Volume 12 · Issue 10 · 2020

Diabetic nephropathy (DKD) is one of the most important and serious microvascular complications of diabetes. Both chronic hyperglycemia and chronic kidney disease (CKD) are independent risk factors for cardiovascular events. The recently published "Expert Consensus on the Clinical Application of Hypoglycemic Drugs in Chinese Adult Patients with Type 2 Diabetes Complicated with Cardiorenal Diseases" once again emphasizes the importance of cardiovascular risk assessment, screening and prevention of diabetic patients. Diabetic patients should pay timely attention to the risk screening and management of atherosclerotic cardiovascular disease (ASCVD) while screening and diagnosing DKD. Combined with the patient's own characteristics, such as the presence of albuminuria, CKD staging and cardiovascular risk stratification, individualized comprehensive management and intervention measures are formulated to delay the progression of DKD and reduce the risk of ASCVD development.

In order to improve the scientific management ability of non-endocrine pediatricians for hospitalized hyperglycemia in children and adolescents, this expert consensus is specially formulated. In the management of hospitalized hyperglycemia, the principle of stratified blood glucose management based on different disease groups should be adhered to. Insulin intravenous infusion and multiple subcutaneous injections (such as basal-meal insulin) are concise, easy to understand and operable, which is convenient for non-endocrine pediatricians to treat patients in relevant departments in time, so that blood sugar can be safely and effectively controlled to the standard. The in-hospital information-based blood glucose management mode, which takes endocrinologists as the core and interactively adjusts the blood glucose management plan in real time through inter-department consultation or network technology, can improve the treatment effect, save hospitalization time and reduce in-hospital cross-infection. It is recommended that qualified medical units actively explore and carry out.

To explore the brachial-ankle pulse wave velocity (baPWV) and its potential risk factors in type 2 diabetes mellitus (T2DM) patients with normoalbuminuric chronic kidney disease (CKD).

T2DM patients hospitalized in the Department of Endocrinology, Huashan Hospital Affiliated to Fudan University from January 2015 to May 2020 were selected as the research objects. 1 567 T2DM patients (953 males and 614 females) with an average age of (60.9±13.2) years and an average course of 10 (4, 14) years were enrolled in this study. According to the estimated glomerular filtration rate (eGFR) and urinary albumin/creatinine (UACR), the patients were divided into three groups: non CKD group [eGFR≥60 ml·min^-1·(1.73 m²)^－1 and UACR<30 mg/g], normoalbuminuric CKD (NACKD) group [eGFR 30-60 ml·min^-1·(1.73 m²)^－1 and UACR<30 mg/g], ALB-CKD G1-2 group [eGFR≥60 ml·min^-1·(1.73 m²)^－1 and UACR≥30 mg/g] and ALB-CKD G3 group [eGFR 30-60 ml·min^-1·(1.73 m²)^－1 and UACR≥30 mg/g]. There were 46 cases in NACKD group and 138 cases in other groups matched with age and gender 1∶3. The general clinical data were collected and body mass index (BMI) was calculated, laboratory parameters such as low density lipoprotein cholesterol (LDL-C) and baPWV were detected. The t test, non-parametric test and χ² test were used for comparison between groups.

Compared with normal albuminuria patients, baPWV in T2DM patients with micro-albuminuria and macro-albuminuria were significantly higher (P<0.01). BaPWV in those with macro-albuminuria was also significantly higher than that in T2DM patients with microalbuminuria (P<0.01). Compared with the group without CKD, the baPWV of ALB-CKD G1-2 group, ALB-CKD G3 group and NACKD G3 group were significantly higher [(1 839.2±458.2), (2 114.2±695.6), (1 892.4±551.7) vs (1 665.7±391.9)mm/s,P<0.01], especially ALB-CKD G3 macro-ALB subgroup. BaPWV of ALB-CKD G3 micro-ALB subgroup was significantly higher than that of NACKD G3 Group [(2 013.9±559.7) vs (1 884.5±557.4) mm/s,P<0.05]. BaPWV of NACKD G3 group was similar to ALB-CKD G1-2 macro-ALB subgroup (P>0.05), but significantly higher than ALB-CKD G1-2 micro-ALB subgroup [(1 884.5±557.4) vs (1 788.4±351.7) mm/s,P<0.05]. Unconditional logistic regression analysis showed that age [odds ratio (OR)=1.105, 95% confidence interval (CI) 1.013-1.605], female (OR=1.198, 95%CI 1.021-2.914), BMI (OR=1.041, 95%CI 1.009-1.104) and LDL-C (OR=3.771, 95%CI 1.076-20.892) were the risk factors for the increase of baPWV in T2DM patients with normal albuminuria but impaired renal function.

T2DM patients with normal albuminuria but impaired renal function have higher risk of cardiovascular events and all-cause death than those with albuminuria but without impaired renal function. Elderly, female, obesity and poor control of LDL-C are the risk factors of increased baPWV in T2DM patients with normal albuminuria but impaired renal function.

To explore clinical, pathological and prognostic characteristics of patients with type 2 diabetic kidney disease and non-diabetic kidney disease and its influence factors.

A total of 363 patients with type 2 diabetic kidney disease confirmed by renal biopsy in the First Affiliated Hospital of Zhengzhou University between January 2014 and June 2016 were retrospectively included in this study. All patients were divided into diabetic kidney disease combined with non-diabetic kidney disease (MIX group, n=142) and diabetic kidney diseaseonly (DKD group, n=221) according to pathological results. Baseline data (diabetes duration, history of retinopathy, etc.) were recorded and biochemical indicators such as fasting blood glucose, glycated hemoglobin A_1c, serum creatinine were detected. The estimated glomerular filtration rate (eGFR) was calculated. Endpoint renal events were defined as end-stage kidney disease, a persistent 40% decline of eGFR from baseline or all-cause mortality. The cumulative renal survival rate was analyzed by Kaplan-Meier analysis. Logistic regression analysis and Cox regression analysis were used to predict related factors of NDKD and to explore the risk factors for adverse renal outcomes.

The mean age at baseline of 363 patients was (50.0±9.9) years and 233 (64.2%) were male. No significant difference was found in gender and age between MIX and DKD groups. Logistic regression analysis showed that diabetes duration ≤5 years [odds ratio (OR): 2.136, 95% confidence interval (CI): 1.315-3.471, P<0.01], higher eGFR (OR: 1.999, 95%CI: 1.246-3.209,P<0.01) and no anemia (OR: 2.596, 95%CI: 1.614-4.175,P<0.01) were independently correlated with the presence of NDKD in patients with type 2 diabetic kidney disease. After 1∶1 matching by sex, age, duration of diabetes and renal function, there was no significant difference in prognosis between MIX and DKD groups (Log-rankχ²=1.138,P=0.286). The presence of retinopathy [hazard ratio (HR): 2.162, 95%CI: 1.056-4.428, P=0.035] and urinary protein excretion rate≥3.5 g/24 h (HR: 2.387, 95%CI: 1.018-5.552, P=0.045) were independent risk factors for adverse renal outcomes of patients in MIX group.

DKD patients with shorter duration of diabetes, higher eGFR and no anemia seems more likely to be complicated with NDKD.

To study the relationship between renal sinus fat (RSF) and estimated glomerular filtration rate (eGFR) in patients with type 2 diabetes mellitus (T2DM).

A total of 260 hospitalized T2DM patients in The First Affiliated Hospital of Chongqing Medical University from January 2014 to July 2018 were recruited in this study. The volume of the RSF were assessed with CT. Patients were divided into 2 groups: high percentile group (RSF≥11.4 cm³, 130 cases), and the low percentile group (RSF<11.4 cm³, 130 case). Fasting plasma glucose, blood uric acid, blood lipids and other metabolic indicators were measured, and the body mass index, eGFR and urine albumin-to-creatinine ratio (UACR) were calculated. Thet test and χ² test were used to compare the differences between the two groups. The relationship between RSF and eGFR or UACR were analyzed by Pearson correlation analysis and multivariate linear regression analysis.

In Chinese T2DM patients, compared with the low percentile group, there was a larger proportion of male patients [68.5% (89/130) vs 43.8% (57/130)], with long history of hypertension (HBP), smoking and drinking in high percentile group. Body mass index [25.0 (22.8, 28.4) vs 24 (21.5, 26.2) kg/m²] and blood uric acid levels [326 (277, 388) vs 293 (228, 361) μmol/L] were higher in higher group, while the level of high-density lipoprotein-cholesterol (HDL-C) [0.9 (0.80, 1.20) vs 1.0 (0.90, 1.38) mmol/L] and eGFR [(85.2±30.3) vs (93.0±29.4) ml·min^－1·(1.73 m²)^－1] were significantly lower (all P<0.05). The univariate linear correlation analysis showed that eGFR were positively correlated with fasting plasma glucose, glycated hemoglobin A_1c, low-density lipoprotein-cholesterol and HDL-C (r=0.160, 0.166, 0.134, 0.143, all P<0.05), whereas negatively correlated with gender, age, duration of diabetes, HBP, serum creatinine,serum uric acid,RSF and UACR (r=-0.587--0.134, all P<0.05). The multiple linear regression analysi revealed that RSF was inversely related with eGFR (β=-0.155,P=0.021) and but not with UACR (β=0.136, P=0.073).

In Chinese T2DM patients, the RSF is independently related to the decline of eGFR.

To explore the mechanism of Klotho reducing the mesenchymal transdifferentiation of renal tubular epithelial cells (HK-2) by inhibiting the expression of microRNA (miR)-21a-5p in HK-2 under high glucose conditions.

HK-2 cells cultured in vitro were divided into low glucose (LG) group, high glucose (HG) group (30 mmol/L glucose), and hyperosmolar (HM) group (30 mmol/L mannitol). According to the time of high glucose stimulation, HK-2 cells were divided into 0, 12, 24 and 48 h. According to pcDNA3.1-Klotho/pcDNA3.1-Vector transfection and low/high glucose stimulation, HK-2 cells were divided into: LG group, HG group, HG+pcDNA3.1-Vector group and HG+pcDNA3.1-Klotho group. According to si-Klotho/si-Negative transfection and low/high glucose stimulation and whether adding pyrrolidine dithiocarbamate (PDTC), HK-2 cells were divided into sixgroups: LG+si-Klotho group, LG+si-Negative group, LG+si-Klotho+PDTC group, HG+si-Klotho group, HG+si-Negative group and HG+si-Klotho+PDTC group. Chromatin immunoprecipitation (CHIP) test groups included: LG+pcDNA3.1-Vector group, HG+pcDNA3.1-Vector group and HG+pcDNA3.1-Klotho group. The expression of miR-21a-5p was detected by real-time polymerase chain reaction; the protein expression of Klotho, fibronectin (FN), α-smooth actin (α-SMA), nuclear factor kappa-B (NF-κB) and NF-κB inhibitor (IκB) were evaluated by Western blot; the direct effect of NF-κB on the promoter of miR-21a-5p was detected by CHIP. The t test analysis was used for comparison between two groups, and one-way ANOVA was used for comparison among multiple groups.

Compared with the LG group, the protein expression of Klotho in the HG group was decreased to 60.8% (P<0.05), the expression of miR-21a-5p was increased to 3.203 times (P<0.01), and the expression of FN and α-SMA were increased significantly. With the prolonged time of high glucose stimulation, the expression of Klotho was gradually decreased, while the expression of miR-21a-5p was gradually increased, the trend was in the opposite direction (P<0.05). Compared with the LG group, the expression levels of nucleoprotein NF-κB and miR-21a-5p in the HG group were increased to 2.934 times and 3.154 times (bothP<0.01) respectively; while overexpression of Klotho can reduce the expression of NF-κB and miR-21a-5p to 50.18% and 49.24% (bothP<0.05) of the HG group. The CHIP results showed that compared with the LG+pcDNA3.1-Vector group, the combination of NF-κB and miR-21a-5p promoter was increased to 3.121 times (1.000±0.742 vs 3.121±0.115,P<0.01) in the HG+pcDNA3.1-vector group; while overexpression of Klotho can significantly reduce the high combination of NF-κB and miR-21a-5p promoter to 54.21% (3.121±0.115 vs 1.692±0.073,P<0.01).

Klotho can reduce the mesenchymal transdifferentiation of renal tubular epithelial cells by inhibiting the binding of NF-κB and miR-21a-5p promoter and reducing the expression of miR-21a-5p under high glucose conditions.

To investigate the relationship between urinary albumin and urinary creatinine ratio (UACR) and cardiovascular autonomic neuropathy (CAN) in patients with type 2 diabetes mellitus (T2DM).

A total of 385 hospitalized T2DM patients in Shanghai Jiaotong University Sixth People′s East-hospital from July 2019 to December 2019 were selected by random sampling method. All patients underwent standard cardiovascular reflex tests (CART) and recorded clinical and biochemical parameters. According to the diagnostic criteria of diabetic kidney disease (DKD), UACR was divided into normal albuminuria, microalbuminuria and a large amount of albuminuria group, and the correlation between urine albumin and CAN was observed. Kruskal-Wallis test were used for comparison between groups. Count date using χ² test. Spearman correlation analysis and binary logistic regression analysis were performed.

The prevalence of CAN was 54.3% (209/385). Normal albuminuria combined with CAN accounted for 46.1% (119/258), microalbuminuria group accounted for 63.6% (56/88), and large albuminuria group accounted for 87.2% (34/39), the difference among three groups was statistically significant (P<0.01). Compared with normal albuminuria group, the Valsalva RR value, the deep respiratory heart rate were smaller in the microalbuminuria group and the large albuminuria group (P<0.05), while the vertical position blood pressure difference was larger (P<0.05). Spearman correlation analysis showed that UACR was negatively correlated with Valsalva R-R value, deep respiratory heart rate difference, and deep respiratory heart rate (r=-0.236, -0.180 and -0.202, P<0.01), but positively correlated with the vertical position blood pressure difference (r=0.116 and 0.182, P<0.03). Stepwise regression analysis was carried out while CAN as the dependent variable. Age, BMI, UACR and HOMA-IR were independent factors of CAN.

UACR was associated with the occurrence of CAN in patients with T2DM, and HOMA-IR maybe a risk factor for the occurrence of CAN.

To evaluate the longitudinal association of glycated hemoglobin A_1c(HbA_1c) and 10-year all-cause mortality in a group of older men with type 2 diabetes mellitus (T2DM) and favorable health care.

A total of 256 older male patients (≥60 years old) with course of T2DM for an average of 10.4 years were selected from an annual physical examination population from a Beijing upper first-class hospital in 2008, and 233 of them finished the follow-up. All patients were grouped according to the tertile of HbA_1c levels(the lowest HbA_1c group: HbA_1c<6.2%; the intermediate HbA_1c group: HbA_1c 6.2%-6.8%; the highest HbA_1c group: HbA_1c>6.8%). Kaplan-Meier survival curve was used to compare 10-year survival rates of patients with different baseline HbA_1c levels. Cox hazards regression analysis with restricted spline were implemented to investigate the association of baseline HbA_1c level and 10 years all-cause mortality risk.

The mean age of the participants was (78.1±8.6) years old. The 10-year survival rates of those who were in the lowest, intermediate, and highest HbA_1c groups were 66.3%, 63.9%, and 51.3%, respectively (P<0.01). Cox proportional hazards regression analysis showed that the baseline HbA_1c level was positively associated with 10 years all-cause mortality risk, and the univariate hazard ratio was 1.33 (95% confidence interval: 1.08-1.65) for each unit (1%) increase of baseline HbA_1c level. After adjustment for confounders including age, body mass index, smoking, alcohol consumption, blood pressure, complications, medications, fasting blood glucose, hemoglobin, serum uric acid, blood lipids, liver function and estimated glomerular filtration rate, the hazard ratio of the 10-year all-cause mortality risk was 1.55 (95% confidence interval: 1.20-2.02) for every unit (1%) increase of baseline HbA_1c level. Restricted spline Cox regression curve showed that patients with baseline HbA_1c≤6.5% had the lowest 10 years mortality risk. When baseline HbA_1c>6.5%, the 10-year all-cause mortality risk increased gradually with the increase of HbA_1c level.

In a group of good healthcare older men with T2DM, the baseline HbA_1c level was positively associated with 10-year all-cause mortality risk. Patients with HbA_1c≤6.5% had the lowest 10-year mortality risk, which suggests that the older patients with T2DM may also benefit from well-designed glycemic control.

To investigate the relationship among systolic blood pressure (SBP), pulse pressure (PP) variability and diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM).

According to the results of dilated funduscopic examination in patients with T2DM, a total of 3 275 patients without DR in Lee′s Joint Clinic in Taiwan from 2002 to 2014 were included as baseline in the study, mean age was (65.53±12.24) years, with an follow-up of 3-10 years. Intrapersonal mean and SDs of all recorded SBP and PP measurements were calculated. SBP-SD and PP-SD represented the measure of SBP variability and PP variability. Participants were divided into four quartiles based on their SBP-Mean (130 mmHg, 1 mmHg=0.133 kPa) and SBP-SD (11.16 mmHg): Q₁ (SBP-Mean<130 mmHg, SBP-SD<11.16 mmHg);Q₂ (SBP-Mean<130 mmHg, SBP-SD≥11.16 mmHg);Q₃ (SBP-Mean≥130 mmHg, SBP-SD<11.16 mmHg);Q₄ (SBP-Mean≥130 mmHg, SBP-SD≥11.16 mmHg). Participants were reclassified into quartiles based on their PP-Mean (80 mmHg) and PP-SD values (6.53 mmHg). Cox regression analysis was used to assess the relationship between blood pressure variables and DR.

Adjusted for age, sex and diabetes duration, cox regression revealed that SBP and PP variability were the risk factors for DR. Patients in Q₄ group had the highest DR prevalence [hazard ratio (HR)=1.980, P<0.01] whileQ₁ group had the lowest. In addition, patients in Q₃ group (HR=1.409, P<0.01) had a higher risk of DR than those inQ₂ group (HR=1.353, P<0.01). After stratification of participants by PP, it was found that patients inQ₂′ group had the highest risk of DR (HR=2.086, P<0.01) whileQ₁′ group had the lowest. In addition, patients in Q₄′ group (HR=1.507, P<0.01) had a higher risk of DR than those inQ₃′ group (HR=1.289, P<0.01).

SBP and PP variability are the predictors of DR in patients with T2DM. They may play greater roles in DR development than mean SBP and PP do.

To investigate risk factors for glucose metabolism disorder at postpartum in women with gestational diabetes mellitus (GDM).

In this prospective Cohort study, women with GDM were enrolled in Peking University Third Hospital from January 2016 to December 2017 and evaluated with 75 g oral glucose tolerance test at 6 to 12 week and 1 year follow-up at postpartum. The main outcome was glucose metabolism disorder, including impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM). Kaplan-Meier survival analysis and Cox multivariate regression analysis were used to determine the independent risk factors for glucose metabolism disorder in women with GDM after their delivery.

A total of 923 women with GDM were screened and 267 were enrolled for this study. Among the eligible participants, 244 (91.4%) and 160 (60.0%) women completed the 12 week and 1 year follow-up, respectively. In this study, 24(9.8%) GDM women developed T2DM, 6 (2.5%) developed IFG and 89 (36.5%) had IGT during the one year follow-up. Pregestational overweight (HR 1.519, 95%CI 1.017 to 2.267) and 1 h blood glucose ≥10.1 mmol/L during the GDM diagnosis (HR 1.546, 95%CI 1.011 to 2.365) were the two independent risk factors for glucose metabolism disorder at postpartum in women with GDM.

Pregestational overweight and 1 h blood glucose ≥10.1 mmol/L during the GDM diagnosis are the important predicting factors for glucose metabolism disorder at postpartum in women with GDM.

To explore the association between pre-delivery serum glycated albumin (GA) level and offspring birth weight in patients with gestational diabetes mellitus (GDM).

This is a retrospective study. GDM patients who had regular antenatal examinations and full-term delivery at our hospital from January 2014 to December 2017 were included in this study. Clinical data, including general information, pre-pregnancy body mass index (BMI), pre-delivery BMI, weight gain during pregnancy, GA level at one week before delivery, gestational age at parturition and neonate birth weight were collected. Pearson correlation analysis was used to analyze the correlation factors of neonate birth weight. The association of risk for neonate overweight (defined as birth weight ≥ 3.5 kg) with GA grading variables was analyzed using binary logistic regression.

A total of 108 GDM patents were enrolled in this study. The birth weight of offspring was positively associated with pre-pregnancy BMI, pre-delivery BMI, weight gain during pregnancy and pre-delivery GA level (r=0.251 to 0.561, all P<0.05). The relative risk of neonate overweight in the two groups of GDM patients with pre-delivery GA levels of 13%-15% and ≥15% was higher than in those with the GA level of<11%. The OR (95%CI) was 6.786 (1.642-28.041) and 12.667 (2.002-80.142), respectively.

Among GDM patients with full-term birth, an increased risk of neonate overweight was associated with higher pre-delivery GA level.

To explore the effect of blood glucose level on the thickness and quality of anterior ulnar muscle and vastus lateralis muscle.

A retrospective study was conducted by collecting the data of patients hospitalized in the Geriatric Department of the First Hospital Affiliated to Nanjing Medical University from June 2018 to January 2019. One hundred and thirty people were included in this study. According to the Chinese diabetes diagnosis standard in 2017, they were divided into normal group (38 cases), abnormal glucose tolerance group (47 cases) and diabetes group (45 cases). The thickness of anterior ulnar and vastus lateralis muscle were detected by ultrasound and the quality of region of interested (ROI) was analyzed by QLAB software. Single factor analysis of variance was used to compare the measurement data among the three groups. Pearson correlation analysis was used to analyze the correlation between glycated hemoglobin, fasting blood glucose and muscular variables. Multiple regression analysis was used for multiple factor analysis.

There was no significant difference in the thickness of anterior ulnar muscle and lateral femoral muscle among the three groups (P>0.05). However, there was significant difference in the muscle quality of anterior ulnar muscle and lateral femoral muscle among the three groups (P<0.05); Compared with normal group, the muscle quality were significantly increased in impaired glucose tolerance group and diabetes group. There was a positive correlation between fasting blood glucose and ROI of vastus lateralis muscle (r=0.233, P<0.01), between glycated hemoglobin A_1c (HbA_1c) and ROI of anterior ulnar muscle (r=0.293, P<0.01), and between HbA_1c and ROI of lateral femoral muscle (r=0.278, P<0.01). Multiple linear regression model analysis showed that there was still a positive correlation between glycosylated hemoglobin and the quality of lateral femoral muscle and anterior ulnar muscleafter adjusting for factors which will affect muscular quality and muscle mass including age, body mass index, albumin and blood lipid (β=0.337,P=0.041; β=0.517, P=0.014).

The muscle quality in patients with abnormal glucose tolerance is impaired and then followed by a decrease in muscle mass. Moreover, glycosylated hemoglobin has a better correlation with muscle quality than fasting blood glucose.

To compare clinical characteristics between the types of insulin antibody related syndromes-insulin autoimmune syndrome (IAS) and exogenous insulin antibody syndrome (EIAS).

A total of 22 patients diagnosed with IAS (n=13) or EIAS (n=9) were recruited from Chinese PLA General Hospital between January 2006 and March 2018. A retrospective analysis was conducted using their clinical characteristics such as age, gender, body mass index (BMI), fasting plasma glucose, postprandial plasma glucose, fasting serum insulin, post load serum insulin, fasting serum C-peptide, post load serum C-peptide, glycated hemoglobin A_1c (HbA_1c) and spontaneous remission rates of hypoglycemia which were compared with t test or chi square test.

A total of 22 patients were included for final analysis. There were no significant differences in age, male female ratio and BMI between the two groups (all P>0.05). There were significant differences in fasting plasma glucose [(4.2±1.8) vs (10.2±5.1) mmol/L,t=3.254, P<0.01], postprandial plasma glucose [(9.6±4.9) vs (19.3±6.6) mmol/L,t=5.240, P<0.01] and HbA_1c [(6.9±1.9)% vs (12.6±1.3)%, t=4.454, P<0.01] between IAS and EIAS groups. Otherwise, there was no difference in fasting serum insulin [923.5 (287.1, 3 714.4) vs 480.0 (278.9, 851.9) mU/L], C-peptide [5.1 (3.3, 13.2) vs 4.1 (1.8, 6.8) ng/ml], insulin/C-peptide molar ratio (5.3±6.6 vs 3.4±2.2) and post load serum insulin [4 069.0 (835.5, 6 921.3) vs 968.7 (381.1, 3 113.0) mU/L], C-peptide [14.6 (12.3, 24.4) vs 7.6 (2.6, 16.3) ng/ml] and insulin/C-peptide molar ratio (5.7±6.0 vs 4.3±3.3) between IAS and EIAS groups (allP>0.05). There was no significant difference in the spontaneous remission rate of hypoglycemia between the two groups [69% (9/13) vs 67% (6/9),P>0.05].

There are no significant differences in demographic and insulin, C-peptide, spontaneous remission rates, treatment strategy and prognosis except plasma glucose between IAS and EIAS.

Through mitochondrial gene detection in early-onset non-obese diabetic patients, patients with mutant genes were screened and their clinical characteristics were explored.

A retrospective analysis of unrelated patients with early-onset diabetes in People's Hospital of Xinjiang Uygur Autonomous Region from 2018 to 2019 was included in the study. General data of patients, diabetic complications, hearing tests, and related laboratory findings were collected and recorded. The mitochondrial mutant gene was sequenced and 61 loci were detected. AdopttTest, X² test, Fisher test and rank sum test were used to compare the differences of measurement data and count data between the groups.

A total of 73 patients were included, including 36 patients with mutant genes, 28 patients (78%) with single mutant genes, and 8 patients (22%) with ≥2 mutant genes; Among them, 19 cases (53%) carried the T16189C mutation gene. The homeostatic model with only one mutant genome assessed a low insulin resistance index compared with no mutant genome, and the difference between the two groups was statistically significant (P=0.040）； The genome carrying only the T16189C mutation suffered from diabetic retinopathy significantly more, and the fasting C-peptide level was lower, and the differences were statistically significant (Pvalues of 0.024, 0.044, respectively). Compared with those who do not carry mutant genes, those with mutant genes have a younger onset age, start insulin therapy earlier, have a maternal genetic history, lower C-peptide levels, earlier onset of diabetic retinopathy, milder insulin resistance, and some patients are also accompanied by hearing impairment, especially those with T16189C and ≥2 mutations.

Genetic testing is recommended for early-onset non-obese diabetic patients with maternal genetic history, short time from diabetes diagnosis to insulin initiation, low fasting C-peptide level, hearing impairment and early onset of diabetic retinopathy, so as to improve the detection rate of mitochondrial diabetes.

The author reports a case of an 11-year-old female child who went to the doctor because of short stature and later found acanthosis nigricans and hyperinsulinemia. The DNA extracted from the peripheral blood of the child and his family was collected, and the pathogenic mutations of the child were analyzed by whole exome sequencing and Sanger sequencing. It was found that the patient carried the heterozygous missense mutation c.3470A>G (p.H1157R) in exon 19 of the human insulin receptor gene. Neither of his parents carried this mutation, which was consistent with a newborn mutation.

Diabetic nephropathy (DKD) is a renal damage caused by chronic hyperglycemia and is a major factor leading to end-stage renal failure. Long-term hyperglycemia and a series of pathophysiological changes derived from it are the common pathogenic pathways causing DKD, but the specific mechanisms are complex. Oxidative stress is the common basis of kidney injury caused by hyperglycemia, and plays a key role in the occurrence and development of DKD. Reducing kidney oxidative stress may be a new therapeutic target of DKD.

The closed-loop insulin infusion system, through the core control algorithm, can automatically adjust the infusion dose and rate of insulin pump according to the glucose data obtained by real-time monitoring, so as to achieve the goal of simulating the physiological function of pancreatic islets to the maximum extent. The application of closed-loop insulin infusion system can provide better glycemic control, reduce the risk of hypoglycemia and improve the quality of life for patients with type 1 diabetes.

With the global epidemic of obesity and type 2 diabetes mellitus (T2DM), various metabolic abnormalities, organ function damage and cardiovascular and cerebrovascular hazards associated with T2DM pose a serious threat to human health. Therefore, actively losing weight, lowering glucose and improving metabolic disorders are effective methods for the treatment of obesity with T2DM. Although traditional drug treatment and lifestyle adjustment have played a certain role, it is difficult to achieve long-term weight loss and hypoglycemic effects for severe obesity patients with T2DM due to poor compliance. In recent years, metabolic surgery is considered to be the most effective treatment for weight loss and hypoglycemia, which can achieve long-term weight loss and stable hypoglycemia. Therefore, for the treatment of obesity with T2DM, multi-disciplinary combined treatment and centralized construction with disease as the center are needed to achieve the optimal therapeutic effect.

Bariatric metabolic surgery (BMS) is currently one of the treatments for obesity with type 2 diabetes. It can reduce glycosylated hemoglobin, fasting blood glucose and body mass index of patients, reduce the dosage of hypoglycemic drugs, and improve microvascular and macrovascular complications. In BMI<35 kg/m²It can also be applied in the population and the obese adolescent population. However, it was also found that the risk of kidney stones, alcoholism, suicide, falls and fractures increased after BMS. This paper reviews the relevant developments and concludes that the benefits of BMS outweigh the risks. Effective perioperative assessment and surgical access are critical.