Volume 15 · Issue 06 · 2023

The key points and difficulties of diabetes prevention and treatment are multi-disciplinary participation, comprehensive adjustment of multiple indicators, personalized programs and continuous and effective management. How to explore and practice the diagnosis and treatment mode of diabetes with Chinese characteristics is a major problem that we must face and solve. The "three divisions co-management" diagnosis and treatment model of diabetes is based on the current situation of diabetes prevention and treatment in China, giving full play to the advantages of holistic view, personalization and emphasis on quality of life of traditional Chinese medicine, and setting up a multidisciplinary collaboration team with endocrine diabetes specialists, traditional Chinese medicine practitioners and health managers as the core, using intelligent information tools for continuous management, and advocating the concept of "paying equal attention to two standards" for metabolic indicators such as blood sugar and quality of life indicators. During the management of "three divisions co-management", four aspects of blood sugar control effect, self-management effect, quality of life and medical experience, and grass-roots diabetes prevention and treatment ability were initially improved, and the exploration and practice of "Chinese-style solutions" were carried out to achieve two important goals of diabetes prevention and treatment (i.e., prevention and treatment of complications and optimization of quality of life).

Type 2 diabetes develops from prediabetes, and effective intervention in prediabetes can significantly reduce the possibility of its conversion to diabetes. Prediabetes is associated with an increased risk of cardiovascular disease, microvascular disease, tumors, dementia, depression, and more. However, the diagnostic criteria of prediabetes are not uniform so far, and whether intervention in prediabetes can bring long-term benefits of microvascular and macrovascular is still controversial. With a series of important progress in prediabetes research at home and abroad, and more new evidence-based medicine evidence on prediabetes prevention, diagnosis and intervention has been obtained, the Endocrinology Branch of Chinese Medical Association, together with experts from the Diabetes Branch of Chinese Medical Association and the Endocrinology and Metabolism Physician Branch of Chinese Medical Physicians Association, revised the original expert consensus and formed the Expert Consensus on Prediabetes Intervention in Adults in China (2023 Edition), so as to timely transmit important progress and guide clinical practice. This expert consensus covers the definition and diagnostic criteria of prediabetes, epidemiology, hazards of prediabetes, screening and management, intervention, prevention and follow-up. The release of the consensus aims to further strengthen the concept of diabetes prevention, clarify the populations and intervention measures that should be focused on, and provide reference for the majority of doctors, especially general practitioners and grass-roots doctors.

Recently, the American Diabetes Association released the 2023 Diabetes Diagnosis and Treatment Standards. This article excerpts the chapter on podiatry prevention and treatment, combines the recent domestic and foreign relevant literature, interprets the identification, screening, evaluation, nursing education and treatment of risk factors of diabetic foot, and introduces the updated key points and expanded auxiliary treatment contents, aiming to provide clinical basis and practical suggestions for the prevention and treatment of diabetic foot disease.

To investigate the effects of gestational weight gain (GWG) on pregnancy outcomes in type 1 diabetes mellitus (T1DM).

This study was a multicenter, prospective, observational cohort study. Pregnant women with T1DM who registered in 11 participating centers nationwide from January 2015 to December 2017 were enrolled. Maternal baseline characteristics, physical examination [height, body mass, body mass index (BMI), waist-to-hip ratio, etc.], and laboratory index [glycated hemoglobin A_1c (HbA_1c), hemoglobin (Hb), etc.] were collected throughout the whole pregnancy, and pregnancy outcomes (neonatal birth weight, birth length and macrosomia, etc.) were recorded. GWG was calculated and categorized into insufficient GWG group, adequate GWG group, and excessive GWG group according to recorded pre-pregnancy weight and antepartum weight. Analysis of variance, non‐parametric test, χ² test were used to compare the differences among groups. Pearson correlation analysis was used to explore factors associated with GWG. Linear regression analysis was used to determine the independent influencing factors of fetal birth weight.

A total of 96 pregnant women with T1DM were included in the study. There were 17 cases (17.71%) in the insufficient GWG group, 47 cases (48.96%) in the appropriate GWG group, and 32 cases (33.33%) in the excessive GWG group. The incidence of macrosomia in the excessive GWG group was significantly higher than that in the adequate GWG group [18.75% (6/32) vs. 6.38% (3/47), P=0.038]. Pearson correlation analysis showed that GWG was positively correlated with antepartum weight, antepartum BMI, neonatal birth weight, and birth length (r=0.381, 0.380, 0.356, 0.303, all P<0.01) and negatively correlated with waist-to-hip ratio, pre-pregnancy weight and pre-pregnancy BMI (r=-0.398, -0.285, -0.342, all P<0.01). After adjusting for preconception/1^st trimester HbA_1c, Hb in the 1^st trimester and pre-pregnancy BMI, GWG was significantly correlated with birth weight in the multiple linear regression (β=0.388, P<0.01). After adjusting for antepartum HbA_1c, Hb in the 3^rd trimester and antepartum BMI, GWG was significantly correlated with birth weight (β=0.264, P<0.05).

Excessive weight gain during pregnancy is associated with a risk of excessive fetal growth in pregnant women with T1DM.

To investigate the current situation of blood glucose monitoring in type 1 diabetes mellitus (T1DM) patients and its impact on glycemic control.

The study was a cross-sectional survey. T1DM patients or their guardians who visited the Department of Endocrinology, First Affiliated Hospital of Nanjing Medical University from October to December 2021 were selected as the research subjects. The patients′ age, course of diabetes, current treatment plan, education level, continuous glucose monitoring (CGM) and self-monitoring blood glucose (SMBG) were assessed by questionnaire. The glycated hemoglobin A_1c (HbA_1c) was measured. According to the Guidelines for the diagnosis and treatment of type 1 diabetes mellitus in China (2021 edition), HbA_1c<7.0% is defined as HbA_1c meeting the standard. Patients were divided into CGM group and SMBG group based on blood glucose monitoring methods. Mann-Whitney U test, chi-square test were used for inter-group comparison, and multivariate logistic regression analysis was used to analyze the influencing factors of HbA_1c compliance and different blood glucose monitoring methods.

A total of 197 patients with T1DM were included, with an average age of 27.0 (18.2, 41.0) years and a course of disease of 5.0 (2.0, 9.8) years. The utilization rates of CGM and SMBG were 61.4% (121/197) and 38.6% (76/197), respectively. The HbA_1c in the CGM group was lower than that in the SMBG group [6.6% (6.1%, 7.5%) and 7.5% (6.4%, 9.5%), Z=3.19, P<0.001], and the compliance rates of HbA_1c in the 2 groups were 62.1% (51/95) and 40.0% (24/60), respectively. The difference was statistically significant (χ²=7.22, P<0.01). After adjustment for age, diabetes course and current treatment, logistic regression analysis showed that the use of CGM (OR=2.028, 95%CI 1.012-2.042, P<0.05) and education level (OR=1.571, 95%CI 1.209-2.042, P<0.01) were correlated with HbA_1c standard.

In our real-world data, 61.4% of the patients with T1DM were using a CGM device, which was associated with improved glycemic control.

To evaluate the efficacy and safety of Abelmoschus manihot (A. Manihot) alone and in combination with irbesartan, for reduction of albuminuria in patients with type 2 diabetic kidney disease.

A multicenter randomized double-blind and parallel controlled clinical trial was performed in 9 hospitals of Jiangsu Province (Affiliated Hospital of Nanjing University of Chinese Medicine, First People′s Hospital of Changzhou, First People′s Hospital of Xuzhou, Wuxi People′s Hospital, Affiliated Hospital of Nantong University, Taizhou Hospital of Traditional Chinese Medicine, First Affiliated Hospital of Soochow University, Zhongda Hospital, Southeast University, Changzhou Hospital of Traditional Chinese Medicine) from May 2017 to March 2021. Huangkui capsule, as a traditional Chinese medicine, is made from the ethanol extract of flowers in A. Manihot. All enrolled patients were randomly assigned to the irbesartan group [irbesartan tablets (150 mg/dose, 1 dose/day)+Huangkui capsule simulant (2.5 g/dose, 3 doses/day)], Huangkui capsule group [Huangkui capsule (2.5 g/dose, 3 doses/day)+irbesartan simulant (150 mg/dose, 1 dose/day)], and combined treatment group [irbesartan tablets (150 mg/dose, 1 dose/day)+Huangkui capsule (2.5 g/dose, 3 doses/day)]. The duration of intervention was 24 weeks. Urinary creatinine and urinary albumin were detected at baseline and 24 weeks after treatment, and the urinary albumin-to-creatinine ratio was calculated to observe the change value and rate of UACR compared with baseline. The occurrence of adverse events, adverse reactions, serious adverse events, serious adverse events, and adverse events leading to withdrawal were recorded and the incidence was calculated. One-way analysis of variance (ANOVA), χ² test or Fisher's exact test were used to compare among groups.

A total of 413 patients with type 2 diabetic kidney disease were included, including 138 in the irbesartan group, 137 in the Huangkui capsule group and 138 in the combined treatment group. After 24 weeks of treatment, the UACR changes of three groups were (-89.07±51.17) mg/g in the irbesartan group, (-146.06±45.52) mg/g in the Huangkui capsule group, and (-262.31±39.08) mg/g in the combined treatment group. The rate of UACR change was (-5.21±6.12)% in the irbesartan group, (-11.89±5.75)% in the Huangkui capsule group, and (-28.56±4.65)% in the combined treatment group, respectively. There were significant differences between the combined treatment group and the irbesartan group in the change value and rate of UACR (P<0.001), while there were no statistical differences between the Huangkui capsule group and irbesartan group (P>0.05). After 24 weeks of treatment, there were no significant differences in the incidence of adverse events, adverse reactions, serious adverse events and serious adverse reactions among the 3 groups (P>0.05).

The combination of irbesartan and Huangkui capsule can reduce the level of UACR in patients with type 2 diabetic kidney disease, and it shows good efficacy and safety in the treatment of albuminuria in patients with type 2 diabetic kidney disease.

To investigate the fatty acid metabolism profile characteristics of patients with type 2 diabetes mellitus (T2DM) and metabolic associated fatty liver disease (MAFLD).

This was a retrospective study. All patients who visited the Department of Endocrinology of the Second Affiliated Hospital of Dalian Medical University from October 2018 to December 2019 were enrolled. Height and weight of the subjects were measured and body mass index (BMI) were calculated, fasting plasma glucose (FPG), fasting insulin (FINS) were measured, and homeostasis model assessment of insulin resistance (HOMA-IR) were calculated and their insulin-like growth factor 1 (IGF-1), triglyceride (TG), palmitoleic acid, eicosapentaenoic acid, docosahexaenoic acid, arachidonic acid, linoleic acid, total omega-3, total omega-6 were measured. According to the results of liver ultrasound and transient elastography technology, the participants were divided into group A (T2DM alone), group B (T2DM combined with fatty liver group) and group C (T2DM combined with liver fibrosis group). One-way analysis of variance (ANOVA), Kruskal-Wallis H test and χ² test were used to compare between groups, Spearman correlation analysis was used to analyze the correlation between fatty acids and various indices, and binary logistic regression was used to analyze the factors influencing T2DM combined with MAFLD.

A total of 426 patients with T2DM were enrolled. There were 165 cases in group A, 170 in group B, and 91 in group C. Compared with group A, BMI, HOMA-IR, TG, FINS and palmitoleic acid were all increased, and IGF-1, eicosapentaenoic acid, docosahexaenoic acid, arachidonic acid, linoleic acid, total omega-3 and total omega-6 were decreased in groups B and C (P<0.05). Compared with group B, BMI and HOMA-IR were increased in group C, and IGF-1, linoleic acid and total omega-6 were decreased (P<0.05). The results of Spearman correlation analysis showed that palmitoleic acid (r=0.174, P<0.001) was positively correlated with BMI, linoleic acid (r=-0.121, P=0.012), total omega-6 (r=-0.108, P=0.026) and BMI were negatively correlated. Eicosapentaenoic acid (r=-0.109, P=0.025) was negatively correlated with HOMA-IR. The results of binary logistic regression analysis showed that BMI, TG, FINS, HOMA-IR, and IGF-1 were the influencing factors of T2DM combined with MAFLD.

Patients with T2DM and MAFLD had lower levels of omega-3 and omega-6 fatty acids, with eicosapentaenoic acid and docosahexaenoic acid representing the omega-3 series and linoleic acid and arachidonic acid representing the omega-6 series.

To investigate the development trajectory of γ-glutamyl transpeptidase (GGT) in a health examination cohort and its correlation with new-onset type 2 diabetes mellitus (T2DM).

From January 1, 2015 to January 1, 2020, 1 566 people who met the team′s inclusion criteria at the Health Management Center of the Second Affiliated Hospital of Dalian Medical University were retrospectively selected. General data and laboratory test indicators were collected, including sex, age, body mass index, systolic blood pressure, diastolic blood pressure, GGT, serum creatinine, uric acid, cholesterol, triglycerides, fasting plasma glucose, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). A group-based trajectory model for the 4-year GGT level development of the target population was constructed, and the number of groups and the trend of GGT development trajectory of the target population were determined. Kaplan-Meier curves were used to show the cumulative incidence of T2DM in each trajectory group, and the LogRank test was used to compare the cumulative incidence of T2DM in different GGT trajectory groups. Cox proportional hazards regression model was used to analyze the risk of T2DM in different GGT trajectory groups, and sensitivity analysis was performed to analyze the primary outcome by supplementing lost to follow-up population and removing the onset population in the first year of follow-up.

The change trajectories of GGT were determined in three subgroups, which were labeled as low level GGT group (734 cases, 46.87%), medium level GGT group (657 cases, 41.95%) and high level GGT group (175 cases, 11.18%). The average GGT of the low/medium level GGT group increased gradually during the 4-year follow-up. However, the GGT high level group showed a trend of first increasing, then decreasing and then increasing, but it was always more than the baseline mean, and showed an overall upward trend. After 4 years of follow-up, the prevalence of T2DM in this cohort was 18.32/1 000 person-years, and the incidence rates in the low to high GGT groups were 13.51/1 000 person-years, 19.12/1 000 person-years, and 36.14/1 000 person-years, respectively. The 4-year cumulative incidence of T2DM in each trajectory group increased progressively with the extension of follow-up time, and the cumulative incidence of high GGT level group was the highest (χ²=15.579, P<0.001). After adjusting for sex, age, body mass index, systolic blood pressure, diastolic blood pressure, GGT, creatinine, uric acid, cholesterol, triglycerides, fasting plasma glucose, HDL-C and LDL-C, Cox regression showed that the risk of T2DM in the high GGT group was approximately 2.594 times that of the low GGT group (HR=2.594, 95%CI 1.112-6.048,P=0.027). Sensitivity analysis showed that the risk of GGT in the high level group was still higher than that in the low level group (P<0.05).

The risk of T2DM in the health examination population increases with the rapid rise in GGT levels.

To preliminarily investigate the role of the Ras-related C3 botulinum toxin substrate 3 (RAC3) in type 1 diabetes mellitus (T1DM) and dendritic cells (DC).

Patients with T1DM were enrolled from the Guangdong Type 1 Diabetes Translational Medicine Study from 2011 to 2016. Healthy controls were volunteers with normal glucose tolerance who visited the Third Affiliated Hospital of Sun Yat-sen University from 2011 to 2016. Whole exome sequencing was performed in the screening stage, and genotyping was performed in the validation stage among all participants. CRISPR/Cas9 gene editing technology was used to construct the RAC3 whole-body knock-out (KO) mouse model on C57BL/6 mouse background. Polymerase chain reaction (PCR), quantitative real-time PCR (qRT-PCR), and Western blotting assay were used to verify that RAC3 was knocked out on DNA, RNA and protein level. Flow cytometry was used to compare the differentiation ratio of DC and the expression levels of maturation and activation indicators, such as major histocompatibility complex-Ⅱ (MHC Ⅱ), CD86 and CD80, between RAC3 KO mice and wild-type (WT) littermate control mice (3 mice in each group). Logistic regression was used to compare the frequency distributions of the alleles between case and control groups. Intergroup comparisons were conducted by independent-samples t-tests.

A total of 72 patients with T1DM and 487 healthy controls were included in the screening stage, and 122 patients with T1DM and 577 healthy controls were included in the validation stage. The results in the screening stage showed that the frequencies of the T allele of RAC3 rs4969478 in patients with T1DM were higher than that in healthy controls [7.64% (11/144) and 1.13% (11/974), respectively, OR=9.38, P<0.001]. The results in the validation stage also showed that the frequencies of the T allele of RAC3 rs4969478 in patients with T1DM were increased compared to the healthy controls [4.50% (11/244) vs. 1.13% (13/1 154), respectively, OR=4.14, P<0.01]. There was no significant difference in the percentage of differentiated DC between WT mice and RAC3 KO mice (85.6%±1.1% vs. 83.3%±0.25%, respectively, P=0.08). There was no significant difference in the expression levels of maturation and activation indicators (such as MHC Ⅱ, CD86 and CD80) in DC between WT mice and RAC3 KO mice (P>0.05).

Genetic studies suggest that RAC3 may be a susceptibility gene for human T1DM, but it may not be involved in the pathogenesis of T1DM via DC.

To investigate the effect and mechanism of glucose-regulated protein 75 (Mortalin) on palmitic acid-induced lipotoxicity in MIN6 cells.

Twenty 6-8 weeks male C57BL/6J (20-24 g) with specific pathogen free (SPF) mice were randomly divided into standard diet (SD) and high-fat diet (HFD) groups, with 10 mice in each group. Mortalin expression levels in pancreatic tissues were detected by immunofluorescence and immunohistochemistry. Mortalin knockdown stable cell lines were constructed by lentivirus transfection using MIN6 cells, and cells were divided into Mortalin short hairpin (Sh-Mortalin) group, Mortalin knockdown and null group (ShNC-Mortalin group), Sh-Mortalin+PA group, and ShNC-Mortalin+PA group according to whether they were treated with bovine serum albumin (BSA) or palmitic acid (PA). Moreover, cells were divided into Sh-Mortalin+dimethyl sulfoxide (DMSO) group, Sh-Mortalin+PA+DMSO group, Sh-Mortalin+U0126 group, and Sh-Mortalin+PA+U0126 group according to whether the extracellular regulated protein kinase (ERK) inhibitor U0126 or DMSO was applied. Cell proliferation rate was then measured using 5-ethynyl-2′-deoxyuridine (EdU). Apoptosis rate and reactive oxygen species (ROS) levels were measured by flow cytometry, and insulin levels were measured by enzyme-linked immunosorbent assay. Expression levels of ERK pathway-related proteins [phosphorylated extracellular regulatory protein kinase 1/2 (p-ERK1/2), phosphorylated v-raf-leukemia viral oncogene 1 (p-Raf-1)] were detected by Western blotting. The t-test was used for comparisons between two groups, and one-way analysis of variance (ANOVA) was used for comparisons between multiple groups.

The results of in vivo experiments showed that Mortalin expression was significantly increased in the pancreas of mice in the HFD group compared with the SD group (P<0.01). The results of in vitro experiments showed that compared with the ShNC-Mortalin+PA group, the Sh-Mortalin+PA group showed significantly higher proliferation levels, lower apoptosis rates, lower ROS levels and higher insulin levels (P<0.05). Western blotting results showed that the p-ERK1/2 and p-Raf-1 protein levels decreased in a PA-time gradient in all cells, and the p-ERK1/2 protein level was higher in the Sh-Mortalin group compared with the ShNC-Mortalin group (P<0.05). Compared with the Sh-Mortalin+DMSO group, EdU positivity and p-ERK1/2 levels were significantly lower in the Sh-Mortalin+U0126 group, and cellular lipotoxic damage was significantly increased (P<0.05).

Mortalin is involved in regulating the process of lipotoxic damage in MIN6 cells and Mortalin knockdown attenuates PA-induced lipotoxic injury in MIN6 cells by activating the Raf-1/ERK signaling pathway.

To investigate whether calcitonin can regulate energy balance via agouti-related peptide (AgRP) neurons.

The 12-week-old male C57BL/6 mice fed normal chow diet were divided into free-feeding group and 24-h fasting group, while 6-week-old male C57BL/6 mice were divided into normal chow diet group and high-fat diet group fed for 3 months, with three mice in each group, and the expression of calcitonin receptor (Calcr) in brain sections was detected by immunofluorescence staining. Twelve 6-week-old male C57BL/6 mice were fed with high-fat diet for 6 months to establish a high-fat diet-fed mouse model. After lateral ventricular cannulation, the mice were divided into saline lateral ventricular injection group (lateral ventricular injection of 1 μl saline) and salmon calcitonin (sCT) lateral ventricular injection group [lateral ventricular injection of 1 μl sCT (1 μg/μl)], with six mice in each group. Body weight and food intake were measured for 24 hours after injection. Oxygen consumption, carbon dioxide production and energy expenditure were measured after injection by Oxymax/CLAMS indirect calorimetry system. The 12-week-old normal chow diet-fed male C57BL/6 mice were divided into saline intraperitoneal injection group (intraperitoneal injection, 10 ml/kg) and sCT intraperitoneal injection group (intraperitoneal injection, 150 μg/kg), with three mice in each group, and the expression of AgRP, c-Fos, phosphorylated signal transducer and transcriptional activator 3 (pStat3) in brain sections was detected by immunofluorescence staining. Independent-samples t test was used for comparison between two groups.

Compared with free-feeding group, Calcr expression in the arcuate nucleus was significantly decreased in 24-h fasting group (P<0.05); compared with normal chow diet group, Calcr expression in the hypothalamic arcuate nucleus was significantly decreased in high-fat diet group (P<0.05). Compared with saline lateral ventricular injection group, body weight and food intake were significantly reduced in sCT lateral ventricular injection group (P<0.05), while oxygen consumption, carbon dioxide production and energy expenditure were significantly increased in sCT lateral ventricular injection group (P<0.05). Compared with saline intraperitoneal injection group, double immunofluorescence staining of AgRP and c-Fos in the arcuate nucleus was significantly decreased, AgRP expression in the paraventricular nucleus was significantly decreased, and c-Fos expression in the paraventricular nucleus was significantly increased in sCT intraperitoneal injection group (P<0.05). Compared with saline intraperitoneal injection group, the expression of pStat3 in the arcuate nucleus was significantly increased in sCT intraperitoneal injection group (P<0.05).

Calcr in the arcuate nucleus is closely related to energy balance. Calcitonin can inhibit the expression of AgRP and the activity of AgRP neurons via Stat3 pathway, which in turn suppresses appetite and promotes energy expenditure.

The American Diabetes Association (ADA) has always emphasized the importance of the "patient-centered" concept in the "Diabetes Medical Diagnosis and Treatment Standards" updated over the years. Practicing this concept is conducive to improving medical service efficiency and patient satisfaction, reducing patient complications, improving patients' quality of life, reducing patients' medical costs, etc. Traditional Chinese medicine has a "people-oriented" diagnosis and treatment idea and rich personalized treatment methods, which is consistent with the "patient-centered" concept in ADA guidelines. Therefore, based on the concept of "patient-centered" in ADA guideline, combined with the current situation of diabetes prevention and treatment in China, this paper discusses the development ideas of comprehensive diagnosis and treatment of diabetes in China, in order to provide reference and experience for the perfection and promotion of comprehensive diagnosis and treatment of diabetes in China.

Continuous glucose monitoring (CGM) is a technology that continuously monitors the glucose concentration of subcutaneous interstitial fluid through glucose sensors. It is divided into retrospective CGM, real-time CGM and scanning CGM, which is an effective supplement to traditional blood glucose monitoring methods. CGM-derived parameters can compensate for glycated hemoglobin (HbA_1c), which can reflect instantaneous hyperglycemia, hypoglycemia and blood sugar fluctuations, and is not easily affected by interference factors such as anemia and chronic kidney disease. The International Conference on Advanced Technology and Treatment of Diabetes defined 14 core indicators of CGM standardization report in the 2017 CGM International Consensus and Recommendation; These indicators were updated by the CGM International Consensus and Recommendation in 2019, where the glycemic management index (GMI) is one parameter that has changed, and the GMI is based on mean blood glucose from CGM sources and laboratory HbA_1cThe linear regression equation is calculated to reflect the blood glucose situation during wearing CGM, but there are few reports and studies related to GMI at present. Therefore, the review focuses on the origin, evolution, and calculation of GMI, joint interpretation of GMI, and laboratory HbA_1cClinical significance, GMI, and laboratory HbA of_1cThe differences of GMI, the relationship between GMI and other blood glucose indicators, and the application of GMI in diabetic blood glucose management and predicting the risk of chronic complications are introduced in five parts.

Diabetic neuropathy is a group of clinical syndromes with diverse manifestations caused by different pathophysiological mechanisms. It is one of the common chronic complications of diabetes. Its incidence is on the rise worldwide, and its disability and death rate are high. Its harmfulness and socio-economic burden have attracted more and more attention. In recent years, it has been found that diabetes mellitus and its complications are closely related to intestinal flora. This paper summarizes the research on the correlation between diabetic neuropathy and intestinal flora and its possible mechanism, and discusses the treatment methods around intestinal flora, aiming at providing new ideas for the prevention and treatment of diabetic neuropathy.

Diabetic retinopathy (DR) is one of the common diabetic microvascular complications. Interleukin-6 (IL-6), as a pro-inflammatory cytokine, causes the destruction of retinal tight junctions by participating in inflammatory response, increases the expression of vascular endothelial growth factor (VEGF), changes vascular permeability, and causes blood-retinal barrier (BRB) dysfunction, which plays a very key role in the pathogenesis of DR. This article reviews the effect of IL-6 on the blood-retinal barrier in DR.