Volume 09 · Issue 11 · 2017

Blood glucose monitoring is an important component in diabetes management, and its results are helpful to evaluate the degree of glucose metabolism disorder in diabetic patients and formulate reasonable hypoglycemic protocols. Self-glucose monitoring (SMBG) is the basic form of glucose monitoring, while glycosylated hemoglobin (HbA_1c) is the gold standard that reflects the average level of long-term glycemic control. But either HbA_1cOr SMBG, there are certain limitations. Continuous glucose monitoring (usually called ambulatory blood glucose monitoring, that is, CGM) technology has become an effective supplement to traditional blood glucose monitoring methods, and has gradually been popularized and applied in clinic.

Blood glucose monitoring is an important part of diabetes management. The results of blood glucose monitoring are helpful to evaluate the degree of glucose metabolism disorder in diabetic patients, formulate reasonable hypoglycemic regimen, follow-up the changes of disease, and guide the adjustment of treatment regimen. Patients undergo self-glucose monitoring (SMBG) is the basic form of glucose monitoring, while glycosylated hemoglobin (HbA_1c) is the gold standard that reflects the average level of long-term glycemic control^[1]。 But either HbA_1cOr SMBG, it has certain limitations. HbA_1cReflects mean blood glucose levels over the past 2 to 3 months, so there is a "delayed effect" on treatment-adjusted blood glucose assessment, while HbA_1cIt is difficult to reflect the characteristics of blood glucose fluctuations in patients, nor can it accurately reflect the risk of hypoglycemia in patients. However, SMBG cannot accurately reflect the fluctuation of blood glucose throughout the day. Therefore, continuous glucose monitoring (usually called ambulatory blood glucose monitoring, that is, CGM) technology has become an effective supplement to traditional blood glucose monitoring methods, and has gradually been popularized and applied in clinic.

To evaluate the comparability of glycated hemoglobin A_1c (HbA_1c) testing results among mutual recognition laboratories by analyzing the results of external quality assessment (EQA) and internal quality control (IQC) of 110 mutual recognition laboratories in Beijing-Tianjin-Hebei region.

Five lots of EQA materials were distributed to the participant laboratories by express mail services (EMS). Laboratories should test the samples within a specific time, and submit results via web-based EQA software. Meanwhile, IQC data in January 2016 should also be reported though web. Then the EQA results without grouping were evaluated by traditional statistical method and simple robust statistical method. Finally, the current coefficient of variation (CV) and cumulative CV of different groups divided by different analytical systems were evaluated against imprecision criteria for IQC recommended by Measurement of Hemoglobin A_1c (WS/T461-2015).

Total of 110 mutual recognition laboratories participated in this EQA scheme and 95 laboratories submitted IQC information. As for EQA results, the percentage of laboratories of which the EQA results were acceptable was 90.9% (100/110) by use of traditional statistical method. When simple robust statistical method were applied, more than 92.3% (107/110) of the laboratories got a simple robust statistical Z score ︱Z︱≤2; less than 4.0% of the laboratories got︱Z︱≥3; only 4(3.64%) laboratories got a ︱Z︱≥3 in two or more lots. EQA results of 4(3.6%) laboratories were unacceptable according to the two kinds of statistical methods. As for IQC data, only 57(60.0%) laboratories tested IQC material of two concentration levels. If the criteria of CV<2% and CV<3% were employed, the range of overall pass rates was 51.2%-66.2% and 77.4%-85.3%, respectively.

Some laboratories still cannot meet the requirements for mutual recognition, the EQA results are satisfactory, but IQC performance should be improved. It is suggested that laboratories with unacceptable performance should take corrective action or their qualifications for mutual recognition could be canceled.

To investigate the long-term outcome of postpartum glucose metabolism and predictive factors in patients with gestational diabetes mellitus (GDM).

A total of 1 191 patients diagnosed with GDM in the First Hospital of Peking University between November 2006 and October 2013, 320 (26.9%) patients were followed up and glucose metabolic data were collected during pregnancy, short-term postpartum (6-12 weeks) and long-term postpartum (1-6 years) periods. With type 2 diabetes mellitus (T2DM) as the end point event, the survival curve was drawn by Kaplan-Meier method to analyze the incidence of postpartum T2DM year by year, and Cox multivariate regression was used to analyze the predictive factors of postpartum T2DM.

In 1-6 years of postpartum period, 9 (2.8%) cases had impaired fasting glucose (IFG), 71 (22.2%) had impaired glucose tolerance (IGT) and 14 (4.3%) had T2DM. Both of fasting plasma glucose (FPG) and 2 hour postprandial glucose (2hPG) elevated year by year in postpartum period. Kaplan-Meier survival curve indicated the cumulative incidence of T2DM were 0, 0.9%, 2.7%, 4.6%, 7.0% and 18.8% in 1-6 years of postpartum period, respectively. Early pregnancy weight, FPG/2hPG during pregnancy, FPG/2hPG/waist/hip ratio in early postpartum period were risk factors of long-term postpartum T2DM (all P<0.05). Body weight ≥72 kg in early pregnancy and FPG ≥5.2 mmol/L in early postpartum period were independent predictive factors, hazard ratio (HR) were 14.9 [95% confidence interval (CI) 2.3-96.1] and 18.2 (1.9-173.0) , respectively.

The cumulative incidence of T2DM in GDM patients increases annually, especially in the 5^th-6^th year of postpartum period. High body weight in early pregnancy and postpartum short-term FPG ≥5.2 mmol/L have important significance to predict the long-term outcome of postpartum glucose metabolism.

To investigate the relationship of estrogen 2 (E₂) level and estrogen receptor α (ERα) expression in placenta with risk factors of gestational diabetes mellitus.

From March 2015 to July 2016, 42 GDM patients and 51 normal pregnant women were collected in the study. The level of E₂ and expression of ERα in placenta were examined with enzyme linked immunosorbent assay and Western-blotting. The relationship of the E₂ concentration and ERα expression with plasma glucose and insulin levels as well as blood lipid levels was further investigated. Data were analyzed witht test, linear correlation analysis and Logistic regression analysis.

The E₂ concentration was slightly higher in GDM patients compared with normal pregnant women, but without statistical significance [(8.46±4.37) vs (6.95±3.40)ng/L, t=1.80, P>0.05]. The expressions of ERα were significantly higher in GDM group than that in control group (1.23±0.48 vs 1.04±0.39,t=2.11, P<0.05). The E₂ concentration was positively correlated with fasting blood glucose(FPG), fasting insulin and homeostasis model of assessment for insulin resistance index (HOMA-IR) (r=0.368, 0.121, 0.194, all P<0.05). The protein expression of ERα was positively correlated with FPG, FIN and HOMA-IR (r=0.216, 0.171, 0.312, all P<0.05). The related independent factors for GDM were HOMA-IR and expression of ERα [theOR and 95% CI was 1.67(1.26-1.89), 1.31 (1.22-1.42), respectively, all P<0.05].

The elevation of E₂ level and expression of ERα in placenta may be one of the molecular mechanisms leading to insulin resistance in patients with GDM.

To investigate the relationship between subfoveal choroidal thickness (SFCT) and microalbuminuria in diabetic patients.

Clinical data of in-patients with type 2 diabetes who underwent optical coherence tomography (OCT) and 8 hours urinary albumin excretion rate (UAER) in department of endocrinology of Beijing Hospital from March 2015 to March 2016 were collected. All subjects were divided into normal albuminuria group (n=196) and microalbuminuria group (n=65) based on UAER. SFCT was calculated from OCT measurement. Differences of SFCT between the two groups were analyzed by ANOVA. Logistic regression and Spearman Correlation analysis were used to analyze the correlation between microalbuminuria and SFCT.

The difference in glycated hemoglobin A₁c (HbA_1c) between microalbuminuria group and normal albuminuria group was statistically significant[(9.5±1.9)% vs (8.7±1.9)%, F=7.606, P=0.006]. There was no significant difference of creatinine clearance rate (Ccr) between two groups [(114±35) vs (111±45) ml/min, F=0.387, P=0.534]. SFCT was thinner in microalbuminuria group compared with normal albumnuria group [(249±91) vs (289±89) μm, F=9.117, P=0.003]. Logistics regression analysis showed that SFCT and HbA_1c had the most significant influence on microalbuminuria (P=0.007 and P=0.001, respectively). Correlation analysis showed that Spearman correlation coefficient of SFCT and microalbuminuria was -0.190 (P=0.002, two tailed), indicating significant negative correlation. After eliminating HbA_1c, partial correlation analysis showed the correlation coefficient of SFCT and microalbuminuria was -0.194 (P=0.002, two tailed), still indicating significant negative correlation.

There is a strong negative correlation of SFCT and microalbuminuria in type 2 diabetes patients which suggesting that SFCT may become a useful diagnostic marker for early phase of diabetic nephropathy.

To investigate the self-management behaviors in adults with type 1 diabetes mellitus (T1DM) in east of Guangdong Province and its related factors.

Adults with T1DM were recruited from the Second Affiliated Hospital of Shantou University Medical College from July 2010 to July 2013. The Chinese version Scale of the Diabetes Self-Care Activities (C-SDSCA) was used to assess self-care behaviors. Demographic data of clinical parameters were collected. Glycosylated hemoglobin (HbA_1c, %) was used to evaluate whether or not glycemic target was achieved (HbA_1c≤7%). The relation between all dimensions of C-SDSCA and clinical parameters, such as HbA_1c, were analyzed by Spearmen rank correlation analysis.

A total of 86 adults with T1DM were enrolled in this study. The mean HbA₁c level was 9.7%±2.5%. Only 15.1% (13/86) of the participants had achieved glycemic target. The total score of self-management behaviors was 34.9±10.6. Among them, 50 (58.1%) cases showed moderate level in self-management and none of them got higher level. The dimension scores of diet and medications behaviors were higher, while foot care and blood glucose monitoring were lower. The level of HbA_1c and the dimension scores of diet behaviors were negatively correlated (r=-0.23, P=0.04).

The self-management behaviors and glycemic control in adults with T1DM in east of Guangdong province still has room to improve. Strengthening diabetes education may improve glycemic control in these group of patients.

To explore the trends of mortality from causes of death related to diabetes mellitus (DM) in Tianjin, and provide basis for prevention and control of DM.

All the death certificates data mentioning DM in 1999-2014 were from Tianjin population based mortality surveillance system maintained by the Tianjin Centers for Disease Control and Prevention, the mortality rates from causes of death related to DM and the proportion from DM specified complications were analyzed, permanent residents' population data was from Tianjin Municipal Public Security Bureau. Standardized mortality rates were calculated for DM related death, adjusted for age and gender using the year 2000 world standard population. Joinpoint regression and Cochran-Armitage trend were used to determine the statistical significance of differences in mortality trends.

The proportions of specified complications including ketoacidosis, coma, renal complications, retinopathy, peripheral circulatory and multiple complications increased dramatically which collectively accounted for over 46.82% in the underlying death cause of DM. Mortality rates from causes of death related to DM in Tianjin was observed from year 1999 to 2014 with the crude mortality rate of 13.53/100 000 to 26.21/100 000[Z=29.21, P<0.001, annual percent change (APC)=3.72%], and with the standardized mortality rate of 12.48/100 000 to 15.08/100 000 (Z=3.74, P<0.001, APC=0.56%). The crude mortality rate of male was lower than that of female. The standardized mortality rate increased in male but flatted in female. With the increase of age, the mortality increased gradually. The distributions of DM mortality in urban and rural were different. The mortality rate was higher for people of living in the urban with the standardized mortality rate of 16.38/100 000 to 16.98/100 000 (Z=-1.53, P=0.125, APC=-0.25%) than that in the rural with the standardized mortality rate of 7.19/100 000 to 12.05/100 000 (Z=9.35, P<0.001, APC=2.17%) during this study period.

The general mortality of DM related death and the proportions of DM complications had increased since the period 1999-2014. The people of elder, female and in urban areas had higher mortality rates. The people of male and in rural areas had mortality in a rising state. Therefore further efforts is needed to prevention and control of DM and to reduce DM related death in Tianjin.

To observe the protective effect of intraperitoneal injection of pancreatic kallikrein on peripheral neuropathy in type 1 diabetic mice.

Akita mice were used as type 1 diabetes mellitus model. The blood glucose and body weight were measured weekly. After the onset of hyperglycemia, the daily treatment was initiated and continued for up to 8 weeks. The mice were divided into three groups: wild type control group receiving saline infusion daily (WT group), diabetic control group receiving saline infusion daily (NS group) and diabetic treatment group receiving PKK daily (PKK group). At the end of treatment, the spinal dorsal root ganglions (DRGs) specific projection to the hind limb were collected from the mice. The ultrastructure of DRG neurons were examined by transmission electron microscopy. Quantitative real time polymerase chain reaction (Q-PCR) was used to detecte the expression of G6PD mRNA in three groups of DRGs. Friedman variance analysis was used to compare and analyze multiple samples.

The blood glucose in NS group was significantly increased compared with the WT group [(6.8±0.3) vs (32.2±1.5) mmol/L, t=48.16, P<0.05] while the body weight in NS group was markedly lower than WT group [(28.4±1.0) vs (23.0±1.5) g,t=8.28, P<0.05). There was no significant difference in blood glucose or body weight between NS group and PKK group (P>0.05). Compared with WT group, NS group showed mitochondrial swelling, increased microvascular microvilli and disorganized microtubule structure. These pathological changes were improved in PKK group. The expression of G6PD mRNA in NS group was significantly lower compared with WT group (1.00±0.17 vs 0.63±0.14, t=2.661, P=0.04), and the G6PD mRNA expression was significantly increased in PKK group (0.63±0.14 vs 1.25±0.44, t=2.642, P=0.03).

PKK improved the ultrastructural changes of DRG neurons in diabetic mice, which may be related to the up-regulation of G6PD and the reduction of oxidative stress.

To explore the protective effect of Tianqi Jiangtang capsule on kidney in rats with diabetic kidney disease (DKD) and its mechanisms.

A total of 60 eight-weeks old male SD rats were randomly and equally divided into 6 groups: control group (normal group), DKD model group (DKD group), irbesartan group [20 mg/(kg·d)], low-dose Tianqi group [0.32 g/(kg·d)], mid-dose Tianqi group [0.64 g/(kg·d)] and high-dose Tianqi group [1.28 g/(kg·d)]. DKD rat model was established by single-dose intraperitoneal injection of streptozotocin (35 mg/kg). The experimental group rats were fed with irbesartan and different doses of Tianqi Jiangtang capsule, the model group rats with normal saline. Weight, plasma glucose and lipids, 24-hour urine and serum sample was collected to detect urinary microalbumin and transforming growth factor-β1 (TGF-β1) after twelve weeks. Kidney tissues of all the rats were collected. One kidney was used for morphological examination, and the other one was homogenized for measurement of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities. Variance analysis(ANOVA), least-significant difference(LSD) and multiple comparison correction (Bonferroni correction) were used for statistical analysis.

Compared with DKD group, the level of fasting plasma glucose [(23.8±3.5) vs (29.4±3.3) mmol/L], total cholesterol [(1.67±0.32) vs (2.40±0.19) mmol/L] and triglyceride [(1.62±0.25) vs (2.76±0.64) mmol/L], 24 h urine microalbumin[(1 411±156) vs (2 018±259) μg/24 h] and serum TGF-β1 level [(333±46) vs (650±64) μg/ml] were decreased in high dose of Tianqi group (allP<0.05). Level of SOD [(402±22) vs (223±32) U/ml] and GSH-Px activities [(1 633±37) vs (1 181±53) U/ml] were significantly increased (allP<0.05), similar to the irbesartan group, even better. Compared with DKD group, there was no thickening of glomerular basement membrane in high dose of Tianqi group. Mesangial cells, extracellular matrix was decreased, and less edema in the epithelial cells of renal tubule.

High dose of Tianqi Jiangtang capsule can ameliorate levels of blood glucose and blood lipid, decrease urine microalbumin in DKD rats and improve the renal fibrosis, thus possibly delaying the progress of DKD. The mechanism is probably related to the increase of antioxidant and anti-fibrosis function of the kidney.

diabetic foot ulcer (DFU) is one of the most serious complications of diabetes, and its incidence is increasing year by year. It is the main cause of disability and death in diabetic patients^[1]However, there are few reports of DFU combined with squamous cell carcinoma (SCC). Clinically, if the pathological examination is neglected or the material is not standardized during DFU debridement, it is easy to misdiagnose and misdiagnose^[2]。 This paper reports the diagnosis and treatment of a case of DFU with SCC, and discusses it in combination with literature.

Gestational diabetes mellitus (GDM) is the first abnormal glucose tolerance occurring during pregnancy. The incidence rate of Chinese population is about 17.5%, and the incidence of fetal distress and macrosomia is significantly increased^[1]。 At present, the diagnosis of GDM is mostly based on the method developed by the International Diabetes and Pregnancy Research Group: 75 g glucose oral glucose tolerance test for pregnant women at 24 to 28 weeks. When a patient is diagnosed with GDM, the body may have been hyperglycemic for a period of time, which can cause the fetus to suffer from the influence of "fetal programming" mechanism, that is, whether the maternal blood glucose is subsequently well controlled or not, the fetus may retain the metabolic memory of the body in the high-glucose environment^[2]It is suggested that the molecular changes in the gene level of pregnant women with GDM have a greater impact on the fetus. In recent years, the function of microRNAs (microRNAs, miRNAs) in pregnancy-related diseases has been gradually reported and is differentially expressed in GDM patients (Table 1）^{[3,4,5,6,7,8,9,10]}And may be involved in the process of its onset and pregnancy outcome^[11]。 MiRNAs are non-coding RNAs of 20-25 nucleotides, which can complementarily bind to the 3' non-coding region of the target gene and mediate its silencing or degradation^[12]。

As a worldwide public health problem, obesity not only affects the quality of life of patients, but also increases the risk of metabolic diseases such as type 2 diabetes, hypertension, and fatty liver^[1]And has been proven to be a risk factor for cardiovascular and cerebrovascular diseases, chronic kidney disease, and even a variety of cancers, and can have adverse effects on the respiratory, digestive, and reproductive systems^[2]。 Obesity has been confirmed to be related to genetic, diet, lifestyle habits, environment and other factors that lead to the imbalance of energy intake and consumption of human body, but these factors can not fully explain the widespread prevalence of obesity. As a new research field, intestinal flora can not only further explain the occurrence and development of obesity, but also provide a new basis for the treatment of obesity.