Diabetology International最新文献

Background: Medication adherence among geriatric diabetic patients is influenced by various factors, including diabetes knowledge and treatment satisfaction. Understanding these relationships is crucial for improving adherence and health outcomes.

Methods: A cross-sectional study was conducted among 300 diabetic patients aged 60 and above at outpatient clinics of a Malaysian teaching hospital. Interviews were conducted for each participant using a set of questionnaires that included a sociodemographic form, 20 questions from the simplified Diabetes Knowledge Test (DKT), 11 questions from the Treatment Satisfaction Questionnaire for Medication (TSQM-II), and 12 questions from the Malaysia Medication Adherence Assessment Tool (MyMAAT).

Results: Participants demonstrated moderate diabetes knowledge [median = 6.67(6.00-7.78)] and high medication adherence [73%]. Diabetes knowledge was significantly associated with age [70-79 years: p = 0.012, above 80: p = 0.007], educational status [high school: p = 0.007, college/university: p < 0.001], and medication type [the presence of insulin in the regimen: p = 0.009]. A significant relationship was found between diabetes knowledge and treatment satisfaction [p < .001] and medication adherence [p = 0.004]. Each one-unit increase in diabetes knowledge was associated with a 34.2% decrease in the odds of nonadherence (OR = 0.658, 95% CI: 0.494-0.876, p = 0.004). Factors like gender [female: p = 0.014], occupational status [retired/ unemployed: p = 0.022], and type of diabetes medications [p < .001] influenced treatment satisfaction, while education [high school: p = 0.004] and global satisfaction [p = 0.009] affected adherence.

Conclusions: Geriatric diabetic patients demonstrated inadequate knowledge about diabetes, and this limited knowledge was significantly associated with lower treatment satisfaction and poorer medication adherence.

Diabetes remains a major cause of kidney failure globally, presenting substantial challenges to healthcare systems worldwide. Although significant progress has been made in understanding its pathogenesis, residual risks persist despite current therapies. Emerging evidence underscores the pivotal role of small GTPases-particularly Rho and Rho-associated coiled-coil-containing protein kinase (ROCK)-in the progression of diabetic nephropathy. This comprehensive review consolidates current knowledge on the distinct pathophysiological roles of the ROCK isoforms, ROCK1 and ROCK2, in diabetic nephropathy, drawing on recent insights from both genetic and pharmacological studies. We explore how ROCK signaling interfaces with key pathological mechanisms, including podocyte injury, glomerulosclerosis, tubular dysfunction, and metabolic disturbances. Particular emphasis is placed on isoform-specific functions: ROCK1 primarily regulates AMP-activated protein kinase-mediated fatty acid metabolism and mitochondrial dynamics, while ROCK2 modulates peroxisome proliferator-activated receptor α signaling and inflammatory responses. Furthermore, we discuss the translational implications of these findings, focusing on the therapeutic potential of ROCK inhibitors in chronic kidney disease (CKD) with diabetes and related disorders, such as focal segmental glomerulosclerosis, as well as their impact on electrolyte balance. By integrating molecular insights with clinical considerations, this review provides a framework for developing targeted strategies to halt the CKD progression in people with diabetes.

Background: Exercise therapy improves glycemic control and reduces cardiovascular risk factors in patients with type 2 diabetes (T2D). However, access to professionally supervised programs is limited, particularly for older adults. Home-based, weather-independent, exercise options have yet to be investigated in detail.

Objective: The present study examined the effects of a self-directed, low-to-moderate intensity dance exercise program performed at home on glycemic control and health-related quality of life (HRQOL) in older adults with T2D.

Methods: In this single-arm, intervention study, 20 elderly patients with T2D (median age, 70.5 years) participated in a standardized, unsupervised, home-based, aerobic dance program ("DaredeMo Dance") for at least 20 min per day for 12 weeks. The program was designed to be of low-to-moderate intensity, namely < 4 metabolic equivalents (METs). Primary outcomes were changes in HbA1c, glycoalbumin (GA), and HRQOL (assessed using SF-36v2). Secondary outcomes included body mass index (BMI), blood pressure (BP), and fasting plasma glucose (FPG).

Results: After 12 weeks, significant improvements were observed in BMI (23.4 to 23.2 kg/m², P = 0.002), systolic BP (134.0 to 125.0 mmHg, P = 0.004), diastolic BP (72.0 to 67.5 mmHg, P = 0.040), HbA1c (7.3 to 7.0%, P = 0.0012), and FPG (150 to 140 mg/dL, P = 0.034). HRQOL improved in all eight domains of SF-36v2, with significant improvements in Bodily Pain, General Health, Vitality, and Mental Health.

Conclusions: A standardized, indoor, low-to-moderate intensity, dance program improved glycemic control and HRQOL in older adults with T2D. This approach offers a safe, accessible, and sustainable exercise option for those with limited access to professional guidance.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00854-6.

Aims/introduction: Glucagon plays a pivotal role in the development of hyperglycemia in diabetes mellitus. The purpose of this study was to investigate the hypothesis that hyperglucagonemia based on measurements of pancreas-specific glucagon is present in diabetic ketosis/ketoacidosis (DK/DKA) and hyperosmolar hyperglycemic state (HHS), and if so, to explore factors contributing to that hyperglucagonemia.

Materials and methods: A total of 109 patients (92 with DK/DKA, and 17 with HHS) were investigated. Pancreas-specific glucagon levels were measured with a sandwich enzyme-linked immunosorbent assay at treatment initiation. The relationships of plasma glucagon levels, serum ketone bodies levels, and endogenous insulin secretion were assessed. The change in plasma glucagon levels after treatment was also assessed.

Results: The median plasma glucagon level was significantly higher in the HHS group (142.9 pg/mL) than in the DK/DKA group (63.6 pg/mL). In the DK/DKA group, the plasma glucagon level was positively correlated with the serum ketone bodies level (ρ = 0.55, P < 0.0001), but there was no correlation in the HHS group. In the DK/DKA group, a negative correlation was seen between the plasma glucagon level and the serum C-peptide immunoreactivity (CPR)/plasma glucose ratio in type 1 diabetes patients (n = 26) (ρ = - 0.67, P = 0.0002). In the HHS group, a positive correlation was seen between the plasma glucagon level and the serum CPR/plasma glucose ratio (ρ = 0.71, P = 0.0013). The plasma glucagon level was significantly lower after treatment in both the DK/DKA and HHS groups.

Conclusions: Hyperglucagonemia was found in DK/DKA and HHS with pancreas-specific glucagon measurements. The results suggest that the causes of hyperglucagonemia differ in DK/DKA due to type 1 diabetes mellitus and HHS.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00852-8.

Introduction: Chinese middle-aged and elderly (≥45 years old) liver disease patients have a high diabetes mellitus (DM) incidence with gender differences. Identify the optimal obesity and blood lipid-related predictors of DM in such patients by sex.

Methods: Using China Health and Retirement Longitudinal Study (CHARLS) 2011-2020 data, we explored DM predictors by sex, evaluating with receiver operating characteristic (ROC), area under curve (AUC), etc., to calculate odds ratio (OR) and 95% confidence interval (CI) after confounder adjustment.

Results: Many indexes were significant (P < 0.05). Obesity and lipid-related indexes had certain discrimination (AUC > 0.5), with the triglyceride-glucose (TyG) index performing best (AUC = 0.78). The visceral adiposity index (VAI) (OR = 1.08, 95%CI = 1.04-1.12) and the triglyceride-glucose-body mass index (TyG-BMI) (OR = 1.14, 95%CI = 1.06-1.22) promoted DM in male patients, while VAI (OR = 1.12, 95%CI = 1.08-1.16) and the triglyceride-glucose-waist circumference (TyG-WC) (OR = 1.15, 95%CI = 1.09-1.21) did so in female patients.

Conclusion: TyG-BMI and TyG-WC are the best DM predictors for male and female liver disease patients, respectively. VAI also has predictive value for DM prevention.

Zinc transporter 8 antibody (ZnT8A) is a key serological marker of type 1 diabetes mellitus (T1DM). Cases of ZnT8A single positivity are relatively rare. This study aimed to investigate a case of ZnT8A single-positive T1DM in a 51-year-old woman who developed diabetic ketoacidosis (DKA) during chemotherapy for colorectal cancer. She had normoglycemia 15 months prior to the presentation. During chemotherapy with intermittent corticosteroid administration, she developed DKA, which required intensive insulin therapy. Although she was negative for glutamic acid decarboxylase antibody (GADA), insulinoma-associated antigen-2 antibody (IA-2A), and insulin autoantibody (IAA), she was positive for ZnT8A. The HLA typing results revealed homozygosity for DRB1*04:06 and DQB1*03:02. At the 6-month follow-up after the initial diagnosis, endogenous insulin secretion remained partially preserved, suggesting an atypical course; the differential diagnosis between acute-onset T1DM with a honeymoon phase and an acute exacerbation of slowly progressive type 1 diabetes mellitus (SPIDDM) remained challenging. Although ZnT8A single-positive T1DM is a relatively uncommon clinical subtype, it should be considered in clinical practice. Previous studies indicated a predominance of acute-onset T1DM in such cases, and even in patients with SPIDDM or an uncertain subtype, there appears to be a potential risk of developing DKA as demonstrated in the present case. Furthermore, given the potential association between ZnT8A positivity and a more rapid deterioration of endogenous insulin secretion, an early assessment of the ZnT8A levels is important when T1DM is suspected.

Background: We have already reported that anti-insulin antibodies are produced at a fairly high frequency in type 2 diabetic patients treated with insulin analogues, and the amount of insulin requirement was significantly higher in antibodies carriers than in non-carriers. On the other hand, insulin autoantibody production by clopidogrel, which has an antiplatelet effect, has been reported. Therefore, we investigated the effect of concomitant use of antiplatelet agents on anti-insulin antibodies production in type 2 diabetic patients treated with insulin analogues.

Methods: Anti-insulin antibodies were measured in 150 type 2 diabetic patients using insulin analogue and 15 patients without insulin treatment but with antiplatelet agents. Among insulin treated patients, 62 had concomitant use of antiplatelet agents.

Results: The overall positivity of anti-insulin antibodies in the insulin-treated patients was 25.3%. On the other hand, the positivity rate in those not on antiplatelet agents (N = 88) was 15.9%, whereas the rate was significantly (P = 0.002) higher in those on antiplatelet agents (N = 62), at 28.7%. No one has anti-insulin antibodies in patients without insulin treatment. The antibodies-positive rate was also significantly higher than that of non-users of antiplatelet agents, irrespective of the type of antiplatelet agent. The amount of daily insulin requirement had a significant and positive association with antibodies positivity by stratified and multiple regression analyses.

Conclusion: These results strongly suggest that antiplatelet agents affect the increased production rate of anti-insulin antibodies by insulin analogues and may have contributed to increased insulin dose requirement via positivity of anti-insulin antibodies.

Background: Diabetic peripheral neuropathy (DPN) is a prevalent and disabling complication of type 2 diabetes mellitus (T2D), leading to significant morbidity and reduced quality of life. Chronic hyperglycemia, metabolic disturbances, and immune system activation are contributors to the development and evolution of DPN. Neopterin, a pteridine derivative produced by activated macrophages, reflects cellular immune activation and oxidative stress, both of which are implicated in diabetic complications. However, the role of serum neopterin as a potential biomarker for diabetic neuropathy has not been fully elucidated. This study aimed to investigate the association between serum neopterin levels and diabetic peripheral neuropathy in patients with T2D.

Methods: A total of 90 participants were enrolled, including 60 patients with T2D and 30 age- and sex-matched healthy controls. The T2D group was subdivided into 30 patients with DPN and 30 patients without DPN. Serum neopterin levels were measured using ELISA. All participants underwent nerve conduction studies (NCS) and Toronto clinical neuropathy score (TCNS) assessments. Glycemic and lipid profiles were also analyzed.

Results: Serum neopterin levels were significantly elevated in T2D patients with DPN compared to those without neuropathy and healthy controls. Higher neopterin levels were strongly associated with neuropathy severity, as patients with axonal neuropathy exhibited the highest neopterin concentrations. Additionally, neopterin correlated positively with TCNS scores, NCS results, and altered lipid profile, suggesting a link between metabolic dysregulation and immune activation in DPN.

Conclusion: Elevated serum neopterin levels may reflect underlying immune activation and oxidative stress in T2D patients with DPN. Neopterin could function as a valuable biomarker for the early detection and severity assessment of DPN.

Aims: The Japan Diabetes Society revised the diagnostic criteria for slowly progressive insulin-dependent diabetes mellitus (SPIDDM) in 2023. We aimed to clarify the clinical differences between definite and probable SPIDDM using the new criteria in real-world clinical settings in Japan.

Materials and methods: We included data of 190 and 582 patients with definite and probable SPIDDM, respectively, from 24 facilities participating in the Japan Diabetes Clinical Data Management Study Group. Age, sex, body mass index, hemoglobin A1c, and fasting C-peptide levels were extracted from the Computerized Diabetes Care database and analyzed cross-sectionally at the time of registration and at the most recent visit from June to December 2021. Data on pharmacotherapy, macro- and microvascular complications, diabetes duration at the onset of these complications, and drugs concurrently used for hypertension and hyperlipidemia were collected and compared between the two groups.

Results: Collectively, 0.8% and 2.3% of patients with all types of diabetes had definite and probable SPIDDM, respectively. The median age at onset of definite and probable SPIDDM was 41 (interquartile range, 33-52) and 47 (38-57) years; male/female ratio (%), 47.4/52.6 and 60.5/39.5; period until insulin initiation, 41.5 (3.3-126.8) and 78 (12-161) months; and median body mass index at registration; 21.9 (19.4-24.5) and 24.0 (21.1-26.9) kg/m², respectively. The macro- and microvascular complication rates did not differ between the groups.

Conclusions: Patients with definite SPIDDM were predominantly female and had a younger age at onset and shorter period until insulin initiation than those with probable SPIDDM did.

Metallothioneins (MTs) are a cysteine-rich protein that scavenges reactive oxygen species. Hypoxia is involved in the progression of diabetic nephropathy (DN) and aggravates oxidative stress. Hypoxia dramatically induced MT3, whereas induced around twofold increment in MT2, but inhibited MT1 in human renal proximal tubular epithelial cells (HRPTECs). Given that the role of MT3 in DN remains unclear, we explored the involvement of MT3 in DN. Microarray analysis also identified MT3-regulated candidate genes, including ceruloplasmin (CP) and cytochrome b reductase 1 (CYBRD1), as well as FGF-Klotho (KL)-FGFR complexes in HRPTECs. Hypoxia significantly induced MT3 expression through HIF-1-dependent mechanisms, and MT3 small interfering RNA (siRNA) decreased CP, CYBRD1, and KL expression under hypoxic conditions. In humanized MT3-BACTg mice, except HIF-1α, diabetes significantly increased the expression of MT3, CP, CYRBD1, FGFR2, and KL in the renal cortex in MT3-BACTg mice. Diabetic MT3-BACTg mice presented more severely damaged mitochondria in proximal tubules than their wild-type littermates did, accompanied with peritubular capillary obstruction by swollen endothelial cells. Moreover, the proximal tubules-specific overexpression of MT3 in mice (MT3Tg) represented no overlap in the protein expression between MT3 and HIF-1α in diabetic kidney. Accordingly, MT3 siRNA significantly augmented HIF-1α protein and HIF1A in HRPTECs. Finally, MT3 expression in the renal tubulointerstitium was positively correlated with the glomerular filtration rate (GFR) in DN subjects by data from Nephroseq. In conclusion, these results showed that there might be a unique interplay between MT3 and HIF-1α in diabetic kidney of to regulate hypoxia-induced HIF-1α expression.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00840-y.