Background: At present, the beneficial effect of the ketogenic diet (KD) on weight loss in obese patients is generally recognized. However, a systematic research on the role of KD in the improvement of glycemic and lipid metabolism of patients with diabetes is still found scarce. Methods: This meta-study employed the meta-analysis model of random effects or of fixed effects to analyze the average difference before and after KD and the corresponding 95% CI, thereby evaluating the effect of KD on T2DM. Results: After KD intervention, in terms of glycemic control, the level of fasting blood glucose decreased by 1.29 mmol/L (95% CI: −1.78 to −0.79) on average, and glycated hemoglobin A1c by 1.07 (95% CI: −1.37 to −0.78). As for lipid metabolism, triglyceride was decreased by 0.72 (95% CI: −1.01 to −0.43) on average, total cholesterol by 0.33 (95% CI: −0.66 to −0.01), and low-density lipoprotein by 0.05 (95% CI: −0.25 to −0.15); yet, high-density lipoprotein increased by 0.14 (95% CI: 0.03−0.25). In addition, patients’ weight decreased by 8.66 (95% CI: −11.40 to −5.92), waist circumference by 9.17 (95% CI: −10.67 to −7.66), and BMI by 3.13 (95% CI: −3.31 to −2.95). Conclusion: KD not only has a therapeutic effect on glycemic and lipid control among patients with T2DM but also significantly contributes to their weight loss.

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: By reviewing the previous research of telemedicine, we have found out that old diabetic patients have difficulties in using computers, so it is unrealistic for medical teams to communicate with old diabetes patients anytime and anywhere. However, the popularity of smartphones and chatting applications has enabled old people of China to develop skills of chatting on smartphones and become familiar with smartphone operations. Therefore, we have designed an Mobile Health (m-Health) system for diabetics based on smartphones, which greatly streamlined operation interface and functions for maximum automation. In addition, the smartphone-based telemedicine of diabetes has been designed for old people. Objective: To investigate smartphone-based telemedicine applications in the management of older Chinese patients with type 2 diabetes mellitus (T2DM). Variables of interest included efficacy and safety. Methods: A total of 91 older (age>65) patients with T2DM, who presented to our department, were included and randomly assigned to one of two groups. Patients in the intervention group (n=44) were given glucometers capable of data transmission, and received advice pertaining to medications, diet, and exercise via a Mobile Health（m-Health）telemedicine system. Patients assigned to the control group (n=47) presented to traditional outpatient clinics for their medical care and received no other interventions. We followed up patients in both groups at regular 3-month intervals. Results: After 3 months, patients in the intervention group had significant (P<0.05) improvements in postprandial plasma glucose levels. After 6 months, patients in the intervention group exhibited decreasing trends in postprandial plasma glucose and glycosylated hemoglobin (HbA1C) levels compared with the baseline and those in the control group (P<0.05). Conclusions: Smartphone-based telemedicine applications are effective for controlling blood glucose and lowering HbA1C in older Chinese patients with T2DM. Clinical Trial: The ethics committee of the First Affiliated Hospital of Jilin University approved this study, and has been registered at the China Clinical Trial Registration Center with a registration number of ChiCTR1800015214.

The question of whether or not intermittent fasting diets improve the clinical indicators of glycolipid metabolism remains unclear. This study systematically reviewed the relevant clinical trials to evaluate the effects of intermittent fasting diet on glucose and lipid metabolism and insulin sensitivity in patients with metabolic syndrome. To evaluate the effect of intermittent fasting diet intervention on patients with disorders of glucose and lipid metabolism, random-effect or fixed-effect meta-analysis models were used to calculate the average difference before and after intermittent fasting diet intervention and the corresponding 95 confidence intervals (CIs). After intermittent fasting diet intervention, in terms of glucose metabolism, fasting blood glucose reduced by 0.15mmol/L (95 CI: 0.23; 0.06), glycosylated hemoglobin reduced by 0.08 (95 CIs: 0.25; 0.10), insulin plasma levels reduced by 13.25uUI (95 CIs: 16.69; 9.82), and HOMA-IR decreased by 0.31 on an average (95 CIs: 0.44; 0.19). In addition, BMI decreased by 0.8kg/m² (95 CIs: 1.32; 0.28), body weight reduced by 1.87kg (95 CIs: 2.67; 1.07), and the waist circumference decreased by 2.08cm (95 CIs: 3.06; 1.10). Analysis of lipid metabolism showed that intermittent fasting diet intervention effectively reduced the total cholesterol level by 0.32mmol/L (95 CIs: 0.60; 0.05), low-density lipoprotein level by 0.22mmol/L (95 CIs: 0.37; 0.07), and triglyceride level by 0.04mmol/L (95 CIs: 0.15; 0.07). Intermittent fasting diets have certain therapeutic effects on blood glucose and lipids in patients with metabolic syndrome and significantly improve insulin resistance. It may be considered as an auxiliary treatment to prevent the occurrence and development of chronic diseases.

Aim: Based on the development of telemedicine and the experience of using it during the COVID-19 epidemic, we aimed to explore its convenience and shortcomings to provide a reference for the further improvement of telemedicine. Background: Traditional healthcare has been significantly affected by the outbreak of COVID-19, which has increased fear in patients with chronic diseases and increased the difficulty of obtaining hospitalized treatment. Methods: This is a conceptual article. The literature search is based on Pubmed, including articles published between January 2015 and December 2020. The purpose was to determine whether telemedicine is effective in the management of chronic diseases in the epidemic situation and to develop telemedicine and chronic disease management for long-term epidemic situations in the future. Findings: Telemedicine has demonstrated its advantages during the COVID-19 epidemic and can provide diversified clinical care services for patients with chronic diseases; these services have played a vital role in epidemic prevention and control, greatly alleviated the shortage of medical resources, increased the utilization level of medical resources, and reduced the cross-infection risk during treatment in hospitals. Furthermore, the epidemic situation presents opportunities for the development of diagnosis and treatment methods via the internet and active health management modalities.

Type 1 diabetes mellitus (T1DM) is a long-term and chronic autoimmune disorder, in which the immune system attacks the pancreatic β-cells. Both adaptive and innate immune systems are involved in T1DM development. Both B-cells and T-cells, including CD4⁺ and CD8⁺ T-cells, as well as other T-cell subsets, could affect onset of autoimmunity. Furthermore, cells involved in innate immunity, including the macrophages, dendritic cells, and natural killer (NK) cells, could also accelerate or decelerate T1DM development. In this review, the crosstalk and function of immune cells in the pathogenesis of T1DM, as well as the corresponding therapeutic interventions, are discussed.