"Diabetes Dialogue" is an international forum of latest cutting-edge research on diabetes. The major topics in the 5th event in 2008 were the novel targets in the treatment of type 2 diabetes. In particular, the latest developments in incretin-based therapies, especially glucagon-like peptide-1 (GLP-1) -based therapies, and their effects on the β-cells have been provided. Studies suggested that type 2 diabetes is characterized by progressively deteriorated β-cell function with the presence of insulin resistance. Owing to its glucose-dependant glucose lowering effect and the effect on improvement of β-cell function, GLP-1 has become the novel target of therapies. Liraglutide, a GLP-1 analogue developed by Novo Nordisk, is one of the novel therapies in the treatment of type 2 diabetes. Many studies have demonstrated that liraglutide showed both an efficacious and sustained effect on glycemic control and a significant improvement of 13-cell function. As a result, recently the role of GLP-1 or GLP-1 analogue in the management of type 2 diabetes has gained more popularity and liraglutide is considered as a promising drug in the treatment of type 2 diabetes.

The aim of RECORD study is to compare the time of first hospitalization due to cardiovascular events or death between patients treated with Metformine+ Rosinglitazone,Sulfonylureas+ Rosinglitazone with those treated with Metformine+Sulfonylureas.The result showed that,after treated equally for 5.5 years,there was no difference in the time of first hospitalization due to cardiovascular events or death between the two groups.The blood glucose control,as indicated by average HbA1c,was improved in Rosinglitazone group compared with that in the control group.

Type 1 diabetes is pathologically characterized by autoimmune insulitis-related islet β-cell destruction.Although intensive insulin therapy for patients with type 1 diabetes can correct hyperglycemia,this therapy does not effectively prevent diabetes-related cardiovascular complications.Hence,preservation of natural β-cell function is critical for the prevention of diabetes-related complications.Receut studies have shown that autologous hematopoietic stem cell transplantation ( A HSCT) is a new promising approach for the treatment of type 1 diabetes by reeonstitution of immunotolerance and preservation of islet β-cell function.Here we introduce the key results of a clinical trial ( NCT 01341899,ClinicalTrials.gov) performed in Chinese type 1 diabetes patients ( most of them with diabetic ketoacidosis at onset ) and discuss the potential mechanisms underlying the action of HSCT and its prospects in the clinical management of type 1 diabetes.

Food intake,energy expenditure and body adiposity are homeostatically regulated.Hypothalamus and brainstem are key brain regions of the system.In the state of hunger or satiety,the neural and hormonal messages from the gut regulate energy homeostasis through reflection or direct effect on the hypothalamus and brainstem,Which is referred to as brain-gut signaling.New researches on the special physiological functions of gut hormones are expected to offer a target for anti-obesity drugs.

Synthetic agonists of peroxisome proliferator-activated receptors-?(PPAR?) have an important role in the preclinical models of metabolic diseases.In the recent years,it has been demonstrated that PPAR? agonists can normalize blood lipids and reduce insulin resistance and adiposity in rodents and primates.PPAR? activation in the skeletal muscle regulates the oxidative capacity of the mitochondrial apparatus,switches fuel preference from glucose to fatty acids and reduces triacylglycerol storage.PPAR? agonists also reduce insulin levels in serum,increase the sensitivity of insulin and improve glucose-tolerance.The genetic polymorphism in PPAR? has been shown to be associated with blood lipids,obesity and type 2 diabetes.

The critical role of α- and β-cell dysfunction in the development of type 2 diabetes has been established.Dipeptidyl peptidase-4 (DPP-4) inhibitors are new class of oral anti-hyperglycemia agents that acts to increase active levels of the incretin hormone glucagon-like peptide-1 ( GLP-1 ) and glucose-dependent insulinotropic polypeptide ( GIP),which improved α- and β-cell function.This action is shown as improved α- and β-cell sensitivity to glucose,increased glucose-dependent insulin secretion and decreased glucagon secretion.DPP-4 inhibitors treatment has also been associated with beneficial extrapancreatic effects,including improved peripheral insulin sensitivity and lipid metabolism.Additionally,DPP-4 inhibitors have shown a minimal risk of hypoglycemia and bodyweight neutrality without effects on gastric emptying.Numerous clinical trials have verified the favorable efficacy,safety,and tolerability of DPP-4 inhibitors treatment in monotherapy or combination with other anti-diabetic agents for patients with type 2 diabetes.

Adiponectin is one of the adipocytokines that are derived from adipose tissue. It has anti-inflammatory, anti-diabetic, anti-atherogenic and insulin-sensitizing effects. Its receptors AdipoR1 and (AdipoR2) mediate the function of adiponectin. Recent researches show that AdipoR1 is abundantly expressed in skeletal muscles, whereas AdipoR2 is predominantly expressed in the liver. Both AdipoR1 and AdipoR2 are found to be expressed in human and rat pancreatic ? cells and the expression levels are similar to those in liver and higher than those in muscles; AdipoR1 and AdipoR2 can also be found in monocytes and macrophages. GH and agonists of PPAR-?, PPAR-? and LXR also affect the exprssion and regulation of adiponectin receptors.

Objective To investigate the carotid intima-media thickness(C-IMT) in type 2 diabetes mellitus(T2DM) and the relationship with risk factors. Methods From 2002-01 to 2003-03, we measured C-IMT by B-mode ultra-sonography in 67 patients with different durations of T2DM. Blood was drawn from patients for the analysis of serum creatinine and C-reactive protein(CRP). 24-hour urine collection was performed to determine the level of urine creatinine clearance. Results C-IMT in patients increased with durations and with decreasing creatinine clearance. Multiple regression analysis revealed that C-reactive protein significantly and independently affected the C-IMT. Conclusion C-IMT increases with durations of T2DM and with BMI of the patients. CRP is the risk factor for carotid atherosclerosis in T2DM.

Objective To investigate the clinical characteristics and classification of ketosis-prone diabetes. Methods Firstly,according to with or without autoantibodies,patients with an initial onset of unprovoked ketosis or ketoacidosis were classified to two different groups. Secondly,based on weather or not depending on insulin,patients without autoantibodies were further divided into two groups,insulin dependent and non-insulin dependent. Clinical characteristics,biochemical parameters were compared between different groups. Results The autoantibodies negative group showed a strong male predominance and family history of diabetes.BMI was higher than type 1 diabetes. Plasma triglyceride level was highest. Fasting and postprandial C-Peptide level was between the other two group. Compared with non-insulin dependent group,insulin dependent group showed a strong male predominance,lower ratio of overweight and obesity,more severe ketosis status. There were no significant differences with regard to blood glucose level and fasting C-Peptide level of initial. But fasting C-Peptide after 3 months was higher in non-insulin dependent group . Conclusion Ketosis-prone diabetes can divided into two groups,based on autoantibody negative or positive. The latter consist of type 1A diabetes mellitus. The former can further classified as ketosis-prone type 2 diabetes and idiopathic type 1 diabetes(type 1B diabetes)according to insulin dependent or non-insulin dependent.

Objective To study the assiociation of-866G/A polymorphism in the promoter of uncoupling protein 2(UCP2)gene in patients with type 2 diabetes and B-cell function in Han population in Nanjing.Methods For the case-control study,PCR-RFLP method was used to determine the distributions of allele and genotype frequencies of-866G/A polymorphism in the human UCP2 gene in 229 type 2 diabetic patients and 196 normal control subjects.All of the testees accepted oral glucose tolerance test and insulin releasing test to detect B-cell secretion function and insulin sensitivity.Results The distribution of genotype and allele frequencies of-866G/A polymorphism in the promoter of the human UCP2 gene were significantly different between type 2 diabetic patients and normal control subjects(?2=6.555,P=0.038;?2=6.363,P=0.012 respectively).The frequency of A/A genotype and A allele in type 2 diabetic were significantly higher than that in contrast(OR=1.99,OR=1.42 respectively,both P