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OBJECTIVES The aims of this study were to analyze the continuous glucose monitoring (CGM) profiles of patients with insulinoma before and after treatment with endoscopic ultrasound-guided ethanol injection and assess the value of CGM in curative effect evaluating. METHODS We included 8 patients, and CGM was performed for 3 to 5 days before and after treatment. RESULTS The proportion of monitoring points at which the glucose level was lower than 3.9 mmol/L after treatment decreased in patient 5 (from 4% to 3%) and patient 8 (from 30% to 12%), whereas the proportion increased in patient 1 (from 1% to 16%), patient 3 (from 5% to 23%), and patient 7 (from 7% to 63%). There was no mean significant difference between CGM values (5.75 [standard deviation, 2.49] mmol/L) and self-monitoring of blood glucose values (5.76 [standard deviation, 2.32] mmol/L) (P > 0.05). Pearson correlation analysis showed positive correlation between CGM values and self-monitoring of blood glucose values (r = 0.88, P < 0.05). Clarke Error Grid Analysis showed that 91.5% of pairs were located in areas A and B. CONCLUSIONS Continuous glucose monitoring is useful for detecting hypoglycemia and evaluating curative effect, but the correction of fingertip blood glucose is necessary when the blood glucose is relatively low.

Shuoning Song,1 Yuemei Zhang,2 Xiaolin Qiao,3 Yanbei Duo,1 Jiyu Xu,4 Zhenyao Peng,5 Jing Zhang,6 Yan Chen,3 Xiaorui Nie,3 Qiujin Sun,7 Xianchun Yang,7 Ailing Wang,8 Zechun Lu,8 Wei Sun,4 Yong Fu,1 Yingyue Dong,1 Tao Yuan,1 Weigang Zhao1 1Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Obstetrics, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 3Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 4Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People’s Republic of China; 5Department of Dean’s Office, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 6Department of Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 7Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 8National Center for Women and Children’s Health, China CDC, Beijing, People’s Republic of ChinaCorrespondence: Tao Yuan; Weigang ZhaoDepartment of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel/Fax +86 1069155073Email t75y@sina.com; xiehezhaoweigang@163.comObjective: This study aimed to find the association between alanine transaminase-to-aspartate aminotransferase ratio (ALT/AST) and the incidence of gestational diabetes mellitus (GDM).Methods: A total of 1128 pregnant women were included in this prospective, double-center, observational cohort study. ALT, AST and total bilirubin (TBil) were tested during 6– 12 weeks of gestation and 75-g oral glucose tolerance test (OGTT) was conducted during 24– 28 weeks of gestation to screen GDM. The association between ALT/AST and glucose concentration during OGTT was analyzed by linear regression model. The OR with 95% CI for incidence of GDM associated with ALT/AST was estimated by binary logistic regression. The discriminatory values of ALT/AST and triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) for GDM were calculated by the area under the receiver operating characteristic curve (ROC-AUC).Results: The incidence of GDM was 22.07% (249/1128). ALT/AST was higher in GDM group than in NGT group (0.92 [0.75, 1.18] vs 0.80[0.65, 1.02], P < 0.001). ALT/AST had positive correlations with fasting blood glucose, 1-hour and 2-hour blood glucose concentration during OGTT (0.089 [95% CI: 0.034, 0.163], 0.176 [95% CI: 0.052, 0.104], and 0.115 [95% CI: 0.199, 0.609], respectively). The OR of ALT/AST for incidence of GDM was 1.603 (95% CI:1.097, 2.344). The ROC-AUC of ALT/AST and TG/HDL-C reached 0.615 (95% CI: 0.575, 0.655) and 0.619 (95% CI: 0.580, 0.659), respectively.Conclusion: ALT/AST in early pregnancy was an independent risk factor of GDM. The predictive ability of ALT/AST was similar to TG/HDL-C for GDM.Keywords: gestational diabetes mellitus, type 2 diabetes mellitus, alanine transaminase, aspartate aminotransferase, triglyceride

Shuoning Song,1 Yanbei Duo,1 Yuemei Zhang,2 Xiaolin Qiao,3 Jiyu Xu,4 Jing Zhang,5 Zhenyao Peng,6 Yan Chen,3 Xiaorui Nie,3 Qiujin Sun,7 Xianchun Yang,7 Ailing Wang,8 Wei Sun,4 Yong Fu,1 Yingyue Dong,1 Zechun Lu,8 Tao Yuan,1 Weigang Zhao1 1Department of Endocrinology, Key Laboratory of Endocrinology of Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People’s Republic of China; 2Department of Obstetrics, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 3Department of Obstetrics, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 4Core Facility of Instrument, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, People’s Republic of China; 5Department of Laboratory, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 6Department of Dean’s Office, Haidian District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 7Department of Clinical Laboratory, Beijing Chaoyang District Maternal and Child Health Care Hospital, Beijing, People’s Republic of China; 8National Center for Women and Children’s Health, China CDC, Beijing, People’s Republic of ChinaCorrespondence: Tao Yuan; Weigang Zhao Email t75y@sina.com; xiehezhaoweigang@163.comObjective: To evaluate the association of hepatic steatosis index (HSI) in the first trimester and the risk of gestational diabetes mellitus (GDM) as well as large for gestational age (LGA) infant in Chinese women.Methods: A total of 1082 pregnant women were included in this study. Maternal basic laboratory data, including ALT, AST, FBG, insulin, TG, and HDL-C, were tested during 6– 12 weeks of gestation and anthropometric characteristics were monitored during gestation. A 75-g oral glucose tolerance test (OGTT) was conducted at 24– 28 weeks of gestation. HSI, nonalcoholic fatty liver disease (NAFLD) liver fat score, triglyceride/high-density lipoprotein cholesterol (TG/HDL-C) and triglyceride-glucose (TyG) index were calculated. Odds ratio with 95% confidence interval for subsequent risk of GDM and LGA by HSI quartiles were assessed by binary logistic regression model. The predictive ability of HSI for GDM and LGA was evaluated by the receiver operating characteristic (ROC) curve analysis and was compared with other indices.Results: The incidence of GDM and LGA were 22.09% (239/1082) and 10.53% (87/826). HSI was higher in GDM group than in NGT group (median, interquartile range: 30.67, 27.20– 35.10 vs 27.98, 25.70– 30.82, P< 0.001). Incidence of GDM was gradually increased with increasing HSI values. Women in the highest HSI quartile had significantly higher risk of LGA delivery than those in the lowest HSI quartile (P< 0.05). The area under the ROC curves of HSI for GDM and LGA were higher than other indices, reaching 0.646 (95%CI: 0.605– 0.686) and 0.600 (95%CI: 0.541– 0.660), respectively.Conclusion: Higher HSI was independently associated with higher risk of GDM and LGA in Chinese women. HSI in the first trimester can predict the risk of GDM and LGA.Keywords: hepatic steatosis index, nonalcoholic fatty liver disease, gestational diabetes mellitus, large for gestational age infant

Objective: To investigate the ability of homeostasis model assessment of insulin resistance (HOMA-IR) in early pregnancy for predicting gestational diabetes mellitus (GDM) in Chinese women with different first-trimester body mass index (FT-BMI) values. Methods: Baseline characteristics and laboratory tests were collected at the first prenatal visit (6–12 weeks of gestation). GDM was diagnosed by a 75 g oral glucose tolerance test (OGTT) at 24–28 weeks of gestation. Partial correlation analysis and binary logistic regression were applied to identify the association between HOMA-IR and GDM. The cutoff points for predicting GDM were estimated using receiver operating characteristic (ROC) curve analysis. Results: Of the total of 1343 women, 300 (22.34%) were diagnosed with GDM in the 24–28 weeks of gestation. Partial correlation analysis and binary logistic regression verified HOMA-IR as a significant risk factor for GDM in the normal weight subgroup (FT-BMI < 24 kg/m2) (adjusted OR 2.941 [95% CI 2.153, 4.016], P < 0.001), overweight subgroup (24.0 kg/m2 ≤ FT-BMI < 28.0 kg/m2) (adjusted OR 3.188 [95% CI 2.011, 5.055], P < 0.001), and obese subgroup (FT-BMI ≥ 28.0 kg/m2) (adjusted OR 9.415 [95% CI 1.712, 51.770], p = 0.01). The cutoff values of HOMA-IR were 1.52 (area under the curve (AUC) 0.733, 95% CI 0.701–0.765, p < 0.001) for all participants, 1.43 (AUC 0.691, 95% CI 0.651–0.730, p < 0.001) for normal weight women, 2.27 (AUC 0.760, 95% CI 0.703–0.818, p < 0.001) for overweight women, and 2.31 (AUC 0.801, 95% CI 0.696–0.907, p < 0.001) for obese women. Conclusions: Increased HOMA-IR in early pregnancy is a risk factor for GDM, and HOMA-IR can be affected by body weight. The cutoff value of HOMA-IR to predict GDM should be distinguished by different FT-BMI values.

We aimed to explore the medium- and long-term (≥12 weeks) effects of dapagliflozin on serum uric acid (SUA) level in patients with type 2 diabetes mellitus (T2DM) in the real world study and to explore the influencing factors of dapagliflozin on reducing SUA level. This observational, prospective cohort study was based on the real world. There were 77 patients included in this study. They were divided into two groups. Patients in treatment group (n = 38) were treated as dapagliflozin 10 mg/d combined with therapy of routine glucose-lowering drugs (GLDs), and patients in the control group (n = 39) were treated with their routine GLDs. All measurements of physical examinations, blood, and urine samples, including age, sex, weight, height, systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), and SUA, were collected at baseline for all patients in these two groups and repeated after 12, 24, and 48 weeks of therapy. We compared the changes of metabolic indicators including SUA in these two groups to evaluate the effects of dapagliflozin and analyzed its influencing factors. In the dapagliflozin group, mean SUA levels significantly decreased from 334.2 ± 99.1 μmol/L at baseline to 301.9 ± 73.2 μmol/L after 12 weeks therapy (t = 2.378, p = 0.023). There was no significant statistical difference of SUA levels after 24 weeks treatment of dapagliflozin compared with 12-week and 48-week treatment with dapagliflozin (p > 0.05). We found that baseline SUA had a significant impact on the effect of dapagliflozin on reducing SUA (OR 1.014, 95%CI 1.003–1.025, p = 0.014) by logistic regression analysis. Receiver operating characteristic (ROC) curve showed that T2DM patients with SUA level ≥ 314.5 μmol/L had relative accuracy in recognizing the good effects of dapagliflozin on reducing SUA (sensitivity 76.9%, specificity 76.2%). Combination therapy of dapagliflozin with routine blood-glucose-lowering drugs in T2DM patients showed the significant and sustained stable effect of lowering SUA level in this real-world study.

Background: Few studies focused on the effects of medium-to-low dose glucocorticoids on glucose profiles and glucose metabolism in patients with interstitial pneumonia with autoimmune features (IPAF). Continuous glucose monitoring system (CGMS) can provide more detailed glucose features than fingertip blood samplings.Methods: This was a observational study in a teaching hospital. Outpatients with IPAF on 15mg prednisone per day for at least 3 months were recruited to receive CGMS and blood tests. The primary data of CGMS were analyzed to demonstrate the glucose features. Data were compared between subjects with a glucocorticoid treatment duration of more than 2 years(Group 1) and subjects with that of less than 2 years(Group 2). In subgroup analysis, among all subjects, subjects who tapered the daily dose to 7.5mg for at least 3 months received second tests. Results: 93% (27/29) on daily 15mg prednisone and all subjects on daily 7.5mg prednisone were with glucocorticoid induced hyperglycemia(GIH). Among subjects on daily 15mg prednisone, glucose AUC of 3 hours post-lunch was significantly higher than those post-breakfast and post-dinner, and mean glucose levels of half an hour pre-lunch and pre-dinner were significantly higher than that pre-breakfast. 81.9% of nocturnal glucose nadirs presented after 5AM, leading to relatively low fasting glucose values. There were no significant differences of glucose profiles between Group 1 and Group 2. No significant differences of CGMS and laboratory parameters were found between on daily 15mg prednisone and on daily 7.5mg prednisone.Conclusions: A large proportion of outpatients on medium-to-low-dose glucocorticoids are with GIH. Post-lunch glucose or post-dinner glucose are good indicators, while fasting glucose is not. The similar glycemic effects of daily 15mg and 7.5mg prednisone provide evidence for physicians to choose long-term maintaining glucocorticoid dose.Clinical Research Registration: This research is registered at clinicaltrials.gov(No.NCT02824757) with the registry named The Effects of Glucocorticoids on Glucose Metabolism in Patients With Interstitial Lung Disease. The URL is https://clinicaltrials.gov/ct2/show/NCT02824757?term=NCT02824757&draw=2&rank=1.This research is registered at July 7th,2016, retrospectively.

Superficial fascia has abundant preadipocytes capable of spontaneous and induced differentiation and is thought to be a novel origin of adipocytes. This study aimed to quantitatively evaluate the spatial distribution and correlation of adipocytes and mast cells in rat superficial fascia. Panoramic images were obtained from whole-mounted fascia stained by toluidine blue. Adipocytes increased gradually in superficial fascia of growing rats. Abundant mast cells, with the degranulation and exocytosis of abundant secretory granules, appeared in fascia where partially differentiating adipocytes and mature adipocytes occurred. Quantitative histological analysis by variance-mean ratio and Morisita index of dispersion indicated that both mast cells and adipocytes in fascia were distributed individually in cluster, but not random or uniform. Spearman's correlation coefficient revealed that the spatial cluster distributions of mast cells and adipocytes positively correlated with each other and correlated with increased number and size of adipocytes and adipogenic areas in fascia. Morphometry analysis indicated the strong correlation between fascial adipocytes and mast cells during the periods of rat growth. The correlation coefficient increased significantly at 8 weeks compared to 4 weeks, consistent with the increasing trend of the number and size of fascia adipocytes in growing rats. This finding provided the first quantitative histological analysis for the spatial distribution and correlation of fascia adipocytes and mast cells, which could be the histocytological basis for further exploring spatial and functional interactions between fascial mast cells and adipocytes. Also, the present data were informative for the research on physiologies and pathologies of fascia and fascia-related connective tissues.

OBJECTIVE To assess the association between insulin resistance and gestational diabetes mellitus (GDM) in early pregnancy and find a simple surrogate index of the homeostasis model assessment of insulin resistance (HOMA-IR). METHODS A total of 700 pregnant women were included in this prospective, double-center, observational cohort study. The glucose and lipid metabolic characterization was performed at 6-12 weeks of pregnancy. All participants underwent a 75-g oral glucose tolerance test at 24-28 weeks of pregnancy. Linear regression analysis was applied to find a novel surrogate index of HOMA-IR. Binary logistic analysis was applied to estimate possible associations of different indices with GDM and insulin resistance. RESULTS GDM was diagnosed in 145 of 700 women with singleton pregnancies (20.7%). HOMA-IR was higher in the GDM group than in the normal glucose tolerance (NGT) group and was an individual risk factor for GDM (adjusted risk ratio RR 1.371, 95% confidence interval [CI] 1.129-1.665, P

The maternal physiological changes which occur during gestation are complex and affect diverse systems in the body. Elucidating the various changes that occur during pregnancy may assist with understanding maternal health and the factors affecting pregnancy outcomes.A longitudinal cohort of 84 pregnant women was established. The urinary proteomes of women in different trimesters of pregnancy (6-8, 22-24, and 32-34 weeks) were characterized using data-independent acquisition tandem mass spectrometry. Gestational diabetes mellitus (GDM) was diagnosed at 24 to 28 weeks. Functional analysis of serial changed proteins was performed.Fifteen women had GDM, 50 were healthy, and 19 experienced spontaneous abortion (SA). Functional analysis showed that the urinary proteome reflected physiological and pathological changes during pregnancy. Compared to those of women with a normal pregnancy, the urinary proteomes of women with GDM and SA showed significant disease-related changes in insulin secretion and estrogen receptor activity, respectively, during the first trimester. Urinary protein during the first trimester of pregnancy achieved an area under the curve of 0.91 and 0.81 for GDM and SA, respectively.The urinary proteome has the potential to reflect serial changes of pregnancy progression; therefore, its use might facilitate early diagnosis of pregnancy complications.

Background We aimed to investigate the clinical characteristics and islet β-cell function in patients with Klinefelter syndrome (KS) and hyperglycemia. Methods This is a retrospective study. In total, 22 patients diagnosed with KS were identified from the electronic medical record system, including 9 patients with hyperglycemia (total patients with hyperglycemia, THG-KS group) and 5 hyperglycemic KS patients with oral glucose tolerance test (OGTT) results (HG-KS group). An additional 5 subjects with hyperglycemia and 5 normal glucose tolerance (NGT) subjects matched based on body mass index were included as the HG group and NGT group, respectively. Data from clinical and laboratory examinations were collected. We further performed a literature review of KS and hyperglycemia. Results We found that KS patients developed abnormal glucose metabolism earlier in life than those without KS, and the median age was 17 years, ranging from 10 years to 19 years. Six of 17 (35.3%) patients were diagnosed with diabetes mellitus and 3 of 17 (17.6%) patients were diagnosed with prediabetes. Among 10 patients with both fasting blood glucose and insulin results recorded, there were 8 out of 17 (47.1%) KS patients had insulin resistance. The prevalence of hypertension and dyslipidemia was higher in patients with hyperglycemia and KS than in patients with NGT KS. Compared with the HG group, insulin sensitivity levels were lower in HG-KS group, whereas homeostasis model assessment of β-cell function levels (p = 0.047) were significantly, indicating higher insulin secretion levels in the HG-KS group. Conclusions KS patients develop hyperglycemia earlier in life than those without KS and show lower insulin sensitivity and higher insulin secretion. These patients also have a higher prevalence of other metabolic diseases and may have different frequencies of developing KS-related symptoms.

Fascial adipocytes are recently identified as a unique population of adipose cells, which have different developmental origins, anatomical locations, cytological and functional characteristics compared with subcutaneous or visceral adipocytes. Superficial fascia in rats (also in pigs but not obviously in mice) contains numbers of lineage committed preadipocytes which possess adipogenic potential in vivo. The present study aimed to investigate the physiological factors that contribute to fascial adipogenesis in rats. We detected that mast cells, adipose progenitor cells, and mature adipocytes distributed in certain fascia areas were closely associated with each other, and numerous heparin-loaded granules released from mast cells were distributed around fascial preadipocytes. The culture supernatants of rat peritoneal mast cells and RBL-2H3 mast cells contained 20–30 μg/ml of heparin, effectively activated PPAR-responsive luciferase activity, promoted mRNA and protein expressions of key adipogenic genes, and hence increased adipogenic differentiation of fascia- or epididymal adipose-derived stromal cells. Adipogenic effects of mast cell supernatants were mimicked by heparin but not by histamine or 5-hydroxytryptamine, and were antagonized by protamine sulfate. In rats, local administration of heparin-loaded microspheres for 30 days induced adipogenesis in local areas of superficial fascia. This adipogenic effects of heparin might be related by chain length of glucosamine units, because heparin stimulated stronger adipogenesis than dalteparin and enoxaparin with relatively short chains. Our findings suggested that mast cell and its granule heparin could serve as the endogenous physiological factors to initiate and accelerate local adipogenesis in superficial fascia, or in adipose tissue with the fascia naturally embedded inside.

Background We aimed to evaluate the effects of short-term therapy with dapagliflozin on serum uric acid (SUA) and urinary uric acid (UUA) levels in patients with type 2 diabetes. Methods In this prospective pilot trial, 8 patients with type 2 diabetes mellitus were assigned to the treatment group with dapagliflozin 10 mg once daily for one week, and 7 subjects with normal glucose tolerance were recruited into the control group. Data of anthropometric measurements, SUA, 24-h UUA, fractional excretion of UA (FEUA), serum lipid parameters and 3-h oral glucose tolerance test (OGTT) were collected in both treatment and control groups; all examinations were repeated after treatment. The area under the curve of glucose (AUCGlu) was calculated to reflect the general glucose levels, while insulin resistance and islet β-cell function were reflected by indexes calculated according to the data obtained from the OGTT. Results The weight and serum lipid parameters showed no differences before and after treatment with dapagliflozin for one week. We found SUA levels decreased from 347.75 ± 7.75 μmol/L before treatment to 273.25 ± 43.18 μmol/L after treatment, with a statistically significant difference (P = 0.001) and was accompanied by a significant increase in FEUA from 0.009 to 0.029 (P = 0.035); there was a linear correlation between SUA and FEUA levels. Glucose control, insulin sensitivity and islet β-cell function were improved to a certain extent. We also found a positive correlation between the decrease in glucose levels and the improvement in islet β-cell function. Conclusions The SUA-lowering effect of dapagliflozin could be driven by increasing UA excretion within one week of treatment, and a certain degree of improvement in glucose levels and islet β-cell function were observed. Trial registration ClinicalTrials.gov identifier, NCT04014192. Registered 12 July 2019, https://www.clinicaltrials.gov/ct2/show/NCT04014192:term=NCT04014192&draw=2&rank=1. Yes.

Background We aimed to evaluate the effects of dapagliflozin short-term therapy on serum uric acid (SUA) and urinary uric acid (UUA) levels in type 2 diabetic patients. Methods In this prospective pilot trial, 8 patients with type 2 diabetes mellitus were assigned to the treatment group with dapagliflozin 10 mg once daily for one week, and 7 subjects with normal glucose tolerance were recruited in the control group. Data of anthropometric measurements, SUA, 24-hour UUA, the fractional excretion of UA (FEUA), serum lipid parameters and 3-hour oral glucose tolerance test (OGTT) were collected in both treatment and control groups, also repeated after treatment. Area under curve of glucose (AUCGlu) was calculated to reflect the general glucose levels, insulin resistance and islet β-cell secretion function were reflected by indices calculated according to the data obtained from OGTT. Results The weight and serum lipid parameters showed no differences before and after dapagliflozin treatment for one week. We found SUA levels reduced from 347.75 ± 7.75 µmol/L before treatment to 273.25 ± 43.18 µmol/L after treatment with a significant difference (p = 0.001), accompanying with a significant increase in FEUA from 0.009 to 0.029 (p = 0.035), and there was a linear correlation between SUA and FEUA levels. The glucose control, insulin sensitivity and islet β-cell secretion function were improved to a certain extent. We also found the decrease in glucose levels were positively correlated with the improvement of islet β-cell secretion function. Conclusions Dapagliflozin can present the effect on reducing SUA by increasing UA excretion within one-week treatment, a certain degree of improvement in glucose levels and islet β-cell function were observed. Trial registration: ClinicalTrials.gov identifier, NCT04014192. Registered 12 July 2019, https://www.clinicaltrials.gov/ct2/show/NCT04014192?term=NCT04014192&draw=2&rank=1. Yes.

Background: We aimed to examine the relationship between serum uric acid (SUA) levels and glucose disposal rate value (M value) evaluated by hyperinsulinemic euglycemic clamp technique in euglycemic Chinese subjects.Methods: There were 19 non-diabetic Chinese subjects included in this study. The participants accepted physical examination, laboratory examination and standardized questionnaire. Insulin resistance was evaluated by M value. Some other indices were also calculated by data obtained from 3-hour oral glucose tolerance test (OGTT). Subjects were divided into two groups based on the median of SUA levels.Results: The level of systolic blood pressure (SBP) (P=0.035), waist circumference (P=0.009), waist-to-hip ratio (P=0.004), Chinese visceral adiposity index (CAVI) (P=0.028), weight (P=0.01), serum creatinine (Cr) (P=0.05) and the percentage of drinking habits (P=0.03) were all significantly increased in high SUA group. The level of M value and high-density lipoprotein cholesterol (HDL-c) were significantly decreased in high SUA group (P=0.041 for M value and P=0.09 for HDL-c). There were no significant differences between those indirect insulin resistance indices and SUA. In addition, the SUA levels were inversely correlated with M value (r=-0.666, P=0.002) and HDL-c (r=-0.619, P=0.005), positively correlated with waist circumference (r=0.615, P=0.005), CVAI (r=0.630, P=0.004), SBP (r=0.521, P=0.022) and Cr (r-0.550, P=0.015) levels. Analysis of stepwise multiple regression showed the independent association between SUA and M value in both male and female euglycemic subjects.Conclusions: There is a significant correlation between SUA levels and glucose disposal rate value in euglycemic Chinese subjects, which suggested that UA played an important role on insulin resistance even in those non-diabetic subjects

Background Needlestick injuries (NSIs) most commonly occur in conjunction with insulin injections, and nurses had the highest rate of NSIs among different occupational groups. However, only few nurses have the awareness to report these incidents. We aimed to investigate the current reporting status and influencing factors of NSIs caused by insulin injection pen devices among nurses and nursing interns in Peking, China. Methods The study consisted of 4,609 nurses and nursing interns in different hospital departments, namely endocrinology wards, medical (except endocrinology) and surgical departments, emergency, outpatient departments, operation theaters, intensive care units, and other departments from 16 districts of Peking, China. A researcher-devised questionnaire was designed to assess the rate of reporting of accidental NSIs and its influencing factors. Descriptive statistics, the χ2 tests, and univariate and multivariate regression were used to analyze the independent influencing factors of reports on NSIs caused by insulin injection pen devices. Results Among all participants, most of them were women (97.61%). More than half of the participants had been working as nurses over 5 years (59.58%). Approximately 63.66% of participants had been trained to prevent and deal with accidental NSIs within 1 year. Approximately 19.33% of the participants experienced NSIs before, but only 30.30% of them reported the injury to the management department or director. The main reasons for not reporting were complex/cumbersome reporting procedure (317 of 621; 51.05%), being too busy at work at the time of injury (301 of 621; 48.47%), and low-risk for personal health (197 of 621; 31.72%). Multivariate analysis showed that age (P = .014; odds ratios [OR; 1.063, 1.736]), prior needlestick training education (P = .018; OR [0.406, 0.917]), and written system for preventing (P Conclusions NSIs caused by insulin injection pen devices are common among nurses and are often not reported. It is necessary to provide nurses with regular training to prevent and deal with NSIs. Hospital management departments should adopt a simpler reporting procedure to understand the actual occurrence of NSIs to develop better prevention and improvement measures.

This is a cross-sectional study among patients with diabetes mellitus who visit Peking Union Medical College Hospital. The recruited subjects undertake sudomotor function tests using SUDOSCAN(Impeto Medical, Paris, France) and cardiac autonomic reflex tests (CARTs), including heart rate variability due to Valsalva maneuver (Valsalva ratio), heart rate response due to deep breathing (HRB) and heart rate response due to standing up (HRS). Presenting 2 abnormal CARTs is defined as cardiac autonomic neuropathy(CAN). CANRS is calculated by the results of sudomotor function tests using SUDOSCAN. Subjects with CAN are included into the Positive Group and subjects without CAN are included into the Negative Group.The clinical parameters and sudomotor functions are compared between the two groups. The relationship between CANRS and the results of the CARTs is evaluated by Spearman’s rank correlation and linear regression analysis. A series of receiver operating character (ROC) curves are calculated to evaluate the diagnostic efficacy of CANRS detecting CAN.

The dermal adipocytes, superficial fascia and subcutaneous adipose tissue (SAT) exist in the interspaces between the dermis and muscular fascia. They are adjacent to each other and traditionally recognized as one SAT. Recently, the dermal adipocyte was redefined as a unique population independent from the SAT. Also, we identified a novel type of adipogenic progenitors in rat superficial fascia. This study aimed to examine cytological and functional characteristics of fascial adipocytes in rats. Superficial fascia had no adipocytes in neonatal rats but gradually appeared numbers of adipocytes in growing rats. Adipogenic progenitors were found to reside in fascia and had strong ability in spontaneous and induced adipogenic differentiation in vitro. Differentiated fascial adipocytes versus subcutaneous or visceral adipocytes expressed increased adipose triglyceride lipase but decreased beta-adrenoreceptor, perilipin-1 and hormone-sensitive lipase (HSL), thus having high basal lipolysis but low lipolysis response to catecholamines. Phosphorylation of perilipin-1 and HSL and translocation of HSL to lipid droplets were attenuated in response to catecholamines rather than post-adrenoreceptoral lipolytic stimulators. The results suggested that superficial fascia was an origin of adipocytes with distinct developmental, cytological and functional characteristics. We proposed that fascial adipocytes could be considered as a unique population of adipocytes in the body. The fascia origin of adipocytes as an adipogenic model might logically explain fat neogenesis occurred at anatomical locations where originally exist no adipose tissues and thereby no adipose-derived stromal precursors. Also, the special histoanatomical relations and overlaps between the dermis, superficial fascia, SAT, and their adipocytes were discussed.

Purpose This article summarizes our experiences in the application of continuous subcutaneous insulin infusion (CSII) as a method of rapid desensitization therapy for diabetic patients with insulin allergy that was subsequently switched to a regimen of multiple-dose injections for long-term insulin therapy. Methods The clinical data of 11 diabetic patients with insulin allergy in Peking Union Medical College Hospital from April 1, 2008, through December 31, 2011, were retrospectively analyzed. Findings All 11 conditions were diagnosed by case history, skin testing, determination of serum specific anti-insulin IgE, and reaction to withdrawal of insulin. Seven patients accepted the traditional injection method of desensitization, and 5 patients accepted CSII with the protocol designed for this study (1 patient accepted CSII after failure by the formal method). Six of the 7 patients who accepted the traditional method and all 5 patients who accepted CSII had successful results. All 5 patients in the CSII group switched to a regimen of multiple dosage injections. In a survey of 28 nurses, both experienced nurses and practical nurses preferred to use CSII as the method of desensitization. Implications It is feasible and effective for diabetic patients with insulin allergy to use CSII as a method of rapid desensitization with subsequent switching to a regimen of multiple-dose injections for long-term insulin therapy.