Journal of Diabetes最新文献

According to the latest data from International Diabetes Federation, China has the largest number of adults with diabetes, with ~140.9 million people having the disease.¹ Traditional Chinese medicine (TCM) is one of the earliest complementary and alternative medicines worldwide to explore the prevention and treatment of diabetes.² Nowadays, TCM is being increasingly utilized as adjuvant therapy for the treatment of diabetes. However, there is a lack of TCM clinical guidelines for diabetes in primary health care, which can provide standardized suggestions to physicians. Fortunately, with the support of the State Administration of Traditional Chinese Medicine, a guideline titled National Chinese medicine guideline for the prevention and treatment of diabetes in primary care has been developed. The guideline working group systematically reviewed the clinical research evidence related to diabetes and assessed the overall quality of available evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. Finally, the guideline was published in Chinese in December 2022.³ In order to enhance readers' understanding of this guideline and offer internationally representative insights on the use of TCM for diabetes in primary care, we have conducted a comprehensive commentary from the perspective of the working group.

Diabetes is a complex clinical syndrome characterized by chronic hyperglycemia. In recent years, TCM interventions have been increasingly deployed for the treatment of diabetes. The integration of TCM and Western medicine in treatment has become a significant policy and guideline at a national level in China. Rich clinical research evidence emerging from recent years has shown that TCM therapies are beneficial for the comprehensive prevention and treatment of diabetes, particularly when combined with Western medicine, where it can play a significant role in enhancing effectiveness. Previous studies have reported that TCM has the potential to improve clinical outcomes (such as weight loss, patient's self-reported symptoms, glucose metabolism) and delay the progression of diabetes.^{4, 5} This guideline provides a comprehensive summary of TCM therapies for the prevention and treatment of diabetes, including prevention strategies, nondrug therapies, and external treatment, and so forth. (Figure 1). Throughout this process, we consolidated evidence-based medical data pertaining to the use of TCM therapies in treating diabetes. The primary medical evidence collected has been compiled and displayed in Appendix S1. Moreover, many Chinese herbs are commonly used as dietary materials in China, which are approved by the National Health Commission (such as Radix Astragali seu Hedysari, Codonopsis pilosula, Radix Rehmanniae Recens, Radix Puerariae Radix Ophiopogonis, and so forth.). Given their beneficial

The 21st annual World Congress on Insulin Resistance, Diabetes and Cardiovascular Disease, held in Los Angeles, California on December 7–9, 2023, included 69 presentations spanning a myriad of aspects of diabetes and its complications, of atherosclerosis, of renal disease, of liver disease, and of novel therapeutic approaches. For this summary, we will focus on presentations illustrating the current understanding of insulin resistance.

Giving an overview of insulin resistance, Ralph DeFronzo reviewed the complex pathways involved in glucose-handling. A total of 5%–10% of ingested glucose is ultimately removed in adipocytes, and the remainder in skeletal muscle. The insulin signal that regulates glucose disposal is associated with changes in adipocyte free fatty acid release, as well as in local vasodilatation via nitric oxide. In type 2 diabetes (T2D) all of these are abnormal.¹ T2D is associated with a defect in muscle glycogen synthesis and glucose oxidation,² with impaired muscle glycogen synthase, pyruvate dehydrogenase, and hexosekinase.³ The insulin signaling pathway involved in activating glucose transport is also involved in activating nitric oxide synthase, with both reduced in T2D, whereas several proinflammatory/atherosclerotic pathways, involving mitogen-activated protein kinase (MAPK) and the nuclear receptor small heterodimer partner, show unrestricted insulin response in T2D leading to vascular smooth muscle growth and inflammation. Lean offspring of two T2D parents who have normal glucose tolerance have hyperinsulinemia and show levels of insulin resistance similar to those of their parents, with the same defect in insulin receptor substrate and the same overactivity the MAPK pathway.⁴ Hepatic glucose output is increased in T2D,⁵ with the dose–response curve of hepatic glucose production vs portal insulin levels shifted to the right and evidence of decreased adipocyte insulin response,⁶ and muscle capillary bed insulin-induced vasodilatation⁷ also is impaired in T2D. DeFronzo observed that thiazolidinediones reverse all of these molecular defects in T2D, suggesting that use of these agents should be considered more strongly in clinical treatment.

Sam Klein asked which comes first, beta cell dysfunction, hyperinsulinemia, or insulin resistance? Answering this seemingly straightforward question, he observed, requires better understanding of the many underlying interrelationships. In a study comparing lean, normoglycemic persons with obese persons having varying degrees of glycemia, he found that the hyperinsulinemia of obesity is primarily associated with increased insulin secretion, as well as with reduction in cell surface insulin receptors in tissues responsible for insulin clearance.⁸ In this view, Klein considered that “it's