blood glucose monitoring is a necessary means to evaluate glucose metabolism disorders and therapeutic effects. Due to the continuous change of human blood glucose, the routine point-time blood glucose cannot fully reflect the fluctuation of blood glucose throughout the day. Therefore, it has always been the dream of clinical workers to realize continuous monitoring of blood glucose. Updike and Hicks first attempted continuous glucose monitoring using animal models as early as 1967^[1]。 Since then, the dynamic blood glucose monitoring (CGM) technology has become increasingly mature, and the successful transformation from experimental monitoring methods to clinical monitoring tools has been completed. In 1999, the U.S. Food and Drug Administration (FDA) approved the first retrospective CGM system for marketing in the United States. By June 2010, four CGM systems with real-time capabilities were available in the United States. Therefore, the CGM techniques currently used in clinical practice can be divided into retrospective CGM system and real-time CGM system. In order to identify the clinical roles of different types of CGM techniques and guide the selection of the best population for CGM, the American College of Clinical Endocrinologists (AACE) released an expert consensus on CGM techniques in October 2010^[2]。

The 14th National Academic Conference of Diabetology Branch (CDS) of Chinese Medical Association was held in the historic city of Suzhou from November 18 to 20, 2010. There are 4,532 delegates officially registered at this annual meeting, and the actual number of attendees is nearly 5,000, the highest in history. Ji Linong, chairman of CDS, served as the chairman of the conference, Jia Weiping, vice chairman, and Guo Xiaohui, member of CDS, served as the vice chairman and executive chairman. The conference held three keynote presentations and 22 seminars, and nearly 70 Chinese and foreign scholars gave rich and high-level academic presentations. The conference received 763 papers, of which 78 papers were communicated orally, 250 posters were communicated, and 20 outstanding posters were selected. This annual meeting covers the epidemiological characteristics of diabetic people in China, the pathogenesis of diabetes and related diseases, the multi-organ regulation of blood glucose homeostasis, the basic and clinical research on the prevention and treatment of diabetes and complications, etc. For the first time, a multi-disciplinary hot forum for new drug research and development was set up, and the recently updated "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China" (discussion draft), "Guidelines for Medical Nutrition Therapy of Diabetes in China" and the position statement of the Diabetes Branch on stem cell treatment of diabetes and stem cell treatment of diabetic peripheral vascular disease were released. At the same time, the senior editorial board members of the Chinese Journal of Diabetes, a journal of CDS, conducted open comments and reviews on actual clinical research papers, which attracted the attention of many doctors.

Chronic hypoxia and tubulointerstitial fibrosis are common alterations in multiple progressive nephropathies, in which hypoxia-inducible factor (HIF) -1 α plays an important role. Human proximal renal tubular epithelial cells (HRPTECs) and male diabetic rats were used to study the effects of metformin on the expression of HIF-1 α in diabetic nephropathy rats from the cellular molecular and animal levels.

In the primary prevention of cardiovascular diseases, obesity is one of the factors that predict its risk. The purpose of this study was to investigate the correlation of body mass index (BMI), abdominal circumference, waist-to-hip ratio and first cardiovascular event.

At present, diabetic retinopathy (DR) is the leading cause of blindness in adults in western countries; However, many diabetic patients often lack clinical symptoms even when they develop late DR. Quickly and effectively assessing the risk of DR in diabetic patients can not only delay vision loss, but also help save medical data and reduce social and personal medical expenses. The aim of this study was to find a rapid way to identify people at high risk for DR.

Clinical studies have shown an increased risk of developing cardiovascular disease in humans with systolic blood pressure>115 mm Hg (1 mm Hg =0.133 kPa). However, there are currently no studies on blood pressure reduction in people with diabetes or cardiovascular disease without hypertension. This study is the first to explore the association between antihypertensive therapy and secondary prevention of cardiovascular disease and all-cause mortality in non-hypertensive (clinically defined hypertension refers to systolic or diastolic blood pressure>140 mm Hg, or treatment with antihypertensive drugs or history of hypertension).

In epidemiological and genetic studies, the use of clamp test and tracer technique to evaluate hepatic insulin resistance is complex, expensive and poor feasibility. To study the degree of insulin resistance in different insulin-sensitive tissues, it is necessary to find alternative indicators. The aim of this study was to find new indicators to assess hepatic insulin resistance.

Proteins are often overlooked when referring to insulin resistance. However, protein resistance and glucose metabolism disorders coexist in male patients with type 2 diabetes under hyperinsulin clamp normoglycemia and fasting aminoacidemia. It is therefore hypothesized that protein resistance will become more severe when postprandial anabolism is maximized.

Diabetic nephropathy is the leading cause of end-stage kidney disease. Studies have proved that the occurrence of diabetic nephropathy in patients with type 1 and type 2 diabetes has familial clustering, and the occurrence of diabetic nephropathy is different among different ethnic groups. It can be seen that genetic susceptibility plays an important role in the pathogenesis of diabetic nephropathy. This study aimed to systematically evaluate the association of genes associated with diabetic nephropathy.

Diabetes is not only associated with vascular diseases, but also with non-vascular diseases. To assess the independent association of diabetes and fasting blood glucose levels with the risk of cause-specific death, researchers analyzed 123 205 deaths in 97 prospective trials to calculate the hazard ratio for cause-specific death based on baseline diabetes levels.