Volume 13 · Issue 03 · 2021

Commonly used clinical detection methods for diabetic peripheral neuropathy (DPN) can only identify moderate to severe neuropathy, which often leads to late diagnosis of DPN. Small nerve fibers will be damaged in the early stage of DPN. In recent years, many new technologies have emerged for the function and structure of small nerve fibers. The evaluation of small fiber damage and repair may be the key to evaluate the efficacy of clinical trials for the treatment of diabetic neurological complications.

Diabetic foot surgery is a key component of treatment. The author focuses on the understanding of diabetic foot surgery and the grading of surgery, the principle of surgical management of diabetic foot, Charcot foot and foot plastic surgery to explain. For patients with diabetic foot who need surgical treatment, attention should be paid to reasonable grading and early treatment. The success of surgery requires multidisciplinary combined diagnosis and treatment. The diagnosis and treatment of patients as a whole, continuous monitoring and treatment by multidisciplinary teams are also important parts of a complete prevention strategy.

To analyze the effects of different lower extremity arterial disease and tissue microcirculation on negative pressure therapy for diabetic foot ulcer, and to explore the peripheral vascular and tissue microcirculation conditions suitable for the treatment of diabetic foot ulcer with negative pressure wound therapy.

A total of 75 patients with diabetic foot ulcer (Wagner grade 2 to 3) who were hospitalized in the Diabetic Foot Treatment Center of Endocrinology and Metabolism Department of Guangxi Zhuang Autonomous Region People′s Hospital from November 2015 to November 2019 were selected. According to the results of lower extremity vascular ultrasound, ankle-brachial index (ABI) and percutaneous oxygen partial pressure (TcPO₂), the patients were divided into three groups (Group A, Group B and Group C) based on the condition of lower extremity arterial lesions and tissue microcirculation. Each group underwent negative pressure therapy for 2 weeks. Image J graphic analysis software was used to measure the ulcer area and granulation area. Wilcoxon rank sum test and Kruskal-Wallis test were used for comparison between groups. Spearman correlation analysis and multiple linear regression analysis were used to study the correlation and influencing factors of ulcer area reduction value and granulation area increase value at the end of 2 weeks negative pressure therapy.

The decrease of ulcer area, and the increase of granulation area in three groups (27, 29 and 19 cases respectively) with different lower extremity arterial lesions and tissue microcirculation at the end of 2 weeks treatment were significantly different compared with those before treatment (P<0.05). In the comparison between the three groups, there were statistically significant differences between Group C and Group A, Group B in the value and rate of ulcer area reduction over the end of 2 weeks negative pressure therapy (P<0.05).However, there was no statistical difference between Group A and Group B (P>0.05). Besides, in the comparison between the three groups, there were statistically significant differences between Group C and Group A, Group B in the value and rate of increased granulation area over the end of 2 weeks negative pressure therapy (P<0.05), but there was no statistical difference between Group A and Group B (P>0.05). In addition, the change value of ulcer area at the end of treatment for 2 weeks was correlated with the diabetic duration (r=-0.311), ABI (r=0.394), TcPO₂ (r=0.301) and lower limb vascular ultrasound (r=-0.292, P<0.05). The change value of granulation area at the end of treatment for 2 weeks was correlated with TcPO₂ (r=0.239, P<0.05) and lower limb vascular ultrasound (r=-0.207, P<0.05).The independent influencing factors of ulcer area reduction at the end of 2 weeks negative pressure therapy were ABI and diabetic course (P<0.05); the independent influencing factor of granulation area increment at the end of 2 weeks negative pressure therapy was TcPO₂ (P<0.05).

The degree of diabetic lower extremity arterial disease and tissue microcirculation play a role in the efficacy of negative pressure assisted closure technique in the treatment of diabetic foot ulcer. The more severe the lower extremity vascular disease and tissue microcirculation disorder are, the worse the effects of negative pressure wound therapy on ulcer area reduction and granulation growth are.

To investigate the therapeutic effect and analyze the influencing factors of toe amputation combined with skin edge suture in patients with diabetic toe gangrene at Wagner stage 3 to 4.

The clinical data of 45 patients with diabetic toe gangrene underwent toe amputation combined with skin edge suture in Department of Endocrinology of Air Force Medical Center from January 2016 to June 2019 were retrospectively analyzed. The patients were divided into grade A healing group and non-grade A healing group according to the postoperative wound healing. The clinical data of the two groups were compared byt test, nonparametric test and chi square test. According to whether antibiotics were applied after surgery and the course of antibiotic application, they were divided into the group without antibiotics, the group with 7 days of antibiotics and the group with 14 days of antibiotics, then wound grade A healing rates between groups were compared. According to the postoperative suture, the patients were divided into a primary suture group and a delayed suture group, and the wound grade A healing rates of both groups were compared.Kaplan-Meier survival curve analysis was used for the wound healing rate over time between primary and delayed suture groups.

Forty-five patients were included in the study. The time from suture to wound healing was 14 (14, 20) days. Among them, there were 33 (73.3%) patients of grade A healing, 11 (24.4%) patients of grade B or C healing, and 1 patient (2.2%) underwent higher level amputation. The proportion of toe branchial index (TBI) ≥0.7 in grade A healing group was higher than that in non-grade A healing group [60.6% (20/33) vs. 16.7% (2/12), χ²=5.155, P=0.023]. The proportion of postoperative antibiotics use in grade A healing group was higher than that in non-grade A healing group [84.8% (28/33) vs. 25% (3/12), χ²=12.047, P=0.001]. There were 14 cases in the group without antibiotics, 5 cases with grade A healing; 17 cases in the group with antibiotics for 1 week, 16 cases with grade A healing; 14 cases in the group with antibiotics for 2 weeks, 12 cases with grade A healing. There was no significant difference in wound healing rate between the patients who used postoperative antibiotics for 7 days and 14 days (P=0.859). There were 37 cases in primary suture group, with grade A healing rate of 78.4% (29/37), and 8 cases in delayed suture group, 4 cases with grade A healing rate.The postoperative wound healing time of primary suture group was shorter than that of delayed suture group [14.00 (14.00, 14.00) days vs. 19.50 (18.25, 28.75) days, Z=-3.591, P=0.001].

Under the effective control of soft tissue infection, toe amputation combined with primary suture and short-term anti-infective therapy is an effective treatment for patients with diabetic toe gangrene when TBI≥0.7.

To research the clinical efficacy of negative-pressure wound therapy with instillation of Carboxymethyl Chitosan Biological Glue in diabetic foot ulcer.

The study was prospective. A total of 60 patients with diabetic foot ulcers in Dongzhimen Hospital, Beijing University of Chinese Medicine were collected from February 2019 to March 2020. The patients were randomly divided into experimental group (n=30) and control group (n=30) according to the random number method. The control group was based on at the same time of treatment, normal saline drip irrigation was used for negative pressure therapy, and the experimental group was used for drip irrigation negative pressure therapy with carboxymethyl chitosan biological glue. The wound volume reduction value and the quantification and scoring criteria of the diabetic foot ulcer curative effect index were recorded in the two groups, and the t test and the rank sum test were used for statistical analysis.

In the control group, there was 1 case of leakage in the negative pressure treatment, and finally a total of 59 patients completed and were included in the statistical data. After 14 days of treatment, the wound volume of patients in the experimental group was significantly better than that of the control group [9.00 (7.75, 12.00) ml vs. 5.00 (3.00, 6.00) ml, P<0.01]; the quantification of diabetic foot ulcer curative effect index and scoring in the experimentalgroup was smaller than that in the control group (16.96±1.74vs. 20.40±7.06, P<0.05). There was no serious adverse events and reactions in the two groups.

Carboxymethyl chitosan bio-glue as a drip irrigation solution for negative pressure drip irrigation can promote diabetic foot ulcers, and the effect is better than normal saline.

To explore the recurrence and death outcomes of the patients with diabetic foot for 5 year follow-up after ulcer healing, and analyze the risk factors.

A prospective cohort study was conducted in 317 patients with diabetic foot and ulcer healing who were hospitalized in the Department of Diabetic Foot Disease of Tianjin Medical University Chu Hsien-I Memorial Hospital from January 2013 to December 2014. The ulcer recurrence and death of patients after 5 years of continuous follow-up were recorded, and binary logistic regression and Cox proportional hazard regression models were used to analyze risk factors, respectively.

Follow-up was completed in 292 of 317 patients (follow-up rate of 92.1%). The 5-year cumulative recurrence rate in follow-up patients was 71.2% (208/292), the recurrence rate of the same site was 29.8% (62/208), multiple recurrence rate was 41.3% (86/208), the highest recurrence rate was 32.7% in the forefoot area (68/208), and the ulcer recurrence rate of the 122 patients with osteomyelitis was 73.8% (90/122). The cumulative five-year mortality rate was 39.7% (116/292). The mortality rate of patients with recurrence was higher than that of patients without recurrence [44.2% (92/208) vs 28.6% (24/84), P<0.05]. Multivariate analysis showed that age, osteomyelitis, foot care behavior, caregiver reaction, glycated hemoglobin A_1c, limb extremity arterial disease (LEAD) stage, and end-stage renal disease were independent influencing factors for ulcer recurrence in patients with diabetic foot (P<0.05). Bathel index, caregiver reaction, glycated hemoglobin A_1c, LEAD stage, end-stage renal disease, and cardiac events were independent influencing factors of death (P<0.05).

The risk factors of ulcer recurrence are mainly age, osteomyelitis and foot care behavior. The risk factors for death are Bathel index and cardiac events. Moreover, caregiver reaction, glycated hemoglobin A_1c, LEAD stage Ⅳ, kidney disease stage 5 are the risk factors of both ulcer recurrence and death.

To investigate the clinical features of bullosis diabeticorum (BD), and to analyze the factors affecting the prognosis.

The clinical data of patients with BD (n=76) admitted to the Henan Provincial People′s Hospital were collected, and their clinical characteristics were summarized and analyzed. Patients were divided into two groups: good prognosis group and poor prognosis group according to the clinical outcomes after 20 days treatment period. The differences in clinical data between patients with different outcomes, including gender, age, duration of diabetes, location and size of bullae, hemoglobin (Hb), albumin (ALB), and glycated hemoglobin A_1c (HbA_1c) were detected. The Chi-square test was used to compare the clinical data between the two groups, and further logistic regression model was used to analyze the relevant factors affecting the prognosis.

The male-to-female ratio of 76 BD patients was 67/9, with an average age of (62.2±13.3) years, the course of diabetes mellitus was (11.2±7.2) years. All patients had no obvious inducement before the occurrence of bullae, tension bullae appeared on normal skin, mostly in the lower limbs; the average area was (14.9±11.7) cm², 82.9% (63/76) of patients with bullae were coinfected at admission. The clinical data of patients in good prognosis group (n=42) and poor prognosis group (n=34) were compared, the proportion of age≥60 years old, duration of diabetes≥10 days, bullous area≥20 cm², serious infections, HbA_1c≥9%, white blood cell≥9.5×10⁹/L, C-reactive protein≥10 mg/L, ALB<35 g/L and severe peripheral vascular disease in the group with poor prognosis were significantly higher than those in the group with good prognosis (P<0.05). Further logistic regression analysis showed that large bulla area, severe infection and poor glycemic control were independent risk factors for poor prognosis (allP<0.05).

BD occurs more often in elderly male diabetic patients with long diabetes duration and poor blood glucose control, and the bullae have large and variable size and shape. Bullae area, secondary infection, and poor blood glucose control are independent risk factors for prognosis, and interventions should be targeted.

To explore the correlation between hemoglobin glycosylation index (HGI) and diabetic cardiovascular autonomic neuropathy (DCAN) in patients with type 2 diabetes and the role of HGI in predicting the risk of DCAN.

This study was a retrospective study. The clinical data of 993 patients with type 2 diabetes who were hospitalized in the Endocrinology Department of the First Affiliated Hospital of Chongqing Medical University from October 2017 to May 2020 were selected. The patients′ gender, age, family history of diabetes, diabetes duration, systolic blood pressure and diastolic blood pressure, body mass index (BMI), and other data were collected, and fasting plasma glucose (FPG), glycated hemoglobin A_1c (HbA_1c), blood lipids, serum creatinine, hypersensitive C-reactive protein (hs-CRP), and other indicators were detected, and the estimated glomerular filtration rate (eGFR) was calculated. The 24-hour morning urine was collected for determination of urinary albumin creatinine ratio (UACR). Based on FPG and HbA_1c, a linear regression equation was established and HGI was calculated. According to the HGI value, the patients were divided into three groups: low-HGI (L-HGI) group, medium-HGI (M-HGI) group, and high-HGI (H-HGI) group using the three-quantile method. One-way analysis of variance (ANOVA) and chi-square test were employed to analyze the differences of baseline data among three groups, multivariate logistic regression was used to analyze the risk factors of DCAN.

Among the 993 patients with type 2 diabetes, there were 293 patients in the DCAN group and 700 patients in the non-DCAN (N-DCAN) group, and the incidence of DCAN was 29.5% (293/993). The incidence of DCAN in L-HGI group (331 cases), M-HGI group (331 cases), and H-HGI group (331 cases) was 15.1% (50/331), 28.7% (95/331) and 44.7% (148/331), respectively. The incidence of DCAN increased with the increase of HGI level, and the difference between the three groups was statistically significant (χ²=69.50, P<0.01). The risk of DCAN in H-HGI group was 4.545 times higher than that in L-HGI group [95% confidence interval (CI) 3.137 to 6.585,P<0.05], and the risk of DCAN in M-HGI group was 2.262 times higher than that in L-HGI (95%CI 1.541 to 3.320,P<0.05). Logistic regression analysis showed that the incidence of DCAN increased with the increase of HGI [odds ratio was 1.445 (95%CI 1.281 to 1.629),P<0.01]. After adjusting for age, family history of diabetes, FPG, HbA_1c, hs-CRP, UACR>30 mg/g, eGFR, BMI, hypertension, and dyslipidemia confounding factors, HGI was an independent risk factor for DCAN (odds ratio was 1.578 (95%CI 1.378 to 1.808),P<0.01].

HGI is closely related to the onset of the type 2 diabetes with DCAN. HGI testing is expected to be used for clinically personalized risk assessment and prediction of complications such as cardiovascular autonomic neuropathy in diabetic patients.

To compare the prevalence of retinopathy in residents with different glucose metabolism in Jiangsu province and analyze its related factors.

This study was a cross-sectional study. We recruited 4 047 urban and rural 18-70 years old residents in two cities of Jiangsu province using stratified multistage random sampling and conducted a questionnaire survey, physical examination, blood glucose testing and diabetic retinopathy (DR) screening among the residents from April to July 2017. Early Treatment Diabetic Retinopathy Study classification≥20 was defined as the “diabetes-specific” retinopathy. The subjects were divided into three groups according to the results of blood glucose testing: normal glucose regulation group (NGR group), impaired glucose regulation group (IGR group) and newly diagnosed type 2 diabetes mellitus group (T2DM group). The ordinary data such as demographic characteristics, disease history were collected, systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured, body mass index (BMI), waist hip ratio (WHR) and waist-to-height ratio were calculated, fasting plasma glucose (FPG), oral glucose tolerance test 2-hour postprandial blood glucose (2hPG), glycated hemoglobin A_1c (HbA_1c), alanine aminotransferase (ALT), and other indicators were detected. Chi-square test was used to compare the prevalence of retinopathy among people with different characteristics of the same glucose metabolism state, and 1∶4 matched conditional logistic regression was used to conduct univariate and multivariate analyses on DR.

Finally, 3 666 subjects were included in the study, including 1 915 cases in the NGR group, 1 186 cases in the IGR group and 565 cases in the T2DM group. The prevalence of DR in the T2DM group was the highest [10.27% (58/565)], followed by IGR [4.38% (52/1 186)] and the prevalence of “diabetes-specific” retinopathy in NGR was 2.77% (53/1 915). There was no statistically significant difference in the prevalence of retinopathy among different gender, age, occupation, education level, family history of diabetes, smoking history, alcohol consumption history in both three groups (allP>0.05). In NGR group, the prevalence of “diabetes-specific” retinopathy in the obese group was significantly higher than that in the normal and underweight groups [5.05% (14/277), 2.57% (22/856) and 2.17% (17/782), respectively,P=0.044]. In the T2DM group, the prevalence of DR in the hypertension group was significantly higher than that in the non-hypertension group [12.57% (42/334) and 6.93% (16/231), respectively, P=0.032]. The results of 1∶4 matched case-control univariate analysis showed that family history of diabetes, high SBP, high DBP, high BMI, high FPG, high 2hPG, high HbA_1c and high ALT may be related to the occurrence of DR. The results of multivariate analysis showed that SBP≥180 mmHg (1 mmHg=0.133 kPa), the waist-to-height ratio≥0.5, high BMI and high FPG were risk factors for DR (the odds ratios were 6.130, 2.738, 1.128 and 1.449, respectively, P<0.05).

The prevalence of retinopathy was high in urban and rural residents of Jiangsu province with different glucose metabolic states, and “diabetes-specific” retinopathy had occurred in NGR and IGR populations. Hypertension, hyperglycemia and obesity all increase the risk of DR in people with various metabolism states.

To evaluate insulin resistance (IR) in patients with rheumatoid arthritis (RA) using fasting triglyceride and glucose simple index (TyG), and to analyze the associated factors of IR in RA.

A total of 177 RA patients without hormone use in the Department of Rheumatology and Immunology of the People′s Hospital of Xinjiang Autonomous Region from January to December 2019 were selected. According to the duration of the disease, the patients were divided into a total of 45 cases of very early RA (disease duration<6 months), 64 cases of early RA (disease duration 6 months to 2 years), and 68 cases of non-early RA (disease duration>2 years), and 68 cases of the control group were collected.The general information and biochemical indexes of the patients were collected, and the homeostasis model assessment of IR (HOMA-IR) index and TyG index were calculated. Disease activity scores of 28 joints based on erythrocyte sedimentation rate (DAS28-ESR) was used to assess disease activity in RA patients. The general data and laboratory indexes of subjects in the very early RA group, the early RA group, the non-early RA group and the control group were compared. The IR in RA patients and non-RA patients were also observed. RA patients were divided into TyG≥1.15 group and TyG<1.15 group according to different levels of TyG index, general data and laboratory indicators of them were observed. The sensitivity and specificity of IR in RA patients with TyG index were analyzed using receiver operating characteristic (ROC) curve. Logistic regression was used to analyze the influencing factors of IR in RA group.

TyG index in RA group was higher than that in control group (P<0.05), the level of TyG was highest in early RA group (P<0.05). The levels of rheumatoid factors (RF) (r=0.215), erythrocyte sedimentation rate (ESR) (r=0.216), C-Reactive Protein (CRP) (r=0.219), high-sensitivity C-reactive protein (hsCRP) (r=0.235), low density lipoprotein cholesterin (LDL-C) (r=0.240), DAS28-ESR (r=0.393) was positively correlated with TyG index in the RA group (P<0.05).The area under the curve of TyG index to judge IR in RA patients was 0.823 (P<0.05), with a cut-off value of 1.15, Yoden index of 0.612, with sensitivity of 76.4% and specificity of 84.8%. The levels of RF, hsCRP, DAS28-ESR were higher in TyG≥1.15 group than in TyG<1.15 group, while the level of HDL-C was lower in TyG≥1.15 group, and the differences were statistically significant (P<0.05). Low level of HDL-C and RF positivitywere independently correlated with TyG≥1.15 (bothP<0.05).

TyG index is a feasible preliminary screening method to screen for IR in patients with RA. Increased IR in RA is associated with disease activity and inflammatory factors. Low level of HDL-C and RF positivity are independent risk factors for IR in patients with RA.

This paper reports a family of adult type diabetes mellitus (MODY) type 10 diagnosed by genetic testing. Proband's peripheral blood DNA was extracted for second-generation sequencing of a special type of diabetes test kit. The genetic test results were compared with the genetic database to find suspected pathogenic mutations, and Sanger sequencing was performed on the corresponding loci of the proband's relatives. The results showed that the proband and his two family members had missense mutation c.137G>A (p.R46Q) in the region of exon 2 of insulin gene, and the family members who did not detect the mutation at this site did not develop the disease. The clinical data of probands and their family members, including pancreatic islet β cell function assessment, complication and comorbidity screening, blood glucose control, etc. were analyzed, and the clinical characteristics and molecular mechanism of MODY10 reported at home and abroad were summarized by literature search.

This article reports a case of a 26-year-old male patient with "diabetic ketoacidosis". Physical examination revealed that the patient was thin and the external genitals were not developed. Laboratory tests showed glycosylated hemoglobin 10.7% and C-peptide 0.38 ng/ml. Glutamate decarboxylase antibody positive. Follicle stimulating hormone, luteinizing hormone and testosterone were lower than normal. Bone age 14 years. Karyotype analysis was 46, XY. Idiopathic hypogonadotropic hypogonadism (IHH) with type 1 diabetes was diagnosed. Genetic testing revealed a missense heterozygous mutation in fibroblast growth factor receptor 1. IHH complicated with type 1 diabetes is very rare, the mechanism of occurrence is unknown, and the correlation of genetic test results needs further research.

A 7-year-old girl with chronic cutaneous and mucosal candidiasis complicated with type 1 diabetes was consulted in the pediatric department. The clinical characteristics and treatment process were analyzed, and the genomic DNA of her and her parents was extracted, and high-throughput sequencing was performed and verified by Sanger sequencing. The patient developed fungal pneumonia, bronchiectasis, decreased serum iron, and decreased parathyroid hormone levels. Fluconazole combined with antibiotics and gamma globule therapy, regular use of insulin and diabetic diet can slow down the development of the disease. Genetic testing in this patient confirmed that there was heterozygous missense nascent mutation c.1154C>T, P.Thr385Met in signal transduction and transcription activator 1 (STAT1) gene, suggesting that STAT1 gene mutation is one of the causes of chronic cutaneous and mucosal candidiasis complicated with type 1 diabetes. Parathyroid hormone can decrease in a few patients, and genetic testing is helpful for early diagnosis.

Lipoatrophic diabetes is a special type of diabetes caused by the genetic defect of insulin action. This paper reports a case of a female patient with lipoatrophic diabetes, who started with hyperglycemia with ketosis and pancreatitis in adolescence, and had low fasting C-peptide at the onset. After being diagnosed as idiopathic type 1 diabetes, further examination found that the patient had menstrual disorders, reduced body fat ratio, partial lipoatrophy and skin acanthoid changes. Auxiliary examination showed hyperglycemia and hypertriglyceridemia, abnormal liver function, obvious increase of fasting and postprandial C-peptide, severe fatty liver and bilateral ovarian polycystic changes. Moreover, his father also had partial lipoatrophy and hypertriglyceridemia. Genetic testing indicated that both the patient and his father had LMNA Lys486Glu mutations. Because of the special onset mode of this patient, the range of lipoatrophy was wider than that of the same type of patients, and there were new amino acid changes in LAMN gene, suggesting that it may be a new subtype of familial partial lipoatrophy diabetes type 2.

Growth differentiation factor 15 (GDF15) is a protein mainly secreted by activated macrophages, which can participate in the regulation of tumorigenesis, inflammatory response, tissue damage and other biological effects. In recent years, it has been found that adipocytes can also secrete GDF15 and play an important role in obesity and related metabolic diseases. In obese patients, the level of GDF15 is compensatorily elevated, which can not only act on the central nervous system to suppress appetite and reduce food intake, but also act on the peripheral nervous system to activate the vagus nerve to delay gastrointestinal emptying, stimulate the sympathetic nerve to promote fat decomposition and heat production, thereby achieving the purpose of weight loss. In addition, in the occurrence and development of obesity-related metabolic diseases, GDF15 can not only improve insulin resistance and inflammatory response in diabetic patients, but also inhibit pancreatic islet β cell apoptosis; It can also promote liver lipolysis and reduce liver inflammatory response in patients with non-alcoholic fatty liver disease. Therefore, GDF15 is highly expected to become an important target for the development of drugs for obesity and related metabolic diseases in the future.

Diabetic retinopathy (DR) is one of the common microvascular chronic complications of diabetes mellitus. Its pathogenesis is complex, and it has been one of the hotspots of research at home and abroad. In recent years, there has been increasing evidence that DR may be a chronic low-grade inflammatory disease involving microglia. Retinal microglia are immune cells of the retina and are involved in DR neurodegeneration and blood retinal barrier disruption. Understanding the function, activation, regulation of retinal microglia and its involvement in the pathogenesis and treatment of DR can open up new ways for the prevention and treatment of DR.

O-linked N-acetylglucosamine (O-GlcNAc) glycosylation modification is a common protein post-translational modification, which plays an important role in insulin resistance and diabetes complications. In recent years, related studies have proved that O-GlcNAc glycosylation modification is closely related to diabetic nephropathy. Under high glucose state, the glucose flux into hexosamine biosynthesis pathway increases, and the level of O-GlcNAc glycosylation modification increases. It induces pathological changes such as basement membrane damage, cell hypertrophy, podocyte dysfunction and interstitial fibrosis by modifying specific proteins, and participates in the occurrence and development of diabetic nephropathy. Inhibition of O-GlcNAc glycosylation modification can reduce the glycotoxicity of related tissues, delay the progression to end-stage renal disease, and provide targeted strategies for clinical diagnosis and treatment.

Self-management education is the key to the treatment of diabetes. However, the participation of diabetic patients in self-management education in the real world is not optimistic. This article summarizes the research status, influencing factors and intervention status of participation in self-management education of diabetic patients at home and abroad, aiming to provide reference for developing targeted intervention measures and improving patients' participation in self-management education.

The risk of tumor development and mortality in patients with type 2 diabetes mellitus increased significantly. Metformin is a recognized first-line hypoglycemic drug. In recent years, more and more studies have found that diabetic patients who take metformin have decreased tumor risk and mortality compared with patients who do not take metformin. In vitro and in vivo studies have also shown that metformin can inhibit tumor growth through a variety of mechanisms, among which the regulation of energy metabolism may play an important role. This paper mainly discusses the role of metformin in tumors and its possible anti-tumor mechanism from the perspective of energy metabolism.

Randomized controlled trials (RCTs) are the gold standard for evaluating the safety and effectiveness of certain drugs or interventions. Rational design is the core of high-quality RCTs and scientific judgment of trial results. The author will take classical diabetes clinical intervention trials, including Look AHEAD and ACCORD trials, as examples to discuss the key points of RCT design, in order to provide reference for the design and development of RCT research on diabetes prevention and treatment in the future.