Volume 10 · Issue 03 · 2018

The prevalence of type 2 diabetes among adults in my country is 10.9%, with about 100 million patients^[1]。 In addition to lifestyle intervention and drug therapy, metabolic surgery has been written into the diabetes management guidelines at home and abroad as a clear treatment measure for type 2 diabetes^[2,3,4]。 International Diabetes Federation (IDF) 2011^[5]Recommended body mass index (BMI) ≥35 kg/m²Patients with type 2 diabetes can be treated by surgery, with a BMI of 30~35 kg/m²Patients who remain unsatisfactory with glycemic control after optimized medication may use surgery as an alternative treatment option, and the BMI cut-off point can be adjusted down by 2.5 kg/m in Asian and other high-risk populations²。 Guidelines for surgical treatment of obesity and type 2 diabetes in China^[6]Recommended BMI ≥32.5 kg/m²Surgical treatment is available for diabetic patients with BMI ≥27.5 kg/m²And patients with type 2 diabetes who are ineffective in medical treatment can also be treated with surgery.

The American Heart Association (AHA) and the American College of Cardiology (ACC) issued new hypertension guidelines on November 14, 2017, defining hypertension as: blood pressure ≥130/80 mmHg (1 mmHg =0.133 kPa), which subverts the previous standard of hypertension ≥140/90 mmHg^[1]。 It is estimated that according to the new standards, the proportion of hypertensive patients in the United States has increased from 32% to 46%, the number of people diagnosed with hypertension in the 45-75 age group in China has increased by 83 million, the proportion of hypertensive patients has increased from 38% to 55%, a total of 267 million hypertensive patients, the number of people not receiving treatment will increase from 74.5 million to 130 million, and the number of people diagnosed with hypertension but not requiring medical treatment will increase from 23.4 million to 51 million^[2]。 The new guidelines are undoubtedly beneficial to the early prevention and treatment of hypertension. The goal is to pursue "better", and China's top priority is how to make blood pressure reach the standard as soon as possible. In view of the close relationship between obesity, type 2 diabetes and some endocrine diseases and the occurrence of hypertension, the impact of the new hypertension guidelines on the field of endocrine and metabolic diseases, and how to evaluate and interpret them are worth our consideration and discussion.

Since the body takes in more energy than it consumes, the remaining energy accumulates in the body in the form of fat, resulting in overweight and obesity. Obesity is a high risk factor for metabolic abnormalities such as diabetes, hypertension, dyslipidemia, hyperuricemia, non-alcoholic fatty liver disease and cardiovascular diseases in adults. It is also an important cause of sleep apnea syndrome, bone and joint diseases, tumors and reproductive abnormalities, and poses a great threat to people's life expectancy and quality of life^[1]。 According to the 2015 Report on Nutrition and Chronic Diseases of Chinese Residents, the prevalence rate of obesity among Chinese adults is as high as 11.9%^[2]。 According to the latest report, the prevalence rate of adult diabetes in China reaches 10.9%, ranking first in the world^[3]。 Obesity is often accompanied by diabetes, and the prevalence of diabetes in obese people is as high as 21.1%. Conventional medical treatment measures for obesity and diabetes have limited efficacy, and the blood glucose control rate is less than 50%^[3]The simultaneous compliance rate of multiple metabolic indicators (blood glucose, blood lipids, and blood pressure) was only 5.6%^[4]。 Metabolic surgery reduces the risk of chronic complications of diabetes because of its reliable effects on weight loss, blood sugar control and many cardiovascular high-risk factors^[5], was first written into the treatment pathway of type 2 diabetes in 2016^[6]。 Furthermore, studies from the Chinese population confirmed that metabolic surgery can effectively improve arterial elasticity, carotid intima-media thickness, and lung function^[7,8]。 However, metabolic surgery cannot be completely cut off from obesity and diabetes, and standardized management after surgery is indispensable.

With the improvement of global productivity level, the sources and types of food have been greatly improved, and all countries are facing the problem of increasing body mass index (BMI) of population year by year, accompanied by the increasing incidence of type 2 diabetes and cardiovascular diseases^[1]。

In modern society, changes in lifestyle and diet structure lead to a significant increase in the prevalence of obesity, and the age of onset is early. The occurrence of obesity increases the risk of obesity-related complications such as type 2 diabetes, non-alcoholic fatty liver disease and cardiovascular disease, and is now a global health problem. In recent years, studies have shown that lifestyle changes, that is, dietary restrictions and increased energy expenditure, as well as weight loss drug intervention, may help patients lose 5% to 10% of their body weight, but they rebound after 3 to 9 months, and 90% of patients rebound to their pre-intervention weight after 1 to 5 years, and some even exceeded their initial weight^[1]。 Compared with traditional therapies, metabolic surgery reduces the average weight of patients by 35% and significantly reduces the risk of obesity-related complications such as cardiovascular adverse events, and has a lower incidence of obesity gain. At present, it has become the most effective method for treating obesity^[2]。

To investigate the incidence of adverse events in type 2 diabetic patients with different body mass indexes (BMI) after Roun-en-Y gastric bypass (RYGB) surgery.

From May 2010 to December 2017, a total of 100 patients with type 2 diabetes mellitus (T2DM) underwent laparoscopic RYGB in Daping Hospital. BMI, blood glucose, blood lipid, blood pressure and adverse events were followed-up before and after RYGB surgery. By using 27.5 kg/m² of BMI as a cut-point, patients with BMI≥27.5 kg/m² were as the high BMI group, and those BMI<27.5 kg/m² were as the low BMI group. The outcome differences of metabolic indexes and the incidences of adverse events between these two groups were compared, and the corresponding treatment measures were reviewed. Data were analyzed by t test and analysis of variance, the rate of comparison was analyzed by χ ² test.

At one year after surgery, BMI, glycosylated hemoglobin (HbA_1c), serum total cholesterol (TC), serum triglyceride (TG), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were significantly decreased in the low BMI group (t=2.1-6.8, all P<0.05). Meanwhile, BMI, fasting blood glucose (FPG), HbA_1c, TG, LDL-C, SBP and DBP were significantly decreased in the high BMI group (t= 2.0-7.6, all P<0.05). No significant difference was found in the incidence of anastomotic leakage, dumping syndrome and malabsorption of the two groups at one year and three years after surgery [27.3%(9/33) vs 20.4%(11/54), 12.1%(4/33) vs 5.6%(3/54), 6.1%(2/33) vs 3.7%(2/54), 6.1%(2/33) vs 0, 12.1%(4/33) vs 16.7%(9/54), 12.1%(4/33) vs 11.1%(6/54), χ ²=0-1.1, all P>0.05]. Nor was the incidence of anemia, zinc deficiency or hypoproteinemia, either (13.3% vs 13.3%, 25% vs 0, 0 vs 26.6%, 22.2% vs 14.2%, 13.3% vs 15.0%, 10% vs 0, χ ²=0-2.9, all P>0.05). Furthermore, according to the number of adverse events at one year after surgery, patients with two kinds of adverse events had significant decrease in HbA_1c (t=2.4, P<0.05), and patients with 3 or more kinds of adverse events had significant differences in FPG, HbA_1c, TG, SBP and DBP (t=2.2-2.9, all P<0.05).

The short and long term effects of gastric bypass surgery on type 2 diabetic patients are significant. There is no significant correlation between postoperative adverse events and preoperative BMI in type 2 diabetic patients with RYGB surgery.

To investigate the association between serum prolactin (PRL) and non-alcoholic fatty liver disease (NAFLD) in overweight and obese (body mass index ≥ 24 kg/m²) patients.

A total of 494 patients from September 2015 to January 2017 in our hospital were retrospectively analyzed. Patients were classified to non NAFLD (n=353) and NAFLD group (n=141) according to abdominal ultrasound. Twenty female obese patients who received bariatric surgery were also underwent liver biopsy. All patients' fasting blood samples were collected for the PRL and other metabolic parameters measurements. Abdominal ultrasound was also performed. The Mann-whitneyU or Kruskal-wallis H rank test were used to compare the data between two groups, and the relationship between serum PRL and NAFLD was analyzed by non-conditional Logistic regression.

Serum PRL levels were significantly lower in patients with NAFLD in males (n=277) and females (n=217) [7.7 (5.9, 10.8) vs 8.7 (6.9, 11.8) μg/L, Z=-2.500, P=0.012 in men; 8.4 (6.2, 12.2) vs 10.7 (7.7, 13.4) μg/L, Z=-3.890, P<0.001 in women] than those without NAFLD. Moreover, there was a stepwise decrease in prevalence of NAFLD in both gender from the lowest to the highest PRL tertiles (both P<0.05). After normalized for confounding factors, PRL level became a protective factor against NAFLD (OR=0.923, P=0.008). In obese patients with pathology diagnosis, NAFLD patients (n=16) also exhibited lower PRL levels than those without NAFLD [n=4, 9.2 (5.0, 13.5) μg/L vs 16.8 (11.8, 20.9) μg/L].

In overweight and obese patients, decreased PRL is a risk factor for NAFLD.

To investigate the effect of abdominal obesity (AO) on urinary protein excretion rate (UAER) of type 2 diabetes mellitus (T2DM) patients with normal body mass index (BMI).

From May 2016 to October 2016, 223 newly diagnosed T2DM patients (in-patient and out-patient) with normal BMI (18.5 kg/m²≤BMI<24 kg/m²) were recruited from the Department of Endocrinology of Wuhan General Hospital of the Chinese People's Liberation Army. Based on visceral fat area (VFA), the subjects were divided into AO (+) group which had 113 cases (VFA>100 cm²) and AO (-) group which had 110 cases (VFA≤100 cm²). Data about BMI, systolic blood pressure (SBP), diastolic blood pressure and other clinical characteristics were collected. Levels of body fat ratio, VFA, fasting insulin (FINS), and UAER were examined. Independent correlation between AO and UAER of diabetes was analyzed by multivariate linear regression analysis.

Subjects in AO (+) group had higher smoking rate, alcohol use, BMI, VFA, SBP, uric acid, C reactive protein, triglyceride, creatinine, fasting glucose, FINS (t=-22.070--2.153, all P<0.05) and lower estimated glomerular filtration rate and high density lipoprotein cholesterol (t=5.319, t=5.028, both P<0.001) than those in AO (-) group. UAER levels were also significantly higher in AO (+) group than in AO (-) group [29.4(22.2, 55.7) vs 18.4(15.4, 24.7) mg/24 h, t=12.540, P<0.001]. The correlation analysis demonstrated that VFA was positively correlated with UAER (r=0.462, P<0.001). The multivariate linear analysis showed that AO was an independent determinant of UAER in newly diagnosed T2MD patients with normal BMI (β=0.256,P=0.01).

VFA is positively associated with UAER in type 2 diabetes; AO is an independent risk factor for UAER in newly diagnosed T2MD patients with normal BMI.

To investigate whether waist circumference is associated with metabolic risk among people with normal body mass index (BMI). Moreover, cut-off values of waist circumference were analyzed with respect to risks for metabolic disorders to provide a guidance for early detection and prevention of metabolic disorders in population with normal BMI.

The population-based cohort study was based on China National Diabetes and Metabolic Disorders Survey in 2007-2008. We calculated optimal cut-offs of waist circumference by computing the risk associated with type 2 diabetes mellitus (T2DM), metabolic syndrome (MS) and hypertension with receiver operating characteristic (ROC) curve analysis. Furthermore we weighed the prevalence rates of metabolic diseases to obtained the most optimal cut-offs.

A total of 22 053 participants were included in this study who have normal BMI (18.5 kg/m²≤BMI<24 kg/m²) with the average of (43±14) years old. The average age of 7 988 male and 14 065 female were respectively (44±15) and (42±13) years old. With the increase in waist circumference, of the risks for type 2 diabetes, MS and other metabolic disorders showed an upward trend in the population with normal BMI regardless of gender. The relationship between waist circumference and prevalence was analyzed for T2DM, MS and hypertension. For male, the optimal cut-offs of waist circumference were 78, 79 and 77 cm for T2DM, MS and hypertension, respectively, female were 73, 78 and 73 cm. Weighed cut-off for male was 78 cm and 74 cm for female after further analysis. Taking into consideration of menopause at the age of 49 for female, we found that the waist circumference was 74 cm (not menopause) and 77 cm (menopause). The prevalence rates of T2DM, MS and hypertension were 11.5% (465/4 111), 12.8% (528/4 111) and 25.0% (1 029/4 111) for male and 9.6% (632/6 553), 12.1% (795/6 553), 22.3% (1 463/6 553) for female respectively by our cut-offs. The same method was used to determine the optimal cut-offs of the waist circumference in all age groups. In 20-30, 31-40, 41-50, 51-60, 61-70 and ≥71 years old groups, the male's cut-offs were 76, 81, 79, 76, 76 and 81 cm, respectively; 74, 74, 73, 76, 81 and 76 cm for female.

It is suggested that metabolic disorders should be screened for people with normal BMI but having waist circumference≥78 cm in male and ≥74 cm in female.

To summarize and review the quality of glycated hemoglobin measurements in the past decade and the progress of the standardization in China.

The raw data and information of National External quality assessment (EQA) for glycated hemoglobin in 2008-2017 were collected. The results of all EQA materials (excluded ±3s) were calculated with Excel 2010. The investigation was carried out though analysis of participating laboratory, instrumentation system inter-laboratory and intra-laboratory variation.

The number of participating laboratories of National EQA for glycated hemoglobin was increased from 313 in 2008 to 1 644 in 2017. The mean of between-laboratories CV (excluded ±3s) was decreased from 16.5% in 2008 to 4.7% in 2017 as well as the mainstream analytical systems in EQA scheme from 8.9% to 4.0%. In 2017, 77% (1 266/1 644) participating laboratories are using methods with between-lab CVs<3.5% at all five HbA_1c levels, 85.6% (1 407/1 644) participating laboratories showed less than 0.5% HbA_1c bias from target values from IFCC reference method at all five HbA_1c levels and 68.9% (1 148/1 644) labs less than 0.3% HbA_1c.

In this decade, the quality of glycated hemoglobin measurements in China has been significantly improved; the gap with the developed countries has been reduced dramatically. The HbA_1c reference systems of China have taken shape.

To analyze the endocrine and metabolic characteristics of patients with polycystic ovary syndrome (PCOS) with different body mass indexes (BMI) and clinical phenotypes, so as to provide some new clues for the individualized and comprehensive clinical management of PCOS.

A total of 388 PCOS patients from December 2012 to December 2016 and 66 women with regular menstruation and normal androgen level matched with age and BMI were enrolled in this study. The PCOS patients were further divided into obese group and non-obese group according to their BMI, or were divided into four subgroups according to their clinical manifestations based on the 2003 Rotterdam criteria: oligo-and/or anovulation (O)+hyperandrogenism (H), O+polycystic ovary morphology (P), H+P and O+H+P. According to the status of hyperandrogenism, the PCOS patients were also divided into two subgroups: hyperandrogenism group (HA) and non-hyperandrogenism group (non-HA). The hormones and metabolic parameters were compared between different groups. Spearman correlation analysis was used for analyzed the association among sex hormones and glucose, lipid and uric acid metabolism and other related indicators.

(1) There were significant differences in hormones and metabolic parameters between obese group and non-obese group (all P<0.05). The fasting insulin (FINS) in OH, HP and OHP group was significantly higher than that in control group [(20±13), (21±13), (22±15) vs (15±10) mU/L, all P<0.05]. The serum FINS level in OHP group was significantly higher than that in OP group [(22±15) vs (17±12) mU/L, P<0.05]. Homeostasis model assessment-insulin resistance (HOMA-IR) in OHP group was significantly higher than that in control group (5.2±3.9 vs 3.4±2.4, P<0.05). (2) The serum level of high density lipoprotein-cholesterol (HDL-C) in OH group, HP group and OHP group was significantly lower than that in control group. The serum level of low density lipoprotein-cholesterol (LDL-C) in HP group was significantly higher than that in control group and OP group (all P<0.05). (3) The differences in BMI, FINS, postprandial insulin, HOMA-IR, HDL-C and sex hormone binding globulin (SHBG) between HA group and non-HA group[(28±6) vs (26±6) kg/m², (22±14) vs (17±12) mU/L, (153±111) vs (121±88) mU/L, 5±4 vs 4±3, (1.1±0.3) vs (1.2±0.3) mmol/L, (22±13) vs (41±23) nmol/L, t=-2.805-3.891] were significant (all P<0.05). (4) SHBG was negatively correlated with fasting plasma glucose, FINS, HOMA-IR, serum uric acid (SUA), triglyceride (TG) , LDL-C (r=-0.233--0.147, all P<0.05), and was positively correlated with HDL-C (r=0.384, P<0.001). Free androgen index was positively correlated with FINS, HOMA-IR, SUA, TG (r=0.143-0.231, all P<0.05), and was negatively correlated with HDL-C (r=-0.160, P=0.012).

Hyperandrogenism and obesity may increase the risk of endocrine and metabolic disorders in PCOS patients. PCOS patients with different clinical phenotypes have different endocrine and metabolic characteristics.

To investigate the frequency and phenotype Helios and cytotoxic T lymphocyte antigen 4 (CTLA-4) of circulating FoxP3⁺CD25⁺ CD4 Tregs and Treg subsets in type 1 diabetes mellitus (T1DM) patients.

Forty T1DM patients and sixty-seven healthy individuals were enrolled in this study. Peripheral blood mononuclear cells (PBMCs) were obtained by density gradient centrifugation using ficoll. Then PBMCs were stained with Foxp3 and CD25 for CD4 Treg (FoxP3⁺CD25⁺), CD45RA and FoxP3 for Treg subsets (naive Treg, CD45RA⁺FoxP3⁺; activating Treg, CD45RA^-FoxP3^hi; secreting Treg, CD45RA^-FoxP3⁺), and additional Helios and CTLA-4 for immune phenotypes of Treg subsets. The analysis was performed with BDFACSAriaII using FACSDiva software. All the statistic analyses were performed by unpaired Student t test.

Compared with the frequencies of healthy individuals, the frequencies of total Tregs, and nTreg, aTreg, sTreg subsets in CD4 T cells of T1DM patients did not alter significantly (t=0.109 5–0.575 0, all P>0.05, respectively);Similarly, the frequencies of nTreg, aTreg, and sTreg subsets in total Tregs of T1DM patients did not alter significantly (t=0.143 8–0.272 3, all P>0.05). Further phenotype analysis revealed that the expression of Helios in total Tregs and Treg subsets did not change in T1DM patients (t=0.178 4–1.124 0, all P>0.05). However, the expressions of CTLA-4 in total Tregs and sTreg, nTreg subsets were significantly lower in T1DM patients (t=2.662–3.435, all P<0.05);the expressions of CTLA-4 in aTreg subsets were not significantly lower in T1DM patients (t=1.728, P=0.088 7).

Although circulating CD4 Tregs and Treg subsets did not change in T1DM patients, expression of CTLA-4 decreased significantly in sTreg and nTreg subsets, which may play a role in Treg dysfunction of T1DM patients.

To assess the relationship between subclinical hypothyroidism and cardiovascular diseases in patients with type 2 diabetes.

A total of 123 type 2 diabetic patients with subclinical hypothyroidism (case group) and 266 type 2 diabetic patients with normal thyroid function (control group) were admitted from July 2013 to July 2014. The general information, as well as the level of plasma glucose, serum lipids, thyroid function, etc., were collected and compared. Tensors were stratified according to serum thyrotropin (TSH), free triiodothyronine (FT3) and free thyroxine (FT4). After adjusting for confounding factors, logistic regression analysis was used for analyzing the correlation among subclinical hypothyroidism, thyroid related indicators and cardiovascular disease.

(1) In the case group, the proportion of male patients [41.46% (51/123) ], statins use [1.67% (2/123) ] and smoking [10.57% (13/123) ], level of glycated hemoglobin (HbA_1c) (8.61%±0.18%) and FT4 [ (16.20±0.25) pmol/L] was significantly lower than that in the control group [60.15% (160/266) , 9.40% (25/266) , 24.06% (64/266) , 9.45%±0.12%, (16.85±0.14) pmol/L, t=-3.808-13.150, all P<0.05]. The level of TSH in the case group was significantly higher than that in the control group [4.9 (4.5-7.1) vs (1.8 (1.2-2.6) nU/L, t=-24.069, P<0.05]. (2) After adjusting multiple traditional cardiovascular risk factors, the risk of cardiovascular disease in case group was significantly increased compared to the control group (OR=3.205, 95%CI=1.219-8.425, P=0.018). The risk of cardiovascular disease was significantly increased in the third TSH tertile group compared to the first TSH tertile group [4.369 (1.462-13.046) , P=0.008]. The tertiles of FT3 and FT4 were not associated with the risk of cardiovascular disease [FT₃: 0.806 (0.305-2.130) , P=0.663; 1.268 (0.481-3.347) , P=0.631; FT₄: 0.462 (0.181-1.179) , P=0.106; 0.873 (0.349-2.185) , P=0.772].

Subclinical hypothyroidism is associated with cardiovascular disease in type 2 diabetic patients independently, and it might increase the risk of cardiovascular disease of type 2 diabetic patients by improving the level of serum TSH.

To explore the long-term therapeutic effects of co-transplantation of Sprague-Dawley (SD) rats islets and bone marrow mesenchymal stem cells (BMSCs) to treat type 1 diabetes mellitus (T1DM).

BMSCs were isolated from 1 week of age of 4 healthy male SD rats while islets were isolated from 6-8 weeks of age of 3 healthy male SD rats BMSCs and islets were both cultured with 1640 nutrient medium in either separately or together in vitro. The cell morphology, levels of insulin and C-peptide in each group were examined at the 1^st, 3^rd, and 7^th day after culture. T1DM model (male SD rats, body weight 180-200 g) was established by administration of 1% streptozotocin (STZ) citrate buffer (60 mg/kg) through intraperitoneal injection. T1DM model rats were randomly divided into 4 groups: model group, BMSCs transplantation group, islets transplantation group, and co-transplantation group (15 rats each group) for the cell transplantation test in vivo. The fasting glucose, body weight, insulin, C-peptide, total bilirubin (TBIL), aspartate transaminase (AST) and alanine aminotransferase (ALT) of each group were examined at the 1^st, 3^rd, 7^th, 14^th, and 30^th day after transplantation. Data between multigroups were analyzed by ANOVA, and data between two groups were analyzed by t test.

Compared to islets transplantation group, blood glucose in co-transplantation group's was lower (t=11.44-28.02, P<0.05), and insulin (t=10.03-6.86, P<0.05) and C-peptide (t=1.47-2.59, P<0.05). However, the TBIL (t=7.67-6.39, P<0.05), AST (t=12.00-8.89, P<0.05), and ALT (t=8.08-10.40, P<0.05) in co-transplantation group were lower than those in islets transplantation group. The expression intensity of insulin was stronger in co-transplantation group than islets transplantation group. The differences of above indexes between model group and BMSCs group had no statistical significance (all P>0.05).

Compared with islets transplantation alone, islets and BMSCs co-transplantation have better therapeutic effects on T1DM.

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, 11 genes have been found to be related to the pathogenesis of CHI, showing 10 genetic types, and the genetic etiology of nearly 50% of children with congenital hyperinsulinemia is still unclear. exercise-induced hyperinsulinism (EI-HI), a rare type of CHI, is caused by a function-enhancing mutation in monocarboxylic acid transporter 1, which is encoded by the SLC16A1 gene. An important feature of EI-HI is that exercise for a period of time can easily lead to the onset of hypoglycemia. In this paper, a child with suspected EI-HI was selected as the research object, and CHI-related pathogenic genes were analyzed in his family by using second-generation sequencing technology, in order to reveal the clinical characteristics of this type of child and improve clinicians' understanding of EI-HI.

Sulfonylureas are one of the earliest discovered and most widely used oral hypoglycemic drugs. Early initiation of sulfonylurea therapy in patients with newly diagnosed type 2 diabetes mellitus (T2DM) can effectively promote insulin secretion and improve blood sugar control. However, whether patients with a long course of disease or who have received insulin should continue to use sulfonylureas remains a long-term problem for clinicians. At the same time, in the process of exploring more mechanisms of action of sulfonylureas, whether there is a correlation between them and β cell function and redifferentiation has triggered deeper thinking. In recent years, many studies have proposed that β cell dedifferentiation rather than apoptosis is the main cause of β cell function defects in T2DM patients. Effective hypoglycemic therapy makes blood sugar tend to be normal, which helps to restore and maintain β cell function^[1]It can even promote the re-differentiation of endocrine progenitor cells into mature beta cells^[2]。 In view of the important therapeutic position of sulfonylureas in the field of diabetes, this article will review the long-term efficacy and safety evidence of sulfonylureas in blood glucose management, and further explore their impact on β cell function, so as to provide scientific reference for formulating and optimizing the sustained blood glucose management regimen of T2DM.