Objective:To summarize the clinical characteristics, reveal evolutionary patterns, and enhance the understanding of idiopathic isolated adrenocorticotripin(ACTH)deficiency(IIAD)by conducting a clinical analysis and follow-up.Methods:The clinical data of 12 patients with IIAD in our center were analyzed retrospectively, and the patients were further followed up to summarize the clinical characteristics of these patients.Results:Among 12 patients with IIAD, the ratio of male to female was 3∶1. The onset showed a bimodal trend, with 2 cases occurring below the age of 18(at 1 year and 11 years respectively), and 10 cases occurring in adults, with an average onset age of 59.4 years old. In adults, the main symptoms were chronic fatigue, anorexia, and weight loss, while pediatric patients exhibited hypoglycemia and seizures. Hyponatremia(50%)was a common biochemical abnormality. ACTH, cortisol, and 24 h urinary free cortisol were significantly lower in all patients, and the functions of other pituitary gland axes were normal. All patients were normal except 2 patients with pituitary MRI showing vacuolar sella turcica. The most common accompanying disease was Hashimoto thyroiditis. After glucocorticoid replacement therapy, all patients showed symptom improvement. The replacement doses include prednisone acetate at 2.5-7.5 mg/d or hydrocortisone at 12-20 mg/d. All the 8 patients were still alive with ongoing ACTH deficiency, without any decline in other pituitary axis functions or occurrence of other diseases.Conclusion:IIAD exhibits a bimodal onset pattern with a higher prevalence in males. Symptoms persist in a chronic and stable manner without remission. Prognosis is favorable with physiological dose of glucocorticoid replacement therapy.

Purpose Chronic kidney disease (CKD) has been one of the most common complications in type 2 diabetes mellitus (T2DM) patients. This retrospective study aimed to investigate the regional differences in the prevalence and management of CKD in T2DM inpatients from two grassroots hospitals in Beijing and Taiyuan. Methods The sociodemographic status, health history, lifestyle information, biochemical parameters and drug choices of the patients were collected from the Diabetes Care Information System using a retrospective cross-sectional analysis. The presence of CKD was defined as albuminuria (urine albumin-to-creatinine ratio of ≥ 30 mg/g) and/or as a reduced estimated glomerular filtration rate (< 60 ml/min/1.73 m 2 ). Results 858 patients with T2DM in Beijing and 1,085 patients with T2DM in Taiyuan were included, with a median age of 61.0 and 61.9 years, respectively. The duration of diabetes was 10.5 and 10.3 years, respectively. The prevalence of CKD in Beijing (39.2%) was significantly higher than in Taiyuan (22.4%). The overall ABC control (A = haemoglobin A 1c ; B = blood pressure; C = cholesterol) in both the Beijing and Taiyuan groups were not ideal. Patients with CKD tended to use insulin, renin–angiotensin–aldosterone system (RAAS) inhibitors, sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and dyslipidaemia therapy in Taiyuan than in Beijing. The actual proportion of carbohydrate, fat and protein in calories was 49.6%:35.4%:14.4% in Beijing and 61.5%:27.8%:10.8% in Taiyuan. Conclusions The higher prescription rates of RAAS inhibitors, SGLT-2i and dyslipidaemia therapy may underlie the fluctuations in the prevalence of CKD in Beijing or Taiyuan. Intensive insulin therapy and personal nutritional guidance, along with the extensive use of RAAS inhibitors, SGLT-2i and dyslipidaemia therapy during follow-up, can all play a positive role in the management of CKD in patients with T2DM in both Beijing and Taiyuan.

Up to now, there has not yet been guidance or consensus from Chinese experts in the field of personalized prevention and treatment of type 2 diabetes. In view of the above, the endocrinology diabetes Professional Committee of Chinese Non-government Medical Institutions Association, the integrated endocrinology diabetes Professional Committee of the integrated medicine branch of Chinese Medical Doctor Association, and the diabetes education and microvascular complications group of the diabetes branch of the Chinese Medical Association organized relevant experts to discuss and reach the "Chinese expert consensus on strengthening personalized prevention and treatment of type 2 diabetes" for reference in clinical practice.

Objective We explore the effect of a structured online DSMES program on glycaemic control and the self-management behaviour of adolescents and young adults with T1DM. Methods We used a pre–post uncontrolled intervention design over a period of 6 months. A total of 37 youths with T1DM aged 10–45 years were enrolled. The intervention comprised 11 structured online DSMES course sessions; these were video-based and delivered by a diabetes specialist, nurses and a dietitian. The primary outcome was a change in (glycated hemoglobin) HbA1c. The secondary outcomes were changes in hypoglycaemia frequency, time in target range (TIR) among patients using a continuous glucose monitoring (CGM) system and self-management behaviour; the latter was measured using a T1DM self-management scale for Chinese adults (SMOD-CA) and the Chinese version of the diabetic behaviour rating scale in adolescents with T1DM (DBRS). Results Twenty-three (85.2%) participants attended ≥8 of the online sessions. There was a significant reduction in HbA1c (from 6.92% to 6.47%, P = 0.002), hypoglycaemic episodes (from 6.0 to 4.0 during the preceding month, P = 0.026) and a significant increase in TIR (from 74.0% to 80.5%, P = 0.027) and an increase in the SMOD-CA score (from 79.6 to 84.6, P = 0.026) in young adults. No significant change in glucose control, hypoglycaemic events or DBRS score were found among children and adolescents. The score of the 12-item version of the Barrett–Lennard Relationship Inventory (B-L RI:mini) indicated that more than half of the participants experienced congruence, positive regard, and an empathic understanding in this programme. Conclusion The online structured DSMES programme was effective in improving the glycaemic control and self-management behaviour of young adults with T1DM; however, integrating offline visits or appointments with online consultations may be necessary for youth patients.

目的 探讨T2DM合并阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者下肢血管病变(LEAD)的影响因素.方法 选取 2020 年 9 月至 2021 年 12 月于太原糖尿病专科医院内分泌科住院治疗的T2DM患者 132 例,按照合并OSAHS程度分为单纯T2DM组[睡眠呼吸暂停次数(AHI)＜5 或最低动脉血氧饱和度(LSaO2)＞90%,n=40]、OSAHS轻度组(5≤AHI≤15 或 85%≤LSaO2≤90%,n=42)、OSAHS中重度组(AHI＞15 或LSaO2＜85%,n=50).检测各组血清 8-异前列腺素F2α(8-iso-PGF2α)、氧化低密度脂蛋白(OX-LDL)、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物歧化酶(SOD)及踝肱指数(ABI).Pearson相关分析ABI与其他指标的相关性.Logistic回归分析LEAD的影响因素.结果 与T2DM 组比较,OSAHS 中重度组BMI 升高(P＜0.05).OSAHS 中重度组HbA1c、AHI、8-iso-PGF2α、OX-LDL、LSaO2＜85%高于T2DM、OSAHS轻度组,ABI、SOD、GSH-Px低于 T2DM、OSAHS 轻度组(P＜0.05).Pearson 相关分析显示,ABI 与 SOD、GSH-Px 呈正相关(P＜0.05),与 HbA1c、8-iso-PGF2α、OX-LDL、AHI 呈负相关(P＜0.05).Logistic 回归分析显示,HbA1c、AHI、8-iso-PGF2α、OX-LDL、SOD、GSH-Px是LEAD的影响因素.结论 氧化应激反应加重T2DM合并OSAHS患者LEAD,T2DM合并LEAD患者应进行睡眠呼吸过筛监测.

To the Editor: Patients with type 2 diabetes have a higher risk of cardiovascular diseases (CVD), relative to people without diabetes. Patients with diabetes always exhibit lipid abnormalities. Rapid economic development and accelerated urbanization have also led to lifestyle changes that may have an influence on the lipid parameters of Chinese patients with diabetes. Given the significant differences in socioeconomic status in China, geographical variations were also observed in the prevalence, awareness, treatment, and control of dyslipidemia among individuals who were ≥45 years old in the general Chinese population.[1] There is a lack of large-scale studies regarding time trends and geographical variations in lipid concentrations and lipid control among Chinese adults with type 2 diabetes. Therefore, we conducted a study on time trends and geographical variations in lipid concentrations and lipid control in this population using the China National HbA1c Surveillance System (CNHSS) database of adult Chinese outpatients with type 2 diabetes during 2009 to 2013. The Ethics Committee of the Chinese People Liberation Army General Hospital approved the study protocol. Informed consent was obtained from all the patients before they were interviewed and data collected. This was a retrospective study based on data from serial cross-sectional surveys during 2009 to 2013. The inclusion criteria included adult outpatients aged ≥18 years with type 2 diabetes, receiving antidiabetic medications, having resided in their location for ≥6 consecutive months, and having at least one outpatient visit for a consultation regarding type 2 diabetes with complete medical records. The exclusion criteria included treatment using only Chinese herbal medicine, pregnant or breastfeeding, and being unconscious or unable to communicate normally. Inadequate lipid control in type 2 diabetes was defined as total cholesterol (TC) concentration of ≥4.50 mmol/L, low-density lipoprotein cholesterol (LDL-C) concentration of ≥2.60 mmol/L, or triglyceride (TG) concentration of ≥1.70 mmol/L.[2,3] To minimize the effects of extreme outliers, we excluded values for systolic blood pressure (SBP), diastolic blood pressure, fasting plasma glucose, 2-h postprandial glucose, HbA1c, TC, LDL-C, and TG that were within the highest and lowest 0.05% quantile. All statistical analyses were performed using SPSS software (version 23.0; IBM Corp., Armonk, NY, USA). Time trends in TC, LDL-C, and TG concentration were evaluated using sex-specific multivariable linear regression models adjusted by age, and a log-transformed coefficient for TG was used because of its skewed distribution. The age-standardized prevalence estimates for inadequate TC, LDL-C, and TG control were calculated for each geographic region using a direct method and the 2010 population distribution in China. Time trends in the age-standardized prevalence of inadequate TC, LDL-C, and TG control were tested using the Mantel–Haenszel χ2 test. Regional comparisons of TC, LDL-C, and TG concentrations were performed using an analysis of variance; and regional rates of inadequate TC, LDL-C, and TG control were compared using the chi-squared test. All P values were two-tailed and P values of <0.05 were considered to be statistically significant. Totally, 942,847 individuals (53.2% men and 46.8% women) were included in the study, with samples of 133,031 patients from the year 2009, 160,185 from 2010, 220,424 from 2011, 206,920 from 2012, and 222,287 from 2013. The mean age was 58.66 years and the median duration of type 2 diabetes was 4.05 years. The mean TC concentration was 4.71 mmol/L, the mean LDL-C concentration was 2.87 mmol/L, and the median TG concentration was 1.78 mmol/L [Supplementary Table 1, https://links.lww.com/CM9/A852]. The overall age-adjusted mean TC concentrations exhibited decreasing trends for both men and women during 2009 to 2013 (P for trend <0.001). There were increasing trends in the overall age-adjusted mean LDL-C concentrations and geometric mean TG concentrations for both men and women (P for trend <0.001). The time trends in overall TC, LDL-C, and TG concentrations still exhibited after further adjusting the geographical region for both men and women. Increasing time trends in the age-adjusted mean TC, LDL-C, and TG concentrations were observed in the North region for both men [Supplementary Table 2, https://links.lww.com/CM9/A852] and women [Supplementary Table 3, https://links.lww.com/CM9/A852] (P for trend <0.001). Time trends in the overall age-standardized prevalence of inadequate TC, LDL-C, and TG control were similar to that in age-adjusted TC, LDL-C, and TG concentrations for both men and women during the study period. Decreasing trends in the overall age-standardized prevalence of inadequate TC control were observed for both men and women (P for trend <0.001), whereas increasing trends were observed in the overall age-standardized prevalence of inadequate LDL-C and TG control. Increasing time trends in the age-standardized prevalence of inadequate LDL-C and TG control were observed in the North and Northeast regions for both men [Supplementary Table 4, https://links.lww.com/CM9/A852] and women [Supplementary Table 5, https://links.lww.com/CM9/A852] (P for trend <0.001). The clinical characteristics of the patients with type 2 diabetes varied according to the geographic region during 2009 to 2013. Patients in the North and Northeast regions had higher body mass index (BMI) values, higher rates of inadequate blood pressure control (≥130/80 mmHg), and higher rates of inadequate HbA1c control (≥7.0%) compared with the other regions [Supplementary Table 6, https://links.lww.com/CM9/A852]. Significant geographical variations were observed in the age-adjusted mean TC, LDL-C, and TG concentrations, which persisted after further adjusting for BMI. Patients in the North and Northeast regions had relatively high age-adjusted mean TC, LDL-C, and TG concentrations for both men and women [Supplementary Table 7, https://links.lww.com/CM9/A852]. The overall age-standardized prevalence was 55.87% for inadequate TC control, 56.20% for inadequate LDL-C control, and 55.32% for inadequate TG control during 2009 to 2013 [Table 1]. When standardized with geographic region, the overall prevalence of inadequate TC, LDL-C, and TG were 54.62%, 55.71%, and 53.91%, relatively. There were significant geographical variations in the age-standardized prevalence of inadequate TC, LDL-C, and TG control. Patients in the North and Northeast regions had relatively high prevalence of inadequate TC, LDL-C, and TG control, whereas patients in the South and Southwest regions had lower prevalence of inadequate TC, LDL-C, and TG control [Table 1]. After further adjusting for age, SBP, HbA1c, BMI, survey year, and duration of type 2 diabetes, North and Northeast regions still had the worst TC, LDL-C, and TG control [Supplementary Table 8, https://links.lww.com/CM9/A852]. Table 1 - Age-standardized prevalence for inadequate control of TC (≥4.50 mmol/L), LDL-C (≥2.60 mmol/L), and TG (≥1.70 mmol/L) concentrations, according to the geographical region. Items Overall East North Central South Southwest Northwest Northeast P values TC Total 55.87 (55.77–55.97) 55.27 (55.09–55.45) 59.16 (58.98–59.34) 50.48 (50.12–50.83) 56.09 (55.73–56.44) 48.01 (47.62–48.40) 49.63 (49.17–50.08) 59.80 (59.52–60.08) <0.001 Men 56.89 (56.76–57.03) 55.62 (55.38–55.87) 60.38 (60.13–60.63) 51.96 (51.48–52.45) 58.07 (57.57–58.57) 49.10 (48.56–49.64) 51.22 (50.62–51.81) 61.05 (60.67–61.43) <0.001 Women 54.21 (54.06–54.35) 54.61 (54.34–54.88) 57.41 (57.14–57.68) 48.01 (47.48–48.54) 53.21 (52.70–53.72) 46.26 (45.70–46.82) 46.28 (45.57–46.98) 57.66 (57.24–58.08) <0.001 LDL-C Total 56.20 (56.10–56.30) 54.30 (54.12–54.49) 59.62 (59.43–59.80) 53.42 (53.07–53.78) 57.03 (56.67–57.38) 49.47 (49.08–49.85) 50.65 (50.19–51.1) 59.64 (59.36–59.92) <0.001 Men 56.66 (56.53–56.80) 54.34 (54.09–54.59) 60.36 (60.11–60.62) 53.97 (53.49–54.45) 58.99 (58.50–59.49) 50.02 (49.49–50.56) 50.30 (49.71–50.89) 60.17 (59.79–60.55) <0.001 Women 55.44 (55.29–55.58) 54.17 (53.90–54.43) 58.59 (58.33–58.86) 52.37 (51.84–52.89) 54.22 (53.70–54.73) 48.61 (48.05–49.17) 51.11 (50.40–51.81) 58.67 (58.25–59.08) <0.001 TG Total 55.32 (55.21–55.42) 53.43 (53.25–53.62) 58.06 (57.87–58.24) 56.30 (55.95–56.66) 41.90 (41.55–42.26) 52.44 (52.05–52.83) 56.91 (56.46–57.36) 61.02 (60.74–61.30) <0.001 Men 57.19 (57.05–57.33) 54.87 (54.62–55.12) 59.51 (59.26–59.76) 57.95 (57.47–58.43) 44.87 (44.37–45.37) 54.97 (54.44–55.51) 59.47 (58.89–60.06) 63.16 (62.78–63.53) <0.001 Women 52.70 (52.55–52.85) 51.49 (51.23–51.76) 56.23 (55.96–56.50) 53.73 (53.21–54.26) 37.75 (37.25–38.25) 48.94 (48.38–49.50) 52.20 (51.50–52.91) 57.80 (57.38–58.22) <0.001 Data are shown as age-standardized prevalence (95% confidence interval). P values were calculated using the chi-squared test.LDL-C: Low-density lipoprotein cholesterol; TC: Total cholesterol; TG: Triglyceride. Up to now, few studies have examined time trends in lipid profiles and lipid control in patients with type 2 diabetes from the Chinese mainland. The present study revealed decreasing trends in the TC concentrations and increasing trends in the LDL-C and TG concentrations among Chinese men and women with type 2 diabetes during 2009 to 2013. Similar time trends were also observed in the age-standardized prevalence of inadequate TC, LDL-C, and TG control. Our study showed that >50% of the patients not having adequate control of TC, LDL-C, or TG among Chinese adult patients with type 2 diabetes between 2009 and 2013, with North and Northeast regions having the worst lipid control. A previous study also based on CNHSS data indicated that the highest risks of CVD were observed in the North and Northeast regions among Chinese patients with type 2 diabetes.[4] Regional differences in lipid abnormities may be associated with lipid-lowering agents, low socioeconomic status, and unhealthy lifestyle choices, such as poor diet, limited exercise, smoking, and obesity. Moreover, our findings also indicate that poor blood pressure, HbA1c control among patients in North and Northeast regions. Therefore, measures to improve control of lipid parameters, blood pressure, and HbA1c are needed to reduce CVD-related morbidity and mortality in Chinese patients with type 2 diabetes, especially in the North and Northeast regions. The present study had several limitations. First, time trends in lipid concentrations and prevalence of inadequate lipid control were not always stable during the 5 years; long-term studies are needed to observe more reliable time trends in lipid among Chinese type 2 diabetes. Second, our study did not collect information about awareness of dyslipidemia and lipid-lowering treatments, but a previous study indicated that the awareness and treatment rates among dyslipidemia subjects were approximately 70.0% and 55.0% among type 2 diabetes aged 45 to 75 years of age during 2010 to 2011.[5] In conclusion, we found that Chinese adults with type 2 diabetes had increasing time trends and poor control of LDL-C and TG concentrations. There were also significant geographic regional differences in the prevalence of inadequate TC, LDL-C, and TG control, with the poorest control typically observed in the North and Northeast regions. Acknowledgements The study was supported by a research grant from Novo Nordisk China. We would like to thank all the health professionals who were involved in the China National HbA1c Surveillance System (CNHSS) for their efforts. Funding This work was supported by the Major Chronic Noncommunicable Disease Prevention and Control Research and the National Key Research and Development Program of China (Nos. 2016YFC1305600 and 2016YFC1305603). The data were from the CNHSS study, which was supported by a research grant from Novo Nordisk China. Conflicts of interest None.

To the Editor: According to the International Diabetes Federation, China has been ranked first worldwide in terms of the prevalence of diabetes among people aged 20 to 79 years.[1] As a cornerstone in the management of patients with type 2 diabetes mellitus (T2DM), the level of glycemic control has changed considerably over the past decades. A multicenter observational study in North China showed that 45.82% of patients with T2DM met the glycated hemoglobin (HbA1c) control standard in 2017.[2] With the largest population of residents with T2DM, China is also faced with significant regional discrepancies in the rates of adequate glycemic control (HbA1c <7%), ranging from 25.9% in Shaanxi province[3] to 56.1% in Jiangsu province.[4] Indeed, previous studies in China were conducted for short periods of time, in a limited number of areas, and with relatively small sample sizes. Based on the data of the China National HbA1c Surveillance System study (CNHSS), this analysis aimed to investigate temporal trends and regional variations in glycemic control in T2DM patients in China from 2009 to 2013. The study was approved by the Ethics Committee of Chinese PLA General Hospital (No. 20090118). After obtaining written informed consent, we began the data collection of all patients. In 2009, the Chinese Diabetes Society launched the CNHSS to monitor glycemic control of T2DM outpatients, which continued through 2013. We conducted a retrospective analysis using the data from the CNHSS. The details of the study methods were published elsewhere[5] During the recruitment period, the first seven qualified patients of each hospital everyday were invited to participate in the survey. The recruitment period was 3 months, or it would end when 400 participants were recruited from each study site. Finally, we analyzed the data of 956,352 patients with T2DM. During the recruitment period, the trained professionals collected patients’ data using a standardized questionnaire. The questionnaire was used to record data, including demographic characteristics, physical examinations, diabetes diagnosis, diabetes complications, comorbidities, and laboratory tests. Regardless of the treatment for T2DM patients (oral antidiabetic drugs or insulin), adequate glycemic control was defined as HbA1c values of <7%. For glycemic control, we calculated age-standardized rates of different HbA1c categories for each year using the national population census of China in 2010 as the reference. The rates of adequate glycemic control in the seven geographic regions of the pooled data were calculated. To assess the increased risk of inadequate HbA1c control, multivariable logistic regression analysis was used to evaluate odds ratios (ORs) and 95% confidence intervals (95% CIs) of adequate glycemic control between different geographic regions (the region with the highest rates of adequate glycemic control was treated as the reference region). Two-tailed P values <0.05 were considered to indicate statistical significance for all analyses. Statistical analysis was performed using the SPSS, version 21.0 (IBM SPSS, Armonk, NY, USA). As shown in Supplementary Table 1, https://links.lww.com/CM9/A857, the mean age was 58.7 (standard deviation, 11.5) years and patients in 2013 were younger than those in 2009. The proportion of males was 53.5% among all participants. Body mass index (BMI) remained stable over this period with a mean of >24.0 kg/m2. The median duration of diabetes was 4.7 years in 2009, reducing to 4.1 years in 2013 (interquartile range [IQR]: 1.6–8.1). The mean HbA1c during this period was nearly 8%. Standardized rates (95% CI) of glycemic control are shown in Supplementary Figure 1 and Supplementary Table 2, https://links.lww.com/CM9/A857. From 2009 to 2013, the proportion of patients with HbA1c ≥9% experienced a downward trend from 33.3% (33.0%, 33.5%) to 30.4% (30.2%, 30.6%) (P < 0.001). Meanwhile, the proportion of patients with HbA1c 7% to < 9% increased from 38.1% to 47.1% (P < 0.001). Of note, the proportion of patients with HbA1c < 7% significantly declined from 28.6% to 22.6% (P < 0.001). Glycemic control varied by duration of diabetes [Supplementary Table 3, https://links.lww.com/CM9/A857]. To avoid the effect of newly diagnosed diabetes on glycemic control, we excluded patients with duration of diabetes <1 year. The remaining patients were divided into three groups according to the duration of diabetes (1 to <5 years [group 1], 5 to <10 years [group 2], and ≥10 years [group 3]). In group 1, the proportion of patients with HbA1c values of <7% and ≥9% decreased considerably over 5 years, whereas the proportion of those with HbA1c values of 7–<9% underwent an upward trend. A similar trend in glycemic control was seen in patients who had diabetes for 5 to <10 years (group 2). However, the trend was different among patients in group 3. In particular, the proportion of patients with HbA1c values of <7% and 7–<9% increased significantly, whereas that of those with HbA1c values of ≥9% decreased. Glycemic control also varied by age [Supplementary Table 4, https://links.lww.com/CM9/A857]. Based on the age, patients were divided into four categories (18–44, 45–64, 65–74, and ≥75 years). Fewer patients were likely to achieve HbA1c targets of <7% over time across all age subgroups. In the 45–64 years subgroup, the proportion of patients achieving these targets decreased the most, from 35.9% to 26.2% (P < 0.001). The trends in glycemic control across different geographic regions between 2009 and 2013 are presented in Supplementary Table 5, https://links.lww.com/CM9/A857 and Supplementary Figure 2, https://links.lww.com/CM9/A857. During the observation period, the rate of adequate glycemic control in the South showed a decreasing trend. Nevertheless, the trends fluctuated in all other regions. The smallest decline in the rates of HbA1c control was 9.1% in the East, followed by 30.3% in the Central, 34.5% in the North, and 40.0% in the Northeast (all P < 0.001). However, the rates of HbA1c control increased significantly from 28.3% to 38.0% in the Southwest and from 32.9% to 35.5% in the Northwest (P < 0.001). To further investigate the regional variations in glycemic control, the data of patients with T2DM from 2009 to 2013 were pooled. The pooled data of the seven geographic regions in China showed that the South region had the highest rate of adequate glycemic control (37.2% [36.8%, 37.5%]), followed by the Southwest region (34.7% [34.4%, 35.1%]). The lowest rate (26.4% [26.2%, 26.7%]) was observed in the Northeast region (all P < 0.001, except the P value [Northwest υs. East] = 0.029). Multivariable logistic regression analysis revealed that the risk of inadequate HbA1c control in the other six regions was significantly higher than that in the South region (the reference region which had the highest rate of adequate glycemic control), after adjustment for age, sex, enrollment hospital, duration of diabetes, and BMI [Supplementary Figure 3, https://links.lww.com/CM9/A857]. The adjusted ORs varied from 1.11 (1.09, 1.13) in the Southwest region to 1.62 (1.59, 1.66) in the Northeast region. Up to now, few researches have proved the trends and regional differences in glycemic control of patients with type 2 diabetes in China 10 years ago. Based on the analysis of the largest database of T2DM patients in China from 2009 to 2013, we found that both the age- standardized rate of patients with adequate glycemic control and that of those with HbA1c ≥9% declined considerably. Meanwhile, the proportion of patients with HbA1c 7–<9% experienced a significant increase. Additionally, the increased risk of inadequate glycemic control varied greatly across geographic regions, which could not be explained by sex, age, enrollment hospital, duration of diabetes, and BMI. Our results may not be applicable to guide current clinical practice, but they can be compared with the current glycemic control in China, which indicates the change over the decade. Acknowledgments We would like to thank all the health professionals who were involved in the China National HbA1c Surveillance System (CNHSS) for their efforts. Funding This work was supported by the Major Chronic Noncommunicable Disease Prevention and Control Research and the National Key Research and Development Program of China (Nos. 2016YFC1305600 and 2016YFC1305603). The data were from the CNHSS study, which was supported by a research grant from Novo Nordisk China. Conflicts of interest None.

OBJECTIVE:This phase 3 confirmatory diabetes mellitus treatment study compared the safety and efficacy of Rapilin and NovoRapid insulin asparts in combination with metformin. METHODS:This 24-week, open-label, randomized, active-controlled, noninferiority phase 3 confirmatory study conducted across centers in China aimed to enroll patients with type 2 diabetes mellitus and blood sugar glucose inadequately controlled by oral antidiabetic drugs. Randomized patients received subcutaneous mealtime Rapilin or NovoRapid (3:1) injections, with metformin. The primary objectives were to demonstrate noninferiority (margin of 0.4%) in HbA1c change from baseline and compare safety profiles of Rapilin versus NovoRapid after 24 weeks. Secondary outcomes included 2-h postprandial plasma glucose (PPG), fasting plasma glucose (FPG), and patients achieving HbA1c <7.0% and ≤6.5%. RESULTS:590 patients with type 2 diabetes mellitus were randomized to Rapilin (n = 441) and NovoRapid (n = 149) groups. After 24 weeks, the mean HbA1c change from baseline was -2.20% (Rapilin) and -2.32% (NovoRapid); the estimated treatment difference based on least-square means was 0.04% (95% CI: -0.17, 0.26), meeting the noninferiority criteria for Rapilin versus NovoRapid. Comparable improvements were reported for mean 2-hour PPG (6.14 and 6.29 mmol/L), FPG (2.02 and 1.70 mmol/L), and patients with HbA1c <7.0% (52.6% and 51.0%) and ≤6.5% (34.2% and 30.9%), in the Rapilin and NovoRapid groups, respectively, with no significant safety or immunogenicity outcome differences. CONCLUSIONS:Rapilin demonstrated non-inferior glycemic control, and matching safety and immunogenicity to NovoRapid in patients with type 2 diabetes mellitus also receiving metformin over 24 weeks. TRIAL REGISTRATION:ChiCTR20003129041.

《中国2型糖尿病防治指南》自2003年发表以来,已进行了5次修订.2021年,又发布了《中国2型糖尿病防治指南(2020年版)》.下面我们一起来看看新版指南有哪些新看点?

Abstract Purpose We aimed to evaluate the association between metabolic score for visceral fat (METS-VF) and prediabetes and to compare the predictive ability among obesity indicators.Methods A total of 4,376 participants (mean age, 55.4±7.1; male, 32.2%) with normal glucose metabolism were recruited in 2011, and were followed up in 2015. The demographic information and anthropometric measurement were collected by standardized procedures. The laboratory test was conducted in local communities. In the follow-up survey, the newly-diagnosed prediabetes incidents were collected. Logistic regression models and receiver operator characteristic curve analysis were used to evaluate the association of obesity indicators and prediabetes.Results During a median follow-up of 3.3 years, 1119 prediabetes participants were identified. After adjusting for all variables, the adjusted odds ratios for the highest, third, second versus lowest METS-VF quartile was 1.56 [95% confidence interval (CI) 1.17-2.08], 1.41 (95% CI 1.09-1.83), 1.25 (95% CI 1.02-1.58), respectively, and elevated with per 1-SD is associated with a 27 % increase in prediabetes risk (OR 1.27, 95% CI 1.17-1.38). A nonlinear relationship of METS-VF with incident prediabetes was observed (P for nonlinear=0.041). In the subgroup analysis stratified by age and sex, similar results were observed. METS-VF showed a better prediction ability for incident prediabetes (AUC 0.623, 95% CI 0.601-0.644).ConclusionMETS-VF is positively associated with the risk of prediabetes, and is a better predictor for prediabetes than all obesity indicators. It has the potential to early identify the risk of prediabetes in future clinical practices or primary health management.

Background: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in adults with type 2 diabetes (T2D). The aim of this study was to determine the CV risk in Chinese patients with T2D based on the 2019 European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD) guidelines on diabetes, pre-diabetes, and CV diseases. Methods: A total of 25,411 patients with T2D, who participated in the study of China Cardiometabolic Registries 3B study, were included in our analysis. We assessed the proportions of patients in each CV risk category according to 2019 ESC/EASD guidelines. Results: Based on the 2019 ESC/EASD guidelines, 16,663 (65.6%), 1895 (7.5%), and 152 (0.6%) of patients were included in "very high risk," "high risk," and "moderate risk" categories, respectively. The proportions of patients in each category varied based on age, sex, body mass index, and duration. While 58.7% (9786/16,663) of elderly patients were classified to "very high risk" group, 89.6% (3732/4165) of patients with obesity were divided into "very high risk" group. Almost all patients with a duration of diabetes >10 years had "very high risk" or "high risk." However, 6701 (26.4%) of Chinese T2D patients, who had shorter duration, and one or two risk factors, could not be included in any category (the "unclear risk" category). Conclusions: In China, most patients with T2D have "very high" or "high" CV risk based on 2019 ESC/EASD guidelines. However, the risk of patients in "unclear risk" group needs to be further classified.

Objective This study aimed to evaluate the prevalence of chronic kidney disease (CKD) in Chinese adults with T2DM in primary care, and the association of HbA 1c , blood pressure (BP) and triglycerides (TG), i.e. ABC control at follow up (FU) with the progress and regression of CKD. Methods A total of 5123 patients with ≥3 measurements of estimated glomerular filtration rate (eGFR), urinary albumin-to-creatinine ratio (UACR), HbA 1c , BP, LDL-C and TG, and FU ≥ 12 months were included into final analysis. The presence of CKD was defined as the presence of albuminuria (UACR ≥ 30 mg/g), impaired eGFR (eGFR < 60 ml/min/1.73 m 2 ) or both, and was categorised as low, moderate and high/very high risk. The change of CKD risk for outcome was categorised as stable (no change), progress (risk increase) and regress (risk decrease) from baseline to the last visits (LV). Results The prevalence of CKD, impaired eGFR and albuminuria was 29.6%, 5.8% and 27.1% at baseline, with 70.4%, 20.3%, 7.0% and 2.3% of patients distributed in low, moderate, high and very high risk group. There were 3457 (67.5%), 1120 (21.8%) and 546 (10.7%) patients had CKD outcome risk stable, progressed and regressed respectively. The proportion of patients reaching targets of BP ≤ 130/80 mmHg, HbA 1c <7.5%, LDL-C<2.60 mmol/L increased from baseline to FU and LV, together with increased usage of insulin, RAS inhibitors and lipid lowering medications. After multivariable adjustment, the HbA 1c <7.5% (OR: 0.66, 95%CI 0.56-0.78), TG< 1.7 mmol/L (OR: 0.81, 95%CI 0.68-0.96) at FU and BP ≤ 130/80 mmHg at LV (OR: 0.82, 95%CI 0.70-0.95) was negatively associated with CKD outcome risk progress. Conclusion The prevalence of CKD was high with 21.8% of patients progressing to higher CKD outcome risk at FU, attention should be paid on long term and better ABC control.

《中国2型糖尿病防治指南》自2003年首次发布以来,至2017年进行了4次修订.2020年最新版《中国2型糖尿病防治指南》发布,内容涵盖中国糖尿病流行病学、诊断与分型、筛查和评估、高血糖治疗路径和2型糖尿病的三级预防、综合控制目标等多个方面内容.对提高和规范我国2型糖尿病的诊疗水平有非常重要的作用,对每位2型糖尿病患者的临床治疗也有重大意义.那么,新版指南在2017年版基础上做了哪些重要修订和更新?

Aim: To identify and understand the main unmet needs of individuals with Type 2 diabetes (T2D). Materials & methods: An online survey was conducted in Brazil, China and Russia of individuals with recently diagnosed T2D. Results: The survey, involving 300 individuals with T2D, identified a need for more information regarding food/diet and for increased awareness of T2D symptoms. While most participants (94%) had experienced symptoms prior to their diagnosis, only 55% of symptomatic individuals sought medical attention. Conclusion: Novel strategies to increase awareness of diabetes should be developed and tested, and may enable earlier diagnosis and improve patients' quality of life.

To evaluate henagliflozin, a novel sodium‐glucose co‐transporter‐2 inhibitor, as monotherapy in patients with type 2 diabetes and inadequate glycaemic control with diet and exercise.

甘精胰岛素U300更接近人体生理状态下基础胰岛素的分泌模式,降糖作用平稳,有效控制血糖的同时低血糖发生风险更低.此外,甘精胰岛素U300在一些特殊患者降糖治疗、用药依从性和灵活性等方面也存在优势,为糖尿病患者的血糖管理提供了更佳选择.

目的 探讨家族史、肥胖及自我管理行为对中国基层2型糖尿病(type 2 diabetes mellitus,T2D)患者糖化血红蛋白(hemoglobin A1c,HbA1c)控制达标的作用.方法 对2016年1月-2019年12月五家糖尿病专科连锁医院连续就诊且资料存储于院内糖尿病共同照护信息系统的门诊或住院T2D患者基线数据进行横断面分析,比较HbA1c是否达标(HbA1c＜7.0％)两组的一般状况,采用多因素logistic回归分析对HbA1c未达标相关因素进行分析.结果 共纳入8506例患者,HbA1c达标率27.75％,有家族史者2860例(33.62％),肥胖者1541例(18.12％).HbA1c是否达标,两组在年龄、病程、体质量指数、吸烟、学历、饮食依从性、运动、遵嘱监测血糖、遵嘱用药及治疗方案方面的比较,差异有统计学意义(均P＜0.05).多因素logistic回归分析显示,肥胖(OR=1.226,95％CI:1.042～1.441)和病程长(OR=1.019,95％CI:1.009～ 1.028)增加了HbA1c不达标的风险,单纯口服药治疗(OR=0.388,95％ CI:0.345～0.436)、遵嘱用药(OR=0.805,95％CI:0.699～0.928)、规律运动(OR=0.886,95％CI:0.786～1.000)降低了HbA1c不达标的风险.结论 本研究提示中国基层T2D患者HbA1c达标率低,治疗方案、遵嘱用药、规律运动及肥胖是HbA1c达标的相关因素.在临床糖尿病管理中需特别关注胰岛素治疗患者及肥胖患者,并关注患者在遵嘱用药及规律运动方面的依从性.

Aims: To estimate the sex differences in the prevalence of overweight and obesity aged 20–89 in Chinese patients with type 2 diabetes (T2D). Methods: 811,264 patients with T2D from six hospital-based, cross-secti onal studies, and 46,053 subjects from the general population were included in ou r analysis. Prevalence of underweight, overweight, obesity were calculated in each sex. Results: In patients with T2D, the standardized prevalence of underweig ht (BMI <18.5 kg/m2), overweight (24 kg/m2 ≤ BMI < 28 kg/m2), and general obesity (BMI ≥28 kg/m2) were 2.2%, 43.2%, and 11.6%, respectively. Similar trend patter ns of the prevalence of underweight and overweight were observed in general and T2D pop ulation, in males and females with T2D (all P for trend <0.01). In patients with T2D, patients at a younger age and older age were more likely to be underweight. The preva lence of overweight increased first, then stabilized or decreased with age. However, different trend patterns of the prevalence of obesity in males and females were found. I n males, the prevalence of obesity decreased first, and then stabilized after 60 years o f age. In females, the prevalence of obesity decreased first, then increased after 50 y ears of age. In the general population, the prevalence of obesity increased with age in fem ales, while, the trend of prevalence of obesity with age in males was not obvious. Conclusion: Different trends in the prevalence of obesity with age in differe nt sex were found in Chinese patients with T2D.

近年来，国内外2型糖尿病的研究取得了诸多重大进展，获得了更多关于糖尿病及其慢性并发症预防、诊断、监测及治疗的循证医学新证据，因此，有必要对我国的2型糖尿病防治指南进行再次修订，及时传递重要进展，指导临床。为了使读者更好地了解这次修改的主要内容，特对指南编写的证据等级以及更新要点进行说明。

OBJECTIVE:To analyse diabetes treatment, treatment change and self-management behaviours in association with 2-year glycaemic trajectories in patients with non-newly diagnosed type 2 diabetes mellitus in Chinese primary care. METHODS:This was an observational, multi-centre, longitudinal, retrospective cohort study. Clinical data of 4690 subjects were extracted from electronic medical records, including serial glycated haemoglobin A1c (HbA1c) measurements, antidiabetic medication records and compliance to exercise, diet, medications and self-monitoring of blood glucose (SMBG). Patterns of longitudinal HbA1c trajectories were identified using the percentage of HbA1c measurements <7.5% from the second available HbA1c measurement. Clinical relevance of the clusters was assessed through multivariable analysis. RESULTS:Approximately half of the participants demonstrated good glycaemic control; of these, 34.5% demonstrated stable, good control, and 13.7% demonstrated relatively good control. About 16.2% demonstrated moderate control, and 35.6% demonstrated poor control. From the good to poor control groups, the percentage of subjects treated with insulin at baseline and during the follow-up period increased gradually, while the percentage of subjects adhering to exercise, diet, medications and SMBG decreased gradually. Compared with baseline, the adherence to exercise, diet, medications and SMBG improved significantly. Approximately 50% and 26% of subjects in the two poorest control groups, respectively, experienced treatment changes. After multivariable adjustments, baseline HbA1c ≥7.5%, HbA1c change ≥-0.5% from baseline to visit 1, insulin treatment, treatment change, poor adherence to diet, exercise, SMBG during the follow-up period and HbA1c measurements <3 per year were significantly associated with poorer glycaemic control. CONCLUSION:We identified four longitudinal HbA1c trajectories in patients with non-newly diagnosed type 2 diabetes. Even if baseline HbA1c is suboptimal, aggressive treatment changes, good adherence during the follow-up period, ≥3 HbA1c measurements per year and reducing HbA1c levels to a certain extent by the first follow-up visit were important for good, stable, long-term glycaemic control.