MedNexus
Volume 12 · Issue 04 · 2020
MedNexus
- Sections
- Editor-In-Chief Column
- Editorial
- Special Article
- Expert Advices
- Original Article
- Case Report
- Review Article
- Lecture
- New Perspective
The author analyzes the hot issues of novel coronavirus pneumonia (COVID-19) combined with diabetes. Current evidence does not show that COVID-19 patients have a higher proportion of diabetes than the general population. The adverse effect of long-term hyperglycemia on the body's immune system makes diabetic patients more prone to various infections. However, for COVID-19, the proportion of COVID-19 patients with diabetes is close to that of the general population of the same age group, whether it is the overall patient or the severe patient. For the management of blood glucose, it is necessary to formulate blood glucose treatment plans and control targets according to the clinical classification of COVID-19 patients.
The prevalence of diabetes among people over 60 years old in China is 20.2%, about twice that of the overall adults. Elderly diabetic patients have their special features in pathophysiological characteristics, clinical characteristics, blood glucose management methods, drug selection, etc. They are a specific group of people who are more difficult in diabetes management. Clinical and basic research and drug development on the classification, comorbidities, complications, coexisting diseases of diabetes mellitus in the elderly are relatively lacking, and their blood sugar control goals and lifestyle interventions are also facing confusion. More research is urgently needed to provide evidence. The control status of diabetes in the elderly affects the overall outcome of diabetes. Paying attention to diabetes in the elderly and improving the control of diabetes in the elderly should be one of the focus of future work.
There is a severe outbreak of novel coronavirus pneumonia (COVID-19) in China, among which diabetic patients have a high proportion of infections due to low immune function. The proportion of COVID-19 co-diabetes is 5.3%, and the mortality rate of co-diabetes is also much higher than that of patients without reported comorbidities. It is urgent to strengthen the in-hospital blood glucose management of diabetic patients complicated with COVID-19. Blood glucose monitoring is the top priority of blood glucose management, and there is a risk of cross-infection. Under the special background of this epidemic, the author puts forward the necessity of blood glucose management in the whole hospital and the key points of preventing and controlling infection, so as to improve the awareness of medical staff and better guide clinical practice.
The novel coronavirus is highly infectious and has diverse clinical manifestations, which seriously affects people's health. It is of great significance to formulate scientific and standardized workflow during the epidemic period for prevention and control. diabetic foot (DF) is one of the chronic complications that seriously affect the health of diabetic patients, with high mortality and disability rates. In order to standardize the diagnosis and treatment of DF patients during the epidemic period, the Diabetic Foot and Peripheral Vascular Disease Group of Diabetology Branch of Chinese Medical Association, according to the relevant national guidelines, consulting the latest literature and combining the experience accumulated in epidemic prevention work, drafted the work suggestions for standardized diagnosis and treatment of DF under the background of novel coronavirus pneumonia for the reference of medical staff.
The main purpose of this management recommendation is to focus on prevention, and it is hoped to improve the scientific management ability of home caregivers, community and grass-roots doctors, including doctors on online medical consultation platforms due to the epidemic, for children and adolescents with diabetes at home protection, blood glucose management and acute complications of diabetes during the novel coronavirus pneumonia (COVID-19) epidemic, so as to facilitate the treatment of children at home or nearby and avoid cross-infection. For children with diabetes, it is recommended to strengthen self-blood sugar management to avoid diabetic ketoacidosis and severe hypoglycemia. In order to reduce the risk of cross-infection, initial treatment programs for mild to moderate diabetic ketosis and ketoacidosis are provided to families and community clinics with basic conditions.
Establishing the reference range of adiponectin by detecting the levels of adiponectin in the population free of metabolic disease in Guangdong China.
A total of 1 156 individuals were collected from Sun Yat-sen Memorial hospital Healthy Examination Center and Dongguan communities, from December 2018 to October 2019. All individuals were collected anthropometric information and biochemical indicators, such as fasting blood glucose and glycated hemoglobin. Adiponectin was detected by latex-enhanced immunoturbidimetry, and its distribution in metabolic diseases-free population was analyzed to establish reference range. The distributions of adiponectin according to gender, age and body mass index were analyzed. Multiple linear regression were performed to analyze the relationship between adiponectin and indicators.
We defined adiponectin reference range was >P25 and the reference value were >3.2 mg/L for total population, >3.0 mg/L for male population and >3.4 mg/L for female population, respectively. Multivariate linear regression analysis showed that adiponectin was effected by age, systolic blood pressure, triglycerides, high-density lipoprotein cholesterin and low-density lipoprotein cholesterin (standardized regression coefficient β=0.037, -0.012, -1.316,1.994, -0.463, all P<0.05).
This study initially established reference values for adiponectin based on diseases-free natural population in Guangdong China, which is important for further exploration of the clinical values of adiponectin.
To evaluate the application value of skin advanced glycosylation end products (AGEs), a non-invasive detection technology for the early screening in community diabetes mellitus.
A total of 701 people without history of diabetes mellitus were recruited from community health check-up center between Jan. 2018 and Jan. 2019 and divided into normal glucose tolerance group (n=443), impaired glucose regulation group (n=198) and newly diagnosed diabetes group (n=60) according to the results of oral glucose tolerance test (OGTT). Upper arm skin AGEs were detected by diabetes mellitus scan (DM Scan). Parameters of fasting plasma glucose (FPG), 2-hour postprandial blood glucose (2 h PG), glycosylated hemoglobin (HbA1c), insulin (INS), C-peptide (C-P), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), creatinine (Cr), urea (UREA) were tested. Additionally, AGEs levels were compared in<45 years old, 45 to 59 years old and ≥60 years old age groups. One-way analysis of variance was used to compare the differences of parameters and skin AGEs levels among 3 groups, and Pearson correlation analysis and logistic regression analysis were performed.
The levels of AGEs in prediabetes and diabetic patients in different ages were higher than those in healthy controls respectively (P<0.05). Pearson correlation analysis showed that skin AGEs were correlated with FPG and HbA1c (r=0.215 and 0.233, P<0.01). Multivariate logistic regression analysis showed that AGEs were independent risk factors for prediabetes and diabetes risk [OR (95%CI): 1.054 (1.025-1.084), 1.116 (1.071-1.163)]. The area under the receiver operator characteristic curve of DM Scan for identifying diabetes was 0.721 [95%CI (0.658-0.783)], with a sensitivity of 73.3% and specificity of 61.3%. The area under receiver operator characteristic curve of DM Scan for pre-diabetes was 0.601 [95%CI (0.551-0.652)], with a sensitivity of 35.4% and specificity of 87.1%.
Non-invasive detection of skin AGEs may be useful for assessing the risk of diabetes, but it may not be suitable for screening early diabetes mellitus.
To investigate the relationship betweenglycemic variability and erectile dysfunction (ED) in patients with type 2 diabetes (T2DM).
Eight hundred and thirteen T2DM outpatientsin Henan Provincial People′s Hospital were enrolled in this study from December 2017 to December 2018. All these patients accepted blood glucose monitoring with flash glucose-sensing technology and answered the International Questionnaire on Erectile Function (IIEF-5) to assess ED severity. At last, they were divided into non-ED group (n=148), mild ED group (n=319), moderate ED group (n=144) and severe ED group (n=202) according to the score of IIEF-5. The time in range (TIR), glucose coefficient of variation (CV), standard deviation (SD) and the mean amplitude of glycemic excursions (MAGE) weregenerated by FGM. Correlation between glycemic variability and ED was analyzed with Pearson correlation analysis, multiple linear regression and logistic regression.
(1) With the development of ED, patients′ age, course of disease, glycated hemoglobin (HbA1c), mean glucose (MBG), CV, SD and MAGE showed an increasing trend, and the difference between the groups was statistically significant (F=5.683 to 108.791, All P<0.05); meanwhile, TIR showed a significant downward trend, and the difference between the groups was statistically significant (F=563.078, P<0.05). (2)Pearson correlation analysis showed that TIR was significantly positively correlated with IIEF-5 (r=0.881, P<0.05). At the same time, CV, SD and MAGE were negatively correlated with IIEF-5 (r=-0.153, -0.370, -0.288, all P<0.05). (3)Multiple linear regression analysis showed that TIR was a relevant factor of ED severity (β′=0.736,P<0.05) and had the greatest impact among the factors included in the analysis. Multivariate logistic regression analysis showed significant correlation between TIR and ED after various confounding factors corrected (all P<0.05).
Glycemic variability is related to ED in T2DM, and low TIR is independently and positively associated with ED. All these indexes may be important risk factors for diabetic patients with ED.
To provide new evidence to avoid overdiagnosis of acute pancreatitis (AP) and unnecessary long-term fasting treatment in diabetic ketoacidosis (DKA) pediatric patients.
Children under the age of 18 suffered from DKA combined with elevated trypsin were enrolled in the Department of Endocrinology, Genetics and Metabolism of Beijing Children′s Hospitalfrom January 2015 to January 2019. Clinical data, including symptoms, serum amylase, lipase, lipid levels, pancreatic imaging, treatment options and clinical outcomes were analyzedretrospectively. The data were represented with median (upper and lower quartile).
Among 330 DKA children admitted in 4 years, there were 38 (11.5%) DKA patients combined with elevated trypsin, 22 (6.7%) children whose trypsin were elevated more than 3 times. Sixteen (4.8%) patients with negative pancreatic imaging were defined as suspected AP, among which 14 patients in the absent of abdominal pain prognosed well without AP treatment. 1 out of 16 patients developed abdominal pain, which was relieved the next day after routine DKA treatment. Another patient presented abdominal pain received 12 days of AP treatment and despite having blood trypsin level increased when oral feeding began at the 14th day, she continued oral enteral nutrition withoutrelapse of AP symptoms. Six patients (1.8%) with positive imaging changes were defined as confirmed AP, among which 4 patients having abdominal pain received regular AP treatment and recovered from abdominal pain in 2-19 days respectively and their blood trypsin levels went below less than 3 times in 2-15 days. All of 6 patients had no recurrence of AP in the 5-32 months of follow-up.
Increased trypsin is common in children with DKA and it is usually associated with low incidence of AP and good prognosis.
To investigate the correlation between visceral adipose tissue and cardiac function in patients with newly diagnosed type 2 diabetes mellitus.
Newly diagnosed type 2 diabetic patients aged 18 to 70 years were recruited between August 2015 and June 2016. According to body mass index (BMI), they were divided into normal weight group (18.5 kg/m2≤BMI<24.0 kg/m2), overweight group (24.0 kg/m2≤BMI<28.0 kg/m2), obesity group (BMI≥28.0 kg/m2). The visceral adipose tissue (VAT) mass, VAT area were measured by dual energy X-ray, right ventricular anterior wall adipose tissue, apical adipose tissue and cardiac function [ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV)] were measured by cardiac color Doppler echocardiography. Analysis of variance and rank -sum test were used for comparison among these three groups, and multiple linear regression analysis was used to evaluate the influencing factors of cardiac function.
(1) A total of 142 patients [77 males, 65 females, aged 51(42,59) years, 3 cases were lost] were recruited in this study. They were divided into obesity group (n=48), overweight group (n=45) and normal weight group (n=46). There were significant differences in BMI, waist circumference, waist hip ratio, VAT mass, VAT area, right ventricular anterior wall adipose tissue, apical adipose tissue among these three groups (all P<0.05). (2)Univariate analysis showed that EF was correlated with BMI, waist circumference, VAT area, right ventricular anterior wall adipose tissue and apical adipose tissue (β=-0.023--0.590, allP<0.05), EDV was correlated with VAT area and apical adipose tissue (β=0.196, 4.357, bothP<0.05), ESV was correlated with VAT area and apical adipose tissue (β=0.113, 2.675, bothP<0.05). (3)Multiple linear regression analysis showed that with the 1 mm increase of apical adipose tissue in model Ⅰ (unadjusted) and model Ⅱ (adjusted by age and sex), EF decreased 0.590% and 0.645%, EDV increased 4.357% and 4.835%, ESV increased 2.675% and 2.931%, respectively.
BMI, waist circumference, VAT mass, VAT area, right ventricular anterior wall adipose tissue, apical adipose tissue are important factors affecting cardiac function. The apical adipose tissue has the greatest effect on cardiac function.
To explore the clinical and genetic characteristics of maturity-onset diabetes of the young (MODY) induced by co-inheritance of hepatocyte nuclear factor 1α (HNF-1α) and glucokinase(GCK) gene mutations.
A case of maturity-onset diabetes of the young diagnosed in Peking Union Medical College Hospital in September 2017 was analyzed for the clinical characteristics and laboratory examinations. Mutations linked to MODY were identified in proband and his family.
A heterozygous mutation in GCK gene (NM_000162) c.686C>T(p.Thr229Met)was identified in 5 members of the family. Mutation in HNF-1α c.1531C>G(p.Gln511Glu)was identfied in 3 of them.
Carriers of both GCK and HNF-1α mutations cause coexistence of different genotypes in the same family. Co-inheritance of MODY 2 and MODY 3 mutations should be considered for accurate diagnosis.
To compare the therapeutic effects of two wound negative pressure treatments on diabetic foot ulcer.
Sixteen patients (10 male, 6 female) with diabetic foot ulcer admitted to the Department of Endocrinology of Guangxi Zhuang Autonomous Region People′s Hospital from April to August 2018 were selected. After comprehensive systemic treatment, wound evaluation and debridement, patients with wound bed suitable for wound negative pressure treatment were randomized into this open label cross-over trial. They were divided into the first vacuum assisted closure (VAC) group (8 cases) and the first vacuum sealing drainage (VSD) group (8 cases). The first VAC group received VAC treatment in the first week, then VSD treatment in the second week. The first VSD group was treated with VSD in the first week and VAC in the second week. The foot ulcer wounds of all the patients were photographed before treatment, after 1 week of treatment, and after 2 weeks of treatment. Changes of ulcer area and granulation tissue area were analyzed using Image J software. Meanwhile, the tissue oxygen partial pressure of the two sites around ulcer were measured with Danish Raydo Percutaneous Oxygen Partial Pressure Analyzer. The changes of ulcer area, granulation tissue area and percutaneous partial pressure of oxygen were compared between two treatments during the first and second weeks of treatment using two-stage cross-design analysis of variance.
(1) Sixteen patients with diabetic foot ulcer were compared with those before treatment. After treatment, there was significant differences observed including decreased area of ulcer [4.61(3.11) vs 9.51(6.55) cm2, Z=3.517], expandedarea of granulation [4.08 (2.49) vs 0.90 (1.12) cm2, Z=-3.516], and increased values of percutaneous oxygen partial pressure [(54.19±6.91) vs (32.16±10.16) mmHg (1 mmHg=0.133 kPa), (56.75±12.95) vs (30.56±11.93) mmHg, t=-11.814,-14.028] (all P<0.05). (2) Two negative pressure treatments of VSD and VAC had statistical significance on the changes of ulcer area, granulation tissue area and percutaneous partial pressure of oxygen in two lesions of subjects (F=5.763-22.090, all P<0.05). The increasesof percutaneous oxygen partial pressure and granulation tissue area, and reduction in ulcer area after VAC treatment were greater than those after VSD treatment (all P<0.05). (3) No matter which negative pressure treatment was adopted, the increase value of percutaneous partial oxygen pressure in the two sites after the first week of treatment was greater than that after the second week of treatment, and the difference was statistically significant (F=13.254,11.205, both P<0.05).
VAC is superior to VSD in the improvement of diabetic foot ulcerarea, area of granulation tissue on wound surface and oxygen partial pressure of surrounding tissues, indicating that VAC treatment has more advantages in treating diabetic foot ulcer.
To investigate the role of caveolin-1 (Cav1) in palmitic acid-induced survival of pancreatic islet β-cell.
Cav1-deficient NIT-1 cells and mouse primary islets were constructed through lentiviral vector transfection. Control-shRNA was transfected as a control. After fatty-acid-free bovine serum albumin (BSA) and palmitic acid (0.5 mmol/L) incubation for 24 and 48 hours, cell viability and apoptosis werecalculated by methylcyclopentadienyl manganese tricarbonylassay and Hoechst33342/propidium iodide (PI) double staining.Real time PCR and Western blot were used to detect the expression of apoptosis-associated mRNA and protein. The t test and one-way ANOVA were used for statistical analysis.
Compared with the control group, the cell survival rate of the palmitic acid treatment group was significantly decreased (0.89±0.10 vs 0.24±0.04, t=13.49, P<0.01), and mRNA and protein expressions of P18 and P19 were up-regulated (1.00±0.09 vs 1.30±0.04, 1.00±0.04 vs 1.37±0.13, t=5.28, 4.71, both P<0.05; 0.87±0.04, 1.48±0.05, 1.02±0.06 vs 1.41±0.07, t=16.50, 7.33, both P<0.01); mRNA expression levels of cysteine-containing aspartic proteolytic enzymes (Caspase-6, Caspase-9, and Caspase-12) were significantly up-regulated (1.00±0.04 vs 1.57±0.08, 1.01±0.15 vs 1.57±0.20, 1.02±0.19 vs 1.57±0.09, t=11.04,3.88, 4.53, all P<0.05), and protein expression of them were also significantly increased (0.86±0.10 vs 1.28±0.11, 0.69±0.01 vs 0.86±0.06, 0.70±0.02 vs 1.18±0.01, t=4.89,4.84, 37.18, all P<0.01). The cell survival rate of Cav1-shRNA+palmitic acid group was significantly higher than that of Ctrl-shRNA+palmitic acid group (0.53±0.10 vs 0.26±0.08, t=4.71, P<0.01). The mRNA and protein expression of P19 were all down-regulated (1.53±0.18 vs 0.66±0.04, 1.48±0.05 vs 0.70±0.02, t=8.17, 25.09, both P<0.01); mRNA expression levels of Caspase-6, Caspase-7, Caspase-9 and Caspase-12 were down-regulated (1.82±0.11 vs 1.03±0.07, 1.43±0.24 vs 0.42±0.15, 1.41±0.22 vs 0.51±0.18, 1.45±0.18 vs 0.42±0.13, t=5.48-10.49, all P<0.01), and protein expression of them were also down-regulated (0.99±0.14 vs 0.63±0.11, 0.90±0.14 vs 0.62±0.04, 0.90±0.02 vs 0.60±0.04, 1.30±0.01 vs 0.65±0.04, t=3.50-27.31, all P<0.01).
Cav1 deficiency inhibites palmitic acid-induced pancreatic β-cell apoptosis via regulating Caspase family, and ultimately protects β cell viability.
Purple urinary bag syndrome (PUBS) is a rare clinical phenomenon, which is characterized by the change of urine color and the change of urine bag and catheter to blue, purple or blue-purple. It is reported more abroad and rarely in China. PUBS are associated with the complex metabolism of tryptophan and urinary tract infections, and most of them have a benign prognosis and do not need treatment. Combined with an 84-year-old woman with type 2 diabetes mellitus (T2DM) who had twice developed PUBS, the pathogenesis, treatment and prognosis of PUBS were discussed, and the relationship between T2DM and PUBS was discussed.
Mitochondria are organelles responsible for cellular energy metabolism, and are important places for the complete oxidation and decomposition of glucose to synthesize adenosine triphosphate or convert into fatty acids and other substances. Its dysfunction is closely related to the pathogenesis of diabetes. Mitochondrial function is determined by many proteins and is finely regulated by post-translational modifications of proteins, such as phosphorylation, acetylation, succinylation and glycosylation. These modifications influence the ability of mitochondria to metabolize glucose by regulating the activity of various enzymes, thereby determining blood glucose homeostasis, and are an important entry point for understanding glucose metabolism disorders. The research progress of post-translational modification of mitochondrial proteins was discussed with the focus on glucose metabolism.
The diabetes specialist medical consortium is a product of conforming to the transformation of China's medical model. It is of great significance to establish a replicable, comprehensive and effective diabetes management model in China and further promote hierarchical diagnosis and treatment and community chronic disease management. The author compares the scale, level, responsibility, operation guarantee mechanism and advantages of foreign diabetes specialist medical service system with the current situation of domestic diabetes specialist medical consortium construction, thinks about the obstacles and countermeasures existing in the current diabetes specialist medical consortium construction in China, and looks forward to the ways and approaches of building a diabetes specialist medical consortium with Chinese characteristics in combination with China's national conditions, so as to provide reference opinions for the construction of diabetes specialist medical consortium in China.
Painful diabetic peripheral neuropathy is a common chronic complication of diabetes and a high risk factor for diabetic foot disease. The pathogenesis of painful diabetic peripheral neuropathy is complex, and the role of cytokines in it has received great attention in recent years. Studies have shown that some chemokines play an important role in neuropathic pain, including painful diabetic peripheral neuropathy. Macrophage inflammatory protein-1 (MIP-1) belongs to the CC chemokine family. This article reviews the research progress of MIP-1 and painful diabetic peripheral neuropathy.
In recent years, the prevention and treatment of gastrointestinal metabolic diseases has gradually become a research hotspot. Intestinal bile acids have gradually become a new target for the prevention and treatment of metabolic diseases (especially type 2 diabetes) due to their abundant metabolic regulatory effects. The role of bile acids in regulating the secretion of intestinal hormones and the metabolic regulation of intestinal microecology and the possible related mechanisms were expounded.
Recent studies have found that sodium-glucose cotransporter 2 (SGLT2) inhibitors have good efficacy and safety in patients with type 2 diabetes mellitus (T2DM), and can bring clinical benefits in cardiovascular and renal diseases. On the basis of sorting out the basic information of drugs, this paper sorts out and analyzes the relevant recommendations and information in the main clinical diagnosis and treatment guidelines and health technology evaluation reports abroad. Overall, SGLT2 inhibitors have been recommended as the first-line treatment option (or one) for T2DM patients with cardiovascular disease and/or kidney disease, and their monotherapy and/or combination therapy have gradually been recommended by various countries for inclusion in the scope of medical insurance payment. However, due to different clinical evidence, the recommended levels, specific patient populations and drug status of different SGLT2 inhibitors are also different. It is recommended that appropriate drug varieties should be comprehensively selected based on the indications approved in the instructions, high-level evidence-based medical evidence and guideline recommendations.
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