Objective To investigate the effects of insulin resistance (IR)on hypoxia/reoxygenation (H/R)inj ury in PC1 2 cells and the protective effects of N-actyl-L-cystine (NAC)against H/R inj ury. Methods PC12 cells were treated with 100 nmol/L insulin to induce IR. The H/R injury model was established by Na2 S2 O4. CCK-8 assay was used to detect the cell viability. Glucose consumption was detected by glucose oxidase method. Activity of superoxide dismutase (SOD)was detected by xanthine oxidase method. The levels of malonaldehyde (MDA)were measured by thiobarbituric acid method. Flow cytometry was used to determine the apoptosis and mitochondrial membrane potential (MMP). Results High-insulin inhibited insulin-induced glucose uptake in PC12 cells without affecting the cell viability (P<0. 05). PC12 cells with IR exhibited lower SOD activity and higher levels of MDA (P<0. 05 ),and enhanced apoptosis and depolarization of MMP induced by H/R(P<0. 05). NAC neutralized these effects induced by IR(P<0. 05). Conclusion IR aggravates H/R injury in PC12 cells by enhancing oxidative stress and NAC reduces the H/R injury in PC12 cells with IR via inhibiting oxidative stress and stabilizing MMP.

Objective To investigate the correlation between blood glucose variability and poor prognosis in diabetes patients with acute stroke. Methods A total of 1 5 5 diabetes patients with acute stroke were divided into glucose variability group(n= 92,GluSD≥1. 4 mmol/L)and non-glucose variability group(n= 63,GluSD<1. 4 mmol/L)according to the GluSD levels. Then,the subjects in glucose variability group were divided into three subgroups according to GluSD levels:the lowest tertile group (GluSD 1. 42~1. 87 mmol/L),the middle tertile group(GluSD 1. 43~2. 32 mmol/L)and the highest tertile group(GluSD 2. 33~2. 87 mmol/L). All patients accepted 72 h CGM after admission. NIHSS score, MoCA scale and Barthel index were used to assess short-term prognosis. Non-conditional logistic regression analysis was used to analyze the risk factors for poor prognosis. Results The levels of FPG [(8. 49± 1. 71 )vs (7. 33 ± 1. 58 )mmol/L],HbA1 c [(8. 61 ± 0. 55 )% vs (7. 14 ± 0. 43 )%]GluAve, GluMAGE,GluGLI and GluCV were higher in glucose variability group than in non-glucose variability group(P<0. 05 or P<0. 01 ). GluAve,GluMAGE,GluGLI and GluCV were higher in the highest tertile group than in the lowest tertile group (P<0. 05 ). With the increase of GluSD level,NIHSS score increased,MoCA score and Barthel index reduced (P<0. 05 ). Multivariate logistic regression analysis showed that age,HbA1 c,GluAve,GluCV and NIHSS score were risk factors for poor prognosis(P<0. 05 or P<0. 01). Conclusion Blood glucose variability is related to poor prognosis in diabetes patients with acute stroke,suggesting that reducing blood glucose fluctuations may be more beneficial to improve outcomes in the treatment of hypoglycemia.

Objective To explore the relation between serum nesfatin-1 ,tumor necrosis factor (TNF)-αand insulin resistance. Methods A total of 105 subjects were enrolled in this study and divided into two groups:patients with newly diagnosed type 2 diabetes mellitus (T2DM group,n= 64)and normal controls (NC group,n= 41). The fasting serum nesfatin-1 and TNF-αlevels were measured by enzyme-linked immuno sorbent assay (ELISA). FPG,HbA1 c,TG,TC,and FIns were also tested. BMI, HOMA-IR,HOMA-β,and ISI were calculated. Results Serum nesfatin-1 and TNF-αlevels were significantly higher in T2DM group than in NC group. Multiple linear regression analysis showed that the most significant influencing factors for nesfatin-1 were TNF-αand ISI(β= 0. 005、-6. 847,P<0. 05). The most significant influencing factors for TNF-αwas HbA1 c (β= 26. 652,P<0. 01). Conclusion Serum nesfatin-1 and TNF-αare significantly elevated in patients with newly diagnosed T2DM,which may influence the glucolipid metabolism through the signal pathway of insulin and play a role in the pathogenesis of T2DM and IR.

[Summary] There is a complementary or synergistic action of saxagliptin and metformin when used in combination. Combination therapy with saxagliptin and metformin can effectively reduce blood glucose and body weight with a low risk of hypoglycemia in patients with diabetes. Additionally,the cardiovascular safety of saxagliptin has been confirmed by the SAVOR study,whereas a cardiovascular protective effect of metformin has been demonstrated by the UKPDS study. As being taken orally once daily,saxagliptin and metformin extended-release fix-dose combination tablet can further improve patients′compliance and adherence. According to the guidelines,this tablet could be recommended as the initial treatment for newlydiagnosed type 2 diabetes with HbA1 c higher than 7. 5%,or in those with inadequately glycemic control under metformin monotherapy.

[Summary] The pathogenesis of type 1 diabetes has not been thoroughly understood. MicroRNA is a kind of small molecule RNA in regulating gene expression at post-transcriptional level. The dysfunction and amount changes of microRNA involve in the regulation of pancreaticβcell volume and function,and thus are related to type 1 diabetes. Here,we reviewed the research advances of microRNA in the development of the pancreas,insulin secretion and type 1 diabetes.

[Summary] Limb numbness is a common symptom of diabetic peripheral neuropathy(DPN),which is similar to lumbar vertebra disease and spinal cord tumor compression syndrome. Diabetes mellitus (DM) combined with lumbar spondylosis and spinal cord tumor compression is rarely occurred and is difficult to distinguish from DPN . Here we reported a case of DM combined with spinal neurilemoma that was misdiagnosed as DPN for half a year.

Objective To investigate the effects of Metformin on serum proprotein convertase subtilisin/kexin type 9(PCSK9)level in patients with type 2 diabetes(T2DM). Methods 48 healthy people with normal glucose tolerance were selected as the controls (NGT group). 93 newly diagnosed T2DM were randomized to Metformin treated group (Met,n= 47 )and Glipizide treated group (Gli,n=46).Serum PCSK9 was measured by ELISA in all participants. After treatment,the changes of serum PCSK9 were observed in Met group and Gli group. Results Serum PCSK9 levels in Met group and Gli group were higher than NGT group(P<0. 01). PCSK9 level was positively correlated with FPG,HbA1 c, HOMA-IR,FIns,TC,LDL-C,TG,hsC-RP,TNF-αand BMI (r= 0. 578,0. 638,0. 556,0. 610,0. 578, 0. 592,0. 589,0. 638,0. 561,0. 552;P<0. 05 or P<0. 01),and negatively correlated with HDL-C(r=-0. 614,P<0. 01). The levels of PCSK9 significantly decreased after treatment with Metformin(P<0. 05). PCSK9 levels had no significant differences before and after treatment with Glipizide. Multiple regression analysis showed that TNF-αand HOMA-IR were independent related factors of PCSK9. Conclusion T2DM patients have high levels of serum PCSK9 which can be decreased by Metformin.

With the growing prevalence of obesity,diagnosis and treatment of obesity has drawn great attention.On the basis of previous guidelines on obesity,May 2016,American Association of Clinical Endocrinologists (AACE)and American College of Endocrinology (ACE)announced the clinical practice guidelines for comprehensive medical care of patients with obesity.The guidelines give advice and guidance in obesity diagnosis,assessment,treatment goals and treatment strategies around obesity-related complications as center.This article interprets the key content of the guideline in order to acquire enlightenment for clinical work.

Objective To investigate the changesof glomerular filtration rate(eGFR)in type 2 diabetic patients with normal serum creatinine(Scr)and serum cystatin C(Cys-C). Methods A total of 166 patients with type 2 diabetes mellitus admitted into our hospital from January 2014 to September 2015 were enrolled in this study and divided into three groups according to the level of Scr and Cys-C:T2DM patients with normal Scr and Cys-C (normal group,n =109),T2DM patients with normal Scr and high level of Cys-C (high Cys-C group,n=40),and T2DM patients with high levels of Scr and Cys-C (high Scr Cys-C group,n=17). Normal group were further divided into two subgroups according to the level of eGFR:eGFR≥90 ml/(min·1.73 m2 )subgroup and eGFR<90 ml/(min·1.73 m2 )subgroup.Clinical characteristics and laboratory datawere collected in all subjects. eGFR were measured by 99mTc-DTPA nephro-dynamic imaging. Results The average value of eGFR were significantly different in normal group(82.68±13.45)ml/(min·1.73 m2 ),high Cys-C group(67.93 ±14.01)ml/(min·1.73 m2 )and high Scr,Cys-C group (50.54±15.10)ml/(min·1.73 m2 ). In normal group,the proportion of patients with eGFR equal or greater than 90 ml/(min·1.73 m2 )was 26.6%,patients with eGFR ranged from 60 to 89 ml/(min·1.73 m2 )was 72.5%,patients with eGFR ranged from 30 to 59 ml/(min·1.73 m2 )was 0.9%. After follow-up for three months,in normal group,the proportion of patients with CKD stage1 was 4.6%,patients with CKD stage 2 was 34.9%,and patients with CKD stage 3 was 0.9%.Multivariate logistic regressionanalysis in normal group showed that female,older age,higher TC,lower LVEF were risk factors for eGFR decline (P <0.05). Conclusion In T2DM patients with normal Scr and Cys-C, 73.4% of them had mild to moderate eGFR decline,and 40.4%entered CKD stage in this study.eGFR should be evaluated especially in T2DM patients with risk factors including female,older age,higher TC and lower LVEF.

Objective To investigate the diagnostic value of serum MK (Midkine)and total bilirubin (TB)in diabetic retinopathy (DR). Methods A total of 148 patients with type 2 diabetes were divided into three groups:diabetes without retinopathy (NDR group,n = 50),diabetic with non proliferative retinopathy (NPDR group,n = 52 )and diabetic with proliferative retinopathy (PDR group,n = 46 ) according to whether retinal lesions were detected. The diagnostic value of serum MK and TB were investigated. Results Age,gender,body mass index (BMI),FPG,HbA1 c,TG,TC,LDL-C,HDL-C, SBP,DBP were not statistically different among the three groups (P >0.05).Duration,UAlb/Cr,SOD, MDA,AOPP,MK,TB and DB were statistically different among the three groups (P<0.05). Duration, ALB/CR,MDA,AOPP,and MK were higher,SOD,TB,DB were lower in PDR and NPDR group than in NDR group (P<0.05). Duration,UAlb/Cr,MDA,AOPP,and MK were higher,and SOD,TB,DB were lower in PDR group than in NPDR group (P <0.05).Logistic regression analysis showed that duration, ALB/CR,MDA,AOPP,and MK were risk factors (OR =1.36,1.71,1.27,1.65,2.35,P <0.05 )and SOD,TB,DB were protective factors for DR (OR =0.46,0.31,0.46,P <0.05). Diagnosis sensitivity, specificity,positive predictive value,negative predictive value and accuracy of TB combined with MK were higher than TB,MK alone(AUC=0.918,0.735,0.762,P <0.05). Conclusion DR may be associated with increased MK and decreased TB.Diagnostic efficacy of MK combined with TB is better than MK,TB alone.