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Objective To investigate the overall state of the glycemic control in children with type 1 diabetes mellitus (T1DM) in a single center and analyze the related factors. Methods This cross sectional clinical based research was conducted among patients under 18 years old diagnosed with type 1 diabetes (the duration of diabetes>3 months) from the Diabetes Clinic of Beijing Children's Hospital from January 2015 to December 2019. The patients were required to receive a follow up every 3 months. The follow up data of the same patient were collected once a year. Glycosylated hemoglobin (HbA1c) was taken as the main research index (the selection principle was the median glycosylated hemoglobin per year). Demographic data included age at onset and at follow up, sex, duration of diabetes, years of follow up. In addition, clinical information on weight, height, modalities of insulin treatment (number of injections or pump therapy), the frequency of self monitoring of blood glucose (SMBG) per day or using of continuous glucose monitoring (CGM)/flash glucose monitoring (FGM) were collected. According to the years of follow-up, the patients were divided into 5 groups. According to the HbA1c control target (7.0%), the patients were divided into the good-control group (HbA1c<7.0%) and the poor-control group (HbA1c ≥7.0%). According to the age of the patients, they were divided into three groups (<5 years old group, 5 to 10 years old group and>10 years old group). The general situation of blood glucose control from 2015 to 2019 was compared by groups, and the related factors were analyzed by linear regression and two level logistic regression. Results A total of 1 976 patients with T1DM were collected (2015 n=362, 2016 n=410, 2017 n=415, 2018 n=384, 2019 n=405), the age was 10.09 (7.18, 12.85) years old; the duration of diabetes was 1.94 (0.88, 3.86) years, 49.5% (978/1 976) were male. There was no significant difference in age, sex and duration of disease among each groups (P>0.05), and comparable. HbA1c decreased from 7.4% (6.7%, 8.3%) in 2015 to 6.8% (6.1%, 7.6%) in 2019 (P< 0.01). The rate of achieved A1C target increased year by year [34.5% (125/362), 42.0% (172/410), 47.0% (195/415), 55.2% (212/384) and 56.3% (228/405), respectively], and the difference was statistically significant (Z=7.02, P<0.01). The HbA1C was positively correlated with age and duration of disease (r=0.095, 0.170 respectively, P<0.01). Logistic regression analysis showed that older of age, longer duration of disease and less frequency of daily blood glucose monitoring were the risk factors of failing to achieve HbA1c target. Conclusions From 2015 to 2019, HbA1c in children with T1DM has decreased year by year, and the rate of achieved A1C target has increased year by year, and it has increased by 1.63 times in 2019 compared with 2015. The increase in the use of CGM/FGM is the main factor to improve blood glucose control. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of growth differentiation factor-11 (GDF-11) on bone marrow endothelial progenitor cells (BM-EPC) cultured with high glucose and its possible mechanism. Methods BM-EPC were cultured in vitro and divided into the following groups: normal glucose (NG) group, high glucose (HG) group, HG+recombinant GDF-11 (rGDF-11) group and HG+rGDF-11+TGF-β receptor I inhibitor SB431542 group. Proliferation was assessed by MTT, and apoptosis of EPC were stained with Annexin V-FITC and propidium iodide (PI), and assessed by flow cytometry. The expression of Bcl-2, Bax and Cleaved-caspase 3 were detected by western blot. The phosphorylation of Smad were assessed by immunofluorescence. Data among multiple groups were compared by using one-way ANOVA and the least significant difference t test. Results Compared with the vehicle control group, Bcl-2/Bax ratio decreased, the protein levels of Cleaved-caspase 3 increased and the percentage of apoptotic EPC elevated in those groups cultured with HG [0.45±0.09 vs 1.21±0.23, 0.28±0.02 vs 0.07±0.00, (18.63±3.02)% vs (2.82±0.46)%, t=3.04, -68.06, -7.60, all P<0.05]. However, the effects were blocked by pretreated with rGDF-11. Treatment of EPC with TGF-β receptor I inhibitor SB431542 partially abolished the pro-proliferation and anti-apoptotic effects of GDF-11 (0.56 ± 0.11 vs 1.14 ± 0.07, t=4.33, P<0.05). Immunofluorescence analyses showed that Smad2/3 phosphorylation decreased in high glucose culturing. Pre-incubation with rGDF-11 restored p-Smad2 / 3 expression, however, GDF-11 mediated Smad2 / 3 activation was partially blocked by SB431542 (0.89±0.12 vs 1.21±0.12, t=-3.20,P<0.05). Conclusion GDF-11 may prevent high glucose-induced EPC apoptosis and improve proliferation through activation of TGF-β/Smad2/3 signaling pathway. [ABSTRACT FROM AUTHOR]