[Preliminary Application of Contrast-Enhanced Ultrasound in the Treatment of Diabetic Ulcers].

Objective: To investigate the role of contrast-enhanced ultrasound (CEUS) in the treatment of diabetic ulcers. Methods: The clinical data of 27 diabetic patients, who underwent CEUS examination of their ulcers in our hospital between April 2021 and July 2022 were collected. Among them, 26 patients suffered from diabetic foot ulcers, 5 of whom underwent amputation during hospitalization, and one patient suffered from hip ulcer. The 27 patients' mean age was (64.08±12.57) years. Fasting blood glucose levels of the patients were 3.36-34.61 mmol/L, with a mean of (10.62±8.77) mmol/L. Their glycosylated hemoglobin levels were 5.80%-10.70%, with an average of 7.96%±1.50%. Philips EPIQ7 ultrasound system with L9-3 linear probe of 3-9 MHz was used. First, the patients' ulcers were examined with conventional ultrasound to observe for abnormal echo. Then, 2.4 mL SonoVue (Bracco, Italy), a contrast agent, was injected intravenously through the elbow to look for effusion/pus, sinus tract, or dead space in the lesion area, and images were acquired. Results: Among the 27 patients, except for 5 with amputation stumps, 22 patients had wound areas ranging from 0.16 cm 2 to 215 cm 2, all being accompanied by sinus tract formation. Ten patients underwent ultrasound examination during their treatment. The positive rate of the results of conventional ultrasound was 50% (5/10) for identifying effusion/pus and pseudoaneurysm in the deep area of ulcers, while the positive rate of CEUS results was 100% (10/10). In addition to the lesions found by conventional ultrasound, CEUS also found large sinus tracts or dead spaces in the deep surface of ulcers in 5 additional patients. Of the 27 patients, 17 underwent ultrasound examination of the healing status of sinus tracts and dead spaces in the deep areas of ulcers before discharge. No sinus tracts in the deep areas of the ulcers were found by conventional ultrasound. However, relatively small dead spaces or sinus tracts in the deep areas of the ulcers were found in 10 patients by CEUS. Conventional ultrasound and CEUS found that 1 patient had a small amount of fluid in the amputation stump. In the remaining 6 patients, no deep sinus tracts in the ulcers were found by either conventional ultrasound or CUES, and the ulcers healed completely. Conclusion: By examining microvascular perfusion in diabetic wounds with CEUS, we can observe the extent of sinus tracts during treatment and whether the sinus tracts have healed or whether there are still dead spaces before patient discharge, which provides support for clinical decision-making concerning the treatment of diabetic ulcers.

[Clinical Characteristics and Prognosis of Diabetic Foot Ulcers Patients of Different Renal Function Statuses].

Objective: To explore the clinical characteristics and the prognosis of diabetic foot ulcers (DFU) inpatients of different renal function statuses. Methods: A retrospective analysis of 962 inpatients with DFU was conducted. The patients were divided into three groups according to their renal function statuses, and the clinical characteristics of the three groups were compared to identify differences. In addition, the patients were followed up in outpatient clinics or by telephone and their prognostic status and risk factors for death were analyzed. Results: Analysis of the clinical characteristics showed that, compared with diabetic patients with normal renal function or mild renal function impairment, diabetic patients with moderate and severe renal function impairment had a longer course of disease ( P<0.001). Patients with foot ulcers of Wagner grade 4 predominates the moderate and severe renal function impairment groups ( P<0.05). Patients in the moderate and severe renal function impairment groups had a relatively higher proportion of comorbidities, including hypertension, coronary heart disease, and peripheral arterial disease ( P<0.05). These patients had relatively lower levels of glycosylated hemoglobin and hemoglobin (all P<0.05) and relatively higher levels of neutrophil ratio and procalcitonin (all P<0.05). Of the two groups, patients in the moderate renal function impairment group were older ( P<0.001) and had lower ankle-brachial index ( P<0.001). The severe renal function impairment group had a higher proportion of patients with foot ulcers of Wagner grades 3 and 5 (all P<0.05). For the purpose of conducting prognostic analysis, 748 patients were followed up in outpatient clinics or by telephone for a median length of 41 months. Among them, 239 died. The all-cause mortality was 31.9%, and the mortality in the three groups was 25.8%, 46.2% ( P<0.001), and 59.4% ( P<0.001), respectively. The survival rate of patients in the moderate and severe renal function impairment groups was significantly lower than those in the normal renal function and mild renal function impairment groups ( P<0.001). Univariate Cox regression analysis showed that age, concomitant coronary heart disease and peripheral arterial disease, degree of renal function impairment, and foot ulcers of Wagner grade 4 and 5 were associated with all-cause deaths. Furthermore, multivariate Cox regression analysis showed that moderate and severe renal function impairment was an independent risk factor for all-cause deaths in DFU patients ( P<0.001). Conclusions: As renal function impairment worsens, patients with DFU present clinical characteristics of greater complexity, higher risks of cardiovascular events, and higher mortality. It is essential to prevent kidney damage and foot ulcers, to pay attention to the cardiovascular risks of DFU patients with moderate and severe renal function impairment, and to reduce mortality.

[Innovation Stimulates Development: How to Cope with the Constant Growth in Refractory Diabetic Foot Ulcers].

Diabetic foot ulcers, with an annual incidence as high as 8.1% in China, impose enormous social and economic burdens on diabetic patients, families and society. Substantial progress has been made in China in the work concerning diabetic foot ulcers in the past two decades, and the major amputation rate in patients with diabetic foot ulcers in China has decreased significantly, even though it is still far higher than the level of developed countries in Europe and North America. Therefore, if we are to further improve the diagnosis and treatment of diabetic foot ulcers in China, the only solution lies in reinforced efforts in innovation, including innovations in concepts, models, and technology, and the training of national and provincial-level leading experts in diabetic foot ulcer care. Only in this way, can we further reduce the disability and mortality caused by diabetic foot ulcers in China. We, herein, discussed the importance and necessity of establishing a comprehensive diabetic foot prevention and control system suited to the actual circumstances of China through strengthening innovative research. On that basis, we also reported existing problems and prospects for future development.

[Latest Findings on MicroRNAs in Diabetic Chronic Wounds].

Diabetic chronic wound is one of the most serious complications of diabetes, imposing enormous socioeconomic burdens on diabetic patients, their families, and society due to its refractory nature. MicroRNAs (miRNAs) have emerged as important regulators of various physiological and pathological processes. Abnormalities arise in the regulatory functions of miRNAs in chronic diabetic wounds. Therefore, the modification of miRNAs expression in diabetic wounds is an important channel for the improvement of wound healing. The clinical translation of miRNA-based therapy may become a prospective direction of diabetic wound healing. However, miRNA-based therapy is still in its early stage of development, and actual translation into clinical application will take a long time. Herein, we summarized the latest research findings on miRNAs in diabetic chronic wounds healing.

[Experimental Study of Using Aloe Vera Gel to Treat Diabetic Chronic Cutaneous Ulcers in Bama Miniature Pigs].

Objective: To investigate the efficacy, safety, and mechanism of topical application of aloe vera gel (AVG) to treat diabetic chronic cutaneous ulcers in Bama miniature pigs. Methods: The Bama miniature pig model of diabetic chronic skin wounds was constructed and the model pigs were randomly assigned to AVG daily administration group (AVG QD), aloe vera gel every-other-day administration group (AVG QOD), and diabetic control group (DC). A non-diabetic chronic skin wounds model pig was set as the non-diabetic control group (NDC). Treatment efficacy was evaluated based on the amount of time needed for complete healing of the wounds, healing rates, granulation growth rates, and skin histopathological changes. Safety was evaluated according to whether adverse reactions were observed. In addition, the dynamic changes of the relative expression levels of miR21, miR29a, miR126, miR146a, miR155, and miR210 in wound granulation tissues were examined. Results: 1) Efficacy and safety: The amount of time needed for complete healing of the wounds was shorter in the NDC group than those of the three other groups, DC group, AVG QD group, and AVG QOD group (all P<0.05). The amount of time needed for complete healing of the wounds was shorter in the AVG QD group and AVG QOD group than that of DC group (all P<0.05). The amount of time needed for complete healing of the wounds was shorter in the AVG QOD group than that of AVG QD group (all P<0.05). No adverse reactions were detected in the whole process of AVG topical treatment. The granulation growth rate of NDC group was higher than those of DC group, AVG QD group, and AVG QOD group (all P<0.05). The wound healing rate of NDC group was higher than those of DC group, AVG QD group, and AVG QOD group (all P<0.05); the wound healing rate of AVG QOD group was higher than those of DC group and AVG QD group (all P<0.05). 2) Histopathology: The results of HE staining light microscopy showed that collagen fiber production increased, and that microvascular formation with slight inflammatory cell infiltration was observed in the dermal interstitium at the initial stage of wound healing after AVG treatment. One year of after complete healing, pathological examination results of wound healing skin showed that the epidermal keratinization was complete, that collagen was arranged neatly and orderly, and that many microvessels were found in the interstitium. The results of picric acid celestite scarlet staining showed that, after AVG treatment, type Ⅰ collagen mainly increased in the initial stage of wound healing, type Ⅲ collagen gradually increased when the wound healed completely, and the collagen was arranged neatly during the whole process. 3) The relative expression of microRNAs: The relative expression of miR21, miR126, and miR210 in NDC group, AVG QD group, and AVG QOD group were higher than that in DC group (all P<0.05). The relative expression of miR29a and miR155 in NDC group, AVG QD group, and AVG QOD group was lower than that in DC group (all P<0.05). The relative expression of miR146a in NDC group was higher than that in DC group ( P<0.05). Conclusion: AVG topical application can shorten the time needed for complete healing of diabetic chronic wounds in Bama minipigs. The wound healing speed of the alternate-day treatment group was faster than that of the daily treatment group. No adverse reactions were observed over the course of the treatment. The mechanism may be related to the up-regulation of the expressions of miR21, miR126, and miR210 and the down-regulation of miR29a and miR155 in wound granulation tissue.

[Clinical Characteristics of Diabetic Patients with Initial and Recurrent Foot Ulcers].

Objective: To explore the risk factors for the recurrence of foot ulcers by analyzing clinical characteristics of the patients with diabetic foot ulcers (DFU) in West China Hospital, Sichuan University. Methods: A retrospective analysis was carried out with the clinical data of 817 DFU patients hospitalized at West China Hospital, Sichuan University between January 1, 2012 and December 31, 2020. The patients were divided into an initial ulceration group (502 cases) and a recurrent ulceration group (315 cases) according to their history of foot ulcers. The differences in clinical characteristics between the two groups were compared, and multivariate logistic regression analysis was conducted to identify the risk factors associated with the recurrence of foot ulcers. Results: Initial and recurrent DFU patients both had predominantly neuro-ischemic foot ulcers, and the most common sites of ulceration were the first and fifth toes in both groups. Compared with the initial DFU group, more patients in the recurrent group had foot ulcers of Wagner grade 3 and ulcerous wounds located on calluses ( P<0.05), and fewer patients in the recurrent group suffered from foot gangrene ( P<0.05). Patients with recurrent DFU had lower glycated hemoglobin, platelet counts, and fibrinogen levels ( P<0.05), and higher serum uric acid and creatinine levels ( P<0.05). Hemoglobin, white blood cell count, estimated glomerular filtration rate, erythrocyte sedimentation rate and C-reactive protein levels were not significantly different between the two groups ( P>0.05). Multivariable logistic regression analysis showed that male sex ( OR=1.555, 95% CI: 1.097-2.204, P=0.013), duration of diabetes≥10 years ( OR=2.369, 95% CI: 1.473-3.810, P<0.001), history of amputation ( OR=4.518, 95% CI: 2.386-8.553, P<0.001), foot osteoporosis ( OR=1.711, 95% CI: 1.065 to 2.751, P=0.027), ulcerous wound located on foot callus ( OR=1.786, 95% CI: 1.058-3.012, P=0.030), and coronary heart disease ( OR=0.668, 95% CI:0.453-0.987, P=0.043) were significantly associated with the recurrence of foot ulcers. Conclusions: Male sex, duration of diabetes being over 10 years, history of previous amputation, foot osteoporosis, and ulcerous wounds located on foot callus are independent risk factors of recurrent foot ulcers in patients with DFU. Therefore, even after their foot ulcers have healed, special attention should be given to the care of foot for patients with DFU, which may reduce the recurrence of foot ulcers.

[Single-Center Experience of Treating Chronic Limb-Threatening Ischemia of Lower Limbs Combined with Diabetes].

Objective: To summarize our hospital's single-center experience of and reflections on the treatment of chronic limb-threatening ischemia (CLTI) of lower limbs combined with diabetes in the past 5 years. Methods: We retrospectively analyzed cases of lower limb CLTI combined with diabetes diagnosed at our hospital from March 2017 to June 2021. The baseline data, surgical information, and follow-up results of the patients were collected. The primary outcome indicator was the patency rate of lower limb target artery within 1 year post-op, and the secondary indicators were the reoperation rate within 1 year post-op and the amputation rate within 1 year post-op. Results: A total of 89 patients with lower limb CLTI combined with diabetes were included in the study. A total of 85 patients underwent percutaneous transluminal angioplasty and the operation of 7 patients ended in failure, with the operation success rate reaching 91.76% (78/85). Three patients underwent femoral popliteal artery bypass grafting with artificial blood vessels and one patient underwent iliac femoral artery bypass grafting with artificial blood vessels, with the success rate of the operations reachign 100% (4/4). Among 78 patients who successfully underwent percutaneous transluminal angioplasty, the median follow-up time was 33 months (13, 64). Two patients died within one year after operation, with the post-op one-year survival rate being 97.44% (76/78). The post-op 1-year reoperation rate was 19.23% (15/78), the 1-year target vascular patency rate (deaths not included) was 85.53% (65/76), and the 1-year amputation rate was 3.85% (3/78). Among the patients who underwent bypass surgery, the follow-up period was 13-48 months. No thrombosis in or re-occlusion of the artificial blood vessels were observed during the follow-up period, and the artificial blood vessels remained unoccluded. Conclusion: Transluminal angioplasty has a relatively ideal rate of postoperative vascular patency. In addition, it is a minimally invasive procedure involving low perioperative risks and is performed under local anesthesia. Therefore, it can be used as the preferred treatment for patients with CLTI. On the other hand, bypass surgery has good long-term patency rate, but it involves higher perioperative risks and the procedure is more invasive. Therefore, bypass surgery can be used as an alternative when transluminal angioplasty ends in failure.

[A Case of Pseudohypoaldosteronism Type â ¡ (PHA2) Caused by a Novel Mutation of KLHL3].

The patient, a 41-year-old woman, was admitted because "it was found out she had elevated serum potassium levels for 18 days". Eighteen days prior to admission at our hospital, the patient was found to have elevated serum potassium during hospitalization at another hospital, where the patient received symptomatic treatment and was discharged after her serum potassium returned to a normal level. However, the patient still had elevated serum potassium repeatedly and was referred to our hospital for further examination. The patient had a history of acute nephritis and gestational hypertension. Six months prior to admission at our hospital, it was found out that the patient had slightly elevated blood pressure, but no intervention was done. The patient's father has a history of hypertension and diabetes. After admission, laboratory results showed that the patient had hyperkalemia, hyperchloremia and metabolic acidosis. The level of plasma renin was obviously below the normal range, but the concentration of plasma aldosterone was within the normal range. A new mutation locus (c.1115delG) in KLHL3 (Kelch like family member 3) gene was revealed by genetic testing, leading to the diagnosis of pseudoaldosteronism type Ⅱ (PHA2). The patient was given regular treatment of oral hydrochlorothiazide hydrochloride at set intervals. Subsequently, her blood electrolyte level, blood pH, BE and BEB have returned to normal levels. The patient was followed up for 12 months and did not feel unwell during the follow-up period.

[The Management of Blood Glucose Should be Emphasized in the Treatment of COVID-19].

Based on the higher mortality and the higher proportion of critically ill adults in coronavirus disease 2019 (COVID-19) patients with diabetes, good inpatient glycemic control is particularly important in the comprehensive treatment of COVID-19. Individualized blood glucose target goals and treatment strategies should be made according to specific circumstances of COVID-19 inpatients with diabetes. For mild patients, a strict glycemic control target (fasting plasma glucose (FPG) 4.4-6.1 mmol/L, 2-hour postprandial plasma glucose (2 h PG) 6.1-7.8 mmol/L) are recommended; a target for the glycemic control of common type patients (FPG 6.1-7.8 mmol/L, 2 h PG 7.8-10.0 mmol/L) and subcutaneous insulin deliver therapy are recommended; a target nonfasting blood glucose range of 10.0 mmol or less per liter for severe-type COVID-19 patients, a relatively Less stringent blood glucose control target (FPG 7.8-10.0 mmol/L, 2 h PG 7.8-13.9 mmol/L) for critically ill patients and intravenous insulin infusion therapy are recommended. Due to the rapid changes in the condition of some patients, the risk of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar status (HHS) maybe occur during the treatment. Blood glucose monitoring, dynamic evaluation and timely adjustment of strategies should be strengthened to ensure patient safety and promote early recovery of patients.

[Successful Treatment of Refractory Ischemic Diabetic Foot Ulcers by Combination Therapy of Autologous Platelet-rich Gel and Topical ß Adrenergic Receptor Blocker: a Case Report].

HISTORY AND CLINICAL FINDINGS: A 76 year-old woman with 8-year history of diabetes mellitus and hypertension was admitted with gangrene of left great toe, 3rd, 4th and 5th toes. Twenty months ago, She started to receive hemodialysis due to end-stage renal disease. She did not have any history of reactive airway disease nor bradycardia that would contraindicate the use of topical beta-blocker. The X-ray of left lower limb and foot showed calcification of left superficial femoral artery, popliteal artery, anterior tibial artery, posterior tibial artery, dorsal foot artery and digital artery, as well as osteolytic destruction at distal end of metatarsal bone, and lateral dislocation of the 4th and 5th toes. Color Doppler ultrasound of bilateral lower extremity arteries showed obvious calcification of bilateral superficial femoral arteries, thrombosis of left popliteal artery, severe stenosis of left anterior tibial artery, occlusion of left posterior tibial artery, right anterior tibial artery and posterior tibial artery. Computed tomographic angiography (CTA) of bilateral lower limb arteries revealed moderate stenosis of left superficial femoral artery, occlusion of left popliteal artery, left posterior tibial artery and dorsal pedal artery, occulusion of right posterior tibial artery, but right dorsal pedal artery was visible. DIAGNOSIS, TREATMENT AND FOLLOW-UP: Diagnosis of diabetic foot (left, grade 4) and diabetic lower extremity arterial occlusion (left, stage 4) was made. Based on multidisciplinary team (MDT) discussion, the patient was unable to undergo vascular bypass surgery, and left lower extermity amputation also was not suitable because of right atrial thrombosis. Therefore, conservative treatment was recommended. The specific scheme used clopidogrel for antiplatelet agglutination, Low Molecular Weight Heparin (Clexane) and warfarin for anticoagulation, lipo-alprostadil for vasodilation, as well as local debridement and ultrasonic debridement. The treatments were given for up to 9 weeks, but with no significant clinical response. So the patient was treated with vacuum-assisted closure and autologous platelet-rich gel therapy for the next 7 weeks, then applied with 1 drop of timolol maleate 0.5% ophthalmic solution per cm 2 wound area every other day for another 6 weeks, the wound rapidly healed and re-epithelialized basically. The follow-up for 5 weeks showed that the wound healed completely without any discomfort. No side effect was found.

[Predictive Value of Obesity Indicators for Metabolic Syndrome in Adults of Han and Yi Nationalities in Sichuan].

OBJECTIVE: To compare the predictive value of different measures of obesity for metabolic syndrome (MetS) in adult Yi and Han nationality population. METHODS: A total of 3 492 urban and rural residents in Chengdu and Liangshan Yi Autonomous Prefecture participated in this study. Demographic and laboratory data were collected. Spearman correlation analysis was used to investigate the relationship between different obesity measurement indexes and MetS. Receiver operating characteristic (ROC) curve was used to compare the predictive value between different obesity measurement indexes. RESULTS: Spearman correlation analysis showed that MetS was related to body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), lipid accumulation index (LAP) and visceral adiposity index (VAI). The ROC curve showed that the LAP had the highest predictive value for MetS in both Yi and Han male adults, area under the curves (AUCs) >0.90; whereas WHR had the lowest predictive value. WHtR had high predictive value for MetS in both Yi and Han female adults (AUCs >0.88), VAI had the worst predictive value. CONCLUSION: Among different measures of obesity, LAP may have the optimal predictive value for MetS in male adults as do WHtR in female adults either in Yi or Han nationality. These findings should be confirmed through the measure of visceral fat volume and prospective study.

[A Study on the Feasibility to Assay Minipig Insulin Through Human Insulin Radioimmunoassay Kit].

OBJECTIVES: To investigate the feasibility of using human-specific insulin radioimmunoassay (Ins-RIA) kit to measure the concentrations of serum insulin in minipigs. METHODS: The Serum samples (219) of Bama minipigs were collected. The concentrations of serum insulin in Bama minipigs were measured by Ins-RIA kit and porcine-specific insulin enzyme linked immunosorbent assay (Ins-ELISA) kit, respectively. The linear regression analysis was undertaken in a randomly selected 175 samples (80% of total samples) to establish predictive equations between the concentrations of serum insulin measured by Ins-ELISA and the concentrations of serum insulin measured by Ins-RIA. The equations were then cross-validated in the remaining 44 samples (20% of total samples) that had not been included in the regression analysis. RESULTS: Measured insulin concentration was lower with the Ins-ELISA than that with the Ins-RIA [(15.32±15.50) µIU/mL vs. (32.31±21.74) µIU/mL, respectively, P<0.000 1]; The final predictive equation for the Ins-ELISA (µIU/mL) was equal to -7.29+0.70 × Ins-RIA(µIU/mL) ( R2=0.94). The differences between the predicted values and the actual measured values were 17.18%. CONCLUSIONS: Insulin values in Bama minipigs obtained from the Ins-ELISA and Ins-RIA are not equivalent and differ significantly. However, the insulin concentration by Ins-ELISA can be well estimated by Ins-RIA.

[Study on Relationship Between Serum 25-hydroxyvitamin D3 Concentration and Glucose Metabolism].

OBJECTIVES: To investigate the relationship between serum 25-hydroxyvitamin D3 [25(OH)D3 ] concentration and glucose metabolism. METHODS: This cross-sectional survey recruited 668 participants, and the demographic and clinical characteristics of the participants were obtained from questionnaires. Physical examination and blood biochemical examination were performed, then the participants were divided into three groups as normal glucose tolerant (NGT) group, impaired glucose regulation(IGR) group, and diabetes mellitus (DM) group. RESULTS: There was no statistical significant difference in serum 25(OH)D3 concentration among the three groups ( P>0.05). With comparison of different serum 25(OH) D3 concentration, there was no statistical significant difference in the incidence of DM and IGR, FPG, 2 h BG, HOMA-IR, ISI-composite, HOMA-ß or ΔI30/ΔG30 ( P>0.05). Serum 25(OH)D3 concentration was not associated with DM, IGR, FPG, 2 h BG, HOMA-IR, ISI-composite, HOMA-ß or ΔI30/ΔG30 ( P>0.05). CONCLUSIONS: No relationship between serum 25(OH)D3 concentration and glucose metabolism is comfirmed.

[Clinical Characteristics of Patients with Type 2 Diabetes Mellitus and Obstructive Sleep Apnea Syndrome].

OBJECTIVES: To compare the clinical characteristics and prevalence of chronic complications in type 2 diabetes mellitus (T2DM) patients with various degrees of obstructive sleep apnea syndrome (OSAS). METHODS: A total of 170 patients with T2DM and OSAS were enrolled in this study. These participants were divided into three groups with low, medium and high apnea-hypopnea index (AHI), respectively. The demographic characteristics, biochemical indicators and chronic complications of the patients in the three groups were compared. Multivariate Logistic regression analysis was performed to determine the associations between chronic complications and OSAS. RESULTS: The patients with severe OSAS had higher waist circumference (P=0.045), higher BMI (P=0.069), higher prevalence of diabetic peripheral neuropathy (DPN), and higher prevalence of diabetic retinopathy (DR) than the patients with mild-moderate OSAS. Similar levels of macrovascular complications were found in the three groups (P>0.05). The logistic regression analyses showed that DPN (OR=1.024, 95%CI 1.002-1.046) and chronic kidney disease (OR=1.026, 95%CI 1.004-1.049) were independent predictors of AHI, adjusting for the lowest oxygen saturation, gender, age, diabetic duration, family history of diabetes, BMI, and HbA1c. Other microvascular and macrovascular complications were not predictors of AHI. CONCLUSIONS: Patients with T2DM and severe OSAS have a higher risk of DPN and DR. Particular attention should be paid to T2DM patients with severe OSAS to prevent complications.

Ertapenem versus piperacillin/tazobactam for diabetic foot infections in China: a Phase 3, multicentre, randomized, double-blind, active-controlled, non-inferiority trial.

OBJECTIVES: Few randomized controlled studies have compared antibiotic regimens against diabetic foot infections (DFIs) in Chinese patients. We evaluated the efficacy and safety of ertapenem versus piperacillin/tazobactam for the treatment of DFIs in Chinese patients. METHODS: Patients with moderate to severe DFIs requiring parenteral antibiotics were randomized in a 1 : 1 ratio to receive ertapenem (1.0 g once daily) or piperacillin/tazobactam (4.5 g every 8 h) by 30 min intravenous (iv) infusions for ≥5 days. The primary outcome was favourable clinical response at discontinuation of iv therapy (DCIV). An evaluable-patient population was identified for primary analysis of non-inferiority at -15%. Safety was assessed. ClinicalTrials.gov: NCT01370616. RESULTS: Of 565 patients randomized, 443 patients (ertapenem = 219 and piperacillin/tazobactam = 224) were clinically evaluable for primary analysis. In the clinically evaluable population, the proportions of patients with favourable clinical response at DCIV were 93.6% (205/219) and 97.3% (218/224) in the ertapenem and piperacillin/tazobactam groups, respectively (difference: -3.8%, 95% CI: -8.3%, 0.0%). Ertapenem had a significantly lower favourable clinical response rate (91.5% versus 97.2%, 95% CI for difference: -12.1%, -0.3%) at DCIV in severe DFI patients. In the modified ITT population, 88.8% (237/267) and 90.6% (241/266) of patients in the ertapenem and piperacillin/tazobactam groups, respectively, had favourable clinical responses at DCIV (difference: -1.9%, 95% CI: -7.3%, 3.3%). Microbiological eradications of causative pathogens and adverse events were similar between treatment groups. CONCLUSIONS: Treatment with ertapenem was non-inferior to piperacillin/tazobactam in Chinese patients with DFIs. Ertapenem treatment resulted in a markedly lower rate of clinical resolution in severe DFIs.

[Pancreatic ß-cell Functions Measured by Continuous Glucose Monitoring in Han Chinese with Varied Degree of Glucose Tolerance].

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

[Prevalence and factors associated with the prevention and control of hypertension in Chinese Yi populations].

OBJECTIVE: To estimate the prevalence of hypertension and to identify factors associated with the prevention and control of hypertension in Chinese Yi populations. METHODS: A cross-sectional study was conducted in Liangshan Yi Autonomous Prefecture of Sichuan province. Random cluster sampling method was adopted to recruit participants. A total of 1 255 Yi people who were 20 years or older from one urban district and three rural villages participated in this study. Demographic and medical and laboratory data were collected from July to September 2007. The prevalence of hypertension and levels of awareness and control of hypertension were calculated and compared between genders and urban and rural residencies. RESULTS: The age-standardized prevalence of hypertension reached 17.3% in the Chinese Yi populations. Urban residents had a significantly higher level of prevalence of hypertension than that of rural residents (25.9% vs. 8.9%, P < 0.001). Among the hypertensive patients, 2.8% were aware of their high blood pressure, 26.1% were taking antihypertensive medications, and 8.8% had their blood pressures controlled (< 140/90 mm Hg). Urban residents had significantly higher levels of awareness (35%) and endorsement of treatment (31.1%) than their rural counterparts (13.6% for awareness and 10.6% for treatment, P < 0.001). For those living in urban areas, higher prevalence of hypertension was associated with older age, being a woman, having higher annual income (> or = yen 10,000), overweight/obesity and higher levels of total cholesterol. Older age and high levels of total cholesterol were also found to be associated with increased risk of hypertension in the rural residents. CONCLUSION: Hypertension is prevalent in Yi populations. The awareness and control of hypertension in Yi populations is poor. Public health interventions are needed.

[Characteristics of 72 h glucose profiles detected by continuous glucose monitoring system in patients with insulinoma].

OBJECTIVE: To identify the characteristics of glucose profiles in patients with insulinoma using continuous glucose monitoring system (CGMS). METHODS: Six patients with insulinoma (All of the patients were diagnosed after operations with pathological tests) admitted to the Department of Endocrinology and Metabolism, West China Hospital of Sichuan University from October 2009 to November 2011 were recruited for this study (group A). They were compared with 71 patients with normal glucose tolerance (NGT) (group B) and 3 patients with responsive hypoglycemia (group C). All of the participants received 75 g oral glucose tolerance tests (OGTT), insulin release tests, and 72 h CGM. Glucose fluctuations and hypoglycemia risks were assessed by the following parameters obtained from CGMS: mean blood glucose (MBG) and standard deviation (SD), mean amplitude of glycemic excursion (MAGE), mean daily differences (MODD), low glucose index (LBGI), glycaemic Risk Assessment Diabetes Equation (GRADE) and M-value. RESULTS: Group A had significantly lower levels of HbA1c, fasting blood glucose, and 2 h-BG than group B (P < 0.05). Compared with Group B, Group A had lower levels of 72 h-MBG (P < 0.001) and higher levels of LBGI, M-value, GRADE, SD and MODD (P < 0.05). The insulinoma patients had 27 occasions of hypoglycemia (glucose < 2.8 mmol/L), more likely in early morning, at a fasting state or preprandial periods. Such events were rare in the control groups (2 occasions in Group B and one occasion in Group C). CONCLUSION: Insulinoma patients present a greater level of glucose fluctuations and frequent hypoglycemia. Hypoglycemia risk detected by CGM is helpful for differentiating diagnosis of insulinoma.

[Efficacy and safety of vitamin D for type 2 diabetes mellitus: a systematic review].

OBJECTIVE: To evaluate the efficacy and safety of vitamin D (VD) for patients with type 2 diabetes mellitus. METHODS: Randomized controlled trials (RCT) were identified from CBM (1978.1-2012.9), CNKI (1979.1-2012.9), Pubmed (1950.1-2012.9), EMbase (1970.1-2012.9) and Cochrane library (issue 4, 2012). Publications of the RCT on the treatment of type 2 diabetes mellitus with VD were included and analyzed according to the criteria of Cochrane handbook. RESULTS: Six RCT involving 328 patients were included. Meta-analysis indicated that VD caused a reduction in glycosylated hemoglobin A 1c (HbA 1c) (P = 0.05) but not in fasting plasma glucose (FPG), homeostasis model assessment index of insulin resistance (HOMA-IR) and failed to improve quantitative insulin sensitivity check index (QUICKI) and homeostasis model assessment index of ß cell function (HOMA-ß) (P > 0.05). As reported in a trial, the side effect of VD was hypercalcemia. CONCLUSION: VD may have positive effects on patients with type 2 diabetes mellitus. However, the evidence is weak due to the general low methodological quality. Thus we have not made a reliable conclusion about the effects of VD for type 2 diabetes mellitus at the moment. Further larger, randomized, double-blind, placebo-controlled and multicenter trials are warranted.

[Variance of mean platelet volume in subjects with normal glucose tolerance, impaired glucose regulation and type 2 diabetic mellitus and its relationship with diabetic peripheral artery disease].

OBJECTIVE: To explore the variance of mean platelet volume (MPV) in subjects with normal glucose tolerance (NGT), impaired glucose regulation (IGR) and type 2 diabetes mellitus (T2DM) and risk factors of MPV changes and analyze the relationship between MPV and diabetic peripheral artery disease (PAD). METHODS: A total of 173 subjects were enrolled into this observational cross-sectional study. They were divided into 3 groups: NGT (n = 41), IGR (n = 41) and T2DM (n = 91). Blood pressure (BP), platelet count (PLT), mean platelet volume (MPV) and such fasting serum lipids as triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL-C), low density lipoprotein (LDL-C), fast plasma glucose (FPG) and serum uric acid (UA) were determined. HbA1c and ankle/brachial index (ABI) were also measured. RESULTS: (1) The MPV level was highest in the T2DM group (12.3 ± 1.5) fl. And it was significantly higher in the IGR group than in the NGT group (9.7 ± 0.9 vs 8.0 ± 0.9) fl (P < 0.01). It was significantly higher in diabetics with HbA1c ≥ 7% (13.2 ± 1.9) fl than in patients those with HbA1c 7% (11.8 ± 1.7) fl (P < 0.01); (2) Stepwise multiple regression analysis showed that age, serum creatinine, LDL-C and fasting plasma glucose (FPG) were important influencing factors of MPV (adjusted R(2) = 0.891); (3) Multiple Logistic regression analysis indicated that MPV was an important risk factor of PAD. CONCLUSION: The MPV level in T2DM is significantly higher than that in NGT and IGR subjects. FPG, LDL-C, age and serum creatinine are important contributors to MPV. And MPV is an important risk factor of PAD.