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The latest epidemiological data suggests that the situation of adult diabetes in China is severe, and metabolic diseases have become significant chronic illnesses that have a serious impact on public health and social development. After more than six years of practice, the National Metabolic Management Center(MMC) has developed distinctive approaches to manage metabolic patients and has achieved a series of positive outcomes, continuously advancing the standardized diagnosis and treatment model. In order to further improve the efficiency, based on the first edition, the second edition guideline was composed by incorporating experience of the past six years in conjunction with the latest international and domestic guidelines.
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Objective:To compare the efficacy and safety of Tonghua Dongbao′s insulin aspart injection (Rishulin) and NovoRapid (Novo Nordisk) in the treatment of diabetes.Methods:A 26-week, randomized, open-label, parallel-group, positive control drug and non-inferiority trial was conducted in 23 centers in China. A total of 563 diabetes with poor blood glucose control treated with insulin for at least 3 months before were included. The subjects were randomized(stratified block random method) into those receiving Rishulin or NovoRapid at a ratio of 3∶1. Both groups were combined with basal insulin (Lantus). The primary endpoint was the change in glycosylated hemoglobin (HbA1c) from baseline to the end of 24 weeks of treatment.Results:For full analysis set, after 24 weeks of treatment, HbA1c level of Ruishulin group decreased from (8.66±1.28)% to (7.77±1.09)% ( P<0.001), and that of NovoRapid group decreased from (8.47±1.28) % to (7.65±0.97) % ( P<0.001). Treatment difference in HbA1c (NovoRapid group-Ruishulin group) was -0.061% (95% CI -0.320-0.199). HbA1c<7.0% target reacing rates were 24.26% and 21.21% ( P=0.456), and HbA1c<6.5% target reacing rates were 9.65% and 6.82% ( P=0.310) in Ruishulin group and NovoRapid group, repectively. The standard 2 hours postprandial blood glucose (2hPG) in Ruishulin group decreased from (16.23±5.22) mmol/L to (12.65±4.57) mmol/L ( P<0.001), and 2hPG in NovoRapid group decreased from (16.13±5.37) mmol/L to (11.91)±4.21) mmol/L ( P<0.001). The fingertips blood glucose at 7-point of both groups exhibited varying degrees of reduction compared with those at baseline, repectively. Positive ratios of specific antibodies were 31.68% in Ruishulin group and 36.36% in NovoRapid group ( P=0.320). Ratios of negative to positive were 7.43% and 10.61% ( P=0.360), and ratios of positive to negative were 10.40% and 7.58% ( P=0.360) in Ruishulin group and NovoRapid group, respectively. The incidence of hypoglycemia was 60.05% and 55.40% ( P=0.371), and the incidence of adverse events was 76.60% and 77.70% ( P=0.818) in Ruishulin group and NovoRapid group, respectively. Conclusions:Rishulin is not inferior to NovoRapid, and has shown good efficacy and safety. It can be an ideal choice for clinicians in patients with poor blood glucose control with insulin.
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Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.
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Background@#Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension. @*Methods@#Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017. @*Results@#The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years. @*Conclusion@#The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.
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Wolfram syndrome(WS) is a rare autosomal recessive neurodegenerative disease characterized by diabetes insipidus, onset diabetes mellitus, optic atrophy and sensorineural hearing loss.The syndrome is mainly caused by mutations in the WFS1 gene, and another causative gene, CISD2 gene is responsible for Wolfram syndrome 2 with different phenotypes.The prognosis of WS is poor, 60% of patients die before the age of 35 years old.Currently, there are no effective treatments to delay or reverse the progression of WS, standardized clinical monitoring and supportive care can help alleviate the debilitating symptoms of patients and improve their quality of life.This article reviews the pathogenesis, clinical feature, diagnosis and new treatments of WS.
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It is important to test creatine kinase in patients with acute diabetic complications in order to detect rhabdomyolysis,especially subclinical rhabdomyolysis.The prognosis of rhabdomyolysis can be improved when it is treated once diagnosed.However,endocrinologists sometimes neglect the diagnosis of rhabdomyolysis.Here,we reviewed the pathogenesis of rhabdomyolysis caused by acute diabetic complications,and also the clinical features,diagnosis,treatment and prognosis of rhabdomyolysis.
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Ninety-one patients over 60 year old with type 2 diabetes mellitus(T2DM) were selected from our outpatient department. The patients of experimental group uploaded their blood glucose data detected with glucometers, and obtained integrated management called " Mobile Health(M-health)" management such as medicines,diet,exercise from medical groups. The patients of control group got medical care in a traditional way without receiving other interventions. Regular follow-up was conducted in 2 groups every 3 months. The results showed that 3 months later,postprandial 2h plasma glucose in the experimental group was significantly improved compared with that of control group (P<0.05). Six months later, postprandial 2h plasma glucose and HbA1Clevels in the experimental group showed a decline comparing to the baseline, showing a statistical significance compared with control group(P<0.05). These results suggest that smartphone-based telemedicine is helpful of blood glucose control in elderly T2DM patients.
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Objective To explore the effects of different hemodialysis ways on insulin resistance (IR) in non-diabetic renal disease patients with maintenance hemodialysis.Methods A total of 101 cases of non-diabetic renal disease patients with maintenance hemodialysis in Xuzhou Central Hospital from January 2014 to January 2015 were selected and divided into three groups:high-flux hemodialysis (HFHD) group,low-flux hemodialysis (LFHD) group and hemodialysis filtration (HDF) group.Patients in the three study groups were treated with HFHD,LFHD and HDF,respectively.After 6 months of hemodialysis treatment,clinical data and biochemical indicators were compared among the three groups,and Pearson correlation analysis and multivariate logistic regression analysis were used to explore the correlated factors of homeostasis model insulin resistance index (HOMA-IR).Results The levels of parathyroid hormone (PTH) in the HDF group and HFHD group were significantly lower than that in the LFHD group (P＜0.05),while the urea clearance index (Kt/V) values were significantly higher than that in the LFHD group (P＜ 0.05).The β2-microglobulin (β2-MG),fasting insulin (FINS) levels and HOMR-IR in the HDL group were significantly lower than those in the HFHD group and LFHD group (P＜0.05),and β2-MG clearance rate (β2-MGCR) in the HDF group was significantly higher than that in the HFHD group and LFHD group (P＜0.001).Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI (r=0.346,P=0.014),and was negatively correlated with β2-MGCR and HDL-C (r=-0.412,P=0.002;r=-0.204,P=0.042).Multivariate logistic regression analysis showed that BMI and HDF were independent factors affecting HOMA-IR values (OR=1.538,95％CI 1.364-1.759,P=0.021;OR=0.137,95％CI 0.045-0.632,P=0.012).Conclusion Compared with HFHD and LFHD,HDF can alleviate IR in non-diabetic renal disease patients with maintenance hemodialysis,which is of great significance for clinical treatment.
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Objective To explore the effects of different hemodialysis ways on insulin resistance (IR) in non-diabetic renal disease patients with maintenance hemodialysis.Methods A total of 101 cases of non-diabetic renal disease patients with maintenance hemodialysis in Xuzhou Central Hospital from January 2014 to January 2015 were selected and divided into three groups:high-flux hemodialysis (HFHD) group,low-flux hemodialysis (LFHD) group and hemodialysis filtration (HDF) group.Patients in the three study groups were treated with HFHD,LFHD and HDF,respectively.After 6 months of hemodialysis treatment,clinical data and biochemical indicators were compared among the three groups,and Pearson correlation analysis and multivariate logistic regression analysis were used to explore the correlated factors of homeostasis model insulin resistance index (HOMA-IR).Results The levels of parathyroid hormone (PTH) in the HDF group and HFHD group were significantly lower than that in the LFHD group (P＜0.05),while the urea clearance index (Kt/V) values were significantly higher than that in the LFHD group (P＜ 0.05).The β2-microglobulin (β2-MG),fasting insulin (FINS) levels and HOMR-IR in the HDL group were significantly lower than those in the HFHD group and LFHD group (P＜0.05),and β2-MG clearance rate (β2-MGCR) in the HDF group was significantly higher than that in the HFHD group and LFHD group (P＜0.001).Pearson correlation analysis showed that HOMA-IR was positively correlated with BMI (r=0.346,P=0.014),and was negatively correlated with β2-MGCR and HDL-C (r=-0.412,P=0.002;r=-0.204,P=0.042).Multivariate logistic regression analysis showed that BMI and HDF were independent factors affecting HOMA-IR values (OR=1.538,95％CI 1.364-1.759,P=0.021;OR=0.137,95％CI 0.045-0.632,P=0.012).Conclusion Compared with HFHD and LFHD,HDF can alleviate IR in non-diabetic renal disease patients with maintenance hemodialysis,which is of great significance for clinical treatment.
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Nowadays,obesity and its related diseases such astype 2 diabetes mellitus (T2DM) and metabolic syndrome (MS) have already become a serious social and medical problem.In addition to oral aitidiabeticdrugs,insulin injection and other traditional treatments,metabolic surgery has gradually been recognized in recent years.However,there are lack of adequate surgical data and evidence-based evidenceof metabolic surgeryin Chinabecause of its postoperative risks,complications and low body mass index in T2DM patients in China.This article summarizes the status and limitations of metabolic surgery.
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Objective To explore the influence of high flux hemodialysis (HFHD) and hemodialysis filtration (HDF) on the dialysis effect and patients mortality in the patients with end-stage renal disease(ESRD).Methods One hundred and twenty-two patients with ESRD in our hospitals were selected and respectively adopted HFHD (HFHD group,62 cases) and HDF (HDF group,60 cases) for conducting the dialysis therapy.The serum indexes before and after treatment were detected and compared between the two groups.Results Compared with before treatment,the level of blood urea nitrogen (BUN),blood uric acid (BUA),serum creatinine (Scr),blood phosphorus (P),parathyroid hormone (PTH),β2 microglobulin (β2-MG) and cysteine protease inhibitors (Cys-C) after treatment in the two groups were significantly decreased(P＜0.05).The clearance rates of P,PTH and Cys-C in the HFHD group were significantly higher than those in the HDF group(t=2.479,t=1.834,t=1.512,P＜0.05).The mortality after an average follow-up of (12.2 ± 3.7) months had statistical difference between the two groups,the mortality rate in the HDF group was significantly higher than that in the HFHD group (P＜ 0.05).The multivariate Cox regression analysis results showed that the HFHD was an important factor affecting death in ESRD patient (HR =0.50,95 ％ CI:0.33-0.84,P =0.009).Conclusion HFHD has more significant effect for clearing P,PTH,β2-MG and Cys-C than HDF in ESRD patients,moreover can reduces their mortality.
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Objective To investigate the efficacy of biphasic insulin aspart 50(BIAsp50)twice daily(bid) versusbiphasichumaninsulin50(BHI50)(bid)plusmetforminonbloodglucosecontrolfollowingastandardmealtest in Chinese patients with type 2 diabetes mellitus(T2DM). Methods A randomized, open-label, 2-sequence, crossover trial for two 4-week treatment periods was conducted in 14 Chines institutes. Eligible subjects inadequately controlled with BHI50(bid)plus metformin were randomized to two sequences in a 1 : 1 ratio(A:BIAsp50-BHI50, B:BHI50-BIAsp50 ) . Standard meal tests were performed at baseline and the ends of two periods within 4 weeks. Primary endpoint was 2h postprandial plasma glucose ( PPG) increment following standard meal test, with insulin dose standardized at 0. 3 IU/kg. Results A total of 161 subjects were randomized into two sequences(81 to sequence A, and 80 to sequence B) and finally analysed. After 4 weeks of treatment, mean 2h PPG increment with BIAsp50 was lower than that with BHI50 [ treatment difference of BIAsp50 vs BHI50: -1. 12 mmol/L ( 95% CI-1. 66,-0. 58), P<0. 01], suggesting superiority of BIAsp50 over BHI50. Incremental area under the curve for PPG(0-2 h)with BIAsp50 was lower than that with BHI50 [treatment difference:-38. 8 mmol·L-1·min-1(95%CI-77. 3,-0. 26), P=0. 049], as was the mean 2h PPG [treatment difference:-0. 58 mmol/L(95% CI -1. 13,-0. 03), P=0. 040]. The FPG value with BIAsp50 was higher than that with BHI50 [treatment difference:0. 52 mmol/L(95%CI 0. 18, 0. 86), P=0. 003]. The rate of nocturnal hypoglycemia with BIAsp50 was lower than that with BHI50(1. 13 vs 2. 86 events per subject year, P<0. 01). Conclusion In patients with T2DM inadequately controlled with BHI50 plus metformin, BIAsp50 was proven to be well-tolerated with improved postprandial glucose control compared with BHI50.
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BACKGROUND:Although there are many studies addressing osteoarthritis in China, population-based epidemiological studies of knee osteoarthritis have been rarely reported. OBJECTIVE:To explore and analyze the clinical efficacy of early ladder-like treatment in knee osteoarthritis patients from Zoucheng city in the southwest of Shandong province based on an epidemiological investigation. METHODS: A total of 3 427 people randomly enroled from Zoucheng city located in the southwest of Shandong province in 2008 were taken as research objects. A self-designed epidemiological survey on knee osteoarthritis was carried out to analyze the sex, age, urban and rural distribution, and incidence of knee osteoarthritis. According to Kelgren Lawrence Grading, 208 patients with levels 0, I, II of knee osteoarthritis were randomly selected and divided into two groups: surgical treatment group was given intraarticular injection, intraarticular rinsing, arthroscopic treatment and functional exercise; oral drug group was only given oral administration of non-steroidal anti-inflammatory drugs and blood circulation drugs. Ninety-eight patients in the surgical treatment group and 87 in the oral drug group were folowed-up for over 1 year. RESULTS AND CONCLUSION:The incidence of knee osteoarthritis showed an increasing trend with aging in Zoucheng city. There were 33.2% patients who did not receive treatment, 53.2% patients who received irregular treatment, and only 13.6 patients who could folow the doctor’s advice. The excelent rate and total effective rate were higher in the surgical treatment group (81% and 99%) than the control group (34% and 87%;P < 0.01). This epidemiological investigation exerts a certain protective role in the occurrence and development of knee osteoarthritis, and active early ladder-like treatment has achieved good outcomes in patients with knee osteoarthritis.
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AIM: To observe the difference of cerebral injury following ischemia/reperfusion and mRNA expression of TGF-β1 between diabetic and non-diabetic rats.METHODS: At first, Wistar rats were divided into two groups,non-diabetes and diabetes, and then two groups followed by sham, middle cerebral artery occlusion(MCAO) 2h and reperfusion 24 h after MCAO 2 h respectively. TGF-β1 mRNA expression was measured by semi-quantitative reverse transcription polymerase chain reaction(RT-PCR); Cerebral damage was evaluated by histopathology.RESULTS: In the same condition of ischemia or ischemia/reperfusion, injuried area enlarged in DM groups; The expression level of TGF-β1 mRNA increased at the time of 2 h after MCAO in non-diabetic group and diabetic group, especialy significantly in non-diabetic group with MCAO 2 h, and decreased at the time of reperfusion 24 h after MCAO 2 h, but still higher than that in the sham group.CONCLUSION: Diabetes mellitus exacerbated brain lesion following ischemia/repefusion, increased TGF-β1 mRNA expresion after MCAO may be an anti-injury reaction,and anti-injury ability is decreased under diabetic condition
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AIM: To study forms of cell death following cerebral ischemia/reperfusion in diabetic rats. METHODS: Based on the modles of diabetes and middle cerebral artery occlusion(MCAO), characteristics of cell death after ischemia/reperfusion were evaluated synthetically by the pathological, flow cytometry(FCM), TUNEL and the DNA agarose electrophoresis.RESULTS: The occurrence of cerebral injury after ischemia/reperfusion were accompanied by cell necrosis and cell apoptosis. And cell apoptosis was mainly located in ischeamic penumbra(IP) zone around the densely ischemic focus. Ischemic centre(IC)was characterized by cell necrosis. At the same time, the results showed that the process of ischemic cerebral injury worsen by diabetes mellitus was related to inducing cell apoptosis in IP and Mid zone.CONCLUSION: Neuronal damage following focal cerebral ischemia/reperfusion included cell necrosis and apoptosis, IC zone was mainly characterized by the former, however IP zone by the latter, and there had close internal relationship between them. Brain damage following cerebral ischemia/reperfusion was worsen instinctly under diabetic condition.
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AIM: To observe the difference of cerebral injury following ischemia/reperfusion and mRNA expression of TGF-? 1 between diabetic and non-diabetic rats.METHODS: At first, Wistar rats were divided into two groups,non-diabetes and diabetes, and then two groups followed by sham, middle cerebral artery occlusion(MCAO) 2h and reperfusion 24 h after MCAO 2 h respectively. TGF-? 1 mRNA expression was measured by semi-quantitative reverse transcription polymerase chain reaction(RT-PCR); Cerebral damage was evaluated by histopathology.RESULTS: In the same condition of ischemia or ischemia/reperfusion, injuried area enlarged in DM groups; The expression level of TGF-? 1 mRNA increased at the time of 2 h after MCAO in non-diabetic group and diabetic group, especialy significantly in non-diabetic group with MCAO 2 h, and decreased at the time of reperfusion 24 h after MCAO 2 h, but still higher than that in the sham group.CONCLUSION: Diabetes mellitus exacerbated brain lesion following ischemia/repefusion, increased TGF-? 1 mRNA expresion after MCAO may be an anti-injury reaction,and anti-injury ability is decreased under diabetic condition.