Volume 16 · Issue 02 · 2024

Vascular endothelial cells are not only mechanical barriers that isolate blood and surrounding tissues, but also secrete a variety of active substances, regulate vasomotor function and maintain vascular homeostasis. Glycolipid toxicity damages endothelial function and promotes the occurrence and development of atherosclerosis. In order to find new targets for the prevention and treatment of endothelial injury induced by glycolipid toxicity, the author's team has done a lot of work. We found that lifestyle interventions and traditional drugs such as insulin, metformin, alpha-lipoic acid and sildelafil have new effects in protecting the endothelium. Cell-active factors such as tumor necrosis factor-related apoptosis-inducing ligand, osteoprotectin and growth differentiation factor 11 have potential endothelial protective effects. Bone tissue, brown adipose tissue, muscle tissue and other tissues can cross-talk with vascular endothelial cells through some active factors, which is expected to become a new target of endothelial cell protection.

With the intensification of aging in China, the prevalence of diabetes in the elderly has increased significantly, and its standardized management is crucial to improving the clinical outcome of elderly diabetic patients. In 2021, the National Geriatric Center, the Geriatric Branch of Chinese Medical Association and the Diabetes Professional Committee of China Geriatric Health Care Association organized experts to write China's first geriatric diabetes guidelines, namely the Chinese Geriatric Diabetes Diagnosis and Treatment Guidelines (2021 Edition), emphasizing the high heterogeneity of elderly diabetic patients and the need for comprehensive evaluation, adopting hierarchical and individualized management strategies, and putting forward the "simple treatment concept" and "de-intensive treatment strategy" for elderly diabetic patients for the first time. This edition of the guidelines provides practical and operational clinical guidance for clinicians, and has greatly promoted the all-round and full-cycle standardized comprehensive management of elderly diabetic patients in China. At the same time, it has also promoted the extensive development of clinical and basic research in elderly diabetes and related fields in China. In the past three years since the release of the guidelines, evidence-based medicine for elderly diabetes and related fields at home and abroad has further accumulated, and new treatment concepts, new drugs and treatment technologies have emerged. The editorial board of the guidelines has timely updated the first edition of the guidelines, further refined and optimized the blood glucose management path of elderly diabetes, and compiled the Guidelines for Diagnosis and Treatment of Elderly Diabetes in China (2024 Edition), with a view to continuing to help the standardized management of elderly diabetic patients in China and the improvement of clinical outcomes.

With the continuous development of continuous glucose monitoring (CGM) technology, dynamic glucose profiling (AGP) reporting has become an important method for evaluating and analyzing CGM data in clinical and research applications. Through systematic analysis of AGP reports, it is possible to comprehensively evaluate the blood sugar control of patients, formulate individualized treatment plans for them, and continuously evaluate the effectiveness and safety of treatment plans. In order to better understand the clinical meanings of various indicators in the AGP report and master the methods of clinical decision-making based on the AGP report, the Endocrinology Branch of Chinese Medical Association and the National High-Performance Medical Device Innovation Center organized experts in relevant fields to systematically review the consensus, guidelines and literature reviews on CGM and AGP published worldwide, and combined with the experience of clinical practice, after many discussions and revisions, the Expert Consensus on Clinical Application of Dynamic Glucose Map Report (2023 Edition) was formed. The content mainly includes the definition of AGP report, the core indicators of AGP report and CGM, the five-step interpretation and decision-making cycle of AGP report, and the clinical application of AGP report.

Diabetic foot ulcer (DFU) is one of the serious complications of diabetes, which has the characteristics of high disability, high mortality and high prevalence. DFU is prone to co-infection, and some DFU patients have no obvious infection symptoms, resulting in delayed treatment and increased risk of amputation. Up to 50% of DFU patients have peripheral arterial disease (PAD), and PAD causes stenosis and occlusion of the arterial lumen, resulting in poor ulcer healing. DFU patients with PAD and infection at the same time have significantly increased risk of amputation and death. This article focuses on the clinical characteristics of DFU patients with PAD and infection, the bacterial spectrum of infection, antibiotic resistance, and how to standardize the diagnosis and treatment of such patients, improve the prognosis of diabetic foot ulcer infection with PAD, so as to reduce the amputation rate of DFU patients and improve the quality of life of patients.

To initially screen children and adolescents with new-onset type 1 diabetes mellitus (T1DM) for celiac disease antibodies and to investigate the relationship between celiac disease antibodies and lipid changes.

This was a cross-sectional study. A total of 98 children and adolescents with newly diagnosed T1DM were recuited for the study from March 2013 to January 2021 from a single center of the Department of Pediatric Endocrinology, Metabolism and Gastroenterology at the Affiliated Hospital of Qingdao University. We collected general data [age, sex, blood pressure, incidence of diabetic ketoacidosis (DKA), etc.] and laboratory indices [lipids (triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein α), glycated hemoglobin A_1c(HbA_1c), glutamic acid decarboxylase antibody (GADA), insulin autoantibody (IAA), etc.], and calculated body mass index standard deviation score (BMI-SDS) and atherosclerosis index. We detected total serum immunoglobin A (IgA) by scattering turbidimetric method, serum anti-tissue transglutaminase antibody-IgA (tTGA-IgA) by enzyme-linked immunosorbent assay, and endomysial antibody-IgA (EMA-IgA) by indirect immunofluorescence. Based on the tTGA-IgA and EMA-IgA test results, the subjects were divided into antibody-positive group and antibody-negative group. Two independent samples t-test, Wilcoxon test, χ² test, or corrected χ² test were then performed for inter-group comparison.

Ninety-eight children and adolescents with new-onset T1DM, aged (9.38±3.56) years, had a male-to-female ratio of 1.18∶1 (53/45). There were 8 cases (8.16%) in the antibody-positive group, aged (8.07±4.12) years, with a male-to-female ratio of 3∶1 (6/2), including 2 cases positive for tTGA-IgA only, 2 cases positive for EMA-IgA only, and 4 cases positive for both tTGA-IgA and EMA-IgA. There were 90 cases (91.84%) in the antibody-negative group, aged (9.50±3.51) years, had a male-to-female ratio of 1.09∶1 (47/43). There was no significant difference between the antibody-positive and antibody-negative groups in terms of gender, age, BMI-SDS, HbA_1c, the positive rates of GADA and IAA, the incidence of DKA and blood pressure (P>0.05). There was also no significant difference in triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, lipoprotein α, and atherosclerotic index between the two groups (P>0.05).

The celiac disease antibodies positive rate in children and adolescents with new-onset T1DM at our center screening was 8.16%. Although celiac disease antibodies, whether positive or negative, have no discernible impact on lipids in children and adolescents with new-onset T1DM.

To investigate the association between the serum CXC chemokine ligand 17 (CXCL17) and type 2 diabetes mellitus (T2DM) with non-alcoholic fatty liver disease (NAFLD).

This was a cross-sectional study. Newly diagnosed T2DM patients hospitalized at the Department of Endocrinology of the First Affiliated Hospital of Soochow University from April 2021 to December 2022 and the healthy volunteers in the physical examination center during the same period were selected as the control group. Height and weight of the participants were collected, body mass index (BMI) was calculated, CXCL17, low-density lipoprotein-cholesterol (LDL-C) and glutamic pyruvic transaminase (ALT) were detected, and hepatic fat fraction (HFF) was measured. According to HFF, patients with T2DM but without NAFLD were assigned to T2DM group (HFF≤5.5%), and patients with T2DM and NAFLD were assigned to T2DM+NAFLD group (HFF>5.5%). One-way analysis of variance (ANOVA), Kruskal-Wallis H test and χ² test were used for comparisons between groups, Spearman correlation analysis was used to analyze the correlation between HFF and other variables, and binary logistic regression analysis was used to analyze the independent influencing factors of T2DM patients with NAFLD.

Two hundred and seventy patients were enrolled. Of these, 88 were in T2DM group, 92 in T2DM+NAFLD group and 90 in control group. The level of serum CXCL17 in T2DM+NAFLD group [(95.62±6.83) ng/L] was higher than that in T2DM group [(56.49±9.45) ng/L] and control group [(21.59±5.12) ng/L] (P<0.05). Spearman correlation analysis showed that HFF was positively correlated with CXCL17 (r=0.672), BMI (r=0.481), ALT (r=0.447), LDL-C (r=0.253), respectively (all P<0.001). Binary logistic regression showed that CXCL17(OR=0.949,95%CI 0.926-0.973), BMI(OR=0.773,95%CI 0.678-0.882), ALT(OR=0.943,95%CI 0.918-0.968), LDL-C(OR=0.632,95%CI 0.432-0.923) were independent influencing factors of NAFLD (P<0.05).

The increase of serum CXCL17 might be an independent risk factor of NAFLD.

To explore the relationship between serum microRNA-21 (miR-21) and type 2 diabetes mellitus (T2DM) with non-alcoholic fatty liver disease (NAFLD).

This cross-sectional study screened patients with T2DM hospitalized in the Department of Endocrinology of Gansu Provincial Hospital and matched healthy individuals from August 2022 to June 2023. T2DM patients were divided into the T2DM alone group and the T2DM combined with NAFLD group based on the presence or absence of NAFLD. Healthy individuals undergoing physical examinations during the same period were included as the healthy control group. Data on age, sex, diabetic duration, height, weight, and body mass index (BMI) were collected. Levels of miR-21, mammalian target of rapamycin (mTOR), high-density lipoprotein-cholesterol (HDL-C), interleukin-6 (IL-6), glycated hemoglobin A_1c (HbA_1c), fasting plasma glucose (FPG), and fasting insulin (FINS) were measured, and the homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. One-way analysis of variance, Kruskal-Wallis H test or χ² test were used for comparisons between groups, Spearman correlation analysis was used to analyze the correlation between miR-21 level and various indicators, and stepwise linear regression analysis was used to analyze the independent influencing factors of serum miR-21 level.

A total of 136 subjects were enrolled in the study, including 91 T2DM patients and 45 healthy physical examination subjects. Among them, there were 45 cases in the T2DM alone group, 46 cases in the T2DM combined with NAFLD group, and 45 cases in the healthy control group. Serum miR-21 levels were reduced in both the T2DM alone and T2DM combined with NAFLD groups compared to the healthy control group (P<0.05). After adjusting for confounding factors, Spearman correlation analysis showed significant positive correlations between miR-21 levels and HDL-C and mTOR levels (r=0.228 and 0.175, respectively, both P<0.05), while negative correlations were observed with HbA_1c, FPG, FINS, HOMA-IR, and IL-6 levels (r=-0.320, -0.230, -0.178, -0.283 and -0.361,respectively, all P<0.05). Stepwise linear regression analysis identified BMI, HbA_1c, and IL-6 as independent variables associated with serum miR-21 levels (t=2.360, -2.354, and -3.188, respectively, all P<0.05).

Serum miR-21 levels are associated with T2DM with NAFLD and may contribute to the development of this condition through insulin resistance, inflammatory response, and glucose lipid metabolism pathways.

To systematically evaluate the efficacy and safety of insulin Icodec in the treatment of type 2 diabetes mellitus (T2DM) in order to provide evidence-based guidance for the rational clinical use of drug.

The databases of PubMed, Embase, Cochrane Library, Web of Science, Sinomed, CNKI, Wanfang and VIP were searched by computer to identify randomized controlled trials (RCT) comparing the efficacy and safety of insulin Icodec (trial group) versus placebo or other hypoglycemic agents (control group) in the treatment of T2DM were collected from the date of database inception to August 2023. The efficacy indexes included: glycated hemoglobin A_1c (HbA_1c) level, HbA_1c compliance rate (HbA_1c<7%), fasting plasma glucose (FPG) level, body weight level, time in range (TIR) percentage. Safety indicators included: incidence of hypoglycemia events, incidence of injection site reactions, incidence of drug allergic reactions, and incidence of serious adverse events. Two evaluators independently screened the literature, extracted data from the literature and assessed the risk of bias of the studies included, and performed a meta-analysis of the data using RevMan 5.4 software.

Seven studies with a total of 3 286 patients were included. The results of meta-analysis showed that compared with the control group, insulin Icodec reduced HbA_1c (WMD=-0.16%, 95%CI -0.26%--0.07%, P<0.01), increased the rate of HbA_1c compliance (OR=1.50, 95%CI 1.29-1.74, and decreased HbA_1c compliance (WMD=-0.16%, 95%CI -0.26%--0.07%, P<0.01). However, there was no statistically significant difference between the two groups in reducing FPG levels (WMD=-0.05 mmol/L, 95%CI -0.29-0.20 mmol/L, P=0.71), and it increased the body weight of patients (WMD=0.52 kg, 95%CI 0.22-0.82 kg, P<0.01), but increased the percentage of TIR in patients (WMD=5.86%, 95%CI 2.02%-9.70%, P=0.003). In terms of safety, although the incidence of hypoglycemic events (OR=1.37, 95%CI 1.17-1.61, P<0.01) was higher in the insulin Icodec group than in the control group, the incidence of anaphylaxis was higher in insulin Icodec group than in the control group (OR=0.91, 95%CI 0.64-1.31, P=0.62), injection site reaction (OR=1.03, 95%CI 0.63-1.66, P=0.92) and incidence of serious adverse events (OR=0.97, 95%CI 0.75-1.24, P=0.79), there was no significant difference between insulin Icodec and control groups.

Insulin Icodec can lower HbA_1c levels in patients and increase the rate of HbA_1c compliance without increasing the incidence of injection site reactions, allergic events and serious adverse events.

To investigate the value of insulin free rate in the diagnosis and treatment of insulin autoimmune syndrome (IAS).

The literature of the National Library of Medicine database (PubMed), the Dutch Medical Abstracts database (Embase) and the Chinese Biomedical Literature Database (CBM) on patients with definite diagnosis of IAS and the values of free insulin (FI) and total insulin (TI) before and after treatment were determined by polyethylene glycol (PEG) precipitation method from the establishment of the database to January 1, 2023 was searched. The basic information included in the literature was extracted and analyzed, and the ratio of FI to TI insulin freedom rate (IFR) was calculated.

A total of 8 articles were included, and a total of 7 patients with IAS were included in the study. Of these, 2 patients with IAS had hyperglycemia (including 1 case with extreme insulin resistance) and 5 presented only with hypoglycemia. FI and TI were measured before and after treatment in all 7 patients by PEG precipitation method. Although FI and TI varied greatly between patients, IAS patients with persistent hyperglycemia and severe insulin resistance had lower IFR. Treatment options for patients include plasma exchange, hormones, immunosuppressants, and anti-CD20 monoclonal antibodies. The decrease of TI and the increase of IFR are important indicators of the onset of treatment.

FI and TI should be determined using PEG precipitation in the diagnosis and treatment of IAS, and IFR should be further calculated. IFR is an important indicator in the diagnosis and treatment of IAS.

The diagnosis and treatment of a patient with Williams-Beuren syndrome due to diabetic ketoacidosis was reported. The patient was a 14-year-old male who was admitted due to "weight loss for 5 months, dry mouth and polydipsia for 1 week". The patient had previous history of bilateral inguinal hernia and congenital heart disease (aortic stenosis), and underwent surgical treatment. After sequencing of peripheral blood related genes, it was detected that there may be a copy number heterozygous deletion variant with a size of about 1 105.97 kbp in the 7q11.23 segment. Combining the clinical manifestations and examination results of the patient, the patient was considered to be Williams-Beuren syndrome. After the patient was corrected for diabetic ketoacidosis, he was given metformin 0.5 g (twice/d) and insulin glargine 18 U subcutaneously before bed. The blood glucose fluctuated from 3.4 to 11.0 mmol/L, and the fasting blood glucose was 5.3 to 7.0 mmol/L. The treatment plan was adjusted to metformin 0.5 g (twice/d), the blood glucose fluctuated from 4.5 to 7.7 mmol/L, and the blood calcium level fluctuated from 2.41 to 2.47 mmol/L during hospitalization. He was discharged after his condition was stable.

A family of adult type 13 diabetes mellitus (MODY13) with adolescent onset is reported. The proband went to the doctor with the main complaint of "blood sugar rise was found for more than 1 year and poor control for half a year", and relevant examinations were improved. Genetic testing found that the proband and his mother, aunt and cousin carriedKCNJ11Gene c.487A>G: p.M163V mutation. Combined with clinical features, the proband was diagnosed as MODY13. After intensive insulin therapy, glimepiride, dapagliflozin and dulaglutide were given to control blood glucose. However, the clinical manifestations and treatment of other diabetic patients with mutations are different. This article discusses the key points of clinical diagnosis and treatment of MODY13 by reviewing relevant literatures, aiming at enhancing clinicians' understanding of MODY13 and improving the diagnosis and treatment level of monogenic diabetes.

A case of hepatocyte nuclear factor 1a-adolescent onset adult diabetes mellitus was reported in the Zhu Xianyi Memorial Hospital of Tianjin Medical University (HNF1A-MODY) patients, who are also characterized by the presence of a strong genetic background of type 2 diabetes. The patient was a 31-year-old woman who was diagnosed with idiopathic type 1 diabetes in her adolescence. She had tried various hypoglycemic regimens, but her blood sugar control was not satisfactory. After visiting our hospital, she was confirmed by genetic testingHNF1A-MODY, the mutation site isHNF1Ac.C787T (p.R263C), the treatment effect of sulfonylurea drugs is not good, the final hypoglycemic regimen is semaglutide 0.5-1.0 mg (once/week), subcutaneous injection of insulin deguspart double 4-6 U before breakfast, dapagliflozin 5 mg (once/d), the patient's current blood sugar control is ideal, glycosylated hemoglobin 5.9%, fasting blood glucose 4.5 mmol/L, postprandial blood glucose 6-8 mmol/L.

This article reports the diagnosis and treatment of a new homozygous mutation in an adult patient with Gitelman syndrome complicated with type 2 diabetes. The patient was a 46-year-old male who was admitted to the hospital mainly for "dizziness and fatigue for 3 months". After admission, genetic testing confirmed that the patient wasSLC12A3Gene C. 1567G>A homozygous mutation. This mutation is a missense mutation that changes the 523rd amino acid residue of the encoded protein from alanine to threonine. Complementary DNA sequencing revealed that this mutation results in abnormal splicing of exon 12, which can cause the stop codon to appear prematurely and affect the sodium chloride cotransporter. Chronic refractory electrolyte disorders caused by this gene mutation can further trigger abnormal blood sugar and impaired pancreatic islet function. The patient was diagnosed with Gitelman syndrome complicated with type 2 diabetes, and the main treatment was long-term oral administration of potassium chloride and potassium magnesium aspartate oral solution. After follow-up, the blood glucose and pancreatic islet function of patients can be recovered to some extent after supplementing potassium and magnesium oral drugs. The patient came from a family with 10 biological sisters. The study further tracked the genetic status of the patient's immediate family members at the same locus, and provided more comprehensive clinical evidence for the clinical phenotype and genotype correlation of Gitelman syndrome.

Diabetic nephropathy (DKD) is one of the serious microvascular complications in diabetic patients. It is very important to find the mechanism of DKD pathogenesis to delay the progression of DKD. The RhoA/ROCK signaling pathway is involved in multiple pathophysiological disorders of DKD, such as inflammatory response, epithelial-mesenchymal transition, mitochondrial dysfunction, oxidative stress, and barrier function impairment. In this paper, the role of RhoA/ROCK signaling pathway in DKD and its possible mechanism were reviewed.

Diabetic cardiomyopathy refers to the structural and functional remodeling of the heart muscle caused by a persistent hyperglycemic state. The uptake of fatty acids in diabetic heart continues to increase. After exceeding the ability to oxidize fatty acids, excess fatty acid synthetic lipids and lipid intermediates accumulate ectopically in myocardial tissue, which eventually triggers a series of pathological changes of heart structure and function, namely myocardial lipotoxicity. Lipid droplets are organelles responsible for storing neutral lipids, and regulate lipid synthesis and catabolism through growth and degradation processes. They are the key links to maintain lipid homeostasis and achieve energy metabolism balance. The large accumulation of lipid droplets observed in the diabetic heart indicates abnormal lipid metabolism, leading to increased lipotoxicity. This paper reviews the relationship between lipid droplets and myocardial lipotoxicity, and summarizes the role of lipid droplet-associated proteins in regulating lipid metabolism. In order to re-regulate the lipid homeostasis of diabetic heart, reduce the lipotoxicity of myocardium, and develop clinical drugs for diabetic cardiomyopathy to provide new potential targets.

Aging is a progressive damage process of physiological homeostasis that occurs at the cellular, tissue and organ levels. During aging, the level of autophagy is significantly down-regulated, and the accumulation of damaged organelles (such as mitochondria) and proteins can lead to age-related changes in many physiological processes, and eventually induce many diseases such as metabolic disorders, myocardial ischemia-reperfusion injury, and cancer. Metformin, as a drug for the treatment of type 2 diabetes, also has a positive effect on other aging-related diseases. It can induce mitophagy through different pathways to clear intracellular damaged mitochondria, but whether it can prevent and treat aging-related diseases by regulating mitophagy pathway is still unclear. This paper reviews the role of mitophagy in the prevention and treatment of aging-related diseases with metformin, in order to provide reference materials for exploring clinical intervention methods to delay aging and prevent and treat aging-related diseases based on autophagy regulation.

Diabetic foot ulcer is an important cause of disability and even death in diabetic patients. Dressing treatment after debridement is the most basic and important treatment in diabetic foot wound treatment. The development of modern material science has greatly promoted the development of dressing technology and products. The international guidelines for the treatment of diabetic foot wounds specify the detailed rules of diabetic foot wound care and the guidance of dressing application according to expert opinions. This article reviews the characteristics of newly developed dressings in recent years and their clinical practice in China. At the same time, it will further analyze the update of the application guidelines of various kinds of dressings in the international guidelines for diabetic foot wound management.

Looking back at the progress of diabetes diagnosis and treatment in recent years, gastric emptying has become a new target. In this paper, scintigraphy, isotope breath test, ultrasound, magnetic resonance and other methods for detecting gastric emptying are reviewed. These methods have greatly enriched the evaluation of gastric emptying and advanced the diagnosis and treatment of related diseases, especially diabetes.

The diagnosis and treatment of diabetic Charcot neuroosteoarthropathy (CNO) is a difficult problem in the world, with unclear concepts and different standards, and insufficient understanding of it by medical staff; Patients often do not receive timely prevention, diagnosis and treatment, resulting in poor prognosis. The International Diabetic Foot Working Group issued the 2023 edition of the Guidelines for the Prevention and Management of Diabetes-Related Podiatry in The Hague in May 2023, which attracted widespread attention. Among them, the guidelines for diabetic active CNO were published for the first time. This guide follows the assessment, formulation and evaluation (GRADE) method of recommended grading, designs questions in the form of PACO (population, assessment, comparison, outcome) and PICO (population, intervention, comparison, outcome). After reviewing a large number of literatures and extensive discussions, it gives a total of 26 suggestions from four aspects: diagnosis of CNO, definition of disease remission, treatment and reactivity prevention, which unifies the concept of CNO well, and gives a detailed discussion on prevention and non-surgical treatment, which has important reference value for the clinical work of medical staff. This article introduces and interprets the guide.