Canagliflozin (CANA) and metformin (MET) can both be used in the treatment of type 2 diabetes (T2DM) , but the clinical efficacy of combined use remains to be further clarified.

To elevate the efficacy and safety of CANA combined with MET in the treatment of T2DM, and to provide clinical reference for the treatment of T2DM.

A systematic review of published randomized controlled trials (RCTs) of 100 mg and/or 300 mg CANA combined with MET for T2DM performed in PubMed, Cochrane Library, EMBase, Clinical Trials.gov, CNKI Database, VIP Database, Wanfang Databases from inception to 18 April 2021 were retrieved by computer, and the included references were retrieved manually. After literature screening, data extraction and quality evaluation, meta-analysis was performed using RevMan 5.3 software.

A total of 9 RCTs with 6 224 patients were included. Meta-analysis results showed that the levels of glycosylated hemoglobin (HbA_1c) , fasting blood glucose (FPG) , body weight, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , and triacylglycerol (TG) in the 100 mg CANA combined with MET group and the 300 mg CANA combined with MET group were lower than placebo control group (P<0.05) . The levels of pancreatic β-cell function index (HOMA-β) , low-density lipoprotein cholesterol (LDL-C) , and high-density lipoprotein cholesterol (HDL-C) in the 100 mg CANA combined with MET group were higher than those in the placebo control group (P<0.05) . The levels of HbA_1c and SBP in the 300 mg CANA combined with MET group were lower than those in the active control group, and the level of HOMA-β was higher than that in the active control group (P<0.05) . The FPG, body weight, DBP and TG in the 100 mg CANA combined with MET group and 300 mg CANA combined with MET group were lower than those in the active control group, and the levels of LDL-C and HDL-C were higher than those in the active control group (P<0.05) . The incidence of reproductive system infection (female) in the 100 mg CANA combined with MET group was higher than that in the placebo control group (P<0.05) . The incidence of reproductive system infection (female) and osmotic diuresis-related adverse events in the 300 mg CANA combined with MET group was higher than that in the placebo control group (P<0.05) . The incidence of reproductive system infection (male) , reproductive system infection (female) , and osmotic diuresis in the 100 mg CANA combined with MET group and 300 mg CANA combined with MET group was higher than that in the active control group (P<0.05) .

100 mg and 300 mg of CANA combined with MET can effectively reduce HbA_1c and FPG levels, body weight, blood pressure and TG levels, and increase LDL-C and HDL-C levels in T2DM patients. For patients with T2DM poorly controlled by MET, it may be considered in combination with CANA, but attention should be paid to infection of the reproductive system. Therefore, high-quality large-sample trials are still needed to confirm the long-term safety of different doses of CANA combined with MET.

High blood pressure can cause damages of target organs such as the heart, brain, kidneys and retina, while diabetes can cause a series of metabolic disorders, resulting in a variety of complications. Both are major risk factors for cardiovascular and cerebrovascular diseases. Eating a healthy diet may significantly contribute to the prevention and control of hypertension and diabetes.

To investigate the effects of a Chinese-style DASH diet in improving the nutritional status of community-living patients with type 2 diabetes and hypertension.

Sixty-one hypertensive patients with type 2 diabetes with medical records created in Chongqing Sihai Community Health Center were selected to undergo an eight-week Chinese-style DASH diet intervention, including dietary guidance (at 1 and 2 weeks) , eating the Chinese-style DASH diet provided using a group-based approach (at 3 and 4 weeks) , and home-based medical care (at 5 to 8 weeks) . Food frequency survey and 24-hour dietary recall were used to investigate the dietary structure and nutritional intake at baseline and after intervention. Anthropometric indicators (BMI and waist-to-hip ratio) , blood lipids (triacylglycerol, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol) , glycemic control and hypertension control status at baseline and after intervention were compared.

A total of 59 cases were included in the study. Regarding dietary structure after intervention, the average daily intake of soy, nuts, pickled products, fried foods and salt significantly decreased in subjects, while that of fresh fruit, milk and dairy products increased significantly (P<0.05) . Regarding nutritional status, the daily average intake of fat and sodium was significantly reduced, while that of dietary fiber, calcium, potassium and magnesium was significantly increased (P<0.05) . The number of participants eating a diet with a recommended ratio of fat increased significantly (P<0.05) . Health monitoring showed that total cholesterol, low-density lipoprotein cholesterol, systolic blood pressure, diastolic blood pressure and 2-hour postprandial glucose were partially improved after intervention (P<0.05) . From the 4th week of the intervention, the control rate of 2-hour postprandial glucose at follow-up was significantly higher than the baseline level (P<0.05) , and it reached 69.5% at the end of the intervention. Except for the 2nd week of the intervention, the blood pressure control rate at follow-up was notably higher than the baseline level (P<0.05) , and it reached 67.8% at the end of the intervention.

Eating the Chinese-style DASH diet helps to promote the health in community-living hypertension patients with type 2 diabetes via effectively adjusting the inappropriate diet structure and improving the nutritional status.

Diabetes is highly prevalent in China, the prevention and treatment of it and its related complications need a lot of medical resources. Local reports have revealed that although the mortality of diabetes is declining, the burden of diabetes is still increasing.

To understand the epidemiological characteristics and burden of diabetes in China from 1990—2019, forecast the incidence of diabetes in China from 2020 to 2030, to provide data for evaluating and formulating diabetes-related prevention and treatment policies and measures.

In August 2022, this study used data from the Global Burden of Disease Study 2019. Temporal trends of the incidence, mortality, disability-adjusted life years (DALY), years of life lost (YLL), and years lost due to a disability (YLD) of diabetes in China from 1990 to 2019 were described. The Bayesian-age-period-cohort analysis was used to predict the incidence of diabetes in China from 2020 to 2030.

Compared with 1990, in 2019, the crude prevalence of diabetes increased to 265.45/100 000, with an increase of 63.12%, the standardized prevalence of diabetes increased to 204.31/100 000, with an increase of 15.93%, the crude mortality rate of diabetes increased to 12.16/100 000, with an increase of 105.41%, and the standardized mortality rate of diabetes increased to 9.44/100 000, with an increase of 2.61%. The YLL rate decreased from 204.71/100 000 in 1990 to 178.45/100 000 in 2019. The YLD rate increased from 260.74/100 000 in 1990 to 316.30/100 000 in 2019. The DALY rate increased from 465.46/100 000 in 1990 to 494.76/100 000 in 2019. Compared with 1990, the DALY rate of diabetes increased by 21.08% in males and decreased by 6.68% in females. The YLL rate, YLD rate and DALY rate increased with age in 2019. According to the prediction of the standardized incidence of diabetes in China from 2020 to 2030, the overall standardized incidence of diabetes would present a decreasing trend during the period, and the standardized incidence of diabetes in 2030 would decrease by 11.45% in men and 18.60% in women compared with 2020.

The burden of diabetes in China is still heavy, with a large number of illness cases and decreased cases, mainly manifested by a high burden caused by diabetes-related disability. Attention should be paid to early prevention of diabetes to reduce the occurrence of complications. The disease burden of males and middle-aged and elderly people is heavy, so sufficient attention should be paid to them. Although the predicted diabetes incidence will reduce between 2020 and 2030, the number of patients is still increasing, so the prevention and control of diabetes should not be slack.

Excessive levels of oxidative stress and long-term inflammatory state seriously affect wound healing in diabetic patients. At present, there are biological agents, traditional Chinese medicines, stem cell therapy etc. used in treating diabetic cutaneous ulcer (DCU) . Due to lack of sufficient evidence of safety and effectiveness, these methods are not widely applied in clinical treatment. Thus new drugs need to be discovered urgently. Hyaluronic acid oligosaccharide (o-HA) is a potential drug for the treatment of DCU because of its antioxidant and anti-inflammatory properties.

To observe the effect of o-HA on DCU wound healing and explore its influence on oxidative stress Nrf2 signaling pathway.

This experiment was conducted from April to December, 2021. Ninety SPF male mice of six-week-old from Kunming were selected. Ten of them were reserved as the normal control group (NC group) and the rest were injected with streptozotocin (STZ) by abdomen to induce diabetes mouse model. Sixty diabetic mice modeled successfully were divided into 6 groups according to random number table with ten in each group, namely the diabetic model group (DM group) , the recombinant human epidermal growth factor positive control group (rhEGF group) , the blank matrix negative group (matrix group) , low-dose o-HA treatment group (0.5% o-HA group) , medium-dose o-HA treatment group (1% o-HA group) and high-dose o-HA treatment group (2% o-HA group) . The DCU model was established in all mice by way of the full-thickness skin excision ring splint. The wounds in NC and DM group were not treated. For the other groups, the corresponding medicines were evenly applied to and around the wounds after daily disinfection. The mice in rhEGF group were administered once a day while the mice in the 0.5%, 1% and 2% o-HA group were medicated twice a day for consecutive 14 days. The wound healing condition of DCU mice was recorded after being treated on the first, the 7th and the 14th day. The morphological changes of granulation tissue, collagen fiber formation and angiogenesis in mice wounds were observed by HE staining, Masson staining and CD34 immunohistochemical staining. The serum SOD and MDA levels of mice were examined by the kits. The Nrf2, HO-1 and NQO1 protein expression in wound tissue of mice were detected by Western-blotting after the administration of 14 days.

On the seventh day of administration, the wound healing rate of rhEGF group and 1% o-HA group was higher than that of DM group and the wound healing rate of 0.5% o-HA group and 2% o-HA group was lower than that of NC group and higher than that of DM group. On the 14th day of administration, the wound healing rate of rhEGF group, 0.5% o-HA group, 1% o-HA group and 2% o-HA group was higher than that of DM group (P<0.05) . The histomorphology showed that the granulation tissue of the wound, collagen fiber and density of neovascularization were significantly increased after o-HA ointment intervention. The level of MDA in the rhEGF group, 0.5% o-HA group, 1% o-HA group and 2% o-HA group was lower than that of DM group, and the level of SOD in these four groups was higher than that of DM group; the level of MDA in 0.5% o-HA and 2% o-HA groups was higher than that of NC group (P<0.05) . The levels of Nrf2, HO-1 and NQO1 protein expression in both rhEGF group and 1% o-HA group were higher than those of NC and DM group; the levels of Nrf2 and NQO1 protein expression in 0.5% o-HA group were higher than those of DM group, and the level of HO-1 protein expression was higher than that of NC and DM group; the level of HO-1 protein expression in 2% o-HA group was higher than that of NC and DM group, and the level of NQO1 protein expression was higher than that of DM group (P<0.05) .

o-HA has a potential healing effect for DCU wound in mice, and the healing effect of 1% o-HA ointment is the most remarkable. It can help wound healing by accelerating wound closure and re-epithelization, promoting angiogenesis and affecting the Nrf2 pathway. With advantages of high safety and good stability, o-HA has great potential in clinical diabetic wound healing.

Rosuvastatin calcium with metformin improves diabetic renal injury, but the mechanism is not yet fully understood.

To explore the mechanism of action of rosuvastatin calcium with metformin improving renal injury in a rat model of streptozotocin (STZ) -induced type 2 diabetes mellitus (T2DM) .

Forty clean grade Wistar rats were equally randomized into a control group (group C) , a metformin group (group M) , a metformin+low-dose rosuvastatin calcium group (group M+RL) , and a metformin+high-dose rosuvastatin calcium group (group M+RH) from July to October 2021. T2DM model was established for three groups (except for group C) using intraperitoneal injection of STZ. Then drug was administered by intragastric administration to the groups as follows: equal amount of 0.9% sodium chloride solution for group C, metformin (200 mg·kg^-1·d^-1) for group M, metformin (200 mg·kg^-1·d^-1) suspension+rosuvastatin calcium (0.42 mg·kg^-1·d^-1) for group M+RL, and metformin (200 mg·kg^-1·d^-1) suspension+rosuvastatin calcium (0.83 mg·kg^-1·d^-1) for group M+RH. Rats were sacrificed after 6 weeks of intervention, while their blood and kidney tissues were collected. The extent of injury of kidney tissues was observed under light microscope after being stained with H&E, and was analyzed using Image-Pro Plus 6.0 after being stained with periodic-acid schiff, and Masson's trichrome, respectively. The expression of glucose transporter 4 (GLUT4) mRNA in the renal tissue was measured by real-time polymerase chain reaction (PCR) , and the protein levels of GLUT4 were detected by Western-blotting.

Compared with group C, the glomerulus of rats in other three groups showed significant structural damage, accompanied by inflammatory cell infiltration and interstitial fibrosis. Moreover, mRNA expression levels of GLUT4 in these groups were significantly lowered (P<0.05) . Furthermore, the protein levels of GLUT4 in groups M and M+RL were lowered notably (P<0.05) . The mRNA and protein expression levels of GLUT4 in group M+RL or M+RH were higher than those of group M (P<0.05) . In addition, the mRNA and protein expression levels of GLUT4 in M+RH group were higher than those in M+RL group (P<0.05) .

Rosuvastatin calcium with metformin could reduce inflammatory cell infiltration in glomerular and tubular, alleviate glomerular basement membrane thickening and tubular vacuolar degeneration, delay the interstitial fibrosis development, and increase GLUT4 mRNA and GLUT4 protein expression in STZ-induced T2DM rats. Moreover, higher dose of rosuvastatin calcium showed better effect. Our study indicated that rosuvastatin calcium combined with metformin may achieve a renoprotective effect by regulating the expression of GLUT4 mRNA and protein in T2DM rats, and this effect may be enhanced with the increase in the dose of rosuvastatin calcium.

The prevalence of type 2 diabetes mellitus (T2DM) is increasing throughout the world. Six out of the top 10 countries with the highest number of adults with diabetes in 2021 were in Asia. Reliable type 2 diabetes risk prediction models can identify individuals at risk of developing T2DM, which may provide a basis for decision-making in the prevention and intervention of T2DM.

To perform a systematic review of risk prediction models for T2DM, providing a reference for the prevention and treatment of T2DM.

In April 2021, we searched for studies on risk prediction models for T2DM in Asian adults in databases of PubMed, EmBase, and the Cochrane Library from inception to April 1, 2021. Two reviewers independently screened the literature, extracted data, and evaluated the risk of bias and applicability of included studies using the Prediction model Risk Of Bias Assessment Tool (PROBAST) . A descriptive analysis was used to summarise the basic characteristics of the models and the risk of bias and applicability of included studies.

A total of 31 studies were included, among which 17 are prospective cohort studies and other 14 are retrospective cohort studies. Logistic regression and Cox regression were widely used to construct the models. The models were externally validated in 5 studies, internally validated in 22 studies, and externally and internally validated in 4 studies. The number of predictors included in the models ranged from 3 to 24, with performance measured by the area under the curve of receiver operating characteristic curve lying between 0.62 and 0.92. There was a high risk of bias in the included studies, which may mainly due to inappropriate treatment of continuous variables and missing data, and ignoring the overfitting of the model.

The included prediction models may have proven to have good predictive performance, which could support medical workers in early identification of the population at high risk of T2DM. Recommendations for future studies developing risk prediction models for T2DM with good performance and low risk of bias are as follows: improving methods for data modeling and statistical analysis, and attaching great importance to external verification and recalibration of the models.

Diabetes mellitus is an important risk factor for the onset, recurrence, disability and lethality of ischemic stroke. Assessing the prevalence of diabetes in patients with ischemic stroke, and carrying out targeted comprehensive prevention and control can effectively improve the prognosis of patients.

To understand the current situation of ischemic stroke patients complicated with diabetes in Liaoning Province, and to provide a theoretical basis for targeted intervention.

From 2017 to 2018, a cross-sectional survey of ischemic stroke patients (≥40 years old) in 28 villages/communities in 6 counties and districts in Liaoning Province was conducted by a combination of stratified sampling, cluster sampling, and random sampling. Multivariate logistic regression was used to analyze the influencing factors of diabetes prevalence, awareness, treatment and control of ischemic stroke patients.

The prevalence, awareness, treatment, and control rates of diabetes among ischemic stroke patients in Liaoning Province were 29.5% (289/980) , 63.3% (183/289) , 56.4% (163/289) , and 47.2% (77/163) , respectively. Multivariate logistic regression suggested that urban residence〔OR=1.818, 95%CI (1.317, 2.508) , P<0.001〕, family history of diabetes〔OR=2.790, 95%CI (1.922, 4.050) , P<0.001〕, hypertension 〔OR=1.813, 95%CI (1.160, 2.834) , P=0.009〕, high triglycerides〔OR=2.312, 95%CI (1.631, 3.277) , P<0.001〕, high-low density lipoprotein cholesterol 〔OR=2.241, 95%CI (1.300, 3.865) , P=0.004〕, and being overweight or obese〔OR=1.562, 95%CI (1.136, 2.146) , P=0.006〕 were the risk factors to diabetes mellitus in ischemic stroke patients; Having an urban residence〔OR=1.865, 95%CI (1.086, 3.203) , P=0.024〕, and having a family history of diabetes〔OR=2.402, 95%CI (1.306, 4.416) , P=0.005〕 favored diabetes awareness, and high cholesterol〔OR=0.389, 95%CI (0.215, 0.705) , P=0.002〕 disfavored diabetes awareness; 60-69 years old〔OR=3.052, 95%CI (1.523, 6.115) , P=0.002〕, urban residence〔OR=1.866, 95%CI (1.104, 3.155) , P=0.020〕, family history of diabetes〔OR=2.303, 95%CI (1.275, 4.161) , P=0.006〕 favored the treatment of diabetes, and high cholesterol〔OR=0.387, 95%CI (0.210, 0.713) , P=0.002〕disfavored the treatment of diabetes; Urban residence〔OR=1.916, 95%CI (1.021, 3.595) , P=0.043〕 favored blood glucose control in patients with ischemic stroke and diabetes.

The prevalence of diabetes in patients with ischemic stroke in Liaoning Province is relatively high, while the awareness, treatment and control of the disease are still at a low level. Factors such as place of residence, having a family history of diabetes are beneficial for improving the knowledge, treatment, and control of diabetes in patients with ischemic stroke, and comprehensive prevention and control are urgently needed

China has the largest number of diabetic patients in the world. Insulin resistance is a major pathogenetic mechanism and cause of type 2 diabetes. Recent studies have suggested potential relationship between triglyceride-glucose index (TyG) and its derivatives index and the development of type 2 diabetes. However, most available evidence is from cross-sectional study or longitudinal study, and there is a lack of studies in the northeast China.

To explore the association between TyG and its derivatives index called triglyceride glucose-body mass index (TyG-BMI) and the incidence risk of type 2 diabetes, analyze the predictive capacity of TyG and TyG-BMI for type 2 diabetes, so as to provide a scientific basis for the early screening of high risk population with type 2 diabetes.

A total of 6843 cases of physical examination in the health management center of the Second Affiliated Hospital of Dalian Medical University from January 2015 to December 2017 were included as research subjects. The baseline data of their physical examinations were collected. By the use of nested case-control study method, 209 patients with new-onset type 2 diabetes during follow-up from January 2018 to April 2021 were selected as the case group; 418 cases among those without new-onset type 2 diabetes, endocrine system diseases and malignancies were selected as the control group after 1∶2 matching by propensity score according to the same gender and age ±2 years. TyG and TyG-BMI were calculated based on baseline data. The Cox regression fitted conditional Logistic regression model was used to analyze the relationship between TyG, TyG-BMI and the development of type 2 diabetes. The restricted cubic spline regression model was used to analyze the dose-response relationship between TyG, TyG-BMI and type 2 diabetes. The receiver operating characteristic (ROC) curve was used to analyze the predictive value of TyG and TyG-BMI for type 2 diabetes.

BMI, AC, SBP, DBP, FPG, TG, TC, LDL-C, TyG, and TyG-BMI in the case group were higher than the control group, and HDL-C in the case group was lower than the control group (P<0.05) . Quartile Q1 group of baseline TyG: TyG<8.46, 157 cases; Quartile Q2 group of baseline TyG: 8.46≤TyG<8.83, 157 cases; quartile Q3 group of baseline TyG: 8.83≤TyG<9.19, 156 cases; Quartile Q4 group of baseline TyG: TyG≥9.19, 157 cases. The risk of type 2 diabetes in quartile Q2 group of baseline TyG, quartile Q3 group of baseline TyG and quartile Q4 group of baseline TyG was 1.57 〔95%CI (0.92, 2.70) 〕, 2.07 〔95%CI (1.21, 3.53) 〕and 3.18 〔95%CI (1.76, 5.75) 〕 times higher than quartile Q1 group of baseline TyG (P_trend<0.001) , respectively. The risk of type 2 diabetes in quartile Q2 group of baseline TyG, quartile Q3 group of baseline TyG and quartile Q4 group of baseline TyG was 2.21 times 〔95%CI (1.25, 3.94) 〕, 2.92 times 〔95%CI (1.58, 5.37) 〕, and 5.34 times 〔95%CI (2.39, 11.95) 〕 higher than quartile Q1 group of baseline TyG (P_trend< 0.001) , respectively. The association between continuous changes in TyG, TyG-BMI and type 2 diabetes showed a linear dose-response relationship (non-linear test, P>0.05) , with an increasing shape in the dose-response relationship. The incidence risk of type 2 diabetes gradually increased when TyG and TyG-BMI were higher than 8.838 and 229.364, respectively. The area under the ROC curve (AUC) for TyG and TyG-BMI to predict type 2 diabetes was 0.696 〔95%CI (0.658, 0.732) 〕and 0.725〔95%CI (0.688, 0.760) 〕with the optimal cut-offs of 8.650 and 224.859, respectively.

Increased TyG and TyG-BMI levels are independent risk factors for type 2 diabetes, showing a linear dose-response relationship with type 2 diabetes, both of which have predictive value for type 2 diabetes. TyG-BMI may be a better prediction index considering the strength of risk association, AUC, and clinical impact of screening results.

Obesity is a risk factor for the development of metabolic syndrome, type 2 diabetes mellitus (T2DM) , atherosclerosis and other diseases, but the correlation between obesity and albuminuria in diabetic patients has been insufficiently explored.

To investigate the correlation between obesity and albuminuria in patients with T2DM.

T2DM inpatients were consecutively recruited from Department of Endocrinology and Metabolism, Shanghai Jiaotong University Affiliated Sixth People's Hospital from January 2007 to June 2009. The general clinical data, physical and laboratory examination results were collected. In accordance with prevalence of obesity (defined as BMI≥25 kg/m²) , the patients were divided into obese group and non-obese group (BMI<25 kg/m²) , then the obese cases were further divided into mild (25 kg/m²≤BMI<30 kg/m²) , moderate (30 kg/m²≤ BMI<35 kg/m²) , and severe obesity subgroups (BMI≥35 kg/m²) . Albuminuria was diagnosed as 24-hour urinary albumin excretion≥30 mg/24 h. The relationship between obesity and albuminuria was analyzed by binary Logistic regression.

In all, 3 023 T2DM cases were enrolled, including 1 609 non-obese cases, and 1 414 obese cases (1 196 cases of mild obesity, 206 cases of moderate obesity and 12 cases of severe obesity) . Compared with non-obese cases, obese cases had higher prevalence of alcohol consumption, hypertension, and history of anti-hypertensive mediation use (P<0.05) . Additionally, obese cases had higher average levels of systolic blood pressure, diastolic blood pressure, waist-to-hip ratio, fasting plasma glucose, 2-h postprandial blood glucose, serum creatinine, fasting C-peptide, 2-hour postprandial C-peptide, triglyceride, total cholesterol, low-density lipoprotein, alanine aminotransferase, and serum uric acid, and lower average levels of glycosylated hemoglobin and high-density lipoprotein (P<0.05) . Obese cases also had higher average level of 24-h urinary albumin excretion 〔13.7 (7.6, 42.6) mg/24 h〕 than did non-obese cases 〔9.7 (6.0, 22.3) mg/24 h〕 (P<0.05) . The prevalence of albuminuria (30.0%, 424/1 414) in obese cases was significantly higher than that of non-obese cases (20.2%, 325/1 609) (P<0.05) . Binary Logistic regression analysis showed that obesity was closely associated with albuminuria in T2DM〔OR=1.266, 95%CI (1.013, 1.582) , P<0.05〕 after adjusting for confounding variables.

Obesity may be an independent risk factor of albuminuria in T2DM. So controlling obesity is very important in decreasing the risk of albuminuria in T2DM patients.

Diabetic foot ulcer (DFU) is a serious diabetic complication with a high recurrence rate after healing. There is a lack of systematic evidence-based studies on multiple risk factors associated with its recurrence.

To investigate the risk factors for DFU recurrence after healing, providing evidence to inform the prevention and treatment of DFU.

A case-control study design was used. Patients with an initial inpatient diagnosis of DFU were selected from Hospital of Chengdu University of TCM from January 1, 2016 to February 1, 2019 as the source population, among whom those with and without a recurrence within three years after healing were assigned to case and control groups, respectively. Baseline characteristics, information related to diabetes and DFU were collected from both groups. Risk factors for DFU recurrence were screened by unconditional multivariate Logistic regression analysis. The relationships of DFU recurrence with the number of risk factors and the time to recurrence were further analyzed.

Among the source population (n=256), 210 had healed DFU, and 190 of them were included for final analysis after excluding 12 missing cases and 8 with incomplete information. The overall recurrence rate within three years after DFU healing was 45.3% (86/190). Multivariate Logistic regression analysis showed that age >60 years〔OR=3.270, 95%CI (1.335, 8.005), P=0.010〕, HbA_1c >7.5%〔OR=2.691, 95%CI (1.242, 7.687), P=0.045〕, peripheral arterial disease (PAD) 〔OR=2.241, 95%CI (1.185, 5.101), P=0.044〕, osteomyelitis〔OR=3.256, 95%CI (1.369, 7.744), P=0.008〕, callus〔OR=2.068, 95%CI (1.262, 4.446), P=0.043〕, ankle-brachial index (ABI) <0.9〔OR=3.616, 95%CI (1.436, 9.102), P=0.006〕, plantar ulcers〔OR=2.192, 95%CI (1.061, 4.998), P=0.042〕, and Wagner grade ≥3〔OR=5.522, 95%CI (2.484, 12.273), P<0.001〕 were risk factors for DFU recurrence. The number of comorbid risk factors mainly ranged from 5 to 9 in the case group (n=86), and 2 to 5 in the control group (n=104). The number of recurrent cases within one, two and three years in the case group was 35, 28 and 23, respectively. The one-, two- and three-year cumulative recurrence rates were 18.4% (35/190), 33.2% (63/190), and 45.3% (86/190), respectively.

The high recurrence rate of DFU may be associated with risk factors such as age >60 years, HbA_1c >7.5%, PAD, osteomyelitis, callus, ABI <0.9, plantar ulcers, and Wagner grade ≥3.

Local wound management is a key part in the management of diabetic foot ulcers (DFUs), and dressings are one major tool. There are no specific guidelines on dressing selection for DFUs, and it is urgently needed to integrate relevant contents scattered in major comprehensive guidelines.

Practice guidelines related to the management of diabetic foot were searched and reviewed, and entries related to dressing selection or application were extracted for evidence synthesis to inform clinical interventions.

Published clinical practice guidelines about diabetes management were searched from diabetes websites and electronic literature databases, the search period was from January 2012 to November 2021, and screened according to inclusion and exclusion criteria, then their methodological quality was evaluated, and evidence related to dressing selection and application in which was translated, extracted and synthesized.

Ten guidelines published between 2012 and 2020 were included, with overall high quality and high consistency between reviewers. Then a table of recommendations for selection and application of wound dressings for diabetic foot disease was developed by comprehensively summarizing relevant evidence extracted from the guidelines (evidence from eight guidelines in foreign languages was first translated into Chinese before being extracted) .

The evidence selected from the guidelines involves wound characteristics, moisture healing, periwound skin management, patient preference, and cost. Among them, wound characteristics should be seriously considered in the selection of dressings for DFUs. Most of the recommendations are about the treatment of wound exudate condition and the presence or absence of infection. However, there are fewer recommendations for basal tissue types, especially gangrene wounds.

The knowledge-based management model has been widely used in chronic disease management recently. The online-to-offline (OTO) model, a common internet-based chronic disease management model integrating online and offline resources, has been used in disease prevention besides disease treatment, and proven to be effective in supporting chronic disease management. However, there are few studies on the application of OTO model in the management of older adults with diabetes in China.

To explore the influence of OTO model on glycemic control and self-management behaviors in older adults with type 2 diabetes in the community.

By use of convenient sampling, older adults with type 2 diabetes (n=110) who were transferred from a tertiary hospital to five community hospitals in Shenyang were selected from August to October 2020. They were randomly assigned in a 1∶1 ratio, to receive a 12-month usual community-based health management (control group) , or a 12-month OTO model-based health management (intervention group) . The intervention results were evaluated by fasting blood glucose (FBG) , 2-hour postprandial glucose (2 h-PBG) and glycosylated hemoglobin (HbA_1c) at baseline, and 6 months and 12 months after intervention, and total score and dimension scores of the Chinese version of Summary of Diabetes Self-care Activities (SDSCA-C) at baseline and 12 months after intervention.

A total of 105 cases (53 in the intervention group and 52 in the control group) who completed the study were finally included. Two groups had was no significant differences in mean levels of baseline FBG, 2 h-PBG and HbA_1c (P>0.05) . Significant interaction effects produced by the intervention method and time, and significant main effects brought by both intervention method and time on FBG, 2 h-PBG and HbA_1c were observed (P<0.05) . FBG, 2 h-PBG and HbA_1c levels in the intervention group decreased significantly either at 6 or 12 months after intervention (P<0.05) . But in the control group, only FBG and 2 h-PBG levels decreased significantly at 6 and 12 months after intervention (P<0.05) . The 12-month intervention lowered FBG, 2 h-PBG and HbA_1c levels more significantly than 6-month intervention in the intervention group (P<0.05) . But in the control group, only 2 h-PBG level was lowered more significantly by 12-month intervention than 6-month intervention (P<0.05) . The intervention group had lower mean FBG, 2 h-PBG and HbA_1c levels than the control group either at 6 or 12 months after intervention (P<0.05) . At baseline there were no differences between the two groups in total score and dimension scores of SDSCA-C (P>0.05) . After 12 months of intervention, the total score and dimension scores of SDSCA-C increased insignificantly in the control group (P>0.05) , but increased notably in the intervention group (P<0.05) . The intervention group had much higher total score and dimension scores of SDSCA-C than the control group after the intervention (P<0.05) .

The OTO model-based health management could contribute to improving glycemic control and self-management behaviors in older type 2 diabetics, which may benefit effective long-term management of diabetes.

The number of elderly diabetic patients is increasing rapidly with the aggravation of population aging. The coexistence of multiple conditions and polypharmacy are common in elderly diabetic patients. Strengthening clinically rational drug use can effectively reduce the incidence of adverse drug events and improve outcomes in these patients.

To understand the characteristics and patterns of polypharmacy including hypoglycemic, antihypertensive, lipid-lowering, antiplatelet agents in elderly patients with type 2 diabetes, so as to provide a reference for promoting rational medication use.

This study retrospectively selected 240 elderly inpatients with type 2 diabetes who were hospitalized in Department of Endocrinology, the Second Affiliated Hospital of Xi'an Jiaotong University from April 1, 2020 to March 31, 2022 by cluster sampling method in April 2022. The drugs used during hospitalization and post-discharge medication regimens were investigated. Descriptive analysis was used to analyze the treatment regimens of hypoglycemic, antihypertensive, lipid-regulating and antiplatelet.

On average, the participants had (13.93±3.12) diagnoses at discharge, (16.48±5.41) kinds of medications during hospitalization, and (8.21±2.46) kinds of long-term medications after discharge. The rate of polypharmacy after discharge reached 89.2% (214/240). After discharge, 216 cases (90.0%) received hypoglycemic treatment, among whom 44.9% (97/216) used single drug therapy, and 58.3% (126/216) were treated with insulin. One hundred and eighty-three cases (76.2%) were treated with antihypertensive therapy, including 44.3% (81/183) with single drug therapy and 79.2% (145/183) with calcium channel blockers. One hundred and eighty-seven cases (77.9%) received lipid-regulation therapy, and 83.4% (156/187) of them received atorvastatin. One hundred and seventeen cases (48.7%) used antiplatelet drugs, among whom 77.8% (91/117) used aspirin. Eighty-four cases (35.0%) received hypoglycemic, antihypertensive, lipid-regulating and antiplatelet therapies.

Polypharmacy is common in elderly patients with type 2 diabetes, including hypoglycemic, antihypertensive, lipid-regulating, antiplatelet and other therapies, which indicates that they have received pre-treatment relatively comprehensive condition evaluation by medical workers. Although the rate of comprehensive management is high in this group, there are still some potential risks of adverse drug events due to irrational use of some drugs alone or in combination.

People with diabetes mellitus are at increased risk of developing osteoporosis (OP) , especially those with postmenopausal type 2 diabetes mellitus (T2DM) . Chronic inflammation plays an important role in the development of OP.

To explore the predictive value of neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-high-density lipoprotein cholesterol ratio (MHR) for OP in postmenopausal patients with T2DM.

Two hundred and sixteen postmenopausal T2DM patients who were hospitalized in the Department of Endocrinology and Metabolism, the First Affiliated Hospital of Zhengzhou University from January 2018 to January 2020 were chosen. Clinical data were obtained, including blood routine and biochemical parameters (such as blood lipids and so on) in fasting venous blood, calculated NLR and MHR, and bone mineral density (BMD) of lumbar spine L_1-4, left femoral neck and left hip measured by dual-energy X-ray absorptiometry (DXA) . According to the BMD, the patients were divided into normal bone mass group (n=51) , osteopenia group (n=78) and OP group (n=87) . In addition, they were divided into 4 groups according to NLR quartiles (A1 to A4 group) and MHR quartiles (B1 to B4 group) , with 54 cases in each. Spearman correlation was used to analyze the association of NLR and MHR with BMD at lumbar spine L_1-4, left femoral neck and left hip. Multivariate Logistic regression analysis was applied to explore the influencing factors of OP. Receiver operating curve (ROC) analysis was performed to evaluate the value of NLR, MHR and their combination in predicting OP.

NLR and MHR were increased in the osteopenia group than the normal bone mass group (P<0.05) . Compared with the normal bone mass group and the osteopenia group, NLR and MHR in the OP group were statistically significant increased (P<0.05) . Compared with A1 group, A3 group had decreased BMD at lumbar spine L_1-4, left femoral neck and left hip, so did A4 group (P<0.05) . A4 group had decreased BMD at lumbar spine L_1-4, and left hip than A2 group (P<0.05) . B1 group had higher BMD at lumbar spine L_1-4, left femoral neck and left hip than did B2, B3, and B4 groups (P<0.05) . B4 group had decreased BMD at lumbar spine L_1-4, left femoral neck and left hip than did B2 group (P<0.05) . B4 group also had decreased BMD at lumbar spine L_1-4 did B3 group (P<0.05) . Spearman correlation analysis showed that both NLR and MHR were negatively correlated with BMD at lumbar spine L_1-4, left femoral neck and left hip (P<0.001) . Multivariate Logistic regression analysis showed that long menopausal duration〔OR=1.092, 95%CI (1.005, 1.186) 〕, increased NLR〔OR=2.341, 95%CI (1.453, 3.770) 〕and increased MHR〔OR=329.250, 95%CI (21.421, 5 060.810) 〕were independently associated with elevated risk of OP, while high BMI〔OR=0.806, 95%CI (0.718, 0.903) 〕was associated with decreased risk of OP (P<0.05) . ROC analysis demonstrated that in predicting OP, the area under the curve (AUC) of NLR was 0.722, with 65.5% sensitivity and 72.1% specificity, and that of MHR was 0.709 with 52.9% sensitivity and 79.8% specificity, and that of NLR with MHR was 0.787, with 81.6% sensitivity and 67.4% specificity. The AUC of NLR with MHR was greater than that of NLR or MHR alone (Z=2.418, P<0.05; Z=2.893, P<0.05) .

Either NLR or MHR could be used as a predictor of OP in postmenopausal T2DM patients, and the predictive efficiency and sensitivity of the combination of them would be higher.

The incidence of diabetic kidney disease (DKD) is increasing, which has become a major cause of end-stage renal disease. DKD has an insidious onset, and progresses rapidly since the presence of proteinuria, it is difficult to slow down its progression with conventional therapy especially when renal function is significantly impaired. Therefore, it is urgently necessary to explore an effective treatment for delaying the progression of advanced DKD. The Xiezhuoxiaozheng therapy, proposed by Professor WANG Yaoxian in accordance with the pathogenesis of advanced DKD manifested by turbid poison and mass signs and symptoms (zhengjia) , has proven to be effective in clinical treatment of advanced DKD.

To assess the clinical efficacy and safety of Xiezhuoxiaozheng therapy in advanced DKD based on the theory of "latent internal heat causing renal collateral mass".

A real-world, prospective cohort study design was used to investigate the clinical efficacy and safety of Xiezhuoxiaozheng therapy for advanced DKD in seven hospitals (Dongzhimen Hospital, Beijing University of Chinese Medicine, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing Hospital of Traditional Chinese Medicine, Wangjing Hospital of CACMS, Xiyuan Hospital of CACMS, Beijing Hospital of Integrated Traditional Chinese and Western Medicine, and Beijing Fangshan District Hospital of Traditional Chinese Medicine) from 2016 to 2020. Patients with DKD who met the inclusion criteria were recruited and divided into a control group (basic western medical treatment) and a test group (basic western medical treatment plus Xiezhuoxiaozheng therapy) taking the method of Xiezhuoxiaozheng and eliminating symptoms as the exposure factor, and received 24-week interventions. At baseline, and the end of 4, 12, and 24 weeks of interventions, serum creatinine (Scr) , blood urea nitrogen (BUN) , 24-hour urine protein, and total cholesterol (TC) , estimated glomerular filtration rate (eGFR) were measured, TCM symptom score was assessed. HbA_1c was measured at baseline, and the end of 12, and 24 weeks of interventions. Adverse events were recorded during treatment, and safety was evaluated.

A total of 59 cases completed the study, including 36 in the test group and 23 in the control group. The intervention duration had significant main effect on eGFR, Scr, and BUN levels in both groups (P<0.05) . The intervention therapy and duration had significant interaction effect on the change in the TCM symptom score in both groups (P<0.05) . The control group had increased BUN level at the end of 12 weeks of intervention, and increased BUN, Scr and heat syndrome score at the end of 24 weeks of intervention (P<0.05) . In contrast, the test group had increased eGFR at the end of 4 weeks of intervention (P<0.05) . The test group had higher eGFR and lower Scr, BUN and TCM symptom score at the end of intervention than did the control group (P<0.05) . The incidence of adverse reactions was 21.74% (5/23) in the control group and 8.33% (3/36) in the experimental group. There was no significant difference between the two groups (χ²=2.15, P=0.14) .

For advanced DKD, Xiezhuoxiaozheng therapy combined with usual western medicine treatment may be superior to usual western medicine treatment alone in delaying the decrease of eGFR, slowing down the increase of Scr and BUN levels, protecting kidney function, reducing the heat syndrome score and improving the TCM symptoms, which could improve the clinical efficacy.

Hyperuricemia (HUA) caused by elevated serum uric acid (SUA) has become the fourth most common disease after hyperglycemia, hyperlipidemia, and hypertension, and the second most common metabolic disease after diabetes. It has been shown that elevated SUA levels are significantly associated with the risk of type 2 diabetes mellitus (T2DM). However, there is a lack of studies on Chinese population and studies on HUA combined with unhealthy lifestyle or chronic disease.

To investigate the association between baseline SUA levels, HUA combined with unhealthy lifestyle or chronic diseases and the risk of T2DM in health examination population.

A total of 17 626 individuals meeting the inclusion and exclusion criteria who had underwent at least two physical examinations from 2017 to 2020 in Preventive Treatment & Health Management Center, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine were selected as the subjects. Information about their demographics, lifestyle, physical examination results, and laboratory indicators was collected. A follow-up was carried out with them until the onset of T2DM or the end of follow-up (2020-12-31), during which the onset day of T2DM and clinical visit information for T2DM were collected. The cumulative incidence and incidence density of T2DM in the total population, and cumulative incidence of T2DM in subgroups were calculated. The Cox proportional-hazards model was used to investigate the association between baseline SUA level and the risk of T2DM. And stratified multivariate Cox proportional-hazards regression model was used to further analyze their association in different subgroups.

The subjects had a median age of 38.2 (31.9, 49.6) years, a median baseline SUA level of 304.50 (248.00, 374.00) μmol/L, and an overall prevalence of HUA of 13.12%. The cumulative follow-up was 54 633 person-years, with a median follow-up of 3.10 years. There were 479 new cases of T2DM. The incidence density was 8.77 〔95%CI (8.00, 9.59) 〕 /1 000 person-years and the cumulative incidence rate was 2.72%〔95%CI (2.48%, 2.97%) 〕. Higher cumulative incidence rate of T2DM was found in older age group (≥60 years old), male cases, or those with current smoking, current alcohol drinking, BMI≥28.0 kg/m², hypertension, dyslipidemia, or HUA. The multivariate-adjusted Cox proportional hazards regression model showed that HUA patients had an increased risk of T2DM, with an HR of 1.32〔95%CI (1.04, 1.67), P=0.023〕. For every 10 μmol/L increase in baseline SUA level, the risk of T2DM increased by 3%〔HR=1.03, 95%CI (1.01, 1.04), P<0.001〕. Stratified analysis of multivariate Cox proportional hazards regression model showed that the risk of T2DM increased in 60-year-olds and above〔HR=6.78, 95%CI (4.16, 11.03), P<0.001〕, females 〔HR=2.31, 95%CI (1.54, 3.45), P<0.001〕, current smokers 〔HR=1.79, 95%CI (1.23, 2.60), P=0.002〕, current alcohol drinkers 〔HR=1.61, 95%CI (1.23, 2.10), P<0.001〕, individuals with BMI≥28.0 kg/m²〔HR=1.69, 95%CI (1.07, 2.68), P=0.026〕, hypertensioners 〔HR=2.89, 95%CI (2.15, 3.89), P<0.001〕, or individuals with dyslipidemia 〔HR=2.39, 95%CI (1.80, 3.16), P<0.001〕with HUA.

Elevated baseline SUA levels are associated with a high risk of T2DM in health examination population, and the risk may be even higher in elderly people, females, current smokers, current drinkers, individuals with obesity, hypertension, or dyslipidemia with HUA.

Diabetic peripheral neuropathy (DPN) is one of the common complications in diabetic patients, and TCM external therapies represented by acupuncture has some advantages in treating DPN, but what combination of TCM external therapies and conventional Western medicine has the best efficacy in treating DPN is still lacking evidence-based medical studies.

To evaluate the efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN by Bayesian Network Meta-analysis.

The five commonly used external therapies of TCM confirmed by pre-survey were acupuncture, foot bath, acupoint massage, acupoint injection and moxibustion, respectively. The Cochrane Library, Web of Science, PubMed, SinoMed, VIP, Wanfang Data and CNKI were searched by computer from their inception to December 29th, 2020, to screen randomized controlled trials (RCTs) about efficacy and safety of the five commonly used external therapies of TCM combined with conventional Western medicine in treating DPN. RevMan 5.3, Stata 15.0 and ADDIS 1.16.6 software were used for plotting and data analysis.

A total of 44 RCTs were enrolled, including 3 471 patients with DPN. Bayesian network Meta-analysis showed that the five commonly used external therapies of TCM combined with Western medicine were all superior to conventional Western medicine alone in improving overall efficacy rate, of which acupuncture had the best effect〔OR=0.20, 95%CI (0.11, 0.36) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve motor conduction velocity (MNCV) , with acupoint injection being the most effective〔MD=-4.50, 95%CI (-5.91, -3.11) 〕. The five commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone in improving median nerve sensory conduction velocity (SNCV) , in which moxibustion had the best effect〔MD=-9.03, 95%CI (-12.59, -5.47) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional Western medicine were all superior to conventional Western medicine alone, with moxibustion having the best effect〔MD=-6.34, 95%CI (-9.31, -3.30) 〕. Except for acupoint massage, the other four commonly used external therapies of TCM combined with conventional western medicine were all superior to conventional Western medicine alone in improving SNCV of the common peroneal nerve, with acupuncture showing the best efficacy〔MD=-5.70, 95%CI (-8.03, -3.31) 〕.

Acupuncture combined with conventional Western medicine is recommended preferentially in treating DPN based on available literature evidence, especially in improving overall efficacy rate and SNCV of the common peroneal nerve, but more high-quality studies are still needed for further validation.

Early neurological deterioration (END) in acute ischemic stroke is associated with permanent neurological deficits and dysfunction, and considered to be an unstable condition requiring comprehensive medical treatment. Moreover, the relationship between END and glycemic variability (GV) remains unclear.

To explore the relationship of GV, time in range (TIR) with END in patients with acute ischemic stroke and diabetes, and based on this, to develop a predictive model.

One hundred and twenty patients with acute ischemic stroke and diabetes (34 with END and 86 without) were selected from the Second Affiliated Hospital of Zhengzhou University from July 2019 to May 2021. Clinical data, GV indices 〔coefficient of variation (CV) , standard deviation (SD) , mean amplitude of glycemic excursion (MAGE) , mean of daily differences (MODD) 〕 and TIR measured by the 72-hour ambulatory continuous glucose monitoring were collected. Factors associated with END were explored by multivariate Logistic regression, and used to develop a nomogram for the prediction of END. ROC analysis was conducted to assess the predictive value of nomogram for END.

Patients with END had higher mean glycosylated hemoglobin (HbA_1c) , admission NIH Stroke Scale score, CV, SD, MAGE, and MODD, and lower mean TIR than did those without (P<0.05) . Multivariate Logistic regression analysis indicated that increased CV〔OR=1.194, 95%CI (1.027, 1.388) , P=0.021〕, SD〔OR=11.040, 95%CI (1.189, 102.473) , P=0.035〕, MAGE〔OR=3.063, 95%CI (1.062, 8.837) , P=0.038〕, and MODD〔OR=20.990, 95%CI (1.420, 201.206) , P=0.027〕 were associated with elevated risk of END, and prolonged TIR〔OR=0.877, 95%CI (0.789, 0.974) , P=0.014〕 was associated with decreased risk of END. Internal validation of the predictive value of nomogram incorporating CV, SD, MAGE, MODD and TIR for END using bootstrapping showed that its predicted value was basically consistent with the actual value, demonstrating good predictive ability. For estimating END in acute ischemic stroke combined with diabetes, the AUC of CV, SD, MAGE, MODD and TIR was 0.847〔95%CI (0.765, 0.929) , P<0.01〕, 0.812〔95%CI (0.723, 0.901) , P<0.01〕, 0.850〔95%CI (0.772, 0.928) , P<0.01〕, 0.803〔95%CI (0.710, 0.896) , P<0.01〕, and 0.825〔95%CI (0.747, 0.903) , P<0.01〕, respectively.

CV, SD, MAGE, MODD and TIR may be influential factors for END in acute ischemic stroke with diabetes, which could partially predict END. It is of clinical significance to take measures to reduce GV and prolong TIR to prevent END.

Patients with diabetic foot undergoing endovascular therapy for lower extremity arterial disease exhibit poor outcomes and a high mortality rate. It is unclear whether malnutrition assessed by geriatric nutritional risk index (GNRI) is associated with clinical outcomes in these patients.

To investigate the association of baseline malnutrition assessed by GNRI and clinical outcomes of endovascular therapy for lower extremity arterial disease in patients with diabetic foot.

Ninety-five patients who were admitted in Department of Endocrinology, Sun Yat-sen Memorial Hospital due to diabetic foot and lower extremity arterial disease were included from January 2011 to December 2016. All of them received endovascular therapy and followed up for two years. Baseline GNRI was assessed, and divided into three levels: normal nutrition (43 cases) , mild malnutrition (31 cases) and moderate to severe malnutrition (21 cases) . Clinical characteristics were collected, including sex, age, diabetes duration, smoking, body mass index, prevalence of cardiovascular and cerebrovascular diseases, diabetic foot classification, systolic and diastolic blood pressure, and blood test results containing white blood cell count, platelet count, lymphocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, hemoglobin, fasting blood glucose, glycosylated hemoglobin, total cholesterol, triglyceride, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol, albumin, creatinine, and estimated glomerular filtration rate. The primary endpoint was all-cause mortality, and the secondary endpoint was major lower extremity amputation. The Kaplan-Meier curve was used for survival analysis. Univariate and multivariate Cox proportional hazards regression analysis were analyzed to evaluate the risk factors of all-cause mortality.

Fifty-two cases (54.7%) were assessed with malnutrition (GNRI≤98) . Normal nutrition, mild malnutrition, and moderate to severe malnutrition patients had significant differences in average body mass index, leukocyte count, neutrophil count, neutrophil-to-lymphocyte ratio, hemoglobin, triglyceride and albumin (P<0.05) . During the follow-up, 16 patients died, 10 of whom were due to cardiovascular or cerebrovascular diseases; five patients underwent major lower extremity amputation. The two-year survival rate was 92.1%, 75.6% and 50.1% in normal nutrition, mild malnutrition, and moderate to severe malnutrition patients, respectively, showing statistically significant difference (Log-rank test: χ²=10.812, P=0.004) . GNRI≤98〔HR=3.937, 95%CI (1.070, 13.942) , P=0.037〕 was an independent risk factor for all-cause mortality.

The two-year survival rate of patients in normal nutrition group (GNRI>98) was higher than that in malnutrition group (GNRI≤98) . Baseline GNRI-assessed malnutrition may be an independent risk factor for all-cause mortality in diabetic foot patients with lower extremity arterial disease treated by endovascular therapy, so assessing and improving the nutritional status may better improve the clinical outcome of these patients.

Diabetic retinopathy (DR) may cause vision loss, visual field defects, vitreous hemorrhage, and even blindness. However, there are few reports about delayed healthcare-seeking in patients with DR.

To analyze the influencing factors of delayed healthcare-seeking and visiting time in DR patients.

DR patients were recruited from Tianjin Eye Hospital from January to May 2018, to attend an anonymous questionnaire survey for understanding their healthcare-seeking status, and delay in healthcare-seeking (taking visiting time over 5 years as delayed healthcare-seeking) . Influencing factors of delayed healthcare-seeking were explored using multinomial ordinal Logistic regression analysis with the stepwise method.

The survey achieved a response rate of 94.5% (120/127) . Among the 120 respondents, the visiting time was less than 1 year in 9 cases, 1 to 2 years in 11 cases, 3 to 5 years in 17 cases, and over 5 years in 83 cases; the prevalence of delayed healthcare-seeking was 69.1% (83/120) . The visiting time differed significantly by educational level, monthly income, place of residence, course of diabetes, vision, classification of diabetic macular edema, status of blood glucose monitoring, and prevalence of hypertension (P<0.05) . Multinomial ordinal Logistic regression analysis with the stepwise method showed that, place of residence〔OR=3.395, 95%CI (1.362, 7.053) 〕, vision〔OR=1.526, 95%CI (1.086, 2.775) 〕, prevalence of hypertension〔OR=1.307, 95%CI (1.002, 5.376) 〕, classification of diabetic macular edema〔OR=5.537, 95%CI (1.897, 9.534) 〕and status of blood glucose monitoring〔OR=2.582, 95%CI (1.271, 6.882) 〕were associated with the visiting time (P<0.05) .

The prevalence of delayed healthcare-seeking is high in patients with DR, which may be influenced by place of residence, vision, prevalence of hypertension, classification of diabetic macular edema and status of blood glucose monitoring.