Volume 14 · Issue 12 · 2022

The Diabetes Branch of Chinese Medical Association was formally established in October 1991, which brought the research and prevention of diabetes into a new stage of organized and coordinated development. Since the establishment of the branch for 30 years, with the efforts of previous committees, great achievements have been made in all works. The author briefly reviews the development process of Diabetes Branch of Chinese Medical Association in these 30 years. Actively promote academic research, and achieve fruitful results in epidemiology, early intensive insulin therapy, clinical research, drug clinical trials, and basic research. Actively formulate guidelines and consensus, standardize the diagnosis and treatment process of diabetes, and promote homogeneous management of diabetes; Strengthen foreign exchanges and cooperation to enhance international influence; Actively carry out health education and science popularization work. In the future, the Diabetes Branch of Chinese Medical Association will continue to contribute to "Healthy China" and the cause of diabetes prevention and treatment in the world.

Insulin resistance (IR) is a common risk factor for type 2 diabetes, metabolic syndrome, non-alcoholic fatty liver disease, hypertension, coronary heart disease and other metabolic diseases. Its etiology and mechanism are complex. However, with the continuous in-depth research of new drugs and targets, the understanding of IR is further deepened. This article expounds the etiology, harm, diagnosis and treatment strategies of IR, aiming to strengthen the new understanding of IR, strengthen the intervention and management, and provide more theoretical basis for the prevention and treatment of various diseases based on IR.

Atherosclerotic cardiovascular disease (ASCVD) is an important concomitant disease in patients with type 2 diabetes mellitus (T2DM), and it is also the main cause of death and disability. In recent years, with the continuous accumulation of evidence from cardiovascular outcome studies (CVOT), the status of glucagon-like peptide-1 receptor agonists (GLP-1RA) in major guidelines has been increasing. Numerous studies have shown that GLP-1RA can exert cardiovascular and cerebrovascular protective effects through various pathways. The author systematically combed and analyzed the possible mechanism of cardiovascular benefit of GLP-1RA and its evidence-based evidence, aiming to deeply understand the role of GLP-1RA in the management of hyperglycemia and the prevention and treatment of ASCVD in patients with T2DM.

The treatment concept of diabetes is constantly updated, which brings new hopes and challenges to the treatment and management of patients. Drugs and therapeutic methods based on the mechanism of action of incretin have been widely and deeply studied in the treatment and management of diabetic patients, and have been gradually applied to clinical practice. Glucagon-like peptide-1 receptor agonist (GLP-1RA) has multiple benefits. The author combs the development history of GLP-1 preparations and expounds its influence on the treatment concept of diabetes, therapeutic mechanism, efficacy and safety.

Scanning Continuous Glucose Monitoring (CGM), as an effective supplement to traditional blood glucose monitoring methods, can continuously record the trend and characteristics of blood glucose fluctuations, and is used to guide personalized drug therapy, medical nutritional therapy, and physical activity, which is beneficial to improving patients' blood glucose control and reducing the risk of hypoglycemia. At the same time, scanning CGM can be used as an auxiliary educational tool to enable patients to intuitively understand the effects of drugs, diet and exercise on blood sugar, stimulate a healthier lifestyle, and improve the quality and effect of home management of diabetic patients.

Insulin resistance is a common clinical phenomenon, which is the pathophysiological basis of chronic metabolism-related diseases such as type 2 diabetes, non-alcoholic fatty liver disease, atherosclerotic cardiovascular disease and some rare diseases and rare diseases. In order to enhance clinicians' understanding of insulin resistance, the Diabetes Branch of Chinese Medical Association organized experts to compile the Expert Consensus on Clinical Issues Related to Insulin Resistance (2022 Edition). This edition of the consensus interprets issues related to insulin resistance in the form of questions and answers, aiming to improve the management level of insulin resistance by clinicians, and improve clinical efficacy and patient prognosis.

Type 2 diabetes is a multifactor-related progressive disease, and monotherapy often struggles to effectively meet clinical needs. Metformin-based fixed compound formulations (FDCs), including dipeptidyl peptidase IV inhibitor (DPP-4i) /metformin FDCs, sodium-glucose cotransporter 2 inhibitor (SGLT2i) /metformin FDCs, thiazolidinediones/metformin FDCs, glidenides/metformin FDCs, and sulfonylureas/metformin FDCs, have been shown to effectively control blood sugar, improve medication safety and patient compliance, and reduce medical expenses. Metformin-based FDC plays an important role in T2DM management. The purpose of this consensus is to improve clinicians' understanding of this class of drugs and standardize the clinical use of metformin-based FDC.

The prevalence of adult diabetes in China is high, and the comprehensive control rate is low. Improving existing in-hospital medical services and applying Internet technology to establish continuous patient management in and out of hospital are feasible strategies that meet the current needs of diabetes management in China. In order to provide practical diabetes self-management education and support (DSMES) practical guidance to diabetes education management teams in hospitals at all levels, the Diabetes Education and Management Branch of China Health Promotion and Education Association invited multidisciplinary experts in the field of diabetes education management. On the basis of relevant clinical guidelines, expert consensus, systematic review and original research at home and abroad, and combined with the experience of integrated offline and online diabetes management in China in recent years, this edition of "Expert Consensus on Clinical Practice of Integrated Offline and Online Diabetes Care in China" was formed after many discussions. The consensus includes management objectives, information management platform, structure and path, structure and process, quality control, etc., and puts forward 30 recommendations on the key problems existing in the clinical practice model of offline and online integrated care for diabetes, aiming at optimizing the management plan, improving the actual effect of diabetes management, and promoting the implementation of DSMES in the field of domestic diabetes education management.

To investigate the prevalence of retinopathy in hospitalized patients with type 2 diabetes mellitus (T2DM) in Heilongjiang province and analyze its related factors.

This study was a cross sectional study. Hospitalized T2DM patients with complete clinical data in 15 hospitals in Heilongjiang province from January to December 2018 were retrospectively enrolled. We collected the general data and laboratory indicators and divided the patients into diabetic retinopathy (DR) group and no DR group according to non-mydriatic fundus photography. We investigated the prevalence of retinopathy among hospitalized T2DM patients in Heilongjing province and logistic regression was used to conduct univariate and multivariate analyses on DR.

Fifteen thousand four hundred and eighteen hospitalized T2DM patients were included in the study. The prevalence of DR in hospitalized T2DM patients in Heilongjiang province was 34.5% (n=5 312), the age-gender-standardised prevalence of DR was 25.6%. Compared to no DR group, the DR group had more family history of diabetes, smoking and drinking history, and hypertension, older age, longer course of disease, higher fasting blood glucose, glycosylated hemoglobin A_1c (HbA_1c), total cholesterol, low-density lipoprotein cholesterol (LDL-C), creatinine (Cr), potassium, sodium, and fibrinogen, lower red blood cell count, hemoglobin, platelets, fasting C peptide, triglycerides (TG), alanine aminotransferase, aspartate aminotransferase, total bilirubin, blood uric acid (SUA), calcium and magnesium, SUA/Cr and TG/high-density lipoprotein cholesterol (HDL-C), the differences were statistically significant (P<0.05). Multivariate logistic regression analysis showed that the course of diabetes (OR=1.097, 95%CI 1.089 to 1.104), family history (OR=1.262, 95%CI 1.150 to 1.384), hypertension (OR=1.326, 95%CI 1.214 to 1.447), drinking history (OR=1.241, 95%CI 1.130 to 1.364), and HbA_1c≥7% (OR=1.415, 95%CI 1.274 to 1.572) were independent risk factors for DR. For SUA/Cr compared with Q₁, the risk of DR in patients in Q₃ and Q₄ groups was 0.884 and 0.796, respectively. For TG/HDL-C, the risk of DR in patients in the Q₃ and Q₄ groups was 0.837 and 0.680, respectively, compared with the Q₁ group.

The prevalence of DR was relatively high in hospitalized T2DM patients in Heilongjiang province. Diabetes course, family history, HbA_1c≥7%, hypertension, and drinking history were independent risk factors for DR, and SUA/Cr was an independent protective factor for DR.

To investigate the evolution of cognitive function and its relationship with olfaction in patients with type 2 diabetes mellitus (T2DM) who were longitudinally followed up.

The prospective study included T2DM patients with complete baseline and follow-up data who were hospitalized in the Endocrinology Department of Drum Tower Hospital from January 2016 to January 2022. Smell behavior tests were performed at baseline, and elaborate cognitive assessment were performed both at baseline and follow-up. The change value of cognitive function was defined as follow-up cognitive scores minus baseline cognitive scores, positive scores indicated increase and negative scores indicated decrease. Paired t-test was used to compare clinical indicators and cognitive test scores before and after the follow-up. Partial correlation was used to analyze the correlation between olfactory test scores and changes in cognitive domains. Participants were categorized into low-smell score group (<45.0 points), middle-smell score group (45.0-49.4 points) and high-smell score group (≥49.5 points) by tertile based on the total smell test scores at baseline, and the cognitive test scores of the three groups were compared by one-way analysis of variance (ANOVA).

Thirty-five T2DM patients completed the follow-up, the baseline age was (56.4±7.9) years, and the median follow-up time was 4.6 years. Compared with baseline, patients with T2DM showed statistically significant decrements in memory and verbal fluency at follow-up [(167.3±22.8) vs. (144.8±18.6) points, P<0.01; (22.1±4.4) vs. (19.1±4.8) points, P<0.01, respectively]. Memory and verbal fluency descent were separately found in 65.7% (23/35) and 37.2% (13/35) of the patients. Partial correlation analysis was performed after adjusting for baseline age, gender, years of education, duration of diabetes, glycated hemoglobin A_1c, and time of follow-up. The significant association of the changes in memory with the total scores of the smell test at baseline was observed (r=0.400, P<0.05). There were separately 11, 12, 12 participants in the low-, middle- and high-smell scores group. Compared with patients in the high-smell scores group, patients with low-smell scores had greater memory decline (P<0.05).

After a median follow-up of 4.6 years, the memory and verbal fluency of T2DM patients significantly decreased. Patients with lower olfactory test scores had greater memory decline. Olfactory impairment might be a potential marker of memory decline in T2DM patients.

To assess whether a lifestyle intervention starting in early pregnancy can reduce the incidence of gestational diabetes mellitus (GDM) among Chinese women with high risk factors.

Between January 2020 and September 2021, women at gestational age of 6-15 weeks with high risk factors [body mass index (BMI) of 24-35 kg/m² or a family history of diabetes] in 4 urban districts and 3 suburban districts of Tianjin were recruited as an intervention cohort. During the same period, the high-risk pregnant women who received routine maternal management from two of the above districts, one in urban and the other in suburban district, were retrospectively enrolled as a control cohort through the hospital system information. Women in the intervention cohort received a combination of online and offline lifestyle intervention (nutrition, exercise, and weight control). At the baseline survey, information including age, family history of diabetes, gestational age, and fasting plasma glucose (FPG) level were collected at the baseline survey. The height and body weight were recorded, and BMI was calculated. All pregnant women underwent two-step GDM screening at gestational age of 24-28 weeks. The comparison between the two cohorts was performed using the t test or theχ² test. Logistic regression model was used to evaluate the effect of lifestyle intervention on GDM incidence.

Finally, 106 and 2 348 patients were included in the intervention and control cohorts, respectively. There were statistically significant differences between the two cohorts in gestational age, family history of diabetes proportion, gestational age and FPG level at the baseline survey (P<0.05). At gestational age of 24-28 weeks, the incidence of GDM in the intervention and control cohorts was 19.8% (21/106) and 29.6% (696/2 348), respectively (P=0.029), with a relative risk reduction of 33%. Multivariate logistic regression analysis showed that the risk of GDM was significantly lower in the intervention cohort than that in the control cohort, with an OR and 95% confidence interval of 0.41 (0.24-0.69).

Lifestyle intervention (nutrition, exercise, and weight control) starting in early pregnancy can reduce the incidence of GDM in pregnant women with high risk factors.

To investigate the composition ratio of inpatients with diabetes mellitus and the effect of diabetic blood glucose control on average length of stay.

Inpatients in Beijing Hospital from July 2019 to June 2020 were included in this cross-sectional study. The conditions of diabetes mellitus diagnosis, blood glucose and length of stay were collected. Charlson comorbidity index (CCI) was calculated according to the age of patients. The composition ratio of diabetes mellitus in inpatients with different departments was calculated. The chi-square test and t test were used to compare the differences in basic characteristics of inpatients with different blood glucose status, the logistic regression analysis was used to analyze the influence of different blood glucose status on length of stay.

There were 1 030 residents involved in the final analysis, among which the composition ratio of diabetes mellitus was 24.2% (249/1 030). The proportion of diabetes mellitus in internal department was significantly higher than that in surgical department [29.7%(149/502) vs. 18.9%(100/528), respectively, P<0.001]. The new-found diabetes mellitus patients accounted for 23.7% (59/249) of the total diabetes mellitus patients. Univariate logistic regression analysis showed that compared with patients with normal blood glucose, diabetic patients with uncontrolled blood glucose level achieved a 78.2% increased risk of length of stay >9 days (95%CI 1.174-2.706,P=0.007). Diabetes mellitus with uncontrolled blood glucose level had a 97.7% increased risk of length of stay >9 days (95%CI 1.375-2.843, P<0.001). Multivariate logistic regression analysis showed that after controlling for age, gender and CCI, compared with the normal blood glucose group, the risk of length of stay >9 days was still increased in patients with diabetes regardless of glycemic control, and the difference was statistically significant [OR values (95%CI) were 1.643 (1.077-2.507), 1.886 (1.292-2.697), respectively, bothP<0.05].

The composition ratio of diabetes mellitus in hospitalized patients was high, and the proportion of newfound diabetes mellitus was high as well. Moreover, diabetes mellitus can prolong the length of stay regardless of blood glucose control level.

To investigate the association between glycated hemoglobin A_1c (HbA_1c) and subclinical left ventricular (LV) systolic function in patients with type 2 diabetes mellitus (T2DM).

T2DM patients who consecutively admitted to the Department of Endocrinology, First Affiliated Hospital of Air Force Medical University, Shaanxi Province from June to December 2021 were selected. The age, heart rate, systolic blood pressure, fasting plasma glucose (FPG), HbA_1c, triglyceride (TG) and urinary albumin to creatinine ratio (UACR), LV global longitudinal strain (GLS) were collected. According to the GLS results, patients were divided into three groups: T1 (GLS≤16.6%), T2 (16.6%<GLS≤19.4%), and T3 (GLS>19.4%). One-way analysis of variance, Fisher exact test or chi-square test, and Kruskal-WallisH test were used to compare the differences in clinical characteristics and metabolic indexes among groups. Pearson correlation analysis was used to evaluate the correlation between HbA_1c and GLS, and multiple linear regression analysis was used to analyze the influencing factors of LV subclinical myocardial systolic dysfunction in patients with T2DM.

A total of 152 patients were included. There were 51 cases in T1 group, 51 cases in T2 group, and 50 cases in T3 group. HbA_1c level decreased with increasing GLS group [(10.01±2.39)%vs. (8.69±1.77)%vs. (7.78±1.38)%, P<0.001]. Pearson correlation analysis showed that HbA_1c was negatively correlated with GLS (r=-0.48, P<0.001). The results of univariate linear regression analysis showed that HbA_1c, age, heart rate, systolic blood pressure, FPG, TG and UACR were significantly correlated with GLS (all P<0.05). Multivariate analysis showed that HbA_1c was independently associated with GLS (β=-0.613, P<0.001). In addition, the results showed that logUACR was an independent and major risk factor for reduced GLS (β=-1.010, P=0.024).

HbA_1c was negatively associated with the progression of LV subclinical systolic function in patients with T2DM. High UACR level was the main influencing factor of LV longitudinal dysfunction.

To investigate the current situation of foot risk screening of diabetic patients by community medical staffs and analyze its influencing factors.

The convenience sampling method was used, and a total of 78 community health service centers (stations) were selected to be included in the investigation from April 12 to 20, 2021, with at least simple diabetic foot screening tools within the jurisdiction of Changsha city. And all medical staffs meeting the inclusion criteria were included as research objects. An online cross-sectional survey was conducted using a self-designed questionnaire via the WJX platform, the general information of the study participants, the status of foot disease risk screening behavior, and its influencing factors were collected and analyzed. Independent sample t test or one-way analysis of variance were used to analyze the general data and screening behavior, and multiple linear regression was used to analyze the influencing factors of foot disease risk screening behavior in diabetic patients.

A total of 1 954 questionnaires weredistributed, and 1 910 were effectively received with effective recovery rates of 97.75%. The score of diabetes foot risk screening behaviors of community medical staff was (54.67±11.86) points (full score was 100 points), and 1 281 patients (67.07%) always or often underwent foot risk screening. Multiple linear regression analysis showed that the influencing factors of community medical staff on foot disease risk screening behavior of diabetic patients were screening cognition degree, screening attitude, education level, participation in training, work position, charges not included in medical insurance, patient cooperation degree, hospital equipment (β=-1.870, 1.341, -1.644, 1.884, 4.303, 3.430, 0.216, 0.941, all P<0.05).

The current situation of diabetes foot screening among the community medical staff is poor, and the relevant screening awareness, attitude, training, medical security, and patient cooperation need to be further improved.

To systematically evaluate the effect of liraglutide on fat distribution in patients with type 2 diabetes mellitus.

Databases of PubMed, the Cochrane Library, Embase, CNKI, Wanfang and VIP were searched for randomized controlled trials (RCT) with therapy of liraglutide in type 2 diabetes mellitus from establishment of the database to December 2021, and the eligible studies were screened according to the inclusion and exclusion criteria, and the relevant data were extracted. The experimental group received liraglutide, and the control group received placebo, active drug, dietary intervention or basal drug control. The primary outcome measures were visceral and subcutaneous adipose tissue, as well as other anthropometric measures, including body weight, waist circumference and body mass index. The Review Manager 5.4.1 and STATA 16.0 for statistical analysis were performed. Egger′s test assessed publication bias. The Cochrane risk of bias tool assessed the risk of bias.

A total of 8 articles including 10 RCT were included. The results of the meta-analysis showed that compared with the control group, the liraglutide group had a significant reduction in visceral adipose tissue [standardized mean difference (SMD)=-0.69 cm², 95%CI -1.09--0.29 cm², I²=78%, P<0.05] and subcutaneous adipose tissue (SMD=-0.48 cm², 95%CI -0.77--0.19 cm², I²=50%, P<0.05). In addition, it also significantly reduced body weight [weighted mean difference (WMD)=-3.65 kg, 95%CI -4.45--2.85 kg,I²=0, P<0.05], waist circumference (WMD=-3.07 cm, 95%CI -4.63--1.51 cm,I²=75%, P<0.05) and body mass index (WMD=-1.23 kg/m²,95%CI -1.62--0.84 kg/m²,I²=50%,P<0.05).

Liraglutide significantly reduced visceral and subcutaneous fat.

To investigate the effects of lectin-like oxidized low density lipoprotein receptor-1 (LOX-1) on liver injury and fibronectin type Ⅲ domain-containing protein 5 (FNDC5) in diabetic mice.

Thirty 7-8 week-old male db/db mice were divided into 3 groups according to the random number table, db/db LOX-1 knockdown [AAV (adeno-associated virus)-shLOX-1] group, db/db negative control virus (AAV-shCON) and blank control group (db/db group), 10 in every group. Ten male db/m mice of the same age were used as normal control group (NC). The HE staining was used to observe the pathological morphology of mouse liver. The mRNA and protein expression levels of LOX-1, interleukin-6 (IL-6) and FNDC5 in liver of mice were detected by the quantitative real-time PCR (qRT-PCR) and Western blotting. Serum levels of glutamic pyruvic transaminase (ALT), triglyceride (TG) and FNDC5 were detected by the enzyme-linked immunosorbent assay (ELISA). One-way analysis of variance was used for the comparison between groups.

HE staining showed that compared with NC group, the hepatic lobule structure of mice in the AAV-shLOX-1, AAV-shCON and db/db groups were disordered, a large number of vacuolate-like lipid droplets were seen in the hepatocytes, showing significant steatosis. Compared with AAV-shCON and db/db groups, the number of lipid droplets in hepatocytes of mice in AAV-shLOX-1 group was reduced, and steatosis was reduced. Compared with the NC group, the mRNA and protein expressions of LOX-1 and IL-6 in the liver of mice in the AAV-shLOX-1, AAV-shCON and db/db groups were increased, while the mRNA and protein expressions of FNDC5 were decreased. Compared with AAV-shLOX-1 group, the mRNA and protein expressions of LOX-1 and IL-6 in liver of mice in AAV-shCON and db/db groups were increased, while the mRNA and protein expressions of FNDC5 were decreased, and the differences were statistically significant (P<0.05).Compared with NC group, ALT and TG were increased and FNDC5 was decreased in AAV-shLOX-1, AAV-shCON and db/db groups. Compared with AAV-shLOX-1 group, ALT and TG were increased and FNDC5 was decreased in AAV-shCON and db/db groups, and the differences were statistically significant (P<0.05).

LOX-1 was involved in the regulation of liver injury and the change of FNDC5 in db/db mice. LOX-1 down-regulation reduced liver steatosis and inflammation in db/db mice and improve the tissue and serum levels of FNDC5 in db/db mice. The liver injury in diabetic mice might be related to the regulation of LOX-1/FNDC5.

To explor the effects of probiotics on blood glucose and depression-like behaviors in rats with diabetes-related depression by regulating gut microbiota.

Twenty-four rats were divided into a control group, a diabetes-related depression (DD) group and a probiotic group, with eight rats in each group. A rat model of DD was established by a high-fat diet combined with stretozotocin(60 mg/kg per rat) and chronic unpredictable mild stress (CUMS) stimulation for 28 days, while probiotics were administered to rebuild their gut microbiota. Fasting plasma glucose (FPG) testing was performed at the same time as the weekly weighing. The depressive behaviors were tested by forced swimming and open field experiments; detection of serum levels of pro-inflammatory cytokines[interleukin-1β (IL-1β), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α)], hypothalamic-pituitary-adrenal axis (HPA)-related proteins [corticotropin releasing hormone (CRH), adreno cortico tropic hormone (ACTH) and Cortisol], and lipopolysaccharide (LPS) were tested by enzyme-linked immunosorbent assay (ELISA); the intestinal contents of each group were collected, sequenced by 16s rRNA analyze. Independent samplet-test was used for comparison between the two groups, and one-way or two-way analysis of variance (ANOVA) was used for comparison between multiple groups.

Compared with the control group, the DD group had elevated FPG and showed significantly increased depression-like behavior (increased resting time and decreased horizontal activity in rats) and hyper-HPA [function-related proteins (CRH, ACTH and cortisol) were elevated], and serum levels of LPS and pro-inflammatory cytokines (IL-1β, IL-6 and TNF-α) were elevated, all with statistically significant differences (P<0.05). Compared with the DD group, the probiotic group showed lower FPG and significantly lower LPS and pro-inflammatory cytokine levels, while depression-like behavior (increased resting time and reduced horizontal activity) and HPA hyperactivity were significantly alleviated, and the differences were statistically significant (P<0.05). 16s rRNA gut microbiota sequencing suggested that there was no significant difference in alpha diversity index, but there was significant difference in Beta diversity (P<0.05) among the groups. PhylumFirmicutes and Phylum Bacteroidetes were the major species of rat gut microbiota, followed by Phylum Proteobacteria and Phylum Actinobacteria. In comparison with the control and probiotic groups, six families in the DD group (Ruminococcaceae_UCG-005,Ruminococcaceae_UCG-013, Ruminiclostridium, Oscillibacter, Desulfovibrionaceae, and Prevotellaceae) were reduced in abundance (P<0.01). Bugbase phenotypic predictions showed that the abundance of aerobic and gram-negative bacteria was increased in the DD group compared to the control group (P<0.05); while the abundance of anaerobic bacteria was lower in the DD group than that in the control group (P<0.05).

Probiotic intervention to improve gut microbiota alleviates symptoms and reduces expression of pro-inflammatory cytokines in DD rats.

In this paper, two patients with multiple complications of diabetes were introduced with different outcomes caused by diabetic bullae and diabetic blisters, emphasizing the importance and effectiveness of doctor-patient cooperation and patient self-management in the process of prevention and treatment of diabetic foot, and how to better play the role of diabetes specialist nurses.

One case of hepatocyte nuclear factor 1A was reported (HNF1A) Diagnosis and treatment of adult type diabetes mellitus (MODY) type 3 patients with adolescent onset caused by gene heterozygous variation. The patient was admitted to the hospital with the main complaint of "finding elevated blood sugar for 1 year". Through clinical data analysis and genetic testing, the patient was admitted to the hospital with the main complaint of "findingHNF1AA heterozygous frameshift insertion variant, c.872dupC: p.Gly292fs, was found in the gene, which conforms to the pathogenic characteristics of MODY3 gene mutation. The patient was diagnosed with MODY3 at age 40, which is different from the age of common diagnosis of MODY. This paper discusses the clinical characteristics, diagnosis and treatment points of MODY in combination with the diagnosis and treatment process of patients, in order to improve the clinical understanding of MODY.

With the development of molecular biology technology, adipose tissue is no longer considered as a passive energy storage warehouse, but a complex endocrine and immune organ that can actively secrete many biologically active substances. It was found that in addition to the classical white fat (WAT) and brown fat (BAT), adipose tissue also has inducible beige fat scattered in WAT and pink fat present in the mammary glands during pregnancy and lactation. In addition to mature adipocytes, preadipocytes, and stem cells, adipose tissue contains a large number of immune cells, including natural immune cells and adaptive immune cells, as well as adipose tissue-associated lymphocyte clusters (FALC) and lymph nodes. Adipose tissue can not only secrete more than 600 adipocytokines, but also secrete a variety of substances including lipids, metabolites, non-coding RNA and extracellular vesicles (EVs), which can regulate the body's energy balance locally or remotely in adipose tissue. In addition, adipose tissue is site-specific, highly plastic, and heterogeneous. Adipose tissue relies on its own phenotypic remodeling, structural remodeling and metabolic remodeling, and plays an important role in maintaining the body's energy homeostasis. Therefore, it is now considered that adipose tissue is an endocrine and immune organ with high heterogeneity, plasticity and dynamic secretion of many biologically active substances. These new understandings of adipose tissue provide new research directions for the future research and development of drugs for weight loss and improvement of glucose and lipid metabolism.

Diabetes mellitus is a chronic disease that affects multiple systems in the whole body, with complex pathogenesis, heterogeneous progression and complications. Current typing methods cannot accurately explain this difference. As an effective multivariate statistical classification technique, cluster analysis has been widely used in various fields. In 2018, Ahlqvist team first applied this method to the classification of diabetes. The purpose of this classification is to provide a more refined classification method for the individualized precise treatment of diabetes and the determination of the risk of complications at the time of diabetes diagnosis, in order to achieve diabetes. Precise treatment and early prevention and treatment of complications. Subsequently, many scholars have verified and supplemented this research. In this paper, the research progress of clustering and typing methods of diabetes mellitus is reviewed.

The incidence of diabetes is increasing day by day, and it has become one of the main factors that endanger public health. In recent years, the relationship between immune system and the development of diabetes mellitus has become a hot research topic. Mucosa-associated constant T cells (MAIT) are a class of congenital-like T cells that play an important role in immunity against microbial pathogens. Recent studies have found that MAIT cells are also involved in the development and development of diabetes. This paper reviews the role of MAIT cells in the development of diabetes mellitus and the latest research progress.

The incidence of reproductive system complications in men with obesity and/or type 2 diabetes can reach 30% to 40%, which has a negative impact on the work, life and interpersonal relationships of patients. At present, it has been found that glucagon-like peptide-1 (GLP-1) is likely to be an important signaling molecule linking human metabolism and reproductive system, and is involved in the occurrence and development of reproductive system complications. GLP-1 receptor agonist (GLP-1RA) and dipeptidyl peptidase IV inhibitor (DPP-4i) are commonly used drugs for the treatment of type 2 diabetes, and there is currently evidence that they also have a therapeutic effect on reproductive system complications. Based on the hypothalamus-pituitary-gonadal axis, the therapeutic effect of GLP-1 on obesity and/or type 2 diabetes patients with reproductive system symptoms was summarized.

From 30 to 31 July 2022, the first Shanghai Advanced Technology and Treatment of Diabetes (SATTD) Forum, sponsored by Zhongguancun Precision Medicine Foundation, hosted by the Endocrinology Department of Shanghai Public Health Clinical Center, and co-organized by the New Technology Group of Blood Glucose Monitoring and Treatment of Diabetes Specialist Branch of Shanghai Medical Association, was successfully held in the form of an online conference. Nearly 1,000 doctors, enterprise R&D personnel, chronic disease service providers and patients from all over the country participated in the meeting. Everyone had in-depth exchanges around new technologies and concepts in the field of diabetes and the ecological construction of digital diabetes medical treatment, covering digital diabetes medical treatment, artificial pancreas, continuous glucose monitoring (CGM), new technology care of diabetes under novel coronavirus pneumonia (COVID-19), precise hypoglycemia under special pathophysiological conditions of diabetes, digitalization and diabetes care, new technology, new products and new concepts of diabetes, and sharing cases of precise hypoglycemia based on large outpatient and small ward mode. The author sorted out the important academic contents.