Volume 10 · Issue 05 · 2018

Diabetic foot is one of the serious complications of diabetes, which brings great pain and heavy economic burden to patients. Its common clinical manifestation is chronic ulcer, which leads to the most serious outcome of amputation (toe) or even death. According to statistics, the risk of foot ulcer in diabetic patients is 25% in their lifetime, and 14% ~24% of patients with foot ulcer need amputation^[1]。 Diabetic foot is the leading cause of amputation in many countries^[2]One person worldwide has a diabetic foot amputation every 20 seconds.

The latest diabetes map of the International Diabetes Federation (IDF) shows that adult patients have reached an astonishing 415 million, that is, 1 in 11 people have diabetes; Type 2 diabetes (T2DM) accounts for 90% ~95% of the total incidence of diabetes^[1]。 China Adult Survey in 2013^[2]Medium: The prevalence rates of diabetes and pre-diabetes reached 11.6% and 50.1% respectively. It is predicted that the number of diabetic patients in China will increase to 366 million by 2030. It can be seen that the prevention and control of diabetes has a long way to go and needs urgent attention. As a controllable factor, lifestyle habits play a key role in the prevention, control and treatment of T2DM. However, due to the different genetic backgrounds, cultures and religious beliefs of different ethnic groups/races, there are objective differences in living habits, and the main risk factors of T2DM based on living habits of various ethnic groups are different. Traditional universal education and intervention strategies are not necessarily applicable to various ethnic minorities, so that the diabetes control of ethnic minorities in various countries is poor. It is urgent to realize accurate intervention of T2DM in different ethnic groups, and the research on race-specific living habits is the premise and key.

Latest Surveys^[1,2]It shows that the prevalence of diabetes in China is 10.4% ~10.9%, and the number of patients is about 114.4 million, ranking first in the world. It can be seen that the prevention and treatment of diabetes in China is very arduous and arduous. Faced with such a huge population of diabetics, how to manage patients more efficiently to prevent the occurrence and development of diabetes, as well as patients' behavior and self-management ability are the keys to the success of diabetes control. Effective diabetes self-management education and support (DSME/S) plays an important role in behavior change^[3]Self-managed prescription is not only a practical tool of DSME/S, but also one of the forms of support of DSME/S. With the implementation and improvement of prescription, DSME/S can be continued and formed a closed loop of behavior change with continuous support^[4]。 In December 2017, the Diabetes Education and Management Group of the Diabetes Branch of the Chinese Medical Association released the "Expert Consensus on Self-management Prescription of Type 2 Diabetes in China" (hereinafter referred to as the "Consensus")^[4]In order to better carry out DSME/S and promote self-managed prescriptions, we have established a hierarchical and hierarchical management path for diabetes to efficiently manage patients and optimize patient outcomes.

Type 2 diabetes is a common chronic disease. With the progress of medicine, patients with T2DM have easily survived for a long time. As diabetes is still difficult to cure, it is the first task of doctors and patients to control the progression of the disease through drugs and other means for a long time. The gold standard for diabetes control is glycated hemoglobin (HbA_1c）。 HbA_1cA product derived from the combination of hemoglobin in red blood cells with sugars in the blood. Due to HbA_1cIt is slowly formed by irreversible glycation reaction, is not affected by daily blood sugar fluctuations, nor by short-term changes in external environment such as exercise or food, and can effectively reflect the blood sugar control of diabetic patients in the past 3 months or so, so it is regarded as the main indicator reflecting the long-term blood sugar control level.

To investigate the effectiveness of diabetes shared care model.

From October 2016 to June 2017, patients with diabetes mellitus who had been visiting shared care clinic for more than 6 months in Peking University First Hospital were selected. Height, weight and glycated hemoglobin A_1c (HbA_1c) level were measured at the first visit and 6-month follow-up. Five scales were used to evaluate its disease self-management ability and social psychology, "Summary of Diabetes Self Care Activities 6" "World Health Organization-5 Well-Being Index" "Patient Assessment of Chronic Illness Care-DAWN Short Form" (PACIC-DSF) "Diabetes Empowerment Scale-DAWN Short Form" and "Problem Areas in Diabetes Scale 5" (PAID-5).

A total of 76 patients met the inclusion criteria and completed data collection and scale evaluation. Compared with baseline, scores of disease self-management ability in monitoring the blood sugar [1.0 (0.0, 3.0) vs 3.0 (1.0, 5.0) points, Z=2.978, P=0.003], and self-examination of the foot [0.0 (0.0, 6.8) vs 4.5 (1.0, 7.0) points, Z=3.374, P=0.001] were significantly improved after 6-month follow up, no significant difference was observed in healthy diet, exercise, or medication. Social psychology related index such as getting help from staff (PACIC-DSF) [(33±16) vs (41±13), t=5.475, P<0.001] and low mood disorders (PAID-5) [43.4% (33/76) vs 48.7% (37/76), χ²=11.023, P<0.05] were significantly increased. No significant difference was found in authorization ability score and the happiness index. Patients achieved greater reduction in HbA_1c (7.3%±1.4% vs 7.0%±1.2%, t=2.133, P<0.05) six months later, with no significant difference in body mass index, low-density lipoprotein-cholesterol, and medication cost (allP>0.05).

Shared care model can improve blood glucose monitoring and foot self-examination ability, promote patients getting more help from healthcare professionals, alleviate mood disorders, and decrease HbA_1c.

To establish a standardized hierarchical classification management process of self-management education and support for non-hospitalized diabetic patients.

Based on the Triangle chronic disease management model and the grading nursing care system, literature review, especially on the "Guide to Prevention and Treatment of Type 2 Diabetes in China " , "Expert consensus on HbA _1c control goals for adult type 2 diabetes in China" , "Guidelines for the Prevention of Atherosclerotic Cerebral and Cardiovascular Diseases in Chinese Adults with Type 2 Diabetes" , "Expert consensus on clinical diagnosis of diabetic nephropathy in Chinese adults" , "Diabetes Foot Diagnosis and Treatment Guide" , "Guidelines for clinical diagnosis and treatment of diabetic retinopathy in China" , "Diabetic neuropathy: a position statement by the American Diabetes Association" , the experts from Diabetes Center of West China Hospital of Sichuan University developed the first draft. Then experts' opinion questionnaire was developed based on the draft. Twenty eight experts from 10 cities and 15 hospitals with background of diabetes treatment, education management, training, specialist nursing, nursing management and community care were recruited, and two rounds of expert consultation were implemented by e-mail or face-to-face. Finally the standardized process of hierarchical classification management in diabetes mellitus had been constructed.

Through 2 rounds of expert consultation, the response rates were 93.33% and 96.43%. The authority coefficients were 0.93 and 0.94, the expert opinion coordination coefficient Kendall'sW were 0.575, 0.826 (P<0.05), the coefficient of variation were 0.15 and 0.14. The final standardized process consisted of 6 first-level indicators and 33 second-level indicators.

The standard of Triangle hierarchical management process of diabetes mellitus constructed in this study has been standardized, which provides a frame work for self-management education and support in non-hospitalized diabetic patients.

To investigate the relationship of type 2 diabetes mellitus (T2DM) with prostate cancer (PCa) pathological grade and prostate-specific antigen (PSA).

We retrospectively evaluated the data from 1 688 patients who underwent prostate biopsy in Shanghai Tenth People's Hospital from 2012 to 2016. These patients were grouped according to PCa pathological grade (low-grade: Gleason score (GS) ≤6; intermediate-grade: GS=7; high-grade: GS 8-10), diabetes duration (0-5 years, 6-10 years and>10 years) and HbA_1c (<6.5%, 6.5%-7.5% and ≥7.5%) for future analysis. The multivariate logistic regression and covariance analysisi were applied to investigate the relationship of T2DM with PCa grade and PSA.

T2DM was significantly correlated with increased incidence risk of overall (OR=1.41, 95%CI: 1.03-1.93, P=0.032) and high-grade PCa (OR=2.54, 95%CI: 1.49-4.24, P=0.001), but not with low-or intermediate-grade PCa. Also, the risk of high-grade PCa increased with diabetes duration and HbA_1c. Serum PSA level in T2DM was lower than that in non-diabetics [(6.5±4.5) vs (8.5±3.7) μg/L, t=-3.380, P=0.001], and the difference increased with duration. Of PCa men, PSA was also lower in diabetics compared to non-diabetics [(18.1±3.5) vs (23.9±3.0) μg/L, t=-2.667, P=0.021].

A positive correlation was found between T2DM and PCa. T2DM contributes to lower serum PSA levels, which is more likely to delay and interfere with PCa diagnosis, leading to higher malignant degree of PCa. The current PSA threshold (4 μg/L) may not be suitable for early screening and follow-up of PCa in the T2DM population.

To investigate the correlation between serum 25-hydroxy vitamin D₃ levels and liver fat content (LFC) in patients with type 2 diabetes mellitus (T2DM).

From 2015 to 2018 a total of 382 patients with T2DM hospitalized in autumn and winter in our hospital were recruited. Based on the presence of fatty liver diagnosed with ordinary B-ultrasound, patients were divided into group with nonalcoholic fatty liver (n=242, 130 male, 112 female) and group without (n=140, 78 male, 62 female). Serum 25-hydroxyvitamin D₃ was detected using electrochemiluminescence. One hundred and forty-one patients (82 male, 59 female) who have received insulin administered subcutaneously for at least half a year and had glycated hemoglobin A_1c level less than 7.5% were selected from 382 patients to be carried out quantitative examination of liver ultrasonic fat. The pictures with legible liver and renal were used to calculate LFC with software NIH image J. The correlation between 25-hydroxyvitamin D₃ and LFC, body mass index (BMI), waist circumference and homeostasis model assessment of insulin resistance (HOMA-IR) were analyzed by simple correlation analysis and partial correlation analysis. The correlation between 25-hydroxylvitamin D₃, HOMA-IR and LFC was analyzed by one-way ANOVA test.

(1) Compared to the group without fatty liver, 25-hydroxyvitamin D₃ level of the group with fatty liver was significantly lower [(51±21) vs (42±17) nmol/L, t=4.60, P<0.05]. (2) The level of serum 25-hydroxyl vitamin D₃ in T2DM patients was negatively correlated with LFC (r=-0.272, P=0.005) after adjusting for age, duration of diabetes, BMI, waist circumference, and blood lipid levels. (3) Among patients with T2DM, significantly negative correlation between 25-hydroxyl vitamin D₃ levels and LFC were found in top quartile of HOMA-IR (most severe insulin resistance) (r=-0.499, P=0.003). After adjustment of BMI and waist circumference, 25-hydroxy vitamin D₃ levels were still negatively correlated with LFC (r=-0.463, P=0.008).

Serum 25-hydroxyvitamin D₃ levels are lower in T2DM patients with fatty liver than that of the group without fatty liver. Serum 25-hydroxy vitamin D₃ levels have a negative correlation with LFC, especially in condition of severe insulin resistance.

To explore the role and molecular mechanism of forkhead transcription factor O1(FoxO1) on cellular and mitochondrial injury in conditionally immortalized mouse podocyte cell line (CIMPs) under high glucose (HG) conditions.

The CIMPs cells were infected by constitutively active FoxO1 lentiviral vector (LV-CA-FoxO1) or empty lentiviral vector (LV-NC), and cultured under different glucose levels (5.5 mmol/L for normal glucose or 25.0 mmol/L for high glucose). The CIMPs were divided into 4 groups: group NG (normal glucose), group HG (high glucose), group FoxO1 (HG+LV-CA-FoxO1) and group NC (HG+LV-NC). After 72 hours of treatment, the expression of FoxO1, mitochondrial and cellular function, and expression of possible downstream genes of each group were examined. Analysis of variance was used for comparison in multiple groups. SNK method was used for comparison between two groups.

(1) The transcriptional activity of FoxO1 in group FoxO1 was increased compared with group HG [(0.94±0.06) vs (1.72±0.27), q=3.77, P<0.05]. (2) Mitochondrial functions: compared with group HG, the level of reactive oxygen species and malonaldehyde were decreased and the mitochondrial membrane potential was increased (q=9.22, 2.44, both P<0.05), whereas the mitochondrial ultrastructure injuries were ameliorated in group FoxO1. (3) Cellular functions: compared with group HG, the expression of phenotypic proteins of podocyte including nephrin, podocin and podocalyxin were increased (q=2.18, 5.87, 5.65, all P<0.05), whereas the monolayer barrier function was improved and apoptosis rate was decreased (q=6.96, 8.99, both P<0.05) in group FoxO1. (4) Mitochondria related protein: compared with group HG, the phosphatase and tensin homolog deleted on chromosome ten (PTEN) induced putative kinase 1 (PINK1) mRNA and parkin mRNA level were increased whereas the dynamin-related protein 1 mRNA level was decreased in group FoxO1 (q=1.46, 7.50, 1.89, all P<0.05). Compared with group HG, the expression of PINK1 protein level was increased (q=2.36, P<0.05). All indices of NC group had no statistical difference with those of HG group (allP>0.05).

Overexpression of FoxO1 alleviates the mitochondrial and cellular injuries induced by high glucose in CIMPs, probably via activation of PINK1/parkin pathway.

To investigate the effects of liraglutide on high glucose induced retinal ganglion cells injury and explore potential mechanisms.

RGC-5 cells were cultured in vitro and divided into the following groups: control group, high glucose group, liraglutide group, high glucose+liraglutide group, high glucose+liraglutide+rapamycin group, high glucose+rapamycin group, high glucose+normal control small interfering RNA (NC siRNA) group, high glucose+optineurin (OPTN) siRNA group. Cell viability was detected with the CCK-8 kit. LC3A/B, Beclin-1, p62 and OPTN were examined via western blotting analysis. Autophagy was also evaluated using the transmission electron microscopy (TEM). The expression of OPTN and LC3A/B was detected by western blotting after transfection with OPTN siRNA. Data were expressed by ±s, data among multiple groups were compared by using one-way ANOVA.

Our results showed that treatment with 65 mmol/L glucose for 24 h decreased cell viability of RGC-5 cells (0.74±0.06 vs 1.26±0.29, F=16.75, P<0.05). High glucose induced increased cell viability, expression of LC3A/B Ⅱ/Ⅰ, Beclin-1 and OPTN, along with p62 degradation and liraglutide suppressed the changes (0.55±0.04 vs 0.40±0.02, 1.08±0.05 vs 1.40±0.14, 0.55±0.06 vs 0.89±0.11, 0.44±0.06 vs 0.71±0.09, 0.82±0.15 vs 0.49±0.05,F=3.53, 10.79, 7.80, 7.52, 11.70, all P<0.05). TEM revealed that high glucose induced mitochondrial morphological changes and autophagosome formation which could be reversed by liraglutide. However, rapamycin induced autophagy and blocked the protective process (0.95±0.19 vs 1.52±0.29,F=13.87, P<0.05). Knockdown of OPTN by transfection with OPTN siRNA significantly down-regulated the expression of LC3A/B Ⅱ/Ⅰ (0.84±0.08 vs 1.61±0.26,F=15.88, P<0.01).

Liraglutide attenuates high glucose induced RGC-5 cell injury by inhibiting autophagy through regulating OPTN.

With the characteristics of urbanization and aging and the change of people's lifestyle in China, type 2 diabetes (T2DM) has become a serious public health problem in China. It is urgent to control the condition of T2DM and strengthen the management. Guiding principles of the 2008 edition of the National Standard for diabetes self-management education (DSME) in the United States^[1]It is clearly stated that in order to maintain the effectiveness of self-managed behavior changes, more follow-up and support are needed to be provided to patients. Medical staff play an important role in disease management of patients with T2DM, and the task of medical staff has shifted from providing services to patients to making health maintenance recommendations^[2]。 Lou Qingqing et al^[3]Studies have shown that medical support has a certain supportive effect on the treatment of diabetic patients. As the number of patients with T2DM continues to grow, the patient needs are increasing day by day. Therefore, it is necessary to understand the current status of medical support and self-management of T2DM patients, and explore the relationship between them, so as to help medical staff provide better medical support for T2DM patients, meet patients' needs, and provide reference for patients' self-management.

Diabetic nephropathy (DKD) and diabetic peripheral neuropathy (DPN) are common chronic complications of diabetes. Myelomatous nephropathy and myelomatous peripheral neuropathy (MMPN) may occur when multiple myeloma (MM) damages the kidney and peripheral nerves^[1,2,3,4,5], whose clinical presentation is similar to that of DKD and DPN. When proteinuria and peripheral neuropathy appear in diabetes and cannot be explained by DKD and DPN, care should be taken to exclude secondary causes such as MM. Fanconi syndrome (FS) is a hereditary or acquired proximal tubular complex transport defect disease, which can be divided into primary and secondary^[6,7]。 MM is one of the common causes of secondary FS^[8,9,10,11]。 This paper reports the diagnosis and treatment of a case of type 2 diabetes mellitus complicated with MM secondary to FS, in order to improve clinicians' understanding of this disease and avoid misdiagnosis and mistreatment. Consult CNKI and Wanfang database. At present, there are no reports of type 2 diabetes complicated with MM secondary to FS in China.

Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia caused by various causes, accompanied by abnormal sugar, fat and protein metabolism caused by defects in insulin secretion or action. It is mainly affected by genetic background and acquired environmental factors, of which more than 90% are type 2 diabetes mellitus (T2DM). Genetic factors determine the susceptibility of individuals to diabetes, while a variety of environmental factors, including lifestyle habits, may be the external causes of diabetes, and their controllability plays a key role in the prevention, control and treatment of diabetes. According to the International Diabetes Federation (IDF), there were 370 million diabetic patients worldwide in 2011, of which 80% were in developing countries. It is estimated that the number of diabetic patients worldwide will reach 550 million by 2030^[1]Primary prevention of diabetes needs urgent attention. Since 1997, China Daqing Study showed that lifestyle intervention can prevent diabetes for the first time, countries around the world have entered a new chapter in poor lifestyle intervention. With the universalization of immigration, ethnic diversity is becoming more and more obvious. Foreign studies show that the differences in culture and living habits of different races have brought about different risk of diabetes to a certain extent. China is a multi-ethnic country, and the genetic background and lifestyle of each ethnic group are very different. The exposure of diabetes risk factors may be different among different ethnic groups^[2]As a controllable factor, living habits are of great significance to the precise prevention and treatment of diabetes in China by deepening the research on living habits of different ethnic groups and the risk of diabetes, and seeking effective group intervention strategies. This article will review the research status of the correlation between different ethnic-ethnic lifestyle habits and diabetes risk at home and abroad from six aspects: diet, exercise, drinking, smoking, drinking and sleeping habits.

Obesity, as a typical energy excess disease, has become one of the main metabolic diseases that threaten health in the 21st century. It not only increases the incidence of a series of metabolic diseases such as type 2 diabetes (T2DM) and cardiovascular diseases, but also reduces the quality of life, which brings great troubles to patients' life^[1]。 Treatment of obesity includes approaches such as lifestyle interventions, medications, and surgery. Lifestyle interventions, although widely used, have unstable effects and frequent weight gain. Drug treatment is limited due to its weak effect and side effects of the drug itself. Although the effect of surgical treatment is obviously stable, the surgical risk and postoperative complications limit its popularization. The gastrointestinal tract is the largest energy intake organ, which determines the intake and absorption of energy. Besides obesity caused by genetic factors or lifestyle, intestinal flora also has an important influence on obesity, and its regulation of energy metabolism is a hot research topic. Changes in the number and proportion of intestinal flora affect the risk of obesity and diabetes^[2]。 The study found that the intestinal flora of obese patients or obese mice was transplanted into sterile mice, and the test mice showed symptoms of obesity^[3]。 The intestinal bacteria associated with obesity are mainly Firmicutes and Bacteroides, both of which are also the dominant flora in the intestine. One of the main ways in which intestinal flora affects the body is the production of short-chain fatty acids (short chain fatty acids, SCFAs). SCFAs are the final products of dietary fiber fermented by intestinal flora, which refer to free fatty acids soluble in water with 1~6 carbon atoms, among which acetic acid, propionic acid and butyric acid are the highest^[4]。 Intestinal flora imbalance in diabetic patients can cause a decrease in intestinal SCFAs content, thus attenuating the role of SCFAs in regulating host energy balance^[5]。 Transplantation of normal human intestinal bacteria into the intestinal tract of patients to restore their SCFAs levels, which has a therapeutic effect on insulin resistance. However, it has also been reported that the increase of SCFAs can also promote the body's absorption of energy from food residues and increase the risk of obesity. The specific mechanisms that determine the transformation of SCFAs' health care to pathogenic effects are unclear. In this paper, we mainly introduce the generation of SCFAs and their role. Taking acetic acid, propionic acid and butyric acid as examples, the effects of SCFAs on energy absorption and utilization were expounded, so as to provide theoretical guidance for clinical SCFAs to intervene in obesity and related metabolic diseases.

Diabetic retinopathy (DR) is one of the microvascular complications of diabetes, and diabetes is also one of the causes of atherosclerosis (AS), both of which are vascular diseases. The phosphatidylinositol 3-kinase/protein kinase B (PI3K/Akt) signaling pathway, as one of the common cell signaling pathways of these two vascular complications, plays an important role in the occurrence and development of the disease. Continuously elevated blood glucose activates PI3K/Akt signaling pathway, promotes the synthesis and release of various cytokines, inhibits vascular smooth muscle cell migration, reduces platelet adhesion, inhibits tissue factor expression, reduces apoptosis of vascular endothelial cells and promotes the expression of endothelial nitric oxide synthase (eNOS). In addition, oxidized low density lipoprotein (oxLDL) and angiotensin Ⅱ (AngⅡ) can increase macrophage activity and enhance immune inflammatory response after activating PI3K in macrophages, and these processes are all related to the formation of DR and AS.