Association between nonalcoholic fatty liver disease and serum magnesium level in patients with type 2 diabetes mellitus / 中华全科医师杂志

Objective@#To investigate the association between nonalcoholic fatty liver disease (NAFLD) and serum magnesium level in patients with type 2 diabetic mellitus (T2DM).@*Methods@#Clinical data of 1 273 consecutive patients with T2DM admitted in hospital from June 2013 to June 2017 were retrospectively analyzed. According to the quartile of serum magnesium levels, patients were divided into 4 groups: Q1 group (≤ 0.79 mmol/L, n=376), Q2 group (0.80-0.84 mmol/L, n=296), Q3 group (0.85-0.89 mmol/L, n=287) , and Q4 group (≥0.90 mmol/L, n=314). Logistic regression was used to analyze the association between NAFLD and serum magnesium level.@*Results@#The average age of the study population was (56.4±13.8) years, males accounted for 52.7%(671/1 273), NAFLD patients accounted for 58.4%(743/1 273). The prevalence of NAFLD in Q4, Q3, Q2 and Q1 groups was 53.8%(169/314), 52.6%(151/287), 57.4%(170/296) and 67.3%(253/376), respectively (χ2=19.00, P=0.000). Logistic regression showed that compared with the Q4 group, OR(95%CI) for NAFLD in the Q1 group was 1.49 (1.03-2.16), Ptrend=0.011 after adjusting for age, sex, duration of diabetes, BMI, systolic blood pressure, alcohol consumption, TG, glycosylated hemoglobin and serum uric acid. After further adjusting for estimated glomerular filtration rate (eGFR), OR(95%CI) for NAFLD was 1.33 (0.92-1.94) and Ptrend=0.065 in the Q1 group compared with the Q4 group.@*Conclusion@#Reduction in serum magnesium is associated with an increased risk of NAFLD in T2DM patients, and eGFR may be a confounding factor.

Progress in diagnosis and treatment of Hashimoto's thyroiditis / 中华全科医师杂志

Hashimoto's thyroiditis is the most common autoimmune thyroid disease and also the primary cause of hypothyroidism.The disease is characterized by long course, slow development, complicated clinical presentation and coexistence with a variety of thyroid diseases.Misdiagnosis and missed diagnosis rates are high,therefore close attention should be attached clinically.

The 464th case: sudden convulsion and coma in a patient with acute leukemia / 中华内科杂志

A 46-year-old female patient was diagnosed as mixed phenotype acute leukemia with chief complaints of intermittent gingival swelling and bleeding for 1 week. The induction chemotherapy was not effective. During the second course chemotherapy, the patient had sudden convulsion and coma. She was transferred to the intensive care unit with worsened condition after transient improvement. Her final diagnosis was secondary adrenocortical insufficiency, adrenal crisis, intractable hyponatremia and cerebral edema.

Association of carotid artery and lower-extremity artery atherosclerosis and coronary heart disease or cerebral infarction in type 2 diabetes / 中华内分泌代谢杂志

cerebral infarction as compare with patients at Grade 1-2 in both vascular locations, whereas the risk was not significantly increased in patients at Grade 3-4 in only one vascular location. Conclusions The simple method of assessing the degree of arterial atherosclerosis can be used to evaluate carotid artery and lower-extremity artery atherosclerosis in patients with type 2 diabetes. Patients with plaques or stenosis in both vascular locations were with a significantly increased risk of coronary heart disease or cerebral infarction if they were evaluated concurrently.

Association of HbA1C with serum uric acid among inpatients with type 2 diabetes mellitus / 中华内分泌代谢杂志

[Summary] Data from 1 589 consecutive inpatients with type 2 diabetes mellitus from January 2012 to March 2015 were collected. The patients were divided into five groups according to the quintile of HbA1C . The association between serum uric acid ( SUA) and HbA1C was tested using a general linear model after adjusting for age, body mass index ( BMI) , systolic blood pressure, and creatinine. Linear regression analysis was used to analyze the association between SUA and HbA1C in patients with HbA1C<9. 0% and HbA1C≥9. 0%, respectively. The results showed that BMI, waist circumference, triglycerides, and the incidence of fatty liver were elevated with increased serum uric acid level. SUA was negatively associated with HbA1C level in inpatients with type 2 diabetes. However, SUA should be measured after glycemic control in men with HbA1C≥7. 0% and women with HbA1C≥9. 0%.

Impaired early-phase insulin secretion is the major risk factor for glucose metabolism deterioration in the population with normal glucose tolerance / 中华内分泌代谢杂志

Objective To evaluate the effect of early-phase insulin secretion and insulin resistance in the pathogenesis of type 2 diabetes, and to analysis the risk factors of glucose tolerance deterioration. Methods Oral glucose tolerance test (OGTT) was performed in subjects over 30 years old coming from 78 families with type 2 diabetes. A total of 118 subjects with normal glucose tolerance (NGT) [fasting plasma glucose (FPG)<6.1 mmol/L and 2h postprandial glucose (2hPG)<7.8 mmol/L] were enrolled. Another OGTT was performed in them to define the glucose tolerance status at the end of the 4-7 years follow-up. AINS30/APG30, the ratio of the increment of insulin to that of plasma glucose at 30 min after the glucose load, was used to assess the early phase insulin secretion. HOMA-IR and HOMA-β were calculated to assess the insulin resistance and β-cell function respectively. Results After 4-7 years follow-up, 66 of 118 subjects still remained NGT, while 52 became either diabetic (n=11)or pre-diabetic (n=41). Using the median of HOMA-IR and AINS30/APG30 as the cutoff points, all subjects were divided into four groups: subjects with good early phase insulin secretion and no insulin resistance, subjects with good early insulin secretion but relative insulin resistance, subjects with impaired early phase insulin secretion but no insulin resistance, subjects with impaired early phase insulin secretion and also relative insulin resistance. The incidences of abnormal glucose tolerance among these four groups were 23.1%, 36.4%, 45.5% and 73.1% respectively. There was a statistical difference between the former three groups and the last one (P<0.05). Log/st/c regression analysis showed that only the early phase insulin secretion was the risk factor of glucose tolerance deterioration, while age, gender, insulin resistance or β-cell function were not. Conclusion Impaired early phase insulin secretion is a major risk factor for the disturbance of glucose metabolism in the population with NGT.

The components of metabolic syndrome analyzed by factor analysis / 中国糖尿病杂志

Objective To evaluate the clustered characteristics of the components of metabolic syndrome. Methods 483 subjects (242 men, 241 women, aged 53±12 years ) in Beijing area underwent a 75g oral glucose tolerance test (OGTT) for screening of diabetes.203 subjects were diagnosed as diabetes through OGTT.Factor analysis was performed using the variables of insulin/blood glucose, total cholesterol (CHO), LDL-C, HDL-C, triglycerides (TG), systolic blood pressure, diastolic blood pressure, BMI, waist-to-hip ratio and waist circumference. Results Five factors, including obesity, insulin resistance/hyperglycemia, CHO/LDL-C, dyslipidemia (elevated TG and decreased HDL) and hypertension, could explain 72.2% of total variance.The most important component was obesity, which could explain 29.8% of total variance.The obesity factor was associated with dyslipidemia factor through C-reactive protein (CRP).Dyslipidemia factor also associated with insulin resistance/hyperglycemia factor.Hypertension factor and CHO/LDL-C factor were isolated from other factors. Conclusions Obesity factor is the most important component of metabolic syndrome.The pathophysiologic mechanism of metabolic syndrome is complex.Insulin resistance alone could not explain all features of the metabolic syndrome.Its pathophysiology maybe include the factors of obesity, insulin resistance and inflammatory reaction.

Fasting plasma glucose and HbA1c as a screening test for diabetes mellitus / 中国糖尿病杂志

Objective To assess the validity of using fasting plasma glucose （FPG） and HbA1c for the screening of diabetes. Methods 1118 subjects （489 men, 629 women） in Beijing area underwent an oral glucose tolerance test （OGTT） for screening diabetes. HbA1c was examined at the same time. They have never undergone OGTT and controlled plasma glucose levels by any methods. Their average age was 48±12 years. Results Using 1999 WHO criteria, 510 had normal glucose tolerance （NGT）, 35 had impaired fasting glucose（IFG）, 155 had impaired glucose tolerance （IGT）, 52 had IGT and IFG, 366 had diabetes. Using a receiver operating characteristic curve （ROC curve）, the optimal cut-point of FPG related to diabetes diagnosed by OGTT was 6.2mmol/L that was associated with a sensitivity and specificity of 85.0% and 90.4% respectively. Area under the curve was 0.943 （95% CI 0.9270.959）, a positive likelihood ratio （LR） was 8.9, and a negative LR was 0.2. The optimal cut-point of HbA1c related to diabetes diagnosed by OGTT was 6.2%, which was associated with a sensitivity and specificity of 86.6% and 77.5% respectively. Area under the curve was 0.896 （95% CI 0.8760.916）, a positive LR was 3.9, and a negative LR was 0.2. The cut-point of FPG related to IGT diagnosed by OGTT was 5.1 mmol/L, which was associated with a sensitivity and specificity of 65.2% and 68.3% respectively. Area under the curve was 0.729 （95% CI 0.6890.769）, a positive LR was 2.1, and a negative LR was 0.5. The cut-point of HbA1c related to IGT diagnosed by OGTT was 5.7%, which was associated with a sensitivity and specificity of 63.3% and 56.5% respectively. Area under the curve was 0.634 （95% CI 0.5910.677）, a positive LR was 1.5, and a negative LR was 0.7. Conclusions When FPG<7.0 mmol/L and ≥6.2 mmol/L or HbA1c≥6.2%, OGTT was necessary to confirm the diagnosis of diabetes. FPG or HbA1c was not reliable to identify IGT.

Cross-sectional study of the pathophysiologic and clinical features in the first-degree relatives of type 2 diabetic patients / 北京大学学报(医学版)

Objective: To explore the pathophysiologic and clinical features and investigate the roles of insulin resistance and insulin secretion in the pathogenesis of type 2 diabetes mellitus. Methods:A total of 888 first-degree relatives without glucose intolerance history underwent an oral glucose test (OGTT) and their level of HbA1c, insulin concentration and lipid levels were determined. The homeostasis model assessment was used to estimate insulin resistance (HOMA IR ) and ?-cell function (HOMA-?). The ratio of incremental glucose (?G30) and insulin (?I30) response was used to evaluate the early insulin secretion.?I30/?G30/HOMA IR was used to evaluate the glucose disposition index (DI). Results: In the subjects, 167 were diagnosed with diabetes, 180 with impaired glucose tolerance or/and impaired fasting glucose (impared glucose regulation), 457 with normal glucose tolerance and normal HbA1c, and 84 with normal glucose tolerance and high HbA1c. From normal glucose tolerance through impared glucose regulation to diabetes mellitus, the HOMA IR , body mass index (BMI), waist/hip ratio (WHR) and serum triglyceride (TG) progressively increased, HOMA-? cell 、?I30/?G30 、 DI and high density liproprotein (HDL) progressively decreased. Subjects with normal glucose tolerance were divided into three tertile subgroups (1/3, 2/3 and 3/3 groups) with different area under the curve of OGTT glucose, after being adjusted by sex, age, BMI, the 3/3 group was found having higher HOMA IR , and lower HOMA-?, ?I30/?G30/, and DI than the 1/3 group. Conclusion: Both insulin resistance and impaired ? cell function are important pathophysiologic changes contributing to the onset and development of type 2 diabetes. These changes and lipid profile have occurred before a patient is diagnosed with abnormal glucose tolerance.