Diabetology International最新文献

Background: This study aimed to compare the economic value of intermittent-scanning continuous glucose monitoring (isCGM) with self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes (T1D).

Methods: Participants were placed on either an isCGM or SMBG arm for 84 days, in a randomized, crossover setup with a 28-day washout period. Clinically relevant hypoglycemia (<54 mg/dL) and severe hypoglycemia (SH) risks were calculated by analyzing the data from isCGM. The effectiveness variable was quality-adjusted life years (QALYs), and costs included medical costs related to the SMBG device. In addition, we performed a sensitivity analysis using a tornado diagram to confirm the robustness of the results.

Patients: A total of 93 Japanese T1D adults (51.4 ± 15.3 years old, male 47.3%, and HbA1c 7.3 ± 0.7%) treated with multiple daily insulin injection (MDI).

Results: Compared to the SMBG arm, clinically relevant hypoglycemia and SH risks over daytime (2.7 ± 1.7 vs. 2.4 ± 1.6 times; P = 0.008 and 3.1 ± 3.2 vs. 2.2 ± 2.7; P = 0.001) and night-time periods (2.1 ± 1.6 → 1.7 ± 1.2; P < 0.001 and 5.1 ± 4.0 → 4.2 ± 3.8; P = 0.013) were reduced with isCGM treatment. The isCGM system was associated with an incremental gain in quality-adjusted life expectancy (QALE) of 0.8 QALYs compared with the SMBG arm (74.6 vs. 73.8 QALYs). The resulting incremental cost-effectiveness ratio was JPY 4,398,932 (US$41,212) per QALY gained, which is well below the generally accepted cost-effectiveness threshold. SH during the daytime period was the primary driver of the incremental QALE.

Conclusion: The findings suggest that isCGM use for Japanese T1D adults treated with MDI is cost saving relative to SMBG.

Aims: Sodium-glucose co-transporter-2 inhibitors (SGLT2i) have been shown to reduce visceral (VAT) and subcutaneous (SAT) adipose tissue. Although many systematic reviews have examined SGLT2i's effect on VAT and SAT, a focus analysis of dapagliflozin, one of the more commonly prescribe SGLT2i, has yet to been done. This study aims to determine the effect of dapagliflozin on reducing VAT and SAT in patients with chronic disease.

Methods: SCOPUS, PubMed, EBSCO, and LILACS databases were searched until December 26, 2023. Heterogeneity was determined using Cochran's Q test and quantified using the inconsistency index. The random-effects model was used to calculate the pooled standardize difference in means (SDM) and 95% confidence intervals (95% CI). Duval and Tweedie trim and fill (DT), Egger's test, and Beggs-Muzamar's test were used to assess publication bias. PROSPERO: CRD42023426208.

Results: Twelve reports were included (treated = 299 and controls = 301). Overall, dapagliflozin treatment reduced VAT (SDM = - 0.406, 95% CI: - 0.526 to - 0.286, p < 0.001) and SAT (SDM = - 0.439, 95% CI: - 0.601 to - 0.278, p < 0.001). These results were stable as determined with a sensitivity analysis; however, there was potential publication bias. Two and three imputed studies were determined by the DT method for VAT and SAT, respectively. When stratified by pathology (obesity, T2D, and T2D/NAFLD), dapagliflozin treatment decreased VAT and SAT for all conditions. However, for specifically SAT, only when compared between T2D and T2D/NAFLD, T2D/NAFLD was associated with a twofold decrease (p = 0.003).

Conclusion: Treatment with dapagliflozin resulted in a significant reduction in VAT and SAT in patients with obesity, T2D, or T2D/NAFLD.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-024-00765-y.

Aim: To investigate the effect of weight loss and metabolic improvement after laparoscopic sleeve gastrectomy (LSG) in older adults aged 65 years or over compared with younger adults in a retrospective analysis.

Methods: The J-SMART study database of 322 Japanese individuals with body mass index (BMI) ≥32 kg/m² who underwent LSG between 2011 and 2014 at 10 centers accredited by the Japanese Society for Treatment of Obesity were analyzed. The subjects were classified into two groups: ≥65 age group (range, 65-76 years; n = 25) and <65 age group (range, 22-64 years; n = 297). Clinical parameters were compared between the groups.

Results: Baseline data for the ≥65 vs. <65 age groups were: median age 67 years vs. 45 years; weight 92.7 kg vs. 114.4 kg; BMI 40.0 kg/m² vs. 41.9 kg/m²; and HbA1c 6.8% vs. 6.5%. The ≥65 age group had significantly lower preoperative weight, BMI, estimated glomerular filtration rate, and ABCD score, but higher visceral fat area and prevalence of diabetes, hypertension, and obstructive sleep apnea (OSAS). Weight was significantly reduced in both groups throughout 5 years post-LSG, though total weight loss at 2 years was lower in the ≥65 age group (28.0%) than in the <65 group (30.0%). Remission rates of diabetes, hypertension, OSAS, and joint disorders 2 years after LSG showed no significant differences, except for dyslipidemia.

Conclusion: LSG may be an efficacious option for improving obesity-related health problems in older adults. However, postoperative safety and complications were not evaluated in this study and further research is needed.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-024-00767-w.

Aims: To clarify the long-term effects of short-term exercise instructions by physical therapists in Japanese people with type 2 diabetes (T2D).

Methods: This was a follow-up study of 2 years after randomized controlled study of short-term exercise instructions included 18 patients (5 in the non-intervention and 13 in the intervention groups). Motor skills, including 6 min walk test scores, and transtheoretical model was evaluated at baseline (week 0), the end of the study of the previous study (week 8), and 2 years after (2 years).

Results: In the intervention group, changes in 6 min walk distance, which was significant at 8 weeks (from 445 (420-480) m to 490 (450-520) m, p = 0.01)), were maintained at 2 years (496 (420-540) m, p = 0.05), whereas in the non-intervention group, there were no changes in 6 min walk distance at 8 weeks (from 460 (458-493) m to 464 (460-485) m, p = 0.86) and 2 years (490 (480-506) m, p = 0.63). Furthermore, the changes in transtheoretical model, which was significant at 8 weeks (p = 0.008), were maintained at 2 years (p = 0.02), whereas in the non-intervention group, there were no changes in 6 min walk distance at 8 weeks and 2 years. On the other hand, the other markers were not significantly different between week 8 and 2 years compared to baseline in both groups.

Conclusions: Short-term outpatient exercise instruction by physical therapists may lead to long-term improvement effect on walking ability in people with T2D.

Introduction: Type 1 diabetes is often accompanied by autoimmune thyroid disease. We aimed to investigate the clinical characteristics of Japanese patients with acute-onset type 1 diabetes and thyroid autoantibodies, focusing on decreased endogenous insulin secretion.

Materials and methods: We examined 80 patients with acute-onset type 1 diabetes, classifying them into two groups with and without thyroid autoantibodies and compared the clinical characteristics of the two groups. A fasting serum C-peptide immunoreactivity (CPR) of less than 0.1 ng/mL was defined as insulin depletion.

Results: In patients with thyroid autoantibodies, the median fasting serum CPR levels at the fourth year after the onset of type 1 diabetes were significantly lower than in those without thyroid autoantibodies (p = 0.02). The cumulative incidence of insulin depletion at 5 years of duration after diagnosis of type 1 diabetes was significantly higher in thyroid autoantibody-positive group than in thyroid autoantibody-negative group (p = 0.01). In the Cox proportional models adjusted for selected baseline factors (age, sex, and BMI), the presence of thyroid autoantibodies did not increase the risk of insulin depletion within 5 years after the onset. However, in bivariate Cox proportional hazards models that investigated the association between thyroid autoantibodies and each baseline factor, the presence of thyroid autoantibodies significantly increased the risk of insulin depletion.

Conclusions: Our study showed that Japanese patients with acute-onset type 1 diabetes and positive for thyroid autoantibodies had a higher risk of insulin deficiency within 5 years after the onset than those without thyroid autoantibodies.

Objective: To examine the validity of the International Physical Activity Questionnaire short form (IPAQ-SF) against an objective method for assessing physical activity (PA) in Japanese adults with type 1 diabetes (T1D).

Methods: This cross-sectional study included 126 adults with T1D (aged 20-74 years). The participants wore a triaxial accelerometer for 7 consecutive days and completed the IPAQ-SF (a recall survey for the last 7 days) on the day following the 7-day accelerometer period. This ensured alignment between the periods assessed by both the methods.

Results: A total of 112 participants were analyzed. The IPAQ-SF group had lower daily time in sedentary behavior (SB), total moderate-intensity PA (MPA) (including walking), vigorous-intensity PA (VPA), total PA (including walking), and daily metabolic equivalent (MET)-min in total PA than those in the accelerometer group. Significant correlations were observed between the methods for all variables: daily time in SB, total MPA, VPA, total PA, and daily MET-min in total PA (ρ = 0.203-0.527). In addition, walking time reported in the IPAQ-SF correlated with the step counts recorded by the accelerometer (ρ = 0.444). However, among these parameters, only daily time in VPA was able to provide acceptable levels of validity (≥ 0.50) and predict values recorded by the accelerometer.

Conclusion: These results indicate that the IPAQ-SF scores have a weak correlation with each type of accelerometer-measured PA, while the IPAQ-SF may underestimate each type of PA compared to an accelerometer in Japanese adults with T1D.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-024-00759-w.

Patients with non-diabetic hypoglycemia have a poorer prognosis than those with diabetic hypoglycemia. However, the factors associated with prognosis remain unclear. Therefore, this study aimed to identify the prognostic factors for non-diabetic hypoglycemia. This is a retrospective study of patients hospitalized for severe hypoglycemia with blood glucose ≤ 3.0 mmol/L (54 mg/dL) due to non-diabetic hypoglycemia between April 2008 and June 2023. Additionally, the underlying cause of hypoglycemia was identified, and the factors associated with mortality were examined. Of the 134 hospitalized patients, 126 were analyzed, excluding cases of multiple or scheduled hospitalizations. The most common causes of hypoglycemia were malnutrition (n = 79, 62.7%), alcohol intake (n = 27, 21.4%), and hypothermia (n = 27, 21.4%); 76 (60.3%) patients had multiple associated factors. Of the 126 patients, 52 died within 90 days. In the multivariate analysis, the estimated glomerular filtration rate (eGFR) (< 30 mL/min/1.73 m²) was independently associated with death [odds ratio (OR) 5.78, 95% confidence interval (CI) 1.69-19.8], whereas blood glucose (OR 0.95, 95% CI 0.92-0.99), serum albumin (OR 0.27, 95% CI 0.12-0.59), and alcohol intake (OR 0.03, 95% CI 0.004-0.34) were associated with survival. Moreover, age (OR 1.0, 95% CI 0.97-1.04) was not associated with death. Patients with non-diabetic hypoglycemia had a very high mortality. Low eGFR, blood glucose levels, and serum albumin levels at admission were associated with 90-day mortality, and alcohol intake was associated with survival.

Fulminant type 1 diabetes (FT1D) is a rapidly progressive form of diabetes in which the endogenous capacity to secrete insulin is depleted. The onset is unpredictable with conventional FT1D, and a few reports have tracked C-peptide in patients with conventional FT1D pre-onset. In this report, we present two typical cases of conventional FT1D where C-peptide was monitored from the onset of precursor symptoms to the development of diabetic ketoacidosis (DKA). Furthermore, we conducted a literature review and provide a detailed description of the process of C-peptide depletion in conventional FT1D. Case 1 involved a 72-year-old woman who initially presented with fever and fatigue. Case 2 involved a 45-year-old woman with fever, abdominal pain, and acute pancreatitis. In both cases, DKA developed five days after initial symptoms. A noteworthy observation in both cases was the drastic drop in C-peptide, which was detectable at initial presentation but depleted by the time of DKA diagnosis. These cases emphasize the importance of close follow-up of plasma glucose and serum C-peptide in cases presenting with infection and pancreatitis. Our literature review revealed that in conventional FT1D, endogenous insulin secretion becomes deficient in an average of 5.3 days. Regardless of any concomitant acute pancreatitis and/or pancreas enlargement, the period until endogenous insulin secretion became deficient showed no substantial variation. This result supports the concept that progression of conventional FT1D is more rapid than that of immune checkpoint inhibitor-related FT1D, which deplete insulin secretion in approximately 2 weeks.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-024-00755-0.