Nucleoside (acid) analogues (NAs) have become the primary treatment for chronic hepatitis B (CHB), but the impact of type 2 diabetes (T2DM) on the efficacy was unclear.

To identify the effect of T2DM on the efficacy of NAs antiviral therapy in CHB patients.

Patients with CHB who underwent liver biopsy in Tianjin Second People's Hospital from January 2015 to June 2023 and newly treated with NAs were included (n=350) .The patients were divided into T2DM-CHB group and CHB group according to their medical history. After matching according to gender, age, HBV DNA level, HBeAg status, ALT and AST level, 238 patients were finally included (T2DM-CHB group: n=70; CHB group: n=168). The patient's medication status, as well as liver and renal function, virological indicators and other data were reviewed once every 6 months for a total of 5 years. To evaluate the effectiveness of early treatment of NAs, follow-up was conducted once at the first and third months after the initiation of antiviral therapy.

After receiving NAs treatment, the serum lgHBV DNA level in T2DM-CHB group was significantly higher than that in CHB group at 1, 3, 6 and 18 months (P<0.05). The HBsAg value of T2DM-CHB group was significantly higher than that of CHB group at 12, 30 and 36 months (P<0.05). Kaplan-Meier survival curve showed that there was a significant difference between the two groups in the time to achieve complete virological response (CVR) for the first time (χ²=14.144, P<0.001), and the median time of first CVR in T2DM-CHB group and CHB group was 18.9 months and 14.3 months respectively. The cumulative clearance rate and seroconversion rate of HBeAg in T2DM-CHB group were lower than those in CHB group at 6, 12, 18, 24 and 30 months after treatment (P<0.05). In terms of liver function recovery, the accumulation rate of normal liver function in T2DM-CHB group was also lower than that in CHB group at 1, 3, 6, 12, 18 and 24 months after treatment (P<0.001). The results of multivariate Cox regression showed that T2DM (HR=0.706, 95%CI=0.584-0.854), HBV DNA (HR=0.624, 95%CI=0.534-0.730), eGFR (HR=1.197, 95%CI=1.017-1.409) were the factors influencing the time of the first CVR in patients with CHB (P<0.05) .

The combination of T2DM weakened the virological response of CHB patients to NAs, and prolonged the time to achieve CVR and liver function recovery.

Heart rate variability (HRV) is associated with cerebral infarction, although this association has been less studied in patients with type 2 diabetes mellitus (T2DM) .

To explore the correlation between HRV and cerebral infarction in T2DM patients.

A total of 577 T2DM patients hospitalized in Ningbo No.2 Hospital between January 2020 and August 2022 were selected. According to the presence or absence of cerebral infarction, patients were divided into the cerebral infarction group and non-cerebral infarction group. The general data and laboratory results were collected. All patients received 24-hour Holter monitoring. HRV parameters, including the standard deviation of normal-to-normal intervals (SDNN), the root mean square of successive RR interval differences (rMSSD), and the percent of adjacent RR intervals with a difference more than 50 ms (PNN50) were recorded. Multivariate Logistic regression analysis was used to analyze the correlation between HRV and cerebral infarction. Patients were further divided into the decreased SDNN group (SDNN<100 ms) and normal SDNN group (SDNN≥100 ms) based on the SDNN measurements in HRV, and the correlation with cerebral infarction was explored.

A total of 577 T2DM patients were enrolled, including 287 cases in the cerebral infarction group and 290 cases in non-cerebral infarction group. Multivariate Logistic regression analysis showed that SDNN was the independent influencing factor for cerebral infarction in T2DM patients (OR=0.970, 95%CI=0.961-0.979, P<0.05). There were 264 cases in the decreased SDNN group and 313 cases in the normal SDNN group. Multivariate logistic regression showed a significantly higher risk of cerebral infarction in the decreased SDNN group than the normal SDNN group (OR=4.164, 95%CI=2.769-6.262, P<0.05) .

The reduction of HRV parameters in T2DM patients is closely correlated to cerebral infarction. With the reduction of SDNN, the risk of cerebral infarction in patients increases.

Hypertension, diabetes, and dyslipidemia-commonly referred to as the "three highs" —are significant risk factors for cardiovascular and cerebrovascular diseases. Co-managing these conditions is crucial for reducing the morbidity and mortality associated with cardiovascular and cerebrovascular diseases; however, there is a notable lack of relevant research on the comorbidities of the "three highs" in Xinjiang.

To analyze the comparison of prevalence and comorbidity of hypertension, diabetes and dyslipidemia in Xinjiang residents, thereby providing data support for the co-management of the "three highs" within the local population.

Data were collected from the baseline of the Chronic Disease Prevention and Control Project of the Xinjiang Production and Construction Corps. A total of 5 673 residents aged 18 years and older participated in a questionnaire survey, physical examination, and laboratory examination conducted in 2022. In this study, the survey data of 4 990 eligible residents (87.96%) were included. The prevalence of the "three highs" (hypertension, hyperglycemia, and hyperlipidemia) and the comorbidity rate were analyzed. Multivariate Logistic regression analysis was employed to identify the risk factors associated with comorbidity of the "three highs" .

A total of 4 990 cases were included in the study, comprising 2 043 (40.94%) Han individuals, 2 666 (53.43%) Uygur individuals, and 281 (5.63%) from other ethnic groups. The standardized prevalence rates for hypertension, diabetes, and dyslipidemia were 32.66%, 14.03%, and 39.20%, respectively. The standardized prevalence of comorbidities was as follows: hypertension with diabetes (8.83%) , hypertension with dyslipidemia (15.31%) , and diabetes with dyslipidemia (8.05%) . The standardized comorbidity rate of the "three highs" was 5.36%. The rates of comorbidity for two and three diseases increased with age and body mass index (BMI) while decreasing with higher levels of education (P<0.05) . The dyslipidemia of the residents primarily characterized by elevated triglyceride levels (TG) (16.47%, 822/4 990) and low high-density lipoprotein cholesterol (HDL-C) levels (15.29%, 763/4 990) , with the prevalence of high total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) being significantly lower in men than in women (P<0.05) . Results from multivariate Logistic regression analysis indicated that age, BMI grade, and educational level were influencing factors for the comorbidity of "three highs" (P<0.05) .

The prevention and control of comorbidities associated with the "three highs" in Xinjiang remains challenging. Advanced age, overweight/obesity, and low educational attainment were risk factors for the comorbidity of the "three highs" . The joint management of the "three highs" and the comprehensive management of risk factors are crucial for the prevention and control of chronic diseases in the region.

The global prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) is rapidly increasing, and its risk significantly inflates when being combined with type 2 diabetes mellitus (T2DM) . The triglyceride glucose-body mass index (TyG-BMI) , as a noninvasive marker of insulin resistance, has demonstrated predictive value for MAFLD in non-diabetic populations, yet its diagnostic efficacy in T2DM patients remains unclear.

To evaluate the diagnostic utility of TyG-BMI in MAFLD combined with T2DM.

From 2022 to 2023, a total of 1 347 T2DM patients aged 18 years or above were recruited from the Health Management Center of the People's Hospital of Longhua, Shenzhen. Based on whether combined with MAFLD, patients were divided into two groups: the T2DM-only group (n=601) and the T2DM combined with MAFLD group (n=746) . Clinical data were compared between the two groups. Logistic regression analysis was performed to evaluate the correlations of triglyceride glucose index (TyG) , body mass index (BMI) , and TyG-BMI with T2DM combined with MAFLD. Receiver operating characteristic (ROC) curve analysis was conducted to assess the diagnostic performance of TyG, BMI, serum uric acid to creatinine ratio (SUA/Scr) , and TyG-BMI in T2DM combined with MAFLD.

Compared with the T2DM-only group, patients in the T2DM combined with MAFLD group showed significantly higher proportion of men, systolic blood pressure (SBP) , diastolic blood pressure (DBP) , total cholesterol (TC) , triglycerides (TG) , aspartate aminotransferase (AST) , alanine aminotransferase (ALT) , uric acid (UA) , fasting plasma glucose (FPG) , glycated hemoglobin (HbA_1c) , BMI, TyG, SUA/Scr, and TyG-BMI levels (P<0.05) , while significantly lower level of blood urea nitrogen (BUN) , high-density lipoprotein cholesterol (HDL-C) and age (P<0.05) . After adjusting for confounders, multivariate Logistic regression analysis showed that TyG (OR=2.989, 95%CI=2.278-3.922, P<0.001) , BMI (OR=1.395, 95%CI=1.324-1.470, P<0.001) , and TyG-BMI (OR=1.039, 95%CI=1.034-1.044, P<0.001) were influencing factors for T2DM combined with MAFLD. ROC curve analysis demonstrated that the sensitivity of TyG, BMI, SUA/Scr, and TyG-BMI in predicting T2DM complicated with MAFLD was 74.7%, 73.7%, 62.0%, and 85.8%, respectively; the specificity was 60.7%, 71.3%, 55.0%, and 66.3%, respectively; and the area under the ROC (AUC) was 0.739, 0.793, 0.608, and 0.833, respectively. The results of Delong test indicated that the AUC of TyG-BMI for T2DM complicated with MAFLD was significantly larger than that of BMI, TyG, and SUA/Scr (Z=8.224, 12.501, and 5.632, respectively; P<0.001) .

TyG, BMI, and TyG-BMI all demonstrate diagnostic value in T2DM complicated with MAFLD. However, TyG-BMI exhibits superior diagnostic value than TyG, BMI, and SUA/Scr.

Currently, hospital physical examination centers or communities mainly use fasting plasma glucose and glycosylated hemoglobin as indicators to evaluate blood glucose levels. Previous studies explored the diagnostic value of detecting these two indicators separately or in combination, but these studies often only focus on the accuracy of the indicators and ignore their practical value. Based on the real situation, the study constructs a screening strategy for type 2 diabetes and prediabetes mellitus to detect and manage the population with abnormal glucose metabolism at an early stage.

Use fasting blood glucose and glycosylated hemoglobin indicators to form screening strategies and screening thresholds for type 2 diabetes and prediabetes mellitus in the physical examination population, so as to improve the detection rate of diabetes and prediabetes in the population.

527 subjects who underwent physical examinations and two-hour postprandial blood glucose testing at Wusong Central Hospital of Baoshan District of Shanghai from September to November 2023. The sensitivity, specificity, positive predictive value, negative predictive value, Youden index, screening cost, and cost-effectiveness of different screening thresholds in the two screening processes of fasting plasma glucose and fasting plasma glucose combined with glycosylated hemoglobin were compared.

Among the 527 subjects, 74 individuals (14.0%) were diagnosed with type 2 diabetes mellitus, 141 individuals (26.8%) were identified as having prediabetes mellitus, and 312 individuals (59.2%) exhibited normal blood glucose levels. In the screening strategy using fasting plasma glucose alone, the maximum Youden index of 0.461 corresponded to a fasting plasma glucose screening threshold of 5.4 mmol/L, with a sensitivity of 54.42%, a specificity of 91.67%, and a cost-effectiveness of 233.97 yuan per person. When the screening threshold for fasting plasma glucose was 5.9 mmol/L, the sensitivity was 33.02%, the specificity wasi 99.68%, Youden index was 0.327, and the cost-effectiveness was 212.55 yuan per person. In the screening strategy combining fasting plasma glucose and glycosylated hemoglobin, the maximum Youden index of 0.433 corresponded to a glycosylated hemoglobin screening threshold of 6.1%, with a sensitivity of 51.63%, a specificity of 91.67%, and a cost-effectiveness of 480.23 yuan per person; When the screening threshold for glycosylated hemoglobin for abnormal glucose metabolism was 5.9%, the sensitivity was 73.95%, the specificity was 65.71%, the Youden index was 0.370, and the cost-effectiveness was 475.62 yuan per person.

When using fasting plasma glucose as a single indicator to screen individuals with abnormal glucose metabolism, lowering the screening threshold for fasting plasma glucose has good screening effectiveness and cost-effectiveness. Glycosylated hemoglobin can serve as a good supplementary screening tool. Supplementing the use of glycosylated hemoglobin screening for individuals with normal fasting plasma glucose can significantly detect individuals with abnormal glucose metabolism status, thereby improving their compliance with glucose tolerance tests and providing more possibilities for optimizing screening strategies.

While the effectiveness of generalist-specialist collaborative care in chronic care management has been well-documented in high-income countries, evidence from China is limited.

To systematically evaluate the effect of multidisciplinary team-based care, collaboratively provided by hospital-based specialists and community-based generalists, on hypertension and diabetic outcomes in primary care settings in China.

In October 2024, a comprehensive literature search was conducted across PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data Knowledge Service Platform, VIP Database, SinoMed, covering publications from 2011-07-06 to 2024-10-14. The control group received standard health management services, while the intervention group received the collaborative model in addition to standard care. Two independent researchers performed literature screening, quality assessment, and data extraction, with consensus reached for any discrepancies. Meta-analysis was conducted using RevMan 5.4.1 and Stata 17.0 software.

Seventeen randomized controlled trials involving 21 591 participants were included, with 13 819 in the intervention group and 7 772 in the control group. Meta-analysis showed that the generalist-specialist collaborative care significantly improved outcomes for diabetic patients, including reduced glycated hemoglobin (MD=-0.72, 95%CI=-0.96 to -0.48, P<0.001) , fasting blood glucose (MD=-0.84, 95%CI=-1.04 to -0.65, P<0.001) , and 2-hour postprandial blood glucose (MD=-1.12, 95%CI=-1.52 to -0.72, P<0.001) . For hypertensive patients, the model significantly reduced systolic blood pressure (MD=-6.49, 95%CI=-7.53 to -5.44, P<0.001) and diastolic blood pressure (MD=-6.00, 95%CI=-8.89 to -3.12, P<0.001) . Subgroup analyses revealed significant differences in intervention effects across gender, age, and intervention duration. Egger's test indicated potential publication bias for glycated hemoglobin (P=0.003) and fasting blood glucose (P=0.002) .

The collaborative service model between generalist and specialists significantly improves blood pressure and blood glucose indicators in patients with hypertension and diabetes at the primary care level, and should be promoted as a key measure in chronic disease management within national basic public health services. High-quality and large community trials are needed to identify strategies to enhance an in-depth collaboration between hospital-based specialists and community-based generalists, thereby further improving population health and enhancing the efficiency of healthcare utilization.

Although intermittent fasting as an emerging dietary therapy has shown beneficial effects on the pathological progression of type 2 diabetes mellitus in animal and general population studies, there is still a lack of sufficient clinical evidence and in-depth understanding of the specific protocols for its use and its precise effects in patients with type 2 diabetes mellitus.

To systematically analyse the studies related to the application of intermittent fasting in patients with type 2 diabetes mellitus, to summarise the specific protocol of intermittent fasting, and discuss the intervention effects of the application of this dietary modality in patients with type 2 diabetes mellitus.

Guided by the methodological framework of the scoping review, national and international databases were searched with a timeframe from database construction to July 1, 2023, two researchers independently screened the literature and extracted information, and categorised and analysed the included literature.

A total of 13 papers were included. Intermittent fasting protocols in the literature have included time-restricted eating and alternate day fasting.Intervention formats included offline hospital outpatient education and feedback sessions, and offline combined with online mobile phone smart management interventions. Intervention durations ranged from a minimum of 3 weeks to a maximum of 18 months. Intervention outcomes had varying degrees of beneficial effects on physiological indicators, psychological outcomes, and blood biochemistry indices, with intermittent fasting resulting in higher compliance and fewer adverse effects compared with continuous fasting.

This paper has shown that intermittent fasting, when used in patients with type 2 diabetes mellitus, can reduce body weight mass, improve metabolic indices and delay disease progression, and can be combined with individual needs and professional guidance to develop an appropriate dietary programme to intervene in type 2 diabetes mellitus.

Type 2 diabetic nephropathy (T2DN) is a major chronic complication of type 2 diabetes mellitus (T2DM) and a leading cause of end-stage kidney disease and cardiovascular disease. It imposes a substantial disease burden on patients and society, representing a growing global public health challenge.

This study aims to analyze the trends in the disease burden of T2DN in China using data from the Global Burden of Disease (GBD), and predict its trajectory to 2050, thus providing evidence for public health policies and prevention and control strategies.

Data on T2DN in China from 1990 to 2021 were extracted from the GBD 2021, including incidence, prevalence, disability-adjusted life years (DALYs), and mortality rates. The estimated annual percentage change (EAPC) was used to evaluate the trends of these indicators by sex and age groups. The autoregressive integrated moving average (ARIMA) and exponential smoothing (ES) models were employed for time-series forecasting. Model prediction accuracy was assessed using the absolute percentage error (APE) .

From 1990 to 2021, the age-standardized incidence rate of T2DN in China showed an increasing trend (EAPC=0.42%, 95%CI=0.34% to 0.50%), while the age-standardized prevalence rate (EAPC=-0.24%, 95%CI=-0.39% to -0.10%), DALY rate (EAPC=-0.70%, 95%CI=-0.80% to -0.60%), and mortality rate (EAPC=-0.57%, 95%CI=-0.66% to-0.49%) showed decreasing trends. Stratified by sex, the increase in age-standardized incidence was greater in females (EAPC=0.6%, 95%CI=0.49% to 0.71%) than in males (EAPC=0.23%, 95%CI=0.17% to 0.29%). The decrease in age-standardized prevalence was more pronounced in males (EAPC=-0.27%, 95%CI=-0.41% to -0.13%) than in females (EAPC=-0.22%, 95%CI=-0.37% to -0.07%). Age-standardized DALY and mortality rates decreased significantly in females (DALY rate EAPC=-1.13%, 95%CI=-1.25% to -1.02%; mortality EAPC=-1.10%, 95%CI=-1.20% to -1.01%), with smaller changes observed in males (DALY rate EAPC=-0.28%, 95%CI=-0.40% to -0.15%; mortality EAPC=-0.06%, 95%CI=-0.19% to 0.08%). Age-specific analysis revealed that all disease burden indicators increased with age, with a heavy burden on the elderly, and incidence and DALY rates showed an upward trend in some older age groups. The ARIMA model predicted that by 2050, the male age-standardized incidence rate, prevalence, DALY rate and mortality rate were predicted to be 27.34/100 000, 877.11/100 000, 140.79/100 000, and 7.64/100 000, respectively. For females, the age-standardized rates were predicted to be 18.17/100 000 (incidence), 938.24/100 000 (prevalence), 69.66/100 000 (DALYs), and 4.77/100 000 (mortality). The ES model predicted that by 2050, male age-standardized rates would be 19.57/100 000 (incidence), 1 055.85/100 000 (prevalence), 140.38/100 000 (DALYs), and 7.30/100 000 (mortality). For females, the age-standardized rates were predicted to be 16.49/100 000 (incidence), 1 092.09/100 000 (prevalence), 105.84/100 000 (DALYs), and 5.16/100 000 (mortality). Model error assessment showed that the ES model had smaller errors for most age-standardized rates and prevalence cases, while the ARIMA model had relatively smaller errors for some case number indicators and the female age-standardized mortality rate.

From 1990 to 2021, the overall age-standardized disease burden of T2DN in China improved, particularly in the mortality and DALY rates. However, the age-standardized incidence rate continued to rise, with an increasingly evident trend of the disease burden concentrating in the elderly population. This study predicts that new cases in China will continue to increase until 2050. Therefore, precision prevention and control strategies targeting high-risk groups (especially the elderly and males) should be developed, and the core role of general practice in chronic disease management must be strengthened to address future public health challenges.

With the increasing aging population, the prevalence of osteoporosis in patients with type 2 diabetes mellitus (T2DM) is rising year by year. It has also been found that impaired sensitivity to thyroid hormone is associated with abnormal bone metabolism. However, there are few studies on the relationship between thyroid hormone sensitivity and the risk of osteoporosis in patients with T2DM.

To analyze the relationship between thyroid hormone sensitivity index and osteoporosis in T2DM patients with normal thyroid function.

This cross-sectional study included 723 T2DM patients with normal thyroid function admitted to the Department of Endocrinology of Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from 2022 to 2023. Based on the results of bone mineral density (BMD) measurements, the patients were divided into three groups: normal bone mass group (n=362), osteopenia group (n=291), and osteoporosis group (n=70). The thyroid feedback quotient index (TFQI), thyroid-stimulating hormone index (TSHI), thyroid-stimulating hormone resistance index (TT4RI), and the ratio of free triiodothyronine to free thyroxine (FT₃/FT₄) were measured and calculated in each patient to assess thyroid hormone sensitivity. One-way analysis of variance (ANOVA) and chi-square test were used for intergroup comparisons. Spearman's rank correlation analysis and ultivariate Logistic regression analysis were employed to explore the association between thyroid hormone sensitivity indices and the risk of osteoporosis in T2DM patients. The receiver operating characteristic curve (ROC curve) was used to evaluate the value of TFQI in predicting osteoporosis

The osteoporosis group had higher age, proportion of females, diabetes duration, systolic blood pressure, 2-hour postprandial glucose (2 hPG), high-density lipoprotein cholesterol (HDL-C), and TFQI compared with the normal bone mass group (P<0.05). In contrast, BMI, alanine aminotransferase (ALT), diastolic blood pressure, creatinine, triglycerides, FT₃, and FT₃/FT₄ were lower in the osteoporosis group than in the normal bone mass group (P<0.05). The osteoporosis group also had higher age, proportion of females, diabetes duration, systolic blood pressure, 2 hPG, HDL-C, and TFQI compared with the osteopenia group (P<0.05), while ALT, creatinine, triglycerides, FT₃, and FT₃/FT₄ were lower (P<0.05). Spearman rank correlation analysis showed that the occurrence of osteoporosis in T2DM patients was positively correlated with TFQI (r_s=0.553, P<0.001) and negatively correlated with FT₃ and FT₃/FT₄ (r_s=-0.098, P=0.009; r_s=-0.080, P=0.031). Multivariate Logistic regression analysis revealed that, after adjusting for confounding factors, TFQI was positively associated with the risk of osteoporosis in T2DM patients (OR=6.612, 95%CI=5.793-8.192, P<0.05). The area under the ROC curve (AUC) for predicting the risk of osteoporosis in T2DM patients using TFQI was 0.831 (95%CI=0.794-0.867), with a best cutoff value of -0.029. The sensitivity and specificity were 100.0% and 55.4%, respectively.

Elevated levels of TFQI are associated with a higher risk of osteoporosis in T2DM patients with normal thyroid function, suggesting that reduced central sensitivity to thyroid hormone in this population is related to the development of osteoporosis.

In recent years, diabetic foot has become an important cause of disability and death among diabetic patients. With the advancement of the times and technology, modern medicine and traditional Chinese medicine have gradually deepened their understanding and research on diabetic foot, further improving the treatment methods for diabetic foot. To a certain extent, this can relieve the pain of patients and improve their quality of life.

The mechanism of action of Simiao Yongan Decoction in the treatment of diabetic foot was explored by combining metabolomics with network pharmacology.

Diabetic foot patients who were hospitalized in the Burn Department, Vascular Surgery Department of Heilongjiang Provincial Hospital and the Vascular Surgery Department of Nangang Campus from July 2023 to August 2024 were selected as the research subjects. A total of 60 patients with heat-toxin intense diabetic foot who met the criteria were included in this study. They were randomly divided into debridement group, Western medicine group, traditional Chinese medicine group and combined Chinese and Western medicine group, with 15 cases in each group. Another 15 normal people were included as the control group. Firstly, databases and software such as TCMSP, GeneCards, OMIM, and TTD were used to search for the pharmacodynamic basis, target sites and metabolic pathways of Simiao Yongan Decoction on diabetic foot. The serum metabolomics and network pharmacology of Simiao Yongan Decoction were integrated for research to verify the possible active ingredients and metabolic pathways of Simiao Yongan Decoction in the intervention of diabetic foot.

The main active ingredients of Simiao Yongan Decoction for treating diabetic foot are luteolin, quercetin and acanthopanthin, etc. Diabetic foot may be treated by regulating pathways such as mitogen-activated protein kinase signaling pathway, tumor necrosis factor signaling pathway, phosphatidyacyl alcohol signaling pathway, HIF-1 signaling pathway, and Toll-like receptor signaling pathway through targets such as AKT1, TNF, HSP90AA1, MAPK8, and STAT3. Among them, the phospholipacyl alcohol signaling pathway is consistent with the research results of the serum metabolomics of Simiao Yongan Decoction.

The main active ingredients of Simiao Yongan Decoction for treating diabetic foot are luteolin, quercetin and acanthopanthin, etc. The phosphatidylinositol signaling pathway may be the one through which Simiao Yongan Decoction interferes with the metabolism of diabetic foot.

In recent years, the prevalence of diabetes among adults in China has continued to rise, reaching as high as 11.9%, with with type 2 diabetes mellitus (T2DM) being the main type, accounting for more than 90% of the diabetic population, and the onset of the disease is becoming increasingly younger. China has now entered the stage of comprehensively building a Healthy China, and exploring the construction of a chronic disease management path with the integration of healthcare and prevention as the core has become an important trend. This specification, based on the existing content and process of the integration of healthcare and prevention services for T2DM, formulates standardized diagnostic and treatment specifications for the integration of healthcare and prevention services for T2DM. The content of the specification mainly includes basic requirements for service provision, content of services, and service processes, aiming to optimize the primary diagnosis and treatment and health management process of T2DM, control the incidence and mortality rate of T2DM through early detection and comprehensive management, and reduce and delay the occurrence of complications, thereby effectively building a primary prevention and treatment line for chronic diseases.

Obesity and type 2 diabetes, both associated with chronic metabolic dysfunction, are characterized by insulin resistance and heightened cardiovascular risk. Concurrent training emerges as an effective intervention to improve physical health in these patients, though the specific impacts warrant further exploration.

This study systematically evaluates the impact of concurrent training on body composition and other health metrics in obese type 2 diabetic patients.

We reviewed randomized controlled trials from databases like PubMed, Web of Science, Ebsco, CNKI, VIP, Wanfang Data, and SinoMed focusing on trials conducted between January 2001 and March 2024. These trials measured the effects of concurrent training on various health outcomes. Quality assessments were performed using the Cochrane risk of bias tool, and data were analyzed using Stata 16.0.

Twelve randomized controled trials involving 967 participants showed that concurrent training significantly improves body composition [BMI: WMD=-0.46, P<0.001; body fat percentage (BF%) : WMD=-3.49, P<0.001; fat-free mass (FFM%) : WMD=3.26, P<0.001; waist circumference (WC) : WMD=-2.73, P<0.001; hip circumference (HC) : WMD=-2.78, P<0.001], cardiorespiratory fitness [maximal oxygen uptake (VO_2max) : WMD=5.13, P<0.001) ], and metabolic profiles [Triglycerides (TG) : SMD=-1.48, P=0.007; total cholesterol (TC) : SMD=-1.66, P=0.002; high-density lipoprotein cholesterol (HDL-C) : SMD=1.10, P=0.011; low-density lipoprotein cholesterol (LDL-C) : SMD=-1.26, P=0.018; glycated hemoglobin percentage (HbA_1c) : WMD=-0.86, P<0.001; homeostasis model assessment of insulin resistance (HOMA-IR) : SMD=-0.97, P=0.004; Glucose: SMD=-1.32, P=0.014], and inflammation markersα (TNF-α) : SMD=-1.98, P<0.001.

Concurrent training markedly improves key health outcomes in obese type 2 diabetes patients. The outcomes vary based on the volume and order of training sessions.

Food intake and energy expenditure are regulated by both neural signals of hypothalamus and peripheral systems, with the neuropeptide Nesfatin-1, released from hypothalamus, playing a significant role in inhibiting food intake, while Ghrelin, secreted by the digestive mucosa, facilitates food intake. However, the roles of these two neuro peptides in the progression of obesity and diabetes mellitus remain unclear.

This study aims to explore the correlation between Nesfatin-1, Ghrelin, and parameters such as blood glucose levels, insulin resistance, and blood lipids, and to analyze their involvement in glucose and lipid metabolism to provide novel insights for the prevention and treatment of metabolic diseases, including diabetes and obesity.

A total of 170 patients with type 2 diabetes mellitus (T2DM), hospitalized in the Department of Endocrinology at the First Affiliated Hospital of Baotou Medical College between January 2020 and February 2021, were selected as the experimental group. Additionally, 85 healthy individuals who underwent physical examinations during the same period were included as the control group. Comprehensive clinical information and test indexes for both groups were gathered, and serum levels of Nesfatin-1 and Ghrelin were measured using enzyme-linked immunosorbent assay. The correlation among Nesfatin-1, Ghrelin, glucose and lipid metabolism were evaluated using Pearson correlation analysis and Spearman rank correlation analysis. The differences in serum Nesfatin-1 and Ghrelin levels among patients with different courses of diabetes and different chronic complications of diabetes were compared. The predictive values of Nesfatin-1 and Ghrelin for diagnosing diabetes mellitus were assessed by plotting the receiver operating characteristic (ROC) curves.

Nesfatin-1 levels were negatively correlated with glycated hemoglobin (HbA_1c), fasting blood glucose, body mass index (BMI), high-density lipoprotein cholesterol (HDL-C), insulin resistance index (HOMA-IR), visceral fat area (VFA), and subcutaneous fat area (SFA) [r (r_s) equaled to -0.58, -0.59, -0.51, -0.26, -0.23, -0.37, -0.27, respectively, P<0.05]. In contrast, Ghrelin levels exhibited positive correlations with these indicators [r (r_s) equaled to 0.41, 0.41, 0.43, 0.15, 0.24, 0.50, 0.30, respectively, P<0.05]. The Nesfatin-1 levels of experimental group was lower than the control group, and the Ghrelin levels of experimental group was higher than the control group (P<0.001). There was no statistically significant difference in the levels of serum Nesfatin-1 and Ghrelin among patients with different courses of diabetes and different chronic complications of diabetes (P>0.05). The ROC curve indicated that Ghrelin had a predictive value for T2DM with an AUC of 0.861 (95%CI=0.816-0.906) and an optimal cutoff value of 30.328 μg/L. For Nesfatin-1, which AUC was 0.764 (95%CI=0.704-0.824) with an optimal cutoff value of 78.579 μg/L.

Nesfatin-1 and Ghrelin regulate glucose and lipid metabolism by influencing blood glucose levels and insulin resistance, and both have predictive value for the diagnosis of diabetes mellitus.

Diabetic nephropathy (DN) is the common microvascular complication of diabetes mellitus, and also one of the main causes of end-stage renal disease. Renal biopsy is the gold standard for the pathological diagnosis of DN. Previous studies on traditional Chinese medicine (TCM) factors influencing DN lack the basis of renal biopsy, potentially leading to an inaccurate participant recruitment (selection bias) .

To investigate the distribution of TCM syndrome types in DN patients and the relevant TCM syndrome elements in those with massive proteinuria and renal insufficiency, thereby providing TCM research directions in the pathogenesis of DN.

From January 2022 to January 2024, TCM and clinical data of 78 patients diagnosed with type 2 diabetes mellitus (T2DM) with a confirmation of DN through renal biopsy in the Department of Nephrology of First Medical Center of Chinese PLA General Hospital were included. The distribution and clinical characteristics of TCM syndrome types were explored. Binary Logistic regression was employed to explore the TCM syndrome elements associated with massive proteinuria (24-hour urinary protein quantification>3.5 g) and estimated glomerular filtration rate (eGFR) <60 mL·min^-1· (1.73 m²) ^-1 in DN patients.

According to the classification of chronic kidney disease (CKD), there were 11 cases in stageⅠgroup, 19 in stageⅡgroup, 22 in stageⅢgroup, 21 in stageⅣgroup, and 5 in stageⅤgroup. There were significant differences in hemoglobin, eGFR, serum albumin, serum creatinine, serum urea nitrogen, and 24-hour urinary protein in DN patients with different CKD stages groups (P<0.05). Based on the TCM syndrome, there were 11 cases of Yin deficiency and dry heat syndrome, 23 of syndrome of deficiency of both Qi and Yin, 15 of liver-kidney Yin deficiency syndrome, and 29 of spleen-kidney Yang deficiency syndrome. Significant differences were found in hemoglobin, eGFR, serum total protein, serum albumin, serum creatinine, and serum urea nitrogen among DN patients with varying TCM syndrome types (P<0.05). There was a significant difference in the distribution of TCM syndrome types among DN patients in stageⅠ-Ⅴ CKD (P<0.05). In the stageⅠ group, the proportions of Yin deficiency and dry heat syndrome (5/11, 45.5%) and syndrome of deficiency of both Qi and Yin (3/11, 27.3%) were relatively high. In the stage Ⅱ group, the proportions of syndrome of deficiency of both Qi and Yin and liver-kidney Yin deficiency syndrome were 42.1% (8/19) and 31.6% (6/19) respectively. In the stageⅢ group, spleen-kidney Yang deficiency syndrome and syndrome of deficiency of both Qi and Yin accounted for 54.5% (12/22) and 31.8% (7/22), respectively. In the stageⅣ group, spleen-kidney Yang deficiency syndrome and liver-kidney Yin deficiency syndrome accounted for 52.4% (11/21) and 28.6% (6/21), respectively. In the stage Ⅴ group, spleen-kidney Yang deficiency syndrome occupied the highest proportion (3/5, 60.0%). Correspondence analysis indicated that Yin deficiency and dry heat syndrome, syndrome of deficiency of both Qi and Yin, and spleen-kidney Yang deficiency syndrome corresponded to CKD stageⅠ, Ⅱ andⅤ, respectively. Yang deficiency syndrome (OR=3.545, 95%CI=1.270-9.895, P=0.016) and heart location of disease (OR=3.208, 95%CI=1.082-9.511, P=0.035) were the influencing factors of DN combined with massive proteinuria. Yang deficiency syndrome (OR=3.000, 95%CI=1.141-7.890, P=0.026) was the influencing factor of DN combined with eGFR<60 mL·min^-1· (1.73 m^{2) -1}.

The distribution of TCM syndromes of DN transits from Yin deficiency and Qi deficiency to Yang deficiency with the worsening of CKD staging. Yang deficiency syndrome and disease location of heart are factors influencing DN with massive proteinuria, and Yang deficiency syndrome is influencing factor for DN with eGFR<60 mL·min^-1· (1.73 m^{2) -1.} TCM syndrome differentiation combined with modern medicine is conducive to grasping the pathogenesis of DN and advantaging integrated TCM and Western medicine diagnosis and treatment.

The global prevalence of type 2 diabetes mellitus (T2DM) continues to rise, posing a significant public health challenge. The shared care model for diabetes has shown substantial clinical value in managing T2DM. However, most research focuses on the short-term effects, while long-term outcomes remain underexplored. Additionally, there is a lack of longitudinal studies examining the relationship between follow-up frequency, app activity levels, and metabolic indicators in T2DM patients.

To assess the impact of regular outpatient follow-up and off-site app activity on the metabolic indicators of T2DM patients within the shared care model, and to identify factors influencing regular follow-up, providing a reference for promoting regular follow-up in T2DM management.

A total of 448 T2DM patients managed in the shared care outpatient clinic of a tertiary hospital in Gansu Province from 2021 to 2023 were included. Based on clinical records, patients were divided into two groups: the regular follow-up group (≥1 visit every 3 months) and the non-regular follow-up group. Health records from the previous 3 years were reviewed, and metabolic indicators (BMI, waist circumference, hip circumference, HbA_1c levels) , complication screening data, and off-site app activity levels were collected. The differences in metabolic indicators between the two follow-up groups and the varying app activity levels were compared, and Logistic regression was performed to identify factors influencing regular follow-up.

Among the 448 patients, 90 (20.1%) were in the regular follow-up group, and 358 (79.9%) were in the non-regular follow-up group. The regular follow-up group exhibited significantly higher app activity levels than the non-regular follow-up group (P<0.05) . Significant time, group, and interaction effects on HbA_1c levels were observed in the regular follow-up group (P<0.05) . After 3 years, the regular follow-up group had higher HbA_1c target achievement rates, and more frequent active screening (P<0.05) . Among patients with high APP activity levels (measured by online communication time, blood glucose monitoring frequency, meal tracking frequency, and app login duration) , significant time and group effects on HbA_1c levels were also observed (P<0.05) , but the interaction between APP activity and time was not significant (P>0.05) . Multivariate Logistic regression analysis revealed that patients with a monthly household income ≥2 000 yuan, those undergoing medication therapy, and those with higher baseline HbA_1c levels were more likely to engage in regular follow-up (P<0.05) .

In the shared care model, regular outpatient follow-up is an effective strategy for controlling blood glucose in T2DM patients. Patients should be encouraged to engage in regular follow-up visits. Furthermore, active participation in the app is closely associated with improved blood glucose control. Promoting online engagement, especially for patients with limited access to healthcare, provides an economically feasible and effective approach to diabetes management.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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