Volume 08 · Issue 04 · 2016

Diabetes is prevalent worldwide. According to the latest statistics of the International Diabetes Federation (IDF), there were 415 million diabetic patients in the world in 2015, while China accounted for about a quarter, with 109 million^[1]。 At the same time, the number of obese people is also rising. According to the statistics of 188 countries from 1980 to 2013, the number of obese or overweight people increased from 857 million in 1980 to 2.1 billion in 2013, accounting for about 30% of the global population; Although the adult obesity rate in China is lower than that in the United States, Britain and other countries, the number of obese people is among the highest in the world^[2]。 According to the data of the Chinese Diabetes Epidemiological Survey from 2007 to 2008, two-thirds of diabetic patients in China suffer from overweight or obesity, among which overweight [24≤ body mass index (BMI)<28 kg/m²] reached 40%, obesity (BMI ≥28 kg/m²) accounted for nearly 25%^[3]。 With the understanding of the harm of diabetes-obesity and its co-occurring mechanism, on the one hand, people are focusing on the research and development of drugs for the treatment of diabetes and obesity, such as glucagon-like peptide 1 (GLP-1) receptor agonists, and actively exploring clinical non-drug treatments, such as bariatric surgery; On the other hand, people are also deeply exploring the pathogenesis and risk factors of the two diseases, so as to formulate effective preventive measures in a targeted manner.

Depression and diabetes are two major public health problems faced by modern society. The relationship between these two diseases has a long history of research. As early as the 17th century, Thomas Willis, a famous British doctor and anatomist, described that "long-term grief can cause diabetes". Today's epidemiological data suggest that at least one-third of people with diabetes develop related depressive disorders^[1]While people with depression have a 37% increased risk of developing diabetes^[2]。 Patients with both diseases are 2 times more likely to have disease-related complications than those with only one^[3]。 The phenomenon of comorbidity poses a great clinical challenge because the presence of another disease leads to worse prognosis for both diseases, including the severity of the disease, increased treatment resistance and mortality, significant increase in individual and social treatment costs, decreased quality of life and self-management of diabetes, increased incidence of complications, and decreased life expectancy. And the two diseases may involve common biological and behavioral pathogenesis, such as hypothalamic-pituitary-adrenal axis activation, inflammatory response, sleep disorders, negative lifestyle, poor eating habits, and environmental and cultural factors^[4]。 Therefore, the study of depression and diabetes should follow the principles of bio-psychosocial medical model as far as possible, and look at these two diseases comprehensively and comprehensively. Despite the importance of comorbidity research, a considerable amount of depression remains untreated among diabetics. Although screening tools can be used to effectively identify depressed patients, the diagnosis rate of depression in diabetic patients is still low, reflecting the problem that some clinicians may pay more attention to biological factors than to psychological factors. In recent years, domestic researchers have paid more and more attention to the comorbidity research of depression and diabetes. This article will discuss the diagnosis, evaluation and treatment of depression in diabetic patients.

Psychological factors, especially emotional factors, are involved in the disease process, especially in the onset, diagnosis, treatment, prognosis and other stages of chronic non-communicable diseases. However, due to the "barrier" of discipline, the understanding of psychological factors and biological factors in medical field is completely separated from clinical practice. This article shares the role of negative emotions in the pathogenesis, diagnosis, treatment and prognosis of diabetes with the industry, so as to establish the concept of unity of mind and body and adopt the concept of big medicine to understand "specialty diseases" in the traditional sense, so as to improve the quality of clinical treatment and provide new thinking for the study of diabetes.

Depression, also known as depressive disorder, is a common mood disorder. According to the 2002 World Health Organization report, depression has become the fourth most common disease in the world. Anderson et al.^[1]A meta-analysis conducted through 42 studies showed that depression was twice as frequent in the diabetic group as in the non-diabetic group. Foreign literature reports that 20% ~30% of diabetic patients are accompanied by clinically relevant depressive diseases, and about 10% of them are severe depressive^[2]。 Large-scale epidemiological data on diabetes combined with depression are still lacking in China. Liu Hui et al^[3]A survey of 2 966 patients with type 2 diabetes mellitus (T2DM) showed varying degrees of depression in 51.1%. Studies have found that antidepressants can cause impaired blood sugar regulation^[4]。 This article mainly expounds the effects of antidepressants on blood glucose regulation.

To investigate the prevalence of food addiction in patients with newly diagnosed type 2 diabetes mellitus(T2DM) and to explore the risk factors of food addiction.

From February 2014 to January 2015, a total of 624 subjects (312 patients from the First Hospital of China Medical University with newly diagnosed T2DM and 312 age-and body mass index(BMI)-matched healthy controls) were recruited. All participants were asked to fulfill the Yale Food Addiction Scale(YFAS) and take physical and lab examinations. The incidence of food addiction, clinical characteristics, the prevalence and symptom scores of food addiction between two groups were analyzed. The T2DM groups were further divided into food addiction group and non-food addiction group. Independent t test and Mann-Whitney test were used to analyze normal and abnormal distribution measurement data respectively. Chi-squared test was used to analyze enumeration data. Logistic regression analysis was applied to explore independent correlation factor for food addiction in patients with newly diagnosed T2DM.

Of the patients with newly-diagnosed T2DM, 8.6% (27/312) met the YFAS proposed diagnostic criteria for food addiction, it was significantly higher than that in the control group(1.3%,4/312) (χ²=16.43, P<0.05). The symptom score of food addiction in T2DM group were significantly higher than that in control group (Z=-8.637, P<0.05). Logistic regression analysis showed that food addiction was positively related to BMI(OR=1.261, 95% CI: 1.130-1.407, P<0.05) and negatively related to age(OR=0.955, 95% CI: 0.919-0.992, P<0.05). Most of the food addiction happened in the age of 20-29 years. There were no differences in gender and history of hypertension between participants with and without food addiction(RR=1.33, 0.93, both P>0.05).

Newly diagnosed T2DM patients in northeast China are more likely to suffer from food addiction. It suggests that ones who have a tendency of food addiction should regularly take diabetes and metabolic diseases screen.

To compare the differences of the clinical characteristics and burden of disease between depressed patients with or without comorbid type 2 diabetes.

A retrospective analysis of clinical data of all 545 patients with major depressive disorder who were admitted to Depression Treatment Center in Beijing Anding Hospital from December 2013 to November 2015 was performed. Of those patients, 115 patients with comorbid T2DM who met eligible criteria were enrolled as DM group, and another 115 patients without any type of DM were enrolled as the control group (NDM group). The two groups were matched by the age, gender and duration of depression. The data concerned the demography, comorbid physical conditions, laboratory tests results, length of stay and medical costs were collected. The data were compared between the groups with t test or rank sum test, and associations between T2DM and clinical outcomes were examined with regression analysis.

The overall prevalence of T2DM in hospitalized patients with major depressive disorder was 26.1% (142/545). Both fasting plasma glucose(FPG) (median 6.6 mmol/L) and glycated hemoglobin A1c(HbA_1c) (median 6.2%) at baseline were beyond normal range in DM group. There were more patients with other comorbid physical diseases in DM group than in NDM group (97.4% vs 74.8%, χ ²=24.539, P<0.01), especially hypertension, hyperlipemia and cerebrovascular disease(χ²= 17.613, 7.196, 6.668, all P<0.05). There were more unemployed patients and patients with lower education level in DM group(41.7% vs 10.4%, 13.0% vs 30.4%, respectively, χ²=29.224, 10.222, both P<0.01). The length of stay in DM group was significantly longer than that of NDM group ((32±11) vs (27±10) days,t=-2.29, P<0.05). In Logistic regression analysis, T2DM (OR=1.928, 95%CI:3.021-15.645, P<0.001) and female (OR=-2.260, 95% CI: 0.0.044-0.249, P<0.001) were associated with unemployed.

More than 1/4 of hospitalized patients with major depressive disorder are complicated with T2DM, which is relevant to poorer physical health, worse social function and increased burden of disease.

To investigate the status of self-monitoring of blood glucose(SMBG) in adults with type 1 diabetes mellitus(T1DM) in Guangdong Province, and to explore its related factors.

Adults with T1DM from Guangdong Type 1 Diabetes Translational Study were enrolled in this cross-over survey from 2010 to 2014. Demographic data and clinical information(frequency of SMBG (SMBG-F) and record of diabetic education) was collected. After the data was grouped by SMBG-F, linear trend among SMBG-F groups was analyzed by one-way analysis of variance(continuous data) or χ ² test (categorical data) for trend. Spearmen rank correlation analysis was used to evaluate the relation between SMBG-F and glycosylated hemoglobin (HbA_1c). Then SMBG-F and its related factors were analyzed by multinomial Logistic regression model.

A total of 869 adults with T1DM, with disease duration over 1 year were enrolled. The mean frequency of SMBG was (0.90±0.29) times daily. Among them, 21.5% of patients hardly ever performed SMBG, and only 6.0% perform SMBG ≥ 4 times daily. A significant negative correlation was observed between SMBG-F and HbA_1c(r=-0.242, P=0.00). Gender (χ²=7.37, P=0.025), education levels (χ²=7.37, P=0.025), resident regions (χ²=19.41, P=0.000) and previous diabetic education received on SMBG (χ²=17.39,P=0.001) were related factors of SMBG.

The SMBG-F in adults with T1DM fails to meet the recommendations of guideline, and differs among regions of Guangdong Province. Strengthening diabetes education on SMBG may exert beneficial effect on achieving glycemic target in adults with T1DM.

To explore the changes of biomarkers for Alzheimer's disease(AD) in aged cynomolgus monkeys with spontaneous type 2 diabetes mellitus(T2DM).

Elderly cynomolgus monkeys (> 18-yrs) were identified in the cynomolgus monkeys' metabolic index database which was certificated by Association for Assessment and Accreditation of Laboratory Animal Care (AAALAC). Fourteen monkeys (fasting plasma glucose (FPG) ≥7.0 mmol/L) were selected as T2DM group (DM group) according to random number table. Nine were females and 5 were males with average weight of(5.8±2.3) kg. Meanwhile, 19 monkeys were randomly selected as normal group (NC group) from those with FPG< 5.6 mmol/L (12 females and 7 males, weighted (5.4±2.0) kg). Glycemic parameters, lipids and AD biomarkers in plasma and cerebrospinal fluid (CSF) were measured. AD-related brain tissue immunohistochemical staining was conducted and compared between the two groups. Student'st-test and Mann-Whitney U test were used for data analysis. Linear regression was adopted to detect the relationship between FPG and the AD-related core biomarkers.

Compared with the NC group, plasma concentrations of Aβ₄₂, tau and p-tau in DM group were significantly decreased (12 (10,14) vs 18 (14,27) pmol/L, 43 (12,96) vs 126 (97,228) ng/L, 11 (10, 12) vs 13 (10,26) ng/L, U=52, 14, 64, all P< 0.05). Liner regression analysis showed that the FPG was liner_{associated with plasma A}β₄₀, p-tau (r² = 0.30, 0.29, both P< 0.05) in DM group. Although the levels of tau, p-tau were lower than those in NC group, the difference was not statistically significant. Compared with the_NC⁺_{group, the levels of A}β₄₀, Aβ₄₂ decreased in CSF in the DM⁺ group (455 (441,545) vs 565 (525,699) pmol/L and 73 (64,105) vs 105 (90,126) pmol/L, U=16, 24, both P<0.05). Immunohistochemistry showed the expression of p-tau in temporal cortex in DM group was significantly increased than that in NC group.

Diabetes may potentially accelerate the course of pathophysiologic progression of AD. Aged cynomolgus monkey with spontaneous T2DM could be regarded as a predictive model of AD for basic and translational research.

To investigate the effects of erythropoietin (EPO) on hepatic lipid metabolism and explore the underlying mechanism.

Twelve eight-week female ob/ob mice were randomly divided into two groups according to random number table and treated intraperitoneally with 3 000 U/kg recombinant human EPO (ob/ob+EPO group, n=6) and phosphate buffer saline(PBS)(ob/ob+PBS group, n= 6), respectively. Lean littermate C57BL/6 mice were selected as normal control (C57BL/6 group, n=6). Human hepatoma cell line HepG2 cells were intervened with palmitic acid (PA, 0.5 mmol/L) and different concentrations of EPO(5 or 10 U/ml). HepG2 cells were divided into four groups: control(no-treating), PA, PA+ EPO (5 U/ml) and PA+ EPO (10 U/ml) group. Steatosis of hepatic cells was observed by oil red O staining. The expression of erythropoietin receptor (EPOR), sterol regulatory element-binding protein-1c (SREBP-1c), fatty acid synthase (FAS), acetyl CoA carboxylase (ACC) and carnitine palmitoyltransferase 1a (CPT-1a) were detected in mice and HepG2 cells by Western blotting mothods. One-way analysis of variance or least significant difference test were used for data analysis.

Reduced lipid accumulation in hepatic cells with EPO treatment was observed by oil red O staining in vivo and in vitro. The protein levels of SREBP-1c, FAS and ACC in ob/ob+EPO group decreased significantly (0.78±0.08 vs 1.23±0.03, 1.03±0.08 vs 1.16±0.01, 1.10±0.33 vs 1.69±0.02, t=-6.906,-2.756,-8.794, all P<0.05), while the protein levels of EPOR and CPT-1a increased significantly (1.28±0.14 vs 0.97±0.06, 0.77±0.06 vs 0.60±0.12,t=2.749, 2.655, all P<0.05) when compared with those in PBS controls. The protein levels of SREBP-1c, FAS and ACC in PA+EPO (10 U/ml) group decreased remarkably (t=-10.731,-2.760,-9.618, all P<0.05), while the protein levels of EPOR and CPT-1a increased markedly(t=7.556,2.674, all P<0.05) when compared with those in PA group.

EPO may alleviate the excessive lipid deposition in the liver via inhibiting lipogenesis and promoting fatty acid oxidation.

To explore the mechanism of insulin resistance on endothelial dysfunction in type 2 diabetic mellitus(T2DM) mice.

Mesenteric arteries isolated from T2DM mice (db/db) and normal control group (db/+)(n=10 for each group) were subjected to wire-myograph for measurement of vasoreactivity response to insulin treatment. The expression levels of cyclooxygenase and putative constrictor prostanoids in the arteries were determined using quantitative polymerase chain reaction(QT-PCR) analysis and enzyme linked immunosorbent assay(ELISA), respectively. The t-test and one way analysis of variance were used for statistical analysis.

Insulin evoked endothelium-dependent vasoconstriction in mesenteric arteries from db/db mice in a dose dependent manner, max vasoconstriction was 28.2%±4.1% to precontraction. Both MEK inhibitor and cyclooxygenase-2 (COX-2) specific inhibitor could reverse the insulin-stimulated vasoconstriction, max vasorelaxation was 41.2%±2.2% and 26.3%±3.2%, respectively(t= 47.3,33.2,P<0.05). The level of COX-2 in the db/db mice was 4 folds of that in the db/+ mice. COX-2-mediated prostaglandin F2a (PGF2a) increased. After COX-2 inhibitor NS-398 pro-treatment, the protein expression of PGF2a decreased from (1 614±8) to (536±4) ng/g(t=381.9, P<0.05)while the level of PGF1a was not decreased.

Insulin may induce endothelium-dependent vasoconstriction in db/db mice. Increased expression and activity of COX-2 maybe involve in insulin resistance on vascular endothelial function.

congenital hyperinsulinism (CHI) is a group of diseases with heterogeneous clinical, genetic and morphological characteristics. It is the main cause of persistent and frequent hypoglycemia in infants and young children^[1]。 So far, nine genes have been found to be involved in the pathogenesis of CHI, showing eight genetic types^[2]And nearly 50% of children with CHI have unclear causes. glucokinase (GCK) type hyperinsulinemia (GCK-HI) is a rare type of CHI caused by mutations in the gene encoding GCK. In the CHI population, this type of patients accounted for approximately 1.2%^[3]The age of onset, the severity of the disease and the morphological variation of pancreatic islets were large. In this paper, a family of a child with CHI with late onset and effective treatment with diazoxide was selected as the research object. The CHI-related pathogenic genes were analyzed by first-generation sequencing technology. As a result, a new mutation of GCK gene was found in the child. In this paper, the data of this case were summarized and analyzed in detail, in order to deepen clinicians' understanding and understanding of this disease.

Diabetic neuropathy is one of the most common chronic complications of diabetes, which greatly affects the quality of life of patients and significantly increases the risk of diabetic foot. Due to the lack of uniform diagnostic criteria, the prevalence of diabetic neuropathy ranges from 10% to 96%^[1]。

Diabetic neuropathy is one of the most common chronic complications of diabetes, which can involve the central and peripheral nerves, and the latter is more common^[1,2]。 Vitamin B₁It is a water-soluble vitamin and is an important coenzyme in various enzyme systems during the biological oxidation of sugar, fat and amino acids. Once the body is deficient in vitamin B₁It will lead to a series of disorders of substance metabolism and dysfunction of organs and tissues, which is more serious in patients with diabetic neuropathy^[3]。 This article elaborates on vitamin B₁The role and mechanism of its derivatives in the development and progression of diabetic neuropathy.

According to the latest survey, the prevalence of diabetes among adults aged 18 and above in China is 11.6%^[1]It is estimated that the incidence of diabetes in the world will reach 4 billion by 2030^[2]。 Absolute insulin deficiency caused by autoimmune destruction of islet beta cells is the main pathogenesis of type 1 diabetes mellitus (T1DM)^[3]。 Type 2 diabetes mellitus (T2DM) is associated with insulin resistance and/or progressive islet β-cell dysfunction^[4]。 At present, the methods of treating diabetes cannot aim at the key links of diabetes onset, and cannot fundamentally cure diabetes. Based on this situation, scholars from various countries began to work on a new therapeutic strategy-replenishing new islet cells with normal secretory function to reconstruct the islet function in patients^[5]。 1980 Largiader et al.^[6]The success of allogeneic islet transplantation was reported for the first time, but the lack of donor sources and lifelong use of immunosuppressants have limited the clinical application of islet transplantation, prompting researchers to shift their research focus to stem cell transplantation technology. In recent years, the development of related basic and clinical research on stem cell treatment of diabetes has brought hope for a complete cure of diabetes.

With the rapid rise of the incidence of diabetes mellitus, the chronic complications of diabetes mellitus have attracted more and more attention. However, the pathogenic mechanism of these complications, which pose a great threat to humans, has not been fully elucidated. Large clinical studies and experimental models suggest that metabolic memory plays an extremely important role in the occurrence and development of chronic complications of diabetes. Diabetic patients who are in a state of hyperglycemia for a long time are still prone to diabetes-related complications even if their blood glucose levels are lowered, and the efficacy produced when blood glucose drops to a lower level seems to persist after blood glucose rises. This phenomenon is called the "imprinting" or "metabolic memory" effect of blood glucose. The "metabolic memory" effect is a bridge between diabetes and its complications, and poses new challenges to blood glucose management in patients with type 2 diabetes.

In 2012, the world's first sodium-glucose cotransporter inhibitor (SGLT-2i) was listed in Europe. Up to now, the SGLT-2i that has been listed abroad and plans to be listed in China mainly include dapagliflozin, canpagliflozin and empagliflozin. This article mainly introduces the clinical effects of these drugs in lowering blood sugar (abbreviated as lowering blood sugar), lowering weight (weight loss), lowering blood pressure (lowering blood pressure) and other clinical effects.