Volume 13 · Issue 02 · 2021

By interpreting the American Diabetes Association "Expert Consensus on Self-management Education and Support of Adult Type 2 Diabetes (2020 Edition)", this paper reviews the current situation of self-management of adult type 2 diabetes in China, summarizes the practice and benefits of self-management education and support of type 2 diabetes in the world, thinks about the current situation and research progress of self-management of type 2 diabetes in China, and puts forward promotion strategies. It is suggested to establish the concept of diabetes self-management and multidisciplinary cooperation, and establish a system of timely referral and reimbursement. Make full use of existing scientific and technological means, implement the seamless connection of diabetes self-management, establish a diabetes self-management system suitable for China's national conditions, and optimize the prevention and treatment mode of diabetes.

The prevalence of diabetes in my country has soared from 0.67% in 1980 to 11.2% in 2017. Medical nutritional therapy is the basis of diabetes treatment. A fixed dietary rhythm helps diabetic patients discover the changes of their postprandial blood sugar, and can help doctors adjust the dosage of drugs for diabetic patients. It is particularly important to understand the influence of dietary rhythm on blood sugar control when making individualized dietary arrangements, which is more conducive to blood sugar control and complication prevention in diabetic patients, and is also the key to improving compliance.

Adult occult autoimmune diabetes (LADA) is an adult-onset and slowly progressing autoimmune disease, accounting for 2% to 12% of all adult-onset diabetic patients. At present, the diagnosis and management of LADA patients are still controversial in the world. In August 2020, the international expert group issued a consensus, namely "International Expert Group Consensus: Management of Adult Occult Autoimmune Diabetes". The consensus summarizes the characteristics of LADA, reviews and evaluates the current treatment options, emphasizes the treatment strategies and management paths of LADA, and recommends the classification and management of LADA patients according to C-peptide levels. The author interpreted the relevant contents of this consensus, aiming at providing reference for peers.

Combined with the guidelines of the International Diabetic Foot Working Group and the guidelines for the prevention and treatment of diabetic foot in China issued by the Diabetology Branch of Chinese Medical Association, the author interpreted the article on the diagnosis of diabetic foot osteomyelitis, aiming at improving the level of understanding and diagnosis.

The author excerpted and interpreted the article "Which diagnostic tests are useful or useless in the daily diagnosis and treatment of diabetic foot?" in order to better apply some commonly used diagnostic tests in the daily clinical work. The simple, feasible and reliable methods for diagnosing peripheral neuropathy are nylon wire tactile sensation, light touch test and tuning fork vibration sensation; Foot artery pulsation palpation and ankle-brachial index were used to diagnose peripheral arterial lesions. The most significant laboratory tests for diagnosing osteomyelitis are erythrocyte sedimentation rate, C-reactive protein and X-ray photography. No index can independently diagnose osteomyelitis. If the possibility of osteomyelitis is suspected in clinical work, it is necessary to combine the results of multiple tests to comprehensively judge. To master the application value and limitation of these clinical trials in clinical work, we can make clinical decisions more scientifically and reasonably.

To investigate the difference of fear of hypoglycemia (FoH) and quality of life between patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

A total of 21 patients with T1DM and 269 patients with T2DM in Departments of Endocrinology from three tertiary hospitals in Tianjin from February to August, 2019 were investigated by multicenter sampling. Among them, 156 cases (53.8%) were males and 134 cases (46.2%) were females, with an average age of (55.12±9.54) years old. All the subjects were surveyed by the questionnaires including the general information questionnaire, the Chinese version of Hypoglycemia Fear Survey Ⅱ-Worry Scale (CHFSⅡ-WS), the medical outcomes study item short Form health survey (SF-36), and the World Health Organization Five-item Well-Being Index (WHO-5). Kruskal-Wallis H test or Mann-Whitney U test was used for the measurement data, one-way analysis of variance (ANOVA) was used for comparison between groups. Chi-square test was used for statistical data. Multivariate linear regression was used for multivariate analysis.

The differences of frequency and type of hypoglycemia between T1DM and T2DM patients were statistically significant (χ²=80.648, P<0.05;χ²=118.856, P<0.05). Scores of CHFSⅡ-WS, WHO-5, physiological function (PF), physical pain (BF), overall health (GH), social function (SF), emotional function (RE), mental health (MH), health change (HT) dimension of SF-36 were significantly different between patients with T1DM and T2DM (allP<0.05). There were significant differences in the scores of PF, SF and HT of CHFSII-WS and SF-36 among the diabetic patients with different types of hypoglycemia (allP<0.05). Multiple linear regression analysis showed that diabetes mellitus type, WHO-5 score, sex, mental health, regular examination and economic status were the independent influencing factors of FoH (partial regression coefficient was -1.621, 0.027, 0.407, -0.010, 0.479, -0.226, allP<0.05).

The frequency, severity and fear level of FoH in T1DM patients are higher than those in T2DM patients. Hypoglycemia not only increases the fear level of hypoglycemia, but also affects the quality of life and mental health of patients.

To evaluate current status and influencing factors of diabetes distress in patients with type 1 diabetes mellitus (T1DM).

A total of 199 diabetes with T1DM treated in Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School from August, 2019 to January, 2020 were enrolled and investigated via general information questionnaire, T1DM Distress Scale (T1-DDS), Medical Coping Modes Questionnaire and Perceived Social Support Scale. The independent sample t test and one-way analysis of variance (ANOVA) were used in the intergroup comparison. Pearson correlation analysis was used to analyze the correlation between psychological distress score and coping style, social support in T1DM patients. The multiple linear regression analysis was used to analyze the influencing factors of diabetes distress in T1DM patients.

Among the 199 T1DM patients, 173 patients had diabetes distress, and the detection rate was 88.44%, the average score of T1-DDS was (2.15±0.61) points. The distress score of T1DM patients was negatively correlated with coping styles, avoidance coping styles, family support and friend support dimensions (r=-0.867--0.407, P<0.01); meanwhile, the distress score of T1DM patients positively correlated with yield coping style (r=0.407-0.749, P<0.01), and not correlated with other supportive dimensions (P>0.05). The multiple linear regression analysis showed that the total pain score of T1DM was correlated with the number of people living together (β=-0.116), complications (β=0.091), severe hypoglycemia events (β=0.061), coping, avoidance, and yield coping methods (β=-0.118, -0.177, 0.116), family support (β=-0.363), and friend support scores (β=-0.171, all P<0.05).

The distress of T1DM patients is at a moderate level. The influencing factors include residence status, diabetic complications, recent severe hypoglycemia events, disease coping styles and social support.

To explore the workload and job satisfaction of diabetes specialist nurses (DSN) in Chinese hospitals and clarify the influencing factors of job satisfaction.

From October to December, 2018, a total of 3 918 DSN were enrolled by using of convenient sampling method in China and demographic data. The current workload of DSN, and job satisfaction were collected using a self-designed questionnaire via WJX platform. Independent sample t test was used for the comparison between dichotomous variables, one-way analysis of variance (ANOVA) was used for the comparison between multiple categorical variables, Pearson correlation analysis was used for the correlation analysis of two continuous variables, and multiple linear regression method was used for the multivariate analysis of job satisfaction of DSN.

A total of 1 920 (49.0%) DSN spent most of the time in diabetes-related work and only 975 (24.9%) were very satisfied. Multivariate linear regression analysis showed that regional, department, professional title, years of diabetes care, work capability enhancement after training, specialist nurses system, proportion of diabetes-related work, diabetes clinical nursing, diabetes education, consultations and providing guidance for primary diabetes care were the influencing factors of job satisfaction (β=-0.210, 0.046, -0.101, -0.008, 0.075, -0.160, -0.200, 0.051, -0.039, -0.046, -0.065, respectively, all P<0.05).

The proportion of diabetes-related work and job satisfaction need to be further improved.

To compare the effects of exenatide and insulin aspart 30 injection on carotid intima-media thickness (cIMT) in patients with type 2 diabetes mellitus (T2DM) with different baseline characteristics, and to explore the influencing factors of exenatide in improving atherosclerosis (AS).

A total of 59 patients with T2DM who were admitted to the Department of Endocrinology of Beijing Hospital from March 10, 2015 to June 20, 2017 were enrolled. The study was designed as a randomized, prospective, parallel positive drug control study. According to the baseline cIMT <1 mm and ≥1 mm, the patients were divided into the following groups: baseline non-atherosclerotic group and baseline atherosclerotic group; according to body mass index (BMI)<24 kg/m ² and ≥24 kg/m², they were divided into normal weight group, overweight and obesity group; according to the baseline glycosylated hemoglobin A_1c (HbA_1c)<8.5% and HbA_1c≥8.5%, they were divided into general hyperglycemia group and significant hyperglycemia group; according to the decrease of HbA_1c<1.5% and HbA_1c ≥1.5% at 52th week, the patients were assigned to the general hypoglycemic effect group and the good hypoglycemic effect group. The cIMT was measured. The results of each group were compared by group t test, nonparametric test and χ² test.

The prevalence rate of carotid atherosclerosis in patients with T2DM was 64.41% (38/59). After 52 weeks of treatment with exenatide, the cIMT of patients with baseline AS was significantly lower than that of patients without baseline AS (P=0.02). After 52 weeks of treatment with exenatide, the cIMT decreased in overweight and obese subjects, but slightly increased in normal weight subjects, and the difference was not statistically significant (P=0.21). After 52 weeks of treatment, the cIMT decreased in both the general hypoglycemic effect group and the good hypoglycemic effect group, but the difference was not statistically significant (P=0.17). After treatment with exenatide, there was no correlation between cIMT changes and blood glucose, low density lipoprotein cholesterol and BMI changes within 52 weeks (P=0.576, 0.188 and 0.352, respectively).

In patients with atherosclerosis at baseline, the improvement of cIMT was more significant and the benefit was greater after the administration of exenatide. cIMT levels were not affected by baseline body weight and hypoglycemic efficacy, and had no correlation with BMI and blood glucose changes after exenatide treatment.

To analyze the possible mechanism of adiponectin in the development of breast cancer patients with type 2 diabetes mellitus (T2DM).

A total of 50 breast cancer patients hospitalized in the Department of Thyroid and Breast Surgery of the First Affiliated Hospital of Anhui Medical University from January to June 2016 were selected in this study. According to whether or not combined with T2DM, the patients were divided into the breast cancer with T2DM group (20 cases) and the breast cancer without T2DM group (30 cases). The breast cancer tissue specimen of the diabetic breast cancer patients was classified as DBCC group, the normal breast tissue specimen of the diabetic breast cancer patients was classified as DBCN group, the breast cancer tissue specimen of the non-diabetic breast cancer patients was classified as BCC group, and the normal breast tissue specimen of the non-diabetic breast cancer patients was classified as BCN group. Fasting plasma glucose (FPG), fasting insulin (FINS), serum lipid, total adiponectin, and high molecular weight adiponectin were detected, and homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. The expression of receptor for advanced glycation end products (RAGE), Cyclin D1 and NF-κB in the tissue specimens were detected by Western blot and quantitative reverse transcription polymerase chain reaction (qRT-PCR) in each group. Group differences were compared by independent-samples t test, and the histological indicators among the four groups were analyzed by analysis of variance (ANOVA) and the LSD-t test of pairwise comparison.

Serum adiponectin [(5.35±1.22) vs (7.29±1.90) mg/L, respectively] and high molecular weight adiponectin [(3.33±0.87) vs (4.41±1.15) mg/L, respectively] in diabetic breast cancer patients were lower than those in non-diabetic breast cancer patients (P<0.05). The correlation analysis showed that serum adiponectin level and high molecular weight adiponectin level were negatively correlated with HOMA-IR(r=-0.916, -0.950, respectively, P<0.05) and tumor size (r=-0.896, -0.909, respectively, P<0.05). The expression of both protein and mRNA of RAGE, NF-κB, Cyclin D1 in DBCC group was higher than that in BCC group and DBCN group (P<0.05). The expression of adiponectin protein and mRNA in DBCC group was lower than that in DBCN group, BCC group and BCN group (P<0.05). Pearson correlation analysis showed that serum adiponectin level was negatively correlated with the expression of RAGE, Cyclin D1 and NF-κB (P<0.05). The expression of adiponectin in breast cancer tissue was negatively correlated with the expression of RAGE, NF-κB and Cyclin D1 (P<0.05).

In the type 2 diabetic breast cancer patients, the serum adiponectin level decreased, the expression of adiponectin in cancer tissues decreased, while the expression of RAGE, Cyclin D1 and NF-κB increased. Adiponectin might play a role in the development of breast cancer patients with T2DM through RAGE-NF-κB-clyin D1 signaling pathway.

To explore the relationship between lipid accumulation product (LAP) and abnormal glucose metabolism in the participants recruited from Jiangxi Province.

This study conducted a cross-sectional survey on community neighborhood communities in 14 cities and towns in Jiangxi Province from March to July 2018. A multi-stage stratified random sampling method was used to recruit 4 790 residents aged 18 and above, and a questionnaire survey (including demography, subject characteristics, drug history, lifestyle and psychological conditions, etc.), physical examination[measure and calculate height, weight, waist circumference, blood pressure, body mass index (BMI), waist to height ratio (WHtR), LAP and visceral adiposity index (VAI)] and laboratory examination [fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C)] were conducted on all subjects. Diagnose diabetes and pre-diabetes according to the diagnostic criteria of theChinese Guidelines for the Prevention and Treatment of Type 2 Diabetes (2017 edition). Kruskal-Wallis H method and multivariate logistic regression model were used to analyze the relationship between different LAP levels (quartiles) with pre-diabetes and diabetes.

There were 2 996 patients in the normal glucose tolerance group, 1 097 patients in the pre-diabetes group, and 697 patients in the diabetes group. In the 3 groups, age, systolic blood pressure, diastolic blood pressure, BMI, waist circumference, LAP, VAI, FPG, 2hPG, TC, TG and LDL-C increased with the increase of glucose metabolism severity, while HDL-C decreased (all P<0.05). According to the LAP quartile, there were 1 196 cases in group Q1 (LAP<16.52), 1 198 cases in group Q2 (16.52≤LAP<29.52), 1 195 cases in group Q3 (29.52≤LAP<50.22) and 1 201 cases in group Q4 (LAP≥50.22).With the increase of LAP level, the prevalence of pre-diabetes and diabetes showed an increasing trend, and the difference was statistically significant (P<0.01). After adjusting for gender, age, education, family history of diabetes, family income, smoking and drinking histories, exercise status, blood pressure, and BMI, the highest LAP level group showed higher risk for pre-diabetes and diabetes with OR(95%CI) 2.94 (2.26 to 3.83) and 5.00 (3.58 to 6.97), respectively.

LAP is closely related to abnormal glucose metabolism. The individuals with higher LAP showed higher risk of pre-diabetes and diabetes, and it has certain clinical value for early warning of abnormal glucose metabolism.

To explore the influence of education level and treatment compliance on metabolic control of type 2 diabetes mellitus (T2DM) patients in elderly community.

This was a cross sectional study with aged ≥ 65 years with T2DM in Taikang Yanyuan Continuing Care Retirement Community. From August 2015 to July 2020, data including general characteristics, laboratory examination results, T2DM history, family history, treatment compliance, concomitant diseases and treatment regimen was collected via clinical surveys and medical reports for each patient. Patients were divided into well-controlled group (HbA_1c≤7.5%) and poorly-controlled group (HbA_1c>7.5%) based on their HbA_1c levels. Logistic regression analysis was adopted to evaluate the factors that interfere with blood glucose control, with independent sample t test, rank sum test and chi square test to compare the indicators of the two groups.

Among 1 459 community residents, 330 (22.6%) were diagnosed with T2DM. There was no significant differences in age, gender, course of disease, body mass index, systolic blood pressure, diastolic blood pressure, microalbuminuria/creatinine and insulin treatment between the well-controlled group (232 cases) and the poorly-controlled group (98 cases) (P>0.05). However, significant differences were discovered in educational level, treatment compliance and low-density lipoprotein cholesterol between the two groups (P<0.05), which indicates the association among educational level, treatment compliance and blood glucose control. The β values were respectively 0.03 (95%CI 0.01 to 0.19) and 0.21 (95%CI 0.07 to 0.65),P<0.01.

These findings suggest that among the aged patients with T2DM in the elderly community, those who with high educational level and good treatment compliance are more likely to obtain ideal blood glucose control.

The incidence of type 1 diabetes mellitus (T1DM) is on the rise globally, and the age of onset tends to be younger. The importance of intestinal flora in autoimmune diseases is increasingly recognized, and recent data suggest that the intestinal flora has a pathogenic role in the pathogenesis of T1DM by regulating the autoimmune system and affecting intestinal barrier integrity. Further understanding of the mechanism of intestinal flora occurrence in T1DM may help to develop new intervention strategies to reduce the incidence of T1DM.

Diabetic foot ulcer is difficult to cure, easy to relapse, and has a poor long-term prognosis. The standard treatment effect of diabetic foot ulcer is limited, and the development of adjuvant treatment has become a new trend. At present, local oxygen therapy adjuvant treatment of diabetic foot ulcer is helpful to wound healing, especially chronic wounds, but there is still a lack of high-quality evidence-based evidence to support it, and clinicians lack understanding of local oxygen therapy. Therefore, the author reviews the relationship between wound healing and oxygen, the principle, development and evolution, common forms, advantages and disadvantages of local oxygen therapy, and the current situation of domestic development, so as to improve clinicians' awareness and attention to local oxygen therapy, so that patients with diabetic foot ulcer can benefit from it.

Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, which seriously affects the quality of life of patients, and even causes disability and death. At present, there is a lack of specific biomarkers for the diagnosis and disease assessment of DPN. Starting from the pathogenesis of DPN, the author expounds the potential biomarkers of DPN from five aspects: oxidative stress, inflammatory response, gene variation, non-coding RNA and nerve tissue damage, so as to develop new ideas for the diagnosis and treatment of DPN.

It is a common concern of scholars at home and abroad to explore new methods and technologies for the diagnosis and treatment of diabetic patients through clinical research, and to provide more clinical evidence for the diagnosis and treatment of diabetic patients in China. Choosing the appropriate clinical study design is key to producing high-quality research evidence. Taking diabetes research as an example, the author will introduce the common design types of clinical research and their applicable scope, as well as how clinical medical staff can choose the appropriate design types of clinical research.

Accurate classification of diabetes can provide scientific basis for epidemiological investigation, etiology research, complication prevention and treatment and precise treatment of diseases. According to the current diabetes classification scheme, diabetes is divided into type 1 diabetes, type 2 diabetes, special type of diabetes and gestational diabetes. With the progress of science and technology and research methods and the deepening of the understanding of diabetes mellitus, the classification of diabetes mellitus on the basis of traditional classification tends to be more and more detailed, and more and more indicators are used. This paper reviews the progress of diabetes classification by official institutions and non-governmental academic groups, and puts forward views on the confusion and future direction of accurate diabetes classification.