Objective:To assess the goal fulfillment in terms of blood glucose, blood pressure, blood lipid, and the composite indicator of these three in patients with diabetes who received intensified treatment at Peking Union Medical College Hospital and regular follow-up for 12 months, analyze the influencing factors, and explore the comprehensive management model for intensive diabetes treatment outpatient services.Methods:This study was a prospective, observational cohort study. The diabetes patients who received long-term regular follow-up at the intensive diabetes treatment outpatient clinic of Peking Union Medical College Hospital from 2012 to 2023 were selected as the research subjects. They were followed up and clinical data were collected at the 1st, 3rd, 6th, 9th, and 12th months of follow-up. The study assessed the goal fulfillment rates in terms of blood glucose, blood pressure, blood lipid, and the composite indicator of these three, with the goals of glycated hemoglobin (HbA1c)<7%, blood pressure<130/80 mmHg, and low-density lipoprotein cholesterol (LDL-C)<2.6 mmol/L. The study also analyzed the impact of factors, including gender, age, type of diabetes, duration of diabetes, body mass index, comorbidities, complications, and treatment regimens, on the outcomes of comprehensive diabetes management.Results:A total of 232 patients were included in the study, of whom 210 were with type 2 diabetes (90.5%), 13 with type 1 diabetes (5.6%), 5 with latent autoimmune diabetes of the adult (2.2%), 3 with diabetes after total pancreatectomy (1.3%), and 1 with mitochondrial diabetes (0.4%). After 3 months of intensified management, the goal fulfillment rates of blood glucose (67.7% vs. 34.1%, Kappa=0.336, P<0.001), blood pressure (53.4% vs. 37.5%, Kappa=0.159, P=0.001), blood lipid (59.1% vs. 39.2%, Kappa=0.198, P<0.001), and the composite indicator (20.7% vs. 3.0%, Kappa=0.177, P<0.001) were significantly increased. Continued treatment at 6, 9, and 12 months showed stable and sustained increases in the goal fulfillment rates of blood glucose, blood pressure, blood lipid, and the composite indicator. Logistic regression analysis showed that baseline hyperglycemia ( P=0.002), disease duration ≥5 years ( P<0.001), smoking ( P=0.009), alcohol consumption ( P=0.038), presence of diabetic complications ( P=0.001), combination therapy with oral antidiabetic drugs and insulin ( P<0.001), and use of antiplatelet drugs ( P=0.037) were risk factors for uncontrolled HbA1c. Baseline hypertension ( P<0.001), alcohol consumption ( P=0.030), and comorbid dyslipidemia ( P=0.028) were risk factors for uncontrolled blood pressure. Baseline uncontrolled LDL-C ( P=0.020) and non-use of statins ( P<0.001) were risk factors for uncontrolled blood lipid. Conclusions:Among patients with the long-term follow-up at our intensive diabetes treatment clinic, the goal fulfillment rates of blood glucose, blood lipid, blood pressure, and the composite indicator of these three are relatively higher. However, it is still necessary to improve patient compliance as much as possible, emphasize weight management, and persist on the comprehensive diabetes treatment.

Objective:To investigate the current status of sarcopenia and self-management in elderly patients with type 2 diabetes mellitus (T2DM), and to explore the identification of risk factors for sarcopenia by diabetes self-management ability.Methods:Using convenience sampling, 284 elderly patients with T2DM who visited a community health service center in Beijing from March to September 2023 were selected as subjects. The patients were screened for sarcopenia and received related health examinations based on Asian working group for sarcopenia (AWGS) 2019 Consensus. Surveys were conducted using general information questionnaire, the Summary of Diabetes Self-Care Activities measure, and other questionnaires. Patients were divided into groups according to the presence or absence of muscle attenuation (defined as suspected and confirmed sarcopenia).Results:The prevalence of muscle attenuation in the 284 elderly patients with T2DM was 48.9%, and the prevalence of sarcopenia was 15.9%. The proportions of females, patients who are over 70 years old, and patients with a sedentary lifestyle were significantly higher in the group with muscle attenuation compared with the group without muscle attenuation. High-quality protein intake, extremity skeletal muscle mass index, grip strength, and six-meter walking speed were significantly lower in the muscle attenuation group. Binary logistic regression analysis revealed that age, alcohol consumption, a sedentary lifestyle, and high-quality protein intake were influencing factors for sarcopenia in elderly patients with T2DM ( P<0.05). The total self-care scores and subtotals in exercise domains showed significant differences ( P<0.05) between patients with and without muscle attenuation. Univariate analysis indicated significant differences in self-management behaviors among patient groups stratified by grip strengths and 6-meter walk speeds ( P<0.05). Multivariate linear regression analysis showed that grip strength and 6-meter walk speed were influencing factors for exercise management behaviors in elderly patients with T2DM ( P<0.05). Conclusions The prevalence of sarcopenia in elderly patients with T2DM is relatively high, and their level of diabetes self-management is medium to low. Practitioners should pay extra attention to patients who are over 70 years old, with sedentary habits, with low intake of high-quality protein, and females. It's recommended to use grip strength and 6-meter walk speed tests as initial screening tools for sarcopenia in elderly patients with T2DM, in order to identify risks early and implement targeted health management to promote the development of good self-management behaviors among patients.

Objective:To investigate the predictive performance of triglyceride and triglyceride glucose (TyG) index in the first trimester for the onset of gestational diabetes mellitus (GDM).Methods:Pregnant women who visited Beijing Chaoyang Maternal and Child Health Care Hospital and Beijing Haidian Maternal and Child Health Care Hospital from 2019 to 2022 were prospectively included. Concurrently, 78 healthy non-pregnant women who visited the Department of Endocrinology of Peking Union Medical College Hospital were included. The clinical characteristics and laboratory biomarkers including fasting blood glucose and blood lipid profiles were collected at the first visit in early pregnancy. Oral glucose tolerance test (OGTT) was performed at 24-28 weeks of gestation for GDM screening. Multivariate Logistic regression analysis was used to determine the association between biomarkers in early pregnancy and the risk of GDM. The receiver operating characteristic curve was used to evaluate the predictive performance and to identify the optimal cut-off value of triglyceride and TyG index in the first trimester for the risk of GDM.Results:A total of 1 677 pregnant women were included in this study, and the prevalence of GDM in our cohort was 19.6%. Compared with women who did not develop GDM, women with GDM showed an older maternal age, higher pre-pregnancy body mass index, and increased levels of laboratory biomarkers including fasting blood glucose, fasting insulin, total cholesterol, triglyceride, low-density lipoprotein cholesterol, TyG index, and Homeostasis Model Assessment of Insulin Resistance ( P<0.001). Logistic regression analysis showed that both triglyceride and TyG index in the first trimester were independent risk factors for GDM. The optimal cut-off values of triglyceride and TyG index for predicting the risk of GDM were 0.93 mmol/L and 8.10, respectively. The predictive performance can be further improved if maternal age and pre-pregnancy BMI are included. Conclusion:Triglyceride and TyG index in early pregnancy are closely associated with the risk of GDM, and can be used as early predictors of GDM.

Objective:To explore the knowledge, attitude, and practice of insulin injection among nurses in Beijing and analyze its influencing factors.Methods:From July to August 2019, stratified-random-cluster multi-stage sampling was used to select 7 448 nurses from 30 hospitals of different levels in Beijing as the research subject. The survey was conducted using the General Information Questionnaire and the Insulin Injection Knowledge, Attitude, and Practice Questionnaire. Multiple linear regression was used to analyze the influencing factors of nurses' knowledge, attitude, and practice on insulin injection.Results:A total of 7 448 questionnaires were distributed and 7 448 valid questionnaires were collected, with an effective response rate of 100.00% (7 448/7 448). Among 7 448 nurses, 6 942 had no positions, and the scores of the belief dimension, behavior dimension, and the total score of questionnaire were calculated; the knowledge dimension score was calculated based on the overall sample. The total score of the Insulin Injection Knowledge, Attitude, and Practice Questionnaire was (115.22±10.75), and the scores for each dimension of the questionnaire were (14.14±2.97), (17.29±2.73), and (83.82±7.72), respectively. The proportion of nurses who scored well in all questionnaire dimensions was 19.01% (1 320/6 942). The excellent score rates of each dimension in the questionnaire, from high to low, were the practice dimension [92.71% (6 436/6 942) ], attitude dimension [76.40% (5 304/6 942) ], and knowledge dimension [22.35% (1 665/7 448) ]. Multiple linear regression analysis showed that the influencing factors of insulin injection knowledge, attitude, and practice among nurses were gender, age, professional title and department ( P<0.05). The influencing factors of knowledge were gender, age, years of work, education level, professional title, and department ( P<0.05). The influencing factors of attitude were gender, professional title, and department ( P<0.05). The influencing factors of practice were gender and age ( P<0.05). The above differences were statistically significant. Conclusions:Nurses at all levels of hospitals in Beijing have great beliefs and behaviors in insulin injection but lack knowledge. The knowledge of insulin injection among clinical nurses can be enhanced by improving the training and education standards on insulin injection, regularly providing insulin injection knowledge training and skill assessment to clinical nurses and other methods.

Objective:To systematically review the effects of probiotics supplementation on the prevention and treatment of gestational diabetes mellitus (GDM).Methods:Computerized literature search (CNKI, Wanfang, CBM, VIP, PubMed, Web of science, Embase, and Cochrane Library) as well as manual search was conducted to collect relevant studies. Data were extracted from qualified literature per pre-defined selection criteria and the risk of bias was evaluated. Systematic review was conducted using Stata 11.0 and Revman 5.3 software.Results:Six studies were included in the systematic review of the prevention effects of probiotics on GDM. The results showed that probiotics supplementation was not associated with the incidence of GDM ( RR=0.84, 95% CI: 0.53~1.34). Moreover, probiotics supplementation may be not associated with the level of glucose, either. Twelve studies were included in the systematic review of the treatment effects of probiotics on GDM. The results showed that in GDM patients, probiotics supplementation could decrease the levels of fasting blood glucose ( WMD=-2.06, 95% CI: -3.95~-0.17), fasting serum insulin ( SMD=-0.61, 95% CI: -0.79~-0.42), insulin resistance index as assessed by homeostatic model assessment ( WMD=-0.64, 95% CI: -0.86~-0.43), triglycerides ( WMD=-21.96, 95% CI: -36.15~-7.78), total cholesterol ( WMD=-10.63, 95% CI: -19.43~-1.83), high-sensitivity C-reactive protein ( SMD=-0.77, 95% CI: -1.00, -0.53), and cesarean section rate ( RR=0.57, 95% CI: 0.38~0.83). Conclusions:Probiotics supplementation could not prevent the onset of GDM but seems beneficial in the treatment of GDM. More studies are needed in the future to explore the effects of probiotics supplementation on GDM.

Gut microbiota is considered as the cornerstone of maintaining the health of human host, because it not only helps to obtain nutrition and energy from the food, but also regulates the energy metabolism through the metabolites produced, which plays an important role in the occurrence and development of various metabolic diseases. In recent years, with the development of science and technology, hypoglycemic treatment has been gradually promoted, safer and more efficient hypoglycemic drugs have been emerging, including sulfonylureas, biguanides, glinides, α-glucosidase inhibitors, dipeptidyl peptidase Ⅳ inhibitors, glucagon like peptide-1 receptor agonists, sodium glucose cotransporter 2 inhibitors and various types of insulin preparations. A large number of studies have proved that intestinal flora may be one of the targets for hypoglycemic drugs to control blood glucose. In this article, we aim to review the effects of hypoglycemic drugs on the composition of intestinal flora and the regulation of nutrition and energy metabolism, and provide reference for future researches on mechanism and target of new antidiabetic drugs.

Objective To explore the difference of gut microbiota between type 2 diabetes mellitus (T2DM) and non-diabetic population in Beijing. Methods 83 T2DM patients were selected as T2DM group and 64 non-diabetic subjects were selected as control group. Fecal samples were collected from all the subjects. The intestinal flora was detected by metagenome sequencing technology. Results 11 bacterialphyla were detec-ted in the two groups, there were significant differences in species diversity of Actinobacteria (P=0. 013), Firmicutes (P=0. 005), Fusobacteria (P=0. 001), Proteobacteria (P<0. 001) between the two groups. Actinobacteria, Fusobacteria and Proteobacteria were all enriched in the T2DM group, Firmicutes were enriched in the control group. 152 bacterial genera were detected in the two groups with 31 bacterial genera ofsignificant differences. In T2DM group, the levels of Roseburia, Eubacterium and Faecalibacterium decreased, while the levels of Bifidobacterium, Lactobacillus and Escherichia increased. Conclusion There are significant differ-ences in the composition of gut microbiota between T2DM patients and non-diabetic population. Regulation of gut microbiota in T2DM patients may be helpful to improve the condition of T2DM.

Objective To explore the long-term outcome of postpartum glucose metabolism among patients with gestational hyperglycemia and its risk factors.Methods Patients with gestational hyperglycemia,diagnosed by 100 g oral glucose tolerance test (OGTT) during 24th to 28th gestation week between 2010 and 2012 and giving the childbirth in Peking Union Medical College Hospital,were included.The glucose metabolism outcomes were evaluated by 75 g OGTT.The risk factors influencing the glucose metabolism outcome and the glucose metabolism parameter changes between the pregnancy term and now were also analyzed.Results Forty patients with gestational hyperglycemia were included.The follow-up time was postpartum 5-8 years and (6.83±0.74) years on average.Among them,3 patients were diagnosed with type 2 diabetes and 9 patients were diagnosed with impaired glucose intolerance.The overall rate of abnormal glucose metabolism was 30 percent.The third-hour glucose of OGTT larger than 7.45 mmol/L and the area under the glucose curve (Glu AUC) during OGTT larger than 24.875 mmol×h/L were the risk factors for the abnormal glucose metabolism outcome,with the odds ratio of 5.769 (95％ confidence interval 1.064-31.270,P=0.042) and 12.5 (95％ confidence interval 2.226-70.187,P=0.004).Using the 2-hour glucose larger than 8.25 mmol/L and 3-hour glucose larger than 7.45 mmol/L in the OGTT of midtrimester to judge the glucose state in the follow-up visit can achieve the diagnostic efficacy with the sensitivity of 75％,specificity of 82％,positive prediction value of 64％ and negative prediction value of 88％.Comparing with now,the fasting glucose in the midtrimester was lower ([5.49±0.43] vs.[4.55±0.47] mmol/L,P＜0.001),the fasting insulin in the midtrimester was high-er (12.30 [6.35,16.55] vs.8.31 [6.79,12.00] μIU/ml,P=0.048),HOMA-β in the midtrimester was higher (202.67 [145.71,335.71] vs.85.41 [78.63,112.13],P＜0.001).Conclusion The third-hour glucose larger than 7.45 mmol/L and the glucose area under the curve larger than 24.88 mmol×h/L in the OGTT of midtrimester are the risk factors for the abnormal glucose state in the postpartum long-term follow-up.The combination of the second-hour and the third-hour glucoses in the 100 g OGTT of midtrimester can help to predict the postpartum long-term glucose state.

Objective To explore the relationship of MTNR1B DNA methylation with gestational diabetes and gestational glucose and lipid metabolism features.Methods 50 patients with gestational hyperglycemia,diagnosed by 100 g oral glucose tolerance test (OGTT) during mid-trimester were selected between 2009 and 2012.50 pregnant women with normal glucose tolkerance of matched age and body mass index were included in the control group.The blood samples during mid-trimester and the clinical parameters were collected.MTNR1B DNA methylation levels were measured.Results After adjusting age and body mass index,the CpG locus located at +64 bp away from the translation initiation site of MTNR1B was related with gestational diabetes (OR=0.859,95％ CI:0.772-0.955,P=0.005).DNA methylation level of several MTNR1B loci was also related with gestational glucose and lipid metabolism features.Conclusion MTNR1B DNA methylation is related with gestational diabetes and gestational glucose and lipid metabolism.

Objective To summarize the experience of nursing three critical children patients with extracorporeal membrane oxygenation (ECMO) during long-distance transfer. Methods Before the transfer,a sound contingency plan was made in case of problems that might happen during the transfer;during the transfer, the patients' vital signs and ECMO parameters were closely monitored,and their complications were identified and managed;when transferred in the ward,they were handed over and nursed carefully. Results The first patient's transfer time and distance were 8h and 700km,the second's 14 h and 1200 km,and the third's 15 h and 1700 km. After successfully transferred,two patients left hospital thanks to treatment,while the other one,who suffered from Nephrotic Syndrome complicated by pneumocystis carinii pneumonia,died in hospital. Conclusions ECMO support for children patients during long-distance transfer is a specialized and systematic process that requires multidisciplinary coordination. The aid of ECMO makes the transfer of severe children patients with Cardiopulmonary Failure possible and safe,and saves valuable time for the treatment of critical patients.