Objective To construct a nomogram prediction model for predicting hemoglobin A1c(HbA1c)failure in type 2 diabetes mellitus(T2DM)patients.Methods A total of 936 inpatients with T2DM admitted to the Department of Endocrinology of the Affiliated Hospital of Shandong Second Medical University from January 2021 to January 2022 were selected as the research objects and divided into the non-standard group(HbA1c≥7%,n=801)and the standard group(HbA1c<7%,n=135).Univariate analysis was used to screen the related factors of HbA1c failure.Logistic regression multivariate model was used to analyze the influencing factors of HbA1c failure in T2DM patients.The R language was used to construct a nomogram,and the area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive ability of the model.The C-index and Hosmer-Lemeshow test were used to evaluate the discrimination and calibration of the model.Results There were statistically significant differences in triglyceride(TG),low-density lipoprotein cholesterol,direct bilirubin,urinary albumin/creatinine ratio(UACR),self-monitoring of blood glucose(SMBG),meat and vegetable pairing,hot pot,whole grain and animal viscera consumption between the two groups(P<0.05).Logistic regression analysis showed that TG(OR 1.699,95%CI 1.298～2.222),UACR(OR 1.003,95%CI 1.001～1.005),SMGB(OR 0.480,95%CI 0.313～0.735),more meat and less vegetables(OR 1.432,95%CI 1.062～1.931)were the influencing factors of HbA1c failure.The AUC of the nomogram prediction model based on the influencing factors was 0.711,with C-index 0.710(95%CI 0.663～0.758)and good calibration(χ2=11.185,P=0.191).Conclusions The nomogram prediction model for HbA1c failure in T2DM patients established based on TG,UACR,SMGB,meat and vegetarian mix has good discrimination and calibration,which can provide certain reference value for warning of poor blood glucose control.

Objective To explore the therapeutic effect and influencing factors of individualized exercise under continuous glucose profile in patients with typ 2 diabetes mellitus(T2DM).Methods A total of 110 patients with T2DM who were treated in the Department of Endocrinology of our hospital from December 2021 to July 2022 were randomly divided into conventional group and personalized group,with 55 cases in each group.The conventional group was given routine health exercise guidance,the personalized group was given a personalized exercise program.Repeated measurement analysis of variance was used to evaluate the improvement of blood glucose related indicators in the two groups at 3 and 6 months after intervention.Logistic regression was used to analyze the influencing factors of blood glucose(BG)control after 6 months of intervention.Results After 3 and 6 months of intervention,FBG,2 hBG,hemoglobin A1c(HbA1c),mean blood glucose(MBG)and time above target range(TAR)in the personalized group and conventional group were all lower than those before intervention(P<0.05).Time in range(TIR)of glucose within 24 h was higher than that before intervention(P<0.05).After 3 and 6 months of intervention,FBG,2 hBG,HbA1c,MBG and TAR in the personalized group were lower than those in the conventional group at the same time point(P<0.05),and TIR was higher than that in the conventional group at the same time point(P<0.05).After 6 months of intervention,the BG control rate in the personalized group was higher than that in the conventional group(P<0.05).Logistic regression analysis showed that the DM duration,exercise intervention methods and TIR were the influencing factors of BG control.Conclusions Exercise guidance is an effective intervention method to control diabetes.Compared with conventional exercise guidance,personalized exercise program has a better effect on controlling patients'BG level,and has a better effect on patients with short course of disease.

Objective To investigate the correlation between hemoglobin A1c(HbA1c)levels and excessive daytime sleepiness(EDS)in patients with type 2 diabetes mellitus(T2DM).Methods A total of 132 T2DM patients and 40 healthy people(NC group)who were treated in the outpatient department of Nanjing Meishan Hospital from December 2020 to December 2022 were selected.General clinical data of the subjects were collected,and their Epworth sleepiness scale(ESS)scores,Pittsburgh sleep quality index(PSQI),and apnea-hypopnea index(AHI)were measured.Based on ESS scores,T2DM patients were divided into simple T2DM group(ESS score<9,n=99)and EDS group(ESS score≥9,n=33)according to ESS score.The baseline data were compared for each group.Spearman correlation analysis and multivariate logistic regression model were used to evaluate the correlation between HbA1c levels and EDS.The receiver operating characteristic(ROC)curve was used to calculate the area under the curve(AUC)to evaluate the predictive value of HbA1c levels for EDS.Results HbA1c,fasting plasma glucose,AHI index and PSQI score in EDS group were higher than those in T2DM and NC group(P<0.05).Spearman correlation analysis showed that ESS score was positively correlated with HbA1c in T2DM patients(P<0.05).Multivariate logistic regression analysis revealed that elevated HbA1c levels emerged as a significant and independent risk factor for the onset of EDS.The ROC curve indicated that the AUC of HbA1c for predicting EDS was 0.736.Conclusions There is an independent positive correlation between HbA1c levels and EDS in T2DM patients,which provides clues for early identification and treatment of EDS in clinical practice.

Objective To analyze the risk factors of multi-drug resistant bacterial infection of urinary system in type 2 diabetes mellitus(T2DM)patients and establish a decision tree model.Methods A total of 371 patients with T2DM were selected and divided into infected(IF,n=47)group and non-infected(NIF,n=324)group.The influencing factors of multi-drug resistant urinary system infection were analyzed in patients with T2DM.IBM SPSS Modeler was used to establish a decision tree model for predicting multi-drug resistant urinary system infection.Results The infection rate of multidrug resistant bacteria in urinary system was 12.67%.Age,female proportion,DM duration,use of antibiotics before admission,length of hospital stay,and hemoglobin A1c(HbA1c)in IF group were higher than that in NIF group(P<0.05).Logistic regression analysis showed that age≥60 years old(OR 2.629,95%CI 1.349～5.125,P=0.005),woman(OR 3.044,95%CI 1.506～6.151,P=0.002),DM duration≥10 years(OR 3.320,95%CI 1.671～6.593,P=0.001),length of hospital stay>15 days(OR 2.406,95%CI 1.237～4.682,P=0.010)and HbA1c>8.02%(OR 2.363,95%CI 1.210～4.617,P=0.012)were influencing factors for multidrug-resistant bacteria infection of urinary system.Decision tree model showed that sex was the most important factor in urinary multidrug-resistant infections.Receiver operating characteristic curve results showed that the area under the curve value of Logistic regression model was slightly higher than that of decision tree(Z=1.465,P=0.143).Conclusions Age,sex,DM duration,length of hospital stay,and HbA1c are the influencing factors of T2DM patients complicated with urinary multi-drug resistant bacteria infection,the decision tree model established in this study has good risk prediction efficiency,which is helpful for early clinical identification of high-risk patients with multi-drug resistant bacteria infection of urinary system.

Objective To explore the interaction between vitamin D(VD)and hemoglobin A1c(HbA1c)and its relationship with type 2 diabetes mellitus(T2DM)combined with osteoporosis(OP).Methods A total of 228 T2DM patients admitted to our hospital from February 2020 to April 2023 were selected and divided into OP group(n=65),osteopenia group(n=89)and T2DM group(n=74)according to the standard deviation of bone mineral density(BMD)decline.Logistic regression was used to analyze the relationship of 25-hydroxyvitamin D[25(OH)D]and HbA1c with OP.Restricted cubic spline model was used to analyze the dose-response relationship of 25(OH)D and HbA1c with OP in different genders.Results DM duration,fasting plasma glucose(FPG),C-telopeptide of type Ⅰ collagen,fasting insulin(FIns)and 2 hIns in the T2DM,osteopenia and OP groups were increased(P<0.05),while osteocalcin,25(OH)D,lumbar L1～L4,BMD of femoral neck and its proximal end,and total hip were decreased(P<0.05).The age and HbA1c in OP group were higher than those in T2DM and osteopenia groups(P<0.05),and the proportion of taking calcium preparations was lower than that in T2DM group(P<0.05).Logistic regression analysis showed that after adjusting for confounding factors,serum 25(OH)D(OR 0.145,95%CI 0.036～0.204)and HbA1c(OR 1.108,95%CI 1.013～1.140)were influencing factors of OP in T2DM patients.There was no nonlinear dose-response relationship between 25(OH)D,HbA1c and OP both in male and female T2DM patients.There were multiplication and additive interactions between serum 25(OH)D and HbA1c(P<0.05).Conclusions There is a multiplicative and additive interaction between serum 25(OH)D and HbA1c,both of which are risk factors for concurrent OP in T2DM patients.

Objective To investigate the expression and regulatory role of adenosine triphosphate binding transporter C4(ABCC4)in patients with type 2 diabetes mellitus(T2DM)and macrovascular disease(MD).Methods A total of 137 patients with T2DM were enrolled in this study from Zhongnan Hospital of Wuhan University during March 2015 and March 2017.All the participants were divided into T2DM group(n=64)and T2DM with MD group(n=73)according to the presence or absence of MD.Another 75 healthy subjects were selected as normal control(NC)group.The general data and biochemical indicators were collected and compared among the three groups.The mRNA expression level of ABCC4 was detected by real-time fluorescence quantitative PCR(qPCR),and the correlation between each indicator and ABCC4 mRNA was analyzed.ABCC4 knockout stable HepG2 cell line was constructed and transcriptome sequencing analysis(RNA-Seq)was performed.Results BMI,FPG,TC,TG and LDL-C were higher,while HDL-C was lower in T2DM and MD groups than in NC group(P<0.05).The expression levels of SBP and ABCC4 mRNA were higher in MD group than in T2DM and NC groups(P<0.05).Spearman correlation analysis showed that the level of ABCC4 mRNA was negatively correlated with cholinesterase(r=-0.359,P<0.05)and positively correlated with lipoprotein(a)(r=0.241,P<0.05).A total of 280 differentially expressed genes were screened out by RNA-Seq in ABCC4 knockout cell lines.GO and KEGG analysis showed that these differentially expressed genes were mainly enriched in biological functions such as vesicle transport and growth factor activity.It is involved in cytokine receptor interaction,glycation products-receptor for advanced glycation end products signaling pathway of DM complications,leukocyte transendothelial migration and other pathways.Conclusions ABCC4 is elevated in patients with T2DM and macrovascular disease.ABCC4 might play a role in occurrence and development of macrovascular disease through affecting the biological function of membrane,inflammation and glycation metabolism pathways.

Fasting plasma glucose(FPG)has been widely used in the diagnosis of diabetes mellitus(DM)for its advantages of rapidity,economy,simplicity and acceptability.Hemoglobin A1c(HbA1c)has the advantages of being simple,stable,accurate and unaffected by related factors,and has been used in the diagnosis of DM since it was standardized.However,the value of FPG and HbA1c in the early diagnosis of diabetes have been controversial.The purpose of this paper is to explore the value of the two in the early diagnosis of diabetes.

Gut microbiotadysbiosisis closely related to the development of type 2 diabetes mellitus(T2DM).Fecal microbiota transplantation(FMT)can reverse gut microbiota imbalance to a certain extent and improve intestinal barrier and metabolism,that is expected to be a new non-invasive treatment for the prevention and treatment of T2DM.This article reviews the research progress of FMT in the prevention and treatment of T2DM.

Objective To explore the effect of SGLT2 inhibitor(SGLT2i)Dagaglipzin(Dap)on mitochondrial autophagy in cardiomyocytes in diabetic cardiomyopathy(DCM)by regulating mitochondrial membrane transporter TOM20.Methods H9C2 cardiomyocytes cultured in vitro were divided into normal control(Con)group,HG+PA group,knockout TOM20(HG+PA+siTOM20)group,knockout control(HG+PA+siNC)group,Dap intervention(HG+PA+Dap)group,and solvent control(HG+PA+DMSO)group.The expression of TOM20 was predicted by RNA-seq second-generation sequencing in HG+PA group.The expression of TOM20 and mitochondrial autophagy related proteins was detected by Western blot,the mitochondrial membrane potential was measured by immunofluorescence staining,and the mitochondrial autophagy level was evaluated by transmission electron microscopy.Results Compared with Con group,protein expressions of TOM20 and P62 were increased(P<0.05),while protein expressions of ULK1,Parkin,Beclin1 and LC3-B were decreased(P<0.05),mitochondrial membrane potential was destroyed,the number of mitochondrial autophagosomes was reduced,and autophagy activity was inhibited in HG+PA group.Compared with HG+PA+siNC group and HG+PA+DMSO group,the protein expressions of TOM20 and P62 were decreased(P<0.05),while the protein expressions of ULK1,Parkin,Beclin1 and LC3-B were increased(P<0.05),the damage of mitochondrial membrane potential decreased,the number of mitochondrial autophagosomes increased,and the inhibition of autophagy activity reversed in HG+PA+siTOM20 and HG+PA+DAPA groups.Conclusions SGLT2 inhibitors appear to partially restore mitochondrial function in diabetic cardiomyopathy by suppressing TOM20 expression,potentially through activation of mitochondrial autophagy.

The theory of fetal metabolic programming indicates that an adverse developmental environment during the mother's pregnancy can significantly increase the risk of chronic metabolic diseases such as obesity,diabetes mellitus and cardiovascular diseases in the offspring in adulthood.Exercise during pregnancy can effectively improve and even reverse the disorders of glycolipid metabolism in offspring caused by poor nutritional environment during pregnancy.The placenta serves as a crucial interface facilitating the exchange of substances and signal molecules between mother and baby,and also plays an important role in mediating fetal metabolic programming and early life intervention.This article reviews the regulatory role of placental function in maternal motion-mediated fetal metabolic programming.