Background Total pancreatectomy (TP) has been increasingly performed in recent years. However, studies on diabetes management after TP during different postoperative periods are still limited. Objectives This study aimed to evaluate the glycemic control and insulin therapy of patients undergoing TP during the perioperative and long-term follow-up period. Methods Ninety-three patients undergoing TP for diffuse pancreatic tumors from a single center in China were included. Based on preoperative glycemic status, patients were divided into three groups: nondiabetic group (NDG, n = 41), short-duration diabetic group (SDG, preoperative diabetes duration ≤12 months, n = 22), and long-duration diabetic group (LDG, preoperative diabetes duration >12 months, n = 30). Perioperative and long-term follow-up data, including the survival rate, glycemic control, and insulin regimens, were evaluated. Comparative analysis with complete insulin-deficient type 1 diabetes mellitus (T1DM) was conducted. Results During hospitalization after TP, glucose values within the target (4.4-10.0 mmol/L) accounted for 43.3% of the total data, and 45.2% of the patients experienced hypoglycemic events. Patients received continuous intravenous insulin infusion during parenteral nutrition at a daily insulin dose of 1.20 ± 0.47 units/kg/day. In the long-term follow-up period, glycosylated hemoglobin A1 c levels of 7.43 ± 0.76% in patients following TP, as well as time in range and coefficient of variation assessed by continuous glucose monitoring, were similar to those in patients with T1DM. However, patients after TP had lower daily insulin dose (0.49 ± 0.19 vs 0.65 ± 0.19 units/kg/day, P < 0.001) and basal insulin percentage (39.4 ± 16.5 vs 43.9 ± 9.9%, P = 0.035) than patients with T1DM, so did those using insulin pump therapy. Whether in the perioperative or long-term follow-up period, daily insulin dose was significantly higher in LDG patients than in NDG and SDG patients. Conclusions Insulin dose in patients undergoing TP varied according to different postoperative periods. During long-term follow-up, glycemic control and variability following TP were comparable to complete insulin-deficient T1DM but with fewer insulin needs. Preoperative glycemic status should be evaluated as it could guide insulin therapy after TP.

According to the data of China's seventh national population census, the elderly population (≥60 years old) accounted for 18.7% of the total population in 2020. About 30%(78.13 million)of them suffer from diabetes mellitus, among which more than 95% have type 2 diabetes mellitus. However, current prevention and treatment of type 2 diabetes mellitus in the elderly is unsatisfactory, and there is a tendency of weakening and negativity. Complications caused by poorly controlled blood glucose are the main risk factors jeopardizing the health and survival of the elderly. The Clinical Guidelines of Prevention and Treatment of Type 2 Diabetes Mellitus in the Elderly in China (2022 Edition) that summarizes the domestic and foreign relevant guidelines and research on elderly diabetic patients, aims to establish and optimize the concept of prevention and treatment in the elderly with diabetes mellitus, promote the implementation of standardized measures of prevention and treatment, and constantly improve the overall management level of diabetes mellitus in the elderly. Therefore, it is necessary to interpret its important contents.

目的 探讨1例胰岛素过敏合并胰岛素自身抗体阳性的暴发性1型糖尿病患者的用药调整与实施药学监护的方案.方法 临床药师参与整个治疗过程,查阅相关文献,根据患者血糖波动特点提出相应建议.结果 医师和患者认可临床药师的建议与药学监护,患者血糖控制平稳.结论 临床药师运用药学知识,协助医师共同制定治疗方案,对患者进行药学监护,保障了患者合理用药安全.

Objective:To investigate the efficacy and safety of liraglutide combined with metformin in the treatment of overweight or obese patients with type 2 diabetes, and to analyze the factors influencing the response to liraglutide.Methods:Seventy-three overweight or obese patients with well-controlled type 2 diabetes on metformin were selected and treated with liraglutide at 1.8 mg/d in addition to metformin at 1500 mg/d for 48 weeks. Relevant data were collected before and after treatment, including blood glucose, glycosylated hemoglobin (HbA1c), fasting insulin, serum lipid, body weight, waist circumference, hip circumference, body mass index (BMI), homeostatic model assessment for β-cell function (HOMA-β) and homeostatic model assessment for insulin resistance (HOMA-IR). Changes in metabolic markers, incidence of side effects, weight loss efficacy and corresponding influencing factors were evaluated.Results:After 48 weeks of treatment, fasting blood glucose, 2-hour postprandial blood glucose, HbA1c, fasting insulin, HOMA-IR, blood lipid, waist circumference, hip circumference and BMI decreased significantly compared with baseline ( P < 0.05). The most common side effects were tolerable gastrointestinal adverse events. The average weight loss after the initial 4-week treatment was 3.99 kg, accounting for 48.8% of the total weight loss, and then the change displayed a more subdued trend during the remaining treatment period. After the 48-week treatment, 73.1% and 34.6% of the patients lost more than 5% and 10% of body weight, respectively. Absolute weight loss was positively correlated with baseline weight and weight loss within the initial 4-week treatment was an independent predictor of weight loss ≥ 5% at the 48th week. Conclusions:Liraglutide combined with metformin is safe and effective in the treatment of overweight or obese patients with type 2 diabetes mellitus. Weight loss is significant during the initial 4 weeks and the early response seems to be a predictor for better long-term effect on weight loss.

目的 探讨左心房功能评估在2型糖尿病患者的左心室舒张功能不全(DD)诊断中的价值.方法 纳入2016年1～10月在北京协和医院糖尿病门诊长期就诊的无心力衰竭症状的2型糖尿病患者78例为糖尿病组;同时入选年龄、性别相匹配的健康人80名为健康对照组.应用斑点追踪超声心动图测量应变进行左心房功能评估,评估标准依据2016年美国超声心动图学会和欧洲心血管影像协会联合发布的左心室舒张功能超声心动图评估指南.收集患者和健康人的一般临床资料、超声心动图指标和左心房应变参数;进行多因素logistic回归分析与DD存在关联的因素;绘制受试者工作特征(ROC)曲线评价左心房功能对DD的预测价值.结果 糖尿病组患者的DD总发生率为21.8％(17/78),其中Ⅰ级DD占15.4％.左心房平均管道功能下降与DD显著相关[F(3,74)=3.548,P=0.018].单因素分析显示,左心室整体纵向应变、左心房峰值应变、左心房平均储器功能、左心房平均管道功能、房间隔管道功能与DD相关(均为P<0.05);多因素分析中仅左心房平均管道功能应变与DD有关(OR=0.756,95％CI:0.637～0.896,P=0.001).在整体人群中,左心房管道功能应变为13.46％时,预测DD的敏感度为100％,特异度为62.5％;在糖尿病组中,左心房管道功能应变为13.05％时,预测DD的敏感度为100％,特异度为62.3％;若结合整体人群的E/e'比值,在糖尿病组中,左心房管道功能应变为6.19％、平均E/e'为12.73时,诊断DD的敏感度为77.0％,特异度为80.0％,ROC曲线下面积为0.859(95％CI:0.761～0.957,P=0.00).结论 通过斑点追踪技术测定左心房应变,评估左心房管道功能,可能是检测早期DD的一个简单而可靠的方法.

我儿子患有1型糖尿病,医生建议使用胰岛素泵.请问,什么是胰岛素泵?哪些患者适合用胰岛素泵? 四川剑阁杨弘毅 胰岛素泵是一种微电脑动力装置,内装胰岛素.它由胰岛素的泵容器即储药器、一个小型电池驱动的泵、计算机芯片三个部件组成,芯片用于患者准确控制泵释放胰岛素的剂量.泵内的胰岛素通过一根细的软塑料管连接小针,小针扎入皮下,24小时不停地向患者体内输注小剂量胰岛素(基础量),进食时输注大剂量胰岛素(餐前大剂量),使人体内的血糖持续处于正常状态而不致上下剧烈波动.

减重手术已成为治疗肥胖的有效手段，可导致长期的体重减轻和肥胖相关共病的缓解。腹腔镜Roux-en-Y胃分流术（Roux-en-Y gastric bypass，RYGB）是最常用的减重术式，具有限制性和吸收不良的组合成分。然而，RYGB也是最常见的与减重术后低血糖发生相关的手术。随着RYGB越来越多地被用于治疗肥胖，医生可能会遇到越来越多的术后低血糖患者。该文报告1例减重术后反复发作高胰岛素血症低血糖患者的诊治过程，为尽早并更好地诊治此病提供参考。

患者女,22岁,诊断1型糖尿病(type 1 diabetes mellitus,T1DM)7年,2020年11月就诊于北京协和医院内分泌科.患者2013年开始胰岛素治疗,外院予三餐前门冬胰岛素30及睡前地特胰岛素皮下注射治疗,监测空腹血糖(fasting blood glucose,FBG) 5.0～7.0 mmol/L,餐后2h血糖(2-hour postprandial blood glucose,2 h-PBG) 9.0～ 12.0 mmol/L,低血糖发生频率约为每周1次.

Whole-room calorimeter is one of the gold standards for measuring energy expenditure, which is of great significance in studies on energy metabolism. It can be used to evaluate energy metabolism of different diets, physical activities and lifestyle in healthy or disease states as well as be applied into intervention plan development and efficacy evaluation of nutrition treatment in metabolic diseases, especially in obesity and anti-obesity treatment. It can also play a role in exploring the mechanism of metabolic disease when combined with metabolism related genes and molecular pathways. Here we aim to review the researches on whole-room calorimeter in energy expenditure measurement and obesity.

免疫检查点抑制剂治疗所引发的糖尿病是其引起的相关内分泌系统不良反应中较为少见的一种类型.但该类型糖尿病常常以糖尿病酮症酸中毒起病,较为凶险.本文对免疫检查点抑制剂引起糖尿病的文献进行了系统回顾,并对其临床表现和诊疗对策作一综述.

近些年,发表在《自然》《细胞》《英国医学杂志》《新英格兰医学杂志》等世界顶级医学杂志上的多项权威研究,都证实和传达了这样一个结论:糖摄入过多危害人体健康.那么,糖究竟是如何危害人们身体的呢?我们先来细数一下!

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.

Recent studies on dyslipidemia-related microRNA (miRNA) have found that some types of dyslipidemia are accompanied by a characteristic spectrum of circulating miRNAs, including circulating exosomal miRNAs.On the other hand, miRNAs existing in tissues and cells can regulate lipid metabolism through various mechanisms, such as the reverse cholesterol transport pathway and the low-density lipoprotein receptor expression pathway.Therefore, miRNAs have the potential to become a biomarker for the precision diagnosis of dyslipidemia and are expected to provide novel therapeutic targets for dyslipidemia.This article reviews the studies on the latest developments in this field.

持续皮下胰岛素输注(CSII),即胰岛素泵,在我国糖尿病治疗中的应用不断增加.本文简要回顾了近期中外胰岛素泵治疗指南,重点分析胰岛素泵治疗中常见不良反应的原因和解决方案,强调通过优先选择理化稳定性较高的胰岛素制剂,可能达到减少胰岛素泵治疗中的不良反应和改善治疗效果的作用.

味蕾: “吃糖让人很舒服,很快乐啊!” 身体: “不要你觉得,我要我觉得……” 你相信吗?糖是世界上使用最广泛的“毒品”!糖的甜味在让人愉悦的同时,会让人上瘾,产生依赖性,甚至出现戒断反应.很多人贪恋糖带来的幸福感,却不知高糖的背后不仅仅是肥胖,它对人体健康的危害是全身性的! 当然,话不能随便说,证据是一定要有的!近些年,发表在《自然》《细胞》《英国医学杂志》《新英格兰医学杂志》等世界顶级医学杂志上的多项权威研究,都在证实和传达这样一个结论:“高糖有毒!”

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.

真实世界研究的概念被提出后,逐渐成为医疗卫生领域的热点话题.真实世界研究具有多种优势,在糖尿病领域的应用已得到广泛关注及肯定.多项真实世界研究结果显示,目前中国2型糖尿病患者的整体达标率低,基础胰岛素治疗起始晚,且起始胰岛素治疗后剂量调整不充分.提示尽早规范使用疗效优、安全性好、依从性佳的长效基础胰岛素类似物,可作为改善中国糖尿病达标现状的一项积极有效的治疗策略.

Autoantibodies are related to occurrence of some types of severe hypertriglyceridemia. Resear-ches showed that autoantibodies of lipoprotein lipase, glycosylphosphatidylinositol-anchored high-density lipo-protein binding protein 1 and apolipoprotein C-Ⅱcould induce hypertriglyceridemia. This review focused on hy-pertriglyceridemia induced by autoantibodies and its treatment.

It is well known that parenteral and enteral nutrition support is helpful to improve clinical outcomes in patients with malnutrition or nutritional risk, and surgical nutrition has been used in China for 40 years. However, there is still insufficient awareness of malnutrition among clinical workers. There were different opinions from many experts after the publications of the European Society for Parenteral and Enteral Nutrition (ESPEN) consensus of malnutrition assessment 2015 and ESPEN guidelines on definitions and terminology of clinical nutrition 2017. Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition has also been published in 2018. Though it is lack of clinical validation, it is a big step forward. In order to achieve better prevention and treatment of malnutrition in clinical work, this present paper analyzes and compares the core contents of malnutrition assessment (diagnosis) in recent years, proposes current practical strategy for Chinese clinical workers, emphasizes that GLIM criteria cannot replace the three steps named "screening-assessment-intervention" .