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Objective To investigate the correlation between subclinical peripheral neuropathy (sDPN) and time in range (TIR) in type 2 diabetes mellitus (T2DM), and to explore the risk factors of sDPN. Methods A total of 485 T2DM patients without DPN symptoms and underwent EMG examination during hospitalization were divided into the sDPN group (n=209) and the non-sDPN group (n=276) according to nerve function conduction examination. The differences of age, course of the disease, blood pressure, complications, biochemical index and continuous glucose monitoring index were compared between the two groups of patients. The correlation between sDPN and TIR was analyzed. Logistic regression analysis was used to analyze influence factors of sDPN. Results Compared with the non-sDPN group, patients in the sDPN group were older and had longer diabetes course, higher systolic blood pressure (SBP), urinary albumin/urinary creatinine (UACR), blood glucose 1 h postprandial (1 h-PG), 2 h-PG, TBR, mean blood glucose fluctuation range (MAGE), standard deviation of blood glucose level (SD) and glycemic coefficient of variation (CV) levels, higher proportion of hypertension (HT), diabetic nephropathy (DN), diabetic retinopathy (DR) and diabetic peripheral vascular disease (PAD), and lower levels of total cholesterol (TC), right limb ankle brachial index (R-ABI), L-ABI, hemoglobin A1c (HbA1c) and TIR. The differences in the above indexes were statistically significant (P＜0.05). The occurrence of sDPN was positively correlated with TBR (rs = 0.104, P＜0.05), and negatively correlated with TIR (rs =-0.093, P＜0.05). Logistic regression analysis showed that increased TBR (OR=1.093,95%CI: 1.009-1.183), combined with DN (OR=3.004, 95%CI: 1.020-8.849) and DR (OR=9.736, 95%CI: 3.499-27.087) were independent risk factors for sDPN, and increased R-ABI (OR=0.005, 95%CI: 0.000-0.424) was protective factor for sDPN. Conclusion sDPN was negatively correlated with TIR. For patients with T2DM complicated with DN, DR and decreased ABI, it is necessary to timely improve neuroelectrophysiological examination to identify sDPN as soon as possible and give early intervention. [ABSTRACT FROM AUTHOR]

Objective To investigate the genetic association between nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) using bidirectional two-sample Mendelian randomization (MR), as well as the causal relationship between NAFLD and T2DM across different body mass index (BMI) categories. Methods The data were derived from genomewide association studies conducted in European populations, with a sample size of 32 941 cases for NAFLD, 312 646 cases for T2DM, and 681 275 cases for BMI. The univariate and multivariate MR methods were used to assess the bidirectional causal relationship between NAFLD and T2DM in the general population and across different BMI subtypes. The methods of inversevariance weighting, MR-Egger regression, constrained maximum likelihood and model averaging, and weighted median were used to conduct the MR analysis, and MR-Pleiotropy Residual Sum and Outlier, radial MR, the MR-Egger intercept method, and the Cochrane Q test were used for sensitivity analysis. Results The univariate MR analysis revealed a bidirectional causal relationship between NAFLD and T2DM in the general population (forward analysis: odds ratio [OR]=9.75, 95% confidence interval [CI]: 2.57—37.00, P<0.001; reverse analysis: OR=1.01, 95%CI: 1.00—1.01, P<0.01) . After adjustment for BMI, the multivariate MR analysis showed that the causal relationship between NAFLD and T2DM remained significant in the general population (OR= 33.12, 95% CI: 7.57—144.95, P<0.000 1) . The subgroup analysis showed a causal relationship between NAFLD and T2DM across all BMI subtypes (lean subgroup: OR=12.19, 95% CI: 3.35—44.40, P<0.001; overweight subgroup: OR=4.30, 95%CI: 1.69—10.92, P<0.01; obese subgroup: OR=1.67, 95% CI: 1.14—2.44, P<0.01) . Conclusion This study reveals the causal relationship between NAFLD and T2DM in the general population of NAFLD and across different BMI subtypes from a genetic perspective. [ABSTRACT FROM AUTHOR]

Diabetic hyperglycemia in males is a significant contributing factor to the development of spermatogenesis disorder. The hypothalamic-pituitary-gonadal (HPG) axis serves as a crucial center for autonomic sexual function and the neuroendocrine network within the human body. It dominates physiological prominence in human reproduction, growth, and development, while also being susceptible to hyperglycemia, which is one of the key mechanisms in the development of spermatogenic disorder in type 2 diabetes mellitus (T2DM). This mechanism involves kidney deficiency, which is a common etiology and pathogenesis of both spermatogenesis disorder and T2DM. The kidney storing essence, which encompasses the functions of "dominating reproduction, manufacturing marrow to fill up the brain" bears similarities to the HPG axis. Kidney tonifying therapy can regulate and improve the function of HPG axis, thereby establishing a theoretical basis for the use of kidney tonification therapy in the treatment of spermatogenesis disorder in T2DM. The traditional formula of tonifying the kidney can serve as a complementary treatment for both DM and spermatogenesis disorder. This approach offers a conceptual framework and methodology for the prevention and treatment of T2DM-induced infertility through kidney tonification.

Background Muscle mass loss increases the risk of hyperglycaemia and sarcopenia in patients with type 2 diabetes mellitus (T2DM), and Chinese adults with T2DM are predominantly non-obese, who are more likely to be associated with muscle mass loss than the obese. Objective To establish an individualized Nomogram prediction model for the risk factors of muscle mass loss in non-obese patients with T2DM. Methods A retrospective study was conducted to select 905 non-obese patients with T2DM admitted to the Department of Endocrinology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2018 to September 2023. The patients were divided into a training set (n=633) and a validation set (n=272) using simple random sampling at a ratio of 7∶3, and the general data and clinical indexes of the two groups of patients were collected and compared. Multivariate Logistic regression analysis was performed to determine risk factors for muscle mass loss in the training set and a Nomogram prediction model was constructed. The predictive value and clinical utility of the Nomogram prediction model were evaluated using receiver operating characteristic (ROC) curve, Hosmer-Lemeshow calibration curve, and decision curve analysis (DCA), respectively. Results The prevalence of muscle mass loss in non-obese patients with T2DM was 42.3% (383/905). Comparison of the clinical indicators of the patients in the training and validation sets showed no statistically significant differences (P>0.05). Multivariate Logistic regression analysis showed that age (OR=1.039, 95%CI=1.010-1.070, P=0.009), male (OR=3.425, 95%CI=2.133-5.499, P

Hypertension, type 2 diabetes mellitus (T2DM), and dyslipidemia are collectively referred to as the "three highs", which often coexist in the same individual. It significantly increases the risk of hospitalization, death, and relevant burdens for affected people. It is necessary to jointly control the risk and standardize the treatment of hypertension, T2DM and dyslipidemia. Primary healthcare institutions have become the main battlefield for the prevention and treatment of chronic diseases. Existing clinical evidence provides important insights into the prevention, treatment, and management of the "three highs", although norms, consensus, and guidelines for the co-management of the "three highs" in primary healthcare institutions at domestic and foreign are current not available. Four academic organizations led by Beijing Hypertension Association organized primary healthcare workers and invited experts and scholars from medical fields of cardiovascular diseases, endocrine, pharmacy, and public health services to participate in the consensus. Through widely soliciting clinical practice needs of primary healthcare workers, integrating and evaluating the evidence related to the prevention and treatment of the "three highs" in primary healthcare institutions, the consensus for primary healthcare in the prevention and treatment of the "three highs" including 21 opinions was developed after multiple rounds of discussions, revisions, and voting. The recommended opinions of this consensus aim to improve the awareness and ability of primary healthcare workers in the prevention and treatment of the "three highs", provide scientific strategic support, implement management with primary healthcare characteristics, and lay a solid foundation for comorbidity co-management.

Background Given the increased risk of adverse pregnancy outcomes in pregnant women with type 2 diabetes, in addition to glycemic control, it is crucial to understand the relationship between gestational weight gain and adverse pregnancy outcomes. Objective To investigate the gestational weight gain in pregnant women with type 2 diabetes and its relationship with pregnancy outcomes. Methods A retrospective analysis was conducted on 691 cases of pregnant women with type 2 diabetes who underwent prenatal care and delivery at Beijing Obstetrics and Gynecology Hospital, Capital Medical University, from 2012 to 2020. According to the Chinese "Standard of Recommendation for Weight Gain during Pregnancy Period", the participants were categorized into the inadequate weight gain group (n=143), appropriate weight gain group (n=289), and excessive weight gain group (n=259). The gestational weight gain characteristics, maternal outcomes, and neonatal outcomes were compared among the three groups. Multivariate Logistic regression analysis was employed to explore the impact of gestational weight gain on pregnancy outcomes. Results The results of multivariate Logistic regression analysis showed that compared to the appropriate weight gain group, the excessive weight gain group had increased risks of cesarean section (aOR=1.626, 95%CI=1.110-2.382), preeclampsia (aOR=1.997, 95%CI=1.071-3.677), macrosomia (aOR=1.948, 95%CI=1.175-3.230), and large for gestational age (LGA) (aOR=2.090, 95%CI=1.321-3.306), while reducing the rate of vaginal delivery (aOR=0.617, 95%CI=0.415-0.918). The inadequate weight gain group was associated with a reduced risk of delivering LGA (aOR=0.497, 95%CI=0.255-0.970), with no impact on small for gestational age (SGA) (P>0.05). Further stratified analysis revealed that excessive weight gain group with pre-pregnancy BMI≥24.0 kg/m2 increased the risks of cesarean section, preeclampsia, LGA [aOR and 95%CI were 1.673 (1.082-2.587), 1.961 (1.022-3.761), 2.031 (1.221-3.379), respectively], while reducing the rate of vaginal delivery (aOR=0.589, 95%CI=0.372-0.933). The inadequate weight gain group with pre-pregnancy BMI≥24.0 kg/m2 showed a decreased risk of delivering LGA (aOR=0.487, 95%CI=0.237-0.999). Excessive weight gain during early, middle, and late pregnancy was identified as a risk factor for macrosomia [aOR and 95%CI were 1.07 (1.00-1.15), 1.16 (1.03-1.31), and 1.16 (1.06-1.27), respectively] and LGA [aOR and 95%CI were 1.08 (1.01-1.16), 1.13 (1.02-1.26), and 1.16 (1.07-1.26), respectively]. Excessive weight gain during late pregnancy was associated with gestational hypertension and preeclampsia (aOR=1.13, 95%CI=1.02-1.24; aOR=1.14, 95%CI=1.03-1.26), while excessive weight gain during middle and late pregnancy was a risk factor for cesarean section (aOR=1.11, 95%CI=1.02-1.21; aOR=1.09, 95%CI=1.02-1.17) . Conclusion Excessive gestational weight gain increases the risk of adverse pregnancy outcomes such as LGA, macrosomia, preeclampsia, and cesarean section in women with type 2 diabetes during pregnancy. Inadequate gestational weight gain reduces the risk of LGA, but does not increase the risk of SGA. There is a clear correlation between gestational weight gain during different stages of pregnancy and adverse pregnancy outcomes. Therefore, optimizing blood glucose levels during pregnancy in patients with type 2 diabetes should be accompanied by enhanced education and interventions on weight gain management from preconception and early pregnancy stages.

Background Diabetes has a high incidence rate and many complications, which was an urgent public health problem, but the prevention and management is still not ideal. Objective To observe the effect of Three Division management on metabolic indicators and self-management levels of diabetes patients with different courses of disease. Methods One hundred and 81 type 2 diabetes patients from April 2021 to April 2022 were managed by the mode of Three Division management and followed up for more than 6 months in Shenzhen Hospital Guangzhou University of Chinese Medicine (Futian). The patients were grouped according to the course of disease (Group A: course of disease5-10 years; Group D: course of disease>10 years) ; In outpatient, the three-division team composed of traditional Chinese medicine practitioners, endocrinologists and caregivers carries out comprehensive treatment such as physique identification, complication screening, medicine, food, exercises and emotion intervention; When patients are at home, the caregivers carry out intelligent management through intelligent Glucose meter equipment and mobile phone APP. We collected changes in blood glucose and body weight indicators in patients with different disease courses after six months of management. Additionally, we used a questionnaire to gather common issues in patient self-management and fill out the Summary of Diabetes Self-Care Activities Measure-6 (SDSCA-6) . Results Through the management of the Three Division management, Group A patients showed significant improvement in reducing fasting blood glucose and postprandial 2-hour blood glucose after the intervention (P

Background In recent years, the number of diabetics in China ranks first in the world. While recommending metformin as the first-line hypoglycemic drug, the Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 edition) emphasize "patient-centere" and select appropriate second-line hypoglycemic agents for combination administration according to the clinical characteristics and preferences of patients. Because there are great differences in the prevalence rate and life behavior of type 2 diabetes between the north and the south of China, whether there is a difference in the second-line drug preference of patients with type 2 diabetes between the two places remains to be further demonstrated. Objective To analyze the difference of second-line drug preference among patients with type 2 diabetes mellitus in North and South China, and to provide empirical evidence for clinical and health management decision-making. Methods The study adopts a Discrete Choice Experimental design, Mixed Logit Model was used to analyze drug preference of patients with type 2 diabetes in the north and south of China based on Multi-stage random cluster sampling and convenient sampling, from October 2021 to January 2022. Results In this study, 1 443 questionnaires were distributed, and 1 388 were valid, with an effective recovery rate of 96.19%. Logit model analysis showed that the effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking drugs and the out-of-pocket cost/month were the influencing factors of the second-line drug preference of southern patients (P

Short-chain fatty acids (SCFAs) play a major mediating role in gut microbiota regulation of host metabolism and are strongly associated with type 2 diabetes mellitus (T2DM), which improves glycemic, body weight, and lipid indices in T2DM patients. Although it has been suggested that SCFAs are expected to be novel therapeutic targets for T2DM, no review has been conducted. Therefore, this paper summarizes the biological properties of SCFAs, discusses the evidence that SCFAs regulate appetite, inflammation, pancreatic β-cells, lipid metabolism and hepatic glycogen metabolism, further clarifies the progress of research on regulating the role of SCFAs in T2DM and their mechanisms, and explores the potential of regulating SCFAs for the treatment of T2DM.

Background Dapagliflozin is an effective drug for the treatment of type 2 diabetes mellitus (T2DM), which can also reduce the risk of nephropathy progression, decrease urinary protein and protect the heart. However, whether dapagliflozin can reduce the incidence of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) in T2DM patients remain unclear. Objective To investigate the impact of dapagliflozin on the incidence of CIN in patients with T2DM underwent PCI. Methods According to the principle of 1∶1 propensity matching based on the use of dapagliflozin, a total of 484 T2DM patients who underwent PCI in the Department of Cardiology, Tianjin Chest Hospital from 2021 to 2023 were retrospectively consecutively enrolled in the study, of which 242 cases were in the dapagliflozin group and 242 cases were in the control group. The pre-PCI clinical data of the two groups were collected and compared, and the renal functions of the two groups were recorded before PCI, 48 hours after PCI and 1 week after PCI, including blood urea nitrogen (BUN), serum creatinine (Scr), creatinine clearance rate (Ccr), cystatin C (Cys-C), β2- microglobulin (β2-MG), and neutrophil gelatinase associated apolipoprotein (NGAL). The primary study endpoint was the incidence of CIN, and the secondary study endpoint was the change in renal function during the perioperative period of PCI. Multivariate Logistic regression was used to analyze the effect of dapagliflozin on the incidence of CIN after PCI in patients with T2DM. Results The incidence of CIN in patients in the dapagliflozin group was 6.2% lower than that in patients in the control group (12.0%). The difference was statistically significant (χ2=4.900, P=0.039). The CIN risk score and B-type natriuretic peptide of patients in the dapagliflozin group were higher than those in the control group (P0.05). At 48 hours after PCI, the levels of Cys-C, β2-MG, and NGAL in the dapagliflozin group were lower than those in the control group (P

Elderly patients with type 2 diabetes mellitus often face the problems of multimorbidity and multiple medications, and these conditions often lead to irrational or inappropriate medication use, significantly affecting patient outcomes and quality of life, making early and effective medication decisions particularly important. As an important supplement to medication support information, decision support tools, including electronic health record-based systems, mobile applications, online health platforms, etc., provide personalized, evidence-based medical information to help patients understand medication regimens, assist patients and healthcare professionals in making more rational medication decisions, enhance the appropriateness and safety of medication, and reduce the risk of drug interactions, thereby improving the overall treatment of patients and reducing the risk of drug interactions. The application of medication management in elderly patients with type 2 diabetes mellitus has made significant progress, thus improving the overall outcome and quality of life of patients. This article summarizes the current situation of medication use in elderly patients with type 2 diabetes mellitus, the influencing factors, types, application methods and their roles of decision aids, aiming to provide reference for the development of medication decision aids for this population in China.

Background In China, there is a significant prevalence of type 2 diabetes patients (T2DM) , who also have an increased risk of developing secondary hyperuricemia (HUA) . Patients with T2DM who develops HUA are at increased risk of developing further problems, which could have detrimental effects on their health. Consequently, it is crucial to promptly identify individuals who have a high risk of developing secondary HUA and to begin early prevention and therapy. Objective Exploring the predictive value of common insulin resistance (IR) surrogates for the HUA in middle-aged and elderly T2DM patients. And employ a subset of these metrics as predictive metrics for the occurrence and progression of HUA. Methods Using stratified random sampling, 479 individuals with type 2 diabetes mellitus (T2DM) and 1 528 patients with non-hyperuricemia (NHUA) were chosen from seven community health service centers in Shenzhen between January and March 2023. Multivariate Logistic regression analysis was used to evaluate the effects of various insulin resistance (IR) metrics and their quartiles on the incidence of HUA in middle-aged and older type 2 diabetic patients. Triglyceride-high density lipoprotein cholesterol (TG/HDL-C) index, non-high density lipoprotein cholesterol ratio (Non-HDL-C/HDL-C) index, triglyceride glucose (TyG) index, triglyceride glucose body mass (TyG-BMI) index, triglyceride glucose waist circumference (TyG-WC) index, and insulin resistance metabolism (METS-IR) index are some of these metrics. The predictive efficacy of several IR substitution measures for HUA in middle-aged and older T2DM patients was assessed using the ROC curve. The CHARLS database's cohort data from 2011 and 2015 were filtered in order to create a nested case-control that would validate the predictive power of different IR alternative indicators for the likelihood of HUA. Results Multivariate Logistic regression study revealed that the METS-IR index, TG/HDL-C index, Non HDL-C/HDL-C index, TyG index, TyG-BMI index, TyG-WC index, and TG/HDL-C index were independent influencing factors for the occurrence of HUA (P

Background Continuous glucose monitoring (CGM) is rarely applied to outpatient treatments. The impact of CGM-based diabetes education to change unhealthy living and eating habits on the blood glucose profile is still unclear. Objective Based on the retrospective results of CGM, outpatient education such as diet and exercise was applied to outpatients with type 2 diabetes mellitus (T2DM) who were managed by oral hypoglycemic drugs. This study aims to evaluate the effects on blood glucose profiles. Methods A total of 88 outpatient T2DM patients medicated with oral hypoglycemic drugs in the Department of Endocrinology, Nanjing First Hospital in 2021 were included and managed by CGM, involving 60 male and 28 female patients. The enrolled patients maintained the original hypoglycemic treatment regimen and lifestyle habits on the 1st to 3rd day. On the 4th day, we downloaded and analyzed CGM data and provided outpatient education based on individualized eating habit and exercise. On the 6th day, the CGM sensor and recorder were removed. CGM data on the 2nd day versus 5th day were compared for dynamic blood glucose profiles, including the 24 h mean blood glucose (MBG), mean amplitude of glycemic excursion (MAGE) and time in target glucose range (TIR) . Results Based on the CGM results, MBG in outpatients with T2DM on the 5th day after outpatient education was significantly reduced from (8.34±1.97) mmol/L to (7.85±1.65) mmol/L (P

Background Type 2 diabetes mellitus (T2DM) and mild cognitive impairment (MCI) are common health problems in the elderly in the community. Research on the status and influencing factors of MCI in the elderly with T2DM who participate in community management is needed. Objective To explore the cognitive characteristics and related factors of elderly patients with T2DM complicated with MCI under community management. Methods From July to October 2022, a total of 399 patients with type 2 diabetes over 60 years of age in a community health service center in Shanghai were selected by systematic sampling method. General demographic data and health problems, physical examination and laboratory test results, including fasting blood glucose (FBG), total triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), glycosylated hemoglobin (HbA1c) were collected. They were divided into MCI group (n=157) and non-MCI group (n=242) according to the presence or absence of MCI. Binary Logistic regression analysis was used to explore the influencing factors of MCI in elderly patients with type 2 diabetes under community management. Results The prevalence of MCI was 39.3% (157/399) in community-managed elderly patients with type 2 diabetes. The comparison of cognitive characteristics between MCI group and non-MCI group showed that the MCI group had higher abnormality rates in executive function, orientation, calculation, abstraction, delayed memory, visual perception, naming and attention than the non-MCI group, and the differences were statistically significant (P9% (OR=5.106, 95%CI=2.150-12.130), LDL-C (OR=2.451, 95%CI=1.266-4.743), 7-12 years of education (OR=0.419, 95%CI=0.183-0.960) and >12 years (OR=0.243, 95%CI=0.086-0.692) was the influencing factor for MCI in elderly patients with type 2 diabetes (P9% and high level of LDC. High level of education is a protective factor for MCI in community-managed elderly patients with type 2 diabetes. Early cognitive impairment screening, long-term blood glucose control, and lowering LDL-C levels are helpful to improve the cognitive function of community-managed elderly patients with type 2 diabetes.

Background Porphyromonas gingivalis (Pg.) is the main pathogen of periodontitis. Studies have found that Pg. can affect systemic diseases including type 2 diabetes mellitus (T2DM) through oral-intestinal pathway, but its specific mechanism remains unclear. Objective To explore whether Pg. has an effect on T2DM by changing intestinal mechanical and immune barriers. Methods A total of 24 among 40 SPF mice were randomly selected to construct T2DM models, among the successful models, 16 mice were selected to be divided into the model group (DM group, n=8) and model+Pg. group (PD group, n=8), and the other 16 mice were divided into the control group (N group, n=8) and Pg. group (n=8). After modeling, body mass and fasting plasma glucose (FPG) of mice were observed, and oral glucose tolerance test (OGTT) was performed at the 5th week, OGTT curve was plotted and the area under the curve (AUC) was calculated. Pg. group and PD group were gavaged with Pg. bacterial solution from the 7th week for 5 consecutive weeks. Lipopolysaccharide (LPS) was determined by enzyme-related immunosorbent assay (ELISA), colonic tight-junction protein and inflammatory factors were detected by real-time fluorescence quantitative PCR, and colonic tissue lesions were observed by hematoxylin-eosin (HE) staining. Pearson correlation or Spearman correlation analysis was used to investigate the relationship of FPG with colonic tight junction protein mRNA expression and serum LPS levels in mice. Results Body weight of DM group was higher than that of N group and Pg. group at 2nd to 6th weeks before irrigation (P

Objective To systematically review the efficacy and safety of metformin extended‑release (ER) (Ⅳ) in the treatment of type 2 diabetes mellitus (T2DM) via network meta‑analysis (NMA). Methods Databases including PubMed, Embase, the Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang Data and Food and Drug Administration (FDA) were searched to identify randomized controlled trial (RCT) from inception to 30 June 2023. After a thorough review of the literature based on exclusion criteria, data extraction, and assessment of study bias, WinBUGS 14.0 software was used to conduct the network meta‑analysis (NMA). Results A total of 7 RCT with 3 769 patients with T2DM were included. The results of NMA showed that, metformin ER(Ⅳ) group had a significant reduction in glycated hemoglobin (HbA1c ), when compared with metformin ER ( Ⅲ) group (MD=-0.62%, 95%CI -0.88%--0.36%, P<0.05), metformin ER ( Ⅱ) group (MD=-0.46%, 95%CI -0.74%--0.19%, P<0.05), metformin ER group (MD=-0.39%, 95%CI -0.65%--0.14%, P<0.05) and metformin immediate release (IR) group (MD=-0.36%, 95%CI -0.59%--0.13%, P<0.05). In meta‑regression analysis, metformin ER ( Ⅳ) group also had an advantage in reducing HbA1c compared with the other four groups after controlling for baseline of HbA1c, body mass index (BMI) and follow‑up time. Compared with metformin ER ( Ⅲ) group, metformin ER (IV) group is more effective in reducing fasting plasma glucose (FPG) (MD= -0.66 mmol/L, 95%CI -1.31--0.01). In terms of safety, compared with other groups, metformin ER ( Ⅳ) group had no significantly different in the withdrawal due to adverse event (WADE) and gastrointestinal adverse events (P>0.05). Conclusion Metformin ER ( Ⅳ) might have beneficial effects on glycemic control in T2DM and has similar performance in WADE to the previous three generations of metformin ER and metformin IR. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of sodium‑glucose co‑transporter 2 inhibitor (SGLT2i) on spermatogenesis and the quality of sperm in the mice with type 2 diabetes mellitus (T2DM). Methods Twenty‑one 8‑week‑old male db/db mice were randomized into three groups (seven mice in each group) using a random number table method: db/db group (received vehicle), Dapa group [received dapagliflozin (1 mg·kg-1 ·d-1 ) ], and Cana group [received canagliflozin (10 mg·kg-1 ·d-1 ) ], orally daily for five weeks. Five littermate db/m mice were chosen as the normal control group. Body weight and the blood glucose levels were monitored in all mice. Sperm concentration and motility were analyzed using a computer‑assisted semen analysis system. Testicular morphology was evaluated using HE staining, and testicular cell apoptosis was examined using terminal deoxynucleotidyl transferase‑mediated dUTP nick end labeling (TUNEL) and immunohistochemistry staining. GC‑2 spermatogonia cells, were divided into three groups: normal control (vehicle), PA group (100 μmol/L palmitic acid intervention), and PA+Dapa group (100 μmol/L palmitic acid combined with 30 μmol/L dapagliflozin intervention) and treated for 48 h. Oxidative stress levels and apoptosis‑related indices were assessed using Western blotting, flow cytometry and test kits. One‑way analysis of variance or Brown‑Forsythe/Welch was used to compare between groups. Results Compared with db/db mice, dapagliflozin and canagliflozin significantly reduced fasting and postprandial blood glucose levels and the area under the glucose curve (all P<0.05). Both interventions increased sperm viability and progressive motility, as well as curve velocity and mean path velocity (all P<0.05). They also decreased activated caspase‑3 expression, TUNEL‑positive spermatogenic tubule ratio, and cell ratio (all P<0.05). In GC‑2 cells, intervention with dapagliflozin reduced intracellular reactive oxygen species levels, malondialdehyde content, increased superoxide dismutase activity, decreased apoptosis rate, and increased B‑cell lymphoma 2 (BCL2) expression (all P<0.05) compared with the PA group. Conclusion SGLT2i provide additional protective effects on testicular structure and sperm quality in db/db mice with T2DM in addition to their hypoglycemic effects. SGLT2i may protect against diabetes‑induced spermatogenesis impairment by attenuating testicular oxidative stress and apoptosis. [ABSTRACT FROM AUTHOR]

Embase, the Cochrane Library, China national knowledge infrastructure (CNKI), Wanfang, VIP and China biomedical literature (CBM) were searched for randomized controlled trials (RCT) and observational studies of the efficacy and safety of heparinoids in the treatment of type 2 diabetic nephropathy from inception to October 2023. Meta‑analysis was performed using RevMan 5.3 and Stata 17.0 software after the literature was screened according to the exclusion criteria, data were extracted from the literature, and the risk of bias was evaluated. Results A total of 22 trials with 3 800 patients were included. The results of the meta‑analysis showed that heparinoids could significantly reduce urinary albumin excretion in patients with type 2 diabetic kidney disease (SMD= -0.65, 95%CI -0.98--0.31, P<0.001). Subgroup analysis showed that heparinoids had an advantage over the control group in reducing urinary albumin excretion in Asian patients (SMD=-0.48, 95%CI -0.72--0.24, P<0.001), while no such advantage was observed in Europeans (SMD=-0.25, 95%CI -0.62-0.13, P=0.190). There was no significant difference between the heparinoid group and the control group in serum creatinine (SMD=-0.08, 95%CI -0.31-0.16, P=0.520), blood pressure [systolic blood pressure: WMD=-1.56 mmHg (1 mmHg=0.133 kPa), 95%CI -3.66-0.55 mmHg, P= 0.150, diastolic blood pressure: WMD=-0.16 mmHg, 95%CI -1.29-0.96 mmHg, P=0.780], fasting plasma glucose (SMD=-0.05, 95%CI -0.24-0.14, P=0.600) and glycated hemoglobin A1c (HbA1c ) (WMD=-0.07%, 95%CI -0.24%-0.10%, P=0.420) in patients with type 2 diabetic nephropathy. In terms of safety, heparinoids did not increase the incidence of adverse events such as injection site hematoma and malignant cardiovascular events (RR=1.11, 95%CI 0.97-1.28, P=0.120). Conclusion Heparinoids can effectively reduce the level of urinary albumin in patients with type 2 diabetic nephropathy, particularly in Asian patients, and there are no obvious adverse effects during the treatment. [ABSTRACT FROM AUTHOR]

A total of 40 T2DM patients and 50 healthy controls who underwent carotid endarterectomy in the Department of Neurointerventional Intervention, Xuanwu Hospital, Capital Medical University from December 2021 to December 2022 were selected for this study. Real‑time fluorescence quantitative polymerase chain reaction (RT‑qPCR) and RNA methylation immunoprecipitation quantitative polymerase chain reaction (MeRIP‑qPCR) techniques were applied to determine the level of FASN mRNA expression and m6 A modification of FASN mRNA in their adipose tissues. Subsequently, a nested case‑control study design was used in “Functional Community Cohort” from 2018 to 2023 at the Health Management Center of Xuanwu Hospital of Capital Medical University. With 2018 as the baseline, new‑onset T2DM patients after 5 years were used as the new‑onset T2DM group (87 cases), and healthy controls were used as the control group according to the 1∶ 1 individual matching method, and the results were validated in peripheral blood. The t‑test was used to compare the differences in the expression levels of FASN mRNA and the m6 A modification levels of FASN mRNA between different groups, and Spearman correlation was used to analyze the correlation between them. Multifactorial binary logistic regression models were used to assess the strength of the association between the m6 A modification level of FASN mRNA and T2DM. Receiver operating characteristic (ROC) curves were constructed to evaluate the ability of m6 A modification levels of FASN mRNA to predict T2DM. Results FASN mRNA was highly expressed in T2DM patients (1.30±0.38 vs. 0.70±0.30 for adipose tissue, P<0.001; 1.25±0.76 vs. 1.02±0.45 for peripheral blood, P<0.01), and the m6 A modification level of FASN mRNA was low in T2DM patients (0.53±0.24 vs. 0.84±0.53 for adipose tissue, P<0.001; 0.67±0.55 vs. 1.54±0.87 for peripheral blood, P<0.001) both in adipose tissue and peripheral blood. FASN mRNA and m6 A modification level of FASN mRNA were negatively correlated (adipose tissue r=-0.360, P<0.001; peripheral blood r=-0.192, P<0.05). Baseline low m6 A modification level of FASN mRNA was a risk factor of T2DM in peripheral blood (OR=5.71, 95%CI 1.73-18.85). The ROC curve for the T2DM prediction model showed that the m6 A modification level of FASN mRNA was a good predictor of T2DM (area under the ROC curve was 0.817, 95%CI 0.753-0.888). Conclusion Abnormal m6 A modification of FASN mRNA was linked to T2DM, and the m6 A modification level of FASN mRNA can predict the risk of developing T2DM. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between serum cholinesterase (ChE) levels and islet α-cell dysfunction in patients with type 2 diabetes mellitus (T2DM).Methods This was a cross-sectional study. T2DM patients were recruited for this study at the Department of Endocrinology of Nantong First People′s Hospital between July 2022 and December 2023. Anthropological parameters, including age, sex, blood pressure and body mass index (BMI) were collected. Duration of diabetes and the use of medications, including hypoglycemic agents and statins, were documented. Serum ChE, liver function indices, blood lipids, serum creatinine (SCr), uric acid (UA), cystatin C (CysC) and glycated hemoglobin A 1c (HbA 1c) were measured in all patients. 75 g oral glucose tolerance test was also performed to simultaneously detect glucose, insulin and glucagon (GLA) at fasting (0 min), 30, 60, 120 and 180 min. Insulin resistance was assessed using the homeostasis model assessment of insulin resistance (HOMA-IR). Overall glucose levels after glucose load were evaluated by the area under the curve (AUC glu). The indices of islet α-cell function included GLA 0, GLA 30, GLA 60, GLA 120 and overall glucagon levels after glucose load (area under the curve of glucagon, AUC gla). All patients were divided into three subgroups according to the tertiles of serum ChE levels: group T 1 (range of ChE, 3.71-7.84 kU/L, 167 patients), group T 2 (range of ChE, 7.85-9.44 kU/L, 168 patients) and group T 3 (range of ChE, 9.45-17.94 kU/L, 167 patients). One-way analysis of variance (ANOVA) with linear polynomial contrasts, the Jonckheere-Terpstra test, or the χ ² test with linear-by-linear association was used to analyze the trend of clinical data between subgroups. Pearson ′s correlation analysis was used to analyze the relationship between ChE and islet α-cell function, and multivariate linear regression analysis was used to analyze whether ChE was an independent factor for islet α-cell function. Results A total of 502 eligible T2DM patients were recruited. From T 1 to T 2 to T 3 of ChE, BMI, HOMA-IR, GLA 0, GLA 30, GLA 60, GLA 120 and AUC gla gradually increased ( P for trend<0.001), but HbA 1c did not. Pearson ′s correlation analysis revealed that the serum ChE levels were significantly correlated with GLA 0, GLA 30, GLA 60, GLA 120 and AUC gla ( r=0.264, 0.230, 0.217, 0.229 and 0.245, respectively; P<0.001). After adjusting for age, sex, BMI, blood pressure, diabetes duration, hypoglycemic agents, statins, liver function indices, blood lipids, UA, SCr, CysC, HbA 1c, AUC glu, HOMA-IR and other clinical variables via multivariate linear regression, serum ChE levels were independently associated with GLA 0 (β=0.196, t=4.333, P<0.001), GLA 30 (β=0.188, t=4.309, P<0.001), GLA 60 (β=0.175, t=3.936, P<0.001), GLA 120 (β=0.186, t=4.195, P<0.001) and AUC gla (β=0.199, t=4.525, P<0.001). Conclusion ncreased serum ChE levels were associated with increased fasting glucagon and postprandial glucagon levels in patients with T2DM and could be considered an independent risk factor for islet α-cell dysfunction. [ABSTRACT FROM AUTHOR]

Objective To explore the efficacy and safety of Tonghua Dongbao (TD) liraglutide injection (Tongboli) versus Victoza in the treatment of type 2 diabetes mellitus (T2DM). Methods This was a multicenter, randomized, open-label, parallel, positive drug controlled phase Ⅲ clinical study with an equivalent design. Patients with T2DM who received metformin, sulfonylureas or a combination of metformin and sulfonylureas from 39 research centres in China from April 19, 2019 to March 19, 2021 were included. They were randomly assigned to TD liraglutide (Tongboli) group and Victoza group according to the ratio of 1∶1. After 26 weeks of treatment, the changes of glycated hemoglobin A 1c (HbA1c), venous fasting plasma glucose (FPG), 7-point self-monitored blood glucose, incidence of hypoglycemic events and adverse events, and the incidence of anti-drug antibody (ADA) were compared between the two groups before and after treatment. The modified intention-to-treat (mITT) population and per protocol set (PPS) were used for efficacy index analysis, and the safety data set (SS) was used for safety analysis. Paired t-test was used to compare the differences in the respective before and after treatment indicatiors. Independent sample t-test, Wilcoxon rank sum test, χ² test or Fisher exact test were used to compare the differences between groups. Repeated-measures mixed-effect model (MMRM) was used to compare the changes in HbA1c, FPG and 7-point self-monitored blood glucose from baseline at the 26th week. The Cochran-Mantel-Haenzel test was used to compare the proportions of HbA1c<7% in the two groups at the 26th week, and the 95%CI of the rate difference between the two groups was calculated. Pearson χ² test was used to compare the incidence of treatment emergency adverse event (TEAE), hypoglycemic events and ADA between the two groups during treatment. Results A total of 524 subjects were randomly enrolled and 482 subjects completed the study cases in the Tongboli group(n=243) and Victoza group (n=239). All 524 subjects were included in the mITT population, 434 subjects were included in PPS, and 262 patients were included in SS. After 26 weeks of treatment, the HbA1c of the two groups decreased by 1.640%±1.011% and 1.620%±1.106% in Tongboli group and Victoza, respectively. The difference in the least squares mean (95%CI) between the two groups was 0 (-0.18%-0.18%), and the difference was within the predetermined range of±0.4%. Tongboli and Victoza can be considered equivalent. At the 26th week, FPG decreased by (2.137±2.489) mmol/L and (2.004±2.331) mmol/L in the two groups, respectively. The difference in the least squares mean value (95%CI) between the two groups was 0.080 (-0.280-0.439) mmol/L, which was not statistically significant (P=0.663). There were 49.6% (130/262) and 50.8% (133/262) subjects in the two groups who achieved the target of HbA1c<7%, respectively. The difference in the rate (95%CI) between the two groups was -0.01% (-0.10%-0.07%,P=0.801). The incidence of TEAE in the two groups was 82.1% (215/262) and 79.0% (207/262), respectively, with no significant difference (χ²=0.78, P=0.377). There was no significant difference in the incidence of hypoglycemic events and ADA between the two groups (P>0.05). Conclusion The overall therapeutic effect of Tongboli and Victoza in controlling blood glucose is comparable, with good safety and clinical application value. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the relationship between early diabetic kidney disease (DKD) and ectopic fat deposition in kidney in patients with type 2 diabetes mellitus (T2DM). Methods A cross-sectional study was used to collect 375 T2DM patients with complete data who were hospitalized from July 2021 to July 2023 at Tianjin Medical University Chu Hsien-I Memorial Hospital, among which there were 226 males, 149 females. Patients were divided into early DKD group (129 cases) and normoalbuminuria group (246 cases). Biochemical indicators including glycated hemoglobin A1c (HbA1c), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C), high-density lipoprotein cholesterol (HDL-C), soluble CD36 (sCD36) and renal tubular function indicators such as retinol binding protein (RBP), β2 microglobulin (β2-MG) and N-acetyl-β-D-glucosa minidase (NAG) were detected. The homeostasis model assessment of insulin resistance (HOMA-IR) and arteriosclerosis index (AI) were calculated. Twenty patients were selected in each group according to the method of random number table. MR mDixon-Quant technique was used to detect renal fat content and renal fat fraction (RFF) was calculated. Independent sample t test or χ² test was used for comparison between the two groups. Binary logistic regression analysis was performed to evaluate influencing factors on early DKD. Results The levels of HbA1c and HOMA-IR in early DKD group were significantly higher than those of normoalbuminuria group [(8.1±2.0)% vs. (7.7±1.7)%, 4.0±1.1 vs. 3.1±1.0, t=2.03, 7.99, all P<0.05]. Compared to normoalbuminuria group, the levels of TG, LDL-C, VLDL-C, sCD36, AI were significantly higher and HDL-C was significantly lower in early DKD group (t=3.14, 2.20, 3.07, 18.39, 2.50, 2.72, all P<0.05). The RFF in early DKD group was (3.8±0.7)%, higher than that in the normal albuminuria group (3.1±0.5)% (t=10.09, P<0.05). The levels of RBP, β2-MG, NAG and the proportion of two and three abnormalities of renal tubular function indictors in early DKD group were higher than those in normoalbuminuria group (t=24.66, 25.50, 4.09, χ²=22.27, 8.42, all P<0.05). Binary logistic regression analysis showed that early DKD was related to HbA1c, sCD36, LDL-C and RFF (OR=1.241, 1.006, 1.005, 5.035, all P<0.05). Conclusion Early DKD may be associated with dyslipidemia and ectopic fat deposition in kidney in patients with T2DM. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between osteocalcin and sarcopenia in patients aged ≥60 years with type 2 diabetes mellitus (T2DM). Methods This was a cross-sectional study. T2DM patients aged ≥60 years were consecutively recruited from the inpatient population of the Department of Endocrinology at Changzhi Medical College Affiliated Heji Hospital, between September 2021 and October 2023. Total osteocalcin (tOC), undercarboxylated osteocalcin (ucOC), simple five-item questionnaire (SARC-F) scale score, calf circumference and sarcopenia-related parameters [skeletal muscle mass index (SMI), handgrip strength, 6-m walking speed] were collected. According to the diagnostic criteria of the Asian Working Group for Sarcopenia (AWGS), all subjects were divided into three groups: controls, pre-sarcopenia, sarcopenia. One-way analysis of variance, Kruskal-Wallis H test or χ² test were used for comparisons between groups. Pearson correlation analysis was used to analyze the correlation between osteocalcin and sarcopenia. Binary logistic regression analysis was used to analyze the influencing factors of sarcopenia. Receiver operating characteristic curve (ROC) was used to analysis the diagnostic value of osteocalcin for sarcopenia in T2DM aged ≥60 years. Results A total of 225 subjects were enrolled in the study. There were 106 cases in the control group, 44 cases in pre-sarcopenia group, and 75 cases in sarcopenia group. Compared with control group, tOC, ucOC, SARC-F scale were higher in sarcopenia group (P<0.05), and the calf circumference was smaller (P< 0.05). Pearson correlation analysis showed that tOC was negatively correlated with SMI and handgrip strength (r=-0.303 and -0.164, respectively, both P<0.05), and ucOC was negatively correlated with SMI, handgrip strength, and 6 m walking speed (r=-0.365, -0.139, and -0.155, respectively, all P<0.05). Logistic regression analysis suggested that increased ucOC (OR=1.576, 95%CI 1.350-1.840) was an influencing factor of sarcopenia in T2DM. ROC curve showed that serum ucOC had a higher diagnostic value for sarcopenia compared to tOC in patients aged ≥60 years with T2DM, with an area under the curve of 0.79. Conclusion Serum ucOC is associated with the development of sarcopenia and has certain diagnostic value in patients aged ≥60 years with T2DM. [ABSTRACT FROM AUTHOR]

Objective To analyze the association between metabolic score for insulin resistance (METS-IR) and cardiac remodeling in patients with type 2 diabetes mellitus (T2DM). Methods This study was a cross-sectional study that retrospectively selected the follow-up data of Beijing branch of the REACTION study conducted from April 2015 to September 2015, ultimately including a total of 2 495 T2DM patients. Height and weight were collected and body mass index was calculated. Fasting plasma glucose (FPG), 2-hour postprandial glucose (2hPG), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), γ-glutamyl transpeptidase (GGT) were determinded and METS-IR was calculated. Interventricular septal thickness (IVS), left atrial diameter (LAD), left ventricular end-diastolic diameter (LVEDD), and diastolic dysfunction were measured by color Doppler echocardiography. The participants were divided into four groups according to METS-IR quartiles: Q1 group (METS-IR<34.93, 622 cases), Q2 group (34.93≤METS-IR<39.60, 625 cases), Q3 group (39.60≤METS-IR<44.44, 624 cases) and Q4 group (METS-IR≥44.44, 624 cases). One-way analysis of variance was used for comparison between groups, and logistic regression was applied to explore the association between METI-IR and cardiac remodeling. Results IVS, LAD and LVEDD increased with higher METS-IR (P<0.001), and METS-IR was an independent risk factor for IVS thickening and LAD dilation. Compared with the Q1 group, the risk of incident IVS thickening was 1.79 times (95%CI 1.21-2.65, P=0.004) and 2.45 times (95%CI 1.58-3.80, P<0.001) in Q3 and Q4 groups, respectively. Compared with the Q1 group, the risk of incident LAD widening was 2.84 times (95%CI 2.11-3.82, P<0.001), 4.01 times (95%CI 2.98-5.40, P<0.001), and 6.86 times (95%CI 5.03-9.36, P<0.001) in Q2, Q3 and Q4 groups, respectively. METS-IR was not an independent risk factor for increased LVEDD and reduced diastolic function (both P>0.05). Conclusion METS-IR is associated with cardiac remodeling, particularly IVS thickening and LAD widening. [ABSTRACT FROM AUTHOR]

Objective To investigate the interaction between mild decrease in estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (UACR) on the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) risk in patients with type 2 diabetes mellitus (T2DM). Methods This was a cross-sectional study. A total of 1 891 diabetic patients were randomly selected from four sampling sites in Shanxi Province (Xinghualing District, Taiyuan City; Yuci District, Jinzhong City; Huguan County, Changzhi City; and Jiangxian County, Yuncheng City) from June to August 2019 using the method of multi-stage stratification random sampling. Age, smoking status, history of dyslipidaemia, waist circumference, systolic blood pressure, fasting plasma glucose (FPG), total cholesterol (TC), estimated glomerular filtration rate (eGFR) and UACR were collected from study participants. The 10-year risk of ASCVD in T2DM patients was calculated based on the prediction for ASCVD risk in China (China-PAR) model, and the patients were categorized into ASCVD low-risk group (the 10-year risk of ASCVD<5.0%), ASCVD medium-risk group (5.0% ≤ the 10-year risk of ASCVD<10.0%), and ASCVD high-risk group (the 10-year risk of ASCVD≥ 10.0%). T2DM patients were divided into non-proteinuria group (UACR<30 mg/g) and proteinuria group (UACR ≥30 mg/g) according to UACR results. T2DM patients were divided into eGFR normal group [eGFR ≥90 ml·min-1·(1.73 m²)-1] and eGFR slightly decreased group [60 ml·min-1·(1.73 m²)-1 ≤ eGFR<90 ml·min-1· (1.73 m²)-1] according to eGFR results, One-way analysis of variance (ANOVA), Kruskal-Wallis H test or χ² test were used for between-group comparisons, binary logistic regression models were used to analyze the factors influencing the risk of high risk of ASCVD, and interaction models were used to explore the effects of eGFR and albuminuria on the risk of high risk of ASCVD. Results A total of 875 T2DM patients with complete data were included, of whom 174 were in the ASCVD low-risk group, 193 in the ASCVD intermediate-risk group, and 508 in the ASCVD high-risk group. Compared with the ASCVD low-risk group, T2DM patients in the ASCVD high-risk group had lower eGFR levels and higher UACR levels (both P<0.001). Binary logistic regression analysis showed that age ≥60 years (OR=32.579, 95%CI 18.199-58.323), smoking (OR=3.297, 95%CI 1.906-5.701), history of dyslipidemia (OR=1.956, 95%CI 1.253-3.054), abdominal obesity (OR=1.712, 95%CI 1.136-2.580), systolic blood pressure ≥140 mmHg (1 mmHg=0.133 kPa) (OR=12.676, 95%CI 7.072-22.719), FPG>7.0 mmol/L (OR=1.739, 95%CI 1.048-2.885), TC≥5.18 mmol/L (OR=1.619, 95%CI 1.017-2.577), and mild decrease in eGFR (OR=3.219, 95%CI 1.932-5.361) were influential factors in the 10-year risk of high risk for ASCVD in T2DM patients (all P<0.05). There was an interaction between mildly decreased eGFR and albuminuria on 10-year risk of ASCVD (Pinteract= 0.034). Compared with T2DM patients with normal UACR and eGFR, patients with albuminuria and mildly decreased eGFR had a 6.235-fold increased odds of having a high 10-year risk of ASCVD (ORinteract=7.235, 95%CI 1.548-33.815, P=0.012). Conclusion The risk of ASCVD in 10 years is increased synergistically by mild reductions in eGFR and albuminuria in patients with T2DM. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between serum myeloid-derived growth factor (MYDGF) levels and carotid atherosclerosis (CAS) in newly diagnosed type 2 diabetes mellitus (T2DM). Methods This cross-sectional study screened newly diagnosed T2DM patients admitted to the Endocrinology Department of Central Theater General Hospital between October 2022 and May 2023, and healthy physical examination subjects who underwent physical examination in the physical examination center of the hospital at the same time were chosen as the study subjects. The newly diagnosed T2DM patients were divided into non-carotid atherosclerosis (NCAS) group and CAS group according to the results of carotid artery color doppler ultrasound, and the healthy individuals who underwent physical examinations during the same period were included as the healthy control group. MYDGF, carotid intimedia thickness (CIMT), diastolic blood pressure (DBP), glycated hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), 2 h-postprandial plasma glucose (2hPG), fasting insulin (FINS), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), apolipoprotein A1 (Apo A1) were collected. FPG and FINS were used to calculate homeostasis model assessment of insulin resistance (HOMA-IR). Height and weight were measured and the body mass index (BMI) was calculated. One-way analysis of variance, Kruskal-Wallis H test or χ2 test were used to compare the groups, Spearman correlation analysis was used to analyze the correlation between CIMT and other indicators in newly diagnosed T2DM patients, and binary logistic regression analysis was used to explore the factors influencing newly diagnosed T2DM patients with CAS. Results A total of 136 newly diagnosed T2DM patients were enrolled, including 62 in the NCAS group and 74 in the CAS group. The healthy control group consisted of 60 subjects. Serum MYDGF in newly diagnosed T2DM patients in both the NCAS group and the CAS group were elevated compared with healthy controls (both P<0.05). Among newly diagnosed T2DM patients, BMI, DBP, HbA1c, FPG, 2hPG, FINS, HOMA-IR, TC and CIMT were higher in CAS group than in NCAS group, and HDL-C, Apo A1 and MYDGF were lower, with statistical significance (all P<0.05). Spearman correlation analysis showed that CIMT in newly diagnosed T2DM patients was positively correlated with BMI (r=0.400, P<0.001), DBP (r=0.240, P=0.005), HbA1c (r=0.428, P<0.001), FPG (r= 0.253, P=0.003), HOMA-IR (r=0.456, P<0.001) and TC (r=0.239, P=0.005), and negatively correlated with MYDGF (r=-0.789, P<0.001). Binary logistic regression analysis showed that DBP (OR=1.149, 95%CI 1.057-1.249, P=0.001), HbA1c (OR=1.604, 95%CI 1.060-2.427, P=0.025), HOMA-IR (OR= 1.443, 95%CI 1.034-2.015, P=0.031), TC (OR=9.839, 95%CI 2.830-34.201, P<0.001), MYDGF (OR= 0.935, 95%CI 0.906-0.964, P<0.001) were influential factors in newly diagnosed T2DM patients with CAS. Conclusion In newly diagnosed T2DM patients, serum MYDGF levels are negatively correlated with CIMT, and MYDGF is an influential factor in newly diagnosed T2DM complicated by CAS. [ABSTRACT FROM AUTHOR]

Objective To establish a nude mouse model of type 2 diabetes mellitus (T2DM) and pancreatic cancer that allows dynamic observation of tumor formation process and facilitates in vivo research. Methods At first, human pancreatic cancer PANC-1 cells were transfected with lentiviral vector GV260 to construct the pancreatic cancer cell line PANC-1-Luc with stable expression of firefly luciferase. Then, 36 specific pathogen-free nude mice were randomly divided into control group with 12 mice and model group with 24 mice (nude mice with T2DM and pancreatic cancer). The mice in the control group were fed with breeding diet and were then given ectopic subcutaneous implantation of PANC-1-Luc cells, and those in the model group were first given high-fat diet and intraperitoneal injection of 1% STZ, followed by ectopic subcutaneous implantation of PANC-1-Luc cells. The fluorescence in vivo imaging system and the manual measurement method were used for simultaneous and dynamic monitoring of the growth of pancreatic cancer in nude mice in the two groups, and the tumor growth curve was plotted to investigate the correlation between fluorescence value and tumor volume. Subcutaneous tumors and pancreatic islets were observed under a microscope to verify whether the model was successfully established, and immunohistochemistry was used to measure the expression of Ki-67 in tumor tissue to investigate the influence of hyperglycemia on the growth of pancreatic cancer in nude mice. The independent-samples t test was used for comparison of normally distributed continuous data between groups, and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups. Results The optimal virus titer was determined as 5×107 TU/mL for the stable transfection of lentiviral vector in PANC-1 cells, and the optimal concentration selected with puromycin was 20 µg/mL, with an optimal selection time of 9 days. The fluorescence value of PANC-1-Luc cells was linearly and positively correlated with the number of cells, with the linear equation of y=42.56x－42 504(r=0.977, P=0.004). The blood glucose value of T2DM nude mice was 23.05(19.25 — 26.40) mmol/L, with a blood glucose level of >11.1 mmol/L in each nude mouse, and there was a significant difference in blood glucose value between the T2DM nude mice and the control nude [6.15 (5.20 — 7.30) mmol/L] (Z=−8.45, P<0.001). Compared with the control group, the model group had reductions in the number and volume of pancreatic islets, with irregular shapes and unclear boundaries, and pathological examination confirmed that the xenograft tumor was pancreatic cancer tissue, which showed that the model was established successfully. In the model group, there was a linear positive correlation between subcutaneous tumor size and fluorescence values, with the linear equation of y=232 348 691x－ 8 258 608(r=0.911, P=0.031). The model group had a significantly higher positive rate of Ki-67 than the control group (50.333%± 7.808% vs 15.917%±4.055%, t=13.55, P<0.001), suggesting rapid tumor proliferation in the model group. Conclusion The T2DM nude mouse model of pancreatic cancer established in this study can simulate the pathological process of the development and progression of pancreatic cancer in the context of T2DM and dynamically observe the influence of hyperglycemia on the growth of pancreatic cancer cells in vivo, thereby providing a new experimental vector for the in vivo study of the development and progression of pancreatic cancer in the context of T2DM. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background The prevalence of diabetes and cardiovascular diseases in China has been increasing annually, and it has been demonstrated that diabetes can exacerbate the adverse effects of cardiovascular diseases through nutritional and inflammatory pathways. The prognostic nutritional index (PNI) is a marker of immunonutrition that reflects the inflammation, immune status and nutritional status of an individual. Due to its advantages of simplicity, rapidity, accessibility, and reliability, research on PNI has been increasing, yet its role in cardiovascular diseases has been less explored. Objective To investigate the relationship between PNI and major in-hospital adverse cardiovascular events (MACE) in patients with acute ST-elevation myocardial infarction (STEMI) complicated by type 2 diabetes mellitus (T2DM) following percutaneous coronary intervention (PCI) . Methods A retrospective analysis of 1 053 STEMI patients with T2DM who underwent PCI at the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2023 was conducted. The patients were divided into the MACE (n=177) and non-MACE (n=876) groups according to the occurrence of MACE during hospitalization, and further categorized into the high PNI (n=686) and low PNI (n=367) groups according based on the cutoff value of PNI to predict the occurrence of in-hospital MACE after PCI in patients with STEMI and T2DM. Univariate and multivariate Logistic regression analyses identified factors influencing in-hospital MACE after PCI in patients with STEMI and T2DM. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of PNI for in-hospital MACE, and the area under the curve (AUC) was calculated. Pearson correlation analysis or Spearman rank correlation analysis was used to explore the correlation between PNI and cardiovascular disease risk factors. Results The differences between the MACE and non-MACE groups in gender, age, history of hypertension, serum glucose, Killip classification, lactate dehydrogenase, heart rate, myoglobin, creatine kinase-MB isoenzyme (CK-MB), white blood cell count, brain natriuretic peptide (BNP), PNI, Global Registry of Acute Coronary Events (GRACE) score, hemoglobin, platelet count, lymphocyte count, albumin, total protein, creatinine, urea nitrogen and triacylglycerol were statistically significant (P

Background The risk of diabetes mellitus can increase with age, and the prevalence of prediabetes and diabetes mellitus in the middle-aged and elderly adults is 40% and 10%, respectively. Good adherence to blood glucose monitoring improves the rate of glycohemoglobin compliance. However, adherence to blood glucose monitoring is poor in patients with type 2 diabetes mellitus (T2DM) in rural areas. Objective To investigate and understand the blood glucose monitoring situation of middle-aged and elderly patients with T2DM aged 45 to 65 years in rural areas of Zhongmou County, Henan Province, explore the psychological and behavioral factors affecting their adherence to blood glucose monitoring and monitoring frequency, so as to provide a reference for targeted interventions to improve the blood glucose monitoring compliance of the middle-aged and elderly patients with T2DM in rural areas. Methods Middle-aged and elderly T2DM patients in rural areas of Zhongmou County, Henan Province from November 2 to 12, 2021 were selected to conduct for questionnaire survey by using convenience sampling method. A self-designed general information questionnaire was used to investigate their basic information and blood glucose monitoring. Additionally, the Five-item Mindful Awareness Attention Scale (MAAS-5), Generalized Anxiety Disorder Questionnaire (GAD-7), Patient Health Questionnaire (PHQ-9), and Diabetic Self-management Scale (DSMS) were used to investigate their mindfulness, anxiety, depression, and self-management ability, respectively. Univariate analysis, multivariate Logistic regression and negative binomial regressions were used to explore the influencing factors of situation and frequency of blood glucose monitoring and monitoring frequency in middle-aged and elderly T2DM patients. Results A total of 484 questionnaires were collected, and 469 were enrolled in this study, with a recovery rate of 96.9%. Of the 469 patients, 58.8% (276/469) were unable to monitor blood glucose monthly, and the frequency of monthly blood glucose measurements for the 193 patients who monitored blood glucose ranged from 1 to 60 times, with a median of 2 times. Logistic and negative binomial regression analysis showed that depression symptoms (AOR=1.127, P=0.005), high information level (AOR=0.133, P=0.023), and high motivation level (AOR=1.093, P=0.002) were facilitators of blood glucose monitoring; high annual income (AIRR=2.063, P

Background Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes, which is highly prevalent and harmful. Early detection of DN is an important task in preventing related diseases. Currently, most of the researches are based on traditional statistical prediction methods, and data need to meet the prerequisites it requires. It is necessary to try to apply new methods such as machine learning in the area of DN prediction for its failing to meet the needs in the field of DN prediction in recent years. Objective To construct DN prediction model using the LASSO regression and BP neural network optimized by sparrow search algorithm (SSA-BP) . Methods This study was conducted from April 2023 to August 2023, and the data was obtained from publicly available data on complications of 133 patients with diabetes mellitus in Iran. Univariate analysis was conducted using SPSS 26.0 software, and variables were screened using LASSO regression. Using the presence of DN as the dependent variable, the training and testing sets were divided into 8∶2 and 7∶3 ratios, respectively. The SSA-BP neural network was used for modeling and analysis, and the prediction performance was compared with classical machine learning models to analyze the better DN model. Model evaluation was performed based on accuracy, precision, sensitivity, specificity, F1-score and AUC indicators. Results Excluding 9 patients with type 1 diabetes, the effective sample size included in this study was 124 patients with type 2 diabetes mellitus (T2DM) , of which 73 (58.9%) were diagnosed with DN. Univariate analysis of risk factors for type 2 DN showed statistically significant for age, BMI, duration of diabetes, fasting blood glucose (FBG) , glycosylated hemoglobin (HbA1c) , low-density lipoprotein (LDL) , high-density lipoprotein (HDL) , triacylglycerol (TG) , systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P

Background Type 2 diabetes mellitus (T2DM) has become a public health burden facing the whole world, with the rapid development of Internet and digital technology, intelligent service model plays an important role in the management of patients with T2DM. Objective To explore the effectiveness of wearable devices combined with health coaching in patients with T2DM. Methods A total of 315 patients with T2DM who were hospitalized in the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were selected as the study subjects, and divided into the control group, the intervention A group and the intervention B group based on the method of randomized numerical table, the control group implemented the routine management measures based on capillary blood glucose monitoring, the intervention A group adopted the wearable devices for routine management, the intervention B group was managed by wearable devices combined with health coaching. The differences in glycemic and lipid control status and self-management behaviors among the three groups before and 3, 6, 9 and 12 months after intervention were compared. Results A total of 15 lost visits were made during the implementation of the study, and 300 study subjects were finally included in the analysis, with 100 in each of the three groups. There was an interaction between intervention method and time in the three groups on 2-hour postprandial blood glucose (2 hPG) , glycated hemoglobin (HbA1c) , number of hypoglycemic episodes, low-density lipoprotein cholesterol (LDL-C) , self-management behaviors of diabetes mellitus (2-DSCS) , and self-management behaviors of diabetic patients (SDSCA) scores (P

Background China ranks first in the world in terms of the number of diabetes patients. In recent years, the prevalence and mortality of diabetes have been rising, threatening people's health and placing a heavy burden on the people of China. As the prevalence of obesity continues to rise, the burden of diabetes is expected to continue to rise, and diabetes has become a public health problem that cannot be ignored in China. Objective To describe and analyze the disease burden of type 2 diabetes attributable to high BMI and its trend in China from 1990 to 2019, and predict the disease burden of type 2 diabetes attributable to high BMI in China from 2020 to 2024, so as to provide a basis for the scientific prevention and control of type 2 diabetes in China. Methods In May 2023, data on the burden of disease indicators of type 2 diabetes such as disability-adjusted life years (DALYs) , DALYs rate, standardized DALYs rate, death toll, mortality rate and standardized mortality rate of type 2 diabetes in China from 1990 to 2019 were extracted from the Global Burden of Disease 2019 (GBD 2019) , and the trend was analyzed by annual percentage change (APC) and average annual percentage change (AAPC) using the Joinpoint Regression Model. An autoregressive moving average (ARIMA) model of DALYs rate and mortality rate of type 2 diabetes attributable to high BMI was constructed based on the data from 1990 to 2016 (training set) , and evaluated using the data from 2017 to 2019 (test set) . The relative error between the predicted value and the actual value, the mean absolute error (MAE) , mean absolute percentage error (MAPE) , mean square error (MSE) and root mean square error (RMSE) of the model were used to determine the model prediction effect, and the optimal model was selected to predict the burden of type 2 diabetes attributable to high BMI in China from 2020 to 2024. Results From 1990 to 2019, the burden of disease showed an overall upward trend (AAPC of standardized DALYs rate=2.85%, AAPC of standardized mortality=2.32%, both P

Background Diabetes nephropathy (DN) is a common complication of diabetes patients. The prediction and validation of its risk will help identify high-risk patients in advance and take intervention measures to avoid or delay the progress of nephropathy. Objective To analyze the risk factors affecting the complication of DN in patients with type 2 diabetes mellitus (T2DM) , construct a risk prediction model for the risk of DN in T2DM patients and validate it. Methods A total of 5 810 patients with T2DM admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2021 were selected as the study subjects and divided into the DN group (n=481) and non-DN group (n=5 329) according to the complication of DN. A 1∶1 case-control matching was performed on 481 of these DN patients and non-DN patients by gender and age (±2 years) , and the matched 962 T2DM patients were randomly divided into the training group (n=641) and validation group (n=321) based on a 2∶1 ratio. Basic data of patients, such as clinical characteristics, laboratory test results and other related data, were collected. LASSO regression was applied to optimize the screening variables, and a nomogram prediction model was developed using multivariate Logistic regression analysis. The discriminability, calibration and clinical validity of the prediction model were evaluated by using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow calibration curve, and decision curve analysis (DCA) , respectively. Results There were significant differences in gender, age, BMI, course of diabetes, white blood cell count, total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, serum creatinine, hypertension, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, apolipoprotein B, 24-hour urinary micro total protein, qualitative urinary protein between the DN and non-DN group (P

Type 2 diabetes mellitus (T2DM) is related to the higher incidence and the increased invasiveness of endometrial cancer (EC). Hyperglycemia, hyperinsulinemia, insulin resistance and obesity in patients with T2DM have been widely studied as potential pathogenesis of EC, and the imbalance of intestinal flora may be the key factor of T2DM-related EC. This paper summarizes the relationships between T2DM and EC, T2DM and intestinal flora, T2DM-related EC and intestinal flora, including the abnormal expression of microRNA, mitochondrial dysfunction, inflammation and adiponectin level, and the progress of intestinal flora in treating T2DM-related EC, in order to provide a reference for the prevention and treatment of T2DM-related EC from the perspective of intestinal flora. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between cognitive function and brain structure changes in overweight and obese patients with type 2 diabetes mellitus (T2DM). Methods This was a cross‑sectional study. T2DM patients who visited the Endocrinology Department of Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, from February 2016 to July 2023 were collected. T2DM Patients were divided into normal weight T2DM group, overweight and obese T2DM group according to body mass index (BMI). At the same time, we recruited healthy people who visited the Health Management Center of Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, matched for age and education level, and whose 18.5 kg/m2 ≤BMI<24.0 kg/m2 served as the healthy control group. The age, education level, height and weight of the three groups were collected, and BMI was calculated. The fat mass in android area was measured to calculate the fat mass index (FMI). Immediate memory was assessed using Repeatable Battery for the Assessment of Neuropsychological Status. Left and right hippocampal volumes were measured. Independent‑samples t test and one‑way analysis of variance were used to compare data between the groups. Covariance one‑way analysis of variance was used to compare cognitive function, the volume of total brain and subcortical nuclei. The mediation effect model was used to analyze the mediating effect of brain structure on the relationship between body fat distribution, brain structure and cognitive function. Results A total of 350 people were enrolled, including 50 healthy controls, 100 normal weight T2DM patients, 200 overweight and obese T2DM patients. Compared with normal weight T2DM group, overweight and obese T2DM patients have higher FMI in android area (t=11.90,P<0.001). The results of covariance one‑way analysis of variance showed that compared with healthy controls and normal weight T2DM patients, overweight and obese T2DM patients have lower immediate memory score (P values were 0.048 and 0.041, respectively) and significantly reduced left and right hippocampal volume (P values were 0.002 and 0.036 on the left side and P values were 0.004 and 0.022 on the right side, respectively). Mediation effect model analysis showed that in patients with T2DM, the volume of left hippocampus partially mediated the association between FMI of android area and immediate memory score (β =-0.313, 95%CI -0.695--0.076). Conclusions Cognitive impairment and hippocampal volume atrophy were more significant in overweight and obese T2DM patients than in normal weight T2DM patients. Increased abdominal fat in T2DM patients is associated with cognitive impairment and hippocampal volume atrophy. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between serum apolipoprotein A1 (ApoA1) levels and the risk of diabetic kidney disease (DKD) in hospitalized patients with newly diagnosed type 2 diabetes mellitus (T2DM). Methods This cross‐sectional study included 670 newly diagnosed T2DM patients who were hospitalized at the Department of Endocrinology of Xuzhou Municipal Hospital, affiliated to Xuzhou Medical University from January 2018 to May 2022. Patient data including age, sex, smoking, alcohol consumption, duration of diabetes mellitus, body mass index (BMI), previous medical history, previous medication history, diabetes complications, ApoA1, triglycerides (TG), total cholesterol (TC), low‐density lipoprotein cholesterol (LDL‐C), high‐density lipoprotein cholesterol (HDL‐C), lipoprotein a (LPa), apolipoprotein B (ApoB), apolipoprotein E (ApoE), fasting plasma glucose (FPG), glycated hemoglobin A1c (HbA1c ), estimated glomerular filtration rate (eGFR), and urinary albumin ‐ to ‐ creatinine ratio (UACR) were collected. Patients were categorized into DKD (233 patients) and non‐DKD (437 patients) groups according to the presence or absence of DKD. The t test, rank sum test and χ² test were used for between‐group comparisons of quantitative and qualitative variables, respectively. The correlation between serum ApoA1 levels and DKD risk was assessed by multivariate logistic regression. Results Serum ApoA1 levels were significantly lower in the DKD group when compared to the non‐DKD group [(1.36± 0.40) vs. (1.53±0.35) g/L, respectively, t=5.22, P<0.010]. After adjusting for age, sex, smoking, alcohol consumption, duration of diabetes, BMI, hypertension, antihypertensive medication, TG, TC, LDL‐C, HDL‐C, LPa, ApoB, ApoE, FPG, HbA1c, eGFR, and UACR, a significant correlation was found between the serum ApoA1 level and the risk of DKD in logistic regression (OR=0.24, P=0.010). Conclusions Among newly diagnosed T2DM patients, serum ApoA1 levels were significantly lower in those with DKD than in those without DKD, and serum ApoA1 levels were significantly and negatively associated with the risk of DKD. [ABSTRACT FROM AUTHOR]

Diabetes is a significant independent risk factor for atherosclerotic cardiovascular disease (ASCVD), with dyslipidemia playing a critical role in the initiation and progression of ASCVD in diabetic patients. Currently in China, the prevalence of dyslipidemia in diabetes is high, while the control rate remains low. Therefore, to enhance lipid management in patients with diabetes, the Endocrinology and Metabolism Physician Branch of Chinese Medical Doctor Association, in collaboration with the Experts′ Committee of National Society of Cardiometabolic Medicine, has convened experts to develop a consensus on the management of dyslipidemia in patients with type 1 or type 2 diabetes. The development of this consensus is informed by the existing practices in lipid management among Chinese diabetic patients, incorporating contemporary evidence‑based findings and guidelines from national and international sources. The consensus encompasses the lipid profile characteristics, the current epidemiological status of dyslipidemia, ASCVD risk stratification, and lipid management procedures in diabetic patients. For the first time, both low‑density lipoprotein‑cholesterol (LDL‑C) and non‑high‑density lipoprotein‑cholesterol (non‑HDL‑C) have been recommended as primary targets for lipid intervention in diabetic patients. The consensus also includes a summary and recommendations for lipid management strategies in special diabetic populations, including children and adolescents, individuals aged 75 years and older, patients with chronic kidney disease, metabolic‑associated fatty liver disease, as well as those who are pregnant. This comprehensive consensus will contribute to the dissemination of key clinical advancements and guide clinical practice, aiming to improve cardiovascular outcomes in diabetic patients. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Journal of Clinical Healthcare is the property of Chinese Journal of Clinical Healthcare and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the predictive value of hemoglobin glycation index (HGI) and monocyte to high‑density lipoprotein‑cholesterol ratio (MHR) in type 2 diabetes mellitus (T2DM) with cerebral small vessel disease (CSVD). Methods This was a cross‑sectional study. Patients with T2DM who were hospitalized in the Department of Endocrinology and Department of Neurology of Suqian First Hospital from January 2020 to December 2022 were enrolled as the subjects. Patients were divided into T2DM alone group and T2DM with CSVD group according to whether they were combined with CSVD. Monocyte counts, high‑density lipoprotein‑cholesterol (HDL‑C), glycated hemoglobin A1c (HbA1c ), fasting plasma glucose (FPG) were collected, and MHR and HGI were calculated. Two independent sample t test, the Mann‑Whitney U test, or the χ² test were used for the comparisons between the two groups. Spearman correlation was used to analyze the correlation between HGI and MHR and T2DM with CSVD. Multivariate logistic regression analysis was used to determine the influencing factors of T2DM with CSVD. Receiver operating characteristic (ROC) curve was used to assess the diagnostic value of HGI and MHR for T2DM with CSVD. Results A total of 361 patients with T2DM were included. There were 170 patients in the T2DM alone group and 191 patients in the T2DM with CSVD group. Compared with T2DM alone, patients in T2DM with CSVD group had higher MHR and HGI (P<0.001). Spearman correlation analysis showed that both HGI (r=0.196, P<0.001) and MHR (r=0.349, P<0.001) were positively correlated with T2DM and CSVD. Multivariate logistic regression analysis showed that both HGI (OR=1.314, 95%CI 1.052-1.642, P=0.016) and MHR (OR=1.056, 95%CI 1.039-1.073, P<0.001) were the influencing factors of T2DM with CVSD. The results of ROC curve analysis showed that the areas under the HGI and MHR were 0.613 (95%CI 0.555-0.671, P<0.001) and 0.702 (95%CI 0.649-0.755, P<0.001), respectively. The area under the curve predicted by HGI and MHR was 0.729 (95%CI 0.678-0.780, P< 0.001). Conclusion HGI and MHR are closely related to the onset of CSVD in T2DM patients, and have certain value in predicting T2DM with CSVD, their combined diagnostic value is higher. [ABSTRACT FROM AUTHOR]

Objective: To detect the stiffness of the gastrocnemius muscle in the patients with type 2 diabetes under different functional states by shear wave elastography (SWE) method, and to provide the objective basis for the early clinical detection of skeletal muscle damage. Methods: A total of 70 patients with type 2 diabetes were selected as diabetes group, and 70 healthy examinees underwent medical checkups were regared as control group. SWE was used to detect the Young’s modulus (E) value of the gastrocnemius muscle of the subjects in both groups under three different conditions (neutral ankle position at rest, plantar flexion ankle position during isometric contraction, and upright position during isometric contraction; the E values were normalized by body mass index (BMI) (EBMI=E/BMI); the differences in passive and active stiffness of the gastrocnemius muscle under various conditions of the subjects between two groups were compared; Pearson correlation analysis was used to assess the correlation of the E value in the diabetic patients with patients’ age, disease duration, level of glycated hemoglobin (HbA1c), and level of advanced glycation end-products (AGEs). Results: There were no significant differences in the passive stiffness E values and EBMI values of the gastrocnemius muscle of the subjects between two groups under neutral position (P>0. 05); there was no significant difference in the active stiffness E values of the gastrocnemius muscle under plantar flexion ankle position (P>0. 05), but the EBMI value of the subjects in diabetes group were lower than that in control group (P<0. 01). Both E value and EBMI value of active stiffness under upright position of the subjects in diabetes group were lower than those in control group (P< 0. 01). The E value of active stiffness of the gastrocnemius of the subjects in diabetes group showed a negative correlation with disease duration, HbA1c level, and AGE level (r= - 0. 645, P<0. 05; r= -0. 741, P<0. 05; r=-0. 675, P<0. 05), and had no correlation with age (r=-0. 116, P>0. 05). Conclusion: The patients with type 2 diabetes exhibit reduced active stiffness in the gastrocnemius muscle, while passive stiffness may not be affected in the early stage. The use of SWE to measure active stiffness of the gastrocnemius muscle in standing isometric contraction can aid in the detection of subclinical muscle contraction function decline in the patients with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background Patients with type 2 diabetes usually lack sufficient awareness of safe exercise and have poor exercise compliance, which requires the management of exercise interventions by professionals to improve the health status of patients with type 2 diabetes. A strategy worth considering is the management of exercise interventions for patients by community health workers. Currently, there is a lack of research on the management of exercise interventions, and studies on the health management of patients with type 2 diabetes usually only mention exercise without specific exercise management measures. Additionally, there is a lack of quantitative systematic reviews. Objective To systematically review the health effects of exercise interventions based on community health workers' management for patients with type 2 diabetes and specific exercise intervention programs. Methods Eight Chinese and English databases, including PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data, VIP and CBM were searched by computer from inception to October 17, 2022, to screen randomized controlled trials on the effects of exercise interventions based on community health workers' management for patients with type 2 diabetes, in which the intervention group adopted an exercise intervention program based on community health workers' management and the control group adopted conventional care. Literature screening, quality assessment, and data extraction were performed independently by 2 investigators. Meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. Sensitivity and subgroup analyses were carried out to find sources of heterogeneity. Pre-identified subgroups were intervention duration (3 months; 6 months; >6 months), frequency of exercise (3 times/week; >3 times/week), and duration of the single exercise session (≤30 min/session; >30 min/session) . Results A total of 1 079 subjects from 11 articles were finally included in this review, of which 550 were in the intervention group and 529 in the control group. The results of the Meta-analysis revealed that the exercise interventions based on community health workers' management were more effective than the control groups in reducing glycated hemoglobin (MD=-1.07, 95%CI=-1.31 to -0.83, P30 min/session compared with ≤30 min/session (P=0.001) ; single exercise session of three months duration showed more significant improvements in glycated hemoglobin (P30 min/session, >3 sessions/week, and duration of ≥3 months in future exercise intervention management for type 2 diabetes. If the patients with type 2 diabetes mellitus have concurrent dyslipidemia, it is recommended that the duration of the exercise intervention should ideally last for more than 6 months.

Type 2 diabetes mellitus (T2DM) is one of the common chronic diseases among the elderly. Persistent hyperglycemia damages blood vessels throughout the body, affecting organs and tissues such as heart, kidneys, eyes, and nerves, leading to various complications. Atherosclerotic cardiovascular diseases (ASCVD) are the main cause of death in T2DM patients. Such patients need comprehensive treatment such as glucose-lowering, lipid-regulation, antihypertensive, antiplatelet, and urinary protein-lowering treatments. Polypharmacy plays a good role in disease control in older adults with multiple comorbidities, but it also poses a number of problems such as potential drug interactions and adverse drug reactions if applied in an irrational and unscientific manner. This paper analyses the management of polypharmacy in elderly T2DM patients combined with ASCVD, with a particular emphasis on the interactions among hypoglycemic, antihypertensive, lipid-regulating, and antiplatelet medications, as well as precautions, so as to improve the rationality, safety and standardization of medication under the premise of ensuring the efficacy of medication, reduce the occurrence of adverse reactions and provide reference for clinicians in the use of drugs.

Background Since 2009, community health management for type 2 diabetes mellitus (T2DM) has been significantly promoted and implemented as a national public health service program. However, the impact of clinical inertia, defined as failure to take timely interventions when therapeutic goals are unmet, hinders the achievement of long-term optimal glycemic control in T2DM patients. Therefore, addressing clinical inertia to improve glycemic control rates is an important and urgent task for optimizing diabetes health management. Objective To identify the key failure modes of clinical inertia in community health management for T2DM, systematically analyze the underlying causes of these failure modes, and propose corresponding intervention measures. Methods Based on community realities and guided by the Healthcare Failure Mode and Effect Analysis (HFMEA) framework, a foundational comprehension of community health management processes for T2DM, the root causes of clinical inertia, and prospective intervention measures were obtained through field research, interviews, and literature review from 2020-01-01 to 2023-06-30. The Delphi method was employed based on this basis to engage 16 experts in two rounds of expert consultation during 2022-01-10—02-25, to delineate the key failure modes, their root causes, and intervention measures concerning clinical inertia in community health management for T2DM. Results The expert authority coefficients for the first and second rounds were 0.791 and 0.729, respectively, ten key failure modes of clinical inertia in community health management for T2DM were quantitatively identified by calculating the risk priority number (RPN) metric and ranked in descending RPN value as follows: untimely insulin treatment, untimely alcohol cessation, untimely routine referral, untimely smoking cessation, untimely emergency referral, untimely triple therapy, untimely weight control, untimely dietary modification, untimely dichotomous therapy, and untimely detection of hypoglycemia. The root causes of these key failure modes were explored from the perspectives of patients, physicians, and the healthcare system, enabling the formulation of targeted intervention measures. Conclusion The devised intervention measures to address clinical inertia exhibit substantial scientific validity and authority, providing a robust foundation for enhancing the community health management model for T2DM.

Background The prevalence rate of type 2 diabetes is increasing in China. General practitioners play an important role in the prevention and treatment of type 2 diabetes and its complications. Chronic kidney disease (CKD) is a common co-existing disease in patients with diabetes. However, at present, there is little research evidence on type 2 diabetes combined with CKD in primary care in China. Objective To investigate the obstructive factors in the monitoring and management of type 2 diabetes mellitus with CKD from the perspective of general practitioners. Methods From May to July 2022, a one-to-half structured interview was conducted with snowball sampling among general practitioners in an urban area of Beijing, and the interview outline was formulated based on the theoretical domains framework (TDF). NVivo 11 software was used to encode and classify the interview contents. Subject frame analysis method was used to sort out and analyze the data, and extract the theme. Results 13 general practitioners were interviewed in this study, and the years of working in general practice ranged from 8 to 22 years. The study identified barriers related to six domains in TDF, namely knowledge/skills, beliefs about outcomes, motivation and goals, medical background, resources and norms of conduct. After refining again, the themes were lack of systematic knowledge and skills related to CKD, imperfect incentive mechanism of primary medical staff, lack of smooth referral process between primary medical institutions and higher hospitals, poor self-management ability of patients and other obstacles. Conclusion There are many factors preventing general practitioners from monitoring and managing patients with type 2 diabetes complicated with CKD in the community. It is necessary to strengthen the knowledge and skills training of general practitioners with diabetes mellitus complicated with CKD, improve the ability of general practitioners to monitor and manage CKD, improve the incentive mechanism of primary medical institutions and establish an effective referral process with superior hospitals, strengthen the health education of patients, improve the self-management ability of patients, and enhance the prevention and treatment ability of primary medical institutions with type 2 diabetes complicated with CKD.

Background With the continuous improvement of diabetes prevention and treatment strategies, clinical guidelines recommend first-line hypoglycemic agents while emphasizing a "patient-centered", and the selection of appropriate second-line hypoglycemic agents based on patients' clinical characteristics and preferences. Objective To quantitatively analyze second-line hypoglycemic agents selection preferences in patients with type 2 diabetes mellitus (T2DM) by using a discrete choice experiment, so as to provide reference for clinical diagnosis and treatment for T2DM patients. Methods This study conducted a questionnaire survey on T2DM patients selected from Hainan and Shanxi provinces from October 2021 to January 2022 by using a combination of multi-stage random cluster sampling. The questionnaire included basic personal information of the respondents, information related to disease treatment and discrete choice experimental choice set (seven attributes of glycemic control, risk of hypoglycemic events, risk of gastrointestinal adverse events, body mass change within six months, cardiovascular protection, mode of medication administration, and out-of-pocket/monthly costs, each of which included a various levels were included through the literature review, focus group discussion, and pre-tests). A mixed Logit regression model was used to quantify the preference of T2DM patients for second-line hypoglycemic agents, and the regression coefficients reflected the direction and magnitude of the preference for second-line hypoglycemic agents among T2DM patients. Willingness to pay (WTP) reflected the monetary value of patients' willingness to pay or receive compensation after the changes in different attribute levels. Results A total of 1 443 questionnaires were distributed and 1 388 valid questionnaires were recovered, with an effective recovery rate of 96.2%. All seven attributes had an effect on medication preference of T2DM patients (P

Background Although type 2 diabetes mellitus (T2DM) cannot be completely cured, however, there is a consensus that timely community management of T2DM patients following guidelines can lead to good glycemic control. However, blood glucose of the patients is chronically suboptimal due to T2DM-related clinical inertia. It is crucial for improving the effectiveness of diabetes control to determine the current status and influencing factors of clinical inertia in T2DM patients in community, but there is limited literature on this topic. Objective To investigate current status and influencing factors of clinical inertia during health management in T2DM patients in community. Methods From January to December 2020, T2DM patients receiving health management services from the national basic public health services in Qingjiangpu and Huaian Districts, Huaian City, Jiangsu Province, were recruited using cluster random sampling method to perform face-to-face questionnaire survey, physical examination, and laboratory tests. Clinical inertia was defined as the absence of intensification in antidiabetic treatment for patients with inadequate HbA1c control (HbA1c≥7.0%) in the past three months. Stepwise multiple Logistic regression analysis was performed to identify influencing factors of the detection of clinical inertia in T2DM patients in community. Results A total of 3 346 T2DM patients with inadequate glycemic control (HbA1c≥7.0%) were included in the study, with the overall detection rate of clinical inertia in T2DM patients of 93.96% (3 144/3 346), 94.84% (1 139/1 201) in men and 93.47% (2 005/2 145) in women, respectively. There were significant differences in the detection rate of clinical inertia among T2DM patients with different levels of dietary control, physical activity, blood glucose monitoring periods, diabetic complications, dyslipidemia (history), and history of coronary heart disease, stroke, and cancer. Stepwise multiple Logistic regression analysis showed that dietary control〔OR (95%CI) =0.585 (0.382, 0.894) 〕, glucose monitoring period≤1 week〔OR (95%CI) =0.470 (0.344, 0.644) 〕, presence of diabetic complications〔OR (95%CI) =0.606 (0.423, 0.868) 〕, dyslipidemia (history) 〔OR (95%CI) =0.725 (0.532, 0.988) 〕, history of coronary artery disease〔OR (95%CI) =0.659 (0.458, 0.949) 〕, and stroke〔OR (95%CI) =0.699 (0.511, 0.955) 〕were associated with a lower prevalence of clinical inertia in T2DM patients (P

Background The clinical application of flash glucose monitoring system (FGM) is becoming increasingly widespread, which can be continuously monitored for 14 days and does not require fingertip blood correction during wearing, providing a basis for clinical treatment. Therefore, the accuracy of FGM is particularly important. Objective To investigate the effect of human body composition and serum biochemical indicators on the accuracy of FGM sensor. Methods Patients with type 2 diabetes mellitus (T2DM) hospitalized in the Department of Endocrinology of the Second Affiliated Hospital of Zhengzhou University in 2022 were selected as the study objects, and their general data was collected through the electronic medical record system. The blood glucose was detected by FGM and compared with intravenous blood glucose, the physical analysis data of patients was collected. Fasting venous blood was collected to analyze hematological parameters. The clinical accuracy of FGM was evaluated by Clarke error grid analysis. The included patients were divided into the accurate group (MARD20%, n=34) according to the matched mean absolute relative difference of blood glucose (MARD). Binary Logistic regression analysis was used to analyze the influencing factors of FGM accuracy. Results A total of 694 pairs of blood glucose data were collected. Clarke error grid analysis was performed on the blood glucose values of FGM scans using venous blood glucose as the reference value. The results showed that 82.9% fell in zone A, 16.9% fell in zone B, 99.8% fell in zone A+B, and 0.2% fell in zone D, with an average MARD of 12.7%. MARD and muscle mass in the inaccurate group were higher than those in the accurate group (P

Background Patients with type 2 diabetes commonly experience a high treatment burden. Currently, both domestic and international researches on the treatment burden of the specific diseases is still in its initial stage. Objective To summarize the conceptual framework of treatment burden related to type 2 diabetes in the Chinese population and explore proactive responding approaches for general practitioners based on video recordings of clinical consultation scenarios. Methods A retrospective analysis of video recordings from general practice training clinics in a standardized training base in Guangdong Province from 2018 to 2019 was conducted by using qualitative research methods such as observation record forms, notes from the fields, encoding-retrieval and thematic analysis, combining with existing conceptual framework of treatment burden. Results A total of 49 video recordings of doctor-patient communication about the treatment burden of type 2 diabetes were extracted from 25 video recordings. All 6 themes of the original conceptual framework were mentioned and 2 new themes (burden of medical information and drug-induced hypoglycemia) were identified by analysis that were mentioned repeatedly. A modified conceptual framework of the treatment burden of type 2 diabetes was finally developed containing 7 observable dimensions including economic, drug, medical management, lifestyle change, healthcare system, time/travel, and medical information burdens and the connotation of subtopics in each dimension. According to the analysis of the response approach, general practitioners who have received training can respond consciously to some of the treatment burdens (medications, medical information, time/travel, lifestyle change) by utilizing the skills of health education, enhanced communication, shared decision-making and motivational interviewing. Conclusion This study constructs a modified conceptual framework of treatment burden for patients with type 2 diabetes. General practitioners can consciously respond to treatment burdens of patients by using effective doctor-patient communication skills, in combination with the identification of conceptual dimensions in clinical practice.