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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 investigate the practice and benefit of national standardized management of type 2 diabetes in Yulin City. 【Methods】 We recruited the adult type 2 diabetes patients who sought medical help at our hospital from May 2020 to October 2022 as subjects. We collected their basic information (sex and age); measured height, weight, waist and hip circumference, and blood pressure; calculated body mass index (BMI); and detected blood glucose, c-peptide, HbA1c, biomarkers, urinary microalbumin, sensory nerve conduction velocity of lower limbs, ABI, and subcutaneous and visceral fat at the time of MMC recruited and the end of six months. T test and Mann-Whitney U rank sum test were used for measurement data and χ2 test or Fisher’s exact probability method for counting data to analyze the data. 【Results】 After 6 months, the levels of fasting blood glucose, postprandial blood glucose, HbA1c, and visceral and subcutaneous fat in all the patients decreased, but the level of fasting c-peptide increased compared with the baseline (all P<0.05). Secondly, compared with the baseline, the control rate of HbA1c (35.21% vs. 13.71% ) and the comprehensive control rate (13.97% vs. 7.26% ) were both significantly increased at six months (P<0.05). Thirdly, after 6 months, the levels of fasting blood glucose, postprandial blood glucose, HbA1c, TG, TC, and UA were decreased more, while the fasting c-peptide and postprandial c-peptide were increased more in the patients of the HbA1c standard group (HbA1c<7% ) than those of the non-standard group. 【Conclusion】 The multiple benefits of blood glucose, blood lipid, uric acid and islet function can be achieved by taking type 2 diabetes patients into MMC. Meanwhile, the rates of HbA1c control and comprehensively reaching the standard are significantly increased. Therefore, MMC can explore a new way for the management of type 2 diabetic patients in this area.
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Objective:To assess the relationship between visceral fat area(VFA) and diabetic peripheral neuropathy (DPN) in type 2 diabets mellitues(T2DM) patients.Methods:A total of 2 615 patients with T2DM were enrolled from the National Metabolic Management Center at Ningbo First Hospital between March 2018 and February 2021. The medical history, questionnaire survey, and laboratory parameters were collected, VFA was measured using bioelectrical impedance analysis, DPN was diagnosed based on neurophysiological examination. Patients were divided into four groups by VFA and body mass index as the following: VFA<100 cm 2 and body mass index<24 kg/m 2 group [VA(-)OB(-) group], VFA<100 cm 2 and body mass index≥24 kg/m 2 group [VA(-)OB(+ ) group], VFA≥100 cm 2 and body mass index<24 kg/m 2 group [VA(+ )OB(-) group], and VFA≥100 cm 2 and body mass index≥24 kg/m 2 group [VA(+ )OB(+ ) group]. Multivariable logistic regression analysis was done to determine the relationship between body mass index, VFA and DPN in patients with T2DM. Results:The proportion of DPN in this study was 46.96%. DPN group featured with older age, higher proportion of men, longer duration of disease, higher proportion of smoking, lower diastolic blood pressure, higher HbA 1C level, lower total cholesterol, lower high density lipoprotein-cholesterol, lower low density lipoprotein-cholesterol, higher blood creatinine levels, higher urinary albumin-to-creatinine ratio, higher VFA level (all P<0.01). Grouping according to VFA and body mass index, 68.1% in the VA(+ )OB(-) group had DPN, which was highest among the four groups. In multivariable logistic regression analysis, compared with VA(-)OB(-) group, VA(+ )OB(-) group had a significantly higher risk of DPN ( OR=2.234, 95% CI 1.339-3.728, P =0.002), VA(+ )OB(+ ) group took second place ( OR=1.281, 95% CI 1.030-1.592, P =0.026). Conclusions:VFA was associated with DPN in T2DM regardless of body mass index. The VA(+ )OB(-) group has the highest risk of DPN. Therefore, evaluation of visceral adiposity may have important clinical significance for the early screening and prevention of DPN in T2DM.
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Objective@#To explore the association between thyroid hormones and visceral fat area(VFA) in the patients with type 2 diabetes.@*Methods@#A total of 729 patients with type 2 diabetes, who joined National Metabolic Management Center(MMC) through Ningbo First Hospital from March, 2018 to July, 2019, were enrolled in this study. Blood tests were taken to assess their thyroid hormones and biochemical indexes. VFA and subcutaneous fat area(SFA) were obtained through bioelectrical impedance analysis. Statistics were later analyzed by Spearman correlation analysis and multivariate linear regression.@*Results@#Spearman correlation analysis showed that VFA were positively correlated with T3、FT3(r=0.225 and 0.211, P<0.01), and VFA were inversely correlated with FT4(r=-0.112, P<0.01). No correlation was found between VFA and either of T4 or TSH(P>0.05). Multivariate linear regression analysis indicated that VFA was independently correlated with FT4 and FT3(P<0.01). An increment of 1 pmol/L in FT4 was associated with 1.759 cm2 increase in VFA, and increment of 1 pmol/L in FT3 was associated with 3.256 cm2 decrease in VFA.@*Conclusion@#VFA in patients with type 2 diabetes are correlated with FT3 and FT4.