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Relationship between time in range and corneal nerve fiber loss in asymptomatic patients with type 2 diabetes

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Chinese Medical Journal 2022年第16期135卷 1978-1985页

作者： Wejing Zhao Jingyi Lu Lei Zhang Wei Lu Wei Zhu Yuqian Bao Jjian Zhou 'Department of Endocrinology and Metabolism Shanghai Jiao Tong Universty Ailatede Sith People's HospitalShanghai Cinical Center for DiabetesShanghai Key Clinical Center for Metabolic DiseaseShanghai Diabetes IstuteShanghai Key Laboratory of Diabetes MellitusShanghai 200233China Shanghai Clinical Center for Metabolic Diseases Shanghai Key Laboratory of Diabetes MeliusShanghai Diabetes IstituteShanghai Jiao Tong University Alilatedae Sith People's HospitalShanghai 200233China Department of Endocrinology and Metabolism Jinshan Branch of Shanghai Jiao Tong University Aflatedae Sixth People's HospitalShanghai 201500China

Background: Corneal confocal microscopy (CCM) is a noninvasive technique to detect early nerve damage of diabetic sensorimotor polyneuropathy (DSPN). Time in range (TIR) is an emerging metric of glycemic control which was reported to be associated with diabetic complications. We sought to explore the relationship between TIR and corneal nerve parameters in asymptomatic patients with type 2 diabetes (T2DM).Methods: In this cross-sectional study, 206 asymptomatic inpatients with T2DM were recruited. After 7 days of continuous glucose monitoring, the TIR was calculated as the percentage of time in the glucose range of 3.9 to 10.0 mmol/L. CCM was performed to determine corneal nerve fiber density, corneal nerve branch density, and corneal nerve fiber length (CNFL). Abnormal CNFL was defined as ≤15.30 mm/mm2.Results: Abnormal CNFL was found in 30.6% (63/206) of asymptomatic subjects. Linear regression analyses revealed that TIR was positively correlated with CCM parameters both in the crude and adjusted models (all P< 0.05). Each 10% increase in TIR was associated with a 28.2% (95% CI: 0.595–0.866,P = 0.001) decreased risk of abnormal CNFL after adjusting for covariates. With the increase of TIR quartiles, corneal nerve fiber parameters increased significantly (allP for trend <0.01). The receiver operating characteristic curve indicated that the optimal cutoff point of TIR was 77.5% for predicting abnormal CNFL in asymptomatic patients.Conclusions: There is a significant independent correlation between TIR and corneal nerve fiber loss in asymptomatic T2DM patients. TIR may be a useful surrogate marker for early diagnosis of DSPN.

关键词： Continuous glucose monitoring Corneal confocal microscopy Time in range Type 2 diabetes

Decreasing complexity of glucose time series derived from continuous glucose monitoring is correlated with deteriorating glucose regulation

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Frontiers of Medicine 2023年第1期17卷 68-74页

作者： Cheng Li Xiaojing Ma Jingyi Lu Rui Tao Xia Yu Yifei Mo Wei Lu Yuqian Bao Jian Zhou Weiping Jia Department of Endocrinology and Metabolism Shanghai Jiao Tong University School of Medicine Affiliated Sixth People’s HospitalShanghai Clinical Center for DiabetesShanghai Diabetes InstituteShanghai Key Laboratory of Diabetes MellitusShanghai 200233China College of Information Science and Engineering Northeastern UniversityShenyang 110819China

Most information used to evaluate diabetic statuses is collected at a special time-point,such as taking fasting plasma glucose test and providing a limited view of individual’s health and disease risk.As a new parameter for continuously evaluating personal clinical statuses,the newly developed technique“continuous glucose monitoring”(CGM)can characterize glucose dynamics.By calculating the complexity of glucose time series index(CGI)with refined composite multi-scale entropy analysis of the CGM data,the study showed for the first time that the complexity of glucose time series in subjects decreased gradually from normal glucose tolerance to impaired glucose regulation and then to type 2 diabetes(P for trend<0.01).Furthermore,CGI was significantly associated with various parameters such as insulin sensitivity/secretion(all P<0.01),and multiple linear stepwise regression showed that the disposition index,which reflectsβ-cell function after adjusting for insulin sensitivity,was the only independent factor correlated with CGI(P<0.01).Our findings indicate that the CGI derived from the CGM data may serve as a novel marker to evaluate glucose homeostasis.

关键词： complexity of glucose time series continuous glucose monitoring impaired glucose regulation insulin secretion and sensitivity refined composite multi-scale entropy

Targeted gene panel provides advantages over whole-exome sequencing for diagnosing obesity and diabetes mellitus

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Journal of Molecular Cell Biology 2023年第6期15卷 40-52页

作者： Hairong Yu Haoyong Yu Rong Zhang Danfeng Peng Dandan Yan Yunjuan Gu Yuqian Bao Weiping Jia Hong Zhang Cheng Hu Shanghai Diabetes Institute Shanghai Key Laboratory of Diabetes MellitusShanghai Clinical Center for DiabetesShanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200233China Department of Endocrinology Affiliated Hospital of Nantong UniversityNantong 226001China Institute for Metabolic Disease Fengxian Central Hospital Affiliated to Southern Medical UniversityShanghai 201499China

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.

关键词： molecular diagnosis monogenic diabetes mellitus monogenic obesity targeted panel whole-exome sequencing

Effectiveness of quality of care for patients with type 2 diabetes in China:findings from the Shanghai Integration Model(SIM)

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Frontiers of Medicine 2022年第1期16卷 126-138页

作者： Chun Cai Yuexing Liu Yanyun Li Yan Shi Haidong Zou Yuqian Bao Yun Shen Xin Cui Chen Fu Weiping Jia the SIM Study Group Shanghai Diabetes Institute Shanghai Jiao Tong University Affiliated Sixth People’s HospitalNational Office for Primary Diabetes CareShanghai Technical Center for Diabetes Prevention and Clinical CareShanghai Key Laboratory of Diabetes MellitusDepartment of Endocrinology and MetabolismShanghai Clinical Center for DiabetesShanghai Key Clinical Center for Metabolic DiseaseShanghai 200233China Shanghai Municipal Center for Disease Control&Prevention Shanghai 200336China Shanghai Eye Disease Prevention and Treatment Center/Shanghai Eye Hospital Shanghai Key Laboratory of Ocular Fundus DiseasesShanghai General HospitalShanghai Engineering Center for Visual Science and PhotomedicineShanghai 200040China Shanghai Municipal Health Commission Information Center Shanghai 200040China 不详

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.

关键词： type 2 diabetes quality of care macrovascular complication microvascular complication treatment pattern epidemiology

Low-carbohydrate diets lead to greater weight loss and better glucose homeostasis than exercise: a randomized clinical trial

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Frontiers of Medicine 2021年第3期15卷 460-471,F0004页

作者： Lingli Cai Jun Yin Xiaojing Ma Yifei Mo Cheng Li Wei Lu Yuqian Bao Jian Zhou Weiping Jia Department of Endocrinology and Metabolism Shanghai Clinical Center for DiabetesShanghai Diabetes InstituteShanghai Key Laboratory of Diabetes MellitusShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghai 200233China

Lifestyle interventions,including dietary adjustments and exercise,are important for obesity management.This study enrolled adults with overweight or obesity to explore whether either low-carbohydrate diet(LCD)or exercise is more effective in metabolism improvement.Forty-five eligible subjects were randomly divided into an LCD group(n=22)and an exercise group(EX,n=23).The subjects either adopted LCD(carbohydrate intake<50 g/day)or performed moderate-to-vigorous exercise(≥30 min/day)for 3 weeks.After the interventions,LCD led to a larger weight loss than EX(−3.56±0.37 kg vs.−1.24±0.39 kg,P<0.001),as well as a larger reduction in fat mass(−2.10±0.18 kg vs.−1.25±0.24 kg,P=0.007)and waist circumference(−5.25±0.52 cm vs.−3.45±0.38 cm,P=0.008).Both interventions reduced visceral and subcutaneous fat and improved liver steatosis and insulin resistance.Triglycerides decreased in both two groups,whereas low-density lipoprotein cholesterol increased in the LCD group but decreased in the EX group.Various glycemic parameters,including serum glycated albumin,mean sensor glucose,coefficient of variability(CV),and largest amplitude of glycemic excursions,substantially declined in the LCD group.Only CV slightly decreased after exercise.This pilot study suggested that the effects of LCD and exercise are similar in alleviating liver steatosis and insulin resistance.Compared with exercise,LCD might be more efficient for weight loss and glucose homeostasis in people with obesity.

关键词： low-carbohydrate diet obesity nonalcoholic fatty liver disease continuous glucose monitoring mean sensor glucose

Insulin sensitivity,βcell function,and adverse pregnancy outcomes in women with gestational diabetes

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Chinese Medical Journal 2022年第21期135卷 2541-2546页

作者： Yun Shen Yanwei Zheng Yingying Su Susu Jiang Xiaojing Ma Jiangshan Hu Changbin Li Yajuan Huang Yincheng Teng Yuqian Bao Minfang Tao Jian Zhou Department of Endocrinology and Metabolism Shanghai Clinical Center for DiabetesShanghai Sixth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200233China Department of Gynecology and Obstetrics Shanghai Sixth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200233China Shanghai Diabetes Institute Shanghai Key Laboratory of Diabetes MellitusShanghai Sixth People’s HospitalShanghai Jiao Tong University School of MedicineShanghai 200233China

Background: The potential impact of β cell function and insulin sensitivity on adverse pregnancy outcomes in women with gestational diabetes mellitus (GDM) remains uncertain. We aimed to investigate the association between β cell dysfunction, insulin resistance, and the composite adverse pregnancy outcomes.Methods: This observational study included 482 women diagnosed with GDM during pregnancy. Quantitative metrics on β cell function and insulin sensitivity during pregnancy were calculated using traditional equations. The association of β cell dysfunction and insulin resistance with the risk of the composite adverse pregnancy outcomes was investigated using multivariable-adjusted logistic regression models.Results: Multivariable-adjusted odds ratios (ORs) of adverse pregnancy outcomes across quartiles of homeostatic model assessment for insulin resistance (HOMA-IR) were 1.00, 0.95, 1.34, and 2.25, respectively (P for trend = 0.011). When HOMA-IR was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 1.34 (95% confidence interval 1.16-1.56) for each 1-unit increase in HOMA-IR. Multivariable-adjusted ORs of adverse pregnancy outcomes across quartiles of homeostatic model assessment for β cell function (HOMA-β) were 1.00, 0.51, 0.60, and 0.53, respectively (P for trend = 0.068). When HOMA-β was considered as a continuous variable, the multivariable-adjusted OR of adverse pregnancy outcomes was 0.57 (95% CI 0.24-0.90) for each 1-unit increase in HOMA-β. However, other quantitative metrics were not associated with the composite adverse pregnancy outcomes.Conclusions: We demonstrated a significant association of β cell function and insulin sensitivity with the risk of adverse pregnancy outcomes. We have provided additional evidence on the early identification of adverse pregnancy outcomes besides the glycemic values.

关键词： βcell function Insulin sensitivity Adverse pregnancy outcomes

早期诊断规范监测--《国家基层糖尿病防治管理指南(2018)》血糖测量部分解读

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中华内科杂志 2019年第4期58卷 318-320页

作者：包玉倩上海交通大学附属第六人民医院内分泌代谢科 200233

血糖监测是糖尿病管理的重要组成部分,维持血糖稳定达标可以有效延缓糖尿病慢性并发症的发生和进展。2018年12月中华医学会糖尿病学分会及国家基层糖尿病防治管理办公室发布了《国家基层糖尿病防治管理指南(2018)》,针对基层医疗卫生现... 详细信息

血糖监测是糖尿病管理的重要组成部分,维持血糖稳定达标可以有效延缓糖尿病慢性并发症的发生和进展。2018年12月中华医学会糖尿病学分会及国家基层糖尿病防治管理办公室发布了《国家基层糖尿病防治管理指南(2018)》,针对基层医疗卫生现状,提出了适用于基层医疗机构的血糖测量方式,为广大基层医务人员规范科学开展血糖监测工作提供了依据。

关键词：糖尿病基层医疗机构血糖测量

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Robust genome and RNA editing via CRISPR nucleases in PiggyBac systems

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Bioactive Materials 2022年第8期7卷 313-320页

作者： yuqian Jiang Rachel Catherine Hoenisch Yun Chang Xiaoping bao Craig E.Cameron Xiaojun Lance Lian Department of Biomedical Engineering Pennsylvania State UniversityUniversity ParkPA16802USA Huck Institutes of the Life Sciences Pennsylvania State UniversityUniversity ParkPA16802USA Department of Biology Pennsylvania State UniversityUniversity ParkPA16802USA Davidson School of Chemical Engineering Purdue UniversityWest LafayetteIN47907USA Department of Microbiology and Immunology University of North Carolina School of MedicineChapel HillNC27599USA

CRISPR/Cas-mediated genome editing in human pluripotent stem cells(hPSCs)offers unprecedented opportunities for developing in vitro disease modeling,drug screening and cell-based therapies.To efficiently deliver the CRISPR components,here we developed two all-in-one vectors containing Cas9/gRNA and inducible Cas13d/gRNA cassettes for robust genome editing and RNA interference respectively.These vectors utilized the PiggyBac transposon system,which allows stable expression of CRISPR components in hPSCs.The Cas9 vector PB-CRISPR exhibited high efficiency(up to 99%)of inducing gene knockout in both protein-coding genes and long non-coding RNAs.The other inducible Cas13d vector achieved extremely high efficiency in RNA knockdown(98%knockdown for CD90)with optimized gRNA designs.Taken together,our PiggyBac CRISPR vectors can serve as powerful toolkits for studying gene functions in hPSCs.

关键词： CRISPR-Cas9 Genome editing Cas13d RNA editing PiggyBac transposon Human pluripotent stem cells

代谢手术:在长期有效性与安全性之间寻找最佳平衡点

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中华糖尿病杂志 2020年第9期12卷 665-669页

作者：包玉倩上海交通大学附属第六人民医院内分泌与代谢科 200030

肥胖及糖尿病是严重威胁人类健康的世界性公共卫生问题,代谢手术作为一种新型治疗方法,在减重、缓解糖尿病及降低其他心血管风险方面具有独特的优势。2016年6月发布的国际糖尿病组织联合声明中,首次将代谢手术写入2型糖尿病的治疗路径,... 详细信息

肥胖及糖尿病是严重威胁人类健康的世界性公共卫生问题,代谢手术作为一种新型治疗方法,在减重、缓解糖尿病及降低其他心血管风险方面具有独特的优势。2016年6月发布的国际糖尿病组织联合声明中,首次将代谢手术写入2型糖尿病的治疗路径,为临床实践提供了良好的遵循。但是,代谢手术犹如一把双刃剑,要做到获益最大化,需要兼顾术式的个体化、精准化,以及术后管理的规范化和科学化,在长期有效性和安全性之间找到最佳平衡点。

关键词：糖尿病肥胖代谢手术