In 2011 ADA/Lancet Forum, a randomized control trial in England was reported. Participants were with intensive diet intervention, or plus a physical activity program. The primary endpoints were improved in both groups, compared to control group, without any difference between two intervention groups. In another multinational trial, although significant improvement of cardiovascular risk factors in the intensive treatment group compared to routine group treated by general practitioners (GP), no significant differences on first cardiovascular event and all-cause mortality were found. This result is attributed to the good practice following guidelines by GP. While in China, a survey on current status of patients with type 2 diabetes who failed to reach the glycemic control target, and an another survey by a questionnaire about Chinese guidelines of diabetes treatment, answered by medical staff at different levels in Shanghai,gave us worrisome concerns. The training of medical staff from community hospitals seems to be particular emergent.

Glucotoxicity, lipotoxicity and glucolipotoxieity are secondary phenomena following the primary pathogenesis, including the effects of genetic and environmental factors of type 2 diabetes. However, there exist two theories: (1) Lipotoxicity, presents before blood glucose rising, may trigger off a chain reaction which results in hyperglycemia. Hence the term " diabetes mellipidus" was proposed. (2) Hyperglycemia is a prerequisite for lipotoxicity. It seems more appropriate to state that (1) the glucotoxieity and iipotoxicity may present separately or concurrently in type 2 diabetes; (2) The combined glucolipotoxicity should describe the deleterious actions by higher levels of both glucose and free fatty acids on β-cell function, which finally causes progressive deterioration of insulin secretion.

A variety oi adipocyte metabolites, hormones and cytokines, including the most spectacular ones such as leptin and recently discovered adiponectin, are intimately involved in the pathogenesis of obesity and metabolic syndrome. To profit from the advantages and to avoid the harmful effects brought about by these products may result in a break through to the treatment of these diseases.

The outcomes of cardiovascular events in diabetics are equal to those found in patients with coronary artery diseases (CAD) not associated with diabetes (DM). DM is hence upgraded from “risk factor” to “equivalent” of CAD. Recently, hyperglycemia has been found in the majority of CAD patients (“Euro Heart Survey” and “China Heart Survey”),the prevalence is far more higher than that in general population. Questions have been raised, regarding DM and CAD, which one is the cause or the result of the other or both are mutually equivalent or homogenous and finally, what are the common points in treatment and prevention

The association of diabetes mellitus to the coronary heart diseases has attracted the greatest attention of both clinical endocrinologists and cardiologists. However, the endocrine issue of cardiovascular system includes but is not only limited to diabetes, and its significance appears to be far much broader. Heart and vessels are also endocrine organs. Diseases of each axis of endocrine system are actually intimately related with the heart outcomes. Hence the cardiovascular endocrinology, as a special area with common interest of classical endocrinology, emerges and challenges our endocrine clinicians who are in the upstream in managing these diseases as well as in the forefront of active research in this area.

More and more extrapancreatic actions of incretin-based therapies have been demonstrated and recently case reports have linked glucagon-like peptide-1 (GLP-1) receptor agouist therapy with the improvements in psoriasis.Psoriasis is a common skin disorder characterized by chronic inflammation.Epideminological studies have showed that patients with psoriasis exhibit increased rates of cardiovascular disease,obesity,and type 2 diabetes,owing probably to the enhanced local and (or) systemic inflammation.The observations of anti-inflammatory actions of GLP-1,which exerts direct and indirect actions on immune function,together with the improved psoriasis,offer new insights into the investigation of non-classical anti-inflammatory actions of incretin-based therapeutics and provide a new direction for the research of the novel clinical application of GLP-1.

Increasing clinical evidence shows that modern lifestyle interrupting circadian rhythm contributes to the prevalence of obesity and diabetes.Recent genetic animal models further support the interaction of circadian rhythms and metabolic state.Circadian clock is not limited to be in central nervous system,and is also present in nearly all cells of the body,which constitute hierarchically circadian systems.The molecular circadian clock is evolved to allow organisms to anticipate and prepared for predictable,daily changes in the environment and regulates cellular and tissue function by driving patterns of gene expression and enzymatic activity.At present,basic science in this field has progressed at an extraordinary pace and is expected to continue unraveling the mechanisms linking circadian clocks to metabolism,which is important for understanding the pathophysiology of metabolic diseases such as obesity and diabetes,and provides a conceptual basis for the prevention and therapeutics of these diseases.

Aldosterone and metabolic syndrome are known cardiovascular risk factors associated with increased morbidity and mortality. This review focuses on the recent advances and clinical significance of the relationship between aldosterone and each single component of metabolic syndrome. The possible role of aldosterone receptor antagonist or aldosterone synthetase inhibitor in the treatment of metabolic syndrome is discussed.

In July 2002, the Women's Heath Initiative (WHI) clinical trial, designed to clarify the risks and benefits of combination hormone replacement therapy (HRT) to the postmenopausal women declared that interim safety review after an average follow-up of 5.2 years found that a combination of estrogen and progestin frequently prescribed to postmenopausal women in USA increased the risk of invasive breast cancer, heart disease, stroke, and pulmonary embolism while reduced bone fractures and colorectal cancer. The overall risks of HRT outweigh the benefits, which provides an opportunity for traditional Chinese medicine (TCM) going abroad. A variety of clinical and experimental evidences have showed that TCM exerts quite satisfactory effect on relieving postmenopausal symptoms with little adverse effect, hence a potential role to replace or to improve HRT or to reduce the side effect induced by HRT.

Obesity is a developing public health issue. As a core organ in energy storage and metabolic modulation, adipose tissue becomes an important target in body weight control. Total caloric intake limitation and /or macronutrient ratio regulation are commonly used in obesity therapy. The anti-obesity agents derived from adipocyte products may bring us new ways more suitable to physiological status in the future.