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Copyright of Journal of Diabetes is the property of Wiley-Blackwell 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.)

Patients with type 2 diabetes mellitus (T2DM) are at risk of developing atherosclerotic cardiovascular disease (ASCVD) and chronic kidney disease (CKD), which are important causes of disabling and death in patients with T2DM. For the prevention and management of ASCVD or CKD, cardiovascular risk factors should be systematically evaluated, and ASCVD and CKD should be screened in patients with T2DM. In this consensus, we recommended that metformin should be used as the first‐line therapy for patients with T2DM and ASCVD or very high cardiovascular risk, heart failure (HF) or CKD, and should be retained in the treatment regimen unless contraindicated or not tolerated. In patients with T2DM and established ASCVD or very high cardiovascular risk, addition of a glucagon‐like peptide 1 receptor agonist (GLP‐1RA) or sodium–glucose cotransporter type 2 (SGLT2) inhibitor with proven cardiovascular benefits should be considered independent of individualised glycated haemoglobin (HbA1C) targets. In patients with T2DM and HF, an SGLT2 inhibitor should be preferably added regardless of HbA1C levels. In patients with T2DM and CKD, SGLT2 inhibitors should be preferred for the combination therapy independent of individualised HbA1C targets, and GLP‐1RAs with proven renal benefits would be alternative if SGLT2 inhibitors are contraindicated. Moreover, the prevention of hypoglycaemia and management of multiple risk factors by comprehensive regimen, including lifestyle intervention, antihypertensive therapies, lipid‐lowering treatment and antiplatelet therapies, should be kept in mind in treating patients with T2DM and ASCVD, HF or CKD. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect on pregnancy outcome of integrating a comprehensive management plan for patients with type 1 diabetes (T1D) into the World Health Organization universal maternal care infrastructure.Research Design and Methods: A comprehensive preconception-to-pregnancy management plan for women with T1D was implemented in 11 centers from 8 Chinese cities from 2015 to 2017. Sequential eligible pregnant women (n = 133 out of 137 initially enrolled) with T1D and singleton pregnancies attending these management centers formed the prospective cohort. The main outcome was severe adverse pregnancy outcome comprising maternal mortality, neonatal death, congenital malformations, miscarriage in the second trimester, and stillbirth. We compared pregnancy outcomes in this prospective cohort with two control groups with the same inclusion and exclusion criteria: a retrospective cohort (n = 153) of all eligible pregnant women with T1D attending the same management centers from 2012 to 2014 and a comparison cohort (n = 116) of all eligible pregnant women with T1D receiving routine care from 2015 to 2017 in 11 different centers from 7 cities.Results: The rate of severe adverse pregnancy outcome was lower in the prospective cohort (6.02%) than in either the retrospective cohort (18.30%; adjusted odds ratio [aOR] 0.31 [95% CI 0.13-0.74]) or the contemporaneous comparison cohort (25.00%; aOR 0.22 [95% CI 0.09-0.52]).Conclusions: The substantial improvements in the prospective cohort are evidence of a potentially clinically important effect of the comprehensive management plan on pregnancy outcomes among Chinese pregnant women with pregestational T1D. This supports the development of similar approaches in other countries. [ABSTRACT FROM AUTHOR]

Objective To identify the candidate pathogenic loci in exons of susceptibility genes for diabetic retinopathy (DR) in Chinese Han population. Methods This was a case-control study. The patients with type 2 diabetes mellitus (T2DM) diagnosed in Drum Tower Hospital Affiliated to Nanjing University Medical School between January 2015 and September 2018 were retrospectively analyzed. There were 101 DR patients in the case group and 103 non-DR patients in the control group. General information and laboratory results of patients were collected. The exons of DR susceptibility genes TBC1D4, COMMD6, UCHL3, LRP2, BBS5, ARL4C, and SH3BP4 in Chinese population were captured and sequenced by the second-generation sequencing technology of FastTarget target region enrichment. Independent sample t test and chi-square test were used to compare the general demographic characteristics between the two groups. Association between common/rare variants and DR risk was evaluated by logistic regression and counting method. Further, for our identified novel DR-related variants, functional annotation was adopted to assess their potential biological functions. Results The age and duration of diabetes in the case group were significantly lower than those in the control group (P<0.05), while the level of glycosylated hemoglobin was significantly higher than that in the control group (P<0.05). Logistic regression analysis showed that four of 82 common variants were associated with DR (P<0.05), including LRP2 rs13417389, LRP2 rs2229267, LRP2 rs2229268, and LRP2 rs886055072. Besides, 14 DR-related rare functional variants with CADD score greater than 20 were identified: LRP2 rs764804647 G>A, LRP2 rs538396567 T>A, LRP2 Chr2: 170010984 T>A, LRP2 Chr2: 170050282 C>A, LRP2 Chr2: 170129538 T>A, LRP2 Chr2: 170129538 T>C, LRP2 Chr2: 170129539 G>A, LRP2 Chr2: 170129539 G>T, LRP2 rs754796717 G>C, LRP2 rs529409328 C>G, UCHL3 Chr13: 76135016 A>G, TBC1D4 Chr13: 75876471 C>A, TBC1D4 rs201459702 T>C, SH3BP4 Chr2: 235950303 G>A. Conclusion The 14 DR-related rare functional variants identified in this study could be used as candidate pathogenic loci for diabetic retinopathy in Chinese Han population. [ABSTRACT FROM AUTHOR]

Aims: Disturbance of intestinal homeostasis promotes the development of type 2 diabetes. Although intensive insulin therapy has been shown to promote extended glycemic remission in newly diagnosed type 2 diabetic patients through multiple mechanisms, its effect on intestinal homeostasis remains unknown. Methods: This study evaluated the effects of intensive insulin therapy on intestinal morphometric parameters in a hyperglycemic mice model induced by high-fat diet (HFD). 16S rRNA V4 region sequencing and multivariate analysis were utilized to evaluate the structural changes of gut microbiota. Results: HFD-induced increases in the lengths of villus, microvillus and crypt depth were significantly reversed after intensive insulin therapy. Moreover, intestinal proliferation was notably decreased after intensive insulin therapy, whereas intestinal apoptosis was further increased. Importantly, intensive insulin therapy significantly shifted the overall structure of the HFD-disrupted gut microbiota toward that of mice fed a normal diet and changed the gut microbial composition. The abundances of 54 operational taxonomic units (OTUs) were changed by intensive insulin therapy. Thirty altered OTUs correlated with two or more intestinal morphometric parameters and were designated 'functionally relevant phylotypes.' Conclusions: For the first time, our data indicate that intensive insulin therapy recovers diabetes-associated gut structural abnormalities and restores the microbiome landscape. Moreover, specific altered 'functionally relevant phylotypes' correlates with improvement in diabetes-associated gut structural alterations. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to evaluate the occurrence of nocturnal hypoglycemia in type 1 diabetes (T1D) based on continuous glucose monitoring (CGM), and to explore the value of capillary glucose profiles in assessing the risk of nocturnal hypoglycemia. The study also intended to develop a predictive model to identify people with high risk of nocturnal hypoglycemia. Methods: A total of 169 participants with T1D received 3 days of blinded CGM; meanwhile, their self-monitoring blood glucose (SMBG) profiles were recorded. Logistic regression analyses were used to evaluate contributory factors of nocturnal hypoglycemia. Potential indicators were estimated using area under receiver operator curve (AUC) analyses. Results: During the retrospective CGM period, 95 (56.2%) participants with T1D reported 238 events of hypoglycemia, and 69 (29.0%) of these episodes occurred during the nighttime. Increased risk of nocturnal hypoglycemia correlated with lower HbA1c, glycated albumin, and mean blood glucose (OR = 0.790, 0.940, 0.651, respectively; P < 0.05) and higher standard deviation, mean amplitude of glycemic excursions, and low blood glucose index (OR = 1.463, 1.168, 4.035, respectively; P < 0.05) after adjustment for age and duration. Of the daily SMBG profiles, fasting blood glucose (OR = 0.643, P = 0.001) and blood glucose at bedtime (OR = 0.851, P = 0.037) were associated with the occurrence of nocturnal hypoglycemia. The BGn model, which was derived from the variation of capillary glucose, could discriminate individuals with increased risk of nocturnal hypoglycemia (AUC = 0.774). Conclusions: Nocturnal hypoglycemia constitutes nearly one-third of hypoglycemic events in people with T1D. Strict glycemic control and great fluctuation of glucose are potential contributory factors. Daily SMBG profiles and the BGn model could help assess the risk of nocturnal hypoglycemia in T1D, which may support further development of preventive strategies. [ABSTRACT FROM AUTHOR]

Background: Fetal sex has recently been considered to be related to maternal glucose homeostasis and perinatal outcomes during pregnancy. Here, we investigated the effects of fetal sex on the perinatal outcomes of pregnancies with normal glucose tolerance (NGT) and gestational diabetes mellitus (GDM).Methods: This was a retrospective cohort study of 1292 women with NGT and 1155 women with GDM. Pregnant women were divided into four groups according to the maternal glucose level and fetal sex. Logistic regression was used to evaluate the risks for adverse perinatal outcomes among NGT-males, NGT-females, GDM-males and GDM-females.Results: NGT-males had higher risks for macrosomia and large for gestational age (LGA) than NGT-females with an odds ratio (OR) of 1.9 (95% CI 1.2-2.9). Additionally, GDM-males had higher risks for neonatal infection (OR, 3.0; 95% CI, 1.3-6.9), acute respiratory disorders (OR, 3.9; 95% CI, 1.1-13.7) and abnormal neonatal central nervous system development (OR, 3.1; 95% CI, 1.1-8.4) than GDM-females. Furthermore, there was a significantly higher risk for newborn infection (OR, 8.5; 95% CI, 1.1-66.8) in the GDM-male group than in the GDM-female group with a glycosylated hemoglobin A1c (HbA1c) level ≥5.5% in the late trimester of pregnancy, which was not observed with an HbA1c level of <5.5%.Conclusions: Male fetuses have worse perinatal outcomes than female fetuses, and the difference is more pronounced in GDM pregnancies. More postpartum care is needed for male fetuses, especially in GDM pregnancies with substandard glycemic control. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Diabetes is the property of Wiley-Blackwell 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.)

Backgrounds: To investigate the value of prolactin (PRL) in diagnosing non-alcoholic fatty liver disease (NAFLD).Methods: Metabolic parameters and serum PRL levels were measured in 452 males and 421 females, who were randomized to the estimation or the validation group as a 1:1 ratio. Hepatic steatosis was diagnosed via abdominal ultrasound. Variables that significantly associated with NAFLD in univariate analysis were included in multiple logistic regression. We used the receiver operator characteristic (ROC) curves to test the model performance. Besides, 147 patients underwent metabolic and liver biopsy were analyzed to validate the diagnostic value of this model.Results: Body mass index, alanine aminotransferase, prolactin, high density lipoprotein cholesterol and HbA1c were included into models. In males, the area under ROC curve (AUC) was 0.86 (95%CI: 0.82-0.91) for the validation group. With two cut-off points (- 0.79 and 1.71), the sensitivity and specificity for predicting NALFD was 95.2 and 91.1% in the validation group, respectively. In females, the AUC was 0.82 (95%CI: 0.76-0.88) for the validation group. With two cut-off points (- 0.68 and 2.16), the sensitivity and specificity for predicting NALFD was 97.1 and 91.4% in the validation group, respectively. In subjects with liver pathology, the AUC was higher than that of fatty liver index. A positive correlation between the scores of the model and the severities of NAFLD was observed. Importantly, we demonstrated a potential value of this model in predicting nonalcoholic steatohepatitis.Conclusion: We established a mathematic model that can conveniently and effectively diagnose the existence and severities of NAFLD. [ABSTRACT FROM AUTHOR]

Purpose: Papillary thyroid carcinoma (PTC), the most common malignant tumor of the thyroid, has been criticized as overtreated by some researchers in recent years. Active surveillance (AS) was first proposed at Kuma Hospital in 1993, and popularized in other institutes ever since. We provide a brief review of low-risk PTC active monitoring studies to date, and discuss the advantages of AS and limitations of existing studies. Results: Most papillary thyroid microcarcinomas do not show significant growth or new lymph node metastasis in a 10-year AS period. Patients who undergo delayed surgery during AS generally have a good prognosis. Tumor progression correlates with age, calcification pattern, and Ki-67 positivity. Serum thyroid stimulating hormone concentration and pregnancy might also influence tumor progression in some studies. Conclusion: Active surveillance for low-risk PTC has shown its safety and feasibility in certain populations. In the future, it is warranted to determine valuable tumor progression predictors and most suitable PTC patients for AS. [ABSTRACT FROM AUTHOR]

Objective To explore the levels of cardiometabolic index (CMI) and its relationship with early phase β-cell function in overweight/obese polycystic ovary syndrome (PCOS) women. Method Three hundred and eighty-two overweight and obese women from Nanjing Drum Tower Hospital between April, 2016 and September, 2017 were recruited and divided into body mass index matched simple overweight/obese group (n=75) and overweight/obese PCOS group (n=307). Data of weight, height, blood pressure, heart rate and related laboratory examinations at their first visit were collected, indexes of early phase β-cell function (AUCIns30/AUCGlu30, DI30, Ins30/FINS) and CMI were calculated. Independent sample t test, analysis of variance and Pearson correlation coefficient were used for statistical analysis. Result Compared with simple overweight / obese women, waist-hip ratio, serum insulin levels during oral glucose tolerance test (OGTT), CMI (1.86±0.69 vs 1.64±0.91) and AUCIns30/AUCGlu30 (1.08±0.24 vs 0.98±0.32) were significantly higher respectively (t=-5.631--2.522, P<0.05), while HDL-C, 1/HOMA-IR (0.20±0.13 vs 0.28±0.16), DI30 (1.69±0.69 vs 1.88±0.72) and Ins30/FINS (5.76±3.29 vs 6.79±3.90) were significantly lower respectively (t=1.938-4.974, P<0.05) in overweight / obese PCOS women. Indexes relating early phase insulin secretion were significantly lower in overweight/obese PCOS women with higher CMI levels than those in overweight/obese PCOS women with lower CMI levels (P<0.05). In addition, CMI was negatively correlated with lgDI30 and Ins30/FINS after adjusting age, BMI, blood pressure and heart rate (r=-0.167, -0.162, P=0.004, 0.006). Conclusion Compared with simple overweight/obese women, overweight/obese PCOS women have higher cardiovascular risk and impaired early phase insulin secretion function. Early phase β-cell function indexes were negatively correlated with cardiovascular metabolic risk in overweight/ obese PCOS women. [ABSTRACT FROM AUTHOR]