Volume 15 · Issue 12 · 2023

Metabolic syndrome (MS) is a group of common metabolic disorders associated with an increased prevalence of obesity, and its components include abdominal obesity, lipid abnormalities, hyperglycemia, and hypertension, among others. The clinical application of glucagon-like peptide-1 receptor agonist (GLP-1RA) is increasing day by day. In addition to its initial use to reduce blood glucose in patients with type 2 diabetes mellitus (T2DM), many evidences for improving metabolic syndrome (MS) have appeared in recent years, including weight loss, blood lipid profile improvement, blood pressure reduction, etc., and it has potential value for the treatment of non-alcoholic fatty liver disease, Parkinson's disease, Alzheimer's disease, and polycystic ovary syndrome. This article focuses on the therapeutic effect and prospect of GLP-1RA on MS, in order to provide reference for the clinical treatment of MS.

The number of diabetic patients in China ranks first in the world. Cardiovascular disease is the main cause of death of type 2 diabetes patients in China, and chronic diseases are one of the risks of death of patients with cardiovascular diseases in China. The Guidelines for Primary Prevention of Cardiovascular Diseases in China and the Expert Consensus on Diagnosis and Treatment of Diabetic Patients with Cardiovascular Diseases provide a reference for the standardization of clinical diagnosis and treatment of patients with diabetes and heart disease (referred to as "sugar heart") in China. Based on the above guidelines and consensus, the author expounds the cardiovascular primary prevention and secondary prevention strategies of diabetic patients, that is, the management of "sugar heart" comorbidity. On the basis of the epidemiology of "sugar heart" comorbidity, the author summarizes the mechanism and mutual influence, prevention and treatment, multiple interventions and comprehensive management of diabetes complicated with cardiovascular disease, and provides ideas for the standardization of clinical diagnosis and treatment of such patients.

With the change of people's lifestyle and the increase of obesity prevalence, the incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is also increasing, which seriously affects the physical and mental health of children and adolescents and increases the burden of disease prevention and control. The epidemiology, pathophysiology, growth and response to treatment of T2DM in children and adolescents are different from those of adult T2DM and type 1 diabetes (T1DM). How to accurately diagnose and treat it, and try to preserve its function before the β cell function of children and adolescents deteriorates significantly is the key. In this paper, the epidemiological status, pathophysiological mechanisms, risk factors, comorbidities, complications and evidence-based evidence for the management of T2DM in children and adolescents are sorted out in combination with the relevant key points of the International Society of Child and Adolescent Diabetes Consensus Guidelines 2022: Type 2 Diabetes in Children and Adolescents and the American Diabetes Society Standards of Care for Child and Adolescent Diabetes 2023 and the latest clinical trials, so as to provide reference for the clinical diagnosis and treatment of T2DM in children and adolescents.

China has a vast territory with large climatic differences, and there are unique epidemiological characteristics of type 2 diabetes mellitus (T2DM) in cold areas. This consensus refers to relevant guidelines and expert consensus at home and abroad, deepens multidisciplinary diagnosis and treatment collaboration, analyzes and summarizes the epidemiological data and research progress of T2DM patients in cold regions. The consensus covers the disease characteristics, risk factors, blood glucose management status, lifestyle intervention, treatment plan selection and other aspects of T2DM in cold regions, and gives key points and tips for important parts, aiming at providing reference and reference for establishing and perfecting T2DM prevention and treatment strategies suitable for cold regions in China, and is suitable for clinicians in endocrinology departments, general practices and related departments of primary hospitals engaged in diabetes diagnosis and treatment and chronic disease management.

Sodium-glucose transporter 2 (SGLT2) inhibitors are a novel type of oral hypoglycemic agent. Clinical trials have found that these drugs not only help control diabetes but also provide additional benefits for heart and kidney outcome. They have shown cardiorenal protection in patients with type 2 diabetes and can improve outcomes in non-diabetic patients with chronic kidney disease (CKD), and the overall safety performance is good. Therefore, SGLT2 inhibitors have become important drugs for cardiorenal protection in CKD patients. The consensus expert group undertook an extensive process to develop this consensus on the use of SGLT2 inhibitor drugs in managing CKD. They engaged multidisciplinary experts from nephrology, endocrinology, and cardiology to ensure a comprehensive and standardized approach. The expert group utilized existing evidence-based evidence and the expertise of the participating clinicians to formulate this consensus through consultation, voting and discussion. The consensus includes the recommended population for SGLT2 inhibitors use, the risk assessment of adverse reactions before use, the recommendation of combination administration, and the monitoring and management of adverse reactions during use. This collaborative effort aims to provide physicians with a reliable and practical framework for the rational use of SGLT2 inhibitor drugs in clinical practice.

Diabetic foot ulcer is one of the most common and serious chronic complications in diabetic patients, with the characteristics of difficult healing, easy recurrence and poor prognosis. Decompression therapy is an important link in the treatment of diabetic foot ulcer, and it is also a key factor to promote ulcer healing and prevent ulcer recurrence. The topics of diabetic foot ulcer decompression treatment in the 9th International Diabetic Foot Forum mainly include 1 conference report, 4 oral exchanges and 2 discussion and interactive workshops. On the last day of the forum, the 2023 International Diabetic Foot Working Group Guidelines were released, including the Guidelines for Decompression of Diabetic Foot Ulcers (2023 Edition). The latest version of the decompression guidelines still proposes different interventions according to the ulcer site and ischemia/infection, but compared with the previous version of the guidelines, some new clinical questions and important outcomes have been added, and the recommended points have been updated and added. This article aims to introduce the contents of the 9th International Diabetic Foot Forum on the decompression treatment of diabetic foot ulcer, and to interpret the Guidelines for Decompression of Diabetic Foot Ulcer (2023 Edition) of the International Diabetic Foot Working Group. By reading this article, readers can get a glimpse of the global research and latest progress on decompression treatment of diabetic foot ulcer in the past four years, and understand the updated content, basis and significance of the new version of the guidelines.

Diabetic foot disease is a serious chronic complication of diabetes, with high incidence, recurrence, amputation and mortality, which is a difficult problem in clinical treatment at present. Lower limb edema is a common sign in patients with diabetic foot disease, and it also significantly affects the quality of life of patients. Patients with diabetic foot ulcer combined with lower limb edema have more difficulty in foot ulcer healing and worse prognosis. Therefore, it is very important to clarify the cause of diabetic foot disease with lower limb edema and treat it targetedly. This article reviews the causes and treatment of diabetic foot disease complicated with lower limb edema.

To evaluate the incidence and risk factors associated with chronic renal insufficiency (CRI) in people with diabetes mellitus (DM) in the community of Binhai County, Yancheng City, Jiangsu Province.

This was a retrospective cohort study. Adults with DM who participated in the health checkups from 1^st January 2018 to 31^st December 2018 in Binhai, and completed annual physical examinations for 4 consecutive years (up to 31^st December 2021) were selected as subjects. General information (sex, age), hematological indicators [fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), and creatinine] were collected. In addition, urinary protein was reported as negative, trace, 1+, 2+, or 3+. Among them, moderate proteinuria was defined as 1+, massive proteinuria was defined as ≥2+, and estimated glomerular filtration rate（eGFR) was calculated according to the chronic kidney disease epidemiology collaboration creatinine equation (CKD-EPI). The diagnostic criteria for CRI was a history of renal insufficiency [eGFR<60 ml·min^-1·(1.73 m²)^-1] lasting≥3 months. The endpoint event was defined as the initial occurrence of renal insufficiency in patients during the follow-up period, and the diagnosis of CRI was confirmed by subsequent outpatient visits, electronic medical record systems, or telephone follow-up. Poisson regression was employed to compute the incidence of CRI within this population, while multivariate Cox regression analysis was used to assess independent risk factors for CRI in individuals with diabetes.

A total of 8 244 individuals were included in this study. The average age was (62.2±9.1) years old and 39.3% (3 238/8 244) individuals were male at baseline. The average baseline eGFR was (98.8±12.8) ml·min^-1·(1.73 m²)^-1, and FPG was (10.1±3.0) mmol/L in this population. Seven hundred and fifteen (8.7%) individuals developed incident CRI during a median follow-up time of 3.4 years (interquartile range, 3.3, 3.5 years). The overall CRI incidence rate was 2.64 (95%CI 2.60-2.67) per 100 person-years. In the multivariable Cox regression analysis, women (HR=1.634, 95%CI 1.389-1.921), elevating triglycerides(per 1 mmol/L increase, HR=1.044, 95%CI 1.014-1.075), elevating FPG (per 1 mmol/L increase, HR=1.063, 95%CI 1.040-1.087), moderate proteinuria (HR=1.290, 95%CI 1.003-1.667), and severe proteinuria (HR=2.086, 95%CI 1.645-2.644) were independent risk factors for CRI. Baseline eGFR was negatively associated with CRI [per 5 ml·min^-1·(1.73 m²)^-1 increase, HR=0.623, 95%CI 0.604-0.642].

The incidence of CRI was high in people with DM in community. Female, elevated TG, elevated FPG, and proteinuria were positively and independently associated with decline in kidney function, while baseline eGFR was negatively associated with the risk of CRI.

To establish and validate a model for estimating the glucose management indicator (GMI) in diabetes mellitus with chronic kidney disease (CKD) stratified by estimated glomerular filtration rate (eGFR) level.

A total of 163 diabetes mellitus with CKD who wore continuous glucose monitoring during hospitalization in the Department of Endocrinology, Nanfang Hospital of Southern Medical University from August 2018 to October 2022 were retrospectively enrolled and divided into G1-3a [eGFR≥45 ml·min^-1·(1.73 m²)^-1, 101 cases] and G3b-5 [eGFR<45 ml·min^-1·(1.73 m²)^-1, 62 cases] groups. General, biochemical and CGM data were collected. Pearson correlation analysis was used to investigate the correlation between glycated hemoglobin A_1c (HbA_1c) and GMI. Patients in G1-3a and G3b-5 groups were divided into training set and validation sets by simple random sampling with a ratio of 6∶4. Based on biochemical data, models to calculate GMI were constructed in G1-3a and G3b-5 groups. In the training set, univariate linear regression analysis was performed for each clinical variable, and univariate significant variables (P<0.05) were selected for multivariate stepwise regression analysis. For model validation, the estimated GMI was compared with real GMI using Pair′s t test and Bland-Altman analysis.

GMI correlated positively with HbA_1c in G1-3a group (r=0.547, P<0.001) but not in G3b-5 group (r=0.197, P=0.125). Based on the clinical data, a linear regression model was developed to estimate the GMI in G1-3a group: GMI (%)=0.245×HbA_1c (%)-0.043×ALB (g/L)+6.380. In the validation set, the estimated GMI was 7.04%±0.76% and real GMI was 6.81%±0.81%, no significant difference was observed (P=0.059). In G3b-5 group, the model was: GMI (%)=0.108×HbA_1c (%)-0.03×ALB (g/L)+anemia (non-anemia,+0; anemia, -0.840)+7.549. In the validation set, the estimated GMI was 6.55%±0.32% and real GMI was 6.82%±0.89%, with no significant difference was observed (P=0.165). Bland-Altman analysis showed that there was 8.33% (3/36) and 4.35% (1/23) pair of estimated GMI and real GMI falling outside the 95% agreement line in the G1-3a and G3b-5 group respectively.

The accuracy of HbA_1c to assess glycemic status in diabetes mellitus with stage G3b-5 CKD decreased. The developed linear model can estimate the GMI level for diabetes mellitus with CKD with reasonable accuracy.

To investigate the clinical correlation between the plasma lipopolysaccharide (LPS) levels and anxiety and depression in patients with type 2 diabetes mellitus (T2DM).

This was a cross-sectional study. A total of 160 T2DM patients who visited the Second People′s Hospital of Qidong City, Nantong, Jiangsu Province from October 2021 to August 2022 were included in the T2DM group, and 80 non-diabetic patients who underwent a physical examination during the same period were included in the non-diabetic group. Plasma LPS levels, fasting plasma glucose (FPG) and glycted hemoglobin (HbA_1c) were collected, and self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate the anxiety and depressive emotional states of T2DM patients. t test, Mann-Whitney U test and Chi-square test were used to analyze the differences between groups. Spearman correlation analysis was used to analyze the correlation between plasma LPS levels and metabolic indexes, SAS or SDS. Multiple linear regression was used to analyze the independent influencing factors of plasma LPS level. Multiple logistic regression was used to analyze the independent influencing factors of anxiety and depression in T2DM patients.

Plasma LPS level in T2DM group was significantly higher than that in non-diabetic group (P<0.001). Spearman correlation analysis showed that plasma LPS levels were positively correlated with FPG and HbA_1c (r=0.441 and 0.398, P<0.001) in T2DM patients. Multiple linear regression analysis showed that FPG and HbA_1c were independent influencing factors of plasma LPS levels (β=0.305 and 0.269, P<0.05). Plasma LPS levels were positively correlated with SAS and SDS scores in T2DM patients (r=0.456 and 0.469, P<0.001). Multiple logistic regression showed that plasma LPS level was an independent influencing factor for anxiety (OR=1.124, 95%CI 1.059-1.193, P<0.001) and depression (OR=1.087, 95%CI 1.024-1.154, P=0.006) in T2DM patients.

T2DM patients have higher plasma LPS levels, which are positively correlated with FPG and HbA_1c levels. Plasma LPS level is an independent influencing factor for anxiety and depression in T2DM patients.

To systematically evaluate the effects of wearable devices combined with exercise management on glycolipid metabolism in diabetic patients.

Databases including CNKI, WanFang Data, VIP databases, Sinomed, PubMed, Embase, Web of science, the Cochrane Library and the CINAHL database were searched to collect randomized controlled trials (RCT) of the use of wearable devices in combination with exercise for glycaemic control in diabetic patients. The RCT were screened and assessed for quality of literature to extract valid information from inception to April 2023. Patients in the experimental group received a management scheme based on portable wearable devices combined with exercise, while patients in the control group did not use portable wearable devices and received routine or other blood glucose management protocols. The primary indicator was glycated hemoglobin A_1c (HbA_1c); secondary indicators were fasting plasma glucose (FPG), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C). Meta-analysis was performed using RevMan 5.4 software, and standardized mean difference (SMD) was used as effect analysis statistic for continuous variables, and 95%CI was provided for each effect size.

A total of 10 RCT with 1 260 patients with diabetes were included. Meta-analysis showed that, compared to the control group, the test group had a higher HbA_1c (SMD=-0.49%, 95%CI -0.62%--0.36%, P<0.01), FPG (SMD=-0.87 mmol/L, 95%CI -1.04--0.70 mmol/L, P<0.001), TC (SMD=-0.28 mmol/L, 95%CI -0.42--0.15 mmol/L, P<0.001), HDL-C (SMD=0.07 mmol/L, 95%CI 0.01-0.13 mmol/L, P=0.02) were significantly improved, the difference was statistically significant. There was no significant difference in TC (SMD=-0.25 mmol/L, 95%CI -0.37-0.12 mmol/L, P=0.27) and LDL-C (SMD=-0.12 mmol/L, 95%CI -0.19--0.06 mmol/L, P=0.22) between the two groups.

Wearable devices combined with exercise management help to improve HbA_1c, FPG, TC and HDL-C levels in diabetic patients, without a significant effect on TC and LDL-C.

To investigate the role of forkhead protein O 3 (FOXO3) in hepatic glucose metabolism in transgenic mice.

Transgenic mice under the control of male liver activating protein (LAP) promoter and expressing tetracycline regulated trans activator (tTA) (LAP-tTA mice) were crossed with female mice carrying lucifinase-tet operating element (tetO) 7-FOXO3 constitutively active alleles [(tetO) 7.FOXO3CA mice] FOXO3CA mice to obtain FOXO3CA^hep mice (tTA⁺/FOXO3CA⁺, conditional overexpression of hepatic FOXO3, seven mice), tTA^- and/or FOXO3CA^- mice were used as control group (nine mice). The expression of FOXO3 in the liver of mice in each group was detected by IVIS in vivo imaging, real-time quantitative polymerase chain reaction (RT-qPCR), Western blotting, and immunohistochemistry. The mRNA levels of related gluconeogenesis genes [glucose 6-phosphate kinase (G6pc), phosphoenolpyruvate carboxylase (Pepck), and pyruvate dehydrogenase kinase 4 (Pdk4)] were detected by RT-qPCR. Blood glucose and serum insulin levels were monitored. Glucose tolerance and insulin tolerance tests were performed. Immunohistochemistry was used to evaluate the pancreatic islet hyperplasia, insulin and glucagon expression. Comparison between groups was conducted using t-test.

IVIS in vivo imaging, RT-qPCR, Western blotting and immunohistochemistry confirmed the high expression of FOXO3 in the liver of FOXO3CA^hep mice, which was mainly expressed in the nuclei of hepatocytes. The high expression of FOXO3 resulted in significant hepatocyte atrophy compared to that of control mice. Compared with the control group, the fasting blood glucose levels of 7-week-old FOXO3CA^hep mice were significantly higher [(165.7±24.1) vs. (87.4±12.1) mg/dl, respectively, P<0.001], and the mRNA levels of gluconeogenic genes G6pc, Pepck, and Pdk4 were significantly increased (P<0.001). Compared with the control group, the fasting blood glucose of 9-week-old mice decreased [(55.6±6.1) vs. (82.8±17.2) mg/dl, respectively, P=0.001], and the insulin levels increased significantly [(10.01±1.56) vs. (1.50±0.82) ng/ml, respectively, P<0.001]. Immunohistochemical results showed that the islet cells of FOXO3CA^hep mice were significantly more proliferative than those in the control group, and the islet cells showed strong positive staining for insulin. The insulin tolerance test indicated that insulin resistance was present.

Sustained high expression of FOXO3 may promote upregulation of gluconeogenesis-related genes in the liver, dysglycemia and elevated insulin levels, islet hyperplasia, and insulin resistance.

This study investigated the efficacy of negative wound pressure combined with autologous platelet-rich gel (APG) therapy for diabetic foot and refractory skin and soft tissue ulcers. Fifty patients with diabetic foot and refractory skin and soft tissue ulcers admitted to the Diabetic Foot Treatment Center of Guangxi Zhuang Autonomous Region People's Hospital from October 2019 to November 2021 were selected as the research subjects. After 2 weeks of assisted negative pressure closed drainage (VAC), the patients were divided into VAC combined with APG treatment group (25 cases, 18 cases with wounds below the foot and ankle, 7 cases with wounds below the knee and above the ankle; 12 cases with Wagner grade 2 and 13 cases with grade 3) and VAC combined with dressing change group (25 cases, 3 cases lost to follow-up, 22 cases were finally included, 21 cases with wounds below the foot and ankle, 1 case with wounds below the knee and above the ankle; 10 cases with Wagner grade 2 and 12 cases with grade 3). The VAC combined APG treatment group was treated with autologous platelet-rich gel, while the VAC combined dressing change group was treated with foam dressing or (and) alginate dressing every day or every other day. The healing of the two groups after treatment was observed by the changes of multi-dimensional geometric evaluation index of wounds. Independent samples were used for comparison between groupstTest, Rank Sum Test Sumχ²Inspection. The results showed that there was no statistically significant difference in wound area, wound circumference and wound circumference area ratio between the two groups before treatment (P>0.05）。 After 2 weeks of treatment, the wound area reduction rates in the VAC plus APG treatment group and the VAC plus dressing change group were 46.84% ± 18.10% and 19.14% ± 11.33%, respectively,P<0.001), perimeter reduction rate [24.51% (18.89%, 32.24%) and 13.68% (3.81%, 20.56%),P=0.002], mean healing rate [0.24 (0.13, 0.43) and 0.14 (0.08, 0.26) cm, respectively²/d,P=0.034], complete epithelialization time [(56.32 ± 21.55) d and (86.09 ± 49.54) d, respectively,P=0.014], the difference was statistically significant. The above results suggest that the treatment of diabetic foot and skin and soft tissue refractory ulcer with VAC combined with autologous platelet-rich gel has better wound healing effect than dressing change treatment, and it is a safe, effective and simple treatment method.

To explore the needs of medical staff and patients with high-risk diabetic foot for the construction of intelligent management platform for diabetic foot.

Using the convenient sampling method, the medical staff in the Diabetic Foot Prevention and Treatment Alliance Hospital of Xiangya Hospital of Central South University were selected as the research subjects of the medical staff part, and the patients with high-risk diabetic foot who attended the Department of Endocrinology of Xiangya Hospital of Central South University from January 2022 to June 2023 were selected as the research subjects of the patient part. Semi-structured interviews were conducted with the included medical staff and patients with high-risk diabetic foot, and the demand of the research subjects for the construction of intelligent management platform for diabetic foot was analyzed using Nvivo 12 software and Colaizzi.

A total of 7 physicians, 8 nurses and 10 high-risk diabetic foot patients were included. The results of semi-structured interviews show that the needs of medical staff for the construction of intelligent management platform for diabetic foot are mainly reflected in five aspects: "patient information management, communication and consultation, academics and statistics, health education and clinical decision-making", and the needs of patients are mainly reflected in three aspects: "health education-related knowledge, the need to obtain information, and the coexistence of multiple forms of information transmission".

There are differences in the needs of medical staff and patients for the construction of intelligent management platform for diabetic foot. Medical staff have a greater demand for diversified functions and design convenience of the platform, while patients are more concerned about the coexistence of health education, latest information acquisition and multiple forms of information transmission.

The diagnosis and treatment of a patient with lipoatrophic diabetes mellitus (LD) in Tianjin Medical University General Hospital was reported. The patient was a 19-year-old woman who came to our hospital mainly because she found that her blood sugar was elevated for 3 years, and she had repeated abdominal pain, nausea and vomiting for more than 1 year. According to the results of oral glucose tolerance test (OGTT), the patient was diagnosed as diabetes, accompanied by severe hypertriglyceridemia and recurrent acute pancreatitis. Dystrophic state, small mandible with deformity of tooth alignment, obvious atrophy of subcutaneous fat in limbs. Genetic testing findingsLMNAA mutation occurred in the gene (c.139G>T, rs267607608) and familial partial lipodystrophy (FPLD) type 2 was diagnosed. LD is one of its important clinical manifestations. Because there are differences in treatment and prognosis between FPLD type 2 and other types of diabetes, it is of great clinical value to understand the clinical characteristics of FPLD type 2 and identify it early.

The diagnosis and treatment of a patient with type 2 diabetes mellitus complicated with Gitelman syndrome in the Department of Endocrinology of the Second Hospital of Tianjin Medical University was reported. The patient was an elderly woman with type 2 diabetes mellitus who was admitted due to "fatigue with palpitations for 1 year and aggravation for 2 months". After admission, completed relevant examinations showed that hypokalemia, hypomagnesemia, hyponatremia, hypochloremia, hypocalciuria, hypotension, and renin-angiotensin-aldosterone system activity were increased. After peripheral blood related gene sequencing, it was detected that it carriedSLC12A3: c. 506-1G>A variant. Combined with the clinical manifestations and auxiliary examination results, the patient was considered to have Gitelman syndrome. After treatment with spironolactone, potassium magnesium aspartate and potassium chloride, the patient's hypokalemia and hypomagnesemia were corrected, and his condition improved and he was discharged. Gitelman syndrome is clinically rare in the elderly population, and it is easy to miss and misdiagnose. It is hoped that through the report of this patient, clinicians can improve the understanding and diagnosis and treatment level of hypokalemia and hypomagnesemia caused by special reasons in the elderly.

The diagnosis and treatment of a case of adult type diabetes mellitus (MODY) type 12 with adolescent onset was reported. The patient was a 44-year-old male who was admitted to hospital with the main complaint of "finding elevated blood sugar for more than 18 years and numbness and pain in his limbs for 4 years". The results showed that the C-peptide was 1.45 and 1.88, 2.43, 3.72, 3.82 ng/ml at fasting and 30, 60, 120, 180 min postprandial, respectively. The mitochondrial gene test was negative, and the gene sequencing test results wereABCC8MODY12 subtype due to gene mutation. Glimepiride (2 mg, twice/d), dapagliflozin (10 mg, once/d) and liraglutide (1.8 mg, once/d) were used to control blood glucose. The blood glucose control was good, and the patients were satisfied with the treatment effect. This article is carried out by reporting on this patientABCC8Review the literature related to MODY12 subtype caused by gene mutation, and remind the clinic to pay attention to the difficult-to-identify type of diabetes, rational application of gene detection technology, so as to improve the diagnosis rate of special types of diabetes, and carry out timely and effective individualized diagnosis and treatment measures to delay the occurrence and development of diabetic complications, so that patients can obtain clinical remission.

Adolescent-onset adult diabetes type 5 (MODY 5) can be combined with abnormal development of the reproductive tract, and congenital anuterine and vaginal syndrome (MRKH) is its most serious condition. At present, there are reports of MODY5 combined with bihorned uterus and other reproductive tract malformations in China, but there are no reports of MODY5 combined with MRKH. In this paper, a case of MODY5 combined with MRKH was reported. After whole exon gene sequencing, it was clear that the microdeletion of chromosome 17q12 fragment was caused. This chromosomal variation resulted in the first case of this phenotype in China, and it was the first case of MRKH caused by chromosomal microdeletion in China. The patient was initially seen with early-onset diabetes, and later it was found that he had abnormal development of the reproductive tract and kidneys, defective development of facial structures, abnormal liver function, hypomagnesemia, subclinical hypothyroidism, etc. MODY5 generally has insulin secretion defects. Insulin glargine combined with insulin aspart is administered subcutaneously multiple times a day and voglibose is administered orally to control blood sugar and delay the development of diabetic complications. The main treatment plan of MRKH is to use vaginal reconstruction to solve the problem of sexual difficulty, and non-surgery is the first-line option. It is recommended that patients can try vaginal compression plasty after their blood sugar control is stable.

The renal tubular epithelium is rich in a variety of glucose transporters (GLUT), including sodium-glucose cotransporter (SGLT) 2, SGLT1, GLUT2, and GLUT1, which together regulate the reabsorption of glucose in the kidney. In recent years, it has been found that the expression and dysfunction of GLUT in renal tubules may be an important factor leading to the imbalance of glucose metabolism. This article focuses on the changes of GLUT expression in diabetic state, and the influence of diet, drugs and sympathetic nerve factors on the expression level or function of SGLT2, so as to provide new ideas for the follow-up research on the treatment of kidney-based type 2 diabetes.

Adolescent-onset adult-type diabetes mellitus (MODY) is an autosomal dominant monotype of diabetes mellitus. Hepatocyte nuclear factor 1A (HNF1A) -MODY is the most common type among the MODY subtypes and is determined byHNF1ACaused by a genetic mutation. on account ofHNF1A-MODY has similar clinical characteristics to type 1 and type 2 diabetes, and there is a phenomenon of clinical misdiagnosis and mistreatment. This article is very importantHNF1A-Recent advances in gene mutations, pathogenesis, differential diagnosis and treatment of MODY are reviewed.

With changes in lifestyle, the incidence of diabetes has increased dramatically worldwide. Studies have shown that dietary quality is central to its pathogenesis. Intermittent fasting is a diet that extends the daily or weekly fasting time, mainly including alternate-day fasting, 5:2 diet and time-limited diet, etc. It has been shown to play an important role in alleviating diabetes, but its mechanism remains to be elucidated. In recent years, more and more studies have found that intermittent fasting can improve the remission rate of diabetes by regulating intestinal flora, thus improving ectopic fat deposition and insulin resistance. Therefore, this article aims to review the research progress and its influence mechanism of intermittent fasting mediated by intestinal flora in alleviating diabetes.