We report a case of immunotherapy-related diabetes mellitus with ketoacidosis(CPI-DM)induced by programmed death receptor 1(PD-1)inhibitor in the treatment of small cell lung cancer.Incancer patients treated with immune checkpoint inhibitors,clinicians should pay attention to blood glucose and diabetes-related clinical symptoms,in order to detect and treat immune checkpoint inhibitor-induced diabetes in time.

Objective To investigate the association between neutrophil-lymphocyte ratio(NLR)and diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods 548 T2DM patients hospitalized in The Second People's Hospital of Liaocheng from January 2022 to March 2023 were divided into control(Con,UACR≤30 mg/g,n=393)group,microalbuminuria(Mic,UACR 30～300 mg/g,n=103)group and macroalbuminuria(Mac,UACR＞300 mg/g,n=52)group according to the levels of UACR.Results In the Con,Mic and Mac groups,blood urea nitrogen(BUN),serum creatinine(Scr),serum uric acid(SUA),cystatin C(CysC)and total cholesterol(TC)increased successively(P＜0.05),and estimated glomerular filtration rate(eGFR)decreased successively(P＜0.05).The systolic blood pressure(SBP),NLR,neutrophil count and lymphocyte count(Lym)in the Mic and Mac groups were higher than those in the Con group(P＜0.05).The age,DM duration and hypertension duration in the Mic group were higher than those in the Con group(P＜0.05),and the hemoglobin(Hb)in the Mac group was lower than that in the Con group(P＜0.05).Logistic regression analysis showed that Hb,Lym,age,SBP,NLR,BUN,Scr,eGFR,SUA,CysC,DM duration,hypertension,hypertension duration,and the use of antihypertensive drugs were all influencing factors for the occurrence of DKD.After adjusting for multiple confounding factors,it was shown that NLR(OR 1.223,95%CI 1.082～1.382),SBP(OR 1.018,95%CI 1.005～1.031),and eGFR(OR 0.973,95%CI 0.954～0.991)remained the influencing factors of DKD.In male DKD patients across different age groups,with BMI＜29.9 kg/m2,non-smoking,non-drinking and without comorbid diabetic retinopathy and hypertension,the NLR was significantly higher compared to the Con group(P＜0.05).However,no interaction effects were observed between these variables and NLR in relation to DKD(P＞0.05).Conclusions NLR is closely related to the occurrence and development of DKD.

Insulin resistance induced by chronic inflammation plays a key role in the progress of metabolic diseases,including obesity,type 2 diabetes and fatty liver disease.In recent years,the process of T helper 17(Th17)cells inducing insulin resistance during inflammation has attracted much attention.Th17 cells can induce inflammatory responses in different insulin target organs(adipose tissue,liver,skeletal muscle,heart and brain)through various pathways,leading to damage to the insulin signal transduction pathway and thus causing insulin resistance.

Type 2 diabetes mellitus(T2DM)is a chronic metabolic disorder caused by a combination of genetic and environmental factors.The epigenetic transcriptional modifications after RNA transcription can affect gene expression and glucose homeostasis.N6-methyladenine(m6A),as an RNA methylation modification,plays an important role in the pathogenesis of T2DM.This article reviews the research progress of m6A methylation in T2DM.

DKD is a common microvascular complication of diabetes mellitus and the main cause of chronic kidney disease in China.Asprosin is a novel adipokine,which plays an important regulatory role in IR,glucose and lipid metabolism,inflammatory response and mitochondrial function.Asprosin is closely related to diabetes mellitus,obesity and other diseases,and may be involved in the pathophysiological process of DKD.Asprosin is expected to become a new biomarker and potential therapeutic target for early screening and diagnosis of DKD.Therefore,this article reviews the research progress of Asprosin in DKD.

Objective To investigate the protective effect of Liraglutide in rats with diabetic kidney disease(DKD)by regulating the nuclear factor E2-related factor 2(Nrf2)/glutathione peroxidase 4(GPX4)ferroptosis signaling pathway.Methods Twelve male Sprague-Dawley(SD)rats were randomly divided into normal control(NC)group,DKD group,and Liraglutide treatment(Lir)group,with 4 rats in each group.The 24 hUAlb,TC,TG,LDL-C,serum creatinine(Scr),BUN,ferrous ion(Fe2+),the activity of glutathione peroxidase(GSH-Px),and malondialdehyde(MDA)were detected in each group.Hematoxylin and eosin(HE),periodic acid-Schiff(PAS),and periodic acid-silver methenamine-Masson(PASM-Masson)staining were used to observe the pathological changes of the kidneys.Immunofluorescence was performed to detect the localization and expression of reactive oxygen species(ROS)in the renal tissue.The protein expressions of Nrf2 and GPX4 were detected by Western blot.Results Compared with the NC group,the levels of 24 hUAlb,Scr,BUN,TC,TG,LDL-C,MDA,ROS,and Fe2+were increased(P＜0.05 or P＜0.01),while the expressions of GSH-Px,Nrf2,and GPX4 proteins were decreased in the DKD group(P＜0.01).Compared with the DKD group,the levels of 24 hUAlb,BUN,TC,TG,LDL-C,MDA,ROS,and Fe2+were decreased(P＜0.05 or P＜0.01),and the expressions of GSH-Px,Nrf2,and GPX4 proteins were increased in the Lir group(P＜0.01).Conclusions Liraglutide may exert a protective effect in DKD by upregulating the Nrf2/GPX4 signaling pathway and inhibiting ferroptosis.

Objective To investigate the effects and mechamism of AdipoRon on oxidative stress and autophagy in diabetic kidney tissue in diabetes mellitas(DM)mice.Methods 24 male C57BL/6 mice were divided into normal control group(NC),DM group,AdipoRon group and AdipoRon combined with 3-MA(AdipoRon+3-MA)group,each group had 6 mice.Body weight,kidney index(KW/W),FPG,FIns,serum creatinine(Scr),BUN and APN levels were measured.Renal histomorphology was evaluated by HE staining.RT-PCR was used to detect the mRNA expression of p22phox,Nrf2,NQO-1,SOD,HO-1,LC3,PINK1,Parkin.Results Compared with NC group,KW/W,FPG,BUN,Scr and the mRNA expressions of p22phox in DM group were increased(P＜0.05),while weight,FIns,APN and the mRNA expressions of Nrf2,NQO-1,SOD,HO-1,LC3,PINK1 and Parkin were decreased in DM group(P＜0.05).Compared with DM group,FIns,APN,the mRNA expressions of Nrf2,NQO-1,HO-1,SOD,LC3,PINK1 and Parkin were increased(P＜0.05),while body weight,KW/W,FPG,BUN,Scr and p22phox were decreased in AdipoRon group(P＜0.05).After 3-MA intervention,the above results were reversed.Conclusions AdipoRon can protect the kidney injury in DM mice by reducing oxidative stress and increasing the level of autophagy.Oxidative stress and autophagy are involved in the process of diabetic kidney injury.

Objective To investigate the correlation between thyroid peroxidase antibody(TPO-Ab)and renal function injury in type 2 diabetes mellitus(T2DM)patients with Hashimoto thyroiditis(HT)and euthyroidism.Methods A retrospective analysis was performed on 180 newly diagnosed T2DM patients admitted to the Department of Chengdu Second People's Hospital from January 2020 to December 2022,including 75 cases without HT(T2DM group)and 105 cases with HT and euthyroidism(HT group).The clinical features,UACR and eGFR between the two groups were compared and analyzed.Results The level of UACR in HT group was higher than that in T2DM group[22.72(17.46,43.45)vs 20.60(14.67,27.32)mg/g,P＜0.05].eGFR was lower than that of T2DM group[(87.47±14.61)vs(94.64±10.32)ml/(min·1.73 m2),P＜0.05].Correlation analysis showed that TPO-Ab was positively correlated with UACR(r=0.376,P＜0.05),and negatively correlated with eGFR(r=-0.354,P＜0.05).Multiple linear regression analysis suggested that TPO-Ab was an influential factor for UACR and eGFR.Conclusions TPO-Ab is associated with kidney injury in T2DM.HT may aggravate kidney injury in T2DM patients through TPO-Ab.

Objective To explore the influencing factors for macrosomia in pregnant women with gestational diabetes mellitus(GDM)who had isolated elevated postprandial blood glucose.Methods A total of 1188 GDM pregnant women with isolated elevated postprandial blood glucose who underwent regular prenatal examination and gave birth at the First People's Hospital of Kunshan City were enrolled in this study from January 2019 to December 2021.The age,pre-pregnancy body mass index(BMI),weight gain during pregnancy,times of pregnancy,times of delivery,fasting plasma glucose(FPG)during first trimester,glycosylated hemoglobin A1c(HbA1c)during first trimester,results of oral glucose tolerance test(OGTT),area under the curve(AUC)of OGTT time-blood glucose curve in the second trimester and neonatal birth weight were analyzed in all the participants.All the newborns were divided into macrosomia group(n=167)and non-macrosomia group(n=1021)according to the birth weight.Logistic analysis was conducted to investigate the influencing factors for macrosomia delivery in GDM pregnant women with isolated elevated postprandial blood glucose.Results The pregnancy weight gain,1,2 hPG,OGTT time blood glucose AUC,OGTT abnormal incidence,and multiparous women rate were higher in macrosomia group than in non-macrosomia group(P＜0.05).Logistic regression analysis showed that gestational weight gain,OGTT time blood glucose AUC,and multiparous women were the influencing factors for delivery of macrosomia in GDM pregnant women with isolated elevated postprandial blood glucose.Conclusions Weight gain during pregnancy,AUC of OGTT time-blood glucose curve and pregnant women are the risk factors for predicting macrosomia in GDM pregnant women with isolated elevated postprandial blood glucose.

Objective To explore the mediating effect of thyroid stimulating hormone(TSH)levels on the risk of osteoporosis(OP)in patients with T2DM and menopause.Methods A total of 179 menopausal T2DM patients who were admitted to our hospital from January 2020 to January 2023 were enrolled in this study.All the participants were divided into diabetes without complication group(T2DM group,n=95)and diabetes with complication group(Com group,n=84)according to the co-existence of complications.Logistic regression analysis was used to analyze the influencing factors for T2DM complications.According to the co-existence of OP,all the patients were divided into OP group(n=86)and Non-OP group(n=93).And the influencing factors for OP occurrence are analyzed using random forest algorithm.Logistic regression analysis was used to investigate the relationship between TSH and T2DM complications and OP.The Bootstrap method was used to analyze the mediating effect of TSH between T2DM complications and OP.Results DM duration,HbA1c,free triiodothyronine,free thyroxine,and TSH were independent influencing factors for T2DM complications(P＜0.05),while P1NP,TSH,vitamin D,and DM duration were influencing factors for the occurrence of OP.After adjusting for confounding factors,there was a negative correlation between TSH and the risk of T2DM complications(P＜0.05),and a negative correlation between TSH and OP(P＜0.05).Mediation effect analysis showed that TSH played a mediating role between T2DM complications and OP.Conclusions TSH is negatively correlated with the risk of T2DM complications and OP,and plays a mediating role between T2DM complications and OP,partially mediating the impact of T2DM complications on OP.