Volume 04 · Issue 08 · 2012

peripheral artery disease (PAD) refers to the stenosis and occlusive disease of other arteries except coronary arteries and cerebral blood vessels, which often leads to corresponding ischemic spasm or necrosis of distal tissues. Its main risk factors include aging, diabetes, hypertension, hyperlipidemia, smoking, etc., mainly involving lower limb arteries^[1]。 Among the risk factors for the development of PAD, the risk of developing lower extremity arteriopathy in diabetic patients is 2 times higher than that in non-diabetic patients^[2]Unlike non-diabetic patients, PAD in diabetic patients more often involves small and medium arteries such as deep femoral artery and anterior tibial artery^[3]。 In China, the prevalence of PAD among diabetic patients over 50 years old is as high as 19.5% ~23.8%^[4,5]。 Diabetic lower extremity arteriopathy is not only one of the risk factors of diabetic foot^[6]It is also one of the independent risk factors for amputation in diabetic foot patients^[7]； More importantly, PAD can increase the risk of cardiovascular events and mortality of patients. The incidence of cardiovascular events in PAD patients is as high as 21.1% one year after diagnosis, which is comparable to the risk of recurrence in patients with cardiovascular and cerebrovascular lesions^[8]。 Therefore, in order to prevent the occurrence of diabetic foot, reduce the amputation rate, and reduce the incidence of cardiovascular events and mortality rate, it is necessary to strengthen the screening of PAD in diabetic patients and give standardized management.

Diabetic lower extremity arteriopathy is the most common manifestation of diabetic arteriosclerosis obliterans (DAO). Severe diabetic lower limb arteriopathy can lead to severe limb ischemia (CLI) in patients^[1], is the main cause of diabetic foot ulcer and major amputation surgery^[2]。 When patients have CLI and seriously threaten the safety of limbs, simple medical drug treatment is often difficult to be effective. At this time, endovascular intervention and surgical intervention should be actively carried out to reconstruct the blood supply of lower limbs, so as to achieve the purpose of limb saving.

lower extremity arterial disease (LEAD) is a common chronic complication of diabetes and is the main cause of the development of diabetic foot. The typical clinical manifestations of LEAD include intermittent claudication, resting pain, ischemic foot ulcer and gangrene. However, diabetic LEAD patients have a hidden onset and atypical early symptoms. Only 10% ~30% have intermittent claudication, and most of them have no identifiable symptoms of limb ischemia. They usually see a doctor when foot ulcer or gangrene has occurred, and many patients eventually need amputation. At the same time, as a local manifestation of systemic atherosclerosis, a considerable proportion of LEAD patients die of cardiovascular diseases. Therefore, the treatment goals of diabetic LEAD should mainly include two aspects: (1) improving symptoms, reducing intermittent claudication and improving quality of life; (2) Reduce the risk of cardiovascular and cerebrovascular events. The treatment of diabetic LEAD is comprehensive, in which drug treatment is the basis and should be carried out throughout the treatment process. This article introduces the progress of the drug treatment of diabetes LEAD, in order to arouse everyone's attention to the drug treatment of this disease.

Recent studies have shown that diabetes increases the risk of cancer in many parts of the body in addition to cardiovascular disease and kidney disease^[1], but the biological mechanism by which diabetes increases cancer risk is unknown. In addition, which subgroup of diabetics is at high risk for cancer? What are the effects of antidiabetic drugs on cancer? Is it possible and how to prevent cancer in these diabetic patients? For these issues under exploration, the Hong Kong Diabetes Register^[2]The series of reports gave some important revelations.

To investigate the effect of combined medication of beraprost sodium and aspirin on lower limb vascular disease in patients with type 2 diabetes mellitus(T2DM).

Total of 36 type 2 diabetic patients complicated with atherosclerosis treated from July 2010 to July 2011 in the out-patients of our hospital were enrolled in this study. Those patients, aged 60-75 years, were randomly divided into two groups according to random number table, 18 cases in each group. Patients in group A(test group) were treated with beraprost sodium (20 μg tid) and aspirin (100 mg qd), while patients in group B(control group) were treated only with aspirin (100 mg qd). All the patients were given corresponding basic therapies for diabetes, hypertension and other diseases during the one-year study. Main observed parameters were artery parameters in both lower limb arteries (inner diameters, maximal atheromatous plaques, largest stenosis rates, highest velocity and flow of dorsal pedal, anterior tibial, and posterior tibial arteries) were measured by color Doppler ultrasound, and serum levels of matrix metal proteinase (MMP)-9, vascular endothelial growth factor(VEGF) of the patients were measured by enzyme-linked immunosorbent assay(ELISA). The t test and K-W rank-sum test was used in data analysis.

After 1-year study, for test group the improvements of the primary targets of observed atherosclerotic parameters in lower limb arteries including the increasing of arteries inner diameters, shrinking of maximal atheromatous plaques, decreasing of highest flow and increasing of highest velocity were superior to those in control group, especially for the increases of inner diameters of right dorsal pedal artery ((2.0±0.6) mm before treatment and (2.2±0.5) mm after, t=2.390, P<0.05), left posterior tibial artery ((2.2±0.4) mm before treatment and (2.6±0.3) mm,t=4.158, P<0.05) and right posterior tibial artery ((2.1±0.4)mm before treatment and (2.7±0.5) mm,t=2.919, P<0.05) in Test group; while in control group, the diameters of maximal atheromatous plaques in left anterior tibial artery increased ((1.1±0.9) and (2.5±2.6) mm before and after treatment,t=2.350, P<0.05) and the highest velocity of left dorsal pedal artery, right dorsal pedal artery, left anterior tibial artery, right anterior tibial artery raised significantly ((45±14) and (62±19), (55±17) and (79±21), (44±12) and (85±29), (59±17) and (91±23) cm/s respectively before and after the treatment,t=8.359, 3.136, 3.946, 2.768, all P<0.05). It was showed that the levels of MMP-9 was in a significant increasing trends in both groups(t=4.110, 4.429, both P<0.05). The level of VEGF in test group decreased after the treatment but not significantly, while it increased in control group and also without statistically differences when compared with that before treatment(t=0.313, 0.561, both P>0.05).

Beraprost sodium, used in combination with aspirin, can effectively alleviate the progress of lower limb vascular disease in patients with T2DM.

To evaluate the effect of Wagner grading and the University of Texas diabetic wound classification system on the prognosis of diabetic foot ulcer.

From March 1999 to September 2009, a total of 242 newly-diagnosed diabetic foot ulcer patients (with a ulcer course of 3 days to two weeks) were involved in this retrospective cohort study, there were 145 males and 97 females aged 19-78 years with a diabetes course of 0.5-27.0 years. The size of the ulcer, clinical evidence of infection, ischemia and neuropathy were recorded. Each ulcer was graded using both the Wagner grading and the University of Texas diabetic foot classification system. The patients were followed-up for 6 months. Once ulcer healed completely or a lower-limb amputation was performed, the outcome was noted and the patients was deemed to have completed the study. The χ ² test for trend, Kaplan-Meier survival analysis and log-rank test were used to assess the capability of grading and stage to predict healing and increased risk of amputation within the study period.

Among the 242 patients with recently diagnosed diabetic foot ulcers, 54.9% (133 patients) were neuropathic, 34.3% (83 patients) were neuroischemic, and 8.7% (21 patients) had no identified underlying factors. Lower-limb amputations were performed in 20.7% (50 cases) of the conditions, whereas 147 cases (60.7%) healed within 6 months and 14% (34 cases) not healed till the study ended, and 3 patients(5.4%) died. The Wagner grade showed a significant positive trend with increased number of amputation (χ²=79.6420, P<0.01). And this was ture for both stage (χ²=32.8046, P<0.01) and grade (χ²=39.2448, P<0.01) of the University of Texas wound classification system with increased number of amputation. For the University of Texas wound classification system, the risk of amputation increased 29-fold in ulcer with infection (RR=29.237, 95%CI: 3.845-222.341, P<0.01) and increased 48-fold in ulcer with ischemia and infection (RR=48.300, 95%CI: 6.209-375.703, P<0.01) and increased 8-fold(RR=8.364, 95%CI: 0.899-77.798, P>0.05) when compared with those ulcers without infection and ischemia. The log-rank test showed that healing times were not significantly different in patients with ulcer in different Wagner grade(χ²=4.761, df=2, P>0.05) or in different grade in the University of Texas wound classification system (χ²=5.452, df=2, P>0.05), but there was a significant stepwise increase in healing time with each stage of the Texas system(χ²=11.234, df=3, P<0.05).

The University of Texas wound classification system is associated with increased risk of amputation and prolonged ulcer time compared with the Wagner system, and it can be a better predictor of the prognosis.

To assess current treatment and glycaemic control of adult subjects with type 2 diabetes mellitus (T2DM) in China, focusing on the therapy of oral anti-diabetic drugs (OAD) in combination with insulin.

From July to September in 2009, 400 hospitals from 75 cities across China were selected by Chinese Diabetes Society for this cross-sectional study. All the T2DM patients (over 18 years) with oral antidiabetic drug (OAD) with/without insulin were eligible for this study. General information of the patients, duration of diabetes, medical history, diabetes complications and concomitant diseases, glycated hemoglobin A1c(HbA1c), fasting blood glucose (FBG), postprandial blood glucose (PBG) and treatment regimen were recorded. All data were analyzed by using SAS 9.13 software.

A total of 143 123 eligible T2DM patients were enrolled in this study (73 544 males and 69 579 females, median age 59 years, median duration of diabetes 6 years). Among the patients treated with insulin plus OADs, the most frequently used insulin is pre-mix insulin (65.5%, 34 487/52 649), followed by basal insulin (24.3%, 12 794/52 649) and basal-bolus insulin (8.5%, 4492/52 649). The percentage of patients achieved HbA1c<6.5% was 20.2% (28 985/143 123) for the overall populations, and 23.4% (21 163/90 474) and 14.9% (7822/52 649) for the patients treated with OADs only and insulin plus OADs respectively. Within patients treated with insulin plus OADs, the percentage of patients achieving HbA1c<6.5% were 15.2% (1944/12 794), 14.9% (5150/34 487) and 14.6% (656/4492) for basal insulin group, pre-mixed insulin group and basal-bolus insulin group respectively. The percentage of patients achieving HbA1c target decreased with the increase of duration of diabetes (allP<0.05). Patients initiated insulin therapy in the earlier stage had more chance to achieve HbA1c target (allP<0.01). Data from this study also indicated that the percentage of patients achieving blood pressure and blood lipid profile target remained low in China. In total, there were 23.5% (33 676/143 123) of the subjects reached blood pressure target and 37.4% (53 550/143 123), 41.4% (59 320/143 123), 19.2% (27 418/143 123) and 41.4% (59 671/143 123) of subjects reached triglyceride(TG), total cholesterol(TC), high-density lipoprotein cholesterol(HDL-C) and low-density lipoprotein cholestorol(LDL-C) targets, respectively.

The overall rate of achieving glycaemic control target remained low in Chinese patients with T2DM, which was even lower for those treated with insulin plus OADs. This study indicates more effective individualized treatment regimen is needed for most patients.

To compare the differences of different methods for glycated hemoglobin (HbA1c) measurement with venous and capillary blood samples.

Total of 91 diabetes outpatients (38 males and 53 females) were selected in Beijing Hospital from January to October 2011. Four fasting venous blood samples were collected in 2 ml EDTA-K₂ anti-coagulation vacuum tubes, meanwhile, 32 μl heparin anti-coagulated capillary blood samples were obtained from the ear lobe and the fingertip. These blood samples were immediately measured by G7 in PLA General Hospital, Beijing Hospital and National Center for Clinical Laboratories, or measured by DCA2000 ⁺ in community clinics. The blood HbA1c levels were compared among different age groups, different samples on DCA2000⁺ (from venous, ear lobes, fingertip) or on G7 (from venous and fingertip) and different laboratories and methods. Mann-Whitney test was applied in data comparison between to groups and Kruskal-Wallis test among multiple groups.

The intra-and inter-assay coefficients of variation(CV) of the DCA2000⁺ analyzer were all less than 4%, and the intra- and inter-assay CV of the G7 analyzer from 3 hospitals were all <2%, the results were all accorded with the American Diabetes Association requirement of a CV<5% for HbA1c analyzers. No significant statistical differences in HbA1c level was observed among different age groups with the G7 measurement in National Center for Clinical Laboratories(χ ²=3.969, P>0.05). There was no significant differences in HbA1c levels measured by DCA2000⁺ with venous, fingertip and ear lobe blood samples in community clinics (χ²=0.474, P>0.05). The results of G7 analysis in Beijing Hospital did not differ significantly with venous blood sample and prediluted fingertip blood(Z=-0.092, P>0.05). There was no statistical differences in HbA1c levels measured in 4 medical institutions using different methods(χ²=5.513, P>0.05).

Two detecting methods of HbA1c used in the 4 medical facilities have good coherency and repeatability, the results are correlated and can be mutually accredited. The HbA1c levels in venous and capillary blood samples are the same.

To investigate the relationship between type 1 diabetes mellitus and human leukocyte antigen(HLA)-A and-DRB1 gene frequencies and haplotypes.

Fifty-one patients (male 27, female 24, average age of onset (14±9) y) with spontaneously acute ketotic onset and insulin-dependent type 1 diabetes mellitus (T1DM) were enrolled during 2008 and 2009 from Jiangyin and Nanjing city in Jiangsu Province. HLA typing data with the similar genetic background of 20 248 unrelated donors in Jiangsu Branch of Chinese Marrow Donor Program were set as controls. DNA was extracted from the peripheral blood, and HLA-A or DRB1 gene was genotyped with polymerase chain reaction-sequence specific oligonucleotide primers, and the haplotype frequencies, linkage disequilibrium and correlation with type 1 diabetes were also analyzed by Arlequin software and Chi-square test in the two groups.

The frequencies of A*02 and A*24 were the highest in HLA-A locus, and DRB1*09 was the highest in DRB1 locus. Compared with the controlled group, the frequencies of HLA-A*03, HLA-A*24, DRB1*09 and DRB1*03 were significantly increased in T1DM patients(6.86% vs 2.43%, 27.45% vs 16.79%, 32.35% vs 16.15%, 15.69% vs 4.76%, respectively; χ ²=8.40, 8.27, 19.69, 26.66; odds ratio=3.00, 1.87, 2.47, 3.69; all P<0.01). A*01-DRB1*03 haplotype was specific with T1DM group in linkage disequilibrium analysis.

We find the herd susceptibility of loci A*03, A*24 and DR03, DR09 in T1DM subjects, and three A-DR susceptibility haplotypes. The relationship between ancestor haplotype of A01DR03 and T1DM is confirmed.

To investigate the effects of Cordyceps sinensis (CS) on the expression of pigment epithelium-derived factor (PEDF) and vascular endothelial growth factor (VEGF) in high glucose induced rat mesangial cells (MCs).

35 SD rats were randomly divided into three groups: normal serum group (Saline, n=18), low dose CS feeding group (5 g·kg^-1·d^-1, n=8), and high dose CS feeding group (10 g·kg^-1·d^-1,n=9). The three groups were given saline and different dosage of CS by gavage for 8 days, then venous blood samples were taken to prepare experimental serum. Rat mesangial cells(MCs, HBZY-1 line) were divided into four groups: the normal glucose control group (NC group, 5.6 mmol/L Glucose+ 10%Fetal bovine serum(FBS)+ 1%normal serum) , the high glucose group ( HG group, 30.0 mmol/L Glucose+ 10% FBS+ 1% normal serum), the Low dose-CS group (LD Group, 30.0 mmol/L Glucose+ 10% FBS+ 1% low dose CS serum), and the High dose-CS group (HD Group, 30.0 mmol/L Glucose+ 10% FBS+ 1%high dose CS serum). The VEGF and PEDF mRNA expression in the MCs were determined by reverse transcription-polymerase chain reaction (RT-PCR), the level of PEDF and VEGF in MCs supernatants were examined by ELISA.

Compared with the NC group, the mRNA expression of PEDF was significantly lower(24 h: 0.375±0.011 vs 0.507±0.008, t=16.828, P<0.01; 72 h: 0.376±0.014 vs 0.515±0.010,t=14.034, P<0.01), whereas the VEGF mRNA expression was significantly higher in the HG group (24 h: 1.005±0.011 vs 0.864±0.012,t=14.963, P<0.01; 72 h: 1.168±0.012 vs 0.873±0.011,t=31.417, P<0.01). After treated with CS, the PEDF mRNA expression was significantly increased(24 h: 0.505±0.018, 0.639±0.012 vs 0.375±0.011,F=354.719, P<0.01; 72 h: 0.612±0.023, 0.700±0.019 vs 0.376±0.014,F=97.82, P<0.01), and the VEGF mRNA expression was significantly decreased in the LD and the HD groups compared with those in the HG group (24 h: 0.838±0.014, 0.767±0.017 vs 1.005±0.011,F=79.55, P<0.01; 72 h: 0.923±0.016, 0.784±0.012 vs 1.168±0.012,F=244.28, P<0.01). After treated with experimental serum for 24 and 72 hours, the level of PEDF was significantly lower(24 h: (267±8) vs (303±10) ng/L,t=6.493, P<0.01; 72 h: (265±27) vs (338±42) ng/L,t=3.259, P<0.01), whereas the level of VEGF was significantly higher in the HG group than those of the NC group(24 h: (128±3) vs (113±8) ng/L,t=3.737, P<0.01; 72 h: (144±7) vs (125±7) ng/L,t=4.215, P<0.01). Compared with the HG group, the level of PEDF was significantly higher(24 h: (297±12), (296±26) vs (267±8) ng/L,F=5.427, P<0.01; 72 h: (323±20), (332±33) vs (265±27) ng/L,F=5.690, P<0.01), and the level of VEGF was significantly lower in the LD and the HD groups(24 h: (106±6), (109±11) vs (128±3)ng/L,F=5.738, P<0.01; 72 h: (124±9), (125±7) vs (144±7) ng/L,F=7.878, P<0.01), no difference was observed between the LD group and the HD group(P>0.05).

Renoprotection of CS on MCs may be mediated through reducing the expression of VEGF and increasing the expression of PEDF.

Islet cell transplantation is an ideal method for the treatment of type 1 diabetes, but the islet cells are directly exposed to the subject's blood after transplantation through the portal vein, and various immune and non-immune challenges lead to massive loss of islet cells, and the mechanism is not well defined due to the lack of effective monitoring tools. Islet transplantation tracing technology can study the changes of graft and its function during vascularization and immune challenge after transplantation, so as to objectively evaluate the distribution, survival and migration of transplanted cells in subjects. The ideal tracer technique should have high resolution monitoring of individual islets in the liver, simple and correct quantification of transplanted islet cells, and conditions that should be related to islet function and islet transplantation effect. In addition, in order to clarify the appearance of immune rejection, the weakening of marker signals should be monitored in time. Finally, it is also necessary to verify its safety to human body^[1]。 This article will focus on an overview of the recent advances in the application of multiple tracer techniques in islet cell transplantation.

Most of the metal ions in the body constitute the inorganic electrolyte components of human body fluids, which mainly include sodium, potassium, calcium and magnesium. They play an important role in maintaining plasma osmotic pressure, acid-base balance and nerve and muscle excitability. In terms of sugar homeostasis, the stable internal environment provided by electrolytes has an important effect on maintaining blood glucose and insulin levels and effects in the body. This paper reviews the research progress of the relationship between electrolyte cations and the development of type 2 diabetes.

The British Diabetes Prospective Study (UKPDS) and its follow-up studies show that achieving good glycemic control through early intensive therapy significantly reduces the risk of macrovascular and microvascular complications in patients with type 2 diabetes mellitus (T2DM)^[1]。 With the prolongation of the disease course, the function of pancreatic islet β cells in patients with T2DM progressively declines, and a single hypoglycemic drug often cannot maintain the stability of blood glucose level for a long time. It is often necessary to use two or more hypoglycemic drugs in combination to make fasting blood glucose, postprandial blood glucose and glycosylated hemoglobin (HbA1c) reach the standard. However, various hypoglycemic drugs have different mechanisms of action, and their combined application often leads to adverse reactions such as hypoglycemia and weight gain. Therefore, long-term stable, safe and effective control of blood sugar is a great challenge for diabetes prevention and treatment. Both basal insulin and glucagon-like peptide-1 (GLP-1) receptor agonist monotherapy have been shown to significantly reduce blood glucose, and this article focuses on the rationality of combination therapy of these two drugs.

According to the latest 2011 data from the International Diabetes Federation (IDF), there are 366 million people with diabetes worldwide. Without emergency measures, the number of people with diabetes will surge to 552 million by 2030^[1], which is equivalent to 3 new cases every 10 seconds, and 1 in 10 adults develops diabetes. Diabetes mellitus is the main cause of blindness, kidney failure, heart disease, stroke and amputation. The complications of diabetes mellitus greatly increase the chances of patients being admitted to hospital, and hospital hyperglycemia becomes an increasingly common phenomenon. However, the data on hyperglycemia in hospitalized patients is not comprehensive. The existing data show that 38% of hospitalized patients have hyperglycemia (including newly discovered diabetes and stress hyperglycemia), of which 26% have a known history of diabetes, and the other 12% have no history of diabetes; 10% ~12% of discharged patients were diabetic patients, 29% of patients undergoing cardiovascular surgery were diabetic patients^[2]。 Diabetic patients stay 1 to 3 days longer than non-diabetic patients^[3,4]This is because hyperglycemia not only leads to increased catabolism, negative nitrogen balance, poor wound healing and increased infection rate, but also affects the stability of the internal environment and increases the mortality of patients in more serious cases^[5,6,7]。 Therefore, the management of hospital hyperglycemia has always been a matter of concern. Combined with recent large-scale clinical studies and the consensus and guidelines of experts from various countries, this paper discusses the control objectives of various types of nosocomial hyperglycemia, the problems that should be paid attention to in the process of hypoglycemia, various hypoglycemic regimens and the choice of hypoglycemic drugs.

With the rapid development of social economy and the acceleration of industrialization, chronic non-communicable diseases such as diabetes and coronary heart disease have become global public health problems. The close relationship between diabetes and cardiovascular diseases has been paid more and more attention by doctors and patients. As a classic drug to prevent cardiovascular and cerebrovascular events, can aspirin be equally effective in preventing cardiovascular events in diabetic patients and bring long-term benefits? This article reviews the results of recent clinical studies and meta-analyses, and discusses the effect of aspirin on the prevention of cardiovascular events in diabetic patients in combination with China's national conditions.

At present, there are many diabetic patients in China, and a large proportion of patients have one or several chronic complications. Among them, diabetic foot has a serious impact on patients' health and quality of life. However, at present, the treatment of diabetic foot is limited, and the effect is not satisfactory. Therefore, scholars at home and abroad have carried out a series of research on this, and many new materials and new methods have been brought into the sight of researchers.

In order to quantify the relationship between diabetes treatment and cancer incidence, case mortality, and all-cause mortality in adults who develop cancer after diabetes diagnosis, and to calculate the proportion of diabetes among various cancer causes, researchers from Johns Hopkins University analyzed prospective data from 599 diabetic patients and 17 681 non-diabetic adults from the CLUE II cohort. The presence or absence of diabetes was determined according to the patient's complaint of using diabetes medication at baseline. Cancer incidence rates are determined by county and state cancer registries. Mortality data were taken from death certificates.

There has been a debate about whether insulin use increases a patient's risk of cancer. Researchers from the University of Bordeaux randomly selected a permanent sample from January 1, 2003 to June 30, 2010 in the French national health insurance system database, and analyzed that the risk of cancer in patients who used insulin glargine was higher than that in patients who used human insulin.

Obesity, with or without type 2 diabetes, is associated with an increased incidence of malignant tumors. Therefore, research on whether therapeutic drugs in patients with type 2 diabetes mellitus and obesity have an effect on the growth of tumor cells has attracted much attention. Glucagon-like peptide-1 (GLP-1), produced by enteroendocrine cells and secreted after eating, regulates blood glucose levels through a variety of mechanisms, mainly inhibiting glucagon secretion and stimulating insulin secretion. In the rodent thyroid, GLP-1 can independently promote its cell growth and survival and continuously activate its GLP-1 receptor signaling, leading to C-cell hyperplasia and medullary thyroid carcinoma. Therefore, it is of great significance to study whether therapy based on GLP-1 receptor activation can change the growth and survival of cancer cells.

Recent research findings that the use of hypoglycemic drugs can increase the risk of cancer in patients have attracted widespread attention. To investigate the comparability of potential cancer risks comparing different hypoglycemic drugs and the pattern of cancer risk changes over time, researchers from the UK Drugs and Medical Products Regulatory Agency analyzed data from the UK Integrated Medical Research Database (GPRD). GPRD was used to identify enrollment of new drug users. The outcome data of cancer patients were derived from GPRD, hospital event statistics and cancer registry records. Comparison of the relative incidence of cancer with different hypoglycemic drugs using Poisson regression.

Type 2 diabetes is a widespread metabolic disease worldwide. Several large population studies have shown that there is a close relationship between diabetes and malignant tumors. For patients with endometrial cancer, breast cancer, colorectal cancer and liver cancer, diabetes is a poor prognostic factor, and its cancer-specific survival rate decreased significantly. At present, research has confirmed that there is an obvious relationship between diabetes mellitus and renal cell carcinoma (RCC), but the effect of diabetes mellitus on the prognosis of RCC is still controversial.