Chinese clinical practice guidelines for perioperative blood glucose management.

With the increased incidence of diabetes, the number of diabetic patients who require surgical treatment is also increasing. Unfortunately, practices in this area lack standardisation. The purpose of this multidisciplinary, evidence-based guidelines for perioperative blood glucose management is to provide a comprehensive set of recommendations for clinicians treating diabetes with different types of surgery. The intended audience comprises Chinese endocrinologists, surgeons, anaesthetists, clinical pharmacists, nurses and professionals involved in perioperative blood glucose management. The guidelines were formulated as follows. First, a multidisciplinary expert group was established to identify and formulate key research questions on topics of priority according to the Population, Intervention, Comparator and Outcomes (PICO) process. We conducted a meta-analysis of available studies using Review Manager version 5.3, as appropriate. We pooled crude estimates as odds ratios with 95% confidence intervals using a random-effects model, and used the Grading of Recommendations Assessment, Development, and Evaluation methods to assess the quality of the retrieved evidence. Finally, 32 recommendations were gathered that covered 11 fields-management and coordination, endocrinologists' consultation, diabetes diagnosis, surgery timing and anaesthesia method, blood glucose target values and monitoring frequency, hypoglycaemia treatment, oral administration of blood glucose lowering drugs, use of insulin, enteral and parenteral nutritional, postoperative treatment and medication and education and training. Twenty-five systematic reviews and meta-analyses were conducted for these guidelines to address the PICO questions. These guidelines are intended to improve perioperative blood glucose management and help doctors in specifying medical diagnosis and treatment, and will be implemented / disseminated extensively in China.

Urinary retinol binding protein and β 2-microglobulin were associated with urinary albumin to creatinine ratio and renal function in hospitalized diabetic patients / 中华内科杂志

Objective:To explore the associations of urinary retinol binding protein (RBP) and β 2-microglobulin (β 2-MG) with urinary albumin to creatinine ratio (UACR) and renal function in hospitalized patients with type 2 diabetes mellitus (T2DM). Methods:A total of 1 030 Chinese patients with T2DM were included in this study. The subjects were divided into the UACR normal group (<30 mg/g), microalbuminuria group (30-300 mg/g) and macroalbuminuria group (>300 mg/g). Patients with normal UACR were further divided into two groups according to the estimated glomerular filtration rate (eGFR): the eGFR low group (<90 ml·min -1·1.73m -2) and the normal eGFR group (≥90 ml·min -1·1.73m -2). Urine RBP and β 2-MG levels among the groups were compared. Multiple linear regression analyses were applied to evaluate risk factors of urine RBP and β 2-MG. Results:In all patients ( n=1 030), urine RBP and β 2-MG increased gradually with the increase of UACR across the three groups, the proportions of abnormal urine RBP (>0.7 mg/L) and β 2-MG (>370 μg/L) in these groups were 3.8%, 8.5%, 39.0% ( P<0.001), and 12.9%, 26.7%, 46.8% ( P<0.001), respectively. In the UACR normal group ( n=788), 12.2% of the patients were with eGFR<90 ml·min -1·1.73m -2. The proportion of abnormal β 2-MG (>370 μg/L) was higher in the eGFR low group than that in the eGFR normal group (29.2% vs. 10.7%, P<0.001). Multivariate linear stepwise regression analyses were performed using natural logarithm of urine RBP or β 2-MG as dependent variable, and showed that urine RBP was independently associated with UACR ( β=0.0005, P<0.001), serum creatinine ( β=0.006, P<0.001) and glycosylated hemoglobin A1c ( β=0.050, P=0.001), and β 2-MG was independently correlated with UACR ( β=0.000 4, P<0.001), serum creatinine ( β=0.011, P<0.001), systolic blood pressure ( β=0.005, P=0.031) and fasting blood-glucose ( β=0.027, P=0.046). Conclusions:Urine RBP and β 2-MG are positively associated with high UACR and impaired renal function in T2DM patients, and these changes could occur before UACR and eGFR turned out to be abnormal. It is recommended that urine RBP and β 2-MG be detected as early as possible to identify diabetic kidney disease in patients with normal UACR and eGFR.

Non-Insulin Antidiabetes Treatment in Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

In order to evaluate the efficacy and side effects of the non-insulin antidiabetes medications as an adjunct treatment in type 1 diabetes mellitus (T1DM), we conducted systematic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials published between the date of inception and March 2020 to produce a systematic review and meta-analysis. Overall, 57 studies were included. Compared with placebo, antidiabetes agents in adjunct to insulin treatment resulted in significant reduction in glycosylated hemoglobin (weighted mean difference [WMD], –0.30%; 95% confidence interval [CI], –0.34 to –0.25%; P<0.01) and body weight (WMD, –2.15 kg; 95% CI, –2.77 to –1.53 kg; P<0.01), and required a significantly lower dosage of insulin (WMD, –5.17 unit/day; 95% CI, –6.77 to –3.57 unit/day; P<0.01). Compared with placebo, antidiabetes agents in adjunct to insulin treatment increased the risk of hypoglycemia (relative risk [RR], 1.04; 95% CI, 1.01 to 1.08; P=0.02) and gastrointestinal side effects (RR, 1.99; 95% CI, 1.61 to 2.46; P<0.01) in patients with T1DM. Compared with placebo, the use of non-insulin antidiabetes agents in addition to insulin could lead to glycemic improvement, weight control and lower insulin dosage, while they might be associated with increased risks of hypoglycemia and gastrointestinal side effects in patients with T1DM.

Non-Insulin Antidiabetes Treatment in Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

In order to evaluate the efficacy and side effects of the non-insulin antidiabetes medications as an adjunct treatment in type 1 diabetes mellitus (T1DM), we conducted systematic searches in MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials for randomized controlled trials published between the date of inception and March 2020 to produce a systematic review and meta-analysis. Overall, 57 studies were included. Compared with placebo, antidiabetes agents in adjunct to insulin treatment resulted in significant reduction in glycosylated hemoglobin (weighted mean difference [WMD], –0.30%; 95% confidence interval [CI], –0.34 to –0.25%; P<0.01) and body weight (WMD, –2.15 kg; 95% CI, –2.77 to –1.53 kg; P<0.01), and required a significantly lower dosage of insulin (WMD, –5.17 unit/day; 95% CI, –6.77 to –3.57 unit/day; P<0.01). Compared with placebo, antidiabetes agents in adjunct to insulin treatment increased the risk of hypoglycemia (relative risk [RR], 1.04; 95% CI, 1.01 to 1.08; P=0.02) and gastrointestinal side effects (RR, 1.99; 95% CI, 1.61 to 2.46; P<0.01) in patients with T1DM. Compared with placebo, the use of non-insulin antidiabetes agents in addition to insulin could lead to glycemic improvement, weight control and lower insulin dosage, while they might be associated with increased risks of hypoglycemia and gastrointestinal side effects in patients with T1DM.

Cardiovascular risk profile and clinical characteristics of diabetic patients: a cross-sectional study in China / 中华医学杂志(英文版)

BACKGROUND@#Cardiovascular (CV) disease is the leading cause of morbidity and mortality in adults with type 2 diabetes (T2D). The aim of this study was to determine the CV risk in Chinese patients with T2D based on the 2019 European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) guidelines on diabetes, pre-diabetes, and CV diseases.@*METHODS@#A total of 25,411 patients with T2D, who participated in the study of China Cardiometabolic Registries 3B study, were included in our analysis. We assessed the proportions of patients in each CV risk category according to 2019 ESC/EASD guidelines.@*RESULTS@#Based on the 2019 ESC/EASD guidelines, 16,663 (65.6%), 1895 (7.5%), and 152 (0.6%) of patients were included in "very high risk," "high risk," and "moderate risk" categories, respectively. The proportions of patients in each category varied based on age, sex, body mass index, and duration. While 58.7% (9786/16,663) of elderly patients were classified to "very high risk" group, 89.6% (3732/4165) of patients with obesity were divided into "very high risk" group. Almost all patients with a duration of diabetes >10 years had "very high risk" or "high risk." However, 6701 (26.4%) of Chinese T2D patients, who had shorter duration, and one or two risk factors, could not be included in any category (the "unclear risk" category).@*CONCLUSIONS@#In China, most patients with T2D have "very high" or "high" CV risk based on 2019 ESC/EASD guidelines. However, the risk of patients in "unclear risk" group needs to be further classified.

Use of SGLT-2 Inhibitors in Patients with Type 2 Diabetes Mellitus and Abdominal Obesity: An Asian Perspective and Expert Recommendations.

The prevalence of obesity in Asia is of epidemic proportions, with an estimated 1 billion overweight/obese individuals in the region. The majority of patients with type 2 diabetes mellitus (T2DM) are overweight/obese, which increases the risk of cardiorenal outcomes in these patients; hence, sustained reductions in body weight and visceral adiposity are important management goals. However, most of the glucose-lowering therapies such as insulin, sulfonylureas, glinides, and thiazolidinediones induce weight gain, which makes the management of overweight/obese T2DM patients challenging. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are the only oral glucose-lowering agents that have been shown to reduce body weight and visceral adiposity. In addition, SGLT-2 inhibitors therapy reduces ectopic fat deposition and improves adipose tissue function and weight-related quality of life. In this article, we aim to consolidate the existing literature on the effects of SGLT-2 inhibitors in Asian patients with T2DM and to produce clinical recommendations on their use in overweight or obese patients with T2DM. Recommendations from international and regional guidelines, as well as published data from clinical trials in Asian populations and cardiovascular outcomes trials are reviewed. Based on the available data, SGLT-2 inhibitors represent an evidence-based therapeutic option for the management of overweight/obese patients with T2DM.

Application of the superior thyroid artery peak systolic velocity in differentiating Graves′ disease from autoimmune thyroiditis / 中华内科杂志

Objective:To evaluate the clinical value of the superior thyroid artery peak systolic velocity (STA-PSV) for the differential diagnosis of autoimmune thyrotoxicosis.Methods:A total of 301 patients with newly diagnosed thyrotoxicosis and without any anti-thyroid drug intervention were collected from the Department of Endocrinology and Metabolism, Peking University People′s Hospital from Jan. 2015 to Oct. 2018. Among them, 241 patients were with Graves′ disease (GD) and 60 patients were with autoimmune thyroiditis (AIT). STA-PSV, thyroid function and thyrotropin receptor antibody (TRAb) were determined. A multiple linear regression was used to identify factors associated with STA-PSV. A receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the discriminating ability of STA-PSV to GD.Results:STA-PSV leves in GD group were significantly higher than those in AIT group [61.00 (41.00, 86.50) cm/s vs. 34.50 (25.25, 46.00) cm/s, P<0.001]. The ROC curve analysis showed that the AUC was 0.790 (95 %CI 0.734-0.845), and 49.5cm/s was the optimal cutoff point for the diagnosis of GD, in which the sensitivity was 64.3% and the specificity was 83.3%. In all patients with thyrotoxicosis, multiple linear regression analyses showed free thyroxine (FT 4) (β=0.371, 95 %CI 0.005-0.010, P<0.001) and TRAb (β=0.138, 95 %CI 0.001-0.014, P=0.035) were positively associated with STA-PSV. Conclusions:The STA-PSV is positively associated with FT 4 and TRAb levels, and it is a helpful marker in differential diagnosis between GD and AIT.

Application of the superior thyroid artery peak systolic velocity in differentiating Graves′ disease from autoimmune thyroiditis / 中华内科杂志

Objective@#To evaluate the clinical value of the superior thyroid artery peak systolic velocity (STA-PSV) for the differential diagnosis of autoimmune thyrotoxicosis.@*Methods@#A total of 301 patients with newly diagnosed thyrotoxicosis and without any anti-thyroid drug intervention were collected from the Department of Endocrinology and Metabolism, Peking University People′s Hospital from Jan. 2015 to Oct. 2018. Among them, 241 patients were with Graves′ disease (GD) and 60 patients were with autoimmune thyroiditis (AIT). STA-PSV, thyroid function and thyrotropin receptor antibody (TRAb) were determined. A multiple linear regression was used to identify factors associated with STA-PSV. A receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the discriminating ability of STA-PSV to GD.@*Results@#STA-PSV leves in GD group were significantly higher than those in AIT group [61.00 (41.00, 86.50) cm/s vs. 34.50 (25.25, 46.00) cm/s, P<0.001]. The ROC curve analysis showed that the AUC was 0.790 (95%CI 0.734-0.845), and 49.5cm/s was the optimal cutoff point for the diagnosis of GD, in which the sensitivity was 64.3% and the specificity was 83.3%. In all patients with thyrotoxicosis, multiple linear regression analyses showed free thyroxine (FT4) (β=0.371, 95%CI 0.005-0.010, P<0.001) and TRAb (β=0.138, 95%CI 0.001-0.014, P=0.035) were positively associated with STA-PSV.@*Conclusions@#The STA-PSV is positively associated with FT4 and TRAb levels, and it is a helpful marker in differential diagnosis between GD and AIT.

Use of sodium-glucose co-transporter-2 inhibitors in patients with type 2 diabetes mellitus and multiple cardiovascular risk factors: An Asian perspective and expert recommendations.

Diabetes mellitus in Asia accounts for more than half of the global prevalence. There is a high prevalence of cardiovascular disease (CVD) in the region among people with type 2 diabetes mellitus (T2DM) and it is often associated with multiple risk factors including hypertension, renal disease and obesity. The early onset of T2DM and the eventual long disease duration portends an increasing proportion of the population to premature CVD. In addition to lowering blood glucose, sodium-glucose co-transporter-2 (SGLT-2) inhibitors exert favourable effects on multiple risk factors (including blood pressure, body weight and renal function) and provide an opportunity to reduce the risk of CVD in patients with T2DM. In this article, we consolidated the existing literature on SGLT-2 inhibitor use in Asian patients with T2DM and established contemporary guidance for clinicians. We extensively reviewed recommendations from international and regional guidelines, published data from clinical trials in the Asian population (dapagliflozin, canagliflozin, empagliflozin, ipragliflozin, luseogliflozin and tofogliflozin), CVD outcomes trials (EMPAREG-OUTCOME, CANVAS and DECLARE-TIMI 58) and real-world evidence studies (CVD-REAL, EASEL, CVD-REAL 2 and OBSERVE-4D). A series of clinical recommendations on the use of SGLT-2 inhibitors in Asian patients with T2DM was deliberated among experts with multiple rounds of review and voting. Based on the available evidence, we conclude that SGLT-2 inhibitors represent an evidence-based therapeutic option for the primary prevention of heart failure hospitalization and secondary prevention of CVD in patients with T2DM, and should be considered early on in the treatment algorithm for patients with multiple risk factors, or those with established CVD.

Analysis of the relationship and influencing factors between pre?diabetes mellitus and hypertension / 中华健康管理学杂志

Objective To explore the relationship and influencing factors between pre‐diabetes mellitus (pre‐DM) and hypertension, providing evidence for formulating strategies for cardiovascular disease prevention and control. Methods We conducted this study from June 2013 to September 2014. Using stratified multistage random sampling, participants were administered a questionnaire survey, their height, weight, waist circumference, hip circumference, other physical attributes, blood pressure and blood lipids were measured. They also underwent the 75‐g glucose tolerance test and other laboratory examinations. A logistic regression model was used to analyze the relationship between pre‐DM and hypertension and its influencing factors. Results A total of 4 002 participants completed the survey. Participants'mean age was 50.3 ± 11.8 years. Of the total participants, 1 962 (49.0%) were males, while 2 039 (51.0%) were females; 1 participant had missing gender data. Further, 2 188 participants had normal glucose metabolism, 1 066 had pre‐DM, and 748 had diabetes. The prevalence of hypertension in participants with normal glucose metabolism, impaired fasting glucose, impaired glucose tolerance, both impaired fasting glucose and impaired glucose tolerance, and DM was 28.3%, 46.5%, 46.3%, 62.0%, and 61.2%, respectively. The prevalence of hypertension varied among people with different glucose metabolism (χ2=306.672, P<0.001). The prevalence of hypertension in the pre‐DM population increased with the aggravation of abnormal glucose metabolism compared to the normal glucose metabolism population, with a linear trend (χ2=299.009, P<0.001). Among those with abnormal glucose metabolism, there were differences in age, cholesterol, triglycerides, low‐density lipoproteins, body mass index, and waist circumference compared to those without hypertension (P<0.05). The risk of hypertension in the pre‐diabetic population was 1.5 times higher than that in the normal glucose metabolism population (OR=2.510, 95% CI: 2.156-2.922, P<0.001). There was no difference in the correlation intensity between pre‐DM and hypertension when gender was taken into account. Age and lipid abnormalities slightly decreased the correlation intensity between abnormal glucose metabolism and hypertension. Considering body mass index and centripetal obesity, the correlation intensity between abnormal glucose metabolism and hypertension could be reduced by controlling these factors. Conclusion The prevalence of hypertension is high in people with pre‐DM. There is a correlation between pre‐DM and hypertension, even when considering factors such as age, dyslipidemia, body mass index, and centripetal obesity. Therefore, it is necessary to strengthen the management of blood pressure in the pre‐diabetic population; improve early intervention for risk factors such as dyslipidemia, body mass index, and centripetal obesity; and reduce the occurrence of hypertension.

Effect of parity on autoimmune thyroid disease / 中华内分泌代谢杂志

The objective of this study was to evaluate parity as a risk factor for autoimmune thyroid disease ( AITD) by comparing features of thyroid autoantibodies of pregnant women with different parities. This prospective cohort study included 477 women of first trimester of pregnancy in Peking University International Hospital from October 2016 to April 2017. Subjects were categorized as never parturition group ( n=287) or previously parturition group(n=190). All pregnant women in this study voluntarily signed informed consents. Thyroid peroxidase antibody (TPOAb), thyroglobulin antibody (TgAb), thyrotropin (TSH), and free T4 were measured in the first trimester of pregnancy( from 7 to 12 weeks) . Meanwhile, height, weight, blood pressure, gestational weeks and pregnancy history were recorded. Data were statistically analyzed. The positive rates of thyroid autoantibodies including TPOAb and TGAb in previously parturition group were higher than those in no parturition group(10.0％vs 5.2％, P<0.05). The previously parturition group tended to be older and had lower TSH levels than the never pregnant group( P<0.05) . TSH 2.5 mIU/L and 4.0 mIU/L were used as upper reference limits respectively. The rate of abnormality of thyroid function was higher in the never parturition group than those in previously parturition ones ( 33. 33 by 29. 5％, 21. 2％ by 10. 8％) . In both previously parturition and never parturition groups, the commonest diseases of abnormal thyroidal function were SCH and subclinical thyrotoxicosis, and there was significant difference in disease of abnormal thyroidal function abnormal(χ2=15.704, P<0.05 and χ2=14.560, P<0.05). Parity was associated with AITD after adjustment for age, BMI, and gestational week [OR=2.346(1.075-5.121)]. Parity may affect AITD. Pregnant women should be monitored for thyroid function and thyroid autoantibodies even if they did not suffer from thyroid disease in the first pregnancy.

Effects of subclinical hypothyroidism on pregnancy outcome and offspring development / 中华内分泌代谢杂志

The metabolism of thyroid hormone changes during pregnancy. Subclinical hypothyroidism during pregnancy may adversely affect the pregnancy outcomes and neuropsychological development of child, controversially. The diagnostic criteria of subclinical hypothyroidism during pregnancy need to be specific. It is important to figure out when should pregnancy with subclinical hypothyroidism be treated and what is the specific goal of the treatment.

Research on Metformin pharmacogenomics in the treatment of type 2 diabetes / 中国糖尿病杂志

Metformin is a first-line therapy for type 2 diabetes mellitus.Individual variation in response to metformin exists in clinical practice,which is associated with genetic background.Current researches focus on elucidating the relationship between the polymorphisms of genes and the absorption,transportation,metabolism,and excretion of metformin,and also pharmacogenomics of metformin treatment.Pharmacogenomics also provides theoretical basis for individualized therapy.Here,we reviewed the literature progress for metformin pharmacogenomics.

Influence of iron metabolism disorders on glucose metabolism and HbA1c / 中国糖尿病杂志

HbA1c has already been one of the standard diagnostic criteria for diabetes and pre-diabetes.However,disorders of iron metabolism could affect glucose metabolism through various pathways,and influence HbA1c level directly or indirectly.So under certain circumstances,it may affect the diagnosis of glucose metabolic status.Here we reviewed researches about the interference of iron metabolism disorders on HbA1c.

Paradigm shift-prospective on anti-diabetic medical treatment strategy based on cardiovascular protection / 中国糖尿病杂志

Diabetes has become one of the most devastating non-communicable chronic diseases worldwide.China has the most diabetes patients in the world,the prevention and control of diabetes face great challenges.The main hazard of diabetes is from its complications;especially the cardiovascular complications that are the leading cause of death in type 2 diabetes patients.With the progress and effort of diabetes treatment,Acute and chronic microvascular complications of diabetes,such as retinopathy,have been significantly reduced over the past few decades.But cardiovascular disease is still remained as the leading cause of premature death.Therefore,with the availability of new medications that could exert cardiovascular-protection and life saving,the future diabetes treatment strategy should change from the current "glucose-centered" approach to "cardiovascular-centered" one with balanced glycemic control.

Effectiveness evaluation of the mobile health patients management mode on treatment compliance and glycemic control for type 2 diabetes patients using basal insulin treatment for 12 weeks / 中华内分泌代谢杂志

Objective To assess the effectiveness of a novel mobile health patient management system involving doctors, nurses, and patients ( TRIO mode) on glycemic control and self-monitoring of blood glucose (SMBG) compliance among the type 2 diabetes mellitus ( T2DM) patients using basal insulin standardization treatment in China. Methods From April 2014 to April 2015, 416 hospitals in 110 cities of 30 provinces, municipalities, and autonomous regions across China were selected to participate in the program. A Online-to-Offline ( O2O) integrated mobile health patients management system with mobile terminals for the doctors, nurses, and patients was applied in the program for patient education, follow-up, and data collection. For all the newly recruited patients, the baseline information was collected and a first-day patient education program were provided by a designated nurse. In the 12-week follow-up period, data of basal insulin doses and fasting plasma glucose ( FPG) values were collected from the patients by text messages or tracking phone call by the nurse. The patients also received timely standardized patients health education and glycemic control guidance by participating in thepatient education forum anddoctors' hotline in order to help them achieve the glycemic control goals. Results A total of 102 524 patients using basal insulin treatment were eligible and enrolled in the program. 64 420 patients completed the 12 weeks follow-up and provided at least one FPG value at all five follow-ups. In total, 62. 6% (40 334 / 64 420) of the patients reached the FPG control target(FPG≤7. 0 mmol/ L) at the end of follow-up period. The weekly average FPG for patients with complete SMBG data decreased from 10. 58 mmol/ L to 6. 91 mmol/ L while the FPG control rates increased from 13. 4% to 69. 2% . The weekly average FPG for the patients provided incomplete SMBG data decreased from 10. 54 mmol/ L to 7. 13 mmol/ L while the FPG control rates increased from 13. 6% to 62. 2% . The FPG control rates for the patients provided complete SMBG were 1. 74 times higher than those patients provided incomplete SMBG. Based on a GEE model, the average decline of the FPG and the increase of the FPG control rates were significantly better for patients who provided complete SMBG as compared to the patients with incomplete SMBG data. The results of the multivariate logistic regression analysis showed that factors such as receiving the first-day education, participating in the follow-up patient education forum, and the doctors' hotline were significantly associated with the improvement of the SMBG compliance, the treatment adherence, and the FPG control rates. The SMBG compliance and the treatment adherence for patients who completed first-day education were 1. 68 times and 1. 22 times higher, respectively. For the patients who participated in follow-up education activities, their SMBG compliance and treatment adherence were 3. 17 times and 3. 36 times higher, respectively. Conclusion The innovativeTRIOmobile health patient management mode was feasible and effective for better managing the type 2 diabetes patients initiated on basal insulin treatment in China. Active participation in the first-day education program and the follow-up patient education activities can effectively improve the SMBG compliance and the treatment adherence, and therefore play an important role in helping patient achieving FPG control in a faster manner.

Effectiveness and safety of initiation of once-daily insulin detemir in Chinese patients with type 2 diabetes previously treated with different quantifies of oral anti-diabetic drugs: subgroup analysis of the Chinese SOLVETM Study / 中华内科杂志

Objective To evaluate the effectiveness and safety on once-daily (OD) insulin detemir (IDet) in Chinese patients with type 2 diabetes mellitus (T2DM) who were treated with different types or combinations of oral anti-diabetic drugs (OADs).Methods The SOLVETM study was a 24-week observational study on the initiation of IDet OD in T2DM patients with uncontrolled hyperglycemia on diet,exercise,and one or more OADs.Subjects were grouped based on the numbers of OADs taken before (＞ 2-OAD,2-OAD,and 1-OAD groups).Efficacy and safety endpoints were evaluated and compared in different groups.Results This study includes 3 272 patients,among them 464 (14.2％) were treated with more than 2OADs,1511 (46.2％) with 2OADs,and 1 218 (37.2％) with 1OAD before the study.The mean glycosylated hemoglobin A1c (HbA1c) was 8.4％,8.3％,8.4％ at baseline,and 7.3％,7.2％,7.1％ at the end of 24-week in each 3 groups (all P ＜0.001 vs.baseline values).The HbA1c reductions were not statistically significant different among groups.Body weight tended to decrease in patients from all groups,however,only that in the 2-OAD group reached statistically significance.No major hypoglycaemia events were reported.However,the overall minor hypoglycaemia rate in the 2-OAD group was higher at the end of the study than that at baseline (P ＜ 0.05).No differences in the rate of nocturnal minor hypoglycaemia were observed in all groups after IDet treatment.Conclusion Initiation of IDet OD was effective and well-tolerated in Chinese patients with T2DM whose glycemia was poorly controlled on OADs irrespective of the number of OADs taken before.(registration number NCT00825643)

The impact of glycosylated hemoglobin target value in treatment guidelines on glycemic control of type 2 diabetic in Chinese cities / 中华内科杂志

Objective To investigate the influence of glycosylated hemoglobin A1c (HbA1c) standard value (2007 and 2010 Chinese Diabetes Prevention Guide) on glycemic control and treatment of type 2 diabetic patients in Chinese cities.Methods A cross-sectional study was carried out in type 2 diabetes mellitus from outpatients in selected hospitals all over China in 2009 and 2012.Patients treated with oral antidiabetic drugs (OADs),insulin or OAD combined with insulin were enrolled.A questionnaire including general characters,therapy,complications and blood glucose was completed by trained surveyors.Results A total of 30 853 patients were enrolled in 2009,and 48 232 patients in 2012.The distribution of HbA1c ＜6.5％,6.5％-＜7.0％,7.0％-＜8.0％,8.0％-＜9.0％,9.0％-＜ 10.0％ and ≥ 10.0％ was 20.35％,12.59％,35.50％,18.94％,6.46％ and 6.16％ in 2012; 14.81％,27.72％,14.55％,6.55％ and 8.36％ in 2009,respectively.The top three OAD were biguanides,sulfonylureas and thiazolidine.The most common treatment options for combined therapy are metformin combined with sulfonylurea in both 2009 and 2012.Conclusions There is an increase in the proportion of patients with good and general blood glucose control in 2012.With the generalization of Chinese Diabetes Prevention Guide,a steady tendency is presented in blood glucose control.

The research progress in the relationship between gut microbiota and obesity and type 2 diabetes / 中华内分泌代谢杂志

Metabolic diseases such as obesity and diabetes have been the most serious social and health problems in the world. Current treatments mainly focus on the disease consequence rather than the cause of metabolic disorders, and it is difficult to curb the global trend of explosive growth of patients. Thus new and more effective prevention and treatment strategies are needed. Genetics and environment influence the process of obesity and diabetes. But the genomic analysis only accounts for 10% to 20% of the metabolic diseases, while environmental factors such as diet and other lifestyle habits play an important role in the onset of metabolic diseases. In recent years, an increasing number of studies have shown that human gut microbiota is closely related to the onset and development of metabolic diseases such as obesity and type 2 diabetes. The rapid progress in this emerging academic field will not only help elucidate the pathogenesis of metabolic disease, but will also provide direction for exploring new therapeutic targets and pathways.

The role of 11β-HSD1 in metabolic syndrome / 中国糖尿病杂志

[Summary] MS ,which is highly related tothe occurrence of cardiovascular disease and T2DM ,is characterized by glucose and fat metabolic dysregulation ,central obesity ,hypertension and hyperuricemia.11β‐hydroxysteroid dehydrogenase type 1 (11β‐HSD1) is regarded as a new therapeutic target for MS.11β‐HSD1 converts inactive glucocorticoid to active glucocorticoid. 11β‐HSD1 knockout improves obesity , hyperlipidemia andhyperglycemia. The inhibition of 11β‐HSD1 alleviates IR in human and rodents ,but the application of 11β‐HSD1 inhibitors is limited by the side effects.