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Association of accelerometer-measured sleep duration and different intensities of physical activity with incident Type 2 diabetes in a population-based cohort study

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Journal of Sport and Health Science 2024年第2期13卷 222-232页

作者： Xinyi Jin Yilin Chen Hongliang Feng Mingqing Zhou Joey W.Y.Chang Yaping Liu Alice Pik Shan Kong Xiao Tan Yun-Kwok Wing Yannis Yan Liang Jihui Zhang Guangdong Cardiovascular Institute Guangdong Provincial People’s HospitalGuangdong Academy of Medical SciencesGuangzhou 510080China Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention Guangdong Cardiovascular InstituteGuangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou 510080China School of Medicine South China University of TechnologyGuangzhou 510641China Center for Sleep and Circadian Medicine The Affiliated Brain Hospital of Guangzhou Medical UniversityGuangzhou 510180China The Second School of Clinical Medicine Southern Medical UniversityGuangzhou 510282China Guangdong Mental Health Center Guangdong Provincial People’s Hospital(Guangdong Academy of Medical Sciences)Southern Medical UniversityGuangzhou 510120China Li Chiu Kong Family Sleep Assessment Unit Department of PsychiatryFaculty of MedicineThe Chinese University of Hong KongHong Kong 999077China Department of Psychiatry Faculty of MedicineThe Chinese University of Hong KongHong Kong 999077China Department of Medicine and Therapeutics Faculty of MedicineThe Chinese University of Hong KongHong Kong 999077China Department of Medical Sciences Uppsala UniversityUppsala 75185Sweden Department of Big Data in Health Science Zhejiang University School of Public HealthHangzhou 310058China Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China Guangzhou 510260China

Purpose:The aim of the current study was to investigate the association of accelerometer-measured sleep duration and different intensities of physical activity(PA)with the risk of incident Type 2 diabetes in a population-based prospective cohort study.Methods:Altogether,88,000 participants(mean age=62.2±7.9 years,mean±SD)were included from the UK Biobank.Sleep duration(short:8 h/day)and PA of different intensities were measured using a wrist-won accelerometer over a 7-day period between 2013 and 2015.PA was classified according to the median or World Health Organization-recommendation:total volume of PA(high,low),moderate-to-vigorous PA(MVPA)(recommended,not recommended),and light-intensity PA(high,low).Incidence of type 2diabetes was ascertained using hospital records or death registries.Results:During a median follow-up of 7.0 years,1615 incident Type 2 diabetes cases were documented.Compared with normal sleep duration,short(hazard ratio(HR)=1.21,95%confidence interval(95%CI):1.03-1.41)but not long sleep duration(HR=1.01,95%CI:0.89-1.15)was associated with excessive Type 2 diabetes risk.This increased risk among short sleepers seems to be protected against by PA.Compared with normal sleepers with high or recommended PA,short sleepers with low volume of PA(HR=1.81,95%CI:1.46-2.25),not recommended(below the World Health Organization-recommended level of)MVPA(HR=1.92,95%CI:1.55-2.36),or low light-intensity PA(HR=1.49,95%CI:1.13-1.90)had a higher risk of Type 2 diabetes,while short sleepers with a high volume of PA(HR=1.14,95%CI:0.88-1.49),recommended MVPA(HR=1.02,95%CI:0.71-1.48),or high light-intensity PA(HR=1.14,95%CI:0.92-1.41)did not.Conclusion:Accelerometer-measured short but not long sleep duration was associated with a higher risk of incident Type 2 diabetes.A higher level of PA,regardless of intensity,potentially ameliorates this excessive risk.

关键词： Light physical activity Sleep duration Triaxial accelerometer Type 2 diabetes UK Biobank

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Stair climbing,genetic predisposition,and the risk of incident Type 2 diabetes:A large population-based prospective cohort study

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Journal of Sport and Health Science 2023年第2期12卷 158-166页

作者： Yuanjue Wu Mengyun Luo Xiao Tan Liangkai Chen Department of Nutrition and Food Hygiene Hubei Key Laboratory of Food Nutrition and SafetySchool of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China Department of Clinical Nutrition Union HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430022China Sydney School of Public Health Faculty of Medicine and HealthUniversity of SydneyNew South WalesNSW 2006Australia Charles Perkins Centre the University of SydneyNew South WalesNSW 2006Australia School of Public Health School of MedicineShanghai Jiao Tong UniversityShanghai 200025China Department of Medical Sciences Uppsala UniversityUppsala 78185Sweden Department of Clinical Neuroscience Karolinska InstituteStockholm 17165Sweden Ministry of Education Key Lab of Environment and Health School of Public HealthTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430030China

Background:Cross-sectional evidence and small-scale trials suggest positive effects of stair climbing on cardiometabolic disease and glucose regulation.However,few studies have examined the long-term association between stair climbing and the incidence of Type 2 diabetes(T2D).We aimed to prospectively evaluate the association of stair climbing with T2D and assess modifications by genetic predisposition to T2D.Methods:We included 451,699 adults(mean age=56.3±8.1 years,mean±SD;55.2%females)without T2D at baseline in the UK Biobank and followed up to March 31,2021.Stair climbing information was collected through the touchscreen questionnaire.Genetic risk score for T2D consisted of 424 single nucleotide polymorphisms.Results:During a median follow up of 12.1 years,14,896 T2D cases were documented.Compared with participants who reported no stair climbing,those who climbed stairs regularly had a lower risk of incident T2D(10-50 steps/day:hazard ratio(HR)=0.95,95%confidence interval(95%CI):0.89-1.00;60-100 steps/day:HR=0.92,95%CI:0.87-0.98;110-150 steps/day:HR=0.86,95%CI:0.80-0.91;>150 steps/day:HR=0.93,95%CI:0.87-0.99,p for trend=0.0007).We observed a significant interaction between stair climbing and genetic risk score on the subsequent T2D risk(p for interaction=0.0004),where the risk of T2D showed a downward trend in subjects with low genetic risk and those who reported stair climbing activity of 110-150 steps/day appeared to have the lowest overall T2D risk among those with intermediate to high genetic risk.Conclusion:A higher number of stairs climbed at home was associated with lower T2D incidence risk,especially among individuals with a low genetic predisposition to T2D.These findings highlight that stair climbing,as incidental physical activity,offers a simple and low-cost complement to public health interventions for T2D prevention.

关键词： Cohort Genetic risk score Stair climbing Type 2 diabetes UK Biobank

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Prevalence of maturity-onset diabetes of the young in phenotypic Type 2 diabetes in young adults:a nationwide,multi-center,cross-sectional survey in China

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Chinese Medical Journal 2023年第1期136卷 56-64页

作者： Yan Chen Jing Zhao Xia Li Zhiguo Xie Gan Huang Xiang Yan Houde Zhou Li Zheng Tao Xu Kaixin Zhou Zhiguang Zhou National Clinical Research Center for Metabolic Diseases Key Laboratory of Diabetes Immunology(Central South University)Ministry of Educationand Department of Metabolism and EndocrinologyThe Second Xiangya Hospital of Central South UniversityChangshaHunan 410011China College of Life Sciences The University of Chinese Academy of SciencesBeijing 100049China National Laboratory of Biomacromolecules CAS Center for Excellence in BiomacromoleculesInstitute of BiophysicsChinese Academy of SciencesBeijing 100101China Shandong First Medical University and Shandong Academy of Medical Sciences JinanShandong 271016China

Background:Maturity-onset diabetes of the young(MODY)is the most common monogenic diabetes.The aim of this study was to assess the prevalence of MODY in phenotypic Type 2 diabetes(T2DM)among Chinese young adults.Methods:From April 2015 to October 2017,this cross-sectional study involved 2429 consecutive patients from 46 hospitals in China,newly diagnosed between 15 years and 45 years,with T2DM phenotype and negative for standardized glutamic acid decarboxylase antibody at the core laboratory.Sequencing using a custom monogenic diabetes gene panel was performed,and variants of 14 MODY genes were interpreted as per current guidelines.Results:The survey determined 18 patients having genetic variants causing MODY(6 HNF1A,5 GCK,3 HNF4A,2 INS,1 PDX1,and 1 PAX4).The prevalence of MODY was 0.74%(95%confidence interval[CI]:0.40-1.08%).The clinical characteristics of MODY patients were not specific,72.2%(13/18)of them were diagnosed after 35 years,47.1%(8/17)had metabolic syndrome,and only 38.9%(7/18)had a family history of diabetes.No significant difference in manifestations except for hemoglobin A1c levels was found between MODY and non-MODY patients.Conclusion:The prevalence of MODY in young adults with phenotypic T2DM was 0.74%,among which HNF1A-,GCK-,and HNF4A-MODY were the most common subtypes.Clinical features played a limited role in the recognition of MODY.

关键词： Maturity-onset diabetes of the young Type 2 diabetes Young adults

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Visit-to-visit glycated hemoglobin A1c variability in adults with Type 2 diabetes: a systematic review and meta-analysis

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Chinese Medical Journal 2022年第19期135卷 2294-2300页

作者： Furong Qu Qingyang Shi Yang Wang Yanjao Shen Kaixin Zhou Ewan R.Pearson Sheyu Li Department of Endocrinology and Metabolism West China HospitalSichuan UniversityChengduSichuan 610041China Department of Guideline and Rapid Recommendation Chinese Evidence-Based Medicine CenterCochrane China Center and MAGIC China CenterWest China HospitalSichuan UniversityChengduSichuan 610041China School of Life Science University of Chinese Academy of ScienceBejing 100101China Divson of Population Health and Genomics Ninewells Hospital and School of MedicineUniversity of DundeeDundee DD19SYScotlandUnited Kingdom.

Background:Current practice uses the latest measure of glycated hemoglobin(HbAlc)to facilitate clinical decision-making.Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes.However,the role of HbAlc variability is unclear in clinical practice.This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro-and macro-vascular complications and death in people with Type 2 diabetes.Methods:We searched PubMed,EMBASE(via OVID),and Cochrane Central Register(CENTRAL,via OVID)for studies investigating the association between HbAlc variability and adverse outcomes in patients with Type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation(SD),coefficient of variation(CV),and HbAlc variability score(HVS).Results:In people with Type 2 diabetes,the highest quantile of all three HbAlc variability metrics(HbAlc-standard deviation[HbAlc-SD],HbAlc-coefficient of variance[HbAlc-CV],and HVS)is associated with increased risks of all-cause mortality,cardiovascular events,progression to chronic kidney disease,amputation,and peripheral neuropathy.For example,the hazard ratio of HbAlc-SD on all-cause mortality was 1.89 with 95%confidence interval(95%CI)1.46–2.45(HbAlc-CV 1.47,95%CI 1.26-1.72;HVS 1.67,95%CI 1.34–2.09).Conclusions:High HbAlc variability leads to micro-and macro-vascular complications of Type 2 diabetes and related death.People with Type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.

关键词： Visit-to-visit HbAlc variability Type 2 diabetes Macrovascular complications All-cause mortality Glycated hemoglobin

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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)(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(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

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New practice in semaglutide on type-2 diabetes and obesity:clinical evidence and expectation

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Frontiers of Medicine 2022年第1期16卷 17-24页

作者： Yalin Liu Xianghang Luo Department of Endocrinology Endocrinology Research CenterXiangya Hospital of Central South UniversityChangsha 410008China National Clinical Research Center for Geriatric Disorders Xiangya Hospital of Central South UniversityChangsha 410008China

Obesity is an important risk factor of Type 2 diabetes(T2D),which has become an important factor threatening human health.However,no perfect drug choice for obesity exists.Semaglutide is a kind of human glucagon-like peptide-1(GLP-1)analog that promotes insulin secretion while inhibiting glucagon secretion through a glucose concentration-dependent mechanism.GLP-1 can also delay stomach emptying and suppress appetite to help lose weight.This review summarizes clinical evidence of the semaglutide effect on T2D and obesity and establishes expectations on future clinical trials for obesity treatment.

关键词： semaglutide Type 2 diabetes obesity

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Association between time in range and cancer mortality among patients with Type 2 diabetes:a prospective cohort study

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Chinese Medical Journal 2022年第3期135卷 288-294页

作者： Yun Shen Chunfang Wang Yaxin Wang Jingyi Lu Lei Chen Lei Zhang Wei Lu Wei Zhu Gang Hu Tian Xia Jian Zhou Department of Endocrinology and Metabolism Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai Clinical Center for DiabetesShanghai Key Clinical Center for Metabolic DiseaseShanghai Key Laboratory of Diabetes MellitusShanghai 200233China Pennington Biomedical Research Center Baton RougeLA 70808USA Division of Vital Statistics Institute of Health InformationShanghai Municipal Center for Disease Control and PreventionShanghai 200336China Shanghai diabetes Institute Shanghai Jiao Tong University Affiliated Sixth People's HospitalShanghai 200233China

Background:Little was known about the association among time in range(TIR),time above range(TAR),time below range(TBR),and cancer mortality among patients with Type 2 diabetes.We aimed to investigate the association among TIR,TAR,TBR,and the risk of cancer mortality among patients with Type 2 diabetes.Methods:A total of 6225 patients with Type 2 diabetes were prospectively recruited in Shanghai,China.TIR was measured with continuous glucose monitoring at baseline and was defined as the average percentage of time in the target glucose range during a 24 h period.Cox proportion hazard regression analysis was used to determine the association between TIR and the risk of cancer mortality.Results:During a mean follow-up of 7.10 years,we confirmed 237 death events related to cancer.The multivariable-adjusted hazard ratio(HR)for cancer mortality was 1.32(95%confidence interval[CI]:1.01-1.75)in patients with TIR≤70%compared with those with TIR>70%.When TIR was considered as a continuous variable,the multivariable-adjusted HR for cancer mortality associated with each 10%decrease in TIR was 1.07(95%CI:1.02-1.14).In the site-specific analysis,a significant association between TIR as a continuous variable and the risk of hepatocellular cancer was found(HR:1.24;95%CI:1.09-1.41).However,no relationship between hemoglobin A1c and cancer mortality was observed(HR:1.04;95%CI:0.97-1.10).Conclusions:The present study found an inverse association of TIR with the risk of cancer mortality among patients with Type 2 diabetes.New evidence of TIR was added into the clinical practice that TIR may be an optimal target of glycemic control among patients with Type 2 diabetes.

关键词： Time in range HbA1c Type 2 diabetes Cancer mortality Cohort study Hepatocellular cancer

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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 P28.2% (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 2DM 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

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Negative association of time in range and urinary albumin excretion rate in patients with Type 2 diabetes mellitus:a retrospective study of inpatients

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Chinese Medical Journal 2022年第9期135卷 1052-1056页

作者： Sanbao Chai Shanshan Wu Sixu Xin Ning Yuan Jianbin Sun Xiaomei Zhang Linong Ji Department of Endocrinology and Metabolism Peking University International HospitalBeijing 102206China National Clinical Research Center of Digestive Diseases Capital Medical University Affiliated Beijing Friendship HospitalBeijing 100050China Department of Endocrinology and Metabolism Peking University People's HospitalBeijing 100044China

Background:Time in range(TIR)refers to the time an individual spends within their target glucose range,which now has been popularized as an important metric to classify glycemic management and also recognized as an important outcome of current diabetes therapies.This study aimed to investigate the association between TIR and the severity of the urinary albumin excretion rate(UAER)in patients with Type 2 diabetes mellitus(T2DM).Methods:We retrospectively analyzed the data of 1014 inpatients with T2DM at the Department of Endocrinology and Metabolism of Peking University International Hospital,China.TIR was defined as the percentage of blood glucose within the target range of 3.90-10.00 mmol/L.Urine samples for assessment of UAER were collected for 3 consecutive days from the start of hospitalization.Results:The TIR values for patients with normal urine levels of albumin,microalbuminuria,and macroalbuminuria were 70%±20%,50%±20%,and 30%±20%,respectively(allP2,55%-72%;Q3,73%-83%;and Q4,>83%.The incidences of microalbuminuria in Q1,Q2,Q3,and Q4 were 41.1%,21.6%,7.1%,and 5.5%(allP24.2%,1.1%,1.4%,and 0%(allP2-0.65,P26,95%CI:0.18-0.38,Pdiabetes duration,systolic blood pressure,and levels of triglycerides,glycosylated hemoglobin A1c,and creatinine.Conclusion:The proportion of blood glucose in TIR is closely related to the severity of UAER in patients with T2DM.

关键词： Time in range Type 2 diabetes Urinary albumin excretion rate Blood glucose

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Transcriptional control of pancreaticβ-cell identity and plasticity during the pathogenesis of Type 2 diabetes

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Journal of Genetics and Genomics 2022年第4期49卷 316-328页

作者： Ziyin Zhang Yue Gao Zhuo-Xian Meng Department of Pathology and Pathophysiology and Department of Geriatrics of Affiliated Hangzhou First People’s Hospital Zhejiang University School of MedicineHangzhouChina Key Laboratory of Disease Proteomics of Zhejiang Province Zhejiang University School of MedicineHangzhouZhejiang310058China Department of Geriatrics Affiliated Hangzhou First People’s HospitalZhejiang University School of MedicineHangzhouZhejiang310006China

Type 2 diabetes(T2D)is caused by insulin resistance and insufficient insulin secretion.Evidence has increasingly indicated that pancreaticβ-cell dysfunction is the primary determinant of T2D disease progression and remission.High plasticity is an important feature of pancreaticβ-cells.During T2D development,pancreaticβ-cells undergo dynamic adaptation.Althoughβ-cell death/apoptosis in later-stage T2D is the major cause ofβ-cell dysfunction,recent studies have revealed thatβ-cell dedifferentiation and reprogramming,which play critical roles inβ-cell functional regulation in the early and middle T2D progression stages,are characterized by(i)a loss of matureβ-cell-enriched genes;(ii)dedifferentiation to a progenitor-like state;and(iii)transdifferentiation into other cell types.The roles of transcription factors(TFs)in the establishment and maintenance ofβ-cell identity during pancreatic development have been extensively studied.Here,we summarize the roles and underlying mechanisms of TFs in the maintenance ofβ-cell identity under physiological and type 2 diabetic conditions.Several feasible approaches for restoring islet functions are also discussed.A better understanding of the transcriptional control ofβ-cell identity and plasticity will pave the way for developing more effective strategies,such asβ-cell regeneration therapy,to treat T2D and associated metabolic disorders.

关键词： Type 2 diabetes Pancreaticβ-cell Transcription factors Dedifferentiation Transdifferentiation Redifferentiation

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