Objective To elucidate the regulatory mechanism of hepatocyte nuclear factor 1α(HNF1A)in inducing human embryonic stem cells(hESCs)towards insulin producing cells(IPCs)differentiation.Methods An optimized stepwise protocol was implemented to generate definitive endoderm-derived IPCs.Dynamic HNF1A expression patterns were systematically monitered by qRT-PCR and Western blot.In the third stage(S3)of differentiation,cells were subjected to lentiviral-mediated interventions:respectively HNF1A knockdown(si-HNF1A)with scramble control(si-NC),and HNF1A over expression(oe-HNF1A)with empty vector control(oe-NC).Quantitative analysis of pancreatic lineage markers was performed by qRT-PCR.Glucose stimulated insulin secretion(GSIS)was assessed using ELISA under low glucose(LG)and high glucose(HG)conditions.Results Both HNF1A mRNA and protein levels demonstrated stage-dependent elevation,reaching peak expression at S3 relative to S1(P<0.05).Genetic silencing of HNF1A significantly suppressed key β-cell markers such as Pancreatoduodenal homeobox protein 1,GluT2,Ins compared to controls(P<0.05).Conversely,HNF1A overexpression enhanced transcriptional activation of these markers.Ins secretion increased stimulated by HG than LG in si-NC group.Functional analysis revealed impaired GSIS in si-HNF1A compared with si-NC group(P<0.05),whereas oe-HNF1A cells exhibited augmented GSIS capacity.Conclusions HNF1A positively regulates the IPC differentiation in hESCs,which may play a vital role in potentiating glucose-responsive insulin secretion.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective To elucidate the regulatory mechanism of hepatocyte nuclear factor 1α(HNF1A)in inducing human embryonic stem cells(hESCs)towards insulin producing cells(IPCs)differentiation.Methods An optimized stepwise protocol was implemented to generate definitive endoderm-derived IPCs.Dynamic HNF1A expression patterns were systematically monitered by qRT-PCR and Western blot.In the third stage(S3)of differentiation,cells were subjected to lentiviral-mediated interventions:respectively HNF1A knockdown(si-HNF1A)with scramble control(si-NC),and HNF1A over expression(oe-HNF1A)with empty vector control(oe-NC).Quantitative analysis of pancreatic lineage markers was performed by qRT-PCR.Glucose stimulated insulin secretion(GSIS)was assessed using ELISA under low glucose(LG)and high glucose(HG)conditions.Results Both HNF1A mRNA and protein levels demonstrated stage-dependent elevation,reaching peak expression at S3 relative to S1(P<0.05).Genetic silencing of HNF1A significantly suppressed key β-cell markers such as Pancreatoduodenal homeobox protein 1,GluT2,Ins compared to controls(P<0.05).Conversely,HNF1A overexpression enhanced transcriptional activation of these markers.Ins secretion increased stimulated by HG than LG in si-NC group.Functional analysis revealed impaired GSIS in si-HNF1A compared with si-NC group(P<0.05),whereas oe-HNF1A cells exhibited augmented GSIS capacity.Conclusions HNF1A positively regulates the IPC differentiation in hESCs,which may play a vital role in potentiating glucose-responsive insulin secretion.

Body weight abnormalities, including overweight, obesity, and underweight, have become a dual public health challenge in Chinese adults: overweight and obesity lead to a variety of chronic complications, while underweight increases the risks of malnutrition, sarcopenia, and organ dysfunction. To systematically address these issues, multidisciplinary experts in endocrinology, sports science, nutrition, and psychiatry from various regions have held multiple weight management seminars. Based on the latest epidemiological data and clinical evidence, they expanded the guideline to include assessment and intervention strategies for underweight, in addition to the core content of obesity management. This guideline outlines the etiological mechanisms, evaluation methods, and multidimensional management strategies for overweight and obesity, covering key areas such as diagnosis and assessment, medical nutrition therapy, exercise prescription, pharmacological intervention, and psychological support. It is intended to provide a scientific and standardized approach to weight management across the adult population, aiming to curb the rising prevalence of obesity, mitigate complications associated with abnormal body weight, and improve nutritional status and overall quality of life.

Objective:To investigate the impact of daily step count on glycemic outcomes in community residents with impaired glucose tolerance (IGT).Methods:This was a prospective cohort study, in October 2018, 204 residents who met the criteria of IGT were recruited in the Shijingshan District in Beijing. The subjects were tested for fasting blood glucose, oral glucose tolerance test 2-hour blood glucose (2hBG), glycated hemoglobin A 1c (HbA 1c), lipid profile, liver and kidney function, as well as measurements of height, weight and waist circumference. A dedicated mobile application was used to deliver prediabetes health knowledge monthly. Online guidance was provided to answer questions and daily step count was collected using the application. Three years later, a follow-up was conducted to assess the participants′ glycemic outcomes and other indexes, and a total of 142 participants completed the follow-up review. According to daily step count, the subjects were categorized into high step count group (42 cases,>7 000 steps daily), moderate step count group (54 cases, 5 000-7 000 steps daily), and low step count group (46 cases,<5 000 steps daily). Subjects were categorized into diabetes group (30 cases), prediabetes group (77 cases) and normal glucose tolerance group (35 cases) with glycemic outcomes. Independent sample t test was used to compare the differences in blood glucose, blood lipids, and step counts between the two groups. Kruskal-Wallis H test or one-way ANOVA was used to compare the differences in blood glucose, blood lipids, and step counts between multiple groups. The χ2 test was used to compare the differences in glycemic outcomes between multiple groups. Multivariate logistic regression analysis was used to assess the impact of daily step counts and body mass index on glycemic outcomes. Linear regression analysis was used to evaluate the relationship between daily step counts and 2 h BG. Results:A total of 142 participants completed the 3-year follow-up, including 43 males and 99 females, with a mean age of (60.15±5.67) years. At baseline, males had significantly higher body mass index, waist circumference, and fasting blood glucose when compared to those in females [(26.97±2.43) vs (24.89±2.93) kg/m 2, (92.68±7.75) vs (83.83±8.60) cm, (5.83±0.61) vs (5.62±0.52) mmol/L], the total cholesterol and HDL-C were also significantly lower in males than those in females [(5.10±1.16) vs (5.55±0.95) mmol/L, (1.35±0.34) vs (1.56±0.35) mmol/L] (all P<0.05). After 3-year follow-up, 21.1% (30/142) of IGT participants progressed to diabetes, with an annual conversion rate of approximately 7%. The normal glucose tolerance group showed significantly higher daily step counts when compared with the prediabetes and diabetes groups [(7 886±2 867) vs (5 981±2 655) vs (4 117±2 674) steps] ( H=31.778, P<0.001). Individuals with higher daily step counts exhibited lower body mass index, 2 h BG, and HbA 1c level when compared with those in the ones with moderate and low step counts [(24.26±3.09) vs (25.44±3.38) vs (26.26±3.59) kg/m 2, (7.50±1.71) vs (9.15±3.30) vs (11.19±3.84) mmol/L, 5.97%±0.46% vs 6.14%±0.99% vs 6.40%±0.96%] (all P<0.05). Higher step count was positively correlated with the reversal of prediabetes to normal blood glucose levels (moderate step count, OR=0.297, 95% CI: 0.109-0.804; low step count, OR=0.055, 95% CI: 0.010-0.287), lower daily step count correlated positively with prediabetes progressing to diabetes ( OR=4.857, 95% CI: 1.140-20.689) (all P<0.05). For every additional 1 000 steps per day, the 2 h BG decreased by 0.5 mmol/L. Conclusion:As daily step count increases, the glucose metabolism improves in IGT community residents. Higher daily step count is associated with reversal of IGT to normal glucose tolerance, while lower daily step count may be associated with the progression of IGT to diabetes.

The prevalence of diabetes mellitus(DM)and prediabetes(Pre-DM)is high in China.Among them,the number of elderly Pre-DM patients is huge.Individualized management tailored to the characteristics of the older adults can prevent or delay their transition to DM.Comprehensive management should also be carried out on the risk factors and potential adverse clinical outcomes of Pre-DM in the elderly to improve quality of life.This article reviews the characteristics of natural course and management strategies of Pre-DM in older adults.

Basal insulin is essential for blood glucose management. However, its clinical application in China faces multiple challenges such as delayed initiation, low initial dosage, and inadequate dose adjustments. The BEYOND series of studies were conducted to provide an evidence-based basis for optimizing basal insulin use in China. Moreover, basal insulin is advancing towards weekly preparation. Phase Ⅲ clinical trials have demonstrated that weekly basal insulin is both effective and safe, and its reduced injection frequency may help address the challenges associated with basal insulin use in China.

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.

Islet β cell protection is one of the key strategies for diabetes treatment. The new antidiabetic drug sodium-glucose cotransporter 2(SGLT2)inhibitor decreases blood glucose by inhibiting glucose reabsorption in the renal tubule, independent of insulin. Various clinical studies have shown that SGLT2 inhibitors improve β cell function. Furthermore, animal experiments have indicated that SGLT2 inhibitors increase β cell mass. SGLT2 inhibitors promote islet regeneration through stimulating β cell proliferation, inhibiting β cell apoptosis and dedifferentiation, enhancing transdifferentiation of α cells to β cells, and initiating progenitor-derived β cell neogenisis. Indirect effects of metabolic improvement(i.e.lowering glucose, losing weight, improving lipid metabolism), inhibiting inflammatory reaction, inducing glucagon-like peptide-1 secreted from α cells, and regulating gene changes might be involved in the β cell protection of SGLT2 inhibitors.

Objective:To survey the status of illness and consultation within two weeks among residents in a community in Chengdu.Methods:A multi-stage stratified random sampling was used to carry out a questionnaire survey among the residents in a community in Chengdu during March to April 2019. The disease status, disease severity and consultation within two weeks were surveyed, and influencing factors of two-week illness were analyzed with logistic regression.Results:Among 2 714 participants, 715 had illness (900 times) within two weeks, with a two-week prevalence rate of 26.3%. The main symptoms were dizziness (6.4%, 58/900), cough (6.2%, 56/900), lumbago and leg pain (4.9%, 44/900), palpitations (3.3%, 30/900) and headache (3.1%, 28/900). The three most common diseases were hypertension (38.3%, 345/900), diabetes (19.3%, 174/900) and common cold (6.4%, 58/900). In this survey, the rate of two-week in bed was 20.6‰(56/2 714), and the rate of two-week off work was 4.8‰(13/2 714). Age, gender, education level and work status were the influencing factors of the illness in two weeks ( P<0.05). The choice of medical institution was also different among residents. Conclusion:The survey suggest that primary care should focus on the key groups of residents in the community such as elderly, women, low education level, retirement and unemployed; and it is necessary to strengthen the primary care institutions and two-way referral system of health care.