Editor's note
Scientific research is an important driving force for the progress and development of clinical practice, and in recent years, mainland scholars have kept up with the times and the international pace in scientific research, and have gradually embarked on the road of research with Chinese characteristics. At the just-concluded 84th Annual Scientific Meeting of the United States Diabetes Association (ADA2024), the research team led by Professor Zhang Lei of Qingdao Endocrine and Diabetes Hospital released three original research results, focusing on the early screening, risk factors and prognosis of diabetic foot disease and diabetes mellitus complicated with macrovascular disease, etc., and conducted in-depth discussions on diabetes-related foot diseases and cardiovascular complications from multiple perspectives. Professor Zhang Lei, the corresponding author of this journal, introduced the three studies.
Correlation between 25-hydroxyvitamin D and the risk of diabetic foot ulcers in Chinese patients with T2DM
1813-LB
ZHANG Qi1, LIU Zhenyu2, GU Yan3, ZHANG Lei1,2, DONG Yanhu1,2
1. Shandong Second Medical University; 2Qingdao Endocrine and Diabetes Hospital and Institute of Endocrine and Metabolic Diseases; 3The Affiliated Hospital of Qingdao University
01
background
Vitamin D is closely related to bone metabolism-related diseases, cardiovascular diseases, diabetes, malignant tumors and autoimmune diseases. Previous studies have found that vitamin D deficiency is associated with the risk of macrovascular disease and various types of pathogen infection in patients with type 2 diabetes mellitus (T2DM), but the correlation between vitamin D and diabetic foot ulcers is relatively limited.
02
method
This study is a retrospective cross-sectional study. The subjects of the study were 5483 patients with T2DM aged 30~89 years old who were hospitalized in Qingdao Endocrine and Diabetes Hospital from January 1, 2017 to October 31, 2019 (2378 males and 3105 females). Serum 25-hydroxyvitamin D [25(OH)D] concentration is determined by electrochemiluminescence. According to the 2011 United States Endocrine Society clinical guidelines, 25(OH)D concentrations < 20 ng/ml are defined as vitamin D deficiency. The diagnostic criteria for diabetic foot ulcers are based on the 2019 International Diabetic Foot Working Group (IWGDF) guidelines for the prevention and treatment of diabetic foot.
03
outcome
本研究人群糖尿病足溃疡患病率为8.1%。 与单纯T2DM患者相比，T2DM合并足溃疡患者的血清25(OH)D浓度显著降低（15.33±4.51 ng/ml vs. 18.54±3.82 ng/ml，P<0.05）。 T2DM合并糖尿病足溃疡组维生素D缺乏的患病率显著高于单纯T2DM组（84.5% vs. 70.1%，P<0.05），且无性别差异。 多因素logistic回归分析显示，校正年龄、性别、糖尿病病程、吸烟、体重指数（BMI）、收缩压、空腹血糖、糖化血红蛋白（HbA1c）、空腹C肽及总胆固醇等因素后，维生素D缺乏是糖尿病足溃疡的独立危险因素（OR=1.36，95%CI：1.01~3.37，P<0.05）。
04
conclusion
Vitamin D deficiency is one of the common vitamin deficiencies in mainland T2DM patients and is an independent risk factor for the increased risk of diabetic foot ulcers. Further research is needed on whether vitamin D supplementation can prevent the onset of diabetic foot ulcers or improve prognosis.
Correlation between high triglyceride waist circumference phenotype and diabetic foot ulcer in Chinese T2DM patients
1814-LB
LIU Zhen-yu1, ZHANG Lei1,2, WANG Mei-ling1, ZHANG Qi2, LIU Yu-qing2, DONG Yan-hu1,2
1Qingdao Endocrine and Diabetes Hospital and Institute of Endocrine and Metabolic Diseases; 2. Shandong Second Medical University
01
background
Previous studies have shown that the high triglyceride-waist circumference (HTGW) phenotype is closely associated with diabetic macrovascular disease. Whether this clinical phenotype is associated with an increased risk of diabetic foot ulcers has not been reported.
02
method
The subjects of this study were 2651 hospitalized patients with T2DM, with a mean age of 56 years (42% male) and a mean duration of 9.3 years. According to the International Diabetes Federation's diagnostic criteria for metabolic syndrome, the HTGW phenotype is defined as triglycerides ≥ 1.70 mmol/L and excess waist circumference (waist circumference ≥≥ 90 cm for men or 80 cm for women). Depending on whether the HTGW phenotype was combined, the participants were divided into HTGW subgroup and non-HTGW subgroup. The diagnostic criteria for diabetic foot ulcers were based on the 2019 IWGDF guidelines for the prevention and treatment of diabetic foot. In this study, logistic regression analysis was used to analyze the association between HTGW and diabetic foot ulcers.
03
outcome
HTGW及非HTGW亚组糖尿病足溃疡患病率分别为9.3%和4.2%（P<0.05）。 HTGW亚组患者收缩压（139.2 mmHg vs. 132.7 mmHg，P<0.05）、空腹血糖（9.1 mmol/L vs. 8.5 mmol/L，P<0.05）、HbA1c（8.83% vs. 7.95%，P<0.05）、载脂蛋白B（ApoB）（0.95 g/L vs. 0.89 g/L，P<0.05）、超敏C反应蛋白（hsCRP）（8.23 mg/L vs. 4.92 mg/L，P<0.05）及肿瘤坏死因子α（26.46 pg/ml vs. 16.80 pg/ml，P<0.05）等水平明显高于非HTGW亚组，而载脂蛋白A1（1.21g/L vs. 1.33g/L，P<0.05）低于非HTGW组。 多因素logistic回归分析显示，校正年龄、性别、糖尿病病程、BMI、吸烟、HbA1c、ApoB及hsCRP后，HTGW表型是糖尿病足溃疡的独立危险因素（OR=1.33，95%CI：1.03~2.71，P<0.05）。
04
conclusion
In patients with T2DM, the combination of waist circumference and triglycerides may be a simple and easy method for screening people at high risk of diabetic foot ulcers.
Long-term effects of baseline glucose metabolic status on restenosis after percutaneous transluminal coronary angioplasty: a 6-year follow-up study
1792-LB
Gu Yan1, Zhang Lei2,3, Zhang Qi3, Liu Zhenyu2, Liu Yuqing3, Dong Yanhu2,3
1Department of Emergency Medicine, Affiliated Hospital of Qingdao University; 2Qingdao Endocrine and Diabetes Hospital and Institute of Endocrine and Metabolic Diseases; 3Shandong Second Medical University
01
objective
Patients with T2DM have a higher risk of restenosis after coronary artery stent surgery than patients without diabetes. Long-term follow-up data on the association of restenosis after percutaneous coronary angioplasty (PTCA) with prediabetes are very limited.
02
method
In this study, a retrospective analysis was performed on 951 patients (mean age 59.5 years, average duration of coronary heart disease 9.1 years, 60.5% male) who underwent emergency PTCA treatment from January 2008 ~ December 2011. Baseline data included blood pressure, fasting blood glucose, lipid profile, HbA1c, hsCRP, and 2-hour capillary blood glucose. According to the baseline blood glucose level and whether there was a history of diabetes mellitus, the subjects were divided into euglycemic (NGT) group (407 cases), glucose dysregulation (IGR) group (263 cases) and diabetes mellitus (DM) group (281 cases). All patients had coronary CTA data for an average of 6.2 years after PTCA. A stenosis of ≥50% within or adjacent to 5 mm of the stent is considered to have occurred.
03
outcome
At baseline, there were differences in BMI, systolic blood pressure, triglycerides and CRP levels among patients in DM, IGR and NGT groups compared with IGR and NGT groups (P<0.01), among which the DM group was the highest, followed by IGR group and NGT group, respectively. The cumulative number of coronary lesions in the DM group was higher than that in the IGR and NGT groups (2.5 vs. 1.8 vs. 1.6, P<0.05). According to the coronary CTA data after 6 years of follow-up, the restenosis rates were 4.8%, 6.5% and 14.2% in the NGT group, IGR group and DM group, respectively, and there were significant differences between the groups (P<0.05). The rate of restenosis was significantly higher in patients with HbA1c ≥8% than in patients with HbA1c <8% (15.8% vs. 12.4%, P<0.05). Multivariate logistic regression analysis showed that after adjusting for age, coronary heart history, BMI, blood pressure, LDL cholesterol, triglycerides, HbA1c and hsCRP, the risk of restenosis in patients with IGR and DM increased by 11% (OR=1.11, 95%CI: 1.01~1.54) and 52% (OR=1.52, 95%CI: 1.03~2.90), respectively.
04
conclusion
The six-year follow-up study found that patients with diabetes had a higher incidence of restenosis after coronary artery stent implantation compared with non-diabetic patients, and prediabetes also increased the risk of restenosis after PTCA.
Introduction of the principal investigator
Professor Zhang Lei
Qingdao Endocrine and Diabetes Hospital and Institute of Endocrine and Metabolic Diseases
Chief physician, professor, master's supervisor, and currently the executive director of Qingdao Endocrine and Diabetes Hospital. Graduated from the Faculty of Medicine of the University of Helsinki in Finland with a doctorate in medicine.
He is also a member of the 7th Youth Committee of the Diabetes Branch of the Chinese Medical Association, a member of the Integrated Endocrinology and Diabetics Professional Committee of the Integrative Medicine Branch of the Chinese Medical Doctor Association, a member of the Chronic Disease Management Committee of the Chinese Association of Traditional Chinese Medicine, the deputy leader of the grassroots support group of the Diabetic Foot Multidisciplinary Joint Committee of the Shandong Medical Association, a member of the Diabetes Branch of the Shandong Medical Association, the vice chairman of the Diabetes Branch of the Qingdao Medical Association, and the vice chairman of the Multidisciplinary Joint Committee of the Diabetic Foot and Wound of the Qingdao Medical Association.
He has long been engaged in the clinical first-line diagnosis and treatment and scientific research of endocrine diseases, diabetes, especially diabetic macrovascular disease, diabetic foot disease, wound and lower limb vascular disease, presided over 5 large-scale international, provincial and ministerial scientific research projects, won 4 international awards, 3 provincial and ministerial awards, and trained 10 master's students in endocrinology. He has published 36 SCI papers in professional core journals at home and abroad, and won 5 scientific and technological progress awards in Shandong Province and Qingdao City. He has been rated as a top-notch professional and technical talent in Qingdao and an outstanding Communist Party member in Qingdao.