Metformin improves glycemic control mainly due to improved insulin sensitivity.Dipeptidyl peptidase-4(DPP-4) inhibitor,which suppresses degradation of glucagon-like peptide-1 (GLP-1) and maintains the bioactivity of endogenous GLP-1,improves islet dysfunction.Moreover,recent studies suggested that metformin enhanced the biological effect of GLP-1 via different mechanisms and that DPP-4 inhibitor enhanced insulin sensitivity in type 2 diabetes.Therefore,the combination therapy of DPP-4 inhibitor and metformin could simultaneously ameliorate the two major defects of type 2 diabetes and obtain complementary and synergistic benefits for glycemic control.

OBJECTIVETo observe the immediate analgesic effect of tendon acupuncture on soft tissue injury in different sites.

METHODSA total of 140 cases of soft tissue injury, involving 14 injury sites, were treated with tendon acupuncture. According to the principle of "considering pain as acupoint", based on injury sites, one to three tendon acupoints were selected in each tendon, which were treated with 1 to 5 times. Totally 676 times Of treatment was given. The visual analogue scale (VAS) was used to evaluate the immediate. analgesic effect before and after the treatment.

RESULTSAfter the treatment, the score of VAS was significantly reduced (4. 20+ 1. 77 vs 2. 43 ± 1. 30, P<0. 001); regardless of the total number of treatment, the score of VAS after each acupuncture was obviously reduced compared with that before acupuncture (all P<0. 001); the score of VAS at each injury sites after treatment was significantly reduced compared with that before treatment (all P<0. 001).

CONCLUSIONThere is an immediate analgesic effect of tendon acupuncture for different sites of soft tissue injury. Also, the effect has been shown in different frequencies of treatment.

Acupuncture Analgesia ; Acupuncture Points ; Acupuncture Therapy ; Adult ; Aged ; Aged, 80 and over ; Female ; Humans ; Male ; Middle Aged ; Pain Measurement ; Soft Tissue Injuries ; physiopathology ; therapy ; Tendons ; physiopathology ; Treatment Outcome ; Young Adult

[Summary] 2015 AACE/ACE Clinical Practice Guidelines for Integrated Management of Diabetes are updated and revised on the basis of 2011 edition. The guidelines highlight the comprehensive consideration of micro- and macro-vascular risks rather than merely focusing on the strategies and approaches of glycemic control. The guidelines also emphasize individualized targets for weight loss and the management of hyperglycemia ,dyslipidemia and hypertension and that more attention should be paid to safety of individualized treatment other than efficacy.

Proinsulin is the precursor of mature insulin.Proinsulin to insulin ratio reflects the degree of pancreatic β-cell dysfunction and the progression of type 2 diabetes, and may predict the risk of diabetes development.Some variants in susceptibility genes of diabetes are associated with the elevation of proinsulin to insulin ratio.Moreover, several antidiabetic drugs are able to decrease the proinsulin to insulin ratio in patients with type 2 diabetes.Therefore, the proinsulin to insulin ratio may act as a simple and useful indicator in the etiological study, risk prediction, disease progression and therapeutical evaluation in type 2 diabetes.

In both type 1 and type 2 diabetes mellitus,β-cell mass (BCM) is lost.Various treatments are developed to restore or reconstruct BCM.The development of non-invasive methods to quantify BCM in vivo offers the potential for early detection of β-cell dysfunction prior to the clinical onset of diabetes.PET imaging with radioligands that directly target the pancreatic β-cells appears promising.The ability to determine the BCM has been investigated in several targets and their corresponding radiotracers,including radiolabeled receptor ligands,antibodies,metabolites and reporter genes.Therefore,we summarize the recent progress in radionuclide molecular imaging of pancreatic β-cells.

Recent studies have demonstrated an association of glucagon-like peptide-1 (GLP-1) signaling defect with non-alcoholic fatty liver disease (NAFLD).Native GLP-1 and GLP-1-based agents may directly act on hepatocytes through activation of GLP-1 receptors in hepatocytes,resulting in the regulation of gene expression associated with insulin resistance and lipid metabolism,and the suppression of oxidative stress in liver cells.Moreover,GLP-1-based agents have been reported to be effective in improving hepatic endpoints in patients with NAFLD.

Objective To investigate the effects and mechanism of glucagon-like peptide-1 ( GLP-1 ) receptor agonist liraglutide on the proliferation and apoptosis of human pancreatic cancer cells. Methods The human pancreatic cancer cell line MIA PaCa-2 was incubated for 24 h with liraglutide at various concentrations (10-1 000 nmol/ L), or with 100 nmol/ L liraglutide for various durations (0-72 h). Cell proliferation was determined by Cell Counting Kit-8 (CCK-8) analysis. RT-PCR and Western blot were used to detect the mRNA and protein expression levels of related genes. Results GLP-1 receptor was expressed in the MIA PaCa-2 cells. Liraglutide suppressed cell proliferation, up-regulated the expression levels of pro-apoptotic protein Bax and down-regulated the expression levels of anti-apoptotic protein Bcl2 in human pancreatic cancer cells in a dose- and time-dependent manner. Meanwhile, liraglutide down-regulated the expression levels of insulin receptor (INSR) and insulin-like growth factor-1 receptor (IGF-1R), and the phosphorylation levels of their downstream signaling proteins Erk1 / 2 and Akt, in a dose- and time-dependent way. Conclusion Liraglutide inhibits proliferation and promotes apoptosis of human pancreatic cancer cells; the process may be mediated via suppressing the expression of INSR and IGF-1R and inhibiting activation of the downstream MEK/ Erk1 / 2 and PI3k/ Akt pathways.

Objective To evaluate the effects of metabolic factors on the quality of 18F-fluorode oxyglucose (18F-FDG) myocardial metabolic imaging in coronary artery disease (CAD) patients with type 2 diabetes mellitus (T2DM). Methods Seventy CAD patients aged 60 years or over with T2DM were studied with myocardial 18 F-FDG dual isotope simultaneous acquisition (DISA) single photon emission computed tomography (SPECT). Fasting plasma glucose, total triglyceride (TG),total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-eholesterol(LDL-C), insulin, C peptide and glyeosylated hemoglobia (HbAlc) were detected. Insulin resistance and islet β cell function were calculated by using the Homeostasis Model Assessment (HOMA) equation. Results Compared with the bad image quality group (36 cases), patients in the excellent image quality group (34 cases) were younger [with average age of (62.2±8.5) years vs. (67.6±8.3) years, P<0.01] and slimmer [with BMI of (24.7±2.6)kg/m2 vs. (26.1±2.5)kg/m2, P<0.05]. The levels of fasting insulin and C peptide were lower in the excellent image quality group than those in the bad image quality group [with fasting insulin level of 8.3 (5.1～12.4) mIu/L vs. 12.7,(6.1～17.9)mIu/L and C-peptide level of 0.6(0.5～0.9)nmol/L vs. 0.9(0.6～1.2)nmol/L, respectively,both P<0.05]. The HOMA insulin resistant index was reduced in the excellent image group [2.7(1.6～4.0) vs. 4.1(1.7～6.5), P<0.05]. Logistic regression analysis showed that obesity and age≥65 years were independent risk factors for image quality, with OR value of 3.73 (95% CI: 1.12～12.45,P=0.022)and 3.75 (95%CI:0.96～14.6,P=0.058)after adjustment of other metabolic factors. Conclusions Insulin resistance is the main factor that influences the quality of 18F-FDG myocardial metabolic imaging in patients with T2DM. In addition, age≥65 years and obesity are also risk factors for image quality.

Objective To evaluate the efficacy and safety of biphasic insulin aspart 30 (BIAsp30)plus metformin in type 2 diabetes subjects switching from basal insulin plus oral antidiabetic drugs (OAD)Methods During 16 weeks, multiple-center, open-label, and single-arm study including 2 weeks of screening period,4 weeks of run-in period,and 16 weeks of treatment period were carried out. Subjects with type 2 diabetes mellitus inadequately controlled on basal insulin therapy with or without oral antidiabetic drugs were switched to twice-daily BIAsp30 plus metformin with dose titration to achieve fasting plasma glucose target. Results Of the 293 Chinese subjects exposed to trial drugs [age: ( 54.0±9.6 ) years, diabetes duration: ( 8.54±5.49 ) years, body mass index: (24.89±3.28)kg/m2, baseline HbA1c: 8.16% ±0.89%], 122 were previously treated with basal insulin analogues and 169 with human basal insulin. At end of the trial ,the mean reduction of HbA1 c was 1.30% ±0.96% (P＜0. 01 ). The proportion of patients achieved HbA1c＜7.0% and HbA1c ≤6.5% was 60.4% and 38.9% respectively. 8-point plasma glucose measurements showed significant improvements at all the time points examined ( all P＜0. 01 ) ,and the average value of all 8 points measured decreased from ( 10.53±2.58 ) mmol/L atbaseline to (7.79± 1.58 ) mmol/L at the end of treatment ( P＜0. 01 ), reduced by 2.76 mmol/L. Postprandial glucose increments were significantly reduced after breakfast ( -1.73 mmol/L,P＜0.01 )and dinner ( -1.28 mmol/L,P＜0.01 ), while no significant reduction was observed after lunch ( -0.09 mmol/L, P = 0. 734 5 ). No severe adverse effect and no major hypoglycemia were reported. The overall hypoglycaemia rate was 2.68 events/subject year. The average weight gain was (0. 76 ±0. 14 )kg (P＜0. 0l ). Conclusion Twice-daily BIAsp30 plus metformin is effective and safe to type 2 diabetic subjects inadequately controlled on basal insulin treatment.BIAsp30 treatment should be considered for type 2 diabetic subjects who have unsatisfactory response to previous basal insulin treatment.

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.