Volume 06 · Issue 06 · 2014

Diabetes is a chronic and even lifelong disease. Once diagnosed, complex and continuous lifelong self-care should begin, which brings great challenges to diabetes health care. Diabetes Self-Management (DSM) is a key component of effective health care for diabetes, both for people with diabetes and those at risk^[1]。 DSM refers to the actions and choices people with diabetes take to cope with their condition, including the use of a range of skills, knowledge, and coping strategies. Simply put, what patients themselves do to manage the disease is self-management. The help provided by healthcare workers, medical units and health care systems for patient self-management is called self-management support^[2]。 Diabetes Self-Management Support (DSMS) is based on the premise of Diabetes Self-Management Education (DSME), but it is not just education, but an ongoing process, providing long-term and continuous help and support for patients.

Exercise plays an important role in the prevention and treatment of type 2 diabetes. As one of the "five carriages", exercise therapy has been incorporated into the prevention and treatment strategy and management system of diabetes in China. Exercise not only improves blood sugar and body composition in patients with type 2 diabetes and pre-diabetes, but also reduces the risk of cardiovascular disease and improves cardiopulmonary function, physical fitness and overall health^[1,2]And is economical, simple, effective and has no side effects. Making full use of exercise therapy will be of great significance to reduce the growing occurrence and development of type 2 diabetes and other chronic diseases in China.

Type 1 diabetes may be caused by insulin deficiency caused by autoimmune attack on islet beta cells (Table 1)。 Monogenic diabetes mellitus (adult-onset diabetes mellitus (MODY) in adolescents) is characterized by a defect in the control of insulin secretion. The secretory control deficiency mechanism is also applicable to neonatal diabetes and mitochondrial diabetes. Patients with type 2 diabetes have increased insulin secretion but are relatively insufficient for obesity and insulin resistance. Many diabetics have overlapping manifestations, leading to difficulties in typing. The group with the highest heterogeneity and the most prone to misclassification was young adults (20-40 years old).

To explore whether the first or the second drop of blood is more suitable for self-monitoring of blood glucose (SMBG).

Type 1 or type 2 diabetes patients were recruited in our department from 2012 June to 2013 June. The fasting or 2 hours after 75 g oral glucose tolerance test (OGTT) blood glucose were measured. The first and second drop of fingertip blood were adopted, and venous glucose was measured meanwhile. And the difference of various groups of blood glucose measurement in different regions of blood glucose levels was comparatively analyzed. Single factor analysis of variance and Kruskal-Wallis test were applied in the data analysis.

A total of 802 groups of blood glucose in 526 patients were obtained. There was no significant difference in the blood glucose levels of 526 groups of fasting blood glucose, 276 groups of OGTT 2 hour blood glucose, and 802 groups of the first, second drop of blood and venous blood glucose (χ²=3.229, F=0.612, χ ²=1.065, all P>0.05). However, after mixing and dividing them into 6 groups according to the blood glucose concentration, there was statistically significant difference between the glucose levels of the first, second fingertip blood and venous blood in the glucose<5 mmol/L, ≥5-10 mmol/L groups, ≥20-25 mmol/L and ≥25-30 mmol/L (F=21.328, χ ²=8.764, F=4.572, F=3.201, all P<0.05); there was no statistically significant difference between the glucose levels of the first, second fingertip blood and venous blood in the ≥10-15 mmol/L and ≥15-20 mmol/L group (F=0.988, 1.367, P>0.05).

In clinical operations, both the first and second drop of fingertip blood can be used for performing SMBG. While the blood glucose level is below 10mmol/L, the blood glucose value of first drop of fingertip blood is close to that of venous blood. And while the blood glucose level is above 20 mmol/L, the blood glucose value of second drop of blood is more credible.

To assess the attitudes toward diabetes and the related factors of the attitudes among patients with type 2 diabetes in China.

This study was a part of a multi-centre, cross-sectional, questionnaire based survey conducted by Diabetes Education and Management Group of China Diabetes Society. This study involved 6 043 patients with type 2 diabetes was conducted in 50 medical centers among 31 administrative divisions in mainland China(144 tertiary, secondary and community hospitals were included). The information of demographic characteristics and diabetes attitudes was collected by general questionnaire and the diabetes attitude scale-3 formula. Independent t test and one-way analysis of variance (ANOVA) were used to compare quantitative data among groups.

The score of patients' attitude to diabetes was 3.76±0.30. The mean scores of 5 subscales ranged from 3.57±0.51 for 'value of tight control' to 4.3±0.49 for 'need for special training'. There was no significant difference in'psychosocial impact of diabetes'(t=1.24) and 'patient autonomy'( t=0.42) between patients with diabetes education and without(both P<0.05). The score of patients' attitudes to diabetes was significantly associated with sex(t=-2.14), level of education(F=11.52), duration of diabetes(F=8.41), diabetes complication(F=16.83), receiving diabetes education or not(t=6.33)(all P<0.05).

It is important to emphasis on the psychosocial impact of diabetes and patient autonomy. Diabetes education should be individualized based on the level of education of the patients, duration of diabetes, receiving diabetes education or not, so as to improve patients' attitudes toward diabetes and improve the prognosis.

To evaluate the efficacy and safety of glargine insulin injection (Uslen) in treatment of diabetic patients.

A multicenter, randomized, open-labeled and positive control clinical trial included the patients with type 1 or type 2 diabetes mellitus having poor glucose control after using oral antidiabetic drug or short-acting insulin. All patients were treated with Uslen or Lantus for 16 weeks in two groups by a ratio of 1∶1. The decreased value and qualification rates of glycated hemoglobin A1c(HbA1c) and fasting blood glucose (FBG), the incidence of hypoglycemic and the adverse events were compared pretreatment at the end of 16 weeks' treatment.

All of 664 cases were randomized into two groups and received therapy (1∶1). But 623 cases were in complete conformity to design plan, 313 cases received Uslen therapy and 310 cases received Lantus therapy. There were no different in age, sex, nation, height and weight between two groups. At the end of 16 weeks' treatment, according to the per-protocol analysis (PPS), the decreased values of HbA1c separately (9.2±1.5)% vs (7.7±1.2)% and (9.3±1.5) vs (7.7±1.1)%, FBG separately (10.2±2.1 vs 7.2±2.0) mmol/L and (10.3±2.3 vs 7.4±2.3) mmol/L were all proved significantly in both Uslen group and Lantus group (allP<0.001). But the changes of HbA1c(1.5% vs 1.6%,F=0.766, P=0.382) and FBG(3.0 vs 2.9 mmol/L, F=0.280, P=0.597)from baseline to endpoint were similar between the treatment groups (P>0.05). There were no significant difference in the two groups on the qualification rates of HbA1c(26.2%(82/313)vs 21.3%(66/310),P=0.155) and FBG(29.1%(91/313) vs 28.4%(88/310), P>0.05). There were no significant difference separately 22.7% (75/330) and 22.0% (74/333) on hypoglycemia incidences, and the other adverse events incidences were similar separately 0.3% (1/330 vs 1/333,P>0.05) in two groups.

Compared with Lantus, the glargine insulin injection of Uslen has similar effect on lowering blood sugar and good security, which has better clinical value.

To assess the effects of monotherapy and combination therapy with sitagliptin and metformin on blood glucose control and β-cell function in type 2 diabetes mellitus(T2DM).

Sixty drug-naïve T2DM patients treated from January 2011 to December 2012 were randomized to receive sitagliptin monotherapy(S group: 100 mg q. d), metformin monotherapy(M group: 500 mg t. i.d) and combination therapy of sitagliptin and metformin (SM group: sitagliptin 100 mg q. d+ metformin 500 mg t. i.d) for 12 weeks according to random number table. Fasting plasma glucose(FBG), 2-hour postprandial blood glucose(2hPG), glycated hemoglobin A1c(HbA1c), body mass index(BMI), triglyceride (TG), total cholesterol(TC), low density lipoprotein-cholesterol(LDL-C), blood pressure (BP), homeostatic model assessment of the insulin secretion index(HOMA-β) and insulin resistance index(HOMA-IR) were measured before and after the treatment. The incidence of hypoglycemia and drug adverse reaction was also observed during the treatment. The Student'st test and analysis of variance was used when data was compared before and after treatment and among groups.

After intervention, FPG, 2hPG, HbA1c, TG, TC, LDL-C, blood pressure and HOMA-IR decreased significantly, while HOMA-β increased significantly in all three groups(allP<0.05). Significant difference of glucose profile and β-cell function was not observed between M group and S group. The HbA1c decreased further in SM group (6.1%±0.5%) when compared with S group (6.6%±0.5%) and M group (6.5%±0.6%)(F=4.964, P=0.01). The HOMA-β in SM group(83±27) was significant higher than those in S group (65±18) and M group (63±23) after treatment (F=4.349, P=0.017). In addition, TG, TC, LDL-C and blood pressure also decreased further in SM group, while HOMA-IR didn't compared with S group or M group(F=0.149, P>0.05). BMI in M group and SM group decreased significantly after treatment but there was no significant change in S group. No severe hypoglycemic events occurred in all groups.

Sitagliptin has similar effect on glycemic control as metformin. Better glucose profile is observed when patients receiving combination therapy.

To evaluate the effects of Real-Time Continuous Glucose Monitoring in blood glucose fluctuation.

One hundreds and twenty-two type 2 diabetes mellitus (T2DM) inpatients who were using insulin were randomly divided into continuous glucose monitoring system (CGMS) group (n=61)and real time CGMS(RT-CGMS) group(n=61). The first day was equipment testing day (d0). The second and third days were observation time (d1 and d2). The CGMS group control blood glucose by finger stick glucose, while the RT-CGMS group by real-time blood glucose curve. Setup the high and low glucose alarm of RT-CGMS. The mean amplitude of glycemic excursions(MAGE), mean blood glucose(MBG), standard deviation of blood glucose(SDBG), absolute means of daily differences(MODD), large amplitude of glycemic excursions(LAGE) and hypoglycemia were calculated within each group and between the two groups.

(1)Intragroup comparison: RT-CGMS group: the MAGE, MBG, SDBG and LAGE of d1 and d2 were (5.3±3.2) vs (4.2±2.1), (8.6±1.7) vs (8.2±1.5), (2.1±0.9) vs (1.8±0.7), (8.6±3.3) vs (7.5±2.8) mmol/L(F=9.797, 5.852, 20.625, 11.057, respectively, both P<0.05), the duration of hypoglycemia was 40(32.5-135)vs 25(15-40)min(Z=2.456, P<0.05). CGMS group: In addition to SDBG, there was no significance difference in MAGE, MBG and LAGE (F=0.229, 0.246, 0.635, both P>0.05). (2)Intergroup comparison of the difference between d1 and d2: the MAGE and LAGE were 0.7(-0.3-2.0)vs 0(-1.0-1.5), 0.9(-0.7-2.1) vs 0.1(-2.5-1.9) mmol/L(Z= 2.002, 2.023, respectively, both P<0.05); MODD was 1.8(1.3-2.6)vs 2.1(1.4-2.9) mmol/L(Z=1.572, P> 0.05).

Making the blood glucose readjustment plan by RT-CGMS could reduce blood glucose fluctuation in a short time.

To investigate the current status of the glycemic control in the patients aged 40 or older in the communities of Beijing.

Total of 19 470 people aged 40 years or older were enrolled to perform census in the present study from three communities, Gucheng, Jinding and Laoshan, of Beijing from December 2011 to August 2012.Each participant who met the standard received a questionnaire survey, physical examination and laboratory examination (liver and kidney function, serum lipid and hemoglobin glycosylated hemoglobin (HbA1c)). The glycemic control of the patient with type 2 diabetes mellitus(T2DM), which is reported in the questionnaire, was assessed according to the goal of HbA1c<7% advocated by the American Diabetes Association(ADA) and the Chinese Diabetes Society.Thet test and ANOVA analysis was used to compare the difference between groups.A logistic regression analysis was made to reveal the characteristics associated with patients attaining HbA1c<7.0%.

Of the 2 523 patients with type 2 diabetes included in the survey, the mean HbA1c was (7.4±1.8)% and patients who met the glycemic goal (HbA1c<7%) was 45.7%.The oral antidiabetic drugs (OADS) monotherapy, insulin monotherapy, OAD+ Insulin groups had mean HbA1c levels of (7.4±1.6)%, (7.9±2.2)% and (7.9±2.0)%, respectively, and among those three groups, 47.2% (568/1 203), 32.5% (87/268), 26.4%(73/276) of the patients met the goal of HbA1c<7.0%.The mean HbA1c of the patients, treated with one OAD, two OADs and more than three OADs, was (7.3±1.5)%, (7.5±1.9)% and (7.5±1.2)%, respectively, while the percentage of patients who met the glycemic goal of HbA1c<7.0% was 45.0%(472/1 049), 39.6%(149/376) and 37.0%(20/54). As the development of the diabetes, the average of the HbA1c among patients with the duration of less than one year, 1-5 years, 5-10 years and more than 10 years was (7.0±1.5)%, (7.1±1.6)%, (7.4±1.8)% and (7.8±1.9)% and the number of patients with the achievement of HbA1c<7% was 56.4%(195/346), 55.5%(422/760), 44.7%(266/595) and 32.8% (270/822). According to the result of the logistic regression analysis , mean HbA1c achievement of HbA1c<7.0% was related to the female, body mass index, waist hip ratio, systolic blood pressure, complications/comorbidities, duration of diabetes and the therapeutic regimen(OR=1.320, 0.762, 0.027, 0.992, 1.264, 0.431 and 0.432, P<0.05 all above).

More than half of the patients aged 40 or older with T2DM do not meet the target of glycemic control of HbA1c less than 7.0% in the communities of Beijing.The glycemic goal rate is down as the duration of diabetes.

To preliminarily assess the rate of glucokinase(GCK) gene mutation in Chinese gestational subjects with abnormal glucose metabolism.

We retrospectively analyzed Chinese gestational subjects who received oral glucose tolerance test and glycosylated hemoglobin A1c (HbA1c) detection in Peking Union Medical College Hospital(PUMCH) from July 2005 to May 2008.Subjects were selected for direct sequencing of GCK gene if they met the following three criteria: (1) fasting plasma glucose was between 5.5 and 10.0 mmol/L; (2) a small increase (<4.6 mmol/L) in plasma glucose 2 hours after an oral glucose load; (3) HbA1c was below 8.0%.

A total of 577 subjects were collected in this study, in which 30 subjects met the criteria for GCK gene mutation testing.Of the 17 subjects whose DNA samples were obtainable, one case of maturity-onset diabetes of the young type 2(MODY2) with GCK gene mutation c. 626 C>T(NM_000162.3) in exon6 and one case with previously unreported variation in noncoding region had been found.The mutation c. 626C>T(NM_000162.3) resulted in the substitution of methionine for threonine in amino acid 209(p.T209M, NP_000153.1). It was estimated the minimum GCK gene mutation rate was 0.27% in Chinese gestational subjects with abnormal glucose metabolism, and the minimum prevalence of MODY2 was 21/100 000 in Chinese population.

The GCK gene mutations are not common in Chinese gestational subjects with abnormal glucose metabolism.

To explore the correlation of rs2802288 (G/A) in forkhead box class O3A (FOXO3A)gene and rs8192678 (G/A) in peroxisome proliferators-activated receptor-γ coactivator-1 (PPARGC1A) gene to the risk of type 2 diabetes mellitus(T2DM) in longevity and general subjects with Han nationality from Guangxi.

By stratified random sampling, a total of 506 longevity subjects (above 90-years old) and 830 general subjects from Guangxi Yongfu County were included in this study from July 2008 to August 2010.The diagnosis for T2DM was based on the 1999 WHO criteria.Based on high resolution melting (HRM) and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) methods, respectively, rs2802288 and rs8192678 were genotyped.The association was estimated by logistic regression.The risk allele accumulation effect and nonparametric multifactor dimension reduction (MDR) were conducted to estimate the gene-gene interaction.

Based on the recessive genetic model, a positive contribution of FOXO3A rs2802288(G) for T2DM was detected only in longevity subjects (χ²=10.933, P<0.05). A synergy between FOXO3A rs2802288(G) and PPARGC1A rs8192678(A)(χ²=9.617, P<0.05) was observed.In addition, the risk of T2DM was increased with the accumulation of risk alleles, and the carriers with 4 risk alleles had the highest risk (OR=6.482, P<0.001). The MDR analysis indicated the combined effect among rs2802288, rs8192678 and ageing was the best interaction model, resulting in an increased T2DM risk (cross validation consistency=10/10,P<0.05).

FOXO3A rs2802288(G) is associated with T2DM in South Chinese Han longevity subjects, and PPARGC1A rs8192678(A) could increase the risk by a synergy effect.

To investigate plamsa levels of vascular endothelial growth factor(VEGF)and its mRNA expression levels in peripheral blood mononuclear cells (PBMCs) from type 2 diabetes mellitus(T2DM) patients with peripheral artery disease (PAD) and their correlation with PAD among T2DM patients.

Total of 126 T2DM patients were enrolled from January 2009 to January 2012 in Tangshan Gongren Hospital in this study; and the patients were divided into three groups including T2DM patients without PAD (DM group, n=40), T2DM with intermittent claudication (IC group, n=46), and T2DM with critical limb ischemia (CLI group, n=40). Plasma level of VEGF and its expression level in PBMCs in the three groups were detected by enzyme-linked immunosorbent assay(ELISA) and real-time polymerase chain reaction(RT-PCR), respectively, and the cutoff value of VEGF to diagnose T2DM with PAD was evaluated.Statistical analysis were performed by using one-way analysis of variance, χ² test, and nonparameter test for multiple-group comparisons.

There was significant difference in plasma levels of VEGF and its mRNA levels in PBMCs among the three groups (F=37.87, 36.41, both P<0.05). Moreover, both plasma levels of VEGF and its mRNA levels in PBMCs were significantly increased in CLI group compared with those in IC group [(568±201) vs (392±144) ng/L, 4.47(2.20-9.06) vs 2.58 (1.21-5.50), bothP<0.05]. The VEGF plasma level ≥345.58 ng/L for the diagnosis of T2DM with PAD was the cutoff value with the highest sensitivity and specificity.Plasma levels of VEGF and its mRNA levels in PMBCs were negatively correlated with ankle brachial index among DM group, IC group and CLI group(r=-0.495--0.319, all P<0.05).

VEGF is closely associated with PAD in diabetics.

To investigate the effect of advanced glycation end products (AGEs) on adhesion molecules expression and leukocyte adhesion on human islet microvascular endothelial cells (HIMVEC), and the related mechanisms.

HIMVEC was treated with AGEs (final concentration 200 mg/L). Cell-based enzyme-linked immunosorbent assay(ELISA) and western blotting were used to detect adhesion molecules level of HIMVEC; the leukocyte-HIMVEC adhesion was evaluated after BCECF-labeled human leukocytes incubated with HIMVEC.The expression levels of receptor of AGEs (RAGE), protein kinase C β (PKCβ) and protein kinase A (PKA) were detected by real-time PCR and Western blotting.The adhesion molecules expression and leukocyte adhesion were evaluated after cells treated with PKCβ inhibitor (LY333531) or PKA activator (8-Br-cAMP). t-test were used to compare the difference between groups for statistical analysis.

Compared to control group, P-selectin, E-selectin and Vascular cell adhesion molecule-1 (VCAM-1) were all up-regulated on HIMVEC by AGEs treatment (1.1±0.13 vs 0.64±0.14, 0.83±0.06 vs 0.47±0.05, 0.87±0.09 vs 0.43±0.07, t=4.93, 9.40, 7.61, all P<0.05), and leukocytes adhesion was increased in AGEs group than control (54±4 vs 23±3,t=12.69, P<0.05). Compared to AGEs group, the expression levels of P-selectin, E-selectin and VCAM-1 were decreased by pre-treated with anti-RAGE antibody (t=5.69, 6.89, 5.43, all P<0.05), and leukocyte adhesion was also inhibited by RAGE antibody (54±4 vs 31±4,t=8.22, P<0.05). Compared to control group, after treated with AGEs for 4 h or 18 h, the mRNA and protein level of RAGE and PKCβ was up-regulated, but PKA was down-regulated (t=10.94, 7.76, 21.82, 5.85, 10.96, 11.47, all P<0.05). Compared to AGEs group, PKCβ inhibitor (LY333531) or PKA activator (8-Br-cAMP) can down-regulate the expression of P-selectin, E-selectin and VCAM-1 (t=7.60, 6.60, 6.25, 11.58, 4.08, 3.47, all P<0.05). And leukocyte adhesion was also reduced in LY333531 or 8-Br-cAMP group than AGEs group (t=7.67, 8.89, both P<0.05).

AGEs increased adhesion molecules expression and leukocyte adhesion on HIMVEC by up-regulating PKCΒ and down-regulating PKA, which might be one reason for leukocyte infiltration in islets of type 2 diabetes.

With the change of medical model and the development of psychosomatic medicine, the concept of diabetes as a typical psychosomatic disease has been widely accepted. Psychological disorders, such as depression and anxiety, or just depressive symptoms, are closely related to the prognosis of diabetes, which seriously affects the quality of life of patients and even increases the mortality rate. In the 2013 edition of the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China, entry 13: "Psychosocial Adaptation of Diabetic Patients" was added to the content of diabetes education, so as to remind the diabetes education team that it must pay attention to the mental health of patients and have the responsibility to improve the psychological condition of patients (to be released). It is particularly important to use correct and effective psychological intervention techniques. The progress of psychological intervention techniques for diabetic patients is summarized as follows.

In 2010, research showed that the prevalence of diabetes in adults aged 20 and over in China reached 9.7%, and the prevalence of prediabetes reached 15.2%. Studies have shown that changes in national lifestyle and diet structure are the main risk factors for overweight and obesity. Glucose-dependent insulin-releasing polypeptides (GIPs), once known as gastrostatic peptides, have previously been thought to neutralize gastric acid, protect the small intestinal mucosa, reduce food entry from the stomach into the intestine, and inhibit gastric emptying and gastric acid secretion. Later, it was confirmed that mice lacking GIP receptor (GIPR) were resistant to high-fat diet-induced obesity^[1]And once again ignited the enthusiasm of scientists to study it. The purpose of this paper is to summarize the current role of GIP in glycolipid metabolism.

In recent years, the incidence of type 2 diabetes and obesity has increased sharply in China, and it tends to be younger, which has become an important disease that seriously threatens people's health. Adipose dysfunction appears in the early stage of obesity, which is an important mechanism of metabolic abnormalities and cardiovascular and cerebrovascular diseases in obese patients^[1,2]。 As an independent risk factor of atherosclerosis, the incidence of hyperhomocysteinemia is at a high level in China^[3]。 Studies have shown that homocysteine (Hcy) can lead to abnormal fat function through multiple pathways, which can lead to chronic inflammatory state and insulin resistance^[4,5]。 The related mechanism of homocysteine and fat dysfunction and the latest research progress are described.

Prader-Willi syndrome (PWS) is a genetic syndrome resulting from the deletion of chromosome 15 q11-q13 and includes characteristic manifestations such as bulimia, obesity, diabetes, and insulin resistance. The incidence rate is 1:10 000 to 1:25 000^[1,2]。 Its clinical manifestations include postnatal hypotonia leading to feeding difficulties, early childhood obesity, characteristic appearance, hypogonadism, impaired growth hormone secretion, mild to severe mental retardation, and behavioral abnormalities^[3]。 Some features reflect the patient's hypothalamic dysfunction^[4]。 Without control, the patient began to gain weight at the age of 2 to 3 years, and then the symptoms of obesity were progressively aggravated due to hyperappetite caused by lack of satiety^[5]。 Retrospective analysis showed that the annual mortality rate of PWS patients over 30 years old was 7%^[6], shortened life expectancy has been associated with obesity-related complications, including cardiovascular disease, respiratory disease, and diabetes. Metabolic syndrome as a risk factor for death in patients with PWS^[5]。 The following is a summary of the research progress in this area in recent years.

A 48-year-old female was admitted with "intermittent epigastric pain for 15 months", during which she lost nearly 25 kg (from 76 kg to 51 kg). The patient underwent plain abdominal CT scan + enhanced scan in the local hospital, which showed that the pancreatic uncinate process and neck occupied space, and considered "pancreatic cancer with biliary dilatation, multiple intrahepatic cysts and gallbladder stones". On May 12, 2012, he went to Peking Union Medical College Hospital. There was no abnormality in outpatient blood test and liver and kidney function. Fasting blood glucose: 6.4 mmol/L; Blood amylase 27 (normal value 0-125, the same below) U/L, lipase 187 (114-330) U/L; Sugar chain antigen (CA) -242: 87.8 (0-20.0) mU/L, CA19-9: 82.1 (0-37.0) mU/L, and carcinoembryonic antigen (CEA): 4.41 (0-5.00) μ g/L. Abdominal B-ultrasound showed "liver cyst, enlarged gallbladder, dilated common bile duct, hypoechoic pancreatic head area (excluding solid occupied space), and dilated pancreatic duct", and was admitted for further surgical treatment. The patient denied a history of diabetes or family history of other diseases, and denied a history of pancreatitis and pancreatic trauma. Admission physical examination: blood pressure: 160/90 mmHg (1 mmHg =0.133 kPa), height 163 cm, weight 51 kg, body mass index (BMI) 19.1 kg/m²No abnormalities were found in cardiopulmonary auscultation, the liver and spleen were not palpable under the costs, and the abnormal mass was not clearly palpable in the whole abdomen. Vascular murmur and mobile voicing (-) could be heard under the xiphoid process.

Dipeptidyl peptidase IV (DPP-4) inhibitors, as a new type of hypoglycemic drugs, have attracted more and more attention from clinicians in recent years. Its main mechanism of action is to block the degradation of endogenous glucagon-like peptides (GLP-1 and 2) and glucose-dependent insulin-releasing polypeptide (GIP), thereby increasing glucose-regulated insulin secretion and inhibiting glucagon secretion^[1,2]。 The average effect of DPP-4 inhibitors on reducing glycosylated hemoglobin is 0.5% ~1.0%. The hypoglycemic efficacy of these drugs is positive, and the relative safety and patient tolerance are good. Four DPP-4 inhibitors have been listed in my country. There is widespread concern about the cardiovascular safety of newly developed hypoglycemic drugs because some drugs such as rosiglitazone and sulfonylureas may increase the risk of cardiovascular events while lowering blood glucose^[3,4]。 Since 2009, the U.S. Food and Drug Administration (FDA) has required all new hypoglycemic drugs to be evaluated for cardiovascular events in a randomized trial phase^[5]。 Prospective large-sample placebo-controlled studies of DPP-4 inhibitors suggest that these drugs do not increase cardiovascular risk and suggest potential cardiovascular benefits, while animal experiments and short-term clinical studies suggest that these drugs have partial protective effects on endothelial function, cardiovascular system^[1,2,3,4]。 This paper reviews the possible mechanisms of DPP-4 inhibitors for cardiovascular protection.

More and more studies have confirmed that reduced sleep duration is a predictor of obesity. However, sleep time and its regularity are also very important. Researchers at Harvard Medical School in the United States evaluated the correlation between objectively quantified sleep patterns and obesity by analyzing the sleep patterns of two groups of elderly people.

Excess adipose tissue can interfere with the physiological effects of anti-inflammatory and pro-inflammatory cytokines, possibly leading to insulin resistance and atherosclerosis. Therefore, chronic low-grade inflammation is one of the important risk factors for type 2 diabetes and cardiovascular diseases, which are the leading causes of premature death in the Nordic region. To this end, Nordic nutritionists propose a healthy Nordic diet that is beneficial to the population, the Baltic Diet (BSD), and substitute it for the Mediterranean diet. However, to date, the relationship between inflammatory markers and BSD has not been evaluated in large epidemiological studies. To this end, the researchers explored whether there was a correlation between BSD and lower concentrations of inflammatory markers.

Obesity is characterized by chronic inflammation, immune dysregulation, and altered gene expression, and is associated with type 2 diabetes and cardiovascular disease. The extent to which these alterations appear in childhood obesity is not fully elucidated and this study is an observational controlled study of Caucasian children. The aim of this study was to investigate the effects of obesity in childhood on the frequency of immune cells, macrophage activation, cytokine production, and specific regulators of metabolic gene expression. The subjects were 29 obese and 20 non-obese children aged 6 to 18 years from Our Lady Children's Hospital in Dublin. Their peripheral blood was analyzed using real-time polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA) and flow cytometry.

Endoplasmic reticulum stress caused by unfolded protein accumulation plays a role in the development of obesity. It is known that Alzheimer's disease is caused by endoplasmic reticulum stress, and the nonsteroidal anti-inflammatory drug flurbiprofen can slow down the progression of Alzheimer's disease. Therefore, the researchers hypothesized that flurbiprofen can weaken endoplasmic reticulum stress and thereby improve obesity.

Skeletal muscle insulin resistance is associated with a shift in muscle fiber metabolism from aerobic oxidation to glycolysis in patients with type 2 diabetes. However, whether this metabolic switch is harmful or beneficial to the internal environmental balance is still unclear. Our recent study found that the Baf60c/Deptor pathway promotes muscle glycolytic metabolism and allows mice to avoid diet-related insulin resistance. However, the effect of the nature of the signal on the pathway and the role of Baf60c in glucose autostabilization in severe insulin resistance remain unknown.