Diabetology International最新文献

We report a case of rhabdomyolysis triggered by initiation of tirzepatide, a novel dual agonist of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide-1 (GLP-1) receptors. The patient was a 68-year-old man with a medical history of type 2 diabetes mellitus (T2DM), dyslipidemia, and chronic kidney disease (CKD). After starting tirzepatide, he developed a significant elevation of creatine kinase (CK) and other muscle injury markers. These laboratory abnormalities rapidly returned to normal range after discontinuation of the drug. Based on the naranjo adverse drug reaction probability scale and the WHO-Uppsala Monitoring Centre (WHO-UMC) causality assessment system, the association between tirzepatide and rhabdomyolysis was classified as "probable." To our knowledge, no previous cases of tirzepatide-induced rhabdomyolysis for T2DM have been reported in the literature. Although this adverse effect appears to be extremely rare, it is important to monitor CK levels when initiating tirzepatide therapy. Early detection of muscle injury markers may help prevent serious complications and ensure the safe use of this novel antidiabetic agent.

[This corrects the article DOI: 10.1007/s13340-024-00781-y.].

Metformin, an oral medication for type 2 diabetes, causes severe diarrhea in approximately 5% of individuals with diabetes in Japan, leading them to discontinue treatment despite the drug efficacy, safety, and low economic burden. Given the absence of animal models for diarrhea, we previously proposed a mouse model for metformin-induced diarrhea using diabetic obese db/db mice. The diarrhea model exhibited elevated gene expression of glucagon-like peptide-1 (GLP-1), which was followed by increased expression of the Cl⁻ channel CFTR. However, it remains unclear which specific risk factors in the db/db mouse model are associated with the development of diarrhea. In this study, healthy C57BL/6 J mouse models with dietary modifications were used to replace db/db mice. Unexpectedly, C57BL/6 J mice fed diets containing 10% cellulose consumed more feed and gained weight more rapidly. Overnight fasting led to increased food intake once feeding resumed. The combination of these feeding conditions and metformin administration resulted in increased water content in their feces. Furthermore, the enhanced expression of GLP-1 and CFTR, the decrease in the abundance of the gut microbial Firmicutes family, and the alleviation of diarrhea symptoms by wood creosote share similarities with metformin-induced diarrhea in db/db mice. Although the administration of the GLP-1 receptor agonist Exendin-4 did not induce diarrhea in mice without metformin treatment, the GLP-1 receptor antagonist Exendin-3 (9-39) inhibited the development of diarrhea in mice treated with metformin. These results suggest that overeating, coupled with abnormal regulation of GLP-1 signaling, may be associated with an increased risk of metformin-induced diarrhea in mice.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00822-0.

This report pertains to a 51-year-old male patient who sought medical attention with the chief complaint of generalized bodily pain. His symptoms commenced approximately six months prior, characterized initially by paresthesia in both lower extremities, eventually evolving into diffuse systemic pain. Noteworthy was his history of a significant weight reduction of approximately 25 kg over the span of several years, prompting investigation for diabetes mellitus. Subsequent assessments revealed an HbA1c level of 7.6% and a random blood glucose level of 188 mg/dl, coupled with findings indicative of pre-proliferative diabetic retinopathy, culminating in a diagnosis of diabetes mellitus. Neurophysiological evaluation graded the severity of diabetic polyneuropathy (DPN) as Stage 3 according to the Baba classification. Management encompassed glycemic control with linagliptin and pain mitigation with mirogabalin and duloxetine. Glycemic stability was achieved with HbA1c levels averaging around 6.2%. Gradual amelioration of subjective symptoms associated with painful DPN ensued, with positive pain manifestations resolved approximately one year post-initiation of therapy; however, residual sensory neuropathic deficits, typified by diminished sensation in both toe tips, persisted.

The aims of this retrospective study were to examine persistence/adherence rates to sodium-glucose co-transporter 2 inhibitors (SGLT2i) monotherapy in patients with type 2 diabetes (T2DM) and identify factor(s) affecting persistence/adherence. Claims data on patients with T2DM newly using SGLT2i monotherapy from the JMDC database between October 2017 and September 2020 were analyzed. Persistence without a 90-day gap was calculated from the index date until the time of discontinuation of SGLT2i in a 1-year follow-up. Adherence was calculated using the proportion of days covered (PDC). Baseline characteristics were examined as potential factors affecting persistence/adherence using a multivariate logistic method. The present study identified 2172 new users of SGLT2i monotherapy. The persistence rate to SGLT2i after 365 days was 61.0%. Mean PDC was 71.2%, and 58.3% of patients adhered to treatment. A multivariate logistic regression analysis showed that an older age, hypertension, dyslipidemia, and hyperuricemia were associated with a lower risk of the discontinuation of SGLT2i monotherapy, while an older age, hypertension, dyslipidemia, and hyperuricemia were associated with a lower risk of poor adherence. The present study identified several factors that reduced the risk of discontinuation/poor adherence to SGLT2i monotherapy in patients with T2DM. An older age, hypertension, dyslipidemia, and hyperuricemia were common factors for a lower risk of discontinuation/poor adherence.

Obesity continues to increase worldwide. The primary cause of obesity is overeating, but the development of pharmacological treatments for obesity related to overeating has taken longer than expected. Recently, agonists of glucagon-like peptide-1 (GLP-1) receptor, designed based on the gut hormone GLP-1, have been developed as anti-obesity drugs and have demonstrated remarkable efficacy in treating both obesity and diabetes. Meanwhile, recent research using factors that promote GLP-1 secretion has highlighted the significance of endogenous GLP-1 function. This review provides an overview of the anorexigenic effects, adverse effects, and their underlying mechanisms of GLP-1 receptor agonists and endogenous gut-derived GLP-1. Furthermore, it discusses the potential anti-obesity effects of dual agonists targeting both the glucose-dependent insulinotropic polypeptide (GIP) receptor and the GLP-1 receptor, which have gained attention in recent years. Finally, we compare the beneficial effects of GLP-1 receptor agonists and meal-induced gut GLP-1 secretion on overeating-induced obesity and discuss how combining these approaches may complement each other's limitations and serve as a promising long-term strategy for preventing and treating obesity.

The management of type 2 diabetes has evolved significantly with the advent of incretin-based therapies, particularly dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists. In Japan, where over 70% of individuals with diabetes are aged 65 or older and often exhibit a non-obese phenotype with impaired insulin secretion, dipeptidyl peptidase-4 inhibitors remain a cornerstone therapy due to their ability to enhance insulin secretion without increasing hypoglycemia risk. Meanwhile, in younger adults with obesity, glucagon-like peptide-1 receptor agonists play a crucial role by improving glycaemia, promoting weight loss, and offering cardiovascular and renal protection. A major breakthrough in 2023 was the introduction of glucose-dependent insulinotropic polypeptide/glucagon-like peptide-1 receptor agonist tirzepatide, which activates both receptors and has shown superior glucose-lowering and weight-reducing effects in both clinical trials and real-world Japanese settings. However, incretin-based therapies are frequently associated with gastrointestinal side effects, and concerns remain regarding their potential impact on pancreatic and biliary diseases as well as frailty and sarcopenia in older adults. In addition, inappropriate discontinuation of insulin following incretin therapy initiation has led to severe outcomes, emphasizing the need for careful clinical decision-making beyond trial data. Emerging incretin-related therapies are under investigation for obesity and metabolic disorders including type 2 diabetes. While these agents hold promise for enhanced metabolic, weight, and cardiorenal benefits, their long-term safety and applicability require further study. To optimize therapeutic strategies, adherence to evidence-based guidelines, such as the "Recommendations for the Safe Use of Incretin-Related Agents, Second Edition" by the Japanese Diabetes Society, is essential.

Background: Although carbohydrate counting (CC) being the recommended dietary strategy for achieving glycemic control in people with diabetes, there is limited evidence. Our aim is to systematically assess the efficacy of CC in people with diabetes.

Methods: We searched PubMed up to October 2024 and assessed randomized controlled trials of interventions longer than 12 weeks in people with diabetes. Change in glycated hemoglobin (HbA1c) levels was the primary outcome. The results of clinically and statistically homogenous studies were pooled and meta-analyzed using the random-effects model to provide estimates of the efficacy of CC.

Results: We identified 16 studies (633 children and 640 adults) in type 1 diabetes mellitus (T1DM) and 6 studies (966 adults) in type 2 diabetes mellitus (T2DM). There was significant improvement in HbA1c levels with CC versus the other diets in T1DM (- 0.21%, 95% CI - 0.41 to - 0.01; p = 0.042) with large heterogeneity (I2 = 85.2%) in people with T1DM. In subgroup analyses, advanced CC (ACC) showed improved HbA1c levels (- 0.47%, 95% CI - 0.78 to - 0.15; p = 0.004) in adults with T1DM, but ACC did not in children with T1DM (- 0.07%, 95% CI - 0.25 to 0.10; p = 0.419). The effects of basic CC (BCC) on glycemic control for children with T1DM were not significant. Additionally, BCC did not show improved HbA1c levels in in adults with T2DM.

Conclusions: For glycemic control in people with T1DM, CC was an effective option. Although BCC was not effective for glycemic control in adults with T2DM, further high-quality and long-term studies are needed to confirm these issues.

The cell death-inducing DFF45-like effector (CIDE) family comprises CIDEA, CIDEB, and CIDEC (fat-specific protein of 27 kDa), all of which are lipid droplet-associated proteins and contribute to fat storage and energy homeostasis. However, the relative impacts of these isoforms on fat storage in adipose tissue and obesity in humans have been unclear. We here examined the expression of CIDE family genes in visceral adipose tissue (VAT) of obese individuals who underwent laparoscopic sleeve gastrectomy and explored its relation to adiposity-related parameters. RNA-sequencing analysis revealed that CIDEA and CIDEC were highly expressed in VAT, whereas CIDEB was expressed at a substantially lower level. CIDEA and CIDEC expression levels were positively correlated with body fat mass and subcutaneous adipose tissue (SAT) area, whereas CIDEB expression was negatively correlated with these markers. In addition, CIDEC and CIDEB expression levels showed positive and negative correlations, respectively, with BMI. Multivariable regression analysis showed that only CIDEC expression was significantly associated with body fat mass. Stratification of the subjects according to tertiles of CIDEC expression revealed that BMI, body fat mass, and SAT area were significantly greater in the highest CIDEC expression group than in the other two groups. Our findings thus suggest that, among CIDE isoforms, CIDEC is the most closely associated with fat storage in human adipose tissue.

Supplementary information: The online version contains supplementary material available at 10.1007/s13340-025-00806-0.

The expression of angiotensin II (Ang II) has been reported in diabetes associated with hypertension and inflammatory processes. It has also been reported a link between Ang II, depression and diabetes; however, underlying mechanisms of Ang II-induced depression in this disease remain unclear. This review focuses on the possible mechanisms of Ang II to induce depression in diabetes. Ang II can induce pro-inflammatory events that activate indoleamine 2,3-dioxygenase and kynurenine monooxygenase. These activated enzymes act by decreasing the production of serotonin and increasing the production of quinolinic acid which acts on the N-methyl-d-aspartate receptor and the amino-methyl propionic acid receptor inducing decreased brain-derived neurotrophic factor (BDNF) expression and depression. Ang II can also induce the production of galectin 3 which has a depressant effect. Neuroinflammation induced by Ang II during diabetes can alter brain cells, event associated with functional disorders and depression. Furthermore, Ang II is capable of inducing oxidative stress in diabetes linked to depressive behaviors. In conclusion, Ang II has the potential to induce depression during diabetes through different mechanisms that involve inflammatory processes, oxidative stress, the production of galectin 3, and decrease in serotonin and BDNF. These findings open the possibility of using anti-Ang II drugs for the treatment of depressive behavior in diabetes.