Normal-weight visceral obesity promotes a higher 10-year atherosclerotic cardiovascular disease risk in patients with type 2 diabetes mellitus-a multicenter study in China.

BACKGROUND: Visceral obesity is associated with high cardiovascular events risk in type 2 diabetes mellitus (T2DM). Whether normal-weight visceral obesity will pose a higher atherosclerotic cardiovascular disease (ASCVD) risk than body mass index (BMI)-defined overweight or obese counterparts with or without visceral obesity remains unclear. We aimed to explore the relationship between general obesity and visceral obesity and 10-year ASCVD risk in patients with T2DM. METHODS: Patients with T2DM (6997) who satisfied the requirements for inclusion were enrolled. Patients were considered to have normal weight when 18.5 kg/m2 ≤ BMI < 24 kg/m2; overweight when 24 kg/m2 ≤ BMI < 28 kg/m2; and obesity when BMI ≥ 28 kg/m2. Visceral obesity was defined as a visceral fat area (VFA) ≥ 100 cm2. Patients were separated into six groups based on BMI and VFA. The odd ratios (OR) for a high 10-year ASCVD risk for different combinations of BMI and VFA were analysed using stepwise logistic regression. Receiver operating characteristic (ROC) curves for diagnosing the high 10-year ASCVD risk were constructed, and areas under the ROC curves were estimated. Potential non-linear relationships between VFA levels and high 10-year ASCVD risk were examined using restricted cubic splines (knot = 4). Multilinear regression was used to identify factors affecting VFA in patients with T2DM. RESULTS: In patients with T2DM, subjects with normal-weight visceral obesity had the highest 10-year ASCVD risk among the six groups, which had more than a 2-fold or 3-fold higher OR than those who were overweight or obese according to BMI but did not have visceral obesity (all P < 0.05). The VFA threshold for high 10-year ASCVD risk was 90 cm2. Multilinear regression showed significant differences in the effect of age, hypertension, drinking, fasting serum insulin, fasting plasma glucose, 2 h postprandial C-peptide, triglyceride, total cholesterol, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol on VFA in patients with T2DM (all P < 0.05). CONCLUSIONS: T2DM patients with normal-weight visceral obesity had a higher 10-year ASCVD risk than BMI-defined overweight or obese counterparts with or without visceral obesity, which should initiate standardised management for ASCVD primary prevention.

Evaluation of Short-Term Insulin Pump for Treatment of Patients with Type 2 Diabetes Mellitus Complicated with Lower Extremity Arterial Disease in Endocrinology by Ultrasonography.

This research aimed to explore the curative effect of short-term insulin pump in the treatment of type 2 diabetes mellitus (T2DM) patients with lower extremity arterial disease (LEAD) based on ultrasonography. 422 patients (220 males and 202 females) with T2DM in the hospital were selected, and they were randomly divided into control group (n = 211, oral hypoglycemic drugs or diet control, appropriate exercise to lower blood glucose) and experimental group (n = 211, insulin pump was used to reduce blood glucose). After 2 weeks, the therapeutic effect was evaluated by ultrasonography. The results showed that after two weeks of treatment, the difference in lumen intima between the two groups was statistically significant (P < 0.05). The intima-media thickness (IMT) values of the experimental group were 0.83 ± 0.03 mm, 0.62 ± 0.03 mm, and 0.41 ± 0.04 mm, respectively, which were significantly different from those of the control group (1.62 ± 0.54 mm, 1.23 ± 0.14 mm, and 0.78 ± 0.11 mm) (P < 0.05). There was obvious difference in low-density lipoprotein cholesterol (LDL-C) level between the experimental group (2.22 ± 0.46 mmol/L) and the control group (3.21 ± 0.62 mmol/L) (P < 0.05). The LEAD score of the experimental group was 5.51 ± 1.11, which was significantly different from that of the control group (7.08 ± 2.73) (P < 0.05). There was clear difference in LEAD score between the two groups under different course of disease (CD) (P < 0.05). Studies indicated that short-term application of insulin pump therapy could effectively improve the pathological changes of lower limbs in patients with T2DM, which had clinical application value.

Changes in intestinal flora in patients with type 2 diabetes on a low-fat diet during 6 months of follow-up.

Type 2 diabetes mellitus (T2DM) is closely associated with changes in the composition of the gut microbiota. To date, studies on the gut microbiota have focused on the genus-level composition and microbial gene sets, whereas changes in the microbiota after clinical treatment have remained largely elusive. In the present study, 16 subjects with T2DM were enrolled and treated long-term with a low-fat diet. Stool samples were collected at the initial diagnosis and after 1, 3 and 6 months of treatment, and named as group T0, T1, T2 and T3, respectively. Simultaneously, stool samples from 16 healthy individuals were collected as a control (group C). In addition, 16S ribosomal RNA sequencing was performed to detect differences in the microbiota between the groups. Following the low-fat diet treatment, the patients' fasting plasma glucose, plasma glucose 2 h after challenge, glycosylated haemoglobin A1c and body mass index (BMI) decreased significantly. The composition of the phylum in patients with type 2 diabetes mellitus was similar to that in healthy individuals. A total of 23 genera from four phyla, namely Firmicutes, Proteobacteria, Bacteroidetes and Actinobacteria, were determined to be different between group T0 and group C, while only 8 genera were different between group T3 and group C. Repeated analysis of variance suggested a complex change during the low-fat diet treatment. The butyrate-producing bacteria Anaerotruncus exhibited a slight increase, while Roseburia was significantly increased at the T1 stage but then gradually decreased at the later stage. In summary, a low-fat diet was effective for patients with T2DM in reducing blood glucose and the BMI, and, to a certain extent, improving the intestinal flora to reach a normal composition. The study was registered in the Chinese Clinical Trial Registry (ChiCTR; registration no. ChiCTR1900028663).