Volume 14 · Issue 03 · 2022

The prevalence of adult pre-diabetes mellitus (preDM) in China is still rising, and at present, preDM intervention and management are facing many difficulties and challenges. This paper reviews the progress of preDM research at home and abroad, and discusses the management mode and comprehensive management system construction of community preDM in China.

To explore the predictive effects of anthropometric indicators on prediabetes.

This study was a cross-sectional survey research. A total of 239 cases from June 2020 to April 2021 were recruited as study subjects from the people aged 18 to 70 years with high risk of diabetes and the healthy people in the Physical Examination Center of the First Affiliated Hospital of China Medical University. All patients′ sex, age, height, weight, systolic blood pressure, diastolic blood pressure, heart rate and so on were collected, oral glucose tolerance test (OGTT) was performed and pancreatic islet function and glycated hemoglobin A_1c (HbA_1c) were detected. Anthropometric indicators including abdominal volume index (AVI), body roundness index (BRI), body adiposity index (BAI), conicity index (C-index), body shape index (ABSI), clínica universidad de navarra-body adiposity estimator (Cun-BAE) and homeostasis model assessment insulin resistance index (HOMA-IR) were calculated. All the subjects were divided into the normal glucose tolerance (NGT) group and the prediabetes group according to the OGTT test results. Rank sum test and chi-square test were used to analyze the difference in basic data between the two groups. Spearman correlation was used to analyze the correlation between HbA_1c, HOMA-IR and anthropometric indicators. The receiver operating characteristic (ROC) curve and logistic regression were used to analyze the predictive effects of anthropometric indicators on prediabetes.

There were 119 cases in NGT group (including 46 healthy people in the physical examination center), 120 cases in prediabetes group. AVI, BRI, BAI, C-index, ABSI, CUN-BAE were statistically different between the two groups (all P<0.05), and they were all related to HbA_1c and HOMA-IR (all P<0.05). ROC curve analysis showed that 3.698 as the boundary value the BRI had the maximum ROC area (AUC=0.710). The multivariate logistic regression analysis showed that BRI (OR=4.408), C-index (OR=4.540, all P<0.05) had the greatest influence on prediabetes, and stepwise logistic regression showed AVI, BAI and ABSI could be combined to predict prediabetes. The area under the ROC curve of the combined application of AVI, BAI and ABSI was also the largest (AUC=0.735).

BRI and C-index are good predictors of prediabetes, but they cannot be used as independent indicators for predicting prediabetes. The combined application of AVI, BAI, and ABSI is more effective in predicting prediabetes.

To explore the relationship between blood pressure and prediabetes in Chinese adults.

A total of 6 846 subjects (normal blood glucose) aged 18 years or older who participated in the baseline survey of China Chronic Disease Surveillance Project in 2010 and the cohort follow-up from 2016 to 2017 with complete survey data were enrolled. The general data and laboratory indicators of the subjects were collected, including age, gender, education, urban and rural, income, regions, smoking, drinking, physical activity, insufficient intake of fruits and vegetables, excessive intake of red meat, height, weight, waistline, systolic blood pressure, diastolic blood pressure, blood lipids, fasting plasma glucose (FPG), 2-hours plasma glucose (2hPG) after 75 g oral glucose test. Body mass index (BMI) was calculated. According to the standard established by the World Health Organization in 1999, FPG<7.0 mmol/L and 7.8 mmol/L≤2hPG<11.1 mmol/L, and/or 6.1 mmol/L≤FPG<7.0 mmol/L and 2hPG<7.8 mmol/L are defined as prediabetes. According to the level of systolic blood pressure and diastolic blood pressure, the subjects were divided into normal blood pressure group (4 304 cases), isolated systolic hypertension (ISH) group (960 cases), isolated diastolic hypertension (IDH) group (277 cases) and systolic diastolic hypertension (SDH) group (1 305 cases). Chi-square test and F-test were used to compare the basic characteristics of different blood pressure, and unconditional Logistic regression model was used to analyze the relationship between blood pressure and prediabetes.

Among the 6 846 subjects, there were 2 936 males (42.9%) and 3 910 females (57.1%), aged (46.67±13.33) years. The average follow-up was 6.4 years. During the follow-up period, a total of 809 cases developed prediabetes, including 452, 147, 31 and 179 cases in normal blood pressure group, ISH group, IDH group and SDH group, respectively. Logistic regression analysis showed that after adjusting for age, gender, education, income, urban and rural, regions, physical activities, central obesity, smoking, drinking, inadequate intake of fruits and vegetables, excessive red meat intake, BMI and dyslipidemia, the risk of prediabetes in the ISH group was 45% (OR=1.45, 95%CI 1.11—1.90, P<0.05) higher than that in the normal blood pressure group,and the risk of prediabetes increased by 53% (OR=1.53, 95%CI 1.21—1.94, P<0.05) in the SDH group. However, there was no correlation between IDH group and the risk of prediabetes (P>0.05).

The risk of prediabetes in hypertensive people in China is increasing. Therefore this population, especially those with ISH and SDH, should be taken as the key intervention target in the future.

To investigate the characteristics and related factors of prediabetes residents in Chengguan district of Lanzhou.

A cross-sectional study was conducted to investigate the Han residents living in 6 communities in Chengguan district, Lanzhou city, Gansu province, from December 2019 to December 2020. The height and weight were collected and the body mass index (BMI) was calculated. The age, waist circumference, neck circumference, systolic blood pressure, erythrocyte, leukocyte, hemoglobin (Hb), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), glutamic pyruvic transaminase (ALT), glutamic oxaloacetic transaminase (AST), fasting plasma glucose (FPG) and 1 h-postprandial plasma glucose (1hPG), 2 h-postprandial plasma glucose (2hPG) after oral glucose tolerance test (OGTT) and glycosylated hemoglobin (HbA_1c) were collected. According to the guideline for prevention and treatment of type 2 diabetes in China (2020 Edition), the subjects were divided into prediabetes (PreDM) [including impaired fasting glucose (IFG), impaired glucose tolerance (IGT), IFG+IGT] group and normal glucose tolerance (NGT) group. t-test and analysis of variance (ANOVA) were used to compare the groups. Pearson′s correlation analysis was used to analyze the correlation among FPG, 1hPG and 2hPG and clinical indexes in PreDM patients.

A total of 479 residents were enrolled. There were 131 patients in NGT group, 348 in PreDM group (193, 52 and 103 patients with IGT, IFG and IGT+IFG respectively). Compared with NGT group, BMI, leukocyte, ALT, AST, TG, HbA_1c, FPG, 1hPG and 2hPG in PreDM group were all higher (P<0.05). IGT, IFG and IGT+IFG accounted for 55.5% (193/348), 14.9% (52/348) and 29.6% (103/348) respectively. The results of Pearson′s correlation analysis showed that FPG was positively correlated with BMI, TC, HbA_1c and Hb in the patients of PreDM group (r values were 0.14, 0.21, 0.15 and 0.14, respectively, all P<0.001), and 1hPG was positively correlated with BMI, AST, ALT, TC, HbA_1c, Hb, erythrocyte and leukocyte (r values were 0.25, 0.10, 0.17, 0.08, 0.30, 0.13, 0.18 and 0.20, respectively, all P<0.05); 2hPG was positively correlated with BMI, AST, ALT, HbA_1c and leukocyte (r values were 0.16, 0.15, 0.21, 0.22 and 0.13, all P<0.05), and FPG, 1hPG and 2hPG correlated with HDL-C negatively (r values were -0.12, -0.18, -0.21, respectively, all P<0.001).

There were great differences in lipid metabolism, liver function and blood cell level between PreDM and NGT patients in Chengguan district of Lanzhou city. IGT accounted for the highest proportion among the PreDM patients.

To explore the relationship of serum level of hyocholic acid species(HCAs)with glucose and lipid metabolism on human.

Participants from Shanghai Obesity Study between December 2009 and June 2010 were enrolled for a cross-sectional study. The gender, age, height and weight of the subjects were collected and their body mass index (BMI) was calculated. Fasting blood glucose (FPG), fasting insulin (FINS), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C) and other biochemical indicators were tested. Serum bile acid spectrum [including hyocholic acid (HCA), hyodeoxycholic acid (HDCA), glycohyocholic acid (GHCA) and glycohyodeoxycholic acid (GHDCA), etc] were measured, then the serum total HCAs were calculated. Homeostasis model of assessment for β-cell function (HOMA-β), Gutt insulin sensitivity index (Gutt-ISI) and other indexes were figured out according to formulas. Subjects were divided into healthy lean, healthy overweight/obese, and overweight/obese with type 2 diabetes (T2DM) based on their BMI and whether they had T2DM. Kruskal-wallis H test, Mann-Whitney U test or χ² test were used to compare the corresponding indexes among the three or two groups. Spearman rank correlation analysis and multiple linear regression model were performed to analyze the association between serum HCAs and metabolic markers.

A total of 304 subjects were included in this study, with 127 in healthy lean group, 107 in healthy overweight/obese group, and 70 in overweight/obese with T2DM group. Total HCAs, HCA, GHCA and GHDCA were lower in overweight/obese with T2DM group than healthy lean group (P<0.05). After adjustment for gender, age and BMI, HCA was inversely correlated with LDL-C (β=-0.006,P=0.011), while positively with Gutt-ISI (β=0.496,P=0.003). HDCA was also positively correlated with Gutt-ISI (β=0.240,P=0.028). GHCA was positively correlated with FINS (β=0.048,P=0.011) and HOMA-β (β=0.582,P=0.032).

The levels of serum HCAs were decreased in overweight/obese patients with T2DM; and this decrease was closely related with their dyslipidemia, islet β cell dysfunction, and insulin resistance.

To explore the distribution characteristics of osteocalcin gene single nucleotide polymorphism in Shanghai Han population and its correlation with type 2 diabetes mellitus (T2DM).

Shanghai Han T2DM patients and healthy controls who were treated in the Department of Endocrinology, Punan Hospital, Pudong New Area, Shanghai from December 2019 to January 2021 were selected. The subjects′ gender, age, height and weight were collected, and body mass index (BMI) was calculated. Fasting C-peptide, fasting plasma glucose (FPG), fasting insulin (FINS) and other indexes were collected. The homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were calculated. The DNA of the subjects was extracted and nine loci of osteocalcin gene (rs1543294, rs2277872, etc.) were genotyped, and the distribution frequency of each genotype was calculated. The t test, Mann‐Whitney U test or χ² test were used to compare the baseline data of healthy controls and T2DM patients. Logistic regression analysis was used to compare the distribution frequency of osteocalcin genotypes between the two groups under different models (additive, codominant, dominant and recessive). The correlations between nine genotypes of osteocalcin gene and (HOMA-β), (HOMA-IR), fasting C-peptide and FINS were analyzed by linear regression analysis. Factors such as gender, age, height, weight and BMI were adjusted.

A total of 221 T2DM patients and 113 healthy controls were enrolled. There was no significant difference in the distribution frequency of different osteocalcin genotypes between the two groups under the four models (P>0.05). After adjusting for gender, age, height, weight and BMI, there was no significant difference (P>0.05).Linear regression analysis showed that the osteocalcin gene locus rs1543294 TT genotype in T2DM patients was associated with (HOMA-β) [OR (95%CI) was 359.10 (173.20-545.00), P<0.001], fasting C-peptide [OR (95%CI) was 7.68 (4.06-11.29), P<0.001] and FINS [OR (95%CI) was 46.45 (23.82-69.07), P<0.001]; locus rs2277872 GG genotype was associated with (HOMA-β) [OR(95%CI) was 354.4(159.3-549.5), P<0.001], fasting C-peptide [OR(95%CI) was 8.12(4.38-11.93), P<0.001] and FINS [OR(95%CI) was 49.98 (26.38-73.57), P<0.001].

TT genotype at rs1543294 and GG genotype at rs2277872 of osteocalcin gene are related to (HOMA-β), fasting C-peptide and FINS in Shanghai Han T2DM patients, which may be the potential genotype of osteocalcin affecting glucose metabolism.

To assess the association of serum asprosin with carotid atherosclerosis among elderly individuals with type 2 diabetes mellitus (T2DM) in the community.

Elderly T2DM patients aged 65 and over who were treated at the Zhuoma Community Health Service Station and Chengbei West Street Community Health Service Center in Changzhi City, Shanxi Province from November 2019 to July 2021 were enrolled. The patients′ height and weight were collected, then the body mass index (BMI) were calculated. The data of patient′s fasting plasma glucose (FPG), glycated hemoglobin A_1c(HbA_1c),triglyceride(TG) and serum albumin were also collected. The carotid intima media thickness (CIMT) were measured by ultrasonography. According to the Mannheim Consensus, patients whose CIMT≥1.5 mm and/or carotid artery plaque were included in the carotid atherosclerosis group, and the rest were included in the carotid atherosclerosis group. Comparisons of continuous variables between two groups were made using Student′s t-test, MannWhitney U test or χ² test. Pearson′s or Spearman′s correlation analysis was used to analyze the association between serum asprosin and other clinical data. Multivariate stepwise logistic regression analysis was used to analyze the influencing factors of carotid atherosclerosis and carotid intima media thickening.

A total of 385 elderly patients with T2DM were enrolled. There were 137 cases in the non carotid atherosclerosis group and 248 cases in the carotid atherosclerosis group. Compared with patients without carotid atherosclerosis group, patients with carotid atherosclerosis group had higher serum aspoin (P<0.001), and lower BMI, FPG,TG and HbA_1c (P<0.05). Pearson′s correlation analysis showed that serum asprosin in patients with T2DM was positively correlated with CIMT on the left and right sides (r values were 0.306 and 0.324, respectively, P<0.001). Multivariate stepwise logistic regression analysis showed that serum asprosin was an influencing factor of carotid atherosclerosis [OR (95%CI) 1.021 (1.015-1.027), P<0.001]. Compared with the patients in the lowest tertile of serum aspeosin, asprosin is between 279.6 and 344.0 pg/ml [OR (95%CI) 7.381 (3.495-15.587), P<0.001] and asprosin>344 pg/ml [OR (95%CI) 30.157 (9.272-98.088), P<0.001] patients have a higher risk of carotid atherosclerosis.

There was a positive correlation between serum asprosin and CIMT in elderly patients with T2DM in the community of Changzhi City, Shanxi Province, which was an influencing factor of carotid atherosclerosis. With the elevation of asprosin, the risk of patients with carotid artery atherosclerosis increased.

To investigate the functional status of pancreatic β-cells in patients with polycystic ovary syndrome (PCOS) with normal glucose tolerance (NGT) during oral glucose tolerance test (OGTT) 1 h blood glucose increase.

This is a retrospective analysis. A total of 87 PCOS patients in the Department of Endocrinology, the First Affiliated Hospital of Guangxi Medical University from January 2012 to January 2020 were enrolled. According to the OGTT results, the patients were divided into NGT group (65 cases) and impaired glucose tolerance (IGT) (22 cases). Then, the 1-h blood glucose was 8.6 mmol/L as the cut-off point, and the NGT component was divided into NGT A group (1-h blood glucose<8.6 mmol/L, 43 cases) and NGT B group (1 hour blood glucose ≥8.6 mmol/L, 22 cases). OGTT was performed to determine the homeostatic model to evaluate the insulin resistance index (HOMA-IR), the homeostatic model to evaluate the β-cell function index (HOMA-β), the modified islet β-cell function index (MBCI), the area under the insulin curve for 0 to 3 h (AUC_{ins 0-3 h}), AUC_{ins 0-3 h} and 0 to 3 h blood glucose curve area ratio AUC_{ins 0-3 h}/AUC_{glu 0-3 h}, peak insulin and peak insulin/basal insulin ratio (I_p/I₀), and evaluate the function of insulin 2-phase secretion. Intravenous glucose tolerance test (IVGTT) was performed to determine I_p, I_p/I₀, acute phase insulin secretion (AIR_{0-10 min}) and the area under the insulin curve at 0 to 10 min (AUC_{ins 0-10 min}) to evaluate the insulin secretion function in phase 1. One-way analysis of variance (ANOVA) or non-parametric test was used to compare multiple groups.

The OGTT examination showed that the insulin peak value of the NGT A group and NGT B group fell at 1 h, the NGT A group was lower than the NGT B group, and the IGT group insulin peak fell at 2 h. There was a statistically significant difference in HOMA-IR, MBCI, AUC_{ins 0-3h} and I_p among the 3 groups. The HOMA-IR of the IGT group was higher than that of NGT A and NGT B groups, and AUC_{ins 0-3 h} and I_p in NGTA group were lower than those in NGT B group and IGT group, the MBCI of NGT A group was higher than NGT B group and IGT group, the difference was statistically significant (all P<0.05); there was no significant differences in HOMA-β, AUC_{ins 0-3 h}/AUC_{glu 0-3 h} and I_p/I_{0 am}ong the three groups (all P>0.05). In IVGTT, there was a statistical difference in I_p/I_{0 am}ong the three groups, among which the IGT group was lower than the NGT A group (all P<0.05); while there was no statistical difference in I_p, AIR_{0-10 min} and AUC_{ins 0-10 min} among the 3 groups (all P>0.05).

PCOS patients with normal glucose tolerance have insulin secretion impairment similar to IGT when OGTT 1 hour blood glucose is ≥8.6 mmol/L, and they belong to the high-risk population of diabetes. MBCI could be used as a method for evaluating pancreatic β-cell function in the early stage of PCOS.

This article reports a patient with 17q12 microdeletion syndrome with central nervous system involvement and his family. In addition to insulin-independent diabetes, multiple renal cysts, epididymal cysts and hyperuricemia, the proband also presented with facial tics. No mutation was found in the first-generation sequencing of hepatocyte nuclear factor 1 β (HNF1 β). Later, two gene detection methods, multiplex ligation probe amplification technology and high-throughput sequencing combined with copy number variation detection technology, were used to determine that both the proband and his father had a large fragment deletion of 1.39 Mb in the 17q12 region including exons 1~9 of HNF1 β gene. After the proband and his father were diagnosed, they successfully switched from insulin to low-dose sulfonylureas. In addition to good blood sugar control, the proband's facial tics also improved significantly, suggesting that tics may be one of the neurological disease spectra of 17q12 microdeletion syndrome, and may be related to the role of sulfonylurea-sensitive potassium channels downstream of HNF1 β in the central nervous system.

Dapagliflozin has been approved in some countries for use in patients with type 1 diabetes due to its non-insulin-dependent hypoglycemic effect and various benefits, but clinicians currently have relatively insufficient understanding of the non-hyperglycemic diabetic ketoacidosis caused by it. This paper reports a case of ketoacidosis in a 50-year-old adult with occult autoimmune diabetes after 6 days of dapagliflozin application, and reviews the literature at home and abroad, hoping to improve the understanding of this disease.

A family of adult-onset diabetes mellitus type 2 (MODY2) in adolescents with gestational hyperglycemia onset combined with glucose kinase (GCK) and B lymphocyte tyrosine kinase (BLK) gene variants was reported. The proband was admitted to the hospital with the main complaint of "6 months of pregnancy, perinatal blood glucose increase". Through family clinical data analysis and genetic testing, it was found that he carriedGCKc. 793G>A andBLKC. 274G>C variant, and carried aloneGCKMembers of the variant conform to the main clinical symptom characteristics of MODY2, but only carryBLKThe results of oral glucose tolerance test were normal in the members of the genetic mutation, and the main cause of the disease was diagnosed asGCKMODY2 caused by genetic variation. The proband was given intensive insulin therapy, diet control, appropriate activities, and a boy was delivered at full term 3 months later. The newborn's blood glucose screening was normal. We combined the literature to explore its clinical characteristics, diagnosis and treatment points, aiming to expand the understanding of related genetic genes of endocrinologists and improve the ability of diagnosis and treatment of MODY.

Leptin is an adipocytokine with a relative molecular mass of 16,000 discovered by Jeffrey M Friedman in 1994 and secreted mainly by white adipose tissue. Leptin binds to its receptors in hypothalamic neurons, and by activating downstream signaling pathways, it can inhibit feeding, increase energy consumption, and improve glucose and lipid metabolism. Studies have reported that the occurrence and development of obesity is closely related to leptin resistance. The main causes of leptin resistance include the restriction of leptin passing through the blood-brain barrier, the decrease of leptin receptor expression, and the damage of postreceptor signaling pathway or abnormal epigenetic regulation. The latest research has found that hyperleptinemia can also drive leptin resistance in obesity, and partially reducing blood leptin levels has an anti-obesity effect. In addition to acting on central neurons to suppress appetite, leptin can also directly regulate glucose and lipid metabolism in peripheral tissues including adipose tissue, liver, skeletal muscle, etc. Leptin promotes white fat browning by activating sympathetic nerves. These results have deepened people's understanding of leptin, and also provided new experimental evidence for the development of leptin-based drugs for weight loss and improvement of obesity-related glucose and lipid metabolism abnormalities.

Diabetes is a group of lifelong metabolic diseases characterized by chronic hyperglycemia caused by multiple etiologies, and microvascular complications are the main cause of disability and death of patients, seriously damaging the function of various organs of patients, affecting the quality of life and prognosis of patients. Therefore, the prevention and treatment of diabetic microvascular disease has received more and more clinical attention. As an environmental factor, intestinal flora is closely related to the occurrence and development of diabetes mellitus, and affects the prognosis of diabetic microvascular complications. In this paper, we summarized the relationship and pathogenesis of intestinal flora and diabetic microvascular disease, and the future research prospects of intestinal flora and diabetic microvascular disease, aiming to provide some reference basis for the prevention and treatment of diabetes and its microvascular disease by regulating intestinal flora.

In recent years, the metabolic surgical treatment of obesity complicated with diabetes has gradually increased, and remarkable results have been achieved. Laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass have become the most popular surgical procedures, and have shown advantages in relieving obesity-related type 2 diabetes, reducing weight, lowering hypertension, lowering blood lipids, improving sleep apnea and reducing tumor occurrence. The specific mechanism remains to be further studied. This article summarizes and discusses the clinical status and research progress of common surgical methods, surgical indications, and the effect of surgical relief of diabetes mellitus in metabolic surgery for diabetes mellitus.