Objective To determine whether smoking increases the risk for developing metabolic syndrome （MetS） in Chinese men.Methods A total of 693 men with no MetS at baseline were followed for 2.9‐5.5 years.Subjects were di...Objective To determine whether smoking increases the risk for developing metabolic syndrome （MetS） in Chinese men.Methods A total of 693 men with no MetS at baseline were followed for 2.9‐5.5 years.Subjects were divided into nonsmokers,ex‐smokers,and current smokers according to baseline smoking status.Results After adjusting for age,education level,alcohol intake,fasting plasma insulin,HOMA‐IR index,and BMI at baseline and weight change,current smokers were dose‐dependently associated with increased risk for developing new MetS compared with nonsmokers.The odds ratio （OR） was 2.131 （95% CI,1.264,3.592;P0.01） for the NCEPIII definition or 3.083 （95% CI,1.807,5.295;P0.01） for the JCDCG definition of MetS.Ex‐smokers who had quit for ≥13 years significantly decreased the risk for developing new MetS defined by the JCDCG definition.Compared with nonsmokers,current smokers were significantly associated with increased incidence of hypertriglyceridemia and low HDL‐C.Conclusion Smoking is a risk factor for developing MetS in Chinese men after adjusting for age,education level,alcohol intake,fasting plasma insulin,HOMA‐IR,BMI,and weight change.This could be due to an increased incidence of dyslipidemia.Smoking cessation for 13 years decreased the risk for developing MetS defined by the JCDCG definition.展开更多
Objective To investigate the relationship of liver enzymes with hyperglycemia in a large population in Shanghai and identify the association between liver enzymes and insulin resistance. Methods A total of 3 756 parti...Objective To investigate the relationship of liver enzymes with hyperglycemia in a large population in Shanghai and identify the association between liver enzymes and insulin resistance. Methods A total of 3 756 participants were enrolled. Each participant underwent an oral glucose tolerance test and completed a questionnaire. Anthropometric indices were recorded and serum samples were collected for measurement. Results Liver enzymes concentrations were independently associated with i-IGT, iFG＋IGT, and diabetes. With the increase of ALT and GGT concentrations, ORs for i-IGT, IFG＋tGT, and diabetes increased gradually. By comparing patients in the highest quartile of GGT concentrations or ALT concentrations with those in the lowest quartile （Q1）, ORs for iqGT, IFG＋IGT, or diabetes was significant after adjustment. Both ALT and GGT concentrations were linearly correlated with HOMA-IR and independently associated with HOMA-IR [ALT OR （95% Cl）： 2.56 （1.51-4.34） P=0.00; GGT OR （95% CI）： 2.66 （1.53-4.65） P=0.00]. Conclusion Serum ALT and GGT concentrations were closely related to pre-diabetes and diabetes in the Shanghai population and positively associated with insulin resistance.展开更多
Objective To investigate a potential relationship between Solute carrier family 30 （zinc transporter） member 8 （SLC3OAS） rs13266634 variant and efficacy of rosiglitazone or repaglinide in treating newly diagnosed ...Objective To investigate a potential relationship between Solute carrier family 30 （zinc transporter） member 8 （SLC3OAS） rs13266634 variant and efficacy of rosiglitazone or repaglinide in treating newly diagnosed Chinese type 2 diabetes patients. Methods A total of 209 diabetic patients without any antihyperglycemic history were recruited and treated with repaglinide or rosiglitazone randomly for 48 weeks （104 and 105 patients, respectively）. Anthropometric measurements and clinical laboratory tests were carried out before and after the treatment. An non-synonymous variant rs13266634 was genotyped by matrix-assisted laser desorption ionization-time of flight mass spectroscopy. Results Ninety-one patients in repaglinide group and ninety-three patients in rosiglitazone group completed the study. 6 value of homeostasis model assessment of beta cell function （HOMA-B） and 6 value of fasting proinsulin levels were statistically significant between three genotype groups （P=0.0149 and 0.0246, respectively） after rosiglitazone treatment. However, no genotype association was observed in the repaglinide or rosiglitazone group with other parameters. Conclusion The SLC3OA8 variant was associated with the efficacy of insulin sensitizer monotherapy on insulin secretion in patients with newly diagnosed type 2 diabetes mellitus in Shanghai, China.展开更多
Objective To evaluate whether waist circumference （WC） 〉85 cm is related to asymptomatic preclinical atherosclerosis in women from Shanghai, China. Methods A total of 2365 females aged 〉20 years recruited from 4 c...Objective To evaluate whether waist circumference （WC） 〉85 cm is related to asymptomatic preclinical atherosclerosis in women from Shanghai, China. Methods A total of 2365 females aged 〉20 years recruited from 4 communities underwent physical examination and carotid artery scanning. Their carotid intima-media thickness （C-iMT） was measured. Results The C-IMT was significantly higher in overweight or obese women with their BMI 〉25.0 kg/m2 {P〈O.01） and in those with their WC _〉85 cm than in those with their WC 〈85 cm （P〈O.01）. Spearman and partial correlation analysis showed that the C-IMT was significantly correlated with WC which was independent of menopausal status. The C-IMT significantly increased with the increasing WC and reached to a platform in about 85 cm. An increment tendency was found in the subgroup with its WC 〈 85 cm （P〈O.01） while no significant tendency was found in the subgroup with its WC_〉85 cm （P=0.07）. Multiple stepwise regression analysis showed that the WC was an independent risk factor for C-IMT. In logistic regression model, the odd ratio of WC _〉80 cm, _〉80 cm and 〈85 cm and 〉85 cm for evaluating the risk of C-IMT elevation was 2.632, 2.501, and 1.878, respectively. Conclusion WC is significantly correlated with C-IMT in women from Shanghai, China, and WC_〉85 cm may be used in identifying the risk of subclinical carotid atherosclerosis.展开更多
Accumulating evidence indicates that overweight and obesity are the major international public health concern. Obesity is a major independent risk factor for chronic diseases, such as hypertension, type 2 diabetes, ca...Accumulating evidence indicates that overweight and obesity are the major international public health concern. Obesity is a major independent risk factor for chronic diseases, such as hypertension, type 2 diabetes, cardiovascular disease, stroke, and certain cancer. Disease burden due to obesity has been dramatically increasing in many countries including China in the past years. According to the Nationwide Health and Nutrition Survey （CHNS）, the prevalence of overweight and obesity among men and women in China increased by 27.6% and 8.8%, respectively, from 1993 to 2009.展开更多
BACKGROUND The prevalence and clinical characteristics of chronic kidney disease(CKD)among patients with ketosis-onset diabetes(also known as ketosis-prone diabetes)remain unclear.Furthermore,the classification of ket...BACKGROUND The prevalence and clinical characteristics of chronic kidney disease(CKD)among patients with ketosis-onset diabetes(also known as ketosis-prone diabetes)remain unclear.Furthermore,the classification of ketosis-onset diabetes remains controversial and requires further investigation.AIM To investigate the prevalence and clinical features of CKD in patients with newly diagnosed ketosis-onset diabetes.METHODS This real-world study included 217 patients with type 1 diabetes mellitus(T1DM),698 with ketosis-onset diabetes,and 993 with non-ketotic T2DM.The prevalence and clinical characteristics of CKD were compared among the three groups.Risk factors associated with CKD were evaluated using binary logistic regression for each group.RESULTS After adjusting for age and sex,the prevalence of CKD among patients with ketosis-onset diabetes(17.8%)was significantly higher than that in those with T1DM(8.3%,P=0.007),but was not statistically different compared to those with non-ketotic T2DM(21.7%,P=0.214).Furthermore,some risk factors for CKD,including age,and serum uric acid and C-reactive protein levels,in patients with ketosis-onset diabetes were similar to those with T2DM,but significantly different from those with T1DM.CONCLUSION The prevalence,clinical characteristics,and risk factors for CKD among patients with ketosis-onset diabetes were more similar to those with non-ketotic T2DM but considerably different from those with T1DM.These findings further support the classification of ketosis-onset diabetes as a subtype of T2DM rather than idiopathic T1DM.展开更多
Diabetes poses a considerable global health challenge,with varying levels of diabetes knowledge among healthcare professionals,highlighting the importance of diabetes training.Large Language Models(LLMs)provide new in...Diabetes poses a considerable global health challenge,with varying levels of diabetes knowledge among healthcare professionals,highlighting the importance of diabetes training.Large Language Models(LLMs)provide new insights into diabetes training,but their performance in diabetes-related queries remains uncertain,especially outside the English language like Chinese.We first evaluated the performance of ten LLMs:ChatGPT-3.5,ChatGPT-4.0,Google Bard,LlaMA-7B,LlaMA2-7B,about:blank ERNIE Bot,Ali Tongyi Qianwen,MedGPT,HuatuoGPT,and Chinese LlaMA2-7B on diabetes-related queries,based on the Chinese National Certificate Examination for Primary Diabetes Care in China(NCE-CPDC)and the English Specialty Certificate Examination in Endocrinology and Diabetes of Membership of the Royal College of Physicians of the United Kingdom.Second,we assessed the training of primary care physicians(PCPs)without and with the assistance of ChatGPT-4.0 in the NCE-CPDC examination to ascertain the reliability of LLMs as medical assistants.We found that ChatGPT-4.0 outperformed other LLMs in the English examination,achieving a passing accuracy of 62.50%,which was significantly higher than that of Google Bard,LlaMA-7B,and LlaMA2-7B.For the NCE-CPFC examination,ChatGPT-4.0,Ali Tongyi Qianwen,about:blank ERNIE Bot,Google Bard,MedGPT,and ChatGPT-3.5 successfully passed,whereas LlaMA2-7B,HuatuoGPT,Chinese LLaMA2-7B,and LlaMA-7B failed.ChatGPT-4.0(84.82%)surpassed all PCPs and assisted most PCPs in the NCE-CPDC examination(improving by 1%–6.13%).In summary,LLMs demonstrated outstanding competence for diabetes-related questions in both the Chinese and English language,and hold great potential to assist future diabetes training for physicians globally.展开更多
This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai,China.A total of 173235 patients with type 2 diabetes in 2017 were included in the analysis.Profiles of risk factors and inte...This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai,China.A total of 173235 patients with type 2 diabetes in 2017 were included in the analysis.Profiles of risk factors and intermediate outcomes were determined.The patients had a mean age of 66.43±8.12(standard deviation(SD))years and a mean diabetes duration of 7.95±5.53(SD)years.The percentage of patients who achieved the target level for HbA_(1c)(<7.0%)was 48.6%.Patients who achieved the target levels for blood pressure(BP)<130/80 mmHg and low-density lipoprotein-cholesterol(LDL-c)<2.6 mmol/L reached 17.5%and 34.0%,respectively.A total of 3.8%achieved all three target levels,and the value increased to 6.8%with an adaptation of the BP target level(<140/90 mmHg)for those over 65 years.Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels:male,young age,short diabetes duration,low body mass index,macrovascular complications,no microvascular complications,prescribed with lipid-lowering medication,and no prescription of antihypertensive medication.In conclusion,nearly 50%and one-third of the patients with diabetes met the target levels for HbA_(1c)and LDL-c,respectively,with a low percentage achieving the BP target level.The percentage of patients who achieved all three target levels needs significant improvement.展开更多
Despite the current guideline's recommendation of a timely stepwise intensification therapy,the "clinical inertia",termed as the delayed treatment intensification,commonly exists in the real world,which ...Despite the current guideline's recommendation of a timely stepwise intensification therapy,the "clinical inertia",termed as the delayed treatment intensification,commonly exists in the real world,which may be partly due to the relatively little substantial evidence and no clear consensus regarding the efficacy and safety of triple oral agents in patients inadequately controlled with dual therapy.In this clinical trial performed in 237 centers in China,5,535 type 2 diabetic patients inadequately controlled by previous therapies were treated with a stable metformin/sitagliptin dual therapy for 20 weeks.The patients who did not reach the glycated hemoglobin A1c(HbA1c) goal were then further randomized into glimepiride,gliclazide,repaglinide,or acarbose group for an additional 24-week triple therapy.A mean HbAlc reduction of 0.85%was observed when sitagliptin was added to the patients inadequately controlled with metformin in 16 weeks.Further HbAlc reductions in the 24-week triple therapy stage were 0.65%in glimepiride group,0.70%in gliclazide group,0.61%in repaglinide group,and 0.45%in acarbose group.The non-inferiority criterion for primary hypotheses was met for gliclazide and repaglinide,but not for acarbose,compared with glimepiride,when added to metformin/sitagliptin dual therapy.The incidences of adverse events(AEs) were 29.2%in the dual therapy stage and30.3%in the triple therapy stage.Metformin/sitagliptin as baseline therapy,with the addition of a third oral antihyperglycemic agent,including glimepiride,gliclazide,repaglinide,or acarbose,was effective,safe and well-tolerated for achieving an HbAlc<7.0%goal in type 2 diabetic patients inadequately controlled with previous therapies.The timely augmentation of up to three oral antihyperglycemic agents is valid and of important clinical benefit to prevent patients from exposure to unnecessarily prolonged hyperglycemia.展开更多
Overweight or obesity has become a serious public health problem in the world, scientists are concentrating their efforts on exploring novel ways to treat obesity. Nowadays, the availabilities of bariatric surgery and...Overweight or obesity has become a serious public health problem in the world, scientists are concentrating their efforts on exploring novel ways to treat obesity. Nowadays, the availabilities of bariatric surgery and pharmacotherapy have enhanced obesity treatment, but it should has support from diet, physical exercise and lifestyle modification, especially the functional food. Resistant starch, an indigestible starch, has been studied for years for its beneficial effects on regulating blood glucose level and lipid metabolism. The aim of this review is to summarize the effect of resistant starch on weight loss and the possible mechanisms. According to numerous previous studies it could be concluded that resistant starch can reduce fat accumulation, enhance insulin sensitivity, regulate blood glucose level and lipid metabolism. Recent investigations have focused on the possible associations between resistant starch and incretins as well as gut microbiota. Resistant starch seems to be a promising dietary fiber for the prevention or treatment of obesity and its related diseases.展开更多
Objective To evaluate the present Chinese body mass index （BMI） criteria with body fat percentage （BF%） in determining obesity in Chinese population. Methods A total of 4 907 subjects （age： 20-90 yrs） were enro...Objective To evaluate the present Chinese body mass index （BMI） criteria with body fat percentage （BF%） in determining obesity in Chinese population. Methods A total of 4 907 subjects （age： 20-90 yrs） were enrolled in the baselirie survey of a longitudinal epidemiological study, and 2 638 of them were reevaluated in 5.5 years later. The Chinese BMI and WHO BF% were used to define obesity, respectively. Results The diagnostic agreement between the Chinese BMI and WHO BF% definitions for obesity was poor for both men （kappa： 0.210, 95% CI： 0.179-0.241） and women （kappa： 0.327, 95% CI： 0.296-0.358）. However, BMI had a good correlation with BF% both in men （r： 0.785, P〈0.01） and women （r： 0.864, P〈0.01）. The age and sex-adjusted relative risks （RR） for incidence of type 2 diabetes （T2DM） were significantly higher in subjects with intermediate BF% （BF%：20.1%-25% for men, 30.1%-35% for women） （RR： 2.35, 95% CI： 1.23-4.48） and high BF%（BF%〉25% for men and 〉35% for women）（RR： 2.89, 95% CI： 1.43-5.81）, or in subjects with high BMI （BMI≥ 28 kg/m2） （RR： 2.46, 95% CI： 1.31-4.63） when compared to those with low BF% （BF%≤20% for men ands〈30% for women） or low BMI （BMI〈24 kg/m^2） respectively. No difference in risk could be found in those with intermediate BMI （BMI： 24-27.9 kg/m^2） （RR： 1.44, 95% CI： 0.86-2.40）, as compared to those with low BMI （BMI〈24 kg/m^2）, whose BF% ranged widely from 7.8 to 50.3%. Conclusion BMI was correlated with BF%. Both BMI and BF% were associated with high risk for T2DM. However, BMI had its limitations in the interpretation of subjects with BMI between 24 and 27.9 kg/m^2.展开更多
Objective Prader-Willi Sydrome （PWS） is a human disorder related to genomic imprinting defect on 15ql 1-13. It is characterized by a series of classic features such as hypotonia, hyperphagia, obesity, osteoporosis, ...Objective Prader-Willi Sydrome （PWS） is a human disorder related to genomic imprinting defect on 15ql 1-13. It is characterized by a series of classic features such as hypotonia, hyperphagia, obesity, osteoporosis, typical facial and body dysmorphosis, hypogonadism, mental and behaviour disorders. Our study was designed to precisely detect the microdeletions, which accounts for 65%-70% of the PWS. Methods Physical and laboratory examinations were firstly performed to diagnose PWS clinically, and to discover novel clinical features. Then the patient was screened with bisulfite-specific sequencing and precisely delineated through high-density array CGH. Results With the bisulfite-specific sequencing, the detected CpG island in the PWS critical region was found homozygously hypermethylated. Then with array CGH, a 2.22 Mb type II microdeletion was detected, covering a region from MKRN3, MAGEL2, NDN, PWRN2, PWRN1, Cl2orf2, SNURF-SNRPN, C/D snoRNAs, to distal of UBE3A. Conclusions Array CGH, after the fast screening of Bisulfite-specific sequencing, is a feasible and precise method to detect microdeletions in PWS patients. A novel feature of metacarpophalangeal joint rigidity was also presented, which is the first time reported in PWS.展开更多
Diabetes affects approximately 10.5%of adults worldwide,and its chronic complications lead to severely disabling sequelae and premature death,thus placing a heavy healthcare burden on both patients affected and societ...Diabetes affects approximately 10.5%of adults worldwide,and its chronic complications lead to severely disabling sequelae and premature death,thus placing a heavy healthcare burden on both patients affected and society[1].China has experienced a dramatic increase in diabetes prevalence from 0.67%in 1980[2]to 12.8%in 2018[3]and has approximately one-quarter of people with diabetes worldwide[1].It is therefore essential to understand the epidemiologic characteristics of the chronic complications and co-morbidities of diabetes,and the current status of diabetes management to guide planning for appropriate diabetes care and intervention for these complications and co-morbidities at the national level[4-7].展开更多
Fibroblast growth factor 19 （FGF19） is a kind of gut-derived postprandial hormone. As an atypical member of the FGF family, FGF19 functions as an endocrine hormone except regulating cell growth and differentiation. ...Fibroblast growth factor 19 （FGF19） is a kind of gut-derived postprandial hormone. As an atypical member of the FGF family, FGF19 functions as an endocrine hormone except regulating cell growth and differentiation. FGF19 plays a key role in coordination of liver bile acid biosynthesis and gallbladder motility, and acts as a regulator of metabolic homeostasis, including strengthening insulin sensitivity, decreasing triglyceride concentration and reducing body weight.展开更多
Objective Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist...Objective Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist circumference and carotid intima media thickness （C-IMT）, as well as the best waist circumference cutoff for identifying C-IMT elevation in Chinese male patients with newly-diagnosed diabetes. Methods Five hundred and seventy-eight patients from Department of Endocrinology and Metabolism in Shanghai Sixth People＇s Hospital affiliated to Shanghai Jiao Tong University were enrolled. Both physical examination （for measurement of waist circumference） and carotid ultrasonography （for measurement of C-IMT） were performed. Results After grouping according to the quartiles of C-IMT, the waist circumference increased across all its quartiles. The waist circumference in 3rd and 4th quartiles （90.7_＋9.8 cm and 90.8＋9.6 cm） was significant higher than in 1st and 2nd quartiles （P〈0.05）. When subjects were divided into 4 groups according to waist circumference, the C-IMT of subjects with waist circumference 90-95 cm was significant higher than that of subjects with waist circumference 85-90 cm and less than 85 cm respectively （P〈0.05）. Both spearman and partial correlation analysis showed that C-IMT was positively correlated with waist circumference （P〈0.01）. C-IMT was found significantly elevated with the increase of waist circumference. Multiple stepwise regression analysis showed that waist circumference was one of the independent risk factors of C-IMT. After an average of 2.23_＋0.85 years follow up, there was a significant elevation of C-IMT in the group with baseline waist circumference over 90 cm P〈0.05）, while no significant difference was detected in the group with baseline waist circumference less than 90 cm （P=0.27）. Logistic regression showed that baseline waist circumference over 90 cm was associated with a relative risk to C-IMT elevation of 1.132 （95% CI 1.043-1.431, P〈0.05）. Conclusion Among newly-diagnosed diabetic male patients, waist circumference over 90 cm not only reflects sub-clinical atherosclerosis in early stage, but also predicts the progression of atherosclerosis.展开更多
Metabolic syndrome （MetS） is a constellation of interconnected cardiometabolic disorders, including obesity, hyperglycemia, dyslipidemia, and elevated blood pressure. MetS is a precursor to type 2 diabetes mellitus ...Metabolic syndrome （MetS） is a constellation of interconnected cardiometabolic disorders, including obesity, hyperglycemia, dyslipidemia, and elevated blood pressure. MetS is a precursor to type 2 diabetes mellitus （T2DM） and cardiovascular disease （CVD）; it increases the risk of T2DM by 3-4 times[11 and the risk of CVD by 1.4-fold[21, and is more prevalent in obese individuals. As the obesity rates increase, the prevalence of MetS in the population is increased. In 2006, the global prevalence of MetS in adults was estimated to be 20%-25%TM, and in China, in 2007-2008, using the criteria of the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults （JCDCG）, it reached 21.9% among the adult population aged 〉20 vears old[4].展开更多
A small fraction of patients diagnosed with obesity or diabetes mellitus has an underlying monogenic cause.Here,we constructed a targeted gene panel consisting of 83 genes reported to be causative for monogenic obesit...A small fraction of patients diagnosed with obesity or diabetes mellitus has an underlying monogenic cause.Here,we constructed a targeted gene panel consisting of 83 genes reported to be causative for monogenic obesity or diabetes.We performed this panel in 481 patients to detect causative variants and compared these results with whole-exome sequencing(WES)data available for 146 of these patients.The coverage of targeted gene panel sequencing was significantly higher than that of WES.The diagnostic yield in patients sequenced by the panel was 32.9%with subsequent WES leading to three additional diagnoses with two novel genes.In total,178 variants in 83 genes were detected in 146 patients by targeted sequencing.Three of the 178 variants were missed by WES,although the WES-only approach had a similar diagnostic yield.For the 335 samples only receiving targeted sequencing,the diagnostic yield was 32.2%.In conclusion,taking into account the lower costs,shorter turnaround time,and higher quality of data,targeted sequencing is a more effective screening method for monogenic obesity and diabetes compared to WES.Therefore,this approach could be routinely established and used as a first-tier test in clinical practice for specific patients.展开更多
Obesity has become one of the most prevalent health issues of our time. According to a 2012 WHO report, around 3.4 million adults die each year as a result of being overweight or obese. Humans are in fact superorganis...Obesity has become one of the most prevalent health issues of our time. According to a 2012 WHO report, around 3.4 million adults die each year as a result of being overweight or obese. Humans are in fact superorganisms composed of both human and microbial cells with 2 sets of genes, those encoded in our own genome and those encoded in our microbiota. All these cells and genes have the potential to influence our health.展开更多
Type 2 diabetes mellitus(T2DM)is closely associated with obesity,while interactions between the two diseases remain to be fully elucidated.To this point,we offer this perspective to introduce a set of new insights int...Type 2 diabetes mellitus(T2DM)is closely associated with obesity,while interactions between the two diseases remain to be fully elucidated.To this point,we offer this perspective to introduce a set of new insights into the interpretation of T2DM spanning the eti-ology,pathogenesis,and treatment approaches.These include a definition of T2DM as an energy surplus-induced diabetes character-ized by the gradual decline ofβcell insulin secretion function,which ultimately aims to prevent the onset of severe obesity through mechanisms of weight loss.The body employs three adaptive strategies in response to energy surplus:the first one is adipose tissue expansion to store the energy for weight gain under normal weight conditions;the second one is insulin resistance to slow down adipose tissue expansion and weight gain under overweight conditions;and the third one is the onset ofT2DM followingβcell failure to reverse the weight gain in obese conditions.The primary signaling molecules driving the compensatory responses are adenosine derivatives,such as adenosine triphosphate(ATP),acetyl coenzyme A(acetyl-CoA),and reduced nicotinamide adenine dinucleotide(NADH).These molecules exert their effects through allosteric,post-translational,and transcriptional regulation of metabolic path-ways.The insights suggest that insulin resistance and T2DM are protective mechanisms in the defense against excessive adiposity to avert severe obesity.The perspective provides a unified framework explaining the interactions between the two diseases and opens new avenues in the study of T2DM.展开更多
To the Editor:Frailty status represents one of the core determinants for the individualization of glycated hemoglobin(HbA1c)targets in the elderly population.However,the most validated tools to quantify frailty,which ...To the Editor:Frailty status represents one of the core determinants for the individualization of glycated hemoglobin(HbA1c)targets in the elderly population.However,the most validated tools to quantify frailty,which are complex and involve multiple dimensions of assessment,are rarely used in the clinical practice of diabetes management.Therefore,a simple and practical metric for the evaluation of frailty is needed.Grip strength is an easily measurable,objective,and reproducible metric for assessing frailty status.[1]It is correlated with overall muscle strength and has been reported to be signicantly related to important health outcomes both in the general population[2,3]and in patients with diabetes.[4]Therefore,grip strength could be a useful marker for patient strati-cation in diabetes management.In this context,this study aimed to examine the associations between HbA1c and all-cause mortality across categories of grip strength,as a measure of frailty status,in older adults with type 2 diabetes in the UK Biobank.The researches had applied to access the UK Biobank database with the application approval number of 82812.展开更多
基金funded by the Major Program of Shanghai Municipality for Basic Research (08dj1400601)the National Natural Science Foundation of China (30971121)the Key Project of Science and Technology of Shanghai (09DZ1950202)
文摘Objective To determine whether smoking increases the risk for developing metabolic syndrome （MetS） in Chinese men.Methods A total of 693 men with no MetS at baseline were followed for 2.9‐5.5 years.Subjects were divided into nonsmokers,ex‐smokers,and current smokers according to baseline smoking status.Results After adjusting for age,education level,alcohol intake,fasting plasma insulin,HOMA‐IR index,and BMI at baseline and weight change,current smokers were dose‐dependently associated with increased risk for developing new MetS compared with nonsmokers.The odds ratio （OR） was 2.131 （95% CI,1.264,3.592;P0.01） for the NCEPIII definition or 3.083 （95% CI,1.807,5.295;P0.01） for the JCDCG definition of MetS.Ex‐smokers who had quit for ≥13 years significantly decreased the risk for developing new MetS defined by the JCDCG definition.Compared with nonsmokers,current smokers were significantly associated with increased incidence of hypertriglyceridemia and low HDL‐C.Conclusion Smoking is a risk factor for developing MetS in Chinese men after adjusting for age,education level,alcohol intake,fasting plasma insulin,HOMA‐IR,BMI,and weight change.This could be due to an increased incidence of dyslipidemia.Smoking cessation for 13 years decreased the risk for developing MetS defined by the JCDCG definition.
基金supported by Shanghai Key Laboratory of Diabetes Mellitus (08DZ2230200)Major Program of Shanghai Municipality for Basic Research (08dj1400601)
文摘Objective To investigate the relationship of liver enzymes with hyperglycemia in a large population in Shanghai and identify the association between liver enzymes and insulin resistance. Methods A total of 3 756 participants were enrolled. Each participant underwent an oral glucose tolerance test and completed a questionnaire. Anthropometric indices were recorded and serum samples were collected for measurement. Results Liver enzymes concentrations were independently associated with i-IGT, iFG＋IGT, and diabetes. With the increase of ALT and GGT concentrations, ORs for i-IGT, IFG＋tGT, and diabetes increased gradually. By comparing patients in the highest quartile of GGT concentrations or ALT concentrations with those in the lowest quartile （Q1）, ORs for iqGT, IFG＋IGT, or diabetes was significant after adjustment. Both ALT and GGT concentrations were linearly correlated with HOMA-IR and independently associated with HOMA-IR [ALT OR （95% Cl）： 2.56 （1.51-4.34） P=0.00; GGT OR （95% CI）： 2.66 （1.53-4.65） P=0.00]. Conclusion Serum ALT and GGT concentrations were closely related to pre-diabetes and diabetes in the Shanghai population and positively associated with insulin resistance.
基金funded by National 863 Program (2006AA02A409)major program of Shanghai Municipality for Basic Research (08dj1400601)"Chen Guang" Project (09CG07)
文摘Objective To investigate a potential relationship between Solute carrier family 30 （zinc transporter） member 8 （SLC3OAS） rs13266634 variant and efficacy of rosiglitazone or repaglinide in treating newly diagnosed Chinese type 2 diabetes patients. Methods A total of 209 diabetic patients without any antihyperglycemic history were recruited and treated with repaglinide or rosiglitazone randomly for 48 weeks （104 and 105 patients, respectively）. Anthropometric measurements and clinical laboratory tests were carried out before and after the treatment. An non-synonymous variant rs13266634 was genotyped by matrix-assisted laser desorption ionization-time of flight mass spectroscopy. Results Ninety-one patients in repaglinide group and ninety-three patients in rosiglitazone group completed the study. 6 value of homeostasis model assessment of beta cell function （HOMA-B） and 6 value of fasting proinsulin levels were statistically significant between three genotype groups （P=0.0149 and 0.0246, respectively） after rosiglitazone treatment. However, no genotype association was observed in the repaglinide or rosiglitazone group with other parameters. Conclusion The SLC3OA8 variant was associated with the efficacy of insulin sensitizer monotherapy on insulin secretion in patients with newly diagnosed type 2 diabetes mellitus in Shanghai, China.
基金supported by National Key Technology R&D Program of China(2009BAI80B01)National Natural Science Foundation of China(81170788)Special Scientific Research Fund of Medical Sanitary(201002002)
文摘Objective To evaluate whether waist circumference （WC） 〉85 cm is related to asymptomatic preclinical atherosclerosis in women from Shanghai, China. Methods A total of 2365 females aged 〉20 years recruited from 4 communities underwent physical examination and carotid artery scanning. Their carotid intima-media thickness （C-iMT） was measured. Results The C-IMT was significantly higher in overweight or obese women with their BMI 〉25.0 kg/m2 {P〈O.01） and in those with their WC _〉85 cm than in those with their WC 〈85 cm （P〈O.01）. Spearman and partial correlation analysis showed that the C-IMT was significantly correlated with WC which was independent of menopausal status. The C-IMT significantly increased with the increasing WC and reached to a platform in about 85 cm. An increment tendency was found in the subgroup with its WC 〈 85 cm （P〈O.01） while no significant tendency was found in the subgroup with its WC_〉85 cm （P=0.07）. Multiple stepwise regression analysis showed that the WC was an independent risk factor for C-IMT. In logistic regression model, the odd ratio of WC _〉80 cm, _〉80 cm and 〈85 cm and 〉85 cm for evaluating the risk of C-IMT elevation was 2.632, 2.501, and 1.878, respectively. Conclusion WC is significantly correlated with C-IMT in women from Shanghai, China, and WC_〉85 cm may be used in identifying the risk of subclinical carotid atherosclerosis.
基金supported by Shanghai Rising-Star Program (12QH1401700)the Drug Innovation Program of the National Science and Technology Project (2011ZX09307-001-02)+2 种基金Science Foundation of Shanghai Municipal Health Bureau (2012291)Excellent Young Medical Experts of Shanghai (XYQ2011041)Program of Shanghai Municipality for Basic Research (11JC1409600)
文摘Accumulating evidence indicates that overweight and obesity are the major international public health concern. Obesity is a major independent risk factor for chronic diseases, such as hypertension, type 2 diabetes, cardiovascular disease, stroke, and certain cancer. Disease burden due to obesity has been dramatically increasing in many countries including China in the past years. According to the Nationwide Health and Nutrition Survey （CHNS）, the prevalence of overweight and obesity among men and women in China increased by 27.6% and 8.8%, respectively, from 1993 to 2009.
文摘BACKGROUND The prevalence and clinical characteristics of chronic kidney disease(CKD)among patients with ketosis-onset diabetes(also known as ketosis-prone diabetes)remain unclear.Furthermore,the classification of ketosis-onset diabetes remains controversial and requires further investigation.AIM To investigate the prevalence and clinical features of CKD in patients with newly diagnosed ketosis-onset diabetes.METHODS This real-world study included 217 patients with type 1 diabetes mellitus(T1DM),698 with ketosis-onset diabetes,and 993 with non-ketotic T2DM.The prevalence and clinical characteristics of CKD were compared among the three groups.Risk factors associated with CKD were evaluated using binary logistic regression for each group.RESULTS After adjusting for age and sex,the prevalence of CKD among patients with ketosis-onset diabetes(17.8%)was significantly higher than that in those with T1DM(8.3%,P=0.007),but was not statistically different compared to those with non-ketotic T2DM(21.7%,P=0.214).Furthermore,some risk factors for CKD,including age,and serum uric acid and C-reactive protein levels,in patients with ketosis-onset diabetes were similar to those with T2DM,but significantly different from those with T1DM.CONCLUSION The prevalence,clinical characteristics,and risk factors for CKD among patients with ketosis-onset diabetes were more similar to those with non-ketotic T2DM but considerably different from those with T1DM.These findings further support the classification of ketosis-onset diabetes as a subtype of T2DM rather than idiopathic T1DM.
基金supported by the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0509202 and 2023ZD0509201)National Natural Science Foundation of China(62077037,8238810007,82022012,81870598,62272298 and 82388101)+4 种基金the National Key Research and Development Program of China(2022YFC2502800 and 2022YFC2407000)the Shanghai Municipal Key Clinical Specialty,Shanghai Research Center for Endocrine and Metabolic Diseases(2022ZZ01002)the Chinese Academy of Engineering(2022-XY-08)the Innovative Research Team of High-level Local Universities in Shanghai(SHSMUZDCX20212700)Beijing Natural Science Foundation(IS23096).
文摘Diabetes poses a considerable global health challenge,with varying levels of diabetes knowledge among healthcare professionals,highlighting the importance of diabetes training.Large Language Models(LLMs)provide new insights into diabetes training,but their performance in diabetes-related queries remains uncertain,especially outside the English language like Chinese.We first evaluated the performance of ten LLMs:ChatGPT-3.5,ChatGPT-4.0,Google Bard,LlaMA-7B,LlaMA2-7B,about:blank ERNIE Bot,Ali Tongyi Qianwen,MedGPT,HuatuoGPT,and Chinese LlaMA2-7B on diabetes-related queries,based on the Chinese National Certificate Examination for Primary Diabetes Care in China(NCE-CPDC)and the English Specialty Certificate Examination in Endocrinology and Diabetes of Membership of the Royal College of Physicians of the United Kingdom.Second,we assessed the training of primary care physicians(PCPs)without and with the assistance of ChatGPT-4.0 in the NCE-CPDC examination to ascertain the reliability of LLMs as medical assistants.We found that ChatGPT-4.0 outperformed other LLMs in the English examination,achieving a passing accuracy of 62.50%,which was significantly higher than that of Google Bard,LlaMA-7B,and LlaMA2-7B.For the NCE-CPFC examination,ChatGPT-4.0,Ali Tongyi Qianwen,about:blank ERNIE Bot,Google Bard,MedGPT,and ChatGPT-3.5 successfully passed,whereas LlaMA2-7B,HuatuoGPT,Chinese LLaMA2-7B,and LlaMA-7B failed.ChatGPT-4.0(84.82%)surpassed all PCPs and assisted most PCPs in the NCE-CPDC examination(improving by 1%–6.13%).In summary,LLMs demonstrated outstanding competence for diabetes-related questions in both the Chinese and English language,and hold great potential to assist future diabetes training for physicians globally.
基金supported by the Shanghai Municipal Government Grants Award(No.GWIV-3)the Shanghai Health Policy Grant(No.2019HP49)+3 种基金the Shanghai Health Commission Grant(No.20194Y0141)the Shanghai Jiao Tong University Grant(No.CHDI-2018-A-05)the Shanghai Public Health Youth Award(No.GWV-10.2-YQ24)the Three-Year Action Program of Shanghai Municipality for Strengthening the Construction of Public Health System(No.GWV-10.1-XK05).
文摘This cross-sectional study aimed to investigate the quality of care of diabetes in Shanghai,China.A total of 173235 patients with type 2 diabetes in 2017 were included in the analysis.Profiles of risk factors and intermediate outcomes were determined.The patients had a mean age of 66.43±8.12(standard deviation(SD))years and a mean diabetes duration of 7.95±5.53(SD)years.The percentage of patients who achieved the target level for HbA_(1c)(<7.0%)was 48.6%.Patients who achieved the target levels for blood pressure(BP)<130/80 mmHg and low-density lipoprotein-cholesterol(LDL-c)<2.6 mmol/L reached 17.5%and 34.0%,respectively.A total of 3.8%achieved all three target levels,and the value increased to 6.8%with an adaptation of the BP target level(<140/90 mmHg)for those over 65 years.Multivariable analysis identified the factors associated with a great likelihood of achieving all three target levels:male,young age,short diabetes duration,low body mass index,macrovascular complications,no microvascular complications,prescribed with lipid-lowering medication,and no prescription of antihypertensive medication.In conclusion,nearly 50%and one-third of the patients with diabetes met the target levels for HbA_(1c)and LDL-c,respectively,with a low percentage achieving the BP target level.The percentage of patients who achieved all three target levels needs significant improvement.
基金supported by Merck&Co.,Inc.,Kenilworth,NJ,the 5010 Project of Sun Yat-sen UniversityProgram for Changjiang Scholars and Innovative Research Team in University(to Jianping Weng)
文摘Despite the current guideline's recommendation of a timely stepwise intensification therapy,the "clinical inertia",termed as the delayed treatment intensification,commonly exists in the real world,which may be partly due to the relatively little substantial evidence and no clear consensus regarding the efficacy and safety of triple oral agents in patients inadequately controlled with dual therapy.In this clinical trial performed in 237 centers in China,5,535 type 2 diabetic patients inadequately controlled by previous therapies were treated with a stable metformin/sitagliptin dual therapy for 20 weeks.The patients who did not reach the glycated hemoglobin A1c(HbA1c) goal were then further randomized into glimepiride,gliclazide,repaglinide,or acarbose group for an additional 24-week triple therapy.A mean HbAlc reduction of 0.85%was observed when sitagliptin was added to the patients inadequately controlled with metformin in 16 weeks.Further HbAlc reductions in the 24-week triple therapy stage were 0.65%in glimepiride group,0.70%in gliclazide group,0.61%in repaglinide group,and 0.45%in acarbose group.The non-inferiority criterion for primary hypotheses was met for gliclazide and repaglinide,but not for acarbose,compared with glimepiride,when added to metformin/sitagliptin dual therapy.The incidences of adverse events(AEs) were 29.2%in the dual therapy stage and30.3%in the triple therapy stage.Metformin/sitagliptin as baseline therapy,with the addition of a third oral antihyperglycemic agent,including glimepiride,gliclazide,repaglinide,or acarbose,was effective,safe and well-tolerated for achieving an HbAlc<7.0%goal in type 2 diabetic patients inadequately controlled with previous therapies.The timely augmentation of up to three oral antihyperglycemic agents is valid and of important clinical benefit to prevent patients from exposure to unnecessarily prolonged hyperglycemia.
基金supported by the National Natural Science Foundation major international(regional)joint research project(81220108006)to WJYoung Scientists Fund of National Natural Science Foundation(81200292),Young Scientists Fund of National Natural Science Foundation(81200655)to LSShanghai Rising-Star Program(13QA1402900)and Hong Kong Scholars Program(XJ2013035)to HL
文摘Overweight or obesity has become a serious public health problem in the world, scientists are concentrating their efforts on exploring novel ways to treat obesity. Nowadays, the availabilities of bariatric surgery and pharmacotherapy have enhanced obesity treatment, but it should has support from diet, physical exercise and lifestyle modification, especially the functional food. Resistant starch, an indigestible starch, has been studied for years for its beneficial effects on regulating blood glucose level and lipid metabolism. The aim of this review is to summarize the effect of resistant starch on weight loss and the possible mechanisms. According to numerous previous studies it could be concluded that resistant starch can reduce fat accumulation, enhance insulin sensitivity, regulate blood glucose level and lipid metabolism. Recent investigations have focused on the possible associations between resistant starch and incretins as well as gut microbiota. Resistant starch seems to be a promising dietary fiber for the prevention or treatment of obesity and its related diseases.
基金funded by the Major Program of Shanghai Municipality for Basic Research(08dj 1400601)the Shanghai Pujiang Program(OTpj14062)Projeot for Shanghai key Laboratlry of Diabetes Mellitus(08DZ2230200).
文摘Objective To evaluate the present Chinese body mass index （BMI） criteria with body fat percentage （BF%） in determining obesity in Chinese population. Methods A total of 4 907 subjects （age： 20-90 yrs） were enrolled in the baselirie survey of a longitudinal epidemiological study, and 2 638 of them were reevaluated in 5.5 years later. The Chinese BMI and WHO BF% were used to define obesity, respectively. Results The diagnostic agreement between the Chinese BMI and WHO BF% definitions for obesity was poor for both men （kappa： 0.210, 95% CI： 0.179-0.241） and women （kappa： 0.327, 95% CI： 0.296-0.358）. However, BMI had a good correlation with BF% both in men （r： 0.785, P〈0.01） and women （r： 0.864, P〈0.01）. The age and sex-adjusted relative risks （RR） for incidence of type 2 diabetes （T2DM） were significantly higher in subjects with intermediate BF% （BF%：20.1%-25% for men, 30.1%-35% for women） （RR： 2.35, 95% CI： 1.23-4.48） and high BF%（BF%〉25% for men and 〉35% for women）（RR： 2.89, 95% CI： 1.43-5.81）, or in subjects with high BMI （BMI≥ 28 kg/m2） （RR： 2.46, 95% CI： 1.31-4.63） when compared to those with low BF% （BF%≤20% for men ands〈30% for women） or low BMI （BMI〈24 kg/m^2） respectively. No difference in risk could be found in those with intermediate BMI （BMI： 24-27.9 kg/m^2） （RR： 1.44, 95% CI： 0.86-2.40）, as compared to those with low BMI （BMI〈24 kg/m^2）, whose BF% ranged widely from 7.8 to 50.3%. Conclusion BMI was correlated with BF%. Both BMI and BF% were associated with high risk for T2DM. However, BMI had its limitations in the interpretation of subjects with BMI between 24 and 27.9 kg/m^2.
基金supported by grants from National 973 Program(2006CB503901)Shanghai Key Laboratory of Diabetes Mellitus(08DZ2230200)+1 种基金Major Program of Shanghai Municipality for Basic Research(08dj 1400601)Program for Outstanding Medical Academic Leader in Shanghai (LJ06010).
文摘Objective Prader-Willi Sydrome （PWS） is a human disorder related to genomic imprinting defect on 15ql 1-13. It is characterized by a series of classic features such as hypotonia, hyperphagia, obesity, osteoporosis, typical facial and body dysmorphosis, hypogonadism, mental and behaviour disorders. Our study was designed to precisely detect the microdeletions, which accounts for 65%-70% of the PWS. Methods Physical and laboratory examinations were firstly performed to diagnose PWS clinically, and to discover novel clinical features. Then the patient was screened with bisulfite-specific sequencing and precisely delineated through high-density array CGH. Results With the bisulfite-specific sequencing, the detected CpG island in the PWS critical region was found homozygously hypermethylated. Then with array CGH, a 2.22 Mb type II microdeletion was detected, covering a region from MKRN3, MAGEL2, NDN, PWRN2, PWRN1, Cl2orf2, SNURF-SNRPN, C/D snoRNAs, to distal of UBE3A. Conclusions Array CGH, after the fast screening of Bisulfite-specific sequencing, is a feasible and precise method to detect microdeletions in PWS patients. A novel feature of metacarpophalangeal joint rigidity was also presented, which is the first time reported in PWS.
基金supported by Shanghai Science and Technology Committee [19692115900 and 17411952600]Shanghai Municipal Key Clinical Specialty
文摘Diabetes affects approximately 10.5%of adults worldwide,and its chronic complications lead to severely disabling sequelae and premature death,thus placing a heavy healthcare burden on both patients affected and society[1].China has experienced a dramatic increase in diabetes prevalence from 0.67%in 1980[2]to 12.8%in 2018[3]and has approximately one-quarter of people with diabetes worldwide[1].It is therefore essential to understand the epidemiologic characteristics of the chronic complications and co-morbidities of diabetes,and the current status of diabetes management to guide planning for appropriate diabetes care and intervention for these complications and co-morbidities at the national level[4-7].
基金supported by the Major Program of the Shanghai Municipality for Basic Research(10JC1412400)the National Natural Science Foundation Major International(Regional)Joint Research Project(81220108006)
文摘Fibroblast growth factor 19 （FGF19） is a kind of gut-derived postprandial hormone. As an atypical member of the FGF family, FGF19 functions as an endocrine hormone except regulating cell growth and differentiation. FGF19 plays a key role in coordination of liver bile acid biosynthesis and gallbladder motility, and acts as a regulator of metabolic homeostasis, including strengthening insulin sensitivity, decreasing triglyceride concentration and reducing body weight.
基金funded by National Key Technology R&D Program of China(2012BAI02B03)Key Discipline of Public Health of Shanghai(Epidemiology)(12GWZX0104)
文摘Objective Waist circumference, as a brief indicator of visceral obesity, is associated with multi-metabolic disorders and cardiovascular diseases. The present study was aimed to find out the relationship between waist circumference and carotid intima media thickness （C-IMT）, as well as the best waist circumference cutoff for identifying C-IMT elevation in Chinese male patients with newly-diagnosed diabetes. Methods Five hundred and seventy-eight patients from Department of Endocrinology and Metabolism in Shanghai Sixth People＇s Hospital affiliated to Shanghai Jiao Tong University were enrolled. Both physical examination （for measurement of waist circumference） and carotid ultrasonography （for measurement of C-IMT） were performed. Results After grouping according to the quartiles of C-IMT, the waist circumference increased across all its quartiles. The waist circumference in 3rd and 4th quartiles （90.7_＋9.8 cm and 90.8＋9.6 cm） was significant higher than in 1st and 2nd quartiles （P〈0.05）. When subjects were divided into 4 groups according to waist circumference, the C-IMT of subjects with waist circumference 90-95 cm was significant higher than that of subjects with waist circumference 85-90 cm and less than 85 cm respectively （P〈0.05）. Both spearman and partial correlation analysis showed that C-IMT was positively correlated with waist circumference （P〈0.01）. C-IMT was found significantly elevated with the increase of waist circumference. Multiple stepwise regression analysis showed that waist circumference was one of the independent risk factors of C-IMT. After an average of 2.23_＋0.85 years follow up, there was a significant elevation of C-IMT in the group with baseline waist circumference over 90 cm P〈0.05）, while no significant difference was detected in the group with baseline waist circumference less than 90 cm （P=0.27）. Logistic regression showed that baseline waist circumference over 90 cm was associated with a relative risk to C-IMT elevation of 1.132 （95% CI 1.043-1.431, P〈0.05）. Conclusion Among newly-diagnosed diabetic male patients, waist circumference over 90 cm not only reflects sub-clinical atherosclerosis in early stage, but also predicts the progression of atherosclerosis.
文摘Metabolic syndrome （MetS） is a constellation of interconnected cardiometabolic disorders, including obesity, hyperglycemia, dyslipidemia, and elevated blood pressure. MetS is a precursor to type 2 diabetes mellitus （T2DM） and cardiovascular disease （CVD）; it increases the risk of T2DM by 3-4 times[11 and the risk of CVD by 1.4-fold[21, and is more prevalent in obese individuals. As the obesity rates increase, the prevalence of MetS in the population is increased. In 2006, the global prevalence of MetS in adults was estimated to be 20%-25%TM, and in China, in 2007-2008, using the criteria of the Chinese Joint Committee for Developing Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults （JCDCG）, it reached 21.9% among the adult population aged 〉20 vears old[4].
基金supported by grants from Shanghai Outstanding Academic Leaders(20XD1433300)Medical-Engineering Cross Foundation of Shanghai Jiao Tong University(YG2021ZD20)+3 种基金Shuguang Project(21SG11),Innovative Research Team of High-level Local Universities in Shanghai(SHSMU-ZDCX20212700)Shanghai Research Center for Endocrine,Metabolic Diseases(2022ZZ01002)Shanghai Sixth People’s Hospital Grant(ynhg202204)Shanghai Municipal Key Clinical Specialty.
文摘A small fraction of patients diagnosed with obesity or diabetes mellitus has an underlying monogenic cause.Here,we constructed a targeted gene panel consisting of 83 genes reported to be causative for monogenic obesity or diabetes.We performed this panel in 481 patients to detect causative variants and compared these results with whole-exome sequencing(WES)data available for 146 of these patients.The coverage of targeted gene panel sequencing was significantly higher than that of WES.The diagnostic yield in patients sequenced by the panel was 32.9%with subsequent WES leading to three additional diagnoses with two novel genes.In total,178 variants in 83 genes were detected in 146 patients by targeted sequencing.Three of the 178 variants were missed by WES,although the WES-only approach had a similar diagnostic yield.For the 335 samples only receiving targeted sequencing,the diagnostic yield was 32.2%.In conclusion,taking into account the lower costs,shorter turnaround time,and higher quality of data,targeted sequencing is a more effective screening method for monogenic obesity and diabetes compared to WES.Therefore,this approach could be routinely established and used as a first-tier test in clinical practice for specific patients.
基金supported by the National Natural Science Foundation major international(regional)joint research project(81220108006)Young Scientists Fund of National Natural Science Foundation(81200292)+3 种基金‘Chen Guang’project supported by Shanghai Municipal Education Commission and Shanghai Education Development Foundation(13CG11)Shanghai Rising-Star Program(13QA1402900)Hong Kong Scholars Program(XJ2013035)Doctoral Fund of Ministry of Education of China(137000)
文摘Obesity has become one of the most prevalent health issues of our time. According to a 2012 WHO report, around 3.4 million adults die each year as a result of being overweight or obese. Humans are in fact superorganisms composed of both human and microbial cells with 2 sets of genes, those encoded in our own genome and those encoded in our microbiota. All these cells and genes have the potential to influence our health.
基金supported by the project from the National Natural Science Foundation of China(32271220 to J.Y.).
文摘Type 2 diabetes mellitus(T2DM)is closely associated with obesity,while interactions between the two diseases remain to be fully elucidated.To this point,we offer this perspective to introduce a set of new insights into the interpretation of T2DM spanning the eti-ology,pathogenesis,and treatment approaches.These include a definition of T2DM as an energy surplus-induced diabetes character-ized by the gradual decline ofβcell insulin secretion function,which ultimately aims to prevent the onset of severe obesity through mechanisms of weight loss.The body employs three adaptive strategies in response to energy surplus:the first one is adipose tissue expansion to store the energy for weight gain under normal weight conditions;the second one is insulin resistance to slow down adipose tissue expansion and weight gain under overweight conditions;and the third one is the onset ofT2DM followingβcell failure to reverse the weight gain in obese conditions.The primary signaling molecules driving the compensatory responses are adenosine derivatives,such as adenosine triphosphate(ATP),acetyl coenzyme A(acetyl-CoA),and reduced nicotinamide adenine dinucleotide(NADH).These molecules exert their effects through allosteric,post-translational,and transcriptional regulation of metabolic path-ways.The insights suggest that insulin resistance and T2DM are protective mechanisms in the defense against excessive adiposity to avert severe obesity.The perspective provides a unified framework explaining the interactions between the two diseases and opens new avenues in the study of T2DM.
基金supported by the Program of Shanghai Academic/Technology Research Leader(No.22XD1402300)the Shanghai"Rising Stars of Medical Talent"Youth Development Program-Outstanding Youth Medical Talents(No.SHWSRS(2021)_099)+2 种基金the Shanghai Research Center for Endocrine and Metabolic Diseases(No.2022ZZ01002)the National Natural Science Foundation of China(No.31971485)the Shanghai Municipal Key Clinical Specialty.
文摘To the Editor:Frailty status represents one of the core determinants for the individualization of glycated hemoglobin(HbA1c)targets in the elderly population.However,the most validated tools to quantify frailty,which are complex and involve multiple dimensions of assessment,are rarely used in the clinical practice of diabetes management.Therefore,a simple and practical metric for the evaluation of frailty is needed.Grip strength is an easily measurable,objective,and reproducible metric for assessing frailty status.[1]It is correlated with overall muscle strength and has been reported to be signicantly related to important health outcomes both in the general population[2,3]and in patients with diabetes.[4]Therefore,grip strength could be a useful marker for patient strati-cation in diabetes management.In this context,this study aimed to examine the associations between HbA1c and all-cause mortality across categories of grip strength,as a measure of frailty status,in older adults with type 2 diabetes in the UK Biobank.The researches had applied to access the UK Biobank database with the application approval number of 82812.
