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Objective To investigate doctors'knowledge and differences in islet function assessment methods in China.Methods This is a cross-sectional study that conducted by online questionnaire survey.Demographic data,examination items,blood collection point of OGTT,detection method,kit type and follow-up frequency were collected and compared among doctors in different regions,different levels of hospitals,different specialties and different titles.Results 79.2%and 85.1%of physicians believed that the levels of insulin and C-peptide should be measured at the same time to assess islet function in patients with newly diagnosed and follow-up diabetes mellitus patients.Endocrinologists preferred to access insulin and C-peptide at the same time(P<0.05).56.0%of physicians chose bread meal test for T1DM patients and 54.7%for T2DM patients.Compared with non-specialists,endocrinologists preferred to commit bread meal test to T1DM patients(61.4%vs 41.0%,P<0.05).In addition,for the islet function assessment of new-onset diabetes patients,7.6%of physicians chose the six-point method(0,30,60,90,120,180 min),27.3%selected the five-point method I(0,30,60,120,180 min),8.5%selected the five-point method II(0,30,60,90,120 min),9.8%selected the four-point method I(0,30,60,120 min),10.3%selected the four-point method II(0,60,120,180 min),13.8%chose the three-point method(0,60,120 min)and 13.4%chose the two-point method(0,120 min).At the time of follow-up assessment,the above selection rates were 5.3%,20.4%,6.4%,6.6%,9.4%,15.8%and 24.1%,respectively.In terms of the frequency of assessment,39.2%of doctors assessed islet function once a year and 24.7%once every six months.Specialists preferred to assess islet function once a year,and physicians with senior titles chose to assess islet function more variably.Conclusion At present,there are still great differences in assessment methods of islet function in China.It is of great significance for the clinical diagnosis and treatment of diabetes to understand the differences in the selection of islet function assessment methods among doctors in different regions,specialties and job titles.
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OBJECTIVE: To evaluate the effects on filtration membrane of glomerulus after islet transplantation in a rat model of streptozotocin-induced diabetic nephropathy. METHODS: The experimental case-control study was conducted at Wenzhou Medical University, Wenzhou, China from January to May 2015, and comprised male Sprague Dawley rats obtained from the Laboratory Animal Centre of Wenzhou Medical University. The rats were intraperitoneally injected with streptozotocin to induce diabetic nephropathy. Diabetic rats were divided into two groups; the islets group received islets transplantation under the kidney capsule; and the diabetic nephropathy (DN) group consisted of untreated diabetic nephropathy rats. The control group consisted of non-diabetic rats. Islets were surgically transplanted under the kidney capsule. Kidney function and blood glucose were measured and pathological changes in the kidney were observed by electron microscope, while the expressions of Wilms' tumour-1, caspase-3 and transforming growth factor-beta 1 were tested by immunohistochemical method and Western blot analysis. RESULTS: Each of the three groups had 6 rats each with body weights ranging from 180g to 220g. Reduced urinary protein excretion and alleviated damage of podocytes and glomerular basement membrane were seen in the islet-transplanted rats. The alleviation of podocyte damage was related to alteration in the synthesis of caspase-3, transforming growth factor-beta 1, and Wilms' tumour-1 protein in the glomerulus. CONCLUSIONS: Diabetic nephropathy rats after islet transplantation can ameliorate the damage of podocytes and basement membrane by inhibiting the pathway of transforming growth factor-beta 1.
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Diabetes Mellitus Experimental/cirugía , Nefropatías Diabéticas/patología , Barrera de Filtración Glomerular/patología , Trasplante de Islotes Pancreáticos/métodos , Podocitos/patología , Animales , Glucemia/metabolismo , Estudios de Casos y Controles , Caspasa 1/metabolismo , Diabetes Mellitus Experimental/complicaciones , Diabetes Mellitus Experimental/metabolismo , Nefropatías Diabéticas/etiología , Nefropatías Diabéticas/metabolismo , Glomérulos Renales/patología , Masculino , Microscopía Electrónica , Ratas , Ratas Sprague-Dawley , Factor de Crecimiento Transformador beta1/metabolismo , Proteínas WT1/metabolismoRESUMEN
Objective To investigate the mechanism of islet transplantation lessening renal damage of diabetic nephropathy (DN) rat model.Method Rat DN model was established by intraperitoneal injection of a single-dose streptozotocir.The rats were divided into normal control group, DN group and islet transplant group.Islet transplantation was taken on the right renal capsule in transplantation group at 8th week after the modeling.At week 12 after the modeling, the urinary protein, urinary creatinine and blood glucose in each group were determined.The kidneys were collected, and transplant islet HE staining, immunofluorescence, kidney electron microscopy were done.Synaptopodin and transforming growth factor-β1 (TGFβ1) protein expression was observed in renal tissues of each group by immunohistochemical staining.Result The urine protein and urinary creatinine ratio in islet transplant group was significantly lower than in DN group (P＜0.001).Blood glucose level in islet transplant group had no significant difference (P＞0.05) with the control group, but was significantly lower than in DN group (P ＜ 0.05).Islet cells by HE staining and immunofluorescence staining showed new blood vessels around the islets, and the insulin secretion was exuberant.Under an electron microscope, there was local fusion of podocyte foot processes, and segmental thickening of the basement membrane in DN group;in islet transplant group, the foot processes of podocytes were neat, basement membrane structure was clear and had no thickening.Synaptopodin protein expression was significantly decreased in the glomeruli of DN group and islet transplant group as compared with the control group (P＜0.05), and that in islet transplant group was significantly enhanced (P＜0.05) as compared with DN group.The expression of TGFβ1 in DN group and islet transplant group was significantly increased (P＜0.05) as compared with control group, and that in DN group was significantly higher (P＜0.05) than in islet transplant group.Conclusion Islet transplantation can inhibit TGFβ1 pathway, improve DN podocyte injury in rats, and alleviate or even reverse proteinuria.