There is growing evidence that pre-hospital use of metformin reduces mortality in patients with diabetes and sepsis; however, the effect of metformin on clinical outcomes in patients with diabetes and sepsis remains controversial. Therefore, there is a need for a systematic review and Meta-analysis of existing studies to further evaluate whether metformin can improve mortality and other clinical outcomes in patients with diabetes and sepsis.

To systematically evaluate the effects of pre-hospital metformin use on mortality, initial plasma lactate level and organ dysfunction in patients with diabetes and sepsis.

PubMed, Embase, Cochrane Library, Web of Science, Scopus, China Biomedical Literature Service System, Wanfang Data, CNKI and other databases were searched by computer for Chinese and English literature on the effects of pre-hospital metformin use on clinical outcomes in patients with sepsis and diabetes from inception to March 15, 2023. The test group (MET group) involved adult patients with diabetes and sepsis received pre-hospital metformin use, and the control group (NM group) involved adult patients with diabetes and sepsis who did not receive pre-hospital metformin use. After screening, data extraction and literature quality evaluation were conducted by two researchers, Meta-analysis was performed using RevMan 5.3 software.

A total of 12 papers were included in this study, involving 12 320 patients with diabetes and sepsis, with Newcastle-Ottawa Scale (NOS) scores of 7-8. The results of Meta-analysis showed that the mortality rate (OR=0.61, 95%CI=0.46 to 0.80, P<0.001) and the use rate of vasopressors (OR=0.83, 95%CI=0.69 to 0.98, P=0.03) in MET group were lower than those in NM group; there was no significant difference in initial plasma lactate level (MD=0.31, 95%CI=-0.12 to 0.75, P=0.16) , serum creatinine level (MD=-0.81, 95%CI=-0.48 to 0.13, P=0.25) , initial blood glucose level (MD=32.94, 95%CI=-10.12 to 76.01, P=0.13) and mechanical ventilation (OR=0.90, 95%CI=0.77 to 1.06, P=0.23) between the MET group and NM group.

The pre-hospital use of metformin can reduce the mortality of patients with diabetes and sepsis, and reduce the use rate of vasoppressors in corresponding patients, providing updated evidence that metformin can reduce the mortality of patients with diabetes and sepsis. However, whether it can reduce the sepsis severity score and reduce the maximum dose of norepinephrine in patients with diabetes and sepsis remains to be further studied.

Diabetic nephropathy (DN) is one of the most common microvascular complications of diabetes, which is highly prevalent and harmful. Early detection of DN is an important task in preventing related diseases. Currently, most of the researches are based on traditional statistical prediction methods, and data need to meet the prerequisites it requires. It is necessary to try to apply new methods such as machine learning in the area of DN prediction for its failing to meet the needs in the field of DN prediction in recent years.

To construct DN prediction model using the LASSO regression and BP neural network optimized by sparrow search algorithm (SSA-BP) .

This study was conducted from April 2023 to August 2023, and the data was obtained from publicly available data on complications of 133 patients with diabetes mellitus in Iran. Univariate analysis was conducted using SPSS 26.0 software, and variables were screened using LASSO regression. Using the presence of DN as the dependent variable, the training and testing sets were divided into 8∶2 and 7∶3 ratios, respectively. The SSA-BP neural network was used for modeling and analysis, and the prediction performance was compared with classical machine learning models to analyze the better DN model. Model evaluation was performed based on accuracy, precision, sensitivity, specificity, F1-score and AUC indicators.

Excluding 9 patients with type 1 diabetes, the effective sample size included in this study was 124 patients with type 2 diabetes mellitus (T2DM) , of which 73 (58.9%) were diagnosed with DN. Univariate analysis of risk factors for type 2 DN showed statistically significant for age, BMI, duration of diabetes, fasting blood glucose (FBG) , glycosylated hemoglobin (HbA_1c) , low-density lipoprotein (LDL) , high-density lipoprotein (HDL) , triacylglycerol (TG) , systolic blood pressure (SBP) and diastolic blood pressure (DBP) (P<0.05) . When the ratio of the training set to the test set was 8∶2, there were 59 DN patients in the training set (n=100) and 14 DN patients in the test set (n=24) . Five influencing factors of age, diabetes duration, HbA_1c, LDL, and SBP were obtained by LASSO regression screening. The accuracy rates of Logistic regression (LR) , K-nearest neighbor (KNN) , support vector machine (SVM) and SSA-BP models in the test set were 83.33%, 79.17%, 79.17%, 87.50%, and 95.83%, with F1-score as 0.846 2, 0.800 0, 0.800 0, 0.888 9, and 0.960 0, respectively. When the ratio of the training set to the test set was 7∶3, there were 52 DN patients in the training set (n=88) and 21 DN patients in the test set (n=36) . Seven influencing factors obtained by LASSO regression screening included age, BMI, diabetes duration, LDL, HDL, SBP, and DBP. The accuracy rates of LR, KNN, SVM, BP, and SSA-BP models in the test set were 86.11%, 86.11%, 86.11%, 72.22%, and 91.67%, with F1-score as 0.871 8, 0.871 8, 0.864 9, 0.705 9, and 0.909 1, respectively.

LR, KNN, and SVM perform better when the training set to the test set is 7∶3, while BP and SSA-BP perform better when the training set to the test set is 8∶2. Compared with the BP neural network and traditional machine learning models, SSA-BP model has the best prediction performance and can timely and accurately identify type 2 DN patients, realize early detection and treatment of DN, thus preventing and mitigating the harm to their bodies.

Type 2 diabetes mellitus (T2DM) has become a public health burden facing the whole world, with the rapid development of Internet and digital technology, intelligent service model plays an important role in the management of patients with T2DM.

To explore the effectiveness of wearable devices combined with health coaching in patients with T2DM.

A total of 315 patients with T2DM who were hospitalized in the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were selected as the study subjects, and divided into the control group, the intervention A group and the intervention B group based on the method of randomized numerical table, the control group implemented the routine management measures based on capillary blood glucose monitoring, the intervention A group adopted the wearable devices for routine management, the intervention B group was managed by wearable devices combined with health coaching. The differences in glycemic and lipid control status and self-management behaviors among the three groups before and 3, 6, 9 and 12 months after intervention were compared.

A total of 15 lost visits were made during the implementation of the study, and 300 study subjects were finally included in the analysis, with 100 in each of the three groups. There was an interaction between intervention method and time in the three groups on 2-hour postprandial blood glucose (2 hPG) , glycated hemoglobin (HbA_1c) , number of hypoglycemic episodes, low-density lipoprotein cholesterol (LDL-C) , self-management behaviors of diabetes mellitus (2-DSCS) , and self-management behaviors of diabetic patients (SDSCA) scores (P<0.05) . There was a significant main effect of intervention method on the number of hypoglycemic episodes, total cholesterol (TC) , high-density lipoprotein cholesterol (HDL-C) , 2-DSCS and DSCS scores (P<0.05) . The main effect of time was significant on all indicators except the number of hypoglycemic episodes (P<0.05) . The levels of HbA_1c, FBG, 2 hPG, TC at 3, 6, 9, and 12 months after the intervention in each group were lower than those before the intervention in the same group, and the level of 2-DSCS and SDSCA scores of T2DM patients were higher than those before the intervention in the same group. After 3 months of intervention, the number of hypoglycemic episodes were lower in the intervention B group than in the intervention A group and control group (P<0.05) ; after 6 months of intervention, the 2 hPG level and the TC level in the intervention B group were lower than those in the control group (P<0.05) , HDL-C level, 2-DSCS score, SDSCA score in the intervention A and intervention B groups were higher than the control group (P<0.05) , SDSCA score in the intervention B group was higher than the intervention A group (P<0.05) ; after 9 months of intervention, FBG level, 2 hPG level, and TC level in the intervention B group were lower than those in the control group (P<0.05) , FBG level and 2 hPG level in intervention B group were lower than those in intervention A group, HDL-C level, 2-DSCS score, and SDSCA score in the intervention B group were higher than those in the control group (P<0.05) , 2-DSCS score and SDSCA score in the intervention B group were higher than those of the intervention A group (P<0.05) ; after 12 months of intervention, FBG level, 2 hPG level, HbA_1c level, TC level, LDL-C level in the intervention B group were lower than those in the control group (P<0.05) , FBG level, 2 hPG level, HbA_1c level in the intervention B group were lower than those in the intervention A group, HDL-C level, 2-DSCS score, and SDSCA score in the intervention B group were higher than those in the control and intervention groups (P<0.05) .

Wearable devices combined with health coaching has short-term and long-term effects in improving the comprehensive control of glucose and lipids, as well as improving self-management ability of them in patients with T2DM.

Diabetes nephropathy (DN) is a common complication of diabetes patients. The prediction and validation of its risk will help identify high-risk patients in advance and take intervention measures to avoid or delay the progress of nephropathy.

To analyze the risk factors affecting the complication of DN in patients with type 2 diabetes mellitus (T2DM) , construct a risk prediction model for the risk of DN in T2DM patients and validate it.

A total of 5 810 patients with T2DM admitted to the First Affiliated Hospital of Xinjiang Medical University from January 2016 to June 2021 were selected as the study subjects and divided into the DN group (n=481) and non-DN group (n=5 329) according to the complication of DN. A 1∶1 case-control matching was performed on 481 of these DN patients and non-DN patients by gender and age (±2 years) , and the matched 962 T2DM patients were randomly divided into the training group (n=641) and validation group (n=321) based on a 2∶1 ratio. Basic data of patients, such as clinical characteristics, laboratory test results and other related data, were collected. LASSO regression was applied to optimize the screening variables, and a nomogram prediction model was developed using multivariate Logistic regression analysis. The discriminability, calibration and clinical validity of the prediction model were evaluated by using the receiver operating characteristic (ROC) curve, Hosmer-Lemeshow calibration curve, and decision curve analysis (DCA) , respectively.

There were significant differences in gender, age, BMI, course of diabetes, white blood cell count, total cholesterol, triacylglycerol, low-density lipoprotein cholesterol, serum creatinine, hypertension, systolic blood pressure, diastolic blood pressure, glycosylated hemoglobin, apolipoprotein B, 24-hour urinary micro total protein, qualitative urinary protein between the DN and non-DN group (P<0.05) . Five predictor variables associated with the risk of DN in patients with T2DM were screened using LASSO regression analysis, and the results combined with multivariate Logistic regression analysis showed that duration of diabetes, total cholesterol, serum creatinine, hypertension, and qualitative urinary protein were risk factors for the complication of DN in T2DM patients (P<0.05) . The area under the ROC curve (AUC) for the risk of DN in the training group of the model was 0.866 (95%CI=0.839-0.894) , and the AUC for predicting the risk of DN in the validation group was 0.849 (95%CI=0.804-0.889) based on the predictor variables. The Hosmer-Lemeshow calibration curve fit was good (P=0.748 for the training group; P=0.986 for the validation group) . DCA showed that the use of nomogram prediction model was more beneficial in predicting DN when the threshold probability of patients was 0.15 to 0.95.

The nomogram prediction model containing five predictor variables (diabetes duration, total cholesterol, serum creatinine, hypertension, qualitative urinary protein) developed in this study can be used to predict the risk of DN in patients with T2DM.

General practitioners (GPs) play an important role in diabetes care in primary care as the "gatekeepers" of population health. The management of diabetes can slow its progression, reduce complications and improve patient outcomes, which requires effective communication and collaboration between patients and their doctors. GPs with good communication skills can help to build long-term care relationships with diabetes patients and help them develop effective self-management skills. This paper summarizes the design and development of diabetes communication skills training for GPs guided by research team with multiple theoretical frameworks, including evidence-based findings from systematic review, experiences and ideas of diabetes patients communicating with GPs based on qualitative studies, prioritization of training content for patient-doctor communication in GPs captured by mixed-methods research, in order to provide new ideas for high-quality diabetes management in primary care and inform the design of training programmes for GPs based on evidence and medical education frameworks.

China ranks first in the world in terms of the number of diabetes patients. In recent years, the prevalence and mortality of diabetes have been rising, threatening people's health and placing a heavy burden on the people of China. As the prevalence of obesity continues to rise, the burden of diabetes is expected to continue to rise, and diabetes has become a public health problem that cannot be ignored in China.

To describe and analyze the disease burden of type 2 diabetes attributable to high BMI and its trend in China from 1990 to 2019, and predict the disease burden of type 2 diabetes attributable to high BMI in China from 2020 to 2024, so as to provide a basis for the scientific prevention and control of type 2 diabetes in China.

In May 2023, data on the burden of disease indicators of type 2 diabetes such as disability-adjusted life years (DALYs) , DALYs rate, standardized DALYs rate, death toll, mortality rate and standardized mortality rate of type 2 diabetes in China from 1990 to 2019 were extracted from the Global Burden of Disease 2019 (GBD 2019) , and the trend was analyzed by annual percentage change (APC) and average annual percentage change (AAPC) using the Joinpoint Regression Model. An autoregressive moving average (ARIMA) model of DALYs rate and mortality rate of type 2 diabetes attributable to high BMI was constructed based on the data from 1990 to 2016 (training set) , and evaluated using the data from 2017 to 2019 (test set) . The relative error between the predicted value and the actual value, the mean absolute error (MAE) , mean absolute percentage error (MAPE) , mean square error (MSE) and root mean square error (RMSE) of the model were used to determine the model prediction effect, and the optimal model was selected to predict the burden of type 2 diabetes attributable to high BMI in China from 2020 to 2024.

From 1990 to 2019, the burden of disease showed an overall upward trend (AAPC of standardized DALYs rate=2.85%, AAPC of standardized mortality=2.32%, both P<0.05) , the standardized DALYs rate increased from 80.21/100 000 to 181.54/100 000, and the standardized mortality rate increased from 1.25/100 000 to 2.39/100 000. The standardized DALYs rate and standardized mortality rate of both men and women showed a rapid upward trend, with standardized DALYs rate increasing by 173% for males and 89% for females compared to 2019, as well as the standardized mortality rate increasing by 146% for males and 58% for females. The DALYs rate and mortality rate increased significantly with age, with DALYs rates increasing rapidly after age 30 years, with peaks basically maintained in the 65-69 (337.47/100 000 in 1990, 711.09/100 000 in 2019) and 70-74 age groups (323.64/100 000 in 1990, 730.47/100 000 in 2019) , and the population mortality rate increased rapidly after the age of 45 years and the peak was maintained above the age of 95 years (12.78/100 000 in 1990 and 33.29/100 000 in 2019) . The DALYs and mortality rates of type 2 diabetes attributable to high BMI in China was increasing at a higher rate compared to the world. There were four inflection points in 1990-2019, the standardized DALYs rate and standardized mortality rate increased the fastest in 2000-2004 and 1996-2004, respectively. The ARIMA model predicted that the standardized DALYs rate and standardized mortality rate of type 2 diabetes attributable to high BMI in China would continue to increase from 2020 to 2024, reaching 205.142/100 000 (95%CI=189.775/100 000-220.508/100 000) and 2.621/100 000 (95%CI=2.343/100 000-2.900/100 000) by 2024, respectively.

The disease burden of type 2 diabetes attributable to high BMI in China is generally on the rise, manifested by an increase in the disease burden and number of deaths attributable to DALYs, and the growth rate is higher than globally. The disease burden of type 2 diabetes attributable to high BMI in men was progressively higher than that in women. The DALYs rate and mortality rate of type 2 diabetes attributable to high BMI were trending towards younger age groups. The ARIMA model indicated that the disease burden of type 2 diabetes attributable to high BMI was expected to continue to rise. In order to reduce the disease burden of type 2 diabetes, health education should be strengthened for the key populations (male, middle-aged and elderly people) to improve the awareness of diabetes prevention and control, and weight management can be strengthened by promoting healthy diet and lifestyle habits.

Primary care physicians (PCPs), who play a crucial role in providing primary healthcare services, utilize clinical practice guidelines as valuable tools for guiding their practice. By investigating these physicians' awareness and usage of guidelines, we can offer innovative strategies for promoting guideline adherence and enhancing physicians' training. This, in turn, can ultimately improve the quality of primary healthcare.

To explore the level of awareness and the current status of reference use of traditional Chinese medicine (TCM) guidelines for diabetes among PCPs, and to identify the influencing factors.

From September 22 to October 29, 2021, an online questionnaire survey was conducted among physicians affiliated with the Specialist Committee for Primary Diabetes Care of China Association of Chinese Medicine, using the snowball sampling method to ensure a broader representation of physicians. The questionnaire consists of three parts: basic information, current status and needs of physicians in using TCM for diabetes prevention and treatment, and a survey on physicians' current awareness and needs regarding diabetes guidelines. Ordered multiclass Logistic regression analysis was used to identify the influencing factors of PCPs' awareness and usage of TCM guidelines for diabetes.

A total of 382 questionnaires were collected from PCPs, 35.34% (135/382) of the physicians were very familiar or fairly familiar with TCM guidelines for diabetes, while 28.80% (110/382) of the physicians referred to these guidelines regularly for diabetes management. The results of the univariate analysis showed that, PCPs with differences in gender, specialty, department, number of diabetic patients treated per week, evaluation of TCM treatment efficacy, availability of TCM herbs and Chinese patent drugs in physicians' institutions, and physicians' awareness of guidelines, showed statistically significant differences in their reference status of TCM guidelines for diabetes (P<0.05). The results of the ordered multinomial Logistic regression analysis showed that, the factors influencing PCPs' awareness of TCM guidelines for diabetes included PCPs' evaluation of TCM treatment efficacy (OR=5.783, 95%CI=1.283-26.102), availability of TCM herbs and Chinese patent drugs in physicians' institutions (OR=2.399, 95%CI=1.548-3.717), and their previous participation in specialized training on diabetes prevention and control guidelines (OR=1.751, 95%CI=1.149-2.667). The factors influencing PCPs' reference to TCM guidelines for diabetes included the physicians' level of familiarity with the guidelines [very or fairly familiar (OR=15.721, 95%CI=7.584-32.557), somewhat familiar (OR=5.392, 95%CI=2.841-10.237) ], work experience less than 5 years (OR=14.083, 95%CI=1.390-142.594), different specialties [TCM (OR=6.869, 95%CI=1.483-31.849), integrated Chinese and western medicine (OR=6.613, 95%CI=1.551-28.219) ], and geographical regions [northeast (OR=2.962, 95%CI=1.064-8.240), southeast (OR=2.686, 95%CI=1.004-7.178) ].

The awareness and reference usage of TCM guidelines for diabetes among PCPs need to be improved. Factors such as guideline awareness, work experience, professional orientation, and geographical region play a significant role in influencing physicians' utilization of the guidelines. In the future, training for PCPs should be strengthened, particularly focusing on the northwest and southwest regions, and PCPs with a background in TCM should receive more training on TCM-related guidelines for diabetes prevention and treatment.

Type 2 diabetes mellitus (T2DM) is one of the common chronic diseases among the elderly. Persistent hyperglycemia damages blood vessels throughout the body, affecting organs and tissues such as heart, kidneys, eyes, and nerves, leading to various complications. Atherosclerotic cardiovascular diseases (ASCVD) are the main cause of death in T2DM patients. Such patients need comprehensive treatment such as glucose-lowering, lipid-regulation, antihypertensive, antiplatelet, and urinary protein-lowering treatments. Polypharmacy plays a good role in disease control in older adults with multiple comorbidities, but it also poses a number of problems such as potential drug interactions and adverse drug reactions if applied in an irrational and unscientific manner. This paper analyses the management of polypharmacy in elderly T2DM patients combined with ASCVD, with a particular emphasis on the interactions among hypoglycemic, antihypertensive, lipid-regulating, and antiplatelet medications, as well as precautions, so as to improve the rationality, safety and standardization of medication under the premise of ensuring the efficacy of medication, reduce the occurrence of adverse reactions and provide reference for clinicians in the use of drugs.

Patients with type 2 diabetes usually lack sufficient awareness of safe exercise and have poor exercise compliance, which requires the management of exercise interventions by professionals to improve the health status of patients with type 2 diabetes. A strategy worth considering is the management of exercise interventions for patients by community health workers. Currently, there is a lack of research on the management of exercise interventions, and studies on the health management of patients with type 2 diabetes usually only mention exercise without specific exercise management measures. Additionally, there is a lack of quantitative systematic reviews.

To systematically review the health effects of exercise interventions based on community health workers' management for patients with type 2 diabetes and specific exercise intervention programs.

Eight Chinese and English databases, including PubMed, Cochrane Library, Web of Science, Embase, CNKI, Wanfang Data, VIP and CBM were searched by computer from inception to October 17, 2022, to screen randomized controlled trials on the effects of exercise interventions based on community health workers' management for patients with type 2 diabetes, in which the intervention group adopted an exercise intervention program based on community health workers' management and the control group adopted conventional care. Literature screening, quality assessment, and data extraction were performed independently by 2 investigators. Meta-analysis was performed using RevMan 5.4 and Stata 15.1 software. Sensitivity and subgroup analyses were carried out to find sources of heterogeneity. Pre-identified subgroups were intervention duration (3 months; 6 months; >6 months), frequency of exercise (3 times/week; >3 times/week), and duration of the single exercise session (≤30 min/session; >30 min/session) .

A total of 1 079 subjects from 11 articles were finally included in this review, of which 550 were in the intervention group and 529 in the control group. The results of the Meta-analysis revealed that the exercise interventions based on community health workers' management were more effective than the control groups in reducing glycated hemoglobin (MD=-1.07, 95%CI=-1.31 to -0.83, P<0.000 01), fasting blood glucose (MD=-1.26, 95%CI=-1.57 to -0.96, P<0.000 01), 2-hour plasma glucose (MD=-1.47, 95%CI=-1.90 to -1.04, P<0.000 01), total cholesterol (MD=-1.02, 95%CI=-1.52 to -0.51, P<0.000 1), low-density lipoprotein (MD=-0.62, 95%CI=-0.87 to -0.37, and P<0.000 01) and triglyceride levels (MD=-0.71, 95%CI=-1.13 to -0.28, P=0.001), whereas there was no significant difference in the improvement of high-density lipoprotein (MD=0.09, 95%CI=-0.02 to 0.21, P=0.11). Subgroup analysis showed more significant improvements in total cholesterol with exercise frequency of more than three times/week compared with three times/week (P=0.02) ; improvement in 2-hour plasma glucose was more significant with >30 min/session compared with ≤30 min/session (P=0.001) ; single exercise session of three months duration showed more significant improvements in glycated hemoglobin (P<0.000 01) and triglycerides (P=0.008) compared with duration of six months and longer. Egger's test indicated that glycated hemoglobin (P=0.34), and fasting blood glucose (P=0.281) did not show any significant publication bias. The quality of evidence evaluation demonstrated that glycated hemoglobin and fasting blood glucose were low-level evidence, and 2-hour plasma glucose and lipid-related outcomes were very low-level evidence.

Exercise interventions based on community health workers' management could significantly improve blood glucose and lipid levels in patients with type 2 diabetes. Community health workers are recommended to develop an exercise program based on aerobic exercise intervention of >30 min/session, >3 sessions/week, and duration of ≥3 months in future exercise intervention management for type 2 diabetes. If the patients with type 2 diabetes mellitus have concurrent dyslipidemia, it is recommended that the duration of the exercise intervention should ideally last for more than 6 months.

China is one of the countries with the fastest growing prevalence of diabetes in the world, and also has the largest number of people with diabetes. The "Health China 2030" plan clearly proposes to further prevent and control major diseases, implement diabetes prevention and control, and guide patients with diabetes to strengthen health management and delay or prevent the development of diabetes. In the past 20 years, value co-creation theory has been well developed in the field of health services, and different countries (regions) have explored programs to prevent and control diabetes at low cost and high effectiveness, but it is currently lacking in the field of chronic disease management in China. Based on the perspective of value co-creation, this paper further summarizes the domestic and international experience of chronic disease management taking community as the research and analysis point, proposes the prospect from four aspects of active health, organizational guidance, digital technology, and incentive assessment, which provides references for optimizing and improving the service system of diabetes management at primary health care, establishing a model of collaborative participation of multiple subjects in community chronic disease management based on value co-creation, and realizing co-creation, co-management and sharing of chronic disease management.

Since 2009, community health management for type 2 diabetes mellitus (T2DM) has been significantly promoted and implemented as a national public health service program. However, the impact of clinical inertia, defined as failure to take timely interventions when therapeutic goals are unmet, hinders the achievement of long-term optimal glycemic control in T2DM patients. Therefore, addressing clinical inertia to improve glycemic control rates is an important and urgent task for optimizing diabetes health management.

To identify the key failure modes of clinical inertia in community health management for T2DM, systematically analyze the underlying causes of these failure modes, and propose corresponding intervention measures.

Based on community realities and guided by the Healthcare Failure Mode and Effect Analysis (HFMEA) framework, a foundational comprehension of community health management processes for T2DM, the root causes of clinical inertia, and prospective intervention measures were obtained through field research, interviews, and literature review from 2020-01-01 to 2023-06-30. The Delphi method was employed based on this basis to engage 16 experts in two rounds of expert consultation during 2022-01-10—02-25, to delineate the key failure modes, their root causes, and intervention measures concerning clinical inertia in community health management for T2DM.

The expert authority coefficients for the first and second rounds were 0.791 and 0.729, respectively, ten key failure modes of clinical inertia in community health management for T2DM were quantitatively identified by calculating the risk priority number (RPN) metric and ranked in descending RPN value as follows: untimely insulin treatment, untimely alcohol cessation, untimely routine referral, untimely smoking cessation, untimely emergency referral, untimely triple therapy, untimely weight control, untimely dietary modification, untimely dichotomous therapy, and untimely detection of hypoglycemia. The root causes of these key failure modes were explored from the perspectives of patients, physicians, and the healthcare system, enabling the formulation of targeted intervention measures.

The devised intervention measures to address clinical inertia exhibit substantial scientific validity and authority, providing a robust foundation for enhancing the community health management model for T2DM.

With the incidence of chronic metabolic diseases rising by year, which has threatened the national health, the study of non-coding RNA and endocrine metabolism-related diseases has become a research hotspot at home and abroad, while lncRNA NEAT1 and miRNA-182-5p in type 2 diabetes mellitus (T2DM) combined with metabolic-related fatty liver disease (MAFLD) has been rarely reported.

To investigate the mechanism and clinical significance of lncRNA NEAT1 and miRNA-182-5p in the development of liver fibrosis in T2DM patients with MAFLD.

A total of 236 T2DM patients admitted to the endocrinology department of the First Affiliated Hospital of Baotou Medical College, Inner Mongolia University of Science and Technology from October 2021 to June 2022 were included as the study subjects, and 49 healthy people were included as the healthy control group. General information and laboratory test results of the subjects were collected. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured. Peripheral blood was collected and lncRNA NEAT1, miRNA-182-5p were determined. T2DM patients were divided into the T2DM with non-MAFLD group (n=82) and T2DM with MAFLD group (n=154). T2DM with MAFLD group was further divided into the low-risk subgroup (n=55), medium-risk subgroup (n=69) and high-risk subgroup (n=30) according to the liver fibrosis index (FIB-4). In addition, healthy people were selected as the healthy control group (n=49). Spearman rank correlation analysis was used to explore the correlation of lncRNA NEAT1 and miRNA-182-5p expression levels in the high-risk subgroup of liver fibrosis, and multilevel ordinal Logistic regression was used to explore the influencing factors of liver fibrosis risk in T2DM patients with MAFLD.

Age, neck circumference (NC), fasting blood glucose (FPG) and glycosylated hemoglobin (HbA_1c) in the healthy control group were lower than those in the T2DM with non-MAFLD and T2DM with MAFLD groups, the albumin (Alb) in the healthy control group was higher than that in the T2DM with non-MAFLD and T2DM with MAFLD groups (P<0.05). BMI, waist circumference (WC), VFA, SFA, homeostatic model assessment for insulin resistance (HOMA-IR), triglyceride (TG), serum uric acid (SUA) and lncRNA NEAT1 in the T2DM with MAFLD group were higher than those in the healthy control group and T2DM with non-MAFLD group, platelet count (PLT) was lower than that of the healthy control group and T2DM with non-MAFLD group, total cholesterol (TC) was lower than that of the healthy control group (P<0.05). HOMA-IR and lncRNA NEAT1 in the T2DM with non-MAFLD groups were higher than those in the healthy control group, miRNA-182-5p was higher than that in the healthy control group and T2DM with MAFLD group, alanine aminotransferase (ALT) and aspartate transferase (AST) were lower than those in the healthy control group and T2DM with MAFLD group (P<0.05). VFA, SFA, AST and lncRNA NEAT1 in the low-risk subgroup were lower than those in the medium-risk subgroup and high-risk subgroup, PLT and miRNA-182-5p were higher than those in the medium-risk subgroup and high-risk subgroup, BMI, WC and NC were lower than those in the high-risk subgroup, TC was higher than that in the high-risk group of liver fibrosis (P<0.05). PLT and miRNA-182-5p in the medium-risk subgroup were higher than the high-risk subgroup, AST and lncRNA NEAT1 were lower than those in the high risk group (P<0.05). Spearman rank correlation analysis showed that lncRNA NEAT1 was significantly negatively correlated with miRNA-182-5p in the high-risk subgroup of liver fibrosis (r_s=-0.438, P<0.05). The results of multilevel ordinal Logistic regression analysis showed that lncRNA NEAT1 (OR=1.326, 95%CI=1.087-1.616), VFA (OR=1.019, 95%CI=1.006-1.033), miRNA-182-5p (OR=0.083, 95%CI=0.027-0.257), PLT (OR=0.956, 95%CI=0.942-0.970), AST (OR=1.048, 95%CI=1.022-1.075) were the risk factors of liver fibrosis in T2DM patients with MAFLD.

Peripheral blood lncRNA NEAT1 and miRNA-182-5p are closely related to the complicated liver fibrosis in T2DM patients with MAFLD, providing a new basis for the early prediction, diagnosis and treatment of the disease.

Pregnant women with gestational diabetes mellitus (GDM) are often comorbid with hypertensive disorders of pregnancy (HDP), which can severely impact pregnancy health and delivery outcomes. The relationship between gut microbiota and pregnancy health has received increasing attention, but its association with concurrent HDP in GDM remains to be investigated.

To explore the association between gut microbiota characteristics and concurrent HDP in GDM patients.

The 204 patients with GDM who underwent prenatal examination at the Hangzhou Women's Hospital from August 2019 to January 2020 were selected as the study subjects. Pregnant women diagnosed with GDM only were categorized as the GDM group (n=181), while those concurrently diagnosed with GDM and HDP were categorized as the GDM with concurrent HDP group (n=23). Clinical data and inflammation detection markers of the enrolled pregnant women were collected, and fecal samples of the same period were retained for gut microbiota 16S rDNA amplicon sequencing analysis. LEfSe analysis was used to compare microbiota composition between the two groups at the phylum, family and genus levels, and to identify distinct bacterial enrichments. Logistic regression analysis was performed to identify gut microbiota characteristics associated with concurrent HDP in GDM. Spearman's rank correlation analysis was performed to explore the association between gut microbiota and inflammatory markers.

No significant differences were found in overall gut microbiota composition and relative abundances of major phyla between the two groups (P>0.05). LEfSe analysis on family level showed that the Veillonellaceae family was enriched in the GDM with concurrent HDP group (P<0.05), while Mollicutes RF39 unclassified family and Lachnospiraceae were depleted (P<0.05). At the genus level, Dialister, Intestinibacter, Eubacterium and Parasutterella were enriched in the GDM with concurrent HDP group (P<0.05), whereas [Eubacterium] xylanophilum group, Ruminiclostridium 6, Mollicutes RF39 unclassified genus and Lachnospiraceae unclassified genus were enriched in the GDM group (P<0.05). Logistic regression analysis results showed increased abundances of Veillonellaceae (OR=1.06, 95%CI=1.01-1.11), Dialister (OR=1.26, 95%CI=1.10-1.45) and Intestinibacter (OR=2.07, 95%CI=1.12-3.84) were independent risk factors for concurrent HDP in GDM (P<0.05), while increased Lachnospiraceae was a protective factor (P<0.05). Spearman's rank correlation analysis results showed Veillonellaceae was positively correlated with the proportion of monocytes (r_s=0.149, P<0.05) ; Dialister was positively correlated with leukocyte count, eosinophil leukocyte, and eosinophil count (r_s=0.151, 0.163, 0.171, P<0.05) .

Increased abundances of Veillonellaceae, Dialister and Intestinibacter are independent risk factors for concurrent HDP in GDM pregnant women, while increased abundance of Lachnospiraceae unclassified genus is a protective factor. Veillonellaceae and Dialister are positively correlated with multiple inflammatory markers. Gut microbiota may be an important risk factor for concurrent HDP in GDM.

Diabetic foot is a common complication of diabetes patients, most of whom are seriously ill with rapid disease progression. A well-performing risk prediction model for the development of diabetic foot can help healthcare professionals to identify high-risk patients and take early interventions.

To systematically review the risk prediction models for diabetic foot, and provide reference for the construction and optimization of the model.

PubMed, Cochrane Library, Embase, Web of Science, CNKI and Wanfang Data were searched to collect the related studies on risk prediction models for diabetic foot from inception to May 15th, 2022. Two reviewers independently screened the literature, extracted data and evaluated the quality of models using prediction model risk of bias assessment tool (PROBAST). Meta-analysis of the predictors in the model was performed using Stata 17.0 software.

A total of 13 papers were included, containing 13 models, 12 of which had AUC>0.7. Model calibration was performed on 7 models and 8 models were validated. PROBAST results showed that 1 of the 13 included papers was at low risk of bias and the remaining 12 were at high risk of bias; for model applicability, only 1 was of low applicability. The results of Meta-analysis showed that age (OR=1.13, 95%CI=1.04-1.24), glycated hemoglobin (OR=1.56, 95%CI=1.26-1.94), foot ulcer history (OR=5.93, 95%CI=2.85-12.37), previous amputation (OR=7.79, 95%CI=2.74-22.17), diminished sensitivity of the monofilament test (OR=1.59, 95%CI=1.42-1.78), foot fungal infection (OR=6.14, 95%CI=1.71-22.01), and kidney disease (OR=2.09, 95%CI= 1.65-2.65) were independent influencing factors for diabetic foot (P<0.05) .

The risk prediction models for diabetic foot was still inadequate, and the future risk prediction model should focus on age, glycated hemoglobin level, foot ulcer history, amputation history, monofilament test sensitivity, foot fungal infection and kidney disease.

The prevalence rate of type 2 diabetes is increasing in China. General practitioners play an important role in the prevention and treatment of type 2 diabetes and its complications. Chronic kidney disease (CKD) is a common co-existing disease in patients with diabetes. However, at present, there is little research evidence on type 2 diabetes combined with CKD in primary care in China.

To investigate the obstructive factors in the monitoring and management of type 2 diabetes mellitus with CKD from the perspective of general practitioners.

From May to July 2022, a one-to-half structured interview was conducted with snowball sampling among general practitioners in an urban area of Beijing, and the interview outline was formulated based on the theoretical domains framework (TDF). NVivo 11 software was used to encode and classify the interview contents. Subject frame analysis method was used to sort out and analyze the data, and extract the theme.

13 general practitioners were interviewed in this study, and the years of working in general practice ranged from 8 to 22 years. The study identified barriers related to six domains in TDF, namely knowledge/skills, beliefs about outcomes, motivation and goals, medical background, resources and norms of conduct. After refining again, the themes were lack of systematic knowledge and skills related to CKD, imperfect incentive mechanism of primary medical staff, lack of smooth referral process between primary medical institutions and higher hospitals, poor self-management ability of patients and other obstacles.

There are many factors preventing general practitioners from monitoring and managing patients with type 2 diabetes complicated with CKD in the community. It is necessary to strengthen the knowledge and skills training of general practitioners with diabetes mellitus complicated with CKD, improve the ability of general practitioners to monitor and manage CKD, improve the incentive mechanism of primary medical institutions and establish an effective referral process with superior hospitals, strengthen the health education of patients, improve the self-management ability of patients, and enhance the prevention and treatment ability of primary medical institutions with type 2 diabetes complicated with CKD.

Diabetic nephropathy is one of the most common complications of diabetic microangiopathy, which significantly reduces the quality of life of diabetic patients and is the main cause of end-stage renal failure. As one of the main drugs in the treatment of diabetes mellitus, metformin plays a vital role in the treatment of diabetic nephropathy. In recent years, studies have found that metformin can not only lower blood sugar through a variety of mechanisms, but also prevent diabetic kidney disease from developing into end-stage renal failure. Several studies have found that metformin has clinical efficacy in the treatment of diabetic nephropathy, and drug safety in patients should be evaluated by glomerular filtration rate. This review summarizes the results of the clinical effects and mechanism of metformin in the treatment of diabetic nephropathy, aiming to better understand the therapeutic effect of metformin on diabetic nephropathy, and provide reference for the treatment of diabetic nephropathy.

With the continuous improvement of diabetes prevention and treatment strategies, clinical guidelines recommend first-line hypoglycemic agents while emphasizing a "patient-centered", and the selection of appropriate second-line hypoglycemic agents based on patients' clinical characteristics and preferences.

To quantitatively analyze second-line hypoglycemic agents selection preferences in patients with type 2 diabetes mellitus (T2DM) by using a discrete choice experiment, so as to provide reference for clinical diagnosis and treatment for T2DM patients.

This study conducted a questionnaire survey on T2DM patients selected from Hainan and Shanxi provinces from October 2021 to January 2022 by using a combination of multi-stage random cluster sampling. The questionnaire included basic personal information of the respondents, information related to disease treatment and discrete choice experimental choice set (seven attributes of glycemic control, risk of hypoglycemic events, risk of gastrointestinal adverse events, body mass change within six months, cardiovascular protection, mode of medication administration, and out-of-pocket/monthly costs, each of which included a various levels were included through the literature review, focus group discussion, and pre-tests). A mixed Logit regression model was used to quantify the preference of T2DM patients for second-line hypoglycemic agents, and the regression coefficients reflected the direction and magnitude of the preference for second-line hypoglycemic agents among T2DM patients. Willingness to pay (WTP) reflected the monetary value of patients' willingness to pay or receive compensation after the changes in different attribute levels.

A total of 1 443 questionnaires were distributed and 1 388 valid questionnaires were recovered, with an effective recovery rate of 96.2%. All seven attributes had an effect on medication preference of T2DM patients (P<0.05), the top three influences on medication preference were the effect of glycemic control, the risk of gastrointestinal adverse reactions, and the risk of hypoglycemic events, respectively. The change in body mass within six months had the lowest impact. Patients with T2DM were willing to pay 411.16 yuan per month when the blood glucose reduction increased from 0.5% to 2.5%, while patients with T2DM were willing to pay only 96.78 yuan per month when the change in body mass switched from an increase of 3 000 g to a decrease of 2 000 g over six months.

T2DM patients preferred second-line hypoglycemic drugs with good glycemic control, no risk of gastrointestinal adverse reactions, no risk of hypoglycemic events, cardiovascular protection, oral mode of administration, and a body mass reduction of 2 000 g within six months.

With the aging of the Chinese population, the prevalence of chronic comorbidity among the elderly has been increasing by year. Hypertension, diabetes or hyperglycemia, and dyslipidemia are the most common patterns of chronic comorbidity among the elderly in China. However, the survival and influencing factors of this most common pattern of chronic comorbidity remain unclear.

To investigate 5-year survival of elderly hypertension and diabetes patients combined with dyslipidemia, and analyze the common risk factors.

Retrospective cohort analysis was used in this study. Elderly residents (≥60 years old) who underwent health examination in the West Campus of the Second Affiliated Hospital of Guangzhou Medical University in 2016 were selected as the study subjects, their relevant information was collected through the Resident Health Record Information System, Health Insurance Information Network, Resident Death Information Network, Resident Health Management Information Registry Platform and telephone interviews, mainly including baseline information such as demographic characteristics, disease-related conditions, medical records, as well as follow-up and death information. According to the survival of the study subjects, they were divided into survival and death groups; according to the presence of hypertension and diabetes, they were divided into no hypertension and diabetes group, hypertension group, diabetes group, hypertension combined with diabetes group; according to the presence of dyslipidemia, they were divided into normal dyslipidemia group, mixed hyperlipidemia group, hypertriglyceridemia group, hypercholesterolemia group, and simple lipoprotein disorder group; according to the presence of hypertension and diabetes mellitus and the presence or absence of combined dyslipidemia were categorized as normal group, hypertension and/or diabetes mellitus group, non-simple dyslipidemia group, non-simple dyslipidemia+hypertension and/or diabetes mellitus group, simple dyslipidemia group, and simple dyslipidemia+hypertension and/or diabetes mellitus group. Log-rank test was used to compare the difference in 5-year crude survival rate between different groups. Multivariate Cox proportional hazards regression analysis was used to explore the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia.

A total of 3 463 elderly residents with complete data and clear diagnosis were collected, including 1 486 males (42.91%) and 1 977 females (57.09%), and a total of 287 (8.29%) died by the end of follow-up. There were significant differences in gender, physical exercise, prevalence of hypertension and diabetes, dyslipidemia, BMI, waist circumference, fasting blood glucose level, red blood cell count level, hemoglobin level, white blood cell count level, platelet level, serum alanine aminotransferase level, serum creatinine level, blood and urine nitrogen level between the survival group and death group (P<0.05). There was significant difference in 5-year crude survival rate of elderly physical examination residents among the no hypertension and diabetes group, hypertension group, diabetes group, and hypertension combined with diabetes group (χ²=15.730, P=0.001). There was statistically significant difference in 5-year crude survival rates among the normal blood lipid group, mixed hyperlipidemia group, hypertriglyceridemia group, hypercholesterolemia group and simple lipoprotein disorder group (χ²=29.290, P<0.001). In addition, there was significant difference in the 5-year crude survival rates among the normal group, hypertension and/or diabetes group, non-simple lipoprotein disorder group, non-simple lipoprotein disorder + hypertension and/or diabetes group, simple lipoprotein disorder group, simple lipoprotein disorder + hypertension and/or diabetes group (χ²=42.400, P<0.001). Multivariate Cox proportional hazards regression analysis showed that daily physical exercise, BMI, waist circumference, fasting blood glucose level, red blood cell count level, hemoglobin level, serum aspartate aminotransferase level and serum creatinine level were the influencing factors of 5-year crude survival rate of elderly residents with hypertension and diabetes combined with dyslipidemia (P<0.05) .

Compared with the general population, the 5-year crude survival rate of people with hypertension and diabetes combined with dyslipidemia is lower, especially those with lipoprotein disorders. At the same time, lifestyle, nutritional status, liver and kidney function also have a significant impact on the 5-year crude survival rate. In the management of chronic diseases such as hypertension, diabetes and dyslipidemia, it is necessary to pay attention to the improvement of lipoprotein level, nutritional status, liver and kidney function and lifestyle in addition to actively lowering blood pressure, blood glucose, cholesterol and triglyceride levels.

Difficult problems such as poor diagnosis and treatment capacity of diabetes in the community, low screening rate of complications, low standardized monitoring rate of blood glucose, and low rate of blood glucose compliance are the problems that general practitioners need to think about and solve when carrying out management of diabetes patients. It is necessary to explore and innovate the standardized management mode of diabetes in the community for making general practitioners become specialists in the general practice and achieve "precision management combining general care and specialty care".

To understand the management effect of diabetes "1358 model" on community diabetes patients based on "precision management combining general care and specialty care".

A total of 212 patients with diabetes who visited the outpatient clinic at the Hongkou District North Bund Street Community Health Service Center from May to July 2020 and had signed a contract with the community general practitioner were selected as the research subjects and divided into 106 cases in the control group and 106 cases in the intervention group by the random number table method. The patients in the control group received routine follow-up management, and the patients in the intervention group received the "1358 model" of diabetes based on "precision management combining general care and specialty care". One year after the intervention, the cognitive and behavioral levels of diabetes, the attainment of key indicators and the experience of visiting community health centers were compared between the two groups.

There was no statistically significant difference in the cognition and behavior related to diabetes management and the attainment rate of key indicators between the two groups (P>0.05). After intervention, the proportions of patients in the intervention group who monitored FPG within 1 month, monitored 2 hPG within 1 month, carried out comprehensive blood glucose monitoring within 1 month, monitored HbA_1c within 6 months, carried out self-monitoring of blood glucose, recorded a blood glucose diary, standardized the use of medication, followed the doctor's advice on diet, screened for peripheral vascular complications within 1 year, screened for urinary albumin/creatinine within 1 year, screened for carotid artery plaques within 1 year, screened for the inner ocular fundus within 1 year were higher than those of the control group, and the difference was statistically significant (P<0.05) ; however, there was no significant difference in the proportions of patients with regular exercise and weekly foot examination between the two groups (P>0.05). After the intervention, the rates of FPG attainment, HbA_1c attainment and ABC composite attainment of patients in the intervention group was higher than those of the control group, and the difference was statistically significant (P<0.05) ; however, there was no statistically significant difference in the 2 hPG attainment rate between the two groups (P<0.05). The proportions of patients who thought that the community diagnosis and treatment capacity was good, the community drugs basically met the demand, the community had testing equipment for blood glucose-related indexes, the community could solve the basic health problems, the community could carry out screening for complications, the community consultation and guidance for specialized diseases was convenient in the intervention group were higher than those of the control group, and the difference was statistically significant (P<0.05) .

The "1358 model" of diabetes based on "precision management combining general care and specialty care" is of positive significance in promoting and improving patients' health beliefs, standardizing blood glucose monitoring behavior, improving the rate of compliance with key indicators, and enhancing community medical experience, which can be promoted and applied in the community. This model may break through the bottleneck of insufficient resources of diabetes specialty in the community, and further improve the management level and service connotation of diabetes specialty of general practitioners.

Community health services play an effective role in delaying the progression of diabetes and managing diabetes complications. Previous studies have suggested that the subjective experiences of visits to community health centers by patients with diabetes contributes to their improved health outcomes. However, few studies have evaluated the correlation of glycemic control outcomes with specific service processes and objective experiences of programs received by diabetic patients in the community health service centers.

To explore the correlation between the community health service experiences and glycemic control outcomes in patients with diabetes mellitus.

A cross-sectional survey design and multi-stage, cluster random sampling method was used to select six community health service centers in the central urban area of Guangzhou, with one family doctor team randomly selected from each center. A total of 336 patients with diabetes who visited the corresponding family doctor teams from September to November 2019 were recruited as the study subjects. A questionnaire was conducted to collect baseline information, fasting plasma glucose (FPG) level, and Primary Care Assessment Tool (PCAT) scores. The glycemic control outcomes of patients were assessed based on the FPG level, and their experiences of community health services were assessed based on the PCAT scores. Logistic regression models were used to evaluate the effect of community health service experiences on glycemic control outcomes in diabetic patients.

The glycemic control rate of the included diabetic patients was 73.2% (246/336). The total PCAT score and the scores for each dimension of PCAT with good glycemic control outcomes were higher than those of patients with poor glycemic control outcomes, and the difference was statistically significant (P<0.05). The results of multivariate Logistic regression showed an effect of total PCAT score on glycemic control outcomes in diabetic patients〔OR (95%CI) =0.12 (0.06, 0.23) 〕, as well as the scores for each dimension of PCAT (P<0.05). The results of subgroup analysis showed that for diabetic patients with different genders, types of health insurance and hypertension history, the total score of PCAT had an effect on the glycemic control outcomes (P<0.05) .

Community health service experience is a protective factor for the glycemic control outcomes of diabetic patients. Enhancing community health service experience is of great significance for improving the glycemic control outcomes in patients with diabetes.

In recent years, studies have demonstrated the use of ultrasound speckle tracking techniques for the early evaluation of subclinical left ventricular (LV) systolic function in patients with type 2 diabetes mellitus (T2DM). In addition, long-term exposure to hyperglycemia severely damages the microvascular system. However, the interaction between diabetic microvascular complications and subclinical LV systolic function has not been fully understood.

To investigate the relationship between subclinical LV systolic function and diabetic microvascular complications in patients with T2DM.

A total of 150 patients with T2DM who were admitted to the Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from June to December 2021 were selected in the cross-sectional study and all underwent conventional echocardiography, pulsed tissue Doppler echocardiography and two-dimensional speckle tracking echocardiography (2D STE). The 2D global longitudinal strain (GLS) of LV was obtained to assess the subclinical LV systolic function. Diabetic microvascular complications were defined as combined diabetic retinopathy, diabetic kidney disease or peripheral neuropathy. The subjects were divided into the T2DM alone group (T2DM alone group, n=76), the T2DM with 1 complication group〔T2DM+C (1) group, n=37〕 and the T2DM with 2 to 3 complications group〔T2DM+C (2 to 3) group, n=37〕 according to the cumulative number of microvascular complications. The general demographic characteristics and biochemical indices of patients in the three groups were compared. The relationship between microvascular complications and subclinical LV systolic function was assessed by using Spearman correlation analysis and Logistic regression analysis.

GLS was lower in the T2DM+C (1) and T2DM+C (2 to 3) groups than in the T2DM alone group (P<0.05). Spearman rank correlation analysis showed that the number of diabetic microvascular complications involved was negatively correlated with GLS (r_s=-0.349, P<0.001). Logistic regression analysis showed that after adjustment for multiple factors of gender, age, duration of diabetes, hypertension, glycosylated hemoglobin, fasting glucose, blood creatinine, heart rate, urinary microalbumin, and LV fraction shortening, GLS was decreased in the T2DM+C (1) group〔OR=0.744, 95%CI (0.601, 0.920) 〕 and the T2DM+C (2 to 3) group〔OR=0.707, 95%CI (0.525, 0.952) 〕 compared with the T2DM alone group (P<0.05). Multivariable Logistic regression analysis based on hypertension stratification showed that after adjustment for the same confounding factors described above, diabetic microvascular complications remained independently associated with reduced GLS〔with hypertension: OR=0.556, 95%CI (0.321, 0.963) ; without hypertension: OR=0.739, 95%CI (0.558, 0.979), P<0.05〕 in T2DM patients with or without hypertension.

The LV systolic function may already be impaired in hospitalized T2DM patients with diabetic microangiopathy. The increased number of microvascular complications involved was closely related to subclinical LV systolic dysfunction, independently of hypertension.

Although type 2 diabetes mellitus (T2DM) cannot be completely cured, however, there is a consensus that timely community management of T2DM patients following guidelines can lead to good glycemic control. However, blood glucose of the patients is chronically suboptimal due to T2DM-related clinical inertia. It is crucial for improving the effectiveness of diabetes control to determine the current status and influencing factors of clinical inertia in T2DM patients in community, but there is limited literature on this topic.

To investigate current status and influencing factors of clinical inertia during health management in T2DM patients in community.

From January to December 2020, T2DM patients receiving health management services from the national basic public health services in Qingjiangpu and Huaian Districts, Huaian City, Jiangsu Province, were recruited using cluster random sampling method to perform face-to-face questionnaire survey, physical examination, and laboratory tests. Clinical inertia was defined as the absence of intensification in antidiabetic treatment for patients with inadequate HbA_1c control (HbA_1c≥7.0%) in the past three months. Stepwise multiple Logistic regression analysis was performed to identify influencing factors of the detection of clinical inertia in T2DM patients in community.

A total of 3 346 T2DM patients with inadequate glycemic control (HbA_1c≥7.0%) were included in the study, with the overall detection rate of clinical inertia in T2DM patients of 93.96% (3 144/3 346), 94.84% (1 139/1 201) in men and 93.47% (2 005/2 145) in women, respectively. There were significant differences in the detection rate of clinical inertia among T2DM patients with different levels of dietary control, physical activity, blood glucose monitoring periods, diabetic complications, dyslipidemia (history), and history of coronary heart disease, stroke, and cancer. Stepwise multiple Logistic regression analysis showed that dietary control〔OR (95%CI) =0.585 (0.382, 0.894) 〕, glucose monitoring period≤1 week〔OR (95%CI) =0.470 (0.344, 0.644) 〕, presence of diabetic complications〔OR (95%CI) =0.606 (0.423, 0.868) 〕, dyslipidemia (history) 〔OR (95%CI) =0.725 (0.532, 0.988) 〕, history of coronary artery disease〔OR (95%CI) =0.659 (0.458, 0.949) 〕, and stroke〔OR (95%CI) =0.699 (0.511, 0.955) 〕were associated with a lower prevalence of clinical inertia in T2DM patients (P<0.05) .

There is a serious problem of clinical inertia in T2DM patients undergoing health management in community, the prevalence of clinical inertia is closely related to patients' dietary control, glucose monitoring period, presence of diabetic complications, and comorbid diseases (history) .

Regular physical activity is a cornerstone of diabetes management, and more precise guidance on exercise prescriptions is needed in children and adolescents with diabetes due to the complexity of glycemic changes, however, there are relatively few guidelines for this population. As the continuous exploration of experts and scholars in this field, after five years, the International Society for Pediatric and Adolescent Diabetes (ISPAD) updated its guidelines on exercise for children and adolescents with diabetes in 2022. The guidelines target the service population more precisely to the children and adolescents with type 1 diabetes and provide comprehensive guidance from the perspectives of exercise types, exercise timing, blood glucose fluctuations during exercise, insulin adjustment and nutritional supplementation. This article interprets the main contents and key updates of the 2022 ISPAD guidelines, aiming to provide more scientific exercise prescriptions for children and adolescents with diabetes in China.

Hypertension and diabetes are two major chronic diseases affecting population health, and need to be controlled through chronic diseases follow-up. However, there is currently insufficient understanding of the impact of different chronic diseases follow-up forms and contents on disease control and healthy behaviors of patients.

To explore the impact of the chronic diseases follow-up on health behaviors and blood pressure/glucose control of patients with hypertension and diabetes in the context of treatment-prevention integration.

Yiyang County in Henan Province, Xianfeng County in Hubei Province and Yangqu County in Shanxi Province were selected as study sites to collect data from the basic public health information system from 2017-01-01 to 2022-06-30. Patient survey was conducted in July 2022 to collect information on basic public health follow-up receiving, health behaviors and disease control of patients. Finally, 102 769 patients with hypertension and 26 586 patients with diabetes were obtained from the basic public health information system, the data of 1 172 patients with hypertension and 456 patients with diabetes were obtained through patient surveys. Multivariate Logistic regression was used to analyze the effects of the standard-reaching frequency of follow-up, follow-up forms and contents on health behaviors and disease control of patients.

In 2021, the standard-reaching rates of follow-up frequency of patients with hypertension and diabetes were 90.83% (67 709/74 545) and 83.35% (13 390/16 065) , with frequency≥4 times/year as the standard. The follow-up forms included household follow-up〔25.74% (408/1 585) 〕, follow-up at institutional visits〔58.80% (932/1 585) 〕, telephone or network follow-up〔15.46% (245/1 585) 〕. The follow-up contents included blood pressure and blood glucose measurements〔91.15% (1 484/1 628) 〕, lifestyle guidance〔74.14% (1 207/1 628) 〕, disease inquiry〔70.02% (1 140/1 628) 〕, and drug use understanding〔69.29% (1 128/1 628) 〕. Multivariate Logistic regression analysis showed that patients with higher standard-reaching rates of follow-up frequency had higher rates of blood pressure control (OR=1.09, P<0.05) and glucose control (OR=1.31, P<0.05) , lower rates of smoking and drinking (OR=0.83, P<0.05) , and higher rates of regular exercise habits (OR=1.30, P<0.05) . The proportions of smoking and alcohol cessation (OR=2.38, P<0.05) and regular exercise habits (OR=1.62, P<0.05) were higher in the patients followed up at institutional visits than those followed up by telephone or network. The proportions of smoking and alcohol cessation (OR=2.33, P<0.05) and regular exercise habits (OR=2.54, P<0.05) of patients received household follow up were higher than those followed up by telephone or network. Patients who received lifestyle guidance, disease inquiry, and drug use understanding had higher rates of blood pressure control (OR=1.61, 1.34, and 1.62, respectively; P<0.05) , smoking and alcohol cessation (OR=3.59, 3.54, and 2.91, respectively; P<0.05) and regular exercise habits (OR=3.16, 2.15, 2.45, respectively; P<0.05) .

Receiving chronic diseases follow-up at least 4 times per year, with follow-up at institutional visits and household follow-up as the forms, provided with blood pressure and blood glucose measurements, lifestyle guidance, disease inquiry and drug use understanding as the contents in patients were positive correlated with blood pressure/glucose control, smoking and alcohol cessation, and regular exercise habits.

The rates of first and multiple recurrence of diabetic foot ulcers (DFUs) are increasing annually worldwide, and the risk of early recurrence is higher than the distant recurrence. There are numerous risk factors for DFUs recurrence, and there is a lack of systematic screening. Therefore, there is a need to explore the risk factors for DFUs recurrence in order to identify high-risk population of recurrence at an early stage.

To explore the predictive value of Logistic regression (LR), support vector machine (SVM), BP neural network model (BPNN) in the recurrence risk of DFUs.

From January 2020 to October 2021, a total of patients with DFUs attending the Department of Burn Plastic Surgery, Endocrinology and Wound Ostomy Outpatient Department in General Hospital of Ningxia Medical University were selected as the research objects and divided into the recurrence group (n=116, 29.7%) and non-recurrence group (n=274, 70.3%) according to the recurrence of DFUs within 1 year after discharge. General information was collected and compared between the two groups of patients, including sociodemographic characteristics, medical history assessment and clinical case information. The Diabetes Foot Self-care Behavior Scale (DFSBS) was used to assess the self-management behavior of diabetes foot in patients and chronic diseases risk perception questionnaire was used to assess the risk perception level of DFUs among patients. Multivariable Logistic regression analysis was used to explore the influencing factors of DFUs recurrence in patients within 1 year after discharge. The patients were divided into training and test sets according to the ratio of 7 to 3, the LR, SVM and BPNN recurrence risk prediction models were developed based on Logistic regression variable screening strategy. The receiver operating characteristic (ROC) curves of each model were plotted to predict the recurrence risk of DFUs.

There were significant differences in BMI, living alone, duration of diabetes, history of smoking, history of alcohol consumption, history of involved toe amputation, classification of diabetic foot ulcers, ankle-brachial index, glycated hemoglobin, sole ulcer, toe involvement, walking impairment, osteomyelitis, multidrug-resistant bacteria infection, diabetic peripheral neuropathy, lower limb atherosclerosis, self-management behavior of diabetes foot, level of risk perception in both groups of DFUs patients (P<0.05). Multivariable Logistic regression analysis showed that BMI〔OR=0.394, 95%CI (0.285, 0.546), P<0.001〕, duration of diabetes〔OR=1.635, 95%CI (1.303, 2.051), P<0.001〕, history of smoking〔OR=0.186, 95%CI (0.080, 0.434), P<0.001〕, classification of diabetic foot ulcers〔OR=2.139, 95%CI (1.133, 4.038), P=0.019〕, glycated hemoglobin〔OR=2.289, 95%CI (1.485, 3.528), P<0.001〕, sole ulcer〔OR=3.148, 95%CI (1.344, 7.373), P=0.008〕, self-management behavior of diabetes foot〔OR=0.744, 95%CI (0.673, 0.822), P<0.001〕and level of risk perception〔OR=0.892, 95%CI (0.845, 0.942), P<0.001〕were influencing factors of the recurrence of DFUs within 1 year (P<0.05). The accuracy rates of LR, SVM and BPNN models to predict the recurrence risk of DFUs in the test sets were 82.43%, 94.87% and 87.17%, with AUCs of 0.843, 0.937 and 0.820, respectively. There were significant differences in AUC of ROC curves of LR, SVM and BPNN recurrence risk prediction models of DFUs (Z=2.741, P<0.05) ; the AUC of ROC curve of SVM recurrence risk prediction model was higher than the LR and BPNN models (Z=5.937, P=0.013; Z=3.946, P<0.001) .

SVM model can predict the recurrence risk of DFUs patients within 1 year after discharge with good accuracy rate, sensitivity, specificity, AUC and other indicators, which is the relative optimal model. It is recommended to further promote and apply the prediction model to verify its effectiveness.

Diabetes mellitus has been a major concern as a common risk factor for cardiovascular disease. Glycated hemoglobin (HbA_1c) variability is an indicator of long-term blood glucose fluctuation. Therefore, it is of great clinical significance to explore the correlation between HbA_1c variability and new-onset atrial fibrillation (AF) in diabetic patients combined with heart failure with preserved ejection fraction (HFpEF) .

To investigate the correlation between HbA_1c variability and new onset AF in type 2 diabetes mellitus (T2DM) patients combined with HFpEF.

The clinical data of 317 T2DM patients combined with HFpEF diagnosed in the Department of Cardiology, the Second Affiliated Hospital of Zhengzhou University from January 2018 to January 2019 were retrospectively analyzed. The follow-up was performed until February 2022, with a mean follow-up time of 3.4 years. The included patients were divided into the AF group (34 cases) and non-AF group (283 cases) based on the presence of new-onset AF during the follow-up period. The HbA_1c variability was expressed as standard deviation of HbA_1c measurement (HbA_1c-SD) and HbA_1c coefficient of variation (HbA_1c-CV). Multivariate Cox regression analysis was used to explore the correlation between HbA_1c variability and new-onset AF in T2DM patients combined with HFpEF. The survival curves were plotted by the Kaplan-Meier (K-M) method. The receiver operating characteristic (ROC) curve of HbA_1c variability predicting new-onset AF in T2DM patients combined with HFpEF was plotted.

The HbA_1c-SD and HbA_1c-CV of patients in the AF group were higher than those in the non-AF group (P<0.05). The included patients were divided into the low HbA_1c variability (HbA_1c-SD≤0.34%, HbA_1c-CV≤4.74%) and high HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) groups according to the median of HbA_1c variability. Log-rank test results showed higher incidence of new-onset AF in patients with high HbA_1c variability (P_HbA1c-SD<0.001, P_HbA1c-CV=0.004). Multivariate Cox regression analysis showed that HbA_1c-SD〔HR=2.22, 95%CI (1.37, 3.61), P=0.001〕 and HbA_1c-CV〔HR=1.65, 95%CI (1.01, 2.67), P=0.001〕 were independent influencing factors for new-onset AF in T2DM patients combined with HFpEF. The AUC of HbA_1c-SD for predicting AF in T2DM patients combined with HFpEF was 0.784 〔95%CI (0.713, 0.855), P=0.001〕, with the optimum cutoff value of 0.36%, sensitivity and specificity of 79.4% and 73.1%, respectively. The AUC of HbA_1c-CV for predicting AF in patients with T2DM and HFpEF was 0.694 〔95%CI (0.591, 0.797), P<0.001〕, with the optimal cutoff value of 4.97%, sensitivity and specificity of 73.5% and 72.1%, respectively.

High HbA_1c variability (HbA_1c-SD>0.34%, HbA_1c-CV>4.74%) is independently associated with an increased risk of new-onset AF in T2DM patients combined with HFpEF, with significant clinical value in predicting AF.

Patients with type 2 diabetes commonly experience a high treatment burden. Currently, both domestic and international researches on the treatment burden of the specific diseases is still in its initial stage.

To summarize the conceptual framework of treatment burden related to type 2 diabetes in the Chinese population and explore proactive responding approaches for general practitioners based on video recordings of clinical consultation scenarios.

A retrospective analysis of video recordings from general practice training clinics in a standardized training base in Guangdong Province from 2018 to 2019 was conducted by using qualitative research methods such as observation record forms, notes from the fields, encoding-retrieval and thematic analysis, combining with existing conceptual framework of treatment burden.

A total of 49 video recordings of doctor-patient communication about the treatment burden of type 2 diabetes were extracted from 25 video recordings. All 6 themes of the original conceptual framework were mentioned and 2 new themes (burden of medical information and drug-induced hypoglycemia) were identified by analysis that were mentioned repeatedly. A modified conceptual framework of the treatment burden of type 2 diabetes was finally developed containing 7 observable dimensions including economic, drug, medical management, lifestyle change, healthcare system, time/travel, and medical information burdens and the connotation of subtopics in each dimension. According to the analysis of the response approach, general practitioners who have received training can respond consciously to some of the treatment burdens (medications, medical information, time/travel, lifestyle change) by utilizing the skills of health education, enhanced communication, shared decision-making and motivational interviewing.

This study constructs a modified conceptual framework of treatment burden for patients with type 2 diabetes. General practitioners can consciously respond to treatment burdens of patients by using effective doctor-patient communication skills, in combination with the identification of conceptual dimensions in clinical practice.

Gestational diabetes mellitus (GDM) is one of the common pregnancy complications, which not only increases the maternal risk of short-term and long-term complications such as maternal preeclampsia and type 2 diabetes, but also the incidence rates of fetal malformation, macrosomia, etc. GDM has become a public health and social issue which can not be ignored.

To investigate the prevalence and epidemiological characteristics of GDM in Hebei Province.

Using a cross-sectional study method, the relevant data of inpatient deliveries from maternal monitoring information system involving 22 monitoring hospitals provided by Hebei Center for Maternal and Child Health were collected, including maternal delivery hospital, maternal age, marital status, education level, number of pregnancies, deliveries and prenatal examinations, season of delivery, complications during this pregnancy, mode of delivery, gender and body mass of newborn, and occupancy at NICU.

A total of 366 212 pregnant women were enrolled in this study, 25 995 of whom were diagnosed with GDM, with the incidence rate of 7.1%. The prevalence of maternal GDM showed an upward trend year after year from 2014 to 2021 (χ²_trend=6 921.4, P<0.001). The incidence rate of GDM in advanced maternal aged (χ²_trend=779.0, P<0.001) and urban maternity (χ²_trend=5 057.1, P<0.001), showing an upward trend year after year. And there were statistical significant differences in the prevalence of GDM among different regions of Hebei Province (χ²=16 919.785, P<0.001). The prevalence of maternal GDM in urban〔10.6% (19 200/180 369) 〕was higher than rural〔3.7% (6 795/185 843) 〕 from 2014 to 2021 in Hebei Province (χ²=6 872.800, P<0.001). There were significant differences in prevalence of maternal GDM among primary〔0.7% (34/4 731) 〕, secondary〔3.7% (6 733/180 923) 〕, and tertiary hospitals〔10.6% (19 228/180 558) 〕from 2014 to 2021 in Hebei Province (χ²=6 872.800, P<0.001). There were statistically significant differences in the prevalence of maternal GDM among women of different maternal age, educational level, number of pregnancies, deliveries and prenatal examinations (P<0.05); The prevalence of GDM in women aged 18-<35, 35-<40, and ≥40 years was higher than women aged <18 years, and the prevalence of GDM in women aged 35-<40, and ≥40 years was higher than women aged 18-<35 years; The prevalence of GDM of women with university or higher education level was higher than women with high school, junior high school, primary school and illiteracy; The prevalence of GDM of women with multiple pregnancies was higher than women with 1 pregnancy; The prevalence of GDM of multipara was higher than unipara; The prevalence of GDM of women ≥8 prenatal examinations was higher than women of <8 prenatal examinations. There were statistically significant differences in the prevalence of maternal GDM among women with deliver season of spring (March to May) 〔7.27% (6 583/90 546) 〕, summer (June to August) 〔6.95% (6 360/91 521) 〕, autumn (September to November) 〔7.08% (6 632/93 729) 〕 and winter (December to February) 〔7.10% (6 420/90 416) 〕 from 2014 to 2021 in Hebei Province (χ²=9.350, P<0.05). The differences in maternal GDM were statistically significant when comparing the combination of gestational hypertension, anemia and uterine atony, delivery modes, and deliver of macrosomia (P<0.05) .

The prevalence of GDM in Hebei Province was 7.1% from 2014 to 2021, showing an upward trend from 2014-2021. And the prevalence of GDM is increased in women with advanced age, living in urban, with high education level, multiple pregnancies, and multipara.

Metabolism-associated fatty liver disease (MAFLD) is considered as a major cause of increased morbidity and mortality from liver disease, type 2 diabetes mellitus (T2DM) is a driving factor in the progression of MAFLD. Estimated glucose processing rate (eGDR) is a simple evaluation indicator of insulin resistance in patients with T2DM, while its relationship with MAFLD has been rarely studied.

To investigate the correlation between eGDR and MAFLD in type 2 Diabetes and its predictive value.

A total of 1 434 patients with T2DM who were hospitalized in Hebei Provincial People's Hospital from 2019-01-01 to 2019-12-31 were selected as the study subjects. baseline data of the patients was collected, with their venous blood from the elbow collected for laboratory examination, and liver condition examined by abdominal ultrasound. According to the results of abdominal ultrasonography, T2DM patients were divided into MAFLD group (n=734) and non-MAFLD group (n=700). The subjects were divided into T1 group (eGDR≤5.09, n=477), T2 group (5.09<eGDR≤7.11, n=478) and T3 group (eGDR>7.11, n=479) according to the eGDR tertiles. Spearman rank correlation analysis was used to explore the correlation between eGDR and baseline data. Univariate and multivariate Logistic regression analysis was used to explore the influencing factors of combined MAFLD. The multiplicative interactions of eGDR with gender, age, hypertension, glycated hemoglobin A1c (HbA_1c), BMI and glutamyl transferase (GGT) were evaluated. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of combined prediction model, FBG and HbA_1c for MAFLD in T2DM and areas under curve (AUC) were calculated and compared by Delong test.

Age, disease course, HDL-C and eGDR of MAFLD group were lower than non-MAFLD group. BMI, alcohol consumption, proportions of hypertension and smoking, fasting blood glucose (FBG), uric acid (UA), total cholesterol (TC), TG, low density lipoprotein cholesterol (LDL-C), alanine aminotransferase (ALT), aspartate aminotransferase (AST), GGT and ALB were higher than non-MAFLD group (P<0.05). The proportion of hypertension, age, BMI, FBG, HbA_1c, Scr and TG in T3 group were lower than those in T1 and T2 groups, GGT was lower than that in T1 group, HDL-C and ALB were higher than those in T1 and T2 groups, the proportion of hypertension, BMI, FBG, HbA_1c and TG in T2 group were lower than those in T1 group (P<0.05). eGDR was negatively correlated with age, FBG and ALB in patients with MAFLD (P<0.05). In patients without MAFLD, eGDR was negatively correlated with age, disease course, FBG, Scr, TG and ALB (P<0.05), and positively correlated with HDL-C, AST and GGT (P<0.05). Multivariate Logistic regression analysis showed that eGDR〔OR=0.814, 95%CI (0.772, 0.858), P<0.001〕, T1 group〔OR=1.310, 95%CI (1.003, 1.712), P=0.048〕and T2 group〔OR=2.554, 95%CI (1.941, 3.359), P<0.001〕 was an influencing factor of T2DM with MAFLD (P<0.05). BMI (P_interaction<0.001), GGT (P_interaction=0.033), hypertension (P_interaction<0.001) had interaction with eGDR. The AUC of the combined prediction model was 0.743, which was greater than FBG (Z=3.227, P=0.001) and HbA_1c (Z=1.877, P=0.061) .

The level of eGDR in T2DM patients with MAFLD is significantly lower than that in patients without MAFLD, and patients with low eGDR level have a higher risk of MAFLD. eGDR is a risk factor for MAFLD with T2MD. The combined prediction model of eGDR can be used as a predictor to evaluate the risk of MAFLD with T2MD.

Glycemic control is usually poor in patients with endogenous-insulin-deficient diabetes, while low-carbon diets (LCD) are beneficial for glycemic control among patients with diabetes. However, few studies on LCD in patients with endogenous-insulin-deficient diabetes have been reported.

To investigate the efficacy and safety of LCD for patients with endogenous-insulin-deficient diabetes.

A total of 80 patients with endogenous-insulin-deficient diabetes (fasting C-peptide≤0.5 ng/mL) who were hospitalized in Shanghai Eighth People's Hospital from August 2018 to August 2022 were selected as research subjects and divided into the control diet (CD) group with 55 cases and LCD group with 25 cases. The CD group and LCD group were matched by propensity score matching (PSM) in a 1∶1 ratio based on age and diabetes duration as matching indicators and caliper value as 0.3. The two groups of patients were compared in terms of glycemic control on the first day of hospitalization and at discharge, including average blood glucose, coefficient of variation (CV), percentages of time in range (TIR), time below range (TBR) and time above range (TAR); use of antidiabetic drugs, including the numbers and dosages of daily insulin injection and the types of oral antidiabetic agents; incidence of adverse events, including proportion of individuals who developed diabetic ketoacidosis (DKA) or hypoglycemia.

After PSM, 22 patients were included in the CD group and LCD group, respectively. The percentages of CV〔 (26.03±7.61) % vs. (33.79±12.46) % 〕and TAR〔 (20.19±17.57) % vs. (30.43±15.74) %〕were lower in the LCD group than in the CD group (both P<0.05), the percentage of TIR〔 (77.79±17.36) % vs. (67.05±17.59) %〕 was higher in the LCD group than in the CD group (P<0.05). The numbers and dosages of daily insulin injection and the types of oral antidiabetic agents in the LCD group were significantly lower than those in the CD group (P<0.05). There was no significant difference in the incidence of adverse events (4 cases, 18.2% vs.5 cases, 22.7%) between the two groups during hospitalization (P=0.709) .

Compared to general diet, LCD is beneficial in reducing glucose variability, prolonging TIR, reducing the use of antidiabetic agents without increasing the risk of DKA or hypoglycemia for patients with endogenous-insulin-deficient diabetes.

At present, there are few intervention studies on cognitive frailty in elderly diabetic patients. This study aims to explore the application effect of Baduanjin combined with cognitive training in elderly diabetic patients with cognitive frailty, in order to provide reference for the management of this population.

To explore the intervention effect of Baduanjin combined with cognitive training on elderly diabetic patients with cognitive frailty.

A total of 84 elderly diabetic patients with cognitive frailty hospitalized in the Department of Endocrinology, Shanxi Provincial People's Hospital from October 2021 to April 2022 were selected as research subjects by convenient sampling method, and randomly divided into the experimental group (n=42) and the control group (n=42) according to the random number table method. The patients in the experimental group received Baduanjin exercise combined with cognitive training, 3 times per week for 12 weeks; patients in the control group were given routine exercise and health education. General data of the patients were collected, including gender, age, education level, marital status, residential status, personal monthly income, type of medical insurance and number of comorbid chronic diseases. The Montreal Cognitive Assessment (MoCA) score, Frailty Phenotype (FP) score, gait speed, grip strength and glycated hemoglobin A1c (HbA_1c) were compared at baseline, 6 weeks and 12 weeks of intervention between the two groups.

During the study period, 3 cases were lost to follow-up in the control group and 2 cases were lost in the experimental group, a total of 79 patients were finally included (39 cases in the control group and 40 cases in the experimental group) . There was no significant difference in the general data between the two groups (P>0.05) . There were interaction effects of group and time on MoCA score, FP score, gait speed and grip strength (P<0.05) . MoCA score of patients in the experimental group was higher than that in the control group at 12 weeks of intervention (P<0.05) , and higher than that at baseline and 6 weeks of intervention (P<0.05) . FP score of patients in the experimental group was lower than that in the control group at 12 weeks of intervention, and lower than that at baseline and 6 weeks of intervention (P<0.05) . Gait speed and grip strength of patients in the experimental group were higher than those in the control group at 12 weeks of intervention, and higher than those at baseline and 6 weeks of intervention (P<0.05) . HbA_1c level of patients in the experimental group was lower than that in the control group, and lower than that at baseline at 12 weeks of intervention (P<0.05) .

Baduanjin combined with cognitive training can slow down the decline of cognitive function in elderly diabetic patients, improve physical frailty and reduce the blood glucose level of patients, which is suitable for vigorously promoting in the clinical and community settings.

Gestational diabetes mellitus (GDM) is a common complication during pregnancy. However, the adherence to individualized medical nutrition therapy (IMNT) alone among GDM women is poor and the impact of group cognitive behavioral therapy (GCBT) on their pregnancy outcomes remains unclear.

To examine the impact of GCBT on the pregnancy outcomes of women with GDM, and to provide reference for improving pregnancy outcomes and developing effective gestational diabetes management programme.

A total of 878 pregnant women with GDM who delivered and received IMNT in our hospital from 2020 to 2021 were retrospectively selected as the study subjects and divided into the observation group including 141 pregnant women with GDM who received GCBT and the control group including 737 pregnant women with GDM who did not receive GCBT. The differences in pregnancy outcomes of pregnant women with GDM between the two groups before and after propensity score matching were analyzed.

There were 134 pregnant women with GDM in the observation group and 256 pregnant women with GDM in the control group after 1∶2 propensity score matching. The proportion of pregnant women with GDM who gained normal weight in the observation group (50.7%, 68/134) was higher than that in the control group (37.5%, 96/256) (P<0.05) . The gestational weeks of delivery of pregnant women with GDM in the observation group (39.0±1.1) were longer than those in the control group (38.5±1.7) (P<0.05) . Additionally, the proportions of preterm infants (3.7%) , macrosomia (1.5%) , and low birth weight infants (2.2%) were lower than those in the control group (10.5%, 5.9%, and 9.0%, respectively) (P<0.05) .

GCBT can help reduce the risk of the delivery of preterm infants, low birth weight infants, and macrosomia in pregnant women with GDM, providing a reference for the establishment of a multidisciplinary management model for GDM.

In recent years, with the aging of the population and the change of lifestyles, patients with type 2 diabetes mellitus (T2DM) have a high prevalence of malignancies, the duration of T2DM and the use of T2DM drugs may accelerate the occurrence of malignant tumor.

To analyze the risk of incidence and influencing factors of malignant tumors in patients with T2DM.

Patients with T2DM who were first treated or diagnosed at the Affiliated Hospital of Nantong University from October, 2011 to December, 2020 were prospectively included, with the follow-up termination date of September 30, 2021. The information of tumor incidence and full cause of death of patients were obtained by matching the ID information with the linkage records of the chronic disease tumor registration system and the cause of death registration system of Nantong City. The crudeincidence rate (CIR) and standardized incidence ratio (SIR) of malignant tumors among T2DM patients were calculated separately by gender. Cox proportional hazard regression model was used to explore the effects of the duration of T2DM and drug use on the incidence of malignant tumor in T2DM patients.

A total of 12 006 patients with T2DM were included in this study, involving 6 328 males (52.71%) and 5 678 females (47.29%). After 56 371 person-years of observation (29 543 person-years for males and 26 824 person-years for females), 601 patients with malignant tumor and 11 405 patients with T2DM alone were observed. The CIR of malignant tumor in T2DM patients was 1 093.24/100 000 in men and 1 032.51/100 000 in women, respectively. The top five combined tumors in T2DM patients are colorectal cancer, lung cancer, liver cancer, gastric cancer, and prostate cancer in male, while breast cancer, lung cancer, colorectal cancer, gastric cancer and pancreatic cancer in female. The incidences of colorectal cancer (SIR=2.03), prostate cancer (SIR=2.24), pancreatic cancer (SIR=1.75), kidney cancer (SIR=4.25), thyroid cancer (SIR=3.50) were higher in male T2DM patients than general population, while the incidences of lung cancer (SIR=0.61) and esophageal cancer (SIR=0.22) were lower than general population. The incidences of breast cancer (SIR=2.59), colorectal cancer (SIR=1.57), pancreatic cancer (SIR=2.10), endometrial cancer (SIR=2.83), kidney cancer (SIR=3.67), thyroid cancer (SIR=4.00) were higher in female T2DM patients than general population, while the incidence of esophageal cancer (SIR=0.27) was lower than general population. Compared with T2DM patients with disease duration of 1 to <3 years, the risk of malignant tumor was increased by 91% 〔HR=1.91, 95%CI (1.15, 3.20) 〕, 123%〔HR=2.23, 95%CI (1.37, 3.64) 〕 and 71%〔HR=1.71, 95%CI (1.04, 2.80) 〕in male with disease duration <1 year, 5 to <10 years and≥10 years, respectively, the risk of malignant tumor was increased by 79%〔HR=1.79, 95%CI (1.10, 2.92) 〕 and 99%〔HR=1.99, 95%CI (1.24, 3.19) 〕 in female with T2DM duration of 5 to <10 years and ≥10 years, respectively (P<0.05). Insulin use alone increased the risk of malignant tumor by 72%〔HR=1.72, 95%CI (1.25, 2.36) 〕and 116%〔HR=2.16, 95%CI (1.53, 3.05) 〕 in male and female, respectively (P<0.05). In addition, there was a significant interaction between insulin use and the duration of T2DM in male, the risk of malignant tumor was decreased by an average of 6% with the interaction over the years (P_interaction=0.006) .

In addition to esophageal cancer in both sexes and lung cancer in male, the risk of colorectal cancer, prostate cancer, pancreatic cancer, kidney cancer, thyroid cancer, breast cancer and endometrial cancer increase by 57%-325% in patients with T2DM, and associated with the disease duration and insulin use, with the greatest risk of malignant tumor in male with disease duration of 5 to <10 years and in female with disease duration of ≥10 years. However, there is an antagonistic interaction between insulin use and increased duration of T2DM disease on the incidence of malignant tumor.

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

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

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

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

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

As a new indicator of glycemic management, time in range (TIR) is significantly related to short-term glycemic variability, but whether it is also associated with long-term glycemic variability is still unclear.

To investigate the relationship of TIR with coefficient of variability (CV) of HbA_1c and HbA_1c variability score (HVS) during a long-term follow-up in elderly male patients with type 2 diabetes.

Two hundred elderly male type 2 diabetic inpatients from the Second Medical Center of PLA General Hospital were enrolled from January 2007 to January 2011. All of them underwent continuous glucose monitoring (CGM) during hospitalization, and by the baseline TIR derived from CGM, they were divided into TIR≥85% group (n=141) and TIR<85% group (n=59), and followed up for (12.5±1.1) years. The CV of HbA_1c and HVS in the follow-up were compared between the groups. The relationships of TIR with the CV of HbA_1c and HVS were analyzed using Pearson correlation analysis and multivariate linear regression analysis.

The long-term CV of HbA_1c〔 (9.7±3.8) % vs (8.2±4.5) %, P=0.028〕 and HVS〔 (48.7±20.4) vs (32.5±20.8), P<0.001〕 in TIR<85% group were both significantly higher than those in TIR≥85% group. Pearson correlation analysis suggested that TIR showed a significant linear negative correlation with CV of HbA_1c (r=-0.239, P<0.001) or HVS (r=-0.400, P<0.001). Multiple linear regression analysis indicated that TIR had an impact on long-term CV of HbA_1c〔b (95%CI) =-0.07 (-0.12, -0.03), P<0.05〕or HVS〔b (95%CI) =-0.44 (-0.67, -0.21), P<0.05〕after adjusting for confounding factors.

TIR was independently associated with long-term CV of HbA_1c or HVS in elderly male patients with type 2 diabetes. With the decrease of TIR, the long-term HbA_1c glycemic variability increased gradually during follow-up.

Diabetic foot is a serious chronic complication of diabetes, tibial transverse transport (TTT) technique can promote the regeneration of vascular tissue, improve microcirculation, achieving good results in the treatment of diabetic foot ulcers, but traditional TTT technique has many complications, which needs to be improved to reduce postoperative complications.

To investigate the efficacy of modified TTT technique, that is, bone and periosteum combined transport technique, in the treatment of patients with Wagner grade Ⅲ and Ⅳ diabetic foot.

The clinical data of 117 diabetic foot patients treated with modified TTT technique in the hand and foot surgery of Yantai Yuhuangding Hospital from January, 2018 to May, 2021 were retrospectively analyzed, and the postoperative foot preservation, functional limb preservation, large amputation, ulcer healing time, complication, foot skin temperature improvement, resting pain, preoperative and postoperative CTA results were collected. The follow-up was till to March 31, 2022.

The follow-up time ranged from 5.5 to 24.0 months, with an average of (14.21±4.06) months. The postoperative foot preservation rate (no amputation or amputation below ankle) was 95.73% (112/117) , the functional limb preservation rate (no amputation or minor amputation distal to midfoot) was 83.76% (98/117) , the major amputation rate (amputation above ankle) was 4.27% (5/117) , and the postoperative ulcers healed well in all patients except amputees, with an average time to healing of (9.07±2.02) weeks, ranging from 6 to 14.5 weeks. The postoperative foot skin temperature at 1, 2, 4, and 8 weeks of the patients were significantly improved compared with the preoperative period (P<0.01) ; The postoperative VAS scores of 35 patients with resting pain at 1, 2, 4, and 8 weeks compared with the preoperative period (P<0.01) ; the CTA results showed improved postoperative vascular condition, increased microvascular vessels number and reconstructed vascular network of the foot in 70.34% (94/117) of included patients postoperatively; The incidence of complication during bone handling was 11.97% (14/117) , among which the incidence of osteotomy area skin edge necrosis, deep vein thrombosis, and pin track infection was 5.98% (7/117) , 4.27% (5/117) , and 1.71% (2/117) , respectively.

The modified TTT technique can promote wound healing through the stimulation of lower limb microcirculation reconstruction, to alleviate resting pain and improve foot skin temperature in diabetic foot patients effectively in the short term, with low incidence of complication, providing an effective approach for the treatment of diabetic foot.

Serum alanine transaminase (ALT) and aspartate aminotransferase (AST) are common liver enzymes, but there are few studies on the correlation of these enzymes with the prevalence of type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS) .

To explore the association of serum ALT and AST/ALT ratio with T2DM and MS in older physical examinees in the community.

From January to December, 2018, 30 060 elderly people (≥65 years) who underwent free physical examination in 19 community health centers of 6 districts in Wuhan were chosen as the subjects. Their demographic data, life style, previous medical history, and results of physical examination and biochemical test were collected. Subjects were divided into quartile groups of ALT〔Q1 (ALT≤11 U/L, n=8 116), Q2 (11 U/L<ALT≤14 U/L, n=7 008), Q3 (14 U/L<ALT≤19 U/L, n=7 438), Q4 (ALT>19 U/L, n=7 498) 〕, or quartile groups of AST/ALT ratio〔q1 (AST/ALT≤1.06, n=7 386), q2 (1.06<AST/ALT≤1.31, n=7 698), q3 (1.31<AST/ALT≤1.62, n=7 529), q4 (AST/ALT>1.62, n=7 447) 〕. Cochran χ² test was used to compare the prevalence trend of T2DM, MS, abdominal obesity, hypertension, elevated triglycerides (TG) and lowered high-density lipoprotein cholesterol (HDL-C) with the change of ALT level and AST/ALT ratio. Multivariate Logistic regression analysis was used to explore the correlation of prevalence of T2DM and MS with ALT level and AST/ALT ratio.

The age of 30 060 subjects (13 381 men and 16 679 women) was 65-99 years old, and the average age was (71.7±5.6) years old. The prevalence of T2DM and MS was 18.76% (5 488/30 060) and 29.73% (8 938/30 060), respectively. The regular exercise rate, BMI, waist circumference, systolic pressure, diastolic pressure, ALT, TG and fasting plasma glucose (FPG) were significantly higher and smoking rate, drinking rate, AST, AST/ALT ratio, total cholesterol (TC), HDL-C, low-density lipoprotein cholesterol (LDL-C) were significantly lower in T2DM subjects compared to non-T2DM subjects (P<0.01). MS subjects had significantly higher regular exercise rate, BMI, waist circumference, systolic pressure, diastolic pressure, ALT, TC, TG and FPG, and significantly lower male ratio, smoking rate, drinking rate, AST/ALT ratio, HDL-C and LDL-C than non-MS subjects (P<0.01). The prevalence of T2DM, MS, abdominal obesity, hypertension, elevated TG and lowered HDL-C increased with the increase of ALT level, and decreased with the increase of AST/ALT ratio (P<0.01). Multivariate Logistic regression analysis showed that compared with group Q1, the risk of T2DM and MS in group Q2-Q4 was increased (P<0.01), and the risk of T2DM and MS in group Q2-Q4 was decreased compared with group q1 (P<0.01). The prevalence risk of T2DM and MS was increased in Q2-Q4 groups compared to Q1 group, and in contrast, the risk was decreased in q2-q4 groups when comparing to q1 group (P<0.01) .

Serum ALT have an association with the prevalence of T2DM and MS, as well as AST/ALT ratio. Either elevated ALT or lowered AST/ALT ratio may increase the risk of prevalence of T2DM and MS.

The incidence of diabetic kidney disease (DKD) and the proportion of its related end-stage renal disease in dialysis patients in China are increasing. So it is urgent to take measures to prevent and control DKD. Intensified multifactorial interventions may prevent or delay the progression of DKD. Therefore, developing a personalized risk prediction model can effectively delay or even prevent the progression of DKD and be useful for the prevention and treatment of DKD.

The purpose of this study was to develop and validate a nomogram for the risk prediction of the progression from microalbuminuria (MAU) to macroalbuminuria (CAU) in type 2 diabetes mellitus (T2DM) patients.

A total of 1 263 T2DM patients with albuminuria who were hospitalized in Department of Endocrinology, the First Affiliated Hospital of Air Force Medical University from October 2016 to March 2020 were retrospectively recruited and divided into a development cohort of 906 cases and a validation cohort of 357 cases, according to the admission time. LASSO regression was used to screen the optimized variables measured at baseline for CAU. A Nomogram was constructed based on selected predictive factors identified by the multivariate logistic regression model of the development sub-cohort. The receiver operating characteristic (ROC) curve, calibration curve and Hosmer-Lemeshow (H-L) test were employed to assess the calibration and discrimination of the model. Decision curve analysis (DCA) was performed to evaluate the net clinical benefit of the Nomogram.

The diabetes duration, systolic blood pressure (SBP), glycosylated hemoglobin A1c (HbA_1c), low-density lipoprotein cholesterol (LDL-C), cystatin C (Cys-C), estimated glomerular filtration rate (eGFR), and diabetic retinopathy (DR) were screened as predictive factors for progression from MAU to CAU by LASSO penalty regression. Multivariable Logistic regression analysis using these factors indicated that seven of those potential predictors were present in the final model, diabetes duration≥10 years, SBP≥140 mmHg, HbA_1c≥7.0 mmol/L, LDL-C≥1.8 mmol/L, Cys-C>1.09 mg/L, and DR were risk factors for the progression from MAU to CAU in T2DM patients (P<0.05), while eGFR showed no statistically significant association with the progression in stratified analysis (P>0.05). External and internal validations of the nomogram indicated a good predictive performance. The AUC of the model was 0.814〔95%CI (0.782, 0.846) 〕 in the development cohort, and was 0.768〔95%CI (0.713, 0.823) 〕 in the validation cohort. The model was well fit according to the calibration curve and the H-L goodness of fit test (internal validation: P=0.065; external validation: P=0.451). DCA curve showed that the Nomogram's net benefit was higher than both extreme curves when the threshold probability set between 0.08 and 0.74 in the development cohort, and between 0.14 and 0.70 in the external validation cohort, suggesting potential clinical benefits provided by this Nomogram.

This study finally constructed a prediction model with seven indicators containing diabetes duration, SBP, HbA_1c, LDL-C, Cys-C, eGFR, and DR, and will be a useful clinical predictive tool for the risk of progression from MAU to CAU in T2DM patients.

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

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

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

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

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