Volume 13 · Issue 12 · 2021

With the remarkable improvement of diabetes diagnosis and treatment, the practice of nutrition management is also constantly improving and updating. This article summarizes the clinical nutritional practice and research progress of diabetes treatment in 2020. The update of various clinical diagnosis and treatment guidelines for diabetes mellitus is also constantly emphasizing the implementation of rational nutritional treatment. In addition, with the development of precision medicine, artificial intelligence, and big data, related research in different fields such as precision nutrition, diabetic nutritional epidemiology, dietary pattern or nutrient selection, diabetic lifestyle intervention reversal research, metabolic surgery and dietary management are also progressing.

Diabetes has become a global epidemic disease, and the number of diabetic patients in China ranks first in the world. However, its etiology and pathogenesis are still unclear. Most of the overall health resources of metabolic diseases in China are distributed in the disease stage or after complications have appeared, so it is urgent to prevent, identify and intervene early. In addition to adult environmental factors, early life is a critical window with a high degree of tissue plasticity. There is substantial evidence that early-life nutrition plays a crucial role in programming adult metabolism. In view of this, this paper summarizes the effects of early life nutrition on glucose metabolism in adulthood and its underlying epigenetic mechanisms, and outlines the early life lifestyle changes and the protective effects of diet and nutritional interventions on these poor metabolic reprogramming, providing theoretical basis and potential targets for the advancement of the prevention and treatment window of diabetes from a new perspective.

Insulin injection-related subcutaneous fat hyperplasia is one of the common complications in the course of insulin therapy, which can affect insulin absorption and glycemic control. In order to standardize long-term insulin injection and reduce the incidence of subcutaneous fat hyperplasia, this consensus defines the diagnosis and classification of subcutaneous fat hyperplasia from the epidemiology, risk factors, histopathological characteristics, mechanism and harm of subcutaneous fat hyperplasia, and puts forward three-level prevention suggestions in combination with China's national conditions, and advocates scientific insulin injection technology education and training for doctors, nurses and patients. The consensus suggests that prevention should be the main priority for subcutaneous fat hyperplasia, the injection site should be correctly and regularly rotated during insulin injection, and the disposable use of insulin injection needles is recommended.

To investigate the influencing factors of diet self-management and its relationship with glycated hemoglobin A_1c (HbA_1c) control in patients with type 2 diabetes mellitus (T2DM).

A total of 275 patients with T2DM in four hospitals in Chaoyang District of Beijing were investigated by WeChat questionnaire and face-to-face questionnaire, and the dietary behavior compliance scale for patients with T2DM (including total score and scores of five dimensions: diet self-regulation, sugar and fat compliance behavior, oil and salt compliance behavior, fruit and vegetable compliance behavior, cooking and eating habits) was used to evaluate their dietary self-management. The weight classification was based on the Chinese adult body mass index (BMI) proposed by the World Health Organization classification. The receiver operating characteristic (ROC) curve was established for 275 subjects to test the diagnostic cut-off point between the total score of patients′ dietary compliance and HbA_1c. The cut-off score of dietary compliance was 80.5, with the highest Jordan index (0.240). The patients were divided into two groups: compliance with diet management group (98 cases) and non-compliance with diet management group (177 cases). Two hundred and four patients provided the latest HbA_1c results in recent 3 months, 69 cases (33.8%) met the standard (HbA_1c<7% group) and 135 cases (66.2%) failed to meet the standard (HbA_1c≥7% group). The measurement data in line with normal distribution were analyzed by t-test between the two groups. The comparison of classified data was analyzed by Chi square test or Fisher exact probability method. Multivariate logistic regression and multiple linear correlation analysis were used to analyze the influencing factors affecting patients′ dietary self-management and HbA_1c compliance.

Among 275 subjects, 115 cases (41.8%) were overweight and 46 cases (16.7%) were obese. There were more women and lower rates of overweight and obesity in the HbA_1c<7% group than those in the HbA_1c≥7% group (all P<0.01). Women and the patients with BMI<24 kg/m² had higher percentage of compliance with diet management (P<0.01). Multivariate logistic regression analysis showed that women and the patients with BMI<24 kg/m² were correlated with better dietary compliance. Patients were stratified according to gender and BMI, and the scores of dietary compliance in five dimensions were compared. The results showed that patients with BMI<24 kg/m² had higher scores in all aspects and total dietary compliance than those with BMI≥24 kg/m² (P<0.05). Females had higher scores than males in other four dimensions of diet compliance behaviors (all P<0.05) except for the score of dietary self-regulation (P>0.05). The total score of dietary compliance of the HbA_1c<7% group was higher than that of the HbA_1c≥7% group [(82.0±12.4) vs. (75.6±12.9) points, P=0.001]. Among the five dimensions of dietary compliance, except cooking and eating habits (P>0.05), the scores of other four dimensions were all higher than those of the HbA_1c≥7% group (all P<0.05). Multivariate analysis showed that BMI<24 kg/m² (OR=3.007, 95%CI 1.525-5.928) and self-management of diet (OR=3.003, 95%CI 1.305-6.912) were related to HbA_1c<7%. The results of multiple linear regression showed that there was a negative correlation between education level (β=-0.175,P=0.022), dietary compliance score (β=-0.162, P=0.026) and HbA_1c level.

The percentage of overweight and obesity of the participants is high, and the percentage of HbA_1c <7% is low. Female and patients with BMI<24 kg/m ² are the factors of good dietary self-management compliance. BMI<24 kg/m² and self-management of diet are the factors of HbA_1c<7%. Patients with higher education level and dietary compliance score have lower HbA_1c level.

To investigate the therapeutic effect of dietary fiber supplement on type 2 diabetes mellitus (T2DM).

A total of 60 T2DM patients admitted to the Department of Endocrinology, Peking University Shenzhen Hospital from October 2020 to April 2021 were randomly divided into the control group (36 cases) and the experimental group (24 cases) according to the coin flipping. The control group maintained the original diabetic diet and lifestyle, while the experimental group took dietary fiber powder 18.9 g/d with meals on the basis of the original diet. All subjects were installed with continuous glucose monitoring instrument before intervention, and we calculated mean blood glucose (MBG), area under the curve of blood glucose (G_AUC), time in range (TIR), time above target glucose range (TAR), time below target glucose range (TBR), standard deviation of blood glucose (SDBG), and mean amplitude of glycemic excursion (MAGE). The changes of the indexes before and after intervention were compared.

After dietary supplement intervention, compared with the control group, MBG, TAR and G_AUC were decreased in the experimental group, and the difference between the two groups was statistically significant (P<0.05), while TIR and TBR showed no significant difference between the two groups (P>0.05). Compared with the control group, the SDBG and MAGE of the experimental group were decreased, which was statistically significant (P<0.01). The MBG, TAR, TBR and G_AUC of the experimental group decreased after intervention, while TIR increased, with statistical significance (P<0.05). SDBG and MAGE were lower after intervention, and the difference was statistically significant (P<0.01).

Dietary fiber supplements could improve the overall average blood glucose of type 2 diabetic patients, ameliorate the intra-day blood glucose fluctuation and have a good regulation on blood glucose management.

To investigate the predictive role of impaired glucose tolerance (IGT) on the risk of type 2 diabetes mellitus (T2DM) in patients with metabolic syndrome (MS).

This study was a retrospective cohort study. A total of 1 989 participants who underwent medical examination in PLA Rocket Force Characteristic Medical Center from June 2012 to September 2019 were enrolled. The participants were equal or more than 40 years old and without previous T2DM. The general information, physical examination data, and laboratory indexes were analyzed, and the occurrence of T2DM was followed up as the research outcome. According to occurrence of T2DM, the subjects were divided into T2DM group and non-T2DM group. Multivariate Cox regression analysis was used to assess the risk of T2DM in people with MS and (or) IGT, and the population attribution score (PAF) was calculated to express the proportion of T2DM attributed to MS and IGT.

The average follow-up time of the study was 5.1 years. During the follow-up period, a total of 291 people (14.6%) were diagnosed with T2DM. Compared with those without T2DM, individuals with T2DM were older and had higher waist circumference, body mass index, systolic blood pressure, triglycerides, fasting blood glucose, and oral glucose tolerance test 2-hours plasma glucose (P<0.01). Participants with a family history of diabetes and a history of smoking were more likely to develop T2DM (P<0.05). After adjusting for baseline age, gender, smoking, drinking, exercise, and family history of diabetes, participants with MC at baseline had a higher risk of developing T2DM (HR=2.84, 95%CI 1.20-6.69) and PAF (PAF=18.70%, 95%CI 11.82%-25.60%) than participants with non-MC. The risk of T2DM with IGT (HR=3.17, 95%CI 1.88-5.34) and PAF (PAF=21.63%, 95%CI 10.07%-35.53%) were higher than those with non-IGT. Participants with non-MC and IGT (PAF=11.50%, 95%CI 10.71%-19.83%) was more related to the incidence of T2DM than participants with MC and normal glucose tolerance (PAF=0.69%, 95%CI -5.75%-11.47%). Patients with MC who have IGT among the metabolic components have the highest risk of T2DM (HR=4.39, 95%CI 2.40-8.04) and the highest PAF (PAF=21.87%, 95%CI 10.63%-37.34%).

In this certain department of physical examination center, individuals with both MC and IGT have the high risk of T2DM.

To evaluate the clinical efficacy and safety of empagliflozin combined with short-term intensive insulin therapy in patients with type 2 diabetes mellitus (T2DM) who have poor glycemic control.

Patients who were hospitalized in the Endocrinology Department of the Second Hospital of Hebei Medical University from April 2019 to March 2021 were included in this clinical trial. T2DM patients expected to receive basal and prandial insulin injections (four times a day) were randomly assigned to two groups using a random number table. The observation group (EMPA group) was given empagliflozin plus short-term intensive insulin therapy and the control group (Con group) was given only short-term intensive insulin therapy. Patients in Con group were treated with four subcutaneous injections of insulin aspart plus insulin degludec daily. In the EMPA group, on the basis treatment of Con group, the empagliflozin was given 10 mg each time, q.d., orally in the morning. The change in fasting blood glucose (FPG), glycated albumin (GA), time in range (TIR) and blood glucose fluctuation indicators [mean amplitude of glucose excursions (MAGE), the standard deviation of blood glucose level (SDBG), largest amplitude of glycaemic excursions (LAGE), absolute mean daily difference (MODD)] were recorded and compared. The time of reaching the standard blood glucose, daily insulin dosage and the occurrence of hypoglycemia in both groups were also recorded and compared. Thet test, t′ test, Mann‐Whitney U test, chi-square test or Fisher exact probability test were used for comparison between groups and paired t test was used for intra-group comparison.

A total of 60 patients completed the trial, including 30 in the EMPA group and 30 in the Con group. After 14 days of treatment, FPG reduced (6.10±3.03) mmol/L and (5.79±3.90) mmol/L, at the same time, GA reduced (7.17±2.81)% and (6.95±3.45)% from baseline respectively in EMPA group and Con group. However, there was no statistically significant difference in the changes of FPG and GA between two groups (P>0.05). TIR, SDBG and LAGE of the EMPA group were significantly lower than those indicators of the Con group after 14 days treatment, and the difference were statistically significant (P<0.05). The time of reaching standard blood glucose in EMPA group and Con group were (4.2±1.4) d and (6.7±1.9) d, respectively. The average insulin aspart dosage was (17.7±5.8) U/d and (21.4±7.8) U/d, and the average dosage of insulin degludec was (12.3±4.0) U/d and (15.1±5.2) U/d in EMPA group and Con group, respectively. These differences were statistically significant (P<0.05). The incidence of hypoglycemia in EMPA group and Con group was 6.67% (2/30) and 3.33% (1/30), and the difference was not statistically significant (P>0.05).

Empagliflozin combined with short-term intensive insulin therapy could control blood glucose levels and shorten the time for reaching target effectively. This therapy could also reduce blood glucose fluctuations and the amount of insulin, and has good safety.

To evaluate the diagnostic accuracy of the SG-DR screening system (the ophthalmic image intelligent recognition software designed and produced by Zhuhai Shang Gong Co., China. Guangdong Registration Certificate for Medical Device No. 20172700901) in detecting diabetic retinopathy (DR) in the general and diabetes population, using single-or double-field fundus photography.

The cross-sectional database was used to analyze among a randomized cluster stratification sample of 18-70 years old residents in six different ethnic groups in eight provinces of China from December 2016 to June 2017. For 8 948 enrolled participants, two retinal fundi (one disc centered 45° and one macula centered 45°) images per eye were collected for the evaluation of DR. All 17 118 images were graded by the Early Treatment Diabetic Retinopathy Study (ETDRS) scale (gold standard for DR grading), and the SG-DR screening system. Area under the receiver operating characteristic curve (AUC), sensitivity and specificity of the SG-DR screening system were performed by the receiver operating characteristic (ROC) curve based on the DR in need of referral (ETDRS>31).

In the general population, the AUC for screening DR in need of referral using SG-DR single-field fundus photography screening system was 0.941 with sensitivity of 98.15% and specificity of 90.08% respectively. Using SG-DR double-field fundus photography screening, the sensitivity and specificity were 100% and 86.91%, respectively. In the diabetes group, for DR in need of referral, the AUC, sensitivity and specificity were 0.901, 98.08%, and 82.10%, respectively.

The SG-DR screening system has shown high sensitivity and specificity in detecting DR both in the general population and diabetic group and could be as an adjunct in the screening of DR.

To investigate the relationship between thyroid function and sarcopenia in Chinese geriatric patients with type 2 diabetes mellitus (T2DM).

Patients with T2DM aged over 60 years old were recruited from department of endocrinology, Xuanwu Hospital, Capital Medical University, from April 2017 to April 2019. Appendicular skeletal muscle mass, grip strength, and walking speed were measured, appendicular skeletal muscle mass index (ASMI) was calculated. Concentrations of free triiodothyronine (FT3), free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were determined, FT3/FT4 ratio was calculated. Sarcopenia was defined based on the standard of the Asian Working Group of Sarcopenia. The included patients were divided into sarcopenia group and non-sarcopenia group. The t test or χ² test was used to compare general characteristics between the two groups; correlation analysis and multivariate logistic regression analysis were used to explore the relationship between thyroid function and sarcopenia.

A total of 535 patients with T2DM aged over 60 years old were enrolled. There were 490 patients in sarcopenia group and 45 patients in non-sarcopenia group, respectively. Compared with non-sarcopenia patients, patients with sarcopenia demonstrated lower levels of FT3 and FT3/FT4 ratio (all P<0.05). In geriatric patients with T2DM, FT3/FT4 ratio was significant positively correlated with ASMI, grip strength and walking speed (r=0.240, 0.242 and 0.227, respectively, all P<0.01), the same with FT3 levels (r=0.300, 0.366 and 0.296, respectively, all P<0.01). Multivariate logistic regression analysis showed that FT3/FT4 ratio (OR=0.396,95%CI 0.158-0.992,P=0.048) was independent risk factor for sarcopenia.

In geriatric patients with T2DM, the concentrations of FT3 and FT3/FT4 ratio are significant positively correlated with the components of sarcopenia, and FT3/FT4 ratio is an independent predictor of sarcopenia.

To conduct a cost-utility analysis of the technology lipido-colloid (TLC) with nano-oligo saccharide factor (NOSF) dressing (TLC-NOSF dressing) versus Non-NOSF advanced wound care dressing in the treatment of diabetic foot ulcer (DFU).

This study established Markov model based on the development process of DFU disease. An initial cohort of 10 000 patients with DFU were assigned to the TLC-NOSF dressing group and the non-NOSF dressing group. Deducted the evaluation model for 20 years (40 cycles), inputted efficacy, cost and health utility parameters, which were obtained by literature review and expert consultation, to evaluate the long-term cost-effectiveness of two dressing groups and implement economic evaluation [survival cohort analysis, cost-effectiveness analysis, sensitivity analysis (univariate sensitivity analysis, subgroup analysis, and probabilistic sensitivity analysis)].

The results showed that after 20 years of modeling, survival rate of NON-NOSF dressing group was 24.59%, while TLC-NOSF dressing group was 27.42%. TLC-NOSF dressing group has lower cost (NON-NOSF dressing group was 168 069.56 yuan,TLC-NOSF dressing group was 156 881.90 yuan,The latter saved 11 187.66 yuan), higher health utilities [quality-adjusted life year (QALY) of NON-NOSF dressing group was 4.220 years, QALY of TLC-NOSF dressing group was 4.471 years, The latter improved 0.251 years], better cost-effectiveness [incremental cost-effectiveness ratio (ICER) was -44 520.838 yuan/QALY]. The results of sensitivity analysis showed that utility of healed state, TLC-NOSF dressing price, DFU to health state transition probabilities of the study group, price of Non-NOSF advanced wound care dressing had a great impact on the results of ICER.

At current price levels, compared with Non-NOSF dressing, TLC-NOSF dressing is more economically efficient in the treatment of DFU.

The clinical data of a patient with SHORT syndrome caused by PIK3R1 gene mutation diagnosed and treated in the Department of Endocrinology of the First Medical Center of the General Hospital of the People's Liberation Army were retrospectively analyzed, and the literature was reviewed. The patient was a 16-year-old female who was admitted to the hospital mainly for "finding elevated blood sugar for 1 1/2 years". The patient was born with low weight, delayed tooth eruption, short height since childhood, and has not had menstrual cramps so far. Physical examination shows short stature, thin body, dark, rough skin and hairy limbs; The forehead is swollen, the distance between the eyes is widened, the eye sockets are deeply sunken, the corners of the mouth are drooping, the mandible is pointed and short, and the ears are large and low; There is less subcutaneous fat in the whole body, acanthoid changes in the neck, and brachydactyly deformity in both feet. The results of laboratory tests showed that insulin resistance, diabetes and hyperandrogenism, and the effect of high-dose insulin treatment was not good. Whole exon gene sequencing suggested that it carried a heterozygous mutation in PIK3R1 gene (c.1945C>T, p.Arg649Trp), and was diagnosed as SHORT syndrome. Metformin combined with acarbose reached the blood glucose standard. SHORT syndrome is a rare autosomal dominant genetic disease caused by PIK3R1 gene mutation. Clinicians should strengthen their understanding of this disease and avoid misdiagnosis and misdiagnosis.

Prader-Willi syndrome (PWS) is a multisystem disease caused by the dysfunction of the imprinted gene located in the paternal chromosome 15 region. It is characterized by neonatal feeding difficulty, low muscle tone, growth and development disorders, behavioral and cognitive disorders, personality abnormalities, various hypothalamic-pituitary endocrine dysfunction, such as hypogonadism, growth hormone/insulin-like growth factor-1 axis dysfunction, etc., and progressively develops into hyperappetite, severe obesity, and can be combined with diabetes, metabolic syndrome, sleep apnea, cardiovascular disease, etc. In this paper, we reported the clinical characteristics and strategies of diagnosis and treatment of 2 patients with PWS complicated with diabetes mellitus diagnosed in adulthood, and discussed the recent treatment methods and the research progress of disease mechanism, so as to provide thinking for the diagnosis and treatment of this disease.

Immune checkpoint inhibitor is a new method of tumor immunotherapy. With the increase of clinical application, the immune-related adverse reactions caused by it are gradually increasing. Diabetes mellitus is a relatively rare adverse reaction. This article reports a case of diabetic patient with onset of diabetic ketoacidosis after treatment with pembrolizumab, in order to increase the understanding of this rare adverse reaction among relevant physicians.

In recent years, the epidemic trend of obesity in the world is very severe. Increased eating and reduced energy expenditure both lead to obesity, both of which are regulated by the hypothalamus. The hypothalamus is an important center for receiving, integrating and emitting appetite regulation signals and maintaining weight stability. Various appetite-promoting/suppressing neuroendocrine factors of the central or peripheral appetite regulation system can form complex appetite regulation networks and mutually projecting neural circuits in the hypothalamus to comprehensively regulate appetite. In this paper, the central regulatory mechanism of appetite was reviewed, and the influence of peripheral appetite regulatory system on appetite center was expounded, in order to provide reference for the prevention and treatment of obesity and its related metabolic diseases.

Diabetic nephropathy is one of the most important microvascular complications of diabetes mellitus and the most important cause of end-stage renal disease. However, with the exception of renin-angiotensin system blockers, there has been limited progress in drugs for the treatment of diabetic nephropathy. Sodium-glucose cotransporter 2 (SGLT2) inhibitor is a new type of hypoglycemic drug. Many clinical studies have proved its exact hypoglycemic effect and renal protective effect, and its renal protective effect is independent of hypoglycemic effect. Although the renal protective mechanism of SGLT2 inhibitors has not been fully defined, several basic studies have elucidated the mechanism of action of SGLT2 inhibitors from multiple aspects. The purpose of this paper is to review the mechanism of action of SGLT2 inhibitors in the treatment of diabetic nephropathy and to look forward to its future research prospects.

The author reviews the pathogenesis of resistance exercise (RT) in patients with type 2 diabetes mellitus (T2DM) complicated with sarcopenia. RT activates PI3K/Akt/mammalian rapamycin target protein (mTOR), mTOR/ULK1, IGF-1/PI3K/Akt/mTOR and other signaling pathways through mechanical stimulation, thereby increasing muscle oxygen consumption, increasing muscle capillaries, inducing muscle protein synthesis, optimizing skeletal muscle quality and function. RT can also down-regulate the ratio of autophagy-specific protein LC31/LC3-1, reduce the level of p62 protein, increase autophagy regulatory proteins such as Beclin1 and ATG5\12\7, improve myocyte autophagy disorder, help maintain skeletal muscle strength and muscle mass, and prevent or improve T2DM. According to the specific situation of the patient, an accurate individualized RT plan can be formulated to increase its muscle strength and muscle mass and improve the prognosis of the patient.

Dressings play an important role in the management of chronic wounds, especially in the treatment of diabetic foot ulcers (DFU). Sucrose octasulfate dressings function by inhibiting matrix metalloproteinases and angiogenic properties, which can effectively promote DFU wound healing, improve patient comfort, and save costs and improve benefits, but individualized evaluation of patient conditions is still required in use.