Large-scale clinical trials have demonstrated that metabolic control achieved early in the course of diabetes can substantially help preventing the onset and slowing down the progression of diabetes and the associated microvascular complications. Various strategies incorporating the use of insulin early in the course of the disease have been developed to meet this goal and to compensate for the progression of β-cell failure. We believe that insulin suppresses inflammation and also reduces glucotoxicity and lipotoxicity, and thus exerts a pivotal and beneficial role. Comprehensive metabolic control, especially when instituted earlier, may alter the natural history of diabetic complications. Therefore, physicians are encouraged to take early and intensive interventions with insulin therapy for patients with type 2 diabetes, especially when attempting to induce "remissions" or in patients suboptimally controlled with oral medications.

Hypoglycemia is a very common problem in contemporary medicine. Recent discoveries in the molecular mechanism leading to hyperinsulinemic hypoglycemia (non-islet?-cell insulinoma) have been rapidly growing. Clinical characters can be shown in different types of hyperinsulinemic hypoglycemia. It is important to understand these characters for improving our diagnostic and therapeutic ability in hyperinsulinemic hypoglycemia.

China is the second largest country of diabetes, which is a great challenge for the Chinese diabetes management. We need a guideline suitable for Chinese patients to guide the physicians. In 2007, Chinese Diabetes Society published "Chinese guideline for type 2 diabetes mellitus", according to the Chinese patients' characters, the guideline gives somewhat different suggestions from ADA and IDF.

The prevalence of diabetes is increasing dramatically and what is more serious is that the age of onset of diabetes in population is much younger than that of before.The author has carried out a series of research in diabetes,which mainly focused on epidemiology of diabetes mellitus and molecular genetics,early diagnosis and treatment of type 2 diabetes.This article aims to raise the attention of diabetes and promote the individual diagnosis and therapy of diabetes.

Diabetic patients are usually accompanied by cardiovaseular diseases (CVD),and the main purpose of diabetes intervention is to prevent cardiovascular events.But recently.the results of clinical trials give us indications that patients may benefit little from the late intensive glycemic intervention.Most patients already had atherosclerosis before the diagnosis of diabetes,and macrovaseular events even happened in the impaired glucose tolerance(IGT)subjects,which means that IGT is the best opportunity of hyperglycenfia intervention for the CVD benefit.

Persistent hyperinsulinemic hypoglycemia in infants is one of the most common causes of persistent hypoglycemia in infants. The knowledge of molecular defects leading to persistent hyperinsulinemic hypoglycemia in infants has been rapidly growing in recent years. According to the responsible genes, this ailment can be divided into five types. However, no molecular defect can be yet found in as many as 50% of the patients.

Objective To detect ret mutations in two Chinese families with multiple endocrine neoplasia type 2A(MEN2A).Methods In our study,9 members from these two families including 3 patients were recruited.Polymerase chain reaction(PCR)and direct gene sequencing of PCR products by an automated DNA sequencer were applied to scan the entire 21 exons of ret proto-oncogene in the leukocyte DNA of the subjects.Results Two missense mutations were detected in exon11 of the ret proto-oncogene.One was C634R in the 2 patients from a family and the other was C634Y in 2 subjects from another family(one was the patient).Two heterozygous variants(A45A and L769L)in these 4 subjects were revealed.Conclusion Two mutations(C634R and C634Y)are detected in two families with MEN2A.Direct DNA sequencing analysis can diagnose MEN2A at gene level,which is helpful in making clinical management of the disease and in diagnosing earlier in their offspring.

Objective To determine the current prevalence and risk factors of metabolic syndrome (MS) among adult residents in Chinese developed areas.Methods The clinical data of 6614 adult residents,including 4051 women,from Guangdong and Jiangsu provinces from China Diabetes and Metabolic Disorders Study (2007-2008) were analyzed.Age and sex standardized prevalences of MS were calculated according to the criteria of Chinese Diabetes Society (CDS),US National Cholesterol Education Program Adult Treatment Panel Ⅲ (ATP Ⅲ),International Diabetes Federation (IDF) and Joint Interim Statement (JIS),respectively.Logistic regression analysis was performed to identify the risk factors of MS.Results Age and sex standardized prevalences of MS were 17.88％ (CDS),28.50％ (ATP Ⅲ),21.99％ (IDF) and 31.50％ (JIS),respectively.The prevalences of residents with at least one metabolic abnormality were 67.86％ (CDS) 79.56％ (ATP Ⅲ),79.62％ (IDF) and 80.74％ (JIS),respectively.MS was more common in female than in male by the ATPⅢ and IDF criterion (ATPⅢ:30.63％ vs 26.45％,P ＜0.01 ; IDF:26.04％ vs 17.91％,P ＜ 0.01),while the prevalence was higher in male by CDS criteria (15.94％ vs 19.87％,P ＜0.01).There was no significant difference in the MS prevalence between the rural and the urban residents.Kappa test showed ATP Ⅲ and JIS criteria were most homogenous (κ =0.95,P ＜ 0.01).The risk factors for MS by the logistic regression model were male,older age,lower degree of education,family history of hypertension and obesity,drinker as well as uncontrolled diet.Conclusion The prevalence of MS is high in the adult residents of Chinese developed areas (Guangdong and Jiangsu provinces),whatever diagnostic criterion was used.Effective measures should be taken to control the modifiable MS risk factors.

Objective To know prevalence of metabolic syndrome (MS) and metabolic abnormalities (MA) in overweight and obese children and adolescents in Guangzhou, China. Methods Totally, 439 children and adolescents aged six to 18 years were enrolled, including 129 obese, 115 overweight and 195 normal control ones. Their body height, body weight, waist circumference, hip circumference and blood pressure were measured, as well as their fasting blood glucose (FBG), lipid profiles and oral glucose tolerance test (OGTF). Results ①Prevalence of MS in overweight and obese children and adolescents was 20.9 % (27/129) and 10.4 % (12/115), respectively, 17.9 % (35/195) and 1.6% (4/244) in those with insulin resistance and non-insulin resistance, respectively. Prevalence of MS, each component of MA and cluster of each components of MA all increased in linear trend with their body mass index (BMI) or insulin resistance increasing. ② BMI correlated with all metabolic indicators and could independently predict risk of MS. Conclusions Prevalence of MS among overweight and obese children and adolescents in Guangzhou was considerably high, and BMI can be used as a suitable index for their obesity assessment in MS diagnosis.

Objective To investigate the distribution of two single nucleotide polymorphism(SNP)-717A/G and-390C/A/T-within the C reactive protein(CRP)promoter region in ethnic Han Chinese and the association with coronary heart disease(CHD).Methods Altogether positive CHD patients and negative controls were studies in this study.The two target fragments were amplied by PCR.Then the-717A/G polymorphism was screened by restriction fragment length polymorphism(RFLP)and the-390C/A/T polymorphism by Sequence Specific PCR(SSP).At last,the association was studied by proper statistical analysis.Results There was no significant difference in the distribution of-717A/G polymorphism betweenpatients and controls.However,the frequencies of allels in-390C/A/T polymorphismwere significant different between them(P