The prevalence of diabetes mellitus(DM)and prediabetes(Pre-DM)is high in China.Among them,the number of elderly Pre-DM patients is huge.Individualized management tailored to the characteristics of the older adults can prevent or delay their transition to DM.Comprehensive management should also be carried out on the risk factors and potential adverse clinical outcomes of Pre-DM in the elderly to improve quality of life.This article reviews the characteristics of natural course and management strategies of Pre-DM in older adults.

Objective:To investigate the impact of daily step count on glycemic outcomes in community residents with impaired glucose tolerance (IGT).Methods:This was a prospective cohort study, in October 2018, 204 residents who met the criteria of IGT were recruited in the Shijingshan District in Beijing. The subjects were tested for fasting blood glucose, oral glucose tolerance test 2-hour blood glucose (2hBG), glycated hemoglobin A 1c (HbA 1c), lipid profile, liver and kidney function, as well as measurements of height, weight and waist circumference. A dedicated mobile application was used to deliver prediabetes health knowledge monthly. Online guidance was provided to answer questions and daily step count was collected using the application. Three years later, a follow-up was conducted to assess the participants′ glycemic outcomes and other indexes, and a total of 142 participants completed the follow-up review. According to daily step count, the subjects were categorized into high step count group (42 cases,>7 000 steps daily), moderate step count group (54 cases, 5 000-7 000 steps daily), and low step count group (46 cases,<5 000 steps daily). Subjects were categorized into diabetes group (30 cases), prediabetes group (77 cases) and normal glucose tolerance group (35 cases) with glycemic outcomes. Independent sample t test was used to compare the differences in blood glucose, blood lipids, and step counts between the two groups. Kruskal-Wallis H test or one-way ANOVA was used to compare the differences in blood glucose, blood lipids, and step counts between multiple groups. The χ2 test was used to compare the differences in glycemic outcomes between multiple groups. Multivariate logistic regression analysis was used to assess the impact of daily step counts and body mass index on glycemic outcomes. Linear regression analysis was used to evaluate the relationship between daily step counts and 2 h BG. Results:A total of 142 participants completed the 3-year follow-up, including 43 males and 99 females, with a mean age of (60.15±5.67) years. At baseline, males had significantly higher body mass index, waist circumference, and fasting blood glucose when compared to those in females [(26.97±2.43) vs (24.89±2.93) kg/m 2, (92.68±7.75) vs (83.83±8.60) cm, (5.83±0.61) vs (5.62±0.52) mmol/L], the total cholesterol and HDL-C were also significantly lower in males than those in females [(5.10±1.16) vs (5.55±0.95) mmol/L, (1.35±0.34) vs (1.56±0.35) mmol/L] (all P<0.05). After 3-year follow-up, 21.1% (30/142) of IGT participants progressed to diabetes, with an annual conversion rate of approximately 7%. The normal glucose tolerance group showed significantly higher daily step counts when compared with the prediabetes and diabetes groups [(7 886±2 867) vs (5 981±2 655) vs (4 117±2 674) steps] ( H=31.778, P<0.001). Individuals with higher daily step counts exhibited lower body mass index, 2 h BG, and HbA 1c level when compared with those in the ones with moderate and low step counts [(24.26±3.09) vs (25.44±3.38) vs (26.26±3.59) kg/m 2, (7.50±1.71) vs (9.15±3.30) vs (11.19±3.84) mmol/L, 5.97%±0.46% vs 6.14%±0.99% vs 6.40%±0.96%] (all P<0.05). Higher step count was positively correlated with the reversal of prediabetes to normal blood glucose levels (moderate step count, OR=0.297, 95% CI: 0.109-0.804; low step count, OR=0.055, 95% CI: 0.010-0.287), lower daily step count correlated positively with prediabetes progressing to diabetes ( OR=4.857, 95% CI: 1.140-20.689) (all P<0.05). For every additional 1 000 steps per day, the 2 h BG decreased by 0.5 mmol/L. Conclusion:As daily step count increases, the glucose metabolism improves in IGT community residents. Higher daily step count is associated with reversal of IGT to normal glucose tolerance, while lower daily step count may be associated with the progression of IGT to diabetes.

Basal insulin is essential for blood glucose management. However, its clinical application in China faces multiple challenges such as delayed initiation, low initial dosage, and inadequate dose adjustments. The BEYOND series of studies were conducted to provide an evidence-based basis for optimizing basal insulin use in China. Moreover, basal insulin is advancing towards weekly preparation. Phase Ⅲ clinical trials have demonstrated that weekly basal insulin is both effective and safe, and its reduced injection frequency may help address the challenges associated with basal insulin use in China.

Bilateral adrenal hemorrhage is a rare cause of primary adrenal insufficiency, and bilateral adrenal hemorrhage due to anticoagulant use is even rarer. We describe the case of a 62-year-old woman receiving post total knee arthroplasty anticoagulant therapy who presented fever, vomitting, stomachache, and severe fatigue on the 8th day. It was until 4 months later that the patient was finally diagnosed with adrenal insufficiency resuting from bilateral adrenal hemorrhage, her symptoms were relieved by glucocorticoid replacement therapy. In order to promote the awareness, diagnosis, and mangement of post-surgery anticoagulants induced bilateral adrenal hemorrhage, the clinical characteristics of the reported cases were summarized and analyzed.

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in adults with type 2 diabetes (T2D). The aim of this study was to determine the CV risk in Chinese patients with T2D based on the 2019 European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) guidelines on diabetes, pre-diabetes, and CV diseases. METHODS: A total of 25,411 patients with T2D, who participated in the study of China Cardiometabolic Registries 3B study, were included in our analysis. We assessed the proportions of patients in each CV risk category according to 2019 ESC/EASD guidelines. RESULTS: Based on the 2019 ESC/EASD guidelines, 16,663 (65.6%), 1895 (7.5%), and 152 (0.6%) of patients were included in "very high risk," "high risk," and "moderate risk" categories, respectively. The proportions of patients in each category varied based on age, sex, body mass index, and duration. While 58.7% (9786/16,663) of elderly patients were classified to "very high risk" group, 89.6% (3732/4165) of patients with obesity were divided into "very high risk" group. Almost all patients with a duration of diabetes >10 years had "very high risk" or "high risk." However, 6701 (26.4%) of Chinese T2D patients, who had shorter duration, and one or two risk factors, could not be included in any category (the "unclear risk" category). CONCLUSIONS In China, most patients with T2D have "very high" or "high" CV risk based on 2019 ESC/EASD guidelines. However, the risk of patients in "unclear risk" group needs to be further classified.
Adult ; Aged ; Cardiovascular Diseases/epidemiology* ; Cross-Sectional Studies ; Diabetes Mellitus, Type 2 ; Heart Disease Risk Factors ; Humans ; Risk Factors

Parathyroid hormone plays an important role in maintaining the homeostasis of calcium and phosphorus metabolism via acting on bone, kidney, and intestine. However, little is known about the effects of parathyroid diseases on the reproductive system. This article describes the association of parathyroid diseases with reproductive function and health.

Islet β cell protection is one of the key strategies for diabetes treatment. The new antidiabetic drug sodium-glucose cotransporter 2(SGLT2)inhibitor decreases blood glucose by inhibiting glucose reabsorption in the renal tubule, independent of insulin. Various clinical studies have shown that SGLT2 inhibitors improve β cell function. Furthermore, animal experiments have indicated that SGLT2 inhibitors increase β cell mass. SGLT2 inhibitors promote islet regeneration through stimulating β cell proliferation, inhibiting β cell apoptosis and dedifferentiation, enhancing transdifferentiation of α cells to β cells, and initiating progenitor-derived β cell neogenisis. Indirect effects of metabolic improvement(i.e.lowering glucose, losing weight, improving lipid metabolism), inhibiting inflammatory reaction, inducing glucagon-like peptide-1 secreted from α cells, and regulating gene changes might be involved in the β cell protection of SGLT2 inhibitors.

Objective:To survey the status of illness and consultation within two weeks among residents in a community in Chengdu.Methods:A multi-stage stratified random sampling was used to carry out a questionnaire survey among the residents in a community in Chengdu during March to April 2019. The disease status, disease severity and consultation within two weeks were surveyed, and influencing factors of two-week illness were analyzed with logistic regression.Results:Among 2 714 participants, 715 had illness (900 times) within two weeks, with a two-week prevalence rate of 26.3%. The main symptoms were dizziness (6.4%, 58/900), cough (6.2%, 56/900), lumbago and leg pain (4.9%, 44/900), palpitations (3.3%, 30/900) and headache (3.1%, 28/900). The three most common diseases were hypertension (38.3%, 345/900), diabetes (19.3%, 174/900) and common cold (6.4%, 58/900). In this survey, the rate of two-week in bed was 20.6‰(56/2 714), and the rate of two-week off work was 4.8‰(13/2 714). Age, gender, education level and work status were the influencing factors of the illness in two weeks ( P<0.05). The choice of medical institution was also different among residents. Conclusion:The survey suggest that primary care should focus on the key groups of residents in the community such as elderly, women, low education level, retirement and unemployed; and it is necessary to strengthen the primary care institutions and two-way referral system of health care.

Whether levothyroxine ( LT4 ) treatment improves outcomes following in vitro fertilization and embryo transfer ( IVF-ET) in euthyroid women who have tested positive for thyroid autoantibodies remains unclear. In Pregnancy Outcome Study in enthyroid women with Thyroid Autoimmunity after Levothyroxine ( POSTAL) trial, which was a randomized controlled study involving 600 euthyroid women undergoing IVF-ET who were tested positive for thyroperoxidase antibodies, the miscarriage rate, clinical pregnancy rate and live-birth rate were not significantly different between the LT4 intervention group and control group. Therefore, LT4 treatment did not appear to improve pregnancy outcomes among women with thyroid autoantibodies undergoing IVF-ET.

To investigate the association between hemoglobin ( Hb ) and thyroid-stimulating hormone ( TSH) levels in different trimester pregnant women with subclinical hypothyroidism (SCH). 62 pregnant women, who were diagnosed as SCH when they had their first antenatal care and eventually delivered in the Affiliated Quanzhou First Hospital of Fujian Medical University from March 2013 to December 2014, were enrolled in this study. These subjects were divided into three groups according to weeks of gestation when they had their first prenatal care:including first trimester (n＝24), second trimester (n＝17), and third trimester (n＝21) groups. All SCH pregnant women were treated with levothyroxine ( L-T4). The clinical and laboratory data in the first antenatal care and antepartum period were collected. Association of Hb level with other clinical and laboratory data were analyzed. Compared to baseline, the levels of TSH, γ-glutamyl transpeptidase, alanine aminotransferase, and total cholesterol were lower (all P<0.05), and the levels of Hb were higher (P<0.05), after treated with L-T4in three groups. Pearson correlation analysis showed that the level of Hb was negativly correlated with TSH in all pregnancies or in third trimester groups (r＝－0.394,－0.308,－0.537 and－0.453 respectivly, all P<0.05). Multivariate regression analysis indicated that the level of Hb was independently associated with TSH and body mass index in pregnant women with SCH. In pregnant women with SCH, the higher TSH and body mass index levels are correlated with increased risk of anemia. L-T4treatment may ameliorate anemia during pregnancy.