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The intensive diabetes management program with the telehealth system is a useful education method to improve blood sugar control and prevent hospitalization in poorly controlled T2D patients receiving insulin injections.

Background: The obesity paradox phenomenon has been found in different populations, such as heart failure and coronary heart disease, which suggest that patients with established cardiovascular disease (CVD) and with normal weight had higher risk of mortality than those with overweight or obesity. However, the obesity paradox is controversial among patients with diabetes which has been considered as the coronary heart disease equivalent. The aim of our study was to summarize current findings on the relationship between body mass index (BMI) and all-cause mortality in patients with diabetes and make a meta-analysis. Methods:We searched previous studies from MEDLINE, EMBASE, and the Cochrane databases using the keywords: BMI, mortality, diabetes, and obesity paradox or reverse epidemiology. Finally, sixteen studies were identified and 385,925 patients were included. Patients were divided into five groups based on BMI (kg/m 2 ) levels: underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), mild obesity (30-34.9), and morbid obesity (>35). A random effect meta-analysis was performed by the inverse variance method.Results: As compared with the normal weight, the underweight had higher risk of mortality [hazard ratio (HR): 1.59, 95% confidence interval (CI): 1.32-1.91]. In contrast, the overweight and the mild obesity had lower risk of mortality than the normal weight (HR: 0.86, 95% CI: 0.78-0.96, and 0.88, 95% CI: 0.78-1.00, respectively), but the morbid obesity did not (HR: 0.99, 95% CI: 0.84-1.16). In addition, the subgroup analysis by sex showed that the overweight had the lowest mortality as compared with the normal weight (HR: 0.82, 95% CI: 0.74-0.90) and the obesity in males, but the risk of mortality did not differ among groups in females. Notably, the heterogeneity was significant in most of group comparisons.Conclusions: Our meta-analysis showed a U-shaped relationship between BMI and all-cause mortality in patients with diabetes. The significant heterogeneity among studies suggested that many confounders such as sex difference may affect the association.

Both decreased insulin sensitivity, and impaired insulin secretion are 2 major pathophyisologies for type 2 diabetes (T2DM). There are two phases of ISEC-the first (1st ISEC) and second phase (2 nd ISEC). In this study, we tried to build an equation to predict 2 nd ISEC.Totally, 82 subjects, including 15 with normal fasting glucose, 26 with pre-diabetes and 41 with T2DM were enrolled. They received a modified low dose graded glucose infusion (M-LDGGI). The M-LDGGI is a simplified version of Polonsky's method. The results were interpreted as the slope of the changes of plasma insulin against the glucose levels. The slopes of these curves were regarded as the 2 nd ISEC.If only metabolic syndrome (MetS) components were analyzed, the equation was built as the following: log (2 nd ISEC) = -2.400-0.088 • (fasting plasma glucose, FPG + 0.072 • (body mass index, BMI). After fasting plasma insulin (FPI) was added , the equation was shown as the following: log (2 nd ISEC) = -2.316-0.093˙FPG + 0.049 • BMI+ 0.434 • log(FPI). The second equation provided a greater accuracy to determine 2nd ISEC than first one in the external validation group (r 2 = 0.545 vs r 2 = 0.423).Using MetS components, 2 nd ISEC could be predicted with good accuracy. After adding FPI into the equation, the predictive power further increases. These equations could be widely used in daily practice and clinical settings.

Background. Type 2 diabetes (T2D) is known to be one of the most prevalent diseases, and its prevalence is significantly associated with age and metabolic syndrome (MetS). Few studies have been conducted on liver function, MetS and insulin secretion among young adults.Objectives. In the present study, we explored the relationship between the liver function enzyme -alanine aminotransferase (ALT) -and first-phase insulin secretion (FPIS) among young adults.Material and methods. There were 22,971 men and 28,740 women, aged 18-27 years, assigned to subgroups according to the presence of MetS and quartiles of ALT values. Simple correlation was applied to evaluate their relationship. The difference between the slopes of these relationships and FPIS were statistically analyzed with Chris's calculator. Results.Most values for metabolic parameters, including ALT and FPIS, were determined to be relatively high in individuals with MetS. By contrast, individuals with MetS had lower high-density-lipoprotein cholesterol (HDL-C) counts and FPIS. Similar results were observed in the quartiles of ALT. Significant positive results were also found in the linear model. Depending on the ALT level, the slope change of FPIS still demonstrated a positive correlation between ALT and FPIS. This correlation was stronger for men than for women. Conclusions.A positive correlation between ALT and FPIS exists among young adults. Moreover, this correlation was stronger for men than for women. Both the cause and the effect require further investigation.

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