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The global pandemic of type 2 diabetes mellitus is still ongoing, in which obesity has played a major role. Obesity not only contributes to the development of type 2 diabetes but also further increases the risk of cardiovascular diseases in patients with type 2 diabetes. In recent years, the management goals of diabetes care has shifted from glycemic control alone to dual " glycemic control and weight loss". Current weight loss strategies include lifestyle intervention, pharmacotherapy therapy, and metabolic surgery, with advancements being made particularly in pharmacological treatments. The novel dual or triple gut hormone receptor agonists hold promise for providing more treatment options for overweight/obese patients with type 2 diabetes.
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Clinical data from 11 previously diagnosed and treated patients with hyperthyroidism(Graves′ disease) complicated by liver failure were collected. Among them, 4 cases were drug-induced liver injury leading to liver failure, 1 case had a history of schistosomal liver cirrhosis combined with hyperthyroidism, and 6 cases had hyperthyroidism-induced liver injury(HILI) leading to liver failure. During hospitalization, all patients received supportive therapy and symptomatic treatment with β-blockers. Nine patients were treated with glucocorticoids and artificial liver support therapy. Among the 11 patients, 2 died, 8 patients achieved normal thyroid and liver function within 1-12 months after treatment, and 1 patient with liver cirrhosis had stable liver function in the later stage. After improvement in liver function, 7 patients received isotope therapy, 1 patient underwent total thyroidectomy, and 1 patient received medication. These results indicate that the clinical characteristics differ for drug-induced liver injury and HILI-related liver failure. Early initiation of artificial liver support therapy, in addition to β-blockers and glucocorticoids, is important in alleviating thyroid toxicity and liver damage, thus creating an opportunity for subsequent radioactive iodine or surgical treatment.
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Objective:To retrospectively analyze the clinical and serological characteristics in rehabilitated patients with common novel coronavirus pneumonia(COVID-19).Methods:A total of 165 patients with common COVID-19 were enrolled in this retrospective study, in which clinical data was collected from February 23 to March 15, 2020 in Leishenshan Hospital(Wuhan, China). The patients with COVID-19 were divided into elderly group and non-elderly group according to their age, and the differences in the clinical and serological metabolic characteristics between these two groups were analyzed.Results:49.7% patients were over 60 years old. The most common clinical symptoms were fever, cough, and fatigue, followed by muscle soreness. Expectoration and digestive tract symptoms were rare. Dyspnea occurred more frequently in the elderly group than in non-elderly group(47.56% vs 25.30%, P<0.01). Hypertension was the most common concomitant disease(accounting for 29.1%)followed by diabetes. Hypertension was more common in the elderly group than in non-elderly group(41.46% vs 16.86%, P<0.01), but without significant difference in diabetes between the two groups. The counts of leukocytes and lymphocytes in all patients were in the normal range, and no difference was observed between the groups. The comparison of serological indicators showed that serum creatinine in the elderly group was higher than that in the non-elderly group( P<0.01)while serum albumin, glomerular filtration rate, and serum calcium were lower in the elderly group. After serum albumin correction, the levels of albumin corrected calcium in all patients were in the normal range, without significant difference between these two groups. There was no significant difference between the two groups when the length of hospital stay was taken as the index of outcome [(34.01±10.24) vs(30.97±10.51)d, P>0.05]. Conclusion:Fever, cough, and fatigue are the most common clinical symptoms in patients with ordinary COVID-19. The elderly are more likely to develop dyspnea. The blood routine and metabolic characteristics in patients with common COVID-19 are normal, but serum albumin level is more likely to decrease in elderly patients with COVID-19.
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Objective:To explore the metabolic outcomes of type 2 diabetes patients with different durations after 1 year treatment under the standardized metabolic disease management model.Methods:(1)From September 2017 to September 2018, 345 type 2 diabetes patients in the Standardized Metabolic Management Center(MMC) of Shanghai General Hospital were recruited and included in this research. They were divided into newly-diagnosed type 2 diabetes(duration≤1 year) and long-term groups(duration>1 year). The general characteristics, blood pressures, glycemic levels, lipids levels, control rates and comprehensive compliance rates(blood glucose, pressure and lipids all reached targets) were compared at baseline between 2 groups.(2)All patients underwent one year standardized management, and metabolic indicators mentioned above and control rates at the time were compared as well.Results:(1) At baseline, compared with long-term group, patients in newly-diagnosed type 2 diabetes group were younger ( P<0.01), and 2 h blood glucose level after glucose loading were higher [(15.20±5.26 vs 13.68±4.94) mmol/L, P<0.01]. (2) After one year standardized management, body weight, blood pressure, glucose and lipids metabolism in all patients were significantly improved. Compared with patients in long-term group, newly-diagnosed type 2 diabetes patients achieved better glycemic level [fasting blood glucose(6.27±1.56 vs 7.63±2.08) mmol/L, P<0.01; glycated hemoglobin(6.33±0.96 vs 7.23±1.37) %, P<0.01] , and had higher HOMA-β [(74.01±56.45 vs 40.17±37.07) %, P<0.01]. The glycemic control, blood pressure and blood lipids control rates in both groups increased significantly in one year. Comprehensive compliance rate of the whole patients increased from 5.80% to 24.06%. The metabolism indexes of the newly-diagnosed type 2 diabetes group were better than those of the long-term group[comprehensive compliance rate: (24.73% vs 17.18%, P=0.087, glycemic control rate(84.62% vs 53.37%, P<0.01)]. Conclusion:Standardized metabolic disease management promoted the overall improvement in blood glucose, blood pressure, and lipids levels in type 2 diabetes patients, especially in terms of blood glucose and those of the newly-diagnosed type 2 diabetes. In the future, we should focus on the early diagnosis and treatment of type 2 diabetes, actively promote the MMC model and stress the integrated management of blood glucose, blood pressure, and blood lipid levels. We should pay more attention to the long-term patients, to improve their awareness and treatment compliance.
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Lymphocytic hypophysitis(LYH) is a rare autoimmune inflammatory disorder of the pituitary gland, usually affecting young women in late pregnancy or postpartum period. To enhance the knowledge of LYH, herein we reported a case of LYH in a female during postpartum who presented with pituitary crisis.
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Objective@#To explore the glycemic control of newly-diagnosed type 2 diabetes with different levels of baseline body mass index (BMI) after 6 months treatment under the standardized metabolic disease management model.@*Methods@#(1) 163 patients of newly-diagnosed type 2 diabetes were divided into normal weight (BMI 18.5-23.9 kg/m2), overweight (BMI 24.0-27.9 kg/m2), and obese (BMI≥28 kg/m2) groups according to baseline BMI, the blood glucose and lipids levels were compared among 3 groups. (2) The blood glucose levels were compared among 3 groups after 6 months of standardized management. (3) The overweight and obese patients were divided into group weight loss≥5% and group weight loss<5% or weight gain in 6 months. The blood glucose levels were compared.@*Results@#(1) At baseline, overweight and obese groups had higher homeostasis model assessment for insulin resistance and lower high density lipoprotein-cholesterol compared with normal weight group. (2) After 6 months of treatment, HbA1C and HbA1C reduction showed no difference among 3 groups (normal, overweight and obese) after adjusted by baseline HbA1C. The rate of HbA1C<7% among 3 groups were 77.78%, 83.95%, and 80.43% (P>0.05). (3) After 6 months of treatment, 32.28% overweight and obese patients lost weight by ≥ 5%, while HbA1Cand HbA1Creduction showed no difference between 2 groups (weight loss≥5% and weight gain or weight loss<5%) after adjusted by baseline HbA1C. Both groups achieved good glycemic control [(6.27±1.38 vs 6.43±0.66)%], but have no significantly(P>0.05). Group weight loss≥5% had better glucose control (92.68% vs 77.91%, P<0.05).@*Conclusions@#As BMI increased, insulin resistance and lipid disorders were more serious in newly-diagnosed type 2 diabetes. After 6 months of standardized metabolic management, newly-diagnosed type 2 diabetes with different baseline BMI and weight changes both achieved good glycemic control. In addition, patients losing weight equal to or more than 5% achieved higher attainment of HbA1C targets.
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Objective To explore the glycemic control of newly-diagnosed type 2 diabetes with different levels of baseline body mass index ( BMI ) after 6 months treatment under the standardized metabolic disease management model. Methods ( 1) 163 patients of newly-diagnosed type 2 diabetes were divided into normal weight (BMI 18.5-23.9 kg/m2), overweight (BMI 24.0-27.9 kg/m2), and obese (BMI≥28 kg/m2) groups according to baseline BMI, the blood glucose and lipids levels were compared among 3 groups. ( 2) The blood glucose levels were compared among 3 groups after 6 months of standardized management. ( 3) The overweight and obese patients were divided into group weight loss≥5%and group weight loss<5% or weight gain in 6 months. The blood glucose levels were compared. Results ( 1) At baseline, overweight and obese groups had higher homeostasis model assessment for insulin resistance and lower high density lipoprotein-cholesterol compared with normal weight group. ( 2) After 6 months of treatment, HbA1C and HbA1C reduction showed no difference among 3 groups ( normal, overweight and obese) after adjusted by baseline HbA1C. The rate of HbA1C<7%among 3 groups were 77.78%, 83.95%, and 80.43%(P>0.05). (3) After 6 months of treatment, 32.28% overweight and obese patients lost weight by ≥5%, while HbA1C and HbA1C reduction showed no difference between 2 groups ( weight loss≥5%and weight gain or weight loss<5%) after adjusted by baseline HbA1C. Both groups achieved good glycemic control [(6.27±1.38 vs 6.43±0.66)%], but have no significantly(P>0.05). Group weight loss≥5% had better glucose control (92.68% vs 77.91%, P<0.05) . Conclusions As BMI increased, insulin resistance and lipid disorders were more serious in newly-diagnosed type 2 diabetes. After 6 months of standardized metabolic management, newly-diagnosed type 2 diabetes with different baseline BMI and weight changes both achieved good glycemic control. In addition, patients losing weight equal to or more than 5%achieved higher attainment of HbA1C targets.
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To evaluate several tests of physical performance for sarcopenia screening and assessment, by investigating physical performance and function in older women. 106 community-dwelling older women from a community in Shanghai were enrolled in this study. Physical function assessed by short physical performance battery (SPPB), timed get-up-and-go (TUG), handgrip strength, and usual gait speed were asked to perform. Total lean mass was determined by Dual energy X-ray absorptiometry, the relative appendicular skeletal muscle mass ( RASM) was defined as appendicular skeletal muscle mass/height2 . 13 individuals were diagnosed as sarcopenia according to a consensus diagnostic criteria for sarcopenia, as developed by the Asian Working Group for Sarcopenia ( AWGS) in 2014. Body mass index and handgrip strength in the sarcopenia group were significantly lower than those in the non-sarcopenia group (P=0. 026, P=0. 004 respectively), and there was no significant differences in the age, SPPB score, TUG, and usual gait speed. Linear regression analysis showed RASM was significantly positively correlated with body mass index (r=0. 842, P<0. 01), time to rise from a chair and return to the seated position five times (r=0. 203, P=0. 036),TUG(r=0. 258, P=0. 008)and grip strength (r=0. 217, P=0. 025), meanwhile, both body mass index and grip strength entered Logistic regression analysis. Low weight and low handgrip strength are independent predictive factors of sarcopenia in older women. Sarcopenia screening for older women with low body-weight and weak handgrip strength is more urgently required
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In recent years,there are gradually increasing attentions on diabetic osteoporosis.Diabeticosteoporosis is characterized by insidious onset,high incidence,and risk of disability.Metabolic disorders caused bydiabetes mellitus are related to an imbalance between osteoblastic bone formation and osteoclastic resorption.Diabetesalters bone mass and increases the risk of fracture.In this review the influence of diabetes on osteoporosis isdiscussed.
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Objective To examine the association between vitamin D and alendronate response,and to investigate the proper vitamin D levels for the efficacy of alendronate treatment of osteoporosis.Methods In this retrospective study,559 post-menopausal women with osteoporosis were devided into two groups:non-responders and responders,based on the European Study of Forsteo (EUROFORS).Demographic and clinical data including mean 25-hydroxy vitamin D (25-OHD) levels between dual-energy X-ray absorptiometry (DEXA) scans were obtained.Mean 25-OHD levels were compared between responders and non-responders and multiple logistic regression analysis was performed to identify factors associated with non-response.Results There were 437 (75.5%) responsers to alendronate therapy and 142 (24.5%) non-responders.Responders with a mean serum 25-OHD level of (59.96 ±12.56) nmol/L,obtained a more favorable result than non-responders,whose serum 25-OHD level was (47.50 ±9.92) nmol/L (P<0.01).25-OHD level was significantly associated with response.Conclusion Patients with a mean 25-OHD ≥50 nmol/L had a substantially greater likelihood of maintaining bisphosphonate response.
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Objective To examine the relationship of body mass index (BMI) with levels of vitamin D,parathyroid hormone (PTH),and bone turnover markers among women in Shanghai area.Methods Altogether 810 Chinese women aged 45 year and older were enrolled to study the associations by multiple linear regression analyses.Bone mineral density was measured by a dual energy X-ray absorptiometry (Lunar,Prodigy,GE),Serum 25-hydroxyvitamin D [25 (OH) D],PTH,C-telopeptide of type Ⅰ collagen (CTX),osteocalcin (BGP),and bonespecific alkaline phosphatase (BSALP) were measured.Results (1) 25 (OH) D,BGP,BSALP,and CTX levels were significantly lower in obesity group than in control group ; PTH level was significantly higher in obesity group than in control group.(2) In multiple linear regression analyses,BMI was significantly associated with lower 25 (OH) D (β =-0.017,P =0.006),BGP (β =-0.077,P =0.019),and higher PTH (β =0.025,P =0.000).Conclusions (1) There were siginificant associations between higher BMI and lower 25 (OH) D among women in Shanghai.(2) Serum osteocalcin was associated not only with bone metabolism but also with energy metabolism.
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Objective To test whether glucagon like peptide-1 (GLP-1) would regulate the expression of visfatin in adipocytes,and to explore the mechanism of this effect.Methods Fully differentiated 3T3-L1 adipocytes were treated with GLP-1.Total RNA was extracted for analyzing the level of visfatin mRNA by quantitative RT-PCR.The media were collected for measuring the level of visfatin protein by enzyme linked immuno-assay (ELISA).In order to test the involvement of PKA pathway,the adipocytes were pretreated with a specific pharmacological PKA inhibitor H89 for 30 min before GLP-1 was added.Results GLP-1 increased visfatin expression in a time-and dose-dependent manner.The level of visfatin significantly increased at the concentration of 10 10 mol/L GLP-1 (P<0.05),and reached the peak at 10-9 mol/L (P<0.01).After incubation for 18 hours,GLP-1 dominantly increased the level of visfatin (P<0.05).Inhibition of PKA pathway by H89 partially blocked the effect of GLP-1 on visfatin expression.Conclusions GLP-1 may enhance the expression of visfatin in 3T3-L1 adipocyte via the PKA pathway,which might contribute to the improvement in glucose homeostasis.
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[Summary] This retrospective analysis showed that the level of apolipoprotein E was significantly higher in diabetic nephropathy group compared with normal albuminuria group [50.4 (40.8,65.9) vs 46.2 (38.6,56.8)mg/L,P<0.01].Difference in urinary albumin to creatinine ratio (ACR) among the groups based on the tertile of apolipoprotein E were significant (P< 0.01).Multiple linear regression analysis demonstrated that apolipoprotein E was independently associated with ACR (β =0.14,P<0.05).
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Objective To analyze the efficacy and safety of glimepiride treatment as initial monotherapy in newly diagnosed patients with type 2 diabetes mellitus (T2DM).Methods This was a subgroup analysis of the GREAT study,which investigated the efficacy and safety of glimepiride as initial monotherapy in Chinese patients with T2DM.This analysis was performed in 209 patients with disease duration less than 6 months and never received any anti-diabetic drugs.The change of HbA1C,fasting plasm glucose (FPG),2 h postprandial blood glucose (2hPPG),homeostasis model assessment for β-cell function index (HOMA-β),homeostasis model assessment for insulin-resistance index(HOMA-IR),the percentage of patients with HbA1C < 7.0% at endpoint and the incidence of hypoglycemia were evaluated after 16-weeks treatment.Results After 16-weeks glimepiride treatment,HbA1C value reduced significantly from baseline to endpoint,the reduction was statistically significant (9.21% ± 1.65% to 6.69%±0.83%,P<0.001),69.7% of the patients achieved HbA1C <7.0% at study endpoint.Glimepiride-treated patients also achieved a significant improvement in FPG [from (10.15 ± 2.13) mmol/L to (7.23 ± 1.50) mmol/L,P<0.001] and 2hPPG [from (17.21 ±4.14) mmol/L to (11.62 ± 3.34) mmol/L].HOMA-β was improved from 17.21± 15.19 [11.62 (2.90,115.8)] to 41.13 ± 44.12 [28.00 (5.1,360.00)],and HOMA-IR was reduced from 2.32± 1.90 [1.76 (0.60,12.80)] to 2.07 ± 1.74 [1.63 (0.4,12.3)].The incidence of all reported symptomatic hypoglycemia was 18.2%,and the incidence of confirmed hypoglycemia was 3.8%.Conclusion This analysis showed that glimepiride treatment as an initial mono-therapy could effectively improve blood glucose control in newly diagnosed patients with T2DM,and the treatment may improve islet β cell function,and the safety profile is reasonably good.
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Objective To investigate the association of single nucleotide polymorphisms (SNPs) in the SCGB3A2(secretoglobin family 3A member 2) gene promoter with susceptibility of Graves' disease.Methods One-hundred and seventy-nine SNPs within a 3.0 Mb region surrounding marker D5s2090 were scanned in a case-control study.The size of the region(s) associated with GD was then narrowed.Results Total 179 SNPs within a 3.0 Mb region surrounding marker D5s2090 were analyzed.The most significant association signal was found at SNP rs1368408 (P =3.69 × 10-5).Subsequent association analysis was then performed and the results suggested that the SNP76 (P =4.11 × 10-8) and SNP75 (P =1.37 × 10-8) in the promoter of SCGB3A2 gene may be the causal variants of GD.Logistic regression analysis suggested these 2 SNPs in this region may contribute to GD susceptibility.Conclusion A significant association seems to exist between GD with the SCGB3A2 gene.
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Two hundreds postmenopausal women with osteopenia, aged 45-80, were randomly divided into 4 groups, and received different drug interventions. After treatment for 12 months, the lumbar spine bone mineral density(BMD)and total hip BMD in alendronate group increased significantly(3.5% and 2.6%, both P<0.05), the lumbar spine BMD raised 2.0% in selective estrogen receptor regulator group(P<0.05). Bone turnover indices improved in both groups(all P<0.05). No change in BMD or bone turnover indices was found in patients treated with active vitamin D3and calcium.
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Objective To explore the difference involved in the activation of inflammation pathway and the plasma level of inflammatory factors in the subjects with different sorts of insulin sensitivity. Methods The study was carried out in 38 women, consisting of obesity (n = 22 ) and control (n = 16 ) groups according to body mass index. The insulin sensitivity was assessed by homeostasis model assessment of insulin resistance (HOMAIR). Plasma concentrations of interleukin-6 (II-6) and IL-1β were determined by enzyme immunoassay. Western blot analysis was used to examine total protein expression and phosphorylation levels of IκB kinase (IKK) ,inhibitor of nuclear factor-κB ( IκB ) in peripheral blood leukcocytes. Electrophoretic mobility shift assay (EMSA)was used to detect the binding activity of NFκB. Results The levels of fasting plasma insulin[62.2 ( 20.0-127. 0) pmol/L vs 19. 15 ( 14. 2-47. 8 ) pmol/L, P<0. 01], HOMA-IR[2. 32 ( 0. 76-5.49 ) vs 0.70(0.53-1.7),P<0.0l], HbA1 C[(5.42±0. 45 ) % vs ( 5.08 ±0. 38) %, P<0. 05], triglyceride[( 1.75 ±0. 68 vs 1.22 ±0. 58 )mmol/L, P<0. 05], plasma IL-6[3. 15 (0. 03-22. 2) pg/ml vs 1.26 (0. 74-6.06 ) pg/ml, P<0. 01], and IL-1 β[6. 53 ( 0. 84-36 ) pg/ml vs 3. 16( 1.48-8. 86 ) pg/ml, P<0. 01]in obesity group were significantly higher than those in control group. Compared with control group, the levels of IKKo, IKKβ expression and IκBα serine phosphorylation in obesity group were markedly increased, while the expression of IκBα was significantly reduced. Accompanied with the degradation of IκBα protein, the binding activity of NFκB in obesity group was significantly increased. Conclusions The plasma levels of IL-6 and IL-1β were significantly raised in obesity group. The activation of IKK-IκB-NFκB pathway is closely associated with the genesis and development of insulin resistance in obese subjects.
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To investigate the effects and the mechanism of visfatin on MIN6 cell signaling pathway and apoptosis induced by palmitate.Human recombinant visfatin promotes protein kinase B (Akt) and extracellularsignal regulating kinase (ERK)1/2 phosphorylation in dose-and time-dependent manner,and prevents MIN6 cell from apoptosis induced by palmitate (P<0.05 or P<0.01).The activation of Akt and ERK1/2 signaling pathway may be one of the molecular mechanisms of visfatin.
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Visfatin was expressed in rat anti mouse islets,as well as in MIN6 cells. The visfatin expression was affected by various concentrations of environmental glucose (5.5 and 33.3 mmoL/L) and palmitate(0.5 mmol/L). As compared with low-level glucose medium (5.5 mmol/L, 1.0±0.11) , visfatin expression increased in media with high glucose and palmitate (1.32 ±0. 18, 1. 33±0. 15,1.72±0.27, all P<0. 05). The result suggests that visfatin seems to be involved in the regulation of insulin secretion.
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Objective To set up the reference value of serum glyeated albumin (CA) in Chinese for using in clinical practice through a multi-center clinical trial. Methods Three hundred and eighty individuals with normal weight and normal glucose regulation, including 183 males and 197 females ranging from 20 to 69 years, were recruited from 10 hospitals in China. Serum GA levels were measured with liquid enzymatic method. Results (1) The GA level of the 380 subjects was (14. 5±1.9)%. When dividing these subjects by age into 3 subgroups, there was no difference in the GA levels among the 3 subgroups (P>0.05). Compared with the women, the men had higher GA level in the first subgroup aging from 20 to 39 (P =0.028). However, no significant difference was detected after adjusting with BMI as confounder.(2) When dividing those subjects by BMI into 3 subgroups, with BMI ranging from 18. 5-20. 9 kg/m2,21.0-22. 9 kg/m<'2>and 23.0-24. 9 kg/m<'2>respectively, we came to the following results: for men, there was no difference in the GA levels among the 3 subgroups (P>0.05), but for women, the GA level of the first subgroup was higher than that of the second subgroup (P =0.024). (3) The level of GA in the 2. 5th to 97.5th percentile was 10. 8%-17. 1%. (4) Sixty normal subjects were chosen to repeat evaluation of GA levels after 2-3 weeks and the GA levels were of no difference (P>0.05).Conclusion The normal range of serum GA for the Chinese population could be suggested at 11%-17%.