Volume 13 · Issue 04 · 2021

The Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition) have made some necessary and important amendments and supplements to the 2017 edition. The data of prevalence and awareness rate of diabetes epidemiological survey in China in the past 40 years show that the task of diabetes prevention and treatment is extremely arduous. It is very important to adopt individualized control targets for diabetic patients. Evidence from randomized controlled trials has promoted the selection of individualized hypoglycemic targets, and the application of new technologies and methods is also expected to improve the level of blood sugar control.

In the Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition), glycosylated hemoglobin (HbA_1c) ≥6.5% were included in the diagnostic criteria of diabetes. However, some physiological and pathological factors can interfere with HbA by altering red blood cell lifespan, hemoglobin glycosylation rate, or_1cof detection, thereby affecting HbA independently of blood glucose concentration_1cThe level of. These physiological and pathological factors include anemia, chronic kidney failure, pregnancy, age, race, medication, and others. Clinicians are using HbA_1cWhen, attention needs to be paid to these common physiological and pathological factors to improve the response to HbA_1cAwareness of.

The Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition) clarified the status and role of traditional Chinese medicine in the prevention and treatment of diabetes, and changed the title of Chapter 19 from the original "Diabetes and Traditional Chinese Medicine" to "Traditional Chinese Medicine Treatment of Diabetes". According to the staging discussion of pre-diabetes, diabetes and complication, the research results of pre-diabetes and complication are emphasized, and non-drug treatment methods such as acupuncture and moxibustion are added. For the convenience of non-TCM doctors, the symptoms of TCM syndrome differentiation were described and annotated.

In recent years, many significant progress has been made in the research of type 2 diabetes at home and abroad, and more new evidence-based medical evidence on the prevention, diagnosis, monitoring and treatment of diabetes and its chronic complications has been obtained. Therefore, it is necessary to revise the prevention and treatment guidelines of type 2 diabetes in China again to deliver important progress in time and guide clinical practice. In order to give readers a better understanding of the main contents of this revision, the level of evidence for the preparation of the guide and the key points of the update are explained.

With the significant progress in the research of type 2 diabetes at home and abroad, more evidence-based medical evidence on the prevention, diagnosis, monitoring and treatment of diabetes and its chronic complications has been obtained. The Diabetes Branch of Chinese Medical Association specially organized experts to revise the original guidelines and form the "Guidelines for the Prevention and Treatment of Type 2 Diabetes in China (2020 Edition)", aiming to deliver important progress in time and guide clinical practice. This guide consists of 19 chapters, covering the epidemiology of diabetes in China, the diagnosis and classification of diabetes, the tertiary prevention of type 2 diabetes, the screening and evaluation of diabetes, the education and management of diabetes, the comprehensive control goals of type 2 diabetes and the treatment path of hyperglycemia, medical nutrition, exercise therapy and weight management, drug treatment of hyperglycemia, diabetes-related technologies, acute and chronic complications of diabetes, hypoglycemia, special cases of diabetes, metabolic syndrome and traditional Chinese medicine treatment of diabetes, etc. The promulgation of these guidelines will help to guide and help clinicians to standardize and comprehensively manage patients with type 2 diabetes, and improve the clinical outcomes of patients with type 2 diabetes in China.

To identify the candidate pathogenic loci in exons of susceptibility genes for diabetic retinopathy (DR) in Chinese Han population.

This was a case-control study. The patients with type 2 diabetes mellitus (T2DM) diagnosed in Drum Tower Hospital Affiliated to Nanjing University Medical School between January 2015 and September 2018 were retrospectively analyzed. There were 101 DR patients in the case group and 103 non-DR patients in the control group. General information and laboratory results of patients were collected. The exons of DR susceptibility genes TBC1D4, COMMD6, UCHL3, LRP2, BBS5, ARL4C, and SH3BP4 in Chinese population were captured and sequenced by the second-generation sequencing technology of FastTarget target region enrichment. Independent sample t test and chi-square test were used to compare the general demographic characteristics between the two groups. Association between common/rare variants and DR risk was evaluated by logistic regression and counting method. Further, for our identified novel DR-related variants, functional annotation was adopted to assess their potential biological functions.

The age and duration of diabetes in the case group were significantly lower than those in the control group (P<0.05), while the level of glycosylated hemoglobin was significantly higher than that in the control group (P<0.05). Logistic regression analysis showed that four of 82 common variants were associated with DR (P<0.05), including LRP2 rs13417389, LRP2 rs2229267, LRP2 rs2229268, and LRP2 rs886055072. Besides, 14 DR-related rare functional variants with CADD score greater than 20 were identified: LRP2 rs764804647 G>A, LRP2 rs538396567 T>A, LRP2 Chr2: 170010984 T>A, LRP2 Chr2: 170050282 C>A, LRP2 Chr2: 170129538 T>A, LRP2 Chr2: 170129538 T>C, LRP2 Chr2: 170129539 G>A, LRP2 Chr2: 170129539 G>T, LRP2 rs754796717 G>C, LRP2 rs529409328 C>G, UCHL3 Chr13: 76135016 A>G, TBC1D4 Chr13: 75876471 C>A, TBC1D4 rs201459702 T>C, SH3BP4 Chr2: 235950303 G>A.

The 14 DR-related rare functional variants identified in this study could be used as candidate pathogenic loci for diabetic retinopathy in Chinese Han population.

To explore the efficacy and safety of biphasic insulin aspart 30 (UBLIN^®30) in treatment of diabetic patients.

A multicenter, randomized, open-labeled and positive control clinical trial included the patients with type 1 or type 2 diabetes mellitus having poor glucose control after using premixed insulin monotherapy or combine with 1 or 2 oral antidiabetic drugs. All patients were treated with UBLIN^®30 or NovoMix^®30 for 24 weeks in two groups by a ratio of 1∶1. The decreased value and qualification rates of glycated hemoglobin A_1c(HbA_1c), fasting blood glucose (FPG) and 2-hour postprandial plasma glucose (2hPG), the incidence of hypoglycemic and the adverse events were compared at the end of 24 weeks. Analysis of variance (ANOVA) test, t test and Wilcoxon test were used.

All of 668 cases were included in the trial, but 618 cases were in complete conformity to the design plan (305 cases received UBLIN^®30 therapy and 313 cases received NovoMix^®30 therapy). At the end of 24-week treatment period, HbA_1c in UBLIN^®30 group and NovoMix^®30 group decreased by (1.38±1.33)% and (1.37±1.53)%, respectively, compared with the pre-treatment period, and the differences in the post-treatment change values were not statistically significant (P>0.05). FPG decreased by (2.28±3.76) mmol/L and (1.67±3.55) mmol/L in the two groups, respectively, and the difference between groups in the decreasing values was statistically significant (P=0.03). The 2hPG decreased by (3.22±5.38) mmol/L and (2.78±4.83) mmol/L in UBLIN^®30 group and NovoMix^®30 group, respectively, and the difference in the decrease was not statistically significant (P=0.27). Moreover, the incidence of hypoglycemic events was 45.6% (151/331) and 43.8% (146/333) in UBLIN^®30 group and NovoMix^®30 group, respectively, and the incidence of other adverse reactions was 0.9% (3/331) and 0.9% (3/333), respectively.

UBLIN^®30 provided similar glycemic control and safety profiles to NovoMix^®30, indicating that UBLIN^®30 is a suitable therapeutic option in clinical practice.

To establish a nomogram for predicting the possibility of progression to type 2 diabetes mellitus (T2DM) in 3 years among Chinese adults.

This retrospective study was one component of the baseline and 3-year follow-up surveys conducted for the Risk Evaluation of cAncers in Chinese diabeTic Individuals: a lONgitudinal study (REACTION) from February 2012 to August 2015. In all, 2 788 subjects who diagnosed without diabetes at baseline and completed the 3-year survey were taken into this analysis. All participants were divided into a modeling cohort (75%, 2 094 cases) or a validation cohort (25%, 694 cases) via simple random sampling. According to the Akaike information criterion, a logistic regression model was adopted to construct the nomogram that predicted the risk of T2DM. Receiver operating characteristic (ROC) curve was utilized to evaluate the predictive value of this nomogram. Decision curve analysis was employed to assess the clinical utility of the predictive model.

After a follow-up of 3 years, 210 cases (7.53%) of the 2 788 non-diabetic participants developed diabetes, with the annual incidence estimated to be 2.51%. In the modeling cohort, multivariate logistic regression analysis exhibited that age, fasting plasma glucose, 2-hour postprandial plasma glucose, glycated hemoglobin A_1c (HbA_1c) were independent risk factors for T2DM (odds ratio were 1.03, 1.13, 1.01, 1.17, respectively, all P<0.05). Therefore, we used these four factors as independent variables to construct our nomogram. The area under the curve (AUC) of the nomogram for predicting the possibility of progression to T2DM in modeling cohort was 0.825 (95% confidence interval 0.787-0.864), and the AUC of the nomogram established above in the validation cohort was 0.781 (95% confidence interval 0.716-0.846). The predictive value of such nomogram is better than that of prediabetes (P<0.01, Delong′s test). Decision curve analysis suggested that the nomogram which was established in this study exhibited clinical application value.

The nomogram constructed in this study can effectively predict the risk of progression to T2DM after a follow-up of 3 years, which can help to identify patients with high-risk of diabetes and develop individualized interventions.

To analyze the differential proteomics of white matter in rats with diabetes-associated cognitive decline (DACD).

The experiment contained two groups: control group (10 SD rats) and type 2 diabetes mellitus (T2DM) group (10 SD rats). Rats in control group were fed with standard diet, T2DM models were established by high fat and high glucose diet combined with intraperitoneal injection of streptozotocin. Morris water maze was used to detect the cognitive function of rats, and diffusion tensor imaging was used to evaluate the degree of white matter lesions (WML). Differential proteomics analysis of white matter was performed through the label-free comparative proteomics technology, and then the changed proteomes that may be related to the molecular mechanism of WML caused by T2DM were screened. After bioinformatics analysis of the differential proteins, some of the differential expressed proteins were verified by Western blot. The differences between groups were compared by independent sample t test or Wilcoxon test.

A total of 38 differential proteins were screened, including 24 up-regulated proteins (fold change>2.0 andP<0.05) and 14 down-regulated proteins (fold change<-2.0 andP<0.05). The differential proteins mainly distributed in cell membrane, cytoplasm and exosomes. And they were mainly involved in biological processes such as nervous system development, negatively regulating apoptosis of neural cells, and chemical synaptic transmission. The varied proteins were mainly concentrated on the four signal pathways, moreover, brain-derived neurotrophic factor, nitric oxide synthase 1, neuromodulin (GAP43), vesicular glutamate transporter 1 (SLC17A7), dynamin-1, metabotropic glutamate receptor 5 and amino acid transporter would be core backbones of the protein complexes to form interactive network.

The differentially proteomics are involved in multiple signal pathways of cognitive dysfunction and WML. GAP43 and SLC17A7 may be the crucial targets of WML.

Congenital hyperinsulinemia (CHI) is the main cause of persistent and recurrent hypoglycemia in infant and childhood. Due to gene mutations related to insulin secretion, the structure or function of proteins related to insulin secretion pathway is damaged, so that pancreatic islet β cells cannot regulate insulin secretion accordingly due to blood glucose level, so secondary hypoglycemia. Fifteen disease-causing genes associated with it have been found so far, correspondingly constituting fourteen genetic types, among which the most common and severe type is ATP-sensitive potassium channel hyperinsulinemia. According to the different histological characteristics of pancreas, CHI can be divided into diffuse, focal and atypical. Preferred pancreas¹⁸Fluoro-L-3-4-dopa positron emission tomography/computed tomography technique assists in histological typing of CHI. In clinical work, for patients with suspected hyperinsulinic hypoglycemia, relevant indicators should be evaluated immediately according to the patient's condition, the diagnosis of CHI should be defined, and according to the characteristics of different types of genetic types, the patient's treatment should be guided, and reasonable and effective treatment should be selected in time according to the diagnosis and treatment process. Means to avoid neurological complications caused by repeated hypoglycemia.

Adult occult autoimmune diabetes (LADA) is an adult-onset, slow-progressing diabetes with autoimmune antibodies. It has some characteristics of type 1 diabetes and type 2 diabetes, and the disease itself has certain heterogeneity in clinical manifestations, immunological characteristics and disease outcome. As the understanding of LADA gradually deepens, there are new advances and controversies about the disease classification, diagnostic criteria and treatment principles of LADA. This article will focus on the definition and classification of LADA, diagnosis and treatment of three aspects of the known and unknown explained.

Diabetic neuropathy is the most common chronic complication of diabetes. In hyperglycemic state, polyol pathway, glycosylation end products, oxidative stress and cytokines interact independently or interactively, and directly or indirectly participate in the occurrence and development of diabetic neuropathy. Aldose reductase-specific inhibitors act by blocking the polyol pathway, while reducing oxidative stress in diabetic individuals and inhibiting non-enzymatic glycation of proteins. They can also be combined with α-lipoic acid, methylcobalamin and other drugs to treat diabetic neuropathy, which can effectively improve its neurological function.