Postprandial hyperglycemia is one of the characteristics of glucose profiles in Chinese T2DM patients. High-ratio premix insulin analogues with advantages of excellent pharmacokinetic characteristics and flexible and convenient administration provide a comprehensive solution for Chinese T2DM patients to effectively control postprandial glucose and reduce blood glucose fluctuation. This paper is a literature review on its clinical evidence and experience.

A lot of functions of mitofusin 2 have been found,such as promoting mitochondria fusion,inhibiting cell proliferation and protecting cell avoid of apoptosis.Now,more and more evidence suggest that it is involved in insulin resistance.

Objective To study the relationship of free fatty acids and oxLDL-C with diabetic retinopathy(DR).Methods The 108 type 2 diabetes cases with(n=68)and without(n=40)DR were enrolled,and compared with 42 health control.FFA was determined by copper chromogenic method.oxLDL-C was determined by ELISA with kits provided.The correlation of risk factors with retinopathy was analyzed by logistic regression analysis.Results FFA and ox LDL-C levels were higher in DR group than in groups of DM and control.Logistic regression analysis showed that as the independent risk factors for DR pathogenesis,LDL-C,FFA,oxLDL-C and course of disease entered into regression equation.Conclusions FFA and oxLDL-C are the important risk factors for DR.

BACKGROUND:Under certain conditions, stem cel s can be induced to differentiate into vascular endothelial cel s, which can promote the angiogenesis of ischemic lower limbs and the establishment of effective circulation and improve distal blood supply of the ischemic limbs. OBJECTIVE:To review the biological characteristics and pro-angiogenesis mechanism of umbilical cord mesenchymal stem cel s and to investigate the current status of umbilical cord mesenchymal stem cel s in the repair of neuropathy and chronic wounds. METHODS:PubMed, VIP and Wanfang databases were searched for relevant articles published from 2000 to 2015 using the keywords of“stem cel s transplantation, umbilical cord mesenchymal stem cel , diabetic angiopathies”in English and Chinese, respectively. RESULTS AND CONCLUSION:Compared with peripheral blood stem cel s and bone marrow mesenchymal stem cel s, umbilical cord mesenchymal stem cel s are characterized as more widespread sources, easy col ection, stronger amplification ability, no immunogenicity, and no ethical controversy, which have become ideal target and seed cel s for pro-angiogenesis and gene therapy in ischemic diseases. Umbilical cord mesenchymal stem cel s can differentiate into vascular endothelial cel s and fibroblasts involved in wound healing. In addition, these cel s can promote the production and expression of neurotrophic factors, promote nerve regeneration in ischemic tissues, and participate in tissue repair and accelerate healing of ulcers by paracrine and autocrine cytokines, anti-inflammation and immunomodulation. Therefore, umbilical cord mesenchymal stem cel s have a broad prospect in the improvement of diabetic lower limb ischemia, repair of diabetic peripheral neuropathy and promotion of chronic ulcer healing. Compared with stem cel transplantation alone, umbilical cord mesenchymal stem cel s transplantation combined with gene therapy can further enhance cel survival and pro-angiogenesis.

[Summary] Considerable efforts have been made to understand the cellular and molecular mechanisms of metformin ,a potent antihyperglycemic agent now recommended as the first‐line treatment of patients with T2DM. The main effect of this drug is to reducethe hepatic glucose output ,primarily through inhibition of the mitochondrial respiratory chain complex Ⅰ and then activating AM P‐activated protein kinase (AMPK) ,which provide a generally acceptable mechanism for the action of metformin on hepatic gluconeogenesis. Beyond its effect on glucose metabolism ,metformin has been reported to improve ovarian function of patients with polycystic ovary syndrome (PCOS) and to reduce the risk of microvascular and macrovascular complications in patients with T2DM. In addition ,metfomin has also recently been suggested as an adjuvant treatment of cancer. Here we reviewed the progress of mechanism research and clinical application of metformin.

[Summary] Activating transcription factor 4 (ATF4) is an alkaline leucine zipper transcriptional factor ,which is involved in many physiological metabolism processes such as stress response ,inflammation and tumor growth. Moreover ,recent studies have shown that ATF4 also plays a key role in regulating lipid and glucose metabolism ,insulin secretion and insulin sensitivity ,which may related to pathways such as endoplasmic reticulum stress (ERS ) ,peroxisome proliferator‐activated receptor gamma coactivator (PGC1α) and target of rapamycin (TOR). This article summarized the recent research progress of ATF4 in regulating glucose and lipid metabolism.

Objective To investigate the effects of high-fat diet on fatty acid metabolism, expression and activity of acetyl coenzyme A carboxylase (ACC) in skeletal muscle in rats. Methods Male Wistar rats aged 22-24 months were randomly divided into old control (OC) group and high-fat diet (HF) group. Male Wistar rats aged 4-5 months were selected as young control (YC) group. The rats in OC and YC groups were fed with basic diet, and the rats in HF group received high-fat diet. Insulin sensitivity was evaluated by hyperinsulinemic-euglycemic clamp technique. Skeletal muscle triglyceride was extracted and measured by an automated biochemistry analyzer. Long-chain acetyl coenzyme A (LCACoAs) were extracted from muscle and measured by a fluorospectrophotometer. Protein expressions of ACC and P-ACC were measured using SDS-PAGE and Western blot techniques. Results (1)Fasting blood glucose (FBG), fasting insulin (FINS) and free fatty acid were higher in OC group than in YC group and they increased significantly in HF group. Triglyceride (TG) and total cholesterol (TO levels were also elevated after high-fat feeding. (2)Glucose infusion rates (GIR) were reduced in OC group than in YC group, and decreased significantly after high-fat feeding. GIR was lower at the end of the 8th week than at the end of the 4th week in HF group. (3) Compared with YC group, skeletal muscle triglyceride and LCACoAs increased in OC group and increased significantly in HF group. (4)No alterations of protein levels of ACC in skeletal muscle were detected among three groups (P>0.05). The protein levels of P-ACC in skeletal muscle were lower in OC group, and much lower in HF group than in YC group (P<0.05 or P<0.01). Conclusions Compared with young rats, abnormal fatty acid metabolism and insulin resistance always exist in aged rats. High-fat feeding results in a significant increase in lipid content in skeletal muscle. Alterations of ACC activity may contribute to fat accumulation in skeletal muscle and insulin resistance.

Objective To study the significance of Helicobacter pylori (Hp) infection and the expression of caudal-related homeobox transcription factor 2 (CDX2),mucin 2 (MUC2) proteins in gastric cancer,and elucidate the prognostic significance of CDX2,MUC2 proteins in gastric cancer.Methods Ninety cases of gastric cancer were available for the study.Hp was studied by Warthin-Starry bacterium stain and CDX2 and MUC2 proteins were studied by immunohistochemical stain.Results There was no Hp infection and no expression of CDX2 and MUC2 proteins in normal gastric mucosa.The positive rate in the cases of intestinal-type gastric cancer was 67.86%(38/56) for Hp,75.00% (42/56) for CDX2,and 66.07%(37/56) for MUC2,respectively,and it was higher than that in the cases of diffuse-type gastric cancer,which was 35.29%(12/34),41.18%(14/34) and 38.24%(13/34) respectively (P<0.01 or < 0.05).In intestinaltype gastric cancer,the positive rate of CDX2 and MUC2 proteins was also higher in Hp positive cases than that in Hp negative cases,and it was the same as CDX2 protein in diffuse-type gastric cancer.Higher positive rates of CDX2 and MUC2 proteins were observed in the cases of early gastric cancer than those in the cases of advanced gastric cancer (P < 0.01 or < 0.05),also it was observed in the cases of no lymph node metastasis than in the cases of lymph node metastasis (P < 0.01 or < 0.05).Moreover,the positive rate of CDX2 protein in the cases of stage Ⅰ～Ⅱwas higher than that in the cases of stage Ⅲ～Ⅳ (P < 0.05).Conclusions Hp infection and the expression of CDX2 and MUC2 proteins are related with gastric cancer,and has close relationship with intestinal-type gastric cancer.The expressions of CDX2 and MUC2 proteins may inhibit the infiltration and metastasis of gastric cancer.

Objective To study the relationship between oxidative stress and endothelial progenitor cells(EPCs)count in the first-degree relatives of diabetes mellitus(FDRs).Methods Three groups were evaluated with 40 type 2 diabetes mellitus(T2DM)patients,38 FDRs and 30 healthy individuals as the control(NC).Fasting plasma glucose(FPG),glycosylated hemoglobin(HbA1c),TG,TC and fasting plasma insulin concentrations were measured and homeostasis model assessment-insulin resistance(HOMAIR)was calculated.Quantity of EPCs and flow-mediated dilation(FMD)were evaluated.Malonaldehyde(MDA),glutathion peroxidase(GSH-Px),erythrocuprein(SOD)and total anti-oxidative capacity(TAO-C)were measured.Results In T2DM group FPG[(7.86 ±0.77)mmol/L]and HbA1c[(7.24 ±0.20)％]were significantly higher than those in NC[FPG(4.90 ± 0.35)mmol/L,HbA1 c(5.34 ± 0.37)％]and FDRsgroup[FPG(5.13±0.95)mmol/L,HbA1c(5.36 ±0.36)％](all P values ＜0.05).TC in T2DM group[(5.88 ±0.76)mmol/L]was higher than in NC[(4.66±0.90)mmol/L]and FDRs [(4.95 ± 0.76)mmol/L].HOMA-IR was 0.48 ± 0.25 in NC,0.81 ± 0.46 in FDRs and 1.47 ± 0.24 in T2DM group,P ＜ 0.01.In T2DM group,the plasma levels of SOD[(69.30 ± 2.21)U/ml],TAO-C [(7.30 ± 0.29)U/ml]and GSH-Px[(856.5 ± 9.01)U/ml]were significantly lower than those in NC [SOD(75.33 ±3.63)U/ml,TAO-C(8.17 ±0.58)U/ml and GSH-Px(938.1 ± 19.35)U/ml]and FDRs group[SOD(74.91 ±4.53)U/ml,TAO-C(8.24 ±0.46)U/ml and GSH-Px(936.9 ± 15.78)U/ml](all P values ＜ 0.01).Serum level of MDA was(2.87 ± 0.63)μmol/L in NC,(3.28 ± 0.71)μmol/L in FDRs and(3.69 ± 0.39)μmol/L in T2DM group(P ＜ 0.01).The quantity of EPCs and FMD％ were 96.75 ±8.11 and 8.36 ± 2.21 in NC,83.34 ± 12.43 and 6.78 ± 0.98 in FDRs and 58.45 ± 7.58 and 2.86 ± 0.35 in T2DM group with statistical differences between different groups(all P values ＜ 0.05).Pearson correlation analysis showed that lnHOMA-IR was positively correlated with MDA(r =0.486,P ＜0.05)and negatively correlated with SOD,TAO-C,GSH-Px(r =-0.426,-0.601,-0.524,all P values ＜ 0.05)in FDRs group.Conclusions Insulin resistance,oxidative stress,decreased quantity of EPCs and impairment of endovascular function have already occurred in the FDRs of T2DM with normal glucose tolerance and they are correlated with each other.

Objective To observe the effects of high sucrose,high saturated fatty acid and high unsaturated fatty acid(diets) on insulin resistance and endothelium-dependent vasodilation function.Methods Adult Wistar rats were divided into normal control(NC) group,high sucrose(HS) group and high saturated fatty acid(HSF) group,high unsaturated fatty acid(HUF) groups.Insulin sensitivity was tested by hyperinsulinemic-euglucemic clamp after 24 weeks.Acetylcholine-induced(or sodium nitroprussideinduced) relaxation of preconstricted isolated renal arteries was measured by Mulvany myograph.Results GIR was obviously lower in experimental groups than that in NC group.GIR was negatively correlated with triglyceride (TG),free fatty acid(FFA).Acetylcholine-induced relaxation was markedly decreased in all experimental groups compared with that in NC group and the maximal response was decreased 37.4% in HSF group,32.7% in HUF group,27.7% in HS group.Acetylcholine-induced relaxation was enhanced by incubation with L-Arg and decreased incubated with L-NNA,MB in all experimental groups.Vasodilation response was negatively correlated with TG,INS and well positively correlated with NO,GIR.There was significantly negative correlation between FFA andNO.Conclusions: The rats fed high sucrose,high saturated fatty acid and high unsaturated fatty acid diets developed insulin resistance with reduced endothelium-dependent vasodilation function.