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Elevated 1-hour post-load plasma glucose (1 hPG) concentration during the oral glucose tolerance test (OGTT) may be associated with insulin resistance and pancreatic β-cell dysfunction, and higher risks of diabetes and cardiovascular disease. We reviewed the studies related to the significance of 1 hPG during the OGTT, in which 1 hPG during the OGTT has been reported to be prevalent in 10% to 40% of people with normal glucose tolerance, and the prevalence is higher in those with impaired glucose tolerance or impaired fasting glucose. Attention should be paid to the cutoff point of 1 hPG during the OGTT for the diagnosis of diabetes and pre-diabetes in Chinese population, which may be beneficial to early diagnosis and intervention of diabetes and pr-diabetes.

Background Gestational diabetes mellitus (GDM) is characterized by increased insulin resistance. As serum complement C1q/tumor necrosis factor-related protein 3 (CTRP3) ratio is closely related to insulin resistance, which may be involved in the development of GDM. However, the association and predictive value of serum CTRP3 ratio with GDM in early pregnancy have been rarely reported. Objective To explore the association and predictive value of serum CTRP3 ratio with GDM in early pregnancy, providing new ideas for the prevention and treatment of GDM. Methods Women in early pregnancy who underwent regular obstetric examinations in Obstetric Clinic, Affiliated Hospital of Chengde Medical University, were prospectively and consecutively enrolled from June 2018 to March 2019. Demographics, fasting plasma glucose (FPG) , fasting insulin (FINS) , glycosylated hemoglobin (HbA1c) , triglyceride (TG) , total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , low-density lipoprotein cholesterol (LDL-C) and serum CTRP3 ratio measured at 6-14 weeks of gestation were collected. The 75 g oral glucose tolerance test (OGTT) was performed to screen GDM at 24-28 weeks of gestation. The patients were divided into GDM group and normal glucose tolerance (NGT) group. Results Finally, 368 of the 393 cases were enrolled for analysis, including 81 (22.0%) who were detected with GDM by the 75 g OGTT. Compared with those with normal glucose tolerance (NGT) diagnosed by the 75 g OGTT, GDM cases had much greater average age, pre-pregnancy BMI, FPG, FINS, HbA1c, and TG (P

Gestational diabetes mellitus (GDM) , gestational hypertension, macrosomia, low birth weight, and premature delivery can directly affect short- and long-term maternal and infant health. Fasting plasma glucose can be obtained conveniently and rapidly during pregnancy. Numerous studies have verified that early- and mild-pregnancy fasting plasma glucose are associated with GDM, large for gestational age, and neonatal birth weight. But there is still some controversy about whether they associate with gestational hypertension and cesarean section. Furthermore, further studies are needed to examine their long-term influence on related diseases of pregnant women and their offspring in childhood and adulthood. This paper gives a summary of recent advances in the associations of early- and mid-pregnancy fasting plasma glucose with pregnancy outcome, providing a reference for future studies that profoundly explore relevant issues.

Diabetes is a chronic metabolic disease caused by multiple factors, and it is an epidemic worldwide in the 21st century. The intestinal flora of diabetic patients is imbalanced, with reduced antioxidant capacity and low-grade inflammation. Relevant studies have shown that probiotics, as a kind of living microorganisms that are beneficial to the health of the intestine, can relieve the symptoms of diabetes by balancing the intestinal flora, reducing the body's oxidative damage and regulating the body's immune factors. This article combs the two commonly used methods for screening hypoglycemic strains with α-glucosidase and DPP-IV as targets, and evaluates the hypoglycemic effect of probiotics through in vivo experiments. At the same time, it further summarizes the mechanism of probiotics in alleviating type 2 diabetes from five aspects such as intestinal flora, immune response, oxidative stress, short-chain fatty acids and intestinal barrier, in order to provide a certain reference for related research on type 2 diabetes.

Objective We aimed to explore the relationship between the change amplitude of glycemic and metabolic syndrome after glucose load in normal glucose tolerance (NGT) people. Methods According to the World Health Organization diabetes diagnostic criteria, a total of 22 302 NGT subjects with complete data were screened from the China National Diabetes and Metabolic Disorders Study (CNDMDS) from 2007 to 2008. The absolute difference between 2 h post-load glucose (2hPG) and fasting plasma glucose (FPG) during oral glucose tolerance test (OGTT) was used to reflect the change amplitude of glycemic, and compare the differences of metabolic indices and the prevalence of metabolic syndrome between different change amplitude. As a part of CNDMDS, 3 247 subjects completed the baseline survey from 2007 to 2008 in Shaanxi Province, in the retrospective cohort to 2016 and 2017, a total of 678 NGT subjects with complete data were included in the confirmatory analysis. According to the cut-off point of the change amplitude of glycemic related to metabolic diseases from the receiver operating characteristic curve (ROC) in the cross-sectional analysis, subjects were divided into two groups to compare the incidence risk of diabetes after 9 years of follow-up. The t test, analysis of variance and chi-square test were used to compare the differences in clinical characteristics and metabolic indices among different groups, and Logistic regression analysis was used to evaluate the influence of different groups on the prevalence of MS and the incidence of diabetes. Results We divided the change amplitude of glycemic after glucose load of 22 302 subjects into quartiles, among which the change amplitude were as follows: Q1 group (<0.45 mmol/L, 5 593 subjects), Q2 group (0.45 to 0.93 mmol/L, 5 603 subjects), Q3 group (0.94 to 1.60 mmol/L, 5 636 subjects), Q4 group (>1.60 mmol/L, 5 470 subjects); the body mass index (BMI), waist circumference, blood pressure, total cholesterol, triglycerides (TG) and low-density lipoprotein cholesterol (LDL-C) were increased significantly with the increasement of the change amplitude of glycemic, while high-density lipoprotein cholesterol (HDL-C) decreased significantly, the prevalence of metabolic syndrome (MS) and the proportion of subjects with middle or high risk for developing coronary heart disease in 10 years [Framingham risk score (FRS) ≥10%] were increased significantly. Logistic regression analysis showed that the large change amplitude of glycemic after glucose load was a risk factor for MS. Use MS and FRS ≥10% as the outcome variables, the change amplitude of glycemic as the independent variable, the cut-off point of the change amplitude of glycemic both were 1.09. Among 678 NGT subjects in the retrospective cohort, the incidence of diabetes in the group with small change amplitude of glycemic (the change amplitude of glycemic ≤1.09 mmol/L) and large change amplitude of glycemic (the change amplitude of glycemic >1.09 mmol/L) were 7.2% (28/388) and 13.1% (38/290), respectively, the difference was statistically significant (P=0.011). Logistic regression analysis showed that the change amplitude of glycemic after glucose load >1.09 mmol/L was a risk factor for diabetes, after adjusting for age, gender, BMI, smoking, drinking, exercise and family history of diabetes, the risk ratio was 1.829 (95%CI 1.079 to 3.101, P=0.025). Conclusion In NGT people, the large change amplitude of glycemic after glucose load was a risk factor for metabolic diseases and could predict the occurrence of diabetes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the impact of abnormal patterns of 75 g oral glucose tolerance test (OGTT) in the second trimester on the risk of large for gestational age (LGA) newborn deliveries. Methods: General clinical data and OGTT results of 66 290 pregnant women who received regular prenatal care and delivered in Guangdong Maternal and Child Health Hospital from December 24, 2016 to July 26, 2022 were collected. According to the results of OGTT, the pregnant women were divided into 8 groups: normal blood glucose group (normal fasting blood glucose, 1-hour and 2-hour after oral glucose, 54 518 cases), gestational diabetes mellitus (GDM) 0 group (only abnormal fasting blood glucose, 1 430 cases), GDM 1 group (only abnormal blood glucose at 1-hour after oral glucose, 2 150 cases), GDM 2 group (only abnormal blood glucose at 2-hour after oral glucose, 3 736 cases), GDM 0+1 group (both fasting blood glucose and 1-hour after oral glucose were abnormal, 371 cases), GDM 0+2 group (both fasting blood glucose and 2-hour after oral glucose were abnormal, 280 cases), GDM 1+2 group (abnormal blood glucose at 1-hour and 2-hour after oral glucose, 2 981 cases) and GDM 0+1+2 group (abnormal fasting blood glucose, 1-hour and 2-hour after oral glucose, 824 cases). Multivariate logistic regression was used to analyze the effects of different abnormal OGTT patterns on LGA. In addition, the blood glucose measurements at the three time points of OGTT were combined and used as continuous variables in the receiver operating characteristic (ROC) curve to evaluate the predictive value of each blood glucose measurement mode for LGA and the area under the curve (AUC) was compared. Results: (1) Multivariate logistic regression analysis showed that the risks of LGA were significantly increased in GDM 0 group ( OR =1.76, 95% CI : 1.50-2.08; P <0.001), GDM 0+1 group ( OR =2.29, 95% CI : 1.72-3.04; P <0.001), and GDM 0+1+2 group ( OR =1.98, 95% CI : 1.61-2.43; P <0.001). (2) ROC curve analysis showed that fasting blood glucose, 1-hour after oral glucose, 2-hour after oral glucose, fasting+1-hour after oral glucose, fasting+2-hour after oral glucose, 1-hour+2-hour after oral glucose, and fasting+1-hour+2-hour after oral glucose had certain predictive value for LGA (all P <0.001). The AUC of fasting blood glucose measurement was higher than that of 2-hour blood glucose measurement in predicting LGA, and the difference was statistically significant ( P <0.05). There was no significant difference in the AUC between fasting blood glucose and other blood glucose measurement modes for predicting LGA (all P >0.05). Conclusions: In the abnormal OGTT patterns, pregnant women with abnormal fasting blood glucose, abnormal fasting+1-hour after oral glucose, and abnormal fasting+1-hour+2-hour after oral glucose have an increased risk of LGA. Fasting blood glucose measurement is of great significance for the prediction of LGA, and could be used as an optimal indicator to evaluate the risk of LGA in clinical practice.

Objective To investigate the predictive effect of oral glucose tolerance test (OGTT) blood glucose on gestational diabetes mellitus (GDM) in the second trimester of pregnancy. Methods A total of 840 pregnant women were prospectively recruited from Jin Shan Branch of Shanghai Sixth Peoples′ Hospital (Zhujing area of Shanghai) between January 1st, 2017 and December 31st, 2018. All subjects received 75 g OGTT test in initial antenatal examination (8-16 gestational week) and received GDM screening in the second trimester. GDM were divided into F‑GDM [only diagnosed by fasting plasma glucose (FPG)] and P‑GDM (diagnosed by OGTT 1hPG or 2hPG). Correlative relationship was analyzed between OGTT FPG, OGTT 2hPG in initial antenatal examination and OGTT FPG, OGTT 1hPG, OGTT 2hPG for GDM screening in the second trimester. The receiver operating characteristic (ROC) curve was used to predict F‑GDM with OGTT FPG and P‑GDM with OGTT 2hPG in initial antenatal examination, the optimal cut‑off points were found respectively. Then the cut‑off points were used as the diagnostic criteria of GDM in the first trimester of pregnancy. Diagnostic characteristics of GDM in initial antenatal examination and GDM in the middle stage were analyzed by four‑fold table. The t test was used for comparison between the two groups, Spearman correlation analysis was used for correlation, Fisher Z transformation method was used for correlation coefficient, and u test was used for comparison. Results (1) FPG in initial antenatal examination was correlated with FPG, OGTT 1hPG or OGTT 2hPG in the second trimester (r1, r2, r3 was 0.461, 0.146, 0.087, respectively, all P<0.05). However, the correlation between FPG in the first trimester of pregnancy and FPG in the second trimester of pregnancy was better (r1 vs r2, r1 vs r3, both P<0.05; r2 vs r3, P>0.05). OGTT 2hPG in initial antenatal examination was correlative with FPG, OGTT 1hPG or OGTT 2hPG in the second trimester (r4, r5, r6 was 0.201, 0.425, 0.436, respectively, all P<0.05). However, the correlation between OGTT 2hPG in initial antenatal examination and OGTT 1hPG or OGTT 2hPG in the second trimester of pregnancy was better (r4 vs r5, r4 vs r6, both P<0.05; r5 vs r6, P>0.05). (2) The maximum area under the ROC curve of F‑GDM predicted by FPG in initial antenatal examination was 0.781 (95%CI: 0.734-0.829, P<0.001), and the optimal cut‑off of FPG was 4.95 mmol / L, the sensitivity was 67.3%, and the specificity was 74.4%. The maximum area under the ROC curve of P‑GDM predicted by OGTT 2hPG in initial antenatal examination was 0.790 (95%CI: 0.742-0.839, P<0.001), the optimal cut‑off of OGTT 2hPG was 7.595 mmol/L, the sensitivity was 67.9%, and the specificity was 80.8%. (3) Compared with GDM in the second trimester, GDM in initial antenatal examination diagnosed with these two cut‑off values, the sensitivity was 78.0%, and the specificity was 60.7%, the positive predictive value was 33.2%, and the negative predictive value was 91.7%. Conclusions OGTT may be used to screen GDM in initial antenatal examination, FPG≥5.0 mmol/L and OGTT 2hPG≥7.6 mmol/L may be used as a reference value for abnormal blood glucose at the beginning of pregnancy. [ABSTRACT FROM AUTHOR]

Pregnancies complicated with diabetes mellitus including pre -gestational diabetes mellitus (PGDM) and gestational diabetes mellitus (GDM), are at risk of developing a number of serious obstetric complications as well as having longterm implications for the wellbeing of mother and infant. Glycated hemoglobin (HbA1c) may reflect glucose levels over the previous 2-3 months, and acts as one of the diagnostic criteria outside of pregnancy recently. Many studies had been carried through about the role of HbA1c in pregnancy, included how can HbA1c in different gestational weeks predict GDM subsequently and adverse pregnancy outcomes even postpartum diabetes risk, the difference of HbA1c levels in different races and the influence factors of HbA1c levels. Further, whether HbA1c level is various in different ethnical and the influence factors of HbA1c level had been investigated. Most authors believed that HbA1c, as a diagnostic indicator of GDM, is not highly sensitive and may increase the rate of missed diagnosis. HbA1c alone or in combination with more indicators is a powerful supplement in screening and diagnosis of GDM and can reduce the number of oral glucose tolerance test (OGTT). HbA1c levels at different time points during pregnancy may be correlated with pregnancy outcomes, and prenatal HbA1c levels are also of certain value in identifying high-risk GDM pregnant women who may progress to T2DM. On account of the cut-off value of HbA1c, the strategies of GDM screen and diagnosis with HbA1c are inconsistent, more researches are needed further. [ABSTRACT FROM AUTHOR]

Objective：To establish the normal reference interval in the second trimester pregnant women of glycosylated hemoglobin (HbA1c) in the Tianjin Central Hospital of Gynecology Obstetrics, and evaluate the application value of HbA1c combined with fasting blood glucose (FPG) in the detection of gestational diabetes mellitus (GDM). Methods：According to the GDM diagnostic criteria of International Association of Diabetes and Pregnancy Study Groups (IADPSG) recommended, 196 GDM pregnant women and 320 health control with 75 g oral glucose tolerance test (OGTT) examination in our hospital from May 2016 to December 2016 during 24 to 28 weeks of pregnancy were enrolled, and the related clinical data were collected. Results： ①The age, pre-pregnancy weight and pre-pregnancy BMI of the GDM group were significantly higher than those of health control group (P＜0.01), no significant difference were found in the gestational age and height between the two groups (P＞0.05). ②The average value of HbA1c, the blood glucose levels of OGTT in GDM women were significantly higher than the health control group (P＜0.01). ③The HbA1c level of all the 320 healthy pregnant women was in normal distribution. The HbA1c reference interval of the normal pregnant women in the second trimester of pregnancy was 4.4%-5.8%. ④The highest sensitivity and specificity in prediction of GDM were 44.9% and 77.5% respectively when the HbA1c was 5.35%. The ROC curve area of HbA1c in diagnosis of GDM was 0.665 (95%CI: 0.617-0.713); The curve area of the HbA1c（≥5.35%）combined with FPG（≥5.1 mmol/L） in diagnosis of GDM was 0.933 (95%CI: 0.909-0.957). Conclusions：The normal reference range of HbA1c of the pregnant women in our hospital was established. HbA1c combined with FPG detection was simple and convenient, and can be used as a powerful supplement to GDM diagnosis. [ABSTRACT FROM AUTHOR]

Objective To analyze the clinical characteristics of insulinoma and evaluate the methods used in the diagnosis and treatment of insulinoma. Methods The clinical data of 18 patients with insulinoma were retrospectively analyzed from January 2008 to December 2015, which were combined with the domestic and foreign related literature for analysis and summary of diagnosis and treatment. Results All the 18 cases had Whipple triad syndrome. Unconsciousness was the most common syndrome due to hypoglycemia (15/18). Five of the patients were misdiagnosed. Fourteen cases had glucose tolerance-insulin release test, and 12 of them had hypoglycemia (blood glucose was below 2.78 mmol/L). Eight patients had a insulin/glucose ratio ＞0.4 in three hours, and 12 patients in 5 hours. Tumor was detected by several imaging techniques in different patients. The sensitivity rate for B ultrasound was 6/15, for plain CT was 1/6, for contract CT was 11/ 13, for perfusion CT was 2/3, for MRI was 10/12, for contract MRI was 5/5, for endoscopic ultrasonography was 1/1, for digital subtraction angiography (DSA) was 1/2, and for intraoperative ultrasonography (IOUS) was 2/2. All 18 patients were underwent surgical treatment, and no any patient was found episodes of hypoglycemia after surgery. Conclusion Consciousness is the most common symptom caused by insulinoma. The 5 h glucose-insulin release test is more meaningful than the 3 h test. Multiple inspection methods can be used for the clear localization of the tumors before operation. Surgery is still the most preferred treatment for insulinoma. [ABSTRACT FROM AUTHOR]

Objective: To investigate the glucose and lipid metabolism indexes in patients with normal glucose tolerance and polycystic ovary syndrome (PCOS). Methods: PCOS was diagnosed according to the Rotterdam Criterion. One hundred and forty-four patients with PCOS undertaken the oral glucose tolerance test (OGTT) and the insulin release test (IRT). One hundred healthy women with normal menstrual cycle served as the control group. Results: Compared with the control group, PCOS patients with normal glucose tolerance had a higher BMI, higher serum glucose and insulin levels at 0, 30, 60 and 180 min in OGTT and IRT, higher levels of HOMA-IR and HOMA-β, and the increased area under curves (AUCs) of glucose and insulin(P <0.05). Additionally, the subgroup analysis was employed based on BMI. In PCOS patients with normal glucose tolerance,the obese subgroup (BMI≥25 kg/m2) had higher serum glucose and insulin levels at 0, 60, 120 and 180 min in OGTT and IRT, higher levels of HOMA-IR and HOMA-β, and the increased level of TG when compared with the non-obese subgroup (P<0.05), which indicated that the ability of glucose and lipid metabolism in those obese PCOS patients was still impaired though they were with normal glucose tolerance after OGTT. Conclusions: OGTT and IRT should be routinely suggested for those PCOS patients with normal glucose tolerance so as to find the potential insulin resistence and to intervent early. For those obese PCOS patients with normal glucose tolerance, it should be advised to check actively the levels of insulin and serum lipid and to have termly the follow-up visit. [ABSTRACT FROM AUTHOR]

Objective：To research the perinatal outcomes of the gestational diabetes mellitus （ＧＤＭ） women who were diagnosed by repeated oral glucose tolerance test (OGTT） examinations. Methods：188 women were diagnosed GDM by preliminary OGTT examinations as GDM1 group, 38 women were diagnosed GDM by repeated OGTT examinations as GDM2 group, and 200 pregnant women with normal blood glucose as control group. Compared 3 groups′perinatal outcomes, such as postpartum hemorrhage, preterm labour, PROM, macrosomia. Results：GDM2 group had significantly more postpartum hemorrhage, PROM, large for gestational age fetus than control group（P＜0.05）. GDM2 group had more macrosomia than GDM1 group, the difference had statistic significance（P＜0.05）. Conclusions：Repeated OGTT examinations can improve the GDM diagnosis ratio, so that we can early diagnose and actively intervene GDM, and improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine whether insulin resistance is associated with all-cause mortality in subjects without diabetes. Methods: A total of 505 participants without diabetes, 198 with normal glucose tolerance (NGT) and 307 with impaired glucose tolerance (IGT), were recruited from the Daqing Diabetes Study. The participants were followed up for 30 years. They were stratified into three groups (tertiles) according to baseline homeostasis model assessment of insulin resistance(HOMA-IR) levels, as the HOMA-IR 0, the HOMA-IR 1 and the HOMA-IR 2 groups, to assess the predictive effect of insulin resistance on risk of all-cause mortality. Results: During the 30-year follow-up, 52, 56 and 78 participants died across the three HOMA-IR groups, respectively. The corresponding mortality per 1 000 person-years (95 %CI ) were 12.12 (9.56-15.01), 13.10 (10.46-16.03) and 19.91 (16.73-23.15), respectively. Participants in the HOMA-IR 2 group had a significantly higher risk of death than those in the HOMA-IR 0 group after adjustment of age, sex and smoking status ( HR =1.97,95 %CI 1.38-2.81, P< 0.001). Cox analyses showed that a one standard deviation increase in HOMA-IR was associated with a 22% increase in the mortality after adjustment of potential confounders ( HR =1.22, 95 %CI 1.08-1.39, P= 0.002). Conclusions: Insulin resistance is associated with increased risk of all-cause death in Chinese people without diabetes, suggesting that improving insulin resistance could be beneficial for people without diabetic in reducing risk of long-term all-cause mortality.

Objective: To examine the associations between plasma n-3 polyunsaturated fatty acids (PUFAs) in the second trimester and gestational diabetes mellitus (GDM) among Chinese pregnant women. Methods: Based on data from the Tongji-Shuangliu Birth Cohort enrolled from 2017 to 2019 in the Shuangliu Maternal and Child Health Hospital, it conducted a case-control study among 269 GDM cases who were diagnosed by 75 g oral glucose tolerance test, and 538 non-GDM controls matched at a 1∶2 ratio on maternal age and gestational weeks. The age range of the 807 women was 18-40 years. Fasting plasma n-3 PUFAs were determined by gas chromatography-mass spectrometry in the second trimester (24-28 weeks). Participants were categorized into quartiles (Q1-Q4) of plasma n-3 PUFAs based on distributions in the control group. Conditional logistic regression models were applied to estimate the associations between plasma n-3 PUFAs and GDM. Results: The median (interquartile) relative concentrations of plasma n-3 PUFA C22∶5n-3 was significantly lower in women with GDM 0.87 (0.72, 1.07) compared with women without GDM 0.94 (0.75, 1.19)( P =0.001). Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM, with an OR (95% CI ) of 0.75 (0.62-0.90) for each SD increase of relative concentration. Compared with the Q1 group, the OR values and 95% CIs of Q2, Q3, and Q4 groups were 0.97 (0.62-1.51), 0.72 (0.45-1.15), and 0.54 (0.32-0.90), respectively ( P trend <0.05). However, there were no significant associations of C18∶3n-3, C20∶5n-3, C22∶6n-3, and total n-3 PUFAs with GDM. Conclusion: Plasma n-3 PUFA C22∶5n-3 was inversely associated with GDM during the second trimester.

Objective: To investigate the risk factors for gestational diabetes mellitus (GDM) in elderly multipara women in the next pregnancy. Methods: A total of 219 elderly multipara women with 2 consecutive delivery records in Tianjin Binhai New Area Tanggu Obstetrics and Gynecology Hospital from January 2018 to May 2019 were included. Among them, 141 had normal glucose tolerance (NGT) and 78 of them had GDM. The clinical data of the previous and current pregnancy were collected to analyze the risk factors of GDM in elderly multipara women. Results: The average ages of 219 elderly women in previous pregnancy and this pregnancy were (31.9±2.2) and (36.7±1.5) years old, and the prevalence of GDM was 35.62% (78 cases). Compared to NGT group, GDM patients had higher fasting blood glucose(previous (5.51±1.43) vs (4.63±0.62) mmol/L; current (5.26±0.63) vs (4.59±0.30) mmol/L, 1 h blood glucose(previous (11.74±2.36) vs (9.50±1.82) mmol/L; current (11.03±2.03) vs (9.51±1.14) mmol/L) in 75 g oral glucose tolerance test (OGTT) in both previous and current pregnancy. The rates of cesarean section, in both previous and current pregnancy were higher in GDM group (previous 34.6% vs 4.3%; current 52.6% vs 22.0%). Furthermore, prenatal weight and body mass index (BMI) of the previous pregnancy, pre-pregnancy weight and BMI, and prenatal BMI of this pregnancy were also higher in GDM group, and the differences were all statistically significant (all P<0.05). Logistic multivariate regression analysis indicated cesarean section history ( OR =10.80, 95% CI : (4.09-28.54)), GDM history of previous pregnancy ( OR =10.64, 95% CI : (4.02-28.20)), 75 g OGTT fasting blood glucose≥ 4.86 mmol/L ( OR =2.70, 95% CI : (1.27-5.70)), 1 h blood glucose after glucose administration ≥ 8.45 mmol/L ( OR =1.78, 95% CI : (1.37-2.31)) were risk factors for GDM in elderly multipara women of this pregnancy. Conclusion: The risk of GDM in elderly multipara women with a history of cesarean section and GDM increases significantly. Results of OGTT in previous pregnancy also has predictive value.

Hyperglycemia in pregnancy (HIP) is the most common pathological obstetric disease. However, there is no uniform standard in the world for classification of HIP and diagnosis of gestational diabetes mellitus(GDM). This article will analyze this issue and support the International association of diabetes and pregnancy study group(IADPSG) criteria as a global standard for diagnosing GDM,also support HIP should be divided into four categories: PGDM, ODM, GDM and prediabetes, so as to refine clinical management.

Objective: To investigate the association of lipoprotein a (Lpa) in early pregnancy with gestational diabetes mellitus (GDM) risk. Methods: A total of 445 pregnant women in 12-14 gestational weeks from "Maternal Key Nutritional Factors and Offspring's Atopic Dermatitis" cohort were included in this study. The demographic characteristics of participants were collected by using questionnaires, and the fasting glucose and lipids levels in early pregnancy were measured. The results of oral glucose tolerance test (OGTT) between 24-28 gestational weeks were recorded. Multivariate logistic regression model was applied to analyze the association of Lpa with GDM by calculating the OR and 95% CI after adjustment for covariates. Results: The incidence number of GDM was 78 (17.5%). The Lpa level in pregnant women with GDM was significantly higher than that in pregnant women without GDM [105.5 (92.0, 122.0) vs. 97.0 (87.0, 109.0) mg/L], P <0.05. Lpa was significantly associated with GDM risk [ OR (95% CI ) =1.21(1.08-1.36) per 10 mg/L], P <0.05. The association was still significant after adjustment for covariates including age, gestational weeks et al, the adjusted OR was 1.14 (95% CI : 1.01-1.30), P =0.03. Conclusions: The elevation of Lpa in early pregnancy is one of risk factor for GDM. Maintaining normal Lpa level during early pregnancy can benefit early prevention of GDM and offspring health.

Objective: To investigate the metabolic changes of umbilical cord blood in pregnant women with gestational diabetes mellitus(GDM) compared with pregnant women with normal glucose tolerance, and to analyze the effect of GDM on neonatal metabolism., Methods: Pregnant women in the first trimester were recruited in the cohort study in Taicang District, Jiangsu Province from 2014 to 2016. Oral glucose tolerance test was used to diagnose GDM, at 24-28 weeks of gestation. Pregnant women with GDM were taken as the case group and normal pregnant women as the control group. Five mL of umbilical cord blood was collected from full-term newborns, and non-target metabolites in serum samples were detected by ultra high performance liquid chromatography-tandem mass spectrometry. The t test, principal component analysis and orthogonal partial least square analysis were used to analyze the difference of metabolites in umbilical cord blood between the two groups. The metabolic pathways involved in the markers were analyzed according to P& lt; 0. 05 and variable importance projection(VIP)& gt; 1. 0. The metabolic pathways involved in the markers were analyzed based on the KEGG database., Results: According to the result of GDM diagnosis, 42 pregnant women with GDM and 39 control pregnant women were included. A total of 868 small molecular metabolites were detected in umbilical cord blood samples. The concentrations of 41 metabolites were different between groups(P& lt; 0. 05 and VIP& gt; 1. 0), including 18 kinds of amino acid metabolites, 9 kinds of lipid metabolites, 5 kinds of exogenous compounds, 4 kinds of nucleotide metabolites, 3 kinds of peptides, 1 kind of vitamin(pantothenic acid) and 1 kind of coenzyme(gulonic acid). γ-glutamylalanine in the GDM group was lower than that in the control group(P& lt; 0. 01), and other compounds in the GDM group were higher than those in the control group(P& lt; 0. 05). Combined with pathway analysis, the above metabolites are mainly involved in lysine degradation pathway and aminoacyl tRNA biosynthesis pathway., Conclusion: Compared with the newborns of pregnant women with normal blood glucose, the metabolites in cord serum from full-term newborns of pregnant women with GDM are mainly characterized by the increase of some amino acids and lipid metabolites.

Objective: To estimate the effect of comorbid gestational diabetes mellitus (GDM) and depression on glucose metabolism and neonatal morphology. Methods: From March 2015 to October 2018, recruited 18 to 28 weeks pregnant women who met the criteria in the Hefei First People's Hospital or First Affiliated Hospital of Anhui Medical University or Anhui Maternal and Child Health Hospital, including a total of 4 380 study subjects, of which the birth outcome information of 3 827 newborns were collected. The self-made questionnaire "Maternal Health Questionnaire for Hefei City" and Edinburgh Postpartum Depression Scale were used to obtain basic demographic characteristics and emotional state of depression. Data from the 75-g oral-glucose-tolerance test were obtained at 24-28 weeks of gestation. After delivery, delivery outcome information were collected from the hospital medical records. Covariance analysis was used to analyze the differences in glucose metabolism indicators and neonatal outcome indicators in pregnant women with different GDM and depression status. Multiple logistic regression model was used to analyze the correlation between GDM and depression, with different groups of GDM and depression status (no GDM and depression, simple depression, simple GDM, comorbid GDM and depression)as independent variables and whether they were large for gestational age as dependent variables. The interaction between GDM and depression was also analyzed. Results: The 4 380 pregnant women were (28.8±4.2) years old. The incidence of GDM was 19.5% (852/4 380), and the detection rates of depression in the second and third trimesters were 12.1% (526/4 380) and 12.3% (536/4 367). PG-1h and AUC in the comorbid GDM and depression group were significantly higher than those in the group with no GDM and depression ( P< 0.05) and the single GDM group ( P <0.05). After adjusting for factors such as the childbirth age, education level, family's main economic income, BMI before pregnancy, parity, number of physical activities, and weight gain during pregnancy, compared with the group with no GDM and depression, the RR (95% CI ) of LGA occurred in the single depression group, the single GDM group and the comorbid group were 1.31(0.89-1.91), 1.51(1.14-2.00) and 2.43(1.29-4.57), respectively. Further analysis showed that the association between GDM pregnant women with depression and newborn LGA ［ RR (95% CI ): 2.12 (1.01-4.49)］ was stronger than that between GDM pregnant women without depression and newborn LGA ［ RR (95% CI ): 1.50 (1.12-1.99)］, the P interaction value was<0.05. Conclusion: The status of comorbid GDM and depression can impair glucose metabolism and increase the risk of LGA.

Objective: To investigate the associations of impaired glucose metabolism and insulin resistance with chronic periodontitis in pre-diabetes patients., Methods: A cross-sectional analysis was conducted and we included a total of 171 pre-diabetes patients aged 30-65 years, free of diabetes. pre-diabetes was defined as impaired fasting glucose (IFG) [fasting glucose (FG): 6.1-7.0 mmol/L] and/or impaired glucose tolerance (IGT) [oral glucose tolerance test (OGTT): 7.8-11.0 mmol/L]. Chronic periodontitis was defined according to Centers for Disease Control and Prevention (CDC)/American Academy of Periodontology (AAP) definition and the patients were divided into mild, moderate, and severe chronic periodontitis groups [mild: at least two interproximal sites with clinical attachment loss (CAL) ≥3 mm and at least two interproxima sites with probing depth (PD) ≥4 mm or 1 site with PD≥5 mm; moderate: at least two interproximal sites with CAL ≥4 mm and at least two interproxima sites with at least two interproximal sites with PD ≥5 mm; severe: at least two interproximal sites with CAL ≥6 mm and at least one interproxima site with at least two interproximal sites with PD≥5 mm]. A periodontal examination indexes [plaque index (PLI), PD, CAL, and bleeding on probing (BOP)] and glucose metabolism indexes [FG, OGTT, hemoglobinA1c (HbA1c), fasting insulin and homeostasis model assessments of insulin resistance (HOMA-IR)] were measured. The association of glucose metabolism and chronic periodontitis was investigated by multivariable logistic regression analysis., Results: FG in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, HOMA-IR in the moderate and severe chronic periodontitis groups was significantly higher compared with mild chronic periodontitis group, OGTT in the severe chronic periodntitis group was significantly higher compared with mild chronic peridontitis group and moderate chronic periodontitis groups, and there was no significant difference between moderate and mild chronic periodontitis groups. For the insulin and HbA1c, there was no significant difference among mild, moderate and severe chronic periodontitis groups. After multivariable adjustment of age, gender, smoking status, hypertension and body mass index, IFG (OR=1.39, 95%CI: 1.01-1.98) and HOMA-IR (OR=1.36, 95%CI: 1.04-1.76) were associated with moderate periodontitis; IFG (OR=1.64, 95%CI: 1.17-2.40), IGT (OR=1.65, 95%CI: 1.21-2.26), and HOMA-IR (OR=1.72, 95%CI: 1.23-2.41) were significantly associated with severe periodontitis., Conclusion: Our data provided evidences that impaired glucose metabolism were associated with chronic periodontitis among pre-diabetes patients.

Objective: To create the early diabetic peripheral neuropathy (DPN) rat model., Methods: After one-week adaption, 26 male Sprague-Dawley (SD) rats were divided into two groups, the control group (n=6) and the model group (n=20). High-sucrose/high-fat diet (D12451, 35% of energy from carbohydrate, 45% of energy from fat) was given to the model group for six weeks to induce insulin resistance, meanwhile normal diet was given to the control group. Afterwards, streptozocin (STZ) buffer solution (35 mg/kg bodyweight) was injected into abdomen of the model group to induce specific pancreatic injury, meanwhile an equal amount of buffer solution was given to the control group. Then 48 h later, type 2 diabetes mellitus (T2DM) was supposed to be successfully induced according to the random blood glucose more than 16.7 mmol/L in the model group. Then the basic features of the T2DM rats were evaluated, including body weight, fasting blood glucose (FBG), glucose tolerance (oral glucose tolerance test, OGTT), and insulin tolerance (intraperitoneal insulin tolerance test, IPITT). Subsequently, withdrawal thermal latency (WTL) was measured regularly to determine when the early DPN occurred. Once confirmed, sciatic nerve conduction velocity (NCV) of all the rats was conducted., Results: The T2DM rats were successfully induced in the model group through high-sucrose/high-fat diet for six weeks along with STZ intraperitoneal injection (35 mg/kg bodyweight). When compared to the control group, the T2DM rats had higher FBG (P<0.001), and the glucose tolerance and insulin tolerance were both damaged (P<0.001 in OGTT, P=0.002 in IPITT). It was on the 17th day when the T2DM rats became much more sensitive to heat stimulus compared to the control group (P=0.004). Meanwhile, the sciatic NCV was conducted. There was no significant difference between the early DPN group and the control group (P=0.196)., Conclusion: High-sucrose/high-fat diet for six weeks along with STZ intraperitoneal injection (35 mg/kg bodyweight) could successfully induce T2DM rat model, manifested by a certain extent of insulin resistance and deficiency of insulin secretion. It was about 17 days later when the early DPN emerged. In the early DPN, small fiber neuropathy came out earlier than large fiber neuropathy.

Objective: To explore the characteristics of maternal glucose and lipid metabolism in twin pregnancies complicated by gestational diabetes mellitus (GDM). Methods: The clinical features of twin and singleton pregnancies complicated by GDM, which delivered in Peking University First Hospital from January 1st, 2012 to December 31st, 2017 were retrospectively analyzed. A total of 286 twin pregnancies with GDM (GDM-T group) were collected, and 572 singleton pregnancies complicated by GDM (GDM-S group) which were matched by delivery time in a ratio of 1∶2 among all singleton pregnancies with GDM. The characteristics of maternal glucolipid metabolism in the second trimesters of pregnancy was compared between two groups. Results: (1) Compared with GDM-S group, the maternal delivery age were lower [(32±4), (33±4) years] and prepregnancy body mass index (BMI) were higher [(24±4), (23±4) kg/m(2)] in GDM-T group, the differences were statistically significant (all P <0.05). The incidence of chronic hypertension was found no significant difference ( P =0.581). (2) The 3 points of glucose values in 75 g oral glucose tolerance test (OGTT) and OGTT-area under curve (AUC) had no significant difference between GDM-T and GDM-S group.When compared with GDM-S group, the maternal glycosylated hemoglobin levels [(5.41±0.35)%, (5.32±0.28)%], the insulin resistance index (4.07±0.77, 2.63±1.50) and the proportion of insulin use (7.7%, 4.4%) were all significantly higher in GDM-T group (all P <0.05). The values of triglyceride [(3.4±1.4), (2.6±1.2) mmol/L], total cholesterol [(6.3±1.1), (6.0±1.0) mmol/L], low density lipoprotein cholesterol [(3.3±0.9), (3.1±0.8) mmol/L] were significantly higher and values of high density lipoprotein cholesterol [(1.7±0.4), (2.0±0.5) mmol/L] were significantly lower in GDM-T group than GDM-S group (all P <0.05). (3) There was no significant difference in the incidence of gestational hypertension between the two groups ( P> 0.05). When compared with GDM-S group, the incidences of preeclampsia and small for gestational age were both significantly higher (13.3% vs 2.4%; 28.7% vs 1.7%) and the incidence of large for gestational age was significantly lower in GDM-T group (4.5% vs 15.2%; all P <0.05). Conclusions: The insulin resistance is aggravated in twin pregnancies and the characteristics of lipid metabolism are different between singleton and twin pregnant women complicated by GDM, and there are more complications in twin GDM pregnancies.

Objective: To explore the relationship between hemoglobin (Hb) level during the first trimester of pregnancy and gestational diabetes mellitus (GDM). Methods: A total of 1 276 participants, who underwent scheduled prenatal examination and normal singleton delivery at the Fifth People's Hospital of Shanghai and Hospital of Intergrated Chinese and Western Medicine in Minhang District, from January 2016 to May 2018 were included. There were 99 cases of GDM (GDM group) and 1 177 cases of normal (control group) pregnant women.Based on the serum Hb level during the first trimester of pregnancy, participants were divided into three groups, 236 cases of low Hb level group (Hb<110 g/L), 868 cases of normal Hb level group (110 g/L≤Hb<130 g/L), and 172 cases of high Hb level group (Hb≥130 g/L). Maternal clinical data were collected, including Hb level during the first trimester of pregnancy, three-point blood glucose (BG) of oral glucose tolerance test (OGTT) and fasting insulin during the second trimester of pregnancy. Homeostasis model assessment of insulin resistance index (HOMA-IR) and homeostasis model assessment of pancreatic β cell function index (HOMA-β) were used to evaluate insulin resistance and pancreatic β cell function. Results: (1) Hb level during the first trimester of pregnancy in GDM group was significantly higher than that in control group [(123±10),(119±11) g/L, P <0.05]. There were no significant difference in gravidity, parity, index of liver and renal function (all P> 0.05). (2) Pre-pregnancy body mass index (BMI), 1-hour BG and 2-hour BG of OGTT were significantly increased in the high Hb level group during the first trimester of pregnancy, which were (23±4) kg/m(2), (7.3±2.0) mmol/L, and (6.5±1.4) mmol/L ( P <0.05), respectively. The pre-pregnancy BMI, 1-hour BG and 2-hour BG of the normal or low Hb level group were (22±3) kg/m(2), (6.7±1.6) mmol/L, (6.1±1.2) mmol/L; (22±3) kg/m(2), (6.5±1.5) mmol/L, (5.9±1.1) mmol/L, respectively. There were no statistically significant difference in levels of fasting blood glucose, fasting insulin, HOMA-IR and HOMA-β within 3 groups (all P> 0.05). (3) In the high Hb level group, prevalence of pregnancy overweight or obesity and GDM were the highest, which were 37.2%(64/172) and 15.1%(26/172), respectively; the differences were statistically significant (all P <0.05). (4) The serum Hb level in the first trimester was positively related with pre-pregnancy BMI ( r =0.130, P <0.05), 1-hour BG ( r =0.129, P <0.05), 2-hour BG ( r =0.134, P <0.05), fasting insulin ( r =0.096, P <0.05), and HOMA-IR ( r =0.101, P <0.05).Logistic regression indicated that Hb≥130 g/L during the first trimester of pregnancy was an independent risk factor for GDM ( OR =2.799, 95% CI : 1.186-6.604; P <0.05). Conclusion: The high level of Hb (Hb≥130 g/L) during the first trimester of pregnancy is associated with GDM.

Objective: To explore the gene mutation characteristics and detailed clinical presentations of hyperglycemia caused by GCK mutations in 10 patients. Methods: The clinical and follow-up data of 10 patients with hyperglycemia caused by mutation of GCK gene were reviewed. The patients were ascertained between January 1, 2014 and August 31, 2018 at the Department of Pediatrics, the First Affiliated Hospital of Zhejiang University and Ningbo Women & Children's Hospital. Clinical data were collected, including age, gender, main complaint, family history, fasting blood glucose, fasting blood insulin, 2-hour blood glucose, 2-hour blood insulin after oral glucose tolerance test, glycosylated hemoglobin, anti-glutamic acid decarboxylase antibody and body mass index. Mutations of GCK gene were detected by Sanger sequencing or high-throughput sequencing of diabetes-related genes in the patients and their family members. Results: There were ten patients, 8 of them were male, 2 were female.The ages at diagnosis varied between 4.7 to 12.3 years. The patients usually did not have obvious clinical symptoms of diabetes mellitus. Most of them were unexpectedly found to have hyperglycemia and with impaired glucose metabolism in three consecutive generations. The fasting blood glucose of patients was 6.8-7.7 mmol/L, 2-hour postprandial blood glucose was 7.8-11.6 mmol/L. Fasting blood insulin was 0.5-8.5 mU/L, glucose tolerance test results showed that 2 h postprondial blood insulin was 1.3-55.4 mU/L. The level of glycosylated hemoglobin was 6.1%-6.8%. Anti-glutamic acid decarboxylase antibody was negative in all patients. The GCK mutations identified in patients and one of their parents were located at exon5 (4 cases), exon9 (2 cases), exon2 (1 case), exon4 (1 case), exon6 (1 case) and exon7 (1 case). Conclusions: Most of the hyperglycemia patients caused by GCK mutations did not have typical clinical symptoms of diabetes. The fasting blood glucose was slightly elevated. Abnormal glucose tolerance test results were found in all 10 patients. Three consecutive generations of family had impaired glucose metabolism. GCK mutations located at exon 5 were common in 10 cases. There was no correlation between type of mutations and plasma glucose levels in domestic and international researches. When fasting glucose was found abnormal in clinic, a complete family history should be taken and the GCK gene should be sequenced to confirm the diagnosis in time.

Objective: To explore the influence of lifestyle intervention on long-term diabetes in subjects with impaired glucose tolerance (IGT) returned to normal glucose tolerance (NGT) within 6 years. Methods: A total of 577 subjects (aged 25-74 years old) with IGT in Daqing were enrolled and randomly assigned to control, and diet, exercise and diet plus exercise groups in a six-year intervention trial in 1986. Subjects who were non-diabetic at the end of the intervention were followed up for additional 14 years. Results: Among all the subjects, 41.38% of them who had returned to NGT from IGT within 6 years maintained NGT status after 20 years, and had a lower incidence of diabetes than subjects maintained IGT status (46.55% vs. 75.25%). Of note, in the intervention group, the percentage of participants developed diabetes in the NGT subjects was significantly lower than that in the IGT group (43.71% vs. 76.25%) after 20 years. There was high long-term risk for diabetes in the IGT subjects after the adjustment of age, sex and baseline glucose ( HR =1.81, 95 %CI 1.27-2.58, P= 0.001), whereas in the non-intervention group, no significant difference could be viewed in long-term diabetic risk between subjects maintained IGT status and those returned to NGT (71.43% vs. 65.22%) after adjusting of the same confounders ( HR =1.03, 95% CI 0.45-2.35, P= 0.94). Conclusions: IGT subjects who had returned to NGT in early years had lower risk for future diabetes than those who remained IGT. However, this beneficial effect could only be viewed in the intervention group, but not in the non-intervention group.

Pu-erh tea is a unique post-fermented tea processed from tender leaves of Camellia assamica. Characteristic component puerins were produced during the microbial fermentation process.This study focuses on the therapeutic effect and mechanism of puerinⅠ(P1) in Pu-erh tea on ApoE-/- mice with dyslipidemia and diabetes. It was found that P1 could significantly decreased total cholesterol (TC), triglyceride (TG) and fast blood glucose (FBG), and markedly improved impaired glucose tolerance (IPGTT) and insulin sensitivity (ITT) in hyperlipidemic and hyperglycemic ApoE-/- mice. Further experiments proved that P1 reduced FBG and plasma TG levels by inhibiting intestinal α-glycosidase enzymes activity and by activating low-density lipoprotein receptor respectively. This study confirmed the therapeutic effect and mechanism of P1 on ApoE-/- mice with diabetes and hyperlipidemia. Based on the good efficacy of this compound, P1 could be used as a new drug to treat the disorder of glycolipid metabolism., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Chinese Pharmaceutical Association.)

Objective: To analyze the rates on prevalence, awareness, status on treatment and control of type 2 diabetes mellitus among Chinese premenopausal women aged 18-49, in 2013. Methods: Data on China Chronic and Non-Communicable Disease Surveillance in year 2013 was used for analysis. Source of data covered 302 surveillance points which were selected by Multi-stage cluster random sampling method that including 176 534 adults over 18 years of age, with 46 674 premenopausal women aged 18-49. Plasma glucose and hemoglobin A1c levels were determined after a 10-hour overnight fast for all the participants, before a 2-hour oral glucose tolerance test was conducted among participants without a self-reported history of diagnosed diabetes. Diabetes was defined according to the 1999 WHO diagnostic criteria-fasting blood glucose level as ≥7.0 mmol/L and/or 2 hours oral glucose tolerance test (OGTT-2 h) level as ≥11.1 mmol/L. After being weighed, according to complex sampling scheme and post-stratification, the sample was used to estimate the rates of prevalence, awareness, treatment and control of type 2 diabetes mellitus by age, education, urban and rural areas, and geographic locations. Results: The overall prevalence of type 2 diabetes mellitus was 5.6% among the Chinese premenopausal women aged 18-49. No statistical difference on the prevalence rates (5.7% and 5.4%, respectively) was seen, between participants from the rural or the urban areas. Prevalence rates in the eastern, central or western geographic areas were 5.8%, 6.2% and 4.4% respectively. The rates of awareness, treatment and control of diabetes appeared as 29.3%, 27.9% and 29.4% in childbearing women aged 18-49. The rate of treatment was 95.4% among those who knew their diabetic situation in childbearing women aged 18-49 years. The control rate of diabetes was 38.9% among those who had taken measures to control glucose, in 18-49-year-old childbearing women. The rate of awareness on diabetes in childbearing women aged 18-49 years in urban areas was higher than that in the rural areas. There were significantly statistical differences on the treatment rates among groups of different education levels but not in the trend test. Conclusion: The prevalence of type 2 diabetes mellitus in childbearing women aged 18-49 appeared high, but with low rates on awareness, treatment and control. However, statistical difference was seen on awareness, between urban and rural areas.

Objective: To investigate the geographical variation of prediabetes in adults in different regions of China, and to analyze the related factors of prediabetes. Methods: Data was obtained from China Chronic Disease and Related Risk Factor Surveillance in 2013. The surveillance adopted multiple-stage stratified cluster random sampling method, which sampled 177 099 residents aged above 18 years old among 298 surveillance points in 31 provinces of Chinese Mainland. Questionnaire interview was used to obtain demographic variables, personal living style, and socio-economical information. Physical examination was conducted and fasting venous blood sample and (oral glucose tolerance test-2 hours, OGTT-2 h) venous blood sample were obtained from the participants. A total of 171 567 residents aged 18 and above were included in the analysis. The prevalence of prediabetes was analyzed by provinces and by China's geographical regions, after complex weighting. Multilevel logistic models were established to explore the related factors of prediabetes on the area level and individual level. Results: The prevalence of prediabetes among residents aged 18 and above was 16.6% (95 %CI: 15.6%-17.6%) in China. The prevalence of prediabetes was the highest (18.3%) in the south China and lowest (13.1%) in the northwest area. The difference of the prevalence in different areas were not statistically significant ( P= 0.510). If categorized the prevalence of prediabetes into 5 groups by quintile, Hainan, Jilin, Shandong, Anhui, Hunan and Chongqing were in the highest group of prevalence of prediabetes (18.6%-22.7%), and Tibet, Qinghai, Gansu, Ningxia, Guizhou, and Jiangxi were in the lowest group (7.6%-12.6%). The variance of prevalence of prediabetes on the county level ( MOR : 1.60 (95 %CI: 1.53-1.67)) was more diverse than the province level ( MOR : 1.21(95 %CI :1.08-1.29)) and higher than the street level (1.23 (95 %CI :1.14-1.30)). Several factors increased risk of pre-diabetes, including smoking, hazardous drinking and harmful drinking, drinking in the past 30 days, overweight, obesity, central obesity, sugary drink intake, hypertension, high total cholesterol, high triglycerides, high blood low-density lipoprotein cholesterol, low blood high-density lipoprotein cholesterol (all P< 0.05). After adjusted the above variables, 92.5% of variance of prediabetes prevalence conld be explained on the provincial level. Conclusion: The geographical distribution of prediabetes in adults in China differed by geographic areas, and it significantly varied on the county level. The related variables included demographic variables, personal behavior, and geographic related variables.

Objective: To assess the effects of laparoscopic sleeve gastrectomy (LSG) on insulin secretion mode and metabolism of glucose and lipid in morbidly obese patients., Methods: Clinical data of 65 morbidly obese patients [body mass index (BMI) ≥30 kg/m 2 ] undergoing LSG at Shanghai 10th People's Hospital from August 2012 to December 2016 were retrospectively analyzed. According to the result of OGTT, these obese patients were divided into three groups: normal glucose tolerance (NGT, 23 cases), impaired glucose tolerance (IGT, 22 cases) and type 2 diabetes mellitus (DM, 20 cases) groups. Twenty-two healthy people [BMI (23.1±1.4) kg/m 2 ] were used as control group. The anthropometries parameters [weight, BMI, waist circumference, body fat percentage, excess weight loss(%EWL)], glucose metabolic indices [fasting plasma glucose (FPG), fasting insulin (FINS), glycosylated hemoglobin (HbA1c), homeostasis model assessment-insulin resistance index (HOMA-IR)], lipid profile (TC, TG, HDL-C, LDL-C) and inflammatory factor (UA, TNF-α) of 3 groups were detected before operation and at postoperative 1-, 3-, 6-month. These variables were analyzed among morbidly obese groups before and after surgery and compared to control group. Clinical registration number of this study was ChiCTROCSl2002381., Results: Body weight, waist circumference and BMI of morbidly obese patients all decreased at postoperative 1-, 3-, 6-month. Postoperative %EWL increased obviously to (71.5±24.7)% with the highest range in DM group. Percentage of successful weight loss (%EWL>50%) in NGT, IGT and DM groups was 63.6%, 83.9% and 90.0% at postoperative 6-month respectively, and DM group was also the highest. At postoperative 6-month, HbA1c of 3 morbidly obese groups became normal; FPG and postprandial 2-hour glucose of IGT and DM group decreased to normal level; insulin level of 3 morbidly obese groups decreased obviously compared to pre-operation (all P<0.05), especially FINS and postprandial 2-hour insulin became normal without significant difference of control group (P>0.05), while postprandial 30-minute and 60-minute insulin levels in 3 groups were still higher as compared to control group. The insulin secretion curves of morbidly obese groups showed hyperinsulinemia before surgery. The peak of insulin secretion curve in IGT and DM group moved back to postprandial 120-minute before operation, and returned to 60-minute after operation, with basic normal rhythm of secretion curve. Preoperative HOMA-IR in all 3 morbidly obese groups was higher than that in control group (all P<0.05) and remarkably lower at postoperative 6-month compared to pre-operation(P<0.05). In 3 morbidly obese groups after operation, TG decreased, HDL-C increased, UA and TNF-α decreased significantly compared to before operation (all P<0.05). At postoperative 6-month, the HOMA-IR of DM group was positively correlated with BMI (r=0.236, P=0.004) and TNF-α (r=0.228, P=0.033), and was not correlated with HDL-C(P>0.05)., Conclusions: LSG can effectively ameliorate hyperinsulinemia and insulin secretion curve, and improve metabolic disorder and insulin resistance of different stage in obesity patients with glucose metabolic disorder. Insulin resistance is correlated with body weight and inflammatory factors.

Objective: To determine the correlation between serum uric acid (SUA) and insulin secretion function in patients with pre-diabetes and type-2 diabetes mellitus (T2DM)., Methods: A total of 4 112 adult people participated in this study. They were divided into three groups according to the results of oral glucose tolerance test (OGTT): 493 with normal glucose regulation (NGR),1 251 with impaired glucose regulation (IGR),and 2 368 with T2DM. Their levels of SUA,fasting insulin (FIns),2 h post-meal insulin (2 h-Ins),and insulin resistance index (HOMA-IR) were determined. Correlations between SUA and insulin secretion and HOMA-IR were estimated., Results: IGR patients had higher levels of SUA and 2 h-Ins compared with those with NGR and T2DM ( P <0.000 1). T2DM patients had higher levels of FIns,glucosylated hemoglobin (HbA1c) and HOMA-IR compared with those with NGR and IGR ( P <0.000 1). In both male and female participants,the highest level of 2 h-Ins appeared in those with IGR,while T2DM had the highest level of HOMA-IA and HbA1c. FIns,2 h-Ins and HOMA-IR increased with SUA in both patients with IGR and T2DM. HbA1c decreased with SUA in T2DM patients., Conclusion: High serum SUA is correlated with islet β-cell dysfunction. It may become an indicator of progression from pre-diabetes to T2DM., (CopyrightCopyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).)

Objective: To investigate the correlation between liver and skeletal muscle fat contents and insulin resistance in obese individuals with different levels of glucose tolerance., Methods: RESULTS: Ten non-obese individuals with normal glucose tolerance (NGT), 9 obese individuals with NGT, and 7 obese individuals with impaired glucose tolerance (IGT) were enrolled in this study. All the participants were examined for insulin sensitivity by hyperinsulinemic-euglycemic clamp and for liver and skeletal muscle fat accumulation quantified by proton magnetic resonance spectroscopy (1H MRS). The data were collected from the subjects including somatometric measurements, fasting plasma glucose, 2-h plasma glucose (2hPG), fasting insulin, and blood biochemistry. Linear correlation analysis and multiple linear stepwise regression analysis were used to analyze the relationship between ectopic fat accumulation and insulin resistance., Results: The glucose infusion rates (GIR, presented as the M value) differed significantly among IGT-obese (3.95∓1.66 mg·kg -1 ·min -1 ), NGT-obese (6.14∓1.90 mg·kg -1 ·min -1 ) and NGT-non-obese (8.78∓2.46 mg·kg -1 ·min -1 ) groups (P<0.05). The 3 groups also showed significant differences in liver fat contents [(15.23∓3.09)%, (6.25∓0.38)%, and (1.89∓0.90)%, respectively, P<0.05] and intramyocellular lipids in the tibialis anterior (2.69∓0.95, 2.61∓1.45, and 1.54∓0.66 mmol/kg, respectively, P<0.05). Linear analysis revealed that liver fat content, but not skeletal muscle fat content, was significantly correlated with the M value. Multiple linear stepwise regression analysis using M value as the dependent variable (Y) revealed that liver fat content (X) was an independent factor inversely correlated with the M value (regression equation: Y=-30.562X+9.007, R 2 =0.717, P<0.01)., Conclusions: Liver fat accumulation, but not skeletal muscle fat accumulation, is correlated with insulin resistance and impaired glucose metabolism.

Objective: To determine the mediating role of hypothalamic-pituitary-adrenal axis (HPA) and hypothalamic-pituitary-thyroid axis (HPT) axis in anxiety disorder in patients with diabetes mellitus., Methods: A total of 562 hospitalized patients with anxiety disorder participate in the study. Serum thyroid-stimulating hormone (TSH),total triiodothyronine (TT3),free triiodothyronine (FT3),total tetraiodothyronine (TT4),free tetraiodothyronine (FT4) ,adrenocorticotropic hormone (ACTH) and cortisol (PTC) were measured. Glucose tolerance test (OGTT) was performed,estimating insulin resistance index (HOMA IR) and insulin sensitivity index (WBISI)., Results: Of the participants,83 (14.8%) had diabetes. In those who were younger than 40 yr.,the diabetic patients were more likely to have abnormal FT4 and HPT ( P <0.05). The patients with diabetes were more likely to be older ( OR =1.067, 95% CI :1.041-1.094, P =0.000) and have higher FT4 ( OR =1.104, 95% CI :1.022-1.193, P =0.012) and PTC ( OR =1.001, 95% CI :1.000-1.003, P =0.025) . Insulin resistance index increased while insulin sensitivity index decreased ( P <0.05) with abnormal PTC and HPA axis. Insulin sensitivity index decreased ( P <0.05) when ACTH,HPT axis,FT4 and TT3 were abnormal., Conclusion: Abnormal HPA or HPT axis mediates diabetic complications in patients with anxiety disorder. Early interventions on neuroendocrine hormone abnormality may help prevent diabetes in patients with anxiety disorder.

Objective: To assess the value of blood glucose at different time points in oral glucose tolerance test (OGTT), particularly one?hour post load plasma glucose (1 hPG), in evaluating glucose metabolism in adult patients with obstructive sleep apnea (OSA)., Methods: Eighty nine adultswith newly diagnosed OSA were analyzed retrospectively for sleep architecture assessed using polysomnography and glucose metabolism assessed by OGTT at different time points (0, 30, 60, 120, and 180 min). Pearson's correlatives and multiple linear regression models were established to investigate the correlations between glucose metabolism and other indices including sleep architecture, apnea hypopnea index (AHI), mean and lowest oxygen saturation (MSO 2 and LSO 2 ) and obesity measurements., Results: The majority (67.4%) of the patients had abnormal 1 hPG, and 41.6% had abnormal 2 hPG. 1 hPG was positively correlated with neck circumference (r=0.245), abdomen circumference (r=0.231), systolic blood pressure (r=0.213), diastolic blood pressure (r=0.276) and AHI (r=0.324), and was negatively associated with MSO 2 (r=-0.341) and LSO 2 (r=-0.387) (all P<0.05). After controlling for age, BMI, neck and abdomen circumferences, 1 hPG was found to inversely correlated with MSO 2 (r=-0.253, P=0.032) and LSO 2 (r=-0.311, P=0.008). In non-obese OSA subgroup, 1 hPG was significantly associated with OSA-related indices, and regression models showed that LSO 2 and N2 were the two most important contributors to 1 hPG (adjusted R 2 =0.349, P<0.001); plasma glucose at other time points did not show such correlations., Conclusions: 1 hPG abnormality occurs earlier than 2 hPG in OSA patients. 1 hPG is significantly associated with OSA independent of obesity and may serve as a better index for measuring OSA-related glucose disorder.

Objective: To investigate the morbidity, diagnostic profile and perinatal outcome of pregestational diabetes mellitus (PGDM) in 15 hospitals in Guangdong province. Methods: A total of 41 338 women delivered in the 15 hospitals during the 6 months, 195 women with PGDM (PGDM group) and 195 women with normal glucose test result (control group) were recruited from these tertiary hospitals in Guangdong province from January 2016 to June 2016. The morbidity and diagnostic profile of PGDM were analyzed. The complications during pregnancy and perinatal outcomes were compared between the two groups. In the PGDM group, pregnancy outcomes were analyzed in women who used insulin treatment ( n= 91) and women who did not ( n= 104). Results: (1) The incidence of PGDM was 0.472%(195/41 338). Diabetes mellitus were diagnosed in 59 women (30.3%, 59/195) before pregnancy, and 136 women (69.7%,136/195) were diagnosed as PGDM after conceptions. Forty-six women (33.8%) were diagnosed by fasting glucose and glycohemoglobin (HbA1c) screening. (2) The maternal age, pre-pregnancy body mass index (BMI) , prenatal BMI, percentage of family history of diabetes, incidence of macrosomia, concentration of low density lipoprotein were significantly higher in PGDM group than those in control group (all P< 0.05). Women in PGDM group had significantly higher HbA1c concentration ((6.3±1.3)% vs (5.2±0.4)%) , fasting glucose [(6.3±2.3) vs (4.8±1.1) mmol/L], oral glucose tolerance test (OGTT) -1 h glucose ((12.6±2.9) vs (7.1±1.3) mmol/L) and OGTT-2 h glucose [(12.0±3.0) vs (6.4±1.0) mmol/L] than those in control group ( P< 0.01). (3) The morbidity of preterm births was significantly higher (11.3% vs 1.0%, P< 0.01), and the gestational age at delivery in PGDM group was significantly smaller [(37.6±2.3) vs (39.2±1.2) weeks, P< 0.01]. Cesarean delivery rate in the PGDM group (70.8% vs 29.7%) was significantly higher than the control group ( P< 0.01). There was significantly difference between PGDM group and control in the neonatal male/female ratio (98/97 vs 111/84, P= 0.033). The neonatal birth weight in PGDM group was significantly higher ((3 159±700) vs (3 451±423) g, P< 0.01) . And the incidence of neonatal hypoglycemia in the PGDM group was higher than the control group (7.7% vs 2.6%, P= 0.036). (4) In the PGDM group, women who were treated with insulin had a smaller gestational age at delivery [(36.9±2.9) vs (37.9±2.5) weeks, P< 0.01], and the neonates had a higher neonatal ICU (NICU) admission rate (24.2% vs 9.6%, P< 0.01). Conclusions: The morbidity of PGDM in the 15 hospitals in Guangdong province is 0.472%. The majority of PGDM was diagnosed during pregnancy; HbA1c and fasting glucose are reliable parameters for PGDM screening. Women with PGDM have obvious family history of diabetes and repeated pregnancy may accelerate the process of diabetes mellitus. Women with PGDM have higher risk for preterm delivery and neonatal hypoglycemia. Unsatisfied glucose control followed by insulin treatment may increase the need for NICU admission.

Objective: To investigate the correlation of intermittent androgen-deprivation therapy (IADT) and continuous androgen-deprivation therapy (CADT) for advanced prostate cancer (PCa) with the risks of secondary diabetes mellitus (DM) and impaired glucose tolerance (IGT)., Methods: We conducted a retrospective case-control study of the advanced PCa patients treated by IADT or CADT in our hospital from January 2013 to December 2015. Based on the levels fasting blood glucose and 2-hour postprandial blood glucose, results of oral glucose tolerance test, and clinical symptoms of the patients, we statistically analyzed the IADT- or CADT-related risk factors for DM and IGT and the relationship of the body mass index (BMI), hypertension, smoking, and alcohol consumption with secondary DM and IGT., Results: IADT was given to 53 (46.5%) of the patients, aged (69.1 ± 4.3) years, and CADT to 61 (53.5%), aged (70.2 ± 5.7) years. No statistically significant differences were observed in clinical characteristics between the two groups of patients (P > 0.05). BMI, blood pressure, smoking and drinking exhibited no significant influence on the development of DM or IGT either in the IADT (P > 0.05) or the CADT group. The incidence of IGT was significantly lower in the IADT than in the CADT group (P = 0.03), but that of DM showed no statistically significant difference between the two groups (P = 0.64)., Conclusions: Compared with CADT, IADT has a lower risk of IGT and a higher safety in the treatment of advanced prostate cancer.

Objective: To investigate the effects of non-surgical periodontal therapy on serum inflammatory factors and metabolism levels in obese rats with experimental periodontitis., Methods: Sixteen obese rats with experimental periodontitis were randomly divided into treatment group and control group with non-surgical periodontal therapy and no treatment, respectively. Oral glucose tolerance test was performed before treatment and 2 weeks after the treatment. All the rats were sacrificed 2 weeks after treatment and the orbital vein blood was taken to detect fasting blood glucose, fasting insulin, and serum level of C-reactive protein (CRP). Results Two weeks after periodontal treatment, fasting blood glucose (t=2.445, P=0.034) and beta cell function index (t=-2.543, P=0.027) were significantly lower in the treatment group than in the control group. Compared with those in the control group, CRP level (t=2.388, P=0.028) and the area under the curve in the oral glucose tolerance test (t=12.053, P=0.000) decreased significantly in the treatment group., Conclusion: Non-surgical periodontal treatment can reduce serum CRP level and improve glucose metabolism in obese rats.

This article reports the clinical features and endocrine and metabolic features of 4 children with Prader-Willi syndrome (PWS). All the patients were female and aged 6-12 years at diagnosis. All of them had clinical manifestations of obesity, unusual facies, developmental retardation, and intellectual disability. Genetic detection showed that 2 patients had paternal deletion of the 15q11.2-q13 region, one patient had maternal autodiploid in the 15q11.2-q13 region, and one patient had no abnormality in the 15q11.2-q13 region. All patients had varying degrees of endocrine and metabolic disorders: 2 patients had short stature, among whom one had delayed appearance of secondary sex characteristics and the other one had type 2 diabetes; one patient had insulin resistance and no mammary gland development; one patient had a body height of P 3 -P 10 and precocious puberty. Patients with PWS have various endocrine disorders, so long-term endocrine follow-up and management is very important.

Objectives: Insulin resistance (IR) is a common manifestation in patients with polycystic ovarian syndrome (PCOS). Both clinical observations and animal studies have demonstrated that IR could be induced by hyperandrogenemia, which is the charac-teristic of PCOS.Nevertheless, the mechanisms of IR in PCOS are still unclear especially at the molecular level.We conduct this study to ellucidate the effects of androgen on insulin sensitivity and chronic low-grade inflammation in adult C57BL/6 female mice. Methods: Eleven adult female C57BL/6 mice aged 8 weeks weredaily injected with testosterone (1.0 mg/100 g body weight)which dissolved in sesame oil (experimental group T) for 16 weeks.Ten control mice were injected with sesame oil only (group Con). The changes of body weight and body fat content were detected.Intraperitoneal glucose tolerance tests (IGTT) were performed at 0, 2, 3 and 16 weeks treatment, blood from tail vein was taken to detect levels of glucose.Intraperitoneal insulin tolerance tests (ITT) were performed at 16 weeks treatment.Both groups were sacrificed after16 weeks treatment, and phosphorylation of GSK3βand InsR, two molecules of insulin signaling pathway, were detected by Western blot from adipose tissue.The phosphorylation of NF-κBp65, CD16/32, and CD206 were also detected in adipose tissues.ELISA was used totest the serum IL-6 and MCP-1. Results: (1) No obvious significance of body weight as well as body fat content was detected between both experimental groups ( P >0.05); (2) 2 weeks treatment with testosterone induced the in-crease of fasting blood glucose and displayed obvious significance compared with group Con ( P <0.05); (3) 3 weeks treatment with testosterone induced the increase of area under the curve (AUC) of the blood glucose following IGTT and displayed significance compared with group Con ( P <0.05). And more obvious significance was detected at 16 weeks treat-ment ( P <0.01); (4) 16 weeks treatment with testosterone induced the increase of AUC of the blood glucose following ITT( P <0.01); (5) the serum IL-6 and MCP-1 in testosterone treat-ment was higher than that in thecontrols ( P <0.05). And 16 weeks treatment with testosterone decreased phosphorylation of GSK3β and InsR in C57BL/6 adipose tissues ( P <0.05), in-creased phosphorylation of NF-κBp65.Testosteroneenhanced the expression of CD206, and decreased the expression of CD16/32. Conclusions: Treatment with testosterone in adult fe-male mice can induce insulin resistance by blocking insulin signal transduction, without in-fluencing body weight and body fat content.Testosterone could activate the NF-κB to pro-mote the expression of IL-6 and MCP-1. And testosterone facilitated to promote macro-phage to M1-subtype transformation.

Objectives: To investigate the relationship between serum 25-hydroxyvitamin D 3 [25(OH)D 3 ] concentration and glucose metabolism., Methods: This cross-sectional survey recruited 668 participants, and the demographic and clinical characteristics of the participants were obtained from questionnaires. Physical examination and blood biochemical examination were performed, then the participants were divided into three groups as normal glucose tolerant (NGT) group, impaired glucose regulation(IGR) group, and diabetes mellitus (DM) group., Results: There was no statistical significant difference in serum 25(OH)D 3 concentration among the three groups ( P >0.05). With comparison of different serum 25(OH) D 3 concentration, there was no statistical significant difference in the incidence of DM and IGR, FPG, 2 h BG, HOMA-IR, ISI-composite, HOMA-β or ΔI30/ΔG30 ( P >0.05). Serum 25(OH)D 3 concentration was not associated with DM, IGR, FPG, 2 h BG, HOMA-IR, ISI-composite, HOMA-β or ΔI30/ΔG30 ( P >0.05)., Conclusions: No relationship between serum 25(OH)D 3 concentration and glucose metabolism is comfirmed.

Objective: To explore the value of using fasting plasma glucose (FPG) and lipid profiles between 7 and 15 gestational weeks to predict gestational diabetes mellitus (GDM). Methods: The medical records of 2 138 pregnant women who had prenatal care in Beijing Obstetrics and Gynecology Hospital from August 2011 to February 2012 were analyzed retrospectively. According to results of the oral glucose tolerance tests, women were devided into the GDM group ( n =240) and the normal group ( n= 1 898). Maternal characteristics, FPG and lipid levels between 7 and 15 gestational weeks were compared between the two groups. Logistic regression analysis and receiver operator characteristics(ROC) curve were used in the analysis. Results: Potential markers for the prediction of GDM included total cholesterol, triglyceride (TG) , low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratios (LDL-C/HDL-C) , triglyceride to high-density lipoprotein cholesterol ratios (TG/HDL-C) and FPG. After adjustment of confounding factors, age ( OR= 1.046, 95% CI: 1.003-1.090), pre- pregnancy body mass index ( OR= 1.104, 95% CI: 1.049-1.161), gravidity>3 ( OR= 1.768, 95% CI: 1.071-2.920), FPG ( OR= 8.137, 95% CI: 5.412-12.236), TG ( OR= 1.460, 95% CI: 1.148-1.858) were independently associated with the risk of developing GDM. Equation, P GDM =1/{1+exp[-(-16.542+0.045×age+0.103×pre-pregnancy body mass index+0.551×gravidity>3+2.110×FPG+0.372×TG)]}, was constructed by the logistic regression analysis. Sensitivity (67.5%) and specificity (70.5%) were determined by the calculated risk score, with a cut-off value of 0.11 (area under the curve: 0.751, 95% CI: 0.718-0.783, P< 0.001). Conclusions: FPG and TG, together with clinical characteristics may have a better predictive value for the risk of GDM.

Objectives: To investigate the influence of sleep status in early pregnant women on the occurrence of gestational diabetes mellitus (GDM)., Methods: In this prospective study,542 pregnant women in early pregnancy were selected as subjects.The sleep time,insomnia,pre-gestational body mass and basic information of the subjects were collected by the trained investigators through questionnaire.At the 24 th to 28 th pregnant week,the body mass of each subject was measured and oral glucose tolerance test (OGTT) was conducted.The diagnosis of GDM was followed the guidelines of diagnose and treatment of gestational diabetes mellitus in China (2014).A non-conditional logistic regression method was adopted to analyze the correlation between sleep status of early pregnant women and the occurrence of GDM., Results: The numbers of subjects in sleep deficiency group,sleep sufficiency group and sleep excessive group were 16 (2.95%),268 (49.45%) and 258 (47.60%),respectively.The incidences of GDM for sleep deficiency group,sleep sufficient group,and sleep excessive group were 62.50%(10/16),25.75%(69/268) and 22.09% (57/258),respectively,the difference was statistically significant (χ 2 =11.280, P <0.05).Compared with either sleep sufficiency or sleep excessive group,sleep deficiency group had higher GDM occurrence rate with statistically significant (χ 2 =8.410,11.218, P <0.017).Insomnia subjects in early pregnancy were 137 (25.28%).The incidences of GDM in insomnia group and normal group were 32.12% and 22.72% respectively,the difference was statistically significant (χ 2 =4.813, P <0.05).After adjusting the confounding factors [age,education,pre-pregnant body mass index (BMI),gained body mass in early and medium pregnancy,family history of type-2 diabetes,gravidity,parity,smoke,drink,exercise and occupation],non-conditional logistic regression results show that sleep deficiency for early pregnant women was an independent risk factor for the occurrence of GDM [odds ratio ( OR )=7.38,95% confidence interval ( CI ): 2.25-24.17].However,the association between insomnia and the occurrence of GDM was not found., Conclusions: Sleep deficiency in early pregnancy may be a risk factor for the occurrence of GDM.

Objectives: To compare the pancreatic β-cell functions of Han people between those with normal glucose tolerance (NGT),prediabetes (PD),and newly-diagnosed type 2 diabetes mellitus (NDDM), and to evaluate the value of the continuous glucose monitoring system (CGMS) in determining β-cell functions., Methods: A total of 169 volunteers of Han people (20-75 years old, 72 male and 97 female) without diagnosed diabetes were given 75-g oral glucose tolerance test (OGTT) and insulin release tests. The body mass index (BMI) of the participants ranged from 18.5 to 28.0 kg/m².They were categorized into NGT ( n =87), PD ( n =52) and NDDM ( n =30) groupsaccording to the World Health Organization (WHO) 1999 criteria.Blood samples were taken to test triglyceride(TG),total cholesterol (TC),and glycosylated hemoglobin A1c (HbA1c). The participants were also given a 72 h continuous glucose monitoring. The β-cell functions were calculated using the OGTT and insulin release test results, which included homeostasis model assessment insulin resistance (HOMA-IR),homeostasis model assessment β-cell function (HOMA-B),basic secretion, early phase secretion, and second phase secretion. The area under the curve of glucose ( AUC -G) was estimated through the CGMS.A multivariate stepwise regression model was developed to identify predictors of β-cell functions., Results: Significant differences in age,BMI,HOMA-IR,HOMA-B, AUC -G, basic secretion, early phase secretion and second phase secretion were found between the NGT and PD groups ( P <0.05) and between the NGT and NDDM groups ( P <0.05). Differences in AUC-G and basic secretion and early phase secretion were found between the PD and NDDM groups ( P <0.05),but not in age, BMI, HOMA-IR, HOMA-B, and second phase secretion.The multivariate stepwise regression analysis showed that HOMA-B (standardized partical regression coefficient β =-0.244, P =0.001), basic secretion ( β =-0.355, P <0.001), and HbA1c ( β =0.638, P <0.001) contributed significantly to the AUC-G., Conclusions: β-cell functions decline in those with prediabetes, which appears first at the second phase secretion. Changes in β-cell secretion functions are more obvious than in insulin resistance during the progression from PD to NDDM. AUC -G can be a better indicator of impaired β-cellfunctions.

Objective: To compare the therapeutic effects between sitagliptin and voglibose both with sensor-augmented insulin pump (SAP) in newly diagnosed type 2 diabetes mellitus (T2DM)., Methods: Fifty-six newly diagnosed hospitalized T2DM patients in Department of Endocrinology of the First Affiliated Hospital of Dalian Medical University, with hemoglobin A1c (HbA1c) value of 9%-11%, were randomized into the sitagliptin (S) group (n=28) and the voglibose (V) group (n=28) by block randomisation. Participants in S group received sitagliptin 100 mg per day, and V group received voglibose 0.2 mg for 3 times per day. All patients were treated with SAP for 9 days. Real-time continuous glucose monitoring (RT-CGM) was used. Glucose variability parameters were observed. The research has been approved by the ethics committee of the First Affiliated Hospital of Dalian Medical University(KY2014-08)., Results: No significant differences were observed in baseline characteristics between the two groups (all P>0.05). In V group and S group, fasting blood glucose (FPG) [(6.4±1.1) vs (11.4±3.0) mmol/L, P=0.008; (5.5±0.8) vs (11.0±2.1) mmol/L, P<0.001], mean blood glucose(MBG) [(7.5±0.8) vs (12.0±1.1) mmol/L, P=0.045; (6.7±0.7) vs (12.5±1.3) mmol/L, P=0.002], standard deviation of blood glucose (SDBG) (P=0.023, 0.036) decreased and homeostasis model assessment (HOMA)-β (P=0.002, 0.001) increased significantly after 9 days therapy. The mean of daily differences (MODD)(P=0.027), coefficient of variation-FPG (CV-FPG) (P=0.033) and HOMA-IR (P=0.039) in S group significantly decreased, while postprandial glycemic excursion (PPGE)(P=0.003, 0.026, 0.011, 3 meals respectively)and the low glycemic index(LBGI)(P=0.025) in V group decreased, the peak postprandial level of glucose(Δt)was longer compared with before (P=0.028, 0.026, 0.030, 3 meals respectively). After therapy, PPGE in V group significantly became lower than those in S group (P=0.041, 0.032, 0.036, 3 meals respectively), while FPG and MBG in S group were significantly lower than those in V group (P=0.041, 0.039)., Conclusions: Sitagliptin or voglibose combined with SAP can improve glucose control and protect islet function for patients with newly diagnosed T2DM. Sitagliptin has advantages in controlling MBG and FPG compared with voglibose. Voglibose has more striking advantages in reducing the postprandial blood glucose fluctuation.

Objective: To study the relationship between gestational glucose, lipid metabolism parameters and fetal distress., Methods: Retrospectively, 82 cases of primipara with fetal distress and 246 cases of primipara without any obstetric complications were analyzed. The latter were treated as control group. All the patients were from the same hospital between January, 2014 and January, 2016. Factors as fasting plasma-glucose (FPG), triglyceride (TG), total cholesterol (TC),high-density lipoprotein (HDL-C), low-density lipoprotein (LDL-C) parameters during early pregnancy, blood glucose of fasting, 1 hour and 2 hours in 75 g oral glucose tolerance test (OGTT), at 24 to 28 weeks of gestation, hemoglobin and blood pressure parameters during ante partum were recorded for all the cases while parameters as glucose and lipid, hemoglobin, blood pressure and cesarean section rate were compared between the 2 groups., Results: FPG during early gestation, blood glucose of fasting, 1 hour and 2 hours 75 g OGTT during mid gestation, systolic blood pressure and diastolic blood pressure during late gestation in the'fetal distress'group were significantly higher than that of the control group. Hemoglobin during late gestation in the fetal distress group was lower than that of the control group, with statistically significant difference (P<0.05). The rate of cesarean section in the fetal distress group was higher than that in the control group (χ(2)=4.489, P=0.034)., Conclusions: High BMI at pre-pregnancy, high blood glucose during early and mid-gestation, high blood pressure and anemia during late gestation were related to the fetal distress group. Cesarean section rate was high for pregnancy women with fetal distress.

Objective: To explore the factors influencing glucose metabolism in young obese subjects with obstructive sleep apnea hypopnea syndrome (OSAHS)., Methods: A total of 106 young obese subjects[18-44 years old, body mass index (BMI) ≥30 kg/m(2)]were enrolled and divided into two groups based on full-night polysomnography (PSG), OSAHS group[apnea hypopnea index (AHI) ≥5 events/h]and non-OSAHS group (AHI<5 events/h). Oral glucose tolerance-insulin releasing test (OGTT-IRT) was performed and serum glycosylated hemoglobin A1 (HbA1c) levels were measured after an overnight fast. Homeostasis model assessment-IR (HOMA-IR), Matsuda insulin sensitivity index (MI), homeostasis model assessment-β (HOMA-β), the early phase insulinogenic index (ΔI(30)/ΔG(30)), total area under the curve of insulin in 180 minutes (AUC-I180) and oral disposition index (DIo) were calculated to evaluate insulin resistance and pancreatic β cell function. Stepwise multiple linear regressions were conducted to determine the independent linear correlation of glucose measurements with PSG parameters., Results: Prevalence of diabetes was higher in OSAHS than in non-OSAHS group (22.0% vs 4.3%, P=0.009). OGTT 0, 30, 60 min glucose and HbA1c levels were higher in OSAHS group than those in non-OASHS group (all P<0.05). DIo were lower in OSAHS group than those in non-OASHS group (P=0.024), HOMA-IR, MI, HOMA-β, ΔI(30)/ΔG(30), and AUC-I(180) were similar between two groups (all P>0.05). In stepwise multiple linear regressions, OGTT 0, 30 and 60 min glucose were positively correlated with oxygen desaturation index (ODI) (β=0.243, 0.273 and 0.371 respectively, all P<0.05). HOMA-β was negatively correlated with AHI (β=-0.243, P=0.011). DIo was negatively correlated with ODI (β=-0.234, P=0.031)., Conclusion: OSAHS worsens glucose metabolism and compensatory pancreatic β-cell function in young obese subjects, which could probably be attributed to sleep apnea related oxygen desaturation during sleep.

Objective: To investigate the prevalence of chronic kidney disease (CKD) in subjects with different glucose metabolism status., Methods: Between January, 2015 and October, 2015, a total of 934 subjects without a previous diagnosis of diabetes visiting the Department of Endocrinology or Health Examination Center underwent oral glucose tolerance test (OGTT), which identified 266 subjects with normal glucose tolerance (NGT group), 243 pre-diabetic subjects, and 425 patients with diabetes mellitus group. The baseline characteristics and laboratory test data of the subjects were collected. The diagnosis of CKD was established for an eGFR <60 mL/min/1.73 m(2) or a ACR≥30 mg/g, and the prevalence of CKD were compared among the 3 groups. Logistic regression model was used to analyze the OR value of the risk factors of CKD., Results: The prevalences of CKD in NGT, pre-diabetic and diabetic groups were 10.2%, 26.3% and 32.5%, respectively. Pairwise comparisons showed that the prevalence of CKD was significantly higher in pre-diabetic group (P<0.001, OR=3.17, 95% CI 1.94-5.17) and diabetic group (P<0.001, OR=4.27, 95% CI 2.72-6.65) than in NGT group, and was comparable between the pre-diabetic and diabetic groups (P=0.115, OR=1.35, 95% CI 0.95-1.91). Logistic regression analysis, after adjustment for age, gender, blood pressure, hypertension, blood lipids and uric acid, showed that pre-diabetes (OR=2.03, P=0.044) and diabetes mellitus (OR=2.22, P=0.016) were independently associated with CKD., Conclusion: Glucose metabolism status has a significant independent impact on the incidence of CKD, suggesting the importance of early detection of pre-diabetes and timely interventions in pre-diabetic subjects in prevention CKD.

Objective: To investigate the change of plasma nesfatin-1 concentration in a nonalcoholic fatty liver disease rat model induced by high-fat diet, and explore its effect on the dysfunction of glucose and lipid metabolism., Methods: The nonalcoholic fatty liver disease rat model was established through introduction of a high-fat diet, and four weeks later, the intraperitoneal glucose tolerance test was conducted. Serum concentrations of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), direct bilirubin (DBIL), indirect bilirubin (IBIL), total cholesterol (TC) triglyceride (TG), high density lipoprotein cholesterol (HDL-C), and low density lipoprotein cholesterol (LDL-C) were detected using chemiluminescence technique. The plasma levels of nesfatin-1, leptin, and insulin (INS) were measured via enzyme-linked immunosorbent assay (ELISA), the histological changes of the liver was observed via HE staining, and the protein expressions of beta-catenin, p-beta-catenin and cyclin D1 in the liver were detected using western blot and compared with beta-actin., Results: The bodyweight, liver weight, liver index, and area under the curve of the intraperitoneal glucose tolerance test were all higher in the model rats than those in the controls. Compared with the control, serum concentrations of ALT, TBIL, IBIL, TC and LDL-C in the model rats were all increased. The plasma nesfatin-1 level was increased in model rats while the plasma concentrations of leptin and insulin were decreased, and a negative correlation was found between the plasma concentration of nesfatin-1 and leptin. Inflammation and hepatocyte steatosis were detected in the livers of model rats, and the protein expression of cyclinD1 was upregulated while the phosphorylation of beta-catenin was decreased in the livers of the model rats., Conclusion: Post-creation of nonalcoholic fatty liver disease rat models through high fat diets, changes were observed in plasma nesfatin-1 concentration, perhaps a vital part of glucose and lipid metabolism dysfunction.

Objective: To investigate the correlation between serum uric acid (SUA) level and early-phase insulin secretion in subjects with normal glucose regulation (NGR)., Methods: Totally 367 community NGR residents confirmed by a 75g oral glucose tolerance test were enrolled. The insulin resistance index (HOMA-IR) and the early-phase insulin secretion index after a glucose load (ΔI30/ΔG30) were used to estimate the insulin sensitivity and the early-phase insulin secretion, respectively. The subjects were divided into 4 groups according to the SUA level quartiles. Differences in early-phase insulin levels, ΔI30/ΔG30, and HOMA-IR were compared among the 4 groups., Results: Age, BMI, waist circumference, systolic blood pressure, diastolic blood pressure, fasting insulin (FINS), 30 minutes postprandial insulin(30 minINS), 2 hours postprandial insulin(2hINS), HOMA-IR and TG levels increased across the rising categories of SUA levels, while the HDL-C was decreased across the SUA groups (P<0.01). The SUA level was positively correlated with age(r=0.157, P<0.01), BMI(r=0.262, P<0.01), waist circumference(r=0.372, P<0.01), systolic blood pressure(r=0.200, P<0.01), diastolic blood pressure(r=0.254, P<0.01), 30 minutes postprandial plasma glucose(r=0.118, P=0.023), FINS(r=0.249, P<0.01), 30minINS(r=0.189, P<0.01), 2hINS(r=0.206, P<0.01), glycosylated hemoglobin(HbA1c, r=0.106, P=0.042), HOMA-IR(r=0.244, P<0.01), TG(r=0.350, P<0.01), ΔI30/ΔG30(r=0.144, P<0.01), and negatively correlated with HDL-C level(r=-0.321, P<0.01). Multiple stepwise regression analysis showed that SUA(β=0.292, P<0.01) and HOMA-IR(β=29.821, P<0.01) were positively associated with ΔI30/ΔG30., Conclusion: SUA level is closely related with the early-phase insulin secretion in NGR subjects.

Objective: To observe the effect of liraglutide (LIRA) in combination of umbilical cord mesenchymal stem cells (hUC-MSCs) in treating type 2 diabetes mellitus., Methods: Eligibility criteria for subjects includes: type 2 diabetes mellitus with more than 10 years duration; having been treated with secretagogues, metformin and insulin in combination with LIRA for at least 6 months; poor glycemic control [glycosylated hemoglobin A1c(HbA1c) 7%-10%]. Totally, twelve patients were enrolled and randomly divided into two groups: the group A (LIRA group, n=6) and the group B (LIRA+ hUC-MSCs group, n=6). The hUC-MSCs were transplanted through infusing of 1×10(6) cells /kg via pancreatic artery directed by interventional radiology on the first day, and followed by infusing 1×10(6) cells /kg through peripheral vein on the eighth, the fifteenth and the twenty-second day sequentially. The control subjects were infused with saline. Both groups were treated with LIRA for 24 weeks at the same period. Fasting plasma glucose(FPG), 2h postprandial plasma glucose(2hPG) and HbA1c were measured. A 75 g oral glucose tolerance test(OGTT)was performed. The early phase of C peptide(CP) secretion function(ΔCP30/ΔG30), the total amount of C peptide secretion function(AUCCP180)and Homeostasis model assessment of insulin resistance (HOMA-IR) were calculated., Results: (1) The baseline FPG, 2hPG, HbA1c, ΔCP30/ΔG30, AUCCP180 and HOMA-IR were comparable between the two groups(P>0.05). (2) Compared with subjects in group A, FPG, 2hPG and HbA1c levels were significantly decreased in subjects in group B [(8.33±0.99) mmol/L vs (6.64±0.79)mmol/L, (13.85±0.86) mmol/L vs (8.65±1.12) mmol/L, (7.82±0.31)% vs (6.82±0.53)%, P<0.05]. (3) Compared with group A, ΔCP30/ΔG30 and AUCCP180 were significantly increased, and HOMA-IR was significantly decreased in group B(0.22±0.13 vs 0.70±0.38, 12.52±5.30 vs 21.16±3.17, 9.46±4.88 vs 4.30±2.68, P<0.05)., Conclusion: LIRA treatment in combination with hUC-MSCs improves glucose metabolism and the β cell function in type 2 diabetic patients. (ClinicalTrials.gov NCT01954147).