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BACKGROUND: Berberine has the potential to induce osteogenic differentiation of various mesenchymal stem cells under normal conditions and special conditions such as high glucose, infection and inflammation. It is a natural small molecule drug that can induce bone formation in seed cells instead of growth factors, and has great application prospect in bone tissue engineering. OBJECTIVE: To review and summarize the research progress in the osteogenic mechanism and efficacy of berberine, especially its osteogenic potential under high glucose, infection and inflammation conditions, and its biological safety, so as to provide theoretical basis for its development and application in bone tissue engineering. METHODS: PubMed, WanFang, and CNKI were searched for relevant literature using the keywords of “berberine, bone defects, bone repair, bone regeneration, osteoinductive, osteoporosis, osteoblast, osteoclast, bone tissue engineering, bone, high glucose, diabetes, inflam*, infect*” in English and Chinese, respectively. A total of 105 literatures were selected for review. RESULTS AND CONCLUSION: Berberine can be used to treat multiple diseases including bone diseases, and it has the ability to promote bone regeneration. This article systematically reviews the mechanism of berberine on bone regeneration and in vivo and in vitro studies. Studies have shown that it can play a role in bone repair by promoting osteogenesis, inhibiting osteoclast formation and activity, and preventing osteoporosis. It shows excellent osteogenic differentiation potential mainly via Wnt/β-catenin, PI3K/AKT, EGFR/MEK/p38MAPK, cAMP/PKA/CREB, ERK and other signaling pathways. Berberine can also relieve the inhibition of osteogenic differentiation caused by high glucose, infection and inflammation, which provides more possibilities for the treatment of bone defects in patients with diabetes or infection and inflammation in the bone defect site. Berberine also has the advantages of low toxicity, low price, easy access (currently it can be synthesized), which is a relatively ideal bone induction potential drug. In recent years, the application of berberine in the treatment of bone defect tends to be localized, mainly through the combination with bone tissue engineering technology to improve bioavailability, and has shown good bone repair effect and excellent biological safety in animal experiments. In addition, preclinical experiments have shown splendid bone regeneration potential in the conditions of diabetes, local infection and inflammation. In the future, more studies are needed to fully reveal the osteogenic mechanism and biological safety of berberine, and seek the most suitable controlled release loading system to make artificial bone replacement materials with good mechanical strength, efficacy and biological safety. [ABSTRACT FROM AUTHOR]

Objective To observe the intervention effect of serum containing Fufang Zhenshu Tiaozhi capsule (FTZ) on palmitic acid (PA) -induced damage to islet β cells in rats. Methods Rat islet β cells INS-1 were cultured and randomly divided into the blank control group, bovine serum albumin (BSA) control group, PA group, and experimental group, respectively. Cells in all groups were cultured in RPMI1640 complete medium, with the BSA control group receiving 1% BSA in the culture medium, the PA group and experimental group receiving 0. 5 mmol/L PA solution, and the experimental group additionally receiving 10% FTZ-containing serum. After treatment, cells were cultured for 24 h. West‐ ern blotting was used to detect the expression of endoplasmic reticulum stress-related protein (CHOP) and autophagy-relat‐ ed proteins (ATG5, BECLIN1) in cells, while real-time fluorescence quantitative PCR was used to detect CHOP, ATG5, and BECLIN1 mRNA. The DCFH-DA reactive oxygen species (ROS) fluorescence probe was used to detect ROS in cells. Results The protein and mRNA expression levels of CHOP and ROS content in the PA group were higher than those in the blank control group and BSA control group, while the protein and mRNA levels of CHOP, and ROS content in the experimental group were lower than those in the PA group (all P<0. 05). The ATG5 and BECLIN1 protein and mRNA expression levels in the PA group were lower than those in the blank control group and BSA control group, while the ATG5 and BE‐ CLIN1 protein and mRNA expression levels in the experimental group were higher than those in the PA group (all P< 0. 05). Conclusion FTZ can reduce oxidative stress and endoplasmic reticulum stress, enhance autophagy, and thus reduce the PA-induced damage to islet β cells. [ABSTRACT FROM AUTHOR]

Copyright of Science & Technology of Food Industry is the property of Science & Technology of Food Industry Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Food Research & Development is the property of Food Research & Development Editorial Department and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the active components and potential molecular mechanism of Triphala (composed of Phyllanthi Fructus, Terminaliae Belliricae Fructus and Chebulae Fructus, THL) in regulating the function of pancreatic islet β by using the network pharmacology method and animal experiment verification. Methods The active constituents and predicted targets of THL were obtained by Traditional Chinese Medicine Database and Analysis Platform (TCMSP) combined with literature search and SwissADME. The main targets of diabetes were obtained from Drugbank, Genecards, OMIM and TTD databases. Venn diagram was used to analyze the common genes of drugs and disease, and STRING database and CytoScape 3.8.0 software was used to construct the protein-protein interaction (PPI) network of the common targets of “THL- compositions- targets- genes- disease.” The potential targets and their enrichment pathways were visualized using ClueGO and CytoHubba. Wistar male rats were randomly divided into normal group, model group and low-, medium- and high- dose (0.43, 0.86, 1.72 g·kg-1) THL groups. The diabetic model was replicated by introperitoneally injecting streptozotocin (STZ). The followup experiment was carried out with corresponding drug. Pancreatic islet function index calculation, pathological section staining, and PCR detection were then carried out. Results There were 23 active ingredients in THL, 434 predicted targets, 1 200 disease genes. A total of 146 common genes in THL and diabetes were obtained by Venn analysis. It was found that THL in the treatment of diabetes was mainly related to regulating insulin secretion, glucose transmembrane transport, activation of protein kinase, promoting vascular growth and MAPK cascade reaction, which were involved seven core targets including protein kinase B alpha (AKT1), glyceraldehyde -3- phosphate glyceraldehyde dehydrogenase (GAPDH), vascular endothelial growth factor A (VEGFA), mitogen activated protein kinase 1 (MAPK1), prostaglandin endoperoxide synthase (PTGS2), signal transduction and transcription activating factor 3 (STAT3), and Toll-like receptor 4 (TLR4) . Animal validation results showed that THL could increase HOMA- β index (P＜0.01), promote recovery of pancreatic islet volume and β cell function, decrease the number of α cell, and significantly up-regulate the expression of AKT1 and GAPDH genes in rat pancreatic tissue (P＜0.001), as well as down-regulate the expression of VEGFA, MAPK1, PTGS2, STAT3, and TLR4 genes (P＜0.001, P＜0.0001). The partial prediction of network pharmacology results were validated with the experimental results. Conclusion THL can treat diabetes through multiple targets and pathways. It is confirmed that THL could achieve the effect of treating diabetes by regulating seven key target genes including AKT1, GAPDH, VEGFA, MAPK1, PTGS2, STAT3 and TLR4 to regulate the function of pancreatic islet β cells. This study can provide a reliable basis for the clinical use and basic research of THL in antidiabetes. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between stress-induced hyperglycemia in acute pancreatitis (AP) patients and the risk of developing new-onset diabetes after pancreatitis. Methods This study selected patients with acute pancreatitis (AP) who had no prior history of diabetes and were hospitalized in the Department of Gastroenterology at Nanjing Drum Tower Hospital, affiliated with Nanjing University, 2015-2019. New-onset diabetes after pancreatitis was diagnosed based on established criteria. The relationship between stress-induced hyperglycemia upon admission and the risk of developing new-onset diabetes was assessed using the COX proportional hazards model. Stratified analyses were conducted based on gender, age, education level, place of residence, marital status, smoking history, admission diagnosis, Body Mass Index (BMI), history of pancreatic necrosis/abscess, and severity of the condition. Results This study included a total of 1258 participants. The follow-up incidence of diabetes was 28.3%. Patients who experienced stress-induced hyperglycemia upon admission had a higher risk of developing new-onset diabetes compared to those with normal blood glucose levels (HR=1.40, 95%CI:1.06-1.85). Subgroup analysis indicated that patients who were elderly(HR=2.01, 95%CI:1.19-2.12), male(HR=1.17, 95%CI:1.03-2.35), from rural areas(HR=1.37, 95%CI:1.24-1.53), had a history of smoking(HR=1.25, 95%CI:1.14-1.38), had a history of pancreatic necrosis/abscess(HR=1.34, 95%CI:1.07-1.98), BMI≥28 kg/m, 倕 (HR=2.33, 95%CI:1.57-4.553), or had moderate to severe pancreatitis(HR=1.45, 95%CI:1.27-2.58; HR=1.23, 95%CI:1.06-1.93), had a greater risk of developing new-onset diabetes if they experienced stress-induced hyperglycemia. Conclusion Stress hyperglycemia at admission is associated with an increased risk of new-onset diabetes after pancreatitis. Effective glucose management in high-risk AP patients with stress hyperglycemia may help reduce the risk of developing new-onset diabetes. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to explore the use of multifaceted pharmacist intervention in the medication compliance of outpatient polypharmacy diabetic patients, and to evaluate the effectiveness of this multiple strategy on the medication compliance behavior, selfefficacy and medication knowledge of outpatient polypharmacy diabetic patients. Methods: The research design was quasi-experimental, and the research execution period is from September 1, 2022 to December 31, 2023. The participants were purposefully sampled. Elderly diabetes patients with polypharmacy were selected from the metabolism clinic of a regional teaching hospital in Taipei City. Participants were paired and assigned to experimental and control groups. The experimental group was then subjected to multiple intervention strategies for three months. The researcher conducted pretests, including self-reported responses to a medication compliance assessment questionnaire and physiological value measurement for middle-aged and elderly patients with diabetes. A follow-up post-test was administered after the 3-month intervention period. Results: Analyzes were performed using generalized estimating equations. The study found that after a three-month multi-intervention strategy, when the equation controlled for group and time, medication compliance behavior (B = 1.13, p = 0.006) and self-efficacy for appropriate medication use (B = 3.57, p = 0.006) and medication knowledge (B = 3.27, p < 0.001), the interaction effect reached a significant level. In addition, among the clinical physiological indicators, the interaction between weight (B = -0.20, p < 0.001) and BMI (B = -0.07, p < 0.001) reached a significant level, indicating that the experimental group can improve the medication intake of middle-aged and elderly diabetic patients with multiple medications. Cooperation behavior, self-efficacy for appropriate medication, medication knowledge, weight and BMI were significantly better than those of the control group. Conclusions: The study revealed significant improvements in medication adherence, self-efficacy in appropriate medication use, and medication knowledge among middle-aged and elderly diabetic patients with polypharmacy following 3-month course using multifaceted intervention strategy. [ABSTRACT FROM AUTHOR]

Objective To explore the correlation between quantitative analysis of contrast-enhanced ultrasound and insulin resistance and foot blood rheology indices in patients with diabetic foot. Methods A prospective study was conducted from December 2020 to January 2022, involving 80 patients with diabetic microvascular complications (lesion group), 40 diabetic patients (DM group), and 42 healthy controls. All participants underwent contrast-enhanced ultrasound and color Doppler ultrasound examinations. The study analyzed quantitative ultrasound indices, levels of insulin resistance, and foot blood rheology parameters. Pearson correlation analysis was used to evaluate the relationships among these factors. Results The average peak intensity (PI) and area under the time-intensity curve (AUC) in the lesion group were significantly lower than those in the DM and control groups, while the time for contrast to reach the right toe (AT) and time to peak (TTP) were higher (P＜0.05). In insulin resistance indicators, the lesion group showed higher fasting blood glucose (FPG), glycated hemoglobin(HbA1C), 2-hour postprandial blood glucose (2 hFPG), fasting insulin (FINS), and insulin resistance index (HOMA-IR), with lower HOMA-β compared to the DM and control groups (P＜0.05). Foot blood rheology indices such as D, peak systolic velocity (PSV), end-diastolic velocity (EDV), arterial pulsatility index (ARI), and arterial resistance index (API) were all lower in the lesion group than in the DM and control groups (P＜0.05). Conclusion There is a correlation between quantitative analysis of contrast-enhanced ultrasound and insulin resistance and foot blood rheology indices. Specifically, FPG is negatively correlated with PI and AUC, while AUC is positively correlated with D and PSV. Additionally, FPG is negatively correlated with D and PSV. [ABSTRACT FROM AUTHOR]

Diabetes is characterized by persistent hyperglycemia. It is a heterogeneous disease with multiple etiologies, affecting the human body at the level of multiple organs. Black beans have a long history of drug and food homology in China, which are used to treat hypertension, poor blood circulation and other diseases. Many studies have shown that black beans also have certain anti diabetic properties, which has been confirmed in clinical trials. In this paper, the bioactive substances such as polysaccharides, polyphenols, a variety of inorganic trace elements and vitamins and their hypoglycemic activity mechanisms were summarized. These bioactive substances inhibit intestinal a Conclusion; glucosidase activity, protection of pancreatic cells, reduction of insulin resistance, regulation of intestinal microbiota and other mechanisms can effectively regulate blood glucose levels, which provides a new research idea for the treatment of diabetes, and also provides a reference for the treatment of diabetes with other herbal medicines. [ABSTRACT FROM AUTHOR]

Objective To investigate clinical features and risk factors of childhood diabetes mellitus (DM) complicated with urinary tract infection (UTI). Methods The data of 160 children with DM in our hospital in the past 2 years were collected as the research object, and they were divided into the UTI group and the non-UTI group UTI, with 80 cases in each group. The clinical data of children with DM and UTI were collected and analyzed, including DM type, sex, age, body mass index (BMI), living environment, duration of disease, length of hospital stay, indwelling catheter, ketoacidosis, antibiotic and insulin use, the types of bacteria isolated from urine samples and various laboratory indicators on admission. Results Pathogen bacteria mainly included Escherichia coli (n=37, 46.2%), Enterococci (n=21, 26.2%) and Klebsiella pneumoniae (n= 9, 11.2%) in the UTI group. Univariate analysis showed that there were significant differences in obesity, duration of disease, length of hospital stay, indwelling catheter, ketoacidosis, antibiotic use, glycosylated hemoglobin (HbA1c), albumin (ALB) and serum creatinine (Cr) between the two groups (P＜0.05). Multivariate regression analysis showed that risk factors for DM complicating UTI included prolonged hospitalization (OR=2.087, 95%CI: 1.562-2.789), indwelling urinary catheter (OR= 15.886, 95%CI: 2.336-108.007), ketoacidosis (OR=9.300, 95%CI: 1.169-73.992), duration of disease ≥36 months (OR= 20.548, 95%CI: 2.425-174.119), increased HbA1c (OR=16.686, 95%CI: 3.666-75.955) and serum Cr (OR=1.010, 95%CI: 1.002-1.019), while the increased serum ALB (OR=0.799, 95%CI: 0.702-0.910) was its protective factor. Conclusion Pathogenic bacteria in the UTI group are mainly Escherichia coli. Children with DM and UTI are closely related to the length of hospitalization, indwelling catheter, ketoacidosis, duration of disease, HbA1c, serum Cr and ALB levels. [ABSTRACT FROM AUTHOR]

Copyright of Practical Pharmacy & Clinical Remedies is the property of Editorial Department of Practical Pharmacy & Clinical Remedies and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To investigate the effectiveness of cognitive-behavioral therapy (CBT) on reducing the fear of hypoglycemia in diabetic patients. Methods A total of 75 diabetic patients admitted to the Emergency Department of Taizhou Traditional Chinese Medicine Hospital between June 2022 and December 2023 were selected and divided into a control group and an observation group based on their admission sequence, consisting of 37 and 38 cases, respectively. The control group received routine care and health education, while the observation group was provided with cognitive-behavioral therapy (CBT) in addition to the standard care. The glycated hemoglobin (HbA1c) levels were measured before and four weeks after the intervention. The Fear of Hypoglycemia scale with 15 items (FH-15) and the Summary of Diabetes Self-Care Activities (SDSCA) scale were used to collect data. Results At 12 weeks after intervention, the HbA1c level of patients in the observation group was lower than that of patients in the control group (P＜0. 05); The score of FH-15 in the observation group was lower than that in the control group (P＜0. 01); The score of SDSCA in the observation group was higher than that in the control group (P＜0. 01). Conclusion Implementing cognitive-behavioral therapy for diabetic patients can reduce their fear of hypoglycemia (FOH), improve their disease self-management skills, stabilize blood glucose control. (目的 探讨认知行为疗法对糖尿病患者低血糖恐惧的干预效果。方法 选取2022年6月—2023年12月台州市中医院急诊科收治的糖尿病患者75例, 按照入院顺序分为对照组(n=37)和观察组(n=38)。对照组给予常规护理及健康教育, 观察组在对照组基础上实施认知行为疗法。分别与护理干预前、干预后8周和干预后12周检测患者糖化血红蛋白水平, 对比两组患者低血糖恐惧调查量表(FH-15)和糖尿病自我管理行为量表(SDSCA)评分。结果 护理干预后12周, 观察组糖化血红蛋白水平低于对照组, 差异有统计学意义(P＜0. 05); 干预后12周, 观察组FH-15量表评分低于对照组, 差异有统计学意义(P＜0. 01)。干预后12周, 观察组糖尿病自我管理行为量表评分高于对照组, 差异有统计学意义(P＜0. 01)。结论 对糖尿病患者实施认知行为疗法能减轻患者低血糖恐惧程度, 提升其对疾病的自我管理能力, 稳定血糖控制效果。)

Objective To explore the clinical application of detail nursing based on the Knowledge-Attitude-Belief-Practice (KABP) model in patients with upper urinary tract stones complicated with diabetes mellitus, and to evaluate the effect of detail nursing. Methods This prospective study included a total of 100 patients with upper urinary tract stones complicated with diabetes mellitus who were admitted to this department from January 2019 to January 2022. The patients were randomly divided into a routine nursing group and a special detail nursing group using the random number table method, with 50 patients in each group. The special detail nursing group received detail nursing based on the KABP model. Baseline data of the two groups were evaluated to analyze the comparability of the data. Statistical analysis was performed on the incidence of perioperative surgical adverse reactions, negative emotions, pain intensity scores, daily living ability scores, satisfaction, and hospital stay between the two groups to evaluate whether there were differences in clinical outcomes between the two groups. Results The incidence rates of postoperative infection, postoperative low back pain, and postoperative hyperglycemia in the special detail nursing group were significantly lower than those in the routine nursing group (4.0% vs. 16.0%, 6.0% vs. 28.0%, 16.0% vs. 38.0%, respectively; all P values were 0.046, 0.003, and 0.013). The scores of the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) in the special detail nursing group were significantly lower than those in the routine nursing group [ (35. 52±3.41) points vs. (46.38±2. 91) points, (32.28±3.17) points vs. (47.89±4.01) points, respectively; both P values were 0.012 and 0.003, respectively]. The subjective pain score in the special detail nursing group was significantly lower than that in the routine nursing group [ (6.54±1.01) points vs. (8.01±1.22) points], and the daily living ability score was significantly higher [ (75. 21±5.87) points vs. (66.01±5.21) points], with both differences being statistically significant (P=0.017, 0.009). The overall satisfaction rate in the special detail nursing group was higher than that in the routine nursing group (98.0% vs. 90.0%), with the proportion of “very satisfied” evaluations being significantly higher in the special detail nursing group (68.0% vs. 46.0%), and both differences were statistically significant (P=0.092, 0.026). There were no statistically significant differences in the median total hospital stay [5.00 (3.75, 5.25) d vs. 4.00 (3.00, 6.00) d] and median postoperative hospital stay [2.50 (2.00, 3.00) d vs. 2.00 (1.75, 2.00) d] between the routine nursing group and the special detail nursing group (P=0.732, 0.678). Conclusion Multi-dimensional and multi-indicator evaluations of the application of detail nursing based on the KABP model in patients with upper urinary tract stones complicated with diabetes mellitus confirmed that the humanized and standardized special detail nursing model benefited patients in multiple perioperative indicators, providing valuable experience for perioperative nursing care of such patients. [ABSTRACT FROM AUTHOR]

Objective To observe the effects of low expression of α-glucosidase (GAA) on morphology, proliferation, inflammatory response, and oxidative stress response of pancreatic β-cells in order to investigate the potential role of GAA in the pathogenesis of diabetes mellitus. Methods The expression of GAA in βTC6 cells was interfered by siRNA1,2,3 and 4, respectively. As a result, the interference effect of siRNA4 was the best, and it was used as the interference sequence in subsequent experiments. βTC6 cells were randomly divided into the siRNA group, negative control group (NC group) and blank control group(Con group), respectively. Cells in the siRNA group were transfected with siRNA4 sequence to reduce the expression of GAA, cells in the negative control group were transfected with siRNANC sequence, and cells in the Con group were not treated. After 24, 48, 72 and 96 h of cell culture, the cell proliferation of each group was detected by CCK-8. They were cultured for 48 h, the number and morphology of cells in each group were observed by inverted microscope, the inflammatory factors IL-6 and IL-1β protein in cells were detected by Western blotting, and the content of reactive oxygen species (ROS) in cells was detected by immunofluorescence. Results Compared with the Con and NC groups, the cells increased, the intercellular space became smaller under the microscope, the OD values of cells increased at 24, 48, 72, and 96 h of culture, and the levels of IL-6 and ROS decreased after 48 h of culture in the siRNA group (all P<0. 01) . No significant differences were found in these indicators between the Con and NC groups(all P>0. 05). Conclusions Low expression of GAA can lead to alterations in cell morphology, enhanced proliferative capacity, and diminished inflammatory and oxidative stress responses of pancreatic β-cells. GAA may participate in the pathogenesis of diabetes by changing the morphology of pancreatic β-cells and enhancing inflammatory and oxidative stress responses. [ABSTRACT FROM AUTHOR]

报道1例因糖尿病就诊的MCLMR综合征患者的诊治经过。患者为15岁男性, 因"口 干、多饮、多尿3 d"入院。入院后完善相关检查, 结果示随机末梢血糖15.79 mmol/L, 糖化血红蛋白 （HbA1c）9.2%, 空腹静脉血糖12.99 mmol/L, C 肽释放试验结果示空腹及餐后120 min C 肽分别为 0.59 及1.08 nmol/L, 空腹及餐后120 min 血糖分别为7.11 及19.32 mmol/L;胰岛细胞抗体、锌转运 体-8 自身抗体、抗谷氨酸脱羧酶抗体、酪氨酸磷酸酶抗体均为阴性, 尿微量白蛋白/肌酐比值为 46.44 mg/g;一代基因测序结果提示, 患者驱动蛋白家族成员11（KIF11）基因上检测到1个杂合插入移 码变异c.202_203insA: p.F68Yfs*2（NM_004523.4）, 患者父母均未检测到该变异。结合病史及检查结 果, 患者确诊为KIF11 基因新发变异导致的MCLMR综合征。收入院期间予患者二甲双胍0.5 g每日 2次、甘精胰岛素12 U睡前皮下注射, 患者血糖波动于4.2~11.0 mmol/L之间, 调整治疗方案, 停用胰岛 素, 仅二甲双胍0.5 g每日2次, 患者血糖波动于4.5~6.9 mmol/L之间, 病情稳定后出院。该文期望通过 对此例患者诊断思路、处理过程的报道, 并复习文献, 以增强临床对MCLMR综合征并发糖尿病的认 识, 并提出有效的处理措施。. [ABSTRACT FROM AUTHOR]

目的 探讨总胆红素（TBIL）与2 型糖尿病（T2DM）微血管并发症之间的相关性。 方法 本研究为横断面研究。选取2019年6月至2020年5月在上海市第六人民医院东院内分泌科住 院的T2DM患者344例作为研究对象, 记录患者身高、体重、糖尿病病程及并发症等资料, 采用比色法 检测血清TBIL, 同时检测24 h尿微量白蛋白、空腹血糖、餐后0.5 h血糖、餐后1 h血糖、餐后2 h血糖、 餐后3 h血糖、糖化血红蛋白（HbA1c）、肌酐、血红蛋白（Hb）等生化指标。采用标准心血管反射试验 （CART）检测Valsalva R-R值、深呼吸心率差值、立卧位心率差值、立卧位舒张压差值和立卧位收缩压 差值。将研究对象按照有无糖尿病视网膜病变（DR）、糖尿病肾脏病（DKD）、糖尿病周围神经病变 （DPN）以及糖尿病心血管自主神经病变（DCAN）并发症进行分组。组间比较采用单因素方差分析、 Kruskal-Wallis H 检验或χ2检验。采用Spearman相关分析法分析TBIL和一般临床指标之间的相关性。 采用多因素二元logistic回归分析法分析TBIL和T2DM多种并发症的关系。结果 随着并发症数量 的增多TBIL水平逐渐下降（P<0.001）。合并DR、DKD、DPN、DCAN的T2DM患者的TBIL较不合并上 述并发症的患者显著降低, 分别为（10.20±4.30）和（13.81±4.87）μmol/L、（10.31±4.45）和（12.38±4.87） μmol/L、（10.41±5.75）和（12.49±5.50）μmol/L、（10.85±5.31）和（12.75±5.01）μmol/L, 差异均有统计学意 义（P<0.001）。Spearman 相关分析结果显示, 年龄（r=-0.132, P=0.015）、糖尿病病程（r=-0.205, P< 0.001）、24 h尿微量白蛋白（r=-0.209, P<0.001）、静息心率（r=-0.135, P=0.012）与TBIL呈负相关, 空腹 血糖（r=0.107, P=0.048）、餐后0.5 h血糖（r=0.14, P=0.013）、餐后1 h血糖（r=0.171, P=0.002）、HbA1c（r= 0.109, P=0.047）、Hb（r=0.375, P<0.001）与TBIL呈正相关, 而与餐后2 h血糖、餐后3 h血糖无明显相关 性（P>0.05）;TBIL 与Valsalva R-R 值、深呼吸心率差值、立卧位心率差值呈正相关（r=0.211、0.135、 0.172, P<0.02）, 与立卧位舒张压差值呈负相关（r=-0.177, P=0.001）, 而与立卧位收缩压差值无明显相 关性（P=0.068）。多因素二元logistic 回归分析显示, TBIL 水平是T2DM 患者发生DR、DKD、DPN、 DCAN的保护因素（OR=0.939、0.941、0.902、0.950, 均P<0.05）。结论 TBIL与T2DM微血管病变密切 相关, 正常范围内的TBIL水平可能是糖尿病微血管并发症的保护因素。. [ABSTRACT FROM AUTHOR]

Objective To systematically review the risk of fracture in type 2 diabetes mellitus (T2DM) patients induced by different receptor-selective sodium-glucose co-transporter 2 inhibitors (SGLT2i). Methods A systematic search of the National Library of Medicine database (PubMed), the Embase database, Clinical trials, and the Cochrane Library was conducted from the inception of each database until June 30, 2023 to identify all randomized controlled trials in T2DM patients using SGLT2i drugs that reported fracture outcomes. After a selection process, data were extracted from the trials. A traditional meta-analysis was performed based on the data. Subsequently, the included trials were categorized into two groups based on the selectivity of the drugs for their receptor sites: high selectivity [the drug has an IC50 ratio of ≥900 at the sodium-glucose cotransporter (SGLT) 1/2 site] and low selectivity [the drug has an IC50 ratio of < 900 at the SGLT 1/2 site]. Control groups were further categorized into other anti-hyperglycemic medications and placebo. A network meta-analysis was performed with these four groups. Results A total of 44 trials were included in this study, with a total sample size of 52 276 cases. The results of traditional meta-analysis showed that there was no statistically significant difference in the risk of fracture in T2DM patients caused by SGLT2i drugs compared with non-SGLT2i interventions (OR= 1.07, 95%CI 0.88-1.30). The network meta-analysis results indicated that compared with placebo, neither high-selectivity SGLT2i (OR=0.94, 95%CI 0.64-1.38) nor low-selectivity SGLT2i (OR=1.19, 95%CI 0.76-1.88) showed a statistically significant difference in the risk of fracture in T2DM patients, and there was no statistically significant difference in the risk of fracture between the high-selectivity and low-selectivity SGLT2i groups (OR=0.79, 95%CI 0.44-1.40). Conclusion The use of SGLT2i drugs in T2DM patients does not increase the risk of fracture, and the fracture risk associated with SGLT2i drugs is not influenced by the differences in the receptor site selectivity of these drugs. [ABSTRACT FROM AUTHOR]

Objective To investigate the relationship between age at diagnosis of type 2 diabetes mellitus (T2DM) and diabetes distress (DD) in adults with T2DM. Methods This study was a prospective cohort study. A total of 3 354 T2DM patients were enrolled at Taiwan Li′s United Clinic from January 1, 2002. According to the age of T2DM diagnosis, the patients were divided into< 40 years old group (young group, 488 cases), 40-59 years old group (middle-aged group, 2 055 cases), and≥60 years old group (elderly group, 811 cases). General data (age, sex, smoking history, drinking history, family history, diabetes course, economic income, educational level, marital status, and physical activity) and clinical indicators [body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), hemoglobin (Hb), glycated hemoglobin A1c (HbA1c), etc.] of the patients were collected. And the characteristics of the disease (whether there are sleep disorders, DD, complications) and medication (antihypertensive drugs, lipid-regulating drugs, hypoglycemic drugs, insulin). The problem areas in diabetes (PAID) scale was used to determine whether T2DM patients had DD. One-way analysis of variance (ANOVA), Kruskal-Wallis H rank sum test and χ2 test were used to compare between groups. Cox regression analysis was used to analyze the influencing factors of DD and the relationship between age at diagnosis and DD. Results There were no significant differences in family history of diabetes, sleep status and proportion of lipid-regulating drugs used among the three groups (P>0.05). Compared with the middle-aged group and the elderly group, T2DM patients in the young group had a longer duration of diabetes, a higher proportion of insulin use, smoking history and drinking history, and a higher level of BMI, HbA1c and Hb with statistical significance (P<0.05). Multivariate Cox regression analysis was conducted with age at diagnosis, sex, disease course, BMI, economic status, exercise habits, HbA1c, hemoglobin, marital status, education level and drug use as independent variables and whether DD occurred as dependent variables. The results showed that, younger age at diagnosis, female, and BMI were independent risk factors for the development of DD (HR=0.962, 1.820, 1.037, all P<0.05). After follow-up, the number of DD cases in the young, the middle-aged and elderly groups was 41, 96 and 23 cases, respectively. Cox regression analysis showed that after adjusting for disease course, sex, income, education, marital status, BMI, HbA1c, drug use, hemoglobin, sleep and complications, the risk of DD in the young group was 3.260 times that of the elderly group (95%CI 1.728-6.151, P< 0.05). Conclusion Patients diagnosed with T2DM at an earlier age have a higher risk of DD, indicating the need for age-appropriate psychosocial support. [ABSTRACT FROM AUTHOR]

Objective To clarify the relationship between mucosa-associated invariant T (MAIT) cells and the development of diabetic kidney disease (DKD) in type 2 diabetes mellitus (T2DM) patients. Methods This was a cross-sectional study. Consecutive patients aged 18-60 years with untreated T2DM who attended outpatients clinics or wards in People′s Hospital of Zhejiang Province were included as study subjects. Their urinary albumin and creatinine were collected and the urinary albumin-to-creatinine ratio (UACR) was calculated, and their peripheral blood total MAIT cell ratio, granzyme B (Grmz-b)+ MAIT cell ratio, and activation index CD69+ MAIT cell ratio were detected. Comparisons between the two groups were made using two independent samples t-test or χ2 test, and the correlation between the proportion of Grmz-b+ MAIT cells in peripheral blood individual cells and UACR was analyzed using Spearman′s correlation analysis. Results A total of 129 untreated T2DM patients were included, including 70 patients with simple T2DM group and 59 patients with DKD (DKD group). There has significant difference in the total proportion of MAIT cells in peripheral blood between the DKD group and the T2DM group [(3.27% ±2.27%) vs (7.08%±5.05%), t=5.37, P<0.001], and the proportions of CD69+MAIT cells [(21.64% ±10.13%) vs (15.82%±6.64%), t=2.47, P=0.014] and Grmz-b+MAIT cells [(31.63%±10.00%) vs (10.21%±6.63%), t=14.04, P<0.001] were significantly higher in the DKD group than in the T2DM group. Correlation analysis found that the proportion of Grmz-b+MAIT cells was significantly positively correlated with the UACR (r=0.242, P=0.001). Conclusions The increased activation rate of mucosa-associated invariant T cells is closely related to the occurrence and development of DKD in patients with T2DM. The high secretion of Grmz-b may be related to its pathogenesis. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between baseline systemic immune inflammation index (SII) and all-cause and cardiovascular disease (CVD) mortality in adults with diabetes mellitus. Methods This study was a cohort study. A retrospective study of 3 170 adults with diabetes mellitus from the 2005--2018 National Health and Nutrition Examination Survey was included, the clinical data such as sex, age, race, body mass index, smoking status, duration of diabetes mellitus, alanine aminotransferase, serum creatinine, estimated glomerular filtration rate, triglyceride, total cholesterol, low-density lipoprotein cholesterol, glycated hemoglobin A1c, hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and diabetic renal disease were collected, and mortality outcomes were determined by the National Death Index as of 31 December 2019. A Cox risk model was constructed to examine the association between SII and all-cause and CVD mortality, using restricted cubic spline to explore non-linear correlations and constructing segmented linear regressions on either side of the inflection point for validation. Weighted Kaplan-Meier curves and subgroup analyses to characterise the association of SII with all-cause and CVD mortality. Results During a median follow-up of 6.58 years, there were 632 deaths from all causes and 179 deaths from CVD. After adjusting for covariates including sex, age, race, body mass index, smoking status, duration of diabetes mellitus, alanine aminotransferase, serum creatinine, estimated glomerular filtration rate, triglyceride, total cholesterol, low-density lipoprotein cholesterol, glycated hemoglobin A1c, hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and diabetic renal disease, the Cox regression analysis results showed that higher SII was associated with the risk of all-cause and CVD deaths associated. For each 1-unit increase in lnSII, the risk of all-cause and CVD mortality was elevated by 40% (HR=1.40) and 123% (HR=2.23), respectively (P<0.05). There was a U-shaped correlation between SII and all-cause and CVD mortality, with thresholds of 6.528 and 6.124 for lnSII, respectively, and a positive correlation with mortality when lnSII was higher than the thresholds (all-cause mortality HR 3.03, 95%CI 2.29-4.00, CVD mortality HR 3.07, 95%CI 2.12-4.44, P<0.001). Weighted Kaplan-Meier curves showed that individuals with higher SII had a significantly higher risk of all-cause and CVD mortality (P<0.001). Conclusions The SII may be a valuable potential tool for predicting the risk of all-cause and CVD mortality in adults with diabetes mellitus. The relationship between SII and mortality showed a U-shaped correlation, especially for the diabetic population with basic glycemic control, SII as an inflammatory marker is more predictive of CVD risk. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of empagliflozin plus insulin on glucose variability in non-obese adults with type 1 diabetes mellitus (T1DM). Methods This study was a prospective, randomized controlled, and open-label clinical trial. From November 2019 to December 2022, a total of 60 non-obese adult patients with T1DM from the Second Xiangya Hospital of Central South University were enrolled. They were randomly assigned in a 1∶ 1 ratio using random numbers generated by SPSS 26.0 software to receive either empagliflozin combined with insulin (intervention group) or insulin alone (control group) for 6 months, with 30 patients in each group. The primary outcome indicator was glycemic variability, which was assessed by mean amplitude of glucose excursions (MAGE), standard deviation (SD), and coefficient variation (CV). The secondary outcome indicator was glycemic control, which was assessed by clinically meaningful glycated hemoglobin A1c (HbA1c) reduction rate, HbA1c level, the rate of achieving the HbA1c target, daily insulin dose, time above/below/in range, and glycemia risk index. Safety was assessed based on the incidence of hypoglycemic events and adverse events. The clinically meaningful HbA1c reduction was defined as a reduction in HbA1c greater than 0.3%. A mixed-effects model and generalized estimating equation were used to compare between groups, and a paired t test was used to compare within groups. Results A total of 59 cases were included in the analysis, with 29 in the intervention group and 30 in the control group [male: 58.62% (17/29) vs. 36.67% (11/30), respectively, P=0.091]. There was no significant difference between the intervention group and the control group in the glycemic variability indicators. The proportion of patients with a clinically meaningful reduction in HbA1c was significantly higher in the intervention group than in the control group [61.54% (16/26) vs. 28.00% (7/25), respectively, P=0.016]. The safety analysis showed no significant difference in hypoglycemia between the two groups in non-obese adults with T1DM [85.71% (24/28) vs. 81.48% (22/27), respectively, P=0.729], and no ketoacidosis events were reported during the trial. Conclusions Empagliflozin combined with insulin in non-obese T1DM patients was safe and did not significantly increase the risk of hypoglycemia and ketoacidosis. Empagliflozin may improve glycemic control status in non-obese patients with T1DM, and did not significantly improve glycemic variability in non-obese adults with T1DM. [ABSTRACT FROM AUTHOR]

体重管理已成为糖尿病患者综合管理的重要组成内容和基础。糖尿病患者需及早进行 体重评估并进行积极管理, 以期实现体重管理的广泛获益。生活方式干预、药物和代谢手术, 是目前 超重或肥胖糖尿病患者体重管理的主要手段。具有体重获益的降糖药物, 尤其是新一代肠促胰素类 药物的问世, 为糖尿病患者的体重管理带来新希望。为进一步规范糖尿病患者的体重管理, 内分泌代 谢科肥胖诊疗联盟邀请国内相关领域的专家, 依据体重管理的最新理念与循证证据共同撰写了《糖尿 病患者体重管理专家共识（2024版）》, 从对超重肥胖的全面评估、个性化减重目标的设定以及分层管 理策略等多个层面分别给出推荐意见, 以期为临床诊疗中糖尿病患者的体重管理提供全面指导, 帮助 糖尿病患者实现体重管理的持续获益。. [ABSTRACT FROM AUTHOR]

Aim To investigate the effect of dietary iron intake on all-cause and cardiovascular mortality in diabetic patients. Methods A total of 5 970 diabetic patients who participated in the national health and nutrition examination survey (NHANES) database of America were included. Baseline data were obtained from the questionnaire and physical examination, and the survival status and cause of death were confirmed according to the national mortality index (until December 31, 2015). Cox proportional survival analysis was used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for iron intake and all-cause and cardiovascular mortality. Restricted cubic spline analysis was used to explore the existence of nonlinear relationship. Results The mean age of the enrolled subjects was 61. 3 years old, 51. 3% of whom were male, and their mean dietary iron intake was 14. 11 mg per day. During a mean follow-up of 6. 3 years, a total of 1 497 deaths occurred. Daily dietary iron intake <8. 34 mg was set as control group. Compared with control group, the risk of all-cause mortality was the lowest in diabetic patients with dietary iron intake between 11. 11 and 14. 36 mg (HR 0. 83 (0. 70 ~0. 99), P<0. 05). Restricted cubic spline regression showed that dietary iron intake was nonlinearly associated with all-cause mortality. However, there was no significant association between dietary iron intake and cardiovascular mortality. Conclusion Dietary iron intake is "L-shaped" associated with the all-cause mortality in diabetic patients, and an appropriate increase of iron intake may decrease the all-cause mortality. [ABSTRACT FROM AUTHOR]

Objective To investigate the influence pathway of the level of discrimination experienced by diabetic patients on psychological insulin resistance. Methods A multi-stage stratified random sampling method was used to select diabetic patients from 27 villages in Shandong Province for a questionnaire survey, with 660 valid responses received. The survey employed a general information questionnaire, the World Health Organization-5 Well-Being Index (WHO-5), and a scale assessing attitudes towards insulin. Results The score for psychological insulin resistance among diabetic patients was (72.97±11.38), and the WHO-5 score was (17.93±4.68). There were correlations among the level of discrimination experienced by patients, their physical and mental health, and psychological insulin resistance. The direct effect value of discrimination on psychological insulin resistance was 2.245 (bias-corrected 95%CI: 1.023-3.403), and the indirect effect value was 0.368 (bias-corrected 95%CI: 0.065-0.758). Conclusion Diabetic patients exhibit moderate to high levels of physical and mental health, with significant psychological insulin resistance. Physical and mental health plays a mediating role between the level of discrimination experienced by patients and psychological insulin resistance. [ABSTRACT FROM AUTHOR]

Objective To identify the key factors associated with diabetic retinopathy (DR) complications in elderly patients, providing a reference for clinical research. Methods This study utilized data from the “Diabetes Complications Early Warning Dataset” publicly available from the National Population Health Science Data Center. A Python program was developed for data preprocessing, resulting in a dataset of 1 337 elderly patients. Descriptive statistics were performed, and Elastic Net regression, EMVS logistic regression, and Lasso regression models were constructed for comparison. The optimal model, EMVS logistic regression, was selected for key factor extraction, with results validated through bootstrap sampling. Results The EMVS logistic regression model outperformed others in model comparison, achieving an AUC value of 0.801, surpassing the AUC values of 0.764 for Elastic Net regression and 0.759 for Lasso regression. The EMVS logistic regression model ultimately identified 10 key factors; among them, systolic blood pressure, diastolic blood pressure, BMI, kidney disease, glycated hemoglobin, and serum creatinine were identified as risk factors for diabetic retinopathy, while hematocrit, total protein, alanine aminotransferase, and prothrombin time were protective factors. The Brier scores were 0.101 and 0.12, respectively, and the calibration curve indicated good consistency of the model. Conclusion The introduction of EMVS logistic regression in the study of diabetic retinopathy complications yielded effective key factor selection. Based on the identified key factors for diabetic retinopathy in elderly patients, healthcare professionals can more effectively guide elderly patients in taking preventive measures, thereby slowing disease progression and significantly improving their quality of life and health status. [ABSTRACT FROM AUTHOR]

Objective To investigate the efficacy of oral Danning tablets for bowel preparation for colonoscopy in diabetes mellitus patients. Methods A study was conducted from November 2022 to May 2024, 100 type 2 diabetic patients (aged≥30 years) admitted to endocrinology department in our hospital were selected and scheduled for colonoscopy as research subjects. These patients were randomly divided into two groups: ① A control group (n=50), received 68.56 g of polyethylene glycol electrolyte powder 10 hours before the colonoscopy and an additional 137.12 g six hours before the procedure. ② An experimental group (n=50), in addition to the bowel preparation regimen of the control group, orally took Danning tablets three times daily, five tablets each time, starting two days before the colonoscopy. Results The experimental group had a BBPS score of (7.44±1.03), which was higher than the control group’s BBPS score of (5.58±1.98), P<0.001. In the experimental group, 96% of the bowel preparations were rated as excellent or good (BBPS score≥6), significantly higher than the 58% in the control group (P<0.001). Conclusion In diabetic patients undergoing colonoscopy, oral administration of Danning tablets during bowel preparation could improve bowel cleanliness and significantly enhance the quality of bowel preparation. [ABSTRACT FROM AUTHOR]

Mi'an, freshly recovered from a serious illness, was preparing for a ceremony to honor Doctor X for his exceptional contributions in defending against disease attacks. Unexpectedly, remnants of the rebellion clandestinely laid traps for innocent civilians, initiating a diabetic onslaught on Mi'an. Thankfully, Doctor X promptly devised a solution. He established the "Medical Barking Team", using their keen sense of smell to detect diseases and temporarily alleviate the situation. However, the enemy proved to be cunning, and the crisis persisted. In a bold move, Doctor X decided to take a chance. He created a machine called the "E-nose", capable of detecting diseases day and night. Ultimately, Mi'an overcame the crisis with the assistance of the E-nose. From that point forward, the E-nose found applications in various fields for the benefit of all. [ABSTRACT FROM AUTHOR]

Objective: As the most common metabolic disease, diabetes is closely related to cardiovascular disease and is an independent risk factor for the occurrence of acute myocardial infarction. Nuclear factor erythroid-2-related factor 2 (NRF2) is a key regulator of the cellular antioxidant response, which increases the transcription of downstream antioxidant genes by interacting with other proteins and binding to antioxidant response elements, thereby maintaining the dynamic balance of redox states. Some studies have shown that NRF2 is involved in the regulation of the occurrence and development of diabetic myocardial ischemia - reperfusion injury, but its mechanism is not yet fully understood. This paper mainly reviews the research progress of NRF2 signaling pathway related to diabetic myocardial ischemia - reperfusion injury and NRF2 targeted therapies, providing new insights for the clinical treatment of diabetic myocardial ischemia-reperfusion injury. [ABSTRACT FROM AUTHOR]

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Objective To explore the influencing factors of mild cognitive impairment （MCI） in patients with atrial fibrillation and diabetes mellitus， and to establish the prediction model， so as to provide guidance for the treatment of MCI in patients with atrial fibrillation and diabetes mellitus. Methods 199 patients with atrial fibrillation and diabetes diagnosed in the second ward of Cardiovascular Department of the Fifth Affiliated Hospital of Zhengzhou University from January 2023 to January 2024 were analyzed. The related factors of MCI in patients with atrial fibrillation and diabetes mellitus were analyzed by univariate analysis and multivariate logistic regression. According to the results of multivariate logistic regression analysis， the prediction model of MCI in patients with atrial fibrillation and diabetes mellitus was established. Results Univariate analysis showed that age （P = 0.002 3）， homocysteine （P < 0.000 1）， fasting blood glucose （P = 0.022 5）， glycated hemoglobin （P = 0.006 6）， and blood uric acid （P = 0.032 2） were the influencing factors of MCI. Multivariate logistic regression analysis: age （OR = 1.08， P = 0.000 4）， homocysteine （OR = 1.37， P < 0.000 1）， fasting blood glucose （OR = 1.22， P = 0.023 5）， glycated hemoglobin （OR = 1.61， P = 0.004 2）， and blood uric acid （OR = 1.29， P = 0.009 1） were the independent influencing factors of MCI. The optimal threshold is when the Youden index （YI = sensitivity + specificity） is maximum. At the optimal threshold， the sensitivity was 0.74， the specificity was 0.80， and the area under the curve （AUC） was 0.809， indicating that the model can effectively predict the occurrence of MCI. Conclusion Age， fasting blood glucose， blood homocysteine， blood uric acid and glycosylated hemoglobin are independent risk factors for MCI in patients with atrial fibrillation and diabetes. The clinical prediction model based on multivariate logistic regression has a certain predictive value for the occurrence of MCI in patients with atrial fibrillation and diabetes mellitus. [ABSTRACT FROM AUTHOR]

Objective To investigate the association between microRNA （miR）-23a， miR-150， and miR-150-5p levels and diabetic osteoporosis（DOP） through correlation analysis. Methods A total of 200 patients with diabetes who visited the hospital between March 2020 and March 2022 were selected and followed up for a duration of 2 years. Patients who developed DOP and those who did not were respectively assigned to the DOP group and the non-DOP group. The general information and serum levels of miR-23a， miR-150， and miR-150-5p between these two groups were compared. Pearson correlation analysis was conducted to examine the relationship between serum levels of miR-23a， miR-150， and miR-150-5p， as well as bone density. Logistic regression model was employed to identify factors influencing DOP. Results The incidence rate of DOP was 28.89%. The serum levels of miR-23a， miR-150， and miR-150-5p were significantly elevated in the DOP group compared to the non-DOP group （P < 0.05）. Pearson correlation analysis revealed a negative association between the serum levels of miR-23a， miR-150， and miR-150-5p in diabetic patients and bone density （P < 0.05）. Logistic regression model analysis demonstrated that age， body mass index （BMI）， as well as miR-23a， miR-150， and miR-150-5p were influential factors contributing to the development of DOP （P < 0.05）. Conclusion The levels of serum miR-23a， miR-150， and miR-150-5p are elevated in patients with DOP， and all three exhibit a negative correlation with bone density. Furthermore， these factors collectively contribute to the development of DOP. [ABSTRACT FROM AUTHOR]

With the improvement of people's living standards， the number of patients with obesity and diabetes in China has been surging， causing a great disease burden. In recent years， evidence-based guidelines has increasingly emphasized the importance of weight management in the prevention and treatment of diabetes. Although there are many issues in theoretical and practical levels to be further elucidated， there is an urgent need for both doctors and patients to adapt to this new situation. Weight loss is a" double-edged sword". Weight loss strategies that maximize the benefits for diabetic patients with overweight or obesity should be based on a proper understanding of the meaning of weight management. Long-term maintenance of weight loss still faces many challenges， which require accurate assessment of the disease， weighing the pros and cons of weight loss， implementation of a reasonable and feasible weight loss program， and adherence to long-term professional management. [ABSTRACT FROM AUTHOR]

This paper discusses the entry point of traditional Chinese medicine in the field of diabetes treatment， and puts forward several directions as the entry point， including unique understanding of diabetes and its complications in TCM， treatment of diabetes at the early stage， improvement in clinical symptoms of diabetes patients， treatment of diabetes complications， improvement in adverse drug reactions， intensive research of classic prescriptions and effective drugs in successive dynasties， and diversity of TCM treatment methods. It can complement the advantages of modern medicine while make best use of the advantages and avoid the disadvantages. Traditional Chinese medicine has the characteristics of general regulation and multi-target effects， and its advantages are more obvious in improving symptoms and treating complications and accompanying diseases. [ABSTRACT FROM AUTHOR]

Objective: To observe the effects of dexmedetomidine combined with ultrasound-guided nerve block on postoperative analgesia, immune stress and pain mediators in patients with hip fracture complicated with diabetes. Methods: 120 patients with hip fracture complicated with diabetes who were admitted to our hospital from June 2020 to June 2023 were divided into control group 60 cases (ultrasound-guided nerve block) and study group 60 cases (dexmedetomidine combined with ultrasound-guided nerve block) according to the random number table method. Postoperative patient-controlled intravenous analgesia (PCIA) was performed in both groups. The sedation, analgesia, PCIA pressing times, immune function, stress response and pain mediators were compared between two groups, and the occurrence of adverse reactions during the treatment was observed. Results: 12 h, 24 h and 48 h after operation, the visual analogue scale (VAS) score in study group was lower than that in control group, and the Ramsay sedation score was higher than that in control group (P＜0.05). The number of PCIA compressions in study group was less than that in control group (P＜0.05). 1 d after operation,CD3+, CD4+, CD4+/CD8+ in study group were higher than those in control group, and cortisol (Cor), norepinephrine (NE), prostaglandin E2 (PGE2), epinephrine (E), calcitonin gene-related peptide (CGRP), substance P (SP) and CD8+were lower than those in control group (P＜0.05). In terms of incidence of adverse reactions, there was no difference observed between the two groups in comparison (P＞0.05). Conclusion: Ultrasound-guided nerve block combined with dexmedetomidine in patients with hip fracture and diabetes, which can exert good sedative and analgesic effects, reduce immunosuppression and postoperative pain. [ABSTRACT FROM AUTHOR]

Objective: To investigate the prognosis and the influencing factors of restenosis after endovascular intervention in diabetes patients with lower extremity arteriosclerosis obliterans. Methods: 100 patients with diabetes complicated with arteriosclerosis obliterans of lower extremities admitted to our hospital from January 2022 to December 2022 were selected. All patients were treated with endovascular intervention, and the treatment conditions were analyzed. Then, the patients were followed up, and the number of patients with restenosis was recorded, A logistic regression model was established to analyze the independent influencing factors of short-term prognosis (good prognosis=0, poor prognosis=1) and occurrence of restenosis (non restenosis=0, restenosis=1) as dependent variables. Results: 100 diabetic patients with lower extremity arteriosclerosis occlusion were treated by endovascular intervention, the length of hospital stay was (13.43±2.42) d, the cost of treatment is RMB (73453.43±1253.64）, the total response rate was 80.00%, The incidence of cardiovascular and cerebrovascular events was 5.00%, the amputation rate was 4.00%, the incidence of restenosis at 1-year follow-up was 25.00%; Significant difference between poor prognosis group and good prognosis group: age, duration of lower extremity arterioscle rosis occlusion, ankle-brachial index, fibrinogen, total cholesterol, smoking history, and combined hyperlipidemia (P＜0.05）,Fasting blood glucose, fibrinogen, total cholesterol, glycated hemoglobin, smoking history, hyperlipidemia, and chronic renal insufficiency between restenosis and non-restenosis patients (P＜0.05); The factors affecting poor prognosis were age, ankle brachial index, fibrinogen, total cholesterol, and hyperlipidemia (P＜0.05); the factors influencing treatment restenosis were fibrinogen, hemoglobin A 1 c, smoking history, hyperlipidemia, with chronic renal insufficiency (P＜0.05). Conclusion: The total effective rate of endovascular intervention for diabetes patients with lower extremity arteriosclerosis obliterans is 80.00%, and the incidence of restenosis is 25.00%. Fibrinogen and hyperlipidemia are the common influencing factors for poor prognosis and restenosis, among which age, ankle brachial index, total cholesterol are also the influencing factors for poor prognosis, and the influencing factors for restenosis include glycosylated hemoglobin, smoking history, and chronic renal insufficiency. [ABSTRACT FROM AUTHOR]

Objective To explore the association between metabolic score of insulin resistance (METS - IR) and the risk of Cardiometabolic multimorbidity (CMM) in middle - aged and elderly Chinese. Methods A population - based cohort study was conducted using data from the China Longitudinal Study of Health and Aging (CHARLS) among Chinese residents aged 45 years or older from 2011 to 2018. Cox proportional hazards regression models were used to calculate Hazard Ratio (HR) and 95% confidence intervals (CI) for the association between METS - IR and new CMM, and stratified analyses were performed in different populations to observe the interaction between covariates and METS - IR. The dose - response relationship between METS - IR and new CMM in different body weight population was observed with restricted cubic spline. Receiver operating characteristic (ROC) curve was constructed to analyze the value of METS - IR in predicting the risk of CMM. Results A total of 5 349 subjects were included in this study, and the incidence of CMM was 2. 08%. After adjusting for all included covariates, METS - IR as a continuous variable was positively correlated with the risk of CMM (HR: 1. 07, 95% CI: 1, 05 - 1. 09, P < 0. 001). As a categorical variable, the highest METS - IR group was still positively associated with the risk of CMM (HR: 3. 47, 95% CI: 2. 06 - 5. 84, P < 0. 001), In total participants (P for overall <0. 001), normal weight (P for overall = 0. 022) and overweight and obese (P for overall = 0. 008) populations still had a linear relationship between MET - IR and CMM risk. METS - IR was predictive of CMM risk (AUC: 0. 651, 95% CI: 0, 598 - 0. 704). Conclusion The study finds that METS - IR is positively associated with an increased risk of new CMM in middle - aged and older adults and should be of continued concern in both normal weight and overweight obese people to reduce the risk of CMM. [ABSTRACT FROM AUTHOR]

Objective To investigate the effect of laser surgery assisted with Leizumab on retinal thickness and visual acuity recovery in patients with type II diabetes retinopathy (DR). Methods A total of 140 type II DR patients in Hopeshine-Minsheng Hospital of Xinzheng from February 2021 to February 2023 were selected retrospectively, and divided into the control group (70 cases) and the observation group (70 cases) according to different surgical methods. The control group received laser treatment, while the observation group received laser surgery assisted by Leizumab. The visual acuity levels, time to clinical symptom improvement. hemodynamic levels [end diastolic blood flow velocity (EDV), peak blood flow velocity (PSV), blood flow resistance index(RI)], low-vision quality of life (CLVQOL) scores, and incidence of complications between two groups were compared. Results The observation group had shorter absorption times for exudate, fundus hemorrhage, and retinal edema compared to the control group, with statistical significance (P<0.05). The observation group had higher visual acuity and the best corrected visual acuity at one month after surgery, and the grayscale value and retinal thickness of the field of view were smaller than those of the control group, with statistical significance (P<0.05). The EDV and PSV levels in the observation group were higher than those in the control group one month after surgery, while the RI levels were lower than those in the control group, with statistical significance (P<0.05). The CLVQOL score of the observation group was higher than that of the control group one month after surgery, and the difference was statistically significant (P<0.05). The incidence of complications in the observation group was lower than that in the control group, and the difference was statistically significant (P<0.05). Conclusion Laser surgery assisted with Leizumab can promote blood circulation in the eyes of type II DR patients, reduce retinal thickness, improve vision, reduce the incidence of postoperative complications, and improve postoperative quality of life. [ABSTRACT FROM AUTHOR]

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Objective To investigate the influencing factors of the grading of acute kidney injury (AKI) caused by partial nephrectomy in patients with malignant renal tumors. Methods General information, surgery and treatment data, clinical and pathological grading, laboratory test results, surgical records and pathological reports and other clinical data of patients with malignant renal tumors who underwent partial nephrectomy in Qingdao Municipal Hospital from January 2013 to January 2023 were collected. All patients were divided into the non-AKI, stage1 and stage 2 AKI groups according to the incidence of AKI. The influencing factors of AKI were identified by Logistic regression analysis. The efficiency of serum creatinine in predicting AKI after partial nephrectomy was analyzed by the receiver operating characteristic (ROC) curve. Results A total of 503 patients with malignant renal tumors underwent partial nephrectomy, including 378 cases (75.1%) of non-AKI, 83 cases (16.5%) of stage 1 AKI and 42 cases (8.3%) of stage 2 AKI, respectively. Patients with stage 1 AKI showed statistically significant differences in the proportion of hypertension and diabetes mellitus, changes of creatinine levels at preoperative 48 h, tumor volume, warm ischemia time, and body mass index (BMI) compared with non-AKI counterparts (all P < 0.05). Patients with stage 2 AKI showed statistically significant differences in the gender composition, proportion of hypertension and diabetes mellitus, R.E.N.A.L. score, changes of creatinine levels at preoperative 48 h, tumor volume, warm ischemia time and BMI compared with AKI counterparts (all P < 0.05). Logistic regression analysis revealed that the influencing factors of stage 1 AKI after partial nephrectomy included BMI, hypertension, diabetes mellitus, the changes of serum creatinine levels at preoperative 48 h, tumor volume and warm ischemia time, and the influencing factors of stage 2 AKI also consisted of gender and R.E.N.A.L score (all P < 0.05). The cutoff values of serum creatinine levels for the diagnosis of AKI and stage 2 AKI were 23.29 and 39.88 mmol/L, with a sensitivity of 98.1% and 99.8%, a specificity of 81.3% and 89.6%, and an area under the ROC curve (AUC) of 0.969 and 0.974, respectively. Conclusions The influencing factors for AKI after partial nephrectomy in patients with malignant renal tumors are hypertension, diabetes mellitus, changes in creatinine levels at preoperative 48 h, tumor volume, warm ischemia time and BMI. In addition, the influencing factors for patients with stage 2 AKI consist of gender and R.E.N.A.L. score. Early identification of these influencing factors and active interventions can reduce the incidence of postoperative AKI and alleviate the severity of AKI. [ABSTRACT FROM AUTHOR]

Objective To analyze and summarize case data of patients with X-linked sideroblastic anemia secondary to hematological diseases. Methods The clinical data of a case of X-linked sideroblastic anemia with secondary hemochromatosis admitted to the Department of Endocrinology of the First Affiliated Hospital of Kunming Medical University were retrospectively analyzed, and the related literatures were reviewed. Results The patient presented with persistent fatigue and sought medical attention at multiple hospitals, yet the underlying cause remained elusive. Subsequently, the patient was admitted to the Department of Endocrinology of the First Affiliated Hospital of Kunming Medical University due to hyperglycemia and cutaneous pigmentation. Following comprehensive diagnostic procedures including bone marrow aspiration, genetic testing, liver CT scan, and MRI examination, a definitive diagnosis was established. The patient's clinical symptoms exhibited improvement subsequent to iron chelation therapy. Later, the patient died of heart failure due to irregular iron treatment. Conclusion Diabetes caused by hemochromatosis is a special type of diabetes. Diagnosing this disease not only relies on serological and imaging examinations, but genetic testing is also very important. In clinical practice, when skin pigmentation combined with diabetes and liver function abnormalities are found, hemochromatosis should be considered. Genetic testing can not only assist in diagnosing hemochromatosis, but also help distinguish between primary and secondary hemochromatosis. [ABSTRACT FROM AUTHOR]

Objective To explore the main risk factors for cancer, cardiovascular and cerebrovascular diseases, diabetes and chronic respiratory disease (referred to as the four major chronic diseases), and to evaluate the disease burden associated with the exposure to risk factors. Methods The data of this study were collected from the 2019 Global Burden of Disease Study (GBD) database. By analyzing the number of deaths and disability-adjusted life years (DALYs) of four major chronic diseases among Chinese residents in 2019, the proportion of these four major chronic diseases attributable to the exposure to related risk factors was determined. Results The primary risk factor for disease burden was the tobacco exposure, which accounted for 31.4% of DALYs. High systolic blood pressure was the main risk factor for cardiovascular and cerebrovascular diseases, which accounted for 55.6% of DALYs. The common risk factors of four major chronic diseases were tobacco exposure, air pollution and high body mass index (BMI); among them, tobacco exposure had the highest proportion of attributable risk in the disease burden of cancer and chronic respiratory disease. Diet related risk factors, alcohol consumption, and physical inactivity were associated with cancer, cardiovascular and cerebrovascular diseases, and diabetes. The results of the attribution analysis of major cancers showed that lung cancer had the highest proportion of attributable risk due to tobacco exposure, followed by esophageal cancer, gastric cancer, liver cancer, and colorectal cancer. Conclusions Tobacco exposure, air pollution and high BMI are common risk factors for the four major chronic diseases in Chinese residents. This result provides important evidence for high⁃risk population screening. [ABSTRACT FROM AUTHOR]

糖尿病患病率在全球范围内呈上升趋势。近期, 美国糖尿病学会发布了 2024年《糖尿 病诊疗标准》, 该文节选了其中的慢性肾脏病和风险管理章节, 结合近期国内外有关指南及文献, 对糖 尿病慢性肾脏病的诊断, 筛查, 监测, 预防及治疗进行解读, 并对更新的要点和扩充的治疗药物进行介 绍, 旨在为糖尿病慢性肾脏病的防治提供临床依据和实践建议。 [ABSTRACT FROM AUTHOR]

我国糖尿病患者基数庞大, 实施高效且科学的糖尿病管理策略至关重要。随着人工智 能技术的发展, 机器学习算法已被应用于糖尿病早期诊断, 血糖监测, 并发症预测和健康管理等方面, 具有广泛的应用前景及革新潜力。该文就机器学习在糖尿病管理领域的应用现状进行综述, 以期为 糖尿病的社区管理和临床决策提供新思路。 [ABSTRACT FROM AUTHOR]

糖尿病肾脏病 (DKD)和肌少症密切相关。DKD是导致肌少症的重要危险因素, 而肌少 症会增加DKD患者进展为终末期肾病的风险。多种病理生理机制, 如胰岛素抵抗, 内皮功能障碍, 慢 性非特异性炎症, 蛋白质能量消耗导致该恶性循环的产生。治疗DKD的药物, 包括钠‑葡萄糖共转运 蛋白2抑制剂, 胰高糖素样肽‑1受体激动剂, 非奈利酮等会影响肌少症发生发展；反之, 肌少症的处理 措施如高蛋白饮食会增加 DKD患者进展为终末期肾病的风险, 而适当运动, 维生素 D及其类似物的 补充则有助于延缓肾功能的下降。因此, 针对DKD合并肌少症患者的治疗需要综合考量, 权衡利弊, 以提高患者的生活质量和生存率。 [ABSTRACT FROM AUTHOR]

报道 1例以 1型糖尿病 (T1DM) 就诊的 18号染色体短臂缺失患儿的诊疗经过。患者为 14岁男童，以“多尿、多饮、乏力 3个月”入院，入院后完善胰岛功能检查，排除单基因糖尿病，诊断为 T1DM，予胰岛素强化降糖治疗。由于患者存在生长及智力发育异常，完善遗传学检测后发现18号染 色体短臂存在14.05 Mb缺失。18号染色体短臂缺失合并T1DM在国内外均罕见，机制可能与蛋白酪 氨酸磷酸酶非受体2型 (PTPN2) 基因缺失导致的自身免疫异常有关。儿童糖尿病合并身材矮小及智 力障碍时需考虑18号染色体短臂缺失综合征的可能性。 [ABSTRACT FROM AUTHOR]

青少年起病的成人型糖尿病(MODY)5型在中国人群中较为罕见, 且临床表现不典型, 临床医师对其认识不足, 极易误诊, 漏诊。该文报道了1例MODY5型患者, 具有多发性肾囊肿和胰腺 发育不全, 低钾血症等临床特征。患者为18岁男性, 因“口干, 多饮, 多食伴乏力9个月”入院。入院后 行外周血遗传性糖尿病相关基因测序, 检测到肝细胞核因子1β基因c.810‑1G>C杂合突变, 是一种特 殊的自发基因变异, 国内外均尚未见报道, 其父母及姐姐均未携带该突变, 结合患者临床表现与辅助 检查, 诊断为MODY5。通过对该例患者诊疗经过的回顾及相关文献的复习, 对青少年起病的糖尿病 合并肾脏, 胰腺损害的患者, 应尽早行基因检测明确诊断, 防止漏诊及误诊。 [ABSTRACT FROM AUTHOR]

我国糖尿病患者比例逐年增高, 血糖管理现状不容乐观, 糖尿病患者血糖控制不佳可引 发多种急慢性并发症, 增加致残率和死亡率。在智慧医疗时代下, 以全方位智能血糖管理系统作为糖 尿病防控的抓手, 依托血糖管理系统中的“虚拟病房”功能, 有助于推行科外胰岛素泵管理新理念。应 用全方位血糖管理系统及胰岛素泵为全院糖尿病患者实施及时血糖监测及胰岛素泵强化治疗, 将患 者纳入“虚拟科室”, 实时监测患者血糖曲线, 实现线上“无科界”精细化及糖尿病患者全病程闭环式管 理, 以有效精准控糖, 达到促进健康, 延缓糖尿病进程, 减少并发症, 降低伤残率, 提高生活质量并降低 医药费用的最终目标。 [ABSTRACT FROM AUTHOR]

自1999年以来, 国际糖尿病足工作组 (IWGDF) 已经多次发表基于循证医学证据的糖尿 病足预防与治疗指南, 其中关于周围动脉病变 (PAD) 诊治内容也有迭代。该文在学习2023年IWGDF 关于糖尿病足溃疡患者PAD的诊治指南基础上, 从诊断, 预后和治疗三个方面对该指南进行解读, 包 括多普勒无创诊断, 预后评价体系, 外科腔内成形和旁路手术以及内科治疗, 期待为从事糖尿病足与 周围血管病变的专业人员理解和实践该指南提供帮助。 [ABSTRACT FROM AUTHOR]

Objective To explore the predictive value of vibration perception threshold (VPT), maximum plantar pressure, and insulin resistance index for the development of foot ulcers in patients with diabetic peripheral neuropathy (DPN) over a one-year follow-up period. Methods The study included 112 patients with diabetic peripheral neuropathy who visited our hospital from May 2020 to May 2022. Patients were divided into two groups: DPN group (n=57, 50.89%) and diabetic neuropathy with foot ulcer (DNFU) group (n=55, 49.11%) based on whether foot ulcers developed during the one-year follow-up. General clinical data and dynamic foot parameters were compared between the groups. Multivariate logistic regression was used to identify independent predictors of foot ulcer development. The relationship between VPT, maximum plantar pressure, and insulin resistance index with the development of foot ulcers was analyzed, and ROC curves and decision curves were constructed to evaluate predictive performance and net benefit. Results The DNFU group had significantly higher diabetes duration (7.93±2.21 years vs. 6.23±1.85 years, t/P=2.678/0.013), HbA1 C levels (8.83±2.23% vs. 7.23±2.12%, t/P=4.725/0.000), and insulin resistance index (3.61±0.38 vs. 2.87±0.34, t/P=4.882/0.000) than the DPN group (P＜0.05) . VPT (12.56±3.22 vs. 8.42±1.32, t/P=4.878/0.000) and maximum plantar pressure (2 456.89±322.74 N vs. 2228.33±234.42 N, t/P=7.838/0.000) were significantly higher in the DNFU group (P＜0.05) . Multivariate logistic regression analysis identified insulin resistance index (OR: 2.275, 95% CI: 1.226-3.452, P=0.028), VPT (OR: 2.594, 95% CI: 1.137-3.786, P=0.005), and maximum plantar pressure (OR: 2.376, 95% CI: 1.342-3.567, P=0.017) as independent predictors for foot ulcer development (P＜0.05) . ROC analysis showed that the area under the curve (AUC) for predicting foot ulcer development was 0.765 (95% CI: 0.712-0.867) for insulin resistance index, 0.834 (95% CI: 0.782-0.927) for VPT, and 0.811 (95% CI: 0.775-0.878) for maximum plantar pressure. Decision curve analysis indicated good net benefit for VPT, maximum plantar pressure, and insulin resistance index in predicting foot ulcer development, with the combined prediction model achieving the highest net benefit. Conclusion VPT, maximum plantar pressure, and insulin resistance index are effective predictors of foot ulcer development in diabetic peripheral neuropathy patients over a one-year follow-up period, demonstrating good predictive performance and net benefit. [ABSTRACT FROM AUTHOR]