An index of open-access diabetes mellitus content relevant to primary care
Development of a Primary Care Needs-based Health Education Services Framework for Type 2 Diabetics Using the Nominal Group Technique
LIN Kai，YAO Mi，XIE Jieying，YUAN Gang，JI Xinxin，CHEN Yongsong
Abstract
Background Most of the health education recommendations from Chinese guidelines ignore the characteristics and patient needs of primary health care，especially type 2 diabetes mellitus（T2DM） health education delivered by primary outpatient clinics is random，untargeted and so on. Objective To develop a primary care needs-based health education services framework for T2DM patients using the nominal group technique（NGT），and to expand its essentials. Methods From September to October 2020，NGT was used to conduct meetings in three groups of Chinese health professionals（n=23） in various medical specialties selected using purposive sampling. The results of meetings were recorded and transcribed，and divided into qualitative and quantitative data for analyses. After merging the similar ones of keywords of qualitative data of each group discussion，the list of network coded（NC） keywords was obtained，and essential contents of these key words were expanded，and analyzed using thematic analysis. Intra-group and overall ranking of keywords of the quantitative data in the list were determined. Finally，the hierarchical frameworkwas determined according to the quartile assigned by the overall ranking. Results Twenty-eight keywords regarding T2DM health education were obtained through group discussions and decision-making，and classified into five themes by thematic analysis and content development：diabetes-related knowledge，self-management，community management，multiple comorbidities management，treatment and medication. After two rounds of ranking and stratification，a four-level hierarchical framework of health education for T2DM patients was finally determined. The A hierarchy includes four top-ranked keywords，accounting for 45.69% of the total mean rank scores. Conclusion We applied NGT to develop a primary care needs-based health education services guiding framework for Chinese T2DM patients，and used an evidence-based approach to determine its four-level hierarchy and highlighted contents. As patients' primary care needs are complex，which need to be satisfied based on group decision-making，our framework may contribute to achieve a higher consistency between guidelines and clinical practice.
Factors Associated with Medication Adherence in Beijing Community-dwelling Residents with Type 2 Diabetes：a Study Using the Theory of Planned Behavior
WU Yao，LIN Yanming，GUO Kai，WU Ming
Abstract
Background In accordance with the regulations of China's national essential public health services，community health centers（CHCs） are required to deliver health management services to diabetic patients to effectively achieve glycemic control. Taking medications regularly and on time is one of the main means to control diabetes. So it is of practical significance to explore the impact of community-based diabetes health management services on medication adherence of diabetic patients. Objective To investigate the utilization status of community-based diabetes health management services and medication adherence in Beijing community-dwelling residents with type 2 diabetes，and to analyze the possible influencing factors of medication adherence. Methods A face-to-face questionnaire survey was conducted between July and August 2018 with 1 218 diabetic patients selected by use of convenient sampling from six CHCs in Beijing using a questionnaire developed by our research group for collecting the patients' general demographics，utilization of community-based diabetes management services and medication adherence（including MMAS-8 and a questionnaire of intention to take medication based on the theory of planned behavior）. The structural equation modeling was used to explore the influencing factors of medication adherence. Results Altogether，1 156 cases（94.91%） who effectively completed the survey were included for final analysis，and the medication adherence of them was 77.16%（892/1 156）. After verification，the number of face-to-face follow-ups and guidance on antidiabetic medications were included as covariates into the modified structural equation model. The values of RMSEA（0.041），CFI（0.893），PNFI（0.639），and CN（499） of the final model indicated that the goodness-of-fit of the model was excellent. Face-to-face follow-up and diabetes medication guidance affected the attitude towards medication（0.09） and subjective norms（0.08） respectively. Face-to-face follow-up indirectly affected medication adherence with an overall standardized effect size of 0.01（P=0.013）. Guidance on antidiabetic medications also indirectly influenced medication adherence with an overall standardized effect size of 0.01（P=0.011）. Conclusion Community-based diabetes health management services indirectly affected the medication adherence of type 2 diabetics. Receiving medication guidance increased the patients' behavioral intention to adhere to medication，and face-to-face follow-ups enhanced the patients' belief in medication adherence，consequently，increasing the possibility of developing medication compliance behaviors.
Application of a Self-made Diabetic Diet Manager in Empty Nesters with Type 2 Diabetes and Poor Glycemic Control
LYU Juanqin，SHEN Lilan，MENG Zuolong，WANG Xiaoping，LI Fulian
Abstract
Background Poor treatment adherence and glycemic control are common in older adults with diabetes. Diet is strongly associated with glycemic control，so studying diet management will greatly contribute to prognosis improvement of diabetic patients. Objective To examine the effect of a self-made diabetic diet manager in empty nesters with type 2 diabetes and poor glycemic control. Methods Participants were 120 empty nesters with type 2 diabetes and poor glycemic control selected from the Third Affiliated Hospital of Gansu University of Chinese Medicine，including 60 hospitalized between February and October 2018（traditional group with 6-month-follow-up routine health education），and 60 hospitalized between February and October 2019（diabetic diet manager group with 6-month-follow-up intervention using a diabetic diet manager developed by our research group）. Medical records and complete follow-up data were collected retrospectively. Pre- and post-follow-up fasting and two-hour postprandial glucose levels and self-care ability（evaluated by the Summary of Diabetes Self-care Activities）of two groups were compared. The complications and readmission of the two groups during intervention were observed and recorded. Results After 6 months of intervention，the fasting blood glucose，two-hour postprandial blood glucose and glycated hemoglobin levels fell notably in both groups（P<0.05），and they decreased more significantly in diabetic diet manager group（P<0.05）. Both groups had an obvious increase in the scores of successful self-management of diet and exercise，blood glucose self-monitoring and taking medicines as prescribed（P<0.05），and a more significantly increase was observed in diabetic diet manager group（P<0.05）. No peripheral neuropathy and macroangiopathy were found in both groups. The incidence of diabetic retinopathy and diabetic nephropathy，and readmission rate in diabetic diet manager group were lower than those in the traditional group（P<0.05）. Conclusion The intervention using the diabetes diet manager developed by us may be far superior to traditional health education in terms of improving self-care ability and glycemic control，as well as reducing complication incidence and readmission rate in empty nesters with type 2 diabetes and poor glycemic control，indicating that it has a high value of clinical application.
Clinical Study of Gegen Qinlian Decoction in Type 2 Diabetes with Non-alcoholic Fatty Liver Disease
FAN Yaofu，CAO Lin，SUN Hongping，XU Juan，BAO Weiping，CHU Xiaoqiu
Abstract
Background Recent years have seen considerable growth in the prevalence of type 2 diabetes mellitus （T2DM） combined with non-alcoholic fatty liver disease （NAFLD），but there is still a lack of effective targeted interventions. Traditional Chinese medicine（TCM） may have some merits in treating T2DM with NAFLD，but few studies have investigated the effects and mechanism of actions of TCM in treating the disease. Objective To investigate the clinical efficacy of adding Gegen Qinlian Decoction（GD） to care as usual to treat T2DM with NAFLD. Methods One hundred patients with T2DM with NAFLD who were treated in the Affiliated Hospital of Integrated Traditional Chinese and Western Medicine，Nanjing University of Chinese Medicine from January 2020 to March 2021 were selected. They were randomly allocated to either the control group（n=51） or the observation group （n=49）. The control group received usual care. The observation groupreceived usual care plus GD. The therapeutic course for all was 8 weeks. Data about the pre- and post-treatment TCM symptom score，glycemic indices〔fasting plasma glucose （FPG），two-hour postprandial glucose（2 hPG）〕，glycated hemoglobin（HbA1c），blood lipid indices〔triglyceride （TG），total cholesterol （TC），low-density lipoprotein cholesterol（LDL-C）〕，homeostatic model assessment for insulin resistance （HOMA-IR），liver function indices（ALT，AST，GGT），lymphocyte subsets，and NAFLD fibrosis score measured by color Doppler ultrasonography of two groups were obtained. Results All patients were included for final analysis except for 10 dropouts（four cases and six controls）. After treatment，the TCM symptom score decreased more significantly in the observation group（P<0.05）. But HbA1c and TC were still similar in both groups after treatment（P>0.05）. The FPG，2 hPG，TG，LDL-C and HOMA-IR decreased more significantly in the observation group after treatment（P<0.05）. Similarly，ALT，AST and GGT were lowered more significantly in the observation group after treatment（P<0.05）. In terms of post-treatment levels of lymphocyte subsets，CD4+ T cell，CD4+/CD8+ ratio and NK cell were elevated while CD8+ T cell was lowered more significantly in the observation group（P<0.05）. The post-treatment NAFLD fibrosis score was also much lower in the observation group（P<0.05）. Conclusion Patients with T2DM and NAFLD could be treated with GD to improve glycolipid metabolism，insulin resistance，and immune function more effectively.
Knowledge，Attitude and Practice of Metformin Hydrochloride Sustained Release Tablets in Outpatients with Type 2 Diabetes Mellitus
LIU Chang，ZHOU Yiling，WANG Yang，TAN Jixue，AN Kang，AN Zhenmei，HE Longtao，LI Sheyu
Abstract
Background Metformin is an important anti-diabetic drug for type 2 diabetes mellitus（T2DM）. Metformin hydrochloride sustained release tablets（XR）shows similar efficacy and safety with normal preparation of metformin （metformin IR），but simpler administration（once-daily use）. Objective To investigate the knowledge，attitude and practice of metformin XR in outpatient adults with T2DM. Methods We recruited outpatient adults with T2DM from the Department of Endocrinology and Metabolism，West China Hospital，Sichuan University using simple sampling from January 1 to July 31，2020. A single investigator interviewed each participant using a self-designed questionnaire of the knowledge，attitude and practice of metformin XR in a face-to-face manner. Results Altogether，151 cases attended the survey，and 149 of them gave an effective response，with a response rate of 98.7%（149/151）. Among the 149 included participants，14（9.4%）knew the correct dosing range of metformin XR，43（28.9%）knew the correct dosing frequency，and 7（4.7%）knew the right time to take the drug. Forty patients（26.8%）preferred metformin XR to metformin IR. A toal of 121 patients（81.2%）believed in the priority of metformin XR in safety. Fifteen patients（10.1%）felt confident to change their treatment regimen without consulting the doctor. Fifty-one（34.2%）and 29（19.5%）patients thought that once or at least twice daily does and does not affect the efficacy，respectively. The numbers of taking metformin XR once daily，twice daily，and thrice daily were 36（24.2%），80（53.7%），and 27（18.1%），respectively. Forty-five patients（30.2%）reported adverse events during the use of metformin XR.According to the subgroup analyses，patients older than 60 years old were less likely to answer the correct dosing frequency but more likely to answer the correct time to take the drug（P<0.05）. Patients receiving 12-year education and more were more likely to believe the priority of metformin XR and the impact of dosing frequency（P<0.05）. Conclusion Our study suggested that the knowledge，attitude，and practice of outpatient adults with T2DM need improving. Most patients did not know the correct usage or understand the advantage of metformin XR.
Construction of a Multi-layer Artificial Neural Network Classification Model for Predicting Subclinical Atherosclerosis in Type 2 Diabetic Patients
WANG Qi，LIU Shangquan
Abstract
Background There are a large number of type 2 diabetes mellitus（T2DM）patients in China at present，it is urgent to develop a simple and effective risk assessment tool for subclinical atherosclerosis in T2DM. Objective To construct a multi-layer artificial neural network classification model for predicting subclinical atherosclerosis in T2DM patients and verify its prediction accuracy based on multiple indicators. Methods A total of 3 627 T2DM patients who were hospitalized in the Third Affiliated Hospital of Anhui Medical University from January 2020 to December 2016 were selected. All of them underwent color Doppler ultrasound of bilateral carotid arteries，including 2 196 cases detected subclinical atherosclerosis（observation group）and 1 431 cases did not detected（control group）. The general information，laboratory examination indicators and fatty liver occurrence of the two groups were compared and a multi-layer artificial neural network classification model was constructed accordingly. A total of 3 027 patients were randomly selected from the 3 627 T2DM patients as the training set，and the remaining 600 patients as the test set to verify the prediction accuracy of the multi-layer artificial neural network classification model. Results There were no significant differences of BMI，DBP，proportion of people with smoking history，proportion of people with alcohol consumption history，alcohol consumption，DBiL，total protein，AST，SUA，TG，LDL-C/HDL-C ratio，TSH，FT3，FT4，HbA1c，FBG，fasting C-peptide，HOMA-C-peptide index，proportion of severe fatty liver between two groups（P>0.05）；but compared with control group，observation group showed higher female ratio，SBP，proportion of hypertension history，globulin，total bile acid，BUN，Scr，cystatin C，UARE，TC，LDL-C，HDL-C，WBC and neutrophil count，older age，larger smoking amount，longer course of disease，smoking time，drinking time（P<0.05），lower proportion of family history of diabetes，TBiL，IBiL，albumin，ALT，GFR，TG/HDL-C ratio，lymphocyte count，red blood cell count，Hb and incidence of fatty liver（P<0.05）. Combining clinical practice，the above 49 indicators are used as input variables to construct the multi-layer artificial neural network classification model；in the testing set，the accuracy of Logistic model for predicting subclinical atherosclerosis in T2DM was 59%，that of multi-layer artificial neural network classification model was 76% when the number of plies was 3. Conclusion The multi-layer artificial neural network classification model successfully constructed in this study has a high accuracy in predicting subclinical atherosclerosis in T2DM patients，and can be used as a risk assessment tool for subclinical atherosclerosis in T2DM patients.
Correlation of Serum Asprosin and Spexin Levels with Visceral Obesity in Type 2 Diabetics
WANG Xiaoyan，WEI Feng，WANG Wei，ZHANG Yue，ZHOU Kun，ZHANG Yuan
Abstract
Background The associations of adipokines with body fat distribution and glycolipid metabolism have become hot topics of research. But the associations of Asprosin and Spexin with obesity in type 2 diabetics have been rarely reported. Objective To explore the correlation of serum Asprosin and Spexin levels with visceral obesity in type 2 diabetics. Methods We recruited 381 type 2 diabetics from National Metabolic Management Center，Endocrinology Department，the First Affiliated Hospital of Baotou Medical College，Inner Mongolia University of Science and Technology between January 2019 and June 2020. We compared general demographics，body fat indices，and serum asprosin and spexin levels between patients with（n=226） and without（n=155） visceral obesity 〔defined as visceral fat area（VFA）≥100 cm2〕. We examined the association of serum asprosin and spexin with other indicators. We used binary Logistic regression analysis to identify factors associated with visceral obesity in type 2 diabetes. Results Compared to patients without visceral obesity，those with visceral obesity had higher mean values of diastolic blood pressure，height，fasting C-peptide（FCP），2-hour postprandial C-peptide （2 hCP），serum triglyceride，uric acid and Asprosin，and homeostasis model assessment-insulin resistance（HOMA-IR），greater mean values of weight，BMI，waist circumference （WC），hip circumference （HC），waist-to-hip ratio （WHR），VFA，subcutaneous fat area （SFA），visceral-to-subcutaneous fat ratio （VSR），and lower male ratio as well as lower mean serum spexin（P<0.05）. Asprosin was positively associated with height，weight，BMI，WC，HC，WHR，FCP，2 hCP，triglyceride，HOMA-IR，VFA，SFA，VSR，but negatively with Spexin （P<0.05）. Spexin was negatively correlated with weight，BMI，WC，HC，WHR，FCP，2 hCP，serum creatinine and uric acid，HOMA-IR，VFA，SFA，and VSR，but positively with HbA1c （P<0.05）. Binary Logistic regression analysis showed that gender 〔OR=2.967，95%CI（1.830，4.810）〕，BMI〔OR=1.729，95%CI（0.801，3.732）〕，WHR〔OR=0.000，95%CI（0.000，0.105）〕，SFA〔OR=0.985，95%CI（0.977，0.992）〕，asprosin〔OR=0.539，95%CI（0.426，0.681）〕，and Spexin〔OR=1.001，95%CI（1.000，1.001）〕were associated with visceral obesity in type 2 diabetics. Conclusion Both serum Asprosin and Spexin levels are closely correlated with visceral obesity in type 2 diabetics，which might be new potential targets for the treatment of type 2 diabetes and the prevention of its related complications.
Construction and Verification of a Predictive Model for Microalbuminuriain Type 2 Diabetes Mellitus Patients
LU Zuowei，LIU Tao，LIU Xiangyang，WANG Qiong，LAI Jingbo，CHEN Yanyan，LI Xiaomiao
Abstract
Background The early onset of diabetic kidney disease （DKD） is insidious，and most patients have irreversible kidney impairment at the time of diagnosis. Early diagnosis and treatment greatly contribute to the prevention or delay the development of DKD. Hence，construction of a simple and effective personalized risk prediction model will significantly help the early diagnosis and treatment of DKD. Objective To identify the risk factors independently associated with microalbuminuria（MAU） in type 2 diabetes mellitus （T2DM） patients，and to use them to develop a simple and effective personalized risk prediction model for MAU in T2DM. Methods T2DM participants（n=1 311） were recruited from Department of Endocrinology，the First Affiliated Hospital of Air Force Medical University，and assigned those who were hospitalized between March 2014 and September 2015，and between October 2015 and March 2016 to a development sub-cohort（n=933），and a validation sub-cohort（n=378），for the convenience of developing and validating a predictive model for MAU. Demographics，results of laboratory and auxiliary examinations，pharmacological treatment，and prevalence of albuminuria（UACR<30 mg/g） or MAU （30 mg/g
Comparative Study of Inflammatory Markers in Early Diagnosis of Diabetic Kidney Disease
WU Hong，WANG Bin，LI Ting，NIE Yijun
Abstract
Background Diabetic kidney disease （DKD），a common diabetic complication，has become a major cause of end-stage renal disease. There are no comparative studies about the values of six inflammatory laboratory markers，heparin binding protein （HBP），C-reactive protein （CRP），serum amyloid A protein（SAA），procalcitonin （PCT），white blood cell count （WBC） and neutrophil percentage （N%），in early diagnosing DKD. Objective To assess the values of six inflammatory markers（HBP，CRP，SAA，PCT，WBC and N%） in early diagnosis of DKD via comparing the levels of them between type 2 diabetic patients and early DKD patients. Methods Participants were selected from Xianghu Branch，the First Affiliated Hospital of Nanchang University from May to December 2020，including 32 with simple type 2 diabetes，35 with early DKD patients and 30 physical examinees with normal examination results and without organic diseases. Fasting venous blood samples were collected for measuring HBP，CRP，SAA and PCT using quantitative immunofluorescence method，measuring WBC and N% using the automated hematology analyzer. ROC analysis was implemented to evaluate the value of HBP，CRP，and SAA in the early diagnosis of DKD. Results There were no significant differences in mean levels of PCT，WBC，and N% among three groups（P>0.05）. The mean level of HBP was increased in simple diabetic patients compared with that of healthy controls. The mean levels of HBP，CRP，and SAA in early DKD patients were significantly higher than those of other two groups（P<0.05）. In predicting early DKD，the AUC of HBP was 0.908〔95%CI（0.841，0.975）〕 with 71.4% sensitivity，96.7% specificity and Youden index of 0.681；the AUC of CRP was 0.760〔95%CI（0.644，0.875）〕 with 48.6% sensitivity，96.7% specificity and Youden index of 0.452；the AUC of SAA was 0.836〔95%CI（0.738，0.934）〕 with 74.3% sensitivity，86.7% specificity and Youden index of 0.610. Conclusion HBP has proved to be more effective in diagnosing DKD，which could be promoted clinically as a predictor of DKD.
Correlation between Serum FGF21 Level and Diabetic Peripheral Neuropathy
LI Yong，QI Licui，ZHANG Ran，YANG Qiwen，CHEN Shuchun
Abstract
Background Fibroblast growth factor 21 （FGF21） is a pleiotropic endocrine metabolism regulator，which can facilitate the regeneration of peripheral nerve axons and myelin sheaths in mice by inhibiting oxidative stress and inflammation. However，there are few studies on the correlation between FGF21 and diabetic peripheral neuropathy （DPN） in humans，and the mechanism of action is still unclear. Objective To explore the correlation between serum FGF21 level and DPN. Methods A total of 200 patients with type 2 diabetes were recruited from Hebei General Hospital from November 2019 to November 2020，including 109 with DPN and 91 without. Serum FGF21 was detected using ELISA，and other clinical data were collected. Pearson and Spearman rank correlation analysis was used to examine the correlation between serum FGF21 and various indicators. Binary Logistic regression analysis was performed to identify the influencing factors of DPN in type 2 diabetes. Results The average serum FGF21 in patients with DPN was significantly higher than that in those without （P<0.05）. Correlation analysis showed that FGF21 was positively correlated with fasting plasma glucose，glycosylated hemoglobin，malondialdehyde，and TNF-α （r=0.184，r=0.156，rs=0.164，r=0.175，P<0.05），and was negatively correlated with the superoxide dismutase （r=-0.189，P<0.05）. Binary Logistic regression analysis showed that course of type 2 diabetes〔OR=1.499，95%CI（1.085，1.935）〕，malondialdehyde〔OR=1.242，95%CI（1.062，1.452）〕，TNF-α〔OR=1.036，95%CI（1.012，1.060）〕 and FGF21〔OR=1.007，95%CI（1.002，1.012）〕 were independent influencing factors for DPN in type 2 diabetes （P<0.05）. Conclusion FGF21 is an independent influencing factor of DPN in type 2 diabetes，which can affect DPN by regulating glucose metabolism，inhibiting oxidative stress and inflammation.
Value of Fasting Fingerstick Glucose as a Screening Test for Diabetes and Prediabetes
SONG Rongwei，YU Jie，WU Chunxiang，ZHANG Xiayun，CAI Ning，WANG Zhongwang，WU Wenjing
Abstract
Background The prevalence of diabetes remains high in China. What's more，there may be a large number of people who may have undiagnosed prediabetes or diabetes. Stable and reliable screening methods will help to identify diabetes and prediabetes patients more quickly and effectively. Objective To evaluate the effect of fasting fingerstick glucose（FFG） in the screening for diabetes and prediabetes in high-risk populations. Methods A stratified sampling survey was conducted in 10 communities of Shanghai's Putuo District according to the population distribution of the district in 2017. A questionnaire developed based on the 2017 Chinese Guidelines for the Prevention and Treatment of Type 2 Diabetes was used for screening residents at high risk for diabetes，which named Diabetes Risk Assessment for Shanghai Community Residents. Then these high risk people underwent laboratory tests to measure FFG and fasting venous blood glucose （FVBG），and received oral glucose tolerance test to determine whether they had prediabetes or diabetes. ROC analysis and performance table of screening test were used to determine the optimal cut-off value of FFG for screening diabetes and prediabetes，and evaluate its effect. Results A total of 13 057 individuals at high risk for diabetes were identified，among whom 108 cases without FVBG were excluded，and the other 12 949 cases were finally included，including 3 182 （24.57%） diagnosed with diabetes and prediabetes〔1 380 （10.66%） with diabetes，and 1 802 （13.92%） with prediabetes〕. There was a strong correlation between FFG and FVBG（rs=0.722，P<0.001）. The ROC analysis showed that the AUC of FFG to predict diabetes and prediabetes was 0.923 8. When 5.7 mmol/L was taken as the cut-off value of the FVBG test，the Youden Index reached the largest value （0.70），and the sensitivity，specificity，positive predictive value，negative predictive value and Kappa value were 88.62%，81.10%，60.44%，95.63% and 0.83，respectively. The cut-off value of FFG in diagnosing diabetes and prediabetes was 5.7 mmol/L either in men or women，and that ranged 5.6-5.8 mmol/L in different age groups，all were similar to that for the overall population. Conclusion FFG measurement is a rapid，accurate，reliable and stable test and has high potential to be used as a pre-screening for diabetes and prediabetes. The recommended cut-off value of FFG for screening for diabetes and prediabetes is 5.7 mmol/L，but it could be adjusted within a certain range according to needs of screening.
Impact of Continuous Glucose Monitoring and Time-in-range on Pregnancy Outcome in Patients with Gestational Diabetes Mellitus
FU Wei，LI Qingju，LI Jun，FU Yanqin，ZHANG Qi
Abstract
Background Gestational diabetes mellitus （GDM） is a common clinical disease with a morbidity about 12.8%-16.7% in China，which may lead to significantly increased risk of maternal and fetal complications due to poor blood glucose control or imprecise blood glucose monitoring in pregnancy. Continuous glucose monitoring （CGM） system detects the glucose concentration in the intercellular fluid through a probe，reflecting the changes of blood glucose，which makes up for the deficiency of traditional capillary glucose monitoring，and could better monitor in-pregnancy blood glucose，promoting the improvement of maternal and infant outcomes. Objective To explore the impact of CGM and time-in-range（TIR） on pregnancy outcome in patients with GDM. Methods One hundred and twenty GDM inpatients who were hospitalized in Department of Endocrinology of the Second Affiliated Hospital of Zhengzhou University from September 2019 to March 2021，were selected and divided into ambulatory glucose monitoring group （n=80） and capillary glucose monitoring group （n=40） according to the glucose monitoring method. Gestational outcomes were compared between ambulatory glucose monitoring and capillary glucose monitoring groups，and between two subgroups of ambulatory glucose monitoring patients divided by the average value of TIR monitored by the CGM system within 72 hours （TIR≥85%，and TIR<85%）. Results Ambulatory glucose monitoring and capillary glucose monitoring groups had no significant differences in the incidence of abnormal amniotic fluid，incidence of intrauterine infection，length of newborns，incidence of neonatal hyperbilirubinemia and incidence of asphyxia（P>0.05）. Ambulatory glucose monitoring group had statistically lower incidence of cesarean section，premature delivery，placental abruption，premature rupture of membranes，pregnancy-induced hypertension，low-weight infants，and macrosomia，and lower average weight of newborns，as well as greater average gestational age of newborns（P<0.05）. Two TIR subgroups had no significant differences in the incidence of premature delivery，placental abruption，premature rupture of membranes，abnormal amniotic fluid，intrauterine infection，pregnancy-induced hypertension，macrosomia，neonatal hyperbilirubinemia and asphyxia（P>0.05）. TIR≥85% subgroup demonstrated statistically lower incidence of cesarean section，lower average weight and length of newborns，as well as greater average gestational age of newborns（P<0.05）. Conclusion The data of CGM for GDM patients may support the clinical treatment，benefiting the improvement of maternal and infant outcomes，and the benefit may be greater when TIR≥85%.
Risk Factors for Type 2 Diabetic Kidney Disease：a Systematic Review
FANG Fengzhen，LI Zhuangmiao，CHEN Tingyu
Abstract
Background Diabetic kidney disease （DKD） has gradually become a noticeable global issue in recent years. As proved，early assessment and intervention of risk factors can prevent or delay the development of DKD. Objective To systematically review the risk factors of type 2 DKD. Methods The databases of the Cochrane Library，PubMed，Web of Science，SinoMed，CNKI，VIP and Wanfang Data were electronically searched for cohort studies and case-control studies on the risk factors related to type 2 DKD. The retrieval time was from the inception to April 2020. Two researchers screened literature，extracted data，and evaluated the bias risk of the eligible studies separately. RevMan 5.3 was used for Meta-analysis. Results In all， three cohort studies and nine case-control studies were included. Meta-analysis showed that older age〔SMD=0.34，95%CI （0.23， 0.46）〕，male〔OR=1.51， 95%CI （1.20， 1.90）〕，smoking〔OR=1.64， 95%CI （1.30， 2.07）〕，hypertension〔OR=2.01， 95%CI （1.73， 2.34）〕，elevated systolic blood pressure〔SMD=0.37，95%CI （0.12，0.63）〕，elevated glycosylated hemoglobin 〔SMD=0.41，95%CI （0.02，0.80）〕，elevated total cholesterol〔SMD=0.14，95%CI （0.06，0.22）〕，elevated serum creatinine〔SMD=0.73，95%CI （0.39，1.07）〕，vitamin D deficiency〔OR=4.06，95%CI （2.11，7.78）〕，non-alcoholic fatty liver disease〔OR=3.53，95%CI （1.61，7.74）〕，associated retinopathy〔OR=2.16，95%CI （1.55，3.01）〕，and insulin therapy〔OR=2.63， 95%CI （1.79，3.85）〕 were associated with increased risk of type 2 DKD（P<0.05）. The prolonged duration of type 2 diabetes〔SMD=-0.44， 95%CI（-0.54， -0.34）〕 and elevated HDL-C〔SMD=-0.20， 95%CI （-0.30， -0.10）〕 were associated with reduced risk of type 2 DKD（P<0.05）. Conclusion Male，older age，smoking，diabetic retinopathy，hypertension，non-alcoholic fatty liver disease，abnormal somatic factors（including elevated total cholesterol，systolic blood pressure，glycosylated hemoglobin，serum creatinine，as well as vitamin D deficiency） and insulin therapy are risk factors for type 2 DKD，which need to be verified by more high-quality large-sample studies due to limited quality and quantity of included studies.
Advances in the Mechanism of Intestinal Electrical Stimulation in the Treatment of Patients with Type 2 Diabetes
MENG Qiao，TAN Chang，YAO Shukun
Abstract
Although there are many therapies for diabetes，poor glycemic control can occur in some diabetes patients due to various reasons. Intestinal electrical stimulation （IES），a new treatment for diabetes，has attracted wide attention of scholars. We reviewed recent studies about IES for type 2 diabetes，and concluded that IES could reduce fasting and postprandial plasma glucose levels and insulin resistance，which has proved its therapeutic value. Furthermore，we found that the glycemic control mechanism of IES may be related to delaying gastric emptying，accelerating intestinal transit，affecting gastrointestinal hormones involved in plasma glucose regulation，and regulating autonomic nervous function. It is hoped that this study could provide new ideas for future research.
Consensus of Chinese Experts on the Remission of Type 2 Diabetes Mellitus
Committee of Consensus of Chinese Experts on the Remission of Type 2 Diabetes Mellitus
Abstract
Type 2 diabetes mellitus（T2DM） is a progressive disease characterized by hyperglycemia，which is generally considered as a disease requiring chronic hypoglycaemic agents therapy. In recent years，a large number of research results have shown that lifestyle intervention，drug therapy，and metabolic surgery can promote the remission of T2DM combined with overweight and obesity，so that patients can avoid the use of hypoglycemic drugs for a long time. T2DM relief can help reduce the psychological burden of patients，enhance patients' confidence in complying with healthy lifestyles，and improve patients' quality of life. In the long term，it can also delay disease progression and reduce the risk of life-long complications. In order to help Chinese clinicians to standardize the clinical diagnosis and treatment related to the alleviation of T2DM in overweight and obese T2DM patients，promote the development of related research，and enable patients to obtain safe and effective intervention measures，the Consensus of Chinese Experts on the Remission of Type 2 Diabetes Mellitus was formulated.
Association of Obesity with Cardiorespiratory Fitness in Patients with Type 2 Diabetes Mellitus
BI Lina，ZHENG Xin，QI Yanyan，HU Su，ZHAO Dan，LI Chang，ZHANG Yan
Abstract
Background Cardiorespiratory fitness（CRF） is closely related to the incidence rate and mortality of type 2 diabetes mellitus （T2DM）. Overweight and obesity are prevalent in a large proportion of patients with T2DM，but it is not clear whether they deteriorate the damage of CRF. Objective To investigate the characteristics of CRF and its association with overweight and obesity in patients with T2DM. Methods We enrolled 87 T2DM inpatients and outpatients from Department of Endocrinology，Beijing Boai Hospital，China Rehabilitation Research Center from December 2018 to December 2019. They all completed symptom-limited cardiopulmonary exercise testing（CPET），and parameters such as peakVO2，peakVO2/kg，resting VO2，peak-METs，peakVO2%P，and Peak-WR were compared among normal weight group（n=22），overweight group（n=27）and obesity group （n=38）stratified by BMI to evaluate the association of BMI with CRF parameters. Results We noted that the level of peakVO2/kg in 59 patients （67.8%） was lower than 20 ml?kg-1?min-1，and the peakVO2%P in 70 patients （80.5%） was lower than 84%. There were significant differences in the peakVO2，peakVO2/kg，resting VO2，and peak-METs among the three groups （P<0.01）. The resting VO2 of overweight group was higher than that of normal weight group（P<0.05）. The peakVO2 of obesity group was higher than that of normal weight group（P<0.05）. The obesity group had lower peakVO2/kg and peak-METs and higher resting VO2 than other two groups（P<0.05）. There were no significant differences in Peak-WR and peakVO2%P across the groups（P>0.05）. Pearson correlation analysis showed BMI was positively correlated with peakVO2，resting VO2，and Peak-WR（r=0.525，0.405，0.222，P<0.05），and was negatively correlated with peakVO2/kg，and peakMETs（r=-0.402，-0.402，P<0.01）. Conclusion It is suggested that the CRF in most T2DM decreased and the impaired CRF is further aggravated by obesity.
Management of Type 2 Diabetes and Prediabetes in the Community：a Survey from Shanghai
WANG Junwei，GUAN Lihua，XING Yuan，PENG Yan，ZHOU Wanying，XUE Huijuan，LIU Yun，LI Lianxi
Abstract
Background The prevalence of adult type 2 diabetes and prediabetes is high，but the rates of treatment and control of diabetes are low in China. Prediabetic patients have higher risk and prevalence of diabetic complications compared to the general population. There is currently a lack of evidence on community diabetes management in terms of interventions，screening for chronic complications，and scientific popularization and education of the knowledge about prediabetes. Objective To investigate and analyze the community-based management of diabetic and prediabetic populations，providing evidence for optimizing community-based diabetes management. Methods An epidemiological survey using the Epidemiological Questionnaire on Type 2 Diabetes and Prediabetes was conducted from November 2020 to January 2021 among 101 prediabetic patients and 1 055 type 2 diabetic patients selected from five community health centers（Anting，Zhenru，Caoyang，Qingcun，and Taopu） in Shanghai，covering the sociodemographic information，prevalence of receiving lifestyle interventions，medication treatment and screening for chronic complications，prevalence of chronic complications，and receiving the scientific popularization of the knowledge about type 2 diabetes and prediabetes. The data of type 2 diabetic and prediabetic patients were compared. Results Compared to prediabetic patients，type 2 diabetes patients had higher prevalence of using lifestyle interventions and medication treatment（P<0.05）. Moreover，they also had higher prevalence of screening for chronic complications〔78.6% （829/1 055） vs 19.8%（20/101）〕（P<0.001）. No chronic complications of diabetes were found in the prediabetic population who had been screened for complications，which was lower than that 〔24.7% （205/829）〕 of their counterparts （P=0.022）. The prevalence of receiving the scientific popularization of the knowledge about type 2 diabetes and prediabetes among the prediabetic population was lower 〔27.7% （28/101） vs 67.2% （709/1 055）〕（P<0.001）. Conclusion Community-dwelling prediabetics had lower prevalence of receiving lifestyle interventions，screening for chronic complications and scientific popularization of the knowledge about type 2 diabetes and prediabetes than community-dwelling diabetics，suggesting that community-based management of this population is under-appreciated and needs to be improved.
Association of Single Nucleotide Polymorphisms of ARL15 and PGC-1α Genes with Diabetic Kidney Disease
TU Yingye，ZHANG Hongjiang，KANG Chun，DU Fei，CUI Jiahui，SHAO Wei，YUAN Zhimin，WANG Weijie，YANG Kangjuan
Abstract
Background ADP-ribosylation factor-like protein 15（ARL15） rs4311394 and peroxisome proliferator-activated receptor-γ coactivator 1α（PGC-1α） rs7656250 have been demonstrated to be closely correlated with dyslipidemia，a key risk factor for diabetic kidney disease （DKD），but whether these gene loci have an association with DKD remains unknown. Objective To explore the association of single nucleotide polymorphisms （SNPs） of ARL15 and PGC-1α genes with DKD. Methods Participants were China's Han and Korean individuals who were enrolled during 2018—2019，including 393 with T2DM（T2DM group，including 205 Han and 188 Korean cases），and 90 with DKD（DKD group，including 55 Han and 35 Korean cases） from Yanbian University Hospital and Yanji Municipal Hospital，and 268 workers with normal glucose tolerance （NGT） undergoing physical examination in Yanbian University Hospital （NGT group，including 137 Han and 131 Korean cases）. Data were collected，comprising physiological and biochemical indicators，alleles and genotypes of ARL15 rs4311394 and PGC-1α rs7656250 detected by single-base extension assay，and levels of ARL15 and adiponectin proteins detected using ELISA. Results The results exhibited no statistically significant differences regarding both allele and genotype frequencies of ARL15 rs4311394 and PGC-1α rs7656250 between Han and Korean cases in the NGT group （P>0.05）. Also，the differences in both allele and genotype frequencies of ARL15 rs4311394 and PGC-1α rs7656250 across three groups were not statistically significant （P>0.05）. In addition，no statistically significant differences were noted in allele and genotype frequencies of ARL15 and PGC-1α gene loci among the three groups （P>0.05）. However，the FPG level was higher in carriers of CT genotype of PGC-1α rs7656250 than in carriers of CC or TT genotype of PGC-1α rs7656250 （P<0.05）. The adiponectin protein level was lower in carriers of CT or TT genotype of PGC-1α rs7656250 than in carriers of CC genotype of PGC-1α rs7656250，and also lower in carriers of TT genotype of PGC-1α rs7656250 than in carriers of CT genotype of PGC-1α rs7656250 （P<0.05）. Besides，the adiponectin protein level in T2DM patients was lower than that in individuals with NGT （P<0.05）. And ARL15 and adiponectin protein levels in DKD patients were higher than those in individuals with NGT and T2DM patients （P<0.05）. Furthermore，Spearman's correlation analysis suggested a positive correlation between ARL15 level and adiponectin level （rs=0.372，P<0.05）. Conclusion Although SNPs in ARL15 and PGC-1α shared no correlation with DKD，the adiponectin protein level was reduced in carriers of CT or TT genotype of PGC-1α rs7656250.
Clinical Efficacy of Dangguibuxue Decoction as an Adjuvant Therapy for Diabetic Nephropathy：a Meta-analysis
CHENG Liying，WANG Mengxi，ZHANG Zhu，SHAO Fengmin
Abstract
Background Excessive inflammatory response and renal fibrosis play key roles in the progression of diabetic nephropathy to end-stage renal disease. However，the usual western treatment for diabetic nephropathy has no significant anti-inflammatory and anti-fibrosis effects. Dangguibuxue Decoction（DD） is often used as an adjuvant therapy clinically due to its notable anti-inflammatory and anti-fibrosis effect，but there is a lack of relevant medical evidence. Objective To systematically study the efficacy and safety of DD as an adjuvant therapy for diabetic nephropathy. Methods Databases of CNKI，Wanfang Data，VIP，SinoMed，PubMed，The Cochrane Library，EMBase，ChiCTR，and ClinicalTrials.gov were searched from inception to December 2020 to identify randomized controlled trials（RCTs） regarding diabetic nephropathy patients treated by usual integrated treatment and modified DD compared with those treated by usual integrated treatment.Data extraction of the included RCTs were performed. The Cochrane Collaboration's tool for assessing risk of bias was used to evaluate the methodological quality. Review Manager 5.4 was used for meta-analysis. Results A total of 10 RCTs meeting the inclusion criteria were included，involving 879 patients. The results of meta-analysis found that the combined therapy of usual integrated treatment with modified DD could further improve the overall response rate〔RR=1.18，95%CI（1.10，1.28），P<0.000 1〕，reduce the 24-hour urinary protein quantification〔MD=-69.22，95%CI（-76.96，-61.48），P<0.000 01〕 and urinary albumin excretion rate〔MD=-31.32，95%CI（-59.87，-2.76），P=0.03〕，decrease the levels of serum creatinine〔MD=-10.24，95%CI（-11.51，-8.98），P<0.000 01〕 and urea nitrogen 〔MD=-0.95，95%CI（-1.61，-0.29），P=0.005〕 with no significant effect on adverse events〔RR=1.00，95%CI（0.30，3.34），P>0.05〕. Conclusion The clinical effect of DD in adjuvant treatment of diabetic nephropathy is significant and has good safety.
Latest Developments in the Effect of Meal Sequence on Postprandial Blood Glucose in Diabetic Patients and Its Possible Mechanism
DING Shaoyu，JU Changping，YANG Bingquan，YU Xingxing，CAI Xue，CUI Lei，CHEN Weixia，ZHOU Xu
Abstract
Postprandial hyperglycemia is a condition where a person has elevated blood glucose （higher than 7.8 mmol/L） 1-2 hours after eating a meal，which is a major contributor to elevated glycosylated hemoglobin，and is related to the occurrence and development of chronic diabetic complications. Therefore，postprandial glycemic control is a key facilitator to reaching the target glycosylated hemoglobin，and preventing and treating chronic diabetic complications. It has been found recently that changing the eating order，a dietary treatment，has notable effect on controlling the postprandial blood glucose of diabetic patients. We reviewed the concept and latest developments in the effect of meal sequence on postprandial blood glucose of diabetics and the potential mechanism，offering evidence for further research.
Fulminant Type 1 Diabetes Mellitus Following Type 2 Diabetes Mellitus：Clinical Diagnosis and Treatment and Literature Review
BAO Yahui，XU Qian，LIU Fang，ZHANG Yang，CAO Zhibin，QU Junsheng，SUN Xiaodong，HUI Zongguang
Abstract
Fulminant type 1 diabetes mellitus is a novel subtype of type 1 diabetes mellitus. It is a relatively rare disease with no sufficiently clear pathogenesis. With rapid onset and progression，notably destroyed or even failed pancreatic β-cell function as the main clinical features，the prognosis of this disease is very poor. This paper reported a case of fulminant type 1 diabetes mellitus following type 2 diabetes mellitus，and analyzed her clinical features and treatment experience by reviewing relevant literature，so as to improve clinicians' understanding of the disease.
Interpretation of SGLT-2 Inhibitors or GLP-1 Receptor Agonists for Adults with Type 2 Diabetes：a Clinical Practice Guideline
AN Kang，LI Sheyu
Abstract
With a comprehensive review of the latest evidence，the BMJ Rapid Recommendations released a clinical practice guideline entitled SGLT-2 inhibitors or GLP-1 receptor agonists for adults with type 2 diabetes，thoroughly introducing the selection of the two novel anti-diabetic drugs in adults living with type 2 diabetes. This guideline adopts a risk-based decision-making strategy instead of that based on glycemia or glycosylated hemoglobin control. It provides a visualized summary for both evidence and recommendations to facilitate quick check and shared-decision making for general practitioners.
Latest Advances in Management Models for Prediabetes
LI Xixi，BIAN Sensen，GUO Qing
Abstract
Diabetes and its complications are currently one of chronic non-communicable diseases that seriously threaten public health，showing an increasing incidence rate year by year. Prediabetes is a high-risk stage for normal glucose metabolism to develop into diabetes，and effective interventions received in this stage is the key to lowering the occurrence of diabetes. To identify a better management model feasible for prediabetes，we selected five representative ones（self-management，family participatory management，community-based group management，TCM management，and management with combined new technologies） from the available prediabetes management models，and performed a comparative analysis of their strengths and limitations. We recommend the management with multiple forms of interventions，which may effectively reduce the possibility of developing diabetes from prediabetes，with a broad application prospect.In addition，the management by a community health team including at least a health manager may be an innovative model for effectively managing prediabetes in the future.
Active Screening，Comprehensive Evaluation，Tiered Diagnosis and Management of Diabetic Foot：Essentials of Screening，Diagnostic and Therapeutic Strategies
WANG Aihong，ZHAO Weibo
Abstract
Diabetic foot is a major cause of diabetes-related disability and mortality，which imposes a tremendous social and economic burden on individuals and society due to high recurrence rate and healthcare expenditure. Diabetic foot ulcer is the most common manifestation of diabetic foot，and the main reason of limb amputation. Complicated disease state，poor general physical conditions，severe infection，and poor outcomes are the features of Chinese patients with diabetic foot ulcer．Moreover，inadequate screening and evaluation，as well as nonstandard diagnosis and treatment still exist clinically. This commentary highlights the value of active screening and early intervention for patients with a high risk of diabetic foot，comprehensive evaluation for diabetic foot patients，using a multidisciplinary approach for tiered diagnosis and treatment，and new model for the management of diabetic foot under regular containment of COVID-19.
Diabetes Management in China：Types and Reflections
WANG Junwei，LIU Yun，LI Lianxi
Abstract
Diabetes management plays very important roles in delaying the progression of diabetes，decreasing the risk of diabetes complications and reducing diabetes-related medical expenditure. Currently，the types of diabetes management in China mainly include hospital management，community management，hospital-community integrated management and information technology-assisted management. However，limitations of various types of diabetes management have become increasingly prominent as the increase of diabetes incidence，such as non-uniform criteria，low management efficiency，and formality. Therefore，it is urgently necessary to develop a standardized information technology-assisted hospital-community integrated management model for diabetes，which will finally reduce the harm of diabetes and its chronic complications via effective，efficient and long-term diabetes management.
Recent Developments in Postpartum Blood Glucose Screening among Patients with Gestational Diabetes Mellitus
ZHANG Dengyan，ZHU Qingshuang
Abstract
Gestational diabetes mellitus（GDM）is defined as diabetes diagnosed in pregnancy although the patient's pre-pregnancy glucose metabolism is normal. The prevalence of GDM is rising globally in recent years，which has become a major public health issue endangering women's health. GDM patients have been found with a higher risk of developing type 2 diabetes，but which may be prevented or delayed effectively by low-cost interventions，so it is critical to carry out postpartum blood glucose screening. Many guidelines for postpartum glucose screening have been issued successively，with partial differences in contents，but a similarity of achieving low patient adherence to screening，which may be attributed to many factors，such as low awareness of postpartum glucose screening，and low rate of being informed about screening by physicians among patients，as well as insufficient communication between involved departments. Various attempts have been made to improve the postpartum glucose screening rate in this group，but the results are as yet unsatisfactory. To offer views on improving postpartum glucose follow-up management of GDM patients，we reviewed the guidelines on postpartum glucose screening among GDM patients，and their adherence to postpartum glucose screening，as well as methods improving the screening prevalence.
Effects of Gestational Diabetes on Glycolipid Levels and Macrosomia Incidence in Late Pregnancy
YANG Jie，HOU Shanshan，ZHAO Lizheng，WANG Yutong
Abstract
Background Great attention has been paid to lifestyle intervention such as diet and exercise in pregnant women with gestational diabetes mellitus（GDM） clinically. Recent studies have found that glycemic control in pregnant women with GDM is satisfactory，but the incidence of macrosomia has not decreased significantly. Objective To investigate the effects of GDM on glycolipid levels and macrosomia incidence in the third trimester of pregnancy. Methods Through the hospital information system of Tongzhou Maternal & Child Health Hospital of Beijing，we retrospectively selected 16 134 women with full-term delivery in the hospital from 2014 to 2018，and divided them into GDM group〔including those with a delivered baby with macrosomia（GM subgroup） and with a delivered baby with normal birth weight（GN subgroup）〕and non-GDM group 〔including those with a delivered baby with macrosomia（NM subgroup） and with a delivered baby with normal birth weight（NN subgroup）〕by GDM prevalence. We compared total cholesterol （TC），triglyceride （TG），high-density lipoprotein cholesterol （HDL-C），low-high lipoprotein cholesterol （LDL-C），and fasting blood glucose（FBG） at the third trimester between GDM and non-GDM groups，GM and GN subgroups，NM and NN subgroups，NM and GM subgroups，and NN and GN subgroups，respectively. Multivariate Logistic regression analysis was used to explore the associated factors of macrosomia. Results There were 3 834 cases in GDM group（411 in GM subgroup，and 3 423 in GN subgroup），and 12 300 in non-GDM group（898 in NM subgroup，and 11 402 in NN subgroup）. GDM group showed higher mean TG and FBG levels and lower mean TC，HDL-C and LDL-C levels than non-GDM group （P<0.05）. GN subgroup had lower mean TG and FBG levels and higher mean HDL-C level than GM subgroup （P<0.05）. NM subgroup had higher mean TC，HDL-C and LDL-C levels and lower mean TG and FBG levels than GM subgroup （P<0.05）. NN subgroup had higher mean TC，HDL-C and LDL-C levels and lower mean TG and FBG levels than GN subgroup （P<0.05）. NN subgroup had higher mean HDL-C level and lower mean TG and FBG levels than NM subgroup （P<0.05）. Multivariate Logistic regression analysis found that GDM〔OR=1.338，95%CI（1.158，1.547）〕，and pre-pregnancy BMI 〔emaciated：OR=0.476，95%CI（0.361，0.626）；overweight：OR=1.770，95%CI（1.537，2.039）；obesity：OR=2.854，95%CI（2.282，3.568）〕，weight gain during pregnancy 〔OR=1.100，95%CI（1.087，1.113）〕，gestational age at delivery 〔OR=1.728，95%CI（1.622，1.841）〕，TC in late pregnancy 〔OR=0.705，95%CI（0.514，0.966）〕，TG in late pregnancy 〔OR=1.282，95%CI（1.153，1.425）〕，LDL-C in late pregnancy 〔OR=1.487，95%CI（1.094，2.021）〕，and FBG in late pregnancy 〔OR=1.692，95%CI（1.482，1.933）〕 were associated with the delivery of a baby with macrosomia （P<0.05）. Conclusion Elevated TG and FBG and decreased TC，HDL-C and LDL-C were found in pregnant women with GDM. GDM，blood lipid and blood glucose in late pregnancy may be associated factors of delivering a baby with macrosomia. To reduce macrosomia incidence，it is suggested to strengthen the monitoring of blood lipid and blood glucese（especially TG and FBG levels） as well as weight management in pregnancy.
Effectiveness and Safety of Immunosuppressive Agents Derived from Chinese Medicine with ACEI/ARB in Early- and Middle-stage Diabetic Nephropathy：a Meta-analysis
WU Yu，ZHANG Zheng，FANG Jinying，WANG Yuedan，LI Wenge
Abstract
Background For early-and middle-stage diabetic nephropathy（DN），the efficacies of angiotensin-converting enzyme inhibitor（ACEI）and angiotensin Ⅱ receptor antagonist（ARB）are limited although they are used as first-line drugs. As inflammatory response play a key role in the development of DN，immunosuppressive agents derived from Chinese medicine may be used as adjuvant therapies for DN. Objective To perform a meta-analysis of the effectiveness and safety of immunosuppressive agents derived from Chinese medicine with ACEI/ARB in the treatment of early-and middle-stage DN. Methods Randomized controlled trials（RCTs）about effectiveness and safety in early-and middle-stage DN patients treated with immunosuppressive agents derived from Chinese medicine with ACEI/ARB（experimental group）compared with those treated with ACEI/ARB（control group）published in Chinese were screened from databases of CNKI，Wanfang Data，VIP and CBM，and those published in English from databases of Medline，EMBase，the Cochrane Library，Web of Science，from inception to May 5，2020. RevMan 5.3 software was used to complete the meta-analysis. Outcome indicators were the decrease in serum creatinine，24-hour urinary protein quantification and leukocyte count，improvement in serum albumin，and change in glutamic pyruvic transaminase after treatment，incidence of adverse reactions and overall response rate. Results A total of 23 studies were included，involving 1 878 patients. The analysis revealed that compared to the control group，the experimental obtained greater decreases in serum creatinine level〔MD=-6.06，95%CI（-10.89，-1.22）〕，24-hour urinary protein quantification〔MD=-0.70，95%CI（-0.87，-0.53）〕，and white blood cell count〔MD=-0.42，95%CI（-0.76，-0.08）〕as well as improvement of serum albumin level〔MD=2.83，95%CI（1.66，4.01）〕. The experimental group had higher incidence of adverse reactions〔OR=1.87，95%CI（1.26，2.77）〕and overall response rate〔OR=3.05，95%CI（1.87，4.97）〕（P<0.05）. But there was no significant difference in the change of glutamic pyruvic transaminase level between the two groups〔MD=0.51，95%CI（-0.65，1.66），P=0.39〕. Conclusion In patients with early-and middle-stage DN，the combination use of immunosuppressive agents derived from Chinese medicine and ACEI/ARB may effectively improve the renal function，serum albumin level and overall response rate，but it may result in higher risk of adverse reactions such as decreased white blood cell count，so it should be used cautiously in clinic practice.
Fulminant Type 1 Diabetes Mellitus Complicated with Acute Myocarditis：a Case Report and Analysis
YU Fang，WANG Aihua，JIN Jianlan，XU Chenglin，GONG Min
Abstract
We reported the diagnosis and treatment of a patient with fulminant type 1 diabetes mellitus （FT1DM） with acute myocarditis，and discussed the possible pathogenesis. The FT1DM is a subtype featured by rapid-onset，critical condition，quick progression from hyperglycemia to diabetic ketoacidosis and nearly complete destruction of pancreatic beta cells even just after the onset while the patient is autoantibody negative. The patient that we encountered had a history of upper respiratory tract infection before the onset of FT1DM，and suffered from acute myocarditis one week after the onset of FT1DM，suggesting that FT1DM may be caused by the destruction of islet beta cells due to virus infection，which may be a clue for exploring the pathogenesis of type 1 diabetes. Clinicians should improve their understanding of FT1DM in order to identify it in the early stage and provide an active treatment.
Hypertension and Diabetes Incidence in Community-dwelling Han and Uygur Chinese People with Obstructive Sleep Apnea：a 7-year Telephone Follow-up Study
JIANG Xuelong，CHEN Dongmei，WANG Qin，ZHANG Qinglong，LI Jianping，SHI Juan，LI Min，HE Zhongming，HAN Fang，CHEN Yan
Abstract
Background Obstructive sleep apnea（OSA） is highly prevalent，which has become a serious disease affecting public health. There are little data comparing the incidence of hypertension and diabetes in Uygur and Han people with OSA，which we assume to be different. Objective To perform a comparative analysis of the incidence of hypertension and diabetes in Han and Uygur people with OSA. Methods This prospective study was conducted from October 2010 to October 2017. Participants（n=1 331） were Han and Uygur Chinese snorers aged more than 35 years with no hypertension and diabetes prior to the study who were selected from Tianshan Community，Karamay. All of them received an annual telephone follow-up in each of the seven years，for investigating the incidence of hypertension and/or diabetes，and the results of ambulatory blood pressure monitoring and oral glucose tolerance test performed when having clinical manifestations of hypertension and diabetes. The primary endpoint was diabetes and/or hypertension. General demographics，and parameters of portable home sleep test（apnea-hypopnea index，hypopnea index，lowest oxygen saturation，and mean oxygen saturation during sleep，and the number of 4% desaturations） were collected. The incidence of hypertension and/or diabetes was compared by OSA（assessed by the portable home sleep test） in all participants，in Han people，and Uygur people，and by OSA and ethnic group in participants. Results All cases were included for final analysis 〔including 532（42.4%） men and 724（57.6%） women with a mean age of（58±13） years〕 except for 75 missed cases. 820 cases（470 Han and 350 Uygur people） were diagnosed with OSA，and 436（164 Han and 272 Uygur people） without. By the end of the follow-up，compared with those without OSA，participants with OSA had higher incidence of hypertension （P<0.05）. Uygur people with OSA had higher incidence of hypertension than those without（P<0.05）. The incidence of diabetes differed significantly between participants with and without OSA（P<0.05）. But the difference in the incidence of diabetes was not significant between Han people with and without OSA，Uygur people with and without OSA，and Han and Uygur people with OSA（P>0.05）. Conclusion Both Han and Uygur people with OSA were more likely to suffer from hypertension. OSA may be an independent risk factor for hypertension and diabetes. Han people with OSA were more prone to hypertension than Uygur counterparts，so early and aggressive intervention is needed.