Epidemiology of diabetes and diabetic complications in China

Identification of risk factors for diabetes in Chinese middle-aged and elderly adults

This study aimed to identify and analyze the factors associated with the prevalence of diabetes among Chinese adults, using data from the China Health and Retirement Longitudinal Study (CHARLS). Data from the CHARLS cohort, with a mean age of 63.3 years, were analyzed using SPSS software. Descriptive statistics were performed for the overall population, as well as urban and rural subgroups. Logistic regression models were employed to assess the association between diabetes and variables such as age, gender, smoking, alcohol consumption, hypertension, and mental health disorders. Paired-sample t-tests were conducted to evaluate changes in diabetes prevalence across 2015, 2018, and 2020. The average of diabetes increased from 1.08 in 2015 to 1.15 in 2020, with a statistically significant difference (P < 0.001). Paired-sample t-tests showed significant differences between 2020 and 2018, as well as between 2018 and 2015 (P < 0.001). Logistic regression analysis identified hypertension (aOR = 0.447, 95% CI: 0.410-0.488, P < 0.001) and chronic disease (aOR = 0.024, 95% CI: 0.013-0.042, P < 0.001) as key risk factors for diabetes. Mild physical exercise was a protective factor (aOR = 0.813, 95% CI: 0.708-0.935, P < 0.01), while smoking (aOR = 1.220, 95% CI: 1.088-1.369, P < 0.001) and alcohol consumption (aOR = 1.125, 95% CI: 1.020-1.242, P < 0.05) increased the risk. Smoking and alcohol had a greater impact in urban areas, while hypertension and mental health disorders were more influential in rural areas. This study demonstrates that age, gender, smoking, alcohol consumption, hypertension, and mental disorders significantly influence the risk of diabetes among Chinese adults aged 45 and above. Distinct risk factors were identified between urban and rural populations, highlighting the necessity for tailored intervention strategies. The longitudinal analysis from 2015 to 2020 revealed a substantial increase in diabetes prevalence, underscoring the critical need for sustained and targeted public health efforts.

Nitrogen-Doped Graphyne as a Promising Material for Sensing Volatile Organic Compounds in Human Breath

Using density functional theory and the nonequilibrium Green function method, the interaction between two-dimensional nitrogen-doped graphyne (N-GY) and volatile organic compounds (ethanol, ethylene glycol, acetone, and toluene) was investigated, and the potential application of N-GY for sensing volatile biomarkers exhaled by human breath was explored. The N-GY is a direct band gap semiconductor with a band gap width of 0.408 eV. The bottom of the conduction band and the top of the valence band are both located at the Γ point. All target volatile organic compounds (VOCs) are in physical adsorption states. In order to verify the sensing mechanism of VOCs, Bader charge transfer, adsorption distance, work function, electron localization function, charge density difference, energy band structure, and density of states were analyzed. At the same time, the I-V relationship of VOCs molecules before and after adsorption was calculated by using the NEGF method. The results show that at 0.5 V bias voltage under the armchair direction, N-GY can well distinguish four gas molecules and has the highest sensitivity for acetone with a sensitivity of 81%. Therefore, the N-GY monolayer is a potential candidate material for analyzing VOCs exhaled by the human body as well as for early screening of diabetes.

Prevalence and Risk Factors of Type 2 Diabetes Mellitus among Depression Inpatients from 2005 to 2018 in Beijing, China

Background: There are few data on the comorbidity of diabetes in Chinese patients with depression. We aimed to calculate the prevalence and explore risk factors of type 2 diabetes mellitus (T2DM) among depression inpatients from 2005 to 2018 in Beijing. Methods: This study is a cross-sectional study. The data collected from 19 specialized psychiatric hospitals in Beijing were analyzed. The prevalence of T2DM and its distribution were analyzed. The multivariable logistic regression was performed to explore the risk factors of T2DM. Results: A total of 20,899 depression inpatients were included. The prevalence of T2DM was 9.13% [95% confidence interval (CI), 8.74% to 9.52%]. The prevalence of T2DM showed an upward trend with year (P for trend < 0.001) and age (P for trend < 0.001). The prevalence of T2DM was higher among readmitted patients (12.97%) and patients with comorbid hypertension (26.16%), hyperlipidemia (21.28%), and nonalcoholic fatty liver disease (NAFLD) (18.85%). The prevalence of T2DM in females was lower than in males among patients aged 18 to 59 years, while the prevalence of T2DM in females was higher than in males among patients aged ≥60 years. T2DM was associated with older age [adjusted odds ratios (aORs) ranged from 3.68 to 29.95, P < 0.001], hypertension (aOR, 3.01; 95% CI, 2.70 to 3.35; P < 0.001), hyperlipidemia (aOR, 1.69; 95% CI, 1.50 to 1.91; P < 0.001), and NAFLD (aOR, 1.58; 95% CI, 1.37 to 1.82; P < 0.001). Conclusions: The prevalence of T2DM among depression inpatients from 2005 to 2018 in Beijing was high and increased with the year. Depression inpatients who were older and with hypertension, hyperlipidemia, and NAFLD had a higher prevalence and risk of T2DM.

Correlation Between Triglyceride-Glucose Index and Microvascular Complications in Patients With Early- Onset of Type 2 Diabetes Mellitus

OBJECTIVE

This study aimed to explore the potential correlation between the triglyceride-glucose (TyG) index and diabetic nephropathy (DN) and diabetic retinopathy (DR) in patients with early-onset type 2 diabetes mellitus (T2DM).

DESIGN

This cross-sectional study statistically analysed TyG index levels across DN and DR stages in patients with early-onset and non-early-onset T2DM.

PATIENTS

A total of 1530 T2DM patients were enrolled between January 2017 and August 2023 at Tianjin Fourth Central Hospital in Tianjin.

MEASUREMENTS

Correlation analysis and logistic regression were used to examine the association between the TyG index and microvascular complications. Kaplan-Meier plots and Cox regression analyses were employed to evaluate the effects of the TyG index on DN incidence. TyG index's diagnostic ability for DN was explored using the area under the receiver operating characteristic curve.

RESULTS

In patients with early-onset T2DM, the TyG index gradually decreased with DR aggravation and gradually increased with DN aggravation, showing a negative correlation with DR and a positive correlation with DN in patients with early-onset T2DM; logistic regression analysis suggested that the TyG index was an independent risk factor for DN (OR = 1.623, 95% CI = 1.175-2.242). The Cox regression analysis and Kaplan-Meier plots suggested that higher TyG was associated with an earlier incidence of DN in patients with early-onset T2DM.

CONCLUSION

In patients with early-onset T2DM, the TyG index could be used to evaluate the risk of microvascular complications, with elevated TyG levels potentially indicating high risk of insulin- resistance related renal injury.

Modification of RNF183 via m6A Methylation Mediates Podocyte Dysfunction in Diabetic Nephropathy by Regulating PKM2 Ubiquitination and Degradation

Diabetic kidney disease (DKD) is a prevalent complication associated with diabetes in which podocyte dysfunction significantly contributes to the development and progression of the condition. Ring finger protein 183 (RNF183) is an ER-localized, transmembrane ring finger protein with classical E3 ligase activity. However, whether RNF183 is involved in glomerular podocyte dysfunction, which is the mechanism of action of DKD, is still poorly understood. In this study, we first demonstrated that RNF183 expression in glomerular podocytes of patients with DKD decreased as the disease progressed. Additionally, our transcriptome sequencing analysis of kidney tissues from diabetic mice revealed a significant reduction in RNF183 expression within the kidney cortex. Similarly, the expression of RNF183 was significantly reduced both in the kidneys of diabetic mice and in human podocytes exposed to high glucose conditions. The downregulation of RNF183 resulted in a suppression of autophagic activity, an increase in apoptotic cell death, and reduced expression of cellular markers in HPC cells. We found that RNF183 was modified via N6-methyladenosine (m6A) RNA methylation. Meanwhile, treatment with meclofenamic acid 2 (MA2), an m6A demethylase inhibitor, resulted in the upregulation of RNF183 expression in HPC cells cultured in high glucose conditions. Furthermore, high glucose treatment decreased the transcription and protein levels in both the m6A writer methyltransferaselike3 (METTL3) and the m6A reader insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2). IGF2BP2 assisted with METTL3, which is jointly involved in the transcription of RNF183. Furthermore, we confirmed that RNF183 directly ubiquitinates M2 pyruvate kinase (PKM2) through co-immunoprecipitation (Co-IP) and liquid chromatography-mass spectrometry (LC-MS) experiments. The level of PKM2 ubiquitination was increased following RNF183 overexpression, leading to enhanced PKM2 protein degradation and subsequently alleviating high glucose-induced podocyte damage. The results of this study indicated that RNF183 was regulated via m6A methylation modification and that RNF183 expression was reduced in HPC cells treated with high glucose, which resulted in decreased PKM2 ubiquitination levels and subsequently aggravated podocyte injury. The findings suggest that RNF183 may serve as a potential therapeutic target for diabetic kidney injury, offering new insights into its role in the progression of DKD.

Influence of High-Altitude Residential History on Optimal HbA1c Cutoff for Detecting Abnormal Glucose Metabolism

Zengmei, Sun, Suyuan Wang, Hua He, Chenghui Zhang, Mingxia Li, Yan Ye, Huiqin Zhang, Xuanyu Yao, Shuyao Sun, Yuanze Du, Yang Zhong, and Yunhong Wu. Influence of high-altitude residential history on optimal HbA1c cutoff for detecting abnormal glucose metabolism. High Alt Med Biol. 26:45-54, 2025. Aims: To explore the influence of recent high-altitude residential history on the optimal cutoff of glycosylated hemoglobin (HbA1c) for detecting abnormal glucose metabolism. Methods: The study included 505 self-reported healthy Han participants of age 18-65 years, recruited in Chengdu and categorized based on recent (within 3 months) high-altitude (>2,500 m) residential history. The 1999 WHO criteria was used as the gold standard for defining prediabetes and diabetes. HbA1c test performance was assessed using receiver operating characteristic curve, with the optimal cutoff determined by Maximum Youden index. Propensity score matching with 0.02 calipers and nearest neighbor method was used to balance confounding factors between groups. Results: Of the participants, 238 (47.13%) were populations with recent high-altitude residential history (HA group), and 267 (52.87%) were low-altitude dwellers (LA group). The HA group had slightly higher HbA1c levels (p > 0.05) and higher erythrocyte and hemoglobin levels (p < 0.05), compared to the LA group. Weak correlations between prediabetes and HbA1c levels were observed in the HA group (rs = 0.21, p < 0.05) and the LA group (rs = 0.07, p = 0.25). The optimal cutoff for the detection of diabetes was 6.5% (area under the curve [AUC] 0.94) in the HA group and 5.9% (AUC 0.97) in the LA group, which remained unchanged after adjustment for confounders. Conclusions: The optimal cutoff of HbA1c for the detection of diabetes in populations with recent history of living at high altitude was higher than that in general populations living at low altitude, and the diagnostic value of HbA1c for prediabetes was also inadequate.

Association between diabetes of different durations and hip fracture in middle-aged and older people: a stratified cohort study from CHARLS 2011-2020

BACKGROUND

The effect of the duration of diabetes on hip fracture is inconsistent. The aim of this study was to analyze the association between different durations of diabetes and hip fracture.

METHODS

This cohort study included participants from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2020. Diabetes was defined as glycated hemoglobin A1c ≥ 6.5%, fasting blood glucose ≥ 126 mg/dL, random blood glucose ≥ 200 mg/dL, or previous diagnosis of diabetes. Participants were stratified according to diabetes duration, and information was collected on their first hip fracture. The association between diabetes of different durations and hip fracture was assessed using Cox proportional risk models and Kaplan-Meier curves.

RESULTS

A total of 9,927 participants with a mean age of 58.4 ± 8.7 and 54.3% female were included, and 574 participants suffered a hip fracture. Compared with no diabetes, the associations between overall diabetes, newly diagnosed diabetes, diabetes with a duration of < 6 years, and hip fracture were all not significant, all P > 0.05. Known diabetes and diabetes of duration ≥ 6 years significantly increased the risk of hip fracture, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.69 (1.19 ~ 2.4), P = 0.003, and 2.2 (1.34 ~ 3.61), P = 0.002.

CONCLUSIONS

Neither newly diagnosed diabetes nor diabetes with a disease duration of < 6 years was associated with hip fracture compared with no diabetes people. When the duration of diabetes is ≥ 6 years, the risk of hip fracture is significantly increased, and appropriate preventive measures are recommended.

Lactation duration and the risk of type 2 diabetes mellitus in parous women: A perspective on socioeconomic status disparity

BACKGROUND & AIMS

Whether and how socioeconomic status (SES) influences the associations between type 2 diabetes mellitus (T2DM) and lactation remains unknown. We aimed to evaluate the associations between lactation duration and T2DM from a perspective of SES disparity.

METHODS

A total of 263,859 parous women without diabetes at baseline (2004-2008) in the China Kadoorie Biobank were included. Lactation duration was counted for the first-child, per-child and lifetime. The latent class analysis of education level, household income, occupation, and residence was conducted to derive SES as low, intermediate, and high. T2DM cases were identified through linkage with records in hospitals, disease registry system and health insurance data during follow-up (2008-2015). Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95 % confidence intervals for T2DM. Population attributable fraction evaluated the cases tied to insufficient lactation by SES.

RESULTS

In a median 9.2-year follow-up, 8,204 cases were identified. Women who breastfed their first child for 12-24 and > 24 months respectively, had a reduced risk of diabetes (fully adjusted HR: 0.84 [0.75-0.94] and 0.81 [0.70-0.95]). Similar results were found for per-child (0.84 [0.72-0.98] and 0.71 [0.59, 0.85]), and lifetime lactation for > 36 months (0.66 [0.56, 0.77]). For dose-response associations, every 5-month increase in lactation duration (first-child, per-child, lifetime) was linked to a 7 %, 10 %, and 4 % lower T2DM risk. These associations were significant among low SES women but not for intermediate or high SES women. For low SES women, 36.42 % of diabetes cases were attributable to per-child lactation duration of < 24 months, and 5.76 %, 25.37 %, 47.29 %, 19.04 % of cases would be prevented if women lactating for 0, 0-6, 6-12, and 12-24 months extended their per-child lactation duration to at least 2 years.

CONCLUSION

Longer lactation duration is associated with a decreased risk of T2DM among women, especially those with low SES. The promotion of extended breastfeeding could potentially prevent a significant proportion of diabetes events.

Overcoming dietary complexity in type 2 diabetes: influencing factors and coping strategies

BACKGROUND

Adherence to dietary guidelines is a fundamental aspect of diabetes management; however, it poses a significant challenge for patients with diabetes. Our research aims to assess the level of dietary compliance among individuals with type 2 diabetes (T2DM) and to identify the factors that influence their adherence to dietary advice.

METHODS

This study was a cross-sectional survey. The patients with T2DM undergoing treatment at our hospital from March, 2023, to June, 2024 were included. Compliance with dietary recommendations was assessed using the validated dietary compliance scale for type 2 diabetes mellitus patients (DCS-T2DM). Spearman correlation and logistic regression analyses were conducted to evaluate the factors influencing dietary compliance in patients with T2DM.

RESULTS

A total of 308 T2DM patients were included in our study. The results revealed that 46.10% of the participants had suboptimal dietary compliance. There were significant correlations between dietary compliance and several demographic and clinical factors, including age (r = 0.501), gender (r = 0.447), education level (r = 0.610), average monthly household per capita income (r = 0.627), and the duration, since T2DM diagnosis (r = 0.552), all of which were statistically significant (p < 0.05). Logistic regression identified age (OR = 1.705, 95%CI 1.262 ~ 1.987), gender (OR = 2.401, 95%CI 1.909 ~ 3.134), education level (OR = 3.083, 95%CI 2.434 ~ 3.957), average monthly household per capita income (OR = 3.721, 95%CI 2.553 ~ 4.405), and the time since T2DM diagnosis (OR = 2.470, 95%CI 1.755 ~ 3.262) as significant predictors of dietary compliance.

CONCLUSIONS

46.10% of patients with T2DM exhibited suboptimal dietary adherence, with age, gender, education, income, and diabetes duration significantly predicting compliance. It is imperative for healthcare providers to devise individualized intervention strategies that incorporate these pivotal factors to enhance dietary adherence in patients with T2DM.

RGD-HSA-TAC nanoparticles targeted delivery of tacrolimus and attenuation of podocyte injury in diabetic kidney disease

BACKGROUND

Diabetic kidney disease (DKD) is a prevalent and severe complication of diabetes and plays a pivotal role in the pathogenesis and progression of DKD. However, the current clinical application of the treatment methods does not yield effective results. Tacrolimus has been utilized in the management of immune-mediated and genetic-mediated nephropathy, with an emphasis on the restoration of podocyte cytoskeletal integrity and inhibition of apoptosis. The clinical management of diabetic nephropathy with tacrolimus remains challenging because of the risk of worsening hyperglycemia and infection.

RESULTS

We developed two RGD-HSA-TAC nanoparticles designed for targeted delivery of tacrolimus to podocytes. Administration of SANPs and CNPs resulted in elevated levels of tacrolimus in podocytes, leading to a reduction in podocyte damage and albuminuria in diabetic nephropathy mice. Furthermore, the use of SANPs and CNPs resulted in a decrease in tacrolimus accumulation in the pancreas, lymph nodes, and thymus, thereby reducing the potential to exacerbate hyperglycemia and infection. Importantly, compared to tacrolimus alone, both SANPs and CNPs demonstrated superior therapeutic efficacy, with CNPs exhibiting a greater advantage over SANPs.

CONCLUSIONS

Compared to tacrolimus, SANPs and CNPs demonstrated superior therapeutic efficacy and a reduced incidence of adverse effects in the treatment of diabetic nephropathy.

Clinical research progress on β-cell dysfunction in T2DM development in the Chinese population

The prevalence of type-2 diabetes mellitus (T2DM) has increased over 10-fold in the past 40 years in China, which now has the largest T2DM population in the world. Insulin resistance and β-cell dysfunction are the typical features of T2DM. Although both factors play a role, decreased β-cell function and β-cell mass are the predominant factors for progression to T2DM. Considering the differences between Chinese T2DM patients and those of other ethnicities, it is important to characterize β-cell dysfunction in Chinese patients during T2DM progression. Herein, we reviewed the studies on the relationships between β-cell function and T2DM progression in the Chinese population and discussed the differences among individuals of varying ethnicities. Meanwhile, we summarized the risk factors and current treatments of T2DM in Chinese individuals and discussed their impacts on β-cell function with the hope of identifying a better T2DM therapy.

Antibacterial betaine modified chitosan-based hydrogel with angiogenic property for photothermal enhanced diabetic wound repairing

Chronic diabetes wound repairing is still a huge challenge in clinical practice. High concentration of reactive oxygen species and vascular disfunction are the main factors hindering the recovery of diabetes wounds. This research grafted betaine onto chitosan (CSBT) to enhance the antibacterial property and the CSBT was cross-linked with PEO90 dialdehyde (PEO DA) to prepare hydrogel with Ca2+ loading to promote the coagulation. The polydopamine nanoparticles (PDA NPs) with photothermal property and antioxidant property was composited to the hydrogel and deferoxamine (DFO) was loaded to fabricate the multifunctional CBPCa/PDA/DFO hydrogel to promote vascular regeneration in combination with photothermal antibacterial performance for the diabetes wounds treatment. The CBPCa/PDA/DFO hydrogel showed good mechanical strength, injectability, anti-inflammatory property and coagulation performance. Furthermore, the antibacterial effect of chitosan based hydrogel was enhanced with near infrared (NIR) stimulated photothermal treatment. Combined with the photothermal effect and the angiogenic drug DFO release, the CBPCa/PDA/DFO hydrogel significantly enhanced vascular regeneration and reduced the inflammation in the in vivo wound repairing experiment. As a result, the CBPCa/PDA/DFO hydrogel may provide a promising therapeutic platform for diabetic trauma repairing.

Kouqiangjie formula alleviates diabetic periodontitis by regulating alveolar bone homeostasis via miR-29a-3p-mediated Dkk-1/Wnt/β-catenin signaling pathway

ETHNOPHARMACOLOGICAL RELEVANCE

Diabetic periodontitis (DP) is a commonly co-occurring complication in diabetes patients characterized by advanced gum disease and bone resorption. Conventional treatment modalities often fail to adequately address the underlying biological disruptions caused by diabetes. The use of traditional medicinal formulas Kouqiangjie Formula (KQJF) potentially offers novel therapeutic approaches for DP, but its detailed regulatory mechanisms remain unclear.

AIM OF THE STUDY

This study aims to investigate the impacts of KQJF on osteoblastic activity and inflammatory responses in a rat model and in vitro pre-osteoblast cultures under conditions mimicking DP, focusing on the involvement of the miR-29a-3p-Dkk-1/Wnt/β-catenin signaling pathway.

MATERIALS AND METHODS

Using network pharmacological analysis, micro-CT, histological staining, and an array of molecular biology methodologies including Western blotting, RT-qPCR, and immunofluorescence, we investigated the systemic and cellular responses to KQJF treatment. Both in vivo (rat model) and in vitro (MC3T3-E1 pre-osteoblasts) models subjected to high glucose and lipopolysaccharide (HG + LPS) stress were used to simulate DP conditions.

RESULTS

Network pharmacological analyses, incorporating protein-protein interactions and pathway enrichment, disclosed that KQJF interacts with pathways crucial for inflammation and bone metabolism. Experimentally, KQJF significantly preserved alveolar bone architecture, reduced osteoclast activity, and dampened inflammatory cytokine production in DP rats. In pre-osteoblasts, KQJF enhanced cell viability, promoted cell cycle progression, and decreased apoptosis. At the molecular level, KQJF treatment upregulated miR-29a-3p and downregulated Dkk-1, thereby activating the Wnt/β-catenin pathway. The interventional studies with miR-29a-3p antagonists and Dkk-1 knockdown further confirmed the regulatory role of the miR-29a-3p/Dkk-1 axis in mediating the effects of KQJF.

CONCLUSION

KQJF mitigates the deleterious effects of DP by enhancing osteoblastic activity and reducing inflammatory responses, predominantly through the modulation of the miR-29a-3p-Dkk-1/Wnt/β-catenin signaling pathway. These discoveries underscore the therapeutic promise of KQJF in managing bone and inflammatory complications of DP, offering insights into its mechanism, and supporting its use in clinical settings.

Inhibition of microRNA-139-5p Improves Fibroblasts Viability and Enhances Wound Repair in Diabetic Rats Through AP-1 (c-Fos/c-Jun)

Introductions

Diabetic foot ulcers (DFU) are notoriously difficult to heal, however, its underlying molecular mechanisms are unknown. MicroRNA-139-5p participates in various biological processes, including cancer and vascular endothelial injury, while its role in diabetic wound healing has not been reported.

Methods

Sprague-Dawley (SD) rats were intraperitoneally injected with streptozotocin and a 1.0 cm full-layer dorsal skin wound was made to establish a diabetic wound model. On days 1, 4, 7, and 10 after the wound was made, a solution containing microRNA-139-5p antagomir or control was injected along the dorsal edge of the wound. Wound healing was analyzed using Image J, histological analysis and molecular analysis. Skin tissues from 4 diabetic and 4 matched non-diabetic ulcer patients were obtained to detect microRNA-139-5p expression. In vitro, human skin fibroblasts were transfected with microRNA-139-5p inhibitors/mimics, the function of the fibroblasts was evaluated by CCK-8 assay and scratch assay, and AP-1 (c-Fos/c-Jun) was detected.

Results

Obviously elevated microRNA-139-5p expression was detected in the wound tissue of the rats with diabetes and patients with DFUs, and the microRNA-139-5p antagonist-treated diabetic wounds had faster healing rates. The pace of diabetic wound re-epithelialization and angiogenesis was accelerated, and the expression of AP-1 family members (c-Fos/c-Jun), and VEGF, PDGF was upregulated in the wound tissue of diabetic rats treated with topical microRNA-139-5p antagomir. In vitro, the expression of microRNA-139-5p was up-regulated in human skin fibroblasts induced by high glucose treatment, while the function of the cell proliferation and migration was promoted and the level of AP-1 (c-Fos/c-Jun) was increased after transfected with the microRNA-139-5p inhibitor, and vice versa. Our study further verified that microRNA-139-5p regulated the migration of human skin fibroblasts by modulating c-Fos.

Conclusion

Inhibiting microRNA-139-5p improves fibroblasts viability and promotes diabetic wound healing, suggesting that this may be a therapeutic strategy for diabetic foot ulcer.

Abnormal insulin metabolism and decreased levels of mindfulness in type 2 diabetes mellitus

OBJECTIVE

Disorders of insulin metabolism are strongly associated with a variety of psychological problems. The aim of this study was to investigate the differences in mindfulness levels among type 2 diabetes mellitus (T2DM) patients categorized based on their insulin resistance and β-cell function.

METHODS

A total of 157 T2DM patients were included in this study and divided into four groups according to their levels of insulin resistance and β-cell function. The Five Facet Mindfulness Questionnaire (FFMQ) was employed to assess the mindfulness levels of the patients. Linear regression models were utilized to investigate the relationships between various T2DM categories and mindfulness levels and dimensions. Furthermore, subgroup analyses of key variables were conducted, and mediation analysis was performed to evaluate the sources of differences.

RESULTS

Significant differences were observed among the four groups in terms of total mindfulness scores and in the dimensions of "Describing," "Non-judging of Inner Experience," and "Acting with Awareness" (P < 0.05). Compared to the control group (low HOMA-IR/high HOMA-β), the high HOMA-IR/low HOMA-β group exhibited markedly lower scores in "Non-judging of Inner Experience" (P = 0.02) and "Acting with Awareness" (P < 0.001). The low HOMA-IR/low HOMA-β group demonstrated weaker performance in "Non-judging of Inner Experience" (P = 0.005) and "Describing" (P = 0.002).

CONCLUSION

Significant differences in mindfulness levels were found to exist among T2DM patients with varying degrees of insulin resistance and β-cell function. Early-stage diabetes patients, particularly those with lower β-cell function or higher insulin resistance levels, may require additional psychological intervention support to enhance their mindfulness and overall well-being.

Urine Tricarboxylic Acid Cycle Metabolites and Risk of End-stage Kidney Disease in Patients With Type 2 Diabetes

CONTEXT

Metabolites in the tricarboxylic acid (TCA) pathway have pleiotropic functions.

OBJECTIVE

To study the association between urine TCA cycle metabolites and the risk for chronic kidney disease progression in individuals with type 2 diabetes.

DESIGN, SETTING AND PARTICIPANTS

A prospective study in a discovery (n = 1826) and a validation (n = 1235) cohort of people with type 2 diabetes in a regional hospital and a primary care facility.

EXPOSURE AND OUTCOME

Urine lactate, pyruvate, citrate, alpha-ketoglutarate, succinate, fumarate, and malate were measured by mass spectrometry. Chronic kidney disease progression was defined as a composite of sustained estimated glomerular filtration rate below 15 mL/min/1.73 m2, dialysis, renal death, or doubling of serum creatinine.

RESULTS

During a median of 9.2 (interquartile range 8.1-9.7) and 4.0 (3.2-5.1) years of follow-up, 213 and 107 renal events were identified. Cox regression suggested that urine lactate, fumarate, and malate were associated with an increased risk (adjusted hazard ratio, [95% CI] 1.63 [1.16-2.28], 1.82 [1.17-2.82], and 1.49 [1.05-2.11], per SD), whereas citrate was associated with a low risk (aHR 0.83 [0.72-0.96] per SD) for the renal outcome after adjustment for cardiorenal risk factors. These findings were reproducible in the validation cohort. Noteworthy, fumarate and citrate were independently associated with the renal outcome after additional adjustment for other metabolites.

CONCLUSION

Urine fumarate and citrate predict the risk for progression to end-stage kidney disease independent of clinical risk factors and other urine metabolites. These 2 metabolites in TCA cycle pathway may play important roles in the pathophysiological network, underpinning progressive loss of kidney function in patients with type 2 diabetes.

From past to present: tracing the trends of diabetes drug trials in mainland China

Background

This study aimed to analyze the changing trend of diabetes drugs clinical trials in China during 2013-2023, and provided a reference for the research and development of diabetes drugs.

Methods

Diabetes drug clinical trial data were obtained from the registration and information disclosure platform of the National Medical Products Administration (NMPA) between January 1, 2013, and December 31, 2023. Trends of clinical trials on diabetes drugs were systematically analyzed in terms of characteristics, trial design, time trends, drug type, and indications.

Results

From 2013 to 2023, a total of 1,256 diabetes drugs clinical trials have been registered on the NMPA platform, of which 1056 were chemical drugs and 184 were biological products. The indications are mainly type 2 diabetes mellitus (n=1237, 98.49%). Among them, 838 clinical trials have been completed, 379 were proceeding, and 39 have been terminated or suspended. There were 42 international multi-center clinical trials, and the remaining 1034 clinical trials were domestic. Bioequivalence trials were 691, accounting for 55.02%, followed by 340 phase I clinical trials and 169 phase III clinical trials. The leading units were mostly distributed in eastern China. The proportion of clinical trial sponsorship from domestic pharmaceutical companies is higher than that from overseas companies.

Conclusions

China has made significant advancements in diabetes drug research and development over the past decade. However, problems such as serious drug homogeneity, and insufficient innovation have become increasingly prominent. The government, clinical trial institutions, and pharmaceutical companies must collaborate to promote the high-quality development of drug clinical trials.

Changes of CA19-9 levels and related influencing factors in patients with type 2 diabetes mellitus after antidiabetic therapy

Abnormalities of carbohydrate antigen 19 - 9 (CA19-9) are common in patients with type 2 diabetes mellitus (T2DM), and in some patients, CA19-9 returns to normal level after glycemic control. The aim of this study was to investigate the factors associated with CA19-9 levels in patients with T2DM and the associated influences on the degree of reduction of CA19-9 levels after antidiabetic therapy (AT). This study was an observational cross-sectional study. A total of 213 patients with T2DM were enrolled in this study, of whom 105 with abnormal CA19-9 and 108 with normal CA19-9. Socio-demographic information, complete blood counts, biochemical indicators, thyroid function indicators, and CA19-9 level were collected separately for each subject. Levels of glycosylated hemoglobin, type A1C (HbA1c), fasting blood glucose (FBG) were significantly higher in T2DM patients with abnormal CA19-9 compared to patients with normal CA19-9 (both FDR < 0.001). CA19-9 level was significantly and positively correlated with neutrophil/lymphocyte ratio (NLR) (r = 0.16, P = 0.02), monocyte/lymphocyte ratio (MLR) (r = 0.16, P = 0.02), and FBG (r = 0.38, P < 0.001), while significantly and negatively correlated with free triiodothyronine (FT3) (r=-0.22, P = 0.002) and albumin count (r=-0.18, P = 0.007). After AT, the degree of decrease in CA19-9 level in T2DM patients with abnormal CA19-9 was significantly positively correlated with degree of decrease in FBG (r = 0.33, P < 0.001), as well as CA19-9 level before AT (r = 0.73, P < 0.001), NLR (r = 0.20, P = 0.04), and MLR (r = 0.25, P = 0.01). In this study, we investigated the influencing factors associated with CA19-9 level and the factors influencing degree of CA19-9 reduction after AT in T2DM patients with abnormal CA19-9.

Threshold-effect of ferritin levels with pathoglycemia in Chinese adults: a cross-sectional study based on China health and nutrition survey data

BACKGROUND

The present study aimed to explore the threshold-effect association of serum ferritin levels with type 2 diabetes mellitus (T2DM) and prediabetes mellitus in Chinese adults.

METHODS

A total of 8365 people from CHNS a cross-sectional survey in 2009 were finally included. The biomarker data, including major cardiovascular biomarkers and important nutrition biomarkers were collected. The association of serum ferritin levels with T2DM and prediabetes mellitus were assessed by using restricted cubic spline function combined with multivariate logistic regression model.

RESULTS

The mean age of the study subjects was 50.3 years, and 46.5% were men. The risk of T2DM and prediabetes mellitus increased when the ferritin level was greater than 140 ng/ml. The OR(OR = 0.59, 95% CI, 0.35-0.98)was lowest between 40 to < 60 ng/ml in men with prediabetes mellitus. The OR(OR = 0.61, 95% CI, 0.41-0.90)was lowest between 20 to < 40 ng/ml in women with prediabetes mellitus. Serum ferritin levels and OR value of women younger than 50 years old are lower than those of other participants.

CONCLUSIONS

There is a correlation between ferritin levels and pathoglycemia, with women under 50 years old having a lower risk for the same ferritin level, and maintaining low levels of ferritin can reduce the risk of developing diabetes mellitus.

Relationship between BMI, indicators of lipid metabolism and diabetic neuropathy: a Mendelian randomization study

BACKGROUND

To identify the relationship between BMI or lipid metabolism and diabetic neuropathy using a Mendelian randomization (MR) study.

METHODS

Body constitution-related phenotypes, namely BMI (kg/m2), total cholesterol (TC), and triglyceride (TG), were investigated in this study. Despite the disparate origins of these data, all were accessible through the IEU OPEN GWAS database ( https://gwas.mrcieu.ac.uk/ ). Instrumental variables and F-statistics for each exposure-outcome pair were determined in weighted mode, weighted median, MR-Egger and Inverse-Variance Weighted (IVW) MR analyses. The p-value threshold was consistently set at 5.00E-08, following established methodology. The preliminary analysis utilized the IVW method to explore potential causal relationships between body constitution-related phenotypes and diabetic neuropathy. Inverse variance weighting, a technique amalgamating random variables, assigns weights inversely proportional to each variable's variance, commonly used for merging findings from independent studies. The weighted median method provides a causal estimate even when up to 50% of the instruments are invalid, enhancing robustness. The weighted mode method identifies the most common causal effect, reducing bias when some instruments exhibit horizontal pleiotropy. The Wald ratio method was utilized to calculate exposure-outcome effects, employing a range of methodologies to ensure result accuracy across different scenarios. This study addresses the critical gap in understanding the causal relationship between BMI, lipid metabolism, and diabetic neuropathy (DN). Employing a MR approach, it highlights BMI as a predictive factor for DN progression, providing insights into potential risk management strategies.

RESULTS

IVW analysis showed that BMI (P = 0.033, OR = 2.53, 95% CI 1.08-5.96) and triglycerides level (P = 0.593, OR = 1.11, 95% CI 0.77-1.60) were positively associated with the initiation of DN, indicating that the values of BMI and triglycerides are potentially the risk factors in DN development. Additionally, TC was negatively associated with the DN (P = 0.069, OR = 0.72, 95% CI = 0.50-1.03).The forest plot of advanced analysis between BMI and DN relationship indicated a positive correlation between increasing BMI and the risk of DN. In addition, it is evident that with the increase in BMI, the risk of diabetic polyneuropathy also rises. This research demonstrates a positive association between BMI and DN risk (P = 0.033, OR = 2.53, 95% CI = 1.08-5.96). However, no significant correlation was observed between triglycerides (P = 0.593) or total cholesterol (P = 0.069) and DN development, underscoring the complex interplay between lipid metabolism and DN.

CONCLUSION

This research demonstrates a positive association between the risk of DN and BMI, while no significant correlation exists between TG or TC and the development of DN. These results imply that BMI may serve as a predictive factor for the progression of DN.

Exploring insulin resistance and pancreatic function in individuals with overweight and obesity: Insights from OGTTs and IRTs

To investigate insulin resistance and pancreatic β-cell function in overweight or obese people under the same glucose tolerance conditions. The subjects were categorized based on the results of the oral glucose tolerance test (OGTT) and the BMI classification criteria. Basal and postprandial glucose concentrations, insulin concentrations, pancreatic β-cell function (HOMA-β), the insulin resistance index (HOMA-IR), and the insulin early secretion index (ΔI30/ΔG30) were compared between the different weight groups. Among individuals with similar glucose tolerances, those in the obese group presented higher HOMA-β, HOMA-IR, and ΔI30/ΔG30 values than did those in the normal weight and overweight groups. Additionally, in individuals with normal glucose tolerance and early diabetes, OGTT 1-h plasma glucose concentrations demonstrated a stronger correlation with early insulin secretion across different body weights. When the same glucose-tolerant population was grouped by weight, OGTTs were significantly less different than IRTs. Therefore, integrating both tests is the optimal approach. In individuals with preobesity, there is an increase in pancreatic β-cell function to maintain normal blood glucose levels. As the disease progresses, obesity substantially increases insulin resistance, which acts as a disease-promoting factor. Furthermore, OGTT 1-h plasma glucose concentrations are strongly correlated with insulin secretion in normal or early diabetic populations.

Multi-omics insights into the pathogenesis of diabetic cardiomyopathy: epigenetic and metabolic profiles

AIM

Diabetic cardiomyopathy (DbCM), a complex metabolic disease, greatly threatens human health due to therapeutic limitations. Multi-omics approaches facilitate the elucidation of its intrinsic pathological changes.

METHODS

Metabolomics, RNA-seq, proteomics, and assay of transposase-accessible chromatin (ATAC-seq) were utilized to elucidate multidimensional molecular alterations in DbCM.

RESULTS

In the heart and plasma of mice with DbCM, metabolomic analysis demonstrated significant differences in branched-chain amino acids (BCAAs) and lipids. Subsequent RNA-seq and proteomics showed that the key genes, including BCKDHB, PPM1K, Cpt1b, Fabp4, Acadm, Acadl, Acadvl, HADH, HADHA, HADHB, Eci1, Eci2, PDK4, and HMGCS2, were aberrantly regulated, contributing to the disorder of BCAAs and fatty acids. ATAC-seq analysis underscored the pivotal role of epigenetic regulation by revealing dynamic shifts in chromatin accessibility and a robust positive correlation with gene expression patterns in diabetic cardiomyopathy mice. Furthermore, motif analysis identified that KLF15 as a critical transcription factor in DbCM, regulating the core genes implicated with BCAAs metabolism.

CONCLUSION

Our research delved into the metabolic alterations and epigenetic landscape and revealed that KLF15 may be a promising candidate for therapeutic intervention in DbCM.

The status of blood glucose monitoring and its influencing factors in Chinese patients with type 2 diabetes initiating premixed insulin: A prospective real-world study

OBJECTIVE

This study aimed to assess the current state of self-monitoring of blood glucose (SMBG) in Chinese patients initiating premixed insulin and its influential factors.

RESEARCH DESIGN AND METHODS

This is a single-arm, multi-center, prospective real-world study enrolling a total of 8214 adult patients with type 2 diabetes mellitus (T2DM) newly initiated premixed insulin analogues. Each patient was followed up for 12 weeks, and the data related to SMBG was collected at week 1, week 4, week 8 and week 12, while data related to glycated hemoglobin were collected at week 1 and week 12. The primary outcome was the frequency of SMBG over 12 weeks.

RESULTS

At week 12, 83.3 % monitored blood glucose at least once, while 20.3 % of participants continued SMBG every week. The average monitoring frequency was 4.78 times/week over the first 4 weeks and 3.33 times/week over 12 weeks. The patients with a higher frequency of SMBG had better control of blood glucose.

CONCLUSIONS

This study found that most T2DM patients would take SMBG but the adherence decreased over time. The adherence to SMBG in Chinese T2DM patients was influenced by age, insulin dosage, education level, and diabetes duration. SMBG benefited the improvement of glycemic control.

Sources, metabolism, health benefits and future development of saponins from plants

Saponins are a class of glycoside compounds whose aglycones are triterpenoids or spirostanes, widely exist in a variety of Chinese herbs. Saponins are one of the important active components of medicinal plants and have a wide range of bioactivities. In order to promote the better development and utilization of saponins, the process of digestion, absorption and metabolism of saponins in vivo was reviewed in this paper. At the same time, the main bioactivities of common saponins and their potential mechanisms for alleviating diseases were summarized. Finally, the potential of saponins as functional food has been pointed out, and microbial transformation can make saponins better play this potential in the future.

Acute kidney injury predicts the risk of adverse cardio renal events and all cause death in southeast Asian people with type 2 diabetes

Patients with diabetes are susceptible to acute kidney injury (AKI) as compared to counterparts without diabetes. However, data on the long-term clinical outcome of AKI specifically in people with diabetes are still scarce. We sought to study risk factors for and adverse cardio-renal outcomes of AKI in multi-ethnic Southeast Asian people with type 2 diabetes. 1684 participants with type 2 diabetes from a regional hospital were followed an average of 4.2 (SD 2.0) years. Risks for end stage kidney disease (ESKD), major adverse cardiovascular events (MACE) and all-cause death after AKI were assessed by survival analyses. 219 participants experienced at least one AKI episode. Age, cardiovascular disease history, minor ethnicity, diuretics usage, HbA1c, baseline eGFR and albuminuria independently predicted risk for AKI with good discrimination. Compared to those without AKI, participants with any AKI episode had a significantly high risk for ESKD, MACE and all-cause death after adjustment for multiple risk factors including baseline eGFR and albuminuria. Even AKI defined by a mild serum creatinine elevation (0.3 mg/dL) was independently associated with a significantly high risk for premature death. Therefore, individuals with diabetes and any episode of AKI deserve intensive surveillance for cardio-renal dysfunction.

Insulin Injection Technique and Related Complications in Patients With Diabetes in a Northwest City of China

OBJECTIVES

Appropriate insulin injection technique can help to enhance positive clinical outcomes in insulin-treated patients. This cross-sectional survey was undertaken to assess the present state of injection technique practices of patients administering insulin and the incidence of local complications associated with insulin injection.

METHODS

This cross-sectional study was conducted at 11 tertiary hospitals in Xi'an City. A total of 1370 patients with diabetes were enroled in the survey. Each patient was asked questions on the Injection Technique questionnaire, demonstrated insulin injection on an injection training pad and had their injection sites inspected by a nurse.

RESULTS

About 98% of participants were type 2 diabetic patients. The 5 mm length needles were used by 640 (46.71%) patients. Around 1286 participants reused pen needles. Only one-third of patients rotate the injection sites. Around 901 patients had ecchymosis at injection sites, 43 participants suffered rash and or pruritus and 661 patients had lipohypertrophy. About 2.99% of patients reported having infection at the injection sites. Most patients (72.55%) occasionally felt pain when injecting insulin. The results of the multivariable logistict analysis showed that gender (male), needle length, priming the pen before injections and correct site rotation were negatively associated with the incidence of injection site ecchymosis. Lower incidence of lipohypertrophy was associated with needle length 4 mm, needle length 6 mm, single use of pen needles, priming the pen before injections and correct site rotation. Higher incidence of injection site infection was related to not disinfecting injection sites before each injection.

CONCLUSIONS

Despite some improvements detected in some aspects of patients' insulin injection practice in recent years, a large gap still exists between insulin injection guidelines and patients' actual injection behaviour. Injection-related complications at injection sites are still considerably common among our study population. Patients' education regarding insulin injection technique should be conducted repeatedly and regularly to make sure patients' compliance to injection guidelines.

Exploration and identification of diabetes targets in nursing: CDH1 and DVL1

Diabetes is a chronic disease caused by absolute or relative insufficiency of insulin secretion and impaired insulin utilization. CDH1 and DVL1 role in diabetes and its nursing care is unclear. The diabetes dataset GSE21321 and GSE19790 profiles were downloaded from the gene expression omnibus (GEO) database. Perform differentially expressed genes (DEGs) screening, weighted gene co-expression network analysis (WGCNA), protein-protein interaction (PPI) network construction and analysis, functional enrichment analysis, gene set enrichment analysis (GSEA), immune infiltration analysis, and Comparative Toxicogenomics Database (CTD) analysis. Gene expression heat map was drawn. TargetScan was used to screen the miRNA that regulates central DEGs. 1983 DEGs were obtained. According to Gene Ontology (GO) analysis, they were mainly enriched in signal regulation, catenin complexes, and signal receptor binding. In Kyoto Encyclopedia of Gene and Genome (KEGG) analysis, they were mainly concentrated in the Rap1 signaling pathway, cAMP signaling pathway, and Hippo signaling pathway. The DEGs are mainly enriched in cell signaling, Wnt signaling vesicles, growth factor activity, and the interaction between neural active ligands and receptors. In the enrichment project of Metascape, BMP signaling pathways and cell population proliferation can be seen in the GO enrichment project. The soft threshold power in WGCNA is set to 5. A total of 15 modules were generated. Core gene expression heatmap showed that core genes (CTNNB1, CDH1, DVL1) were highly expressed in diabetes samples. CTD analysis showed thatCTNNB1, CDH1, DVL1were associated with weight gain, inflammation, and necrosis. CDH1 and DVL1 are highly expressed in diabetes and may become molecular targets for diabetes and its care.

Paeoniflorin alleviates high glucose-induced endothelial cell apoptosis in diabetes mellitus by inhibiting HRAS-activated RAS pathway

Paeoniflorin (Pae) can improve diabetes mellitus (DM), especially endothelial dysfunction induced by high glucose (HG). Molecularly, the mechanism pertinent to Pae and DM lacks further in-depth research. Hence, this study determined the molecular mechanism of Pae in treating DM through network pharmacology. The target of Pae was analyzed by TCMSP database, and DM-related genes were dissected by Genecards database and Omim database. PPI network was constructed for cross targets through Cytoscape 3.9.1 and STRING platform. GO and KEGG analyses were carried out on the cross targets. Protein molecular docking verification was completed by AutoDockTools and Pymol programs. Human umbilical vein endothelial cells (HUVECs) were separately treated with HG, Pae (5, 10, 20 μM) and/or HRAS overexpression plasmids (oe-HRAS). The cell viability, apoptosis and the protein expressions of HRAS and Ras-GTP were evaluated. There were 50 cross targets between Pae and DM, and VEGFA, EGFR, HRAS, SRC and HSP90AA1 were the key genes identified by PPI network analysis. GO and KEGG analyses revealed signal paths such as Rap1 and Ras. Molecular docking results confirmed that Pae had a good binding ability with key genes. In HG-treated HUVECs, Pae dose-dependently facilitated cell viability, attenuated cell apoptosis, and dwindled the expressions of HRAS and Ras-GTP, but these effects of Pae were reversed by oe-HRAS. In conclusion, Pae regulates the viability and apoptosis of HG-treated HUVECs by inhibiting the expression of HRAS.

The mechanisms underlying Chinese medicines to treat inflammation in diabetic kidney disease

ETHNIC PHARMACOLOGICAL RELEVANCE

Diabetic kidney disease (DKD) is the main cause of end-stage renal disease (ESRD), which is a public health problem with a significant economic burden. Serious adverse effects, such as hypotension, hyperkalemia, and genitourinary infections, as well as increasing adverse cardiovascular events, limit the clinical application of available drugs. Plenty of randomized controlled trials(RCTs), meta-analysis(MAs) and systematic reviews(SRs) have demonstrated that many therapies that have been used for a long time in medical practice including Chinese patent medicines(CPMs), Chinese medicine prescriptions, and extracts are effective in alleviating DKD, but the mechanisms by which they work are still unknown. Currently, targeting inflammation is a central strategy in DKD drug development. In addition, many experimental studies have identified many Chinese medicine prescriptions, medicinal herbs and extracts that have the potential to alleviate DKD. And part of the mechanisms by which they work have been uncovered.

AIM OF THIS REVIEW

This review aims to summarize therapies that have been proven effective by RCTs, MAs and SRs, including CPMs, Chinese medicine prescriptions, and extracts. This review also focuses on the efficiency and potential targets of Chinese medicine prescriptions, medicinal herbs and extracts discovered in experimental studies in improving immune inflammation in DKD.

METHODS

We searched for relevant scientific articles in the following databases: PubMed, Google Scholar, and Web of Science. We summarized effective CPMs, Chinese medicine prescriptions, and extracts from RCTs, MAs and SRs. We elaborated the signaling pathways and molecular mechanisms by which Chinese medicine prescriptions, medicinal herbs and extracts alleviate inflammation in DKD according to different experimental studies.

RESULTS

After overviewing plenty of RCTs with the low hierarchy of evidence and MAs and SRs with strong heterogeneity, we still found that CPMs, Chinese medicine prescriptions, and extracts exerted promising protective effects against DKD. However, there is insufficient evidence to prove the safety of Chinese medicines. As for experimental studies, Experiments in vitro and in vivo jointly demonstrated the efficacy of Chinese medicines(Chinese medicine prescriptions, medicinal herbs and extracts) in DKD treatment. Chinese medicines were able to regulate signaling pathways to improve inflammation in DKD, such as toll-like receptors, NLRP3 inflammasome, Nrf2 signaling pathway, AMPK signaling pathway, MAPK signaling pathway, JAK-STAT, and AGE/RAGE.

CONCLUSION

Chinese medicines (Chinese medicine prescriptions, medicinal herbs and extracts) can improve inflammation in DKD. For drugs that are effective in RCTs, the underlying bioactive components or extracts should be identified and isolated. Attention should be given to their safety and pharmacokinetics. Acute, subacute, and subchronic toxicity studies should be designed to determine the magnitude and tolerability of side effects in humans or animals. For drugs that have been proven effective in experimental studies, RCTs should be designed to provide reliable evidence for clinical translation. In a word, Chinese medicines targeting immune inflammation in DKD are a promising direction.

Eldecalcitol ameliorates diabetic osteoporosis and glucolipid metabolic disorder by promoting Treg cell differentiation through SOCE

Active vitamin D, known for its role in promoting osteoporosis, has immunomodulatory effects according to the latest evidence. Eldecalcitol (ED-71) is a representative of the third-generation novel active vitamin D analogs, and its specific immunological mechanisms in ameliorating diabetic osteoporosis remain unclear. We herein evaluated the therapeutic effects of ED-71 in the context of type 2 diabetes mellitus (T2DM), delving into its underlying mechanisms. In a T2DM mouse model, ED-71 attenuated bone loss and marrow adiposity. Simultaneously, it rectified imbalanced glucose homeostasis and dyslipidemia, ameliorated pancreatic β-cell damage and hepatic glycolipid metabolism disorder. Subsequently, in mice injected with the Treg cell-depleting agent CD25, we observed that the beneficial effects of ED-71 mentioned earlier were partially contingent on the Treg subsets ratio. Mechanistically, ED-71 promoted the differentiation of CD4+ T cells into Treg subsets, facilitating Ca2+ influx and the expression of ORAI1 and STIM1, pivotal proteins in store-operated Ca2+ entry (SOCE). The SOCE inhibitor, 2-APB, partially attenuated the positive effects of ED-71 observed in the above results. Overall, ED-71 regulates SOCE-mediated Treg cell differentiation, accomplishing the dual purpose of simultaneously ameliorating diabetic osteoporosis and glucolipid metabolic disorders, showcasing its potential in osteoimmunity therapy and interventions for diseases involving SOCE.

Inhibition of YIPF2 Improves the Vulnerability of Oligodendrocytes to Human Islet Amyloid Polypeptide

Excessive secretion of human islet amyloid polypeptide (hIAPP) is an important pathological basis of diabetic encephalopathy (DE). In this study, we aimed to investigate the potential implications of hIAPP in DE pathogenesis. Brain magnetic resonance imaging and cognitive scales were applied to evaluate white matter damage and cognitive function. We found that the concentration of serum hIAPP was positively correlated with white matter damage but negatively correlated with cognitive scores in patients with type 2 diabetes mellitus. In vitro assays revealed that oligodendrocytes, compared with neurons, were more prone to acidosis under exogenous hIAPP stimulation. Moreover, western blotting and co-immunoprecipitation indicated that hIAPP interfered with the binding process of monocarboxylate transporter (MCT)1 to its accessory protein CD147 but had no effect on the binding of MCT2 to its accessory protein gp70. Proteomic differential analysis of proteins co-immunoprecipitated with CD147 in oligodendrocytes revealed Yeast Rab GTPase-Interacting protein 2 (YIPF2, which modulates the transfer of CD147 to the cell membrane) as a significant target. Furthermore, YIPF2 inhibition significantly improved hIAPP-induced acidosis in oligodendrocytes and alleviated cognitive dysfunction in DE model mice. These findings suggest that increased CD147 translocation by inhibition of YIPF2 optimizes MCT1 and CD147 binding, potentially ameliorating hIAPP-induced acidosis and the consequent DE-related demyelination.

ISIS 449884 Injection Add-On to Metformin in Patients with Type 2 Diabetes: A Randomized, Double-Blind, Placebo-Controlled, Phase II Clinical Study

INTRODUCTION

ISIS 449884, a 2'-O-methoxyethyl antisense oligonucleotide that targets the glucagon receptor (GCGR), has demonstrated an ability to reduce hepatic glucose output and lower the blood glucose level. The primary objective of this study was to investigate the safety and efficacy of ISIS 449884 as an add-on to metformin in a population of Chinese patients with type 2 diabetes mellitus (T2DM).

METHOD

This was a multicenter, placebo-controlled (2:1), randomized, double-blind, parallel-enrollment, multiple-dose phase II study in Chinese patients with T2DM. A total of 90 patients who were uncontrolled by stable metformin monotherapy were randomized into three cohorts. Thirty subjects were enrolled in each cohort and received injections of ISIS 449884 (50 mg or 60 mg weekly or 100 mg every other week) or a corresponding volume of placebo (0.25 mL and 0.3 mL weekly or 0.5 mL every other week) subcutaneously in a 2:1 ratio for 16 weeks.

RESULTS

The primary efficacy endpoint was analyzed in 88 subjects (ISIS 449884, n = 59; placebo, n = 29). The corrected LS mean change from baseline in glycated hemoglobin (HbA1c) at week 17 in the pooled ISIS 449884 treatment group was - 1.31% (95% CI - 1.66%, - 0.96%), and that in the pooled placebo group was 0.15% (95% CI - 0.37%, 0.66%). The LS mean difference between the two groups was - 1.46% (95% CI - 1.92%, - 1.00%, P < 0.001). Treatment-emergent adverse events (TEAEs) occurred in 53/60 subjects (88.3%) and 25/30 subjects (83.3%) in the pooled ISIS 449884 treatment group and the pooled placebo group, respectively, with similar incidences. Drug-related TEAEs occurred in 41/60 subjects (68.3%) and 9/30 subjects (30.0%), respectively. TEAEs of grade 3 or higher occurred in 5/60 (8.3%) subjects and 2/30 (6.7%) subjects, respectively, and none of them were drug related.

CONCLUSIONS

The ISIS 449884 injection add-on to metformin significantly reduced HbA1c in patients with T2DM uncontrolled by stable metformin monotherapy and showed an acceptable benefit/risk profile.

CLINICAL TRIAL REGISTRATION

www.chinadrugtrials.org.cn , CTR20191096.

Supernatural Beliefs-Based Intervention to Improve Type-2 Diabetes Self-Management: A Pilot Randomized Controlled Trial from China

China has over 100 million people living with type 2 diabetes mellitus (T2DM). Interventions framed around pre-existing personal beliefs in the supernatural may improve T2DM self-management, but such interventions are lacking in China. This pilot randomized controlled trial (RCT) assessed the feasibility of a full-scale RCT to evaluate the efficacy of a supernatural beliefs-based intervention on T2DM management self-efficacy in China. In 2019, 62 T2DM patients were enrolled at two hospitals in Suzhou, China. Participants were randomly assigned to view a 30-s control or intervention video at baseline. The control video showed general diabetes self-management information. The intervention video showed identical information, but also indicated that some diabetics with supernatural beliefs (chao ziran xinnian) have lower glycemic levels, because their beliefs enhance their confidence in diabetes self-management. Development of the intervention was guided by the theory of planned behavior and literature on spiritual framing health interventions. Baseline and follow-up measures after two weeks were assessed by interviewer administered surveys in-person and by telephone, respectively. Diabetes management self-efficacy was assessed with the diabetes management self-efficacy scale. Randomization of intervention allocation appeared to be successful. However, follow-up retention was low, especially for the intervention group (3% vs. 31%). A full-size efficacy RCT using the current study design is unlikely to succeed. T2DM patients shown the supernatural beliefs-based intervention had significantly higher loss to follow-up that was insurmountable. T2DM patients in Suzhou, China may not be receptive to brief, non-tailored supernatural beliefs-based interventions delivered to a general population in clinical settings.

Multifunctional Photothermal Nanorods for Targeted Treatment of Drug-Resistant Bacteria-Induced Wound Healing

The challenge of drug-resistant bacteria-induced wound healing in clinical and public healthcare settings is significant due to the negative impacts on surrounding tissues and difficulties in monitoring the healing progress. We developed photothermal antibacterial nanorods (AuNRs-PU) with the aim of selectively targeting and combating drug-resistant Pseudomonas aeruginosa (P. aeruginosa). The AuNRs-PU were engineered with a bacterial-specific targeting polypeptide (UBI29-41) and a bacterial adhesive carbohydrate polymer composed of galactose and phenylboronic acid. The objective was to facilitate sutureless wound closure by specially distinguishing between bacteria and nontarget cells and subsequently employing photothermal methods to eradicate the bacteria. AuNRs-PU demonstrated high photothermal conversion efficiency in 808 nm laser and effectively caused physical harm to drug-resistant P. aeruginosa. By integrating the multifunctional bacterial targeting copolymer onto AuNRs, AuNRs-PU showed rapid and efficient bacterial targeting and aggregation in the presence of bacteria and cells, consequently shielding cells from bacterial harm. In a diabetic rat wound model, AuNRs-PU played a crucial role in enhancing healing by markedly decreasing inflammation and expediting epidermis formation, collagen deposition, and neovascularization levels. Consequently, the multifunctional photothermal therapy shows promise in addressing the complexities associated with managing drug-resistant infected wound healing.

Maggot extract accelerates skin wound healing of diabetic rats via enhancing STAT3 signaling

BACKGROUND

Diabetic skin wound is a complex problem due to the disruption of normal repairing program and lack of effective remedy. Lucilia sericata larvae (maggot) is a folk method to treat chronic skin wound, while its therapeutic effects on that caused by diabetic remains unknown.

OBJECTIVE

This study aims to investigate the therapeutic effects of maggot extract (M.E.) on diabetic skin wound and its molecular mechanism by establishing the skin wound model of diabetic Sprague Dawley (SD) rats.

METHODS

Diabetic model was established by injecting intraperitoneally streptozotocin in SD rats under specific pathogen-free (SPF) conditions. The rat fasting blood glucose values were ≧16.7 mmol/L 72 hours after intraperitoneal streptozotocin (60mg/kg body weight) injection. The rats were divided into five groups (n = 10/group): normal group: normal SD rats without any treatment, diabetic blank group: the diabetic rats without any treatment, Vaseline group: the diabetic rats dressed with Vaseline, recombinant human epidermal-growth-factor (rhEGF) group: the diabetic rats dressed with a mixture of Vaseline and 200 μg/g rhEGF, M.E. group: the diabetic rats dressed with a mixture of Vaseline and 150 μg/ml maggot extract. The round open wounds (1.0 cm in diameter) down to the muscle fascia were made on both sides of rat dorsa by removing the skin layer (epidermis and dermis) and were daily photographed for calculating their healing rates. Hematoxylin-eosin (HE) and Masson's trichrome staining were performed on skin wound sections to analyze re-epithelialization and granulation tissue formation. Immunohistochemical (IHC), immunofluorescent (IF) stainings and Western blotting were conducted to analyze the statuses of STAT3 signaling.

RESULTS

The average wound healing rates on the 14th day were 91.7% in the normal, 79.6% in M.E., 71% in rhEGF, 55.1% in vaseline and 43.3% in the diabetes blank group. Morphological staining showed more active granulation tissue formation, re-epithelialization and neovascularization in M.E.-group than those in the blank and the vaseline-treated groups. Decreased p-STAT3 nuclear tranlocation and down-regulated Bcl-2, CyclinD1 and vascular endothelial growth factor (VEGF) expression were evidenced in the diabetic rats, which could be improved by rhEGF and especially M.E.

CONCLUSION

Maggot extract would be an alternative and/or adjuvant candidate for the better management of diabetic skin wounds because of its activity in enhancing STAT3 activation.

A great diversity of ROBO4 expression and regulations identified by data mining and transgene mice

ROBO4 involves in the stabilization of blood vessel and mediates the migration of hematopoietic stem cell and newborn neuron. However, the patterns of expression and regulation are not quite clear. To resolve this, we analyzed the single cell sequence data, and confirmed that Robo4 mainly expresses in various endothelial cells, but also in epithelial cells, pericytes, and stem or progenitor cells of bone marrow, fibroblast cells/mesenchymal stem cell of adipose tissues, muscle cells and neuron. Robo4 expressions in endothelial cells derived from capillary vessel, tip/stalk/activated endothelial cells were higher than that in artery and large vein (matured endothelial cells). On the other hand, via mining the gene expression data deposited in the NCBI Gene Expression Omnibus database as well as National Genomics Data Center (NGDC), we uncovered that the expression of Robo4 were regulated by different stimulus and variable in diseases' condition.Moreover, we constructed enhanced GFP (eGFP) transgene mouse controlled by Robo4 promoter using CRISPR/CAS9 system. We found GFP signals in many cell types from the embryonic section, confirming a widely expression of Robo4. Together, Robo4 widely and dynamically express in multiple cell types, and can be regulated by diverse factors.

Polysaccharides from fruit and vegetable wastes and their food applications: A review

Fruit and vegetables are a great source of nutrients and have numerous health benefits. The fruit and vegetable industry produces enormous amounts of waste such as peels, seeds, and stems. The amount of this waste production has increased, causing economic and environmental problems. Fruit and vegetable wastes (FVWs) have the potential to be recovered and used to produce high-value goods. Furthermore, FVWs have a large variety and quantity of polysaccharides, which makes them interesting to study for potential industrial use. Currently, the investigations on extracting polysaccharides from FVWs and examining how they affect human health are increasing. The present review focuses on polysaccharides from FVWs such as starch, pectin, cellulose, and inulin, and their various biological activities such as anti-inflammatory, anti-tumor, anti-diabetic, antioxidant, and antimicrobial. Additionally, applications as packaging material, gelling agent, emulsifier, prebiotic, and fat replacer of polysaccharides from FVWs in the food industry have been viewed in detail. As a result, FVWs can be reused as the source of polysaccharides, reducing environmental pollution and enabling sustainable green development. Further investigation of the biological activities of polysaccharides from FVWs on human health is of great importance for using these polysaccharides in food applications.

Measuring the Impact of Postsimultaneous Pancreas-Kidney Transplantation Complications: Comparing the Comprehensive Complication Index and Clavien-Dindo Classification

INTRODUCTION

The Clavien-Dindo classification (CDC) is commonly used for assessing postoperative complications; however, it may not be comprehensive. A comprehensive complication index (CCI) was introduced to address this limitation. This study aimed to compare the effectiveness of the CCI and CDC in evaluating the complications after simultaneous pancreas-kidney (SPK) transplantation.

METHODS

Data were collected from patients who underwent SPK transplantation at our center between February 2018 and February 2021. Complications encountered during hospitalization were assessed using both the CDC and CCI. Linear regression analyses were performed to identify the factors related to postoperative length of stay (PLOS).

RESULTS

Overall, 125 patients were included, with an average age of 46.87 years. Type 2 diabetes was present in 79% of the recipients. Among them, 117 patients experienced postoperative complications of CDC grades I (2.4%), II (57.6%), IIIa (8.0%), IIIb (9.6%), IVa (14.4%), IVb (0.8%), and V (0.8%) postoperative complications. The median CCI for the entire cohort was 37.2. Spearman's correlation analysis revealed significant associations between the CDC and PLOS and the CCI and PLOS. Notably, CCI exhibited a stronger correlation with PLOS (CCI: ρ = 0.698 vs. CDC: ρ = 0.524; p = 0.024).

CONCLUSION

The CCI demonstrated a stronger correlation with PLOS than CDC. Our finding suggests that the CCI may be a useful tool for comprehensively assessing complications following SPK transplantation.

Association of body roundness index with diabetes and prediabetes in US adults from NHANES 2007-2018: a cross-sectional study

OBJECTIVE

The present study examined the ability of the body roundness index (BRI) to predict the incidence of diabetes and prediabetes among adults in the USA.

METHOD

The study enrolled 11,980 adults aged ≥ 20 years from the National Health and Nutrition Examination Survey (NHANES). Logistic regression served as the primary method for analyzing the relevant link between BRI and the incidence of diabetes and prediabetes, including univariate analysis, multivariate regression analysis, smooth curve fitting analysis, and subgroup analysis. What's more, receiver operating characteristic (ROC) analysis was applied to confirm the predictive values of BRI for diabetes and prediabetes.

RESULTS

Each unit higher than BRI was associated with a 17% increased risk of diabetes and prediabetes after covariate adjustments (OR: 1.17, 95% CI: 1.07-1.27). Those with BRI in the high scores (Q4) possessed an increased likelihood of having diabetes and prediabetes than individuals in the reference group (OR: 1.83, 95% CI: 1.29-2.58). A smooth curve fitting analysis revealed a non-linear trend. The results across all population subgroups were uniform to those of the total population. The ROC curve indicated that the BRI was the best predictor of diabetes and prediabetes among other anthropometric indices.

CONCLUSIONS

Diabetes and prediabetes occurrence rates and BRI have a positive and non-linear relationship in American adults. The BRI indices could function as predictive markers for diabetes and prediabetes.

The effect of lifestyle factors on chronic complications of diabetes at public health hospitals in Southwest Ethiopia

Ethiopia faces a significant challenge with increasing non-communicable diseases like diabetes, ranking among the top four in sub-Saharan Africa. However, there is a lack of research on how lifestyle affects chronic complications of diabetes in Ethiopia, highlighting the need for urgent exploration to develop better intervention strategies. This study aimed to evaluate the link between lifestyle factors and chronic complications of diabetes in public health hospitals in Southwest Ethiopia. A cross-sectional study involving 389 diabetes patients from Mizan-Tepi University Teaching Hospital (MTUTH) and Gebretsadik Shawo General Hospital (GSGH) in Southwest Ethiopia was conducted. Data collection methods included interviewer-administered questionnaires, patient medical record reviews, physical examination, and serum analysis. SPSS version 25 was used for data analysis, including descriptive statistics and bivariate and multivariate logistic regression analyses. Statistical significance was determined at a p-value < 0.05. The study revealed a 32.1% prevalence of chronic complications of diabetes, with 13.4% having chronic kidney disease, 8.0% experiencing visual disturbances, and 16.7% suffering from peripheral sensory pain. After adjusting for confounding variables, age (41-60 years [AOR = 1.77; 95% CI 1.01, 3.15] and > 60 years [AOR = 2.18; 95% CI 1.20, 4.33]), duration of diabetes mellitus (> 6 years [AOR = 2.90; 95% CI 1.74, 4.85]), alcohol consumption [AOR = 2.30; 95% CI 1.33, 3.98], physical inactivity [AOR = 2.43; 95% CI 1.38, 4.27], and body mass index (underweight [AOR = 7.66; 95% CI 1.68, 34.8] and obese [AOR = 3.53; 95% CI 1.84, 10.5]) were significantly associated with chronic complications of diabetes. Chronic complications of diabetes are a major problem in the study area. Lifestyle factors strongly influence chronic diabetes complications, highlighting the importance of preventive measures. Implementing health education and prevention programs focusing on modifiable lifestyle factors is crucial.

Development and Validation of a Nomogram for Predicting Lacunar Infarction in Patients with Hypertension

Background

A considerable proportion of hypertensive patients may experience lacunar infarction. Therefore, early identification of the risk for lacunar infarction in hypertensive patients is particularly important. This study aimed to develop and validate a concise nomogram for predicting lacunar infarction in hypertensive patients.

Methods

Retrospectively analyzed the clinical data of 314 patients with accurate history of hypertension in the Second Affiliated Hospital of Wannan Medical College from January 2021 to December 2022. All the patients were randomly assigned to the training set (n=220) and the validation set (n=94) with 7:3. The diagnosis of lacunar infarction in patients was confirmed using cranial CT or MRI. The independent risk factors of lacunar infarction were determined by Least absolute shrinkage and selection operator (LASSO) regression and multivariable logistic regression analysis. The nomogram was built based on the independent risk factors. The nomogram's discrimination, calibration, and clinical usefulness were evaluated by receiver operating characteristics (ROC) curve, calibration curve, and decision curve analysis (DCA) analysis, respectively.

Results

The incidence of lacunar infarction was 34.50% and 33.00% in the training and validation sets, respectively. Five independent predictors were made up of the nomogram, including age (OR=1.142, 95% CI: 1.089-1.198, P<0.001), diabetes mellitus (OR=3.058, 95% CI: 1.396-6.697, P=0.005), atrial fibrillation (OR=3.103, 95% CI: 1.328-7.250, P=0.009), duration of hypertension (OR=1.130, 95% CI: 1.045-1.222, P=0.002), and low-density lipoprotein (OR=2.147, 95% CI: 1.250-3.688, P=0.006). The discrimination with area under the curve (AUC) was 0.847 (95% CI: 0.789-0.905) in the training set and was a slight increase to 0.907 (95% CI: 0.838-0.976) in the validation set. The calibration curve showed high coherence between the predicted and actual probability of lacunar infarction. Moreover, the DCA analysis indicated that the nomogram had a higher overall net benefit of the threshold probability range in both two sets.

Conclusion

Age, diabetes mellitus, atrial fibrillation, duration of hypertension, and low-density lipoprotein were significant predictors of lacunar infarction in hypertensive patients. The nomogram based on the clinical data was constructed, which was a useful visualized tool for clinicians to assess the risk of the lacunar infarction in hypertensive patients.

Endogenous Endophthalmitis at a Tertiary Referral Center in China: A Retrospective Study Over Three Decades

PURPOSE

To investigate the etiology, pathogens, treatment, and prognosis of endogenous endophthalmitis (EE).

METHODS

Patients diagnosed with EE over three decades at Peking Union Medical College Hospital were retrospectively reviewed and analyzed.

RESULTS

A total of 97 eyes from 81 patients were included. Diabetes was the most common predisposing medical condition (34.6%). Klebsiella pneumoniae (31.3%) and Candida albicans (32.8%) were the most common pathogens. Liver abscess (20.6%) was the predominant cause EE due to liver abscess had a worse initial visual acuity (P < 0.05). Patients who initially underwent pars plana vitrectomy (PPV)+silicone oil tamponade underwent fewer total treatments (P < 0.05). In the past 10 years, the proportion of Gram-positive cocci, Gram-negative bacilli, and Candida showed an upward trend. Over the past 15 years, EE after liver abscess and immunosuppression has increased, while EE from genitourinary systems has decreased.

CONCLUSION

EE was a devastating intraocular disease with a poor visual prognosis. The initial condition and prognosis of EE after liver abscess were the worst. PPV+silicone oil tamponade as an initial treatment may reduce additional therapy.

Gastric emptying in newly diagnosed, treatment-naïve Han Chinese with type 2 diabetes and the impact of 4-week insulin pump therapy

AIM

To evaluate gastric emptying (GE) and the glycaemic response to a 75-g oral glucose load in newly diagnosed, treatment-naïve Han Chinese with type 2 diabetes (T2D) before insulin pump therapy, after 4 weeks of insulin pump therapy, and 12-15 months after insulin pump therapy.

MATERIALS AND METHODS

Twenty participants with T2D (baseline glycated haemoglobin [± SD] 10.7% [± 1.2%] 93 [± 10] mmol/mol) ingested a 75-g glucose drink containing 150 mg 13C-acetate, to determine the gastric half-emptying time, and underwent assessment of plasma glucose and serum insulin, C-peptide and glucagon-like peptide-1 (GLP-1) over 180 min before and after 4 weeks of insulin pump therapy (discontinued for 48 h before re-assessment). Data were compared to those in 19 healthy participants matched for sex and age. After 12-15 months, GE was re-measured in 14 of the T2D participants.

RESULTS

At baseline, participants with T2D exhibited substantially augmented fasting and post-glucose glycaemia, diminished insulin secretion, and more rapid GE (p < 0.05 each), but comparable GLP-1, compared to healthy participants. Following insulin pump therapy, insulin secretion increased, GLP-1 secretion was attenuated, fasting and post-glucose glycaemia were lower, and GE was slowed (p < 0.05 each). The slowing of GE in T2D participants was sustained over 12-15 months of follow-up.

CONCLUSIONS

In newly diagnosed Han Chinese with T2D, GE is often accelerated despite poor glycaemic control and is slowed by short-term insulin pump therapy. The effect on GE is maintained for at least 12 months.

Independent Risk Factors Associated With Venous Thromboembolism After Knee Arthroscopy: A Retrospective Study of 222 Patients

Background

A serious complication after knee arthroscopy is venous thromboembolism (VTE), which includes both deep vein thrombosis (DVT) and pulmonary embolism (PE). However, asymptomatic VTE is frequently undetected.

Purpose

To (1) report the incidence of VTE after knee arthroscopy using ultrasound examination and computed tomography pulmonary angiography (CTPA) and (2) discover the independent risk factors of VTE after knee arthroscopy and determine the corresponding cutoff values of these indicators.

Study Design

Case-control study; Level of evidence, 3.

Methods

Included were 222 patients (115 male) who underwent arthroscopic knee procedures between October 2022 and January 2023. Baseline characteristics, blood test results, and VTE assessments were collected. During the 2-week follow-up, routine lower extremity vascular ultrasound was applied for DVT measurement, with CTPA evaluation for suspected PE. Patients were allocated into VTE and no-VTE groups, and descriptive statistics were used to analyze baseline data. Logistic regression analysis was used to determine the correlation between binary variables and the presence of postoperative VTE. Multivariate logistic regression analysis was further performed to determine the independent risk factors of VTE.

Results

Of the 222 patients, 37 (16.7%) had DVT and 1 (0.5%) had both DVT and PE. Compared to the no-VTE group, the VTE group was significantly older, with more female patients; higher body mass index (BMI) and postoperative D-dimer level; and higher rates of hypertension, hyperlipidemia, varicose veins of the lower extremity, and abnormal postoperative fibrin degradation product level (P≤ .043 for all). Notably, operative time >20 minutes was not significantly associated with postoperative VTE (P = .513). The independent risk factors for VTE included age >32 years (odds ratio [OR], 20.71 [95% CI, 4.40-97.47]; P < .001), BMI >23 kg/m2 (OR, 3.52 [95% CI, 1.11-11.14]; P = .032), hyperlipidemia (OR, 6.81 [95% CI, 1.86-24.88]; P = .004), and postoperative D-dimer level >0.63 mg/L (OR, 34.01 [95% CI, 7.36-157.07]; P < .001).

Conclusion

The incidence of VTE after knee arthroscopy was 16.7% at the 2-week follow-up. Age >32 years, BMI >23 kg/m2, hyperlipidemia, and postoperative D-dimer >0.63 mg/L were independent risk factors of postoperative VTE within 2 weeks after knee arthroscopy. For patients with knee arthroscopy, the cutoff value of postoperative D-dimer for VTE was found to be 0.63 mg/L for timely intervention.

Factors associated with psychological insulin resistance among patients with type 2 diabetes in China

Objective

The aim of this study was to understand the psychological insulin resistance status among Chinese patients with type 2 diabetes and investigate its associated factors in these patients.

Methods

A multi-stage stratified random sampling was performed to randomly select patients with type 2 diabetes from the eastern, central, and western regions in Shandong Province, China, and 660 valid questionnaires were collected. Psychological insulin resistance was assessed by the scale of My Opinion on Insulin (MOI). Factors associated with psychological insulin resistance were examined in a binary logistic model.

Results

Four-fifths of the patients with type 2 diabetes (82.1%) had psychological insulin resistance. Being female (OR = 1.770, 95% CI: 1.063-2.950, p < 0.05), having a monthly income of greater than 4,000 Renminbi (approximately $1,540) (OR = 0.444, 95% CI: 0.216-0.915, p < 0.05), living with type 2 diabetes for 11 years or more (OR = 0.387, 95% CI: 0.238-0.630, p < 0.05), self-rated poor health (OR = 1.706, 95% CI: 1.092-2.664, p < 0.05), and moderate discrimination against type 2 diabetes (OR = 1.924, 95% CI: 1.166-3.175, p < 0.05) were associated with psychological insulin resistance.

Conclusions

The prevalence of psychological insulin resistance among Chinese patients with type 2 diabetes is relatively high. Approaches are needed to address the issue of psychological insulin resistance of type 2 diabetes.

Association of remnant cholesterol with renal function and its progression in patients with type 2 diabetes related chronic kidney disease

Background

The association of Remnant cholesterol (RC) with renal function and its progression in patients with Type 2 diabetes (T2DM) related chronic kidney disease (CKD) remains unclear.

Methods

8,678 patients with T2DM-related CKD were included in cross-sectional analysis, and 6,165 patients were enrolled in longitudinal analysis and followed up for a median of 36.0 months. The outcomes were renal composite endpoint event and rapid progression of renal function.

Results

24.54% developed a renal composite endpoint event, and 27.64% rapid progression of renal function. RC levels above 0.56 mmol/L independently increased the risk of both renal composite endpoint (HR, 1.17; 95% CIs, 1.03-1.33) and rapid progression of renal function (OR, 1.17; 95% CIs, 1.01- 1.37). TG levels above 1.65 mmol/L only increased the risk of renal composite endpoint (HR, 1.16; 95% CIs, 1.02 -1.32). TC levels above 5.21 mmol/L increased the risk of renal composite endpoint (HR, 1.14; 95% CIs, 1.01-1.29) only in patients with proteinuria≥0.5g/d. Conversely, HDL-C levels below 1.20 mmol/L or above 1.84 mmol/L increased the risk of rapid progression of renal function (OR, 0.88; 95% CIs, 0.70 -0.99) in patients with proteinuria<0.5g/d (all P<0.05).

Conclusion

In patients with T2DM-related CKD, RC was an independent risk factor for progression of renal function, and maintaining it below 0.56 mmol/L could reduce the risk of renal function progression.

Long Non-coding RNA ZFAS1 Regulates Fibrosis and Scortosis in the Cell Model of Diabetic Nephropathy Through miR-525-5p/SGK1 Axis

Diabetic nephropathy (DN) is a common clinical syndrome in diabetic patients. Functional characterization of non-coding (ncRNAs) involved in the progression of DN can provide insights into the diagnosis and therapeutic management of DN. Human kidney proximal tubular epithelial cells (HK-2) were challenged by high glucose (HG, 50 mM) as a cell model of DN. The expression level of long non-coding RNA (lncRNA) ZFAS1 was quantified by qRT-PCR. The proteins and cytokines related to fibrosis and scortosis in DN (NLRP3, GSDMD-N, IL-1β and Caspase 1, fibronectin, collagen I, collagen III, IL-1β, and IL-18) were examined by western blot or ELISA. RNA precipitation and luciferase reporter activity experiments were conducted to assess the molecular associations. ZFAS1 and SGK1 were highly induced in HK-2 cells challenged with HG, while miR-525-5p downregulated upon HG treatment. ZFAS1 knockdown attenuated HG-induced fibrosis and scortosis in HK-2 cells by reducing the levels of NLRP3, GSDMD-N, Caspase 1, fibronectin, collagen I/III, IL-1β, and IL-18. Mechanically, ZFAS1 knockdown protected HK-2 cells from HG-induced injury by upregulating miR-525-5p and repressing SGK1 expression. Overall, our results suggest that knocking down ZFAS1 may be formulated as a protective strategy in ameliorating DN progression through regulating miR-525-5p/SGK1 pathway. Targeting ZFAS1 could be further explored as a potential approach for the management of DN.

The effect and mechanism of palmar ginseng in type 2 diabetic cognitive impairment

Objective

To investigate the therapeutic effect of palmar ginseng on cognitive impairment in rats with type 2 diabetes, evaluate its neuroprotective effects, and explore its underlying mechanism.

Methods

A rat model of diabetic cognitive impairment (DCI) was established by feeding with homemade high-fat, high-sugar chow combined with intraperitoneal injection of streptozotocin (STZ). Rats were continually fed high-fat, high-sugar chow for 60 days after successful induction of the model. Palmar ginseng was administered via gavage. The Morris test was performed after 30 days of treatment. At the end of the test, blood samples were collected, and the activities of IL-6, IL-10, TNF-α, and IL-1β in rat serum. Pathological changes in hippocampal tissues were observed by Haematoxylin-eosin (HE) staining of the brain, activation of microglia in hippocampal tissues was detected by immunofluorescence, and the expression of PI3K/Akt/mTOR and JAK2/STAT3 proteins in the hippocampal tissues by Western blot.

Results

During the administration of palmar Ginseng, the body weight and blood glucose levels of DCI rats were measured weekly, with results showing that Palmar Ginseng effectively reduced blood glucose levels and body weight of DCI rats. Behavioural tests in the water maze indicated that palmar ginseng effectively improved the learning and memory ability of DCI rats. HE and immunofluorescence staining showed that palmar ginseng improved DCI in rats, ameliorated hippocampal neuronal damage, and improved microglial activation. ELISA showed that palmar ginseng significantly reduced the expression of pro-inflammatory factors in the serum of DCI rats. Increased expression of anti-inflammatory factors was observed, and Western blot analysis showed that Palmar Ginseng regulated PI3K/Akt/mTOR and JAK2/STAT3 protein expression, promoted the phosphorylation of PI3K/Akt/mTOR, and inhibited JAK2/STAT3 protein phosphorylation in rat hippocampal tissues as well as in BV2 cells.

Conclusions

Palmar ginseng may improve the onset and development of DCI by upregulating the phosphorylation of proteins in the PI3K/Akt/mTOR pathway.