Background and aimAlthough artificial intelligence (AI) technologies show promise in diabetes management, real-world evidence supporting AI-driven personalized care remains limited. We developed an AI-powered platform that generates dynamic self-management plans (DSMPs) and enables continuous, whole-process patient monitoring. This study aimed to evaluate its effectiveness in patients with type 2 diabetes mellitus (T2DM).DesignThis was a 12-month, multicenter, prospective, open-label, quasi-experimental cohort study. A total of 1,452 eligible patients with T2DM were enrolled between April 2022 and April 2023 and assigned by an AI-driven platform, based on enrollment sequence, to either the intervention group (n = 726) or the control group (n = 726). All participants received integrated diabetes management via the AI-driven platform. The intervention group was provided with DSMPs, whereas the control group received routine care.FindingsAmong the 1,343 patients who completed the study (655 in the intervention group and 688 in the control group), the intervention group demonstrated significantly better glycemic control at 3 months. Reductions in glycated hemoglobin (HbA1c) (1.92% vs. 1.31%) and fasting plasma glucose (FPG) (3.23 vs. 2.31 mmol/L) were significantly greater in the intervention group, and significantly more patients achieved treatment targets for both HbA1c (57% vs. 26%) and FPG (68% vs. 39%). Furthermore, the intervention led to significant improvements (all p < 0.05) in Self-Monitoring of Blood Glucose (SMBG) frequency, hypoglycemia incidence, Body Mass Index (BMI), Urine Albumin-to-Creatinine Ratio (UACR), and most blood lipids compared to the control group and baseline, though Total Cholesterol (TC) remained unchanged (p = 0.53). Notably, the co-primary outcome was achieved by 18.2% (119/655) of patients in the intervention group, which was significantly higher than the 5.5% (38/688) observed in the control group (p < 0.001).ConclusionsAI-driven personalized management was feasible and effective for the management of T2DM and was associated with an increased rate of diabetes remission. However, further evidence is required to justify its integration into routine clinical practice, and improvements in cholesterol management remain necessary.

Background and aim: Diabetes self-management education programs have been shown to improve patients' health outcomes, and Internet technology have provided more ways for diabetes management. However, it is difficult for patients to grasp all the information during a short period of consultation time. In this study, we implemented a fully integrated regional diabetes management model that information platform-based personalized prescription, and evaluated its feasibility and effectiveness among patients with type 2 diabetes( T2DM). Design: This was a 12-month long, multi-centered, prospective, and open-labeled cohort study. In this study, 1452 eligible participants with T2DM were enrolled and randomized to an intervention (n = 726) or a control (n = 726) group from April 2022 to April 2023. All patients underwent integrated management through an information platform. The intervention group was provided individualized self-management prescriptions, while the control group received routine care. Findings: 1342 patients completed valid observations, 655 in the intervention group and 688 in the control group. The intervention group showed significant HbA1c and fasting plasma glucose(FPG) reduction (1.92% (mmol/mol) and 3.23mmol/L) at the first follow-up time, and 57% HbA1c (373) and 68%FPG (474) patients reached treatment target rate (HbA1c ≤ 7% (mmol/mol), FPG ≤ 7mmol/L), compared with the control group (HbA1c = 1.31% (mmol/mol),26% (179) and FPG = 2.31mmol/L,39% (265)). Meantime, the intervention group showed significant improvements in the frequency of SMBG, the incidence of hypoglycemia, BMI, UACR, and blood lipids after the intervention compared with a control group and baseline (all p < 0.05), except the TC (p = 0.53 baseline vs. after intervention). The co-primary outcomes were achieved by 119 people (18%) in the intervention group, and this was significantly higher than the control group (38 (6%), P < 0.001). Moreover, the achieved co-primary outcomes rate is higher among middle-aged (19%) and female (19%) patients in the intervention group. Conclusions The platform-based diabetes self-management prescriptions provided feasible and effective in the management of T2DM, also can promote the remission rate of diabetes. But need to justifying their integration into clinical practice, with cholesterol management needs to be improved.

Aims: To investigate the prevalence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) and the associated risk factors among Chinese patients with type 2 diabetes mellitus. Methods: A cross-sectional study was conducted using data between November 1, 2018, and December 31, 2022. PAD was defined as ABI <= 0.9. DPN diagnosis involved specialized physician assessments using questionnaires and vibration perception threshold tests. Logistic regression analysis was used to identify related factors. We also evaluated the association between the clustering of risk factors and disease incidence. Results: The study population comprised 13,315 patients (mean age: 63.3 years). 4.9 % of the patients had PAD and 43.9 % had DPN. Multivariate regression analysis revealed advanced age, smoking, hypertension, coronary heart disease, dyslipidemia, elevated HbA1c, and uric acid levels as independent risk factors for PAD. For DPN, independent risk factors included advanced age, female gender, hypertension, coronary heart disease, elevated total cholesterol, triglycerides, lipoprotein(a), fasting plasma glucose, HbA1c, alkaline phosphatase, cystatin C, albumin-to-creatinine ratio, and elevated homocysteine levels, whereas apolipoprotein A was a protective factor. The clustering of risk factors was prevalent and associated with higher disease risk. Conclusions: Our study contributed to identifying high-risk individuals and improving lower limb health among diabetic individuals.

Introduction:Cellular adaptation to physical training and energy metabolism play an important role during physical exercise. This study sought to investigate the effects of α-KG on cell growth and energy metabolism in C2C12 cell culture.Methods:C2C12 cells were cultured in media pretreated without (control) or with α-KG at different concentrations, and cells and media were harvested every 24 h for 8 days. From cell counts, specific cell growth rate (SGR) and doubling time were calculated. The content of glucose, glutamine, lactate, and ammonia in media was determined, and the specific consumption rate (SCR) or production rate (SPR) was calculated. Additionally, cell colony-forming efficiency (CFE) was determined.Results:The control cells showed a CFE at 50%, a typical cell growth curve in the first 5 days with a mean SGR at 0.86/day, and a mean cell count doubling time at 19.4 h. In the group with α-KG at 100 mM, the cells underwent rapid cell death, and thus no further analysis was made. The treatment with α-KG at lower concentrations (0.1 mM and 1.0 mM) led to a higher CFE at 68 and 55%, respectively, whereas those in groups with higher α-KG concentration decreased (10 and 6% for 20 mM and 30 mM α-KG, respectively). The mean SGR was 0.95/day, 0.94/day, 0.77/day, 0.71/day, and 0.65/day for groups treated with α-KG at 0.1, 1.0, 10.0, 20.0, and 30.0 mM, respectively, and the corresponding cell count doubling time was 17.6, 17.8, 20.9, 24.6, and 24.7 h, respectively. In comparison with that of the control group, the mean glucose SCR decreased in all the groups treated with α-KG, while the mean glutamine SCR remained unchanged; the mean lactate SPR increased in the groups treated with α-KG ≥ 20.0 mM. Finally, the mean SPR of ammonia was lower in all α-KG groups than that in the control.Discussion and conclusion:The treatment with α-KG at lower concentrations increased cell growth whereas at higher concentrations decreased cell growth, and α-KG reduced glucose consumption and ammonia production. Therefore, α-KG stimulates cell growth in a dose-dependent manner, which is likely through the improvement of glucose and glutamine metabolism in a C2C12 culture setting.

肠道菌群对人体健康起着至关重要的作用,与多种肾脏疾病关系密切并且相互影响.糖尿病肾脏病(DKD)是糖尿病患者常见的慢性并发症,也是终末期肾病的重要病因,其发病机制复杂,且临床治疗手段有限.目前研究认为肠道菌群参与DKD的发生发展,并有望成为防治DKD的新靶点,本文作者就相关研究进展进行综述.

Mortality risk declined over time. Patients with fragility hip fracture experienced an approximate ninefold excess mortality, peaking shortly after fracture, in comparison with that of the general population. Continuous efforts in lowering the occurrence of hip fracture have the potential to improve the survival of the elderly population in China. Hip fractures in older adults often lead to an elevated risk of death. However, few studies investigated mortality risk following hip fracture in mainland China. This retrospective cohort study aimed to evaluate the crude mortality and excess mortality after fragility hip fractures in Lishui residents aged 50 years and older. Patients having a fragility hip fracture between October 2013 and August 2019 were identified from the Lishui District Inpatient Data Collection and followed up until August 2020. Death information was ascertained from the linked death registry records. We calculated the follow-up mortality rate and corresponding 95

糖尿病足（DF）作为糖尿病慢性严重并发症之一，具有高截肢率及死亡率，给患者及社会带来了沉重的经济负担。延迟转诊是目前我国乃至全球DF患者高截肢率及死亡率的重要原因，国际糖尿病足部护理小组和D-foot国际团队的学者开发出一套DF快速转诊路径并根据各国立法在英国、法国、德国、意大利、西班牙进行实施，而我国目前尚未制定出一套完整的快速转诊路径，加之患者及部分基层卫生保健人员对DF仍有认识误区，导致部分地区的DF患者仍无法得到及时、标准的诊疗。因此，完善一套完整的快速转诊路径，实现基层与综合医院的DF防治联动模式需求越来越迫切。

目的:随着疾病诊断相关分组(DRG)支付方式改革推进,规范促进医院运行效能提升以达到更少的医疗花费、更短的住院时间、更好的诊疗效果,探索常规临床路径(以下称"临床路径")的实施对DRG运行效率、服务能力及结算指标的影响,为指导临床路径在DRG支付方式改革中提供理论依据.方法:回顾分析南京某三甲医院2022年1月至9月所有参与DRG支付方式改革结算的28 281例病例,以是否完整完成临床路径及其对不同病种类型、分组类型及结算类型结算的影响进行统计分析,并探索医疗费用类别在不同的DRG结算类型中对结算率的影响.结果:基础病组病例数较非基础病组病例数少(4 008例vs.24 273例,P＜0.005),内科病组较操作病组及手术病组病例数多(12 324例vs.3 388例vs.12 569例,P＜0.005),正常倍率病例组较低倍率病例组及高倍率病例组病例数多(26 419例vs.1 445例vs.417例,P＜0.005);从整体情况来看,使用临床路径会伴随着较低的结算率[(10.17±1.58％)％vs.(10.36±1.83)％,P＜0.005];无论是否使用临床路径,对不同的病种类型、分组类型还是结算类型病例,均未显示出有利于结算率的提高且差异具有统计学意义(P＜0.05);医疗费用是影响DRG结算率的重要因素,且与是否使用临床路径无必然的关系(P＜0.05).结论:临床路径的实施在提高DRG运行效能上未显示出有效性,基于DRG支付政策优化临床路径可能是未来需要研究的方向.

目的:评价低碳水化合物早餐对新城镇居民2型糖尿病(T2DM)患者心理痛苦及饮食管理自我效能的影响.方法:选择2018年8月至2019年3月就诊于南京市某卫生院的90例新城镇居民T2DM患者,随机分为试验组与对照组两组各45例.两组患者在接受常规糖尿病相关知识教育的基础上,分别接受低碳水化合物早餐教育(试验组)和指南推荐均衡早餐教育(对照组),比较干预前后两组患者心理痛苦及饮食管理自我效能的变化.结果:试验组干预前后糖尿病痛苦量表(DDS)均分及情感、生活规律、人际关系相关痛苦均分的差值均大于对照组(P＜0.05).试验组干预前后饮食管理自我效能中务目2、3得分的差值均大于对照组(P＜0.05).除就医相关痛苦外,两组患者DDS均分及各维度得分的差值与饮食管理自我效能中条目3的差值均呈负相关(P＜0.05);DDS均分及生活规律相关痛苦得分的差值与条目2的差值呈负相关(P＜0.05).结论:低碳水化合物早餐可以显著改善新城镇居民T2DM患者的心理痛苦和饮食管理自我效能,且效果优于指南推荐均衡早餐.

Immune checkpoint therapy is a new mode of tumor therapy. At present, many kinds of PD-1/PD-L1 inhibitors have been approved for clinical application on various tumors, such as malignant melanoma, lung cancer, bladder cancer, lymphoma, etc. However, with the gradual promotion and application in clinical practice, various immune-related adverse reactions caused by PD-1/PD-L1 inhibitors have attracted extensive attention. Especially in recent years, a number of adverse reactions related to endocrine gland injury have been reported. This paper reviews the research status and corresponding clinical treatment methods of endocrine gland related adverse reactions caused by PD-1/PD-L1 inhibitors.

背景 我国糖尿病患病率逐年升高,饮食管理是糖尿病治疗的基础措施.低碳水化合物饮食虽对糖尿病患者的糖脂代谢有益,但严格的碳水化合物控制与我国传统饮食文化差距较大,导致患者长期饮食依从性欠佳.目的 探讨低碳水化合物早餐治疗新城镇2型糖尿病(T2DM)患者的效果.方法 采用便利抽样法选取2018年8月—2019年3月就诊于南京市溧水区东屏镇卫生院的90例新城镇T2DM患者为研究对象,采用抛硬币法将其分为试验组和对照组,每组45例.以标准碗和基于此而制定的食物定量图谱为研究工具,为对照组进行指南推荐早餐教育,试验组进行低碳水化合物早餐教育,两组午餐、晚餐的碳水化合物摄入比例不做限定.于干预前和干预3、6个月检测两组患者空腹血糖(FPG)、早餐后2 h血糖、糖化血红蛋白(HbA1c)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、自我效能量表(SED)评分,干预2周和干预3、6个月记录饮食依从性.结果 对照组2例患者分别因脑梗死复发、嫌控制饮食麻烦退出研究,试验组3例患者分别因搬迁、外出打工、拒绝随访退出研究;失访率为5.6％.干预3个月试验组患者早餐后2 h血糖低于对照组(P<0.05).对照组患者干预3、6个月早餐后2 h血糖、HbA1c低于组内干预前(P<0.05);试验组干预3个月早餐后2 h血糖、HbA1c、HDL-C、LDL-C、TG低于组内干预前,干预6个月FPG、早餐后2 h血糖、HbA1c、HDL-C、LDL-C、TG低于组内干预前(P<0.05).干预6个月试验组患者SED评分高于对照组(P<0.05).两组患者干预3、6个月SED评分均高于组内干预前(P<0.05);试验组患者干预6个月SED评分高于组内干预3个月(P<0.05).两组患者干预3、6个月饮食依从性均高于组内干预2周(P<0.05).结论 指南推荐早餐教育和低碳水化合物早餐教育均能有效改善新城镇T2DM患者的糖脂代谢、自我效能和饮食依从性,且低碳水化合物早餐在改善糖脂代谢、自我效能方面优于指南推荐早餐教育.

餐后高血糖是指进餐后1～2 h的餐后血糖高于7.8 mmol/L,餐后高血糖是导致糖化血红蛋白升高的主要原因,且其与糖尿病慢性并发症的发生发展具有相关性,控制餐后血糖是促进糖化血红蛋白达标、防治糖尿病慢性并发症的重要措施.近年研究发现,改变进餐顺序的饮食治疗方法可以显著改善糖尿病患者的餐后血糖.本文就进餐顺序的概述、进餐顺序对糖尿病患者餐后血糖的研究现状及其可能机制做如下综述,旨在为进一步的研究提供借鉴.

Objective:To explore the feasibility and utility of quantitative proteomics tandem mass tag (TMT) in screening antimicrobial peptides from diabetic foot skin.Methods:During April 2017 to December 2018, 3 samples from the skin around the ulcer of the lower extremity in patients with diabetic foot who underwent debridement, and another 3 from the skin around the ulcer of the lower extremity in non-diabetic patients who received other operations in Zhongda Hospital, Southeast University, were collected. TMT was used to analyze the proteomics of these samples, and the significantly changed proteins were screened. The biological functions of the identified differential proteins were interpreted based on UniProt-GOA database. Using the identified proteins as the background, Fisher exact test was used to evaluate the function of differentially expressed proteins. The magnitude of the enrichment of functional domains of differentially expressed proteins was analyzed using InterPro database.Results:A total of 133 differentially expressed proteins were identified, of which 101 and 32 were up-regulated and down-regulated, respectively. Gene ontology (GO) enrichment analysis showed that the most significant enrichment process in protein biology was the defense process against bacteria, followed by the humoral response process against bacteria. A total of 19 proteins involved in the defense response process to bacteria, of which 18 proteins were up-regulated and 1 protein was down-regulated. Eight proteins were up-regulated more than four-fold, which included Lysozyme C, neutrophil elastase, bactericidal permeability increasing protein, lactoferrin, membrane-associated phospholipase A2, peptidoglycan recognition protein 1, immune globulin J chain, and protein S100-A12. A total of 8 proteins were involved in the process of antimicrobial humoral response, of which 7 proteins overlapped with proteins involved in the defense response to bacteria. Protein interaction analysis showed that the differentially expressed antimicrobial proteins formed a complex regulatory network with 14 nodes and 34 edges, the average node degree was 4.86, and the clustering coefficient was 0.652.Conclusions:The TMT labelled proteomics suggested that proteins, such as lysozyme C, neutrophil Elastase, bactericidal permeability increasing protein, lactoferrin, membrane-associated phospholipase A2, peptidoglycan recognition protein 1, immune globulin j-chain and protein S100-A12, which are involved in the defense and humoral immune responses against bacteria, hold promise as the new target for the treatment of diabetic foot infection.

Abstract Background Gestational diabetes mellitus (GDM) is now a global health problem. Poor blood glucose control during pregnancy may lead to maternal and neonatal/foetal complications. Recently, the development of information and communication technology has resulted in new technical support for the clinical care of GDM. Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. This study aimed to update the systematic review of the effectiveness of telemedicine interventions on glycaemic control and pregnancy outcomes in pregnant women with GDM. Methods We searched the Web of Science, PubMed, Scopus, Cochrane Central Register of Controlled Trials, Chinese National Knowledge Infrastructure, Wan-fang Database, China Biology Medicine and VIP Database for randomized controlled trials (RCTs) related to the effectiveness of telemedicine interventions for GDM from database inception to July 31st, 2019. Languages were limited to English and Chinese. Literature screening, data extraction and assessment of the risk of bias were completed independently by two reviewers. Meta-analysis and trial sequential analysis were conducted in Stata 14.0 and TSA v0.9.5.10 beta, respectively. Results A total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = − 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. The trial sequential analyses conclusively demonstrated that the meta-analytic results of the change in HbA1c, the change in 2hBG, the change in FBG, the incidence rates of caesarean section, pregnancy-induced hypertension or preeclampsia, premature rupture of membranes, premature birth, neonatal asphyxia, and polyhydramnios were stable. Conclusions Compared to standard care, telemedicine interventions can decrease the glycaemic levels of patients with GDM more effectively and reduce the risk of maternal and neonatal/foetal complications.

Objective To evaluate the effect of smoking and smoking cessation on transcutaneous oxygen pressure (TcPO2) of low extremity in man with type 2 diabetics. Methods 120 men with type 2 diabetes (aged≥18 years) were recruited from the Endocrinology Department, Zhongda Hospital, Southeast University. Based on the smoking status, they were assigned to three groups: current-smoking (CS, n=40); quit-smoking (QS, n=40) and non-smoking (NS, n=40). General clinical data of all subjects were recorded and assessed. TcPO2 at the dorsum of foot and chest was monitored before and after five-minute treadmill exercise. Analysis of variance (ANOVA) and Generalized Estimating Equations (GEE) were performed to analyze the effect of smoking /smoking-cessation on TcPO2 before and after exercise respectively. Results In resting-state (t=0 min), the TcPO2 on dorsal foot in CS was significantly decreased compared with NS ((36.12±10.25) vs (55.46±7.32) mmHg, 1 mmHg=0.133 kPa, F=1.145, P=0.011) and QS (41.05± 11.23, F=2.221, P=0.023). Instead, TcPO2 on the chest and bilateral perfusion index were undifferentiated among the three groups (F=1.125, P=0.424). After a five-minute treadmill exercise, TcPO2 on the chest showed an upward trend in all three groups with no significant difference (Wald χ2=3.212, P=0.549). The partial regression coefficient B of TcPO2 at dorsum of foot decreased significantly in CS (B=-46.823) and QS (B=-38.267) and the difference was statistically significant compared with NS (Wald χ2=8.263, 6.078 and all P<0.05) in spite of no difference between the CS and QS (Wald χ2=0.512, P>0.05). Conclusions Smoking can induce a decline in TcPO2 in man with type 2 diabetics. To an extent, smoking cessation only ameliorates the decrease of TcPO2 in the lower extremities.

BACKGROUND:Evidence emerges that cardiorespiratory fitness (CRF) might be implicated in the development of heart failure (HF). This meta-analysis aimed to quantify the association between CRF exposed at baseline and HF risk with dose-response analysis and to assess whether CRF changes over time are correlated with alterations in HF risk. METHODS AND RESULTS:Cohort studies that assessed the association between CRF and risk of HF in subjects without baseline HF were included. Study-specific multivariate-adjusted relative risks (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Ten studies from 8 articles were included, enrolling 8987 incident HF cases from 154,598 participants. The RR of HF per 1-metabolic equivalent (MET) higher CRF at baseline was 0.82 (95% CI 0.80-0.84) in the overall population. The RRs were similar in men (0.82, 95% CI 0.80-0.85) and women (0.81, 95% CI 0.78-0.84), and remained minorly changed in patients with existing diabetes, hypertension, or cardiovascular disease at entry. No evidence of a nonlinear relationship between CRF at baseline and risk of HF was observed (Pnonlinearity = .18). The RR of HF per 1-MET increase in CRF over time was 0.79 (95% CI 0.67-0.93), and the measurement of CRF provided incremental value to the prediction of HF beyond conventional models. CONCLUSIONS:High or increased CRF resulted in reduced risk of HF in a dose-dependent manner, supporting the necessity to increase CRF to prevent HF in clinical practice.

Background and aims: Cell adhesion molecules (CAMs) are implicated in the initiation and progression of atherosclerosis, but their association with risk of type 2 diabetes remains inconsistent. This meta-analysis aimed to quantify this association with dose-response analysis in the general population without type 2 diabetes at baseline. Methods: Prospective studies, investigating the association of circulating (plasma/serum) CAMs, such as intercellular adhesion molecule-1 (ICAM-1), E-selectin, vascular cell adhesion molecule-1 (VCAM-1), and P-selectin, with risk of type 2 diabetes, were included. The overall relative risks (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results: Sixteen datasets from 15 studies were included. The overall RR was 1.88 (95% CI 1.59 to 2.23) per 1-ln mu g/ml increase in ICAM-1, and 2.44 (95% CI 1.90 to 3.12) per 1-ln mu g/ml increase in E-selectin. These associations were log-linearly shaped (both pnon-linearity> 0.05) and independent of traditional cardiovascular risk factors (all p < 0.05). ICAM-1 had comparable predictive ability as E-selectin (2.22 versus 2.66, p = 0.40). However, no significant association was observed for VCAM-1 (RR 1.20, 95% CI 0.73 to 1.98) or P-selectin (RR 1.01, 95% CI 0.64 to 1.59), and the added predictive value of circulating CAMs assessed by Integrated Discrimination Improvement to the basic prediction models was small (0.01 for ICAM-1, 0.003 for E-selectin, and 0.007 for VCAM-1). Conclusions: Elevated circulating CAMs, especially ICAM-1 and E-selectin, led to increased risk of type 2 diabetes in a dose-dependent manner, supporting the assumption that endothelial dysfunction contributes to the development of diabetes.

Objective This meta-analysis aimed to (1) quantify the association of cardiorespiratory fitness (CRF) with type 2 diabetes risk in the general population and statin users and (2) investigate the joint effects of CRF and fatness with type 2 diabetes risk. Methods Databases were searched for cohort studies reporting the association between CRF and type 2 diabetes risk. Summary hazard ratios (HRs) were obtained using random-effects models. Results Fifteen studies were included. The HRs of type 2 diabetes for every 1-metabolic equivalent increase in CRF were 0.90 (95% CI: 0.86-0.94) for the general population and 0.92 (95% CI: 0.87-0.97) for statin users, and the HRs were linearly shaped (both P-nonlinearity > 0.40). Compared with the nonstatin cohort, there was an increased risk of type 2 diabetes in statin users with the lowest and moderate CRF categories, but this was not present in the highest CRF category. The HR of type 2 diabetes for overweight/obesity-fit category versus normal weight-fit category was larger than that of the normal weight-unfit category versus the normal weight-fit category (P-interaction = 0.004). Conclusions There was an inverse and dose-dependent association between CRF and type 2 diabetes risk. High CRF may eliminate the diabetogenic effect from statins, yet decreased body weight index seems superior in preventing type 2 diabetes.

Purpose: We investigated the effects of Traditional Chinese Medicine (TCM) on the occurrence and progression of albuminuria in patients with type 2 diabetes. Methods: In this randomized, double-blind, multicenter, controlled trial, we enrolled 600 type 2 diabetes without diabetic nephropathy (DN) or with early-stage DN. Patients were randomly assigned (1:1) to receive Liuwei Dihuang Pills (LWDH) (1.5 g daily) and Ginkgo biloba Tablets (24 mg daily) orally or matching placebos for 24 months. The primary endpoint was the change in urinary albumin/creatinine ratio (UACR) from baseline to 24 months. Results: There were 431 patients having UACR data at baseline and 24 months following-up in both groups. Changes of UACR from baseline to follow-up were not affected in both groups: -1.61(-10.24, 7.17) mg/g in the TCM group and -0.73(-7.47, 6.75) mg/g in the control group. For patients with UACR ≥30 mg/g at baseline, LWDH and Ginkgo biloba significantly reduced the UACR value at 24 months [46.21(34.96, 58.96) vs. 20.78(9.62, 38.85), P < 0.05]. Moreover, the change of UACR from baseline to follow-up in the TCM group was significant higher than that in the control group [-25.50(-42.30, -9.56] vs. -20.61(-36.79, 4.31), P < 0.05]. Conclusion: LWDH and Ginkgo biloba may attenuate deterioration of albuminuria in type 2 diabetes patients. These results suggest that TCM is a promising option of renoprotective agents for early stage of DN. Trial registration: The study was registered in the Chinese Clinical Trial Registry. (no. ChiCTR-TRC-07000037, chictr.org).