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Weiran Xu,1,&ast; Xiling Hu,2,&ast; Xing Zhang,3 Cong Ling,4 Chaofan Wang,5 Lingling Gao1 1School of Nursing, Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 3Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People’s Republic of China; 4Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 5Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Lingling Gao Email gaoll@mail.sysu.edu.cnObjective: This study investigated the biomedical, psychological, and social behavior risk factors for cognitive impairment in middle-aged and elderly patients with type 2 diabetes mellitus (T2DM).Methods: This cross-sectional study included 240 patients with T2DM. A questionnaire was used to collect demographic and disease-related data on patients, and the Self-rating Depression Scale (SDS), Diabetes Self-care Scale (DSCS), and Social Support Rating Scale (SSRS) were used to assess patients’ depression status, self-management behavior, and social support, respectively. The Chinese version of the Montreal Cognitive Assessment (MoCA) was used to evaluate cognitive function, with a score < 26 set as the threshold for cognitive impairment.Results: The prevalence of cognitive dysfunction in middle-aged and elderly patients with T2DM was 52.5%. Multivariate logistic regression analysis showed that older age, a history of hypoglycemia within 1 month, and depression were independent risk factors for cognitive impairment. Education for > 12 years, urban living, and a higher total score on the DSCS were independent protective factors against cognitive impairment.Conclusion: T2DM patients with high risk of cognitive impairment can be identified early from the bio-psycho-social perspective. Patients with T2DM who are older, less educated, living in rural areas, have hypoglycemia history, and have poor self-management of diabetes are at increased risk of cognitive impairment. Closer monitoring of patients with hypoglycemia, early detection of depression, and improving patients’ self-management capacity can prevent cognitive impairment in middle-aged and elderly patients with T2DM.Keywords: type 2 diabetes mellitus, cognitive impairment, depression, self-care, social support

Xiling Hu,1,&ast; Yao Zhang,2,&ast; Bin Yao,2 Beisi Lin,2 Dan Yang,3 Cong Ling,4,&ast; Lingling Gao3,&ast; 1Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 3School of Nursing, Sun Yat-sen University, Guangzhou, People’s Republic of China; 4Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Cong LingDepartment of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, 510630, People’s Republic of ChinaTel +86-13580465121Email doctor200@126.comLingling GaoSchool of Nursing, Sun Yat-sen University, No. 74, Zhongshan Er Road, Guangzhou, Guangdong, 510085, People’s Republic of ChinaTel +86 13539965693Email gaoll@mail.sysu.edu.cnPurpose: The purpose of this exploratory qualitative study was to identify the needs and barriers to diabetes dietary education issues in a Chinese context among people with type 2 diabetes and also their family members.Patients and Methods: Nineteen patients with type 2 diabetes and 15 family members were randomly selected from a larger study in Guangzhou. Descriptive phenomenological qualitative inquiry guided this study.Results: Both patients and their family members claimed a variety of needs regarding diabetes dietary information and that it should be patient-centered. In addition, both groups identified the effectiveness and helpfulness of diabetes diet-related health education, but family members reported a lack of professional education. Patients reported that the barriers to diabetes diet-related health education were: 1) patients’ different faculties of memory and acceptance, 2) educators’ methods of explaining the information, 3) lack of advertising and intensity of publicity both inside and outside of the hospital. Family members identified that diabetes diet-related health education assisted them with taking care of patients with diabetes and it was also beneficial for themselves to gain more dietary knowledge and develop healthy dietary habits.Conclusion: It is necessary to make some adjustment to traditional diabetes dietary education. It may be a good strategy to investigate the needs and faculties of memory and acceptance of people with diabetes before starting a diabetes education program. Hospitals should intensify their publicity of diabetes education and make it more attractive to patients with diabetes and their family members. Educators should add information specifically for family members while conducting diabetes education. Tertiary hospitals could provide standardized training regarding diabetes-related health education to community family physicians; in this way, diabetes education could gradually be transferred to them and both groups of clinicians could share in the education.Keywords: diabetes, family members, dietary education, needs, barriers, qualitative

Intracranial aneurysm (IA) is cerebrovascular disorder which refers to local vessel wall damage to intracranial arteries, forming abnormal bulge. Both endothelial cells (ECs) and vascular smooth muscle cells (VSMCs) are closely associated with IA formation and rupture. Inflammatory SMCs (iSMCs) were reported to induce EC dysfunction and result in IA progression. Phoenixin-14 (PNX-14) is a recently discovered brain peptide with pleiotropic roles, which participates in reproduction, cardio protection, lipid deposition and blood glucose metabolism. PNX-14 was previously reported to protect brain endothelial cells against oxygen-glucose deprivation/reoxygenation (OGD/R)-induced cell injury. Therefore, our study was designed to investigate the influence of PNX-14 on iSMCs-induced endothelial dysfunction.Inflammation in SMCs was induced by cyclic mechanical stretch. Human umbilical vein endothelial cells (HUVECs) were exposed to SMC- or iSMC-conditioned medium and then treated with 100 nM PNX-14 for 24 h. The levels of proinflammatory cytokines (IL-1β, IL-6 and TNF-α) in cell supernatants were analyzed by ELISA. Cell viability, apoptosis, angiogenesis and migration were subjected to CCK-8 assay, flow cytometry analysis, tube formation assay and Transwell migration assay. The protein levels of proinflammatory cytokines and apoptosis markers (Bcl-2 and Bax) were evaluated by western blotting.Cyclic mechanical stretch upregulated IL-1β, IL-6 and TNF-α levels in SMCs. Treatment with SMC- or iSMC-conditioned medium HUVECs inhibited cell viability, angiogenesis and migration and induced apoptosis in HUVECs. iSMC-conditioned medium has more significant effects on cell functions. However, the influence of SMC- or iSMC-conditioned medium treatment on HUVEC biological functions were reversed by PNX-14 treatment. PNX-14 exerts no significant influence on the biological functions of HUVECs treated with SMC medium.PNX-14 alleviates iSMCs-induced endothelial cell dysfunction in vitro.

Xiling Hu,1,* Yao Zhang,2,* Shuo Lin,2 Xiaodi Guo,2 Dan Yang,3 Mengyin Cai,2,* Lingling Gao3,* 1Department of Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China; 3School of Nursing, Sun Yat-Sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Mengyin CaiDepartment of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong 510630, People’s Republic of ChinaTel +86 13922131451Email my.sabrina.c@163.comLingling GaoSchool of Nursing, Sun Yat-Sen University, No. 74, Zhongshan Er Road, Guangzhou, Guangdong 510085, People’s Republic of ChinaTel +86 13539965693Email gaoll@mail.sysu.edu.cnPurpose: To investigate the dietary knowledge, attitude and practice (KAP) among the family members (FMs) of Chinese type 2 diabetes mellitus (T2DM) patients and its influence on the KAP of T2DM patients.Patients and Methods: Two hundred thirty-six pairs of hospitalized T2DM patients and their FMs (472 in total) in our hospital were enrolled. A pair of self-designed questionnaires on dietary KAP (Cronbach’s α ≥ 0.763, I-CVI ≥ 0.857, S-CVI = 0.964, 0.958) were used to collect data and assess the KAP towards diabetes diets.Results: The mean score for dietary KAP of T2DM patients was 2.33 ± 0.60, 3.03 ± 0.44 and 2.77 ± 0.38, whereas that of their FMs was 2.37 ± 0.55, 3.08 ± 0.48 and 2.82 ± 0.61, respectively. Pearson’s correlation analysis showed that the glycosylated hemoglobin (HbA1c) of T2DM patients was negatively correlated to their dietary practice (r = − 0.218, P < 0.01). There was a positive correlation between T2DM patients and their FMs for dietary KAP (r = 0.306, P < 0.05). The dietary practice of T2DM patients was positively correlated with the dietary KAP of their FMs (r = 0.305, 0.252 and 0.136, respectively, P < 0.01). Logistic regression analysis revealed that the score for dietary knowledge and attitude, occupation, residence, family history, complications of the T2DM patient, and the sex and dietary knowledge score of the FM were significantly associated with dietary practice for T2DM patients.Conclusion: The dietary attitude of FMs was moderate but dietary knowledge and practice were poor. Dietary KAP was positively correlated with T2DM patients and their FMs.Keywords: type 2 diabetes mellitus, self-management, family characteristics

IntroductionResearch on the needs and preferences of patients with poorly controlled type 2 diabetes mellitus (T2DM) with mobile health (mHealth) service is limited. With the principles of co-production, this study aims to address this research gap by exploring the health needs of Chinese patients with poorly controlled T2DM.Methods and analysisThis study uses a three-phase, exploratory sequential mixed-method design. Phase 1 aims to assess the health needs of patients with poorly controlled T2DM by conducting semi-structured interviews with patients, doctors and nurses. Participants will be recruited by purposive sampling with maximum variation. Content analysis will be employed. Phase 2 will form item generation and develop the mHealth need scale. The scale will be subject to pilot testing and psychometric evaluation, including content validity, construct validity, discriminant validity, internal validity and test–retest reliability. Phase 3 will explore the priority of health needs perceived by patients with poorly controlled T2DM through a cross-sectional study. The measurement tools include an mHealth needs scale, the Summary of Diabetes Self-care Activities Questionnaire, the Diabetes Empowerment Scale-Short Form, the Diabetes Health Literacy Scale and the eHealth Literacy Scale. Multiple regression techniques with a hierarchical block design will be used for the model building to identify the factors contributing to the heterogeneity of the perceived mHealth needs. The findings of phase 1 and phase 3 will be integrated using data correlation, comparison and consolidation.Ethics and disseminationThe Ethics Committee of the School of Nursing, Sun Yat-sen University, has approved this study (No. 2021ZSLYEC). The results of this study will be disseminated through conference presentations and peer-reviewed publications.

Insulin antibodies (IAs) induced by exogenous insulin rarely cause hypoglycemia. However, insulin autoantibodies (IAAs) in insulin autoimmune syndrome (IAS) can cause hypoglycemia. The typical manifestations of IAS are fasting or postprandial hypoglycemia, elevated insulin level, decreased C-peptide levels, and positive IAA. We report a 45-year-old male with type 1 diabetes mellitus (T1DM) treated with insulin analogues suffering from recurrent hypoglycemic coma and diabetic ketoacidosis (DKA). His symptoms were caused by exogenous insulin and were similar to IAS. A possible reason was that exogenous insulin induced IA. IA titers were 61.95% (normal:5%), and the concentrations of insulin and C-peptide were300 mU/L and0.02 nmol/L when hypoglycemia occurred. Based on his clinical symptoms and other examinations, he was diagnosed with hyperinsulinemic hypoglycemia caused by IA. His symptoms improved after changing insulin regimens from insulin lispro plus insulin detemir to recombinant human insulin (Gensulin R) and starting prednisone.

Aims This study investigated self-care activities and identified their related factors in Chinese patients with type 2 diabetes mellitus. Methods A cross-sectional study was conducted in Guangzhou, China, between September 2016 and February 2017, involving 202 Chinese patients with type 2 diabetes mellitus. Measures included the Summary of Diabetes Self-Care Activities Questionnaire and Revised Illness Perception Questionnaire. Results Self-care activities in Chinese patients with type 2 diabetes mellitus were suboptimal overall. Foot care and blood sugar testing were the self-care activities that were performed the least. One fifth of patients smoked. Some subscales of illness perceptions, receiving health education on diabetes, employment status, education level, body mass index, age and time since type 2 diabetes mellitus diagnosis, were related to self-care activities in patients with type 2 diabetes mellitus. Conclusion Health-care providers and nurses should encourage greater engagement in self-care activities in patients with type 2 diabetes mellitus, especially foot care and blood sugar testing. Illness perceptions may be used as a framework to guide interventions.

Xiling Hu,1,* Hongrong Deng,2,* Yao Zhang,2 Xiaodi Guo,2 Mengyin Cai,2 Cong Ling,3,* Kun Li4,* 1Department of Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 2Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 3Department of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People’s Republic of China; 4School of Nursing, Sun Yat-sen University, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Cong LingDepartment of Neurosurgery, The Third Affiliated Hospital of Sun Yat-sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, 510630, People’s Republic of ChinaTel +86-13580465121Email doctor200@163.comKun LiSchool of Nursing, Sun Yat-sen University, No. 74, Zhongshan Second Road, Guangzhou, Guangdong, 510085, People’s Republic of ChinaTel +86-13822206519Email likun22@mail.sysu.edu.cnObjective: The main aim of this study was to evaluate a combined fasting blood glucose based dosage self-titration setting and decision supported telephone coaching intervention on glycemic control and diabetes self-management skills, compared to the conventional care.Methods: A 12-week, single-blinded, randomized controlled trial was conducted on adults with type 2 diabetes (T2DM) primarily treated with basal insulin. After randomization, the intervention group (IG, n = 426) received a basal insulin self-titration decision support intervention administered by the Diabetes Specialty Nurses while the control group (CG, n = 423) received conventional care for 12 weeks, both included five telephone interviews. The primary efficacy endpoint was the effect of intervention on glycemic control, measured as the change in glycated hemoglobin (HbA1c) from baseline to Week 12 (after intervention) compared to the control group. Other endpoints included comparisons of the effects of intervention on fasting plasma glucose (FPG), postprandial plasma glucose (PPG), body weight, Michigan diabetes knowledge test (MDKT), diabetes empowerment scale-short Form (DES-DSF), and summary of diabetes self-care activities (SDSCA). Changes in the primary and secondary outcomes were compared using the t-test for continuous variables with a normal distribution and χ2-test for categorical variables.Results: The IG showed more improvements on mean HbA1c, compared to the CG (− 2.8% vs − 1.8%), so did the FPG, PPG, MDKT, DES-DSF and SDSCA (all P< 0.01) after the 12-week follow up. Though the final mean insulin dose in the IG was higher than the CG at the end of the study (0.32 U/kg vs 0.28 U/kg), the changes of body weight were similar between the two groups (0.46kg vs 0.40kg, P=0.246), and the proportion of patients with hypoglycemia events during the whole trial were similar (20.65% vs 17.73%, P=0.279).Conclusion: Decision supporting of basal insulin glargine self-titration assisted by Diabetes Specialty Nurses is effective and safe in patients with T2DM. Decision supported telephone coaching intervention offers ongoing encouragement, guidance, and determination of relevant sources of decisional conflict, facilitating adjusting the insulin dose.Keywords: type 2 diabetes mellitus, basal insulin, dosage titration

Cushing disease is a rare but serious endocrine disorder. It involves increased cortisol levels, which can damage the function of various systems throughout the body, including the central nervous system, affecting cognition, memory, and emotion. However, it is rare that Cushing disease presents as a mental disorder. This paper reports the complete diagnosis, treatment process, and follow-up of a patient with Cushing disease whose main symptom was bipolar disorder.A 31-year-old woman was diagnosed with bipolar disorder 9 years ago and was admitted to hospital several times due to repeated episodes of depression and mania. In October 2017, after careful examination and consideration by doctors, the patient was diagnosed with Cushing syndrome and underwent transsphenoidal pituitary microadenoma resection. Glucocorticoid replacement therapy and antipsychotic therapy were administered postoperatively. After careful treatment and care by the medical staff, the patient's cortisol levels returned to normal, and her mental symptoms were significantly improved.This is a rare case of Cushing disease marked by psychiatric symptoms. Neuropsychiatric symptoms can precede the onset of Cushing disease, making diagnosis challenging.

BackgroundThis study aimed to compare nutritional effectiveness and complication rate between early nasojejunal and nasogastric tube feeding in patients with an intracerebral hemorrhage.MethodsEighty patients with an intracerebral hemorrhage were randomly divided into a nasojejunal and a nasogastric tube feeding group. Feeding tubes were placed within 6 hours after admission, and enteral feeding began within 2 hours after tube placement. The nutritional status and complication rate of the 2 groups were compared before and 2 and 4 weeks after beginning feeding.ResultsSerum prealbumin, serum albumin, and hemoglobin levels were significantly higher in the nasojejunal tube feeding group than in the nasogastric tube feeding group at 2 and 4 weeks after beginning feeding (all, p #These authors contributed equally to this work.

Aims. To develop a simple hypoglycemic prediction model to evaluate the risk of hypoglycemia during hospitalization in patients with type 2 diabetes treated with intensive insulin therapy. Methods. We performed a cross-sectional chart review study utilizing the electronic database of the Third Affiliated Hospital of Sun Yat-sen University, and included 257 patients with type 2 diabetes undergoing intensive insulin therapy in the Department of Endocrinology and Metabolism. Logistic regression analysis was used to derive the clinical prediction rule with hypoglycemia (blood glucose≤3.9 mmol/L) as the main result, and internal verification was performed. Results. In the derivation cohort, the incidence of hypoglycemia was 51%. The final model selected included three variables: fasting insulin, fasting blood glucose, and total treatment time. The area under the curve (AUC) of this model was 0.666 (95% CI: 0.594–0.738, P<0.001). Conclusions. The model’s hypoglycemia prediction and the actual occurrence are in good agreement. The variable data was easy to obtain and the evaluation method was simple, which could provide a reference for the prevention and treatment of hypoglycemia and screen patients with a high risk of hypoglycemia.

Background Our research aimed to explore the correlation between mid-upper arm circumference (MUAC) and central obesity and insulin resistance (IR) in Chinese subjects with type 2 diabetes. Materials A total of 103 participants (60 men) were recruited in our study. MUAC was measured around the mid-arm between the shoulder and elbow. Waist circumference (WC) was obtained as central obesity parameter, and the IR parameter of Homeostasis Model Assessment-Insulin Resistance (HOMA-IR) was calculated. The subjects were divided into three groups according to the tertiles cut-points of MUAC level. Results Body mass index (BMI), WC, the percentages of central obesity and HOMA-IR were significantly higher in the groups with higher MUAC than those in the group with lower MUAC (all P < 0.05). Pearson analysis showed that MUAC was correlated with BMI, WC, waist-to-hip ratio (WHR), logHOMA-IR, low density lipoprotein cholesterol (LDL-C), uric acid (UA) and high density lipoprotein cholesterol (HDL-C) in all subjects. Multivariate linear regression analysis revealed that MUAC was independently associated with logHOMA-IR (β = 0.036, P

Self-adjustment of basal insulin dose were proved to be effective and widely used in clinical practice. However, no study compares the efficacy and safety of different self-adjustment regimens of basal insulin in T2DM. T2DM with inadequate glucose control on OADs who were to start basal insulin from our outpatient clinics were enrolled and randomized to two groups. Patients in Group A were guided to adjust insulin dose 2-6U weekly; those in Group B adjusted insulin dose 2-3U every 3 days. Dose titration was based on self-monitored blood glucose (SMBG) to achieve a target FBG of 6.1mmol/L. The titration regimen is shown in Table. A total of 648 patients aged 53.9 years old finished the 12-week visits. The baseline characteristics were even between groups. The FBG achieving rates were similar between Group A (75.7%) and Group B (74.4%). Compared with baseline, FBG and HbA1c decreased in both groups (FBG:10.7mmol/L vs. 6.6mmol/L in Group A, 10.8mmol/L vs. 6.5mmol/L in Group B; HbA1c:9.3% vs. 6.9% in group A, 9.5% vs. 6.8% in Group B, respectively, All P In conclusion, both self-adjustment regimens in this study are effective and safe in T2DM.Table. Insulin Titration Protocol.Fasting blood glucose(mmol/L)Dose adjustment (U)Group AGroup B10.0+6U+2∼3U Disclosure X. Hu: None. X. Yang: None. W. Xu: None. H.R. Deng: None. X. Guo: None. B. Yao: None. L. Zeng: None. J. Weng: None.

Male patients with idiopathic hypogonadotropic hypogonadism (IHH) characterized with low serum testosterone(T) might have higher risks of diabetes and coronary heart disease partly due to the high level of plasma insulin. Low serum T might also affect the body fat mass(BFM) in patients with IHH. However, the relationship between BFM and plasma insulin level in IHH patients has not been clearly clarified. A total of 22 patients who were admitted to our hospital with IHH and normal glucose tolerance(NGT) confirmed by oral glucose tolerance test and 10 healthy subjects as controls were enrolled into our study. Glucose, insulin, serum T levels, HOMA-IR, HOMA-B and percentage of BFM were determined. When compared with controls subjects, patients with IHH had significantly lower T concentrations(1.80nmol/L vs. 19.82nmol/L, P BFM was an independent factor of plasma insulin level in IHH patients with NGT. Disclosure X. Yang: None. Q. Lin: None. X. Hu: None. W. Xu: None. H.R. Deng: None.

Background: Preconception care (PCC) can improve pregnancy outcomes in women with type 1 diabetes (T1D). Little was known on current status of PCC in China. We aimed to investigate the current practice and attitude about PCC from the perspective of the patients’ family members. Method: We conducted in-depth interviews with family members of T1D women. By purposive sampling we included their husbands, parents and parents-in-law. Transcripts of the interviews were coded into themes by 3 researchers via thematic framework method and analyzed in NVIVO 11. The recruitment ended when no new themes emerged. Results: We interviewed 16 family members of 14 T1D women (10 husbands, 4 mothers, 1 father and 1 mother-in-law) and rendered 9 themes. 1. Knowledge of T1D and PCC: most demonstrated little knowledge of both due to lack of education. 2. Content of PCC: dietary guidance and glycaemic control were most required. 3. Timing of starting PCC: adulthood was most recommended while the rest adolescence. 4. Approach of PCC: internet and on-site consultation were well recognized while tutorials and materials as supplements. 5. Multi-disciplinary cooperation: most suggested that endocrinology professionals take the main responsibility of PCC with other professionals. 6. Attitude on pregnancy: most thought women had the obligation of childbearing while the rest showed respect to the women’s own decision. 7. Concern: worries on complications during pregnancy, inheritance of T1D, social discrimination and economic cost. 8. Doctor-patient communication: most considered the information and consultation time provided by doctors were inadequate. 9. Peer support: peer communication was mainly supported in order to convey experience and confidence while the minority opposed it fearing the spread of negative information. Conclusions: Family members of T1D women scarcely owned knowledge of PCC and suffered various concerns. Their participation in PCC should be encouraged and mental support should be enhanced. Disclosure C. Wang: None. S. Luo: None. X. Zheng: None. X. Hu: None. J. Yan: None. Y. Guo: None. S. Xiong: None. D. Yang: None. L. Qiu: None. B. Yao: None. J. Weng: None.