Volume 10 · Issue 01 · 2018

In 217 AD, Cao Pi, one of the "three Cao Cao of Jian'an", called "articles, the great cause of governing the country, the immortal grand event". Time flies, fixed in 2017 AD. According to incomplete statistics, with only "diabetes" as the search term, Chinese researchers published 1,510 articles in foreign "SCI" journals throughout the year, doubling that of 2013. In addition, this year, Springer Publishing HouseTumor BiologyThe magazine withdrew 107 published papers from China in one sitting, shocking academic circles at home and abroad. Investigations showed that the main reason for the withdrawal was the existence of false peer-reviewed opinions from third parties. These news from international peers prompt us to constantly think: What kind of academic responsibility should the Chinese Diabetes Journal have in the new era?

The Guidelines for the Prevention and Treatment of Diabetes in China were first published in 2003 and revised three times in 2007, 2010 and 2013. In recent years, many important progress has been made in the research of type 2 diabetes at home and abroad. The Chinese Medical Association has clear requirements for the compilation of the guidelines, so it is necessary to publish the guidelines in 2013 edition^[1]The guidelines for diabetes prevention and treatment in China were revised again on the basis of^[2]。 In order to enable readers to better understand the main contents of this revised edition of the Guide, the following compilation instructions are made.

In the past 40 years, with the aging of China's population and the changes of lifestyle, diabetes has changed from a rare disease to an epidemic, and the prevalence of diabetes has soared from 0.67% in 1980 to 10.4% in 2013. Correspondingly, the development of science and technology has also brought progress in our understanding and diagnosis and treatment of diabetes. In terms of blood glucose monitoring, it has developed from only detecting blood glucose in hospitals to continuous glucose monitoring and even non-invasive blood glucose monitoring. In terms of treatment, there are only few kinds of hypoglycemic drugs such as sulfonylureas, biguanides and human insulin. At present, there are dipeptidyl peptidase IV (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) receptor agonists, sodium-glucose cotransporter 2 (SGLT2) inhibitors, various insulin analogues and other drugs with rich varieties and fewer adverse reactions, as well as metabolic surgery for obese patients with type 2 diabetes.

At the 2017 Annual Meeting of the American Diabetes Society, the Annual Meeting of the European Diabetes Society and the International Diabetes Federation Congress, special reports and posters on diabetic foot disease reflected the current deepening understanding of diabetic foot disease. In particular, the International Diabetes Federation released the "2017 Diabetic Foot Clinical Practice Guidelines" to standardize the screening, diagnosis, treatment and prevention of diabetic foot disease^[1]。 The author summarizes the contents of special reports, conference speeches and poster exchanges on diabetic foot disease in these three international conferences.

To observe the distribution and influential factors of serum lactate levels in healthy Tibetan adults in Lhasa (average elevation of 3 680 m).

From 2015 May to 2016 December, One thousand volunteers from Lhasa and surrounding areas were enrolled into this study conducted by Department of Endocrinology, People's Hospital of Tibet Autonomous Region. The height, weight, waist circumference, systolic blood pressure and diastolic blood pressure were recorded, and body mass index (BMI) was calculated. Fasting blood glucose (FPG), glycated hemoglobin A_1c (HbA_1c), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), serum uric acid (UA) and 2 h blood glucose in 75 g oral glucose tolerance test (OGTT) were measured. Fasting serum lactate levels were measured after serum centrifugation. The distribution of blood lactate was analyzed with the data of volunteers with normal blood glucose, blood pressure and blood lipids. Continuous data were compared with the Mann-Whitney U test. The association between other factors and blood lactate was analyzed with spearman correlation and the risk factors associated with blood lactate was analyzed with multivariate linear regression.

A total of 438 healthy subjects were finally enrolled in the study [158 males and 280 females, average age (45±15 years)]. Lactate levels in fasting venous blood were skewed distribution, with a median (upper and lower quartiles) of 2.15 (1.63, 2.85) mmol/L, and a reference range of 1.00-4.91 mmol/L. Blood lactate level in males was 2.49 (1.92, 3.12), significantly higher than that in females [1.94 (1.52, 2.69) mmol/L] (Z=-4.762, P<0.01). With the growth of age, lactate acid level decreased gradually. Correlation analysis showed that there was a negative correlation between lactate level and age (r=-0.147, P<0.01). Multivariate linear regression analysis showed that gender and FPG were independent risk factors of blood lactate levels (β=-0.201,-0.314, respectively, allP<0.001). Meanwhile, blood lactate level was not correlated with other clinical parameters (BMI, systolic blood pressure, diastolic blood pressure, waist circumference, blood glucose at 2 h OGTT, HbA_1c, TC, LDL-C and HDL-C) (P>0.05).

The distribution range of serum lactate in normal Tibetan adults in Lhasa range was from 1.00 to 4.91 mmol/L. Blood lactate level was significantly higher in males than in females, and blood lactate levels were inversely correlated with age and FPG.

To investigate the correlations between serum uric acid levels and different categories of impaired glucose regulation (IGR) in adults.

Study data came from China National Diabetes and Metabolic Disorders Study 2007-2008 in ShaanXi Province. 3 002 participants without diabetes were enrolled. Prediabetes was defined according to 1999 WHO criteria. Hyperuricemia (HUA) was defined as serum uric acid ≥420 μmol/L in male or ≥360 μmol/L in female. The influence of hyperuricemia on the prevalence risk of prediabetes and serum uric acid levels on different categories of IGR were analyzed by logistic regression analysis.

(1) The prevalence rates of hyperuricemia in male and female were 8.9% (46/1 756) and 2.6% (111/1 246), respectively. The prevalence rate of prediabetes in population with hyperuricemia was significantly higher than in normal population [31.2% (49/157) vs 16.7% (475/2 845), χ ²=21.754, P<0.001]. (2) Logistic regression analysis showed that the prevalence risk of prediabetes was associated with hyperuricemia (OR 1.692; 95%CI: 1.129-2.538). Compared with the first quartile of serum uric acid level (<198 μmol/L), the prevalence risks (OR, 95% CI) of prediabetes in the second, third and fourth quartile of serum uric acid (198-245 μmol/L, 246-306 μmol/L and ≥307 μmol/L) were 1.256(0.917-1.719), 1.323(0.961-1.822), 1.772(1.247-2.517), respectively. (3) When uric acid concentration increased by 59.48 μmol/L(1 mg/dl). The prevalence risks of different categories of IGR ( OR,95% CI) were: isolated impaired fasting glucose (IFG) (1.208, 1.046-1.395), isolated impaired glucose tolerance (IGT) (1.160, 1.042-1.292), IFG/IGT (1.316, 1.080-1.603), respectively.

The prevalence risk of prediabetes may increase with serum uric acid levels elevating. Prediabetes screening in population with serum uric acid ≥ 300 μmol/L should be concerned.

To explore the relationship between diabetes and autoimmune thyroid disease (AITD) by evaluating the difference of clinical characteristics and the level of specific antibodies in diabetics associated with or without AITD.

From June 2014 to December 2016, subjects with newly diagnosed type 1 diabetes mellitus (T1DM, n=162) and type 2 diabetes mellitus (T2DM, n=314) were recruited, and they were divided into two subgroups including T1DM complicated with AITD (Combination group 1) and T2DM with AITD (Combination group 2). AITD included Graves' disease (GD) or Hashimoto's thyroiditis (HT). Furthermore, diabetics associated with AITD were classified according to thyroid function including clinical thyroid dysfunction, subclinical thyroid dysfunction and normal thyroid function. The effect of thyroid function on clinical indicators of diabetic patients was evaluated. Fasting blood glucose (FPG), C peptide, glycated hemoglobin A₁c (HbA_1c), biochemical tests and thyroid function of these subjects were measured. The level of thyroid autoantibodies, islet autoantibodies and specific antibody of celiac disease (tTGA) were detected by radio ligand assay. Quantitative data were analyzed by t-test or one-way analysis of variance and enumeration data were tested by Chi-square test or Fisher exact test.

FPG and HbA_1c in Combination group 1 were higher than those in T1DM alone group [(20.5±8.4) vs (13.6±6.4) mmol/L, 12.2%±2.2% vs 10.7%±2.9%, respectively, t=3.888, 2.105, both P<0.05], while the level of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) obviously decreased in Combination group 1 (t=2.870, 3.749, both P<0.05). Combination group 2 showed significant lower BMI when compared with T2DM alone group (t=3.516, P<0.001). FPG level in T1DM+GD group and T1DM+HT group was significantly higher than that in T1DM alone group (F=7.627, P<0.05), and HbA_1c level in T1DM+GD group was higher than that in T1DM alone group (F=2.638, P<0.05). However, the level of TC and LDL-C in T1DM+GD group were significantly lower than those in T1DM alone group (F=4.357, 5.482, both P<0.05). Among the diabetics associated with AITD, the level of FPG and HbA_1c were significantly higher in patients with clinical thyroid dysfunction than those with normal thyroid function [(17.9±7.5) vs (11.7±6.4) mmol/L, 11.8%±2.6% vs 9.9%±2.6%, respectively, t=2.979, 4.584, both P<0.05]. In addition, the positive rate of glutamic acid decarboxylase antibody [72.7%(16/22) vs 48.6%(68/140), 14.3%(8/56) vs 3.9%(10/258)] and at least one islet autoantibodies [86.4%(19/22) vs 62.1%(87/140), 17.9%(10/56) vs 6.6%(17/258)] in combination groups were higher than those in patients with diabetes alone (χ²=4.444-7.401, both P<0.05). There was no significant difference in the positive rate of tTGA between combination groups and diabetes alone groups (χ²=0.818, 0.005, both P>0.05).

It is very common for diabetics to be associated with AITD. This comorbidity may affect glycemic control in diabetics. Hence, early screening of thyroid disease is necessary for newly diagnosed diabetic patients.

As an important part of the intestinal mucosal biological barrier, intestinal microecology protects the intestinal tract from the invasion of pathogenic bacteria and assists nutrient absorption. Gut microbial dysbiosis is involved in a variety of chronic diseases, such as diabetes, cardiovascular disease. In recent years, some studies have confirmed the association between intestinal microecology and chronic kidney disease^[1,2,3]However, there are few studies between intestinal microecology and diabetic nephropathy (DKD), so we will explore the relationship between intestinal microecology and DKD by expounding the relationship between intestinal microecology and diabetes and chronic kidney disease, and find new methods to treat DKD based on intestinal microecology.

Type 2 diabetes mellitus (T2DM) is a major risk factor for cardiovascular diseases (CVD), and CVD is the leading cause of death in T2DM patients. Chinese research shows that among outpatient T2DM patients, 14.6% have CVD, and 10.1% have cerebrovascular diseases including ischemic stroke^[1]。 An epidemiological study involving 115 740 T2DM patients showed that the number of new CVDs in the population of T2DM patients in China reached 17.2 times per thousand people per year^[2]。 Another national epidemiological survey showed that the risk of cardiovascular death in diabetic patients was 2.07 times higher than that in the general population, and the risk of developing coronary events, ischemic stroke and hemorrhagic stroke was 2.44 times, 1.67 times and 1.24 times, respectively^[3]。 The above research data suggest that the burden of CVD in T2DM people in China is very heavy, which has become a huge challenge to diabetes management and deserves the attention of clinicians.