Correlación entre la glucosa salival con la glucosa de ayuno, la Hemoglobina glicada y el Péptido-C en personas con diabetes mellitus tipo 2

Objetivo : Determinar la correlación entre la glucosa salival con la glucosa en ayunas, HbA1c y el péptido C en personas con Diabetes Mellitus tipo 2 (DM2). Materiales y métodos : Estudio transversal llevado a cabo en el Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) en Lima, Perú durante el año 2021. Se categorizó en buen control metabólico (HbA1c<7 %) y mal control metabólico (HbA1c≥7 %). Se midió la glucosa basal, HbA1c y el péptido C en sangre. La glucosa salival se midió con el método glucosa oxidasa. La correlación de Spearman fue usada para determinar la asociación entre la glucosa salival con la glucosa en ayunas, HbA1c y el péptido- C. Resultados : Participaron un total de 142 personas con DM2. La concentración de glucosa salival fue significativamente más elevada en DM2 con mal control metabólico (p<0.01). Se observó una correlación positiva débil significativa entre la glucosa salival y la glucosa basal (r=0.23, p=0.04) y HbA1c (r=0.26, p=0.02) en DM2 con mal control metabólico y una correlación negativa insignificante (r=-0.08; p=0.47) con el péptido C. Conclusiones : La glucosa salival presenta una asociación significativa y positiva con la glucosa en sangre y la HbA1c, pero no con el péptido C en personas con DM2 con mal control metabólico. Sin embargo, hay muchos factores que deben ser considerados y analizados más a fondo para determinar su posible uso.

Objetivo : To determine the correlation between salivary glucose levels with fasting blood glucose, HbA1c, and C-peptide in patients with type 2 diabetes mellitus (T2DM). Materials and methods : This is a cross-sectional study performed at the Centro de Investigación en Diabetes, Obesidad y Nutrición (CIDON) in Lima, Peru, during 2021. Patients were categorized as those with good metabolic control (HbA1c<7 %), and poor metabolic control (HbA1c≥7 %). Baseline fasting blood glucose, as well as blood HbA1c and C-peptide values were measured. Salivary glucose was measured using the glucose oxidase method. Spearman's correlation was used for determining an association between salivary glucose levels and fasting blood glucose, HbA1c, and C-peptide. Results : One-hundred and forty-two subjects with T2DM participated in the study. Salivary glucose was significantly higher in T2DM subjects with poor metabolic control (p<0.01). A weak positive correlation between salivary glucose and fasting blood glucose (r= 0.23, p= 0.04) and HbA1c (r= 0.26, p= 0.02) was observed in subjects with T2DM and poor metabolic control, and also a non-significant negative correlation (r=-0.08; p= 0.47) with C-peptide. Conclusions : Salivary glucose levels show significant and positive association with fasting blood glucose and HbA1c, but not with C-peptide in persons with T2DM and poor metabolic control. However, there are many factors that should be considered and analyzed in detail aiming to determine its potential use.

The impact of flash glucose monitoring on glycemic control, residual islet function, and patient-reported outcomes in children and adolescents with newly diagnosed type 1 diabetes / 中国医师杂志

Objective:To assess the effect of flash glucose monitoring (FGM) compared with self-monitoring of blood glucose (SMBG) on glycemic control, residual islet function, and patient-reported outcomes in children and adolescents with newly diagnosed type 1 diabetes within 1 year.Methods:133 children and adolescents with newly diagnosed T1DM in the T1D clinic of the Second Xiangya Hospital of Central South University from January 2016 to January 2020 were divided into two groups: FGM group ( n=82) and SMBG group ( n=51). The observation indexes included hemoglobin A1c (HbA 1c), fasting and postprandial blood glucose (FBG and 2 h BG), C-peptide (FCP and 2 h CP) during the one-year follow-up, Δ CP (2 h CP-FCP), patient-reported hypoglycemia and questionnaires regarding self-management of diabetes and quality of life. Results:At 6 months, HbA 1c in 2 groups was significantly decreased (all P<0.05); at 6 to 12 months, HbA 1c in FGM group tended to be stable ( P>0.05); at 12 months, HbA 1c in SMBG group was significantly increased compared with 6 months ( P=0.001). At 12 months, HbA 1c in SMBG group was higher than that in FGM group ( P=0.001). At 12 months, FBG in FGM group was equivalent to the baseline level ( P>0.05), while FBG in SMBG group was significantly higher than the baseline level ( P=0.006). 2 h BG only decreased at the 6th and 12th month in FGM group (all P<0.05). The FCP of SMBG group was significantly decreased at 12 months ( P<0.05), and the 2 h CP, Δ CP in the two groups decreased gradually (all P<0.05). FGM group had more hypoglycemic events at 6 and 12 months (all P<0.05). At 6 months, the score of Self-Management of T1D for Adolescents (SMOD-A) in FGM group was significantly improved ( P=0.001). During the follow-up period, the quality of life score of FGM group was stable ( P>0.05), while the quality of life score of SMBG group had a downward trend ( P=0.052). Conclusions:In newly diagnosed children and adolescents with T1DM, early application of FGM for blood glucose management will help to improve HbA 1c and reduce postprandial blood glucose. In addition, the self-management ability of children with FGM was improved after 6 months.

Changes and significance of triglyceride-glucose index, C-peptide and lipid metabolism in patients with type 2 diabetes mellitus complicated with hyperuricemia / 中国医师进修杂志

Objective:To explore the changes and significance of triglyceride-glucose (TyG) index, C-peptide and lipid metabolism in patients with type 2 diabetes mellitus (T2DM) complicated with hyperuricemia (HUA).Methods:A prospective research method was adopted. One hundred and three patients with T2DM treated in Tongling Hospital of Traditional Chinese Medicine were selected between March 2019 and November 2021, and they were divided into HUA group (34 cases) and non-hyperuricemia (NUA) group (69 cases) according to whether they were complicated with HUA. The general data, fasting blood glucose (FBG), serum uric acid (SUA), serum C-peptide, total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) and serum creatinine (SCr) were compared among the patients, and the TyG index was calculated. The relationship between the above different indicators and SUA was analyzed, and the possible risk factors of HUA with T2DM were analyzed.Results:There were no statistical differences in gender, disease course of diabetes and smoking history between HUA group and NUA group ( P>0.05), but the age in HUA group was younger than that in NUA group: (46.71 ± 10.23) years old vs. (58.74 ± 11.22) years old, and the body mass index (BMI) was higher than that in NUA group: (24.48 ± 2.26) kg/m 2 vs. (22.05 ± 2.14) kg/m 2, and the proportion of patients with alcohol drinking history was higher than that in NUA group: 55.88% (18/34) vs. 24.64% (17/69) ( P<0.05). There were no statistically significant differences in the levels of FBG, TC and LDL-C between HUA group and NUA group ( P>0.05), but the TG, TyG index, C-peptide, SUA and SCr were higher in HUA group than those in NUA group: (2.68 ± 0.57) mmol/L vs. (1.57 ± 0.33) mmol/L, 10.58 ± 3.52 vs. 7.03 ± 2.14, (2.59 ± 0.67) μg/L vs. (2.07 ± 0.41) μg/L, (356.74 ± 56.47) μmol/L vs. (319.87 ± 50.92) μmol/L, (72.05 ± 8.31) μmol/L vs. (58.59 ± 8.04) μmol/L, while the HDL-C level was lower than that in NUA group: (1.09 ± 0.33) mmol/L vs. (1.38 ± 0.41) mmol/L ( P<0.05). Pearson correlation results showed that TyG index, C-peptide, TG, LDL-C and SCr were positively correlated with SUA ( r = 0.42, 0.49, 0.41, 0.30 and 0.51; P<0.05), and HDL-C was negatively correlated with SUA ( r = -0.47, P<0.05). Multivariate Logistic regression analysis showed that increased BMI, alcohol drinking, increased TyG index and C-peptide, TG and SCr and reduced HDL-C were risk factors for HUA in patients with T2DM ( P<0.05). Conclusions:The TyG index, serum C-peptide and TG in patients with T2DM complicated with HUA are abnormally increased and are positively correlated with SUA, while HDL-C is decreased and is negatively correlated with SUA. High BMI, alcohol drinking, high TyG index, C-peptide, TG and SCr, and low HDL-C level are risk factors for HUA in patients with T2DM.

Clinical characteristics and genetic analysis of 6 cases of neonatal diabetes mellitus / 中国新生儿科杂志

Objective:To study the clinical features, genetic characteristics and prognosis of neonatal diabetes mellitus (NDM).Methods:From January 2015 to January 2022, neonates with NDM admitted to the Department of Neonatology of our hospital were retrospectively reviewed.Their clinical manifestations, biochemical data, genetic tests, treatments and outcomes were analyzed.Results:A total of 6 cases with NDM were included, with 3 males and 3 females. All 6 cases were full-term infants, 5 were low birth weight infants and 1 had family history of diabetes. High blood glucose were found on 1~11 d (average 4 d) after birth. 3 cases were diagnosed during blood glucose screening for low birth weight and 3 cases were diagnosed due to infection and/or diabetic ketoacidosis. Blood C-peptide levels were below normal range in all 6 cases. Blood insulin levels were decreased in 5 cases and remained at the lower limit of normal range in 1 case. All infants received genetic tests and 4 showed abnormal results, including 2 cases of ABCC8 gene mutation [c.2060C>T (p.T687M), not reported; c.674T>C (p.L225P), reported], 1 case of KCNJ11 gene mutation [c.602G>A (p.Arg201His), not reported] and 1 case of paternal uniparental disomy (UPD)6q24 (reported). All 6 cases were treated with insulin. Glibenclamide was experimented to replace insulin in 3 cases and 1 case was successful. During follow-up (at the age 4 months~5 years old), 4 cases were diagnosed with transient NDM, 1 case with permanent NDM and 1 case died at the age of 4 months without classification. 1 case showed psychomotor and language delay and the others had otherwise normal development.Conclusions:Most NDM infants are low birth weight infants with reduced blood insulin and C-peptide.Transient NDM are common. Proactive genetic testing may help treatment.

Application of the Chinese Expert Consensus on Diabetes Classification in clinical practice / 中华内科杂志

Objective:To evaluate the diagnostic for classification of newly diagnosed diabetes patients and assess the application of the screening tests recommended by the 2022 Chinese Expert Consensus on Diabetes Classification.Methods:Retrospective case series study. The data from the electronic medical record system of patients with new-onset diabetes mellitus (within 1 year of disease onset) who attending the Diabetes Specialist Outpatient Clinic at the Second Xiangya Hospital of Central South University from January 1, 2018 to December 31, 2021 were collected for the analysis. Based on the consensus, patients were categorized according their age of onset, body mass index (BMI), and suspicion of type 1 diabetes mellitus (T1DM). The chi-square statistic was used to compare key classifier indicators, including C-peptide, islet autoantibodies, and genetic markers, in the subgroups. The diagnosis in suspected T1DM patients was also evaluated. The screening strategy recommended in the consensus was further assessed using a logistic regression model and the area under the receiver-operating curve (AUC).Results:A total of 3 384 patients with new-onset diabetes were included. The average age of disease onset was (46.3±13.9) years, and 61.0% (2 065/3 384) of the patients were male. The proportions of patients who completed C-peptide and glutamic acid decarboxylase antibody (GADA) tests were 36.6% (1 238/3 384) and 37.5% (1 269/3 384), respectively. There were no significant differences in C-peptide test results among the subgroups (all P>0.05). In contrast, the GADA detection rate was higher in patients with young age of onset (<30 years old), in those who were non-obese (BMI<24 kg/m 2), and in those clinically suspected of T1DM (all P<0.05). According to the diagnostic pathway proposed by the consensus, only 57.4% (1 941/3 384) of patients could be subtyped. For a definitive diagnosis, the remaining patients needed completion of C-peptide, islet autoantibody, genetic testing, or follow-up. Furthermore, among patients with clinical features of suspected T1DM, the antibody positivity rate was higher than in non-suspected T1DM patients [24.5% (154/628) vs. 7.1% (46/646), P<0.001]. When the clinical features of suspected T1DM defined in the consensus were taken as independent variables and antibody positivity was considered the outcome variable in the logistic regression model, young onset, non-obese onset, and ketosis onset could enter the model. Based on AUC analysis, the accuracy of the diagnostic model was 0.77 (95% CI 0.73-0.81), suggesting that the clinical features of suspected T1DM in the consensus have good clinical diagnostic value for this patient subgroup. Conclusions:There was a significant discrepancy between the clinical practice of diabetes classification and the process recommended by the consensus, which was specifically reflected in the low proportions of both subtyping indicator testing and definitively subtyped diabetes patients. Attention should be pay to the classification diagnosis process proposed in the consensus and the clinical detection rate of key diabetes subtyping indicators such as C-peptide and islet autoantibodies for diabetes classification should be improved. Noteworthy, the screening strategy for T1DM proposed by the consensus showed good clinical application value.

Study of serum C-peptide levels in newly diagnosed diabetic mellitus subjects of North Gujarat region of India

Background:Serum C-peptide has appeared as the chief clinical and practically adequate marker of ?-cell function of pancreas. Serum insulin and C-peptide are concomitantly secreted into the blood circulation in equal amount. The aim of the study was to determineserum C-peptide levels in newly diagnosed diabetic mellitus subjects of North Gujarat region of India.Methods:The present cross-sectional study was done on 50 subjects of recently diagnosed Diabetes mellitus (T2DM) and non-diabetic healthy controls at Banas Medical College and our trust-based hospital. All diabetics patients were further classified into two groups; normal FC group consist of subjects with FC level 0.5-3.2 ng/ml (N=14) and high FC group included subjects with FC>3.2 ng/ml (N=36). The patients' demographic and anthropometric parameters were recorded; detailed history and clinical examination were performed in the entire cases. All biochemical parameters were analyzed. Results:Predominance of the T2DM subjects was in the age group of 41-50 years. Mean value for age (p<0.01), anthropometric (p<0.01), fasting plasma glucose (p<0.001), HbA1c (p<0.01), cholesterol (p<0.01), triglycerides (p<0.001) and C-peptide (p<0.001) were significantly higher in the T2DM subjects. The mean values of fasting plasma glucose (p<0.001) and HbA1c (p<0.01) are significantly higher in T2DM subject with high C-peptide level as compared to normal C-peptide level. Conclusions:In our study, we conclude that elevated levels of fasting C-peptide in newly diagnosed T2DM.Therefore, we suggested that serum C-peptide levels are valuable as marker of endogenous insulin production from ?-cell of pancreas.

Combination therapy with lansoprazole and cholecalciferol is associated with a slower decline in residual beta-cell function and lower insulin requirements in children with recent onset type 1 diabetes: results of a pilot study

Abstract Objective To investigate the effects of combination therapy with cholecalciferol and lansoprazole on residual β-cell function and glycemic control in children with new-onset type 1 diabetes. Methods Children aged 6-12 years with type 1 diabetes were allocated to receive cholecalciferol and lansoprazole (Group 1) or no treatment (Group 2). Children were maintained on their respective insulin regimens and kept records of blood sugar and insulin doses taken. Children were followed at three-month intervals for six months. Changes in mean fasting C-peptide and HbA1c levels, daily insulin doses, fasting blood glucose and mean blood glucose levels from baseline to end of the study were analyzed. Results Twenty-eight children (14 per group) met the eligibility criteria. Fasting C-peptide levels decreased significantly from baseline to study end in both groups (mean decrease -0.19±0.09ng/mL and -0.28±0.08ng/mL, p=0.04 and p=0.001; Group 1 and Group 2 respectively). However, fasting C-peptide level drop was significantly smaller in Group 1 compared to Group 2 (30.6% and 47.5% respectively; p=0.001). Likewise, daily insulin doses decreased significantly in both groups (-0.59±0.14units/kg and -0.37±0.24units/kg respectively; p=0.001). All patients recruited completed the study. No adverse events were reported. Conclusion Combined therapy with cholecalciferol and lansoprazole for six months was associated with smaller decline in residual β-cell function and lower insulin requirements in children with new-onset type 1 diabetes. Preliminary findings of this small-scale study need to be confirmed by larger studies. Registry of Clinical Trials (www.ctri.nic.in) under number REF/2021/03/041415 N.

Análisis comparativo de respuesta glicémica y de péptido C, tras la ingesta de estevia y D-tagatosa, según habitualidad de consumo de edulcorantes no nutritivos y preferencias alimentarias reportadas por mujeres con resistencia a la insulina / Comparative analysis of glicemic response and c peptide, after comsumption of stevia and d tagatosa, according to regular compsumtion of not nutritive sweeteners andnourish preferences reported by woman with insuline resistance

INTRODUCCIÓN: El consumo de edulcorantes no nutritivos (ENN) ha ido en aumento. A pesar de ello, se desconoce el efecto entre el consumo habitual de ENN y las preferencias alimentarias con parámetros bioquímicos en pacientes con resistencia a la insulina. OBJETIVO: Comparar la respuesta glicémica y de péptido C, según habitualidad de consumo de edulcorantes y preferencias alimentarias reportados por mujeres con resistencia a la insulina tras la ingesta de estevia y D-tagatosa. MÉTODOS: Treinta y tres mujeres con RI se sometieron a una encuesta de opción múltiple sobre preferencias alimentarias y ETCC modificada de edulcorantes. Aleatoriamente recibieron una precarga de control o experimental (estevia y D-tagatosa) donde se midió glicemia y péptido C en los tiempos -10, 30, 60, 90, 120, 180. RESULTADOS: Se encontró un ABC de péptido C más alto después de la ingesta de D-tagatosa (p = 0,02) en pacientes que prefieren alimentos ricos en proteínas en comparación con aquellos que prefieren alimentos ricos en grasas o en carbohidratos simples. Se observó un mayor ABC de péptido C (p = 0,04) para la prueba control en quienes prefieren el sabor salado y consumen menor cantidad de ENN, sin diferencias significativas entre quienes prefirieron sabor dulce. CONCLUSIONES: Al comparar las respuestas glicémicas e insulinémicas entre habitualidad de consumo de edulcorantes y preferencias alimentarias reportados por las pacientes tras la ingesta de agua, estevia y D-Tagatosa, no se obtuvieron diferencias significativas. Salvo en quienes preferían alimentos ricos en proteínas tras la ingesta de D- tagatosa y quienes preferían sabor salado con menor consumo habitual de ENN tras ingesta control.

INTRODUCTION: The consumption of non-nutritive sweeteners (NNS) has been increasing. Despite this, the effect between the habitual consumption of ENN and food preferences with biochemical parameters in patients with insulin resistance is unknown. OBJECTIVE: To compare the glycemic and C-peptide response, according to the habitual consumption of sweeteners and food preferences reported by women with insulin resistance after ingesting stevia and D-tagatose. METHODS: Thirty-three women with IR underwent a multiple choice survey on food preferences and modified ETCC for sweeteners. They randomly received a control or experimental preload (stevia and D-tagatose) where glycemia and peptide C were measured at times -10, 30, 60, 90, 120, 180. RESULTS: A higher C-peptide AUC was found after ingestion of D-tagatose (p = 0.02) in patients who prefer foods rich in protein compared to those who prefer foods rich in fat or simple carbohydrates. A higher AUC of peptide C (p = 0.04) is performed for the control test in those who prefer a salty taste and consume a lower amount of ENN, without significant differences between those who prefer a sweet taste. CONCLUSION: When comparing the glycerol and insulin responses between the habitual consumption of sweeteners and the food preferences reported by the patients after the ingestion of water, stevia and D-Tagatose, no significant differences were obtained. Except in those who prefer foods rich in protein after ingesting D-tagatose and those who prefer salty taste with less habitual consumption of NNS after control intake.

Association between liver fibrosis and C-peptide in patients with type 2 diabetes and nonalcoholic fatty liver disease / 临床肝胆病杂志

ObjectiveTo investigate the effect of serum C-peptide level on the progression of liver fibrosis in patients with type 2 diabetes mellitus (T2DM) and nonalcoholic fatty liver disease (NAFLD). MethodsA total of 484 patients with T2DM who were admitted to Department of Geriatrics, The Second Hospital of Lanzhou University, from December 2018 to July 2020 were enrolled, and according to the results of abdominal ultrasound examination, they were divided into simple T2DM group with 107 patients and T2DM+NAFLD group with 377 patients. According to NAFLD fibrosis score, the patients with T2DM and NAFLD were divided into fibrosis exclusion subgroup （T2DM+F0） with 136 patients, uncertain subgroup (T2DM+F1) with 146 patients, and fibrosis subgroup (T2DM+F2) with 95 patients. Medical history data and laboratory markers were collected. The chi-square test was used for comparison of categorical data; the t-test or the Mann-Whitney U test was used for comparison of continuous data, and a one-way analysis of variance or the Kruskal-Wallis H test was used for comparison between multiple groups; a logistic regression analysis was used to explore the risk factors for the progression of liver fibrosis; the receiver operating characteristic (ROC) curve was used to analyze the clinical value of serum C-peptide in predicting and diagnosing the progression of liver fibrosis. ResultsCompared with the simple T2DM group, the T2DM+NAFLD group had a significant increase in C-peptide level (Z=-6.040,P＜0.001); compared with the T2DM+F1 and T2DM+F0, the T2DM+F2 had significantly higher C-peptide level ［2.89 (1.84-3.77) vs 1.97 (1.12-2.65)/1.87 (1.25-2.68), H=36.023,P＜0.001) and rate of fasting C-peptide (56.84% vs 23.29%/24.27%, χ2=37.583,P＜0001). The logistic regression analysis showed that C-peptide (OR=1.435, 95% confidence interval: 1.227~1.678， P＜0.001) was a risk factor for liver fibrosis in patients with T2DM and NAFLD, and the ROC curve analysis also showed that C-peptide had great significance in predicting liver fibrosis in such patients, with an area under the ROC curve of 0.814, a sensitivity of 642%, a specificity of 897%, and a Youden index of 0.539 at the optimal cut-off value of 2.405 ng/ml. ConclusionC-peptide is an independent risk factor for the progression of liver fibrosis in patients with T2DM and NAFLD.

C-peptide level as predictor of type 2 diabetes remission and body composition changes in non-diabetic and diabetic patients after Roux-en-Y gastric bypass

OBJECTIVES: Several predictors of type 2 diabetes mellitus (T2DM) remission after metabolic surgery have been proposed and used to develop predictive scores. These scores may not be reproducible in diverse geographic regions with different baseline characteristics. This study aimed to identify predictive factors associated with T2DM remission after Roux-en-Y gastric bypass (RYGB) in patients with severe obesity. We hypothesized that the body composition alterations induced by bariatric surgery could also contribute to diabetes remission. METHODS: We retrospectively evaluated 100 patients with severe obesity and T2DM who underwent RYGB between 2014 and 2016 for preoperative factors (age, diabetes duration, insulin use, HbA1c, C-peptide plasma level, and basal insulinemia) to identify predictors of T2DM remission (glycemia<126 mg/dL and/or HbA1c<6.5%) at 3 years postoperatively. The potential preoperative predictors were prospectively applied to 20 other patients with obesity and T2DM who underwent RYGB for validation. In addition, 81 patients with severe obesity (33 with T2DM) underwent body composition evaluations by bioelectrical impedance analysis (InBody 770®) 1 year after RYGB for comparison of body composition changes between patients with and those without T2DM. RESULTS: The retrospective analysis identified only a C-peptide level >3 ng/dL as a positive predictor of 3-year postoperative diabetes remission, which was validated in the prospective phase. There was a significant difference in the postoperative body composition changes between non-diabetic and diabetic patients only in trunk mass. CONCLUSION: Preoperative C-peptide levels can be useful for predicting T2DM remission after RYGB. Trunk mass is the most important difference in postoperative body composition changes between non-diabetic and diabetic patients.

Correlations between C-peptide insulin resistance index, very low density lipoprotein-cholesterol and atherogenic index in type 2 diabetic patients / 中国医师杂志

Objective:To investigate the correlation between multiple parameters of islet function evaluation and atherogenic index (AIP) in patients with type 2 diabetes mellitus (T2DM).Methods:A cross-sectional study was conducted to observe 216 T2DM patients hospitalized in Tianjin Medical University Chu Hsien-I Memorial Hospital in 2019. They were divided into non atherogenic phenotype group (N Group, AIP<0.06) and atherogenic phenotype group (A group, AIP≥0.06) with AIP=0.06 as the cut-off point. The general clinical indexes and evaluation indexes of oral glucose tolerance test (OGTT), such as insulin action index (IAI), quantitative insulin sensitivity check index (QUICKI), homeostasis model of insulin resistance index (HOMA-IR), homeostasis model assessment-β (HOMA-β), C peptide insulin resistance index (HOMA IR-CP) and C peptide islet function index suitable to diabetes patients (HOMA islet-CP DM) were compared between two groups. Pearson correlation analysis and multiple stepwise regression analysis were performed.Results:Compared with the N group, the very low density lipoprotein-cholesterol (VLDL-C), ln (HOMA IR-CP) and ln (HOMA islet-CP DM) in A group were higher ( P<0.01), while ln (QUICKI) was lower ( P<0.05), with statistical significance. AIP was positively correlated with VLDL-C ( r=0.765), ln (HOMA-IR) ( r=0.257), ln (HOMA-β) ( r=0.189), ln (HOMA IR-CP) ( r=0.418) and ln (HOMA islet-CP DM) ( r=0.377, P<0.01), and negatively correlated with IAI ( r=-0.145, P<0.05) and ln (QUICKI) ( r=-0.254, P<0.01). Multiple stepwise regression analysis showed that VLDL-C and ln (HOMA IR-CP) were independent influencing factors of AIP in type 2 diabetic patients ( P<0.01) . Conclusions:AIP is positively correlated with insulin resistance and negatively correlated with insulin sensitivity. VLDL-C and HOMA IR-CP are independent predictors of AIP.

Low rate of latent autoimmune diabetes in adults (LADA) in patients followed for type 2 diabetes: A single centers experience in Turkey

ABSTRACT Objective In this study, we aimed to determine the frequency of and the clinical and metabolic features of patients with latent autoimmune diabetes in adults (LADA) at a single center in Turkey. Subjects and methods Patients over 30 years of age diagnosed with type 2 diabetes who did not require insulin for a minimum of 6 months following diagnosis were included. Data from 324 patients (163 women; 161 men), with a mean age of 54.97 ± 7.53 years, were analyzed in the study. Levels of antibodies to glutamate decarboxylase (anti-GAD) were measured in all patients, and LADA was diagnosed in patients testing positive for anti-GAD antibodies. Results Anti-GAD positivity was identified in 5 patients (1.5%). Family history of diabetes, body mass index (BMI), age, sex distribution, insulin resistance, serum triglycerides, high-density lipoprotein, and low-density lipoprotein were similar in the LADA and type 2 diabetes patients. Median HbA1c was significantly higher (10.8% vs. 7.38%, p = 0.002) and fasting C-peptide was lower (0.75 ng/mL vs. 2.82 ng/mL, p = 0.009) in patients with LADA compared to in those with type 2 diabetes. Among the 5 patients with LADA, 4 were positive for antithyroid peroxidase antibodies. The median disease duration was relatively shorter among patients with LADA (4 years vs. 7 years, p = 0.105). Conclusion We observed a LADA frequency of 1.5% among Turkish patients followed for type 2 diabetes. The presence of obesity and metabolic syndrome did not exclude LADA, and patients with LADA had worse glycemic control than patients with type 2 diabetes did.

Utilidad de la prueba de tolerancia de comida mixta con Nutrial I para la evaluación de la función de las células beta en diabetes tipo 1 / Usefulness of the tolerance test of mixed food with Nutrial I for the assessment of beta cells function in diabetes type 1

RESUMEN Introducción: La prueba de tolerancia de comida mixta es considerada la prueba de oro para la medición de la producción de insulina endógena en pacientes con diabetes tipo 1. Objetivo: Determinar la utilidad de la prueba de tolerancia de comida mixta con Nutrial I para evaluar la función de las células ß en diabéticos tipo 1 de diagnóstico reciente y la relación de esa función con algunas características clínicas y bioquímicas. Métodos: Se estudiaron variables bioquímicas como la glucemia, hemoglobina glucosilada (HbA1c), péptido C y fracciones lipídicas. La prueba de tolerancia de comida mixta con Nutrial I se aplicó a 18 sujetos con diabetes tipo 1 de diagnóstico reciente y a 8 voluntarios con edades comprendidas entre 19 y 35 años. El consumo del suplemento Nutrial I se calculó según el peso del paciente. Se obtuvieron muestras para glucemia y péptido C a los -10, 0, 30, 60, 90 y 120 minutos. Resultados: Se observaron concentraciones elevadas de glucemia y disminuidas de péptido C durante la prueba de tolerancia de comida mixta en los diabéticos tipo 1 de diagnóstico reciente, en comparación con los voluntarios, así como, diferencias en las áreas bajo la curva de péptido C (AUC-pc) (p= 0,001). En los diabéticos tipo 1 de diagnóstico reciente se evidenció una correlación negativa entre el AUC-pc con los niveles de glucemia en ayunas (r= -0,747; p ( 0,0001) y la HbA1c (r= -0,535; p= 0,022). Por el contrario, se encontró una correlación positiva entre el AUC-pc y el péptido C en ayunas (r= 0,722; p= 0,001). El AUC-pc después de la prueba de tolerancia de comida mixta es mayor en los sujetos con glucemia en ayunas si GA < 7 mmol/L con respecto a los sujetos con glucemia en ayunas ( 7 mmol/L (p= 0,012). Conclusiones: El empleo del Nutrial I en la prueba de tolerancia de comida mixta fue útil en la evaluación de la función de las células β en diabéticos tipo 1 de diagnóstico reciente. Los valores bajos de glucemia en ayunas durante esta prueba son marcadores indirectos de una función residual de células ( más conservada en los diabéticos tipo 1 de diagnóstico reciente(AU)

ABSTRACT Introduction: The tolerance test of mixed food is considered the gold standard for the measurement of endogenous insulin production in patients with diabetes type 1. Objective: To determine the usefulness of the tolerance test of mixed food with Nutrial I to assess the ß-cells function in patients with diabetes type 1 of recent diagnosis and the relation of this function with some clinical and biochemical characteristics. Methods: There were studied biochemical variables as the blood glucose, glycosylated haemoglobin (HbA1c), C-peptide and lipid fractions. The tolerance test of mixed food with Nutrial I was applied to 18 individuals with diabetes type 1 of recent diagnosis and in 8 volunteers aged between 19 and 35 years old. The consumption of Nutrial I supplement was calculated according to the weight of the patient. Samples were obtained for blood glucose and C-peptide at -10, 0, 30, 60, 90 and 120 minutes. Results: There were observed high concentrations of glycemia and decreased amounts of C-peptide during the tolerance test of mixed food in recently diagnosed type 1 diabetics in comparison with the volunteers, as well as differences in areas under the curve of C-peptide (AUC-pc) (p= 0.001). In the recently diagnosed type 1 diabetics was evident a negative correlation between the AUC-pc with fasting plasma glucose levels (r= -0,747; p(0.0001) and HbA1c (r= -0,535; p= 0.022). On the contrary, it was found a positive correlation between the AUC-pc and fasting C-peptide (r = 0.722; p = 0.001). The AUC-pc after the tolerance test of mixed food was greater in subjects with fasting blood glucose < 7 mmol/L with respect to the subjects with fasting blood glucose ( 7 mmol/L (p= 0.012). Conclusions: The use of Nutrial I in the tolerance test of mixed food was useful in the assessment of the role of the β-cells in patients with recently diagnosed diabetes type 1. Low values of fasting blood glucose during this test are indirect markers of a residual function of (cells more preserved in type 1 diabetics of recent diagnosis(AU)

Influence of selenium yeast combined with levothyroxine sodium on outcomes in type 2 diabetes mellitus patients complicated with chronic lymphocytic thyroiditis / 中国基层医药

Objective@#To investigate the clinical efficacy of combination therapy of selenium yeast and levothyroxine sodium in the treatment of type 2 diabetes mellitus complicated with chronic lymphocytic thyroiditis(CLT).@*Methods@#A total of 96 patients with type 2 diabetes mellitus complicated with CLT who admitted to Wenling Hospital of Traditional Chinese Medicine from June 2017 to December 2018 were randomly divided into control group and treatment group according to the digital table, with 48 patients in each group.On the basis of stable blood sugar control, the control group received routine treatment with levothyroxine sodium tablets.The treatment group was given selenium yeast on the basis of the control group.The blood glucose, thyroid, clinical efficacy within 3 months of treatment were recorded.@*Results@#The total effective rate of the study group was 95.83%(46/48), which was significantly higher than 68.75%(33/48) of the control group(χ2=12.080, P<0.05). The levels of blood sugar and glycosylated hemoglobin in the study group were significantly lower than those in the control group after treatment(all P<0.05), and the levels of C-peptide in the fasting and postprandial 2h were significantly higher than those in the control group(t=4.927-8.725, all P<0.05). After treatment, the serum selenium level in the study group was significantly higher than that in the control group(P<0.05), and the serum TPOAb and TGAb levels were significantly lower than those in the control group(t=17.264-27.032, all P<0.05). There were no statistically significant differences in serum TSH, FT3 and FT4 levels between the two groups(t=0.704-1.926, all P>0.05).@*Conclusion@#The clinical efficacy of selenium yeast and levothyroxine in the treatment of type 2 diabetes with CLT is significantly better than traditional treatment.

Relationship between fasting serum C-peptide level and heart function in patients with or without diabetes mellitus and chronic heart failure / 中国综合临床

Objective@#To evaluate the relationships between admission fasting serum C-peptide concentration and cardiac function status in chronic heart failure (CHF) patients with or without diabetes.@*Methods@#From July 2017 to December 2018, 262 CHF patients with or without diabetes in the Department of Cardiology of Pudong hospital in Shanghai were analyzed.Their cardiac function was classified as New York Heart Association (NYHA) grade Ⅱ to Ⅳ, and they were divided into diabetes group (80 cases) and non diabetes group (182 cases). At the same time, 62 subjects without diabetes and heart disease were randomly selected as the control group.To analyze the relationship between fasting serum C-peptide level and cardiac function in diabetic and nondiabetic CHF patients.@*Results@#(1)The fasting plasma glucose and serum C-peptide concentrations of diabetes group paitents were(8.7±2.9) mmol/L and(0.78±0.67) nmol/L respectively, the nondiabetes group paitents were(5.8±1.67) mmol/L and(0.56±0.61)nmol/L respectively, the control group were(5.1±0.69) mmol/L and(0.16±0.12)nmol/L respectively.The difference in the three groups was statistically significant(all P<0.001). The levels of fasting blood glucose and serum C-peptide in diabetic group were significantly higher than those in non diabetic group and control group (all P<0.01). The levels of fasting blood glucose and serum C-peptide in non diabetic group were significantly higher than those in control group (P<0.05 or P<0.01). The left ventricular ejection fraction (LVEF) in diabetic group was(44.1±8.3)%, and those in non diabetic group and control group were(46.7±7.2)% and(64.8±3.8)%.The difference in the three groups was statistically significant(<0.001). The LVEF of diabetic group was significantly lower than that of non diabetic group and control group (all P<0.01), and the CRP of diabetic group was (1.39±0.91) mg/L, the N-terminal pro-B-type natriuretic peptide (pro-BNP) was (1 771.3±23.1) ng/L, the hemoglobin was (125.6±16.7) g/L in the diabetic group, and (1.22±0.73) mg/L, (1 659.2±19.3) ng/L, (126.1±16.5) g/L in the non diabetic group, respectively, and (0.85±0.72) mg/L, (87.2±17.2) ng/L, (136.4±15.2) g/L in the control group, respectively.The differences among the three groups were statistically significant (P<0.001). CRP and pro-BNP in the diabetic group and non diabetic group were significantly higher than those in the control group (all P<0.01), and hemoglobin levels were significantly lower than those in the control group(all P<0.01). There were no statistically significant differences in CRP, pro-BNP and hemoglobin between the diabetic group and non diabetic group (all P>0.05). (2) In all patients with heart failure, diabetes mellitus and non diabetes heart failure, the levels of serum C-peptide were (1.05±0.85), (1.17±0.82), (0.99±0.86) nmol/L in NYHA Ⅳ group, and (0.53±0.22), (0.52±0.20), (0.54±0.23) nmol/L in NYHA Ⅲ group, and (0.32±0.09), (0.32±0.11), (0.31±0.09) nmol/L in NYHA Ⅱ group.After adjustment of age, gender, smoking, insulin secretion and hypoglycemic drugs, body mass index, blood pressure, total bilirubin (TBIL), alanine aminotransferase (ALT), creatinine, blood glucose, blood lipid, white blood cell count (WBC) and hemoglobin level by covariance analysis, all patients with heart failure The level of serum C-peptide in NYHA Ⅳ group was significantly higher than that in Ⅲ group (all P<0.01) and Ⅱ group (all P<0.01). In all patients with heart failure and non diabetic heart failure, the level of serum C-peptide in NYHA Ⅲ group was significantly higher than that in Ⅱ group (all P<0.05). There was no significant difference in serum C-peptide between all patients with heart failure, diabetes mellitus and non diabetes heart failure (all P>0.05) (3) Using multiple linear regression analysis, the adjustment factors included age, gender, smoking, BMI, blood pressure, TBIL, alt, creatinine, blood glucose, blood lipid, WBC and hemoglobin levels.The results showed that the serum C-peptide level was positively correlated with pro-BNP in all patients with heart failure, diabetes and non diabetes heart failure (β: 0.006, 95%CI -0.016-0.028 , P=0.007; β: 0.117, 95%CI-0.042-0.277 , P=0.006; β: 0.411, 95%CI-0.149-0.971 , P=0.023), negatively correlated with LVEF(β: -0.122, 95%CI-0.285-0.041, P=0.004; β: -0.008, 95%CI-0.032-0.016, P=0.010; β: -0.065, 95%CI-0.139-0.011, P=0.036).@*Conclusion@#The level of fasting serum C-peptide was significantly increased in patients with CHF and non-diabetic patients, and was related to the severity of heart failure.

Analysis of the correlation between IL-23, IL-17and β-cell function in latent autoimmune diabetes in adult patients / 中国医师杂志

Objective@#To determine interleukin (IL)-23 and IL-17 level in latent autoimmune diabetes in adult (LADA) patients, and to explore the relationship of IL-23, IL-17and β-cell function in these patients.@*Methods@#Forty LADA patients from 2011 to 2016 in our hospital were selected as LADA group, and forty participants were as normal control group. Clinical and biochemical data was collected and the level of the IL-23 and IL-17 was measured with the enzyme linked immunosorbent assay (ELISA). The differences in interleukin levels among the two groups were compared. Pearson correlation analysis was used for investigating the relationship between the dependent of statistical significant interleukins and the independent data in the LADA patients, all closely related variables then were included in a stepwise multiple linear regression analysis.@*Results@#The levels of serum IL-23 , IL-17 and IL-23/IL-17 were significantly higher in LADA group than those in control groups [3.54(2.88~5.24)μg/L vs 1.98(1.62~2.18)μg/L, P<0.05], [22.42(17.71~26.07)ng/L vs 17.97(17.15~20.70)ng/L, P<0.05], (175.79±38.67 vs 105.22±19.08, P<0.01). IL-23 and IL-17 in the LADA group were negatively correlated with fasting C peptide (FCP) (r=-0.42, r=-0.48, P<0.05), and the ratio of IL-23/IL-17 was positively correlated with fasting plasma glucose (FPG) (r=0.44, P=0.00). Stepwise multiple liner regression analysis showed that serum IL-23 and IL-17 level were independently associated with the FCP in LADA group.@*Conclusions@#IL-23 and IL-17 were possibly important proinflammatory factor in LADA patients, and can provide the new immunodiagnosis markers for LADA.

Influence of selenium yeast combined with levothyroxine sodium on outcomes in type 2 diabetes mellitus patients complicated with chronic lymphocytic thyroiditis / 中国基层医药

Objective To investigate the clinical efficacy of combination therapy of selenium yeast and levothyroxine sodium in the treatment of type 2 diabetes mellitus complicated with chronic lymphocytic thyroiditis (CLT).Methods A total of 96 patients with type 2 diabetes mellitus complicated with CLT who admitted to Wenling Hospital of Traditional Chinese Medicine from June 2017 to December 2018 were randomly divided into control group and treatment group according to the digital table ,with 48 patients in each group.On the basis of stable blood sugar control,the control group received routine treatment with levothyroxine sodium tablets .The treatment group was given selenium yeast on the basis of the control group.The blood glucose, thyroid,clinical efficacy within 3 months of treatment were recorded.Results The total effective rate of the study group was 95.83%(46／48 ), which was significantly higher than 68.75%(33／48) of the control group (χ2 ＝12.080,P＜0.05).The levels of blood sugar and glycosylated hemoglobin in the study group were significantly lower than those in the control group after treatment (all P＜0.05),and the levels of C -peptide in the fasting and postprandial 2h were significantly higher than those in the control group(t＝4.927-8.725,all P＜0.05).After treatment,the serum selenium level in the study group was significantly higher than that in the control group ( P ＜0.05 ), and the serum TPOAb and TGAb levels were significantly lower than those in the control group ( t＝17.264-27.032,all P＜0.05).There were no statistically significant differences in serum TSH ,FT3 and FT4 levels between the two groups (t＝0.704-1.926,all P＞0.05). Conclusion The clinical efficacy of selenium yeast and levothyroxine in the treatment of type 2 diabetes with CLT is significantly better than traditional treatment.

Correlation analysis between plasma insulin level and refractive development / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the correlation between plasma insulin level and refractive development.<p>METHODS: Collected 293 adolescents aged 11-12 who were examined in our hospital from January to June 2019.According to the refractive power, they were divided into emmetropia group(76 cases), low and moderate myopia group(144 cases), high myopia group(35 cases), and hyperopia group(38 cases). Measure and compare the plasma insulin and related indexes(blood sugar, glycosylated hemoglobin, C-peptide levels)of the four groups of subjects on an empty stomach and 2h after a meal. Person correlation was used to analyze the correlation between plasma insulin and its related indexes and diopter. The receiver operating characteristic(ROC)curve was used to explore the diagnostic value of plasma insulin levels for refractive dysplasia.<p>RESULTS: The average levels of insulin, blood glucose, glycosylated hemoglobin, and C-peptide in the low and moderate myopia group and the high myopia group on an empty stomach or 2h after a meal were higher than those in the emmetropia group and the hyperopia group. The levels of insulin, blood sugar and glycosylated hemoglobin in the high myopia group were higher than those in the low and moderate myopia group(all<i> P</i><0.01). Plasma insulin, blood glucose, glycosylated hemoglobin, and C peptide levels were negatively correlated with diopter 2h after a meal(<i>r</i>=-0.691, -0.756, -0.546, -0.311, all <i>P</i><0.05). The ROC curve showed that the cut-off value of plasma insulin level 2h after meal for identifying refractive errors was 0.367, the maximum area under the curve was 0.708(<i>P</i><0.001, 95% <i>CI</i>: 0.576-0.840), the sensitivity was 63%, and the specificity was 73.7%.<p>CONCLUSION: Elevated plasma insulin level may affect refractive development, the higher the level, the higher the degree of myopia. Therefore, regular high-glycemic carbohydrate diets during the growth period may lead to the development of refractive errors and permanent visual impairment.

Analysis of the correlation between IL-23, IL-17and β-cell function in latent autoimmune diabetes in adult patients / 中国医师杂志

Objective To determine interleukin (IL)-23 and IL-17 level in latent autoimmune diabetes in adult (LADA) patients,and to explore the relationship of IL-23,IL-17and β-cell function in these patients.Methods Forty LADA patients from 2011 to 2016 in our hospital were selected as LADA group,and forty participants were as normal control group.Clinical and biochemical data was collected and the level of the IL-23 and IL-17 was measured with the enzyme linked immunosorbent assay (ELISA).The differences in interleukin levels among the two groups were compared.Pearson correlation analysis was used for investigating the relationship between the dependent of statistical significant interleukins and the independent data in the LADA patients,all closely related variables then were included in a stepwise multiple linear regression analysis.Results The levels of serum IL-23,IL-17 and IL-23/IL-17 were significantly higher in LADA group than those in control groups [3.54 (2.88 ～ 5.24) μg/L vs 1.98 (1.62 ～ 2.18) μg/L,P ＜0.05],[22.42 (17.71 ～ 26.07) ng/L vs 17.97 (17.15 ～ 20.70) ng/L,P ＜ 0.05],(175.79 ± 38.67 vs 105.22 ± 19.08,P ＜0.01).IL-23 and IL-17 in the LADA group were negatively correlated with fasting C peptide (FCP) (r =-0.42,r =-0.48,P ＜ 0.05),and the ratio of IL-23/IL-17 was positively correlated with fasting plasma glucose (FPG) (r =0.44,P =0.00).Stepwise multiple liner regression analysis showed that serum IL-23 and IL-17 level were independently associated with the FCP in LADA group.Conclusions IL-23 and IL-17 were possibly important proinflammatory factor in LADA patients,and can provide the new immunodiagnosis markers for LADA.

Relationships between serum osteocalcin levels and C-peptide in post-traumatic male patients / 中华急诊医学杂志

Objective To investigate the relationships between serum osteocalcin (OC) levels and glycometabolism markers in nondiabetic post-traumatic male patients.Methods Populaitons were selected at the Department of Emergency Medicine of Shanghai Jiao Tong University Affiliated Sixth People's Hospital from October 2017 to February 2019.The age,injury severity score (ISS),and characteristic indicators were recorded.The inclusion criteria were age ≥ 18 years and blood collection time ＜ 24 h after the injury.The exclusion criteria were emergency surgery,acute brain trauma,and hemoglobin A1c (HbA1c) ≥ 6.0％.The patients were divided into two groups by fasting plasma glucose (FPG):stress hyperglycemia (SH) (FPG＞7.8 mmol/L) and nonstress hyperglycemia (NO-SH) (FPG ≤ 7.8 mmol/L) groups.The fasting venous blood samples were collected and examined.The characteristics and biochemical indicators in the two groups were compared statistically by LSD-t test,rank sum test and ANOVA,and the relationships between serum OC levels and glycometabolism markers were analyzed by partial correlation analysis.Results A total of 395 traumatic patients were enrolled and divided into the SH group (n=182) and NO-SH group (n=213).There were no differences in ISS,fasting insulin (FINS),and C-peptide (C-P) levels between groups.Age,HbAlc and FPG were higher (P=0.041,P=0.037,P＜0.01),while the OC level was lower (P=0.023),in the SH group than those in the NO-SH group.The serum OC level did not correlate with HbAlc,FPG,and FINS,but negatively correlated with C-P by partial correlation analysis (r=-0.262,P=0.008).The multivariate linear regression analysis showed that C-P was an independent factor affecting serum OC levels after trauma (β=-0.655,P=0.043).Conclusion A correlation existed between the serum OC level and glycometabolism markers in nondiabetic post-traumatic male patients.