Volume 14 · Issue 08 · 2022

In view of the high prevalence of diabetes mellitus in patients with liver cirrhosis and the increasing trend of non-alcoholic fatty liver disease-associated cirrhosis, the diagnosis and treatment of diabetes mellitus in patients with liver cirrhosis are becoming widespread concerns. Therefore, the Chronic Disease Management Branch, China Pharmaceutical Biotechnology Association, organized multidisciplinary experts from gastroenterology, infective disease, endocrinology, etc, to draw up expert consensus on the management of diabetes mellitus in patients with liver cirrhosis, with focusing on the classification and management of hyperglycemia in cirrhotic patients. The consensus summarizes the prevalence, pathogenesis, clinical setting and prognosis of the concomitant diabetes mellitus in patients with liver cirrhosis, and definitely puts forward a proposal regarding "hepatogenous diabetes" as one of the four subtypes of diabetes mellitus in cirrhotic patients, and further recommends the basic principles for diagnosing and monitoring diabetes mellitus and the selection of antidiabetic drugs based on liver functions in patients with liver cirrhosis.

To investigate the relationship between disposition index (DI) and the risk of adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM).

A total of 1 912 women were prospectively recruited from January 2015 to December 2017 in Department of Gynecology and Obstetrics of the Shanghai Jiao Tong University of Medicine Affiliated Sixth People′s Hospital. According to whether they had GDM, they were divided into GDM group (434 cases) and non-GDM group (1 478 cases). All participants received a 75 g oral glucose tolerance test (OGTT) during the 24-28 gestational weeks and completebasal and delivery information was collected. The insulin sensitivity index (ISI) and the area under the insulin curve/area under the blood glucose curve (AUC_INS120/AUC_GLU120) were calculated from the results of the 75 g OGTT. The DI was calculated as the product of the ISI and AUC_INS120/AUC_GLU120 and then log transformed. Adverse pregnancy outcomes were defined as large for gestational age (LGA), primary cesarean section, preeclampsia, and preterm birth. Comparison between groups was performed by t test, Wilcoxon rank sum test and χ² test. Logistic regression analysis was used to explore the relationship between DI and the risk of adverse pregnancy outcomes.

Women with GDM had a lower ISI even DI than women without GDM. Compared with women with GDM in the lowest quartile (Q₁, DI<2.90) of DI, multivariable adjusted (age, body mass index, other pregnancy complications, gestational age at the time of OGTT, fetal sex and parity) odds ratios (OR) of adverse pregnancy outcomes of those in the second (Q₂, DI 2.90-3.02), third (Q₃, DI 3.03-3.16), and highest (Q₄, DI>3.16) quartiles of DI were reduced by 55% (95%CI 0.23-0.87), 34% (95%CI 0.35-1.25), and 59% (95%CI 0.24-0.71) (P for trend=0.01), respectively. When DI was considered as a continuous variable, the multivariable adjusted OR of adverse pregnancy outcomes in women with GDM was reduced by 60% (95%CI 0.21-0.73) for each one unit increase in DI. However, DI was not associated with adverse pregnancy outcomes in women without GDM (OR=0.66, 95%CI 0.36-1.18).

Elevated DI levels in women with GDM are closely associated with a reduced risk of adverse pregnancy outcomes.

To explore the feasibility and the value of Pittsburgh formula, SEARCH formula, coronary artery calcification in type 1 diabetes mellitus (CACT1) formula and Guangdong formula in evaluating insulin sensitivity in patients with type 1 diabetes mellitus (T1DM).

This study was a retrospective study. The patients who were admitted into T1DM comprehensive management clinic of the Second Xiangya Hospital of Central South University from November 2015 to December 2016 were collected. Waist circumference and hip circumference were recorded, and waist-hip ratio was calculated. Their blood pressure, fasting plasma glucose (FPG), glycated hemoglobin A_1c (HbA_1c), triglyceride (TG) and low-density lipoprotein-cholesterol (LDL-C) were collected. According to the 4 alternative formulas, the insulin sensitivity index of patients was calculated, respectively. The upper and lower quartile of insulin sensitivity indexes were defined as low and high insulin resistance respectively, and between the upper and lower quartile of insulin sensitivity indexes were defined as moderate insulin resistance. According to age, the patients were divided into minor group (≤ 18 years old) and adult group (>18 years old). T test or Mann-Whitney U test was used for comparison between the two groups. Kappa analysis was used for consistency analysis of 4 alternative formulas. Pearson or Spearman correlation analysis was used to analyze the correlation between insulin sensitivity index calculated by different formulas and clinical features of patients.

Eighty-four patients with T1DM were included. Among them, there were 40 cases in adult group and 44 cases in minor group. There were 21 cases in high insulin resistance group, 42 cases in moderate insulin resistance group and 21 cases in low insulin resistance group. The consistency between Guangdong formula and Pittsburgh formula was the best, with the consistency rate of 78.6% and the Kappa coefficient of 0.657 (P<0.01). The insulin sensitivity indices calculated by the 4 alternative formulas were negatively correlated with waist circumference (r values were -0.300, -0.697, -0.422 and -0.349, respectively), waist-hip ratio (r values were -0.733, -0.514, -0.231 and -0.678, respectively), systolic blood pressure (r values were -0.241, -0.263, -0.356 and -0.384, respectively), FPG (r values were -0.355, -0.321, -0.359 and -0.300, respectively), TG (r values were -0.358, -0.700, -0.686 and -0.423, respectively) and LDL-C (r values were -0.385, -0.369, -0.329 and -0.428, respectively) (all P<0.05). The insulin sensitivity indices evaluated by Pittsburgh formula, SEARCH formula and Guangdong formula were negatively correlated with waist-hip ratio in minor and adult groups (r values in minor group were -0.651, -0.472 and -0.631, respectively; r values in adult group were -0.755, -0.651, -0.730, respectively), HbA_1c (r values in minor group were -0.936, -0.843 and -0.895, respectively; r values in adult group were -0.799, -0.752 and -0.826, respectively) and TG (r values in minor group were -0.449, -0.696 and -0.499, respectively; r values in adult group were -0.353, -0.697 and -0.360, respectively) (all P<0.05).

Four alternative formulas can be used to evaluate insulin sensitivity in T1DM patients. Among them, Guangdong formula and Pittsburgh formula have the best consistency. Pittsburgh formula, SEARCH formula and Guangdong formula can be used to evaluate insulin sensitivity of minor and adult patients with T1DM.

To compare the efficacy and safety of Mixed Protamine Zinc Recombinant Human Insulin Lispro Injection (50R) (WANBANG) and Humalog Mix 50 (Lilly) in the treatment of type 2 diabetes mellitus (T2DM).

A multicenter, randomized, parallel, positive control, phase Ⅲ clinical trial was conducted. From August 30, 2018 to May 27, 2020, 612 patients with T2DM with poor glycemic control by oral hypoglycemic agents were enrolled from 36 centers nationwide, and were followed random number method assigned to the experimental group (WANBANG) and the control group (Lilly) according to 1∶1 for 16 weeks. The glycated hemoglobin A_1c (HbA_1c), fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), body weight, blood lipid, HbA_1c compliance rate at the end, the incidence of hypoglycemic events and adverse events and the positive rate of insulin antibody were compared between the two groups before and after treatment.

Of the 612 patients, 609 were included in the safety data set, including 305 in the experimental group and 304 in the control group; 534 cases were enrolled into the protocol set, including 267 cases in the experimental group and 267 cases in the control group. After 16 weeks of treatment, HbA_1c decreased by 1.85%±1.23% and 1.90%±1.27%, respectively. FPG decreased by (3.56±2.99) and (3.72±3.26) mmol/L, 2hPG decreased by (6.94±5.41) and (7.07±5.10) mmol/L, respectively, there was no significant difference in the above indexes between the two groups (P>0.05). There was no significant difference in the overall incidence of hypoglycemia [51.15% (156/305) vs. 45.72% (139/304)], the incidence of adverse events [76.39% (233/305) vs. 77.63% (236/304)] and the positive conversion rate of insulin antibody [22.85% (61/267) vs. 19.10% (51/267)] between the experimental group and Humalog Mix 50 group (P>0.05).

The efficacy and safety of Mixed Protamine Zinc Recombinant Human Insulin Lispro Injection 50R (WANBANG) in treating T2DM is similar to that of Humalog Mix 50, and is well tolerated. This study has positive significance for reducing the medical burden of the country.

To investigate the relationship between diabetic peripheral neuropathy (DPN) and cognitive impairment in elderly patients with Type 2 diabetes mellitus (T2DM).

The elderly T2DM patients (aged 60 to 75 years) hospitalized in the Department of Endocrinology, Beijing Hospital from December 2020 to November 2021 were enrolled in the group sequentially. The patients′ medical history, general data and laboratory results were collected, the cognitive function was assessed by mini-mental state examination (MMSE) and Montreal Cognitive Assessment (MOCA) scale, and the body function was evaluated by 4-meter walking speed and standing test on one foot with eyes closed. According to the presence or absence of DPN, patients were divided into DPN group and non-DPN group. Chi-square test, t test or Mann-Whitney U test were used to compare the differences of clinical features between the two groups, and logistic regression analysis was used to analyze the risk factors of cognitive impairment.

Two hundred and six patients with T2DM were enrolled in the study, including 87 patients in the DPN group (42.2%) and 119 patients in the non-DPN group (57.8%). There were statistically significant differences in gender distribution, smoking history, the level of glycosylated hemoglobin A_1c(HbA_1c), 2 h postprandial C-peptide, 1, 25 (OH)₂-vitamin D3, and standing time on one foot with eyes closed between non-DPN group and DPN group (P<0.05). There were statistically significant differences in MMSE score, MOCA score, memory score and attention score between non-DPN group and DPN group (P<0.05). According to MOCA score, patients were divided into normal cognitive function group (59 cases, 28.6%) and cognitive impairment group (147 cases, 71.4%). The education level, 2 h postprandial C-peptide level, standing time on one foot with eyes closed and 4-meter walking speed in the cognitive impairment group were lower than those in the normal cognitive function group, while the proportion of clinical DPN patients in the cognitive impairment group was higher than that in the normal cognitive function group [50.3% (74/147) and 22.0% (13/59), respectively], and the differences were statistically significant (P<0.05). Logistic regression analysis showed that in elderly patients with T2DM, DPN was a risk factor for cognitive impairment [OR (95%CI) was 3.622 (1.722 to 7.619)]. Educational background [OR (95%CI) was 0.458 (0.247 to 0.849)], 4-meter walking speed [OR (95%CI) was 0.339 (0.151 to 0.762)] and standing time on one foot with eyes closed [(OR (95%CI) was 0.830 (0.698 to 0.987)] were protective factors for cognitive impairment.

Peripheral neuropathy was associated with cognitive impairment in elderly patients with T2DM, and DPN was a risk factor for cognitive dysfunction.

To investigate the relationship between the expression of OX40 on circulating follicular helper T cells (cTfh) in newly diagnosed type 2 diabetes and insulin resistance.

The newly diagnosed T2DM patients hospitalized in the First Affiliated Hospital of Soochow University from November 2020 to December 2021 were selected, and the healthy volunteers in the physical examination center during the same period were selected as the control.The height and weight of the subjects were measured, and the body mass index (BMI) was calculated. The subjects′ fasting plasma glucose (FPG) and fasting serum insulin (FINS) were collected, and the area under the serum insulin curve (AUC_INS) and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated. The proportion of cTfh cells in the peripheral blood and the expression of OX40 on the surface of cTfh cells were detected. T-test or χ² test was used to compare the indexes between the two groups. Pearson correlation analysis was used to analyze the correlation between HOMA-IR and clinical indicators, and multiple linear regression was used to analyze the influencing factors of HOMA-IR.

A total of 160 subjects were included. There were 96 cases in T2DM group and 64 cases in control group.The expression of OX40 on cTfh cells in T2DM (7.51±5.32)% was significantly higher than that in control group (3.95±1.62)%, and the difference was statistically significant (t=4.29,P=0.006).Pearson correlation analysis showed that HOMA-IR was positively correlated with the ratio of OX40⁺Tfh cells (r=0.569), BMI (r=0.450) and AUC_INS (r=0.341), (P<0.001), respectively. Multiple linear regression showed that the increase of OX40⁺Tfh cells (B=0.284,95%CI 0.029-0.538, P=0.017) and BMI (B=0.249,95%CI 0.030-0.486,P=0.022) had independent positive effects on the degree of insulin resistance in newly diagnosed T2DM.

OX40 was up-regulated on the surface of cTfh in T2DM patients. Moreover, the increase of OX40⁺Tfh cells might be an independent risk factor of insulin resistance in patient with newly diagnosed type 2 diabetes.

To systematically evaluate the effects of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on urinary tract infections or genital infections in patients with type 2 diabetes mellitus.

We searched PubMed, EMbase, Web of Science, Clinical trials and Cochrane Library, as well as Chinese literature databases such as China national knowledge infrastructure (CNKI), Wanfang, VIP, and SinoMed databases from the establishment of the databases to 31st, August 2021 for randomized controlled trials (RCT) that involved SGLT2i and safety events of urinary tract infections or genital infections. A series of network Meta-analysis were performed on all available evidence. The titles, interventions, background medication, outcome events, sample size and other information of the included studies were extracted. In a multi-layered mesh Meta-analysis of all available evidence, the relative effect values of urinary tract infection or genital infection were showed as odds ratio (OR) values and 95% confidence intervals (95%CI).

A total of 100 studies were included, 97 of which reported urinary tract infections and 28 of which reported genital infections. The total sample size of SGLT2i group was 46 697, including Canagliflozin, Dapagliflozin, Bexagliflozin, Remogliflozin, Ertugliflozin and Henagliflozin, etc. The total sample size of the control group including other hypoglycemic drugs and placebo was 33 284. Other hypoglycemic drugs included dipeptidyl peptidase Ⅳ inhibitor (DPP-4i), insulin, sulfonylureas, etc. Some kinds of SGLT2i were associated with an increasing risk of urinary tract infections at different magnitude. The risk of urinary tract infection induced by Canagliflozin was lower than that of Dapagliflozin (OR=0.67, 95%CI 0.45-0.99), Bexagliflozin (OR=0.43, 95%CI 0.19-0.98) and Remogliflozin (OR=0.27, 95%CI 0.08-0.97). Ertugliflozin increased the risk of urinary tract infection (OR=1.21, 95%CI 1.04-1.40) compared with placebo. Compared with Henagliflozin and insulin, Bexagliflozin increased the risk of urinary tract infection with the OR values (95%CI) of 4.15 (1.08-15.95) and 12.16 (1.27-116.55), respectively. In addition, Hengglitazin reduced the risk of urinary tract infection (OR=0.15, 95%CI 0.03-0.80) compared with Remogliflozin. Compared with insulin and sulfonylureas, Remogliflozin might increase the risk of urinary tract infection with the OR values (95%CI) of 19.32 (1.65-226.07) and 5.82 (1.11-30.57), respectively. The results of network Meta-analysis also showed that SGLT2i significantly increased the risk of genital infections compared with other hypoglycemic drugs (OR=4.18,95%CI 2.33-7.53). A detailed comparison showed that SGLT2i had a higher risk of genital infection compared with DPP-4i (OR=3.26, 95%CI 1.18-9.06), in which Canagliflozin had an increased risk compared with DPP-4i (OR=3.80, 95%CI 1.08-13.39).

In patients with T2DM, SGLT2i was associated with a higher risk of genital infections compared with other hypoglycemic drugs, especially DPP-4i. Dapagliflozin, Ertugliflozin, Bexagliflozin, and Remogliflozin were associated with increasing risk of urinary tract infections.

To explore the characterization of gut microbiota in latent autoimmune diabetes in adults (LADA) based on 16S rRNA gene sequencing.

This was a case-control study. Patients with LADA and type 2 diabetes mellitus (T2DM) were selected from the Department of Endocrinology, Heji Hospital Affiliated to Changzhi Medical College from September 2019 to October 2020, and healthy people were selected as normal control people (NCP) from the physical examination center of this hospital.The data of glutamic acid decarboxylase antibody (GADA), protein tyrosine phosphatase 2 antibody (IA-2A), etc., and the 16S rRNA gene sequence of the gut microbiota were collected. The analysis software QIIME (version 1.8.0) was used to analyze the alpha diversity index reflecting the diversity and richness of gut microbiota and the Beta diversity index reflecting the structural similarity between groups. The t-test or analysis of one-way variance, Mann-Whitney U test, Kruskal-Wallis H test or χ² test were adopted for comparison among the groups. The changes of microbial functions were predicted based on the PICRUST. Spearman correlation was used to analyze the correlation between gut microbiota and biochemical data.

A total of 42 subjects were included, including 14 in NCP group, 14 in T2DM group and 14 in LADA group. There was no significant difference in alpha diversity index (P<0.05), but there was significant difference in Beta diversity (P<0.05) among the three groups of gut microbiota. Compared with the NCP group, the short-chain fatty acid producing bacteria such as Lachnospira, Roseburia and Lac_(Ruminococcus) genera significantly decreased (P<0.05), and the Lac_(Ruminococcus) genera significantly decreased in LADA group compared with the T2DM as well (P<0.05). Compared with NCP group, the metabolic prediction function pathways such as phenylalanine synthesis, primary bile acid biosynthesis and secondary bile acid biosynthesis in LADA group decreased (P<0.05). Spearman correlation analysis showed that the GADA antibody titer was negatively correlated with Lac_(Ruminococcus) (r=-0.44), and positively correlated with Prevotella (r=0.38), Dialister (r=0.34), Rum_Ruminococcus genera (r=0.13, all P<0.05), the titer of IA-2A antibody was positively correlated with the Megasphaera genus (r=0.13, P<0.05).

LADA patients maight have a distinctive gut microbiota composition, accompanied with a decrease of some short-chain fatty acid-producing bacteria Lachnospira, Roseburia and Lac_(Ruminococcus) genera, and a decrease in some important metabolic prediction function pathways such as phenylalanine synthesis, primary bile acid biosynthesis and secondary bile acid biosynthesis. In addition, islet autoantibodies are correlated with some genera like Prevotella, Dialister, and Rum_Ruminococcus genera, etc.

To investigate the mechanism of lipopolysaccharide (LPS) promoting the expression of miR-425-5p in intestinal L cells.

Intestinal L cell line GLUTag cells were divided into normal control (NC) group, LPS group (LPS 200 ng/ml cultured for 24 hours), small interfering RNA (siRNA) NC group (LPS 200 ng/ml cultured for 24 hours and then transfected with siRNA NC) and nuclear factor-κB (NF-κB) siRNA group (LPS 200 ng/ml cultured for 24 hours and then transfected with NF-κB siRNA), with 3 replicate wells in each group. The protein levels of NF-κB p65 in the nucleus and cytoplasm were detected by Western blotting. The expression level of miR-425-5p was detected by real-time fluorescence quantification polymerase chain reaction. The secretion level of glucagon-like peptide-1 (GLP-1) was determined by enzyme-linked immunosorbent assay.The potential binding sites of NF-κB on the miR-425-5p promoter were analyzed and predicted using Promo software. The relative activity of the binding site in the promoter region of miR-425-5p was detected by dual luciferase reporting assay.The interaction between NF-κB and miR-425-5p was verified by chromatin immunoprecipitation reaction. The independent sample t test was used for comparison between the two groups, and one-way analysis of variance was used for comparison between multiple groups.

Compared with the control group, the secretion level of GLP-1 in the LPS group was significantly decreased (P<0.01), the expression level of miR-425-5p was increased (P<0.01), and the protein expression level of NF-κB p65 in cytoplasm and nucleus was increased (P<0.05). Compared with the siRNA NC group, the protein level of NF-κB p65 in the nucleus and cytoplasm and the expression level of miR-425-5p in the NF-κB siRNA group were significantly decreased (all P<0.01). Under LPS induction, the activity of the miR-425-5p promoter with two binding sites (2-Luc/3-Luc) was significantly higher than that with a single binding site (3-Luc) (P<0.01). The binding ability of NF-κB to miR-425-5p promoter sequence at site 2 was strongest (P<0.01).

LPS could activate NF-κB and promote its binding to the binding site 2 of the miR-425-5p gene promoter sequence, which in turn promoted miR-425-5p transcription in intestinal L cells, and ultimately regulated the secretion of GLP-1 in intestinal L cells.

Application of sodium-glucose cotransporter 2 inhibitor (SGLT2i) in predisposing circumstances can trigger non-hyperglycemic ketoacidosis (EDKA), which is often overlooked because of low blood glucose. This article reports the case characteristics, diagnosis and treatment of 2 patients with type 2 diabetes mellitus (T2DM), and discusses the literature. Patient 1, with a history of diabetes for 13 years, was treated with metformin combined with dapagliflozin. After drinking alcohol, he experienced nausea and vomiting. Combined with auxiliary examination, EDKA was diagnosed. The islet function examination showed fasting C-peptide 0.80 ng/ml. Patient 2, with a 12-year history of diabetes, was treated with metformin + dapagliflozin + insulin glargine, and was admitted to the hospital with skin and soft tissue infection of the right ankle. After examination, EDKA was diagnosed, and fasting C-peptide was 0.75 ng/ml. Both patients were discharged after discontinuation of dapagliflozin, fluid rehydration, intravenous insulin pumping, and correction of acid-base imbalance and electrolyte disorder. The characteristics, triggers, diagnosis and prevention of EDKA in patients with T2DM caused by SGLT2i were discussed in order to improve the clinical emphasis on EDKA and avoid missed diagnosis and delayed treatment.

A diabetic patient with microcephaly and mental retardation was reported. The patient was a 14-year-old boy who was admitted to hospital with the main complaint of "dry mouth, polydipsia, polyuria for 2 months, repeated palpitation and sweating for 1 week". The whole exome sequencing of peripheral blood DNA showed that the long arm gene of chromosome 10 had a copy number deletion of about 1.823 Mb. Its gene deletion fragment contains insulin-degrading enzyme gene, and the mutation of this gene can lead to the occurrence and development of diabetes. It is suggested that in clinic, for diabetic patients with growth and development malformation and mental retardation, the patient and family should be performed as much as possible after the patient's consent. Genetic examination to confirm the diagnosis, active treatment and discover more genetic susceptibility genes for diabetes.

A case of mitochondrial A3243G mutation was reportedABCC8Diabetic patients with genetic mutations had earlier onset of diabetes, obvious weight loss, and no obvious hearing impairment. The first genetic screening suggested thatABCC8Genetic mutations, considerABCC8-MODY. Later, because his son developed diabetes and did not combine the mutation at this site, the patient and his son were subjected to genetic screening again, suggesting that the patient had a combined mitochondrial A3243G mutationABCC8Mutations. This case reminds clinicians to pay attention to the differentiation between atypical mitochondrial diabetes and adult diabetes with adolescent onset in their work.

Islet cell hyperplasia is the most common cause of pancreatic hyperinsulinemic hypoglycemia in neonates and infants, but it is rare in adults. Its qualitative diagnosis is similar to that of insulinoma, but its localization diagnosis is difficult and difficult to detect by conventional imaging techniques. Selective arterial calcium-stimulated hepatic venous blood collection (ASVS) is an invasive interventional radiological technique mainly used for the localized diagnosis of insulinoma. Its clinical application value in the diagnosis of adult islet cell hyperplasia is relatively insufficient at present. This article reports a case of hypoglycemia with definite qualitative diagnosis and negative non-invasive examinations, endoscopic ultrasound and surgical exploration, which was finally diagnosed as adult diffuse islet cell hyperplasia by ASVS, in order to improve the diagnostic rate of this disease.

A family of cystic fibrosis with diabetes was reported. The proband was admitted with the main complaint of "intermittent cough, expectoration, fever for 15 years, and blood sugar increase for 2 months". Genetic testing found that the proband carried cystic fibrosis transmembrane conduction regulator (CFTR) gene c.1322T>C (p.L441P) and c.1521_1523del (p.F508del) compound heterozygous mutation, combined with the clinical data of transmembrane conduction regulator of cystic fibrosis in the family, the diagnosis of cystic fibrosis with diabetes mellitus, the bronchiectasis and infection of the lung were mainly comprehensive supportive treatment, and the blood glucose was controlled by acarbose. His father carried the heterozygous mutation of p.L441P, which showed pulmonary bullae with impaired glucose metabolism, suggesting that the heterozygous mutation of p.L441P may cause disease, and special attention should be paid to in clinical diagnosis and treatment and genetic counseling.

Smoking is the main risk factor of cardiovascular disease in diabetic patients. Smoking may also increase the risk of diabetes. Risk factor management plays an important role in the course of diabetes. This article reviews the research evidence of the interaction between smoking, diabetes, risk factor management and cardiovascular diseases, and provides more reasonable reference for formulating precise clinical prevention and treatment strategies in the future, so as to reduce the burden of cardiovascular diseases in diabetic patients.

Type 2 diabetes (T2DM) is one of the common diseases in the elderly population. Elderly patients with T2DM have the characteristics of high risk of hypoglycemia, many complications and comorbidities, and poor self-management ability. When formulating hypoglycemic goals and drug treatment plans, patients should be comprehensively evaluated to fully weigh the benefit-risk ratio of treatment plans. Based on its excellent safety profile, dipeptidyl peptidase IV inhibitor (DPP-4i) is one of the first-line hypoglycemic drugs for elderly T2DM recommended by domestic and foreign guidelines and/or consensus in recent years. This article focuses on many aspects of clinical management of elderly T2DM, combined with relevant clinical research data of DPP-4i in the treatment of elderly T2DM patients, and comprehensively analyzes the hypoglycemia risk and long-term cardiorenal safety of DPP-4i in elderly T2DM patients, and discusses the application experience of DPP-4i in patients with hepatic insufficiency. The safety and efficacy of DPP-4i and commonly used hypoglycemic drugs, complications or comorbid diseases in elderly patients are also briefly discussed, and the ongoing research status of some new DPP-4i included in elderly patients is sorted out, in order to provide evidence-based reference for the clinical management of elderly patients with T2DM.

Selenium is an essential trace element for human body, which is crucial to human health. In recent years, the relationship between selenium and T2DM has caused controversy with the continuous research reports that high selenium nutritional levels are associated with the risk of type 2 diabetes mellitus (T2DM). The present situation and challenges of the relationship between selenium and the pathogenesis of T2DM were discussed from three aspects: cross-sectional study, cohort study and randomized controlled trial. Large selenium supplementation may increase the risk of T2DM, especially in people with high baseline selenium nutritional levels.

Diabetes is a common chronic metabolic disease, of which type 2 diabetes (T2DM) accounts for about 90%, and is easily accompanied by cognitive dysfunction, which significantly reduces the quality of life of patients. Insulin resistance (IR) can mediate the development of diabetic cognitive dysfunction, but its specific mechanism remains to be clarified. Focusing on the relationship between IR and T2DM cognitive impairment, this paper reviews the key mechanisms of IR-mediated cognitive impairment in T2DM, mainly focusing on IR-mediated energy metabolism impairment, cerebrovascular disease, beta amyloid deposition and tau hyperphosphorylation, inflammation and oxidative stress, neuronal plasticity damage and hypothalamus-pituitary-adrenal axis dysregulation, etc., focusing on the possible roles of inositol 3-phosphate kinase/protein kinase B pathway and mitogen-activated protein kinase pathway in the development of cognitive function in T2DM patients, hoping to provide reference for follow-up research.

Peripheral neuropathy is one of the common chronic complications of diabetic patients, which seriously affects the quality of life of patients. However, due to diverse clinical manifestations and hidden onset, early diagnosis and precise treatment are still very limited. It is found that non-coding RNAs such as microRNA, long chain non-coding RNA and circular RNA are closely related to their occurrence and development. This paper discusses the role of non-coding RNA in the pathogenesis of peripheral neuropathy, and provides reference for early diagnosis and treatment.

The management of diabetes should fully follow the principle of individualization, but due to the increasing number of patients, individual differences between patients, and the complexity of diabetes treatment plan, it is difficult for doctors to achieve personalized treatment in the clinical decision-making process. The emergence of clinical decision support systems (CDSS) has created opportunities and pathways to achieve personalized treatment of diabetes. The concept of CDSS can be traced back to 40 years ago. In recent years, the combination of advanced artificial intelligence technologies such as fuzzy logic, neural network and reinforcement learning with CDSS has promoted the continuous improvement of the performance of CDSS, and more intelligent CDSS has been developed and applied in clinical practice. To a certain extent, satisfactory results have been achieved. This paper reviews the research status and progress of CDSS in diabetes mellitus in recent years.