Educational intervention on perceived stress among adults with type 2 diabetes and metabolic syndrome: a non-randomized clinical trial / Intervención educativa sobre el estrés percibido en adultos con diabetes tipo 2 y síndrome metabólico: ensayo clínico no aleatorizado / Intervenção educativa sobre o estresse percebido de adultos com diabetes tipo 2 e síndrome metabólica: ensaio clínico não-randomizado

Objective.To assess the effectiveness of an educational intervention on perceived stress and metabolic syndrome parameters among adults with type 2 diabetes mellitus. Method. Fifty-one adults (aged 48.73±7.84; 86.3% of women) were included in a non-randomized clinical trial performed in a healthcare unit for six months (Brazilian Clinical Trial Registry: RBR-43K52N). All participants were diagnosed with type 2 diabetes mellitus and metabolic syndrome (intervention group, n=26; control group, n=25). The intervention consisted of a nurse-led educational health-promoting program with a multidisciplinary approach organized in seven workshops. The primary outcome was decreased perceived stress, and the secondary outcome was improvement in metabolic syndrome parameters according to perceived stress levels. These outcomes were assessed at two points in time, at the baseline and follow-up. Results. Participation in the intervention program resulted in a significant decrease in perceived stress (p=0.028). The stressed participants in the intervention group experienced a significant decrease in blood glucose levels (p=0.001) and a significant increase in high-density lipoprotein-cholesterol (p=0.003) concentrations after the six-month intervention. Conclusion.The nurse-led educational health-promoting program decreased perceived stress among adults with type 2 diabetes mellitus and metabolic syndrome, improving fasting blood glucose and high-density lipoprotein cholesterol among the stressed participants in the intervention group.

Objetivo. Evaluar la efectividad de una intervención educativa sobre el estrés percibido y los componentes del síndrome metabólico en adultos con diabetes mellitus tipo 2. Métodos. Se incluyeron 51 adultos (48.73±7.84 años; 86.3% mujeres) de un estudio no-ensayo aleatorizado realizado en una unidad de salud durante seis meses, con Registro Brasileño de Ensayos Clínicos: RBR-43K52N, todos los participantes fueron diagnosticados con diabetes mellitus tipo 2 y síndrome metabólico (grupo intervención, n=26; grupo control, n=25). La intervención consistió en un programa educativo de promoción de la salud con enfoque multidisciplinario, liderado por una enfermera, estructurado en siete talleres grupales. El resultado primario fue la reducción del estrés percibido y el secundario, la mejora de los componentes del síndrome metabólico influenciados por el nivel de estrés percibido, evaluado en dos momentos, al inicio y después del seguimiento. Resultados. La participación en el programa de intervención resultó en una reducción significativa del estrés percibido en comparación con el grupo control (p=0.028). Los participantes estresados en el grupo de intervención tuvieron, respectivamente, una disminución y un aumento significativos en las concentraciones séricas de glucosa (p=0.001) y lipoproteínas de alta densidad-colesterol (p=0.003) después de seis meses de intervención. Conclusión. Un programa educativo de promoción de la salud liderado por enfermeras fue eficiente para reducir el estrés percibido entre adultos con diabetes mellitus tipo 2 y síndrome metabólico, además de mejorar la glucemia en ayunas y el colesterol unido a lipoproteínas de alta densidad en los participantes del grupo estresado de intervención.

Objetivo. Avaliar a efetividade de uma intervenção educativa sobre o estresse percebido e os componentes da síndrome metabólica em adultos com diabetes mellitus tipo 2. Métodos. Foram incluídos 51 adultos (48.73±7.84 anos de idade; 86.3% mulheres) em um ensaio clínico não-randomizado realizado em uma unidade de saúde durante seis meses, com Registro de Ensaio Clínico Brasileiro: RBR-43K52N.Todos os participantes apresentavam diagnóstico de diabetes mellitus tipo 2 e síndrome metabólica (grupo intervenção, n=26; grupo controle, n=25). A intervenção consistiu em um programa educativo de promoção da saúde com abordagem multidisciplinar, liderado por enfermeiro, estruturado em sete oficinas em grupo. O desfecho primário foi a redução do estresse percebido, e o secundário, a melhora dos componentes da síndrome metabólica conforme influência do nível de estresse percebido, avaliados em dois momentos, na condição basal e após o acompanhamento. Resultados. A participação no programa de intervenção resultou na redução significativa do estresse percebido em comparação com o grupo controle (p=0.028). Os participantes estressados do grupo intervenção tiveram, respectivamente, diminuição e aumento significativos das concentrações séricas de glicose (p=0.001) e da lipoproteína-colesterol de alta densidade (p=0.003) após seis meses de intervenção. Conclusão. Um programa educativo de promoção da saúde liderado por enfermeiros foi eficiente para reduzir estresse percebido entre adultos com diabetes mellitus tipo 2 e síndrome metabólica, além de causar melhora da glicemia de jejum e e da lipoproteína-colesterol de alta densidade dos participantes estressados do grupo intervenção.

Estimación del riesgo cardiovascular en pacientes con diabetes mellitus tipo 2

Introducción: Las personas diabéticas tienen entre dos y tres veces más riesgo de morbilidad y mortalidad cardiovascular que aquellas que no padecen la enfermedad. Objetivo: Estimar el riesgo cardiovascular en pacientes con diabetes mellitus tipo 2 atendidos en un Área de Salud. Métodos: Se realizó un estudio descriptivo y trasversal de 103 pacientes con diabetes mellitus tipo 2, pertenecientes al Consultorio Médico de la Familia No. 23 del policlínico Carlos J Finlay, municipio Songo-La Maya en la provincia Santiago de Cuba, desde enero hasta diciembre de 2023. Se estudiaron variables cualitativas y cuantitativas (edad, año de diagnóstico y duración de la enfermedad); se estimó el riesgo cardiovascular según el modelo para la predicción del riesgo en personas con diabetes tipo 2. Resultados: Se observó predominio del sexo femenino (58,3 %). La mayoría de los pacientes tenían hipertensión arterial (76 %) y microalbuminuria (31,2 %). La edad media de los pacientes fue de 65,5 años y como promedio tenían un tiempo de evolución de la diabetes de 8,6 años. La evaluación del riesgo cardiovascular ubicó a 43,3 % de la población en un nivel moderado y 25,7 % con alto riesgo. Conclusiones: Los pacientes diabéticos estudiados mostraron un riesgo de moderado a alto de presentar eventos cardiovasculares. Se hace necesario realizar intervenciones educativas en estos pacientes y sus familiares para lograr cambios favorables en los estilos de vida y mejorar el control de la enfermedad, previniendo así complicaciones y la ocurrencia de eventos fatales en los próximos años.

Introduction: Diabetic people have between two and three times more risk of cardiovascular morbidity and mortality than those who do not suffer from the disease. Objective: To estimate cardiovascular risk in patients with type 2 diabetes mellitus treated in a Health Area. Methods: A descriptive and cross-sectional study was carried out on 103 patients with type 2 diabetes mellitus, belonging to the Family Medical Office No. 23 of the Carlos J. Finlay polyclinic, Songo-La Maya municipality, Santiago de Cuba province, from January to December 2023. Qualitative variables and quantitative (age, year of diagnosis and duration of the disease) were studied; Cardiovascular risk was estimated according to the model for predicting cardiovascular risk in people with type 2 diabetes. Results: A predominance of the female sex was observed (58.3%). Most patients had arterial hypertension (76.0%) and microalbuminuria (31.2%). The average age of the patients was 65.5 years and on average they had a duration of diabetes of 8.6 years. The cardiovascular risk evaluation placed 43.3% of the population at a moderate level and 25.7% at high risk. Conclusions: The diabetic patients studied showed a moderate to high risk of presenting cardiovascular events. It is necessary to carry out educational interventions in these patients and their families to achieve favorable changes in lifestyles and improve disease control, thus preventing complications and the occurrence of fatal events in the coming years.

Terminology subset for the International Classification of Nursing Practice in Diabetes Mellitus / Subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus / Subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus

Objective: to describe the process of developing a terminological subset for the International Classification of Nursing Practice in Diabetes Mellitus, based on Horta's Basic Human Needs Theory and Bandura's Social Cognitive Theory. Method: a methodological study based on the identification in the literature of 313 statements of nursing diagnoses pertinent to diabetes care, selected and validated by a consensus of nurses from different states of Brazil, specialists in diabetes, using the nominal group technique. Results: 156 nursing diagnosis/result statements were selected, of which 111 (71.15%) related to psychobiological needs, 42 (26.92%) to psychosocial needs and three (1.92%) to psychospiritual needs. A total of 433 nursing interventions were developed. The diagnostic statements were validated on the basis of a consensus among the experts, with an average content validity index of 0.89: 0.87 for psychobiological needs, 0.93 for psychosocial needs, and 0.77 for psychospiritual needs. Conclusion: the study validated the terminological subset for the International Classification of Nursing Practice in Diabetes, favoring clinical reasoning, the qualification of the Nursing Process, and the improvement of self-care practices in diabetes. It has made it possible to use nursing's own language based on a globally recognized classification.

Objetivo: describir el proceso de elaboración de un subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en Diabetes Mellitus , basado en la Teoría de las Necesidades Humanas Básicas de Horta y en la Teoría Social Cognitiva de Bandura. Método: estudio metodológico realizado a partir de la identificación en la literatura de 313 enunciados de diagnósticos de Enfermería pertinentes al cuidado en diabetes, seleccionados y validados por consenso de enfermeras especializadas en diabetes, provenientes de diferentes estados de Brasil, utilizando la técnica de grupo nominal. Resultados: fueron seleccionados 156 enunciados diagnósticos/resultados de Enfermería, así relacionados: 111 (71,15%) con las necesidades psicobiológicas; 42 (26,92%) con las psicosociales y tres (1,92%) con las psicoespirituales. Fueron construidas 433 intervenciones de Enfermería. Los enunciados diagnósticos fueron validados a partir del consenso entre las especialistas con índice de validez de contenido medio de 0,89; siendo: 0,87 para las necesidades psicobiológicas; 0,93 para las psicosociales y 0,77 para las psicoespirituales. Conclusión: el estudio validó los enunciados del subconjunto terminológico para la Clasificación Internacional para la Práctica de Enfermería en diabetes, favoreciendo el raciocinio clínico, la calificación del Proceso de Enfermería y la mejora de las prácticas de autocuidado en diabetes. También, posibilitó la utilización de lenguaje propio de la Enfermería basado en una clasificación reconocida mundialmente.

Objetivo: descrever o processo de elaboração de um subconjunto terminológico para a Classificação Internacional para a Prática de Enfermagem em Diabetes Mellitus , baseado na Teoria das Necessidades Humanas Básicas de Horta e na Teoria Social Cognitiva de Bandura. Método: estudo metodológico realizado a partir da identificação na literatura de 313 enunciados de diagnósticos de Enfermagem pertinentes ao cuidado em diabetes, selecionados e validados por consenso de enfermeiras especialistas em diabetes, provenientes de diferentes estados do Brasil, utilizando a técnica de grupo nominal. Resultados: foram selecionados 156 enunciados diagnósticos/resultados de Enfermagem, sendo relacionados: 111 (71,15%) às necessidades psicobiológicas; 42 (26,92%) às psicossociais e três (1,92%) às psicoespirituais. Foram construídas 433 intervenções de Enfermagem. Os enunciados diagnósticos foram validados a partir do consenso entre os especialistas com índice de validade de conteúdo médio de 0,89, sendo: 0,87 para as necessidades psicobiológicas; 0,93 para as psicossociais e 0,77 para as psicoespirituais. Conclusão: o estudo validou os enunciados do subconjunto terminológico para a Classificação Internacional para a Prática de Enfermagem em diabetes, favorecendo o raciocínio clínico, a qualificação do Processo de Enfermagem e a melhoria das práticas de autocuidado em diabetes. Possibilitou a utilização de linguagem própria da Enfermagem com base em uma classificação reconhecida mundialmente.

Percepção dos usuários com diabetes sobre o autocuidado com os pés: uma análise qualitativa / Perception of diabetic users about self-care for their feet: a qualitative analysis / Percepción de los usuarios con diabetes sobre el autocuidado de sus pies: un análisis cualitativo

RESUMO Objetivo: valiou-se a percepção de usuários com Diabetes Mellitus tipo 2 (DM2) para autocuidado com os pés mediante a utilização de vídeos educativos. Método: trata-se de uma pesquisa qualitativa, realizada com usuários com DM2 atendidos na Atenção Primária à Saúde no estado do Amazonas, Brasil. Os participantes assistiram a dois vídeos sobre o autocuidado com os pés e responderam a seis perguntas sobre suas percepções. A análise dos dados foi produzida com o apoio do software ATLAS.ti 9®. Resultados: foram originadas três categorias: 1) 'conhecimento prévio' com as subcategorias 'fragilidade nas orientações profissionais' e 'os vídeos como ferramentas para lembrar'; categoria 2) 'assimilação da linguagem e formato audiovisual'; e categoria 3) 'possibilidades de impacto no autocuidado'. Conclusão: Observou-se a falta de informações necessárias sobre os cuidados com o pé diabético em comunidades remotas. Dispor de tecnologias audiovisuais para educação em saúde é essencial para informar e promover o autocuidado.

ABSTRACT Objective: To assess the perception of users with type 2 diabetes mellitus (DM2) regarding self-care of their feet using educational videos. Method: This qualitative study was carried out with users with DM2 treated in primary health care in Amazonas, Brazil. The participants watched two videos on foot care and answered six questions about their perceptions. The data was analyzed using ATLAS.ti 9® software. Results: Three categories were created: 1) 'previous knowledge' with the subcategories 'fragility in professional guidance' and 'videos as tools for remembering'; category 2) 'assimilation of language and audiovisual format'; and category 3) 'possibilities of impact on self-care'. Conclusion: A lack of necessary information on diabetic foot care was observed in remote communities. Audiovisual technologies for health education are essential to inform and promote self-care.

RESUMEN Objetivo: Evaluar la percepción de los usuarios con diabetes mellitus tipo 2 (DM2) sobre el autocuidado de sus pies mediante el uso de videos educativos. Método: Se trata de un estudio cualitativo realizado con usuarios con DM2 atendidos en Atención Primaria de Salud en el estado de Amazonas, Brasil. Los participantes vieron dos videos sobre el cuidado de los pies y respondieron a seis preguntas sobre sus percepciones. Los datos se analizaron con el software ATLAS.ti 9®. Resultados: TSurgieron tres categorías: 1) "conocimientos previos" con las subcategorías "fragilidad en la orientación profesional" y "videos como herramientas para recordar"; categoría 2) "asimilación del lenguaje y del formato audiovisual"; y categoría 3) "posibilidades de repercusión en el autocuidado". Conclusión: Se señaló la falta de información necesaria sobre el cuidado del pie diabético en las comunidades remotas. Las tecnologías audiovisuales para la educación sanitaria son esenciales para informar y promover el autocuidado.

Progresses of functional MRI for exploring mechanism of neurovascular coupling changes in diabetes mellitus type 2 / 中国医学影像技术

The cognitive impairment of diabetes mellitus type 2(T2DM)is closely related to neurovascular coupling(NVC)changes,but the exact mechanism remains unclear.Functional MRI(fMRI)technology were able to jointly analyze NVC changes of T2DM,providing new ideas for revealing the mechanism of cognitive dysfunction caused by T2DM.The progresses of fMRI for exploring NVC changes in T2DM were reviewed in this article.

Changes of thickness and elasticity of skeletal muscles in diabetic patients and relative impact factors / 中国医学影像技术

Objective To observe changes of thickness and elasticity of skeletal muscles in patients with type 2 diabetes mellitus(T2DM)and relative impact factors.Methods Totally 62 T2DM patients(T2DM group)and 60 healthy adults(HC group)were prospectively recruited.Shear wave elastography(SWE)technology was used to measure the maximum Young's modulus(Emax)of the rectus abdominis and gastrocnemius muscles under relaxed and contracted states in both groups.The thickness and elasticity modulus of the skeletal muscles under the two states were compared between groups.Multiple linear regression analysis was performed to screen impact factors of the elasticity modulus of the rectus abdominis and gastrocnemius muscles.Results No significant difference of muscle thicknesses of rectus abdominis,nor of gastrocnemius muscle was found between groups under relaxed and contracted states(all P＞0.05).Under both relaxed and contracted states,the Emax of the rectus abdominis and gastrocnemius muscle in T2DM group were all lower than those in HC group(all P＜0.05).Multiple linear regression analysis showed that in T2DM group,the elasticity modulus of the rectus abdominis and gastrocnemius muscle under both relaxed and contracted states decreased linearly with disease duration,fasting blood glucose(FBG)and glycosylated hemoglobin(HbA1c)(all P＜0.05).Conclusion The elasticity modulus of skeletal muscle decreased in T2DM patients,and the reducing scales linearly related to disease duration,FBG and HbA1c.

Contrast-Enhanced Ultrasound in Assessing the Blood Perfusion of Kidney in Type 2 Diabetic Nephropathy / 中国医学影像学杂志

Purpose To explore the clinical value of quantitative assessment of renal perfusion using ultrasound contrast imaging for the auxiliary diagnosis of type 2 diabetic nephropathy.Materials and Methods This prospective study was conducted from May 2017 to December 2019 at the First Medical Center of Chinese PLA General Hospital.A total of 41 patients with type 2 diabetes and renal function abnormalities,who were scheduled for renal biopsy,underwent contrast-enhanced ultrasound.Differences in contrast imaging parameters,including time to peak in the renal cortex,peak enhancement,mean transit time local,and area under the curve between diabetic nephropathy and focal segmental glomerulosclerosis were compared,and the correlation between imaging parameters and pathological results was analyzed.Results Among 41 patients,30 cases were diagnosed as diabetic nephropathy,and 11 cases were diagnosed as focal segmental glomerulosclerosis.The peak enhancement and area under the curve in the diabetic nephropathy group were significantly lower than those in the focal segmental glomerulosclerosis group[peak enhancement:3 837.16(2 449.16,5 929.16)vs.8 508.00(4 334.88,21 201.00),Z=-2.766,P=0.006;area under the curve:0.14±0.05 vs.0.19±0.05,t=-3.135,P=0.003].In the diabetic nephropathy group,peak enhancement showed a negative correlation with the global glomerulosclerosis rate(r=-0.489,P=0.006).Conclusion Contrast-enhanced ultrasound can quantitatively evaluate renal perfusion and has certain clinical value in assisting the diagnosis of type 2 diabetic nephropathy.

Effect of blood glucose control on lumbar facet joint osteoarthritis in patients with type 2 diabetes mellitus / 中华骨科杂志

Objective:To investigate the effect of blood glucose control on the imaging severity and clinical symptoms of facet joint osteoarthritis (FJOA) in patients with type 2 diabetes mellitus (T2DM).Methods:A total of 286 patients with lumbar degenerative diseases who were diagnosed and treated in the Department of Spinal Surgery of the Third Affiliated Hospital of Sun Yat-sen University from December 2021 to December 2022 were retrospectively collected. Patients were divided into diabetic and non-diabetic groups according to whether T2DM was diagnosed at admission. Age, gender, presence of hypertension, and body mass index (BMI) were recorded. The duration of diabetes was recorded. Fasting blood glucose and peak postprandial blood glucose were monitored for 3 consecutive days. Plasma glucose and glycosylated hemoglobin were assessed by blood biochemical results. Diabetic patients were divided into three sub-groups according to fasting blood glucose and glycosylated hemoglobin levels (HbA1c): ideal blood glucose control (HbA1c<6.5% and fasting blood glucose<6.1 mmol/L), good (6.5%≤HbA1c≤7.5% or 6.1 mmol/L≤fasting blood glucose≤7.0 mmol/L), and poor (HbA1c>7.5% and fasting blood glucose>7.0 mmol/L). Visual analogue scale (VAS) was used to assess the degree of low back pain. Pathria grading system was used to assess the severity of FJOA at different levels of the lumbar spine on lumbar CT. Mann-whitney U test was used to compare the difference of FJOA between L 1-S 1 segments in diabetic and non-diabetic patients. Logistic regression was used to analyze the effect of diabetes on FJOA. Kruskal-Wallis test was used to compare the difference of FJOA between different segments in diabetic patients among different sub-groups. Logistic regression was used to analyze the effect of blood glucose control on FJOA. Results:A total of 121 patients in the diabetic group and 165 patients in the non-diabetic group were included. L 4, 5 FJOA grade 3(2, 3) in diabetic patients was greater than grade 2(1, 3) in non-diabetic patients with significant difference ( Z=-3.179, P=0.001), and diabetes was an independent risk factor for L 4, 5 FJOA [ OR=1.767, 95% CI(1.032, 3.025), P=0.038]. There was no significant difference in age, BMI, sex ratio, prevalence of hypertension and blood glucose fluctuation values among different subgroups of glycemic control in the diabetic group. Patients in the poor glucose group had higher FJOA grades 2(1, 2), 3(3, 3) and 3(2, 4) at L 1, 2, L 4, 5 and L 5S 1 than those in the ideal glucose group at grades 1(1, 2), 2(1.5, 3) and 2(1, 2) with significant differences ( H=9.530, P=0.009; H=18.248, P<0.001; H=27.916, P<0.001). Patients in the poor glucose group had higher grades 3(3, 3) and 3(2, 4) of osteoarthritis of the L 4, 5 and L 5S 1 facet joints than those in the good glucose group, grades 3(2, 3) and 2(1, 2) with significant differences ( H=18.248, P<0.001; H=27.916, P<0.001). Low back pain was positively correlated with poor glycemic control, L 4, 5 and L 5S 1 FJOA ( r=0.512, P<0.001; r=0.383, P<0.001; r=0.484, P<0.001). Poor glycemic control was an independent risk factor for FJOA at L 4, 5 and L 5S 1 [ OR=4.963, 95% CI (1.095, 22.496), P=0.038; OR=6.010, 95% CI(1.061, 34.049), P=0.043]. Conclusion:Compared with non-diabetic patients, patients with type 2 diabetes have a higher risk of osteoarthritis in the facet joints of L 4, 5. Compared with diabetic patients with good or ideal glycemic control. Patients with poor glycemic control had more severe osteoarthritis of the L 4, 5 and L 5S 1 facet joints. Patients with severe facet joint degeneration and poor glycemic control often suffered more from severe low back pain.

Correlation between time in range and glycated hemoglobin in patients with newly-diagnosed type 2 diabetes mellitus / 中华健康管理学杂志

Objective:To explore the correlation between time in range (TIR) after short-term treatment and glycated hemoglobin after 3 months (HbA lc-3m) in patients with newly-diagnosed type 2 diabetes mellitus (T2DM). Methods:In this cross-sectional study, a total of 94 patients with newly-diagnosed T2DM who received treatment in the Department of Endocrinology of Inner Mongolia Autonomous Region People′s Hospital were enrolled from January 2018 to September 2022. The patients were followed-up for 3 months and had complete medical record. TIR was divided into three groups according to different target ranges of blood glucose (TIR1: TIR with blood glucose between 3.9 and 10.0 mmol/L, TIR2: TIR with blood glucose between 3.9 and 7.8 mmol/L, TIR3: TIR with fasting, premeal or bedtime blood glucose <6.1 mmol/L and 2 h postprandial blood glucose <8.0 mmol/L). The patients were divided into two groups based on whether their HbA 1c-3m level was less than 6.5%, and the baseline data and variations in TIR for distinct target glucose levels were compared between the two groups. Spearman′s correlation analysis and binary logistic regression analysis were used to analyze the relationship between baseline indicators, TIR after short-term treatment and HbA 1c-3m. Receiver operating characteristic curve (ROC) was drawn to evaluate the predictive ability of different TIR after short-term therapy for HbA 1c-3m. Results:There were statistically significant differences in TIR1 [81.0 (67.5, 94.6)% vs 71.4 (51.7, 85.7)%], TIR2 [57.7 (29.7, 70.8)% vs 40.9 (22.4, 52.3)%] and TIR3 [23.8 (10.2, 39.5)% vs 13.0 (4.8, 25.0)%] between patients with a HbA 1c-3m<6.5% and patients with a HbA 1c-3m≥6.5% (all P<0.05). Spearman correlation analysis showed that among all the patients with newly-diagnosed T2DM, TIR1, TIR2 and TIR3 were all negatively correlated with HbA 1c-3m [6.4 (6.1, 6.9)%] ( r=-0.322, -0.348, -0.303, respectively, all P<0.01). Logistic regression analysis showed that after adjusting for the confounding factors, TIR1 ( OR=1.021, 95% CI: 1.002-1.041; P=0.034), TIR2 ( OR=1.024, 95% CI: 1.006-1.043; P=0.011), TIR3 ( OR=1.037, 95% CI: 1.010-1.065; P=0.008) were all independently related to HbA 1c-3m. When HbA lc-3m<6.5% was taken as the target value, the area under the ROC curve: TIR1 was 0.639 (95% CI: 0.528-0.751), TIR2 was 0.671 (95% CI: 0.560-0.782), TIR3 was 0.659 (95% CI: 0.549-0.770), respectively. When HbA lc-3m<7.0% was taken as the target value, the area under the ROC curve: TIR1 was 0. 730 (95% CI: 0.619-0.841), TIR2 was 0.744 (95% CI: 0.642-0.846), TIR3 was 0.701 (95% CI: 0.588-0.814). There was no significant difference in the area among the three statistics ( P>0.05). Conclusions:For newly-diagnosed T2DM patients, TIR after short-term treatment is negatively correlated with HbA 1c after 3 months and has good predictive value for it.

Effect of novel erythrocyte preservation solution on quality of erythrocytes in stored blood of T2DM rats / 中华麻醉学杂志

Objective:To evaluate the effect of novel erythrocyte preservation solution on the quality of erythrocytes in stored blood of type 2 diabetes mellitus (T2DM) rats.Methods:Forty SPF male Sprague-Dawley rats, aged 8 weeks, weighing 180-220 g, were used in this study. Ten rats randomly selected served as conventional erythrocyte preservation solution group (group A). T2DM model was prepared in the remaining 30 rats. Twenty T2DM rats were divided into 2 groups ( n=10 each) using a random number table method: T2DM conventional erythrocyte preservation solution control group (group C) and T2DM novel erythrocyte preservation solution observation group (group Y). Erythrocyte preservation solution was prepared to simulate the preoperative autologous blood donation process, and blood was collected from the tail vein to isolate the red blood cells, and then the corresponding preservation solution was added. Immediately after blood collection (T 0) and at 7, 14 and 21 days of preservation (T 1-3), the morphological structure of erythrocytes was observed with a light microscope, and the concentrations of 2, 3-diphosphoglycerate (2, 3-DPG) and reactive oxygen species (ROS) were also determined by enzyme-linked immunosorbent assay at T 0-T 3 and 28 days of preservation (T 4). PKH26 was used to label the erythrocytes stored in vitro for 28 days, and then the erythrocytes were transfused back into rats. The survival rate of erythrocytes was detected by flow cytometry at 1, 7, 13 and 18 h after retransfusion. Results:The erythrocyte damage was aggravated at different time points of preservation in group C when compared with group A. Compared with group C, the damage to erythrocytes was significantly alleviated at different time points of preservation in group Y. Compared with group A, the concentration of 2, 3-DPG in erythrocytes was significantly decreased at T 0 and T 2-T 4, the concentration of ROS was increased at T 0-T 4, and the survival rate of erythrocytes was decreased at 1, 7 and 18 h after retransfusion in group C ( P<0.05). Compared with group C, the concentration of 2, 3-DPG in erythrocytes was significantly increased at T 0-T 4, the content of ROS was decreased at T 1, T 3 and T 4, and the survival rate of erythrocytes was increased at 1, 7 and 18 h after retransfusion in group Y ( P<0.05). Conclusions:The novel erythrocyte preservation solution can improve the quality of stored erythrocytes and increase the survival rate of erythrocytes in vivo after retransfusion in T2DM rats.

Effects of the ultrafast pulse wave velocity for assessing carotid artery elasticity in patients with diabetes mellitus type 2 by SGLT-2 inhibitors / 中国现代医生

@#Objective To evaluate the effect of sodium-dependent glucose transporters 2(SGLT-2)inhibitors on carotid artery elasticity in patients with diabetes mellitus type 2 by applying the ultrafast pulse wave velocity(UFPWV).Methods A total of 82 patients with diabetes mellitus type 2 admitted to the First Affiliated Hospital of Jinzhou Medical University from January to June 2022 were selected and randomly divided into control group(n=41)and observation group(n=41),and both groups were treated with conventional hypoglycemic therapy,and patients in observation group were combined with the treatment of SGLT-2 inhibitor on the basis of control group,and the patients of both groups were treated for 1 year.Systolic blood pressure(SBP),diastolic blood pressure(DBP),body mass index(BMI),fasting blood glucose(FPG),2-hour postprandial blood glucose(2hPG),glycosylated hemoglobin(HbA1c),carotid intima-media thickness(CIMT),and UFPWV technique was used to measure the common carotid artery pulse wave velocity-beginning of systole(PWV-BS)and pulse wave velocity-end of systole(PWV-ES).Results ①The comparison between SBP,DBP,BMI,FPG,2h PG,HbA1c,CIMT,PWV-BS,PWV-ES indexes of the two groups of patients before treatment,the difference was not significant(P>0.05);② After receiving treatment,SBP,DBP,BMI,FPG,2hPG,HbA1c,CIMT,PWV-BS,PWV-ES of patients in observation group were lower than those of control group before treatment,and the differences were statistically significant(P<0.05);③ FPG,2hPG,HbA1c,SBP,DBP,BMI,CIMT,PWV-BS,PWV-ES indexes of observation group were lower than those of control group after treatment,and the difference was statistically significant(P<0.05).Conclusion UFPWV can effectively assess the value of SGLT-2 inhibitors in improving carotid artery elasticity in patients with diabetes mellitus type 2 with high accuracy and simplicity.

Association between insomnia and type 2 diabetes:A two-sample Mendelian rando-mization study / 北京大学学报(医学版)

Objective:To explore the robust relationship between insomnia and type 2 diabetes mellitus by two-sample Mendelian randomization analysis to overcome confounding factors and reverse causality in observational studies.Methods:We identified strong,independent single nucleotide polymorphisms(SNPs)of insomnia from the most up to date genome wide association studies(GWAS)within European ancestors and applied them as instrumental variable to GWAS of type 2 diabetes mellitus.After excluding SNPs that were significantly associated with smoking,physical activity,alcohol consumption,educational attainment,obesity,or type 2 diabetes mellitus,we assessed the impact of insomnia on type 2 diabetes mellitus using inverse variance weighting(IVW)method.Weighted median and MR-Egger regression analysis were also conducted to test the robustness of the association.We calculated the F statistic of the selected SNPs to test the applicability of instrumental variable and F statistic over than ten indicated that there was little possibility of bias of weak instrumental variables.We further examined the existence of pleiotropy by testing whether the intercept term in MR-Egger regression was significantly different from ze-ro.In addition,the leave-one-out method was used for sensitivity analysis to verify the stability and relia-bility of the results.Results:We selected 248 SNPs independently associated with insomnia at the genome-wide level(P＜5 ×10-8)as a preliminary candidate set of instrumental variables.After clum-ping based on the reference panel from 1000 Genome Project and removing the potential pleiotropic SNPs,a total of 167 SNPs associated with insomnia were included as final instrumental variables.The F statistic of this study was 39.74,which was in line with the relevance assumption of Mendelian randomi-zation.IVW method showed insomnia was associated with higher risk of type 2 diabetes mellitus that po-pulation with insomnia were 1.14 times more likely to develop type 2 diabetes mellitus than those without insomnia(95％CI:1.09-1.21,P＜0.001).The weighted median estimator(WME)method and MR-Egger regression showed similar causal effect of insomnia on type 2 diabetes mellitus.And MR-Egger re-gression also showed that the effect was less likely to be triggered by pleiotropy.Sensitivity analyses pro-duced directionally similar estimates.Conclusion:Insomnia is a risk factor of type 2 diabetes mellitus,which has positively effects on type 2 diabetes mellitus.Our study provides further rationale for indivi-duals at risk for diabetes to keep healthy lifestyle.

Comparison of the predictive value of new simplified insulin resistance assessment indexes in identifying left ventricular subclinical dysfunction in T2DM patients / 解放军医学杂志

Objective To investigate the predictive value of new simplified insulin resistance(IR)assessment indexes in identifying subclinical left ventricular systolic function impairment in patients with type 2 diabetes mellitus(T2DM).Methods A total of 150 T2DM patients with preserved left ventricular ejection fraction(LVEF≥50%)who were admitted to Department of Endocrinology of the First Affiliated Hospital of Air Force Medical University from June 2021 to December 2021 were retrospectively analyzed.All patients underwent two-dimensional speckle tracking echocardiography to measure left ventricular global longitudinal strain(GLS).According to GLS value,the subjects were divided into the normal group(GLS≥18%group,n=80)and the impaired group(GLS<18%group,n=70).Some new simplified IR assessment indicators were calculated and compared between the two groups,including body mass index(BMI),TG/HDL-C ratio,triglyceride-glucose(TyG)index,TyG-BMI index,TyG-WHR and metabolic score for IR(METS-IR).Correlation between the GLS and the new simplified IR assessment indexes was analyzed.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of different simplified IR assessment indexes,with the area under the curve(AUC)calculated.Furthermore,according to whether the subjects were complicated with hypertension,binary logistics regression analysis was performed to explore the independent correlation between the simplified IR assessment index and GLS<18%.Results Total 150 were included with aged(54.5±13.7)years with 96(64.0%)men and 54(36.0%)women.Compared with the GLS≥18%group,the TG/HDL-C ratio,TyG index,TyG-BMI,and METS-IR of subjects in the GLS<18%group were significantly increased(P<0.05).Pearson correlation analysis showed that TG/HDL-C ratio,TyG index,TyG-BMI,TyG-WHR,and METS-IR were negatively correlated with GLS(P<0.05).ROC analysis showed that TyG index had a certain predictive value for the evaluation of GLS<18%(AUC=0.678,95%CI 0.591-0.765,P<0.001).Stratification based on hypertension and further adjusting for confounding factors,TyG index remains significantly associated with GLS<18%(OR=3.249,95%CI 1.045-10.103,P=0.042).Conclusions The novel simplified insulin resistance evaluation indexes are closely associated with left ventricular subclinical systolic dysfunction in T2DM patients with preserved ejection fraction.TyG index is an effective index to identify left ventricular subclinical dysfunction in these populations.

Clinical application of noncompliant balloon post-dilatation during emergency PCI in patients with a-cute ST-segment elevation myocardial infarction and type 2 diabetes mellitus with low thrombus bur-den / 心血管康复医学杂志

Objective:To explore the clinical therapeutic effect and safety of noncompliant balloon post-dilatation(PD)during emergency percutaneous coronary intervention(PCI)in patients with acute ST-segment elevation my-ocardial infarction(STEMI)and type 2 diabetes mellitus(T2DM)with low thrombus burden.Methods:A total of 122 STEMI±T2DM patients,who underwent emergency PCI in our hospital from Jan 2016 to Dec 2021,were con-secutively enrolled.According to PD therapy after PCI or not,they were divided into PD group(n=78)and non-PD group(n=44).Clinical data,PCI condition,postoperative TIMI blood flow,ST-segment elevation index res-olution(∑STIR),incidence rate of the major adverse cardiac events(MACE)during hospital and LVEF,incidence rates of in-stent restenosis and MACE within one year after PCI were compared between two groups.Results:Compared with non-PD group,there were significant reductions in incidence rate of MACE during hospital(15.9％vs.3.8％),incidence rates of in-stent restenosis(14.3％vs.2.6％)and MACE within one year after PCI(21.4％vs.2.6％)in PD group(P＜0.05 or＜0.01),there were significant rise in LVEF within one year after PCI[58.50(52.75,65.25)％vs.64.00(58.25,67.50)％]in PD group(P=0.005).Conclusion:It's safe and feasible to apply noncompliant balloon PD during emergency PCI in STEMI+T2DM patients with low thrombus bur-den.It can reduce incidence rate of MACE during hospital,in-stent restenosis and MACE within one year after PCI,and improve left heart function of patients,and provide clinical reference for the use of PD therapy in emer-gency PCI for these patients.

Clinical study of atorvastatin combined with indobufen in the treatment of elderly patients with diabetic kidney disease complicated with large atheromatous ischemic stroke during convalescence / 中国医师进修杂志

Objective:To investigate the efficacy and safety of atorvastatin combined with indobufen in the treatment of elderly patients with diabetic kidney disease (DKD) complicated with large atheromatous ischemic stroke (LAA-IS) during convalescence.Methods:The clinical data of 102 elderly patients with DKD complicated with LAA-IS during convalescence from September 2018 to April 2022 in Baoding Second Central Hospital were retrospectively analyzed. Among them, 51 patients were treated with atorvastatin combined with indobufen (observation group), 51 patients were treated with atorvastatin combined with aspirin (control group), and both groups were treated continuously for 6 months. The prethrombotic state indexes, neurological function and quality of daily life, carotid artery ultrasound indexes, renal fibrosis indexes before treatment and after treatment were compared between two group. The prethrombotic state indexes included arachidonic acid (AA) and adenosine diphosphate (ADP) induction platelet aggregation rate, fibrinogen (FIB), protein C; the National Institutes of Health Stroke Scale (NIHSS) was used to evaluate the neurological function, and the modified Barthel index (MBI) was used to evaluate the quality of daily life; carotid artery ultrasound indexes included carotid artery intima-media thickness (IMT) and maximum plaque area; the renal fibrosis indexes included transforming growth factor-β 1 (TGF-β 1), matrix metalloproteinase-9 (MMP-9), hyaluronic acid and platelet derived growth factor-BB (PDGF-BB). The adverse reactions were recorded. Results:There were no statistical differences in the all indexes before treatment between two groups ( P>0.05). In two groups, compared before treatment, the AA induction platelet aggregation rate, ADP induction platelet aggregation rate, FIB, NIHSS score, IMT and maximum plaque area after treatment were significantly lower, the protein C and MBI score were significantly higher, and there were statistical differences ( P<0.01); but there were no statistical differences after treatment between two groups ( P>0.05). The TGF-β 1, MMP-9, hyaluronic acid and PDGF-BB after treatment in two groups were significantly lower than before treatment, and the indexes in observation group were significantly lower than those in control group: (39.46 ± 6.89) μg/L vs. (45.04 ± 8.20) μg/L, (278.46 ± 49.39) μg/L vs. (327.30 ± 57.28) μg/L, (102.37 ± 20.62) μg/L vs. (116.84 ± 24.97) μg/L vs. (25.26 ± 4.45) μg/L vs. (28.13 ± 5.08) μg/L, with statistically significant differences( P<0.01). The incidence of adverse reactions in observation group was significantly lower than that in control group: 7.84% (4/51) vs. 23.53% (12/51), and there was statistical difference ( P<0.05). Conclusions:Compared with atorvastatin combined with aspirin, atorvastatin combined with indobufen in elderly patients with DKD complicated with LAA-IS during convalescence has the same effect in improving the related indicators of prethrombotic state, reducing neurological function deficit, improving the ability of daily living, and reversing carotid atherosclerosis. However, atorvastatin combined with indobufen can further protect renal function with higher safety.

Efficacy of the combination of semaglutide, insulin degludec, and metformin in the treatment of type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity / 中国基层医药

Objective:To investigate the efficacy of the combination of semaglutide, insulin degludec, and metformin in the treatment of type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity.Methods:A total of 160 patients with type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity were included in this case-control study after receiving treatment at Bayannur Hospital from April 2022 to March 2023. These patients were divided into a control group and an observation group based on different treatment regimens, with 80 patients in each group. The control group was treated with degludec insulin combined with metformin, while the observation group was treated with semaglutide, degludec insulin, and metformin. The treatment lasted for 12 weeks in both groups. The changes in fasting plasma glucose, 2-hour postprandial blood glucose (2 h PG), glycosylated hemoglobin, time in range for 2 h PG, fasting insulin, Homeostatic Model Assessment for Insulin Resistance index, body mass index, and visceral fat area and adverse reactions were monitored.Results:The overall response rate in the observation group was 100% (80/80), which was significantly higher than 97.5% (78/80) in the control group (χ 2 = 11.03, P < 0.05). After treatment, the levels of 2 h PG, glycosylated hemoglobin, fasting insulin, Homeostatic Model Assessment for Insulin Resistance index, body mass index, visceral fat area in the observation group were (7.35 ± 0.17) mmol/L, (6.08 ± 0.24)%, (10.30 ± 2.58) μU/mL,(2.69 ± 0.66), (24.40 ± 0.68) kg/m 2, (80.20 ± 8.94) cm 2, respectively, which were significantly lower than (7.92 ± 0.24) mmol/L, (6.34 ± 0.27)%,(13.71 ± 3.13) μU/mL,(3.57 ± 0.83), (26.77 ± 3.49) kg/m 2, (116.12 ± 34.09) cm 2 respectively in the control group ( t = -0.73, -3.74, -4.20, -4.15, -3.35, -5.10, all P < 0.05). The time in range for 2 h PG in the observation group was (72.68 ± 4.09)%, which was significantly higher than (50.16 ± 10.00)% in the control group ( t = -10.42, P < 0.05). The incidence of adverse reactions in the observation group was 3.8% (3/80), which was slightly, but not significantly, higher than 2.5% (2/80) in the control group ( P > 0.05). Conclusion:The combination of semaglutide, degludec insulin, and metformin demonstrates an ideal clinical effect in the treatment of type 2 diabetes mellitus and poor glycemic control accompanied by overweight or obesity. This combined approach can effectively regulate fasting and postprandial blood glucose levels, markedly decrease the body mass index and visceral fat levels, and improve insulin resistance while not significantly increasing the incidence of adverse reactions.

Correlation analysis between gene polymorphism of TCF7L2 and type 2 diabetes mellitus in the Uygur and Han populations in Xinjiang / 中国糖尿病杂志

Objective To investigate the correlation between the gene polymorphisms of rs7100927,rs10885409,rs4918789,rs290487 of TCF7L2 gene and type 2 diabetes mellitus(T2DM)of Uygur nationality and Han nationality.Methods 577 T2DM patients(T2DM group,293 Han and 284 Uyghu)were enrolled in the Department of Endocrinology,Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University from December 2013 to August 2015.In the same period,307 healthy subjects were selected as normal control(NC)group,of which 208 were Han Chinese and 99 were Uyghu.The polymorphism of TCF7L2 gene rs7100927,rs10885409,rs4918789 and rs290487 were identified by imLDRTM multiple SNP typing technique.Results In Uygur,the frequency of allele G at rs7100927 and rs4918789 of TCF7L2 gene and the frequency of allele C at rs10885409 and rs290487 in T2DM group were lower than those in NC group(P<0.05).Conclusion The G allele at rs7100927 and rs4918789 and C allele at rs10885409 and rs290487 of TCF7L2 gene may be protective factors for T2DM in Xinjiang Uygur population.

Study on the biomarker of circular RNA in peripheral blood of Uygur patients with type 2 diabetes mellitus / 中国糖尿病杂志

Objective To explore the potential circular RNA(circRNA)biomarker of Uygur type 2 diabetes mellitus(T2DM).Methods A total of 120 T2DM patients and 120 subjects with normal glucose tolerance were recruited from the Department of Endocrinology and Metabolism of the First Affiliated Hospital of Shihezi University and Shihezi community from October 2020 to August 2021,and divided into four groups:60 Uygur T2DM patients(Uygur T2DM group),60 Uygur subjects with normal glucose tolerance(Uygur NC group),60 Han T2DM patients(Han T2DM group)and 60 Han subjects with normal glucose tolerance(Han NC group).Hsa_circRNA_0042817,hsa_circRNA_0006532 and hsa_circRNA_0004131 were selected as candidate circRNA,and the expression in peripheral blood were detected by RT-qPCR.Logistic regression was used to analyze the influencing factors for Uygur T2DM,and the receiver operating characteristic(ROC)curve was used to evaluate the biomarker value of circRNA in Uygur T2DM.Results The expressions of hsa_circRNA_0042817,hsa_circRNA_0006532 and hsa_circRNA_0004131 were higher in Uygur T2DM group than in Uygur NC group(P<0.05).The expression of hsa_circRNA_0042817 was higher in Uygur T2DM group than in Han T2DM group(P<0.05).Logistic regression analysis showed that hsa_circRNA_0042817 was an influencing factor for T2DM in Uygur population[OR(95%CI)3.420(1.567～7.465)].ROC curve analysis showed that the area under the curve was the largest(0.798)in hsa_circRNA_0042817.Conclusion There were up-regulated circRNA in peripheral blood in Uygur T2DM patients,and hsa_circRNA_0042817 may be a biomarker for T2DM in Uygur patients.

Relationship between polymorphism of Visfatin gene rs61330082,rs4730153 and type 2 diabetes mellitus / 中国糖尿病杂志

Objective To evaluate the value of rs61330082 and rs4730153 polymorphisms of Visfatin locus for the diagnosis of type 2 diabetes mellitus(T2DM)in a high-risk population.Methods SNPscanTM high-throughput single nucleotide polymorphism typing technique was used to genotype Visfatin gene loci rs61330082 and rs4730153 in 346 T2DM patients(T2DM group)and 1426 normal controls(NC group).Logistic regression analysis was used to analyze T2DM risk factors.ROC curves were used to analyze the optimal cut-off values of Visfatin gene rs61330082 and rs4730153 for the diagnosis of T2DM.Results The proportion of women,age,obesity,smoking,hypertension,FPG,HbA1c and TG were higher in T2DM group than those in NC group(P<0.01)and HDL-C was lower than in NC group(P<0.01).The frequency of G allele and GG genotype was higher in T2DM group compared with NC group(P<0.05).Logistic regression analysis showed that age,female,obesity,hypertension,TG,and GG genotype at rs4730153 locus were risk factors for T2DM,HDL-C was a protective factor for T2DM.The area under the ROC curve of GG genotype at Visfatin rs4730153 mutation for diagnosis of T2DM was 0.668 and the optimal cut-off point for predicting T2DM was 20.04%,with sensitivity 60.1%and specificity 66.1%,respectively.Conclusion The GG genotype of Visfatin gene rs4730153 locus is associated with the risk of T2DM and can beused as a candidate gene for predicting phenotype of T2DM.

Differential expression analysis of plasma circRNA in patients with type 2 diabetes mellitus / 中国糖尿病杂志

Objective To examine the differential expression of plasma circRNA in individuals with type 2 diabetes mellitus(T2DM)and to elucidate the potential role of circRNA in the pathogenesis and progression of T2DM.Methods A total of 33 newly diagnosed T2DM patients who were hospitalized in the Department of Endocrinology of Heze Municipal Hospital and 33 healthy subjects with normal glucose tolerance(NC)were enrolled in this study from March 2022 to March 2023.Three subjects with T2DM and 3 with NC were randomly selected from study population and underwent high-throughput sequencing to identify differentially expressed circRNA.Six circRNA with significant differences were selected,and validated in the remaining study population using Real-Time Quantitative Polymerase Chain Reaction(RT-qPCR).Bioinformatics analyses were conducted on the differentially expressed circRNA-associated genes,and their interaction with microRNA(miRNA)was predicted.Results Microarray analysis revealed 166 significantly differentially expressed circRNA(FC≥2,P<0.05)in the T2DM group compared with NC group.Among them,137 were up-regulated and 29 were down-regulated.RT-qPCR validation of six circRNA showed that the expression level of hsa_circ_0000705 was significantly higher,while the expression levels of hsa_circ_0005362 and hsa_circ_0042839 were significantly lower in T2DM group,consistent with the microarray results.However,hsa_circ_0117392,hsa_circ_0008311,and hsa_circ_0087641 showed no significant changes.Conclusion Differentially expressed circRNA are present in T2DM patients.Hsa_circ_0005362 was significantly down-regulated and may be involved in the development of T2DM through the regulation of related signaling pathways by targeting miR-128-1-5p.