Volume 05 · Issue 12 · 2013

With the acceleration of urbanization and the abundance of material supply, people's lifestyle has also undergone corresponding changes. The increase of energy intake, the prolongation of sitting time and the decrease of physical activity make the common metabolic diseases of adults such as obesity, hyperglycemia, hypertension and dyslipidemia show a high incidence and younger age. The resulting atherosclerotic cardiovascular disease has posed a major threat to people's health and life. From the beginning of atherosclerosis to the occurrence of cardiovascular events is a pathophysiological process that has gone through many years. How to take measures for early warning and early intervention to contain cardiovascular events from the source is a hot issue that scholars at home and abroad pay common attention to.

Metabolic syndrome (MS) is a collection of interrelated diseases. 1988 Reaven^[1]The concept of "Syndrome X", later known as MS, was first proposed, noting that some patients had concomitant dysglycemia, hyperinsulinemia, hypertriglyceridemia (TG), low high density lipoprotein cholesterolemia (HDL-C), and hypertension. For more than 20 years, MS has always been the most concerned and controversial research field of scholars. To date, there is still no consensus on the definition of MS. The World Health Organization (WHO) has developed a definition centered on blood glucose, the International Diabetes Federation (IDF) is a definition centered on obesity, and the National Cholesterol Education Program-Adult Treatment Group III (NCEP: ATP III) is a definition centered on comprehensive cardiovascular disease-related risk factors. On the one hand, the different definitions formulated by these authorities illustrate the importance of MS, and on the other hand, they also reflect the differences in understanding of MS.

In the past 30 years, the prevalence of obesity has increased rapidly worldwide. In most western countries, the prevalence of obesity has doubled to three times compared with that before 1980. Obesity and overweight people account for nearly 50% of the total population. China, often considered to have one of the thinnest people in the world, is now facing a major conundrum of soaring overweight and obesity, which now numbers 401 million people. Obese individuals have a significant increase in the incidence of type 2 diabetes, cardiovascular disease, sleep apnea, cancer, osteoarthrosis, and sexual dysfunction. For every 3.1 kg of weight gain, the risk of early death increased by 30%, and severely obese patients died 8 to 10 years earlier than those with normal weight. How to curb obesity has become a huge challenge facing the world.

To explore the relationship between liver fat content and carotid intima media thickness (C-IMT) with ultrasound measurement.

1217 subjects with complete data on physical examination, plasma glucose, blood pressure and lipid profile from a community of Shanghai Obesity Study (SHOS) between December 2009 and June 2010 were enrolled. All of them underwent carotid artery ultrasound scan and liver attenuation coefficient tested by ultrasonography to evaluate liver fat content. Subjects were grouped by tertile analysis of liver attenuation coefficient. The comparison of clinical indexes and C-IMT was conducted, using correlation analysis and multiple stepwise regression to explore the risk factors which affected C-IMT.

(1)A total of 505 subjects (225 men and 280 women), who aged from 34 to 66 years old was diagnosed as non-Nonalcoholic fatty liver disease (NAFLD) without history of cardiovascular disease and non-carotid arterial plaque. Compared with those in the lowest tertile of liver attenuation coefficient, subjects in the highest group had significantly higher age (t=-2.41, P<0.05) and diastolic blood pressure (DBP) (Z=-1.27, P<0.05), and significantly lower waist circumference (W) (t=3.95, P<0.05) and body mass index (BMI) (t=6.17, P<0.05). (2) C-IMT significantly increased with the increment of liver attenuation coefficient (F=13.83, P<0.05). The frequency of C-IMT elevation was also significantly higher in the highest tertile group compared with the lowest one (35.3% vs 23.2%, χ²=6.19, P<0.05). (3) Multiple stepwise regression analysis showed that liver attenuation coefficient was independent risk factor with C-IMT after adjustment of age, W, SBP fasting blood glucose (FBG) and smoking (β=0.03, P<0.05).

Liver attenuation coefficient measured by ultrasonography is an effective method to identify liver fat content, which is closely correlated with C-IMT among undiagnosed NAFLD subjects by ultrasonography and it shows a clinical significance for early screening of subclinical atherosclerosis even among low cardiometabolic risk subjects.

To investigate the prevalence of metabolic syndrome(MS)among residents who are more than 18 years old in Guangdong province and to compare the differences of the three diagnostic criteria used for MS. The three diagnostic criteria were from Chinese Medical Association Diabetes Branch(CDS), Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults (JCDCG) and international Joint Interim Statement (JIS).

Using multi-stage stratified cluster sampling method, 3591 inhabitants who were more than 18 years old and from 6 counties in Guangdong Province were enrolled. Questionnaire survey, medical examination and biochemical analyses were conducted in the residents. Data analyses of two groups were performed using t test. Comparision of rate were used by χ² test.

According to the three definitions (CDS, JCDCG and JIS), the prevalence (standardized prevalence rate) of MS was 21.1%(756 cases, 19.0%), 28.6%(1026 case, 25.4%) and 44.5%(1599 cases, 40.6%), respectively. The prevalence rate of subjects who had at least 3 risk factors among all the subjects with MS was 97.5%(737 cases), 98.4% (1010 cases)and 100.0%(1599 cases), respectively. The agreement rate (Kappa index) between CDS and JIS, JCDCG and JIS, JCDCG and CDS was 74.8% (2688 cases, 0.46), 82.1% (2950 cases, 0.63) and 87.8% (3153 cases, 0.68), respectively. The area under receiver operator characteristic (ROC) curve was 0.719 for CDS and 0.802 for JCDCG when JIS was used as the reference.

The prevalence of MS has been in a high level among residents who are more than 18 years old in Guangdong province, the strengthen measures should be taken to prevent the people with higher MS risk.JIS definition can screen out the highest prevalence, sensitivity of MS and risk factors aggregation among three definitions.

To analysis the correlation between thyroid function and abdominal subcutaneous fat and visceral fat determined by magnetic resonance image (MRI) scnning, and to investigate the influence of thyroid function on abdominal fat distribution.

763 residents aged between 40 and 65 years old were randomly selected from South Station community. A detailed questionnaire and physical examination, height, weight, waist circumference, hip circumference, blood pressure was conducted. Body mass index and waist to hip ratio were calculated."Tanita TBF 300A"body fat component instrument was used to measure body fat. Fasting blood was collected to test fasting blood glucose, total cholesterol, triglycerides, high density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting insulin, TSH, FT_4,FT₃ and TPOAb. Oral glucose tolerance test was performed. MRI scan was conducted to measure the subcutaneous fat (SF) and visceral fat (VF) area.

Pearson correlation analysis showed that LnTSH and SF were positively correlated (r=0.183, P<0.05), but no correlation was found between LnTSH and VF. FT₄ and SF were negatively correlated (r=-0.164, P<0.05), and FT₄ was positively correlated with VF (r=0.118, P<0.05). FT₃ and SF were negatively correlated (r=-0.098, P<0.05), and FT₃ was positively correlated with VF (r=0.261, P<0.05). Variables relevant to SF or VF area in single correlation model were put into the regression model, and the results showed that systolic blood pressure (SBP), LnTSH and FT₃ were risk factors of SF area. While BMI, waist circumference, blood uric acid and OGTT 2 h blood glucose were risk factors of VF area.

The cross-sectional epidemiological study showed serum TSH elevation and FT₃ decrease were risk factors of SF area, which indicated serum TSH and FT₃ may play a certain role in the distribution of body fat.

To investigate the current status of the blood glucose, blood pressure and lipid control and antiplatelet therapy in Chinese retired military cadres with type 2 diabetes mellitus (T2DM).

This was a cross-sectional, multicenter observational study. The questionnaires were dispatched from March to August in 2012 to out-patient departments of military medical centers or cadre relaxation clubs in 18 provinces across China, to collect data about demographic information, medical history, cardiovascular disease(CVD) risk factors, and recent laboratory measurements and medication were collected among retired military cadres with T2DM. The impact factors of comprehensive standard reaching rate was analyzed by using logistic regression analysis.

A total of 4976 eligible questionnaires were collected. All patients were diagnosed with T2DM, 77.0% of them were male, and 46.0% reported self-monitoring blood glucose once or more a week, whereas 16.5% reported less than once a month. According to the recent laboratory measurement, 45.3%, 33.9% and 63.3% of patients achieved the individual target goals of blood glucose (glycated hemoglobin A1c(HbA1c)<7.0%), blood pressure (<140/80 mm Hg, 1 mm Hg=0.133 kPa) and blood lipid (low density lipoprotein cholesterol (LDL-C)<2.6 mmol/L), respectively, and only 10.0% achieved all the standards. In all patients, 59.8% reported a history of CVD or stroke/transient ischemic attack(TIA), and 64.3% of them took aspirin for secondary prevention. In patients without CVD or stroke/TIA, 94.1% were at moderate or high risk of CVD (men aged >50 years or women aged >60 years), whereas 56.7% of them took aspirin for primary prevention.The use of aspirin was beneficial to reach the comprehensive standard(OR=1.382, 95%CI: 1.131-1.688, P=0.002).

The control rates of blood glucose, blood lipids, blood pressure and aspirin use are relatively high in Chinese retired military cadres with T2DM. This system may be helpful in preventing diabetic complications.

To analyze the early therapy strategy on glucose control in type 2 diabetic patients.

From June 2002 to May 2003, the medication and blood glucose control in 1396 cases with type 2 diabetes in national 10 grade 3A hospitals were retrospectively analyzed. The patients were diagnosed newly or within one year in CDCPS (Chinese Diabetes Complication Prevention Study), with(51±9)yrs, body mass index(BMI) (24.9±3.0)kg/m². Besides the same instruction of lifestyle intervention, the patients were further divided as four groups: without intervention(group A), single oral hypoglycemic agent(group B), combined oral hypoglycemic agents(group C) and treatment including insulin(group D). The χ ² test and analysis of covariance was used for count data and measurement data between groups. The paired t test was used comparison before and after the intervention. Pearson correlation analysis was used for factors affecting the efficacy of glucose analysis.

(1)The level of HbA1c at baseline was (7.3±1.9)%, and the fasting blood-glucose(FBG) was(7.5±2.4)mmol/L among the four intervention group before the treatment adjusted. After 20 months of follow-up, the mean FBG and HbA1c reached to (6.7±1.6) mmol/L and (6.1±1.4) %, respectively. (2) For patients with HbA1c>7%, sulfonylurea and (or) biguanide monotherapy or combination therapy in this study was the most frequently chosen treatment. Compliance rates of HbA1c were 79.2%, 81.9%, respectively. The difference was not statistically significant. (3) HbA1c levels at the end of the follow-up and the patient's age (r=0.087, P<0.01), initial HbA1c levels (r=0.228, P<0.001) showed a significant positive correlation. But HbA1c levels showed no correlation with body weight, BMI and hypertension(r=0.053, 0.011, 0.019, -0.034, all P>0.05).

According to the levels of glucose and HbA1c, the early individualized therapy strategy mainly based on sulphanylureas and/or biguanides is proved to be persistently effective and safe in newly diagnosed type 2 diabetic patients. More positive treatment should be recommended to the patients with higher HbA1c level.

To evaluate the effect of two-way referral care in the treatment of patients with type 2 diabetes in urban community in Shanghai.

Two local primary care hospitals(Grade A) in Yangpu District in Shanghai were selected as the research points, and 265 patients with type 2 diabetes involved in two-way referral care were selected using random number table, and investigated changes of their metabolic index and feeling before and after two-way referral care.And 301 diabetic patients did not participate in two-way referral care were selected randomly as control group from the same 2 hospitals at the same time, and investigated the changes in glucose control and other metabolic indexes.Baseline data were comparable between the two groups. Data between groups were compared using independent samples t test.

After referral treatment, the differences in fasting blood glucose(FBG), postprandial blood glucose(PBG), glycated hemoglobin A1c(HbA1c), systolic blood pressure(SBP), diastolic blood pressure(DBP), total cholesterol(TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglyceride(TG) between the two groups were significant (t=4.584, 9.721, 6.291, 5.246, 5.179, 2.976, 2.894, 7.358, 3.114, all P<0.05). Referral group were superior to the non-referral group.The FBG decreased in 72.1% of the patients in non-referral group and it was lower than that in referral group(81.5%). And FBG increased in 23.6% of the patients in non-referral group and it was higher than that in referral group(17.4%). Referral patients felt better to the two-way Referral Mode.

Two-way referral do benefit to diabetes patients, improve metabolism index of blood glucose, blood fat and blood pressure of patients, there are some details need to be further perfected in operation process of the referral system.

To investigate the immunogenicity of exosome and its correlation with the course of type Ⅰ diabetes mellitus.

Exosomes were prepared with ultrafiltration and ultracentrifugation from the supernatant of insulinoma cell line MIN6 and primary insulin glial cells.Afterwards, their physicochemical properties were identified by the electron microscope and western blotting.The phenotype and cytokine profile of antigen processing cells (APCs) upon the exosome stimulation were analyzed by flow cytometry.³[H] thymidine incorporation assay was applied to determine lymphocyte proliferation level.Consequently, enzyme-linked immunospot assay (ELISPOT) was executed to study the correlation of the course of type Ⅰ diabetes and the number of interferonγ-producing T cell clone upon the stimuli of exosome.The data were compared among groups by using stuentst test.

(1)The exosome was characterized by a classical microparticle features containing diabetic autoantigen glutamic acid decarboxylase (GAD65) expression.(2) MHCII⁺ and expression were enhanced by exosomes from baseline 2.6% to 11.5% on APCs.(3) With regard to , and subsets in the exosome group, the secretion of inflammatory cytokines interleukin(IL)-6 was increased than the control group((115.0±2.4) vs (25.3±2.9) pg/ml, (64.7±3.0) vs (22.9±1.4) pg/ml, (10.7±1.2) vs (6.3±0.6) pg/ml, all P<0.05)and tumor necrosis factor(TNF)-α((125.0±8.6) vs (29.7±1.6) pg/ml, (108.0±6.7) vs (16.7±2.1), (24.2±1.4) vs (13.5±1.7) pg/ml, allP<0.01). (4) CD₄⁺ T cells from NOD mice expanded from baseline 31.2% to 68.4% and count per minute(cpm) value of proliferation increased significantly(10 μg/ml group: (21510±1704) cpm, 1 μg/ml group: (4450±304) cpm, negative control group: (575±64) cpm, all P<0.01). (5) ELISPOT data demonstrated that the two different origin exosome sharing the immunogenicity property consistently, and the number of interferon-γ producing T cell clone increased with diabetes course.

Esosomes can trigger and prime auto-reactive T clones in diabetic setting in a positive correlation with type 1 diabetes course.

To assess the efficacy and safety of saxagliptin added to metformin in newly diagnosed type 2 diabetes mellitus (T2DM) and inadequate glycemic control on metformin alone.

The 180 newly diagnosed T2DM patients with inadequately controlled on metfomin monotherapy for 12 weeks were randomly divided into the saxagliptin group and acarbose group.The two groups were respectively administered saxagliptin and acarbose additionally for 12 weeks(n=90). The fasting plasma glucose(FPG), two-hour postprandial plasma glucose (2 h PG), hemoglobin A1c (HbA1c), the targeting rate of HbA1c, fasting plasma insulin, homeostatic model assessment of insulin resistance index(HOMA-IR), body mass index (BMI), the incidence of hypoglycemia and gastrointestinal adverse reactions in both groups were observed.

After treatment, the levels of FPG, 2 h PG and HbA1c were decreased in both two groups (the t value was 1.401, 1.321, 1.574, 1.510, 1.421, 1.601, respectively, all P<0.05). Compared with the acarbose group, the level of 2 h PG and HbA1c (%) decreased significantly and the targeting rate of HbA1c was significantly high in the saxagliptin group (thet value was-2.711,-2.600, respectively, all P<0.05). The targeting rate of HbA1c in the saxagliptin group(83.33%)was higher than in the acarbose group(67.78%) (χ²=5.870, P<0.05). After treatment the level of fasting plasma insulin was increased in both groups((9.24±1.21)vs(8.17±0.25) U/L, (8.62±1.20)vs(8.15±0.24) U/L, the value of t were 1.563, 1.620, bothP<0.05). The level of HOMA-IR was significantly decreased compared with baseline in both groups((2.60±0.21)vs(3.02±0.39), (2.76±0.40)vs(3.01±0.38), thet value was 1.431, 1.459, both P<0.05). Compared with acarbose group, the level of fasting plasma insulin and HOMA-IR were significantly improved(thet value was 3.451,-3.359, both P<0.05). Compared with the acarbose group, the saxagliptin group had better compliance(χ²=8.760, P<0.05).

Compared with acarbose group, the combination of metformin with saxagliptin is more effective for the treatment of newly diagnosed T2DM patients without increased risk for incidence of hypoglycemia and gastrointestinal adverse reactions, and has good compliance.

Ketosis-prone diabetes (KPD) refers to a type of diabetes with spontaneous ketosis or ketoacidosis onset. It was once considered an important clinical feature of autoimmune type 1 diabetes. However, in recent years, a type of obese diabetic patients with spontaneous ketosis onset began to attract people's attention. These patients have typical hyperglycemic symptoms with spontaneous ketosis onset, and have the clinical features of type 2 diabetes such as obesity and short-term independence of insulin therapy. It used to be called type 1B diabetes, idiopathic type 1 diabetes, atypical diabetes, etc.^[1,2,3]Recently, more scholars have called it ketosis-prone type 2 diabetes. This study analyzed the clinical characteristics and islet β cell function of patients with type 2 diabetes with ketotic and non-ketotic onset, so as to provide a basis for the choice of treatment options.

Metabolic syndrome is characterized by a variety of cardiovascular disease risk factors, such as abdominal obesity, abnormal glucose and lipid metabolism, hypertension, insulin resistance, etc. clustered in the same individual. Obesity, especially abdominal obesity, plays a central role in metabolic syndrome. Waist circumference is commonly used as a simple parameter to measure abdominal obesity in clinical medical treatment and large-scale epidemiological investigations. However, the body surface measurement marks of waist circumference are not obvious, and the measurement is especially inconvenient in winter, which is easily interfered by factors such as eating and exercise. In recent years, some scholars have proposed that the horizontal circumference of the neck through the lower edge of the Adam's apple, that is, neck circumference (NC), may be an index reflecting upper body obesity, which is not only simple and stable to measure, but also related to various cardiovascular disease risk factors^[1,2,3]Therefore, the research on neck circumference as a new anthropometric index for assisting the judgment of metabolic syndrome and its components at home and abroad will be further reviewed.

Active metabolites of vitamin D Active vitamin D_3,i.e. 1,25-dihydroxyvitamin D₃[1, 25- (OH)₂D₃The role of] is divided into "classical" and "non-classical". The so-called "classical" effect means that Vitamin D can regulate the balance of calcium and phosphorus metabolism in the body. In recent years, the "non-classical" effect of Vitamin D has attracted more attention, such as affecting the cell cycle, immune regulation, inhibiting the production of inflammatory factors, etc., and all of them play a role by binding to the specific Vitamin D receptor (VDR) in the nucleus. At present, the renal protection of vitamin D has been paid much attention to. This paper will summarize the research progress of renal protection of vitamin D at home and abroad in recent years from basic and clinical aspects.

The prevalence of diabetes in China is increasing year by year, and it has become one of the major chronic diseases that seriously threaten people's health. Blood glucose control is the key to diabetes treatment, and good blood glucose control can reduce or delay the development of complications. In recent years, more and more studies have proved the harm of postprandial blood glucose (PPG), which has attracted the attention of medical workers.

In recent years, efforts have been made to understand the role of 25 hydroxyvitamin D [25 (OH) D] in the immune system, especially in T cell mediated immunity and insulin secretion. 25 (OH) D can stimulate cell differentiation and reduce cell proliferation, which is essential for cell growth and wound healing. However, studies on the association between low plasma levels of 25 (OH) D and diabetic foot are rare. For this reason, researchers from India examined patients with diabetic foot ulcers who attended multiple hospitals (n=162) and patients without developing foot ulcers (n=162) of 25 (OH) D in plasma was tested to analyze its relationship with diabetic foot.

Osteomyelitis is the main risk factor of amputation in patients with diabetic foot. However, there is still a lack of research on the pathophysiology of early infection of diabetic foot osteomyelitis and the technical means of early clinical diagnosis, which greatly hinders clinicians' early limb salvage diagnosis of diabetic foot.

It has been established that the use of lipid-lowering drugs for diabetic patients at cardiovascular risk can help them prevent the occurrence of cardiovascular disease. To observe the effect of cholesterol reduction with statins on the risk of non-traumatic major lower limb amputation (LEA) and treatment failure (LEA or death) in diabetic patients. Investigator retrospective cohort analysis in the United States was baseline for non-elderly patients without cholesterol lowering drugs in 2003 (<65 years old) diabetic.

Studies have confirmed that elevated blood uric acid levels are associated with a high risk of diabetes, and lowering blood uric acid levels may be beneficial to prevent the occurrence of diabetes in people at risk of diabetes. Researchers from Southern Medical University of China explored the relationship between elevated blood uric acid and the occurrence of diabetic foot ulcers in Chinese people with type 2 diabetes.