Volume 12 · Issue 03 · 2020

This paper expounds the intrinsic relationship between energy metabolism imbalance and diabetes mellitus. Hyperinsulinemia and insulin resistance caused by excessive and insufficient energy intake are one of the important causes of type 2 diabetes mellitus; In contrast, type 1 diabetes is mainly caused by insulin deficiency, which causes excessive energy consumption and inefficient storage. Therefore, to prevent and treat diabetes, measures can be taken to reduce energy intake and promote consumption or increase energy synthesis and reduce consumption according to the patient's energy imbalance state, and it is proposed that the research and prevention of diabetes should change from insulin as the core to control energy metabolism.

Metabolic surgery can be defined as: surgical procedures performed on normal organs for health benefits based on specific physiological mechanisms. Therefore, metabolic surgery has some characteristics that are different from other surgeries, namely, normal organ manipulation, emphasis on cognition, and emphasis on evaluating health benefits. Bariatric metabolic surgery is the most common metabolic surgery. The author briefly talks about bariatric metabolic surgery in the eyes of surgeons from the above three angles, and believes that metabolic surgery is essentially cognitive surgery.

Obesity and diabetes have now become public health problems worldwide, seriously affecting the health of patients and exacerbating the burden of family life. Metabolic surgery as an emerging treatment has shown its unique advantages in the treatment of morbid obesity and obesity diabetes and other metabolic abnormalities. More and more clinical evidence indicates that metabolic surgery for obese diabetes has absolute advantages over non-surgical treatment in blood glucose control and complication prevention. In order to standardize the development of bariatric metabolic surgery, a series of clinical guidelines have been launched one after another. However, with the continuous accumulation of clinical evidence-based medical evidence, various guidelines need to be continuously updated and improved according to clinical findings and mechanism research. Therefore, the author makes a preliminary interpretation and discussion of the latest domestic and foreign metabolic surgery guidelines.

Cardiometabolic disease is an interrelated constellation of diseases such as hypertension, diabetes, dyslipidemia, coronary heart disease and stroke, leading to great threats to public health and increasing burden of diseases in China. The important and essential action to prevent cardiometabolic diseases is to promote healthy lifestyle throughout life. This guideline provides recommendations on diet and beverage, physical activity, smoking, drinking and other lifestyle habits, mainly based on evidence derived from Chinese studies. The recommendations are developed to guide actions in living a healthy lifestyle for primary prevention of cardiometabolic diseases among Chinese adults, and also to promote the implementation of the Healthy China initiative.

To investigate the effect and associated factors of multi-disciplinary team approach on weight loss in Chinese obese patients.

The multi-disciplinary team for obesity in Peking University First Hospital consists of 2 endocrinologists, 2 dieticians, 2 exercise therapists, a bariatric surgeon, an acupuncturist and several health educators. A total of 445 patients treated by multi-disciplinary team were recruited from June 2015 to June 2017, the mean age was (37.6±12.5) years old, with 293 females (65.8%) and 152 males (34.2%). Patients were followed up at 3, 6, 12, 18 and 24 months after their first visit. We analyzed body weight changes overs follow-up and factors that affected the successful rate in weight reduction using Logistic regression or chi-square analysis.

Body weight declined significantly at each follow-up visit compared with baseline (P<0.01), and the reduction at 6 months and 12 months of follow-up were significant compared with corresponding former visit [6 months vs 3 months: (87.2±20.2) vs (87.8±19.8) kg, P<0.01; 12 months vs 6 months: (86.7±19.0) vs (87.2±20.2) kg, P<0.01]. Defining body weight reduction over 5% as success, the rate of success was as high as 40.9%-50.9% during visits. Defining the reduction of body weight over 10% as success, the successful rate gradually increased from 13.2% to 26.9% during visits. Female, baseline body mass index, waist circumference and weight reduction in early treatment phase were associated with weight-loss success rate (all P<0.01). There was no correlation between the use of metformin and weight-loss success rate (P>0.05).

A multi-disciplinary approach to manage obesity could significantly achieve the goal of body weight reduction. Female, baseline body mass index, waist circumference and weight reduction in early treatment phase are associated with successful weight control.

To evaluate the changes in serum ceramide (CER) and its subspecies in obese patients at 1 month after laparoscopic sleeve gastrectomy (LSG) and explore the correlation between serum ceramide subtypes and metabolic disorders.

A total of 34 obese patients undergoing LSG [obese group, mean age was (29.0±8.9) years, 30 female (88.2%),4 male (11.8%)] and 31 healthy subjects [normal group,mean age was (24.8±3.8) years, 18 female (58.1%) , 13 male (41.9%) ] who had not received anti-obesity treatment were recruited in the First Affiliated Hospital of Nanjing Medical University from November 2017 to May 2018. The clinical data of obese patients were collected and compared before surgery and 1 month after LSG. Insulin resistance was evaluated with homeostasis model assessment of insulin resistance (HOMA-IR). Serum lipidomics analysis was performed in an electrospray ionization mode using Exion UPLC-QTRAP 6500 PLUS (Sciex) LC/MS. Thet test, Wilcoxon rank test and SNK-q test were wsed for statistical analysis. Pearson and Spearman rank correlation analysis were used to analyze the correlation between CER and serological indexes.

1 month after LSG, serum ceramides including Cer d18∶1/22∶0 [piror and post LSG respectively: 0.99(0.83,1.25), 0.55(0.45,0.77) pmol/L, Z=4.59, P<0.01] and Cer d18∶1/24∶0 [piror and post LSG respectively: 2.63(2.22,3.45), 1.46(0.99,2.22) pmol/L, Z=5.10, P<0.01] decreased in 34 obese patients, and they were significantly positively correlated with body mass index, total cholesterol, low density lipoprotein cholesterol, HOMA-IR, C-reactive protein, and interleukin-6 (r=0.26-0.59, all P<0.05).

Cer d18∶1/22∶0 and Cer d18∶1/24∶0 may be related to the recovery of insulin resistance, reduction of inflammatory cytokines and cardiovascular risk in obese patients treated with LSG.

To explore the mechanism of long-term maintenance of weight loss and blood glucose homeostasis after Roux-en-Y gastric bypass(RYGB).

12 weeks old male Sprague Dawley (SD) rats were used as animal models and randomly divided into Sham group (n=22), RYGB group (n=12) and pancreatectomy group (n=10), and were with normal diet or high-fat diet for 8 weeks. The levels of insulin secretion, glucose infusion rate, body weight and blood glucose were measured, and the metabolic pathways of adipose tissue were detected by gene chip and western blot. The t test and variance analysis were used to compare the difference among the three groups.

Compared with Sham group, the fasting and glucose stimulated plasma insulin in SD rats were significantly reduced after metabolic surgery [(1.3±0.2) vs (0.6±0.1) ng/ml, t=3.6, P<0.01; (4.1±0.4) vs (2.1±0.3) ng/ml, t=4.3, P<0.01]. In addition, fasting insulin and body weight could be maintained at a low level for a long time on high fat diet [(3.1±0.3) vs (0.7±0.1) ng/ml, t=8.1, P<0.01; (453±11) vs (349±6) g, t=8.5, P<0.01]. The mechanism study found that insulin signal pathway of adipose tissue was inhibited (1.0±0.1 vs 0.5±0.1, t=6.4, P<0.01), fatty acid synthesis and decomposition were decreased, and the expression of adenosine monophosphate-activated protein kinase was enhanced (1.0±0.1 vs 1.4±0.1, t=4.0, P<0.01). After the removal of most pancreatic tissues, the levels of fasting plasma insulin and glucagon were reduced 71.7% and 68.0% respectively [(1.10±0.10) vs (0.30±0.04) ng/ml, t=7.5, P<0.01; (16.2±0.8) vs (5.2±0.9) pmol/L, t=9.1, P<0.01], but the fasting blood glucose was not significantly increased, and the body weight was significantly lower in the normal diet and high-fat diet group compared to sham group [(434±13) vs (389±5) g, t=3.1, P<0.05; (548±16) vs (433±11)g, t=6.0, P<0.01].

RYGB can maintain low body weight and blood glucose homeostasis for a long time by reducing energy intake and avoiding hyperinsulinemia. The mechanism is closely related to the inhibition of fat synthesis and metabolism, and the enhancement of catabolism.

To investigate the correlation between the degree of abdominal obesity and the prevalence of gallstones and urinary stones in patients with type 2 diabetes. 2 477 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in the Department of Endocrinology and Metabolic Diseases of the Third Affiliated Hospital of Sun Yat-sen University from January 2016 to December 2018 were selected. Each subject underwent physical examination, biochemical tests, and abdominal B-ultrasound examination. The total population was divided into 4 groups according to the quartile of waist-to-hip ratio, and baseline data differences between groups were analyzed by ANOVA. χ²The prevalence of gallbladder stones and urinary stones was analyzed by testing and analyzing the risk factors of stones in type 2 diabetic patients by Logistic regression analysis. The results showed that in the gallstones group, the prevalence increased from 2.4% (15/625) to 12.5% (77/618) with increasing waist-to-hip ratio quartile. Multivariate Logistic regression analysis of gallbladder stone prevalence showed that in the gallbladder stone group, patients with T2DM located in the 4th quartile of waist-to-hip ratio had a significantly increased risk of developing gallbladder stones compared with patients in the 1st quartile (OR =3.78，95% CI1.16~12.30，P =0.027）。 In the kidney stone group, the prevalence increased from 2.4% to 6.8% with increasing waist-to-hip ratio quartile. After adjusting for possible confounding factors in addition to BMI, patients in the 4th quartile of waist-to-hip ratio in T2DM patients had a significantly increased risk of kidney stones compared to patients in the 1st quartile (OR =5.34，95% CI1.14~25.01，P =0.033）。 However, after further correction for BMI, the results were not statistically significant (P>0.05）。 It shows that the degree of abdominal obesity in T2DM patients is significantly correlated with the increased risk of gallstones.

The author reports a case of diabetic patient with ketoacidosis onset and intractable hypokalemia during treatment, accompanied by hyperkalemia, hypocalcemia, increased activity of renin-angiotensin-aldosterone system and metabolic alkalosis. Finally, a new mutation c.635G>T (p.G212V) was found by genetic test, thus confirming the diagnosis of Gitelman syndrome. This case suggests that if there is hypokalemia that cannot be corrected by conventional treatment during the treatment of diabetic ketoacidosis, patients with hypomagnesemia, hypocalciuria and hypochloremia should consider the possibility of complicating Gitelman syndrome.

Circular RNA (circRNA) is a kind of endogenous covalently closed circular RNA molecule, which has the characteristics of specificity, high stability and high abundance, and is a novel gene expression regulatory molecule. circRNAs are involved in a variety of disease development and are currently found to be closely related to diseases such as diabetes, atherosclerosis, cardiovascular diseases, neurological diseases, and cancer. The study of its mechanism of action is helpful to develop new diagnostic markers, explore the pathogenesis of diseases, and find effective therapeutic targets. In this paper, the characteristics, functions and recent research progress of circRNAs in diabetes mellitus and its complications were reviewed, so as to provide reference for further circRNAs research.