The diagnostic criteria of diabetes has been changed several times in the latest thirty years.The diagnostic criteria is based on plenty of epidemic studies,especially the relationship between the glucose level and the microvascular complications.However,there are many problems in the clinical practice of using the recent diagnostic criteria(1999 WHO criteria).Glycosylated hemoglobin(HbA1c) has been recommended as a diagnostic criteria in the 69th ADA.

Objective To analyze the dietary habits, energy intake and expenditure, anthropometrics, and body composition of the outpatients visiting the weight loss clinic of Beijing Hospital.Methods We pro-spectively enrolled 89 consecutive patients with body mass index ( BMI) ≥24 kg/m2 from November 2014 to August 2015 in the weight loss clinic of Beijing Hospital.There were 35 male and 54 female, with the mean age of (45.8 ±16.4) years.We divided them into two groups:the diabetes group (n=35) and the non-diabetes group (n=54), and compared the dietary habits, energy intake and expenditure, anthropometrics and body composition between the two groups.Results Regardless of diabetes, the overweight and obese patients all ate fast, mostly finishing a meal in about 10 minutes.They preferred Chinese food and meat, and disliked hot food.The frequency of dinning out in the non-diabetes group (3-5 times per week) was higher than that in the diabetes group (1-2 times per week) .Compared with the diabetes group, the non-diabetes group had higher fat-to-energy ratio [(34.9 ±7.6)%vs.(30.8 ±5.9)%], but lower carbohydrate intake [(232.2 ±59.7) g vs.(283.6 ±89.5) g], carbohydrate-to-energy ratio [ (47.9 ±8.3)%vs.(53.4 ±7.1)%], and the ratio of resting metabolic rate to body weight [ (66.9 ±9.6) kJ/(d? kg) vs.(71.1 ±7.9) kJ/(d? kg)] (all P<0.05).There were no statistically significant differences between the two groups in total energy intake, pro-tein intake, high quality protein intake, fat intake, protein-to-energy ratio, and resting metabolic rate (all P>0.05).Anthropometrics showed that the mean BMI of the patients was (32.8 ±4.4) kg/m2, with the maxi-mum being 53.5 kg/m2.The hip circumference [ (117.15 ±9.9) cm vs.(111.1 ±8.2) cm], upper arm circumference [ (36.4 ±3.8) cm vs.(34.0 ±3.3) cm], and triceps skinfold thickness [ (36.1 ±8.9) mm vs.(31.6 ±8.8) mm] were larger in the non-diabetes group than in the diabetes group (all P<0.05), but the mean age was lower in the non-diabetes group [ (41.7 ±16.9) years vs.(52.9 ±13.1) years) (P=0.01).There were no statistically significant differences between the two groups in body weight, BMI, waist circumference, neck circumference, and bilateral hand grip strength (all P>0.05).According to body compo-sition analysis, the body weight [ (94.8 ±18.3) kg vs.(86.9 ±17.2) kg], body fat mass [ (39.7 ± 11.3) kg vs.(33.5 ±8.9) kg], body fat percentage [ (41.7 ±6.5)%vs.(38.5 ±6.7)%], and visceral fat area [ (145.3 ±24.8) cm2 vs.(130.7 ±27.5) cm2 ] were larger in the non-diabetes group than in the di-abetes group ( all P<0.05) .There were no statistically significant differences between the two groups in BMI and skeletal muscle mass (both P>0.05).Conclusion Compared with diabetes patients, overweight and obese non-diabetes patients may be younger, having worse dietary habits, and having larger body fat mass, body fat percentage, and visceral fat area.

The impact of hypofunction of kidney on evaluating of islets β cell function in patients with type 2 diabetes was investigated. 635 type 2 diabetic patients with normal liver function were grouped using Cockcroft-Gault. Following the decrease in kidney function, blood C-peptide concentration was increased with decreased urinary exeretion of C-peptide(P<0. 05). It is proposed to pay an attention to renal function while evaluating islets β cell function in the patients.

Objective To evaluate lipid profile and its relationship with body mass index (BMI)in 4784 elderly male subjects. To explore the possibility of using an improvemem of dyslipidemia as an alternative target in the weight control in elderly male population. Methods 4784 elderly male subjects were surveyed with, the measurement of blood lipids and were grouped according to age (60-69, 70-79, 80-96 yrs) and BMI (＜18.5, 18.5-23.9, 24.0-27.9, ≥28.0 kg/m2), respectively.Results The mean levels of TC, LDL-C, TG and HDL-C (mmol/L) were (5.1±0.9)mmol/L,( 3.0±0. 8)mmol/L, (1.5±1.0)mmol/L and (1.3±0. 3)mmol/L, respectively. The prevalence of dyslipidemia was 44.8% (2141 cases) in this population, with specific abnormality rates in TC,LDLC, TG, HDL-C being 10. 4% (497 cases), 9.3% (445 cases), 29.8% (1425 cases) and 19.4% (928cases), respectively. Within all age groups, TG decreased dramatically and HDL-C incre ased with increasing age (P＜0.01), while the 60-69 yrs age group versus other age groups showed a tendency to an increment of TG, and a decrement of HDL-C. (P＜0. 05). Prevalences of overweight and obesity were 46.8% and 15.5% in the elderly male subjects, respectively. The level of TC increased with the increasing BMI, while HDL-C decreased. The differences in TG and LDL-C among various BMI groups were of no statistical significances. High TG and low HDL-C were predominant abnormalities amongst the oldest old, whose lipid profile resembled that of the 70-79 yrs age group.Whilst, the prevalences of overweight and obesity were at the lowest levels of 44.6% (228 cases) and 11.9% (61 cases), respectively. Conclusions High TG and low HDL-C are predominant abnormalities in elderly male subjects. TC level in the current population is higher than that from the national census in 2002. Prevalences of overweight and obesity are close to that in developed countries.TC and LDL-C levels are negatively related to age in the elderly male population, contrasting the correlation between HDL-C and age.

Objective To develop a nomogram for the use of predicting renal outcomes of Chinese lupus nephritis (LN) patients.Methods From January 1,2005 to October 1,2015,513 patients with biopsy-proven LN in the First Affiliated Hospital of Sun Yat-Sen University were enrolled into this study.Renal outcomes were defined as end-stage renal disease or doubling of serum creatinine.Demographic characteristics,laboratory data,and pathologic data were recorded and included for analysis.Nomograms were designed using multivariate Cox proportional hazards regression to predict the non-outcome renal survival in 5 and 8 year according to the Akaike information criterion (AIC) and continuous reclassification net improvement (cNRI).Predictive accuracy and discriminative ability of the models were determined by concordance index (C-index) and calibration curve.Results During a median follow up of 48 (24,71) months,44 patients (8.58％) reached the endpoint.1-year,5-year and 8-year non-outcome renal survival were 97.57％,92.89％,79.89％ respectively.According to multivariate Cox regression,four nomograms including index for baseline renal function,pathologic severity,and response to treatment were designed.The best model,within which included eGFR was lower than 30 ml · min-1 · (1.73 m2)-1(HR=4.44,95％ CI 2.16-9.13,P ＜ 0.01),percentage of global glomerulosclerosis was higher (HR=12.28,95％CI 3.58-42.13,P ＜ 0.01) and partial remission occurred after 6-month induction treatment (HR=9.16,95％ CI 4.71-17.82,P ＜ 0.01) demonstrated good discrimination to predict 5-year and 8-year non-outcome renal survival [C-index,0.80(95％CI 0.81-0.91),0.76(95％CI 0.68-0.85),respectively].The nomogram based on above model also performed good calibration.Conclusion The nomogram based on patients' baseline eGFR,percentage of global glomerulosclerosis,and treatment reaction after 6-month induction therapy can accurately predict 5-year and 8-year non-outcome renal survival in Chinese lupus nephritis patients.

Objective To observe the incidence and awareness of dyslipidemia in newly diagnosed elderly type 2 diabetic patients,and to determine the efficacy and safety of simvastatin and Xuezhikang in the treatment of dyslipidemia.Methods Totally 255 newly diagnosed type 2 diabetic patients aged 60 to 75 years in CDCPS research were included and the incidence of dyslipidemia were retrospectively analyzed.Patients were divided into 3 groups:the group 1 was given simvastatin (20 mg/d); the group 2 was given Xuezhikang (0.6～ 1.2 g/d); the group 3 was given no lipid-lowering drugs.All the three groups were given lifestyle intervention and blood pressure and blood sugar control.All patients were followed up monthly and TG,TC,LDL-C,BUN,ALT and creatinine were examined at 7th,14th,and 20th months.Results The incidence of dyslipidemia and the rate of awareness in the study cohort was 62％ and 55.7％.Hypertriglyceridemia was the most common type of dyslipidemia (29％).Among 88 patients with dyslipidemia,25 (28.4％) patients had been treated with lipid-lowering drugs before our study,in whom,8(32％) patients had normal serum lipid levels and only 3 (12％)patients reached to the control standards.20 months after the treatment,the decrement scales of TG,TC and LDL-C were 1.8％,10.5 ％ and 20 ％ respectively in group 1;5.5 ％,15.0％ and 15.7％ respectively in group 2;2.7％,8.7％ and 4.5％ respectively in group 3.The long-term lifestyle intervention and blood pressure and blood sugar control reduced serum lipid to some degree.In the patients with dyslipidemia,lipid-lowering drugs had a better effect on serum lipid reduction than did the lifestyle intervention (P=0.0047,0.0433).There was no significant difference between simvastatin and Xuezhikang.The function changes of liver and kidney had no difference before and after drug intervention (P＞0.05).Conclusions Serum lipid should be monitored and early medicine intervention should be taken in newly diagnosed elderly type 2 diabetic patients.Medicine intervention has a better effect on serum lipid reduction than lifestyle intervention,and there are no significant differences in efficacy and safety between simvastatin and Xuezhikang.

Objective To explore the utility of different body composition for the prediction of myocardial ischemia in exercise in type 2 diabetes mellitus (T2DM) patients. Methods T2DM outpatients were selected from Jul. 2013 to Nov. 2014 (male 83, female 57) to measure body composition and clinical biochemical parameters, and divided them into two groups according to treadmill exercise testing results. Group A cases were positive (27 patients) and Group B cases were negative (113 patients). SPSS19.0 was used to make statistical analysis. Results (1) The age, gender, diabetes mellitus (DM) duration, medical history of hypertension and dyslipidemia, body mass index (BMI), waist circumference, the waist-hip fat ratio of the two groups had no significant difference (P>0.05). (2) The fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) between the two groups had no significant difference. Compared with group B, the low density lipoprotein cholesterol (LDL-C) of group A [(2.48 ± 0.75) mmol/L vs. (2.81 ± 0.77) mmol/L, t=2.009, P<0.05] decreased significantly. (3) Overall body fat percentage, skeletal muscle weight of the two groups had no significant difference. Compared with group B, the waist-hip fat ratio (0.93±0.06 vs. 0.88±0.08, t=-2.790, P<0.01) andvisceral fat area [(99.47 ± 32.84) cm2 vs. (81.10 ± 25.47) cm2, t=-2.822, P<0.01] of group A increased significantly, while this difference mainly existed in male patients visceral fat area [(100.99±39.33) cm2 vs. (79.91 ± 27.09) cm2, t=-2.231, P<0.05], and waist-hip fat ratio was different in female patients of the two groups (0.91±0.06 vs. 0.85±0.09, t=-2.043, P<0.05) . Conclusion Abdominal obesity, especially visceral fat accumulation had close correlation with myocardial ischemia in exercise in T2DM patients. Waist-hip fat ratio and visceral fat area may be more effective indicators of myocardial ischemia in exercise in T 2DM patients than BMI.

Objective To analyze the initial treatment strategies, blood glucose control and reaching standard status of newly diagnosed type 2 diabetes mellitus (T2DM) in the middle-aged and elderly. Methods The 771 patients diagnosed with T2DM newly or within one year, aged 50-70 years, selected from Chinese Diabetes Complication Prevention Study (CDCPS) were enrolled in this study. The correlations of initial treatment strategies with blood glucose control (target value of glycated hemoglobin was less than 7.0%) and reaching standard status were analyzed retrospectively. Based on the same lifestyle intervention, the therapy was further divided into group A (without medication), group B (single oral hypoglycemic agent), group C (combined oral hypoglycemic agents), group D (treatment including insulin). Results Although receiving the different treatments, the 771 patients had a similar mean glycated hemoglobin level, from 7.2% to 7.7%, among the four kinds of intervention before entering the study. The increased intensity and complexity after therapy adjustment along with the increased glycated hemoglobin level was observed at baseline. The corresponding relationships between medication and HbA1c were as follow: without medication-6.1%, single oral hypoglycemic agent-7.2%, combined oral hypoglycemic agents-7.7%, treatment including insulin-9.2%. After 20 months of follow-up, the mean fasting glucose and glycated hemoglobin were 6.6 mmol/L and 6.2%, separately. According to the target glycated hemoglobin level of less than 7.0%, all four-kinds of therapies had high achievement rates, which were all above 80% except that was 63.2% in group D. Sulphonylurea and biguanide as initial single oral hypoglycemic agent therapy had the similar effectiveness on glucose control and target glycated hemoglobin achievement. Conclusions According to the levels of glucose and glycated hemoglobin, multiple individual therapies should be enacted at the beginning of treatment. The strategy mainly based on sulphanylurea and biguanide is proved to be persistently effective in newly-diagnosed middle-aged and elderly diabetic patients in China.

Objective To analyze the impact of atorvastatin on blood lipids and arterial media thickness(IMT)in new-onset type 2 diabetes patients. Methods 333 patients,30-70 years old and diagnosed within one year as type 2 diabetes,were selected from the Chinese Diabetes Complication Prevention Study(CDCPS)to take part in this study. Changes of blood lipids and IMT of carotid, femoral and iliac artery pre and post the administration of atorvastatin were tested and followed for 24 months. Results Total cholesterol,triglycerides and low-density lipoprotein decreased significantly (P=0.000)and maintained at a low level. The carotid artery IMT decreased significantly(P=0.022) at the end of this study,but the femoral and iliac artery IMT did not show any obvious change. There were no serious adverse events noticed,during the study period. Conclusion Long-term use of atorvastatin seemed to be safe and effective in reducing blood lipids in patients with type 2 diabetes thus could delay the development of atherosclerosis.

Objective:The aim of the present study was to observe the effects of liralutide on body composition and muscle function in adult obese patients with type 2 diabetes.Method:A total of 63 adult obese type 2 diabetic patients who were (52.6±9.7) years of age and with body mass index (BMI) of ≥28 kg/m 2 were enrolled. The patients were randomly assigned into two groups. On the basis of maintaining the original hypoglycemic regimen, patients in the control group ( n=24) were given dietary guidance only, and those in the treatment group ( n=39) were injected with liraglutide. All patients were followed up for a period of 12 weeks. Blood glucose, glycosylated hemoglobin(HbA1c) and insulin levels, liver and kidney function, body composition assessed with electrical impedance methods, and grip strength measured by a grip meter for muscle function were detected at the baseline and the end of the study. Results:Compared with those in the control group, the reductions in HbA1c [(-1.54±2.10) % vs.(-0.53±0.84) %], body weight [(-3.46±4.2) kg vs.(-0.34±3.66) kg], body fat mass [(-1.97±2.98) kg vs.(-0.01±2.16) kg] and visceral fat area [(-0.01±2.16) cm 2 vs.(0.34±6.39) cm 2] were more pronouced in liraglutide treated group (all P<0.05). However, no changes could be observed in muscle mass and grip strength after liraglutide treatment. Conclusions:In addition to reducing blood glucose, body weight and fat mass, treatment with lilaluptide had no impact on muscle mass and muscle function. Therefore, liralutide is suitable for obese patients with type 2 diabetes, especially for weight management patients who are at risk of muscle loss.