Volume 05 · Issue 01 · 2013

Since its founding in 2009, Chinese Diabetes Journal has entered the statistical source journal of scientific and technological papers in China after experiencing rapid development in the initial stage, and began to gradually move towards the ranks of fine journals. Faced with the ever-changing Internet era and the emergence of a large number of We Media such as blogs, Weibo and WeChat, as editors of academic journals, we have been thinking: What kind of academic journals do readers need? What nutrition can academic journals provide today? What beliefs do you need to uphold in a changing environment? How can the magazine adapt to the new era and lead the academic orientation? Those who seek the longest of wood must solidify their roots; Those who want to flow far away must dredge their springs. We need to go back to the root^[1]In order to explore the way of running a journal that adapts to the times.

Real-time dynamic blood glucose monitoring (CGM) is a new type of blood glucose monitoring technology gradually applied in clinic in recent years. Its monitoring principle is the same as retrospective CGM, but it can provide blood glucose alarm and early warning functions while reflecting instant blood glucose information, so as to more comprehensively display the characteristics of blood glucose fluctuation and assist patients in instant blood glucose regulation. At present, evidence-based medical evidence shows that blood sugar management under the guidance of real-time CGM can achieve better hypoglycemic effect. However, as a new technology, real-time CGM requires higher operational proficiency, monitoring result interpretation ability and patient education of medical staff. In order to make this new technology standardized, reasonable and better serve the clinic, the Diabetes Branch of Chinese Medical Association organized national experts in 2012 to revise the 2009 edition of the Clinical Application Guidelines for Dynamic Blood Glucose Monitoring in China. The revised Guidelines elaborate on the technical characteristics of real-time CGM, the main differences between real-time CGM and retrospective CGM, the indications for clinical application, etc. At the same time, the standardized process of clinical application and the methods of alarm treatment are detailed. The following is combined with the "Clinical Application Guidelines for Ambulatory Blood Glucose Monitoring in China (2012 Edition)"^[1]This paper briefly introduces the accuracy, clinical application characteristics and indications of real-time CGM technology.

Glycosylated hemoglobin (HbA1c) is the product of non-enzymatic glycosylation reaction between glucose and hemoglobin free amino groups in blood, which reflects the average blood glucose level 2~3 months before detection. Since 1968 Rahbar^[1]It has been more than 40 years since HbA1c was first discovered in the red blood cells of diabetic patients and proved that it is closely related to diabetes. During this period, after repeated exploration, research and practice by scientists and clinicians all over the world, people's understanding of the application of HbA1c has become more and more deep and comprehensive. HbA1c is not only the internationally recognized gold standard for diabetic glycemic control and monitoring, but also a large number of clinical studies have shown that it is closely related to the occurrence and development of chronic complications of diabetes. In recent years, the clinical application of HbA1c has gradually expanded to the screening, diagnosis and prediction of diabetes.

Effective and convenient screening of people with abnormal glucose metabolism is the key to diabetes prevention. EZSCAN is a tool for non-invasive detection of sweat gland function developed by French Impeto Medical Company. It can detect abnormal glucose tolerance and the occurrence of diabetes early, and can also detect chronic complications of diabetes. This method can make up for the shortage of commonly used detection methods at present, and is expected to become a powerful tool for early screening of diabetes and detection of chronic complications in the future.

To date, the idea that hyperglycemia can lead to the development of atherosclerosis has not been doubted. In the Diabetes Control and Complications Trial (DCCT)^[1]Medium, intensive treatment group [mean glycated hemoglobin (HbA1c<7%)] and the conventional treatment group (HbA1c<9%), the risk of retinopathy, nephropathy and neuropathy was significantly reduced; Subsequent Epidemiological Study of Diabetes Control and Complications (EDIC)^[2]The results showed that compared with the conventional treatment group, the incidence of cardiovascular events in patients in the intensive treatment group was reduced by 42% (P=0.02), whereas the risk of nonfatal myocardial infarction, stroke, and cardiovascular death was reduced by 57% (P=0.02), indicating long-term cardiovascular benefits after early intensive glycemic control in patients with type 1 diabetes. Similarly, the UK Prospective Diabetes Study (UKPDS)^[3]It was shown that for newly diagnosed patients with type 2 diabetes, compared with the conventional treatment group (mean HbA1c 7.9%), patients in the intensive treatment group (mean HbA1c 7.0%) had a 25% reduction in the incidence of all microvascular complications and a 16% reduction in cardiovascular complications (including fatal and non-fatal myocardial infarction and sudden death), although this difference was not statistically significant at that time (P=0.052), but an epidemiological observational study performed after the end of the study^[4]Compared with the conventional treatment group, early intensive hypoglycemic therapy can not only sustainably reduce microvascular events for a long time, but also significantly reduce long-term macrovascular events (myocardial infarction) and all-cause death, thus verifying the conclusion drawn by EDIC study in type 1 diabetes patients that "early intensive glycemic control is beneficial to long-term macrovascular complications".

To investigate 24-hour blood glucose profile and blood glucose fluctuation following peritoneal exchange in patients with end stage renal disease (ESRD) undergoing continuous ambulatory peritoneal dialysis (CAPD) with glucose-based peritoneal dialysis solution.

A total of 28 patients receiving CAPD due to ESRD were enrolled, of whom 15 subjects with diabetic nephropathy (DN group) and 13 were free of diabetes (NDN group). Data of 12 healthy volunteers (control group) was also analyzed. Patients of three groups were evaluated by continuous glucose monitoring systems (CGMS) and the parameters were measured.

>11.1 percentage of time (PT) was higher in NDN group than that in control group (1%(0-5%) vs 0) (P<0.05) . There were no significant difference of >7.8 area under curve (AUC), >11.1 AUC, standard deviation of blood glucose (SDBG), maximum glucose (MAX) and large amplitude of glycogenic excursion(LAGE) (P value between 0.056 and 0.094). Compared to healthy volunteers group, patients in DN group presented higher CGMS parameters. Patients in DN group also presented higher mean blood glucose(MBG), 24-hour AUC, BG during peritoneal exchange(PE) and MAX after PE , compared with NDN group((9.4±2.5) vs (6.4±1.3)mmol/L, (7.0±2.7) vs (4.2±1.3) mmol·L^-1·d^-1, (8.6±2.8) vs (6.2±1.4) mmol/L, (11.5±2.6) vs (8.5±2.4) mmol/L, all P<0.05). Patients with DN and HbA1c<7% also displayed higher MBG, 24-hour AUC, >7.8AUC and >7.8PT, >11.1 PT and MAX after PE than NDN group(t=1.808-3.627, all P<0.05). Hypoglycemia events occurring at night in DN group was higher than that in NDN group and control group. There was no significant difference of the impact on blood glucose level with the use of 1.5% or 2.5% peritoneal solution in the diabetic nephropathy patients group(allP>0.05).

Continuous ambulatory peritoneal dialysis with glucose-based peritoneal dialysis solution may impose disturbance to glucose homeostasis in patients with ESRD, with a more significant impact in those with diabetic nephropathy.

To investigate the characteristics and related risk factors of hypoglycemia in hospitalized diabetic patients.

Retrospectively analyze the characteristics and related risk factors of hypoglycemia in 3634 diabetic patients hospitalized from January 2008 to December 2011 according to the 203 802 blood glucose monitoring data. The blood glucose was monitored with SureStep Flexx bedside blood glucose management system. Comparison of rates among groups was carried out with contingency table analysis.

Total of 3634 patients (male/female: 1805/1829) were enrolled in this study with a mean age of (59±15) yrs. During the study period, the blood glucose were monitored for 203 802 times in these patients, and was monitored more frequently before breakfast (33 567/203 802, 16.5%), and monitored less in early morning and before lunch (17 701/203 802, 8.7% and 21 271/203 802, 10.4%). Hypoglycemia episodes occurred for 2453 times in the patients and the occurrence of hypoglycemia was 1.2% (2453/203 802), and occurred more frequently in early morning and before lunch (506/2453, 20.6% and 406/2453, 16.5%). About one third (1127/3634, 31.0%) of the patients experienced hypoglycemia, of which with one episode of hypoglycemia occurred in 590 cases (52.4%), 2-3 episodes in 370 cases (32.8%) and more than four episodes in 167 patients (14.8%). With the binary logistic regression analysis , type 1 diabetes mellitus(T1DM)(OR: 2.478, 95%CI: 1.067-5.754), repeated insulin therapy(insulin pump therapy: 2.254(1.283-3.959), more than 3 times insulin therapy daily: 2.307(1.310-4.065), pre-mixed insulin therapy: 2.119(1.179-3.808) )and glycated hemoglobin A1c(HbA1c) <7.0%(2.008(1.560-2.583) ) were the main risk factors of hypoglycemia in hospitalized diabetics.

For hospitalized diabetics, hypoglycemia happens more frequently in early morning and before lunch, but the blood glucose is monitored less in these two periods of time. The blood glucose should be paid more attention to in patients with T1DM or repeated insulin therapy or a HbA1c>7.0% to prevent hypoglycemia.

To investigate the association between neck circumference and lipid profile in Chinese individuals with type 2 diabetes.

Total of 2410 subjects with type 2 diabetes (age 20-80 yrs) were recruited from 15 community health centers in Beijing using a multi-stage random sampling approach. Dyslipidemia was diagnosed according to 2007 Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults.

(1)The study sample consisted of 986 men and 1424 women with a mean neck circumference of (36±4)cm. Mean total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol was (5.2±1.1)mmol/L, (1.8±1.2)mmol/L, (1.3±0.4)mmol/L and (3.0±0.9)mmol/L, respectively. (2)Neck circumference correlated positively with triglyceride (men(r=0.093), women(r=0.077), P<0.01). Neck circumference correlated negatively with high-density lipoprotein cholesterol (men(r=-0.144), women(r=-0.062), P<0.05). (3)Receiver operating characteristic analysis showed that a neck circumference of 37 cm for men and 35 cm for women was the best cutoff point for determining hypertriglyceridemia subjects. A neck circumference of 40 cm for men and 35 cm for women was the best cutoff point to determine subjects with decreased high-density lipoprotein cholesterol. (4)Receiver operating characteristic analysis showed that the area under the curve for neck circumference and hypercholeslerolemia was 0.511 for men and 0.480 for women (P>0.05). Receiver operating characteristic analysis showed that the area under the curve for neck circumference and low-density lipoprotein cholesterol was 0.527 for men and 0.519 for women (P>0.05).

In the present study, neck circumference is related with lipid profile in Chinese individuals with type 2 diabetes, especially triglyceride and high-density lipoprotein cholesterol. Neck circumference might be used in a clinical setting as an indicator for screening or evaluating dyslipidemia in type 2 diabetic subjects.

To investigate the prevalence and related factors of exocrine pancreatic insufficiency in patients with diabetes mellitus (DM).

A total of 150 patients including 23 with type 1 diabetes mellitus (T1DM) and 127 with type 2 diabetes mellitus (T2DM), and 48 healthy controls from Xijing Hospital were enrolled in this investigation between March 2009 and June 2010. The clinical and laboratorial parameters such as age, gender, body mass index (BMI), diabetes course, diabetic microvascular complications, glycated hemoglobin A1c (HbA1c) of diabetic patients were recorded. Stool samples were collected for 24 hours. Exocrine pancreatic function was measured by assaying fecal elastase (FE) concentration by enzyme-linked immunosorbent assay (ELISA) in all the subjects. Categorical values were compared using either the χ ² test or the Fisher exact test.

The concentration of FE was significantly lower both in T1DM group ((394±237) μg/g) and T2DM group ((502±194) μg/g) than that in control group ((576±170) μg/g) ( F=6.93, P<0.01). When the diagnosis criterion of exocrine pancreatic insufficiency was defined as FE<200 μg/g, the results showed that higher prevalence of exocrine pancreatic insufficiency was found both in T1DM patients (30.4% (7/23)) and T2DM patients (7.9% (10/127)) than that in control subjects (0) (Fisher'sP<0.05). However, when the diabetic patients were divided into two groups 2 h postprandial insu lin. with and without exocrine pancreatic dysfunction, no significant statistic differences in gender distribution, age, BMI, diabetes course, prevalence of diabetic microvascular complications and insulin medication, fasting insulin, 2 h postprandial insulin, homeosbasis model assessment of β cell function(HOMA-β) or HbA1c were found between the two groups (P>0.05).

Exocrine pancreatic dysfunction was in higher prevalence in T1DM and T2DM patients than that in healthy controls.

To study the single nucleotide polymorphism of rs13266634 (the genotype and the frequency) in SLC30A8 gene and its association with Gestational Diabetes Mellitus and relevant metabolic parameters.

A total of 451 24-28 weeks of pregnant women who visited Affiliated Hospital of Jining Medical College from October 2010 to March 2012 were enrolled in this case-control study. All the participants underwent 75 g oral glucose tolerance test (OGTT), 203 of them were diagnosed GDM (GDM group), and the others (248) were normal glucose tolerance (NGT group). The rs13266634 polymorphism in SLC30A8 gene was genotyped in 203 patients with Gestational Diabetes Mellitus and 248 pregnant women with normal glucose tolerance by PCR-RFLP analysis (polymerase chain reaction-restriction fragment length polymorphism). Meanwhile clinical characteristics such as body mass index(BMI), blood pressure(Bp), triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterin (LDL-C), high density lipoprotein cholesterin (HDL-C), etc were measured and calculated. HOMA-β and HOMA-IR were used to estimate β-cell function and insulin resistance. We usedt-testing of independent samples to compare the difference between two groups and used analysis of variance to test the difference among the several groups. χ ²analysis was used to compare the difference in genotype and allele frequencies. Logistic regression analysis was used to test for association between rs13266634 polymorphism in SLC30A8 gene and GDM.

(1)In GDM group, the frequency of CC genotype (42.9%, 87/203) and C allele (65.5%, 266/406)were significantly higher than those (31.4%, 78/248 and 56.0%, 278/496)in the NGT group (χ² were 6.259 and 8.362, both P<0.05); The TT genotype(11.8%, 24/203) and T allele(34.5%, 140/406) were significantly lower than those(19.4%, 48/248 and 44.0%, 218/496) in the NCT group (χ² were 4.721 and 8.362, both P<0.05). (2)The C-allele significantly increased GDM risk with an allelic odd ratio (OR) of 1.49(OR=1.490, 95%CI: 1.136-1.953, P=0.004); Compared with non-carriers, homozygous carriers of C-allele were liable to have GDM with OR of 2.60(OR=2.600, 95%CI: 1.321-5.119, P=0.006). (3)From CC→CT→TT gene, HOMA-β level showed a growing trend (5.1±0.5→5.4±0.6→5.6±0.6,P<0.01).

The rs13266634 polymorphism in SLC30A8 gene is association with GDM in Shandong Jining, the C-allele might be a risk factor for GDM. SLC30A8 gene might be one of susceptible genes of GDM in this area.

To investigate the inhibitory role of curcumin in palmitic acid-induced inflammatory response of macrophages.

Murine macrophage cell line RAW264.7 were treated with 0, 250, 500 μmol/L palmitic acid for 24 h, then the morphology of cells were observed, receptor interacting protein140( RIP140), tumor necrosis factor α(TNF-α) and interleukin 6(IL-6) mRNA levels were determined by reverse transcription-polymerase chain reaction (RT-PCR) and levels of TNF-α and IL-6 in supernatant were tested by enzyme- linked immunosorbent assay (ELISA). The optimum time and concentration of curcumin on RAW264.7 cells were determined by MTT assay. Cells were separated into two groups and treated with 20 μmol/L curcumin and the same volume of dimethyl sulfoxide (DMSO) for 1 h, respectively; then both groups were treated with 500 μmol/L palmitic acid. After 24 h, the morphology of cells were observed, and the mRNA abundance of RIP140, TNF-α and IL-6 and protein levels of TNF-α, IL-6 in supernatant were detected. The research data was assessed by one-way ANOWA and t test.

After intervening with 500 μmol/L palmitic acid for 24 h, RIP140 mRNA level was higher than that in 0 μmol/L palmitic acid group (3.40±0.51 vs 1.01±0.21, t=7.436, P<0.01). After intervening with 0, 250, 500 μmol/L palmitic acid for 24 h, TNF-α mRNA levels (1.00±0.03, 1.79±0.12, 2.16±0.13) and protein levels ((197±25), (371±10), (485±17) ng/L), IL-6 mRNA levels (1.00±0.51, 2.55±0.15, 2.59±0.17) and protein levels ((953±66), (1081±36), (1182±18)ng/L) were increased significantly in a dose-dependent manner(F=99.308, 187.049, 152.958, 26.594, respectively, all P<0.01); After the treatment of palmitic acid, cells shrank, rounded and even disintegrated; The optimum time of curcumin treating on RAW264.7 cells was 1 h, and the optimum concentration was 20 μmol/L. After treated with 20 μmol/L curumin, compared to control group, RIP140 mRNA abundance (0.63±0.01 vs 1.00±0.05,t=-13.79, P<0.01), TNF-α mRNA abundance (0.64±0.11 vs 1.00±0.07,t=-4.532, P<0.05) and protein concentration ((322±12) vs (485±17) ng/L,t=-13.577, P<0.01), IL-6 mRNA abundance (0.57±0.05 vs 1.00±0.02,t=-14.167, P<0.01) and protein concentration ((241±47) vs (1182±18) ng/L,t=-44.810, P<0.01) were significantly lower, the morphology of cells was not impaired and cell junction still existed.

Curcumin may repress palmitic acid-induced inflammation by decreasing RIP140 expression.

Glycosylated albumin (GA) is an early glycosylation product of non-enzymatic glycation reaction between glucose and albumin in blood^[1]。 Because the half-life of albumin in the body is short (about 17 days), and the binding speed of albumin to blood glucose is faster than that of hemoglobin, GA is more sensitive to the changes of blood glucose in the short term than glycosylated hemoglobin (HbA1c). It is generally believed that GA measurement can reflect the recent blood glucose control of patients (about 2 weeks). At present, GA has become a widely used blood glucose monitoring index in clinic^[2]。 This article will briefly describe the research progress of GA and diabetes screening and diagnosis.

Drug allergy can not only cause extensive skin lesions, such as exfoliative dermatitis, Stevens-Johnson syndrome, toxic epidermal necrolysis, etc., but also symptoms such as fever and lymph node enlargement. With the development of virology, cellular immunology and molecular genetics, scholars have found that drug allergy can also induce a variety of diseases. A case of fulminant type 1 diabetes (F1D) after drug allergy is reported.

Diabetes mellitus is one of the main causes of death from chronic diseases, and its epidemic situation is becoming increasingly severe. According to data recently released by the International Diabetes Federation (IDF), the number of diabetes patients worldwide in 2011 was 366 million, of which 4.6 million died of diabetes, and the cost of diabetes was about 465 billion US dollars. From 2007 to 2008, there were 92.4 million adults aged ≥20 years with diabetes and 148 million prediabetic patients in China. Cardiovascular complications are the most common cause of death in diabetic patients. 75% to 80% of diabetic patients die from cardiovascular disease. Compared with non-diabetic patients, the risk of cardiovascular events in diabetic patients increased by 2 to 4 times.

According to the American Diabetes Association (ADA)^[1]And my country's diabetes treatment guidelines^[2]If single or combined with multiple oral hypoglycemic drugs cannot maintain the treatment target of glycosylated hemoglobin (HbA1c) below 7% or 6.5%, insulin therapy should be initiated in time. A number of clinical studies have confirmed that early intensive hypoglycemic therapy can significantly reduce diabetic complications and mortality. Studies in my country have found that early intensive insulin therapy in patients with type 2 diabetes can also preserve the patient's β cell function and delay the progression of the disease^[3]。 However, while insulin therapy brings many benefits, there are also inevitable problems, such as the risk of hypoglycemia and weight gain. Among them, weight gain is receiving more and more attention, which not only becomes a psychological barrier for patients to start insulin therapy, but also may offset the benefits of insulin therapy to some extent.

Surgical trauma impairs intraoperative insulin sensitivity and is associated with the occurrence of postoperative adverse events. Recently, the European and American College of Cardiology have recommended statin therapy before coronary artery bypass grafting (CABG). However, studies have reported that statin therapy increases insulin resistance and the risk of new onset diabetes. Therefore, the investigators investigated the relationship between preoperative statin therapy and intraoperative insulin sensitivity in patients with dyslipidemia without diabetes mellitus.

At present, the clinical diagnosis and evaluation of diabetic nephropathy (DN) is mainly based on urinary albumin or glomerular filtration rate calculated by serum creatinine. There is no sensitive index for early diagnosis of DN. Previous studies have found that the changes of collagen metabolism in urine are closely related to kidney injury. Before the increase of urinary albumin secretion, the secretion of collagen fragments in urine is abnormal. There are many collagen fragments with high specificity and sensitivity in urine, of which fragment 273 (CKD273) is highly sensitive to chronic kidney disease (CKD). In this study, a prospective cohort study was conducted to evaluate whether urine protein fraction can be used as the diagnostic basis for early DN (before microalbuminuria occurs), and to identify protein fragments from 273 protein fragments that are valuable for early diagnosis of DN.

Cutaneous autofluorescence is a non-invasive marker for detecting the accumulation of advanced glycation end products. Previous studies based on primary healthcare institutions have shown that skin autofluorescence is strongly associated with microvascular and macrovascular complications in type 2 diabetes and has a predictive effect on complications.

Epidemiological studies and randomized clinical trials have demonstrated that resting heart rate (RHR) is an independent predictor of cardiovascular disease risk and all-cause mortality in various populations.

In order to investigate the specific role of mitogen-activated protein kinase (MAPK) on endothelial cell dysfunction during the progression of diabetes mellitus, and to explore whether MAPK blockers and agonists can improve endothelial cell function, the researchers evaluated the expression and activation levels of p38, c-Jun amino-terminal kinase (JNK) and extracellular signal-regulated kinase (Erk) in mesenteric arteries of 3-month and 9-month-old diabetic model mice and control mice, respectively.