With advances in cancer diagnosis and treatment technologies, as well as the rapid development of anti-cancer drugs, the survival of cancer survivors has significantly improved. Cardiovascular diseases, particularly heart failure, resulting from cancer treatment have become a significant concern. Dapagliflozin, a novel sodium-glucose cotransporter 2 (SGLT2) inhibitor, has demonstrated significant clinical benefits in the treatment of type 2 diabetes and heart failure (HF). However, studies on its prognostic impact in elderly breast cancer survivors with HF with preserved ejection fraction (HFpEF) and type 2 diabetes remain scarce.

To investigate the prognostic impact of dapagliflozin in elderly breast cancer survivors with HFpEF and type 2 diabetes.

Ninety-three elderly female breast cancer survivors with HFpEF and type 2 diabetes admitted to the Affiliated Hospital of Qingdao University from January 2018 to August 2023 were enrolled. Based on the medication regimen, patients were divided into the dapagliflozin group (47 patients) and the control group (46 patients). Baseline data were collected, and patients were followed up for 6 months, with the follow-up period ending in April 2024. The primary endpoint was the occurrence of rehospitalization due to HF during the follow-up. Adverse reactions during the follow-up were also recorded. The Kaplan-Meier method was used to plot survival curves, and the Log-rank test was used for comparisons between groups. A multivariate Cox proportional hazards model was employed to analyze the factors influencing rehospitalization events.

The average age of the patients was (70.1±3.8) years. There were no statistically significant differences in baseline characteristics between the two groups (P>0.05). After 6 months of treatment, both the dapagliflozin group and the control group showed decreased levels of fasting plasma glucose (FPG) and glycated hemoglobin (HbA_1c), and increased estimated glomerular filtration rate (eGFR) (P<0.05). At 6 months post-treatment, the dapagliflozin group had lower FPG and HbA_1c levels and higher eGFR levels compared to the control group (P<0.05). Additionally, the left ventricular end-diastolic diameter (LVEDD), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), early diastolic mitral valve flow velocity (E) /early diastolic mitral annular peak velocity (e'), left atrial volume index (LAVI), and left ventricular mass index (LVMI) decreased in both groups, while the left ventricular ejection fraction (LVEF) increased compared to pre-treatment levels (P<0.05). At 6 months post-treatment, the dapagliflozin group had lower LVEDD, IVST, LVPWT, LVMI, LAVI, and E/e', and higher LVEF compared to the control group (P<0.05). Levels of high-sensitivity cardiac troponin I (hs-cTnI) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) decreased in both groups after 6 months of treatment (P<0.05). At 6 months post-treatment, the dapagliflozin group had lower hs-cTnI and NT-proBNP levels compared to the control group (P<0.05). During the 6-month follow-up, 5 patients (10.6%) in the dapagliflozin group and 13 patients (28.3%) in the control group were rehospitalized due to HF. Kaplan-Meier survival analysis showed a statistically significant difference in cumulative rehospitalization-free survival rates between the two groups (χ²=4.517 9, P=0.032 6). Multivariate Cox regression analysis results indicated that the use of dapagliflozin (HR=0.325, 95%CI=0.116-0.912, P=0.033), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors (HR=0.562, 95%CI=0.236-0.949, P=0.035), and spironolactone (HR=0.836, 95%CI=0.710-0.985, P=0.037) were protective factors against rehospitalization events, while increasing age (HR=1.343, 95%CI=1.198-1.506, P<0.001), higher BMI (HR=1.305, 95%CI=1.111-1.532, P=0.001), and the use of anthracyclines (HR=1.197, 95%CI=1.035-1.384, P=0.023) were risk factors for increased rehospitalization events.

In elderly breast cancer survivors with HFpEF and type 2 diabetes, dapagliflozin not only effectively controls blood glucose and improves renal function but also significantly improves cardiac function, enhancing long-term prognosis.

Percutaneous coronary intervention (PCI) is the preferred reperfusion therapy for acute myocardial infarction (AMI). However, the slow flow/no-reflow phenomenon is a significant predictor of poor prognosis after PCI.

To evaluate the predictive value of the triglyceride-glucose body mass index (TyG-BMI) for slow flow/no-reflow events in patients with type 2 diabetes mellitus (T2DM) and AMI undergoing emergency PCI.

This retrospective study included 368 patients with T2DM and AMI admitted to Department of Cardiology and Macrovascular Diseases, Beijing Tiantan Hospital, Capital Medical University, from July 2020 to December 2023. Patients were divided into normal flow group (TIMI 3, n=292) and slow flow/no-reflow group (TIMI 0-2, n=76) based on TIMI scores. Univariate and multivariate Logistic regression analyses were used to identify influencing factors for slow flow/no-reflow in patients with T2DM and AMI. The receiver operating characteristic (ROC) curve was plotted to assess the predictive value of TyG-BMI for slow flow/no-reflow. The incremental effect of TyG-BMI on the baseline risk model was evaluated using the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices.

The slow flow/no-reflow group had higher age, female proportion, smoking rate, history of coronary artery disease, TyG-BMI, right coronary artery (RCA) infarction rate, white blood cell count, C-reactive protein, serum creatinine, triglycerides (TG), fasting plasma glucose (FPG), and TyG-BMI than the normal flow group (P<0.05). Hemoglobin, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), thrombus aspiration rate, left anterior descending artery (LAD) infarction rate, and statin use rate were lower in the slow flow/no-reflow group than in the normal flow group (P<0.05). Multivariate Logistic regression analysis showed that TyG-BMI (OR=4.25, 95%CI=2.92-6.18), age (OR=1.05, 95%CI=1.02-1.08), C-reactive protein (OR=1.12, 95%CI=1.09-1.15), LVEF (OR=0.96, 95%CI=0.96-0.99), statin use (OR=0.72, 95%CI=0.61-0.85), LAD (OR=0.29, 95%CI=0.15-0.56), and RCA lesion (OR=2.68, 95%CI=1.96-3.66) were influencing factors for slow flow/no-reflow in AMI patients (P<0.05). Incremental effect analysis showed that adding TyG-BMI significantly improved the reclassification and discrimination of the baseline risk model, with NRI=0.075 and IDI=0.068 (P<0.05) .

Elevated TyG-BMI is associated with an increased risk of slow flow/no reflow in patients with diabetes mellitus and AMI following PCI. TyG-BMI is an effective predictor of the slow flow/no reflow phenomenon. Compared with FPG and TG, the addition of TyG-BMI can significantly improve the reclassification and discrimination ability of the baseline risk model.

Type 2 diabetes mellitus (T2DM) is the most common type of diabetes. The incidence of metabolic associated fatty liver disease (MAFLD) in T2DM patients is higher than that in non - diabetic patients. Therefore, it is of great significance to find effective indicators for predicting the occurrence of MAFLD in T2DM patients.

This study aims to explore the predictive value of the ratio of fasting C-peptide to diabetes duration (FCP/DD) for the occurrence of MAFLD in patients with T2DM, providing a potential indicator for the early prevention and management of MAFLD.

This study enrolled 532 patients diagnosed with T2DM at the Department of Endocrinology, Hebei General Hospital from September 2018 to December 2021. Demographic data were collected, and fasting blood samples were obtained to assess biochemical parameters. The FCP/DD was computed using a predefined formula. Participants were stratified into MAFLD (n=359) and non-MAFLD (n=173) groups based on the presence or absence of MAFLD. Further classification into low FCP/DD (n=266) and high FCP/DD (n=266) groups was performed according to the median FCP/DD ratio. The relationship between the FCP/DD ratio and MAFLD incidence in T2DM patients were examined using Spearman rank correlation and Logistic regression analyses. The predictive efficacy of the FCP/DD ratio for MAFLD was evaluated by constructing receiver operating characteristic (ROC) curves and calculating the area under the curve (AUC) .

The FCP/DD in the MAFLD group was higher than that in the non-MAFLD group (P<0.05). The incidence of MAFLD in the high FCP/DD group was higher than that in the low FCP/DD group (P<0.05). The Spearman rank correlation analysis results showed that in patients with T2DM and MAFLD, FCP/DD was negatively correlated with age and high-density lipoprotein cholesterol (HDL-C), and positively correlated with BMI, fasting blood glucose (FBG), glycated hemoglobin (HbA_1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), serum uric acid (SUA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and triglyceride-glucose index (TyG) (P<0.05). The results of multivariate Logistic regression analysis showed that after adjusting for confounding factors, a high level of FCP/DD was an independent risk factor for the occurrence of MAFLD in T2DM patients (P<0.05). The ROC curve results showed that the AUC of FCP/DD for predicting the occurrence of MAFLD in T2DM patients was 0.829 (95%CI=0.791-0.867), the AUC of FCP was 0.758 (95%CI=0.711-0.805), the AUC of HbA_1c was 0.525 (95%CI=0.471-0.578), and the AUC of TyG was 0.733 (95%CI=0.689-0.778) .

The level of FCP/DD was significantly increased. T2DM patients with high levels of FCP/DD had a higher risk of developing MAFLD. FCP/DD ratio has better predictive value than FCP, HbA_1c, TyG for combined MAFLD in T2DM patients.

Metabolic dysfunction-associated fatty liver disease (MAFLD) and type 2 diabetes mellitus (T2DM) are the two most common metabolic diseases worldwide. The coexistence of MAFLD and T2DM has a high prevalence rate and accelerates disease progression, imposing a significant disease burden on patients and posing a major public health challenge. MAFLD and T2DM mutually influence each other, sharing common pathogenic mechanisms. Developing effective co-management strategies for MAFLD and T2DM is a critical clinical priority. This review elaborates on recent advances in the epidemiology, pathogenesis, screening, monitoring, and treatment of T2DM combined with MAFLD. It highlights that the co-existence of T2DM and MAFLD has become a common clinical phenomenon with each condition exacerbating the development and progression of the other. Screening for MAFLD should be implemented in T2DM patients. Non-invasive diagnostic tools such as the Fibrosis 4 Index and NAFLD Fbrosis Score can be used for routine screening, though their accuracy requires further validation. Additionally, medications like sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists have been shown to improve outcomes in patients with T2DM and MAFLD, effectively preventing cardiovascular events. This review provides reference for the optimization of clinical diagnosis and treatment strategy of T2DM combined with MAFLD and the formulation of clinical "glycohepatic co-management" strategy.

Obesity can influence the occurrence and progression of diabetic retinopathy (DR) through various pathways, however there are limited studies on the mediation of DR by obesity through non-lipid metabolic pathways.

To investigate the mediating role of non-lipid metabolites in the relationship between obesity and DR.

In August 2023, we utilized genome-wide association study (GWAS) data and conducted Mendelian randomization (MR) analysis to explore the mediating role of non-lipid metabolites in the association between obesity and DR.

BMI (OR=1.78, P=5.3E-12) and waist-to-hip ratio (WHR) (OR=1.91, P=1.3E-10) was associated with increased risk of DR, respectively. Lower levels of isoleucine (OR=0.62, P=0.039) , pyruvate (OR=0.60, P=0.039) , albumin (OR=0.65, P=0.002) , glycoprotein (OR=0.92, P=0.002) , and decreased ratio of dienes to double bonds (OR=0.93, P=0.048) was associated with increased risk of DR, respectively. Positive causal associations were observed between BMI and isoleucine (OR=1.21, P=1.0E-08) , glycoprotein (OR=1.33, P=3.2E-14) , pyruvate (OR=1.08, P=0.03) , and negative causal associations with albumin (OR=0.93, P=0.04) and the ratio of dienes to double bonds (OR=0.82, P=2.8E-05) . Positive causal associations were also found between WHR and isoleucine (OR=1.34, P=3.4E-08) and glycoprotein (OR=1.26, P=1.2E-04) . Isoleucine (β=-0.16, P=0.019) , glycoprotein (β=-0.05, P=0.029) , pyruvate (β=-0.07, P=0.027) , and the ratio of dienes to double bonds (β=0.02, P=0.036) mediated the causal association between BMI and DR, while isoleucine (β=-0.21, P=7.2E-04) and glycoprotein (β=-0.03, P=0.031) mediated the causal association between WHR and DR.

Obesity has a positive causal association with DR, with BMI's association with DR mediated by isoleucine, glycoprotein, pyruvate, and the ratio of dienes to double bonds, and WHR's association with DR mediated by isoleucine and glycoprotein. Non-lipid metabolic products play a mediating role between obesity and DR.

Diabetes mellitus is difficult to cure and has a long process. The level of self-care is crucial for determining the regression and health outcomes of patients with diabetes. A comprehensive and theory-based tool is urgently needed to assess the level of self-care of diabetes. In this way, the self-care of patients with diabetes can be kept up to date and accurate nursing care can be carried out.

To examine the psychometric properties of the Chinese version of Self-Care of Diabetes Inventory (SCODI) , and provide a scientifically validated assessment tool for the self-care of Chinese patients with diabetes.

The Brislin Translation Model was used for translation and cultural adaptation of the English version of the SCODI into Chinese. A total of 261 adult patients with diabetes were enrolled using a consecutive sampling method at the First Affiliated Hospital and the Affiliated Sir Run Run Hospital of Nanjing Medical University from December 2022 to June 2023. Data were collected using a self-developed general information questionnaire and the Chinese version of SCODI.Exploratory factor analysis was used to assess the structural validity. Cronbach's α, split-half reliability and composite reliability were used to describe the reliability. Glycosylated hemoglobin was used as a criterion to assess the criterion-related validity. Spearman's rank correlation analysis was used to examinate the correlation between the Chinese version of SCODI score and glycosylated hemoglobin.

The Chinses version of SCODI contained 4 dimensions and 40 items: self-care maintenance score (75.94±13.15) , self-care monitoring score (70.65±18.71) , self-care management score (69.16±18.24) , and self-care confidence score (85.41±13.63) . In the self-care maintenance dimension, 4 factors were identified: complication screening behaviors, exercise behaviors, hygienic care behaviors and diet-medication behaviors. The self-care monitoring dimension had 2 factors: physical monitoring and symptom identification. The self-care management dimension included 2 factors: autonomous behaviors and counseling behaviors. Two factors were extracted from the self-care confidence dimension: monitoring and managing confidence, health maintenance confidence. The Cronbach's α, split-half reliability and composite reliability values for the total scale were 0.915, 0.836 and 0.912, respectively. The Cronbach's α for the four dimensions were 0.709-0.908. A significantly negative correlation was observed between each subscale and glycosylated hemoglobin (r_s=-0.160, -0.300, -0.177, -0.192; P<0.001) , serving as a criterion.

Based on the middle-range theory of self-care of chronic illness, the Chinese version of SCODI exhibits strong psychometric properties, making it a valid and reliable instrument for evaluating self-care of Chinese patients with diabetes.

Type 2 diabetes mellitus (T2DM) and sarcopenia are common conditions that significantly impact the health of elderly individuals. However, clinical intervention studies focusing on T2DM with sarcopenia are relatively limited in China.

To investigate the effects of resistance exercise combined with nutritional intervention on skeletal muscle mass and blood glucose stability in elderly T2DM patients with sarcopenia at a primary care hospital.

A total of 61 elderly T2DM patients with sarcopenia (aged≥65) who attended the Shanghai Huangpu District Yuyuan Community Health Service Center between February 2022 and May 2024 were enrolled in the study. The patients were randomly assigned to a control group (n=30) and an intervention group (n=31) . All patients were managed by routine diabetes education, and those in the intervention group additionally received resistance exercise combined with nutritional intervention. A 12-week intervention was performed to compare the time in glucose target range (TIR) , mean amplitude of glycemic excursions (MAGE) , appendicular skeletal muscle mass index (ASMI) , grip strength, and 6-meter walking speed. The correlations between grip strength, 6-meter walking speed, ASMI with TIR and MAGE were assessed before and after the intervention.

Before the intervention, there was no significant difference in parameters between the two groups (P<0.05) . After the 12-week intervention, significantly decreased TIR was detected in the control group (P<0.05) , and significantly improved glycated hemoglobin (HbA_1c) , TIR, MAGE, and 6-meter walking speed and grip strength were found in the intervention group (P<0.05) , with statistical differences between groups (P<0.05) . Before and after intervention, the change of HbA1c, TIR, MAGE, and 6-meter walking speed, ASMI, and grip strength showed statistically significant differences between control and intervention group (P<0.05) . The change in 6-meter walking speed was positively correlated with the change in TIR (r_s=0.411, P<0.05) , and negatively correlated with changes in MAGE (r_s=-0.472, P<0.05) and HbA_1c (r_s=-0.315, P<0.05) . No adverse events were reported.

Resistance exercise combined with nutritional intervention can not only increase muscle mass and physical function, but also improve blood glucose stability and TIR in elderly T2DM patients with sarcopenia. Our interventions are simple, easy to implement, with high safety, making them valuable for promotion in primary healthcare setting.

Currently, there are several glucagon-like peptide-1 receptor agonists (GLP-1RAs) used for the treatment of type 2 diabetes (T2DM) , but most are administered by subcutaneous injection, which reduces patient compliance.Danuglipron and Orforglipron are novel oral small molecule GLP-1RAs, which may become a strong choice for hypoglycemic drugs in the future.

To systematically evaluate the efficacy and safety of Danuglipron and Orforglipron in the treatment of T2DM.

A computerized search was performed on several authoritative databases, including PubMed, Embase, Cochrane Library, Web of Science, SinoMed, CNKI, Wanfang Data, and VIP databases. Randomized controlled trials (RCTs) comparing the efficacy and safety of Danuglipron or Orforglipron (test group) and placebo (control group) for the treatment of T2DM were collected, and the time frame for searching were all from the inception of the databases to May 2024. Screening was conducted based on pre-defined inclusion and exclusion criteria, and the quality of the screened literature was evaluated, the data were meta-analyzed using RevMan 5.4 software .

A total of 6 studies were included in the analysis. The results indicated that in terms of efficacy, compared to the placebo group, the Danuglipron/Orforglipron group showed a reduction in glycosylated hemoglobin (HbA_1c) (MD=-1.04, 95%CI=-1.36 to -0.73, P<0.01) levels, fasting plasma glucose (FPG) (MD=-1.88, 95%CI=-2.53 to -1.23, P<0.01) levels, and an increase in fasting plasma insulin (FPI) (MD=4.68, 95%CI=2.42 to 6.95, P<0.01) levels. However, there was no statistically significant difference between the two groups in terms of weight reduction (MD=-4.00, 95%CI=-10.14 to 2.15, P=0.20) . Regarding safety, compared to the placebo group, the Danuglipron/Orforglipron group had increased rates of nausea (OR=7.85, 95%CI=4.25 to 14.50, P<0.01) , vomiting OR=9.45, 95%CI=4.19 to 21.31, P<0.01) , diarrhea (OR=1.96, 95%CI=1.13 to 3.39, P=0.02) , decreased appetite OR=4.56, 95%CI=1.75 to 11.91, P<0.01) , indigestion (OR=3.35, 95%CI=1.54 to 7.32, P<0.01) , belching OR=4.79, 95%CI=1.13 to 20.23, P=0.03) , constipation (OR=3.45, 95%CI=1.24 to 9.56, P=0.02) , and overall gastrointestinal adverse reactions (OR=5.37, 95%CI=3.32 to 8.69, P<0.01) . And there was no statistically significant difference in the occurrence rates of bloating (OR=2.67, 95%CI=0.72 to 9.86, P=0.14) and headache (OR=0.73, 95%CI=0.37 to 1.42, P=0.35) symptoms.

Oral administration of GLP-1 RAs Danuglipron and Orforglipron can effectively reduce the levels of HbA_1c and FPG, also increase the levels of FPI and the incidence of nausea, vomiting, diarrhea, decreased appetite, dyspepsia, belching, constipation and total gastrointestinal adverse reactions, but have no effect on the incidence of abdominal distension and headache.

Finerenone, a nonsteroidal mineralocorticoid antagonist, is a novel therapeutic agent for renal protection in patients with diabetic kidney disease, joining the ranks of angiotensin-converting enzyme inhibitors and sodium-glucose cotransporter 2 inhibitors in providing renal protection for such patients. Recently, two meta-analyses focusing on patients with chronic kidney disease have yielded conflicting conclusions regarding the impact of finerenone on the decline of estimated glomerular filtration rate (eGFR) . In light of this, the present meta-analysis specifically targets the population with type 2 diabetes, aiming to thoroughly investigate the efficacy and safety of finerenone.

To systematically evaluate the efficacy and safety of finerenone in patients with type 2 diabetes and kidney disease.

A computerized search was conducted in the Cochrane Library, Web of Science, Embase, and PubMed databases, covering the period from their inception to April 2024. Literature was screened and data extracted according to the inclusion and exclusion criteria. Meta-analysis was performed using Revman 5.3, comparing indicators such as the urine albumin-to-creatinine ratio and estimated glomerular filtration rate in type 2 diabetes patients treated with finerenone.

A total of 7 articles were ultimately included, involving 15 528 patients. The results showed that compared with the control group, intervention group (using finerenone) had statistically significant differences in the urine albumin-to-creatinine ratio (SMD=-0.46, 95%CI=-0.48 to -0.39, P<0.05) , estimated glomerular filtration rate (SMD=-0.15, 95%CI=-0.19 to -0.10, P<0.05) , renal composite endpoint (OR=0.83, 95%CI=0.75 to 0.92, P<0.05) , all-cause mortality (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) , and end-stage renal disease (OR=0.88, 95%CI=0.78 to 0.99, P<0.05) . Compared with the control group, intervention group significantly increased the risk of hyperkalemia (OR=2.13, 95%CI=1.89 to 2.39, P<0.05) .

Finerenone can significantly improve renal composite endpoint events in patients with type 2 diabetes and kidney disease, reduce the urine albumin-to-creatinine ratio, and slow down the decline of estimated glomerular filtration rate; however, attention should be paid to the risk of hyperkalemia during treatment.

Type 2 diabetes mellitus (T2DM) combined with obesity is an increasingly concerned severe global public health issue. Patients typically experience insulin resistance, metabolic abnormalities, chronic inflammation, and impaired cardiopulmonary function. Bariatric surgery can reduce the BMI, and alleviate diabetic and hypertensive symptoms. However, postoperative cardiopulmonary function decline negatively influences the motor function and quality of life. Postoperative intervention of rehabilitation is an established way to improve the cardiopulmonary function, although the effect of postoperative aerobic and resistance training on the cardiopulmonary function of T2DM patients combined with obesity remains unclear.

To explore the effects of exercise training after bariatric surgery on cardiopulmonary function in T2DM patients combined with obesity.

Sixty T2DM patients combined with obesity admitted at the Nanjing Drum Tower Hospital in 2022, who were treated with an elective bariatric surgery were selected as study subjects. They were randomly divided into the exercise group (n=30) and control group (n=30) using a random number table method. A recovery period was defined as the first 4 weeks postoperatively, during which patients were encouraged to engage in physical activities at a moderate intensity. After 4 weeks, cardiopulmonary exercise tests were conducted in both the exercise group and the control group to assess cardiopulmonary function and tailor exercise prescriptions. The control group was instructed to perform daily activities that met general physical activity recommendations, while the exercise group was additionally given to moderate-intensity aerobic and resistance training at 80% of the anaerobic threshold. Both groups were intervened for 12 weeks. After 12 weeks of training, the morphological parameters, cardiopulmonary function indicators, and blood biochemical markers of the two groups were assessed.

One patient in the control group was unable to continue with the study due to personal reasons. In the exercise group, 4 subjects were unable to complete the study, with 3 failing to meet the required exercise volume and 1 withdrew for personal reasons. Ultimately, 55 patients completed the trial, including 26 in the exercise group and 29 in the control group. The mixed ANOVA showed an interaction between group and time for abdominal circumference and cholesterol (P_intercation<0.05) . The main effects of the group were significant for abdominal circumference, postprandial 2-hour blood glucose, and cholesterol (P_group<0.05) . There was a significant interaction between group and time in the peak oxygen uptake, peak oxygen uptake in kg, peak METs (among of energy used during any activity) , peak work rate, anaerobic threshold (AT) power (power@AT) , peak work rate in kg, peak ventilatory equivalent (VE) , anaerobic threshold oxygen uptake (VO₂) , VO₂@AT/peakVO₂, peak O₂ pulse, and resting systolic blood pressure (SBP) (P_intercation<0.05) . In the exercise group, there were significant differences in the peak respiratory exchange ratio (RER) , peak watts, power@AT, peak VE, VE/VCO₂ slope, and anaerobic threshold oxygen uptake before and 4 weeks after surgery (P<0.05) . In the control group, there were significant differences in peak oxygen uptake, peak METs, power@AT, peak VE, VE/VCO₂ slope, and anaerobic threshold oxygen uptake before and 4 weeks after surgery (P<0.05) . After 12 weeks of training, there were significant differences in abdominal circumference, fasting blood glucose, postprandial 2-hour blood glucose, hemoglobin A_1C (HbA_1c) , cholesterol, peak oxygen uptake, power@AT, peak work rate, peak VE, anaerobic threshold oxygen uptake, anaerobic threshold oxygen uptake in kg and VO₂@AT/peakVO₂ between groups (P<0.05) .

Cardiopulmonary function decreases in T2DM patients combined with obesity at four weeks after bariatric surgery. Twelve weeks of exercise training post-surgery can reduce waist circumference, improve blood glucose and lipid levels, and enhance cardiopulmonary function.

Diabetes and depression are global public health issues. There is a significant correlation between diabetes and depression. Therefore, monitoring and intervening in diabetes, depression, and their comorbidity among middle-aged and elderly people is crucial.

To explores the prevalence of diabetes and depression, as well as their comorbidity, among the elderly population, and the impact of sleep, exercise, and social activities on these conditions.

Based on the 2018 China Health and Retirement Longitudinal Study, 11 177 participants who met the research criteria were included as subjects. A multifactorial Logistic regression analysis model was employed to investigate the association between sleep, exercise, and social activities with the comorbidity of diabetes and depression. Subsequently, the product of nap duration and nighttime sleep duration was incorporated into the regression model for interaction analysis.

A total of 11 177 subjects were included in the study, with a prevalence of diabetes of 13.95% (1 559/11 177), a prevalence of depressive status of 24.85% (2 777/11 177), and a comorbidity prevalence of both diabetes and depressive status of 14.64% (1 636/11 177). The results of the multinomial Logistic regression analysis indicated that a nighttime sleep duration of 7 to 9 hours (OR=0.337, 95%CI=0.296-0.384), a nighttime sleep duration greater than 9 hours (OR=0.509, 95%CI=0.374-0.692), and a nap duration greater than 90 minutes (OR=0.792, 95%CI=0.666-0.941) were all protective factors for the comorbidity of diabetes and depressive status. High levels of social interaction were also found to reduce the risk of comorbidity (OR=0.778, 95%CI=0.686-0.882, P<0.05). The interaction analysis results showed that maintaining a nighttime sleep duration of 7 to 9 hours, regardless of nap duration, was effective in preventing the comorbidity of diabetes and depressive status (P<0.001). If the nighttime sleep duration is less than 7 hours, a nap duration of 60 to 90 minutes can also reduce the risk of comorbidity (OR=0.740, 95%CI=0.577-0.950, P<0.05). In the case of a nighttime sleep duration greater than 9 hours, not taking a nap (OR=0.270, 95%CI=0.125-0.581) or maintaining a nap duration of 60 to 90 minutes (OR=0.165, 95%CI=0.040-0.674) can also reduce the risk of comorbidity.

The comorbidity prevalence of diabetes and depressive status among middle-aged and elderly people in China is relatively high (14.64%). Nighttime sleep duration of more than 7 hours, nap duration of more than 90 minutes, and a high level of social interaction can all effectively reduce the risk of comorbidity of diabetes and depressive status. Moderate levels of physical activity can reduce the risks of diabetes and depressive status respectively. Napping serves as a compensatory mechanism, helping to make up for insufficient nighttime sleep. If nighttime sleep is less than 7 hours, controlling the nap duration to 60 to 90 minutes can also reduce the risk of comorbidity of diabetes and depressive status.

With the continuous development of the concept and practice of "patient-centered" medical and health service, the traditional family doctor contract service model, which focuses on single-disease treatment and management, cannot effectively meet the service needs of patients with multiple chronic diseases.

To explore that preference of patients with hypertension and type 2 diabetes for family doctor contract service in Hainan Province, and to provide empirical evidence for optimizing the contract service plan of family doctor.

A multi-stage stratified random sampling method was used to conduct a questionnaire survey from July 2023 to February 2024. The service preference of family doctors with hypertension and type 2 diabetes comorbid patients in Hainan Province was measured by discrete choice experiment (DCE). The set preference attributes were institutional nature, implementation environment, doctor's title, service mode, medication guidance and out-of-pocket expenses, service content attribute. A mixed Logit model was constructed with Python 3.11.7 software for preference analysis.

A total of 581 questionnaires were sent out, and 558 were valid, with an effective recovery rate of 96.0%. Six attributes, including institutional nature, implementation environment, doctor's title, service mode, medication guidance and out-of-pocket expenses, had significant effects on patients' preference for family doctor contracted service (P<0.05). The service content attribute had no significant effect (P>0.05). Patients with HTN-T2DM prefer to choose government-run institutions, door-to-door service, priority referral, senior doctor title, 50 yuan/month and 2 weeks medication guidance.

The institutional nature being government-run is the most highly valued attribute for patients. Home visit services and priority referral are important attributes that influence the preference for family doctor contracted services. It is suggested that a personalized family doctor contract service plan based on the preferences of patients with chronic diseases and comorbidities be formulated with a patient-centered approach to promote the high-quality development of family doctor contract services.

Type 2 diabetes mellitus (T2DM) among the elderly has become a significant public health problem both globally and in China, affecting population health. It is extremely urgent to clarify the related disease burden.

To assess the disease burden of T2DM among the elderly population globally and in China from 1990 to 2021, project future trends, and offer insights to inform public health and medical decision-makings.

Data on incidence and mortality burdens of individuals aged 60 years and above with T2DM in China and around the world were extracted from the global Burden of Disease (GBD) 2021 database. Age-standardized incidence and mortality rates were estimated based on the GBD 2021 standard population. Joinpoint regression was utilized to calculate the average annual percentage change (AAPC) for assessing disease burden trends. Subgroup analyses were performed based on age and sex, and decomposition analysis was performed to examine how aging, population growth, and epidemiological changes impacted disease burden. Bayesian models were employed to forecast prevalence and mortality between 2022 and 2035.

In 2021, the global incidence of T2DM stood at 6 047 049, while in China, it reached 800 764, representing increases of 178.68% and 220.28%, respectively, compared to the incidence in 1990. Over the period from 1990 to 2021, the global age-standardized incidence rate exhibited a significant overall upward trend (AAPC=1.21%, P<0.001), whereas the trend in China was not statistically significant (AAPC=0.29%, P=0.189). The number of deaths among elderly T2DM patients in 2021 in the global and Chinese populations was 1 304 150 and 149 972, respectively, marking increases of 164.68% and 197.98% compared to the number of deaths in 1990. Throughout the same period, the global age-standardized mortality rate displayed a consistent upward trend (AAPC=0.32%, P<0.001), while the trend in China remained relatively stable (AAPC=0.01%, P=0.922). Notably, the number of incidence and mortality for female in 1990 and 2021, globally and in China, exceeded those of males. Meanwhile, the 60-64 age group had the highest proportion of incidences in 2021, while the 70-74 age group had the highest proportion of deaths. Population growth emerged as the primary influencer driving the rise in incidence and mortality in elderly T2DM patients in both global and Chinese populations, as revealed by decomposition analysis. The projection indicates a continued increase in the incidence and mortality of elderly T2DM patients worldwide and in China from 2022 to 2035.

The persistent heavy burden of incidence and mortality among elderly individuals with T2DM in both global and Chinese populations necessitates urgent reinforcement and formulation of more effective public health policies and clinical prevention and control strategies to alleviate the fundamental burden associated with this demographic.

Type 2 diabetes (T2DM) and metabolism-associated fatty liver disease (MAFLD) interact with each other, and the coexistence of the two further increases the risk of adverse outcomes such as cardiovascular disease (CVD) and liver fibrosis. Therefore there is a need for MAFLD screening and liver fibrosis risk stratification in patients with T2DM, especially those with multiple cardio-metabolic risks.

To investigate the clinical metabolic characteristics of T2DM patients with different risk of liver fibrosis and CVD risks.

A total of 1 425 T2DM patients admitted to our department from July 2020 to June 2023 were included in the study. All patients underwent liver transient elastography (FibroTouch) examination. According to the 2023 American Diabetes Association (ADA) Standards of Medical Care in Diabetes, the population is classified based on the FIB-4 index and liver stiffness measurement (LSM) into three groups: low-risk group (n=1 235), intermediate-risk group (n=110), and high-risk group (n=80). The clinical characteristics among the groups were compared, and the Framingham Risk Score (FRS) was utilized to assess the 10-year risk of CVD. Furthermore, the different populations at varying risks of liver fibrosis were stratified based on CVD risk into three groups: Low-CVD Low hepatic risk Group (n=214), High-CVD Low hepatic risk Group (n=1 021), High-CVD High hepatic risk Group (n=178), Low-CVD High hepatic risk Group (n=12). The clinical characteristics of T2DM patients were compared in the first 3 groups.

The results showed that inclusion 5.6% of the 1, 425 patients with T2DM were at high risk of liver fibrosis.Age, alanine aminotransferase (ALT), direct bilirubin (DBIL), glycosylated hemoglobin (HbA_1c), fat attenuation parameter (UAP), LSM, FIB4, muscle mass loss, diabetic peripheral neuropathy, lipid-lowering therapy were higher in patients in the high-risk group than in the low-risk group of hepatic fibrosis, and platelets (PLT), low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), and skeletal muscle mass index (SMI) were lower than those in the low-risk group for liver fibrosis, and aspartate aminotransferase (AST) and diabetic retinopathy were higher than those in the low-risk group for liver fibrosis and the intermediate-risk group for liver fibrosis (P<0.05). Stratified analysis showed that T2DM patients with age>60 years, HbA_1c>9%, abnormal liver enzymes, and combined muscle mass loss were at higher risk of liver fibrosis (P<0.05). Comparison of the incidence of CVD risk in patients with different risks of liver fibrosis showed a progressive increase in the incidence of high CVD risk as the risk of liver fibrosis increased (χ²_trend=35.900, P<0.001). Age, AST, DBIL, UAP, LSM, FIB4, FRS, diabetic peripheral neuropathy, and lipid-lowering therapy were higher and PLT was lower in patients in the High-CVD High hepatic risk Group than in the the Low-CVD Low hepatic risk Group and the High-CVD Low hepatic risk Group (P<0.05) .

Patients with T2DM are at high risk of developing liver fibrosis and CVD, in which advanced age, poor glycemic control, combination of multiple diabetic complications, liver enzyme abnormalities, increased hepatic lipid deposition, or decreased muscle mass increase the risk of CVD and hepatic fibrosis, and early monitoring and preventive management should be strengthened in this group of patients.

As an early stage of diabetes, prediabetes is closely related to the increased risk of diabetes, cardiovascular disease, and even death, which seriously harms national health and has become the core of major chronic disease management. Proactive health emphasizes individual health as the center, with the characteristics of prevention, autonomy, precision, and personalization, covering prevention, diagnosis, treatment, rehabilitation, and other aspects, and is an important strategy to promote the strategy of Healthy China. Through systematic combing of relevant domestic and foreign guidelines, it was found that the concept of proactive health is widely used in the treatment and management of prediabetes, covering a variety of aspects such as lifestyle adjustment (diet, exercise, weight management), traditional Chinese medicine (Chinese herbal medicine compound, proprietary Chinese medicines, tea replacement, acupuncture, acupuncture point embedding, tuina massage, etc.), and western medicine (metformin, acarbose, glucagon-like peptide 1 receptor agonists, etc.). The combination of Chinese and western medicine in the treatment of pre-diabetes can achieve an organic integration of "overall regulation" and "precise treatment". This approach can reduce the dosage of western medicines, minimize toxic side effects, and lower medical costs, enabling patients to maintain a healthy state in the long term. However, due to the problems of low public awareness and attention and the lack of quantifiable and standardized clinical practice guidelines for lifestyle and treatment strategies combining TCM and western medicine, it is necessary to use social media to raise public awareness in the future, to carry out high-quality, large-sample, whole-population, randomized controlled trails, and to formulate practical guidelines for lifestyle guidance accordingly. Combining modern science and technology to explain the mechanism of Chinese medicine, to promote its application in the treatment of pre-diabetes, to realize the effective integration of Chinese and western medicine, to enhance the efficiency of comprehensive management of the disease.

The lack of disease self-management awareness in patients after percutaneous coronary intervention (PCI) affects the prognosis, and the prognosis of patients with diabetes is worse. The establishment of chronic disease follow-up system and the collaborative management of the two diseases become the key to the rehabilitation of patients.

To construct a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI based on the theory of chronic disease self-management and CICARE communication model, and to explore the application effect.

From January to April 2022, literature review, semi-structured interviews and expert correspondence were used to constructed a comorbidity follow-up model for patients with coronary heart disease complicated with diabetes after PCI. Patients with coronary heart disease complicated with diabetes who received PCI in the Department of Cardiology of Chu Hsien-I Memorial Hospital, Tianjin Medical University from May to December 2022 were selected as research subjects. They were divided into two groups by using the random number table method. The control group (77 cases) received routine follow-up, and the test group (78 cases) received comorbidity follow-up model. The scores of Coronary Heart Disease Self-management Scale (CSMS) and other outcome indicators were compared between the two groups before discharge, 3 months and 6 months after discharge.

The positive coefficients of experts in the two rounds of expert correspondence were both 100%, the authority coefficient was 0.87, and the coordination coefficient was 0.310 and 0.334, respectively (all P<0.001) . The comorbidity follow-up model included three dimensions, 11 modules and 30 contents. Finally, 64 patients in each group completed the follow-up. There was an interaction between group and time on the scores of CSMS (F=150.504, P<0.001) . The scores of CSMS at 3 months and 6 months after discharge were higher than those before discharge (P<0.001) , and the scores of the test group were higher than those of the control group (P<0.05) . After 6 months, the BMI of the test group was lower than that of the control group (P<0.05) .

The constructed comorbidity follow-up model after PCI was scientific and effective, which can improve the self-management behavior of patients after PCI and reduce BMI.

Type 1 diabetes mellitus (T1DM) is currently considered to be a chronic autoimmune disease caused by destruction of pancreatic β-cells. It is mainly caused by a combination of genetic and environmental factors that lead to destruction of pancreatic β-cells, which results in an absolute lack of insulin secretion in the body and a lifelong dependence on extracorporeal insulin therapy. As the incidence of T1DM continues to increase globally, more attention has been paid to the prevention and treatment of T1DM. Numerous studies have demonstrated that vitamin D, in addition to its value in bone metabolism and calcium-phosphorus homeostasis, also plays an important role in the development and progression of chronic inflammatory and immune-related diseases. Therefore, on the basis of introducing the epidemiology of T1DM and the role of vitamin D, this article further elaborates the correlation between vitamin D and T1DM and its complications, with a view to providing a theoretical basis for clinicians to comprehensively diagnose and treat T1DM.

With the prevalence of obesity, the incidence of non-alcoholic fatty liver disease (NAFLD) is increasing, the risk of liver fibrosis and liver cancer is also increasing. Screening for early fibrosis is of great significance. International guidelines recommend fibrosis-4 (FIB-4) index as an indicator for screening hepatic fibrosis. However, it is unclear whether FIB-4 index screening is affected by type 2 diabetes and BMI in screening for early fibrosis.

To evaluate whether the effectiveness of FIB-4 index in primary care screening is affected by type 2 diabetes and BMI.

A total of 110 patients diagnosed with NAFLD by liver biopsy in the Affiliated Hospital of Hangzhou Normal University from 2013 to 2023 were selected as the study objects. They were divided into type 2 diabete (T2DM) group and non-T2DM group according to T2DM. According to BMI, they were divided into normal weight group, overweight group and obesity group. According to the liver biopsy results, they were divided into F0-F1 group and F2-F4 group. FIB-4 index was calculated and the differences among each group were compared. Spearson correlation was used to analyze the correlation between FIB-4 index and various indexes. The accuracy of FIB-4 index was evaluated via receiver operating characteristics (ROC) curves. The area under ROC curve (AUC) was calculated and Delong test was used to compare AUC differences between groups.

The comparison results of FIB-4 index showed that the T2DM group was higher than non-T2DM group, and F0-F1 group was lower than F2-F4 group with statistical significance (P<0.05). There was no significant difference in FIB-4 index among normal weight group, overweight group and obesity group (P>0.05). Correlation analysis showed that FIB-4 index was positively correlated with age, aspartate aminotransferase, fasting glucose and fibrosis (P<0.05), and negatively correlated with platelet count (P<0.05). The AUC of FIB-4 index in the diagnosis of NAFLD was 0.77 (95%CI=0.68-0.86, P<0.001) and the AUC of FIB-4 index in the diagnosis of NAFLD with T2DM was 0.85 (95%CI=0.72-0.98, P<0.001). The AUC of FIB-4 index in the diagnosis of NAFLD without T2DM was 0.71 (95%CI=0.58-0.84, P=0.006). Delong test results showed that there was no significant difference in AUC between the T2DM group and the non-T2DM group (Z=1.509, P=0.131). The AUC of FIB-4 index in the diagnosis of NAFLD was 0.91 (95%CI=0.76-1.00, P=0.029) in the normal group, 0.65 (95%CI=0.46-0.83, P=0.125) in the overweight group, and 0.82 (95%CI=0.70-0.94, P<0.001) in the obese group. The AUC of the normal group was higher than that of the overweight group, and the difference was statistically significane (Z=2.037, P=0.042). There was no significant difference in AUC between the obese group and the normal group or the overweight group (Z=0.876, P=0.381; Z=1.452, P=0.146) .

FIB-4 is not affected by T2DM in the assessment of early fibrosis in NAFLD patients, but has a certain relationship with BMI.

Type 2 diabetes mellitus (T2DM), as a chronic metabolic disorder, represents a significant health threat to middle-aged and elderly populations in China and is a major risk factor for osteosarcopenia. The presence of osteosarcopenia can markedly impact the health status and quality of life of individuals with T2DM. A comprehensive examination of the epidemiological characteristics of osteosarcopenia holds substantial significance in guiding the prevention and management of osteosarcopenia among T2DM patients in China.

To conduct a systematic evaluation of the prevalence of osteosarcopeniain patients with T2DM in China.

A comprehensive search was conducted for studies on the prevalence of osteosarcopenia in Chinese patients with T2DM across multiple databases, including CNKI, Wanfang Data, VIP, SinoMed, Cochrane Library, PubMed, Web of Science, EBSCO and Embase. The search period extended from the establishment of these databases to June 2024. Two researchers independently screened the literature, extracting relevant information such as the first author, publication year, survey period, geographical region, osteosarcopenia prevalence, diagnostic criteria, assessment tools and quality evaluation information. The methodological quality of the included studies was assessed using the AHRQ tool. Data were analyzed using Stata 15.0.

A total of 18 cross-sectional studies were included, involving 3 724 T2DM patients, of whom 623 were diagnosed with osteosarcopenia. The meta-analysis revealed that the overall prevalence of osteosarcopenia in Chinese T2DM patients was 21% (95%CI=15%-26%). Subgroup analysis showed that the prevalence after 2020 (25%) was higher than that before 2020 (19%) ; the prevalence in the elderly group (27%) was higher than in the middle-aged group (13%) ; the prevalence using the AWGS diagnostic criteria (23%) was higher than with the AWGS2 criteria (14%) ; the detection rate by BIA (22%) was higher than by DXA (17%) ; males (38%) had a higher prevalence than females (36%) ; the prevalence in patients with a T2DM duration of ≤10years (25%) was higher than in those with a duration > 10 years (20%) ; the prevalence in the western region (27%) was higher than in the central (18%) and eastern regions (16%) (P<0.05). Meta-regression analysis revealed no statistically significant results (P>0.05), and no significant sources of heterogeneity were identified.

Existing evidence suggests a relatively high prevalence of osteosarcopenia among patients with T2DM in China, with significant disparities observed across factors such as survey period, age groups, diagnostic criteria, assessment tools, gender, duration of T2DM, and regional differences. Consequently, it is imperative to enhance early screening and intervention strategies for high-risk populations, in order to effectively prevent and mitigate the progression of the disease.

With the comprehensive implementation of the family doctor system in China, community health service resources have been widely utilized. However, there is a lack of research on the utilization tendency of primary outpatient medical resources for adult diabetic patients using objective medical visit data.

To understand the characteristics of outpatient visits for diabetic patients in the community, analyze the factors influencing frequent visits by patients enrolled in family doctor services, correctly identify the utilization tendency of primary outpatient medical resources by enrolled patients, and provide a basis for promoting the high-quality development of family doctor contract services.

In August 2023, outpatient visit records of adult diabetic patients from 13 community health service centers in Minhang District, Shanghai, for the year 2021 were retrieved. Personal information such as names and contact details were forcibly anonymized, while data on sex, age, enrollment in family doctor services, triggered diagnosis records, frequency of medical treatment, department of medical treatment, and Chinese medicine services during visits were collected. The characteristics of outpatient visits for adult diabetic patients in the community were analyzed, and multiple logistic regression and decision tree models were used to analyze the factors influencing frequent visits by enrolled patients.

There were 66 838 adult patients, resulting in 1 281 972 outpatient records. Among them, 48.96% (32 723) were male; the median age of the patients who visited the hospital was 71 (66, 77) years old; the median number of diagnosis types was 6 (3, 10) ; the median frequency of visits was 15 (9, 26), 10.28% (6 871) of the adult patients frequently visited the hospital for 362 068 times; 1-2 departments were the main ones (60.38%), and 9.33% (6 233) of the patients with≥5 departments involved; 39.53% (26 423) visited Chinese medicine services. During the year, Contracted patients accounted for 92.77% (62 005) of all the patients, while non-contracted patients only accounted for 7.23% (4 833). There were significant differences between contracted patients and non-contracted patients in sex, age, complexity of illness, frequency of medical treatment, department of medical treatment, Chinese medicine service (P<0.05). The results of multivariate Logistic regression analysis showed that sex, age, complexity of illness, department of medical treatment, Chinese medicine service were the influencing factors of frequent visits by contracted patients (P<0.05). The results of decision tree model analysis showed that the complexity of the disease was the most important factor affecting the frequent visits of contracted patients.

The signing rate of adult diabetic patients in community primary clinics in Minhang District of Shanghai was high, the effect of family doctor signing system was remarkable, the aging of adult diabetic patients in community primary clinics was prominent, the contracted patients' condition was more complicated, and the demand for Chinese medicine treatment was stronger. The frequent visits of contracted patients were affected by many factors, especially the complexity of their condition. Therefore, it is suggested that relevant departments identify frequent patients efficiently according to the patients' condition, so as to make more rational use of medical resources in primary clinics.

China's primary health care system is advancing family doctor contract services, aiming to provide integrated and continuous services for residents, which are essential characteristics needed by chronic disease patients such as those with diabetes. Existing studies have largely focused on descriptive analyses of the coverage rate of family doctor contract services, with insufficient assessment of their actual effects in chronic disease services.

To understand the impact of family doctor contract services on the cognition, behavior, and health outcomes of diabetic patients.

From February 22 to 25, 2023, a multi-stage stratified random sampling method was used to survey 716 registered diabetic patients in a city in Shandong Province. The questionnaire included demographic information, disease and medical conditions, acceptance of diabetes management services, and patients' disease cognition, health management behaviors, and health outcomes. Descriptive analysis was conducted on the coverage rate of diabetes management services accepted by patients to reflect the integration of family doctor team services. Multifactorial Logistic regression analysis was used to explore the impact of contracting with a family doctor on patients' disease cognition, health management behaviors, and health outcomes.

The contract rate of diabetic patients was 80.9% (579/716). Among them, 47.8% (277/579) felt that the family doctor understood their psychological condition.The rate of receiving follow-up recently was 89.8% (643/716). Among them, 76.0% (489/643) received diabetes health education, and 43.9% (282/643) received the complication-related examination items such as fundus, ECG, and dorsalis pedis artery pulsation. Of the patients with sudden worsening/acute complications, 37.7% (32/85) contacted the family doctor, among which 37.5% (12/32) received emergency treatment, and 25.0% (8/32) received referral services. The correct rate of patients' cognition on diabetes diagnosis was 19.8% (142/716), and the correct rate of cognition on intervention methods other than drug treatment was <70.0%. The results of the multifactorial Logistic regression analysis showed that the probability of contracted patients having a disease cognition score >5.5 was higher [OR (95%CI) =1.80 (1.23-2.62), P<0.05], the probability of undergoing glycosylated hemoglobin testing was higher [OR (95%CI) =2.67 (1.75-4.18), P<0.05], the probability of regular self-monitoring of blood glucose was higher [OR (95%CI) =4.28 (2.57-7.09), P<0.05], the probability of dietary control was higher [OR (95%CI) =0.46 (0.28-0.80), P<0.05], and the acceptance rate of diabetes-related expenses was lower [OR (95%CI) =1.58 (1.04-2.39), P<0.05] .

Family doctor contracted services have shown a significant impact on enhancing the quality of management services for chronic diseases. However, there is still a need for further improvement in implementing patient health education and psychological care components within the service package. Establishing a robust referral mechanism and improving the screening of diabetes complications are essential steps towards enhancing these services. Meanwhile, greater attention should be given to the health services of patients who have not enrolled in the contracted services.

Shanghai has been implementing the "1+1+1" combined family doctor contract service for nearly a decade, and its effectiveness in promoting graded diagnosis and treatment and guiding residents to seek medical treatment at the grassroots level needs to be verified. Existing related studies mostly focus on the number of visits to primary clinics and patients' willingness to visit primary clinics as key analysis variables. However, these two indicators cannot comprehensively and truly reflect the actual utilization of primary healthcare services by residents.

To investigate the influencing factors of family doctors' signing up for type 2 diabetes patients to see doctors at the grass-roots level, so as to provide a scientific basis for further optimizing the allocation of community health service resources.

In May 2023, 550 patients with type 2 diabetes who have signed a contract with family doctors were selected by random sampling in Jinshanwei Town, Jinshan District, Shanghai. By accessing the medical data of patients enrolled in the regional health information platform in 2022, if the proportion of patients' visits to community health service institutions in that year to the total number of visits is less than 90%, it is considered that the compliance with grassroots medical treatment is poor, and if it is greater than or equal to 90%, it is considered that the compliance with grassroots medical treatment is good. Conduct a "face-to-face" questionnaire survey on the included patients, covering their basic information, disease and treatment status, health policy awareness and service utilization, etc. According to the Anderson model, the indicators are divided into three categories: propensity factors, ability factors, and need factors. The influencing factors of compliance of contracted type 2 diabetes patients with primary care were analyzed by binary logistic regression.

The questionnaire of 508 patients (92.4%) was effectively collected. Among them, 371 cases (73.0%) had good compliance with grassroots medical treatment, and 137 cases (27.0%) had poor compliance. The average scores of patients on the four dimensions of policy awareness, institutional trust, medical expenses, and medical services are (11.0±3.6), (17.6±2.6), (12.8±1.9), and (17.0±2.3) points, respectively. The results of binary Logistic regression analysis showed that the occupation and the nature of residence in the propensity factors, the type of medical insurance, the per capita monthly income of families, the medical service score in the ability factors, and the institutional trust score in the need factors were the influencing factors of type 2 diabetes patients' compliance with grassroots medical treatment (P<0.05) .

The patients with type 2 diabetes didn't have enough knowledge of the service policy signed by family doctors. Higher quality medical services and more reliable institutional trust were the promoting factors for the grassroots medical behavior of contracted residents with type 2 diabetes. It is suggested to strengthen the policy promotion of family doctor contract services, further enhance the capacity of community health services, and optimize the quality of community health services.

Behavior and lifestyle interventions (BLIs) can reduce blood glucose and blood pressure, regulate blood lipids, control obesity, reduce cardiovas cular events and are a first-line treatment for chronic diseases such as diabetes mellitus. BLIs include helping patients maintain a healthy diet, adhere to physical exercise, maintain a normal weight, ensure good sleep, avoid smoking and alcohol abuse, make good psychological adjustments, establish good social support, as well as scientific self-monitoring of blood glucose and adherence to drug therapy. Except for the severe hyperglycemia and acute complications requiring medication, patients with newly diagnosed diabetes mellitus should first undergo BLIs. BLIs should follow the principles of effectiveness-centered, mutual trust establishment, problem-solving orientation, integration, and individulization. Common strategies for BLIs include applying behavior change theories, utilizing behavior change technologies, effectively emlpoying communication strategies, improving patient behavior skills, and implementing patient-centered self-management education and support (DSMES). The steps of BLIs include evaluating behavior, lifestyle and their influencing factors, setting behavioral goals, developing intervention plans, and conducting interventions and effectiveness evaluation. The evaluation measures for the effectiveness of BLIs include process indicators, clinical outcomes, socio-psychological and behavioral outcomes, patient reports, and health outcomes. Evaluation can be performed using a combination of qualitative and quantitative methods. Common evaluation tools include the SDSCA, PAM, and DMSES.

The incidence of acute aortic dissection with type 2 diabetes is on the rise; however, relatively little research has been done on its risk factors and prognosis. Therefore, actively seeking a simple and effective diagnostic tool has become the focus of research.

To analyze the risk factors, prognosis and rapid screening of AAD patients with type 2 diabetes.

A total of 168 patients with AAD admitted to Ningbo Medical Center Li Huili Hospital from January 2016 to October 2022 were selected as the study objects, and the patients were initially screened and triaged using the aortic dissection detection risk score (ADD-RS) table. Aortic CTA was selected as the "gold standard" for the diagnosis of AAD, and the diagnostic results of aortic CTA were compared with the preliminary screening results of ADD-RS. The general data of the diabetic group and the non-diabetic group were compared, and the risk factors of type 2 diabetes in AAD patients were analyzed by multivariate Logistic regression analysis. The short-term prognosis and pain score of the two groups were compared. The factors influencing the short-term prognosis of AAD patients were analyzed by Cox regression analysis, and the predictive value of ADD-RS was analyzed by ROC curve.

59 patients with AAD combined with type 2 diabetes (diabetes group) and 109 patients with AAD combined with non-diabetes (non-diabetes group) were screened by ADD-RS table. Multivariate Logistic regression analysis showed that increased age (OR=1.088, 95%CI=1.042-1.136, P<0.001), BMI≥25 kg/m² (OR=2.000, 95%CI=1.421-2.834, P<0.001), coronary heart disease (OR=7.654, 95%CI=1.850-31.677, P=0.005), hyperlipidemia (OR=4.948, 95%CI=1.384-17.681, P=0.014), and LVEF (OR=1.199, 95%CI=1.109-1.297, P<0.001) were risk factors for AAD combined with type 2 diabetes. There was no statistically significant difference in pain score between AAD patients with or without diabetes mellitus (P>0.05), and the 30-day mortality of the two groups was 3.39% and 3.67%, respectively, with no statistically significant difference between the two groups (P>0.05). Cox regression analysis showed that hypertension was not an independent factor affecting the short-term prognosis of patients with acute aortic dissection (HR=0.673, 95%CI=0.094-4.791, P>0.05). The ADD-RS score of the diabetic group was 1 ⁽¹⁾, significantly higher than that of the AAD patients in the non-diabetic group 1 ⁽²⁾ (Z=-4.640, P<0.001). The high risk and moderate risk in diabetic group were higher than those in non-diabetic group (Z=2.309, P=0.021). The maximum area under ROC curve is 0.706 (95%CI=0.634-0.779) .

Risk factors for AAD patients with type 2 diabetes include age, BMI≥25 kg/m², coronary heart disease, hyperlipidemia, and LVEF. Moreover, ADD-RS score has high clinical value in the risk assessment of AAD patients with type 2 diabetes.

The prevalence of non-alcoholic fatty liver disease (NAFLD) significantly increases in patients with type 2 diabetes mellitus (T2DM). However, the correlation of NAFLD with visceral fat area (VFA) and thyroid nodules in T2DM patients has been rarely reported.

This study aims to investigate the influencing factors for NAFLD in T2DM patients, and the correlation of NAFLD with VFA, thyroid nodules, and thyroid function in this population.

Hospitalized T2DM patients in the Department of Endocrinology, the Fourth Affiliated Hospital of Guangxi Medical University (Liuzhou Worker's Hospital) from January 2018 to April 2023 were retrospectively recruited. They were divided into two groups based on abdominal ultrasound findings: NAFLD group and non-NAFLD group. General data, including VFA, subcutaneous fat area (SFA), insulin function, thyroid function, prevalence of thyroid nodules, blood glucose levels, lipid levels, and liver and kidney function were compared between the two groups. Additionally, patients were divided into visceral obesity group (VFA≥100 cm²) and non-visceral obesity group (VFA < 100 cm²) based on VFA. Age, sex, prevalence of NAFLD and thyroid nodule were compared between the two groups. Spearman correlation analyses were employed to investigate factors associated with NAFLD and VFA, as well as their correlation with thyroid nodules. Influencing factors for the volume of thyroid nodules were explored as well. Furthermore, binary Logistic regression analysis was used to determine risk factors for both NAFLD and thyroid nodules in T2DM patients. Receiver operating characteristic (ROC) curve analysis evaluated the predictive value of BMI, waist-hip circumference, and waist-hip ratio, VFA, homeostatic model assessment for insulin resistance (HOMA-IR) in predicting NAFLD in T2DM patients and their optimal cut-off values.

A total of 578 T2DM patients were enrolled in this study, including 293 (50.69%) patients in the NAFLD group and 285 in the non-NAFLD group. The age of the NAFLD group was significantly lower than that of non-NAFLD group [ (57.0±12.8) years vs. (59.3±11.6) years, P<0.05]. Compared to those of the non-NAFLD group, patients in the NAFLD group had significantly higher body weight, body mass index (BMI), waist circumference, hip circumference, VFA, SFA, glycated hemoglobin (HbA_1c), fasting insulin levels (FINS), fasting C-peptide levels (FCP), HOMA-IR, homeostasis model assessment of β-cell function (HOMA-β), free triiodothyronine levels (FT₃), serum uric acid (SUA), total cholesterol (TC), triglyceride (TG) and C-reactive protein (CRP), but significantly lower serum creatinine (SCr) (P<0.05). There were 251 cases in the visceral obesity group and 327 cases in the non-visceral obesity group. The age of the visceral obesity group was significantly lower than that of the non-visceral obesity group [ (55.3±13.4) years vs. (60.3±10.8) years, P<0.05]. The incidence of NAFLD was significantly higher in the visceral obesity group than that of non-visceral obesity group (P<0.05). However, there was no significant difference in the prevalence of thyroid nodules between the visceral obesity group and non-visceral obesity group (64.94% vs. 59.82%, P>0.05). Spearman correlation analysis revealed that the occurrence of NAFLD in T2DM patients was positively correlated with body mass, BMI, waist circumference, hip circumference, waist-to-hip ratio, VFA, SFA, HbA_1c, FINS, FCP, HOMA-IR, HOMA-β, total triiodothyronine (TT₃), FT₃, and CRP (P<0.05), but negatively correlated with age (P<0.05). VFA in T2DM patients was found to be significantly correlated with gender, age, height, body mass, BMI, waist circumference, hip circumference, waist-to-hip ratio, SFA, diastolic blood pressure (DBP), FINS, FCP, HOMA-IR, HOMA-β, TT₃, FT₃, CRP and NAFLD (P<0.05). The thyroid nodule area showed a negative correlation with height, thyroid stimulating hormone (TSH) and waist-to-hip ratio (P<0.05), while it showed positive correlations with sex, age, TT₃, TT₄ and thyroglobulin (P<0.05). Univariate unconditional Logistic regression analysis revealed that age, weight, BMI, waist circumference, hip circumference, VFA, SFA, HbA_1c, FCP, HOMA-IR, FT₃, SCr, SUA, TC and TG were the influencing factors for NAFLD in T2DM patients. Binary Logistic regression results demonstrated that body weight (OR=0.962), VFA (OR=1.025), SFA (OR=1.006), FT₃ (OR=1.429) and HOMA-IR (OR=1.140) were the influencing risk factors for NAFLD in T2DM patients. Gender (OR=0.342), age (OR=1.073) and free thyroxine (FT₄) (OR=1.140) were influencing factors for thyroid nodules in T2DM patients (P<0.05). ROC curve results showed that the area under the curve (AUC) of BMI, waist circumference, hip circumference, waist-to-hip ratio, VFA and HOMA-IR was 0.704, 0.704, 0.705, 0.629, 0.757, and 0.569, respectively. The optimal cut-off value, sensitivity and specificity of them were listed as follows: BMI (25.37 kg/m², 67.7%, 36.0%), waist circumference (84.5 cm, 67.3%, 36.4%), hip circumference (96.5 cm, 69.4%, 38.9%), waist-to-hip ratio (0.895, 38.8%, 19.1%), VFA (88.4 cm² in female and 99.45 cm² in male, 78.9%, 35.3%), and HOMA-IR (3.08, 64.3%, 49.8%) .

The prevalence of NAFLD and thyroid nodules in T2DM patients significantly increase, but not correlated. Obese T2DM patients, especially those with visceral obesity, are more likely to suffer from NAFLD, thyroid nodules, hyperlipidemia, hyperuricemia and other metabolic diseases. HOMA-IR is a influencing factor for NAFLD in T2DM patients, but it is not a influencing factor for thyroid nodules. BMI, waist circumference, hip circumference and VFA are predictive factors of NAFLD in T2DM patients, and VFA has the highest diagnostic value and HOMA-IR has the lowest value. VFA predicts NAFLD in T2DM patients with the optimal cut-off value of 88.4 cm², which is equal in females and 99.45 cm² in males.

Diabetic foot ulcer (DFU) is usually accompanied by varying degrees of peripheral neuropathy and vasculopathy. It is a difficult-to-heal wound. The delayed healing process is mainly due to new blood vessel regeneration disorder, persistent wound inflammation, wound re-epithelialization disorder and abnormal fibroblast proliferation. Exosomal miRNA, as an important medium for intercellular communication, is involved in a variety of biological processes and can regulate the transcription and translation of various target genes affecting DFU healing. This paper aims to briefly review the role of exosomal miRNAs in the regulation of neointimal regeneration, inflammatory response, wound re-epithelialization function, and fibroblast proliferation function in the repair of DFU, to provide new ideas for the treatment of DFU.

The phenomenon of non-standard treatment of diabetes patients in rural areas is particularly serious. Diabetes health management is focused on preventing and controlling diabetic complications in rural areas of China, as well as lowering disability and death rates.

To explore the effects of O2O peer mentor collaborative health management on the risk perception and diabetes management self-efficacy in rural patients with non-standard diabetes treatment.

A total of 90 diabetic patients with non-standard treatment in Lamadian Town, Ranghulu District, Daqing City from April to November 2023 were selected as the study subjects by convenience sampling method, and randomly assigned 45 patients to the experimental group and 45 to the control group. The experimental group adopted O2O peer mentor collaborative health management scheme, the intervention lasted for 6 months, and the control group adopted conventional chronic disease health management. A comparison was made between the two groups' risk perception and self-efficacy in managing their diabetes.

The study was concluded with 42 cases in the experimental group and 41 instances in the control group. Following the intervention, the experimental group and control group had scores on the diabetes risk perception scale of (43.86±7.00) and (32.56±4.24), there was a statistically significant difference between them (t=8.864, P<0.001). Similarly, the experimental group and control group had scores on the diabetes management self-efficacy scale of (100.45±16.74) and (75.54±13.82), there was a statistically significant difference between them (t=7.384, P<0.001) .

The O2O peer mentor collaborative health management program can effectively improve the risk perception and diabetes management self-efficacy of rural patients with non-standard diabetes treatment, and improve their health management level.

The influence mechanism of health management on self-management behavior in patients with type 2 diabetes is still unclear.

To explore the mediating effect of core attributes of general practice between the health management and self-management behavior of type 2 diabetes in basic public health services.

From April to September 2023, this study randomly selected 1-2 community health service centers from each district of 6 urban areas in Fuzhou City. Patients with type 2 diabetes from 11 community health service centers were surveyed by general situation questionnaire, Assessment Survey of Primary Care and Summary of Diabetes Self Care Activities. Descriptive analysis and correlation analysis were conducted using SPSS 26.0, and a structural equation model was constructed using AMOS 28 for mediation testing.

A total of 483 valid questionnaires were collected. The standardized health management rate for completing all prescribed service contents was 46.2%. The score of Summary of Diabetes Self Care Activities was (27.77±10.67), and the score of Assessment Survey of Primary Care was (64.33±13.90). There was a positive correlation between standardized health management, core attributes of general practice and self-management behavior (r=0.452, 0.483, P<0.01), and standardized management was positively correlated with core attributes of general practice (r=0.638, P<0.01). The mediation analysis showed that the mediating effect of the core attributes of general practice between basic public health service and patient self-management behavior was 0.403 (95%CI=0.267-0.541) .

Core attributes of general practice may be a mediator between type 2 diabetes mellitus health management in the basic public health service and self-management behaviors of patients.

Acute Myocardial Infarction (AMI) remains one of the leading threats to global public health. Despite available reperfusion therapies, major adverse cardiovascular and cerebral events (MACCEs) associated with AMI continue to be a leading cause of death worldwide. This is particularly true for patients with AMI and concomitant diabetes mellitus, where coronary artery disease is more complex and severe, making early detection and prognosis of long-term outcomes for these patients challenging. Therefore, the identification of simple and accessible laboratory markers could facilitate the prediction of post-percutaneous coronary intervention (PCI) MACCEs in patients with type 2 diabetes mellitus (T2DM) and AMI.

To investigate the predictive value of the serum C-reactive protein (CRP) /albumin (Alb) ratio (CAR) for long-term MACCEs following PCI in patients with T2DM and AMI.

A total of 1 683 patients with T2DM and AMI treated at the Department of Cardiovascular Medicine, General Hospital of Ningxia Medical University between 2014 and 2019 were enrolled. General clinical data and test results were collected for these patients. Follow-ups were conducted via telephone or outpatient visits, with a median follow-up period of 5.6 years. MACCEs were defined as all-cause mortality, non-fatal myocardial infarction, recurrent unstable angina, non-fatal stroke, new-onset heart failure, or rehospitalization for worsening heart failure, and revascularization. Patients were divided into the MACCEs group (508 cases) and the non-MACCEs group (1 175 cases) based on the occurrence of MACCEs during the follow-up period. Univariate and multivariate Logistic regression analyses were performed to identify factors influencing MACCEs in patients with T2DM and AMI. Kaplan-Meier survival curves were plotted, and the Log-rank test was used for comparisons. Receiver operating characteristic (ROC) curve analysis assessed the predictive efficacy of CAR for long-term MACCEs in patients with T2DM and AMI, while the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) indices evaluated the improvement in prognostic assessment provided by CAR.

Among the 1 683 patients, 508 (30.18%) experienced MACCEs. Multivariate Logistic regression analysis indicated that hypertension [OR (95%CI) =1.994 (1.142-3.483) ], length of coronary stent implanted [OR (95%CI) =1.031 (1.002-1.062) ], CRP [OR (95%CI) =0.950 (0.915-0.986) ], Alb [OR (95%CI) =0.933 (0.880-0.989) ], and CAR [OR (95%CI) =5.582 (1.705-18.277) ] were significant predictors of post-PCI MACCEs in patients with T2DM and AMI (P<0.05). Based on the median CAR level (0.86), patients were divided into two groups: CAR<0.86 and CAR≥0.86. The log-rank test showed that the incidence of MACCEs was significantly higher in the CAR≥0.86 group compared to the CAR<0.86 group (52.68% vs. 22.92%; χ²=65.65, P<0.001). The ROC curve indicated that the area under the curve (AUC) for CAR in predicting MACCEs in patients with T2DM and AMI was 0.728 (95%CI=0.702-0.754), with an optimal cut-off value of 0.576, sensitivity of 0.617, and specificity of 0.747. Compared to baseline models, CAR significantly improved the prediction of adverse cardio-cerebral events (NRI=0.377, IDI=0.166, C-index =0.690; P<0.05) .

CAR is an effective predictive marker for the risk of long-term MACCEs in patients with T2DM and AMI following PCI.

Cardiovascular diseases are the main cause of death in patients with type 2 diabetes mellitus (T2DM). Carotid intima-media thickening (CIMT) can predict the occurrence of cardiovascular diseases. Moderate-to-high levels of physical activities (PA) improve glycemic control and reduce the incidence of cardiovascular diseases and mortality. Exploring the relationship between this modifiable lifestyle and CIMT may be an effective strategy to prevent cardiovascular diseases in the early stage.

To analyze the correlation between PA at varying levels and CIMT in T2DM patients, and to provide a scientific basis for recommending individualized PA programs to them.

This was a cross-sectional study. From January 2019 to February 2022, a total of 3 099 T2DM patients visited endocrinology clinics at two tertiary hospitals in Jiangsu Province were selected. PA level in T2DM patients was surveyed using the International Physical Activity Questionnaire (IPAQ). They were assigned into mild and lower PA group, moderate PA group and vigorous PA group. The correlation between PA and CIMT was identified by binary logistic regression. Stratified analyses were performed based on the obesity degree, blood pressure, blood lipids, and hemoglobin A_1c (HbA_1c). Restricted cubic splines were used to evaluate the dose-response relationship between PA and CIMT with PA level as the continuous variable.

Compared with those in the mild and lower PA group (n=981), T2DM patients in moderate PA group (n=1 389) and vigorous PA (n=729) were significantly younger with higher HbA_1c and low-density lipoprotein cholesterol (LDL-C) (P<0.05). Binary Logistic regression analysis showed that moderate PA was negatively correlated with the risk of CIMT, and this correlation was independent of socio-demographic characteristics, lifestyle and blood lipids (OR=0.775, 95%CI=0.629-0.956, P<0.05). The results of restricted cubic spline showed a nonlinear relationship between PA level and the risk of high CIMT (P_nonlinear=0.014). Stratified analysis showed that PA was not associated with CIMT in T2DM patients with normal weight (n=996) or overweight (n=1 395) (P>0.05). However, only moderate PA was associated with CIMT in obese patients (n=708) (OR=0.614, 95%CI=0.382-0.987, P<0.05). Moderate PA was negatively associated with CIMT in patients (n=324) who did not meet any of the three indicators (blood pressure, blood lipids and HbA_1c) and those (n=1 416) who met only one indicator (P<0.05) .

There is a dose-response relationship between PA levels and CIMT in T2DM patients thickening. Moderate PA is significantly negatively associated with CIMT, especially in T2DM patients with poor control of obesity, blood pressure, blood lipids, and glycaemia, while vigorous PA is not correlated with CIMT.

Hypertriglyceridemic-waist phenotype is a risk factor for type 2 diabetes mellitus (T2DM). The risk of T2DM may vary in different genders, regions, age groups, and overweight /obese people.

To explore the risk of T2DM by hypertriglyceridemic-waist phenotype in different genders, regions, ages, and overweight /obese people, and to provide a scientific basis for the prevention and control of T2DM.

This was a prospective cohort study involving 9 280 permanent residents over 18 years in 12 districts (counties) of Guizhou province in 2010 selected by multi-stage stratified cluster random sampling. From 2016 to 2020, 8 163 residents were followed up, and finally 6 743 eligible participants were enrolled after excluding those with baseline T2DM, lacking sufficient clinical data, lost to follow-up and deaths. Participants were assigned into 4 groups based on their baseline waist circumference (WC) and serum triacylglycerol (TG) levels: Normal WC and TG group (NWNT, WC<90 cm in men and WC<85 cm in women, TG<1.7 mmol/L), normal WC and high TG group (NWHT, WC<90 cm in men and WC<85 cm in women, TG≥1.7 mmol/L), large WC and normal TG group (EWNT, WC≥90 cm in men or WC≥85 cm in women, TG<1.7 mmol/L) and large WC and high TG group (EWHT, WC≥90 cm in men or WC≥85 cm in women, TG≥1.7 mmol/L). A Cox proportional hazards regression model was used to analyze the correlation between hypertriglyceridemic-waist phenotype grouping and new-onset T2DM.

The median follow-up period was 6.58 years. Among 6 743 participants, new-onset T2DM was observed in 706 (10.47%) individuals. After adjusting confounding factors, the Cox proportional hazards regression analysis showed that the risk of T2DM was 1.486 times in the EWHT group than the NWNT group (HR=1.486, 95%CI=1.185-1.865, P=0.001). Multivariate Cox proportional hazards regression analysis showed that in the subgroups of male gender, rural region, aged<45 years, and overweight /obese, the risk of T2DM in the EWHT group was 1.792 (HR=1.792, 95%CI=1.297-2.476, P<0.001), 1.483 (HR=1.483, 95%CI=1.115-1.971, P=0.007), 1.540 (HR=1.540, 95%CI=1.083-2.190, P=0.016), and 1.614 (HR=1.614, 95%CI=1.123-2.321, P=0.010) times higher than the NWNT group, respectively.

After a median follow-up time of 6.58 years in a large cohort, the hypertriglyceridemic-waist phenotype is the risk of T2DM in Guizhou Province, which is more significant in males, rural areas, aged<45 years, and overweight /obese people. Therefore, health education should be strengthened for high-risk populations. Weight control through reasonable diet and appropriate exercise, and reducing serum triacylglycerol levels are necessary and effective methods to prevent the incidence of T2DM.

Diabetes mellitus is a global public health issue. Cross sectional studies have found that visceral fat is closely related to the prevalence of diabetes mellites, while prospective cohort studies on the trend of onset time of diabetes mellitus and its correlation with Chinese visceral adiposity index (CVAI) are scant.

To analyze the trend of onset time of diabetes mellitus and its correlation with CVAI in Pudong New Area, Shanghai, residents by the prospective cohort study, thus providing evidence for the scientific prevention and treatment of diabetes mellitus.

This was a prospective cohort study involving 5 236 residents from 12 townships and 35 village committees who participated in the chronic disease risk factor monitoring project in Pudong New Area, from January to July, 2013. Baseline data were collected, including CVAI, visceral adiposity index (VAI), body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), a body shape index (ABSI), and body adiposity index (BAI). Follow-up was conducted in 2016 and 2019. By the end of follow-up in October 2019, the incidence of new onset of diabetes mellitus in this cohort was calculated through questionnaire survey, laboratory testing, medical system visit information and vital statistics information system. According to the baseline quartile, the CVAI, VAI, BMI, WC, WHR, WHtR, ABSI, and BAI of the included population were divided into Q1 to Q4 quartiles. The number of cases in CVAI Q1-Q4 groups was 1 306, 1 307, 1 307, and 1 307, respectively. The number of cases in VAI Q1-Q4 groups was 1 300, 1 316, 1 306, and 1 306, respectively. The number of cases in BMI Q1-Q4 groups was 1 305, 1 302, 1 312, and 1 311, respectively. The number of cases in WC Q1-Q4 groups was 1 302, 1 273, 1 287, and 1 367, respectively. The number of cases in WHR Q1-Q4 groups was 1 180, 1 203, 1 332, and 1 514, respectively. The number of cases in WHtR Q1-Q4 groups was 1 199, 1 393, 1 400, and 1 237, respectively. The number of cases in ABSI Q1-Q4 groups was 1 316, 1 302, 1 302, and 1 308 respectively. The number of cases in BAI Q1-Q4 groups was 1 310, 1 304, 1 308, and 1 307, respectively. The multivariable Cox regression analysis was used to analyze the correlation of CVAI and other obesity indicators with the onset of diabetes mellitus. The predictive potential of CVAI and other obesity indicators in diabetes mellitus was assessed using receiver operator characteristic (ROC) curves.

The incidence density of diabetes mellitus in Pudong New Area was 33.55/1 000 person-years from 2013 to 2016, and 23.25/ 1 000 person-years from 2017 to 2019. With aging, the total incidence density of diabetes mellitus showed an increasing trend (2013-2016: χ²=28.503, P_trend<0.001; 2017-2019: χ²=25.600, P_trend<0.001). By 2016, the baseline CVAI quartile was positively correlated with the cumulative incidence of diabetes mellitus (CVAI: χ²=131.865, P_trend<0.001) and the incidence density (CVAI: χ²=100.105, P_trend<0.001). Mutivariable Cox regression analysis after adjusting for relevant confounders showed that compared with CVAI in Q1, the risk of diabetes mellitus in men with CVAI in Q4 increased by 79.4% (HR=1.794, 95%CI=1.044-3.083, P<0.05). Women had a 371.2% increased risk of diabetes mellitus (HR=4.712, 95%CI=2.601-8.538, P<0.05). ROC curve results showed that in predicting the incidence of male diabetes, the area under the ROC curve (AUC) of CVAI for male diabetes was 0.600 (95%CI=0.561-0.640), with the Youden index of 0.181, and the cutoff value of 104.118. Delong test showed that CVAI had the highest accuracy in predicting female diabetes mellitus (AUC=0.699), with the Youden index of 0.317, and the optimal cutoff value of 104.609.

From 2013 to 2019, the incidence density of diabetes mellitus increased with the increased age in Pudong New Area, Shanghai. Compared with other obesity indicators, CVAI can be used as an indicator to predict the risk of diabetes mellitus.

Prediabetes is a condition characterized by impaired fasting glucose, impaired glucose tolerance, or a combination of both, which is classified under the category of "Pi Dan" in Traditional Chinese Medicine (TCM). With the changes in modern lifestyles, the prevalence of prediabetes is continuously rising, carrying a risk comparable to diabetes prognosis. Therefore, timely diagnosis and early intervention are crucial. This article reviewed the origins and definitions of prediabetes from both TCM and modern medical perspectives, revealing that TCM had already recognized "Pi Dan" as early as the composition of the "SuWen". With the development of evidence-based medicine and the implementation of standardized clinical research, China has gradually established the standardized clinical practice guidelines for prediabetes with TCM characteristics. Regarding diagnosis, diagnostic indicators and thresholds for monitoring blood glucose levels, various non-invasive integrated TCM and modern medical diagnostic methods, including TCM syndrome diagnosis, integrated TCM and Western medicine diagnostic models, disease risk scoring models, biomarkers, and wearable devices, have been continuously improved. However, its primary focus lies in diabetes prevention rather than the early detection and screening of prediabetes. Besides, 1-hour plasma glucose may be a new outcome for prediabetes diagnosis or identifying high-risk diabetes populations in the future. However, further research is required to validate its broader application. Addressing the challenges of dynamic diagnostic standards, complex screening processes, atypical clinical symptoms, and low disease awareness during early prediabetes diagnosis, it is imperative to continuously update and refine diagnostic standards. The integration of digital health management and wearable devices should be promoted to fully capitalize on TCM strengths in constructingt disease diagnostic models that combine TCM macro manifestations and omics microdata for prediabetes. Simplified and expedited integrated TCM and modern medical screening methods can facilitate early screening, early diagnosis, early intervention, and early recovery for prediabetes.

In recent years, the number of diabetics in China ranks first in the world. While recommending metformin as the first-line hypoglycemic drug, the Chinese Clinical Guidelines for the Prevention and Treatment of Type 2 Diabetes in the Elderly (2022 edition) emphasize "patient-centere" and select appropriate second-line hypoglycemic agents for combination administration according to the clinical characteristics and preferences of patients. Because there are great differences in the prevalence rate and life behavior of type 2 diabetes between the north and the south of China, whether there is a difference in the second-line drug preference of patients with type 2 diabetes between the two places remains to be further demonstrated.

To analyze the difference of second-line drug preference among patients with type 2 diabetes mellitus in North and South China, and to provide empirical evidence for clinical and health management decision-making.

The study adopts a Discrete Choice Experimental design, Mixed Logit Model was used to analyze drug preference of patients with type 2 diabetes in the north and south of China based on Multi-stage random cluster sampling and convenient sampling, from October 2021 to January 2022.

In this study, 1 443 questionnaires were distributed, and 1 388 were valid, with an effective recovery rate of 96.19%. Logit model analysis showed that the effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking drugs and the out-of-pocket cost/month were the influencing factors of the second-line drug preference of southern patients (P<0.05). Patients with type 2 diabetes in South China prefer to take oral second-line hypoglycemic drugs with 0 yuan, no risk of gastrointestinal side effects, strong blood sugar control effect, no risk of hypoglycemia events, and can protect the cardiovascular system (P<0.05). When the risk of gastrointestinal side effects changes from high to no risk, patients in South China are willing to pay 408.06 yuan per month. The effect of blood sugar control, the risk of hypoglycemia, the risk of gastrointestinal side effects, whether the cardiovascular system can be protected, the way of taking medicine, out-of-pocket expenses/month, and the change of body mass within half a year are the influencing factors of the preference for second-line medication in northern patients (P<0.05). The patients with type 2 diabetes in the north prefer the second-line hypoglycemic drugs with 0 yuan, strong blood sugar control effect, no risk of hypoglycemia events, cardiovascular protection and no risk of gastrointestinal reaction, taking orally and reducing body weight by 2.0 kg within six months (P<0.05). When the blood sugar control effect is weak and changed to strong, the patients in the north are willing to pay 435.98 yuan per month.

In addition to out-of-pocket expenses/month, patients with type 2 diabetes in the south pay more attention to gastrointestinal side effects, while patients with type 2 diabetes in the north pay more attention to the effect of blood sugar control. There are differences in second-line medication preferences between the two places. Regional differences provide a basis for individualized treatment of patients with type 2 diabetes mellitus. Clinical diagnosis and treatment should be "patient-centere" and pay attention to individual preference differences.

With the acceleration of the aging process of the population and the change of the disease spectrum of residents, the prevalence of chronic diseases such as diabetes is increasing year by year. It is urgent to establish a wide coverage and efficient medical prevention integration mode. Most of the existing studies have focused on the demand for health management services and the influencing factors of service adoption, and few have identified and analyzed the demand for chronic disease healthcare and prevention integration services under digital technology.

To explore the demand of residents for medical and preventive integration services for diabetes in the context of digital health, and the impact of different service contents on the acceptance and satisfaction of service objects, so as to provide a theoretical basis for the public to improve the whole process and all-round medical and preventive integration services.

Combined with relevant research and practical work, 20 survey items on demand for diabetes medical and prevention integration services were established. From January to June 2023, convenient sampling method was used to survey diabetes patients and risk groups in Fujian Province, Guangdong Province and Yunnan Province, and 410 respondents' data were obtained. According to five demographic characteristics of gender, age, education level, residence type and medical insurance type, attribute classification analysis was carried out according to Kano model analysis method, to investigate the relationship between service demand of different attributes and residents' satisfaction, and then put forward the supply strategy of diabetes medical and prevention integration services.

Residents with different demographic characteristics show common and individual differences in the demand for medical and preventive integration services for diabetes. Among them, the demand for services among people of different ages and educational levels is quite different. The demand for medical prevention integration services of diabetes prevention and treatment groups focuses on screening, prevention and treatment, but the relevant convenient services provided by the Internet and social media have nothing to do with user satisfaction.

The level of personalization of diabetes primary health care and prevention services should be improved to fully satisfy the needs of the service population for essential attributes such as "initial screening for diabetes and complications", improve the services for desired attributes such as "establishment of a full-cycle personal electronic health record", and enhance the services for charismatic attributes such as "risk prediction" and "remote health monitoring". It will also improve services with desired attributes such as the establishment of a full-cycle personal electronic health record, and enhance services with attractive attributes such as "risk prediction" and "remote health monitoring".

Diabetic hyperglycemia in males is a significant contributing factor to the development of spermatogenesis disorder. The hypothalamic-pituitary-gonadal (HPG) axis serves as a crucial center for autonomic sexual function and the neuroendocrine network within the human body. It dominates physiological prominence in human reproduction, growth, and development, while also being susceptible to hyperglycemia, which is one of the key mechanisms in the development of spermatogenic disorder in type 2 diabetes mellitus (T2DM). This mechanism involves kidney deficiency, which is a common etiology and pathogenesis of both spermatogenesis disorder and T2DM. The kidney storing essence, which encompasses the functions of "dominating reproduction, manufacturing marrow to fill up the brain" bears similarities to the HPG axis. Kidney tonifying therapy can regulate and improve the function of HPG axis, thereby establishing a theoretical basis for the use of kidney tonification therapy in the treatment of spermatogenesis disorder in T2DM. The traditional formula of tonifying the kidney can serve as a complementary treatment for both DM and spermatogenesis disorder. This approach offers a conceptual framework and methodology for the prevention and treatment of T2DM-induced infertility through kidney tonification.

Diabetes is an important health problem due to its high prevalence and associated disability and mortality. Research evidence provides effective information for improving patient health outcomes. Decision aids can help patients obtain evidence and increase physician-patient interaction.

To obtain patients' preferences for anti-diabetic drugs and develop an evidence-based decision aid to achieve the integration of evidence, patient values, and decision settings, thus facilitating patient-centered evidence-based decision making.

Several literature databases, like PubMed, Web of Science Core Collection, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure (CNKI), VIP Chinese Science Journals Database, and Wanfang Data were searched to determine the value assessment dimensions and attributes of anti-diabetic drugs. The time limit for literature search is from the establishment of the database to December 31, 2022. The questionnaires for investigating patients' preferences for anti-diabetic drugs were designed using the best-worst scaling method. Then, the empirical study to explore preferences was carried out in five hospitals in Jiangsu Province. Based on the analysis of patients' preferences, an evidence-based decision aid was developed using techniques including Vue + Element UI, Spring Boot, Spring Security, Java, etc.

The most important five attributes in patient decisions were incidence of macrovascular complications, length of extended life years, change of health-related quality of life, incidence of microvascular complications, and control of HbA_1c. The evidence-based decision aid provides a structured summary of evidence on the comparative effectiveness, comparative safety, convenience, and affordability of new anti-diabetic drugs. The multi-attribute value assessment module of new anti-diabetic drugs is the core element of the decision aid, supporting patients' evidence-based assessment of the drugs' value.

Evidence-based decision aid integrates research evidence of new anti-diabetic drugs, patients' preferences and values, and helps realize shared decision-making between physicians and patients.

Muscle mass loss increases the risk of hyperglycaemia and sarcopenia in patients with type 2 diabetes mellitus (T2DM), and Chinese adults with T2DM are predominantly non-obese, who are more likely to be associated with muscle mass loss than the obese.

To establish an individualized Nomogram prediction model for the risk factors of muscle mass loss in non-obese patients with T2DM.

A retrospective study was conducted to select 905 non-obese patients with T2DM admitted to the Department of Endocrinology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University from January 2018 to September 2023. The patients were divided into a training set (n=633) and a validation set (n=272) using simple random sampling at a ratio of 7∶3, and the general data and clinical indexes of the two groups of patients were collected and compared. Multivariate Logistic regression analysis was performed to determine risk factors for muscle mass loss in the training set and a Nomogram prediction model was constructed. The predictive value and clinical utility of the Nomogram prediction model were evaluated using receiver operating characteristic (ROC) curve, Hosmer-Lemeshow calibration curve, and decision curve analysis (DCA), respectively.

The prevalence of muscle mass loss in non-obese patients with T2DM was 42.3% (383/905). Comparison of the clinical indicators of the patients in the training and validation sets showed no statistically significant differences (P>0.05). Multivariate Logistic regression analysis showed that age (OR=1.039, 95%CI=1.010-1.070, P=0.009), male (OR=3.425, 95%CI=2.133-5.499, P<0.001), BMI<23.5 kg/m² (OR=19.678, 95%CI=11.319-34.210, P<0.001), elevated HbA_1c (OR=1.196, 95%CI=1.081-1.323, P<0.001), increased visceral fat area (OR=1.021, 95%CI=1.010-1.032, P<0.001) were independent risk factors for muscle mass loss in non-obese patients with T2DM. The area under curve (AUC) of the ROC for the Nomogram prediction model to predict the risk of muscle mass loss occurring in patients in the training and validation sets was 0.825 (95%CI=0.793-0.856, P<0.001) and 0.806 (95%CI=0.753-0.859, P<0.001), respectively. The Hosmer-Lemeshow test showed that the model had a good fit (training set: χ²=11.822, P=0.159; validation set: χ²=8.189, P=0.415). Bootstrap method of plotting the calibration of the model showed that the calibration curves fitted well to the standard curves. The DCA curves showed that it was more beneficial to use the Nomogram prediction model to predict the incidence risk of muscle mass loss in patients with T2DM when the threshold probability of the patient was 0.06 to 0.94.

Age, male, BMI<23.5 kg/m², elevated HbA_1c, and increased visceral fat area are independent risk factors for muscle mass loss in non-obese patients with T2DM. The Nomogram prediction model established in this study can individually predict the risk of muscle mass loss in non-obese patients with T2DM, which facilitates the early identification of high-risk groups and the development of individualised interventions.

Diabetic microvascular disease (DMiVD) is the most common chronic complication of diabetes mellitus, and early identification and effective intervention can significantly improve patients' quality of life and prognosis. The Diabetes and Microcirculation Professional Committee of Chinese Society of Microcirculation and the Primary Endocrine and Metabolic Diseases Group of the Chinese Society of Endocrinology have convened experts in the field to revise the Expert Consensus on Screening and Prevention of Diabetic Microvascular Diseases for Primary Care (2024), based on the 2021 edition, considering the latest research advances and the specific needs of primary care. This consensus elaborates the screening methods, comprehensive management and prevention strategies for DMiVD (diabetic retinopathy, diabetic kidney disease, distal symmetric polyneuropathy and diabetic cardiomyopathy), clarifies the graded diagnosis and treatment and referral processes, emphasizes the importance of preventing and treating DMiVD, and offers guidance and recommendations for physicians, particularly primary care physicians and general practitioners. The aim is to reduce the incidence, progression, and disability associated with DMiVD, ultimately lowering morbidity and mortality rates.

Type 2 diabetes is a major public health problem that jeopardizes the health of the population in China. The prediabetic state population is a huge reserve force for diabetes, for which appropriate intervention can prevent or delay diabetes, but community health management is ineffective at this stage.

To investigate the problems and influencing factors in community health management practice in prediabetic state, and propose systematic and operable strategies and recommendations on health management measures.

A systematic search was conducted from March to April 2023 to retrieve literature related to community health management of prediabetes in CNKI, Wanfang Data, CQVIP, PubMed, and Web of Science. The key informant interviews based on multiple perspectives were conducted from April to May 2023 in Shanghai communities, hospitals, and CDCs, which included 20 community health service center staff, health administrators, clinical endocrinologists, CDC health management staff, diabetes patients or prediabetes and their family members, and people with diabetes risk factors. The interviews content covered the current status of community health management of prediabetes, related attitudes and perceptions of prediabetes, and acceptance of relevant services. Fishbone diagram analysis were used for data analysis to sort out the hierarchy between the problems related to community health management of prediabetes.

14 relevant literature were eventually included to summarize 22 existing problems in community health management of prediabetic state based on literature and interviews, derive the problems in 4 dimension: patients, intervention scope, service ability and information system, and propose 8 influencing factors: disease risk perception level, self-management skill level, funding budget, work experience, workload, service accessibility, electronic health record construction level and information sharing scope level.

The prediabetic state population is an important target of community health management, and the process of policy change reflects the strengthening of attached to the them, but multiple sources of evidence prove that it is still a weak link at present. In view of the problems in the current practice, it is necessary to improve the knowledge, skills and other management capabilities of community health service personnel, optimize the information system platform based on the medical treatment combination, and further develop a more feasible and continuous health management model for prediabetic state integrating screening, management and intervention.