Fulminant type 1 diabetes mellitus(FT1DM)is a new subtype of type 1 diabetes.It is characterized by rapid occurrence of extreme hyperglycemia or diabetic ketoacidosis,generally less than 2 weeks,with glycosylated HbA1c＜8.7%.Genetic factors,virus infection,antiviral immune mechanism and immunomodulatory factors are all related to the development of FT1DM,certain drugs and pregnancy are high-risk factors for it.This article reviews the research progress on the etiology of FT1DM.

Autoimmune diabetes includes type 1 diabetes mellitus(T1DM)and latent autoimmune diabetes in adult(LADA),which are characterized by islet β cell destruction caused by islet antigen-specific T cell attack.Fatty acids metabolism might play an important role in the development of diabetes.n-3 polyunsaturated fatty acids have been found to play protective effects on the development of autoimmune diabetes.This article reviews the research progress of fatty acid metabolism and autoimmune diabetes.

Objective To evaluation of abnormality of intrarenal veins in the patients of diabetic nephropathy (DN) and the correlation between the intrarenal venous impedance index (VII) and renal function with color Doppler ultrasonography. Methods Sixty-four subjects with type 2 diabetic nephropathy from December 2016 to October 2017 were enrolled and divided into three groups according to glomerular filtration rate(GFR) level: GFR≥90 ml/(min·1.73 m2) as group B (25 cases), 60 ml/(min·1.73 m2)≤GFR＜90 ml/(min·1.73 m2) as group C (21 cases), GFR＜60 ml/(min·1.73 m2) as group D(18 cases), and 25 healthy volunteers were recruited as group A. Color Doppler ultrasonography was used to obtain the intrarenal VII. Results There were significant differences among A, B, C, D group of right renal segmental vein (0.41 ± 0.04, 0.36 ± 0.09, 0.29 ± 0.05, 0.19 ± 0.05; F＝81.85), right renal interlobular vein (0.41 ± 0.03, 0.35 ± 0.04, 0.29 ± 0.04, 0.22 ± 0.11; F＝96.42), left renal segmental vein (0.42 ± 0.08, 0.36 ± 0.05, 0.30 ± 0.08, 0.20 ± 0.04; F＝101.38) and left renal interlobular vein (0.40 ± 0.15, 0.36 ± 0.04, 0.30 ± 0.04, 0.20 ± 0.07; F＝95.71), all P＜0.05. The VII of group B, C and D was significantly lower than that of group A (P＜0.05). The VII of group D was lower than that of group B and C (P＜0.05), and the VII of group C was lower than that of group D(P＜0.05). There were no significant differences of the VII between the left and right kidneys (F＝0.001, P＞0.05). The VII was positively correlative with GFR (r＝0.85, P＜0.05). Conclusions The VII of the patients of DN can be obtained by color Doppler ultrasonography conveniently and non-invasively, which can reflex the renal function changes and provide a new diagnostic index for the patients of DN in diagnosis and treatment.

Objective To reveal pathogenesis and etiology in adrenal incidentaloma. Methods The clinical data of 116 patients with adrenal incidentaloma from January 1, 2015 to January 1, 2017 were retrospectively analyzed. Results In 116 patients with adrenal incidentaloma, 49 cases (42.2％) were male and 67 cases (57.7％) were female; there were 14 cases (12.1％) aged from 20 to 40, 63 cases (54.3％) aged from 40 to 60, and 39 cases (33.6％) > 60 years. Forty-three patients (37.1％) were found by health examination, 26 patients (22.4％) were found because of hypertension, 27 patients (23.3％) were found by CT detection because of other diseases, and 20 cases (17.2％ ) were found because of other reasons. The result of endocrine function examination showed that nonfunctioning adrenal tumor was in 56 cases (48.3％); functional adrenal tumor was in 44 cases (37.9％), among whom primary aldosteronism was in 27 cases, Cushing syndrome was in 10 cases, and pheochromocytoma was in 7 cases;nonfunctioning non- adenoma was in 16 cases (13.8％ ). Conclusions It is frequent that the adrenal incidentaloma is found by health examination. The patients with adrenal incidentaloma should examine the endocrine function and identify the benign or malignant. And if necessary, surgical treatment should be performed.

Objective To investigate the changes in tumor necrosis factor-α(TNF-α) and plasminogen activator inhibitor(PAI) in the presence of obstructive sleep apnea syndrome(OSAS) in patients with type 2 diabetes mellitus,and to investigate if that 2 inflammatory factors is associated with hypoxemia during sleep.Methods Fiftyfour patients with type 2 diabetes mellitus hospitalized for glycemic control were subgrouped into 27 patients with OSAS (group O) and 27 patients without OSAS (group N).26 people without diabetes and OSAS were selected from a health check-up program to serve as control group (group C).Serum TNF-α and PAI levels were measured by commercial ELISA kits.Apnea hypopnea index (AHI),the lowest pulse oxygen saturation (LSpO2) at night were detected by portable sleep monitor.The relativity regarding TNF-α,PAI,homeostasis model assessment for insulin resistance (HOMA-IR),fasting blood glucose(FBG),AHI,LSpO2,and age was discussed.TNF-α and PAI were regard as dependent variables,and FBG,HOMA-IR,AHI,LSpO2,and age as independent variables in multivariate stepwise linear analysis.Results The levels of HOMA-IR,TNF-α,PAI in group O [2.69 ± 1.53,(1.97 ±0.13) ng/ml,and (2.27 ± 0.85) ng/ml] were higher than the those in other 2 groups,and those in group N [1.70 ± 0.88,(1.09 ±0.29) ng/ml,and (1.59 ± 0.13) ng/ml] were higher than group C [1.15 ± 0.67,(0.73 ± 0.19) ng/ml,and (0.89 ±0.25) ng/ml].The levels of FBG in the 2 diabetic groups were higher than those in group C.The level of AHI in group O was higher than that in group N and group C,while LSpO2 in group O was lower than that in group N and group C.Spearman univariate analysis showed that TNF-α and PAl both were associated positively with HOMA-IR,FBG,and AHI,while negatively with LSpO2.Multivariate stepwise linear analysis denoted that TNF-α was independently associated with AHI,FBG,while PAI was independently associated with AHI and HOMA-IR.Conclusions Patients with diabetes and OSAS manifest raised level of chronic inflammatory activity,and therefore,OSAS might be implicated in the pathogenesis of chronic complication of patients with type 2 diabetes.

ObjectiveTo explore the prevalence of thyroid nodules and metabolic syndrome,and to analyze the correlation between thyroid nodules and the components of metabolic syndrome.MethodsThis cross-sectional study included 8 217 people in our hospital health check-up center.Height,body weight,blood pressure,blood glucose,lipid profile,and liver function were measured and ultrasonic scanning of thyroid was performed.Metabolic syndrome was diagnosed according to criteria of CDS/2004.Results ( 1 ) The prevalence of thyroid nodules was 42.1％.The prevalence in women (49.6％) was significantly higher than that in men( 38.4％,P＜0.01.),and it was progressively increased with aging in both sexes.(2) The overall prevalence of metabolic syndrome was 21.7％.The prevalence in men( 28.5％ ) was significantly higher than that in women( 12.8％,P＜0.01 ),and was increased with age until 70 years old.( 3 ) Body mass index,systolic pressure,diastolic pressure,blood glucose,triglyceride in subject with thyroid nodules (TN) were higher than those in subjects without ( non-TN,P＜0.05 ).No difference in the levels of HDL-C was found between cases with TN and non-TN ( P＞0.05 ).(4) Logistic regression analysis revealed that the existence of thyroid nodules was significantly associated with overweight/obesity ( OR =1.263,95 ％ CI 1.134-1.407 ) after adjusting age and sex.Conclusion( 1 ) The prevalences of thyroid nodules and metabolic syndrome are high,and both prevalence increase with advancing age.(2) Obesity or overweight might be a risk factor for the development of thyroid nodules.

Objective To characterize the baseline status of Chinese diabetic patients based on data derived from Chinese cohort from SOLVETM study.Methods Patients with type 2 diabetes initiating basal insulin detemir at the decision of the physician were eligible for the study.Data on demographics,medical history,glycemic profile and treatment regimen at baseline were collected by physicians.Results A total of 3272 patients [female 42％,male 58％,mean age (56.2 ± 10.8) years] were included in the study.Their BMI was (25.3 ± 3.3) kg/m2.The duration of diabetes was 4.0 (0.1-27.0) years,and the duration of treatment with oral antidiabetic drugs (OADs) was 3.0(0.0-20.2) years.The proportions of subjects with diabetic macro-and micro-vascular complications were 15.8％ (515 cases) and 27.1％ (866 cases),respectively.The hemoglobin Al c (HbAl c) at baseline was (8.33 ± 1.70) ％,and the fasting blood glucose (FPG) was (9.5 ± 2.6) mmol/L.Conclusions A large proportion of patients with type 2 diabetes remain in poor glycemic control,and the prevalence of diabetic complications is high,which requires optimal therapeutic strategy for the patients with suboptimal glycemic control.

ObjectiveTo investigate the positive rate of thyroid peroxidase antibody(TPO-Ab) in the diabetic in-patients. MethodsThe positive rates of thyroid peroxidase antibody ( TPO-Ab ) was measured in 1884 subjects, including 1508 type 2 diabetes mellitus ( T2DM ), 76 classic typetype 1 diabeties( T1 DM ), 44 latent autoimmune diabetes in adults (LADA) and 256 "untype" diabetics ( NTDM ). Clinical data were registered and analyzed. Results( 1 )The positive rates of TPO-Ab were 14. 59％ in T2DM(220/1508) ,42. 11％ in T1DM (32/76) ,31.25％ in NTDM ( 80/256 ), 63.64％ in LADA group ( 28/44 ), respectively. The positive rate of T2DM was significantly lower than that of LADA ( P ＜ 0. 05 ), but no significant difference was found in the coparison between T1 DM and NTDM ( P ＞ 0. 05 ). ( 2 ) There were no significant differences between LADA and NTDM groups in the comparison of age, course of disease and BMI ( Ps ＞ 0. 05 ). Conclusion①The positive rate of TPO-Ab in NTDM was significantly higher than that of T2DM, whereas significantly lower than that of T1 DM and LADA.②The positive rate of TPO-Ab was highest in LADA, which indicate that LADA and AIT might have the common etiological mechanisms. ③There is a consisted increasing trend in the positive rate of TPO-Ab from T2DM ,NTDM,and classic T1DM to LADA.

A total of 118 patients with type 2 diabetes mellitus were divided into acarbose treatment group ( A group,n =58 ) and no acarbose treatment group ( B group,n =60),and 57 healthy subjects were used as control group (C group).The quantification of fecal bifidobacteria and enterococcus faecalis in these subjects was made by realtime PCR.The results showed that fecal bifidobacteria contents in A and B groups were lower and enterococcus faecalis contents were higher compared with C group.After four weeks of intervention,fecal bifidobacteria contents in A and B groups increased ( P＜0.01 ),especially in A group,while enterococcus faecalis contents decreased ( P＜0.05 )compared with the baseline.Univariate correlation analysis showed that bifidobacteria content was negatively associated with lipopolysaccharides(LPS),advanced glycation index,high sensitive C reactive protein ( hs-CRP),and body mass index ( BMI ) at baseline ( P＜0.05 or P＜0.01 ).The enterococcus faecalis content was positively associated with levels of monocyte chemoattractant protein-1,LPS,tumor necrosis factor-α,hs-CRP,plasminogen activator inhibitor-1,BMI,and HbA1c (P ＜0.01 ).After four weeks of intervention,the above associations disappeared.Stepwise multivariate regression showed that basal BMI,HbA1c,and age contributed to the increase in the number of enterococcus faecalis,and BMI negatively contributed to the decrease in number of bifidobacteria.

Objective To evaluate the effect of acarbose on the circulating concentration of inflammatory factors in patients with type 2 diabetes mellitus(T2DM). Methods Total 118 patients with T2DM who did not take acarbose before enrollment within 4 weeks were recruited by a randomizing formula into 2 groups ( group A and B). 57 healthy subjects were included into group C as control. After excluding those of inadequate samples, 57 patients with T2DM were enrolled into group A in which acarbose was prescribed 50 mg three times a day, 59 patients with T2DM were enrolled into group B in which acarbose was not given and other hypoglycemic approaches were similar to group A. Serum samples at the time of enrollment and at the end of 4 weeks intervention were collected and stored in refrigerator at -80℃ until analysis. Analysis of biochemical indexes was performed in central lab of the institution,inflammatory factors were determined with commercial ELISA kits. Results (1) The metabolic indexes were significantly decreased after intervention in two diabetic groups. (2) The baseline levels of monocyte chemoattractant protein-1 (MCP-1), tumor necrosis factor-α( TNF-α), prothrombin activator inhibitor-1 (PAI-1), lipopolysaccharide (LPS), high sensitive C reactive protein ( hs-CRP), and advanced glycation index (AGI) in diabetic patients were significantly higher than in group C MCP-1 [( 463.4± 187.1 vs 267.1 ± 158.3 ) pg/ml, TNF-α( 12.07 ± 19.59 vs 4.18 ±3.03 ) pg/ml, PAI-1 ( 2.47 ± 1.87 vs 1.38 ± 2.37 )ng/ ml, LPS ( 130.6 ± 128.5 vs 29.39 ± 17.93 ) pg/ml, hsCRP(4.25 ±2.29 vs 2.11 ± 1.07 ) μg/ml, AGI (3.78 ± 2.61 vs 0. 74 ± 0. 15 ) AU, all P ＜ 0. 05]. (3) Repeated measurement ANOVA analysis showed that after four weeks of intervention, MCP-1 [F( 1,106 ) = 19. 830, P＜0.001],LPS[F(1,106)=7.815, P＜0.01], PAI-1 [F(1,106)= 7.792, P＜0.01], TNF-α[F(1,106=24. 656, P=0.001 )] ,AGI[F( 1,106)= 12. 971 ,P=0. 01] decreased significantly in group A than in group B. Although hsCRP decreased in both group A and group B, but the trend was not different [F( 1,102 )= 0. 915, P = 0. 342].Conclusion The levels of inflammatory factors were elevated in patients with type 2 diabetes mellitus, which could be mostly reduced by acarbose.