Objective The aim of this study is to determine the residual C-peptide level and to explore the clinical significance of preserved C-peptide secretion in glycemic control in Chinese individuals with type 1 diabetes (T1D). Research design and methods A total of 534 participants with T1D were enrolled and divided into two groups, low–C-peptide group (fasting C-peptide ≤10 pmol/L) and preserved–C-peptide group (fasting C-peptide >10 pmol/L), and clinical factors were compared between the two groups. In 174 participants who were followed, factors associated with C-peptide loss were also identified by Cox regression. In addition, glucose metrics derived from intermittently scanned continuous glucose monitoring were compared between individuals with low C-peptide and those with preserved C-peptide in 178 participants. Results The lack of preserved C-peptide was associated with longer diabetes duration, glutamic acid decarboxylase autoantibody, and higher daily insulin doses, after adjustment {OR, 1.10 [interquartile range (IQR), 1.06–1.14]; OR, 0.46 (IQR, 0.27–0.77); OR, 1.04 (IQR, 1.02–1.06)}. In the longitudinal analysis, the percentages of individuals with preserved C-peptide were 71.4%, 56.8%, 71.7%, 62.5%, and 22.2% over 5 years of follow-up. Preserved C-peptide was also associated with higher time in range after adjustment of diabetes duration [62.4 (IQR, 47.3–76.6) vs. 50.3 (IQR, 36.2–63.0) %, adjusted P = 0.003]. Conclusions Our results indicate that a high proportion of Chinese patients with T1D had preserved C-peptide secretion. Meanwhile, residual C-peptide was associated with favorable glycemic control, suggesting the importance of research on adjunctive therapy to maintain β-cell function in T1D.
To investigate the glucose profile of Chinese individuals with type 1 diabetes (T1D) who also have metabolic syndrome. Type 1 diabetes participants from Peking University People's Hospital were recruited from Jan 2017 to Jan 2024. The diagnosis of metabolic syndrome was developed based on the updated National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) criteria. Demographic data, anthropometric measurements, clinical information and continuous glucose monitoring (CGM) data were collected and compared between participants with metabolic syndrome and those without. The median age of the participants was 50.0 years (IQR 35.0-63.3), and the median duration was 10.0 years (IQR 2.0-17.0). Compared to those without metabolic syndrome, participants with metabolic syndrome were older (63.0 years, IQR 41.0-69.0 vs. 48.5 years, IQR 35.0-60.0; P < 0.001) and had a longer duration (13.0 years, IQR 5.0-22.0 vs. 9.0 years, IQR 2.0-15.0; P = 0.011). The comparison of CGM metrics suggested significantly higher time above range (TAR, 48.9%, IQR 35.3-59.5 vs. 32.8%, IQR 16.1-47.6; P < 0.001), standard deviation (SD, 3.6 ± 0.9 mmol/L vs. 3.2 ± 1.0 mmol/L; P = 0.022) and interquartile range (IQR, 4.2 mmol/L, IQR 3.2-4.8 vs. 3.7 mmol/L, IQR 3.0-4.5; P = 0.046) in those with metabolic syndrome. And the Logistic regression analysis showed that TAR (OR 1.53, 95% CI 1.02-2.23, per 20% increase), SD ( OR 1.75, 95% CI 1.07-2.84, P = 0.025) and IQR (OR 1.50, 95% CI 1.03-2.19, P = 0.036) were positively associated with metabolic syndrome after adjusting for age, sex, diabetes duration, BMI and complication status. Our findings suggested that in T1D participants, metabolic syndrome was associated with higher glucose level and glycemic variability. Personalized diabetes education including optimal meal planning and sufficient physical activity should be emphasized to improve glycemic control in T1D with metabolic syndrome.
Immune checkpoint inhibitor-induced type 1 diabetes (ICI-T1D) is a rare immune-related adverse event (irAE) of immune checkpoint inhibitors (ICIs). This retrospective study aimed to characterize the clinical features and glucose patterns of ICI-T1D in Chinese individuals and compare them with those of traditional T1D. Between January 2019 and April 2024, 15 patients diagnosed with ICI-T1D were consecutively enrolled. Continuous glucose monitoring (CGM) data from 7 of these patients were compared with data from 14 traditional T1D patients, matched for age, sex, fasting C-peptide levels, and diabetes duration. Median time from ICI initiation to T1D onset was 16 weeks (IQR, 6–96). Notably, T1D developed in four participants at 144, 112, 108, and 96 weeks after PD-1 treatment, respectively. Three ICI-T1D had pre-existing type 2 diabetes (T2D). Moreover, two had concurrent hypothyroidism and adrenal insufficiency alongside ICI-T1D. CGM analysis suggested that ICI-T1D exhibited a higher overall coefficient of variation (CV) (36.3 ± 4.8% vs. 28.2 ± 6.5%; p = 0.009), a greater CV during the night (37.4 ± 8.4% vs. 23.4 ± 7.3%; p = 0.001), and an increased standard deviation (SD) during the night (3.3 ± 0.8 mmol/L vs. 2.1 ± 1.1 mmol/L; p = 0.017) compared to those with traditional T1D. The study highlighted diverse clinical presentations of ICI-T1D, including delayed onset and multiple endocrine organs dysfunctions after ICI treatment. Consequently, long-term glucose monitoring and early identification are crucial. Furthermore, the observed greater glucose variability in ICI-T1D emphasizes the critical importance of diabetes education and personalized insulin regimen.
Efficiencies of removal of Cadmium from irrigation water by 14 different purification processes and effects of the purified irrigation water on Cd concentration in paddy soil and rice grains were studied using a field experiment combining different stages (levels) of ecological ditches, plant ponds, and artificial wetlands. Results showed that there were significant differences among efficiencies of purification of Cd contaminated irrigation water using different processes and that pH, chemical form of Cd in irrigation water, vegetation coverage and biomass of aquatic plants significantly affect the efficiency. Of the 14 purification processes, seven have resulted in the concentration of Cd in the effluent water meeting the National Standard GB5084-2021 for Irrigation Water Quality for all days of the experiment period. The highest amount and rate of Cd removal were achieved by the combination of two-stage ecological ditch, two-stage plant pond, and one-stage artificial wetland, while the highest removal amount and rate per 100 m2 was achieved by the combination of one-stage plant pond and one-stage artificial wetland. After purification, there were minor changes of pH values of the effluent water. The removal amount of dissolved Cd was higher than that of suspended Cd and the opposite was true for the removal rate. Considering purification efficiency, area of coverage, and cost of construction and maintenance, we suggest that combination of plant pond and artificial wetland be a priority choice for purification of Cd pollution in irrigation water. Compared to the control data collected from rice grain and paddy soil irrigated by unpurified water, Cd concentration in rice grain and paddy soil irrigated by purified water declined by 30.93-77.15% and 5.08-19.42% respectively. All results showed that removal of Cd contamination from irrigation water effectively controlled cadmium pollution in rice grain and paddy soil.
Microvascular complications, such as diabetic retinopathy (DR), diabetic nephropathy (DN) and diabetic peripheral neuropathy (DPN), are common and serious outcomes of inadequately managed type 1 diabetes (T1D). Timely detection and intervention in these complications are crucial for improving patient outcomes. This study aimed to develop and externally validate machine learning (ML) models for self-identification of microvascular complication risks in T1D population.
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