Volume 09 · Issue 04 · 2017

With the rapid development of economy, the prevalence of overweight/obesity in China has increased rapidly in the past two decades. Numerous epidemiological evidence suggests that obesity is an independent risk factor for many diseases, such as cardiovascular disease, diabetes, nonalcoholic fatty liver disease, and is also closely related to diseases such as sleep apnea, hypertension, stroke and tumors. This may be because fat accumulation has a series of adverse effects on blood pressure, glucose and lipid metabolism, etc. through various pathophysiological processes such as insulin resistance (IR), inflammatory reaction, oxidative stress, etc., and even leads to death in severe cases^[1,2]。 Studies suggest that obesity is not only weight gain, but also metabolically obese normal-weight (MONW)^[3]。 As the name suggests, this type of obesity is characterized by metabolic abnormalities caused by a significant increase in body fat content in the normal range. The effects and harms of this obesity on the body need to be studied and understood in depth. On the other hand, we should also pay attention to the harm caused by obesity. People often lose fat and weight through dieting, exercise and other ways. However, it is inevitable that weight fluctuations will occur in the process of fat loss. And how weight fluctuations affect human health is still inconclusive. For this, more scientific research and clinical data are needed to help us correctly understand obesity and weight fluctuation.

Diabetic nephropathy (DKD) is a common microvascular complication of diabetes, and about 40% of diabetic patients are complicated with DKD. The study showed that in the general population, the prevalence of DKD was 2.2% from 1988 to 1994, 2.8% from 1999 to 2004, and 3.3% from 2005 to 2008, respectively, suggesting that the prevalence of DKD increased year by year^[1]。 Another study showed that the age-standardized incidence of end-stage renal disease in diabetic patients was 27.9/10 000, 28.6/10 000, and 20.0/10 000 at three time points in 1990, 2000, and 2010, respectively, and the changes were not significant^[2], suggesting that the current treatment modalities based on hypoglycemic and antihypertensive drugs cannot completely prevent the progression of DKD. It can be seen that the prevalence of DKD is increasing year by year, and the harm is serious. It has gradually become a public health problem of general concern at home and abroad.

The relationship between obesity and diabetes is very close, and it becomes an important risk factor for type 2 diabetes. In the past 30 years, the average body mass index (BMI) of adults in China has increased by about 1.8 kg/m², the prevalence of obesity increased 8-fold, and the prevalence of diabetes increased 14-fold^[1]。 Increased body fat is the most important change in obese patients and the most critical factor in the development of diabetes. However, in addition to the increase of body fat, the redistribution of body fat often occurs in obese patients, that is, the increase of visceral fat and ectopic deposition of fat, such as liver, muscle and other parts. These changes often bring greater harm and are more closely related to diabetes. Studies have shown that some obese patients have no abnormalities in metabolic indicators such as blood glucose for a long period of time, showing metabolically healthy obesity (MHO); There are also some individuals with normal body weight, with abnormal metabolic indexes such as blood sugar, which are manifested as abnormal metabolism of normal body weight (metabolic unhealthy normal weight, MUNW). Therefore, the redistribution of body fat is more important to the pathogenesis of diabetes than the increase of body fat content. This article will briefly explain the relationship between body fat distribution and the risk of diabetes mellitus and its possible mechanism.

To analyze the prevalence and epidemic characteristics of obesity in China and provide the evidence for the early interventions to decrease the complications of obesity.

This population-based cohort study was based on China National Diabetes and Metabolic Disorders Survey. Data were collected during 2007-2008. A multi-stage stratified sampling method was used to select a nationally representative sample of Chinese adults aged no less than 20 years. A structured questionnaire was used to collect the information of physical examination. The cut-off values of BMI to define overweight and obesity were no less than 24 kg/m² and 28 kg/m², respectively. Abdominal obesity was diagnosed if the waist circumference (WC) was no less than 90 cm in men or no less than 85 cm in women. Body fat (BF) greater than or equal to 20% in man or 30% in women was considered to be obesity. The t test was applied in data analysis.

A total of 14 204 women and 9 718 men aged 20-88 years were included in this study. The average age was (45±14) years. Using BMI as a diagnostic standard, the prevalence of overweight and obesity were 46.51%(6 591/14 171) in women and 56.49% (5 473/9 688) in men. The prevalence of obesity were 13.37% (1 895/14 171) in women and 17.10% (1 657/9 688) in men. The prevalence of abdominal obesity were 37.73% (3 658/9 695) for men and 29.94% (4 141/14 165) for women when using WC as standard. When BF was used to define obesity, the prevalence were 77.79% (7 560/9 718) and 59.16% (8 403/14 204) in men and women, respectively. When using BF no less than 20% in men or 30% in women to define obesity, the corresponding cut off values of BMI were 23.0 kg/m² and 22.9 kg/m2, respectively.

Men have higher prevalence of overweight and obesity than women. Using BMI alone to evaluate obesity may not be suitable since this will underestimate the prevalence of obesity.

To analyze the therapeutic effect and prognosis of pancreatectomy in 12 patients with congenital hyperinsulinism (CHI).

Total of 12 patients with CHI, hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from February 2002 to January 2016, were set as research subjects. All the patients received pancreatectomy. A retrospective study was done for the clinical data, therapeutic effects and gene tests of the 12 patients.

Most patients (8/12) had no response to diazoxide treatment and the effects of diazoxide were uncertain in the rest four patients. Four patients were completely cured, four patients remained hypoglycaemic, and three patients were diagnosed with type 1 diabetes after pancreatectomy. In the eight patients who received ABCC8 and KCNJ11 gene tests, one frameshift mutation, two nonsense mutations and three missense mutations were found.

Partial pancreatectomy is an effective treatment for focal CHI patients. Patients with diffuse disease who undergo near-total pancreatectomy may remain hypoglycemic and have a high risk of hypoglycemia and type 1 diabetes.

To investigate the expression and clinical significance of serum microRNA(miRNA) in Uygur patients with diabetic kidney disease(DKD).

A total of 50 Uygur patients with type 2 diabetes mellitus(T2DM) were collected from March 2015 to December 2015 in the Department of Endocrinology and Physical Examination Center of the First Affiliated Hospital, Xinjiang Medical University. Patients were divided into 2 groups: T2DM group[24 h microalbunminuria(MAU)<30 mg/24 h,n=25]and DKD group (MAU≥30 mg/24 h, n=25). Another 25 Uygur healthy volunteers were included as control group(n=25).The level of serum miRNAs were measured by real-time polymerase chain reaction, and the associations between miRNAs with clinical parameters in diabetic nephropathy were analyzed.

The expression of miR-21, miR-187, miR-451 were decreased in T2DM group(0.7±0.4, 0.8±0.4, 0.7±0.4) and DKD group(0.7±0.4, 0.8±0.3, 0.8±0.6)compared with those in control group(1.5±0.9, 1.2±0.7, 1.7±1.0, t=2.29-3.99, all P<0.05). The miR-145 level was significantly decreased in DKD group compared with that in T2DM group or control group (0.6±0.3 vs 0.9±0.4, 0.6±0.3 vs 1.1±0.6, t=2.50, 3.06, all P<0.05) . The level of serum miR-21, miR-187, miR-145, or miR-451 was positively correlated with eGFR (r=0.365-0.743) , but inversely correlated with SCr and UAER (r=-0.545--0.223,all P<0.05) . The level of serum adiponectin was decreased in T2DM group and DKD group compared with that in control group. However, the adiponectin level was higher in DKD group than in T2DM group (t=-2.11-4.18, all P<0.05). miR-21, miR-187, miR-145, and miR-451 were significantly correlated with adiponectin level (r=0.281-0.671, all P<0.05) .

miR-21, miR-187, miR-145 and miR-451 may be involved in the pathogenesis of DKD, and may be potential diagnostic biomarkers of DKD.

To observe the expression of receptor activator of nuclear factor kappa B (RANK) and its ligand (RANKL) in the kidney of rats with type 2 diabetic kidney disease induced by streptozotocin (STZ), and explore the mechanism of renal protective effects of alpha lipoic acid.

Among 35 male SPF Sparague Dawley rats [8-week-old, weighing (200±20) g], eight rats were randomly chosen as normal control group (NC group), the rest 27 rats were used to establish the animal model of type 2 DKD with high glucose and high fat diets in combination with intraperitoneal injection of STZ. Eighteen rats with established DKD were randomly divided into the DKD group (n=9) and alpha lipoic acid group (DL group, n=9). The DL group was administered with alpha lipoic acid in a dose of 60 mg·kg^-1·d^-1, and the NC group and the DKD group were given equal volume of normal saline. Rats were killed after 12 weeks, blood glucose and other index were detected, and creatinine clearance rate was calculated. The renal pathological changes were observed with hematoxylin-eosin and periodic acid-Schiff staining. Expressions of RANKL and RANK in kidney were detected using immunohistochemistry. Expressions of RANK, RANKL, nuclear factor kappa B and synaptopodin protein on podocyte were detected by Western blotting method. One-way analysis of variance was used for statistical analysis.

Compared with NC group, biochemical index of DKD group was significantly higher at 12 weeks, the RANK(0.25±0.07 vs 0.78±0.09), RANKL (0.19±0.06 vs (0.58±0.10, t=22.62, 15.98, both P<0.01) and the protein expressions of nuclear factor kappa B were increased in the kidney, while the expression of synaptopodin was decreased; Compared with DKD group, biochemical indexes of DL group and kidney pathological alteration were significantly decreased, RANK (0.50±0.11 vs 0.78±0.09), RANKL (0.35±0.09 vs 0.58±0.10, t=12.28, 10.49, both P<0.01) and the renal protein expressions of nuclear factor kappa B were decreased, and synaptopodin protein expression was increased.

The expression of RANK/RANKL is increased in renal tissue of DKD rats which may be involved in the pathogenesis of DKD; alpha lipoic acid may reduce renal podocyte injury in DKD rats and proteinuria, partly through inhibiting the expression of RANK/RANKL.

To investigate the role of MicroRNA-27a (miR-27a) in the anti-apoptotic effects of liraglutide (LR) in cardiomyocytes.

The H9c2 rat cardiomyocytes were cultured in different environment and divided into low glucose group, high glucose group, miR-27a over-expression group, miR-27a inhibited group, miR-27a negative over-expression group, miR-27a negative inhibited group, liposome 2000 group, hypertonic solution group, LR intervention group, LR intervention and miR-27a over-expression group, LR intervention and miR-27a negative over-expression group. The expression of miR-27a in cardiomyocytes, which were cultured in low glucose solution, high glucose solution and interferenced by LR, was detected by fluorescence-based real-time quantitative polymerase chain reaction (PCR). The apoptosis of cardiomyocytes was detected by terminal-deoxynucleoitidyl transferase mediated nick end labeling (TUNEL) and then the cell apoptosis index (AI) was computed and compared among the groups. The expression of apoptosis-related protein B-cell lymphoma/leukemia-2 (Bcl-2), Bcl-2 associated X protein (Bax), cysteine-containing aspartate-specific proteases-3 (caspase-3), cellular inhibitors of apoptosis-1 (cIAP-1), anti-apoptotic protease activating factor-1 (Apaf-1) was detected by Western blotting method. Data were analyzed with one-way analysis of variance test or t test.

The expression of miR-27a in high glucose group was higher than that in low glucose group(35.8±4.9 vs 1.0±0.0, t=12.199, P<0.05). Compared with the high glucose group, the AI of cardiomyocytes increased significantly in miR-27a over-expression group (78.5±6.6 vs 22.9±1.7, least-significant difference (LSD), P<0.05), and the protein expression of Bcl-2 and cIAP-1 decreased (LSD, both P<0.05), the protein expression of Bax, caspase-3 and Apaf-1 increased(LSD, all P<0.05). Compared with the high glucose group, the AI of cardiomyocytes decreased significantly in miR-27a inhibition group (2.6±0.4 vs 22.9±1.7, LSD, P<0.05), and the protein expression level of Bcl-2 and cIAP-1 increased (LSD, both P<0.05), the protein expression level of Bax, caspase-3 and Apaf-1 significantly decreased(LSD, all P<0.05). Compared with the high glucose group, the expression level of miR-27a decreased significantly in LR intervention group (7.9±0.2 vs 35.8±4.9, t=-9.785, P<0.05), and the AI of cardiomyocytes decreased remarkably (4.9±0.1 vs 22.9±1.7, LSD, P<0.05). The AI of cardiomyocytes increased in LR intervention and miR-27a over-expression group when compared with that in LR intervention group (61.3±5.1 vs 4.9±0.1, LSD, P<0.05).

LR may ameliorate the apoptosis of cardiomyocytes in the condition of high glucose by inhibiting the expression of miR-27a in H9c2 rat cardiomyocytes.

Insulin pump therapy is the best method for intensive treatment of diabetes. It can mimic the function of the human pancreas to secrete insulin, and glycated hemoglobin (HbA_1c) and the blood glucose level continuously controlled within the normal range, reducing and preventing the occurrence of diabetic complications, and improving the quality of life of patients^[1]。 In the process of glycemic control, blood glucose monitoring is the key to treatment. "Model 722 real-time dynamic insulin pump system" can integrate real-time dynamic blood glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII) and diabetes information management (CareLink). Compared with Model 712 insulin pump, it has the function of real-time monitoring of blood glucose changes and trends. However, patients with intensive insulin pump therapy have different degrees of anxiety and depression, which may lead to large fluctuations in blood sugar, thus prolonging the time of pumping^[2,3]。 In addition, the 722 insulin pump adopts English operation mode and the blood glucose value is visible in real time. Whether this will increase patients' anxiety and depression, and whether it has better hypoglycemic effect in the process of clinical application are all questions worth exploring. In this study, 72 patients with different types of insulin pumps were analyzed. The purpose of this study was to investigate the effects of type 722 insulin pump and type 712 insulin pump on newly diagnosed type 2 diabetes mellitus and the differences in anxiety and depression.

Osteoporosis is an evolving systemic bone disease characterized by low bone mass and degeneration of bone tissue microstructure, resulting in increased bone fragility and increased fracture probability^[1]。 Type 2 diabetes mellitus (T2DM) can cause progressive lesions of nerves, blood vessels, bones and other systems and tissues due to long-term disorders of glucose and lipid metabolism and insulin resistance. Since Albright first proposed the idea of diabetic osteoporosis (DO) in 1948, DO has received increasing attention due to its high disability and mortality rate. A survey in China has shown that among T2DM patients, the prevalence rate of patients with osteopenia and osteoporosis reaches 78%^[2]。 Therefore, the study of pathogenesis will have important clinical and practical significance for the early diagnosis and treatment of DO. Recent studies have found^[3,4]Osteogenesis and angiogenesis are coupled during bone formation, and the bone blood vessels contain specific endothelial cells-CD31^hiEmcn^hisubtypevessels (i.e., H-type ECs), which secrete Noggin protein and have a regulatory effect on osteoblast and chondrocyte growth; The vascular endothelial growth factor (VEGF) secreted by the latter two can promote angiogenesis. Therefore, the release of Noggin links H-type ECs to osteogenesis. In this study, the serum levels of Noggin in patients with T2DM with different bone mass were measured, and its correlation with VEGF, bone metabolism and bone transformation were analyzed, so as to explore its role in the development of DO.

Glucagon-like peptide 1 (GLP-1) can significantly reduce glycosylated hemoglobin (HbA) in patients with type 2 diabetes mellitus (T2DM) by promoting the proliferation of pancreatic islet β cells, increasing the secretion of insulin by β cells and decreasing the secretion of glucagon by α cells_1c) Level^[1,2]。 Exenatide is the first GLP-1 receptor agonist (GLP-1RA) approved for marketing^[3]It can also suppress appetite and delay gastric emptying, thereby further reducing weight^[4,5]。 Patients with T2DM have benefited a lot from long-term treatment with exenatide, but due to the short clinical application time, its adverse reactions still need to be accumulated clinically. Gastrointestinal discomfort such as nausea, diarrhea, constipation and indigestion are common adverse reactions of exenatide^[6]However, no cases of hypothermia caused by exenatide have been reported at present. We found a patient who experienced a lower-than-normal temperature drop while treating T2DM with exenatide. It is now introduced as follows.

Reactive perforating collagenopathy is a perforating skin disease characterized by the excretion of denatured collagen through the epithelium. The specific cause is still unclear, and it is a rare disease. It is generally more common in children and less common in adults. Adult patients are mostly complicated with diabetes, renal insufficiency, liver cirrhosis, pulmonary fibrosis, thyroid disease, hepatitis, malignant tumor, etc., which is called acquired reactive perforating collagen disease^[1]。 A case of type 2 diabetes mellitus with acquired reactive perforating collagenopathy is reported in this paper, and related literature is reviewed to improve clinicians' understanding of this disease.

diabetic retinopathy (DR) is one of the serious complications of diabetic microvascular damage. In recent years, the prevalence of the disease in the world has been increasing, and the situation is more serious in developing countries. DR has become the first disease causing blindness among people aged 20 to 74^[1]。 Studies have shown that angiopoietin (Ang) /tyrosine kinase receptor (Tie2) pathway, vascular endothelial growth factor (VEGF) and its receptor (VEGF-R) pathway are closely related to the development of DR. As a neurovascular disease, the formation mechanism of DR is complex, and recent studies have shown that Ang/Tie2 and VEGF/VEGF-R signaling pathways play a key role in the changes of DR exudation and retinal neovascularization. This paper reviews the research progress of these two signaling pathways in recent years, and expounds the mechanism related to DR lesions.

Islet transplantation is one of the effective methods to cure type 1 diabetes mellitus (T1DM). At present, new progress has been made in islet transplantation technology^[1]。 It can obviously improve the blood sugar fluctuation of "fragile diabetes", and has the advantages of high safety and mild adverse reactions. Clinical studies have demonstrated that pancreatic transplantation and islet transplantation can delay diabetes and its progression, and even reverse chronic complications including renal lesions and neuropathy through transplantation. However, clinically, islet transplantation still faces the problems of primary non-function (PNF), immune rejection, and donor shortage. It is of great clinical significance to protect the function of transplanted islets. In this paper, the research progress of functional protection of transplanted pancreatic islets in recent years is briefly reviewed.

Diabetic foot is one of the most serious complications of diabetes mellitus. The treatment time is long and expensive, and the amputation caused by it exceeds 60% of non-traumatic amputation^[1]And seriously affects the quality of life of patients. Approximately 85% of diabetic amputations have been reported to start with ulcers^[2]Only by giving specialized treatment in time can it be controlled or cured to avoid amputation or even death. As a newer disease management tool to improve clinical progress, clinical pathways have been widely used in hospitals and medical centers all over the world. At present, many studies have proved that the clinical pathway can improve clinical efficiency, shorten the length of hospital stay, reduce the hospitalization cost and improve the clinical outcome^[3,4,5]。 The following is a brief review of the application of clinical pathways in diabetic foot.

Dipeptidyl peptidase IV (DPP-4) inhibitor (DPP-4i), as a novel incretin-based oral hypoglycemic drug, can transform glycosylated hemoglobin (HbA_1c) decreased by 0.4% to 0.9%, and its use alone did not increase the risk of hypoglycemia, and the effect on body weight was mostly neutral^[1]。 In recent years, more and more studies have confirmed that DPP-4i has multiple target organ protective effects in addition to hypoglycemic effects. In this paper, the related progress of DPP-4i hypoglycemic benefits in recent years is briefly introduced.