Objective:To classify individuals with prediabetes into distinct subtypes using cluster analysis and to assess their associated prognostic risks.Methods:This was a cohort study. Prediabetic patients from the China Health and Retirement Longitudinal Study (CHARLS; 2011—2020) and the English Longitudinal Study of Ageing (ELSA; 2008—2018) were selected as research subjects. The analysis was conducted in CHARLS and validated in ELSA. General information and laboratory indicators of patients were collected, including age, sex, education level, marital status, place of residence, smoking status, drinking status, height, weight, blood pressure, comorbidities, as well as fasting plasma glucose (FPG), glycated hemoglobin A 1c (HbA 1c), total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and other indicators. Body mass index (BMI) was calculated using height and weight measurements. Consensus clustering was used to determine the optimal number of clusters, and K-means was used for clustering. Jaccard similarity was applied to evaluate cluster stability. Cox proportional hazards models were used to compare the risks of type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD). Results:A total of 3 340 prediabetic patients were included in CHARLS, and 1 529 prediabetic patients were included in ELSA. Six metabolic indicators including systolic blood pressure (SBP), HDL-C, LDL-C, FPG, HbA 1c, and BMI were ultimately determined as clustering variables. The optimal number of clusters was determined to be seven. Seven reproducible subtypes of prediabetic patients were identified: cluster 1 (646 cases, 9.34%, normal metabolic indicators subtype); cluster 2 (532 cases, 15.93%, high HDL-C subtype); cluster 3 (351 cases, 10.51%, hypertension subtype); cluster 4 (467 cases, 13.98%, high HbA 1c subtype); cluster 5 (435 cases, 13.02%, high LDL-C subtype); cluster 6 (468 cases, 14.01%, high BMI subtype); and cluster 7 (441 cases, 13.20%, hyperglycemia subtype). We identified seven replicable clusters of prediabetes patients that exhibited significant differences in metabolic characteristics and risks of T2DM and CVD. Individuals in the high HbA 1c subtype, high LDL-C subtype, high BMI subtype, and high FPG subtype had significantly higher risks of T2DM than those in normal metabolic indicators subtype (HR 1.49,95%CI 1.06-2.08; HR 1.54, 95%CI 1.11-2.15; HR 2.72, 95%CI 2.00-3.70; HR 2.75, 95%CI 2.03-3.74, respectively), while the hypertension subtype had the highest CVD risk (HR 1.52, 95%CI 1.16-2.01). Conclusions:We categorized patients into seven clusters that exhibited differences in metabolic characteristics and risks of T2DM and CVD. This classification could help to identify the populations that would benefit most from early intervention for risk factors.
With the deepening of aging in China,the prevalence of diabetes in older people has in-creased noticeably,and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people.In 2021,the National Center of Gerontology,Chinese Society of Geriatrics,and Diabetes Pro-fessional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China,the Guideline for the Management of Diabetes Mellitus in the Elderly in China(2021 edition).The guideline emphasizes that older patients with diabetes are a highly hetero-geneous group requiring comprehensive assessment and stratified and individualized management strategies.The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes.This edition of the guideline provides clinicians with practical and operable clinical guidance,thus greatly contribu-ting to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields.In the past 3 years,evidence-based medicine for older patients with diabetes and related fields has fur-ther advanced,and new treatment concepts,drugs,and technologies have been developed.The guideline edito-rial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China(2024 edition).More precise management paths for older patients with diabetes are proposed,for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.
在2型糖尿病（T2DM）患者的综合管理中，运动是生活方式干预的主要形式之一。我国目前仍然缺乏符合中国国情且纳入最新研究证据的T2DM运动治疗指南。为此，国家老年医学中心、中华医学会糖尿病学分会和中国体育科学学会联合组织国内内分泌及代谢病学、运动医学、康复医学、医学营养、老年医学等相关领域专家团队，系统整理了近年来国内外高质量文献，编写了《中国2型糖尿病运动治疗指南（2024版）》，旨在为临床医师、糖尿病教育护士等糖尿病防控人员提供安全、有效的T2DM运动指导。该指南包括T2DM运动治疗的基本原则、急慢性并发症、共患疾病、常用药物、运动时机、运动中血糖监测、运动营养、运动损伤、运动依从性及数字医疗等，共76条推荐意见。该指南具有较强实用性和可操作性，期望能为中国T2DM患者提供科学、规范的运动治疗方案。
报道1例湖南省人民医院马王堆院区内分泌二科新诊断2型糖尿病合并非酒精性脂肪性肝病患者应用胰岛素泵强化治疗后转换为西格列他钠联合司美格鲁肽治疗，糖脂代谢紊乱得到改善、肝脏功能得到保护的治疗经过。患者为52岁男性，因“发现血糖升高2个多月”入院，入院后完善各项检查，诊断为2型糖尿病合并非酒精性脂肪性肝病。予胰岛素泵控制血糖6 d，入院第4天加用西格列他钠（32 mg，1次/d）降糖，第6天停用胰岛素泵治疗，加用司美格鲁肽0.5 mg/周联合降糖，出院2个月后停用司美格鲁肽，使用单药西格列他钠（32 mg，1次/d）降糖，出院4个月、6个月复诊时，患者血糖、血脂、肝功能等指标均达标。
报道1例在海军军医大学第一附属医院内分泌科因低钾原因待查的青年男性，完善相关检查后发现该患者存在低钾、低氯、低镁、代谢性碱中毒、肾素-血管紧张素-醛固酮系统激活，高度怀疑Gitelman综合征（GS），后经基因检查明确是 SLC12A3基因有2个杂合突变，确诊GS；同时，发现该患者存在明显的高胰岛素血症、胰岛素抵抗，给予枸橼酸钾（30 ml、3次/d）、螺内酯（20 mg、1次/d）、盐酸二甲双胍治疗（0.5 g、2次/d），随访发现治疗效果佳。文献复习提示，GS患者出现胰岛素抵抗的原因并不十分明确，但GS患者确实应该控制糖的摄入，生活方式的干预尤其重要。
